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Anna Satake,1 Wataru Kobayashi,1 Yoshihiro Tamura,1 Toshiaki Oyama,1 Haruka Fukuta,1 Akinari Inui,2 Kahori Sawada,2 Kazunari Ihara,2 Takao Noguchi,1 Koichi Murashita,3 Shigeyuki Nakaji2 1Department of Oral and Maxillofacial Surgery, Hirosaki University Graduate School of Medicine, Hirosaki, Aomori, Japan; 2Department of Social Medicine, Hirosaki University Graduate School of Medicine, Hirosaki, Aomori, Japan; 3COI Research Initiatives Organization, Hirosaki University Graduate School of Medicine, Hirosaki, Aomori, JapanCorrespondence: Anna SatakeDepartment of Oral and Maxillofacial Surgery, Hirosaki University Graduate School of Medicine, 53 Honcho, Hirosaki-shi, Aomori, JapanTel +81 172 39 5127Fax +81 17 239 5128Email anna12@hirosaki-u.ac.jpPurpose: Oral frailty or the loss of oral functionality can be a symptomatic precursor of overall frailty. Previous studies have suggested that decreased tongue pressure causes a decline in ingesting and swallowing function and poor nutrition. This study investigated what factor(s) contribute to tongue pressure, thereby leading to frailty.Patients and methods: For the purposes of the present study, 467 residents of Hirosaki city in northern Japan aged≥60 years who completed a questionnaire about frailty and underwent an intraoral assessment, which included number of teeth, presence or absence of periodontitis, tongue pressure, and oral diadochokinesis (ODK) were recruited.Results: Of the 467 participants with complete data sets, frailty was identified in 13 (7.5%) of 173 males and in 34 (11.6%) of 294 females. Significantly fewer teeth, lower tongue pressure, and a reduced diadochokinetic syllable rate were more prevalent among frail than among healthy residents. Multivariable logistic regression analysis revealed that age, body mass index, number of teeth, and tongue pressure significantly contributed to frailty, whereas ODK did not. Multiple regression analysis showed that tongue pressure was positively associated with muscle index and number of teeth.Conclusion: The results of the present study suggest that fewer teeth and lower tongue pressure, but not ODK function, are risk factors for developing overall frailty among older residents.Keywords: aging, low nutrition, number of teeth, oral diadochokinesis

Norio Sugawara,1,2 Ayako Kaneda,2 Ippei Takahashi,3 Shigeyuki Nakaji,3 Norio Yasui-Furukori2 1Department of Clinical Epidemiology, Translational Medical Center, National Center of Neurology and Psychiatry, Kodaira, Tokyo, 2Department of Neuropsychiatry, Hirosaki University School of Medicine, Hirosaki, 3Department of Social Medicine, Hirosaki University School of Medicine, Hirosaki, Japan Background: Efficient screening for depression is important in community mental health. In this study, we applied a stratum-specific likelihood ratio (SSLR) analysis, which is independent of the prevalence of the target disease, to screen for depression among community-dwelling individuals.Method: The Center for Epidemiologic Studies Depression Scale (CES-D) and the Mini International Neuropsychiatric Interview (MINI) were administered to 789 individuals (19–87 years of age) who participated in the Iwaki Health Promotion Project 2011. Major depressive disorder (MDD) was assessed using the MINI.Results: For MDD, the SSLRs were 0.13 (95% CI 0.04–0.40), 3.68 (95% CI 1.37–9.89), and 24.77 (95% CI 14.97–40.98) for CES–D scores of 0–16, 17–20, and above 21, respectively.Conclusion: The validity of the CES-D is confirmed, and SSLR analysis is recommended for its practical value for the detection of individuals with the risk of MDD in the Japanese community. Keywords: screening, depression, Center for Epidemiologic Studies Depression Scale, stratum-specific likelihood ratio

Akinari Inui,1 Ippei Takahashi,2 Sizuka Kurauchi,2 Yuki Soma,2 Toshiaki Oyama,1 Yoshihiro Tamura,1 Takao Noguchi,1 Kouichi Murashita,3 Shigeyuki Nakaji,2 Wataru Kobayashi1 1Department of Oral and Maxillofacial Surgery, 2Department of Social Medicine, 3COI Research Initiatives Organization, Hirosaki University Graduate School of Medicine, Hirosaki, Aomori Prefecture, Japan Purpose: Prevention, early detection and effective rehabilitation of dysphagia are important issues to be considered in an aging society. Previous studies have shown conflicting findings regarding the association between dysphagia and its potential risk factors, including age, malnutrition, oral conditions, lifestyle and medical history. Herein, we assessed the prevalence and association of dysphagia with potential risk factors in 50- to 79-year-old adults dwelling in a community in Japan. Patients and methods: In this study, there were 532 participants (185 males and 347 females). Participants who responded positively to the question “Do you sometimes choke on drinks/food such as tea and soup?” or those who presented with abnormal repetitive saliva swallowing test findings were diagnosed with dysphagia. The data collected from these participants included the following: number of teeth, occurrence of oral dryness, age, body mass index, serum albumin concentration, smoking, drinking and exercise habits, presence of diseases, such as diabetes mellitus and hypertension, and questions from the Mini–Mental State Examination. Results: Dysphagia was observed in 33 males (17.8%) and 76 females (21.9%). To explore the effect of the potential risk factors on the prevalence of dysphagia, a model was built by multivariate logistic regression analysis. Using the forced entry method, oral dryness (odds ratio [OR] =3.683 and P=0.003 in males; OR =1.797 and P=0.032 in females) and the number of teeth (OR =0.946 and P=0.038 in males) were found to be significantly related to dysphagia. Conclusion: This cross-sectional study demonstrated associations between oral conditions and dysphagia. Factors such as oral dryness and number of teeth may contribute to dysphagia more so than aging, lifestyle and comorbidity in community-dwelling adults over the age of 50. Keywords: oral dryness, number of teeth, swallow, nutrition, lifestyle

Akinari Inui,1 Ippei Takahashi,2 Kaori Sawada,2 Akimoto Naoki,2 Toshirou Oyama,1 Yoshihiro Tamura,1 Toshiyuki Osanai,1 Anna Satake,1 Shigeyuki Nakaji,2 Wataru Kobayashi1 1Department of Oral and Maxillofacial Surgery, Hirosaki University Graduate School of Medicine, 2Department of Social Medicine, Hirosaki University Graduate School of Medicine, Hirosaki City, Aomori Prefecture, Japan Purpose: Decline in the number of teeth and physical fitness begins from 40 years of age; however, several epidemiological studies have identified relationships between oral conditions and physical performance parameters in community-dwelling elderly population. The aim of this study was to validate the relationship between the muscle mass and its function and oral conditions (number of teeth and dental occlusion) after 40 years of age in a community-dwelling population in Japan.Materials and methods: The subjects comprised of 552 volunteers (198 males and 354 females, 40–79 years) who participated in the Iwaki Health Promotion Project in 2013. Multiple linear regression analyses were performed with the measures of the muscle mass and its function as objective variables and the measures of the number of teeth, age, body mass index, medical history, serum albumin concentration, smoking status, habitual alcohol intake, marital status, education levels, and exercising habits as explanatory variables. The relationships between the Eichner index and the muscle mass and its function were analyzed using analysis of covariance, with adjustment for confounding factors.Results: After adjusting for confounding factors, the number of teeth was shown to be an independent risk factor for the timed 10 m walk test (in females) and the skeletal muscle mass of the whole body (in males). The results also revealed that the timed 10 m walk test was significantly correlated with the Eichner index (Classes A and C in females were correlated).Conclusion: This cross-sectional study on a Japanese community-dwelling population revealed relationships between oral conditions and the muscle mass and its function. However, the interpretation of our results was hampered by a lack of data, including those on socioeconomic status and longitudinal observations. Future research exploring teeth loss and the muscle mass and its function is warranted. Keywords: number of teeth, sarcopenia, timed 10 m walk test, hand grip strength, skeletal muscle mass

Kazutoshi Kubo,1 Norio Sugawara,1,2 Ayako Kaneda,1 Ippei Takahashi,3 Kazuhiko Nakamura,1 Shigeyuki Nakaji,3 Norio Yasui-Furukori1 1Department of Neuropsychiatry, Hirosaki University School of Medicine, Hirosaki, 2Department of Psychiatry, Aomori Prefectural Center for Mental Health and Welfare, Aomori, 3Department of Social Medicine, Hirosaki University School of Medicine, Hirosaki, Japan Objectives: Restless legs syndrome (RLS) is a sensorimotor disturbance that causes the production of impulses and dysesthesia and makes the patients feel as though they must move their lower extremities. Because the symptoms of RLS in the lower limbs tend to develop at night, RLS could cause sleep disorders. We investigated an association between the symptoms of RLS and the health-related quality of life among community-dwelling individuals in Japan. Methods: In this cross-sectional survey, we enrolled 985 volunteers who participated in the Iwaki Health Promotion Project in 2013. The symptoms of RLS were evaluated by the criteria of the International Restless Legs Syndrome Study Group. The assessments included an interview to obtain sociodemographic data, the second version of the Short Form Health Survey, the Center for Epidemiological Studies Depression scale, and the Pittsburgh Sleep Quality Index. A multiple regression analysis was used to assess the relationship between the symptoms of RLS and subscores of the Short Form Health Survey, Version 2. Results: The overall prevalence of RLS in our participants was 1.0%. We found a significant and negative association between symptoms of RLS and physical functioning, role – physical functioning, bodily pain, social functioning, and the physical composite summary score. Conclusion: After adjusting for confounders such as age, sex, and comorbidity, the burden of RLS appears to be mainly a physical problem. Impaired health-related quality of life among community individuals with RLS emphasizes the importance of screening for these symptoms and evaluating the need for treatment. Keywords: cross-sectional study, restless legs syndrome, quality of life, Japanese

Koji Tsuruga,1 Norio Sugawara,1 Yasushi Sato,1 Manabu Saito,1 Hanako Furukori,2 Taku Nakagami,3 Kazuhiko Nakamura,1 Ippei Takahashi,4 Shigeyuki Nakaji,4 Norio Yasui-Furukori1 1Department of Neuropsychiatry, Hirosaki University School of Medicine, Hirosaki, Japan; 2Department of Psychiatry, Kuroishi-Akebono Hospital, Kuroishi, Japan; 3Department of Neuropsychiatry, Odate Municipal General Hospital, Odate, Japan; 4Department of Social Medicine, Hirosaki University School of Medicine, Hirosaki, Japan Background: It has been reported that the onset of schizophrenia and the physical complications after its onset are related to diet. Diet has been considered as a variable factor of the pathogenesis of schizophrenia. However, the results of studies on this relationship have been inconsistent. Nutrients are consumed as a mixture in the diet. It is difficult to study them in isolation because they may have mutually complementary effects. The aim of this study was to assess the association between dietary patterns and schizophrenia in Japan.Methods: The subjects comprised 237 outpatients aged 30–60 years (123 males and 114 females) with diagnoses of either schizophrenia or schizoaffective disorder. The patient diagnoses were determined based on medical records. Patients were recruited between June 2011 and August 2011. As a reference group, 404 healthy volunteers aged 30–60 years (158 males and 246 females) were also included. Demographic data (age, sex, and level of education) were collected by face-to-face method interviews and self-administered questionnaires. We assessed eating habits over the last month using a validated brief self-administered diet history questionnaire. We detected dietary patterns through a principal component analysis of calorie-adjusted intake; two principal components were retained. The principal components for each dietary pattern and for each individual were divided into tertiles by principal component scores. Results: We derived two dietary patterns by principal component analysis; namely, the “vegetable” dietary pattern and the “cereal” dietary pattern. In the “cereal” dietary pattern, the high tertile was associated with a significantly increased risk of schizophrenia (P

Koji Tsuruga,1 Norio Sugawara,1 Norio Yasui-Furukori,1 Ippei Takahashi,2 Shoko Tsuchimine,1 Ayako Kaneda,1 Shigeyuki Nakaji,2 Kazuhiko Nakamura1 1Department of Neuropsychiatry, 2Department of Social Medicine, Hirosaki University School of Medicine, Hirosaki, Japan Background: Amyloid beta (Aβ) levels have been associated with an increased risk of Alzheimer’s disease (AD). As depression is common before the onset of AD, serum Aß levels could be associated with depressive symptoms. The aim of this study was to investigate whether serum Aβ levels are associated with depressive symptoms and/or cognitive function in community-dwelling elderly individuals. Methods: We examined the association between serum Aβ levels and depression among 419 Japanese community-dwelling elderly individuals aged 60 years and over. Subjects were divided into two subgroups: younger elderly between 60 and 69 years old and older elderly over 69 years old. The Mini-Mental State Examination (MMSE) was used to assess cognitive function, and symptoms of depression were assessed using the Center for Epidemiologic Studies Depression Scale (CES-D). The ability to perform activities of daily living was evaluated using the Tokyo Metropolitan Institute of Gerontology Index of Competence. Serum Aβ levels were measured with a human amyloid beta enzyme-linked immunosorbent assay kit. Results: After controlling for potential confounding variables, a multiple linear regression analysis showed that increased levels of serum Aβ40 and Aβ42 were associated with higher CES-D scores in the older elderly subgroup. Under the same condition, multiple regression showed that serum Aβ levels were not associated with MMSE scores among the total subjects, younger elderly, or older elderly. Conclusion: Serum Aβ levels were associated with depressive symptoms in community-dwelling elderly individuals. The present study indicates the possibility that serum Aβ may be involved in the development of late-onset depression. Keywords: Alzheimer’s disease, depression, dementia, Japanese

Backgrounds/Aims: Chronic gastritis induced by Helicobacter pylon is characterised by considerable neutrophil infiltration into the gastric mucosa without mucosal invasion of bacteria. Bacteria have different characteristics with respect to their [...]

BACKGROUND: Compared with other developed countries, the United Kingdom has exhibited less of an increase in life expectancy over the past 30 years. METHODS: We compared the chronological changes in the age-adjusted mortality rates (AMRs) from all causes or major causes, and in life expectancy in the United Kingdom and Japan between 1970 and 1997. RESULTS: In both 1970 and 1997 the AMRs for most major causes were higher in the United Kingdom than in Japan; the difference in the AMR between countries was smaller in 1970 than in 1997. The difference in the AMR from all causes between the United Kingdom and Japan in 1997 was mainly due to differences in the AMR for heart diseases. The trend for an increasing difference over time between the United Kingdom and Japan in the AMR from all causes was due to the decreased rate of AMR from heart diseases from 1970 to 1997 in the United Kingdom being lower than those from cerebrovascular diseases in same period in Japan. CONCLUSIONS: These data suggest that mortality rates could be reduced by a change in focus of the National Health Service toward an emphasis on primary rather than secondary prevention and associated clinical interventions. The greatest priority should be placed on reducing the incidence of heart disease by aggressively improving primary prevention. [ABSTRACT FROM AUTHOR]

Abstract Background Bioartificial liver systems, designed to support patients with liver failure, are composed of bioreactors and functional hepatocytes. Immunological rejection of the embedded hepatocytes by the host immune system is a serious concern that crucially degrades the performance of the device. Induced pluripotent stem (iPS) cells are considered a desirable source for bioartificial liver systems, because patient-derived iPS cells are free from immunological rejection. The purpose of this paper was to test the feasibility of a bioartificial liver system with iPS cell-derived hepatocyte-like cells. Methods Mouse iPS cells were differentiated into hepatocyte-like cells by a multi-step differentiation protocol via embryoid bodies and definitive endoderm. Differentiation of iPS cells was evaluated by morphology, PCR assay, and functional assays. iPS cell-derived hepatocyte-like cells were cultured in a bioreactor module with a pore size of 0.2 μm for 7 days. The amount of albumin secreted into the circulating medium was analyzed by ELISA. Additionally, after a 7-day culture in a bioreactor module, cells were observed by a scanning electron microscope. Results At the final stage of the differentiation program, iPS cells changed their morphology to a polygonal shape with two nucleoli and enriched cytoplasmic granules. Transmission electron microscope analysis revealed their polygonal shape, glycogen deposition in the cytoplasm, microvilli on their surfaces, and a duct-like arrangement. PCR analysis showed increased expression of albumin mRNA over the course of the differentiation program. Albumin and urea production was also observed. iPS-Heps culture in bioreactor modules showed the accumulation of albumin in the medium for up to 7 days. Scanning electron microscopy revealed the attachment of cell clusters to the hollow fibers of the module. These results indicated that iPS cells were differentiated into hepatocyte-like cells after culture for 7 days in a bioreactor module with a pore size of 0.2 μm. Conclusion We consider the combination of a bioreactor module with a 0.2-μm pore membrane and embedded hepatocytes differentiated from iPS cells to be a promising option for bioartificial liver systems. This paper provides the basic concept and preliminary data for an iPS cell-oriented bioartificial liver system. PACS code: 87. Biological and medical physics, 87.85.-d Biomedical engineering, 87.85.Lf Tissue engineering, 87.85.Tu Modeling biomedical systems.

Abstract Background Hearing impairment is a prevalent and chronic condition in older people. This study investigated the relationship between cognitive function and hearing impairment in a Japanese population. Methods A pure-tone average (0.5-2.0 kHz) was used to evaluate hearing impairment in 846 participants of the Iwaki Health Promotion Project who were aged at least 50 years old (310 men and 536 women). We also administered the Mini-Mental State Examination (MMSE), the Center for Epidemiologic Studies for Depression (CES-D) scale, Starkstein's apathy scale (AS) and the Short Form Health Survey Version 2 (SF-36v2). A multiple linear regression analysis assessed the association between hearing impairment and mental correlates. Results The overall prevalence of hearing impairment in this study population was 37.7%. The participants with hearing impairment were older and less educated compared to those with no hearing problems. We observed significant differences in the MMSE and AS scores between the mild/moderate to severe groups versus the non-impaired group. After adjusting for age, gender and amount of education, hearing impairment was significantly associated with MMSE and AS scores, but not with CES-D scores. Hearing impairment was significantly related to the social functioning (SF) and role emotional (RE) scores of the SF-36v2. Conclusions Hearing impairment is common among older people and is associated with cognitive impairment, apathy and a poor health-related quality of life. Screening for and correcting hearing impairments might improve the quality of life and functional status of older patients.