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The mucosal drug delivery system (mDDS) is one of the promising approaches to control the pharmacokinetic behavior of drugs. In this approach, surface properties of drug nanoparticles are key determinants to provide particles with mucoadhesive and mucopenetrating properties for prolonged retention at mucosal tissue and rapid mucosal absorption, respectively. In this paper, we would like to discuss the preparation of mDDS formulations by flash nanoprecipitation using a four-inlet multi-inlet vortex mixer, in vitro and ex vivo evaluation of mucopenetrating and mucoadhesive properties of polymeric nanoparticles as well as the application of mDDS to the pharmacokinetic control of cyclosporine A after oral administration to rats. We also share our current research on in silico modeling and prediction of the pharmacokinetic behavior of drugs after intratracheal administration to rats.

The article focuses on measuring the membrane thickness of the lower alveolar crest and different areas of membrane as classified by prosthodontics. It mentions the 31 individuals with mandibular free-end wherein their oral mucous membrane was measured at the four regions with Schleimhaut-Dicken-Meb (SDM). Further, it notes that measurements were also taken by palpation in the fixed, movable, hard-fixed, and flabby areas of membrane as classified by prosthodontists.

We describe here the case of a 7-year-old male patient with Stevens-Johnson syndrome (SJS), which was suspected to be caused by treatment with tipepidine hibenzate (Asverin ® ). The day after taking tipepidine hibenzate and L-carbocysteine (Carbocysteine ® DS) for relief of a cold, he began presenting with the following symptoms: fever above 38°C, wheezing, and decreased oxygen saturation. Two days later, mucous membrane rashes, such as erosions on the lips, eye mucosa, vulva, and blisters on the trunk appeared, and SJS was thus diagnosed. Because pseudomembrane formation and corneal epithelial defect in the eyes were also observed, steroid pulse therapy was administered early in the course of the disease, and the patient recovered without sequelae.A drug-induced lymphocyte stimulation test performed to determine the cause of the disease was positive for fixed-dose combination therapy with tipepidine hibenzate plus L-carbocysteine and for tipepidine hibenzate alone. It has now been three years since the onset of the disease, and no sequelae have been observed. Although tipepidine hibenzate is a drug frequently used for pediatric patients, it should be administered with caution because of its potential to cause SJS.

An 83-year-old man was detected to have solitary abdominal lymphadenopathy, and pathological findings revealed squamous cell carcinoma. Endoscopic examination revealed a depressive lesion in the middle thoracic esophagus. Endoscopic submucosal dissection was performed. Pathological findings revealed invasion to the lamina propria mucosae, negative vascular invasion, and surgical margins. At 8 months after metastatic lymphadenectomy, no recurrence was observed.

A 64-year-old man was found to have an irregular region in the stomach by medical examinations. Upper gastrointestinal fiberscopy(GIF)revealed a reddish lesion in the lesser curvature of the upper stomach. Biopsy showed moderately differentiated adenocarcinoma. CT revealed swollen lymph nodes from the lesser curvature of the stomach to the para-aortic region. EUS-FNA was performed twice; however, histology revealed few atypical cells. A definitive diagnosis could not be obtained. Endoscopic findings revealed that the gastric cancer had invaded as far as the mucosa. Moreover, the swollen lymph nodes were considered to have originated from a different disease, such as lymphoma. The lesion of the stomach was an indication for ESD. On April 2016, ESD was performed, and histology revealed the following: Ⅱc, 31×23 mm, tub2, T1a(M), UL-, ly-, v-, VM0, and HM0. Incisional biopsy of the lymph nodes of the para-aorta was performed the followingmonth, and histology revealed poorly differentiated adenocarcinoma, which metastasized from gastric cancer. SOX therapy was performed in 10 courses. The para-aortic lymph nodes disappeared, and the number of lesser curvature lymph nodes decreased. On August 2018, follow-up GIF endoscopy was performed. A depressed mucosa was found in the lesser curvature of the gastric body, which was away from the ESD scar. Biopsy showed moderately differentiated adenocarcinoma. Total gastrectomy with lymph node dissection was performed on November 2018. Metastasis of the lesser curvature lymph nodes was positive; however, curative resection was performed histologically.

Background: Upper airway reflexes include a reflex protecting the airway as well as another one dilating the airway. The latter reflex, the pharyngeal dilator reflex to negative airway pressure (NPAR), plays an important role in maintaining airway patency, although the peripheral receptors involved in NPAR have not been specified., Methods: The effects of surface anesthesia of the pharyngeal mucous membrane on NPAR were evaluated by observing activity of the musculus genioglossus (GG) in rabbits. Following anesthesia with thiopental, two incisions were made on the trachea of each rabbit. Through these incisions, a tube connected to the anesthetic circuit was inserted into the lung and another tube connected to an aspirator into the pharynx. Effects of negative pressure on the myelogram of the GG were recorded with and without surface anesthesia with 1% lidocaine., Results: Electric discharge from the GG was increased in the sessions with exposure to negative pressure without surface anesthesia, but was significantly decreased in those with surface anesthesia., Conclusions: These findings suggest that the peripheral receptors of NPAR are located in the pharyngeal mucous membrane.

Insulin is usually administered by s.c. injection to subjects with type 1 and type 2 diabetes. For a long time, non-parenteral delivery approach, such as conjunctiva, nasal cavity, oral cavity, alveolar space, intestine, and rectum, etc has been tried and showed that some portion of administered insulin was absorbed through trans-mucosal route. Short-term glycemic control on diabetic animal and patients was reported to be succeeded by intra-nasal insulin, oral insulin, and insulin suppository. After administration of these insulin, insulin was absorbed as rapid as intra-muscular injection of insulin and thus could effectively control postprandial glycemic excursion in diabetic patients.

A 49-year-old female with pemphigus vulgaris underwent the removal of a meningioma under general anesthesia. Neither bulla nor erosion was observed on her skin and oral cavity mucosa. She had been on prednisolone 15 mg for six years daily to avoid the recurrence of skin lesion. Anesthesia was induced and maintained with total intravenous anesthesia with propofol and fentanyl. No adverse episodes were encountered during the operative procedure. We checked the tracheal mucosa using bronchofiberscope before extubation. A small bulla was found on the tracheal mucosa, where the cuff of the tracheal tube was located. The trachea was extubated slowly under bronchofiberscopic observation, and no other bullae were found. It would have been formed by mechanical stimulation of the tracheal tube. This case suggests that we have to pay careful attention to the formation of bullae at any part of the body by mechanical stimuli during anesthetic management of patients with pemphigus vulgaris.

Purpose: Balloon applicators are generally used in intraluminal irradiation for esophageal cancer. CT exhibits a distortion of the applicator during treatment. Because little attention has been paid to dose non-uniformity in the esophageal mucosa, we analyzed mucosal surface dose using CT., Materials and Methods: Eleven patients with esophageal cancer treated with a double-lumen balloon applicator (balloon length: 15 cm, diameter: 20 mm) were evaluated. Reference dose was prescribed at 5 mm under the mucosal surface. Mucosal surface points were determined from CT images, and relative surface dose to reference dose was calculated. Hot and cold spots were defined respectively, as dose points receiving at least 200% and less than 100% of the reference dose., Results: The mean mucosal dose ranged from 138% to 174%. Mucosal dose was distributed widely from 100% to 199% in 94% of all patients. Hot and cold spots accounted for 5.3% and 0.7% of mucosal dose points, respectively., Conclusion: 1) CT analysis exhibited the inhomogeneity of esophageal mucosal dose in intraluminal irradiation. 2) At present, it is acceptable to prescribe the reference dose at 5 mm under the esophageal surface. 3) Balloon applicators should be improved to achieve dose uniformity in the esophageal mucosa.

We performed rectal and/or oral challenge tests on 8 patients with suspected but unproven diagnosis of food allergy based on detailed medical history and findings from radioallergosorbent tests (RAST). The cells appearing in the rectal mucosal smear serially for 48 hours after allergen challenge were examined. The following results were obtained: 1) Significant numbers of not only eosinophils but also mast cells appeared in the rectal smears after challenges with suspected-food allergens, but not with unrelated foods. This confirmed the antigen-specificity of the method. 2) In some cases, the appearance of mast cells and eosinophils was bimodal, suggesting the existence of a later allergic response in addition to an immediate-type reaction. 3) The food-specific appearance of mast cells and eosinophils was observed in association with clinical symptoms after challenge, even in patients whose IgE antibodies to the allergen were negative or commercially unavailable. In conclusion, we propose that rectal mucosal cytology in conjunction with rectal and/or oral challenge tests is a reliable and objective method to diagnose unproven or suspected food allergy.

The mechanism of the occurrence of anti-peristaltic discharge originated in the stomach distal to the transection followed by end-to-end anastomosis has not been elucidated. The purpose of this study is to investigate the effect of the enteric nervous system on the anti-peristaltic discharge in the canine stomach distal to the transection by using sodium channel blocking agent TTX and ganglion blocking agent C6 together with local anesthetic lidocaine electromyographycally. Following results were obtained. 1. The retardation of propagation velocity of normo-peristaltic discharge and the decrease of frequency of anti-peristaltic discharge were noted both at TTX 10 micrograms/kg iv. and TTX 10 micrograms/kg iv. together with mucosal anesthetization by lidocaine. And no significant difference was recognized between them. 2. The retardation of propagation velocity of normo-peristaltic discharge and the decrease of frequency of anti-peristaltic discharge were noted at C6 10 mg/kg iv. together with mucosal anesthetization by lidocaine. While the decrease of frequency of anti-peristaltic discharge was only noted at C6 10 mg/kg iv. Conclusively, it was suggested that the nervous pathway which transmits some excitive information from mucosa to the myenteric plexus exists and that the myenteric plexus has a important role on the occurrence of anti-peristaltic discharge.