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OBJECTIVE To investigate the potential association between periodontitis and arterial stiffness among the older Japanese population. BACKGROUND The prevalence of periodontitis is increasing in Japanese older adults. Arterial stiffness increases the risks of cardiovascular events and death, morbidity, and dementia. METHODS This secondary analysis of data from a cross-sectional study evaluated the periodontal inflamed surface area (PISA), reflecting the amount of inflamed periodontal tissue that was estimated by a full-mouth periodontal examination. Severe periodontitis was defined per the parameters provided by the Centers for Disease Control/American Academy of Periodontology. The Cardio-Ankle Vascular Index (CAVI) was used for measuring the overall stiffness of the artery, and higher CAVI indicated increased arterial stiffness. An ordinal logistic regression model was used to evaluate the association between periodontitis and arterial stiffness. RESULTS The analysis included 185 Japanese adults [35% men; age, mean (standard deviation) 80.2 (4.4) years]. The average PISA and the prevalence of severe periodontitis were 64.4 mm2 and 27.6%, respectively; 54 (29.2%), 56 (30.3%), and 75 (40.5%) participants were stratified to the CAVI

Purpose: The purpose of this study is to assess the usefulness of liraglutide in elderly patients with type 2 diabetes to prevent progression of dementia. Methods: We retrospectively reviewed 31 outpatients with 65 years of age or older, who have been treated with liraglutide for 6 years (Group G; 12 males/19 females, 73.1 ± 8.6 years-old, HbA1c 7.5 ± 0.4%, 9 patients with cerebrovascular diseases, 8 patients with cardiovascular diseases, 16 patients with insulin therapy). Daily dose of liraglutide was 0.9 mg except 2 patients (0.6 mg). We examined Voxel-based Specific Regional Analysis System for Alzheimer’s Disease (VSRAD) on MRI, max-IMT measured by carotid artery ultrasonography, visceral fat area, concentrations of HbA1c and FPG, serum levels of CRP, HDL/LDL cholesterol, and TG, both before and after the treatment. Age, HbA1c, and VSRAD values-matched 16 patients who were treated with linagliptin were analyzed as a control (Group D). Results: After 6 years, VSRAD was significantly deteriorated in Group D (1.06±0.98→1.39±1.05 (p Conclusion: Liraglutide possibly prevent progression of dementia. The reduction of visceral obesity may contribute to this beneficial effect through anti-arteriosclerosis. Disclosure M. Yoshida: None. A. Yoshida: None. E. Oh: None. N. Yamamoto: None. E. Sasaki: None. S. Yoshida: None. N. Ohsawa: None. M. Sugino: None. I. Koyama: None.

Purpose: The aim of this study was to assess the long-term efficacy of liraglutide on diabetic nephropathy in elderly patients with type 2 diabetes. Methods: Liraglutide was administrated to elderly patients with poorly controlled type 2 diabetes in Aino Hospital. We recruited and retrospectively reviewed 31 patients who were treated with liraglutide for 5 years (Group L: 7 males/24 females, 75.4±8.1 years old of age, 16 with cerebrovascular and 8 patients with cardiovascular diseases at baseline) and 25 patients who were not treated with liraglutide (Group N, 9 males/16 females, 74.6±11.6 years old of age). Daily dose of liraglutide was 0.9mg except 2 patients (0.6 mg). Results: After 5 years of treatment, HbA1c, FPG, and 2h-PPG significantly decreased in both groups (7.5±0.4 to 6.8±0.5 vs. 7.4±0.6 to 6.9±0.4%, 138±19 to 120±11 vs. 132±16 to 113±13, 206±31 to 173±18 vs. 186±23 to 163±18mg/dl, respectively(p60, Group B (n=18): eGFR = 30-60, Group C (n=7): eGFR Conclusion: Liraglutide improved glycemic control, lipid profile and BMI of elderly patients with type 2 diabetes. Liraglutide also demonstrated its beneficial effect on renal function. Disclosure M. Yoshida: None. A. Yoshida: None. E. Oh: None. N. Yamamoto: None. E. Sasaki: None. A. Saeki: None. S. Yoshida: None. T. Kuzuya: None. N. Ohsawa: None. M. Sugino: None.

Purpose: The aim of this study was to assess the efficacy of liraglutide on prevention of dementia in elderly patients with type 2 diabetes (T2DM). Subjects and methods: We studied 34 (male 8/female 26) outpatients with 65 years or older, whose HbA1c was over 7.0% by other antidiabetic treatment. We administrated liraglutide 0.3mg before breakfast for the first week, 0.6mg for the second week, and 0.9mg after the third week. 34 subjects in the liraglutide group (G group) [8 males/ 26 females, 75.7±7.8 years old, HbA1c 7.5 ± 0.38%] were followed-up for 3 years. We examined Voxel-based Specific Regional Analysis System for Alzheimer’s Disease (VSRAD) on MRI, max-IMT measured by carotid artery echo, visceral fat area, HbA1c, FPG, serum HDL/LDL level, and TG, both before and after the treatment.10 patients in the linagliptin group (D group) in which ages, HbA1c, visceral fat, and VSRAD were matched with G group were used as controls. Result: After 3 years, VSRAD was not changed in G group and was significantly deteriorated in D group (G group: 1.22±0.73→1.19±0.73 (NS) vs. G group: 1.36±0.87→1.53±0.99 (p = 0.022)). Max IMT was significantly improved in G group (2.42±1.65→2.14±1.40 (p =0.035) vs. 2.25±1.19→2.19±1.01(NS)). Visceral fat was significantly reduced in G group (137.1±54.0→128.0±59.3 (p Conclusion: Liraglutide improved the glycemic control, lipid profile, and visceral obesity of elderly patients with T2DM for 3 years. In addition, the hippocampal atrophy and arteriosclerosis were not deteriorated, suggesting the possibility of being effective for prevention of dementia. Disclosure M. Yoshida: None. T. Morimoto: None. E. Oh: None. N. Yamamoto: None. K. Nagata: None. A. Saeki: None. E. Sasaki: None. S. Yoshida: None. T. Kuzuya: None. N. Ohsawa: None. M. Sugino: None.

Tumour necrosis factor-alpha (TNF-α) is an important mediator in the pathogenesis of rheumatoid arthritis (RA) and hypertension. TNF-α inhibitors improve clinical symptoms and inhibit joint destruction in RA, but their effect on blood pressure (BP) has not been fully investigated. We measured 24-h BP using an ambulatory BP monitor in 16 RA patients treated with a TNF-α inhibitor, infliximab, to investigate its influence on BP and its association with the regulatory factors of BP and renin-angiotensin-aldosterone and sympathetic nervous systems. Infliximab significantly reduced the 24-h systolic BP (SBP) from 127.4±21.8 to 120.1±23.4 mm Hg (P0.0001). Particularly, morning BP (0600-0800 h) decreased from 129.7±19.7 to 116.9±13.4 mm Hg (P0.0001), and daytime BP decreased from 131.8±15.1 to 122.5±13.7 mm Hg (P0.0001). Infliximab significantly reduced the plasma level of norepinephrine and plasma renin activity (PRA) (from 347.5±180.7 to 283.0±181.8 pg ml(-1) and 2.6±2.7 to 2.1±2.9 ng ml(-1) h(-1), respectively) but did not significantly reduce the plasma levels of dopamine and epinephrine. The reduction in morning SBP correlated with the reduction in the norepinephrine level (P0.05) but not with that in PRA and inflammatory parameters related to RA. This study shows the effect of infliximab on ambulatory BP, especially daytime BP, which may be partly accounted for by the reduction of sympathetic nerve activity after infliximab treatment.

Correction to: npj Microgravity (2015) 1, 15018. 10.1038/npjmgrav.2015.18; published online 30 November 2015 In this Article, data within Table 1 and a sentence within the Methods inadvertently included information that breached subject confidentiality. This information has been removed from Table 1and Methods in the online versions of the paper.

We report a case of a patient with dementia for whom a psychoeducational intervention based on a cognitive functional assessment by multiple cognitive functional tests was useful. She was an 82-year-old woman with hypertension and hyperlipidemia. She often asked about the date, scorched pans several times, and bought large amounts of the same items over 2 years. Her family worried that she might have dementia and hospitalized her. Mixed type dementia was diagnosed from the results of a cognitive functional assessment and magnetic resonance imaging findings. A psychoeducational program was conducted based on the findings of retained and impaired cognitive abilities derived from the above assessment. Her daily life disturbances were modified by an external compensation method. For example, her son told her repeatedly when it was not necessary to make supper, and made use of a block calendar. To consider how to cope appropriately with daily life disturbances derived from the symptoms of dementia, it is important to understand retained and impaired cognitive abilities, by comparing multiple cognitive functional assessments with the type of disturbances, and to deepen understanding of patients' psychological profiles, from the viewpoint of psychoeducation for the patient and family.

To clarify the reversibility of cognitive decline in elderly people with type 2 diabetes, we evaluated cognitive function in 55 elderly people with diabetes and 74 control subjects before and after lifestyle intervention. Lifestyle intervention has a beneficial effect on cognitive decline in elderly people with type 2 diabetes mellitus.

We investigated the prediction of outcomes of patients with dermatomyositis with acute/subacute interstitial pneumonia (DM-A/SIP) on the basis of chest computed tomography (CT) images.In 20 patients with DM-A/SIP (13 survivors; seven deaths), the relationships between prognostic outcomes and chest high-resolution CT (HRCT) findings or limited three-level thin-section CT scoring on the first examination were retrospectively investigated.No significant difference was noted in chest HRCT findings between the survivor group and death group. The ground-glass opacity (GGO) scores of the right upper and middle lobes and left upper lobe, and the fibrosis score of the right middle lobe were significantly higher in the death group than in the survivor group (p = 0.01, 0.001, 0.02, and 0.02, respectively). The influence of the GGO score of the right middle lobe on death from IP was the strongest among the items examined, and it was independently significant (p = 0.01). A right middle lobe GGO score of ≥3 (GGO ≥ 25% of the lobe) was determined to be the best cut-off value for a poor prognosis (sensitivity: 85.7%, specificity: 85.7%), and the survival rate after 24 weeks was significantly lower in patients with a right middle lobe GGO score of ≥3 (survival rate: 0.0%) than in those with a score of 3 (92.9%) (p 0.0001).The prognosis of patients with DM-A/SIP was poor when the range of right middle lobe GGO was 25% or higher on limited three-level thin-section CT.

Suicide rates are higher at high altitudes, and some hypothesize that hypoxia is the cause. There may be a significant correlation between rates of depression and altitude, but little data exist outside the United States. The purpose of the present study is to conduct a survey of depression among the elderly highlanders in Asia. We enrolled 114 persons aged 60 years or older (mean, 69.2 ± 6.7 years; women, 58.8 %) in Domkhar (altitude, 3800 m), Ladakh, India and 173 ethnic Tibetans (mean, 66.5 ± 6.1 years; women, 61.3 %) in Yushu (altitude, 3700 m), Qinghai Province, China. The two-item Patient Health Questionnaire (PHQ-2) and the geriatric depression scale were administered. A psychiatrist interviewed the subjects who had a positive score on the PHQ-2. The results of the interview with the residents conducted by the specialist showed that two cases (1.8 %) from Domkhar and four (2.3 %) from Qinghai had depression. Despite the high altitude, the probability of depression was low in elderly highlander in Ladakh and Qinghai. Our finding seems to indicate that cultural factors such as religious outlook and social/family relationship inhibit the development of depression.

We evaluated their circadian rhythms using data from electrocardiographic records and examined the change in circadian period related to normal RR intervals for astronauts who completed a long-term (≥6-month) mission in space. The examinees were seven astronauts, five men and two women, from 2009 to 2010. Their mean ± SD age was 52.0 ± 4.2 years (47–59 yr). Each stayed in space for more than 160 days; their average length of stay was 172.6 ± 14.6 days (163–199 days). We conducted a 24-h Holter electrocardiography before launch (Pre), at one month after launch (DF1), at two months after launch (DF2), at two weeks before return (DF3), and at three months after landing (Post), comparing each index of frequency-domain analysis and 24-h biological rhythms of the NN intervals (normal RR intervals). Results show that the mean period of Normal Sinus (NN) intervals was within 24 ± 4 h at each examination. Inter-individual variability differed among the stages, being significantly smaller at DF3 (Pre versus DF1 versus DF3 versus Post = 22.36 ± 2.50 versus 25.46 ± 4.37 versus 22.46 ± 1.75 versus 26.16 ± 7.18 h, p, Accepted: 2014-10-20, 資料番号: PA1510086000

Background Since serum albumin is glycosylated more rapidly than hemoglobin, it is possible that the glycated albumin (GA) to HbA1c ratio (GA: HbA1c ratio) is potentially a more sensitive indicator of blood glucose excursion than HbA1c. The aim of the present study was to assess the clinical usefulness of GA: HbA1c ratio as a marker of daily glucose excursions in patients with type 1 diabetes according to the subtypes; acute onset type 1A, fulminant and slowly progressive type 1 diabetes. Methods Fifty-six outpatients with type 1 diabetes [16 fulminant, 20 acute-onset type 1A and 20 slowly progressive (SPIDDM)] were recruited consecutively. Each patient performed self-monitoring of blood glucose at seven points a day. The associations among the daily profile of glucose and GA, HbA1c, GA: HbA1c ratio were examined across and within the subtypes of type 1 diabetes. Results GA and GA: HbA1c ratio were each independently correlated with mean amplitude of glucose excursion (MAGE) in patients with type 1 diabetes (F=27.53, p

Background: Heavy rainfall in northern India in August 2010 caused flash floods, seriously damaging homes and infrastructure. There have been no major disasters in the history of Ladakh, and no surveys on post-disaster psychiatric disorders have been conducted in this area. Aims and methods: To examine the impact of this disaster in Ladakh one month post-disaster, we visited Choglamsar, located near the town of Leh, where the flood had the most severe impact. In total, 318 survivors (mean age: 58.6 years; female–male ratio: 59.7%; Tibetan refugees: 86.2%) participated in the survey. We used the two-item Patient Health Questionnaire (PHQ-2) along with questions covering background characteristics and disaster exposure. A psychiatrist interviewed the survivors with a single or double positive score in the PHQ-2 or with post-traumatic stress disorder (PTSD) symptoms. Results and conclusion: There were only two PTSD cases and five of major depressive disorders. PTSD and depression were less common in the Tibetan cultural areas than in other areas. The social background and temperamental characteristics of the Tibetan culture may play a suppressive role in psychiatric disorders.

Seasonal variations in blood pressure (BP) have often been attributed to meteorological factors, especially changes in outdoor temperature. We evaluated the direct association between meteorological factors and circadian BP variability. Twenty-four-hour ambulatory BP was monitored continuously for 7 days in 158 subjects. Mean awake, asleep, morning (first 2 h after waking) BP, prewaking morning BP surge (morning systolic BP (SBP)-mean SBP during the 2-h period before waking) and nocturnal BP decline were measured each day. We compared BP values for the lowest and highest days with regard to the daily mean outdoor temperature and mean atmospheric pressure. Morning BP and prewaking morning BP surge on the coldest day were significantly higher than those on the warmest day (morning SBP, 136.6 ± 1.6 vs. 133.1 ± 1.5 mm Hg, P = 0.002; morning diastolic BP, 84.4 ± 0.9 vs. 82.6 ± 0.9 mm Hg, P = 0.02; and prewaking morning BP surge, 20.8 ± 1.3 vs. 15.3 ± 1.3 mm Hg, P = 0.0004). The magnitude of nocturnal BP decline on the coldest day was significantly greater than that on the warmest day (15.8 ± 0.7 vs. 13.9 ± 0.7%, P = 0.01). Outdoor temperature is an important determinant of morning BP, prewaking morning BP surge and the magnitude of nocturnal BP decline. These findings may have important implications in management of hypertension and prevention of cardiovascular events.

This study clarified whether detrended fluctuation analysis (DFA) can evaluate how to advance the loss of complexity from impaired glucose tolerance (IGT) through mild diabetes mellitus (DM) to overt DM.Continuous glucose monitoring (CGM) was done during a 48-h interval for 59 subjects from multiple centers. Subjects were divided according to CGM data into those with impaired glucose tolerance (IGT) (n = 20), mild DM (n = 13), and overt DM (n = 26). The short-term (α1) and long-term (α2) range exponentials by DFA were compared among the three groups.The value of α1 within 1h was significantly lower in the IGT group than in either of the other two groups (IGT vs. mild DM vs. overt DM, 1.53 ± 0.22 vs. 1.71 ± 0.17 vs. 1.77 ± 0.13, P0.0001), and α1 within 2h differed significantly among the three groups (1.49 ± 0.13 vs. 1.57 ± 0.10 vs. 1.72 ± 0.10, P0.0001). The α1 within 3h was significantly higher in overt DM than in either of the other two groups but did not change between IGT and mild DM (1.44 ± 0.12 vs. 1.52 ± 0.11 vs. 1.67 ± 0.09, P0.0001). All short-term exponents decreased gradually but significantly as the window widened in all groups (P0.0001). The α2 over 1h was significantly higher in overt DM but was unchanged in IGT and mild DM (1.22 ± 0.11 vs. 1.27 ± 0.12 vs. 1.36 ± 0.13, P = 0.0010). The α2 over 3h did not differ among the three groups.Progressive loss of complexity in the glycemic profile occurred from the short-term range and spread to the long-term range concomitantly with the progression of the DM state.

Background/Aim: The relation between markers of generalized atherosclerosis and cognitive impairment in old age is controversial. The aim of the study was to evaluate the cardio-ankle vascular index (CAVI) as a predictor of longitudinal changes in cognitive function in older individuals. Methods: We evaluated the cognitive function in elderly people with high (AS(+)) and low (AS(–)) values of CAVI each year over 4 years. Results: The changes in the Hasegawa Dementia Scale Revised (HDS-R) and the mini-mental state examination (MMSE) at 4 years were significantly larger in the AS(+) group (AS(+) vs. AS(–) = –1.8 ± 4.4 vs. 0.3 ± 2.8 points and –1.1 ± 3.0 vs. 0.1 ± 2.3 points, p = 0.008 and 0.03, respectively). The annual changes in the HDS-R were significantly decreased from baseline at 1 year later to 4 years later in AS(+) (baseline vs. 1, 2, 3, 4 years = 26.5 vs. 25.0, 25.5, 25.7, 24.8 points, p < 0.001); in comparison, the annual changes in MMSE significantly decreased from the baseline over the 4 years in AS (+) (baseline vs. 1, 2, 3, 4 years = 26.8 vs. 26.2, 25.8, 26.4, 25.7 points, p = 0.002). Conclusion: The results of this study suggest that elderly people with a high CAVI value are at a greater risk of cognitive decline.

The fractal scaling of the long-term heart rate variability (HRV) reflects the ‘intrinsic’ autonomic regulatory system. Herein, we examine how microgravity on the ISS affected the power-law scaling β (beta) of astronauts during a long-duration (about 6 months) spaceflight. Ambulatory electrocardiographic (ECG) monitoring was performed on seven healthy astronauts (5 men, 52.0±4.2 years of age) five times: before launch, 24±5 (F01) and 73±5 (F02) days after launch, 15±5 days before return (F03), and after return to Earth. The power-law scaling β was calculated as the slope of the regression line of the power density of the MEM spectrum versus frequency plotted on a log10–log10 scale in the range of 0.0001–0.01 Hz (corresponding to periods of 2.8 h to 1.6 min). β was less negative in space (−0.949±0.061) than on Earth (−1.163±0.075; P

We previously showed that diabetes contributes to the development of sclerotic lesions in cerebral arteries. In this study, we attempted to clarify whether differences in heart rate variability in non-hypertensive diabetic patients were dependent on the presence or absence of underlying cerebrovascular disease. Thirty diabetic subjects between 40 and 59 years of age and who had no prior history of hypertension were used in this study. Lacunar lesions (LA) were detected with magnetic resonance imaging and atherosclerotic lesions (AS) were detected using intra- and extracranial magnetic resonance angiography, and by ultrasonographic scanning of the carotid artery. Patients underwent a full clinical laboratory screening and a power spectrum analysis of their heart rate variability. Subjects were divided into two groups: those with and without LA. The low frequency/high frequency ratio (LF/HF ratio) was found to be significantly increased (P

To the Editor: The close relationship between diabetes mellitus and arteriosclerosis of the cerebral arteries has recently been reported. However, in these studies, the subjects included older patients with hypertension, which itself is a significant risk factor for arteriosclerosis of the cerebral arteries.1–3 Thus, previous studies on the effect of diabetes on the development of sclerosis were confounded by hypertension and aging. Therefore, we examined relatively young patients with diabetes mellitus who did not have hypertension in order to clarify the influence of diabetes mellitus itself on the development of sclerosis of the cerebral arteries. The subjects included 30 patients with type 2 diabetes mellitus (DM). The subjects with DM did not have hypertension (systolic blood pressure

入院中の高齢者において抑うつは疾患治療を困難にする重要な問題であるが影響を与える因子については明らかではない．65歳以上の入院高齢患者174名を対象に，Geriatric depression scale（以下，GDS）を実施し，性別，年齢，基礎疾患，居住形態，認知機能との関連を検討したところ，患者の居住形態がGDSに最も強く独立して関連し独居群は家族同居群よりもGDSが高く治療意欲の低下を支持する回答が多く，独居高齢者では入院中に心理的援助がより必要である．