Objective

The purpose of this study was to examine the relationships between oropharyngeal dysphagia （OD） and the concentration of substance P （SP）, as well as the activity of dipeptidyl peptidase 4 （DPP4 activity） in saliva.

Methods

The study comprised 106 community-dwelling elderly with an average age of 78.75 ± 6.18 years. Swallowing function was assessed via the Repetitive Saliva Swallowing Test, Modified Water Swallowing Test, and Seirei Dysphagia Screening questionnaire. The total and active SP concentrations in saliva were measured by enzyme-linked immunosorbent assay. The DPP4 activities in the supernatant and the adjusted and unadjusted bacterial fluid in the saliva were examined using the synthetic fluorescent substrate Gly-Pro-MCA in order to DPP4 activity was compared whether it was influenced by blood, bacteria flora, or bacteria counts.

Results

OD was associated with decreased total and active SP concentrations and high DPP4 activity by bacteria in saliva. The logistic regression models identified the concentration of total SP in saliva and the DPP4 activity in unadjusted bacterial fluids from the saliva as significant variables accounting for OD.

Conclusion

These results suggest that measuring the concentration of SP and the bacterial DPP4 activity in saliva may be useful in assessing OD.

Myelodysplastic syndrome （MDS） is a hematopoietic tumor with various forms of cytopenia. We report a case of oral cancer surgery for a patient with significant thrombocytopenia due to MDS.

The patient, a 68-year-old woman, was diagnosed with right-sided mandibular gingival cancer （cT1N0M0, squamous cell carcinoma） and was scheduled for a mandibular marginal resection at the Head and Neck Cancer Center of Iwate Medical University Hospital. The patient was treated for thrombocytopenia due to unclassifiable MDS with γ-globulin therapy and platelet transfusion 3 days prior to surgery, but her platelet count did not recover from the 10,000/μL level. Since the fatal risk of bleeding from the bone marrow could not be avoided, the resection was reduced to soft tissue only. No abnormal bleeding was observed in the perioperative period, and histopathological findings showed no tumor cells in the resected margins of the surgical specimen. Postoperatively, the patient was followed regularly at the Head and Neck Tumor Center but there were no findings suggestive of tumor recurrence or metastasis of oral cancer.

In the treatment of patients with oral cancer associated with MDS, it is extremely important to pursue safe and beneficial treatment methods for the patients while comprehensively assessing the prognosis of MDS and oral cancer.