Evaluation of facilitative factors for preventing cognitive decline: A 3-year cohort study of community intervention

AIM

We conducted a cohort study to elucidate paticipants' facilitative factors that may help to prevent cognitive decline.

METHODS

This study followed 100 participants (average age: 74.1 ± 5.8; 10 men, 90 women) for 3 years; participants had previously been part of the Taketoyo Project (n = 366) in 2007-2011. The end-point was defined as reduced cognitive function in elderly community residents participating in a preventive intervention for dementia. The presence or absence of reduced cognitive function at the end of the third year of intervention was the dependent variable, and all evaluation items were considered explanatory variables. After Fisher's exact test (P < 0.15), stepwise multiple logistic regression analysis (P < 0.05) was performed, and facilitative factors for prevention of cognitive decline were extracted.

RESULTS

Items with a significant adjusted odds ratio (OR) based on multiple logistic regression analysis were the three-word delayed recall test (OR: 0.330, 95% confidence interval (CI): 0.142-0.767; P < 0.05), word fluency (OR: 0.565, 95%CI: 0.359-0.891; P < 0.05), frequency of going out (OR: 2.790, 95%CI: 0.803-6.380; P < 0.05) and number of friends with whom they engaged in activities (OR:0.344, 95%CI: 0.127-0.932; P < 0.05).

CONCLUSION

Subjects who had maintained a certain level of cognitive function, engaged in activities with friends, and went out frequently at baseline were extracted. In other words, the results suggested that enhancement of social networks and leisure activities prompted by recreational centre participation had a positive effect on maintaining cognitive function. The results also suggest that to improve the effectiveness of preventive interventions for cognitive dysfunction, support for social factors and leisure activities, in addition to cognitive function, may improve the long-term effectiveness of maintaining cognitive function.

[Tension Pneumothorax Developing Hemothorax after Chest Tube Drainage]

A 61-year-old man visited a physician complaining of progressive chest pain and dyspnea. The chest radiography showed complete collapse of the right lung suggesting tension pneumothorax. The patient was transferred to our hospital. A small amount of the right pleural effusion was also seen in addition to pulmonary collapse on the chest radiography. Chest drainage was performed, and continuous air leakage was seen. At 2 hours later, air leakage was disappeared but the bloody effusion was noted. The chest radiography revealed massive effusion and the enhanced computed tomography showed active bleeding. The emergency surgery was conducted. The bleeding point was a ruptured vessel between the apical parietal pleura and the pulmonary bulla. Hemostasis and the resection of the bullae was performed. Careful observation after chest drainage is necessary to prepare unexpected hemothorax in case of tension pneumothorax with pleural effusion.

Abnormal bias in subjective vertical perception in a post-stroke astasia patient

[Purpose] Post-stroke astasia is an inability to stand without external support despite having sufficient muscle strength. However, the dysfunction underlying astasia is unclear. We tested the hypothesis that astasia is the result of an abnormal bias in vertical perception, especially subjective postural vertical (SPV), mediated by somatosensory inputs. [Subjects and Methods] A patient with a right posterolateral thalamus hemorrhage had a tendency to fall toward the contralesional side during standing after 8 weeks of treatment. SPV, standing duration, and physical function were evaluated before and after a 1 week standard rehabilitation baseline period, and after a 1 week intervention period, where standing training requiring the patient to control his body orientation in reference to somatosensory inputs from his ipsilateral upper limb was added. [Results] SPV was biased toward the contralesional side before and after the 1 week baseline period. However, SPV improved into the normal range and he could stand for a longer duration after the intervention period. [Conclusion] This case suggests that abnormal SPV is one of the functional mechanisms underlying astasia, and it indicates the effectiveness of standing training with somatosensory information to improve abnormal SPV and postural disorders.

[Evaluation of Fat Suppression of Diffusion-weighted Imaging Using Section Select Gradient Reversal Technique on 3 T Breast MRI]

This study evaluates fat suppression of diffusion-weighted imaging (DWI) using section select gradient reversal (SSGR) technique in clinical images on 3 T breast MRI. A total of 20 patients with breast cancer were examined at a Philips Ingenia 3 T MRI. We acquired DWI with SPAIR, SSGR-SPAIR, STIR, and SSGR-STIR. We evaluated contrast between the fat region and lesion, the coefficient of variance (CV) of the fat region and the apparent diffusion coefficient (ADC) of normal breast tissue and lesion. The contrast between the fat region and lesion was improved with SSGR technique. The CV of the fattest region did not have any significant difference in SPAIR technique (p>0.05), but it was significantly decreased in the STIR technique using SSGR technique (p<0.05). Positive correlation was observed in ADC value between SPAIR and other fat suppression techniques (SSGR-SPAIR, STIR, SSGR-STIR). DWI using SSGR technique was suggested to be effective on 3 T breast MRI.

A Proteomic Approach Identifies Candidate Early Biomarkers to Predict Severe Dengue in Children

BACKGROUND

Severe dengue with severe plasma leakage (SD-SPL) is the most frequent of dengue severe form. Plasma biomarkers for early predictive diagnosis of SD-SPL are required in the primary clinics for the prevention of dengue death.

METHODOLOGY

Among 63 confirmed dengue pediatric patients recruited, hospital based longitudinal study detected six SD-SPL and ten dengue with warning sign (DWS). To identify the specific proteins increased or decreased in the SD-SPL plasma obtained 6-48 hours before the shock compared with the DWS, the isobaric tags for relative and absolute quantification (iTRAQ) technology was performed using four patients each group. Validation was undertaken in 6 SD-SPL and 10 DWS patients.

PRINCIPAL FINDINGS

Nineteen plasma proteins exhibited significantly different relative concentrations (p<0.05), with five over-expressed and fourteen under-expressed in SD-SPL compared with DWS. The individual protein was classified to either blood coagulation, vascular regulation, cellular transport-related processes or immune response. The immunoblot quantification showed angiotensinogen and antithrombin III significantly increased in SD-SPL whole plasma of early stage compared with DWS subjects. Even using this small number of samples, antithrombin III predicted SD-SPL before shock occurrence with accuracy.

CONCLUSION

Proteins identified here may serve as candidate predictive markers to diagnose SD-SPL for timely clinical management. Since the number of subjects are small, so further studies are needed to confirm all these biomarkers.

High Glucose Concentrations Suppress the Proliferation of Human Periodontal Ligament Stem Cells and Their Differentiation Into Osteoblasts

BACKGROUND

Diabetes mellitus (DM) is a major risk factor for periodontal disease and affects various cellular functions. Periodontal ligament stem cells (PDLSCs) play an important role in periodontal tissue regeneration; however, the effect of hyperglycemia on PDLSCs is unclear. The aim of this study is to investigate whether hyperglycemia affects periodontal tissue regeneration, using human PDLSCs and high-glucose medium as a model of DM.

METHODS

PDLSCs were obtained from healthy adult human mandibular third molars. Cell proliferation, osteoblastic differentiation, and proinflammatory cytokine expression were investigated by culturing PDLSCs in media supplemented with four different glucose concentrations representative of control patients (5.5 mM), patients with postprandial or controlled DM (8.0 mM), and patients with uncontrolled DM (12.0 and 24.0 mM). The molecular effects of hyperglycemia on PDLSC physiology were examined with a focus on the nuclear factor (NF)-(κB signaling pathway. The involvement of NF-κB was investigated with a specific NF-κB inhibitor in PDLSCs under hyperglycemic conditions.

RESULTS

High glucose levels inhibited PDLSC proliferation and differentiation into osteoblasts but induced NF-κB activation and subsequent interleukin (IL)-6 and IL-8 expression. Treatment with an NF-κB inhibitor rescued the defects in cell proliferation and osteoblastic differentiation and inhibited the IL-6 expression caused by the high-glucose environment.

CONCLUSION

The results of this study demonstrate that hyperglycemia inhibits human PDLSC proliferation and osteoblastic differentiation.

The impact of aging on the spatial accuracy of quick corrective arm movements in response to sudden target displacement during reaching

Age-related declines in visuomotor processing speed can have a large impact on motor performance in elderly individuals. Contrary to previous findings, however, recent studies revealed that elderly individuals are able to quickly react to displacement of a visual target during reaching. Here, we investigated the influence of aging on quick, corrective responses to perturbations during reaching in the terms of their functional contribution to accuracy. Elderly and young adults performed reaching movements to a visual target that could be displaced during reaching, and they were requested to move their hand to reach the final target location as quickly as possible. Results showed that, for the younger group, the variance in the directional error of the corrective response correlated with the variance in the reaching trajectory at the halfway point of the reach, but the correlation decreased at the end of the reaching. On the other hand, such correlations were not significant in elderly participants, although the variance of the directional error did not show a significant difference between age groups. Thus, the quick, corrective response seems to play an important role in decreasing variability, especially before the end of reaching, and aging can impair this process.

Control of Precision Grip Force in Lifting and Holding of Low-Mass Objects

Few studies have investigated the control of grip force when manipulating an object with an extremely small mass using a precision grip, although some related information has been provided by studies conducted in an unusual microgravity environment. Grip-load force coordination was examined while healthy adults (N = 17) held a moveable instrumented apparatus with its mass changed between 6 g and 200 g in 14 steps, with its grip surface set as either sandpaper or rayon. Additional measurements of grip-force-dependent finger-surface contact area and finger skin indentation, as well as a test of weight discrimination, were also performed. For each surface condition, the static grip force was modulated in parallel with load force while holding the object of a mass above 30 g. For objects with mass smaller than 30 g, on the other hand, the parallel relationship was changed, resulting in a progressive increase in grip-to-load force (GF/LF) ratio. The rayon had a higher GF/LF force ratio across all mass levels. The proportion of safety margin in the static grip force and normalized moment-to-moment variability of the static grip force were also elevated towards the lower end of the object mass for both surfaces. These findings indicate that the strategy of grip force control for holding objects with an extremely small mass differs from that with a mass above 30 g. The data for the contact area, skin indentation, and weight discrimination suggest that a decreased level of cutaneous feedback signals from the finger pads could have played some role in a cost function in efficient grip force control with low-mass objects. The elevated grip force variability associated with signal-dependent and internal noises, and anticipated inertial force on the held object due to acceleration of the arm and hand, could also have contributed to the cost function.

Analysis of causal relationships by structural equation modeling to determine the factors influencing cognitive function in elderly people in Japan

The purpose of this study is to identify a potentiality factor that is a preventive factor for decline in cognitive function. Additionally, this study pursues to clarify the causal relationship between the each potential factor and its influence on cognitive function. Subjects were 366 elderly community residents (mean age 73.7 ± 6.4, male 51, female 315) who participated in the Taketoyo Project from 2007 to 2011. Factor analysis was conducted to identify groupings within mental, social, life, physical and cognitive functions. In order to detect clusters of 14 variables, the item scores were subjected to confirmatory factor analysis. We performed Structural Equation Modeling analysis to calculate the standardization coefficient and correlation coefficient for every factor. The cause and effect hypothesis model was used to gather two intervention theory hypotheses for dementia prevention (direct effect, indirect effect) in one system. Finally, we performed another Structural Equation Modeling analysis to calculate the standardization of the cause and effect hypothesis model. Social participation was found to be activated by the improvement of four factors, and in turn, activated "Social participation" acted on cognitive function.

[Hemopneumothorax after thoracic sympathetic nerve block; report of a case]

A 72-year-old man, who had been treated pneumothorax 50 years ago, visited a physician complaining of dyspnea after thoracic sympathetic nerve block for postherpetic neuralgia. The patient was diagnosed as pneumothorax, and was consulted to our hospital. Clinical sign and the chest radiography suggested tension hemopneumothorax, and the chest drainage was immediately performed. Although bloody fluid of 1,100 ml was initially drained, no further increase was noted. The patient was discharged on the 21st hospital day.

Flt3 ligand treatment modulates parasitemia during infection with rodent malaria parasites via MyD88- and IFN-γ-dependent mechanisms

We previously showed that treatment of mice with the Flt3 ligand (Flt3L) prevents development of lethal experimental cerebral malaria and inhibits parasitemia during Plasmodium berghei ANKA (PbA) infection. In this study, we investigated the mechanisms underlying the reduction of parasitemia in Flt3L-treated mice. Studies using gene knockout mice and antibody treatment indicated that the anti-parasitemia effect of Flt3L was mediated by innate immune system and was dependent on MyD88, IFN-γ, IL-12 and natural killer (NK) cells. The number of NK cells and their ability to produce IFN-γ was enhanced in Flt3L-treated mice. Phagocytic activity of splenocytes was increased in Flt3L-treated mice after PbA infection when compared with that in untreated mice, and this activity was mainly mediated by the accumulation of F4/80(mid) CD11b(+) cells in the spleen. In both MyD88(-/-) and IFN-γ(-/-) mice, the proportion of F4/80(mid) CD11b(+) cells was not increased in the spleen of Flt3L-treated mice after infection. These correlations suggest that NK cells produce IFN-γ in Flt3L-treated mice, and accumulation of F4/80(mid) CD11b(+) cells in the spleen is promoted by an IFN-γ -dependent manner, culminating in the inhibition of parasitemia. These findings imply that Flt3L promotes effective innate immunity against malaria infection mediated by interplay among varieties of innate immune cells.

Dynamics of Centrocestus armatus Transmission in Endemic River in Hyogo Prefecture, Japan

Centrocestus armatus is an intestinal parasite belonging to the family Heterophyidae. We developed an apparatus for recovering cercariae and clarified the infection dynamics of this parasite. To clarify the circadian rhythm of cercarial shedding in the summer season, we filtrated 30 l of river water every 2 h for 24 h. Cercariae were first detected between 06:00 and 08:00 h, increased over time to reach peak at 16:00 h and decreased thereafter, thus showing a single-peak pattern. In a survey of seasonal change, approximately 200 cercariae were contained in 1 l of river water during the summer season, while none were found during the winter. This cercarial shedding pattern appeared to be related to sunrise/sunset and water/atmosphere temperature. Therefore, we examined whether cercarial shedding was affected by light or temperature changes under laboratory conditions, and confirmed that both light and temperature were important factors for cercarial shedding. Light was a stronger factor than water temperature. Cercarial shedding of C. armatus occurred in response to temperature and light. The change in the number of juvenile metacercariae detected in fish brain corresponded with monthly detection rates of cercariae; however, the incidence of new infections decreased in August. This suggests that Nipponocypris temminkii contains a defense mechanism against new infections that may have hindered the increase in parasite infectivity. These results clarified the smooth infection from the first to the second intermediate host of C. armatus in the endemic river. Throughout the study period, fecal samples were collected from 19 kites, 114 herons, and three unidentified species. However, our results using C. armatus showed a low value of 1% in herons and 5% in kites. The infection dynamics of final host to first intermediate host need to be further investigated.

[Results of non-rigid prosthetic reconstruction with expanded polytetrafluoro-ethylene( ePTFE) soft tissue patch following chest wall resection for malignant tumors]

Twenty patients underwent chest wall reconstruction using expanded polytetrafluoroethylene(ePTFE) soft tissue patch following resection between June 1996 and December 2012. The patients included 15 men and 5 women, aged 18 to 80 years. The indications for resection included 4 primary tumors, 8 metastatic tumors, and 8 infiltrating tumors. The lesions were located anteriorly in 10 patients, laterally in 5 patients and posteriorly in 5 patients. Skeletal resection involved an average of 2 ribs in 19 patients, and a partial sternectomy in 1 patient. The size of chest wall defects ranged from 20 to 210 cm2( mean, 69.8 cm2). Lung resection was performed in 7 patients included a wedge resection, 5 lobectomy, and a bilobectomy. Chest wall defects were closed primarily with ePTFE soft tissue patch. There were no critical complications or postoperative mortalities. The mean follow-up in all patients is 72.7 months. Recurrence of malignancy occurred in 10 patients included a local recurrence in 1 patient, and metastases in 9 patients. The overall postoperative 5-year survival rate is 61.0%. Non-rigid prosthetic reconstruction with ePTFE soft tissue patch provides satisfactory outcome. New prosthetic materials have to be examined whether they are superior to ePTFE soft tissue patch.

[Elderly Bochdalek hernia found out by intestinal obstruction]

A 78-year-old man, who had been pointed out elevation of the diaphragm by chest radiography, visited local physician complaining of abdominal pain and vomiting. He was referred to our hospital and was diagnosed as intestinal obstruction. The patient had neither respiratory symptoms nor findings of peritonitis. The radiography revealed intestinal gas with neveau formation in the left thorax. The computed tomography showed dilatation of the stomach and small intestine, and a diaphragmatic hernia was suspected. Although conservative treatment was started, radiographic and laboratory findings got worse on the 5th hospital day. The patient underwent surgery for a left diaphragmatic hernia with the intestinal obstruction. Diagnosis of Bochdalek hernia with hernia sac was established. The content of hernia was the perforated small intestine. Postoperative course was almost uneventful, and the patient was discharged on the 35th postoperative day without pyothorax. In treatment of adult Bochdalek hernia, early surgery is important because patients with incarceration or perforation often experience severe postoperative complication.

Accumulation of major histocompatibility complex class II(+)CD11c(-) non-lymphoid cells in the spleen during infection with Plasmodium yoelii is lymphocyte-dependent

The spleen is the main organ for immune defense during infection with Plasmodium parasites and splenomegaly is one of the major symptoms of such infections. Using a rodent model of Plasmodium yoelii infection, MHC class II(+)CD11c(-) non-T, non-B cells in the spleen were characterized. Although the proportion of conventional dendritic cells was reduced, that of MHC II(+)CD11c(-) non-T, non-B cells increased during the course of infection. The increase in this subpopulation was dependent on the presence of lymphocytes. Experiments using Rag-2(-/-) mice with adoptively transferred normal spleen cells indicated that these cells were non-lymphoid cells; however, their accumulation in the spleen during infection with P. yoelii depended on lymphocytes. Functionally, these MHC II(+)CD11c(-) non-T, non-B cells were able to produce the proinflammatory cytokines alpha tumor necrosis factor and interleukin-6 in response to infected red blood cells, but had only a limited ability to activate antigen-specific CD4(+) T cells. This study revealed a novel interaction between MHC II(+)CD11c(-) non-lymphoid cells and lymphoid cells in the accumulations of these non-lymphoid cells in the spleen during infection with P. yoelii.

RNA editing of the Q/R site of GluA2 in different cultured cell lines that constitutively express different levels of RNA editing enzyme ADAR2

Adenosine deaminase acting on RNA 2 (ADAR2) catalyzes RNA editing at the glutamine/arginine (Q/R) site of GluA2, and an ADAR2 deficiency may play a role in the death of motor neurons in ALS patients. The expression level of ADAR2 mRNA is a determinant of the editing activity at the GluA2 Q/R site in human brain but not in cultured cells. Therefore, we investigated the extent of Q/R site-editing in the GluA2 mRNA and pre-mRNA as well as the ADAR2 mRNA and GluA2 mRNA and pre-mRNA levels in various cultured cell lines. The extent of the GluA2 mRNA editing was 100% except in SH-SY5Y cells, which have a much lower level of ADAR2 than the other cell lines examined. The ADAR2 activity at the GluA2 pre-mRNA Q/R site correlated with the ADAR2 mRNA level relative to the GluA2 pre-mRNA. SH-SY5Y cells expressed higher level of the GluA2 mRNA in the cytoplasm compared with other cell lines. These results suggest that the ADAR2 expression level reflects editing activity at the GluA2 Q/R site and that although the edited GluA2 pre-mRNA is readily spliced, the unedited GluA2 pre-mRNA is also spliced and transported to the cytoplasm when ADAR2 expression is low.

Dengue virus strain DEN2 16681 utilizes a specific glycochain of syndecan-2 proteoglycan as a receptor

Dengue virus (DENV) causes fever and severe haemorrhagic symptoms in humans. The DEN2 16681 strain, derived from a dengue haemorrhagic fever patient, has been widely used in studies related to DENV pathogenesis, such as mouse and non-human primate haemorrhagic models and human vascular endothelial-cell permeability. To clarify the entry mechanism of the 16681 strain, we characterized a novel cell receptor for this strain. Our two major findings were as follows: firstly, the SDC2 membrane protein was an effective DEN2 16681 receptor in a cloned K562 cell line. Secondly, a heparan sulfate (HS) glycochain (of four glycochains in SDC2) is the specific binding site of DENV and seems to be involved in tissue-culture adaptation. Our findings present an entry mechanism that could be implicated for DENV adaptation and HS-mediated DENV infection.

A clinical study of the prognostic factors for postoperative early recurrence in patients who underwent complete resection for pulmonary adenocarcinoma

PURPOSE

The 2-[F-18]-Fluoro-2-deoxy-D-glucose (FDG) uptake in positron emission tomography (PET) and serum neutrophil/lymphocyte ratio (NLR) are recently noteworthy prognostic factors. We studied the prognostic factor to predict early recurrence after curative resection for pulmonary adenocarcinoma including FDG uptake and NLR.

METHODS

We performed a retrospective review of 23 patients who underwent a complete resection for pulmonary adenocarcinoma. The patients were divided into 2 groups: 19 patients in the disease-free group, and 4 patients in the recurrent group. Clinical and pathological factors concerning the recurrence within 1 year of surgery were analyzed between two groups.

RESULTS

No significant differences between the recurrent group and disease-free group was seen in age, gender, CEA, NLR, CRP, pathological stage, pleural invasion, pathological grading, Ki-67 expression, venous invasion and lymphatic invasion. The SUVmax was significantly elevated in the recurrent group (12.5 ± 2.01 vs. 5.70 ± 3.97, p = 0.0094). Tumor size was significantly larger in the recurrent group (5.58 ± 0.71 vs. 3.62 ± 1.33 cm, p = 0.0058). The first, recurrent sites in 4 patients were brain, in 3 patients; and lung, in 1 patient.

CONCLUSION

Both tumor size and SUVmax are possible predictors of early recurrence after curative resection in patients with pulmonary adenocarcinoma. Although it is impossible to determine the SUVmax as an independent prognostic factor, the SUVmax may be one of the predictors of early hematogenous recurrence in surgically treated pulmonary adenocarcinoma.