Negative impact of computed tomography-based low skeletal muscle mass on swallowing recovery in patients with post-stroke dysphagia.

OBJECTIVES: Dysphagia due to stroke has a high prevalence, and evaluating the swallowing function of dysphagia and promoting oral intake is essential in patients with stroke. The psoas muscle mass index（cm2/height2（m2））, calculated by the psoas muscle area at the L3 level via abdominal computed tomography （CT）, can predict the development of dysphagia. However, knowledge about the impact of CT-based skeletal muscle mass on swallowing recovery, remains unknown. Therefore, we investigated whether CT-based low skeletal muscle mass impacted swallowing recovery. METHODS: A retrospective cohort study was conducted on patients with post-stroke dysphagia who underwent acute treatments along with a videofluoroscopic swallowing study（VFSS）. Swallowing recovery was identified as the improvement of the Functional Oral Intake Scale （FOIS） from the time of VFSS to discharge（observational period: ObPd）. The psoas muscle mass index's cut-off values for low skeletal muscle mass were 3.74 cm2/m2 and 2.29 cm2/m2 for men and women respectively. RESULTS: There were 53 subjects （36 male, median age 73.9）. The median during the ObPd was 26 days, and the median days from onset to admission and admission to VFSS were 0 and 18, respectively. Sixteen patients had low skeletal muscle mass. The median improvement of FOIS during the ObPd was 2, and the median length of hospital stay was 51 days. In the stepwise multiple linear regression analysis for the improvement of FOIS during the ObPd, low skeletal muscle mass （ߠ- 0.245; 95% confidence interval - 2.248 to - 0.127; p = 0.029） was a significant factor, even adjusted for serum albumin at admission, disturbance of consciousness at VFSS, FOIS at VFSS, and aspiration during VFSS. CONCLUSION: CT-based low skeletal muscle mass negatively impacted swallowing recovery during the ObPd in patients with post-stroke dysphagia.

Glucuronidation as a metabolic barrier against zearalenone in rat everted intestine.

Zearalenone (ZON), produced by Fusarium fungi, exhibits estrogenic activity. Livestock can be exposed to ZON orally through contaminating feeds such as cereals, leading to reproductive disorders such as infertility and miscarriage via endocrine system disruption. However, the details of ZON metabolism remain unclear, and the mechanism of its toxicity has not been fully elucidated. In this study, we investigated the kinetics of ZON absorption and metabolism in rat segmented everted intestines. ZON absorption was confirmed in each intestine segment 60 min after application to the mucosal buffer at 10 µM. Approximately half of the absorbed ZON was metabolized to α-zearalenol, which tended to be mainly glucuronidated in intestinal cells. In the proximal intestine, most of the glucuronide metabolized by intestinal cells was excreted to the mucosal side, suggesting that the intestine plays an important role as a first drug metabolism barrier for ZON. However, in the distal intestine, ZON metabolites tended to be transported to the serosal side. Glucuronide transported to the serosal side could be carried via the systemic circulation to the local tissues, where it could be reactivated by deconjugation. These results are important with regard to the mechanism of endocrine disruption caused by ZON.