Relationships among tooth loss, prefrailty, and dietary patterns in community-dwelling older Japanese females: a cross-sectional study.

BACKGROUND/OBJECTIVES: Poor oral health has been predicted the development of frailty and sarcopenia as well as the subsequent need for long-term care. This cross-sectional study examined the relationships among tooth loss, prefrailty, and dietary patterns in community-dwelling older Japanese females. SUBJECTS/METHODS: Information on the number of teeth, food consumption, and lifestyle factors was collected from 271 participants aged ≥ 65 yrs using a questionnaire. The number of teeth was self-reported and classified into 2 groups: natural teeth ≥ 20 and natural teeth < 20. Prefrailty was assessed using the Japanese version of the Cardiovascular Health Study. Three dietary patterns ("vegetables and dairy products" [VD], "rice and fish and shellfish" [RF], and "bread and beverages") were adopted from a cluster analysis of the intakes of 20 foods evaluated using the Food Frequency Questionnaire. The odds ratios (ORs) for prefrailty and dietary patterns were calculated using a binary logistic regression analysis. RESULTS: A total of 267 participants were analyzed, excluding those with frailty (n = 4). The rates of natural teeth < 20 and prefrailty were 57.3 and 37.4%, respectively. Natural teeth < 20 was positively correlated with prefrailty (OR, 4.66; 95% confidence interval [CI], 2.54-8.52) and inversely correlated with VD pattern (OR, 0.43; 95% CI, 0.27-0.69). Furthermore, both VD (OR, 0.38; 95% CI, 0.16-0.91) and RF (OR, 0.26; 95% CI, 0.11-0.62) patterns were inversely correlated with prefrailty. CONCLUSIONS: Maintaining the number of natural teeth ≥ 20 into old age plays an important role in preventing a prefrailty. The promotion of VD and RF dietary patterns has potential as an effective nutritional strategy for preventing tooth loss and prefrailty.

Relationships among falls and dietary patterns, nutritional inadequacy and prefrailty in community-dwelling older Japanese females: A cross-sectional study.

BACKGROUND AND OBJECTIVES: Falls are common among older females. This study investigated the relationships among falls and dietary patterns, nutritional inadequacy and prefrailty in community-dwelling older Japanese females. METHODS AND STUDY DESIGN: This cross-sectional study involved 271 females aged 65 and over. Prefrailty was defined as exhibiting one or two of the five Japanese version of the Cardiovascular Health Study criteria. Frailty was excluded (n=4). Energy, nutrient and food intakes were estimated using a validated FFQ. Dietary patterns were determined from intakes of 20 food groups assessed with FFQ, by cluster analysis. Nutritional inadequacy for the selected 23 nutrients in each dietary pattern was examined based on DRIs. Binomial logistic regression was applied to examine the relationships among falls and dietary pat-terns, prefrailty, and inadequate nutrients. RESULTS: Data from 267 participants were included. The incidence of falls was 27.3%, and 37.4% of participants were classified as prefrailty. Three dietary patterns identified were namely; 'rice and fish and shellfish' (n=100); 'vegetables and dairy products' (n=113); and 'bread and beverages' (n=54). A binomial logistic regression analysis revealed that dietary patterns of 'rice and fish and shellfish' (OR, 0.41; 95% CI, 0.16-0.95), and 'vegetables and dairy products' (OR, 0.30; 95% CI, 0.12-0.78) were negatively correlated with falls, and falls was positively associated with prefrailty. CONCLUSIONS: Dietary patterns characterized by 'rice and fish and shellfish', and 'vegetables and dairy products' were associated with a reduced incidence of falls in community-dwelling older Japanese females. Larger prospective studies are needed to validate these results.

High Blood Pressure and Changes in the Body Mass Index Category Among Japanese Children: A Follow-Up Study Using the Updated American Academy of Pediatrics Guidelines.

Background High blood pressure (HBP) has become a public health issue worldwide. The relationship between high BP and changes in the body mass index (BMI) category in Japanese pubertal children has not yet been examined. To resolve this issue, we examined existing data with a focus on the primordial prevention of high BP signs, including elevated BP, among pubertal children aged 12 and 15 years. Methods Height, body weight, and BP data were examined from health checkups of 18,247 children conducted between 1993 and 2000 in the Karatsu Study, which was a cohort of pediatric lifestyle-related disease prevention medical health checkups in Japan. BP and BMI were assessed using the updated American Academy of Pediatrics (AAP) guidelines and Endocrine Society's clinical practice guidelines definitions, respectively. Results Follow-up data were obtained from 7,090 subjects (50.5% boys). Stage 2 hypertension (HTN) was detected in 3% and 2.7% of boys and girls aged 12 years, respectively, and in 2.7% and 1% of boys and girls aged 15 years, respectively. Among children aged 15 years, 1.4% were newly classified with stage 2 hypertension, and 15.6% exhibited improvements to a normal BP. A binomial logistic regression analysis of high BP and BMI category changes revealed odds ratios (OR) in the group with a deteriorated BMI category of 1.51 (95% confidence interval (CI), 1.17-1.94), 2.30 (95%CI, 1.66-3.17), and 6.83 (95%CI, 4.14-11.29) for elevated BP, stage 1 hypertension, and stage 2 hypertension, respectively. Conclusion High BP in puberty positively correlated with BMI category changes. Considering the presence of the tracking phenomenon in hypertension, BP monitoring is an essential part of the early strategy for the prevention of lifestyle-related diseases in childhood, and improvements in BP control are crucial in early life.

Association of physical prefrailty with prevalence of inadequate nutrient intake in community-dwelling Japanese elderly women: A cross-sectional study.

BACKGROUND AND OBJECTIVES: This study evaluated the association of physical prefrailty with the prevalence of inadequate nutrients among community-dwelling Japanese elderly women. METHODS AND STUDY DESIGN: This cross-sectional study included 120 older women (age range, 65-79 years) at an elders college. Frailty was evaluated using the Japanese version of the Cardiovascular Health Study (J-CHS). Participants were classified as either prefrailty (1-2 deficits) or nonfrailty (0 deficits) based on set criteria. Both groups were compared in terms of physical function, exercise time, nutrient intake, and food group intake estimated by Food Frequency Questionnaire Based on Food Groups (FFQg), and estimated prevalence of inadequate nutrient intake, which was evaluated using each dietary reference value, set as the estimated average requirement (EAR) and dietary goal (DG), based on the Dietary Reference Intakes (DRIs) for Japanese, 2020. RESULTS: Of the participants, 45.0% exhibited physical prefrailty. Binary logistic regression analysis identified that vitamin C intake below EAR (OR, 7.12; 95% CI, 1.47-34.41, p=0.014) was the only factor associated with physical prefrailty. CONCLUSIONS: In addition to measuring physical function, dietary surveys and evaluation of nutritional adequacy by DRIs are expected to be useful for the early prevention of physical prefrailty by linking to nutrition education among community-dwelling Japanese elderly adults.

Fulminant Tracheobronchial Aspergillosis in an Apparently Healthy Adult.

A 56-year-old healthy man who was a current smoker died from fulminant tracheobronchial aspergillosis despite a month of treatment with a combination of intravenous anti-fungal agents that had been started immediately after the diagnosis. This case report is important for understanding and managing fulminant Aspergillus infections in healthy subjects, although the pathogenesis and underlying pathways are still unknown.

Co-activation of macrophages and T cells contribute to chronic GVHD in human IL-6 transgenic humanised mouse model.

BACKGROUND: Graft-versus host disease (GVHD) is a complication of stem cell transplantation associated with significant morbidity and mortality. Non-specific immune-suppression, the mainstay of treatment, may result in immune-surveillance dysfunction and disease recurrence. METHODS: We created humanised mice model for chronic GVHD (cGVHD) by injecting cord blood (CB)-derived human CD34+CD38-CD45RA- haematopoietic stem/progenitor cells (HSPCs) into hIL-6 transgenic NOD/SCID/Il2rgKO (NSG) newborns, and compared GVHD progression with NSG newborns receiving CB CD34- cells mimicking acute GVHD. We characterised human immune cell subsets, target organ infiltration, T-cell repertoire (TCR) and transcriptome in the humanised mice. FINDINGS: In cGVHD humanised mice, we found activation of T cells in the spleen, lung, liver, and skin, activation of macrophages in lung and liver, and loss of appendages in skin, obstruction of bronchioles in lung and portal fibrosis in liver recapitulating cGVHD. Acute GVHD humanised mice showed activation of T cells with skewed TCR repertoire without significant macrophage activation. INTERPRETATION: Using humanised mouse models, we demonstrated distinct immune mechanisms contributing acute and chronic GVHD. In cGVHD model, co-activation of human HSPC-derived macrophages and T cells educated in the recipient thymus contributed to delayed onset, multi-organ disease. In acute GVHD model, mature human T cells contained in the graft resulted in rapid disease progression. These humanised mouse models may facilitate future development of new molecular medicine targeting GVHD.

Dengue Hemorrhagic Fever in a Japanese Traveler with Pre-existing Japanese Encephalitis Virus Antibody.

An adult Japanese man who had just returned from Thailand developed dengue hemorrhagic fever (DHF). A primary infection of dengue virus (DENV) was confirmed, specifically DENV serotype 2 (DENV-2), on the basis of the detection of the virus genome, a significant increase in the neutralizing antibody and the isolation of DENV-2. DHF is often observed following a secondary infection from another serotype of dengue virus, particularly in children, but this case was a primary infection of DENV. Japan is a non-endemic country for dengue disease. In fact, only Japanese encephalitis (JE) is known to be a member of the endemic flavivirus family. In this study, IgG antibody against Japanese encephalitis virus (JEV) was detected. JEV belongs to the family of dengue virus and prevails in Japan, particularly Kyushu. Among many risk factors for the occurrence of DHF, a plausible candidate could be a cross-reactive antibody-dependent enhancement (ADE) mechanism caused by JEV antibody. This indicates that most Japanese travelers who living in dengue non-endemic areas, particularly Kyushu, should be aware of the occurrence of DHF.

Application of an imaging plate system to the direct measurement of a fixed surface contamination.

An imaging plate (IP) system was used as an effective detector for direct measurement of radioactive surface contamination. The IP system displayed images designating the locations and extent of fixed surface contamination of uranyl acetate. The amount of radioactive waste produced during decontamination was reduced because the contaminated spots could be isolated; furthermore, creation of radioactive dust during removal of contamination was prevented because the contaminated spots could be removed without being pulverized. The images were used in efficiently and safely isolating the location of fixed surface contamination. The IP system surface contamination detection limit for uranyl acetate was 2.5 × 10 Bq cm, a value much lower than the surface contamination limit and the clearance level.

Effect of sera from seronegative myasthenia gravis patients on neuromuscular junctions.

About 85 % of patients with generalized myasthenia gravis (MG) have anti-nicotinic acetylcholine receptor (nAChR) antibodies in their sera (seropositive MG; SPMG). The other 15 % (seronegative MG; SNMG) are also considered to have antibody-mediated disease, but the nature of the antibodies in SNMG is not fully understood. We investigated the effect of sera from patients with MG on spontaneous muscle action potentials and acetylcholine (ACh)-induced potentials, and we examined the localization of epitopes recognized by SPMG sera or SNMG sera. SPMG sera and SNMG sera inhibited spontaneous muscle action potentials and ACh-induced potentials in the spinal-muscle co-culture system. However, spontaneous muscle action potentials and ACh-induced potentials in the neuromuscular junctions were strongly blocked by SPMG serum, whereas they were weakly blocked by SNMG serum. Both types of sera reacted strongly with the neuromuscular junctions in normal rat muscles, as shown by double immunostaining with serum and α-bungarotoxin. The SPMG epitope remained in the neuromuscular junctions, whereas that of SNMG disappeared after denervation of the sciatic nerve. Therefore, we suggest that the skeletal muscle weakness in SNMG may be due to an interaction with presynaptic neuromuscular transmission and nAChR.

Characteristics of bacterial species in positive blood cultures among hospitalized patients in three wards in the Department of Internal Medicine: retrospective chart review 1999-2008.

OBJECTIVE: This study aimed to establish the clinical significance of positive blood cultures during the past 10 years in Saga University Hospital. METHODS: All hospitalized patients with positive blood cultures in the gastroenterology, hepatology and respiratory wards in the Department of Internal Medicine, Saga University Hospital were evaluated by retrospective chart review between January 1999 and December 2008. The results were compared between period I (1999-2003) and period II (2004-2008). RESULTS: During the study, 2,680 isolates from 22,694 samples (11.8%) were detected in Saga University Hospital: 106 (13.1%) isolates from 812 samples were detected in the gastroenterology ward; 71 (7.8%) from 914 in the hepatology ward; and 160 (6.0%) from 2,671 in the respiratory ward. The number of positive blood cultures increased during period II compared with period I in all three wards. The ratio of gram-negative rods increased in the gastroenterology ward during period II (p<0.05). The ratio of gram-positive cocci was higher in the respiratory ward compared with the other two wards (p<0.05 in each). In contrast, the ratio of gram-negative rods was higher in the gastroenterology and hepatology wards (p<0.05 in each). Fungemia increased in the gastroenterology and respiratory wards in period II (p<0.05 in each). CONCLUSION: The trends in bacterial species in positive blood cultures differed between the gastroenterology, hepatology and respiratory wards. This could be important for decision making regarding antimicrobial therapy in the early therapeutic phase.

Comparison of leukotriene receptor antagonists and anti-histamines as an add-on therapy in patients with asthma complicated by allergic rhinitis.

Patients with asthma are often complicated by allergic rhinitis, and the intimate pathophysiological association between allergic rhinitis and asthma often imposes a significant morbidity on affected individuals. The present study was conducted to assess the clinical efficacies of leukotriene receptor antagonists (LTRAs) and anti-histamines on asthma as an add-on therapy in patients with asthma complicated by allergic rhinitis. Consecutive patients with asthma were recruited to fill in systematic self-administered questionnaires concerning symptoms and conditions related to asthma and allergic rhinitis. The questionnaire was conducted twice, one month apart, and the attending physicians gave detailed information on disease control and medications on both occasions. In the study 3,140 patients with asthma participated, and 634 had concomitant allergic rhinitis (mean age: 53.1, 389 female). The second survey disclosed that treatment with LTRAs or anti-histamines had been added in 26 patients and 19 patients, respectively, without any changes in other medications. There were no significant differences in age, gender, severity of disease, or baseline treatments. The initial survey indicated that the patients who were treated with LTRAs had significantly more severe asthma-related symptoms (i.e. wheeze, cough and sleep disturbance) and experienced greater dissatisfaction with the treatment than did those who were treated with anti-histamines. The second survey disclosed significant reductions in sneezing (p=0.03), rhinorrhea (p=0.01), dyspnea (p=0.046), sleep disturbance (p=0.02), over-all asthma symptoms (p=0.013), and an improvement in satisfaction with treatment (p=0.019) in patients to whom LTRAs were added-on, whereas the patients receiving anti-histamines reported no significant changes in these symptoms. These results suggest that LTRAs are more effective than anti-histamines as an add-on therapy in symptomatic patients with asthma complicated by allergic rhinitis.

Concurrent lung cancer in non-tuberculous mycobacteriosis: case report.

An 82-year-old woman was admitted to our hospital after multiple round opacities were detected in chest X-rays performed during a routine health screening. Mycobacterium avium complex (MAC) was found in sputum cultures, and compatible pathological findings on biopsy confirmed pulmonary MAC infection, whereas biopsies from another opacity revealed adenocarcinoma of the lung.Curative surgery for the lung cancer confirmed a concurrence of lung cancer and pulmonary MAC infection. Since the prevalence of both of these lung diseases is increasing, suspicion of concurrence is critical to provide appropriate care.

Adult meningism and viral meningitis, 1997-2004: clinical data and cerebrospinal fluid cytokines.

OBJECTIVE: Although meningism manifesting acute headache has been observed to be associated with common viral and bacterial infections, its definition and pathogenesis have not been clarified. Clinical findings and cerebrospinal fluid (CSF) cytokines in adult patients with meningism were investigated and compared with those in viral meningitis. PATIENTS AND METHODS: Among the adult inpatients in our hospital from 1997 to 2004, 5 with meningism and 17 with viral meningitis were identified according to the criteria described in this study, and their clinical data were analyzed. In the CSF samples of the 5 patients with meningism and the 17 with viral meningitis, the concentrations of interferon-gamma (IFN-gamma), tumor necrosis factor-alpha (TNF-alpha), interleukin-2 (IL-2), IL-4, IL-6, and IL-10 were determined using a cytometric bead array. RESULTS: The five patients with meningism all showed fever and meningeal signs such as severe headache and nuchal stiffness without CSF pleocytosis (<5 cells/mm3). Four patients were associated with herpetic Kaposi's eczema, herpes simplex, or herpes zoster, and all five patients had favorable outcomes. The levels of all CSF cytokines in patients with meningism were below normal values, whereas IFN-gamma and IL-6 in patients with viral meningitis were moderately elevated. CONCLUSION: The normal cytokine levels in meningism may possibly reflect the lack of direct viral infection and may be helpful in differentiating both meningism and viral meningitis at an early stage.

Molecular phylogenetic and chemical analyses of the microbial mats in deep-sea cold seep sediments at the northeastern Japan Sea.

Microbial communities inhabiting deep-sea cold seep sediments at the northeastern Japan Sea were characterized by molecular phylogenetic and chemical analyses. White patchy microbial mats were observed along the fault offshore the Hokkaido Island and sediment samples were collected from two stations at the southern foot of the Shiribeshi seamount (M1 site at a depth of 2,961 m on the active fault) and off the Motta Cape site (M2 site at a depth of 3,064 m off the active fault). The phylogenetic and terminal-restriction fragment polymorphism analyses of PCR-amplified 16S rRNA genes revealed that microbial community structures were different between two sampling stations. The members of ANME-2 archaea and diverse bacterial components including sulfate reducers within Deltaproteobacteria were detected from M1 site, indicating the occurrence of biologically mediated anaerobic oxidation of methane, while microbial community at M2 site was predominantly composed of members of Marine Crenarchaeota group I, sulfate reducers of Deltaproteobacteria, and sulfur oxidizers of Epsilonproteobacteria. Chemical analyses of seawater above microbial mats suggested that concentrations of sulfate and methane at M1 site were largely decreased relative to those at M2 site and carbon isotopic composition of methane at M1 site shifted heavier ((13)C-enriched), the results of which are consistent with molecular analyses. These results suggest that the mat microbial communities in deep-sea cold seep sediments at the northeastern Japan Sea are significantly responsible for sulfur and carbon circulations and the geological activity associated with plate movements serves unique microbial habitats in deep-sea environments.

Herpes simplex virus type 2 recurrent meningitis (Mollaret's meningitis): a consideration for the recurrent pathogenesis.

We report a 44-year-old Japanese woman with herpes simplex virus (HSV) type 2 recurrent meningitis (Mollaret's meningitis). The diagnosis was confirmed by nested polymerase chain reaction in her cerebrospinal fluid, but the patient's conventional HSV antibodies by complement fixation, neutralizing test or enzyme immunoassay showed low titres with low lymphoproliferative response. Several similar cases are discussed. Although the reason for the recurrent pathogenesis is uncertain, our report suggests that the low immune response including immune evasion may be involved in the pathogenesis of HSV type 2 recurrent meningitis. For this patient, long-term suppressive and patient-initiated therapies were conducted to prevent the recurrence of meningitis.

A multifunctional shuttling protein nucleolin is a macrophage receptor for apoptotic cells.

Early apoptotic Jurkat T cells undergo capping of CD43, and its polylactosaminyl saccharide chains serve as ligands for phagocytosis by macrophages. This suggests the presence of a polylactosaminoglycan-binding receptor on macrophages. Here we show that this receptor is nucleolin, a multifunctional shuttling protein present in nucleus, cytoplasm, and on the surface of some types of cells. Nucleolin was detected at the surface of macrophages, and anti-nucleolin antibody inhibited the binding of the early apoptotic cells to macrophages. Nucleolin-transfected HEK293 cells expressed nucleolin on the cell surface and bound the early apoptotic cells but not phosphatidylserine-exposing late apoptotic cells. This binding was inhibited by anti-nucleolin antibody, by polylactosamine-containing oligosaccharides, and by anti-CD43 antibody. Deletion of the antibody binding region of nucleolin resulted in loss of the apoptotic cell-binding ability. Moreover, truncated recombinant nucleolin in solution containing this region blocked the apoptotic cell binding to macrophages, and the blocking effect was cancelled by the oligosaccharides. These results indicate that nucleolin is a macrophage receptor for apoptotic cells.

[Pulmonary tuberculosis mimicking fungus ball].

We treated a 42-year-old man with pulmonary tuberculosis presenting as a round mass in a cavitary lesion that resembled a fungus ball. These findings appeared within a short time. The diagnosis was confirmed by isolation of Mycobacterium tuberculosis from his sputum. He also had diabetes mellitus that was poorly controlled. The patient was treated with antituberculous chemotherapy and insulin therapy. With these treatments, the roentgenographic abnormalities resolved fairly rapidly.

Tuberculosis associated with gastrectomy.

We describe the incidence and clinical features of patients with tuberculosis who had undergone gastric resection in our hospital. A total of 26 patients with tuberculosis who had undergone gastric resection were studied. The prevalence of gastrectomy among patients with tuberculosis was 8.0% (7/87) in 2000, 5.1% (4/78) in 2001, and 13.2% (10/76) in 2002. The average 3-year incidence was 9.1%. The patients' body mass indexes (BMIs) were below 18 kg/m2 in 9 of the 21 patients in whom it was possible to determine BMI and above 22 kg/m2 in only 2 of these 21 patients. Analysis of impaired glucose tolerance revealed oxyhyperglycemia or diabetes mellitus as one risk factor for the development of tuberculosis. Furthermore, poor nutrition among patients who have undergone gastrectomy may provide prognostic information for the development or reactivation of tuberculosis. In Japan, a fairly large percentage of elderly people have undergone gastrectomy for gastric cancer or gastric ulcer, and many have a past history of tuberculosis. Gastrectomy may be a risk factor for the reactivation of tuberculosis.

Biochemical and genetic characterization of mundticin KS, an antilisterial peptide produced by Enterococcus mundtii NFRI 7393.

Mundticin KS, a bacteriocin produced by Enterococcus mundtii NFRI 7393 isolated from grass silage in Thailand, is active against closely related lactic acid bacteria and the food-borne pathogen Listeria monocytogenes. In this study, biochemical and genetic characterization of mundticin KS was done. Mundticin KS was purified to homogeneity by ammonium sulfate precipitation, sequential ion-exchange chromatography, and solid-phase extraction. The gene cluster (mun locus) for mundticin KS production was cloned, and DNA sequencing revealed that the mun locus consists of three genes, designated munA, munB, and munC. The munA gene encodes a 58-amino-acid mundticin KS precursor, munB encodes a protein of 674 amino acids involved in translocation and processing of the bacteriocin, and munC encodes a mundticin KS immunity protein of 98 amino acids. Amino acid and nucleotide sequencing revealed the complete, unambiguous primary structure of mundticin KS; mundticin KS comprises a 43-amino-acid peptide with an amino acid sequence similar to that of mundticin ATO6 produced by E. mundtii ATO6. Mundticin KS and mundticin ATO6 are distinguished by the inversion of the last two amino acids at their respective C termini. These two mundticins were expressed in Escherichia coli as recombinant peptides and found to be different in activity against certain Lactobacillus strains, such as Lactobacillus plantarum and Lactobacillus curvatus. Mundticin KS was successfully expressed by transformation with the recombinant plasmid containing the mun locus in heterogeneous hosts such as E. faecium, L. curvatus, and Lactococcus lactis. Based on our results, the mun locus is located on a 50-kb plasmid, pML1, of E. mundtii NFRI 7393.