[The characteristics of a comprehensive geriatric assessment in patients with mild cognitive impairment with a cerebral white matter lesion].

AIM: Vascular dementia may be referred to as "treatable dementia" because its development and progress can be inhibited by intervention in the early stage. In particular, cerebral white matter lesions are readily encountered the clinical setting. In this study, we aimed to clarify the phenomenon and symptoms of patients with mild cognitive impairment (MCI) with cerebral white matter lesions prior to the onset of dementia. METHODS: The subjects included 181 cases diagnosed with MCI among 643 consecutive new patients of the Center for Comprehensive Care on Memory Disorder at Kyorin University Hospital from January 1, 2013 to January 31, 2014. Patients with particular diseases were excluded. An interview, physical examination, comprehensive geriatric assessment, brain MRI and SPECT were performed for all subjects. The cerebral white matter lesions were evaluated using the modified Fazekas scale. We defined Grades 0 and 1 as the group without apparent cerebral white matter lesions and Grades 2 and 3 as the group with apparent cerebral white matter lesions. We compared the laboratory findings and outcomes of these two groups. RESULTS: The age of the group with apparent cerebral white matter lesions was significantly higher than the group without apparent cerebral white matter lesions (P<0.05). No significant difference was observed regarding gender, MMSE, or "vegetable" term retrieval. A significant difference was observed in the total score and the subordinate component of the 21-item fall risk index and geriatric depression scale between the groups (P<0.05). Additionally, a significant difference was observed regarding the subordinate component of the instrumental ADL, the Dementia Behavior Disturbance Scale and the Zarit Care Burden Scale between the groups (P<0.05). CONCLUSIONS: Our results suggest that the presence of white matter lesions at the stage of MCI has a significant relationship to care burden due to the deterioration of ADL, risk of falling, and the presence of depression and behavior disorders. We speculate that our results are useful for the explanation of the characteristics of MCI with white matter lesion to the patients and the care givers. Furthermore, these results may lead to improvements in the appropriate approach, intervention and appropriate nursing of such patients.

Assessment of testicular corticosterone biosynthesis in adult male rats.

Corticosterone is synthesized in the adrenal glands and is circulated throughout the body to perform regulatory functions in various tissues. The testis is known to synthesize and secrete testosterone and other androgens. We developed an accurate method to measure steroid content using liquid chromatography-mass spectrometry analysis. In the present study, significant levels of the precursor compounds of testosterone and corticosterone synthesis could be detected in rat testis using this method. After adrenalectomy, corticosterone remained in the blood and testicular tissue at approximately 1% of the amount present in the control testis. When the excised testicular tissue was washed and incubated with NADH, NADPH and progesterone, not only testosterone and its precursors but also 11-deoxycorticosterone and corticosterone were produced; the levels of 11-deoxycorticosterone and corticosterone increased with incubation time. The production rate of 11-deoxycorticosterone from progesterone was estimated to be approximately 1/20 that of 17-hydroxyprogesterone, and the corticosterone level was approximately 1/10 that of testosterone. These ratios coincided with those in the testicular tissue of the adrenalectomized rats, indicating that corticosterone was synthesized in the testis and not in the blood. A primary finding of this study was that corticosterone and testosterone were synthesized in a 1/10-20 ratio in the testis. It is concluded that corticosterone, which has various functions, such as the regulation of glycolysis and mediating spermatogenesis, is produced locally in the testis and that this the local production is convenient and functional to respond to local needs.

[Quantitative assessment of pressure relief at the sacral area in adults lying supine on the operating room table].

BACKGROUND: It is important to prevent development of the pressure ulcers in patients undergoing lengthy surgery, particularly at areas of skin overlying bony prominences. This study was designed to investigate distribution of the interface pressure (IP) over the body area (from the head to pelvic area) in supine adults and also evaluate the ability of a polyurethane-made cushion to reduce the IP at their sacral area. METHODS: Utilizing a recently developed device to measure the IP (ERGO-CHECK, ABW Co., Germany), we evaluated distribution of the IP (estimated per 3 x 4 cm2 area) over the body area in healthy volunteers (n=31) and patients under general anesthesia (n=6) lying supine on the operating room (OR) table. RESULTS: In all the subjects, the highest IP was generated at the sacrum; 62.5 +/- 23.8 (mean +/- SD) and 35.7 +/- 5.5 mmHg in the volunteers and patients, respectively. The polyurethane-made, "doughnut" cushion (5 cm in thickness) inserted between the pelvic area and the OR table significantly reduced (P < 0.05) the IP at the sacrum in both groups: the IPs after the insertion in the volunteers and patients were 35.1 +/- 11.1 and 25.6 +/- 6.5 mmHg, respectively. In addition, the insertion significantly reduced (P < 0.05) the high-risk area (i.e., area of IP > 32 mmHg) in both groups. CONCLUSIONS: Quantitative assessment of the IP would be useful in evaluating precisely the effectiveness of various types of pillows, cushions, or mattresses designed to reduce the IP.