Assessment of Oral Function and Proper Diet Level for Frail Elderly Individuals in Nursing Homes Using Chewing Training Food.

OBJECTIVES: We aimed to investigate the relationship between the ability to press Process Lead (PL) in the oral cavity and the tongue pressure and recommended diet form for elderly individuals in nursing homes, using PL normalized physical properties. DESIGN: Cross-sectional observation study. SETTING: Geriatric facilities. PARTICIPANTS: A 100 elderly individuals aged between 67-96 years. MEASUREMENTS: PL was pressed between the tongue and palate to evaluate its deformation. The thickness was set at 6, 9, and 18 mm. The tongue pressure was measured with a JMS tongue pressure manometer. The number of chewing cycles until an 18-mm thick PL was first swallowed was measured (PL chewing test). The diet was set to level 4, and the recommended form was evaluated by video endoscopic evaluation of swallowing (VE). The results of the PL pressing test and correlations between PL chewing test, tongue pressure, and diet level were statistically examined. RESULTS: The tongue pressure was significantly decreased in groups that could not press the PL. The PL pressing test and recommended diet form showed a significant correlation, and the elderly with difficulty in pressing the PL had a lower diet level. In addition, the diet level decreased with decreased PL chewing test performance in those without molar occlusion. CONCLUSIONS: The PL pressing and chewing tests may aid in ascertaining the appropriate diet level. In the future, we would like to verify the usefulness of these tests in determining the diet level of elderly people requiring long-term care at the time of entering the facility.

[Usefulness of exercise electro-cardiography in a THP (Total Health Promotion Plan)].

We conducted ergometer exercise electrocardiography (ergometry) on 3,477 subjects in a THP (Total Health Promotion Plan). One hundred cases in which abnormal findings were detected by ergometry were analyzed. In the hundred cases there were 3 patterns: abnormal ST change, 50 cases; abnormal reaction, 22 cases; and extreme increase in blood pressure, 28 cases. Electrocardiograms (ECG) in 78 of these 100 cases indicated no abnormalities. Of the 31 subjects who underwent further examinations, in 18 cases abnormal findings were detected, and further observation or treatment was necessary. They were over two thirds of the 26 cases requiring observation or treatment on further examination. In other words, exercise electrocardiography revealed more than 3 times as many problem cases as electrocardiography only. One hundred and four cases were analyzed, and among them abnormal findings on ECG made further examination or treatment necessary. Of 68 subjects with an abnormal ECG and who needed to undergo exercise electrocardiography, 51 (75%) had no need to undergo further examinations, because there were no abnormal findings on ergometry in the THP. Of the 104 subjects who underwent ECG examination at rest, 51 no longer needed to waste time, effort and expense on further medical evaluation. Ergometry in a THP serves as a medical check and as a means to decide the strength of exercise before the initiation of exercise training, which is very important in preventing coronary artery disease, rather than in detecting the disease. Ergometry is expensive and it takes a lot of time and labor, but it is necessary in ensuring the safety of exercise training and in prescribing proper exercise. This analysis has shown that ergometry in THP is very useful and cost effective in improving the accuracy of health examinations.

Simple and specific assessment of Ca-entry-blocking activities of drugs by measurement of Ca reversal.

A new, simple, and specific screening method for Ca-entry blocker is reported. In the presence of various blockers of Ca-entry (Ca-channel blockers), Ca2+ (1 x 10(-4) M) causes Ca reversal, i.e., it causes relaxation of rat uterine smooth muscle that has been tonically contracted with oxytocin in Ca-free medium (Ca-free contraction) after prolonged preincubation with 3 mM EGTA. The potencies of various drugs to cause Ca reversal, assessed on an all-or-none basis, were found to reflect their activities of blocking Ca entry. The potencies of drugs for blocking Ca entry via voltage-operated Ca-channels could be determined in 125.6 mM K+ Ca-free medium. Drugs that inhibited Ca-free contraction directly have some other antispasmodic activity. Conventionally, activity for blocking Ca entry is screened by measuring inhibition of Ca-induced contraction, but true Ca-entry blocking activity cannot be differentiated clearly from other antispasmodic activity when a drug has both activities. However, by measuring Ca reversal, activity for blocking Ca entry only can easily be found, when done in solution with high K+ content for blocking voltage-operated channels and when done in solution with normal K+ content for blocking voltage-independent channels.

[Surgical treatment of infective endocarditis--decision tree for the treatment and introduction of translocation method].

Persistent fever during active-phase IE is an indication for surgical treatment in the light of the causative organism and the underlying disease. To counter worsening hemodynamics, surgery may be the only feasible way. Surgery is performed when the patient does not respond to vasodilators and he shows FS of less than 25%. The introduction of translocation provides a solution for the treatment of active IE. Lesions, vegetations more than 5mm in diameter, periannular abscess, and mycotic aneurysm that could never be overlooked by two-dimensional echocardiography may hasten the early stage decision of ways to treat IE.

Surgical treatment for infective endocarditis--decision tree for the treatment and introduction of translocation method.

Persistent fever during active-phase IE is an indication for surgical treatment in the light of the causative organism and the underlying disease. To counter worsening hemodynamics, surgery may be the only feasible way. Surgery is performed when the patient does not respond to vasodilators and he shows an FS of less than 25%. The introduction of translocation provides a solution for the treatment of active IE. Lesions, vegetations more than 5 mm in diameter, periannular abscess, and mycotic aneurysm that could never be overlooked by two-dimensional echocardiography may hasten the early-stage decision of ways to treat IE.