Dysphagia is a common problem among older adults, causing aspiration pneumonia and malnutrition. It has been reported that calf circumference (CC), an index of nutritional status and physical activity, correlated with dysphagia in acute care hospitals, suggesting that CC can be a useful index for assessing dysphagia. We therefore aimed to explore the association between dysphagia and CC among community elderly people who require long-term care and determined the optimal CC cut-off value for patients with dysphagia. Our cross-sectional study, conducted at Tokyo Metropolis, included 154 participants (65 men) aged > 65 years (mean age: 80.1 ± 7.1) who required long-term care and were examined for dental disease and dysphagia during home visiting treatment. Age, body mass index (BMI), mini-nutritional assessment short-form (MNA-SF) score, Barthel index (BI), CC, functional oral intake scale (FOIS), and dysphagia severity scale (DSS) were evaluated. A DSS score < 5 was defined as dysphagia. To determine the association between CC and dysphagia, we performed logistic regression analysis and calculated the CC cut-off value for dysphagia. Thirty-seven participants (24.0%) were diagnosed with dysphagia. The logistic regression analysis showed that the presence of dysphagia was independently associated with CC after adjusting for age and sex. The CC cut-off value for the presence of dysphagia was 31.0 cm in men (sensitivity, 0.818; specificity, 0.868) and 29.3 cm in women (sensitivity, 0.760; specificity, 0.859). CC is a useful index for assessing dysphagia among community dwelling individuals who require long-term care.
Abstract Background Lower limb peripheral artery disease classified as Rutherford category IV, is characterized by lower limb ischemic pain both during exertion and at rest. This disease has an unclear course. We aimed to evaluate outcome predictors in this patient group after endovascular therapy. This single-center, retrospective, observational study included 234 consecutive patients (264 limbs), between April 2007 and December 2020. We investigated the disease clinical course after endovascular therapy. The primary endpoint was the wound formation rate 3 years after endovascular therapy. Results The mean observation period was 48.2 ± 8.9 months. The patients (61.9% male; mean age, 76 ± 10 years) presented with diabetes (64.1%), and received hemodialysis with chronic kidney disease (35.0%) and ambulatory treatment (85.0%). The average ankle-brachial index before endovascular therapy was 0.69 ± 0.23. Skin perfusion pressure on the dorsal and plantar sides was 38 ± 13 mmHg and 36 ± 12 mmHg, respectively. The wound incidence rates at 1, 2, and 3 years after endovascular therapy were 8.3%, 11.4%, and 14.4%, respectively. Multivariate analysis revealed the following factors associated with wound formation: P2 in inframalleolar/pedal disease category in the Global Limb Anatomical Staging System (hazard ratio: 1.73, 95% confidence interval: 1.22–2.83, P = 0.01), non-ambulatory status (hazard ratio: 1.09, 95% confidence interval: 1.11–1.36, P = 0.02), intervention up to infrapopliteal lesion (hazard ratio: 1.55, 95% confidence interval: 1.17–2.46, P = 0.03), and patient with chronic kidney disease on hemodialysis (hazard ratio: 1.61, 95% confidence interval: 1.32–2.18, P = 0.03). Conclusions The 3-year incidence of wound onset in this study was 14.4%. Factors associated with this outcome included P2 in the Global Limb Anatomical Staging System, non-ambulatory status, intervention up to infrapopliteal lesion, and patient with chronic kidney disease on hemodialysis.
Carrageenan has been widely used as an irritant to evoke inflammation in animals or to selectively deplete macrophages in vivo. Although precise understanding of carrageenan activity is a prerequisite for the experimental use of this polysaccharide, the effects of this agent on host-biological systems are still poorly understood. We investigated the effect of carrageenan on serum concentrations of complement C3 and interleukin (IL)-6, a potent complement-inducing factor. Intraperitoneal administration of carrageenan (4 mg) in mice resulted in an initial fall in serum C3 (70% of control, P < 0.05) between 3 and 6 h, but was followed by a significant rise (180% of the control, P < 0.05) at 24h. Prior to the rise in complement C3, a sharp peak of serum IL-6 was observed at 6h after carrageenan treatment. These results indicate potential of carrageenan to enhance host complement systems, which may be associated with, at least in part, an acute induction of IL-6.
We report an autopsy case of acute-onset insulin-dependent diabetes mellitus, type I, that occurred in an adult. The patient died 3 days after the clinical onset of diabetes. Hyperglycemia, ketonuria, and hyperamylasemia were observed at admission. The pathologic examination of the pancreas showed a markedly decreased number of islets, and residual islets were small and shrunken. Diffuse inflammatory cell infiltrates, which were found in islets and also in acini, were mainly T lymphocytes. Shrunken islets were composed of insulin cells, glucagon cells, somatostatin cells, and pancreatic polypeptide cells. A decreased number of zymogen granules in acini were prominent [corrected]. This case suggested that pan-pancreatitis, destroying whole islets and acini, can initiate insulin-dependent diabetes mellitus.
Abstract Introduction Sleep related breathing disorder is one of the risk factors for stroke. In addition, post-stroke patients often have dysphagia. Although sleep related breathing disorder and dysphagia occur in the oropharyngeal region, their relationship is not well defined and understudied, especially during the recovery phase. This study investigated the oral intake level and obstructive respiratory events in post-stroke patients with dysphagia. Methods Seventy post-stroke patients (36 men; mean age ± S.D., 72.1 ± 11.1) who were hospitalized in a rehabilitation hospital between August 2021 and October 2023 were recruited for this study. Age, sex, body height, body weight, and scores of the functional oral intake scale (FOIS) were collected from their medical record. The body mass index (BMI) was calculated from their height and weight. FOIS was used to evaluate swallowing function. The apnea hypopnea index (AHI), 3% oxygen desaturation index (3%ODI), minimum oxygen saturation (min SpO2) was assessed to evaluate the severity of obstructive respiratory events using WatchPAT (Philips Japan, Ltd.), a portable device to test to diagnose sleep related breathing disorder. In the statistical analysis, we classified the FOIS into three groups: 7 points (no dysphagia), 6,5,4 points (ingestion of texture-modified diet), and 3,2,1 point (mainly feeding through tube). And Kruskal Wallis test was performed on AHI, 3%ODI, minSpO2. Results We obtained approval from our ethical committee before starting this study. According to the analysis, there was a significant difference between the groups in FOIS, AHI and min SpO2 (p < 0.05). Conclusion We showed that poorer oral intake was associated with worse obstructive respiratory events. Our results suggest that clinicians should pay attention to sleep related breathing disorder in post-stroke dysphagia patients in rehabilitation hospitals, also to prevent stroke recurrence. Support (if any)
The effect of ML-236B, a specific inhibitor of 3-hydroxy-3-methylglutaryl coenzyme A reductase, on serum lipids and plasma cortisol responses to ACTH were studied in 11 hypercholesterolemic patients. Mean serum total cholesterol decreased significantly [279 +/- 57 (SD) mg/dl to 213 +/- 48 mg/dl], as did serum triglycerides (211 +/- 140 mg/dl to 166 +/- 125 mg/dl) and low density lipoprotein cholesterol (195 +/- 49 mg/dl to 139 +/- 47 mg/dl), after ML-236B treatment for 12 weeks in doses ranging from 15-60 mg/day. The mean basal plasma cortisol level was not changed after ML-236B treatment, but the mean absolute increment in plasma cortisol increased from 15.4 +/- 3.4 to 26.7 +/- 8.4 micrograms/dl (P less than 0.005) after treatment. These data demonstrate a new effect of a potent inhibitor of 3-hydroxy-3-methylglutaryl coenzyme A reductase in human adrenal tissue.
High-temperature stress during the ripening stage leads to quality deterioration due to an increase in chalky grains in brown rice (Oryza sativa L.). In a previous study, we identified a QTL for Appearance quality of brown rice 1 (Apq1) using chromosome segment substitution lines of the indica cultivar 'Habataki' in the japonica cultivar 'Koshihikari' background and narrowed down the locus to a 48-kb region on chromosome 7. To verify the function and mechanisms of this QTL in grain appearance, in this study, we fine-mapped the gene and conducted high-temperature tolerance tests. As a result of the genetic mapping, we narrowed down the candidate region of Apq1 to a 19.4-kb region including three predicted genes. Among these, the temporal expression pattern of sucrose synthase 3 (Sus3) corresponded well with the high temperature-sensitive period during ripening, and expression of the 'Habataki' allele of Sus3 was increased under high-temperature condition. In addition, we transformed the 'Habataki' Sus3 gene into 'Nipponbare', and the transformants obtained high-temperature tolerance. Therefore, we conclude that the causal gene underlying the QTL Apq1 is the thermo-responsive Sus3 allele, and the increase in Sus3 expression under high-temperature condition during ripening leads to high-temperature tolerance in rice.
