Treatment of Esophageal Achalasia With Sarcopenic Dysphagia by Rehabilitation and Nutritional Support: A Case Report.

Esophageal achalasia is a disease characterized by esophageal motor dysfunction, leading to various symptoms, including vomiting and chest pain. There is no curative treatment for this disease, and the consensus on nutritional therapy or rehabilitation is unclear. Herein, we present the case of a 90-year-old woman with symptoms of esophageal achalasia, exacerbated by secondary sarcopenia and sarcopenic dysphagia after coronavirus disease 2019 (COVID-19) pneumonia. The patient presented with chest pain and vomiting while on a soft diet, and esophagography revealed typical esophageal achalasia. Her esophageal achalasia symptoms resolved, with improvements in nutritional status, skeletal muscle mass, and physical capacity, when a combination of nutritional and comprehensive rehabilitation therapies was adopted. This case highlights that oral dysphagia is associated with worsening esophageal achalasia symptoms and that nutritional and rehabilitative interventions are effective in relieving the symptoms of achalasia in patients with esophageal achalasia and sarcopenia.

Cross-Sectional Area Analysis of the Head of the Caudate Nucleus in Huntington's Disease.

BACKGROUND: Caudate nucleus atrophy is a well-known neuroimaging feature of Huntington's disease (HD). Some researchers have reported a decrease in the volume of the striatum on magnetic resonance images (MRIs) even in the presymptomatic stage of the disease. Despite the many neuroimaging studies on HD, the optimal method for measuring the caudate nucleus area on MRIs and the most effective cutoff values for diagnosing HD remain unclear. OBJECTIVES AND METHODS: To define suitable imaging sequences and cutoff values for HD, we measured the area of the head of the caudate nucleus (HCN) in 11 patients with HD, 22 age- and sex-matched individuals without neurodegenerative disorders in the central nervous system, 22 sex-matched patients with Alzheimer's disease, 22 sex-matched patients with Parkinson's disease, and 7 patients with dentatorubral-pallidoluysian atrophy. RESULTS: On T2-weighted images (T2WIs), we found significantly reduced HCN area at the rostral level in individuals with HD relative to those of the individuals in the other groups. A significant inverse correlation (ρ = -0.61, p = 0.046) was observed between the HD duration and HCN area at the rostral slice level on T2WIs. The cutoff value for distinguishing patients with HD from healthy individuals and those with other neurodegenerative diseases was 85 mm2 at the rostral level on T2WIs (100% sensitivity and specificity). CONCLUSIONS: This cutoff value can be applied clinically to evaluate brain atrophy in HD. Our method is advantageous because it is simple and can be implemented easily in daily clinical practice.

Specific amyloid-ß42 deposition in the brain of a Gerstmann-Sträussler-Scheinker disease patient with a P105L mutation on the prion protein gene.

Although colocalization of amyloid ß (Aß) with prion protein (PrP) in the kuru plaque has previously been observed in the brain of prion diseases patients, the participating Aß species has not been identified. Here, we present an immunohistochemical assessment of the brain and spinal cord of a 69-year-old Japanese female patient with Gerstmann-Sträussler-Scheinker disease with a P105L mutation on the PRNP gene (GSS-P105L). Immunohistochemical assessment of serial brain sections was performed using anti-PrP and -Aß antibodies in the hippocampus, frontal and occipital lobes. She died 69 years after a 21-year clinical course. Immunohistochemistorical examination revealed that ~50% of the kuru plaques in the cerebrum were colocalized with Aß, and Aß42 was predominantly observed to be colocalized with PrP-plaques. The Aß deposition patterns were unique, and distinct from diffuse plaques observed in the normal aging brain or Alzheimer's disease brain. The spinal cord exhibited degeneration in the lateral corticospinal tract, posterior horn, and fasciculus gracilis. We have demonstrated for the first time that Aß42, rather than Aß40, is the main Aß component associated with PrP-plaques, and also the degeneration of the fasciculus gracilis in the spinal cord in GSS-P105L, which could be associated with specific clinical features of GSS-P105L.

Predicting Preoperative Hemodynamic Changes Using the Visual Analog Scale.

PURPOSE: This study aimed to investigate how both visual analog scale cutoff scores and State-Trait Anxiety Inventory scores relate to hemodynamic changes in patients entering the operating theater. DESIGN: A prospective observational study. METHODS: The study subjects included 130 prospectively enrolled patients who were scheduled for abdominal surgery under combined epidural-general anesthesia and who underwent preoperative anxiety level measurements using both scales. FINDINGS: The heart rate and systolic blood pressure on entering the operating theater were significantly higher than those at baseline in the high and low/moderate anxiety groups. Variations in heart rate and systolic blood pressure were significantly higher, whereas peripheral blood flow was significantly lower in the high anxiety group compared with the low/moderate anxiety group. CONCLUSIONS: Using the visual analog scale to measure anxiety can improve our understanding of the hemodynamic changes that occur when patients enter the operating theater.

[Central nervous system infection presenting with cognitive impairment].

In diabetes mellitus, various complications are caused by microvascular damage caused by a long-term hyperglycosemic state. In diabetes mellitus, the prevalence of the infectious disease is high and is easy to become severe. And, central nervous system infection is one of the most important causes of cognitive impairment. We want to show about some important central nervous system infections which affect to cognitive functions.

Effects of an off-site walking program on fibrinogen and exercise energy expenditure in women.

PURPOSE: Increased fibrinogen levels may trigger cardiac events in patients with atherosclerosis. Early control of fibrinogen levels before the progression of atherosclerosis that occurs with aging and menopause may benefit women, but the effects of exercise on fibrinogen levels as a preventive value have not been examined in early to middle adulthood women with lack of regular exercise. The present study aims to identify the effect of an off-site walking-based exercise program on fibrinogen levels in such women. METHODS: A prospective, 12-week, randomized and controlled study was used. Fifty-two women aged 32 to 57 years who did not exercise regularly or exercised with a weak intensity level were randomly assigned to either an intervention group (IG, n = 26) or a control group (CG, n = 26) for a 12-week study. Exercise energy expenditure (EEE) was measured using a microelectronic device. Fibrinogen levels were assessed using the clotting time method before and after the exercise program. RESULTS: The mean change from baseline EEE was 1.17 ± 0.98 kcal/kg/day in IG subjects (n = 24) and 0.46 ± 0.68 kcal/kg/day in CG subjects (n = 25), a 30% difference between groups (p = .01). The mean change in fibrinogen levels was -8.0 ± 34.5 mg/dl (3% decrease) in IG subjects (n = 24) and -3.6 ± 40.0 mg/dl (1% decrease) in CG subjects (n = 25). No significant difference in fibrinogen levels was seen between groups (F = 1.179, p = .279). CONCLUSION: EEE increased significantly, but fibrinogen levels did not decrease significantly. The effects of a 12-week off-site walking program on fibrinogen levels were inconclusive. As implications for nursing practice, our findings have suggested fibrinogen levels are not a novel cardiovascular risk factor any more, and provide important information on safe exercise to minimize adverse effects from fibrinogen arising from exercise intensity, especially in women with advanced atherosclerosis when nurses increase exercise intensity levels. Further studies with larger sample sizes in women to confirm the effect of exercise on reducing fibrinogen levels are necessary.

Role of the Schizosaccharomyces pombe F-Box DNA helicase in processing recombination intermediates.

In an effort to identify novel genes involved in recombination repair, we isolated fission yeast Schizosaccharomyces pombe mutants sensitive to methyl methanesulfonate (MMS) and a synthetic lethal with rad2. A gene that complements such mutations was isolated from the S. pombe genomic library, and subsequent analysis identified it as the fbh1 gene encoding the F-box DNA helicase, which is conserved in mammals but not conserved in Saccharomyces cerevisiae. An fbh1 deletion mutant is moderately sensitive to UV, MMS, and gamma rays. The rhp51 (RAD51 ortholog) mutation is epistatic to fbh1. fbh1 is essential for viability in stationary-phase cells and in the absence of either Srs2 or Rqh1 DNA helicase. In each case, lethality is suppressed by deletion of the recombination gene rhp57. These results suggested that fbh1 acts downstream of rhp51 and rhp57. Following UV irradiation or entry into the stationary phase, nuclear chromosomal domains of the fbh1Delta mutant shrank, and accumulation of some recombination intermediates was suggested by pulsed-field gel electrophoresis. Focus formation of Fbh1 protein was induced by treatment that damages DNA. Thus, the F-box DNA helicase appears to process toxic recombination intermediates, the formation of which is dependent on the function of Rhp51.

Effects of an off-site walking program on energy expenditure, serum lipids, and glucose metabolism in middle-aged women.

The present study aims to identify the effects of systematic walking on exercise energy expenditure (EEE) and blood profiles in middle-aged women. Fifty-two female nurse managers, aged 32 to 57 years (42.0 +/- 6.2), were randomly assigned to an intervention group (IG) and a control group (CG) for a 12-week study of the walking program. EEE was measured using a microelectronic device. Blood profiles were assessed before and after the walking program. The mean EEE (kcal/kg/d) in the IG and CG was 4.73 +/- 1.02 and 3.88 +/- 0.81 (P = 0.01), indicating an increase of 1.17 +/- 0.98 and 0.46 +/- 0.68 from baseline (P = 0.01), respectively. The mean change in high-density lipoprotein cholesterol in the IG and CG was 1.8 +/- 8.3 mg/dL and -2.9 +/- 7.0 mg/dL (P = 0.051); that in insulin was -4.5 +/- 7.5 microU/dL and -0.6 +/- 4.3 microU/dL (P = 0.046), respectively. These results show that systematic walking increases EEE and improves blood profiles.