A comprehensive intervention following the clinical pathway of eating and swallowing disorder in the elderly with dementia: historically controlled study.

BACKGROUND: Eating problems in patients with advanced dementia are strongly associated with their deteriorating survival. Food and drink intake in people with dementia may be supported by specific interventions, but the effectiveness of such interventions is backed by almost no evidence. However, comprehensive geriatric assessment (CGA) might potentially clarify the etiology of decreased oral intake in people with dementia; thus improving their clinical outcomes. METHODS: This study was a single-arm, non-randomized trial that included historically controlled patients for comparison. We defined elderly patients with both severely decreased oral intake depending on artificial hydration and/or nutrition (AHN) and dementia as "Eating and Swallowing Disorder of the Elderly with Dementia (ESDED)". In the intervention group, participants received CGA through the original clinical pathway with multidisciplinary interventions. This was followed by individualized therapeutic interventions according to assessment of the etiology of their eating problems. RESULTS: During the intervention period (between 1st April 2013 and 31st March 2015), 102 cases of ESDED were enrolled in the study and 90 patients had completed receiving CGA. Conversely, 124 ESDED patient controls were selected from the same hospital enrolled during the historical period (between 1st April 2011 and 31st March 2012). Most participants in both groups were bedridden with severe cognitive impairment. For the intervention group, an average of 4.3 interventional strategies was recommended per participant after CGA. Serological tests, diagnostic imaging and other diagnostic examinations were much more frequently performed in the intervention group. Recovery rate from ESDED in the intervention group was significantly higher than that in the historical group (51% v.s. 34%, respectively, P = 0.02). The 1-year AHN-free survival in the intervention group was significantly higher than that in the historical group (28% v.s. 15%, respectively, P = 0.01). No significant difference between the two groups was found for 1-year overall survival (37% v.s. 28%, respectively, P = 0.08). CONCLUSIONS: Use of CGA with multidisciplinary interventions could improve the functional status of eating and allow elderly patients with severe eating problems and dementia to survive independently without the need for AHN. TRIAL REGISTRATION: ISRCTN57646445 , this trial was retrospectively registered on 8th December 2015.

Floating aerial LED signage based on aerial imaging by retro-reflection (AIRR).

We propose a floating aerial LED signage technique by utilizing retro-reflection. The proposed display is composed of LEDs, a half mirror, and retro-reflective sheeting. Directivity of the aerial image formation and size of the aerial image have been investigated. Furthermore, a floating aerial LED sign has been successfully formed in free space.

Lipid components, fatty acid distributions of triacylglycerols and phospholipids in rice brans.

Endogenous tocochromanols in extracted lipids from rice brans of the five cultivars were determined by high-performance liquid chromatography, and were investigated in relation to the fatty acid (FA) distribution of triacylglycerols (TAG) and phospholipids (PL). The dominant tocols were α-tocopherol and γ-tocotrienol, followed by α-tocotrienol and with much smaller amounts of γ-tocopherol and δ-tocotrienol. The lipids of these rice brans comprised mainly TAG (80.6-86.0wt.%), free FA (4.2-9.0wt.%), and phospholipids (5.5-6.7wt.%), whilst other components were also detected in minor proportions (0.2-2.1wt.%). The PL components included phosphatidyl choline (31.8-46.8wt.%), phosphatidyl ethanolamine (25.0-38.9wt.%) and phosphatidyl inositol (20.2-23.2wt.%). Comparison of these different cultivars showed, with a few exceptions, no significant differences (P>0.05) in FA distribution. FA distribution of TAG among the five cultivars was evident in the rice brans: unsaturated FA were predominantly concentrated at the sn-2 position and saturated FA primarily occupying the sn-1 or sn-3 position. These results suggest that the tocopherol content, lipid component, and FA distribution in rice brans are not dependent on the cultivation areas during the growing season.

Variation in fatty acid distribution of different acyl lipids in rice (Oryza sativa L.) brans.

The lipids extracted from rice brans were classified by thin-layer chromatography into eight fractions, and their fatty acid (FA) compositions were investigated among five different Japanese cultivars. The lipids of these rice brans comprised mainly triacylglycerols (TAG; 84.9-86.0 wt%), free FA (4.2-4.6 wt%), and phospholipids (PL; 6.5-6.7 wt%), whilst other components were also detected in minor proportions (0.2-2.1 wt%). The PL components included phosphatidyl choline (43.3-46.8 wt%) phosphatidyl ethanolamine (25.0-27.3 wt%) and phosphatidyl inositol (20.2-23.2 wt%). Comparison of the different cultivars showed, with a few exceptions, no substantial difference (P > 0.05) in FA distribution. FA distribution of TAG among the five cultivars was characterized as: unsaturated FA predominantly concentrated at the sn-2 position and saturated FA primarily occupying the sn-1 or sn-3 position in these lipids. These results suggest that the rice bran lipids may be well incorporated into our daily diet to improve nutritional value of the Japanese diet.

Regiospecific profiles of fatty acids in triacylglycerols and phospholipids from Adzuki beans (Vigna angularis).

Regiospecific distributions of fatty acids (FA) of triacylglycerols (TAG) and phospholipids (PL) isolated from five cultivars of adzuki beans (Vigna angularis) were investigated. The lipids comprised mainly PL (72.2-73.4 wt-%) and TAG (20.6-21.9 wt-%), whilst other components were detected in minor proportions (0.1-3.4 wt-%). The principal profiles of the FA distribution in the TAG and PL were evident in the beans among the five cultivars: unsaturated FA were predominantly distributed in the sn-2 position, whilst saturated FA primarily occupied the sn-1 or the sn-3 position in the these lipids. The results would be useful information to both producers and consumers for manufacturing traditional adzuki confectionaries such as wagashi in Japan.

Distribution of fatty acids in triacylglycerols and phospholipids from peas (Pisum sativum L.).

BACKGROUND: The fatty acid distribution of triacylglycerols (TAG) and major phospholipids (PL) obtained from four varieties of peas (Pisum sativum) was investigated. The total lipids extracted from the peas were separated by thin layer chromatography into seven fractions. RESULTS: The major lipid components were PL (52.2-61.3%) and TAG (31.2-40.3%), while hydrocarbons, steryl esters, free fatty acids and diacylglycerols (sn-1,3 and sn-1,2) were also present in minor proportions (5.6-9.2%). The main PL components isolated from the four varieties were phosphatidylcholine (42.3-49.2%), phosphatidylinositol (23.3-25.2%) and phosphatidylethanolamine (17.7-20.5%). Significant differences (P < 0.05) in fatty acid distribution were found for different pea varieties. Phosphatidylinositol was unique in that it had the highest saturated fatty acid content among the three PL. However, the principal characteristics of the fatty acid distribution in the TAG and three PL were evident among the four varieties: unsaturated fatty acids were predominantly located in the sn-2 position while saturated fatty acids primarily occupied the sn-1 or sn-3 position in the oils of the peas. CONCLUSION: These results should be useful to both producers and consumers for the manufacture of pea foods in Japan. Copyright © 2007 Society of Chemical Industry.