The relationship between white tongue and gastroesophageal reflux disease

Background Signs of gastroesophageal reflux disease (GERD) are limited, therefore, follow up of treatment are mainly based on patients’ symptoms. The aims of study were: 1) to compare the prevalence of white tongue (WT) between individuals with GERD and control group, 2) to evaluate the correlation between WT extension and severity of symptoms in GERD. Materials and methods This case-control study consisted of 100 consecutive individuals with GERD who were referred to the gastroenterology clinic of a referral hospital during 2019-2020. The diagnosis of GERD was made by a gastroenterologist if heart burn or regurgitation existed. The same number of healthy accompanies of patients without GERD participated as the control group. A single examiner defined WT if whitish-gray discoloration of tongue surface existed in two separate sessions [Kappa = 0.93; p < 0.01]. WT extension was estimated based on the approximate white discoloration of the tongue surface. Results All participants with GERD showed white tongue in the first observation and 98% in the second observation, while only 5% of the individuals in the control group revealed WT in both observations (p < 0.001). There was a positive correlation between the WT extension and GERD symptom severity (r: 0.44; p < 0.001). Conclusion It seems that WT might be a reliable sign of GERD. Considering the association between GERD symptoms severity and the extent of WT in this observation, further studies may assess the utility of WT extension as a reasonable objective in monitoring treatment response.

Comparative morphology of tongue surface in Neotropical aerial insectivore bats (Mammalia: Chiroptera)

Comparative morphological characters in Neotropical bats are mostly restricted to external and cranio-dentary complexes, and few studies focusing on other morphological complexes have been carried out. In the case of tongue morphology, comparative analyses of the structure have been restricted to the superfamily Noctilionoidea with a wide range of diets, and Molossidae, a strictly aerial insectivore family. In this paper, we studied the morphology of tongue papillae in 10 aerial insectivore Neotropical bat species, representing six families (Emballonuridae, Furipteridae, Thyropteridae, Mormoopidae, Natalidae, and Vespertilionidae), and data from the previous study of Molossidae were compared. We studied tongues in light and scanning electron microscopes following material preparation protocols. We observed two types of sensitive papillae, circumvallate and fungiform, the latter at times presenting a groove surrounding the papillae. Nine mechanic types were observed, one of them, which we called flaky-like, not hitherto described. All Vespertilionoidea families (Vespertilionidae, Natalidae, and Molossidae) presented, as diagnosing characters, fungiform papillae distributed throughout the tongue, as well as anteriorly at the dorsum, and scale-like papillae on the medial lobe directed laterally and anteriorly. Emballonuridae showed the simplest tongue morphology regarding the presence and abundance of some papillae. Families composing the clade Furipteridae + Thyropteridae + Mormoopidae presented small and non-grooved fungiform papillae, and mechanical bifid papillae were absent. In summary, this study has provided additional traits (putative synapomorphies) of the bat tongue to support the clades on the current bat phylogeny.

A Novel Quantitative Prediction Approach for Pungency Level of Chinese Liquor (Baijiu) Based on Infrared Thermal Imager

Pungency is a crucial sensory feature that influences consumers’ appreciation and preferences toward alcoholic beverages. However, the quantitation of pungency is challenging to achieve using sensory analysis because of persistence, accumulation, and desensitization to the pungency perception. This study aimed to design a novel pungency evaluation method based on the measurement of tongue surface temperature. An infrared thermal (IRT) imager technique for measuring tongue surface temperature was established. To validate its feasibility, the IRT technique was used to measure tongue surface temperatures after the tongue was stimulated by (1) water and Baijiu, (2) different concentrations of ethanol aqueous solution (10, 20, 30, 40, and 50%, v/v), (3) ethanol aqueous solution and Baijiu samples with the same ethanol content, and (4) 26 Baijiu samples with different pungency level. For all cases, tongue surface temperatures showed large differences as a result of the different stimulation. The results showed that the tongue surface temperature correlated with the pungency intensity obtained by the sensory analysis. The relationship between tongue surface temperature and pungency intensity was established by multiple linear regression analysis. The IRT technique was able to be a useful support tool to quantitatively predict the pungency of alcoholic beverages, based on the measurement of tongue surface temperature.

Structural Equation Modeling of Tongue Function and Tongue Hygiene in Acute Stroke Patients

In acute stroke patients, it is important to maintain tongue hygiene and tongue function for prognosis management. However, the direct relationship between these factors is unclear, since these are often assessed by multiple observables. In this study, we used structural equation modeling (SEM) analysis, a tool to analyze the relationship between concepts that cannot be measured directly, to analyze the relationship between tongue hygiene and tongue function. The subjects were 73 patients with acute stroke admitted to a university hospital who underwent dental intervention. Age, sex, nutritional intake method, clinical severity classification of dysphagia, number of current teeth, number of functional teeth, oral health, tongue movement, tongue coating, number of microorganisms on the tongue surface, tongue surface moisture level, and tongue pressure were measured at the first visit. SEM analysis showed that the relationship between tongue function and tongue hygiene was 0.05 between tongue function and swallowing function was 0.90, and that between tongue hygiene and swallowing function was 0.09. We found no statistical relationship between tongue function and tongue hygiene in acute stroke patients. However, it was reconfirmed that tongue function is strongly related to feeding and swallowing functions.

Pharmacokinetic Model Analysis of Supralingual, Oral and Intravenous Deliveries of Mycophenolic Acid

Mycophenolic acid (MPA) is commonly used for organ rejection prophylaxis via oral administration in the clinic. Recent studies have shown that MPA also has anticancer activities. To explore new therapeutic options for oral precancerous/cancerous lesions, MPA was designed to release topically on the dorsal tongue surface via a mucoadhesive patch. The objective of this study was to establish the pharmacokinetic (PK) and tongue tissue distribution of mucoadhesive MPA patch formulation after supralingual administration in rats and also compare the PK differences between oral, intravenous, and supralingual administration of MPA. Blood samples were collected from Sprague Dawley rats before and after a single intravenous bolus injection, a single oral dose, or a mucoadhesive patch administration on the dorsal tongue surface for 4 h, all with a dose of 0.5 mg/kg of MPA. Plots of MPA plasma concentration versus time were obtained. As multiple peaks were found in all three curves, the enterohepatic recycling (EHR) model in the Phoenix software was adapted to describe their PK parameters with an individual PK analysis method. The mean half-lives of intravenous and oral administrations were 10.5 h and 7.4 h, respectively. The estimated bioavailability after oral and supralingual administration was 72.4% and 7.6%, respectively. There was a 0.5 h lag-time presented after supralingual administration. The results suggest that the systemic plasma MPA concentrations were much lower in rats receiving supralingual administration compared to those receiving doses from the other two routes, and the amount of MPA accumulated in the tongue after patch application showed a sustained drug release pattern. Studies on the dynamic of drug retention in the tongue after supralingual administration showed that ~3.8% of the dose was accumulated inside of tongue right after the patch removal, ~0.11% of the dose remained after 20 h, and ~20.6% of MPA was not released from the patches 4 h after application. The data demonstrate that supralingual application of an MPA patch can deliver a high amount of drug at the site of administration with little systemic circulation exposure, hence lowering the potential gastrointestinal side effects associated with oral administration. Thus, supralingual administration is a potential alternative route for treating oral lesions.

Ultrasound examination of swallowing disorder characteristics in patients with oncopathology of the oral cavity

The aim of the study was to compare the dynamics of oral and oropharyngeal muscles contraction during swallowing in normal individuals and in patients with malignant tumors depending on the clinical disease using ultrasound. Materials and methods. The study included 29 patients aged 38–55 years (men), normtrophic, who were treated in the Department of Head and Neck Tumors of Podolsk Regional Oncology Center for malignant tumors of the tongue, floor of the mouth and oropharynx. Among them, there were 12 patients with cancer of the lateral tongue surface, 9 - with oral mucosa cancer and 8 – with tongue base cancer. Scanning was performed in the sagittal and frontal planes with a 7.5 MHz sensor in two modes (B and M) at rest and during swallowing in several stages on the TOSHIBA device (Model USDI-A500A/EL; Serial No. ELA14Z2082). B-mode was the main one in all the studied areas where one image frame was vertically lined up. The swallowing act was assessed in M-mode (a length of the axial movement). The obtained indicators were compared with the normal ones. Results. The work was carried out to verify the musculoskeletal complex involved in the act of swallowing. Measurements of several indicators were performed revealing a violation of the swallowing act, namely a decrease in indicators in the longitudinal and lateral examination of the sublingual muscle group in B-mode and M-mode in patients diagnosed with cancer of the tongue base and mucosa of the mouth floor. In addition, a deviation and displacement of the musculoskeletal complex to the healthy contralateral side with preserved muscle function in patients diagnosed with the lateral tongue surface cancer was revealed by M-mode ultrasound of the swallowing act. Conclusions. In patients with malignant tumors of the lateral tongue surface, the longitudinal examination of the sublingual muscle group in B-mode ultrasound showed decreased indicators by 7 % and in the lateral projection of the anterior belly of the digastric muscle in M-mode – by 3.5 times. In tongue base cancer, the mentohyoid distance was merely 4 mm reduced during the act of swallowing, and in the longitudinal projection of the sublingual muscle group - by only 5 %. In oral mucosa cancer, there was the lowest reduction in the mentohyoid distance, about 4 mm when swallowing, (in healthy people 8–12 mm) and decreased indicators in longitudinal examination of the sublingual muscle group by 8 % in B-mode, in lateral M-mode ultrasound – by 2 mm.