[The relationship between physical activity and sleep status among older adults requiring nursing care in the community].

AIM: We investigated the relationship between physical activity and sleep status among older adults requiring nursing care in the community. METHOD: We included 45 participants ≥65 years old (33 females; mean age, 83.2±4.4 years old) requiring nursing care. Physical activity was evaluated using the Life Space Assessment (LSA), and sleep status was measured by the Pittsburg Sleep Quality Index (PSQI) to determine the total sleep time, sleep efficiency, and PSQI total score. The physical function was measured by the timed up and go test (TUG) and grip strength. We performed a multiple regression analysis with the LSA as the dependent variable and sleep indicators (total sleep time, sleep efficiency, PSQI total score) and TUG as independent variables (demonstrating significant correlations with the LSA), and gender and age as adjusted variables. The analysis was divided into sleep time (Model 1), sleep efficiency (Model 2), and PSQI total score (Model 3). We used R commander, and < 0.05 was considered statistically significant. RESULTS: TUG (ß=-0.375) and sleep time (ß=0.383) in Model 1, TUG (ß=-0.368) and sleep efficiency (ß=0.570) in Model 2, and TUG (ß=-0.392) and PSQI total score (ß=-0.590) in Model 3 were independently selected as significant variables. CONCLUSION: In addition to TUG, sleep status, such as the sleep duration and sleep quality, was shown to be related to physical activity in older adults who require nursing care. To improve physical activity, it is necessary to consider not only the physical function but also quantitative and qualitative assessments of sleep.

Coordination between respiration and swallowing during non-invasive positive pressure ventilation.

BACKGROUND AND OBJECTIVE: The purpose of this study was to test the hypothesis that the risk of silent aspiration is increased in non-invasive positive pressure ventilation. METHODS: We analysed the coordination between respiration and swallowing, in 12 young volunteers and 10 elder volunteers, by simultaneously monitoring respiratory flow, laryngeal movement and swallowing sound in three different conditions: control, continuous positive airway pressure (CPAP), and bi-level positive airway pressure (BiPAP). A step-wise multiple regression analysis was performed with the occurrence rate of inspiration after swallows as the dependent variable and various correlated variables as the independent variables. RESULTS: In both subject groups, the occurrence rate of inspiration after swallow was greater with BiPAP compared with control and CPAP conditions. Repetitive saliva swallowing test count and swallow non-inspiratory flow occurrence rate were extracted as predictor variables for risk of inspiration after swallows during BiPAP treatment. CONCLUSION: We found that the occurrence rate of inspiration after swallow is increased with BiPAP use irrespective of age. The results suggest that swallow non-inspiratory flow may trigger inspiratory support in the BiPAP mode, resulting in a risk of aspiration.

Knee Extensor Weakness Potently Predicts Postoperative Outcomes in Older Gastrointestinal Cancer Patients.

OBJECTIVES: Muscle weakness, assessed by grip strength, has been shown to predict postoperative mortality in older patients with cancer. Because lower extremity muscle strength well reflects physical performance, we examined whether lower knee extension muscle strength predicts postoperative mortality better than grip strength in older patients with gastrointestinal cancer. DESIGN: Prospective, observational study in a single institution. SETTING AND PARTICIPANTS: A total of 813 patients (79.0 ± 4.2 years, 66.5% male) aged 65 years or older with gastrointestinal cancer who underwent preoperative evaluation of grip strength and isometric knee extension muscle strength between April 2012 and April 2019 were included. METHODS: The study participants were prospectively followed up for postoperative mortality. Muscle weakness was defined as the lowest quartile of grip strength or knee extension strength (GS-muscle weakness and KS-muscle weakness, respectively). RESULTS: Among the study participants, 176 patients died during a median follow-up of 716 days. In the Kaplan-Meier analysis, we found that patients with both GS-muscle weakness and KS-muscle weakness had a lower survival rate than those without muscle weakness. As expected, higher clinical stages and abdominal and thoracic surgeries compared with endoscopic surgery were associated with increased all-cause mortality. In addition, we found that KS-muscle weakness, but not GS-muscle weakness, was an independent prognostic factor after adjusting for sex, body mass index, cancer stage, surgical technique, and surgical site in the Cox proportional hazard model. CONCLUSIONS AND IMPLICATIONS: In older patients with gastrointestinal cancer, muscle weakness based on knee extension muscle strength can be a better predictor of postoperative prognosis than muscle weakness based on grip strength.

Age Group Differences in the Association Between Sleep Status and Frailty Among Community-Dwelling Older Adults: The SONIC Study.

Objective: We aimed to determine whether the association of sleep status with frailty differs between age groups of older adults. Method: This cross-sectional study was part of the observational Septuagenarians, Octogenarians, Nonagenarians Investigation with Centenarians (SONIC) study. Subjects were community-dwelling older adults in their 70s and 80s. Frailty was evaluated using the Japanese version of the Cardiovascular Health Study criteria (J-CHS). Pittsburgh Sleep Quality Index (PSQI) was used to assess sleep status. Poor sleep quality was defined as a PSQI global score ≥6. Sleep duration was categorized as short (<6 hr), normal (6-8), and long (>8). We performed multivariable logistic regression to investigate the association between sleep status and frailty separately for each age group adjusted for multiple covariates. Results: In those in their 70s, long sleep duration and sleep medication use were independently associated with frailty. In those in their 80s, poor sleep quality was independently associated with frailty. Conclusions: The association between sleep status and frailty was different between age groups. The findings underscore the importance of incorporating the evaluation of sleep quantity and non-pharmacological therapies in those in their 70s and the evaluation of sleep quality in those in their 80s to help prevent the onset of frailty.

The Muscle Thickness Assessment Using Ultrasonography is a Useful Alternative to Skeletal Muscle Mass by Bioelectrical Impedance Analysis.

Purpose: Muscle mass, a key index for the diagnosis of sarcopenia, is currently assessed using the appendicular skeletal muscle mass index (ASMI) by bioelectrical impedance analysis (BIA). Muscle thickness (MT) assessed by ultrasonography (US) may be a better determinant and/or predictor of muscle condition than ASMI. Thus, we compared it to the ASMI determined by the BIA. Patients and Methods: Our study included 165 ambulatory older adults (84 males, 81 females, mean age: 76.82 years). The ASMI by the BIA method, MT by US, and the distribution of body mass index (BMI) and body fat percentage (BFP) were examined using defined values for men and women. These were used as the basis for examining the association of MT and ASMI with handgrip strength (HGS), leg muscle strength (LMS), gait speed (GS), and echo intensity (EI). We compared HGS, LMS, GS, and EI for high and low ASMI among lower BMI or BFP. The same was also done for MT assessed by US. Results: MT, as well as ASMI, was strongly associated with HGS and LMS. There was a correlation between MT and GS and EI but not between ASMI and GS and EI. There were significant differences in the prevalence between high ASMI and high MT or low ASMI and low MT in those with lower BMI or BFP. In non-overweight participants, HGS, LMS, GS, and EI were significantly higher in those with high MT than in those with low MT; however, there were no significant differences in them between those with high and low ASMI. Conclusion: In the non-overweight group, the MT assessment by US showed a stronger relationship to muscle strength and muscle quality than the ASMI assessment by BIA. The MT assessment using US is a useful alternative to BIA-assessed ASMI, especially in non-overweight participants.

Effects of noninvasive ventilation on the coordination between breathing and swallowing in patients with chronic obstructive pulmonary disease.

Purpose: As shown in our previous study, inspiration after swallowing (SW-I) increases during the bi-level positive airway pressure ventilation (BiPAP) in healthy subjects because swallowing-associated non-inspiratory flow (SNIF) triggers inspiratory support, while SW-I during continuous positive pressure ventilation (CPAP) is rare. In the present study, we evaluated the coordination between breathing and swallowing during spontaneous breathing, BiPAP, and CPAP in patients with chronic obstructive pulmonary disease (COPD). Patients and methods: This study is a prospective intervention study at the Hoshigaoka Medical Center (November 01, 2015-April 30, 2018). We simultaneously recorded the respiratory flow, laryngeal motion, and swallowing sounds during saliva swallowing in patients with COPD. We estimated the respiratory phase after swallowing, frequency of SNIF, the duration of the respiratory pause during swallowing, and timing of swallowing in the respiratory cycle and compared these parameters among control, CPAP, and BiPAP conditions. Results: The expiration after swallowing (SW-E) frequency was associated with the occurrence of SNIF (p<0.01), pause duration ≤0.8 s (p<0.01), and timing of swallowing at the intermediate respiratory phase (50-80% of the respiratory cycle from the onset of inspiration) (p<0.01). In particular, the occurrence of SNIF most substantially affected the SW-E frequency. The SW-I frequencies under the control, CPAP, and BiPAP conditions were 35.0%, 3.0%, and 37.7%, respectively. The pause durations were shorter during CPAP and BiPAP than under the control condition (p<0.01). During CPAP, the occurrence rates of SW-E. Residual denotes the percentage difference between observed and expected values (residual =10.8: p<0.01) and SNIF (residual =9.1: p<0.01) were significantly increased, and timing of swallowing shifted toward the intermediate respiratory phase (residual=3.5: p<0.01). Conclusion: CPAP decreases the SW-I frequency, increases the SNIF occurrence, and normalizes the timing of swallowing, all of which suggest that CPAP alleviates the risk of aspiration in patients with COPD.

The Usefulness of an Alternative Diagnostic Method for Sarcopenia Using Thickness and Echo Intensity of Lower Leg Muscles in Older Males.

OBJECTIVES: Sarcopenia is diagnosed on the basis of skeletal muscle mass and muscle strength/function; however, simpler and more accurate measures for muscle mass and muscle strength/function should be explored using ultrasonography. This study aimed to investigate a new screening method using ultrasonography to diagnose sarcopenia of lower leg muscles in older males. DESIGN: Cross-sectional study. SETTING AND SUBJECTS: A total of 60 males, aged 65 years or older, participated in this study. MEASURES: The muscle thickness (MT) and echo intensity (EI) of the lower leg muscles were measured using ultrasonography, and the physical functions were examined. The MT and EI values of the lower leg muscles for predicting low appendicular skeletal muscle mass index (ASMI) and low grip strength were analyzed using receiver operating characteristic curve analysis and significant cutoff values were observed. A binary logistic regression analysis was performed with an MT below the cutoff value or an EI above the cutoff value as the independent variable, and with sarcopenia according to the Asian Working Group for Sarcopenia criterion as the dependent variable. RESULTS: Using the optimal cutoff points of MT and EI for predicting a low ASMI and low grip strength, the MT of the tibialis anterior (TA), the EI of the TA and gastrocnemius, and the MT/EI index of the TA and soleus were found to be associated with sarcopenia after adjusting for age, body mass index, calf circumference, presence of diabetes mellitus, and statin use in the binary logistic regression model. In addition, the combined MT and EI of the TA showed predictability with respect to sarcopenia. CONCLUSIONS/RELEVANCE: Ultrasonographic assessment of lower leg muscles might be useful as a convenient approach for detecting sarcopenia. In particular, the determination of both MT and EI of the TA should be considered as an alternative method of screening for sarcopenia.

Different Effects of Eicosapentaenoic and Docosahexaenoic Acids on Atherogenic High-Fat Diet-Induced Non-Alcoholic Fatty Liver Disease in Mice.

Non-alcoholic fatty liver disease (NAFLD), the hepatic manifestation of metabolic syndrome, can progress to steatohepatitis (NASH) and advanced liver damage, such as that from liver cirrhosis and cancer. Recent studies have shown the benefits of consuming n-3 polyunsaturated fatty acids (PUFAs) for the treatment of NAFLD. In the present study, we investigated and compared the effects of the major n-3 PUFAs-eicosapentaenoic acid (EPA, C20:5) and docosahexaenoic acid (DHA, C22:6)-in preventing atherogenic high-fat (AHF) diet-induced NAFLD. Mice were fed the AHF diet supplemented with or without EPA or DHA for four weeks. Both EPA and DHA reduced the pathological features of AHF diet-induced NASH pathologies such as hepatic lobular inflammation and elevated serum transaminase activity. Intriguingly, EPA had a greater hepatic triacylglycerol (TG)-reducing effect than DHA. In contrast, DHA had a greater suppressive effect than EPA on AHF diet-induced hepatic inflammation and ROS generation, but no difference in fibrosis. Both EPA and DHA could be effective for treatment of NAFLD and NASH. Meanwhile, the two major n-3 polyunsaturated fatty acids might differ in a relative contribution to pathological intermediate steps towards liver fibrosis.

Hyperlipidemia and hepatitis in liver-specific CREB3L3 knockout mice generated using a one-step CRISPR/Cas9 system.

cAMP responsive element binding protein 3-like 3 (CREB3L3), a transcription factor expressed in the liver and small intestine, governs fasting-response energy homeostasis. Tissue-specific CREB3L3 knockout mice have not been generated till date. To our knowledge, this is the first study using the one-step CRISPR/Cas9 system to generate CREB3L3 floxed mice and subsequently obtain liver- and small intestine-specific Creb3l3 knockout (LKO and IKO, respectively) mice. While LKO mice as well as global KO mice developed hypertriglyceridemia, LKO mice exhibited hypercholesterolemia in contrast to hypocholesterolemia in global KO mice. LKO mice demonstrated up-regulation of hepatic Srebf2 and its corresponding target genes. No phenotypic differences were observed between IKO and floxed mice. Severe liver injury was observed in LKO mice fed a methionine-choline deficient diet, a model for non-alcoholic steatohepatitis. These results provide new evidence regarding the hepatic CREB3L3 role in plasma triglyceride metabolism and hepatic and intestinal CREB3L3 contributions to cholesterol metabolism.

Type 1 diabetes mellitus associated with Graves' disease and Vogt-Koyanagi-Harada syndrome.

A 30-year-old woman was diagnosed as having Vogt-Koyanagi-Harada (VKH) syndrome. Her past history was Graves' disease. She was administered 1 g of methylprednisolone for three days, which was followed by oral prednisolone. Four weeks later, she developed hyperglycemic hyperosmolar coma. She was treated with intravenous normal saline and insulin, and glycemic control was improved. She was diagnosed as having type 1 diabetes mellitus (DM) because of positive test results for glutamic acid decarboxylase (GAD) antibodies and islet cell antibodies. Her human leukocyte antigen (HLA) genotypes were DQB1(*)0401 and DRB1(*)0405, which were susceptible genes for VKH syndrome, type 1 DM and Graves' disease. Therefore, we should consider that VKH syndrome might be associated with type 1 DM or Graves' disease.