One-year changes in activities of daily living and social life in elderly patients undergoing home-based rehabilitation within 1 year of stroke onset.

[Purpose] In this study, we investigated changes in activities of daily living and social participation over 1 year in elderly patients with stroke, who underwent home-based rehabilitation. [Participants and Methods] This 1 year, multicenter cohort study included patients aged ≥65 years with diagnosis of the first onset of stroke within 1 year. Variables recorded included the functional independence measure and performance qualifiers for "d6 domestic life" and "d9 community, social, and civic life" (social life) based on the International Classification of Functioning, Disability and Health framework. [Results] Of the 44 partients recruited at baseline, 19 completed the study over 1 year. We observed significant improvements in the functional independence measure-motor, functional independence measure-cognitive, and functional independence measure-total and in the performance qualifiers ("domestic life" and "social life") of the International Classification of Functioning, Disability and Health tool. We also observed that the functional independence measure-total scores improved over 3 months and "domestic life" and "social life" scores gradually improved over 1 year. [Conclusion] Our results showed that activities of daily living improved earlier than other variables, including social participation, which gradually improved over 1 year and that home-based rehabilitation may effectively improve activities of daily living and social participation.

Effects of Early Postdischarge Rehabilitation Services on Care Needs-Level Deterioration in Older Adults With Functional Impairment: A Propensity Score-Matched Study.

OBJECTIVE: To examine the effects of early postdischarge rehabilitation on care needs-level deterioration in older Japanese patients. DESIGN: Propensity score-matched retrospective cohort study. SETTING: A secondary data analysis was conducted using medical and long-term care insurance claims data from a suburban city in Japan. PARTICIPANTS: We analyzed patients (N=2746) aged 65 years or older who were discharged from hospital to home between April 2012 and March 2014 and had care needs certification indicating functional impairment. INTERVENTIONS: The provision of early rehabilitation services by rehabilitation therapists within 1 month of discharge. Propensity score matching was used to control for differences in characteristics between patients with and without early rehabilitation services. MAIN OUTCOME MEASURES: Any deterioration in care needs level during the 12-month period after discharge. Cox proportional hazards analyses were conducted to identify the association between the exposure and outcome variables after matching. RESULTS: Among 2746 patients, 573 (20.9%) used early rehabilitation services. Care needs-level deterioration occurred in 508 patients (incidence: 18.3 per 1000 person-months), of which 76 used early rehabilitation services (12.3 per 1000 person-months) and 432 did not use early rehabilitation services (20.0 per 1000 person-months). One-to-one propensity score matching produced 566 matched pairs that adjusted for the differences in all covariables. In these matched pairs, the hazard of care needs-level deterioration was significantly lower among patients who used early rehabilitation services (hazard ratio=0.712, 95% CI, 0.529-0.958). A Kaplan-Meier survival analysis showed similar results (log-rank: P=.023). CONCLUSIONS: Early rehabilitation services provided by rehabilitation therapists after hospital discharge appeared effective in preventing care needs-level deterioration, and involving rehabilitation therapists in transitional care may aid the optimization of health care for older Japanese adults with functional impairment.

Influences of remote exercise training for community-dwelling older adults in Japan during the COVID-19 pandemic.

[Purpose] The coronavirus disease (COVID-19) pandemic has caused sudden lifestyle changes. This study aimed to determine the limitations in activity and the influences of remote exercise training on community-dwelling older adults during a state of emergency in Japan. [Participants and Methods] In May 2020, during the COVID-19 state of emergency, we carried out a mail survey of community-dwelling older adults who had previously participated in a disability prevention program in Ami town, Ibaraki, Japan. The mail included a brochure on exercises and a DVD. The attached exercise program was comprised of 10 different exercises, which could be conducted in approximately 30 minutes. [Results] Of the 191 older adults, 73 responded to this survey (38.2%), of which 42 (58.5%) participants had decreased outdoor exercise activity, and 50 (68.5%) decreased the amount of time spent on physical activities during the COVID-19 state of emergency. There were significant reductions (19.2-22.5%) in the perceived exercise load for each posture after two weeks of remote exercise training with DVD (n=26). [Conclusion] Our results suggested that the remote exercise training with the brochure and DVD may be effective. Since this study involved a small number of participants, future studies should involve larger populations.

Gait Training after Stroke with a Wearable Robotic Device: A Case Report of Further Improvements in Walking Ability after a Recovery Plateau.

BACKGROUND: Conventional rehabilitation is known to improve walking ability after stoke, but its effectiveness is often limited. Recent studies have shown that gait training combining conventional rehabilitation and robotic devices in stroke patients provides better results than conventional rehabilitation alone, suggesting that gait training with a robotic device may lead to further improvements in the walking ability recovered by conventional rehabilitation. Therefore, the aim of this report was to highlight the changes in kinematic and electromyographic data recorded during walking before and after gait training with the Honda Walking Assist Device® (HWAT) in a male patient whose walking speed had reached a recovery plateau under conventional rehabilitation. CASE: The patient was a 42-year-old man with severe hemiplegia caused by right putaminal hemorrhage. He underwent conventional rehabilitation for 20 weeks following the onset of stroke, after which his walking speed reached a recovery plateau. Subsequently, we added robotic rehabilitation using HWAT to his regular rehabilitation regimen, which resulted in improved step length symmetry and gait endurance. We also noted changes in muscle activity patterns during walking. DISCUSSION: HWAT further improved the walking ability of a patient who had recovered with conventional rehabilitation; this improvement was accompanied by changes in muscle activity patterns during walking. The improvement in gait endurance exceeded the smallest meaningful change in stroke patients, suggesting that this improvement represented a noticeable enhancement in the quality of life in relation to mobility in the community. Further clinical trials are needed to confirm the results of the present case study.

Changes in social participation and life-space mobility in newly enrolled home-based rehabilitation users over 6 months.

[Purpose] This study aimed to examine whether we were able to measure changes in social participation and life-space mobility of newly enrolled home-based rehabilitation (HR) users by using the activities and participation components of the International Classification of Functioning, Disability and Health (ICF) and Life-Space Assessment (LSA) over a 6-months period. [Participants and Methods] We enrolled 47 HR users who had suffered from a stroke or other condition within the previous year. A 6-month prospective cohort study was conducted. The performance qualifiers "d6 domestic life" and "d9 community, social and civic life" in the activities and participation components of the ICF and LSA were used. [Results] We observed significant improvements in the performance qualifier "d9 community, social and civic life" of the ICF over 3 months, and the LSA over a 6-months period. We also identified significant improvements in "d910 community life" and "d920 recreation and leisure" of the ICF. The LSA results showed that HR users had more frequent mobility within the neighborhood. [Conclusion] This study showed that newly enrolled HR users improved their social activities in the community, recreational activities, and life-space mobility over a 6-months period. These were measured using performance qualifiers from the ICF and LSA.

Number of consulting medical institutions and risk of polypharmacy in community-dwelling older people under a healthcare system with free access: a cross-sectional study in Japan.

BACKGROUND: Under the Japanese free access healthcare system, patients are allowed to consult multiple medical institutions (including clinics and hospitals for general or specialist consultation) without primary care referral. This potentially increases the risk of polypharmacy. We examined the association between the number of consulting medical institutions and polypharmacy under a healthcare system with free access. METHODS: Via a self-administered questionnaire, we identified people aged ≥65 years with ≥1 disease and ≥1 consulting medical institution in a Japanese city in 2016. The exposure of interest was the number of consulting medical institutions (1, 2, or ≥3) and the outcome was polypharmacy (use of ≥6 types of drugs). We performed a multivariate logistic regression analysis, adjusting for age, sex, household economy, and the number and type of comorbidities. To minimize confounding effects, we also performed propensity-score-matched analysis, categorizing patients into two groups: 1 and ≥2 consulting medical institutions. RESULTS: Of 993 eligible individuals (mean (standard deviation) age: 75.1 (6.5) years, men: 52.6%), 15.7% (156/993) showed polypharmacy. Proportions of polypharmacy were 9.7% (50/516), 16.6% (55/332), and 35.2% (51/145) for people who consulted 1, 2, and ≥3 medical institutions, respectively. Relative to people who consulted 1 medical institution, adjusted odds ratios (95% confidence intervals) for polypharmacy were 1.50 (0.94-2.37) and 3.34 (1.98-5.65) for those who consulted 2 and ≥3 medical institutions, respectively. In propensity score matching, of 516 and 477 patients who consulted 1 and ≥2 medical institutions, 307 pairs were generated. The proportion of polypharmacy was 10.8% (33/307) and 17.3% (53/307), respectively (P = 0.020). The odds ratio for polypharmacy (≥2 vs. 1 consulting medical institution) was 1.73 (95% confidence interval 1.09-2.76). CONCLUSIONS: Patients who consulted more medical institutions were more likely to show polypharmacy. The results could encourage physicians and pharmacists to collect medication information more actively and conduct appropriate medication reviews. Strengthening primary care is needed to address the polypharmacy issue, especially in countries with healthcare systems with free access.

Rebamipide suppresses 5-fluorouracil-induced cell death via the activation of Akt/mTOR pathway and regulates the expression of Bcl-2 family proteins.

Oral mucositis is a common adverse effect of chemotherapy that limits the required dose of chemotherapeutic agents. Numerous attempts to mitigate chemotherapy-induced oral mucositis have failed to identify an appropriate treatment. Recently, it has been indicated that rebamipide prevents chemoradiotherapy-induced oral mucositis in patients. However, the details of the underlying mechanism involved in the cytoprotective effect of rebamipide remain obscure. In the present study, we investigated the mechanism behind rebamipide cytoprotective effect in the oral mucosa using primary normal human oral keratinocytes (NHOK cells). We found that rebamipide prevented 5-fluorouracil (5-FU)-induced cell death in NHOK cells. In addition, rebamipide increased the levels of phosphorylated Akt and mTOR, enhanced the Bcl-2 and Bcl-xL expressions, and suppressed the expression of Bax and Bim. This is in contrast to 5-FU-induced suppression of Akt and mTOR activation, Bcl-2 and Bcl-xL expressions, and the enhanced expression of Bax and Bim. These findings suggest that rebamipide can potentially be used for the protection of oral mucosa from chemotherapy-induced mucositis. This is the first study that elucidates the specific molecular pathway for the cytoprotective effect of rebamipide.

[A Case of Difficult Airway Management during an Invasive Procedure].

It is the mission of an anesthesiologist in periopera- tive management to secure the airway safely. In a recent case we encountered a difficult airway manage- ment (DAM) situation that could not be settled by usual DAM algorithm. A 69-year-old man underwent a carotid endarec- tomy (CEA) operation. The procedure lasted six hours and his initial awakening from anesthesia was excel- lent Thirty minutes later, a neck swelling was noticed during a scheduled CT follow-up examination and there was a leakage of contrast medium from a blood vessel. To stop the bleeding a re-operation was required but the patient's breathing gradually deteriorated. Even though a supraglottic device -(SGD ; air-Q04.5) was inserted to ensure airway management, the situation progressed to CICV (cannot intubate cannot ventilate). An abnormal anatomical orientation made it difficult to perform an invasive airway access by a cricothyroid- otomy and it took over 20 minutes to access the crico- thyroid membrane and insert an endotracheal tube through the membrane whilst the patient was in a hypoxic state. Invasive airway access is positioned as the final res- cue procedure when less-invasive methods failed to manage a difficult airway. In the above situation where the rapidly progressing CICV state could not be resolved smoothly by a surgical airway approach due to the cervical anatomic abnormality, it is necessary to secure the airway immediately when the neck is swelling with the possibility of airway obstruction.

[A Case of Overlooking the Failure of the Badkup Battery Operation of an Anesthesia Machine].

Recently the near flawless fail-safe system in the operating room protects anesthesiologists from irrepa- rable incidents. Still a slight possibility remains where careless use of the anesthesia apparatus can lead to safety system failures. For instance, we did not notice an unintended run- ning of the battery backup fail-safe system during an anesthetic procedure. Despite a complete start-up inspection this eventually led to a serious system alarm that falsely alerted us to a dangerous situation that the apparatus had been operating without an electric power supply and had been working under the battery backup supply. Because there is no general unified standard warn- ing system, the ways and means of warning on oper- ating anesthesia apparatus differ with each manufac- turer. Therefore we must check the warning process and understand the meaning of each alarm regardless of which fail-safe system is being used. We propose that a general standard alarm system is preferable to prevent anesthesiologists from overlooking a serious mishap.

[Introduction of long-term care insurance: changes in service usage].

OBJECTIVES: With the aging of the population, Japan's long-term care system has shifted from a welfare-placement system to a social-insurance system, which is a precedent of policies for the elderly. We examined how individuals who used care services before the implementation of long-term care insurance (LTCI) (previous service users) currently use the LTCI services, with a focus on the processes of service use. METHODS: Panel data were obtained from the Nihon University Japanese Longitudinal Study of Aging database. These data were collected by interviews conducted before (November 1999 and March 2000) and after (November 2001 and December 2001) the establishment of LTCI. Among the 3992 individuals who participated in these interviews, 416 of the previous service users, aged ≥65 years, were sampled. The outcome measures were the processes of using LTCI services (application for LTCI, certification of long-term care need, and contract with LTCI service providers). Logistic regression analysis was performed to identify individual factors associated with the process of application for LTCI. RESULTS: There were 133 LTCI users among the 416 previous service users (32.0%). Of the service processes used, 45.5% of previous service users were applicants, 85.7% of the applicants were certified individuals, and 88.7% of those certified used services with service contracts. The application process was significantly easier for individuals with disease (odds ratio[OR], 8.34 : 95% confidence interval [CI], 1.86-37.46), those dependent for their instrumental activities of daily living (IADL) (OR, 11.21 : 95% CI, 5.22-24.07), those with an equivalent income of <1.25 million yen (OR, 2.72 : 95% CI, 1.30-5.69), and those who had used respite care (OR, 3.29 : 95% CI, 1.16-9.35) previously. In contrast, the application process was significantly difficult for community rehabilitation users (OR, 0.38 : 95% CI, 0.17-0.82). CONCLUSION: Only half of the previous service users were applicants, and they had severe diseases or were more dependent for their IADL. Our findings suggest that many individuals who were functionally independent were covered under the welfare-placement system. Additionally, low-income individuals did not refrain from applying.

A sodium manganese ferrocyanide thin film for Na-ion batteries.

A thin film of sodium manganese ferrocyanide, Na1.32Mn[Fe(CN)6]0.83·3.5H2O, exhibits discharge capacity (= 109 mA h g(-1)) and discharge voltage (3.4 V in average) at 0.5 C against Na in aprotic solvent. The ex situ XRD experiments reveal that the host framework remains cubic without showing any structural phase transition during the charge process. The discharge property is discernible up to 40 C.

Control of the alkali cation alignment in Prussian blue framework.

We found that the alignments of the alkali cations can be controlled by a distortion of Prussian blue framework; the rubidium ions form a rod structure in a distorted framework of Rb(0.85)Cu[Fe(CN)(6)](0.95)·1.3H(2)O, while the cesium ions are isolated dot structures in a non-distorted framework of Cs(0.97)Cu[Fe(CN)(6)](0.99)·1.1H(2)O. The Madelung energy calculations revealed that the novel rod structure is stabilized by the alternating rotations of the [Fe(CN)(6)] units within the three-dimensional coordination polymer framework.

Blocking effect of NIP-142 on the KCNQ1/KCNE1 channel current expressed in HEK293 cells.

We examined the effect of NIP-142, a benzopyran compound with terminating effect on experimental atrial arrhythmia, on the KCNQ1/KCNE1 channel, which underlies the slow component of the cardiac delayed rectifier potassium channel (I(Ks)). NIP-142, as well as chromanol 293B, showed concentration-dependent blockade of the current expressed in HEK293 cells; the EC(50) value of NIP-142 and chromanol 293B for the inhibition of tail current was 13.2 µM and 4.9 µM, respectively. These results indicate that NIP-142 has blocking effect on the KCNQ1/KCNE1 channel current.

Relaxin-3/INSL7 regulates the stress-response system in the rat hypothalamus.

Relaxin-3 (RLN3) is a neuropeptide belonging to the insulin-relaxin superfamily. RLN3-expressing neurons are predominantly located in the dorsal pons known as the nucleus incertus, and project their axons to the forebrain including the hypothalamus. RLN3 has been suggested to be involved in the stress response. In the present study, we investigated the hypothalamic action of RLN3 in the stress-response system by intracerebroventricular (icv) administration of RLN3. Compared with saline icv injection, 1 nmol icv RLN3 injection induced c-Fos expression in the paraventricular nucleus of the hypothalamus (PVN) at 1 h after administration. Some RLN3-induced c-Fos-positive cells in the PVN were also corticotropin-releasing factor (CRF)-expressing neurons. CRF and c-fos mRNA levels in the PVN were increased at 2 h after RLN3 administration. Plasma adrenocorticotropic hormone (ACTH) levels were also increased after RLN3 administration. These results suggest that RLN3 is able to stimulate the hypothalamopituitary CRF-ACTH system during the acute response.

Symmetry switch of cobalt ferrocyanide framework by alkaline cation exchange.

We observed a reversible symmetry switch of a cobalt ferrocyanide framework by the alkaline cation exchange and resultant control of the optical properties at room temperature.

Synthesis of a metal oxide with a room-temperature photoreversible phase transition.

Photoinduced phase-transition materials, such as chalcogenides, spin-crossover complexes, photochromic organic compounds and charge-transfer materials, are of interest because of their application to optical data storage. Here we report a photoreversible metal-semiconductor phase transition at room temperature with a unique phase of Ti(3)O(5), lambda-Ti(3)O(5). lambda-Ti(3)O(5) nanocrystals are made by the combination of reverse-micelle and sol-gel techniques. Thermodynamic analysis suggests that the photoinduced phase transition originates from a particular state of lambda-Ti(3)O(5) trapped at a thermodynamic local energy minimum. Light irradiation causes reversible switching between this trapped state (lambda-Ti(3)O(5)) and the other energy-minimum state (beta-Ti(3)O(5)), both of which are persistent phases. This is the first demonstration of a photorewritable phenomenon at room temperature in a metal oxide. lambda-Ti(3)O(5) satisfies the operation conditions required for a practical optical storage system (operational temperature, writing data by short wavelength light and the appropriate threshold laser power).

Vascular endothelial growth factor in epithelial lining fluid of patients with acute respiratory distress syndrome.

BACKGROUND AND OBJECTIVE: Vascular endothelial growth factor (VEGF) is known to contribute to the development of pulmonary oedema, and has been suggested to have a protective role against lung injury. To determine the role of VEGF in acute lung injury (ALI) and ARDS, VEGF levels were measured in lung epithelial lining fluid (ELF) collected from patients with ALI/ARDS. METHODS: Forty patients with ALI/ARDS underwent bronchoscopic microsampling to collect ELF on days 0 (onset of ALI/ARDS), 1, 3, 5, 7 and 10, unless the patient was extubated or had died. Twelve patients, who underwent bronchoscopy for examination of small, peripheral pulmonary nodules, served as controls. RESULTS: The initial (day 0) levels of VEGF in ELF of the ALI/ARDS patients who survived and those who did not were 5.5 ng/mL (IQR: 2.3-19.7) and 1.7 ng/mL (IQR: 0.0-6.4), respectively. On days 0, 5, 7 and 10, the VEGF levels in ELF were significantly greater in survivors than in non-survivors (P < 0.05). VEGF levels on days 1 and 3 did not differ between survivors and non-survivors. There was no significant difference in ELF VEGF levels between control subjects and patients with ALI/ARDS at any time point. Lung injury score was inversely correlated with VEGF concentration in ELF (P < 0.001). CONCLUSIONS: In patients with ALI/ARDS, elevated VEGF levels in ELF may predict a better outcome. Increased production of VEGF in the injured lung may contribute to resolution of inflammation in the lung.

Poly[[hexa-µ-cyanido-manganese(II)iron(III)] penta-hydrate].

The structure of the title compound, Mn(II)[Fe(III)(CN)(6)](2/3)·5H(2)O, features a face-centered cubic -Mn-NC-Fe- framework with both Mn and Fe having site symmetry mm. Since one-third of the [Fe(CN)(6)](3-) units are missing for a given formula in order to maintain charge neutrality, each Mn atom around such a vacancy is coordinated not only by the N atoms of the CN groups but also by the O atoms of the ligand water mol-ecules. In addition to ligand water mol-ecules, two types of non-coordinated water mol-ecules, so-called zeolitic water mol-ecules, exist in the inter-stitial sites of the -Mn-NC-Fe- framework. The positions of the O atoms of the zeolitic water mol-ecules are fixed by the linkage via hydrogen bonds between ligand water and zeolitic water mol-ecules. The structure is related to a recently reported rubidium manganese hexa-cyano-ferrate. Site occupancy factors for Fe, C, N are 0.67; for two O atoms the value is 0.83 and for one O atom is 0.17.