Thinning and thickening transitions of foam film induced by 2D liquid-solid phase transitions in surfactant-alkane mixed adsorbed films.

Mixed adsorbed film of cationic surfactant and linear alkane at the air-water interface shows two-dimensional phase transition from surface liquid to surface frozen states upon cooling. This surface phase transition is accompanying with the compression of electrical double layer due to the enhancement of counterion adsorption onto the adsorbed surfactant cation and therefore induces the thinning of the foam film at fixed disjoining pressures. However, by increasing the disjoining pressure, surfactant ions desorb from the surface to reduce the electric repulsion between the adsorbed films on the both sides of the foam film. As a result, the foam film stabilized by the surfactant-alkane mixed adsorbed films showed unique thickening transition on the disjoining pressure isotherm due to the back reaction to the surface liquid films. In this review, we will summarize all these features based on the previously published papers and newly obtained results.

Effectiveness of fibrin coating in the management of web formation after laryngomicrosurgery.

PURPOSE: To explore the effectiveness of fibrin coating in reducing web formation after endoscopic management of the anterior commissure of the larynx. MATERIALS AND METHODS: Using a spray device that is generally used for laparoscopic operations, we covered the wound with fibrin glue (Bolheal®) to avoid web formation. This technique was employed in cases wherein the anterior commissure was mainly managed by laser operation; the glue was sprayed after vaporization. Fibrinogen was first sprayed and the wound was properly soaked with a swab, which was followed by application of thrombin. We used this method in 17 cases and evaluated voice function by acoustic analysis - pitch perturbation quotient (PPQ) and amplitude perturbation quotient (APQ) - and maximum phonation time (MPT) before and after the operation. RESULTS: No severe web formation was observed at three months after the operation. PPQ values improved from 3.048±2.801% to 0.653±0.463% (p<0.05, paired t-test). APQ values improved from 7.996±5.003% to 3.042±1.872% (p<0.05, paired t-test). Voice quality did not worsen in any of the cases. MPT values improved from 17.2±10.8s to 26.7±14.2s (p<0.05, paired t-test) Voice function improved 3months after the operation in all cases. CONCLUSION: The fibrin coating method is an easy and effective approach to avoid web formation without creating cervical wounds in cases that require handling of the anterior commissure under laryngomicrosurgery.

Endonasal endoscopic surgery with combined middle and inferior meatal antrostomies for fungal maxillary sinusitis.

OBJECTIVE: The purpose of this study was to evaluate the effectiveness of the combination of inferior and middle meatal antrostomies for treatment of a maxillary sinus fungus ball by functional endoscopic sinus surgery. METHODS: A retrospective analysis including 28 patients with non-invasive fungal maxillary sinusitis was performed. Fourteen patients underwent FESS with both middle and inferior meatal antrostomies (combined group). The remaining 14 patients were treated with FESS through only the middle meatal antrostomy (control group). RESULTS: Post-operative computed tomography showed normal maxillary sinuses in all patients in the combined group. In contrast, in the control group, five patients (36 per cent) exhibited a normal maxillary sinus, seven (50 per cent) showed maxillary mucosal thickening and two (14 per cent) had persistent fungus balls in the maxillary sinus. CONCLUSION: FESS with a combination of middle and inferior meatal antrostomies proved more effective for treating fungal maxillary sinusitis.

Clinical outcomes of tracheoesophageal diversion for intractable aspiration.

OBJECTIVES: The purpose of the present study was to examine the clinical outcomes of using tracheoesophageal diversion for preventing intractable aspiration. METHOD: We retrospectively reviewed 25 patients who underwent tracheoesophageal diversion from 2003 to 2009 at our hospital (median age, 25 years; range, 0-78 years). End-to-side anastomosis was used in 16 cases and side-to-side anastomosis was used in 9. RESULTS: The average operative time was 141 minutes for end-to-side anastomosis and 191 minutes for side-to-side anastomosis. Peri-operative complications were observed in only two (8 per cent) cases: one with infection and one with haematoma. No fistulas were observed. Aspiration was prevented in all cases, but the nutritional route depended on the swallowing function of the patient. Oral feeding was the main nutritional route after surgery in only four patients (16 per cent). CONCLUSION: This procedure is well suited to patients who lack speech communication and are at high risk of aspiration.

New technique for laryngomicrosurgery: narrow band imaging-assisted video-laryngomicrosurgery for laryngeal papillomatosis.

OBJECTIVE: In the present report, we describe the use of narrow band imaging during video-laryngomicrosurgery for laryngeal papillomatosis. CASE REPORT: It is difficult to peri-operatively locate all the superficial papillomatous lesions when the disease is widespread, which then results in tumor recurrence. Therefore, we have constructed a narrow band imaging video-laryngomicrosurgery system, which we have used for two cases of laryngeal papillomatosis. CONCLUSION: Our narrow band imaging-assisted video-laryngomicrosurgery system to visualise superficial laryngeal papillomatosis more clearly.

Sarcoidosis of the tongue: a case report.

A case of sarcoidosis involving the tongue is described in a 48-year-old Japanese man. A definite diagnosis of sarcoidosis was made for the clinical lesion and pathological examinations. Sarcoidosis is a multisystem granulomatous disease that may affect any organ. Sarcoidosis of the tongue is particularly rare.

Cortical influences on the vestibular nuclei of the cat.

Our goal was to study potential substrates for cortical modulation of vestibular reflexes in the cat. In initial experiments, injections of wheat-germ-agglutinate-horseradish-peroxidase into Deiters' nucleus and the rostral descending nucleus revealed bilateral colonies of retrogradely filled neurons in cortical areas 6, 2, and 3a (about 60 cells per colony). In cats anesthetized with chloralose-urethane, we stimulated areas 2 and 3a with trains of pulses while recording from ipsilateral vestibular-nucleus neurons, which were characterized by their responses to sinusoidal tilts and tested for the presence of antidromic responses to stimulation of the upper cervical cord. A majority of the neurons was affected by cortical stimulation, showing either facilitation, inhibition, or a mixture of the two. Stimulation in area 2 was more effective than stimulation in area 3a. Despite the anatomic presence of direct cortico-vestibular projections, properties of facilitation and inhibition suggest that both were evoked by polysynaptic pathways. Cortical effects were broadly distributed to vestibular neurons without regard to responses of these neurons to sinusoidal tilts. There was no significant difference between effects on lateral and medial vestibulospinal tract neurons, but, as a group, vestibulospinal neurons were much more likely to be affected by cortical stimulation than neurons not antidromically activated from the C2 segment. We conclude that, by their influence on vestibulospinal neurons, neurons in cortical areas 2 and 3a should be able to modulate, in behaving animals, vestibular reflexes acting on the neck and limbs.

Behaviors of bulbar respiratory interneurons during fictive swallowing and vomiting.

Behaviors of the same individual medullary respiratory interneurons were examined during both swallowing and vomiting. In 8 decerebrated and paralyzed cats, 18 neurons having either augmenting expiratory (E-AUG), decrementing expiratory (E-DEC), decrementing inspiratory (I-DEC), or constant inspiratory (I-CON) firing patterns were recorded near the most rostral part of the nucleus ambiguus. All neurons exhibited elementary reflexes to single-shock stimulation of the superior laryngeal nerve. During fictive swallowing elicited by superior laryngeal nerve stimulation, all neurons were basically inactive. During fictive vomiting induced by vagal stimulation and/or emetic drugs, all E-AUG and E-DEC neurons tested either were silent or fired weakly between successive retches, whereas I-DEC and I-CON neurons tested exhibited burst activity during the retching and early-expulsion phases. These results indicate that these bulbar respiratory neurons, which may be involved in respiratory rhythmogenesis, are multifunctional neurons that could also be involved in vomiting but not likely in swallowing.

Recovery of retching after lesions involving the nucleus of the solitary tract.

The nucleus of the solitary tract (NTS) in the caudal brainstem receives various inputs that trigger vomiting. Chemical (kainic acid) NTS lesions in decerebrate, paralyzed cats temporarily suppressed fictive vomiting induced by different emetics. Subsequently, retching but not expulsion, resumed in 2-3.5 h. Since the NTS does not appear essential for retching, antiemetic drugs targeted at the NTS may not completely suppress vomiting.

Medullary swallowing-related neurons in the anesthetized cat.

Swallowing-related neurons (SRNs) were recorded systematically in the medulla oblongata of urethane-anesthetized cats. The SRNs received orthodromic inputs from the superior laryngeal nerve (SLN) and showed transient changes in their activity synchronous with swallowing. These neurons could be divided into three types. Type I SRNs are sensory-relay neurons from the SLN in the nucleus of the tractus solitarius (NTS), type II are interneurons located diffusely in the parvocellular reticular formation ventral to the NTS, which received oligosynaptic inputs from the SLN, and type III are motoneurons in the nucleus ambiguus. Some type II neurons still showed the swallowing activity after the animals were paralysed, which suggests that they could be involved in the generation of swallowing outputs.

Upper airway motor outputs during vomiting versus swallowing in the decerebrate cat.

Swallowing and vomiting are antagonistic motor acts; nevertheless, vomiting can be immediately followed by swallowing. The purpose of this study was to clarify the interrelationship between these two behaviors, particularly in regard to comparing the upper airway motor patterns at the end of the expulsion phase with those during subsequent swallowing. Experiments were conducted using both paralyzed and non-paralyzed decerebrate cats, in which recordings were obtained either from upper airway muscles, the diaphragm and abdominal muscles or from the nerves that innervate those muscles. The activity patterns of most nerves recorded in paralyzed animals were consistent with the behavior recorded in non-paralyzed animals from the muscles innervated by those nerves, with the exception of the cricothyroid and stylopharyngeus muscles. Vomiting can be divided into a series of retches followed by expulsion, which itself can be further subdivided into three phases. The final stage of expulsion, characterized by burst-like exaggerated activity of the laryngeal elevator thyrohyoid and the pharyngeal constrictors, proved to be different from pharyngeal swallowing, as judged from differences in the spatio-temporal patterns of the upper airway motor outputs. However, post-vomiting swallowing activity was still observed even after total deafferentation of the laryngeal and pharyngeal areas in paralyzed animals. It is therefore likely that the central processes for vomiting and swallowing closely relate in generating these two behaviors.

Crossing inputs of the superior laryngeal nerve afferents to medullary swallowing-related neurons in the cat.

To understand the neural mechanism for generation of synchronous activity on both sides during swallowing, we examined the convergence of inputs from the bilateral superior laryngeal nerves (SLNs) in the urethane-anesthetized cat medulla and we also examined the changes in swallowing outputs after a longitudinal brain-stem split in decerebrate cats. Twenty-six (31%) of 84 swallowing-related neurons (SRNs) that were oligosynaptically activated by ipsilateral SLN stimulation and recorded mostly in the reticular formation received contralateral inputs, which were confirmed by orthodromic spike responses (n = 16) or were detected as subliminal facilitatory or inhibitory inputs (n = 10) using conditioning-test stimuli. The rate of convergence of inputs from bilateral SLNs in these SRNs was significantly higher than that (4%) in the SRNs that were regarded as sensory-relay neurons in the nucleus tractus solitarius (NTS). The SRNs receiving signals from the contralateral SLN were located diffusely from the NTS and the adjacent reticular formation to the nucleus ambiguus (NA) and the reticular formation dorso-medial to the NA. A midsagittal split from 3 mm caudal to 6 mm rostral to the obex could change symmetrical swallowing to unilateral swallowing. Thus the crossing projections to the contralateral SRNs appear to contribute to symmetrical swallowing.

Behaviors of hypoglossal hyoid motoneurons in laryngeal and vestibular reflexes and in deglutition and emesis.

Reflex responses of hypoglossal motoneurons innervating the geniohyoid (GH) and thyrohyoid (TH) muscles from the superior laryngeal (SLN) and vestibular nerves and their behaviors during fictive swallowing and vomiting were examined by recording both the extracellular activities of 11 single cells in the hypoglossal nucleus and GH and TH muscle nerve activity in eight decerebrate, paralyzed, and artificially ventilated cats. The majority of TH motoneurons were either active and/or exhibited shortened antidromic latencies during early expiration. In contrast, GH motoneurons did not exhibit any respiratory-related activity. Electrical single-shock stimulation of the SLN never evoked an excitatory reflex response on GH or TH motoneurons but rather evoked inhibitory responses on the THs. Unlike other hypoglossal motoneurons, GH and TH motoneurons do not appear to receive vestibular inputs. However, they can exhibit robust activities during fictive swallowing and vomiting, particularly during expulsion. Thus these motoneurons may play an important role in airway protection during swallowing and vomiting but not in controlling upper airway patency regulated by vestibular afferents.

Changes in laryngeal muscle activities during hypercapnia in the cat.

The larynx has three functions: phonation, airway protection, and respiration. Few studies have dealt with laryngeal respiratory function. To elucidate respiratory regulation by the larynx, we studied the changes in the activity of the intrinsic laryngeal muscles during hypercapnia in decerebrated cats. The electromyographic activities of the posterior cricoarytenoid (PCA) and thyroarytenoid (TA) muscles were recorded simultaneously with an electromyogram of the diaphragm, endotracheal pressure, and concentrations of O2 and CO2. The activity of the intrinsic laryngeal muscles during hypercapnia (end-tidal CO2, 8% to 10%) was analyzed in comparison with that during eucapnia. In hypercapnia, both the PCA and TA muscles increased their activities, and the endotracheal pressure during expiration was elevated to a higher level than that in eucapnia. TA muscle activities returned to the level during eucapnia after ligation of the common carotid arteries. These findings suggest that hypercapnia causes a further widening of the glottis during inspiration to decrease inspiratory resistance and a further narrowing of the glottis during expiration to prevent alveolar collapse. Thus it may be concluded that the larynx actively participates in respiratory regulation under the control of the brain stem through a process of peripheral inputs from the carotid receptors.

Role of nucleus retroambigualis in respiratory reflexes evoked by superior laryngeal and vestibular nerve afferents and in emesis.

An ascending projection from the medullary nucleus retroambigualis (NRA) has recently been described as important for the control of the upper airway during vocalization. We evaluated the importance of this projection in other behaviors by making localized injections of the neurotoxin kainic acid in the NRA in decerebrate cats, most of which were paralyzed and artificially ventilated. In contrast to its importance for vocalization, the NRA is not essential for activation of upper airway musculature during respiration, swallowing, vomiting, or reflexes elicited by superior laryngeal or vestibular nerve afferents. However, kainic acid injections in the NRA and adjacent reticular formation prolonged the inhibitory phrenic motoneuronal response to superior laryngeal nerve stimulation and abolished or reduced abdominal motoneuronal responses during respiration, vomiting, and superior laryngeal nerve stimulation. Thus, of the behaviors we investigated, the importance of the ascending projection from the NRA appears to be limited to vocalization, while descending projections from the NRA region are important in a number of behaviors.

Vestibular inputs to bulbar respiratory interneurons in the cat.

Vestibular inputs to medullary respiratory interneurons were studied in decerebrated and artificially ventilated cats. Extracellular recordings were made from 40 neurons located in the area of pre-Bötzinger complex and activated antidromically from the contralateral ventral respiratory group. Neuronal populations analyzed included inspiratory and expiratory neurons with augmenting, constant and decrementing firing patterns, and a late inspiratory neuron. Seventeen neurons responded to ipsilateral and/or contralateral vestibular nerve electrical stimulation. These responses were observed in all seven cell types. Most neuronal reflex responses consisted of inhibition, while a few consisted of either excitation or a combination of both inhibition and excitation. These results indicate that pre-Bötzinger respiratory interneurons, which may be involved in respiratory rhythmogenesis, also participate in vestibulorespiratory responses.

[A case of an elderly patient with dementia and gait disturbance associated with influenza].

We report a case of progressive dementia and prolonged gait disturbance correlated with influenza A/H3N2 infection in 91-year-old female patient, admitted because of in ability to take care of herself due to aging and cerebral infarction. At admission, conversation and comprehension were not significantly impaired, and she was able to walk by herself. Flu symptoms such as high grade fever, chills, arthralgia, and cough appeared after a short stay at home. Influenza A/ H3N2 was confirmed serologically. Delirium occurred on the sixth day after influenza onset, persisted for three weeks, followed by recovery. Dementia symptoms such as memory defects and disorientation continued and did not improve. Due to this febrile episode, she was unable to walk unassisted. The results of computed tomography performed before and after the influenza episode were unremarkable for additional cellebro-vascular events during the observed period. Influenza infection may be an important risk factor for reducing the quality of life in the elderly. In geriatric cases, influenza should not be treated as a mere transient illness, but rather one which has important consequences for the elderly population, including the possibility of life threatening complications.

The nucleus retroambigualis controls laryngeal muscle activity during vocalization in the cat.

The purpose of this study was to determine (1) whether the nucleus retroambigualis (NRA) plays an essential role in periaqueductal gray (PAG)-induced vocalization and (2) which NRA neurons are involved in the projection from the PAG to laryngeal motoneurons. Bilateral injections of the neurotoxin kainic acid into the NRA in decerebrate cats abolished PAG-induced vocalization; PAG stimulation after the injections no longer modulated vocal fold adductor or tensor activity, and only tonically, but no longer phasically, activated the abdominal muscles. In contrast, PAG-induced inspiratory excitation remained even after the injections. These results suggest that the NRA is essential for the vocal activation of the laryngeal adductor and abdominal muscles, and that an additional pathway from the PAG to respiratory motoneurons other than through the NRA is important for mediating PAG-induced inspiratory activation. Secondly, axonal projections of NRA neurons to the contralateral nucleus ambiguus (NA) were studied electrophysiologically. Five expiratory neurons, which had decrementing (n=4) or constant (n=1) firing patterns, were identified as both having axonal projections to the NA and receiving inputs from the PAG. Furthermore, following NA stimulation many constant-latency action potentials of silent cells were recorded in the vicinity of the NRA, where many silent cells were also orthodromically activated by PAG stimulation. No NRA augmenting expiratory neurons could be antidromically activated from the NA. It is suggested that the NRA and adjacent reticular formation integrate inputs from the PAG and send outputs to laryngeal motoneurons for vocalization.

Role of pre-inspiratory neurons in vestibular and laryngeal reflexes and in swallowing and vomiting.

Fifteen pre-inspiratory (Pre-I) neurons were extracellularly recorded in the pre-Bötzinger complex and their involvements in vestibular (VN) and superior laryngeal (SLN) nerve reflexes and in fictive swallowing and vomiting were tested in decerebrated and artificially ventilated cats. Both type I (1 of 9) and type II (1 of 6) pre-I neurons could project to the contralateral ventral respiratory group region. Pre-I neurons changed their firing during VN and SLN respiratory reflexes and fictive swallowing and vomiting; different response properties were observed among individual pre-I neurons. These results suggest that pre-I neurons are a population of heterogeneous and multi-functional propriobulbar neurons.