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Aim: Dysphagia is a problem typically associated with aging. The aim was to investigate the relationship between dysphagia and motor function using a simple assessment method that can be performed in the community setting, and to promote the early detection and prevention of dysphagia. Methods: Data from the Locomotive Syndrome and Health Outcome in Aizu Cohort Study (LOHAS) were used. Those aged ≥65 years were included. Motor function was assessed using a grip strength test, single limb standing test (SLS), and timed up and go test (TUG). Swallowing function was assessed using the Japanese version of the 10‐item Eating Assessment Tool (EAT‐10). The association between motor function and swallowing function was analyzed. Results: In total, 1732 participants were included. In logistic regression modes in which grip strength, SLS, and TUG results were included separately, the odds ratio for dysphagia increased by 1.08 (P = 0.001) for each 1‐kg decrease in grip strength, and increased by 1.15 (P < 0.001) for each 1‐s increase in TUG time. No association was found for SLS. In the model in which grip strength and TUG were included simultaneously, the odds ratio for dysphagia increased by 1.06 (P = 0.01) in grip strength, and increased by 1.11 (P = 0.009) in TUG time. Conclusion: Our results suggest that skeletal muscle strength and dynamic balance function are associated with dysphagia in community‐dwelling older people. Geriatr Gerontol Int 2023; 23: 603–608. [ABSTRACT FROM AUTHOR]

Epidermal growth factor receptor (EGFR)‐tyrosine kinase inhibitors are standard therapeutic agents for non‐small cell lung cancer (NSCLC) patients with major EGFR mutations such as exon 19 deletions and a L858R mutation, whereas treatment strategies for cases with uncommon EGFR mutations remain to be fully established. Here, we report a long‐term (≥20 years from initial diagnosis) NSCLC survivor carrying EGFR L858R and L747V mutations. The patient received gefitinib monotherapy, systemic chemotherapy/chemoimmunotherapy, and local consolidative therapies for oligometastatic lesions, and responded to afatinib rechallenge with a progression‐free survival of 12 months. The current case suggests that afatinib is effective in NSCLC patients with EGFR L858R and L747V mutations and that a therapeutic approach combining appropriately timed systemic therapies with local consolidative therapies for oligometastatic lesions improves long‐term survival. [ABSTRACT FROM AUTHOR]

Objective: To verify the validity of the prediction of oral intake recovery for inpatients with aspiration pneumonia using the Hyodo‐Komagane score. Background: Patients admitted for treatment of aspiration pneumonia sometimes have difficulty in resuming oral intake due to decreased swallowing function. Predicting whether the swallowing function will recover enough to achieve oral ingestion at discharge is an important factor in developing a treatment strategy. No studies have investigated the prediction of oral intake recovery using videoendoscopic examination. Methods: Subjects were 65 patients who were admitted to an acute care hospital for the treatment of aspiration pneumonia. The patients were divided into two groups, the oral feeding group and the tube feeding group, according to their oral intake status at discharge or transfer. Logistic regression analysis was performed using the condition that tube feeding was not required as an objective variable and the items with significant differences between the two groups as explanatory variables. Additionally, the receiver operating characteristic curve was used to identify patients who could take food orally at discharge. Results: The odds ratios for the Hyodo‐Komagane score and the pharyngeal clearance score were 1.485 and 3.379, respectively. When the cut‐off values of the Hyodo‐Komagane score and the pharyngeal clearance score were 6 and 1, the sensitivity was 0.88 and 0.91, and the specificity was 0.64 and 0.70, respectively. Conclusion: The Hyodo‐Komagane score and especially the pharyngeal clearance score are useful indices to predict oral intake recovery for inpatients with aspiration pneumonia. [ABSTRACT FROM AUTHOR]

Background The incidence of biliary tract infection ( BTI), especially healthcare-associated cholangitis, is increasing. However, there are few reports concerning biomarkers of acute cholangitis. We therefore performed an exhaustive investigation of several biomarkers. Methods We retrospectively measured 11 cytokines, six chemokines and procalcitonin ( PCT), and endotoxin activity assay ( EAA) values ( IRB: 110512019) of 61 samples with acute cholangitis. Result The 28-day mortality rate was 9.8%. The levels of most cytokines and chemokines were significantly correlated with each other. A low IL-7 level was found to predict blood culture positivity. Low IL-7 level was also found to predict disseminated intravascular coagulation. Low IL-7 levels and a high PCT level were found to be predictors of severe cholangitis. The 28-day mortality in the group of patients with an IL-7 level of ≤6.0 and a PCT level of >0.5 was 18.2%. It was significantly higher than in the other group. Conclusion The combined use of IL-7 and PCT may be useful for evaluating severe acute cholangitis; these results may suggest that severe acute cholangitis is affected by immunosuppressive changes. [ABSTRACT FROM AUTHOR]

Exocrine glands, e.g., salivary and pancreatic glands, play an important role in digestive enzyme secretion, while endocrine glands, e.g., pancreatic islets, secrete hormones that regulate blood glucose levels. The dysfunction of these secretory organs immediately leads to various diseases, such as diabetes or Sjögren's syndrome, by poorly understood mechanisms. Gland-related diseases have been studied by optical microscopy (OM), and at higher resolution by transmission electron microscopy (TEM) of Epon embedded samples, which necessitates hydrophobic sample pretreatment. Here, we report the direct observation of tissue in aqueous solution by atmospheric scanning electron microscopy (ASEM). Salivary glands, lacrimal glands, and pancreas were fixed, sectioned into slabs, stained with phosphotungstic acid (PTA), and inspected in radical scavenger d-glucose solution from below by an inverted scanning electron microscopy (SEM), guided by optical microscopy from above to target the tissue substructures. A 2- to 3-µm specimen thickness was visualized by the SEM. In secretory cells, cytoplasmic vesicles and other organelles were clearly imaged at high resolution, and the former could be classified according to the degree of PTA staining. In islets of Langerhans, the microvascular system used as an outlet by the secretory cells was also clearly observed. Microvascular system is also critically involved in the onset of diabetic complications and was clearly visible in subcutaneous tissue imaged by ASEM. The results suggest the use of in-solution ASEM for histology and to study vesicle secretion systems. Further, the high-throughput of ASEM makes it a potential tool for the diagnosis of exocrine and endocrine-related diseases. [ABSTRACT FROM AUTHOR]

Purpose The Great East Japan Earthquake in March 2011 destroyed many communities, and as a result many older victims lost their removable dentures. No previous studies have documented the prevalence of denture loss after a natural disaster or examined its negative impact. Therefore, investigation of the consequences of such a disaster on oral health is of major importance from a public health viewpoint. Materials and Methods Three to five months after the disaster, questionnaire surveys were conducted in two coastal towns, Ogatu and Oshika, located in the area of Ishinomaki city, Miyagi prefecture. Among the survey participants, 715 individuals had used one or more removable dentures before the disaster, and these comprised the population analyzed. The effect of denture loss on oral health-related quality life (OHRQoL) was examined by a modified Poisson regression approach with adjustment for sex, age, subjective household economic status, dental caries, tooth mobility, psychological distress (K6), access to a dental clinic, physical activity, and town of residence. Results There were 123 (17.2%) participants who had lost their dentures. In comparison with participants who had not lost their dentures, those lacking dentures showed a significantly higher relative risk for eating difficulties (RR = 2.65, 95%CI = 1.90-3.69), speech problems (RR = 4.37, 95%CI = 2.46-7.76), embarrassment upon smiling, laughing, or showing their teeth (RR = 5.32, 95%CI = 2.34-12.1), emotional distress (RR = 2.38, 95%CI = 1.41-4.03), and problems related to social interaction (RR = 6.97, 95%CI = 1.75-27.7). Conclusions Denture loss appeared to impair eating and speaking ability, thus discouraging communication with others. Public health intervention after major natural disasters should include dental care. [ABSTRACT FROM AUTHOR]

Objective This study aimed to elucidate the actual activities conducted by public health nurses during their dispatch and their health status during and after dispatch to the three prefectures most severely affected by the Great East Japan Earthquake. Sample A survey request was sent to a total of 2,237 facilities. Of these, 778 facilities returned questionnaires from dispatched public health nurses. Results The participants of this study were 1,570 dispatched health nurses who participated in activities mostly at evacuation centers, followed by evacuees' homes. After dispatch, an earlier postdisaster phase at the start of dispatch was independently associated with poor subjective well-being, low mood, worsened sleep state, and intense fatigue. Work hours per day were associated with poor subjective well-being and intense fatigue after dispatch. Conclusion Results suggest that the factor that most strongly affected the postdispatch health of the nurses was the phase that they began their dispatch. [ABSTRACT FROM AUTHOR]

Background Acute cholangitis and cholecystitis ( AC) often progress to severe septic conditions. We evaluated the endotoxin activity assay (EAA) for assessment and prediction of the severity of AC. Methods We retrospectively reviewed 98 patients diagnosed with AC. We divided them into low (<0.4) and high (≥0.4) groups based on EAA values. Results Endotoxin levels showed no correlation with EAA values. Serum C-reactive protein (8.57 vs. 5.23 mg/dl, P = 0.02), procalcitonin (2.45 vs. 0.48 ng/ml, P = 0.004), and the positive culture rate of blood (50% vs. 15%, P < 0.001) were significantly higher in the high group than in the low group. Platelet counts were significantly lower in the high group than in the low group (23.9 vs. 13.5 104/ml, P = 0.004). The ratio of patients with a Japanese Association for Acute Medicine disseminated intravascular coagulation score ≥4 (32% vs. 14%, P = 0.032) was significantly higher in the high group than in the low group. There was a significantly higher percentage of patients with a severe grade of AC in the high group than patients with a mild or moderate grade (32% vs. 15%, P = 0.05). Conclusions Endotoxin activity assay is useful for assessment and early prediction of septic conditions due to AC. [ABSTRACT FROM AUTHOR]

In eukaryotic cells, degradation of most intracellular proteins is carried out by the ubiquitin-proteasome pathway. Recent investigations suggest that bone metabolism is also regulated by this pathway. The clinical efficacy of bortezomib, a 26 S proteasome inhibitor used as an anticancer drug, has been linked to an increase in bone formation. In this study, we show that proteasome inhibitors induce expression of osteoblastic differentiation-related genes such as osteocalcin and alkaline phosphatase in C2 C12 cells. In contrast, myogenic differentiation is inhibited. Among the proteasome inhibitors tested, bortezomib induced the greatest increase in osteocalcin expression. Although these effects were similar to that of bone morphogenetic protein ( BMP) 2, proteasome inhibitors did not induce transcriptional activity of Smad1/4-dependent reporter or BMP2 signaling target gene expression. Transient transfection of osteocalcin promoter-luciferase constructs with bortezomib resulted in an increase in luciferase activity. Mutation of OSE2, but not OSE1, sites of the osteocalcin promoter diminished the bortezomib-induced activity. Also, Runx2 binding activity and protein levels were induced by bortezomib treatment. These results suggest that the bortezomib induces osteoblastic differentiation by modifying the activity of Runx2 and that the function of the proteasome in controlling degradation of differentiation-related transcription factors plays an important role in osteoblast differentiation. [ABSTRACT FROM AUTHOR]

xiaoyan x & sato mk (2011) Journal of Nursing and Healthcare of Chronic Illness 3, 513-520 Quality of life and related factors among people living with HIV in China Aim. Aim of the study is to assess quality of life and its influencing factors among people living with HIV. Background. The Ministry of Health of People's Republic of China (Joint united nations programme on HIV/AIDS world health organization, 2006) reported that 650 000 people were estimated to be living with HIV in China and among them 75 000 people were living with AIDS, and five provinces, Henan, Hubei, Anhui, Hebei, and Shanxi accounted for 80·4% of infected individuals within this population. Maximising quality of life in people living with HIV/AIDS has become an important objective of care, and understanding the factors that impact quality of life would help achieve this objective. Methods. A cross-sectional study based on a convenient sample was used. The sample consisted of 94 HIV-positive people in Hubei province, age range 21-67 years ( M = 42·68, SD = 8·88). Quality of life was measured using the WHOQOL HIV-BREF which was developed by WHO group. Date were collected between December 2008-June 2009. Results. People living with HIV had best quality of life in level of dependence domain (13·44) and poorest quality of life in social relationships domain (11·75). They were most satisfactory with family social support (22·37), followed by perceived social support from significant others (18·69) and least satisfactory with social support from friends (12·19). Quality of life was statistically related to gender, CD4 counts and perceived social support. Women had lower quality of life scores in the psychological ( p = 0·028) and spiritual ( p = 0·009) domain than men. Patients with CD4 counts <200 cells/mm3 had poorer quality of life in physical ( p = 0·023) and level of independence domain ( p = 0·039) compared to those with CD4 counts >500 cells/mm3. Perceived social support from family ( r = 0·28, p < 0·01), from friends ( r = 0·36, p < 0·001) and from significant others ( r = 0·28, p < 0·01) was positively associated with quality of life. Implications for clinical practice. Perceived social support was significantly related to quality of life in our study, and this suggests that strengthening social support of HIV-positive people is necessary. As their major support was from family members, a family-focused intervention may be useful, for example, to educate family members to improve their HIV-related knowledge and informational support. Conclusion. This study suggests that the health workers should pay more attention to women living with HIV. Strengthening social support of HIV-positive people is also necessary. [ABSTRACT FROM AUTHOR]

Wnt/β-catenin signaling plays an important role in the developing skeletal system. Our previous studies demonstrated that Wnt/β-catenin signaling inhibits the ability of bone morphogenetic protein (BMP)-2 to suppress myotube formation in the multipotent mesenchymal cell line C2C12 and that this inhibition is mediated by Id1. In this study, we examined the role of intracellular signaling by Wnt/β-catenin and BMP-2 in regulating the expression of osteoprotegerin (OPG) and of the receptor activator of NFκB ligand (RANKL). OPG expression was induced by Wnt/β-catenin signaling in C2C12 cells and osteoblastic MC3T3-E1 cells. Silencing of glycogen synthase kinase-3β also increased OPG expression. In contrast, R expression was suppressed by Wnt/β-catenin signaling. In a transfection assay, β-catenin induced the activity of a reporter gene, a 1.5 kb fragment of the 5′-flanking region of the OPG gene. Deletion and mutation analysis revealed that Wnt/β-catenin signaling regulates transcription of OPG via a promoter region containing two Wnt/β-catenin responsive sites. BMP-2 enhanced Wnt/β-catenin-dependent transcriptional activation of the OPG promoter. In response to BMP-2 stimulation, Smad 1 and 4 interacted with Wnt/β-catenin responsive sites. These results show that the regulation of OPG expression is mediated through two transcription pathways that involve the OPG promoter. [ABSTRACT FROM AUTHOR]

The incidence rate after a colonoscopic polypectomy includes the true incidence rate of new polyp formation and miss rate of polyps at the initial colonoscopy. It is therefore important to assess accurate incidence rates of polyps as well as those of missing polyps with colocoscopy.Six hundred and eighty-eight patients who underwent total colonoscopy twice within 30 days were investigated to determine the miss rates of neoplastic polyps under colonoscopy. The cumulative incidence rates of neoplasm were evaluated by the Kaplan-Meier method in another series of investigations on 864 patients who underwent surveillance total colonoscopy over 31 days.In 157 (22.8%) patients out of 688, 200 neoplastic lesions (all adenomas) were missed during the first examination. The miss rate was 16% for adenomas≤ 5 mm and 2% for adenomas> 10 mm. The miss rates of patients with 0, 1, 2, or> 2 neoplastic polyps on the first examination was 5.3%, 19.6%, 23.5% and 35.5%, respectively. One year cumulative incidence rates of patients with 1, 2, or> 2 neoplastic polyps on the first examination were 18.4%, 21.1% and 34.2%, respectively.Detection of multiple neoplasms on index colonoscopy predicts a high miss rate and cumulative incidence rate on surveillance colonoscopy. A substantial proportion of neoplasms detected at nearly 1-year postpolypectomy surveillance colonoscopy were missed at the initial total colonoscopy. [ABSTRACT FROM AUTHOR]

Abstract We examined the relations between cognitive function and age and education in the normal elderly population. As per the community-based stroke, dementia, and bed confinement pre-vention in the town of Tajiri, neuropsychological assessments, including the Cognitive Ability Screening Instrument (CASI), were performed for 99 randomly selected normal elderly subjects. We assessed the frontal function (working memory, word fluency, Trail-Making Tests, CASI subitems of list-generating fluency, attention, and concentration/mental manipulation), language function (proverbs, CASI subitem language), non-language function (the digit symbol test of the Wechsler Adult Intelligence Scale-Revised (WAIS-R), CASI subitem visual construction), memory (Alzheimer's Disease Assessment Scale recall/recognition, story recall, CASI subitems short and long-term memory, the Rey-Osterrieth Complex Figure Test), and the global function (CASI subitems orientation and abstraction and judgment). We found that the only test affected by age was the digit symbol test of the WAIS-R. The effects of education were distributed among various tests. There was a significant correlation between age and the frontal lobe atrophy in the lower educated group. The present findings suggest that cognitive function is spared by the aging process itself and dementia should be considered as age-related, not aging-related disorders, and that education might have a protective effect on cognitive change, supporting the reserve hypothesis. [ABSTRACT FROM AUTHOR]

Reports on two cases of insulin requiring diabetic patients accompanied by a hallucinatory-delusional state and diagnosed as having schizophrenia. Medical history of the patients; Results of the neurological examination conducted; Improvements observed on the patients after treatment.