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With the imminent advent of an extremely aged society, there will be an increasing requirement for the prediction, early detection and treatment of cerebral infarction. Involved in the etiological mechanisms of cerebral infarction are a number of complex genetic and environmental factors related to the onset and progression of hypertension and arteriosclerosis. Elucidation of the significance of the various risk factors will require definite identification of phenotypes using large numbers of subjects. The present study was conducted as part of a cohort study with subjects from the general population of a rural community (the Ohasama Study). Blood pressure (BP) patterns were assessed through random home-based and clinical measurements, as well as 24 h ambulatory BP monitoring. Magnetic resonance imaging of the brain was carried out in some subjects in order to detect asymptomatic cerebral infarcts, the maximum intima–media thickness was determined by carotid high-resolution ultrasonography, and cognitive function was assessed using the mini mental state examination. Correlation analysis of these parameters and the candidate hypertensive genotypes was then performed. Significant associations were seen between (i) gene polymorphisms in the renin–angiotensin system and asymptomatic cerebral infarction and the non-dipper pattern of circadian blood pressure variation; and (ii) endothelial nitric oxide synthase (eNOS) gene polymorphism and arterial pressure, lacunar score and cognitive function. An association was seen between the endothelin-1 polymorphism and hypertension, but only in obese subjects. There are interactions between genes and the environment in the etiology of cerebral infarction. [ABSTRACT FROM AUTHOR]

Background: The purpose of the present paper was to determine clinical risk factors for the development of pressure ulcers in bedridden elderly inpatients. Methods: A case-control study was performed for 117 subjects with pressure ulcers (mean age: 80.6 ± 7.2 years) with a 1-year observation period, and 351 age- and sex-matched controls. Factors examined were subitems of the Braden scale; convenient clinical assessment (continence, sitting, turning, oral intake, and sitting up); underlying chronic conditions (stroke and diabetes mellitus); and circulating levels of albumin, total cholesterol, total lymphocyte count, and hemoglobin. Results: Compared to the controls, test cases showed lower scores of the Braden scale and lower levels of circulating factors, and higher incidences of incapability of the subitems of convenient clinical assessment, and of diabetes mellitus (P < 0.20). Three models of multiple logistic regression analysis revealed that decreased serum level of albumin and impaired self-positioning in bed were significant independent risk factors. The relative risk for the development of pressure ulcers after full adjustment in the group with both hypoalbuminemia (< 35 g/L) and incapability of turning over in bed, the group with the former risk alone, and the group with the latter risk alone, was 14.0 (95% confidence interval (CI): 4.2–46.6), 4.9 (1.6–14.9), and 5.9 (1.8–19.0), respectively, compared to subjects without the two risk factors. Moreover, decreased circulating levels of albumin and hemoglobin were associated with aggravation of pressure ulcers. Conclusion: A combined measure of albumin and incapability of self-positioning may serve as a simple but useful index for the risk of pressure ulcers in bedridden elderly inpatients. [ABSTRACT FROM AUTHOR]