Case Report: Disseminated Cysticercosis due to Intentional Ingestion of Parasitic Worm Eggs for Weight Loss

A 20-year-old female resident of Beijing intended to consume the eggs of the parasitic worm, Taenia saginata, for weight loss; however, she apparently inadvertently ingested Taenia solium (pork tapeworm) eggs, which resulted in disseminated cysticercosis. Cysticerci developed in the brain, tongue, muscles, liver, peritoneum, and subcutaneous tissues. She was administered oral albendazole and praziquantel. After four 10-day courses of treatment, most of the cysts disappeared and she recovered. After 3 years, the patient remains in good health.

A medullary centre for lapping in mice

It has long been known that orofacial movements for feeding can be triggered, coordinated, and often rhythmically organized at the level of the brainstem, without input from higher centers. We uncover two nuclei that can organize the movements for ingesting fluids in mice. These neuronal groups, IRtPhox2b and Peri5Atoh1, are marked by expression of the pan-autonomic homeobox gene Phox2b and are located, respectively, in the intermediate reticular formation of the medulla and around the motor nucleus of the trigeminal nerve. They are premotor to all jaw-opening and tongue muscles. Stimulation of either, in awake animals, opens the jaw, while IRtPhox2b alone also protracts the tongue. Moreover, stationary stimulation of IRtPhox2b entrains a rhythmic alternation of tongue protraction and retraction, synchronized with jaw opening and closing, that mimics lapping. Finally, fiber photometric recordings show that IRtPhox2b is active during volitional lapping. Our study identifies one of the subcortical nuclei underpinning a stereotyped feeding behavior.

Progressive Protrusive Tongue Exercise Does Not Alter Aging Effects in Retrusive Tongue Muscles

Purpose: Exercise-based treatment approaches for dysphagia may improve swallow function in part by inducing adaptive changes to muscles involved in swallowing and deglutition. We have previously shown that both aging and progressive resistance tongue exercise, in a rat model, can induce biological changes in the genioglossus (GG); a muscle that elevates and protrudes the tongue. However, the impacts of progressive resistance tongue exercise on the retrusive muscles (styloglossus, SG; hyoglossus, HG) of the tongue are unknown. The purpose of this study was to examine the impact of a progressive resistance tongue exercise regimen on the retrusive tongue musculature in the context of aging. Given that aging alters retrusive tongue muscles to more slowly contracting fiber types, we hypothesized that these biological changes may be mitigated by tongue exercise.Methods: Hyoglossus (HG) and styloglossus (SG) muscles of male Fischer 344/Brown Norway rats were assayed in age groups of young (9 months old, n = 24), middle-aged (24 months old, n = 23), and old (32 months old, n = 26), after receiving an 8-week period of either progressive resistance protrusive tongue exercise, or sham exercise conditions. Following exercise, HG and SG tongue muscle contractile properties were assessed in vivo. HG and SG muscles were then isolated and assayed to determine myosin heavy chain isoform (MyHC) composition.Results: Both retrusive tongue muscle contractile properties and MyHC profiles of the HG and SG muscles were significantly impacted by age, but were not significantly impacted by tongue exercise. Old rats had significantly longer retrusive tongue contraction times and longer decay times than young rats. Additionally, HG and SG muscles showed significant MyHC profile changes with age, in that old groups had slower MyHC profiles as compared to young groups. However, the exercise condition did not induce significant effects in any of the biological outcome measures.Conclusion: In a rat model of protrusive tongue exercise, aging induced significant changes in retrusive tongue muscles, and these age-induced changes were unaffected by the tongue exercise regimen. Collectively, results are compatible with the interpretation that protrusive tongue exercise does not induce changes to retrusive tongue muscle function.

Tongue muscle contractile, fatigue and fiber type properties in rats.

The intrinsic and extrinsic tongue muscles manipulate the position and shape of the tongue and are activated during many oral and respiratory behaviors. In the present study in 6-month-old Fischer 344 rats, we examined mechanical and fatigue properties, of tongue muscles in relation to their fiber type composition. In an ex vivo preparation, isometric force and fatigue was assessed by direct muscle stimulation. Tongue muscles were frozen in melting isopentane and transverse sections cut at 10 µm. In H&E stained muscle sections, the relative fractions of muscle vs extracellular matrix were determined. Muscle fibers were classified as type I, IIa and IIx and/or IIb based on immunoreactivity to specific myosin heavy chain isoform antibodies. Cross-sectional areas (CSA) and proportions of different fiber types were used to calculate their relative contribution to total muscle CSA. We found that the superior and inferior longitudinal intrinsic muscles (4.4 N/cm2) and genioglossus muscle (3.0 N/cm2) generated the greatest maximum isometric force compared to the transversalis muscle (0.9 N/cm2). The longitudinal muscles and the transversalis muscle displayed greater fatigue during repetitive stimulation consistent with the greater relative contribution of type IIx and/or IIb fibers. By contrast, the genioglossus, comprising a higher proportion of type I and IIa fibers was more fatigue resistant. This study advances our understanding of the force, fatigue and fiber type specific properties of individual tongue musculature. The assessments and approach provide a readily accessible muscular readout for scenarios where motor control dysfunction or tongue weakness is evident.

An executive center for the intake of liquids

It has long been known that orofacial movements for feeding can be triggered, coordinated, and often rhythmically organized at the level of the brainstem, without input from higher centers. We uncover two nuclei that can organize the movements for ingesting fluids in mammals. These neuronal groups, defined by unique transcriptional codes and developmental origins, IRtPhox2b and Peri5Atoh1, are located, respectively, in the intermediate reticular formation of the medulla and around the motor nucleus of the trigeminal nerve. They are premotor to all jaw-opening and tongue muscles. Stimulation of either, in awake animals, opens the jaw, while IRtPhox2b alone also protracts the tongue. Moreover, stationary stimulation of IRtPhox2b entrains a rhythmic alternation of tongue protraction and retraction, synchronized with jaw opening and closing, that mimics lapping. Finally, fiber photometric recordings show that IRtPhox2b is active during volitional lapping. Our study identifies one of the long hypothesized subcortical nuclei underpinning a stereotyped feeding behavior.

RESULTS OF STUDY OF THE HYPOGLOSSAL NERVE FUNCTIONS IN PATIENTS AFTER HYPOGLOSSAL-FACIAL ANASTOMOSIS

Hypoglossal-facial anastomosis is a common method of restoring and/or replacing lost facial nerve function. At the same time, there are works that compare functional disorders of the XII pair of cranial nerves that arise in patients with various types of hypoglossal-facial anastomosis, which, in turn, indicates the rather great importance of this problem, as well as the need for further research. There are several modifications of the hypoglossal-facial anastomosis, which differ significantly, including the effect on the function of the tongue muscles. An important instrumental method for studying the function of the hypoglossal nerve is electromyography, namely, the determination of the total evoked potentials of the tongue muscles. In order to study complications in the form of dysfunction of the tongue muscles due to hypoglossal-facial anastomosis, a comparative analysis of the data of the tongue electromyography in patients after performing these interventions was carried out. Materials and methods. The study included 55 patients with chronic suppurative otitis media, with tumors of the cerebello-pontine angle (acoustic and vestibular schwannomas, tumors of the jugular glomus) complicated by a lesion of the facial nerve. In the main group of patients (20 patients), the original technique of the modified hypoglossal-facial anastomosis was used to restore the facial nerve function. Patients (n=35) in the control group underwent a classic hypoglossal-facial anastomosis. Results. As can be seen from the above data, when comparing the tongue muscles contraction amplitude 3, 6 and 12 months after the formation of the hypoglossal-facial anastomosis, a statistically significant decrease in this indicator is observed on the side of performing the hypoglossal-facial anastomosis in comparison with the intact side at all stages of the study (p <0.05) (p <0.05) (p <0.01), respectively. When comparing the indicators of the total muscle response in patients after using the modified and classical methods of XII-VII anastomosis, there was a statistically significant increase in the compound muscle response of the tongue in the main group - by an average of 10.94% (p <0.05). Conclusion. Performing hypoglossal-facial anastomosis leads to gross dysfunction of the hypoglossal nerve on the side of the intervention, manifested in the form of a significant decrease in the amplitude of muscle contraction according to electromyography of the tongue. The use of the modified technique of XII-VII anastomosis provided the restoration of the total muscle potential of the tongue by 8.82% after 3 months, by 8.7% – after 6 months. and by 15.38% – after 12 months after surgery in comparison with the group where the classic hypoglossal-facial anastomosis was performed.

Daytime Neuromuscular Electrical Therapy of Tongue Muscles in Improving Snoring in Individuals with Primary Snoring and Mild Obstructive Sleep Apnea

Study Objectives: Evaluating daytime neuromuscular electrical training (NMES) of tongue muscles in individuals with Primary Snoring and Mild Obstructive Sleep Apnea (OSA). Methods: A multicenter prospective study was undertaken in patients with primary snoring and mild sleep apnea where daytime NMES (eXciteOSA® Signifier Medical Technologies Ltd, London W6 0LG, UK) was used for 20 min once daily for 6 weeks. Change in percentage time spent snoring was analyzed using a two-night sleep study before and after therapy. Participants and their bed partners completed sleep quality questionnaires: Epworth Sleepiness Scale (ESS) and Pittsburgh Sleep Quality Index (PSQI), and the bed partners reported on the nighttime snoring using a Visual Analogue Scale (VAS). Results: Of 125 patients recruited, 115 patients completed the trial. Ninety percent of the study population had some reduction in objective snoring with the mean reduction in the study population of 41% (p < 0.001). Bed partner-reported snoring reduced significantly by 39% (p < 0.001). ESS and total PSQI scores reduced significantly (p < 0.001) as well as bed partner PSQI (p = 0.017). No serious adverse events were reported. Conclusions: Daytime NMES (eXciteOSA®) is demonstrated to be effective at reducing objective and subjective snoring. It is associated with effective improvement in patient and bed partner sleep quality and patient daytime somnolence. Both objective and subjective measures demonstrated a consistent improvement. Daytime NMES was well tolerated and had minimal transient side effects.

Case report

Myasthenia gravis (MG) is a rare autoimmune disease in which antibodies bind to acetylcholine receptors in the postsynaptic membrane at the neuromuscular junction. Muscle-specific kinase (MuSK) antibody-associated MG patients often have severe symptoms, including bulbar dysfunction, respiratory insufficiency, and atrophy of the facial and tongue muscles. Due to its fluctuating nature and the similarity to the symptoms other disorders MG is one of the most challenging medical diagnoses.Fluctuating character and the similarity of symptoms to those of other disorders make MG one of the most challenging medical diagnoses. Initial misdiagnosis of MuSK-MG can lead to worsening of symptoms. The diagnosis is confirmed by positive results on pharmacological testing, electrodiagnostictesting and serum antibodyassay. Symptomatic, immunoactive, and supportive approaches to therapy have very good effect and the prognosis is improved with precocious interventions.

Case report

Myasthenia gravis (MG) is a rare autoimmune disease in which antibodies bind to acetylcholine receptors in the postsynaptic membrane at the neuromuscular junction. Muscle-specific kinase (MuSK) antibody-associated MG patients often have severe symptoms, including bulbar dysfunction, respiratory insufficiency, and atrophy of the facial and tongue muscles. Due to its fluctuating nature and the similarity to the symptoms other disorders MG is one of the most challenging medical diagnoses.Fluctuating character and the similarity of symptoms to those of other disorders make MG one of the most challenging medical diagnoses. Initial misdiagnosis of MuSK-MG can lead to worsening of symptoms. The diagnosis is confirmed by positive results on pharmacological testing, electrodiagnostictesting and serum antibodyassay. Symptomatic, immunoactive, and supportive approaches to therapy have very good effect and the prognosis is improved with precocious interventions.