Frailty and audiovisual senses in older patients with diabetes: a cross-sectional observational study.

Objective: This study aimed to analyze the relationship between frailty in older patients with diabetes and audiovisual senses. Methods: The survey included (1) basic attributes, (2) diabetes-related items, (3) frailty, evaluated according to the Obu Study of Health Promotion for the Elderly (OSHPE) standard, and (4) audiovisual function. Participants included 157 diabetes patients aged ≥65 years, divided into three groups: robust health (n=50), pre-frail (n=76), and frail (n=31). A simple regression analysis, in which the total OSHPE score was used as the dependent variable and the most relevant audiovisual items were used as independent variables, was performed to analyze the frailty factor. Next, a multiple regression analysis adjusted for age and sex was performed with total OSHPE score as the dependent variable and the items most relevant for audiovisual senses as independent variables. Results: For the robust health, pre-frail, and frail groups, frequencies of hearing loss were 18.4%, 42.1%, and 35.5%, respectively, and were associated with frailty; visual impairment frequencies were 38%, 63.2%, and 58.1%, respectively. In multiple regression analysis, economic difficulties (B=0.349, ß=0.172, p<0.05), absence of dyslipidemia (B=-0.494, ß=-0.171, p<0.05), lower MNA score (B=-0.169, ß=-0.214, p<0.05), and worsening hearing in the poor hearing ear (B=0.015, ß=0.176, p<0.05) were significantly associated with frailty. Conclusions: Hearing but not vision was associated with frailty in older patients with diabetes.

Frailty and visual, auditory, olfactory, and taste senses in older patients visiting a frailty outpatient clinic.

AIM: Although studies have analyzed the relationship between frailty and human senses, few have comprehensively evaluated and examined their correlations. This study aimed to clarify the relationship between frailty and the senses of sight, hearing, smell, and taste. METHODS: The subjects were outpatients at the Locomo Frail Outpatient Clinic. Sensory organ items were evaluated subjectively, and frailty was classified as nonfrail or frail using the Kihon Checklist. Univariate analysis was performed using the presence or absence of frailty as the dependent variable. Logistic regression analysis (forced entry method) was performed for the variables that showed significant differences. RESULTS: A total of 269 and 226 participants were assigned to the nonfrail and frail groups, respectively. The frequency of sensory organ impairment was 10.1% for taste, 12.7% for smell, 44.6% for vision, and 58.3% for hearing. Univariate analysis using the presence or absence of frailty as the dependent variable was determined to be significant for years of education, number of medications, Geriatric Depression Scale, Mini-Mental State Examination, Mini Nutritional Assessment-Short Form, grip strength, gait speed, sense of taste, sense of smell, sense of vision, and sense of hearing. Logistic regression analysis using the presence or absence of frailty as the dependent variable, adjusted for age, showed significant correlations with the Geriatric Depression Scale, gait speed, Mini Nutritional Assessment-Short Form, and olfactory impairment. CONCLUSIONS: Olfactory impairment had the strongest correlation with frailty. Although the sense of smell decreases with disease and aging, olfactory impairment may be correlated with frailty as a symptom of neurodegenerative diseases. Geriatr Gerontol Int 2023; 23: 871-876.

Exploring the size of reference population for expected accuracy of genomic prediction using simulated and real data in Japanese Black cattle.

BACKGROUND: Size of reference population is a crucial factor affecting the accuracy of prediction of the genomic estimated breeding value (GEBV). There are few studies in beef cattle that have compared accuracies achieved using real data to that achieved with simulated data and deterministic predictions. Thus, extent to which traits of interest affect accuracy of genomic prediction in Japanese Black cattle remains obscure. This study aimed to explore the size of reference population for expected accuracy of genomic prediction for simulated and carcass traits in Japanese Black cattle using a large amount of samples. RESULTS: A simulation analysis showed that heritability and size of reference population substantially impacted the accuracy of GEBV, whereas the number of quantitative trait loci did not. The estimated numbers of independent chromosome segments (Me) and the related weighting factor (w) derived from simulation results and a maximum likelihood (ML) approach were 1900-3900 and 1, respectively. The expected accuracy for trait with heritability of 0.1-0.5 fitted well with empirical values when the reference population comprised > 5000 animals. The heritability for carcass traits was estimated to be 0.29-0.41 and the accuracy of GEBVs was relatively consistent with simulation results. When the reference population comprised 7000-11,000 animals, the accuracy of GEBV for carcass traits can range 0.73-0.79, which is comparable to estimated breeding value obtained in the progeny test. CONCLUSION: Our simulation analysis demonstrated that the expected accuracy of GEBV for a polygenic trait with low-to-moderate heritability could be practical in Japanese Black cattle population. For carcass traits, a total of 7000-11,000 animals can be a sufficient size of reference population for genomic prediction.

Development and Testing of the Foot Care Scale for Older Japanese Diabetic Patients.

We aimed to develop and test the reliability and validity of a foot care self-management assessment tool for older Japanese patients with diabetes. In this cross-sectional observational study, which was carried out according to the Strengthening the Reporting of Observational Studies in Epidemiology guidelines, additional items were developed and selected to reflect older Japanese patients' needs a thorough investigation with experts in diabetes and geriatrics. A total of 200 older patients with diabetes in a foot care outpatient clinic were included in the study to finalize the scale items and verify the scale's reliability and validity. A factor analysis yielded a 4-factor, 9-item scale. Factors 1 to 4 were "skin condition" (3 items), "nail clipping" (2 items), "attention to wounds" (2 items), and "relationships with others" (2 items). The Cronbach's α coefficients for the 4 factors were .852, .900, .820, and .571, respectively. The overall scale was 0.797, indicating good internal consistency. Spearman's correlation coefficients for each of the 4 factors with the scale's total score showed good stability; all correlations were significant. In Japan's super-aged society, it is important to focus on foot care practices among older adults and to promote good foot care practices among early older adults so that they can practice self-care at home. Therefore, a scale for comprehensively evaluating foot care in elderly patients with diabetes is needed. The Foot Care Scale for Older Diabetics could be useful as a tool for assessing the ability to self-manage foot care in older Japanese patients with diabetes.

Associations between diabetes-related foot disease, diabetes, and age-related complications in older patients.

PURPOSE: To examine the relationship of diabetes-related foot disease (DFD) with diabetes and age-related complications in older patients with diabetes mellitus (DM). METHODS: We examined 562 outpatients with diabetes, aged ≥ 65 years, for DFD. The variables collected in this study were demographics, DM-related complications, treatment method, and age-related complications. Differences in the complications were compared between patients with and without DFD. Logistic regression analysis was used to determine the associations of DFD with DM and age-related complications. RESULTS: A total of 246 patients (43.8%) had DFD. Logistic regression analysis identified low grip strength [Odds ratio (OR): 1.83, 95% confidence interval (CI) 1.21-2.76), hypertension (OR: 1.81, 95% CI 1.09-3.00), and diabetes-related peripheral neuropathy (DPN) (OR: 1.92, 95% CI 1.24-2.98) to be significantly associated with DFD. Patients with DPN and hypertension had a higher risk of DFD than patients with DPN or hypertension alone. Individuals with DPN and low grip strength (OR: 1.74, 95% CI 1.09-2.81) were at a lower risk than those with low grip strength alone. CONCLUSION: Hypertension, DPN, and low grip strength were significantly associated with DFD in older patients with DM, with the risk of DFD being higher in patients with both DPN and hypertension. When considering DFD in older patients with DM, low grip strength should be considered equally important as a DM-related complication.

Microvascular complications and frailty can predict adverse outcomes in older patients with diabetes.

AIM: We aimed to assess whether frailty and diabetes-related factors could predict the occurrence of adverse events in older patients with diabetes, who constitute a patient population prone to physical decline and reductions in skeletal muscle mass. METHODS: This retrospective cohort study comprised 477 patients who were being managed by outpatient diabetes care, and the reductions in their muscle strength and walking speed were assessed. Patients were evaluated using the Kihon Checklist, Mini Nutritional Assessment and Mini Mental State Examination, and followed up for 1 year, during which adverse events were monitored and confirmed from past medical records and face-to-face interviews. Intergroup comparisons of participants with and without adverse events during the observation period were undertaken by the paired-sample t-, Mann-Whitney U- and chi-square tests. Multiple logistic regression analysis, adjusted for sex and age, was conducted to determine significant predictors of adverse event incidence. RESULTS: Overall, 12.4% (n = 59; age 74.2 ± 6.2 years) of the patients experienced adverse events. We observed significant between-group differences in the Kihon Checklist total score, walking speed, hypoglycemia episodes, nephropathy, retinopathy, and neuropathy. Microvascular complications and frailty were significant predictors of adverse event incidence (respective odds ratio [95% confidence interval]: 1.403 [1.109-1.775] per additional complication; 2.419 [1.331-4.397] for frailty; both P < 0.05). CONCLUSIONS: In this study, we found that frailty, which was assessed using the Kihon Checklist, and the number of microvascular complications predicted adverse events in older patients with diabetes and should to be assessed. Geriatr Gerontol Int 2021; 21: 359-363.

Performance of laboratory tests for detection for Clostridioides difficile: A multicenter prospective study in Japan.

BACKGROUND: The optimal and practical laboratory diagnostic approach for detection of Clostridioides difficile to aid in the diagnosis of C. difficile infection (CDI) is controversial. A two-step algorithm with initial detection of glutamate dehydrogenase (GDH) or nucleic acid amplification test (NAAT) alone are recommended as a predominant method for C. difficile detection in developed countries. The aim of this study was to compare the performance of enzyme immunoassays (EIA) detecting toxins A and B, NAAT detecting the toxin B gene, and GDH compared to toxigenic culture (TC) for C. difficile as the gold standard, in patients prospectively and actively assessed with clinically significant diarrhea in 12 medical facilities in Japan. METHODS: A total of 650 stool specimens were collected from 566 patients with at least three diarrheal bowel movements (Bristol stool grade 6-7) in the preceding 24 h. EIA and GDH were performed at each hospital, and NAAT and toxigenic C. difficile culture with enriched media were performed at the National Institute of Infectious Diseases. All C. difficile isolates recovered were analyzed by PCR-ribotyping. RESULTS: Compared to TC, the sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of EIA were 41%, 96%, 75% and 84%, respectively, and for NAAT were 74%, 98%, 91%, and 92%, respectively. In 439 specimens tested with GDH, the sensitivity, specificity, PPV, and NPV were 73%, 87%, 65%, and 91%, and for an algorithm (GDH plus toxin EIA, arbitrated by NAAT) were 71%, 96%, 85%, and 91%, respectively. Among 157 isolates recovered, 75% of isolates corresponded to one of PCR-ribotypes (RTs) 002, 014, 018/018", and 369; RT027 was not isolated. No clear differences in the sensitivities of any of EIA, NAAT and GDH for four predominant RTs were found. CONCLUSION: The analytical sensitivities of NAAT and GDH-algorithm to detect toxigenic C. difficile in this study were lower than most previous reports. This study also found low PPV of EIAs. The optimal method to detect C. difficile or its toxins to assist in the diagnosis of CDI needs further investigation.

Clostridioides (Clostridium) difficile infection burden in Japan: A multicenter prospective study.

Clostridioides (Clostridium) difficile is the leading cause of healthcare-associated infectious diarrhea in the developed world. Retrospective studies have shown a lower incidence of C. difficile infection (CDI) in Japan than in Europe or North America. Prospective studies are needed to determine if this is due lack of testing for C. difficile or a true difference in CDI epidemiology. A prospective cohort study of CDI was conducted from May 2014 to May 2015 at 12 medical facilities (20 wards) in Japan. Patients with at least three diarrheal bowel movements (Bristol stool grade 6-7) in the preceding 24 h were enrolled. CDI was defined by positive result on enzyme immunoassay for toxins A/B, nucleic acid amplification test for the toxin B gene or toxigenic culture. C. difficile isolates were subjected to PCR-ribotyping (RT), slpA-sequence typing (slpA-ST), and antimicrobial susceptibility testing. The overall incidence of CDI was 7.4/10,000 patient-days (PD). The incidence was highest in the five ICU wards (22.2 CDI/10,000 PD; range: 13.9-75.5/10,000 PD). The testing frequency and CDI incidence rate were highly correlated (R2 = 0.91). Of the 146 isolates, RT018/018″ was dominant (29%), followed by types 014 (23%), 002 (12%), and 369 (11%). Among the 15 non-ICU wards, two had high CDI incidence rates (13.0 and 15.9 CDI/10,000 PD), with clusters of RT018/slpA-ST smz-02 and 018"/smz-01, respectively. Three non-RT027 or 078 binary toxin-positive isolates were found. All RT018/018" isolates were resistant to moxifloxacin, gatifloxacin, clindamycin, and erythromycin. This study identified a higher CDI incidence in Japanese hospitals than previously reported by actively identifying and testing patients with clinically significant diarrhea. This suggests numerous patients with CDI are being overlooked due to inadequate diagnostic testing in Japan.

Diagnostic utilities of a fully automated molecular test for toxigenic Clostridium difficile.

Laboratory underdiagnosis of toxigenic Clostridium difficile can lead to inappropriate management of C. difficile infection (CDI). A fully automated molecular test (FAMT), BD MAX, and enzyme immunoassays for C. difficile glutamate dehydrogenase (GDH) and for toxin A/B antigen test were evaluated using clinical specimens. Laboratory analysis of 231 fecal specimens from patients suspected with CDI, indicated that the sensitivity (Sn), specificity (Sp), positive predictive value (PPV), and negative predictive value (NPV) of FAMT was 98.1%, 98.9%, 96.3%, and 99.4%, while that of toxin A/B antigen was 52.8%, 100.0%, 100.0%, and 87.7%, respectively, compared to toxigenic culture. Sn, Sp, PPV, and NPV of GDH test compared to toxigenic culture was 92.5%, 94.4%, 83.1%, and 97.7%, respectively. FAMT can support the accurate laboratory diagnosis of toxigenic C. difficile and be an effective tool for appropriate treatment of CDI.

Predominance of PCR-ribotypes, 018 (smz) and 369 (trf) of Clostridium difficile in Japan: a potential relationship with other global circulating strains?

Global spread and evolutionary links of an epidemic Clostridium difficile strain (PCR-ribotype 027) have been noted in recent decades. However, in Japan, no outbreaks caused by type 027 have been reported to date. A total of 120 C. difficile isolates from patients at 15 hospitals during non-outbreak seasons between 2011 and 2013 as well as 18 and 21 isolates collected from two hospitals in 2010 and 2009, respectively, in outbreak periods in Japan, were examined. Among these 120 isolates, Japan-ribotypes smz and ysmz (subtype variant of smz) were the most predominant (39.2 %) followed by Japan-ribotype trf (15.8 %). Types smz/ysmz and trf were also concurrently predominant at two hospitals in the outbreak settings. Out of the five binary toxin-positive isolates observed, only one was PCR-ribotype 027 and another PCR-ribotype 078. Type smz was later found to correspond to PCR-ribotype 018. High rates of resistance against gatifloxacin, moxifloxacin, erythromycin and clindamycin were observed in the PCR-ribotype 018 isolates. Interestingly, all trf isolates were toxin A-negative, toxin B-positive, but they did not correspond to PCR-ribotype 017, thus being assigned a new ribotype (PCR-ribotype 369). In conclusion, PCR-ribotypes 018 (smz) and 369 (trf) were identified as major circulating strains in both outbreak and non-outbreak settings in Japan. Given their epidemiological relevance, molecular investigations are warranted to clarify potential evolutionary links with related strains found elsewhere, such as PCR-ribotypes 018 and 017 from Europe and North America.

Fluorescence detection of the endonuclease III reaction using modified oligonucleotides.

We have developed a method for the detection of the endonuclease III reaction by fluorescence. The probes were 13-base-pair hairpin-shaped oligonucleotides containing one of the isomers of thymine glycol or 5,6-dihydrothymine as a damaged base at the center, and had a fluorophore and a quencher at the 5' and 3' ends, respectively. Fluorescence was detected when the probe was cleaved by the enzyme, because the short fragment bearing the fluorophore could not be hybridized to the quencher strand at the incubation temperature. The substrate specificity was shown using Escherichia coli and human enzymes.