Clinical background factors affecting outcomes of Helicobacter pylori eradication therapy in primary care.

OBJECTIVE: Few studies have reported the influence of clinical background factors on the outcome of Helicobacter pylori eradication therapy in primary care practice. We aimed to determine which clinical background factors influence the outcome of eradication therapy in a primary care setting. METHODS: This was a retrospective study of patients who received H pylori eradication therapy at Higashiohmi City Gamo Medical Center, Shiga, Japan, from January 2012 to December 2015. We investigated clinical background factors associated with success, failure, and self-interruption of H pylori eradication therapy: patients' age, gender, first- or second-line treatment, reasons for receiving gastroenterological endoscopic examination, method of drug administration, and attending physicians' age and their specialties. RESULTS: There were 369 patients (208 females, 161 male), with a mean age of 59 years (range 30-88 years). The middle-aged group (50-69 years) was associated with successful eradication therapy compared with the young group (30-49 years). The elderly group (>70 years) was associated with eradication therapy failure compared with the middle-aged group. The young group was associated with self-interruption of eradication therapy. There was a marginally significant association between male patients and self-interruption. Older attending physicians (>50 years) were also associated with failure compared with younger physicians. There was no difference in outcome of eradication therapy between generalists and gastroenterology specialists. CONCLUSION: We have identified clinical factors associated with success, failure, and self-interruption of H pylori eradication therapy in a primary care setting.

A nationwide survey of hepatitis E virus (HEV) infection in wild boars in Japan: identification of boar HEV strains of genotypes 3 and 4 and unrecognized genotypes.

To investigate the nationwide prevalence of hepatitis E virus (HEV) infection and to characterize HEV genomes among Japanese wild boars (Sus scrofa leucomystax), 578 boars captured in 25 prefectures from 2003 to 2010 were studied. Anti-HEV IgG was detected in 8.1%, and HEV RNA in 3.3% of boars. Among the 19 boar HEV isolates obtained from infected boars, 14 isolates (74%) were classified as genotype 3, 4 isolates (21%) as genotype 4, and the remaining isolate (wbJOY_06) was distantly related to all known HEV isolates of genotypes 1-4, differing by 18.4-25.0% and 18.0-24.3% within the 412-nucleotide sequence of ORF1 and ORF2, respectively. A genotype 4 boar HEV isolate (wbJGF_08-1) obtained herein shared 98.6% identity over the entire genome with a human HEV isolate obtained from a patient who developed acute hepatitis after consuming undercooked wild boar meat, suggesting that wild boars are also reservoirs for genotype 4 HEV in humans.

Cognitive function in Japanese centenarians according to the Mini-Mental State Examination.

BACKGROUND/AIMS: We examined the effect of aging on cognitive function at the limit of human life expectancy by characterizing state of cognition in centenarians without clinical cognitive impairment. METHODS: Participants were 68 centenarians without cognitive impairment (Clinical Dementia Rating (CDR) 0), 96 controls 60 to 74 years old, and 46 controls 75 to 89 years old. We visited the places where centenarians were living and administered the Mini-Mental State Examination (MMSE) individually. Control subjects came to the assembly hall within their dwelling area, to be administered the MMSE. RESULTS: Mean total scores of centenarians (22.3) were lower than for either 60-74 (27.2) or 75-89 (26.2). Comparison of scores in each of five cognitive domains measured by MMSE showed a significant age-group effect upon orientation, memory, and attention. Centenarians' scores were lower than for younger groups in every domain except for the language and praxis, concentration, and for repetition. CONCLUSION: The centenarians' scores in memory and orientation declined as in earlier studies of normal aging. Centenarians' scores for attention and concentration differed from those in previous studies. The present result suggests that even primary memory is influenced by advanced age in centenarians, while ability to store information declines, ability to process is maintained.

Adipose endocrine function, insulin-like growth factor-1 axis, and exceptional survival beyond 100 years of age.

BACKGROUND: Observational studies have demonstrated similarities between the underpinning of frailty and biological features of centenarians, suggesting that adaptability to age-related multiple physiological decline may be a core component of successful aging. The aim of this study is to determine whether hormonal pathways potentially involved in energy homeostasis contribute to survival beyond 100 years of age. METHODS: We assessed a total of 252 centenarians (mean [standard deviation (SD)] age, 101.5 (1.8) years, range 100-108 years) using a complete set of biomarkers of adipose endocrine function and the insulin-like growth factor-1 (IGF-1) axis. Conventional risk factors at baseline were also assessed. The participants were followed up for all-cause mortality every 12 months by telephone contact. RESULTS: During 2253 days of follow-up, 208 centenarians (82.5%) died. The lowest tertile of leptin and the highest tertile of tumor necrosis factor-alpha were associated with higher mortality risk among centenarians after adjusting for age (per 6-month increase), sex, education, smoking, activities of daily living (ADL), cognitive function, and comorbidities (hazard ratio [HR] 1.6; 95% confidence interval [CI], 1.14-2.35; and HR 1.45; 95% CI, 1.00-2.08, respectively). The lowest tertiles of both IGF-1 and IGF binding protein 3 (IGFBP3) were also associated with increased mortality. The adipose risk score, indicating cumulative effects of adipokine dysregulation, was strongly associated with increased mortality risk; ADL; cognitive function; and levels of albumin, cholinesterase, high-density lipoprotein-cholesterol, C-reactive protein, interleukin 6, and IGF-1 at baseline. CONCLUSIONS: The results suggested that preservation of adipose endocrine function and the IGF-1 axis may be potentially important for maintaining health and function and promoting survival at an extremely old age.

Morbidity of Tokyo-area centenarians and its relationship to functional status.

BACKGROUND: Research in Western countries has shown most centenarians to be survivors with multiple comorbidities. However, Japanese centenarians' morbidity and its relationship to functional status has yet to be elucidated. The aim of this study is to clarify the association of morbidity with the physical and cognitive function of centenarians. We examined Tokyo-area centenarians to determine their kinds of morbidity profiles and how such morbidity related to their functional status. METHODS: We studied 302 centenarians living in Tokyo (101.2+/-1.8 years; 65 men, 237 women), and assessed their physical status, morbidity, and use of medication. Activities of daily living and cognitive function were also assessed using the Barthel Index and the Clinical Dementia Rating. RESULTS: More than 95% of the centenarians had chronic diseases. Both the physical and cognitive functions were significantly higher in men. The present and previous illnesses most frequently included hypertension, heart disease, stroke, fractures, and cataracts. Fractures were observed significantly more frequently in women. Diabetes mellitus was uncommon. The physical and cognitive function of centenarians with a history of stroke or fracture were particularly poor, whereas those centenarians with hypertension tended to show a high level of physical and cognitive function. CONCLUSIONS: Almost all centenarians had chronic diseases. Stroke and fracture were correlated with poorer function; therefore, we hypothesize that prevention of stroke and fracture might improve functional status in the oldest-old.

Three-dimensional culture of keratinocytes and the formation of basement membrane for canine footpad substitute.

A pad equivalent for a dog was prepared as a substitute for the loss of footpad. In addition to the time course of formation on epidermal morphogenesis, we investigated expressions of alpha(6) integrin subunit as adhesive molecule, and laminin and type IV and VII collagens as extracellular matrices of basement membrane components. Epithelium of the pad equivalent was thick enough to be easily confirmed at 5 days at the air-liquid interface, but many creases appeared on it at 7 days, and it shrank at 10 and 14 days. Keratinocytes were increased in 4 to 5 cell layers at 1 day at the air-liquid interface, differentiating into basal cell layer. Granular and corneal cell layers were confirmed until 5 days, and maintained their shape at least until 14 days. Alpha 6 integrin was expressed at almost the same fluorescent intensity as native pad tissue at 1 day at the dermal-epidermal junction. Laminin and type IV collagen were intermittently expressed at 5 and 10 days, respectively, at the dermal-epidermal junction, and at 14 days the fluorescence showed almost the same intensity as native pad tissue. The expression of type VII collagen was discontinuous at 2 days at the dermal-epidermal junction, but remained as it was at 14 days. The present findings suggested that although the formation of anchoring fibrils in basement membrane was incomplete, the pad equivalent in the dog was reconstructed similar to a native pad by epidermal morphogenesis.

Functional status of centenarians in Tokyo, Japan: developing better phenotypes of exceptional longevity.

BACKGROUND: Centenarians are sometimes said to be representative of lifelong healthy aging. Whether they are, in fact, examples of healthy aging remains a subject of debate. The existence of heterogeneity in functional status has been reported repeatedly in previous studies of centenarians. However, there is as yet no standardized classification system with which to describe their functional phenotype. METHODS: As part of a dynamic cohort study, we studied 304 centenarians (65 men and 239 women) living in Tokyo. Their functional status (sensory, physical, and cognitive), which we used to represent their phenotype, was assessed and subsequently classified by standard assessment methods (simple questionnaire, Barthel index, Mini-Mental State Examination, and the Clinical Dementia Rating, respectively). RESULTS: We classified participants into 4 categories according to their functional status. Only 5 (2%) were classified as "Exceptional," with all of their functions graded as excellent, and 56 (18%) were "Normal," exhibiting maintenance of fine cognitive and physical functions. One hundred sixty-seven (55%) were "Frail," exhibiting impairment of either cognitive or physical functions, and the remaining 76 (25%) were "Fragile," exhibiting deterioration of both physical and cognitive functions. CONCLUSIONS: The relationships between biochemical marker, mortality rates, lifestyle, and functional phenotypes demonstrated by this classification method indicate that the system is reliable to address the functional status of extremely old persons. Thus, this framework would be a useful tool for exploring the factors that contribute to exceptional longevity as well as those that help to maintain the functional status of the extremely old population.

Contribution of an affect-associated gene to human longevity: prevalence of the long-allele genotype of the serotonin transporter-linked gene in Japanese centenarians.

Negative affect such as depression and anxiety has been reported to be associated with morbidity and mortality, and polymorphisms of the serotonin transporter (5HTT) gene may be associated with such affect disorders. Hypothesizing that 5HTT gene polymorphisms could influence human longevity via negative affect; we compared the polymorphic variation of the 5HTT gene between 265 Japanese centenarians and control subjects. In addition, we evaluated the relationships between the 5HTT genotype and the physical, cognitive, and biologic status of centenarians, as indicated by the Barthel Index, the Mini-Mental State Examination, and serum albumin concentration, respectively. The frequency of the l/l genotype and the l allele was significantly greater in centenarians than in younger control subjects, particularly women. A significant effect of the 5HTT genotype on serum albumin concentration was observed in both sexes. Although, there was sex optionality, the l allele may carry a longevity advantage possibly through behavioral mechanisms.

Blood type B might imply longevity.

The aim of the present study was to investigate the association between blood groups and life expectancy. We compared frequencies of ABO blood group in 269 centenarians (persons over 100 years) living in Tokyo and those in regionally matched controls (n=7153). Frequencies of blood types A, O, B, and AB in centenarians were 34.2, 28.3, 29.4, and 8.2%, respectively, while those in controls were 38.6, 30.1, 21.9, and 9.4%, respectively. Blood type B was observed more frequently in centenarians than in controls (chi(2)=8.41, P=0.04). This tendency also was true in comparison between centenarians and 118 elderly old individuals of the 7153. Approximate one-third of the centenarians were free from serious diseases such as malignancy. However, blood types were not associated with such medical records. Our findings suggest that blood type B might be associated with exceptional longevity. Responsible mechanisms need to be investigated.