Factors influencing interprofessional collaboration in long-term care from a multidisciplinary perspective: a case study approach

Systematic assessments of interprofessional collaboration barriers and enablers in long-term care settings are critical for delivering person-centered healthcare. However, research on factors influencing interprofessional collaboration in long-term care settings is limited. For this study, 65 healthcare professionals across multiple facilities experienced in long-term care in Japan participated in online focus group discussions and individual interviews to discuss cases. The qualitative data were analyzed using qualitative content analysis. Seven themes emerged: coordination, the need for care manager training, hierarchy among healthcare professionals, specialization but not the mind-set of overspecialization, casual conversations, electronic group communication tools, and excessive fear of personal information protection. These findings highlight the need to develop coordinator roles and for interprofessional education on the proper approach to personal information protection laws. Furthermore, daily casual conversations, the use of online platforms, and the prevention of patients being left behind due to overspecialization are required.

Effect of number of medications on the risk of falls among community-dwelling older adults: A 3-year follow-up of the SONIC study

AIM

This study examined the association between the number of prescribed medications and falls among community-dwelling older adults.

METHODS

We conducted a geriatric comprehensive health-checkup on community-dwelling adults aged 69-91 years who participated in the Septuagenarians, Octogenarians, and Nonagenarians Investigation with Centenarians study. The final analysis of this study included 1,076 participants with complete data. The participants were divided into four groups based on the number of medications at baseline: 0, 1, 2-4, and ≥5. At the 3-year follow-up, the participants were asked whether they had fallen in the past year. Multivariable logistic regression analysis was performed to assess the relationship between the number of medications taken and falls after adjusting for confounding factors.

RESULTS

The prevalence rates of falls were 10.5%, 18.2%, 18.3%, and 19.8% in the no-medication, one-medication, comedication, and polypharmacy groups, respectively. In the one-medication prescription group, 59% of prescriptions were for fall-risk-increasing drugs (FRID). Multivariable analysis showed a significantly higher incidence of falls in the one-medication group (adjusted odds ratio [OR], 1.91; 95% confidence interval [CI], 1.04-3.54), co-medication (OR, 1.89; 95% CI, 1.09-3.29), and polypharmacy groups (OR, 1.94; 95% CI, 1.09-3.45) than in the no-medication group.

CONCLUSIONS

The study showed that polypharmacy, as well as just taking one medication, can affect the occurrence of falls. This suggests that in addition to the number of medications and polypharmacy, the type of medication, such as FRID, affects the risk of falls. Therefore, pharmacotherapy should consider the risk of falls in older adults when prescribing medications. Geriatr Gerontol Int 2024; 24: 306-310.

Hypoxia-induced immortalization of primary cells depends on Tfcp2L1 expression

Cellular senescence is a stress response mechanism that induces proliferative arrest. Hypoxia can bypass senescence and extend the lifespan of primary cells, mainly by decreasing oxidative damage. However, how hypoxia promotes these effects prior to malignant transformation is unknown. Here we observed that the lifespan of mouse embryonic fibroblasts (MEFs) is increased when they are cultured in hypoxia by reducing the expression of p16INK4a, p15INK4b and p21Cip1. We found that proliferating MEFs in hypoxia overexpress Tfcp2l1, which is a main regulator of pluripotency and self-renewal in embryonic stem cells, as well as stemness genes including Oct3/4, Sox2 and Nanog. Tfcp2l1 expression is lost during culture in normoxia, and its expression in hypoxia is regulated by Hif1α. Consistently, its overexpression in hypoxic levels increases the lifespan of MEFs and promotes the overexpression of stemness genes. ATAC-seq and Chip-seq experiments showed that Tfcp2l1 regulates genes that control proliferation and stemness such as Sox2, Sox9, Jarid2 and Ezh2. Additionally, Tfcp2l1 can replicate the hypoxic effect of increasing cellular reprogramming. Altogether, our data suggest that the activation of Tfcp2l1 by hypoxia contributes to immortalization prior to malignant transformation, facilitating tumorigenesis and dedifferentiation by regulating Sox2, Sox9, and Jarid2.

Effects of fermented soymilk with Lacticaseibacillus paracasei YIT 9029 on gut microbiota and defecation habits: a randomised, double-blind, placebo-controlled study

Previous studies have demonstrated that soymilk and Lacticaseibacillus paracasei YIT 9029 (strain Shirota: LcS) each beneficially affect the gut microbiota and defecation habits. To investigate the effects of daily consumption of fermented soymilk containing LcS (FSM), we conducted a randomised, double-blind, placebo-controlled study of 112 healthy Japanese adults with a low faecal Bifidobacterium count. They consumed 100 ml FSM or placebo (unfermented soymilk base) once daily for 4 weeks. Their gut microbiota was analysed by 16S rRNA gene amplicon sequencing and quantitative reverse transcription-polymerase chain reaction (PCR), and faecal short-chain fatty acids (SCFAs) and urinary putrefactive products were assessed during the pre- and post-consumption periods. Defecation habits were examined weekly using a subjective questionnaire. In the post-consumption period, living LcS were not detected in two subjects in the FSM group (n = 57) but were detected in one subject in the SM group (n = 55). The FSM group had a significantly higher number and relative abundance of faecal lactobacilli compared with the placebo group. The relative abundance of Bifidobacterium, alpha-diversity of microbiota, and concentrations of acetate and total SCFAs in faeces were significantly increased in the FSM group, although no significant differences were detected between the groups. The number of defecations and defecation days per week significantly increased in both groups. Subgroup analysis of 109 subjects, excluding 3 with inconsistent LcS detection (2 and 1 subjects in the FSM and SM groups, respectively), revealed that the FSM group (n = 55) had significantly greater increases in faecal acetate concentration compared with the SM group (n = 54) and significant upregulation of pathways related to energy production or glucose metabolism in the gut microbiota. These findings suggest that daily FSM consumption improves the gut microbiota and intestinal environment in healthy adults and may help to maintain health and prevent diseases. Registered at the University Hospital Medical Information Network (UMIN) clinical trials registry under: UMIN 000035612.

Helicobacter pylori Eradication Does Not Adversely Affect the Clinical Course of Gastric Cancer: A Multicenter Study on Screening Endoscopic Examination in Japan

BACKGROUND

Since gastric cancers (GCs) detected after Helicobacter pylori (HP) eradication present with different morphological characteristics from conventional HP-positive GCs, delayed detection of early-stage GCs may be observed. This study aimed to investigate the clinical impact of HP eradication on diagnosing GC during screening endoscopy.

METHODS

Eleven health checkup institutions in Japan participated in the present study. All GC cases newly diagnosed by screening endoscopy between January 2016 and December 2020 were included. After propensity score matching, multivariable regression analysis was performed to estimate the effect of HP eradication on deep tumor invasion among HP-eradicated and HP-positive GC cases.

RESULTS

A total of 231 patients with GCs (134 HP-eradicated and 97 HP-positive cases) were enrolled. After propensity score matching, there were 81 cases in each group. The distribution of the depth of tumor invasion (pT1a, pT1b1, pT1b2, and pT2) between the HP-eradicated group and HP-positive group was similar (p = 0.82). In the propensity analysis, with HP-positive as the reference value, HP eradication was not significantly associated with T1b-T4-GCs and T1b2-T4-GCs, with odds ratios (95% confidence intervals) of 1.16 (0.48-2.81) and 1.16 (0.42-3.19), respectively.

CONCLUSIONS

HP eradication does not adversely affect the clinical course of GCs, supporting the recommendation of HP eradication in screening programs to reduce the total number of GC cases without delaying diagnosis.

Reappraisal of a Renovated Cell-free and Concentrated Ascites Reinfusion Therapy for Malignant Ascites

BACKGROUND/AIM

Cell-free and concentrated ascites reinfusion therapy (CART) was established for refractory ascites and renovated CART (Keisuke Matsusaki (KM) -CART) has been recently developed especially for malignant ascites; however, the actual clinical efficacy of KM-CART has been rarely reported.

PATIENTS AND METHODS

We performed 226 KM-CART procedures in 104 patients with malignant ascites in three hospitals from August 2013 to September 2018. Medical records were retrospectively reviewed for ascites data, related complications, symptoms before and after each CART and prognosis after the first CART. The modified Glasgow Prognostic Score (mGPS) was reviewed before every procedure, as an indicator of nutritional status.

RESULTS

Pancreatic cancer was the most common indication for the KM-CART procedure, followed by gastric cancer, hepatocellular carcinoma, ovarian cancer, and cholangiocarcinoma (five major diseases). The 50% survival times of these five major diseases after the first procedure were 25, 39, 31, 49, and 33 days, respectively. The mean survival time for all patients was 73.5 days, and 75.6 days for those with the five major diseases. All patients experienced symptomatic relief, and complications were rare. Repeated KM-CART was performed in 47.1% of the patients, most often in those with ovarian cancer (66.7%). Regarding the mGPS at the first CART procedure, 89% of patients were in the group with the poorest nutritional status. Patients who underwent KM-CART three or more times had longer survival than those who were treated once or twice.

CONCLUSION

Repeated KM-CART provides a survival benefit for patients with malignant ascites, even in cases of poor nutritional status.

Association of Spousal Social Support in Child-Rearing and Marital Satisfaction with Subjective Well-Being among Fathers and Mothers

This study explored the association of spousal support and marital satisfaction with the subjective well-being of fathers and mothers using a mediation analysis. Data were gathered from 360 fathers and 338 mothers (aged 25-50 years). Subjective well-being was measured as an outcome using the Japanese version of the World Health Organization-Five Well-Being Index. Marital satisfaction was measured as a mediating variable using the Japanese version of the Marital Relationship Satisfaction Scale. Spousal social support (including instrumental, emotional, and appraisal support) was measured as an independent variable using four-point scales. Control variables were the father's and mother's ages, number of children, age of the youngest child, children going to nursery school or kindergarten, use of childcare services, self-evaluated low economic status, and weekday working hours. Among fathers, instrumental and emotional support had significant direct and indirect effects, with the latter mediated by the impact of marital satisfaction on subjective well-being; appraisal support had only significant indirect effects. Among mothers, instrumental support had significant direct and indirect effects; emotional and appraisal support had only significant indirect effects. Our findings indicate that social support from spouses has protective direct and indirect effects on subjective well-being among parents and suggest the need for mutual support between spouses to facilitate effective co-parenting.

Immature functional development of lumbar locomotor networks in adult Irf8-/- mice

To date, research on the role of the brainstem and spinal cord in motor behavior has relied on in vitro preparations of the neonatal rodent spinal cord, with or without the brainstem; their spatial and temporal scope are subject to technical limitations imposed by low oxygen tension in deep tissues. Therefore, we created an arterially perfused in situ preparation that allowed us to investigate functional interactions in the CNS from the neonatal to adult period. Decerebrated rodents were kept alive via total artificial cardiopulmonary bypass for extracorporeal circulation; the plasma oxygen and ion components needed for survival were supplied through the blood vessels. Interferon regulatory factor 8 (IRF8) is a transcription factor that promotes myeloid cell development and stimulates innate immune responses. In the brain, IRF8 is expressed only in microglia and directs the expression of many genes that serve microglial functions. Recent evidence indicates that IRF8 affects behavior and modulates Alzheimer's disease progression in a mouse model. However, whether this immune deficiency arising from the absence of IRF8 influences the development of the neuronal network in the spinal cord is unknown. We applied the above methodology to mice of all ages and electrophysiologically explored whether the absence of IRF8 influences the development of lumbar central pattern generator (CPG) networks. In mice of all ages, bilateral neuronal discharges by the normal CPG networks activated by the modulated sympathetic tone via descending pathways at high flow rates became organized into discharge episodes punctuated by periods of quiescence. Similar discharge episodes were generated by the adult CPG networks (≥P14 days) activated by drug application. However, discharge episodes elicited by activating the neonatal-juvenile CPG networks ( Collapse

Key Words

• adult interferon regulatory factor 8 (IRF8)-deficient mice
• decerebrate and arterially perfused in situ preparations
• discharge episodes
• immature adult lumbar CPG
• rhythmic discharge

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Affiliation(s)

Itaru Yazawa Department of Food and Nutrition, Kyushu Nutrition Welfare University, Kitakyushu, Japan Laboratory of Neural Control, National Institute of Neurological Disorders and Stroke (NINDS), National Institutes of Health (NIH), Bethesda, MD, United States
Yuko Yoshida Division of Developmental Biology, National Institute of Child Health and Human Development (NICHD), NIH, Bethesda, MD, United States
Ryusuke Yoshimi Division of Developmental Biology, National Institute of Child Health and Human Development (NICHD), NIH, Bethesda, MD, United States Department of Stem Cell and Immune Regulation, Graduate School of Medicine, Yokohama City University, Yokohama, Japan
Keiko Ozato Division of Developmental Biology, National Institute of Child Health and Human Development (NICHD), NIH, Bethesda, MD, United States

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Good death for people living with dementia: a qualitative study

BACKGROUND

Ensuring a good death is one of the primary objectives of palliative care and end-of-life care. There is insufficient evidence regarding what defines a good death for people living with dementia. Obtaining an understanding of what constitutes a good death could help improve dementia care. This study aimed to explore how multiple stakeholders perceive a good death for people living with dementia.

METHODS

This qualitative study was carried out across six prefectures in Japan. Enrollment of participants took place within dementia outpatient clinics, hospitals, daycare centers, and community centers. A total of thirty-three in-depth interviews with people living with dementia, physicians, and nurses were conducted. Six focus group discussions were performed with family caregivers and care workers. Verbatim transcripts of the interviews were prepared, and inductive content analysis was used to examine the data.

FINDINGS

Regarding the perception of a good death, the following themes were derived: (1) painless death; (2) dying in a preferred environment; (3) family's coping with loss; (4) maintaining regular life; (5) living with respect; and (6) preparation for death. All these themes are interrelated. Participants viewed a good death as a process rather than a single event.

CONCLUSION

This study identifies crucial components of a good death for people living with dementia. The findings could be used to improve dementia care.

Neonatal malnutrition impacts fibroblast growth factor 21-induced neuron neurite outgrowth and growth hormone-releasing hormone secretion in neonatal mouse brain

Neonatal malnutrition is one of the most common causes of neurological disorders. However, the mechanism of action of the factors associated with neonatal nutrition in the brain remains unclear. In this study, we focused on fibroblast growth factor (FGF) 21 to elucidate the effects of malnutrition on the neonatal brain. FGF21 is an endocrine factor produced by the liver during lactation which is the main source of nutrition during the neonatal period. In this study, malnourishment during nursing mice induced decreased levels of Fgf21 mRNA in the liver and decreased levels of FGF21 in the serum. RNA-seq analysis of neonatal mouse brain tissue revealed that FGF21 controlled the expression of Kalrn-201 in the neonatal mouse brain. Kalrn-201 is a transcript of Kalirin, a Ras homologous guanine nucleotide exchange factor at the synapse. In mouse neurons, FGF21 induced the expression of Kalirin-7 (a Kalirin isoform) by down-regulating Kalrn-201. FGF21-induced Kalirin-7 stimulated neurite outgrowth in Neuro-2a cells. FGF21 also induced Growth hormone-releasing hormone (GHRH) expression in Neuro-2a cells. Kalirin-7 and GHRH expression induced by FGF21 was altered by inhibiting the activity of SH2-containing tyrosine phosphatase (SHP2) which is located downstream of the FGF receptor (FGFR). Additionally, malnourished nursing induced intron retention of the SHP2 gene (Ptpn11), resulting in the alteration of Kalirin-7 and GHRH expression by FGF21 signaling. Ptpn11 intron retention is suggested to be involved in regulating SHP2 activity. Taken together, these results suggest that FGF21 plays a critical role in the induction of neuronal neurite outgrowth and GHRH secretion in the neonatal brain, and this mechanism is regulated by SHP2. Thus, Ptpn11 intron retention induced by malnourished nursing may be involved in SHP2 activity.

Effects of Daily Consumption of Soy Products on Basic/Instrumental Activities of Daily Living in Community-Dwelling Japanese Women Aged 75 Years and Older: A 4-Year Cohort Study

Introduction

Since soy isoflavones compensate for age-related estrogen reduction, adequate intake of soy products may prevent the decline in activities of daily living (ADL) due to estrogen reduction in women. However, it is unclear whether regular soy product intake prevents ADL decline. This study examined the effects of soy product consumption on basic/instrumental ADL (BADL/IADL) in Japanese women 75 years or older for 4 years.

Materials and Methods

The subject population consisted of 1289 women aged 75 years or older living in Tokyo who underwent private health examinations in 2008. For 1114 (or 1042) participants without baseline BADL (or IADL) disability, we examined the association between baseline soy product consumption frequency and the BADL (or IADL) disabilities 4 years later using logistic regression analyses. The models were adjusted for baseline age, or further for dietary variety for food groups other than soy products, exercise and sport participation, smoking, pre-existing disease number, and body mass index.

Results

Regardless of adjustment for potential confounding factors, less frequent soy product consumption was associated with higher BADL or IADL disability incidence. In the fully adjusted models, the trend toward a higher incidence of disabilities with less frequent soy product consumption was statistically significant for both BADL (p = 0.001) and IADL (p = 0.007).

Conclusions

Those who consumed soy products more frequently at baseline were less likely to develop BADL and IADL disabilities after 4 years than those who did not. The results show that daily soy product consumption may prevent functional ADL decline in older Japanese women.

Criterion validity of the health assessment questionnaire for the national screening program for older adults in Japan: The SONIC study

AIM

In our previous study, we proposed that the total score of the 12 frailty-related items in the health assessment questionnaire for the national screening program for older adults could be used as an indicator of frailty. We aim to examine the criterion validity of the 12 frailty-related items for frailty.

METHODS

The data used in this study were from older Japanese individuals aged 78-81 years (n = 461) who participated in the in-venue (2019) and mailed questionnaire (2020) surveys of the Septuagenarians, Octogenarians, Nonagenarians Investigation with Centenarians study. A receiver operator characteristic (ROC) curve analysis was used to evaluate the criterion validity of the 12 frailty-related items for frailty defined based on the Japanese version of the Cardiovascular Health Study criteria. A multivariable logistic regression model was used to examine the independent association of the 12 frailty-related items with frailty.

RESULTS

The area under the ROC curve of the scores of the 12 frailty-related items for frailty was 0.79 (95% confidence interval [CI] = 0.73-0.85, P < 0.001). The cut-off value for frailty was 3 and 4 points, and the sensitivity and specificity were 55.9% and 85.8%, respectively. The multivariable logistic regression model showed that four or more scores of the 12 frailty-related items were significantly associated with frailty (adjusted odds ratio = 7.75, 95% CI = 4.10-14.65, P < 0.001).

CONCLUSIONS

The results of this study suggest that the 12 frailty-related items in the health assessment questionnaire for older adults may be useful for assessing frailty in community-dwelling older adults in a simplified manner. Geriatr Gerontol Int 2023; ••: ••-••.

A case report of a prolonged decrease in tacrolimus clearance due to co-administration of nirmatrelvir/ritonavir in a lung transplant recipient receiving itraconazole prophylaxis

BACKGROUND

Drug-drug interaction management is complex. Nirmatrelvir/ritonavir is a potent cytochrome P450 (CYP) 3A inhibitor and influences pharmacokinetics of co-administered drugs. Although there are several reports about drug-drug interactions of nirmatrelvir/ritonavir, an influence of a concomitant use of nirmatrelvir/ritonavir and another potent CYP3A inhibitor on tacrolimus remains unclear. Here, we experienced a lung transplant patient with the novel coronavirus disease 2019 (COVID-19). In this patient, nirmatrelvir/ritonavir was administered, and the inhibitory effect of itraconazole on CYP3A was prolonged.

CASE PRESENTATION

We present a case in forties who had undergone lung transplantation. He was administered itraconazole and tacrolimus 1.0 mg/d, with a trough value of 8-12 ng/mL. The patient contracted the COVID-19, and a nirmatrelvir/ritonavir treatment was initiated. During the antiviral treatment, tacrolimus administration was discontinued for 5 d. Tacrolimus was resumed at 1.0 mg/d after completion of the nirmatrelvir/ritonavir treatment, but the trough value after 7 d was high at 31.6 ng/mL. Subsequently, the patient was placed on another 36-h tacrolimus discontinuation, but the trough value decreased to only 16.0 ng/mL.

CONCLUSIONS

Co-administration of ritonavir caused a prolonged decrease in tacrolimus clearance through its inhibitory effects on CYP3A in a patient taking itraconazole. Management of drug-drug interaction by pharmacists can be important for patients with multiple medications.

[Association between gender role attitudes and social support from mothers and paternal involvement in childcare]

Objective　Paternal involvement in child-rearing is an action goal of Healthy Parents and Children 21 (Tier 2), and should be actively promoted. Clarifying the related factors may contribute to countermeasures for promoting paternal involvement in child-rearing. This study aimed to examine the association between fathers' gender role attitudes and social support from their spouses (i.e., the mothers of the children) and their involvement in child-rearing.Methods　We obtained the data of fathers involved in childcare (aged 25-50 years; all full-time workers) through an internet research company. The paternal involvement in childcare scale (11 items, 4-point scale, e.g., "taking care of children," "cooking") was used as the dependent variable. The independent variables were gender role attitude ("Husbands should work outside the home and wives should take care of the home," 4-point scale) and social support from the mothers of the children (including appraisal, emotional, and instrumental support). The control variables were father's age, mother's employment status, number of children, the age of the youngest child, children going to nursery school or kindergarten, use of childcare services, self-evaluation of low economic status, work hours on weekdays, and marital relationship satisfaction.Results　The data of 360 men were analyzed (mean age 36.8 years, standard deviation 5.6). The results of the multivariable regression analyses with interaction terms are as follows: gender role attitude was significantly associated with childcare (β=-0.103) and housework (β=-0.125); appraisal support was significantly associated with childcare (β=0.142) and housework (β=0.199); and the interaction between gender role attitude and instrumental support was significant (β=0.176), indicating that, in individuals with a high gender role attitude score, a higher level of instrumental support was related to a higher childcare score (β=0.242).Conclusions　Fathers with egalitarian gender role attitudes and those who receive appraisal support from the other parent are more likely to participate in childcare. In addition, fathers with traditional gender role attitudes who receive instrumental support from the other parent may tend to participate in childcare.

Acrylamide monomers in universal adhesives

OBJECTIVES

The mono-functional monomer 2-hydroxyethyl methacrylate (HEMA) is often added to universal adhesives (UAs) to improve surface wetting and prevent phase separation. Nevertheless, HEMA promotes water sorption and hydrolysis at adhesive interfaces, hereby affecting long-term bonding to dentin. This study investigated if two acrylamide monomers could replace HEMA in an UA formulation applied in etch-and-rinse (2E&R) and self-etch (1SE) bonding mode.

METHODS

Four experimental UAs were bonded to bur-cut dentin. In addition to 12 wt% 10-MDP, 25 wt% Bis-GMA and 10 wt% TEGDMA as common monomer composition, 20 %wt ethanol and 15 %wt water as solvent, and 3 wt% polymerization-related additives, the four formulations solely differed for either the acrylamide cross-linker monomer 'FAM-201' as TEGDMA alternative and HEMA replacement, the hydroxyethyl acrylamide monomer 'HEAA' as HEMA alternative, HEMA ('HEMA+'), or extra TEGDMA in a HEMA-free control ('HEMA-'), all added in a 15 wt% concentration. The split-tooth study design involved application in 2E&R mode on one tooth half versus 1SE mode on the corresponding half. Micro-tensile bond strength of half of the micro-specimens was measured upon 1-week distilled water storage ('immediate' 1w μTBS), with the other half measured after additional 6-month storage ('aged' 6 m μTBS). Statistics involved linear mixed-effects (LME) modelling (p < .05). Additionally, interfacial TEM characterization, thin-film (TF) XRD surface analysis, LogP determination, and a cytotoxicity assay were carried out.

RESULTS

FAM-201 revealed significantly higher μTBS than HEMA+ at 1w and 6 m when applied both in E&R and SE bonding modes. HEAA's μTBS was significantly lower than that of HEMA+ at 1w when applied in SE mode. TF-XRD and TEM revealed similar chemical and ultrastructural interfacial characterization, including stable 10-MDP_Ca salt nano-layering. FAM-201 was least cytotoxic and presented with an intermediary LogP, while HEAA presented with the highest LogP, indicating high hydrophilicity and water-sorption sensitivity.

SIGNIFICANCE

The acrylamide co-monomer FAM-201 could replace HEMA in an UA formulation, while HEAA not.

Abstract P349: Predictive Value of Long-Term Systolic Blood Pressure Variability for the Development of Type 2 Diabetes Mellitus

Background: Better identification of high-risk individuals of type 2 diabetes mellitus (T2DM) for focused delivery of preventive measures requires risk prediction models using novel predictors. We evaluated the predictive value of long-term variability of systolic blood pressure (SBPV), which was recently reported to be associated with T2DM incidence, if added to a model with conventional T2DM predictors in a Japanese cohort study.

Methods: A cohort of 3017 Japanese individuals (2446 male, 571 female) ages 36-65 years were followed from 2007 to 2019. Root-mean-square error (RMSE) and slope of systolic blood pressure (SBP) change regressed on year were calculated per individual using SBP values obtained consecutively from 2003 to 2007 to represent SBPV. An initial Cox model included age, sex, smoking status, regular exercise, family history of diabetes, body mass index (BMI), baseline SBP, blood levels of triglycerides (TG), high-density lipoprotein cholesterol (HDLC) and fasting blood glucose (FBG), and backward elimination was used for variable selection. The c-statistics, net reclassification improvement (NRI) and integrated discrimination improvement (IDI) were used to compare the performance of prediction models without (Model 1) and with SBPV (Model 2).

Results: During 9.8-year (median) follow-up, 135 developed T2DM. We confirmed that RMSE was significantly associated with T2DM incidence independent of other variables used in a conventional model. Backwards elimination procedure selected BMI, TG, HDLC, FBG, SBP RMSE, and SBP slope for the final model (Table 1). Although the c-indices were not statistically different between Model 1 (0.77) and Model 2 (0.78) as well as the NRI (7.1%), the IDI was statistically significant (0.8%, p<0.05).

Conclusions: The present study revealed that long-term variability of SBP slightly improved the predictive value of T2DM if added to a conventional prediction model.

Search for the Majorana Nature of Neutrinos in the Inverted Mass Ordering Region with KamLAND-Zen

The KamLAND-Zen experiment has provided stringent constraints on the neutrinoless double-beta (0νββ) decay half-life in ^{136}Xe using a xenon-loaded liquid scintillator. We report an improved search using an upgraded detector with almost double the amount of xenon and an ultralow radioactivity container, corresponding to an exposure of 970 kg yr of ^{136}Xe. These new data provide valuable insight into backgrounds, especially from cosmic muon spallation of xenon, and have required the use of novel background rejection techniques. We obtain a lower limit for the 0νββ decay half-life of T_{1/2}^{0ν}>2.3×10^{26}  yr at 90% C.L., corresponding to upper limits on the effective Majorana neutrino mass of 36-156 meV using commonly adopted nuclear matrix element calculations.

Physical performance reference values for Japanese oldest old: a SONIC study

Background

The oldest old, defined as those aged 90 or over, is now the fastest-growing population sector. This study aimed to determine reference values for several physical performance measures (PPMs) among 90-year-olds using internationally standardized measurements and to clarify the characteristics of these indices by comparing their results for 90-year-olds with those for older people 70 and 80.

Methods

We used the Septuagenarians, Octogenarians, and Nonagenarians Investigation with Centenarians (SONIC) study data from 2010 to 2018. The study subjects were 70, 80, and 90-year-olds in the target area eligible to participate in the venue. Excluding those certified for long-term care, the final number of eligible persons is 70s cohort 1000 (2010), 80s cohort 973 (2011), and 90s cohort 690. 90s cohort only consisted of three survey waves: 2012, 2015, and 2018. We used hand grip strength and score on the Short Physical Performance Battery (SPPB) for our physical performance measurements. In addition, we statistically analyzed sex and age differences.

Result

The simple mean ± standard deviation (SD) for the 90-year-old respondents were in men, 24.1 ± 5.4 kg in hand grip strength, 0.80 ± 0.22 m/s in usual gait speed, 17.2 ± 6.73 s in 5times chair stand, 5.89 ± 4.42 s in tandem balance, and 8.3 ± 2.2 in SPPB respectively and in women, 14.4 ± 4.0 kg in hand grip strength, 0.72 ± 0.20 m/s in usual gait speed, 17.8 ± 7.89 s in 5times chair stand, 4.72 ± 4.35 s in tandem balance, and 7.5 ± 2.4 in SPPB, respectively. For all PPMs, the age 90 cohort was statistically significantly different from the age 70 and 80 cohorts (all trends P <  0.001). Hand grip strength decreased with a similar gradient with age cohort increase of 10 years for both sexes. In contrast, SPPB lower limb score showed a larger drop between the age 80 and 90 cohorts than between the age 70 and 80 cohorts. We also constructed sex-specific appraisal standards according to quintiles.

Conclusions

Our study yielded inclusive sex-specific reference values and appraisal standards for major physical performance measures not certified as requiring long-term care, community-dwelling, oldest old Japanese. The characteristics of age-related decline in physical performance differed between the upper and lower extremity assessments.

Construct Validity of a New Health Assessment Questionnaire for the National Screening Program of Older Adults in Japan: The SONIC Study

The Japanese government has implemented a new screening program to promote measures to avoid worsening lifestyle-related diseases and frailty among the older population. In this effort, the government formulated a new health assessment questionnaire for the screening program of old-old adults aged ≥75 years. The questionnaire comprises 15 items, of which 12 address frailty, two address general health status, and one addresses smoking habits. This study examined the construct validity of this questionnaire, using the explanatory factor analysis (EFA) and confirmatory factor analysis (CFA). The data used in this study were drawn from a mail-in survey conducted in 2020 as part of the Septuagenarians, Octogenarians, Nonagenarians Investigation with Centenarians study. A total of 1576 respondents (range, 78-99 years of age) were included in the study. Although the EFA did not show an interpretable factor structure of the questionnaire with 15 items, the CFA using only 12 frailty-related items showed the goodness of fit for a higher-order factor "frailty", and the five frailty-related sub-factors model was acceptable. These results suggest that the total score of the 12 frailty-related items in the questionnaire can be used as an indicator of the degree of "frailty".

Association between Neutrophil-to-Lymphocyte Ratio and Physical Function in Older Adults: A Community-Based Cross-Sectional Study in Japan

Inflammatory responses contribute to physical decline in older adults. Clinical studies have shown that the neutrophil-to-lymphocyte ratio (NLR), a marker of inflammation, is associated with physical decline. However, its association with physical function in community-dwelling older people is still unclear. Hence, we used cross-sectional data to investigate the relationship between NLR and physical function in community-dwelling older adults. Specifically, we analyzed data corresponding to 818 individuals (336 men and 482 women) aged ≥ 75 years, all of whom participated in comprehensive health examinations, including face-to-face interviews, biochemical analyses, and physical function tests. Using these data, we performed multivariable logistic regression analysis to assess the relationship between NLR and physical function, adjusting for sex, age, education, alcohol consumption, smoking, instrumental activity of daily living, body mass index, chronic disease, physical activity, serum albumin level, and depressive mood. The results showed that a higher NLR was associated with a lower grip strength, lower knee extension strength, and slower walking speed. Importantly, the relationship between NLR and physical function was maintained after adjusting for the confounding factors. Thus, we showed a significant association between NLR and physical function, supporting the use of NLR as a marker of physical function in community-dwelling older adults.

Association of Personality with Cognitive Failure among Japanese Middle-Aged and Older Adults

This study explored the associations between personality traits and cognitive failure (including minor lapses and prospective and retrospective memory failure) among middle-aged and older adults living in Japan. The participants were 373 adults, aged 40–84 (167 men and 206 women). The 15-item Japanese version of the Short Inventory of Minor Lapses was used to evaluate minor lapses, and the 16-item Japanese version of the Prospective and Retrospective Memory Questionnaire was used to assess prospective and retrospective memory failure. The participants’ variables evaluated for their association with cognitive failure were gender, age, education, paid work, social network, chronic disease, sleep quality, and the Big Five personality traits (i.e., neuroticism, extraversion, openness, agreeableness, and conscientiousness). Multivariable regression analyses demonstrated that sleep quality (β = −0.232), neuroticism (β = 0.163), and conscientiousness (β = −0.295) were related to minor lapses; age (β = 0.152), sleep quality (β = −0.168), and conscientiousness (β = −0.290) were associated with prospective memory failure; and age (β = 0.268), sleep quality (β = −0.146), and conscientiousness (β = −0.221) were associated with retrospective memory failure. These findings may facilitate the development of efficient strategies for the prevention of cognitive dysfunction and its adverse consequences for personal health.

Exposure of female NZBWF1 mice to imiquimod-induced lupus nephritis at an early age via a unique mechanism that differed from spontaneous onset

Systemic lupus erythematosus (SLE) is a chronic inflammatory and representative autoimmune disease. Extremely complicated and multifactorial interactions between various genetic factors and individual susceptibility to environmental factors are involved in the pathogenesis of SLE. Several studies have reported that mutation and activation of toll-like receptor (TLR) 7 are involved in the onset of autoimmunity, including SLE. Thus, we investigated the response of SLE-prone mice to continuous environmental factors, particularly TLR7 agonist exposure, and changes in their phenotypes. Female and male NZBWF1 (BWF1) mice were treated from 20 weeks of age with a TLR7 agonist, imiquimod (IMQ), 3 times weekly for up to 12 weeks. IMQ-exposed female BWF1 mice showed worsened lupus nephritis. However, autoantibody production was not enhanced in IMQ-exposed female BWF1 mice. The Th1 cytokine expression was upregulated in the kidney of IMQ-treated mice. In IMQ-exposed BWF1 mice, neutralization of IFN-γ suppressed early-phase lupus nephritis. Additionally, in male BWF1 mice IMQ exposure induced minor aggravation of lupus nephritis. These results suggest that the induction of aggravated lupus nephritis by TLR7 agonist exposure was related to the expression of IFN-γ via acute TLR7 signal-induced renal inflammation, and that the involvement of genetic factors associated with a predisposition to SLE is also essential. Thus, the activation of TLR7 signaling by exposure to environmental factors may upset the balance of factors that maintain SLE remission. We hypothesize that the inhibition of TLR7 signaling and IFN-γ signaling is effective for preventing the onset and flare and maintaining remission of lupus nephritis.

Association of personality traits with polypharmacy among community-dwelling older adults in Japan: a cross-sectional analysis of data from the SONIC study

Background

Polypharmacy is a serious concern among older adults and is frequently related to adverse outcomes, including health problems, reduced quality of life, and increased medical expenses. Although personality traits are associated with health behaviors and diseases, the effect of polypharmacy on personality traits is unclear. Therefore, we examined the association of personality traits with polypharmacy among community-dwelling older adults.

Methods

This cross-sectional study analysed data on 836 community-dwelling older adults aged 69–71 years who participated in the Japanese longitudinal cohort study of Septuagenarians, Octogenarians, and Nonagenarians Investigation with Centenarians. Polypharmacy was defined as the intake of ≥ 5 medications concurrently. Personality traits were assessed using the Japanese version of the NEO-Five-Factor Inventory (NEO-FFI). A five-factor model of personality traits, including “neuroticism,” “extraversion,” “openness,” “agreeableness,” and “conscientiousness,” was measured by the NEO-FFI.

Results

The average number of medications was about 3 in both men and women. Among the participants, polypharmacy was observed in 23.9% of men and 28.0% of women. Multivariable logistic regression analysis showed that neuroticism (adjusted odds ratio [aOR] per 1 point increase = 1.078, 95% confidence interval [CI] = 1.015–1.144) in men and extraversion (aOR = 0.932, 95% CI = 0.884–0.983) in women were associated with polypharmacy.

Conclusions

Higher neuroticism in men and lower extraversion in women were associated with polypharmacy. This study suggests that personality traits may be involved in the process leading to the development of polypharmacy. Information on individual personality traits may help medical professionals in decision-making regarding medication management for lifestyle-related diseases.

Risk factors of breakthrough aspergillosis in lung transplant recipients receiving itraconazole prophylaxis

INTRODUCTION

Invasive Aspergillus infection (IA) in lung transplantation can result in poor outcomes. Itraconazole has been shown to be effective for fungal prophylaxis in lung transplant recipients. However, IA remains a major cause of death after lung transplantation. Therefore, we aimed to clarify the risk factors for IA on itraconazole prophylaxis.

METHODS

We examined 120 recipients to uncover their IA epidemiology, clinical characteristics, and outcomes. In addition, a case-control study was performed to identify risk factors of IA.

RESULTS

Of the 120 patients, 12 developed IA under itraconazole prophylaxis. The patient demographics and clinical characteristics were compared among the following two groups: IA group, 12 patients, and control group, 108 patients. Significant differences were observed in age (p = 0.004), history of interstitial pneumonia (p = 0.032), and CMV infection (p < 0.001) between the groups. Before the onset of IA, 92% (11/12) of the patients received itraconazole with trough concentrations above the therapeutic range. IA developed at 272.9 ± 114.1 days after lung transplantation. Of the 12 patients who developed IA, 66.7% (8/12) had early cessation of cytomegalovirus (CMV) prophylaxis due to toxicity of valganciclovir, as follows: leukocytopenia in 4 patients, and renal dysfunction in 4 patients. Of the 8 patients who stopped valganciclovir, 75% (6/8) developed CMV infection subsequently.

CONCLUSION

This study suggests that older age, history of interstitial pneumonia, and CMV infection may be important risk factors for IA on itraconazole prophylaxis. These results may help clinicians optimize prophylactic strategies for IA.

Cdc42 has important roles in postnatal angiogenesis and vasculature formation

Cdc42, a Rho family low molecular weight G protein, has important roles in various cell functions, including cytoskeletal rearrangement, cell adhesion and cell proliferation and differentiation. To investigate the involvement of Cdc42 in the activities of vascular endothelial cells, we generated Cdc42 conditional knockout mice in which Cdc42 was time -specifically deficient in vascular endothelial cells (Cdc42 ​fl/fl; VE-Cad CreERT: Cdc42 cKO). When the Cdc42 gene was deleted after birth, Cdc42 cKO mice were smaller than the control mice, and died between postnatal day 8 (P8) and P10. Necropsy findings confirmed that these mice had various pathological aberrances in the vessels of most organs, such as blood flow congestion and blood cell invasion. Electron microscopic observations also revealed that capillary endothelial cells were detached from the basement membrane as well as phagocytosis of dead endothelial cells induced by macrophages. Moreover, vascular sprouting from aortic rings induced by VEGF-A was diminished in samples from the Cdc42 cKO mice because of an endothelial cell proliferation defect. These results suggest that Cdc42 in vascular endothelial cells has important roles in blood vessel formation after birth.

Clinical efficacy and safety of second line and salvage aflibercept for advanced colorectal cancer in Akita prefecture

BACKGROUND

Angiogenesis inhibitors (AIs) combination with cytotoxic chemotherapy is a promising treatment for patients with colorectal cancer (CRC). Aflibercept (AFL) is an option for second-line treatment of CRC, according to the ‘VELOUR’ trial. Currently, we can choose from three AIs, including bevacizumab, ramucirumab, and AFL. Different AIs can be used in subsequent treatment because of their distinctive mechanisms of action. We addressed the uncertainty regarding AFL efficacy and safety in heavily-treated patients by comparing outcomes of survival treatment with second-line treatment.

AIM

To determine and compare the efficacy and safety profiles of AFL in the second-line and salvage therapy settings.

METHODS

Clinical data of 41 patients with advanced CRC who received intravenous AFL combined with the folinic acid-fluorouracil-irinotecan (FOLFIRI) regimen were collected retrospectively from six institutions in Japan, for the period from May 2017 to March 2019. Patient characteristics collected included age, sex, tumor location, RAS and RAF status, metastatic sites, number of previous treatment cycles, therapeutic response, adverse events, duration of previous AI treatment, and survival time. The end points were time to AFL treatment failure (aTTF) and median survival time post-AFL (aMST). Statistical analyses were performed to compare the efficacy and safety in the second-line setting with those of the salvage therapy setting, which was defined as the days since the end of second-line therapy.

RESULTS

All 41 patients who received AFL + FOLFIRI for advanced CRC had metastatic or unresectable cancer. Twenty-two patients received AFL in the second-line setting and nineteen in the salvage therapy setting. The patient characteristics were similar in the two groups, except for two factors. The median duration of the previous AI administration was shorter in the second-line patients compared with that in the salvage therapy patients (144 d vs 323 d, P = 0.006). In the second-line and salvage therapy groups, the objective response rates were 11% and 0%, respectively (P = 0.50), and the disease control rates were 53% and 50%, respectively (P = 1.00). In the second-line and salvage therapy groups, the aTTF (123 d vs 71 d, respectively), aMST (673 d vs 396 d, respectively), and incidence of adverse events of grade 3 [8 (36%) vs 9 (47%)] were not significantly different between the two groups.

CONCLUSION

AFL can be used to treat advanced CRC patients, with a similar safety and efficacy in the salvage therapy setting as in the second-line setting.

Leisure activity moderates the relationship between living alone and mental health among Japanese older adults

AIM

As living alone is associated with poor mental health, seeking a moderating factor in this relationship may help enhance quality of life of older people living alone. Therefore, this study examined the moderating effect of leisure activity on the relationship between living alone and mental health in older people.

METHODS

This study employed a cross-sectional analysis of questionnaire data. Research was conducted in a metropolitan Tokyo ward from September to October 2017. Participants were 314 community-dwelling Japanese individuals (158 women, 156 men) aged 70-84 years (mean ± SD, 77.7 ± 4.4). We analyzed mental health using the Japanese version of the World Health Organization-Five Well-Being Index as the outcome variable, and the 11 items of the Leisure Activity Scale and living arrangements as explanatory variables. Multivariate analyses were used to examine effects of leisure activity on living arrangements and mental health.

RESULTS

The proportion of people living alone was 22.9% (N = 72), and the mental health score was mean ± SD, 14.2 ± 7.2. Multiple regression analysis showed that subjective economic status (β = -0.177), instrumental activities of daily living (β = 0.167), living arrangements (β = -0.142) and leisure activity (β = 0.481) were associated with mental health. The interaction effect between living arrangements and leisure activity on mental health was significant (β = 0.112).

CONCLUSIONS

Our findings show that leisure activity moderates poor mental health in older adults living alone. Accordingly, interventions should encourage older adults living alone to engage in leisure activity to improve their mental health. Geriatr Gerontol Int 2021; 21: 421-425.

Touch-Cure Polymerization at the Composite Cement-Dentin Interface

Ceramic restorations are often adhesively luted onto the tooth prep. The so-called touch-cure concept was developed to yield optimum polymerization of composite cement at the restoration-cement-tooth interface for immediate bond stabilization. Although this touch cure is theorized to initiate polymerization at the interface when the accelerator in the primer makes contact with the cement, this process has not yet been proven. This study aimed to elucidate the mechanism of touch cure by measuring the degree of conversion (DC) of composite cement applied with or without an accelerator-containing tooth primer (TP) versus an accelerator-free primer using real-time Fourier-transform infrared spectroscopy (RT-FTIR) and attenuated total reflection (ATR)-FTIR. Interfacial bond strength was measured in shear mode, the accelerator composition confirmed by X-ray fluorescence analysis (XRF), and the interfacial interaction of TP and composite cement with dentin investigated by X-ray diffraction (XRD), focused-ion-beam scanning electron microscopy (FIB-SEM) with 3-dimensional interface reconstruction, and transmission electron microscopy (TEM). RT/ATR-FTIR revealed the significantly highest DC when the composite cement was applied with the accelerator-containing primer. XRF disclosed a vanadium compound as a novel chemical accelerator within TP, instead of a classic chemical curing initiator system, to set off touch cure as soon the cement contacts the previously applied primer. Although the TP contains the acidic functional monomer 10-MDP for adhesion to tooth tissue, touch cure using the accelerator-containing TP combined the fastest/highest DC with the highest bond strength. FIB-SEM and TEM confirmed the tight interfacial interaction at dentin with submicron hybridization along with stable 10-MDP also Ca-salt nanolayering.

Is skin disinfection before subcutaneous injection necessary? The reasoning of Certified Nurses in Infection Control in Japan

Nurses continue to disinfect the skin before administering subcutaneous injections as a standard process in clinical settings; despite evidence that disinfection is not necessary. To implement evidence-based practice, it is critical to explore why this gap between "evidence" and "practice" exists. This study aimed to describe the reasons offered by Certified Nurses in Infection Control (CNIC) in Japan for performing skin disinfection before subcutaneous injection. Adopting an inductive qualitative design, interviews were conducted with 10 CNIC in 2013. According to the participants, skin disinfection before subcutaneous injection: (a) was common practice; (b) may have been beneficial if it was omitted; (c) adhered to hospital norms; (d) prevented persistent suspicion of infection; (e) had no detrimental effect; (f) was an ingrained custom; and (g) involved a tacit approval for not disinfecting in home care settings. The themes (c) and (g) were cited as the main reasons affecting decision-making. The CNIC administered injections following skin disinfection in hospitals in accordance with hospital norms. On the contrary, outside the hospital, they administered subcutaneous injections without skin disinfection. All themes except (b) and (g) reflect the barriers and resistance to omitting skin disinfection, while (g) shows that it is already partly implemented in home care settings. It is necessary to create a guideline for skin disinfection before subcutaneous injection that considers the quality of life of patients at home, their physical conditions, and the surrounding environment at the time of injection, in addition to the guidelines applicable in hospitals.

Urinary incontinence onset predictors in community-dwelling older women: A prospective cohort study

AIM

We aimed to investigate whether physical function was associated with urinary incontinence (UI) onset in community-dwelling older Japanese women.

METHODS

This was a 4-year prospective cohort study. After excluding participants with UI and missing data in the baseline survey, we included 890 participants in the analyses. Physical function including grip strength, maximal walking speed, knee extension strength, single-leg balance, and timed up and go (TUG) were measured. The primary outcome was the onset of all UI and different types of UI (urge, stress and mixed) based on the questionnaire survey. Binary logistic regression analysis was applied to calculate the adjusted odds ratios and 95% confidence intervals for the association between physical function and the risk of all UI and different types of UI incident.

RESULTS

Among the 890 participants, 221 (25%) developed UI during the 4-year follow-up. After adjusting for confounders, better knee extension strength, maximal walking speed and TUG were significantly associated with a lower risk of all UI and urge UI onset, and better single-leg balance and TUG were significantly associated with a lower risk of mixed UI onset (P for trend <0.05). No significant association was found between physical function and the risk of stress UI onset.

CONCLUSIONS

This study confirmed that better lower extremity physical function is associated with lower risk of urge and mixed UI onset, indicating that exercise programs focusing on maintaining and improving lower extremity physical function may be useful for reducing such events among older women. Geriatr Gerontol Int 2021; 21: 178-184.

Nano-Layering Adds Strength to the Adhesive Interface

X-ray diffraction (XRD) surface analysis and ultrastructural interfacial characterization using transmission electron microscopy (TEM) confirmed that the functional monomer 10-methacryloyloxydecyl dihydrogen phosphate (10-MDP) self-assembles into nano-layers at adhesive-tooth interfaces. Self-assembled nano-layering is thought to contribute to the durability of bonding to tooth dentin, although this has not been proven yet. In order to disclose this potential bond-durability contribution of nano-layering, we observed the 3-dimensional (3D) spreading of nano-layering by a series of focused-ion-beam (FIB) milled cross sections by scanning electron microscopy (FIB-SEM) and examined the mechanical properties of self-assembled nano-layering using scanning probe microscopy (SPM). A commercial 10-MDP-containing 3-step self-etch adhesive partially demineralized dentin up to submicron depth, forming a submicron hydroxyapatite-rich hybrid layer. TEM chemically and ultrastructurally confirmed the formation of interfacial nano-layering. FIB-SEM 3D reconstructions disclosed a 3D network of self-assembled nano-layering extending from the hybrid layer up to within the adjacent adhesive-resin layer. SPM revealed that nano-layering within the adhesive-resin layer possessed a higher elastic modulus than that of the surrounding adhesive resin, hereby suggesting that nano-layering contributes to the mechanical strength of adhesives like filler particles do. Nano-layering's 3D expanded structure is expected to strengthen the surrounding resin, as well to better interconnect the adhesive-resin layer to the hybrid layer. In conclusion, this exploratory study demonstrated that nano-layering constitutes a strong phase at the adhesive interface, which may contribute to the clinical longevity of the 10-MDP-based bond to dentin.

Effects of colour narrative in community-dwelling older adults: A mixed methods study

BACKGROUND

Based on occupational storytelling/story-making, this study developed Colour Narrative, a program to promote the health and well-being of community-dwelling older adults.

OBJECTIVES

To conduct a pilot study to implement Colour Narrative in a heavy snowfall area of Japan and verify the participants' experiences in the program and its effectiveness.

MATERIAL AND METHODS

An advanced mixed methods design was used. The participants were 22 members of a community-based social group for older adults. Quantitative measurements of life functions and health-related quality of life (HRQOL) were conducted before and after the intervention. Qualitative data were collected from focus group interviews regarding the participants' experiences during the intervention process. Lastly, both datasets were integrated.

RESULTS

The harsh living conditions due to heavy snowfall reduced the participants' overall activity. In this environment, Colour Narrative encouraged them to control their lives more in their own ways and enhanced their HRQOL. The core of their experiences was 'negating occupations'. This negotiation was a highly intellectual task that significantly improved their cognitive function.

CONCLUSIONS

The structure and content of Colour Narrative were found to be useful and feasible for community-dwelling older adults.

SIGNIFICANCE

Colour Narrative offers a new occupation-based intervention strategy for preventive occupational therapy.

Purification of human iPSC-derived cardiomyocytes by HDAC inhibition through inducing apoptosis and cell arrest in non-cardiomyocytes

Background

Cell therapy is one of the most promising strategies for treatment of heart failure. During preparation of iPSC-derived cardiomyocytes for cells therapy, it is important to eliminate the presence of residual proliferative non-target cells in the preparation as these non-target cells could present the risk of tumorgenicity. To minimize the risk, selective and more precise purification process is necessary.

Purpose

We hypothesized that the differences in proliferative activity between cardiomyocytes and non-target cells might result in different sensitivities to the drugs targeting cell growth/survival. The aim of this study is to obtain compounds that eliminate non-cardiomyocytes selectively and to study the mechanism of action of these compounds.

Methods and results

We screened 314 small compounds using both iPSCs and sorted hiPSC-derived cardiomyocytes (hiPSC-CMs). We identified several compounds, which markedly decreased the cell numbers of iPSCs, but showed minimum effects on those of hiPSC-CMs. Among them, HDAC inhibitors were selected as the most promising candidates. We examined whether HDAC inhibitors could purify hiPSC-CMs containing non-cardiomyocytes populations, which were differentiated using the classical embryoid body (EB) method. As a result, HDAC inhibitors increased the purity of cardiomyocytes (up to 98%) by decreasing non-target cells such as smooth muscle cells, endothelial cells, and endodermal lineage cells. Moreover, we confirmed HDAC inhibitors could be used for purification of cardiomyocytes in monolayer differentiation protocol using GSK3β inhibitor and Wnt inhibitor. We measured the expression levels of mRNA and protein in iPSCs and hiPSC-CMs (EB method) treated with HDAC inhibitors. mRNA levels of CDKN1A (p21) and BAX were upregulated in iPSCs. Western blotting analyses revealed that HDAC inhibitors also induced the expression of p21 and the cleavage of Caspase3 in iPSCs.

Conclusions

Our result suggests that the inhibition of HDAC enables an efficient purification of hiPSC-CMs in multiple differentiation methods. Furthermore, our data indicate that HDAC inhibitors induce the apoptosis and cell cycle arrest in iPSCs but not hiPSC-CMs.

Figure 1

Funding Acknowledgement

Type of funding source: Private company. Main funding source(s): Takeda Pharmaceutical Company Limited

Preclinical proof-of-concept study: antisense-mediated knockdown of CALM as a therapeutic strategy for calmodulinopathy

Background

Calmodulin (CaM) is a ubiquitous Ca2+ sensor molecule encoded by three distinct calmodulin genes, CALM1–3, and has an important role for cardiac ion channel function. Recently, heterozygous missense mutations in CALM genes were reported to cause a new category of life-threatening genetic arrhythmias such as long-QT syndrome (LQTS) and catecholaminergic polymorphic ventricular tachycardia (CPVT), which is called as “calmodulinopathy”. The patients with calmodulinopathy show poor prognosis and there is no effective treatment for them.

Purpose

Considering the dominant-negative effect of mutant calmodulin proteins produced by heterozygous missense mutations in CALMs, we aimed to prove the concept of antisense-based therapy to treat calmodulinopathy using human iPS cell-derived cardiomyocyte (hiPSC-CM) model.

Methods

We designed multiple locked nucleic acid (LNA) gapmer-antisense oligonucleotides (ASOs) targeting CALM2 and analyzed the silencing efficiency and toxicity in cultured cells to select the most potent ASO. Using CMs differentiated from hiPSCs which were generated form a 12-year-old boy with LQTS carrying a heterozygous CALM2-N98S mutation, CALM2 expression and action potentials (APs) were analyzed to evaluate the efficacy of ASOs.

Results

We identified several ASOs which reduced CALM2 expression without affecting cell viability in human cultured cells (HepG2) (ASO 50 nM, n=2; Figure 1A). Considering further experiments in vivo mouse model, we investigated the CALM2 silencing activity in mouse cultured cells (3T3-L1) without transfection (free-uptake) (ASO 1 μM, n=2; †ASOs have homologous sequence between human and mouse; Figure B). After free-uptake CALM2 silencing analysis in 3T3-L1 cells, we identified that ASO #2 has the most potent CALM2 silencing activity and low cytotoxicity (Figure 1B). ASO #2 effectively reduced CALM2 expression even in hiPSC-CMs (ASO(−): n=3, lipofection: n=4, free-uptake: n=3; P&lt;0.05; Figure 1C). In action potential recordings, we demonstrated that ASO #2 ameliorated prolonged AP durations (APD90) in N98S-hiPSC-CMs at 0.5 Hz pacing (ASO(−): 666±123 ms (n=7), lipofection: 329±21 ms (n=8), free-uptake: 388±34 ms (n=12); P&lt;0.05; Figure 1D).

Conclusion

Our results using patient-derived hiPSC-CM model suggest that ASO-based therapy might be a promising strategy for the treatment of calmodulinopathy.

Figure 1

Funding Acknowledgement

Type of funding source: Private company. Main funding source(s): Nissan Chemical Corporation

Visceral fat accumulation and left atrial phasic function in the general population

Background

Obesity carries independent risk for incident atrial fibrillation (AF), although the impact of abdominal fat distribution on LA morphological and functional remodeling is not fully elucidated. Speckle-tracking echocardiography is a novel and sensitive tool that allows quantification and detection of subtle alterations in left atrial (LA) phasic function.

Purpose

This study aimed to investigate whether increased visceral adiposity is independently associated with impaired LA phasic function in a community-based cohort.

Methods

We included 527 participants without overt cardiac disease who underwent laboratory testing, abdominal computed tomographic examination and speckle-tracking echocardiography. Abdominal adiposity was quantitatively assessed as visceral fat area (VFA) and subcutaneous fat area (SFA) at the level of the umbilicus. Speckle-tracking echocardiography was performed to assess LA phasic function including reservoir, conduit and pump strain as well as left ventricular global longitudinal strain (LVGLS).

Results

Mean age was 57±10 years and 362 of the participants (69%) were men. LA reservoir and conduit strain were decreased according to the VFA quartiles (both p&lt;0.05), whereas there was no significant difference in LA volume index and LA pump strain. When stratified by SFA, there was no significant differences in LA volume index and all LA phasic strain across the quartiles. In multivariable analysis, VFA as continuous variable was significantly associated with LA conduit strain, independent of traditional cardiovascular risk factors, pertinent laboratory parameters and LV morphology and function including LVGLS (standardized b=−0.146, p=0.011). Representative cases are shown in the Figure.

Conclusion

In a sample of the general population, VFA accumulation was independently associated with worse LA conduit strain, which may be involved in the pathophysiological mechanism of obesity-related AF.

Funding Acknowledgement

Type of funding source: Foundation. Main funding source(s): Yamauchi Susumu Scholarship for Cardiovascular Research

Obesity associated pro-fibrotic protein augments fibrosis in heart

 

Chronic sterile inflammation in visceral fat has causal roles for systemic metabolic disorders in obesity. Inflamed visceral adipose tissue secretes pro-inflammatory adipokines, and this contributes to tissue remodeling under a metabolically stressed condition. Various kinds of white adipokines are broadly studied, however, roles of brown adipose tissue (BAT) derived adipokines (BATokine) remain to be explored. In this project, we tried to characterize pathogenic role of BATokine in obesity related fibrotic disorders, especially focusing on heart failure with preserved ejection fraction (HFpEF). For this purpose, we analyzed two sets of DNA microarray data, and identified an obesity associated pro-fibrotic protein (OAFP) as a possible pathogenic BATokine. Our biobank studies showed OAFP increased in patients with diastolic dysfunction, and E/e' analyzed with cardiac echo increased in direct proportion to circulating OAFP level in humans. We generated dietary obese mice model, and found OAFP increased both in BAT and circulation. We generated a murine systemic or BAT specific OAFP knockout (KO) models, and found that obesity-induced diastolic dysfunction ameliorated in these models. Cardiac fibrosis was also suppressed by genetic depletion of OAFP. We found OAFP increased in circulation in aged humans and mice, and studies in chronologically aged mice showed this molecule increased in BAT with aging. Our results indicate that OAFP is secreted predominantly from BAT, and mediates pathogenic roles by augmenting cardiac fibrosis in dietary obesity or aging. Suppression of OAFP may become a therapy for HFpEF.

Funding Acknowledgement

Type of funding source: None

Sarcopenia-derived exosomal micro-RNA 16-5p exerts the cardio-repair disturbance via pro-apoptotic mechanism in myocardial infarction of mice

Background

Sarcopenia is a pathophysiological malfunction induced by skeletal muscle atrophy, and several studies reported an association between sarcopenia-induced cardiac cachexia and poor prognosis in heart disease. Since only a few established animal models are recently available, the underlying mechanism of disturbed cardiac repair accompanied with sarcopenia remains poorly understood.

Purpose

We hypothesized that specific microRNAs in sarcopenia-derived exosomes play crucial roles in disturbed cardiac repair with sarcopenia, and these microRNAs directly exacerbate cardiomyocyte injury following cardiac ischemia and reperfusion.

Methods

We developed a novel sarcopenia-induced cardiac repair disturbance mouse model that is induced by tail suspension (TS) 7 days after a 45-min coronary occlusion of cardiac ischemia and reperfusion (I/R). The reduction of the left ventricular ejection fraction (LVEF) after I/R was compared in mice with TS [I/R-TS(+), n=14] and without [I/R-TS(−), n=12] by echocardiography. To investigate the exosomal mechanism of cardiac repair disturbance, a comprehensive analysis of extracted exosomal microRNAs from mice serum was performed in the 2 groups at day 8. Then, we investigated the impact of the identified candidate microRNA in neonatal rat cardiomyocytes (NRVMs). After 4 days in primary culture, candidate microRNA was transfected into NRVMs under hypoxic culture conditions. TUNEL analysis and quantitative PCR analysis of apoptosis-related genes were performed on the NRVMs.

Results

At day 8 after I/R, the LVEF of I/R-TS(+) was not significantly ameliorated compared to that of I/R-TS(−) (ΔLVEF; 1.59±6.92 vs. 8.04±7.71% p=0.034). Four candidate microRNAs obtained from I/R mice serum were identified in the microRNA array analysis. The re-analysis of these candidate micro-RNAs using all I/R mice demonstrated that the level of mir-16-5p in I/R-TS(+) was raised by approximately nine-fold than that in I/R-TS(−) (9.67±13.35 vs. 0.99±1.41, p&lt;0.05). Next, an in vitro experimental model using a microRNA mimic revealed that apoptosis in NRVMs was greatly enhanced by the transfection of a mir-16-5p mimic in hypoxic culture conditions (mir-16-5p vs. control = 5.77±2.84 vs. 1.72±0.55%, p&lt;0.01). Furthermore, by qRT-PCR analysis, the expression of CASP3 and TRP53 were upregulated in NRVMs treated with a mir-16-5p mimic than in control NRVMs.

Conclusion

Myocardial I/R injury in sarcopenia ended in cardiac repair disturbance accompanying with the enhanced expression of exosomal-mir-16-5p. A pro-apoptotic effect of mir-16-5p may exacerbate myocardial I/R injury and thus can be a novel therapeutic target for cardiac repair disturbance in sarcopenia.

Funding Acknowledgement

Type of funding source: Public grant(s) – National budget only. Main funding source(s): Japan Society for the Promotion of Science

The crucial roles of coagulation factors in inducing brown adipose tissue dysfunction and systemic metabolic disorder in obesity

 

The prevalence of obesity is increasing worldwide. Obese individuals are predisposed to cardio-metabolic disorders. Brown adipose tissue (BAT) is an active metabolic organ abundant with mitochondria, and studies suggest a potential role of BAT in the maintenance of metabolic health in rodents and humans. Metabolic stress causes BAT dysfunction, but the underlying mechanisms are largely unknown. Coagulation factor Xa (FXa) is critically involved in a coagulation cascade, and it is also known to mediate biological effects by the activation of protease-activated receptor (PAR)-signaling. Accumulating evidence shows that PAR1 contributes to tissue remodeling in cardiovascular system. Analyzing deposited microarray data, we found transcripts for coagulation factors including factor VII (F7), factor X (F10), and PAR1 receptor were increased in BAT from obese mice. Here we show a previously unknown role of FXa-PAR signaling in promoting BAT dysfunction and systemic metabolic disorder in a murine dietary obese model.

Imposing a high fat diet (HFD) on C57BL/6NCr mice led to a marked increase in tissue factor (TF), coagulation factor VII and FXa in BAT. TF-FVIIa (activated form of FVII)-FXa complex is known to activate PAR1, and we found a significant increase in PAR1 expression in BAT upon metabolic stress. Administration of a FXa inhibitor ameliorated BAT whitening, improved thermogenic response and systemic glucose intolerance upon dietary obesity. Fxa inhibition reduced reactive oxygen species (ROS) level in BAT. In contrast, administration of warfarin did not show any phenotype in BAT. BAT specific TF and PAR1 over-expression model showed significant whitening of this tissue, which was associated with systemic glucose intolerance. We generated BAT specific PAR1 KO mice. BAT-PAR1 KO mice exhibited re-browning of BAT along with reduced ROS level in this tissue. In BAT-PAR1 KO mice, glucose intolerance and thermogenic response under a metabolically stressed condition were ameliorated. In differentiated brown adipocytes, FXa markedly increased mitochondrial ROS and reduced mitochondrial membrane potential. Inhibition of PAR1 ameliorated FXa-induced mitochondrial ROS production and reduction in membrane potential. We also found that plasma FXa level did not increase in obese mice as well as in obese individuals. These results suggest the previously unknown role of coagulation systems in promoting BAT dysfunction, leading to systemic metabolic disorders. Maintenance of BAT homeostasis through the suppression of FXa-PAR1 signaling would become a new therapeutic target for obesity and diabetes.

Funding Acknowledgement

Type of funding source: None