The Incidence of Severe Radiation-Induced Lymphopenia during Chemoradiotherapy for Stage Ⅲ Non-Small Cell Lung Cancer: A Comparative Study of Proton Versus Photon-Based Radiotherapy

PURPOSE/OBJECTIVE(S)

To investigate the incidence of severe radiation-induced lymphopenia (SRL) and the survival in patients with stage Ⅲ non-small cell lung cancer treated with concurrent chemoradiotherapy with passive scattering proton beam (PSPT) or photon-based radiotherapy (XRT) including 3D-CRT and IMRT.

MATERIALS/METHODS

We conducted a retrospective cohort study including 355 patients who received definitive concurrent chemoradiotherapy with PSPT (n = 38) or XRT (n = 317) at our institution between January 2010 and December 2020. SRL during concurrent chemoradiotherapy was defined as absolute lymphocyte counts (ALCs) of <500 cells/mm3. Propensity score matching (PSM) analysis was performed to adjust for the patient characteristics between the PSPT and XRT groups. Propensity scores were calculated using age, sex, PS (0-1 vs. 2), primary tumor location (upper/middle vs. lower lobe), pathology (Adeno vs. Others), PTV volume, ALCs at pretreatment, year of treatment (before vs. after July 2018, when durvalumab approved in Japan), and platinum-based chemotherapy regimen (CDDP based vs. CBDCA based). After PSM, the incidence of SRL and the overall survival (OS) were analyzed.

RESULTS

The GTV and PTV volumes were significantly lower in the PSPT group than in the XRT group (median, 57 vs. 103 mm3; p < 0.05, 322 vs. 399 mm3; p < 0.05, respectively). ALCs at pretreatment were significantly lower in the PSPT group than in the XRT group (median, 1531 vs. 1718 cells/mm3; p < 0.05). SRL was observed in 275 patients (87%) in the XRT group and 27 patients (71%) in the PSPT group (p < 0.05). After PSM, PSPT significantly reduced the incidence of SRL compared to XRT (68.6 % vs. 88.6 %, p < 0.05), and the patients without SRL may have better 3-year OS than those with SRL (71.1 % vs. 55.3 %; p = 0.062).

CONCLUSION

Compared with XRT, PSPT significantly reduced the incidence of SRL, and the patients without SRL had a good prognosis.

The Impact of Generativity on Maintaining Higher-Level Functional Capacity of Older Adults: A Longitudinal Study in Japan

Generativity is defined as an individual's concern for and actions dedicated toward the well-being of others, especially youth and subsequent generations. It is a key stage of psychological development from midlife to older age and can be a guiding concept for promoting engagement of older adults in productive and contributive activities, which benefit their well-being. This study examined the longitudinal association between generativity and higher-level functional capacity (HLFC) decline in older Japanese adults. The two-year longitudinal data of 879 older adults aged 65-84 years were analyzed. Participants' HLFC and generativity were assessed using the Tokyo Metropolitan Institute of Gerontology Index of Competence and the Revised Japanese version of the Generativity Scale, respectively. The binary logistic regression analysis results showed that a higher generativity score was negatively associated with HLFC decline, indicating that generativity effectively prevents HLFC decline over 2 years. On adding the interaction term between generativity and sex to examine whether the protective effect of generativity differed by sex, we found that generativity was especially effective in protecting the HLFC decline in men with higher generativity. The study results highlight the importance of promoting engagement of older adults in generative activities to maintain their HLFC.

[Actual work situation of second-layer Seikatsu-shien coordinators before and after the first emergency declaration during the COVID-19 pandemic]

Objective　This study aims to understand the status of the resident support activities of second-layer Seikatsu-shien coordinators, who assist in local residents' community development activities, based on long-term care. It observes the effects of these activities, and the presence or absence of relevant instructions from the government or affiliated institutions during and after a state of emergency, such as a lockdown situation. This was examined during the first state of emergency following the COVID-19 crisis, from April to May 2020.Method　In October 2020, a self-administered questionnaire was distributed by mail to 279 second-layer Seikatsu-shien coordinators working in Tokyo's special wards, and 181 responses were collected. The survey focused on the coordinators' activities and activity frequency before the spread of COVID-19, during the state of emergency, and after the activities resumed. Furthermore, the survey questioned whether relevant instructions from the government or affiliated institutions were given during the state of emergency and after the activities resumed. Their details were confirmed in the free comments section.Activity　In creating and revising regional diagnosis tables for the area covered, creating and distributing information magazines and leaflets, etc. included in "understanding social resources and providing information to relevant parties," activity frequency was significantly higher after activities resumed, than before the spread of infection. During the state of emergency, activity frequency was high in the affiliated institution, and only 3.4% of the coordinators visited and spoke to local residents; 91.1% of respondents received instructions from government and affiliated institutions during the state of emergency, and activity frequency was significantly higher when there were instructions; 76.5% received instructions after resuming activities, and activity frequency, such as understanding residents' needs through individual interviews and visits, matching them with services, and supporting the resumption of activity groups was significantly higher when instructions were provided.Conclusion　 After resuming activities, understanding the value of social resources and providing information to the relevant parties was prioritized. During the state of emergency, almost no visits or calls were made to local residents. The frequency of activities to reach out to residents was higher in the presence of instructions, especially after activities resumed. It was suggested that with the rapid spread of a new infectious disease, confusion will likely occur in the field, and having specific instructions will affect the Seikatsu-shien coordinators' activities.

Effects of intergenerational contact on social capital in community-dwelling adults aged 25–84 years: a non-randomized community-based intervention

Background

Accumulating social capital in urban areas is essential to improve community health. Previous studies suggested that intergenerational contact may be effective for enhancing social capital. However, no study has examined the effect of intergenerational contact on social capital through a population-based evaluation. This study aimed to investigate the effects of a community-based intervention to increase the frequency of intergenerational contact on social capital among adults aged 25–84 years.

Methods

This study used a non-randomized controlled trial design to conduct a community-based intervention (from March 2016 to March 2019). The study area was Tama ward, Kawasaki city, Kanagawa, Japan. The area comprises five districts; one district was assigned as the intervention group and the other four districts as the control group. We provided the intervention to residents in the intervention group. The intervention comprised three phases: Phase 1 was the preparation term (organizing the project committee); Phase 2 was the implementation term (trained volunteer staff members, conducted the intergenerational greeting campaign, and held intergenerational contact events); and Phase 3 was the transition term (surrendering the lead role of the project to the city hall field workers). In the control group, field workers provided public health services as usual. We conducted mail surveys in September 2016 and November 2018 to assess the effects of the intervention on social capital during Phase 2. Eligible participants were randomly selected from community-dwelling adults aged 25–84 years according to age (10,620 control group individuals and 4479 intervention group individuals). We evaluated social trust, norm of reciprocity, and social support as outcome variables.

Results

In total, 2518 participants completed both surveys and were analyzed (control group: 1727; intervention group: 791). We found that social trust (coefficient = 0.065; 95% confidence interval [CI]: 0.006, 0.125) and norm of reciprocity (coefficient = 0.084; 95% CI: 0.020, 0.149) positively changed in the intervention group compared with the control group.

Conclusions

This community-based intervention may contribute to sustaining and improving social capital among community-dwelling adults.

Trial registration: UMIN000046769 (UMIN-CTR); first registered on January 28, 2022 (retrospectively registered).

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-022-14205-6.

Therapeutic efficacy of intra-arterial docetaxel and nedaplatin infusion concomitant with radiotherapy for T4 maxillary sinus squamous cell carcinoma

The aim of this study was to evaluate the efficacy of intra-arterial chemoradiotherapy with docetaxel and nedaplatin for T4 maxillary sinus squamous cell carcinoma (MSSCC). Data were retrospectively analysed for 22 consecutive patients with T4 MSSCC who underwent intra-arterial chemoradiotherapy. Participants received intensity-modulated radiotherapy (70 Gy in 35 fractions) concomitantly with docetaxel (60 mg/m²) and nedaplatin (80 mg/m²) administered every 4 weeks for a total of three sessions. The median follow-up period was 49 months (range 12-91 months). T4a tumours were found in 16 patients (73%) and T4b tumours in six patients (27%). Cervical metastasis was found in nine patients (41%; five N2b, four N2c). The 5-year loco-regional control, disease-free survival, and overall survival rates for patients with T4a disease were 92.3%, 92.3%, and 90.3%, respectively, compared to 83.3% (P = 0.42), 66.7% (P = 0.07), and 83.3% (P = 0.46), respectively, for those with T4b disease. The 5-year loco-regional control, disease-free survival, and overall survival rates for patients with cervical lymph node metastasis were all 87.5% compared to 92.3% (P = 0.86), 84.6% (P = 0.69), and 92.3% (P = 0.93), respectively, for those without cervical metastasis. Intra-arterial chemoradiotherapy with docetaxel and nedaplatin may provide favourable loco-regional control and increased survival in T4 MSSCC.

Association between the frequency of daily intellectual activities and cognitive domains: A cross-sectional study in older adults with complaints of forgetfulness

OBJECTIVES

Frequent engagement in intellectual activities has been shown to reduce the risk of developing dementia. The present study sought to examine the association between the frequency of daily intellectual activities and cognitive domains in older adults with complaints of forgetfulness.

METHODS

A cross-sectional study was conducted as a part of regional health examination in Tokyo from 2014 to 2016. A total of 436 participants were asked the frequency of intellectual activities in four categories: 1) reading, 2) writing, 3) using technology, and 4) watching TV and listening to the radio. The Japanese version of the Montreal Cognitive Assessment (MoCA-J) scale was used for the cognitive assessments. The relationships between MoCA-J scores and each intellectual activity were explored.

RESULTS

Binominal logistic regression analysis revealed that the frequencies of reading, writing, and using technology were significantly related to the language and attention, language, and memory domains, respectively, even after adjusting for demographic characteristics.

CONCLUSIONS

The results suggested that the frequency of daily intellectual activities differed depending on the activity type, and each activity was related to a specific cognitive domain.

Generativity Among Japanese Elderly: Its Association With Demographic Characteristics and Health Indicators

Generativity is defined as concern and activity dedicated to contributing to the welfare of others, especially younger generations. Although generativity is postulated to be an important developmental task in old age, there are few reports of its related factors in Asian countries. The purpose of our study is to examine the gender difference of generativity and to explore the defining factors among Japanese elderly. During August to September 2016, we conducted a questionnaire survey for randomly selected 1,187 people aged 65–84 years in the Tokyo area (527 males, 660 females, mean age 72.6 years±5.5), and measured the following variables: generativity, gender, age, length of residence, parental status (having children or grandchildren), working status, commitment to child-rearing activities, mental health (WHO-5 scores), and Instrumental Activities of Daily Living (IADLs). As a result of Student’s t-test, we found that males scored significantly higher on generativity than females (t=2.678, df=1067.097, p<.01). Moreover, we carried out multiple regression analysis, separated by gender. The results showed that, only among males, generativity was positively related to age (β=.096, p<.05) and having children (β=.148, p<.001). In addition, we found that generativity was positively associated with the following variables in both genders: having jobs, commitment to child-rearing activities, mental health, and IADLs (β=.081–.318, p=.000–.032). Among them, mental health and IADLs especially had strong effects on generativity (β=.188–.318, p<.001). We have concluded that the related factors of generativity differ between males and females, but regardless of gender, health indicators are strongly associated with generativity in old age.

The Impact of Taking Care of Grandchildren on Health Outcomes in Japanese Community-Dwelling Elderly

Taking care of grandchildren may provide health benefits to older adults due to keeping their social roles and feeling more generative; however, we have scarce knowledge of the relationships in Asian countries. This study addressed this question in older Japanese. The data was obtained from a two-year follow-up mail survey conducted in 2016 on 3,116 randomly selected older Japanese, aged 65-84 years, living in a metropolitan area. The main outcome was deterioration of health assessed by the Self-Rated Health (SRH), WHO-5, and Instrumental Activities of Daily Living (IADLs), defined as decline in 1 or more points obtained after 2 years of follow-up. The frequency of taking care of grandchildren was assessed as every day, 4-6 days per week, 1-3 days per week, 1-3 days per month, several days per year, and none. A multiple linear regression examined the impact of taking care of grandchildren as a predictor of protection of decline in SRH, WHO-5 and IADLs. The models were adjusted for confounding factors. Of 1,561 who responded to the follow-up survey, 959 people had grandchildren at baseline. The subjects had a mean age of 73.2±5.3 years, and mean scores of SRH:2.1±0.6; WHO-5;16.1±5.3, IADLs; 4.9±0.6 (higher scores represent higher evaluation). The higher frequency of taking care of grandchildren were longitudinally associated with less decline in SRH, WHO-5, and IADLs (standardized partial regression coefficient, β=-0.090, p=0.013; β =-0.023, p=0.547; β =-0.107, p=0.008, respectively). In conclusion, taking care of grandchildren might be a protective factor of comprehensive and functional health deterioration.

[School students' greeting behavior and its association with their community attachment and helping behavior]

Objectives　Many local governments and elementary and junior high schools in Japan have conducted a "greeting campaign". This has been done in order to activate communication among local residents, and to instill public spirit and sociability in students' minds. However, few studies have explored the significance of greeting campaigns. The present study investigates greeting in neighborhoods and its relationship with students' spontaneous greeting behavior. The study also seeks to understand the quantity of greeting in daily life and its association with a student's community attachment and helping behavior.Methods　A self-completion questionnaire survey was conducted with 1,346 students studying in the fourth and higher grades at elementary schools, and 1,357 students in the first and second grade at junior high schools. There were 2,692 valid respondents. We performed the following analyses using the data of elementary school students and junior high school students separately. A partial correlation analysis was conducted wherein gender and grade were introduced as control variables. This analysis tested the correlation between the frequency of being greeted by surrounding people and the frequency of greeting by students, of their own accord. A path analysis that tested the relationship between students' greeting behavior, their attachment to residential areas, and helping behavior was also conducted.Results　The results of the partial correlation analysis revealed that there was a positive correlation between the frequency of being greeted by surrounding people and the frequency of greeting by students, of their own accord, regardless of gender and grade. Moreover, the results of the path analysis revealed that the frequency of being greeted was positively associated with community attachment and that the frequency of students' spontaneous greeting behavior was positively associated not only with community attachment but also with helping behavior. The goodness of model fit was high for both the data of elementary school students as well as the data of junior high school students.Conclusion　We found that exchanging greetings with surrounding people in daily life enhanced students' attachment to the community. In particular, we showed that students' spontaneous greeting behavior led to their helping behavior, which supports the significance of recommending greeting at home, school, or in the local community. Since there was a correlation between the frequency of being greeted and the frequency of greeting willingly, we consider that actions of surrounding adults become important to help students acquire spontaneous greeting behavior.

[The relationship between intra- and inter-generational exchange and mental health among young and older adults]

Objective　The purpose of this study was to examine the relationship between intra- and inter-generational exchange and mental health among young adults aged 25-49 years and older adults aged 65-84 years.Methods　In 2016, a community-based, cross-sectional survey was conducted. A total of 3,334 young adults (valid response rate: 24.6%), and 3,116 older adults (valid response rate: 46.0%) completed the survey and were included in the analysis. Their mental health was evaluated using the World Health Organization-Five Well-Being Index (WHO-5), and those who scored under 13 or scored less than one on any item were considered to have poor mental health. To evaluate the intra- or inter-generational exchange, participants were asked about their frequency of interaction with people aged 20-49 years or aged ≥70, excluding family and co-workers. Young adults who interacted with people aged 20-49 years or older adults who interacted with people ≥70 were classified as "having intra-generational exchange," while young adults who interacted with people ≥70 years or older adults who interacted with people aged 20-49 years were classified as "having intergenerational exchange." Therefore, individuals who interacted with both generations were classified as "having multi-generational exchange," and those who did not interact with any generation were categorized as "no exchange." We conducted a logistic regression analysis that included mental health as a dependent variable, intra- and inter-generational exchange as independent variables, and gender, age, educational attainment, marital status, living situation, subjective economic status, social participation, employment, self-rated health, and Instrumental Activity of Daily Living as covariates.Results　Of the 3,334 young adults, 61.5% were mentally healthy, 51.3% had intra-generational exchange, 21.9% had inter-generational exchange, 16.5% had multi-generational exchange, and 42.7% did not have any exchange. Of the 3,116 older adults, 65.8% were mentally healthy, 67.9% had intra-generational exchange, 34.3% had inter-generational exchange, 29.9% had multi-generational exchange, and 21.1% did not have any exchange. A logistic regression analysis revealed that "having intra-generational exchange" and "having intergenerational exchange" were significantly related to better mental health in both young adults (intra-generational; Odds ratios (OR) 1.19, 95% confidence intervals (CI) 1.10-1.30: inter-generational; OR 1.13, 95% CI 1.03-1.25) and older adults (intra-generational; OR 1.15, 95% CI 1.02-1.29: inter-generational; OR 1.46, 95% CI 1.30-1.65). Therefore, "having multi-generational exchange" was more strongly related to better mental health compared with "only having intra-generational exchange."Conclusion　Among young and older adults, intra- and inter-generational exchange were related to better mental health, and multi-generational exchange showed the strongest relationship with better mental health.

[Community Child-Rearing Support Scale: Applicability across generations and differences in the supportive behaviors among generations]

Objectives　Using the Community Child-Rearing Support Scale (CCRSS), which was developed for older adults, we examined 1) the reliability and validity of the scale for multiple generations, as well as the generational differences in the 2) degree and content of supportive behaviors for child rearing and 3) correlates of the behavior, in conjunction with gender differences.Methods　A mail survey was conducted with residents aged 25-84 years who were randomly selected from two cities in Tokyo and the surrounding areas, and responses were obtained from 8918 residents (response rate: 33%). The respondents were grouped as follows: old-aged (65-84 years), middle-aged (50-64 years), and young-aged (25-49 years). We performed the following analyses by age group and gender: 1) Cronbach's reliability coefficient and a confirmatory factor analysis of the CCRSS, 2) analysis of variance of the total CCRSS scores and scores of the three subscales ("children's security and sound growth," "instrumental support to parents," and "emotional support to parents"), and 3) a multiple regression analysis of the total scores in which various individual characteristics were introduced as explanatory variables.Results　The reliability coefficient was over 0.85 for each age group, and the factor analysis showed good model fitness. Compared to the middle- and young-aged groups, the old-aged group was more likely to provide support for "children's security and sound growth," and equally (for women) or more likely (for men) to provide "emotional support to parents," thereby resulting in the highest total score among the three generations. The mean score of "instrumental support to parents," such as taking care of a child, was the highest for young women, although the score was low overall. Having a child or grandchild under 13 years old and stronger generativity were positively associated with child-rearing support for all age groups; however, the degree of associations varied across the groups. While having a child was strongly associated with support among the young-aged group, the association between support and generativity was stronger for older groups. Moreover, participation in neighborhood associations or volunteer groups and high school or lower education were associated with more support among all age groups, whereas living in rental apartments was associated with less support among the young-aged group.Conclusion　Our findings suggest that the CCRSS can be used for multiple generations and that old people play an important role in child rearing in the community. We found both differences and similarities between generations with respect to the correlates of child-rearing support.

Occlusal Support, Dysphagia, Malnutrition, and Activities of Daily Living in Aged Individuals Needing Long-Term Care: A Path Analysis

OBJECTIVES

This study aimed to examine the interrelationships among occlusal support, dysphagia, malnutrition, and activities of daily living in aged individuals needing long-term care.

DESIGN

Cross-sectional study and path analysis.

SETTING

Long-term health care facilities, acute care hospitals, and the community.

PARTICIPANTS

Three hundred and fifty-four individuals aged ≥ 65 years with dysphagia or potential dysphagia in need of long-term care.

MEASUREMENTS

The modified Eichner Index, Dysphagia Severity Scale, Mini Nutritional Assessment Short Form, and Barthel index.

RESULTS

The participants included 118 males and 236 females with a mean (standard deviation) age of 83 (8) years. A total of 216 participants had functional occlusal support with or without dentures. Of the total participants, 73 were within normal limits regarding the severity of dysphagia, 119 exhibited dysphagia without aspiration, and 162 exhibited dysphagia with aspiration. Only 34 had a normal nutritional status, while 166 participants were malnourished, and 154 were at risk of malnutrition. The median Barthel index score was 30. Path analysis indicated two important findings: occlusal support had a direct effect on dysphagia (standard coefficient = 0.33), and dysphagia was associated directly with malnutrition (standard coefficient = 0.50). Dysphagia and malnutrition were associated directly with impaired activities of daily living (standard coefficient = 0.57, 0.22).

CONCLUSION

In aged individuals needing long-term care, occlusal support is associated directly with dysphagia and indirectly with malnutrition and activities of daily living via dysphagia.

Ultrasonographic Abdominal Screening of Atomic Bomb-Exposed Subjects

Abdominal ultrasonographic screening for cancer was performed in 6001 Hiroshima and Nagasaki A-bomb exposed and comparison subjects, all members of the Adult Health Study of the Radiation Effects Research Foundation, formerly the Atomic Bomb Casualty Commission. This study yielded 20 cancers, including 7 hepatocellular, 3 gastric, 3 renal and 2 urinary bladder cancers; one cancer each of the ovary, pancreas, colon and ureter; and one cancer metastatic to the liver, whose primary was unknown. Seventeen of these 20 subjects manifested no symptoms or signs of their disease. A variety of additional tumors, unproven and probably benign, including uterine myomata, and other abnormalities were also detected. Abdominal ultrasonographic screening greatly assisted in the detection of cancers, most of which neither the patients nor their physicians were aware. In this screened fixed population sample the cancer detection rate was 0.33%, exceeding any such rates previously reported in the medical literature.

Radiographic Changes in Cardiac Contours following Heart Transplantation

Chest radiographs of 46 patients who had undergone heart transplantation were reviewed with special attention to abnormalities of the cardiac contours. MR imaging in 3 such patients revealed 3 types of double right cardiac contours: the recipient right atrium combined with the donor right atrium; the donor right atrium combined with the recipient left atrium; and a cardiac fat pad combined with the right atrium. A prominent main pulmonary artery was shown by MR imaging to result from leftward displacement of the main pulmonary artery caused by clockwise rotation and transverse position of the transplanted heart. Recognition of these unique radiographic appearances is of value in assessing transplanted hearts and in avoiding misdiagnosis.

Mr Imaging of Pediatric Hematologic Disorders

The present report illustrates the efficiency of MR imaging in evaluating children with hematologic disorders.

Correlation of immunologic status with high-resolution CT and distributions of pulmonary tuberculosis

Purpose: To investigate the correlation of cluster of differentiation (CD)4 lymphocyte counts with high-resolution CT (HRCT) findings and distribution of pulmonary tuberculosis.

Material and Methods: Thirty-seven bacteriologically proven pulmonary tuberculosis, clinically non-AIDS, patients underwent HRCT and CD4 lymphocyte counts in peripheral blood cells were obtained within 3 days after the CT examinations. Patients were categorized into four groups according to CD4 lymphocyte counts (A &gt;800; B 800-500; C 500-200; D &lt;200). HRCT findings analyzed were as follows: typical, atypical, and mixed findings of post-primary tuberculosis, common, uncommon, and mixed distribution, and number of lobes involved.

Results: CD4 lymphocyte counts correlated with the degree of the mixture of atypical CT findings (ρ=0.565, p&lt;0.001) and the degree of the mixture of uncommon distribution (ρ=0.431, p&lt;0.01). Number of involved lobes showed no statistically significant correlation (ρ=0.209, p=0.21).

Conclusion: In patients with low CD4 levels, atypical HRCT findings co-exist with typical findings, and uncommon sites are involved in addition to common sites.

[Characteristics of elderly people registering with emergency contacts systems Case study of "elderly monitoring key ring"]

OBJECTIVES

Here we investigated the characteristics of users of an emergency system that tracks elderly people, known as the "elderly monitoring key ring." The relevance of a spreading policy or strategy and the user characteristics were investigated to develop programs conducted by local governments to manage unidentified elderly people with dementia.

METHODS

A questionnaire was conducted in July 2013 in a district of the Ota Ward in Tokyo. The questionnaire was administered to residents >65 years of age (N=7,608), of which 5,166 (67.9%) responded. Fully completed responses (N=4,475) were analyzed with binomial logistic regression analysis using "monitoring key rings" as the dependent variable and simultaneously inputted sex, age, living arrangement, social isolation, Instrumental Activities of Daily Living (IADL), and complaints of memory loss as independent variables. Interviews were also conducted in August 2014 of the staff members (N=12) of six community comprehensive support centers in the Ota Ward.

RESULTS

The logistic regression analysis results indicated that women used the monitoring key rings 1.64 times more often than men, late elderly used it 4.39 times more often than early elderly, elderly living alone used it 2.14 times more often than elderly not living alone, non-isolated people used it 1.36 times more often than isolated people, IADL non-independent people used it 1.50 times more often than independent people, and people with complaints of memory loss used it 1.37 times more often than those without such complaints. On the other hand, the results of interviews indicated that elderly people living alone, those with worries, and relatively young and healthy elderly people were targets. The main targets of community comprehensive support centers were elderly individuals living alone and early elderly individuals. The utilization rate of elderly people living alone was high; however, that of early elderly people was low. They recognized that people registered with the system tended to have high anxiety, be relatively young and highly independent, and register after learning about the system from their peers or through neighborhood associations.

CONCLUSION

Individuals who were female, late elderly, elderly living alone, non-isolated, IADL non-independent, or had complaints of memory loss were most likely to be registered with the key ring. The circumstance of registration which community comprehensive support centers recognize related to the low utilization rate of elderly people who are isolated. In the future, the system should be introduced to socially isolated as well as relatively young elderly people.

Affinity imaging mass spectrometry (AIMS): high-throughput screening for specific small molecule interactions with frozen tissue sections

A novel screening system, called affinity imaging mass spectrometry (AIMS), identifies candidate small molecules with specific affinity for nanoscale structures, including proteins, in unfixed human tissue sections.

Genes associated with the progression of neurofibrillary tangles in Alzheimer's disease

The spreading of neurofibrillary tangles (NFTs), intraneuronal aggregates of highly phosphorylated microtubule-associated protein tau, across the human brain is correlated with the cognitive severity of Alzheimer's disease (AD). To identify genes relevant to NFT expansion defined by the Braak stage, we conducted whole-genome exon array analysis with an exploratory sample set consisting of 213 human post-mortem brain tissue specimens from the entorinal, temporal and frontal cortices of 71 brain-donor subjects: Braak NFT stages 0 (N=13), I-II (N=20), III-IV (N=19) and V-VI (N=19). We identified eight genes, RELN, PTGS2, MYO5C, TRIL, DCHS2, GRB14, NPAS4 and PHYHD1, associated with the Braak stage. The expression levels of three genes, PHYHD1, MYO5C and GRB14, exhibited reproducible association on real-time quantitative PCR analysis. In another sample set, including control subjects (N=30), and in patients with late-onset AD (N=37), dementia with Lewy bodies (N=17) and Parkinson disease (N=36), the expression levels of two genes, PHYHD1 and MYO5C, were obviously associated with late-onset AD. Protein-protein interaction network analysis with a public database revealed that PHYHD1 interacts with MYO5C via POT1, and PHYHD1 directly interacts with amyloid beta-peptide 42. It is thus likely that functional failure of PHYHD1 and MYO5C could lead to AD development.

Management of angiogram-negative acute colonic hemorrhage: safety and efficacy of colonoscopy-guided superselective embolization

BACKGROUND

We evaluated the efficacy and safety of superselective embolization with assistance of colonoscopy for acute colonic hemorrhage.

METHODS

Of 92 cases of acute colonic hemorrhage requiring colonoscopic intervention, 11 (12 %) could not be successfully treated. Of these, 10 patients (9 men, mean age 65.5 years, range 39-75 years) underwent superselective embolization. Hemorrhage was caused by diverticular disease (n = 8), polypectomy (n = 1), and vascular malformation (n = 1). In all 10 cases, the radiopaque clips were placed at the bleeding point via colonoscopy. Microcatheters were used in all procedures, and embolization was performed at the level of the vasa recta leading to or near the clips with Gelfoam particles, microcoils, or both.

RESULTS

Immediate hemostasis was achieved in all patients. In 6 of 10 patients (60 %), selective angiograms showed no active extravasation at the time of the procedure and the embolization was performed using clips as a landmark. In the remaining four patients, selective angiograms showed active extravasation from the vasa recta leading to the clips. The mean number of embolized vessels with no active extravasation and with active extravasation was 1.83 (range 1-3) and 1.25 (range 1-2), respectively. The mean duration of clinical follow-up was 11.6 months (range 1-29 months). One patient (10 %) bled from a different site than the treated site a month after embolization, but the bleeding ceased after endoscopic intervention. All the patients (100 %) were evaluated for objective evidence of ischemia by colonoscopy. Four of the 10 patients (40 %) were found endoscopically to have small areas of ischemia involving only the mucosa, but they remained asymptomatic. There was no bowel infarction or stricture.

CONCLUSIONS

Colonoscopy-assisted superselective embolization may be a safe and useful procedure for acute colonic hemorrhage without active extravasation on angiogram.