Prevalence and prognosis of cachexia according to the Asian Working Group for Cachexia criteria in sarcopenic dysphagia: A retrospective cohort study.

OBJECTIVE: The aim to examine the prevalence and prognosis of cachexia according to the Asian Working Group for Cachexia (AWGC) criteria in patients with sarcopenic dysphagia. METHODS: A retrospective cohort study was conducted with 271 patients diagnosed with sarcopenic dysphagia out of 467 patients enrolled in the Japanese sarcopenic dysphagia database. Cachexia was diagnosed by the AWGC criteria. The AWGC criteria includes chronic diseases, either or both weight loss (2% or more over 3-6 mo) or low BMI (<21 kg/m2), and at least one of the following: anorexia, decreased grip strength (<28 kg in men and <18 kg in women), or elevated C-reactive protein levels (>0.5 mg/dL). Outcomes were death, swallowing function as assessed by the Food Intake LEVEL Scale (FILS), and activities of daily living as assessed by the Barthel Index (BI) at follow-up. RESULTS: The mean age was 84 (±8) y; 152 (56%) were female, and 97 (36%) had cachexia. In univariate analysis, death was significantly more common in the cachexia group (15% versus 2%, P ≤ 0.001). Logistic regression analysis showed that cachexia was independently associated with death (odds ratio: 3.557, 95% confidence interval: 1.010, 12.529). No significant differences were found in the presence or absence of cachexia in the FILS (7 versus 8, P = 0.849) and BI (55 versus 52.5, P = 0.892). CONCLUSIONS: Cachexia was found in 36% of patients with sarcopenic dysphagia, and death was significantly higher in cachexia.

Endotracheal Tube Obstruction Experienced during an Anterior Cervical Discectomy and Fusion.

During anterior cervical discectomy and fusion (ACDF), endotracheal tube difficulties are anticipated at the operative level but are unexpected elsewhere in the airway. We report the case of a 66-year-old woman who underwent C4/C5 ACDF to treat adjacent segment disease following a previous anterior cervical fixation surgery. Shortly after her lower jaw was elevated and the fusion cage was inserted, a rise in airway pressure was observed, indicating impaired breathing. Subsequent examination revealed a bent endotracheal tube in the oral cavity as the cause of the respiratory impairment. During anterior cervical surgery, elevating the lower jaw can cause the tongue root to press against the endotracheal tube. Reinforced endotracheal tubes, with a spiral-wound wire in the inner wall, would effectively prevent this issue. In the unlikely event of impaired breathing during such an operation, the oral cavity should be inspected for confirmation of an open airway.

Antianxiety and antidepressant-like effects of AC-5216, a novel mitochondrial benzodiazepine receptor ligand.

We investigated the ability of N-benzyl-N-ethyl-2-(7,8-dihydro-7-methyl-8-oxo-2-phenyl-9H-purin-9-yl)acetamide (AC-5216), a novel mitochondrial benzodiazepine receptor (MBR) ligand, to produce anti-anxiety and antidepressant-like effects in various animal models. AC-5216 showed high affinity for MBRs prepared from rat whole brain (Ki 0.297 nm), rat glioma cells (IC50 3.04 nm) and human glioma cells (IC50 2.73 nm), but only negligible affinity for the other main receptors including central benzodiazepine receptors. AC-5216 produced anti-anxiety effects in the Vogel-type conflict test in rats, and in the light/dark box and social interaction tests in mice at 0.1-3, 0.003-0.01 and 0.01-0.3 mg kg(-1), p.o., respectively. These effects of AC-5216 were antagonized by PK11195, an MBR antagonist. In the forced swimming test in rats, AC-5216 (3-30 mg kg(-1), p.o.) reduced the immobility time, and this effect was blocked by PK11195. AC-5216 had no myorelaxant effects, did not affect the memory or prolong hexobarbitone-induced sleep in mice, even at doses as high as 1000 mg kg(-1), p.o. Although it did slightly prolong the ethanol-induced sleep time at 1000 mg kg(-1), AC-5216 (1-100 mg kg(-1), p.o.) produced no distinct change in the rat electroencephalogram. These results indicate that AC-5216 produces anti-anxiety and antidepressant-like effects that are mediated by MBR, but does not cause the side effects normally associated with conventional benzodiazepines. Hence, AC-5216 shows potential for the treatment of stress-related disorders including anxiety and depression.

Age-related changes of myocardial norepinephrine transporter density in rats: implications for differential cardiac accumulation of MIBG in aging.

The myocardial regional distribution of [(125)I]MIBG was examined in various aged (7-, 18-, 42-, 47-, and 65-week-old) rats and compared with the effects of regional myocardial blood flow and norepinephrine transporter (NET) function on regional [(125)I]MIBG accumulation in aged rats. In 7- and 18-week-old rats, the accumulation of [(125)I]MIBG was higher in the inferior wall than anterior wall. However, in more than 42-week-old rats, the uptake of MIBG was lower in the inferior wall than that the anterior wall. The uptake of [(99m)Tc]MIBI was greater in the inferior wall than the anterior wall in 18-week-old rats, but was reduced in the inferior wall compared to the anterior wall in 42- and 47- week-old rats. Furthermore, the in vitro binding studies of [(3)H]desipramine to cardiac membranes showed that the B(max) value of NET was larger for the inferior wall than the anterior wall in 7-week-old rats, but was smaller for the inferior wall than the anterior wall in 47-week-old rats. The K(D) values for both walls were significantly larger in 47-week-old than 7-week-old rats. These results indicated that myocardial MIBG accumulation was lower in the inferior wall than the anterior wall of older rats, and that this differential MIBG accumulation in aging was related to the regional changes in myocardial blood flow and NET functions in the inferior wall.

[Evaluation of a "stop smoking" contest in Japan].

BACKGROUND: In 1988, the Osaka Cancer Prevention and Detection Center developed a self-help smoking cessation program, the "stop smoking" contest, based on the Quit and Win strategy developed in the United States in the early 1980's. It consisted of a two-week preparation period, followed by a four-week complete abstinence period. Participants were asked to try to achieve their goals on their own, using self-help materials, mailed to all applicants. Successful participants--"contest winners"--were awarded prizes by lot. The purpose of the present study is to examine the applicability of the Quit and Win strategy in Japan, through evaluating the effectiveness of the program in general and identifying predictors of successful quitting. METHOD: We analyzed the results of three consecutive programs conducted in 1998, 1999, and 2000. The programs defined as "participants" all those who demonstrated that their intentions were sincere by signing on for the contest. Of the participants, those who reported complete abstinence for four weeks were defined as "winners." Finally, of the winners, those who reported successful abstinence during the following six- and twelve-month periods were defined as continuing winners. "Abstinent" status was confirmed through self-reporting letters signed by the subject and two witnesses. We hypothesized that successful quitting would be predicted by demographic and smoking-related variables. Predictors of successful quitting were analyzed statistically using logistic regression. RESULTS: Of 4,221 applicants, 2,550 (60%) smokers eventually joined the program as "participants." Forty-six percent of the participants reported complete tobacco abstinence during the four-week contest period. Twenty percent of the participants maintained abstinence during the following six months. Fifteen percent maintained abstinence for a full year. Significant predictors of tobacco abstinent for the four-week contest period were as follows; male, more advanced age, being married, lower nicotine dependence, greater readiness for quitting, higher confidence in quitting, and better health. Of these, sex and psychological characteristics for quitting such as readiness and confidence were the only factors significantly correlated with successful abstinence throughout the follow-up periods. Previous longer abstinence experiences and chronic disease did not predict four-week abstinence, though it was significantly correlated with abstinence maintenance during the follow-up periods. CONCLUSION: The present "stop smoking" contest, a "Quit and Win" type population-based, self-help smoking cessation program combined with incentives, could be successfully implemented in Japan. The success rate was essentially comparable to those of similar programs previously conducted in other countries, and other types of professional-assisted programs in Japan.

[Identifying perceived needs among nurses in providing their patients with smoking cessation support in a Japanese hospital results from focus group interviews].

OBJECTIVE: To identify perceived needs among nurses in providing their patients with smoking cessation support in a Japanese hospital. SUBJECTS: Thirty-three female nurses who were interested in providing their patients with smoking cessation support in the hospital setting participated in focus group interviews. They conducted six focus group interviews segmented by age, working conditions (e.g., outpatient or inpatient sections) and occupational class (e.g., administrative post or not). DESIGN: An experienced researcher moderated two focus groups and another researcher who received training moderated four focus groups. At least two observers hand-recorded participants' conversations in each group and all groups were also tape-recorded. Moderators and observers analyzed the focus group data together. RESULTS: We found that smoking cessation counseling or health education on effects of smoking to be rarely conducted in the hospital. The study participants ordinarily just told patients to stop smoking. They mentioned several barriers to conducting smoking cessation support and suggested a number of ideas to promote this aim in the hospital. CONCLUSIONS: The focus group interview is an effective means to determine the needs and interests of Japanese health professionals. Nurses have many opinions and insights for supporting smoking patients. To introduce a smoking cessation program into hospitals, there are various problems that should be solved. First, nurses and other health professionals should have accurate knowledge, positive attitudes and appropriate skills for smoking cessation support. Second, smoking cessation support should be programmed as part of treatment or nursing. Third, healthcare professionals, especially doctors, should collaborate in supporting patients to stop smoking. Fourth, the hospital environment should be modified to promote smoking cessation. Finally, hospitals should develop a consensus among all staff about the importance of smoking cessation support and smoking control activities. As the result, multidimensional strategies are needed to effectively promote smoking cessation support in the hospital setting.

Two cases of autosomal recessive woolly hair with LIPH gene mutations.

BACKGROUND: Woolly hair is a hereditary disorder characterized by fine and tightly curled hair. Autosomal recessive woolly hair (ARWH) was recently determined to result from mutations in either the lipase H (LIPH) or the LPAR6 (P2RY5) gene. CASE REPORT: An 8-year-old boy (proband) and his 11-year-old brother presented with tightly coiled and sparse scalp hair. The boys did not have cardiomyopathy, palmoplantar keratoderma, or facial dysmorphism. Their parents had normal hair growth and no woolly hair. The sequence analysis of their genomic DNA revealed that the proband and his brother had a homozygous mutation of c.736T > A in the LIPH gene. On the basis of these findings, these patients were diagnosed with ARWH. CONCLUSIONS: To the best of our knowledge, only 20 cases of ARWH have been previously reported in Japan. However, several reports showed that one mutation was detected in the 4/200 normal and unrelated alleles in healthy Japanese control individuals, indicating the presence of ARWH in patients with extremely mild symptoms.

Lack of tolerance to anxiolysis and withdrawal symptoms in mice repeatedly treated with AC-5216, a selective TSPO ligand.

AC-5216, a ligand for the translocator protein (18 kDa) (TSPO), produces anxiolytic-like effects in animal models of anxiety without causing the side effects normally associated with conventional benzodiazepines. This study aimed to investigate whether repeated administration of AC-5216 induces tolerance to anxiolytic-like effects of AC-5216 and produces withdrawal on abrupt cessation, and compare the results with those of diazepam. In the tolerance experiment, AC-5216 (0.1 mg/kg, p.o.) produced significant anxiolytic-like effects in both groups of mice pretreated with the vehicle and AC-5216 twice daily for 14 days. Diazepam (0.1 mg/kg, p.o.) also retained its anxiolytic effects in mice repeatedly treated with diazepam. In the withdrawal experiment, mice were orally treated with either AC-5216 (0.1, 1 or 10 mg/kg; twice daily) or diazepam (0.1, 1 or 10 mg/kg; twice daily) for 14 days, and examined, during a treatment withdrawal period, for anxiogenic-like effects in the social interaction test, and for body weight loss as indices of emotional and somatic withdrawal symptoms, respectively. In AC-5216-treated groups, neither anxiogenic-like effects nor body weight loss was observed upon treatment withdrawal at any of the doses tested. In contrast, in diazepam 1 mg/kg- and 10 mg/kg-treated groups, treatment withdrawal not only induced anxiogenic-like effects on the second day of the withdrawal period, but also decreased body weight gain and brought about body weight loss in mice. These findings indicate that AC-5216 when repeatedly administered does not induce tolerance to its anxiolytic-like effects or withdrawal symptoms.

Cold-water face immersion per se elicits cardiac parasympathetic activity.

BACKGROUND: Cold-water face immersion (FI) is known to produce physiological changes, including bradycardia, by stimulating the parasympathetic system. However, other factors such as sympathetic activity, intrapleural pressures, and changes in chemical mediators may also contribute to these changes. METHODS AND RESULTS: Eight healthy volunteers underwent a series of experiments designed to observe the effects of FI on heart rate and its variability, as detected using wavelet transformation. Each subject was instructed to bend over and put the entire face into an empty basin with and without breathing (protocols 1 and 2, respectively), and then perform FI in warm-water (protocols 3 and 4, respectively) and cold-water (protocols 5 and 6, respectively) while breathing and breath holding. Change in the R-R interval with FI was only significantly greater for protocol 6 than for the control procedure (protocol 1). Also, changes in the natural logarithm of high-frequency power with FI were significantly greater for protocols 5 and 6 than the protocol 1. CONCLUSIONS: Bradycardia associated with cold-water FI is mainly attributed to cardiac vagal activity, which is independent of both the change in body position caused by bending over a basin and breath holding.

Tailored coupled cluster singles and doubles method applied to calculations on molecular structure and harmonic vibrational frequencies of ozone.

To assess the separation of dynamic and nondynamic correlations and orbital choice, we calculate the molecular structure and harmonic vibrational frequencies of ozone with the recently developed tailored coupled cluster singles and doubles method (TCCSD). We employ the Hartree-Fock and complete active space (CAS) self-consistent field (SCF) orbitals to perform TCCSD calculations. When using the Hartree-Fock orbitals, it is difficult to reproduce the experimental vibrational frequency of the asymmetric stretching mode. On the other hand, the TCCSD based on the CASSCF orbitals in a correlation consistent polarized valence triple zeta basis yields excellent results with the two symmetric vibrations differing from the experimental harmonic values by 2 cm(-1) and the asymmetric vibration differing by 9 cm(-1).

Coupled-cluster method tailored by configuration interaction.

A method is presented which combines coupled cluster (CC) and configuration interaction (CI) to describe accurately potential-energy surfaces (PESs). We use the cluster amplitudes extracted from the complete active space CI calculation to manipulate nondynamic correlation to tailor a single reference CC theory (TCC). The dynamic correlation is then incorporated through the framework of the CC method. We illustrate the method by describing the PESs for HF, H2O, and N2 molecules which involve single, double, and triple bond-breaking processes. To the dissociation limit, this approach yields far more accurate PESs than those obtained from the conventional CC method and the additional computational cost is negligible compared with the CC calculation steps. We anticipate that TCC offers an effective and generally applicable approach for many problems.

Singular value decomposition applied to the compression of T3 amplitude for the coupled cluster method.

We apply the singular value decomposition to compress the degrees of freedom of T3 amplitude for the CCSDT-1 method (compressed CCSDT-1). This method enables us to make the number of the T3 amplitudes less than that of the T2 amplitudes, making CCSDT-1 calculations much less expensive without losing accuracy. We perform test calculations on some atoms and molecules to investigate the applicability of this method. Computational results for the electronic energies as well as timings of these calculations are presented.