Occupational Fall Risk Assessment Tool for older workers.

BACKGROUND: No easy-to-use fall risk assessment tools have been devised to assess occupational fall risk in older workers. AIMS: To develop an Occupational Fall Risk Assessment Tool (OFRAT) and report its predictive validity and reliability in older workers. METHODS: The baseline fall risk assessment was completed by 1113 participants aged ≥60 years who worked ≥4 days/month in Saitama, Japan. Participants were followed up for falls during occupational activities for 1 year, and 30 participants were assessed twice for test-retest reliability. The following assessment measures were summed to form the OFRAT risk score: older age, male sex, history of falls, physical work participation, diabetes, use of medications increasing fall risk, reduced vision, poor hearing, executive dysfunction and slow stepping. The scores were then classified into four grades (0-2 points: very low, 3 points: low, 4 points: moderate and ≥5 points: high). RESULTS: During follow-up, 112 participants fell 214 times during work. The negative binomial regression model showed that participants with higher grades had a higher incidence rate ratio [95% confidence interval] for falls than those with very low grades (low: 1.64 [1.08-2.47], moderate: 4.23 [2.82-6.34] and high: 6.12 [3.83-9.76]). The intraclass correlation coefficient for risk score was 0.86 [0.72-0.93], and the weighted kappa coefficient for grade assessment was 0.74 [0.52-0.95]. CONCLUSIONS: The OFRAT is a valid and reliable tool for estimating the occupational fall risk in older workers. It may assist occupational physicians implement strategies to prevent falls in this group.

Discrimination of Frailty Phenotype by KinectTM-Based Stepping Parameters.

Background: Frailty increases the risk of falling, hospitalization, and premature death, necessitating practical early-detection tools. Objectives: To examine the discriminative ability of KinectTM-based stepping parameters for identifying frailty phenotype. Design: Population-based cross-sectional study. Setting: Eighteen neighborhoods near Tokyo Metropolitan Institute for Geriatrics and Gerontology, Itabashi, Tokyo, Japan. Participants: In total, 563 community-dwelling older adults aged ≥75 years without mobility limitations, neurological disease, or dementia were included. Measurements: Step number (SN) and knee total movement distance (KMD) during a 20-s stepping test were evaluated using the KinectTM infrared depth sensor. Results: The number (%) of participants with frailty were 51 (9.1). The area under the receiver operating characteristic curves (95% confidence interval) of a parameter consisting of SN and KMD for frailty was 0.72 (0.64, 0.79). Conclusions: Stepping parameters evaluated using KinectTM provided acceptable ability in identifying frailty phenotype, making it a practical screening tool in primary care and home settings.

Exercise and/or Dietary Varieties and Incidence of Frailty in Community-Dwelling Older Women: A 2-Year Cohort Study.

OBJECTIVE: Exercise and dietary habits rich in variety may reduce the risk of frailty incident, but such association remains unexamined. This study aimed to examine the longitudinal associations between exercise and/or dietary varieties and incidence of frailty in older women. DESIGN: A 2-year population-based prospective cohort study. SETTING AND PARTICIPANTS: Six hundred and four community-dwelling older Japanese women aged ≥75 years with non-frailty at baseline survey. MEASUREMENTS: Frailty was assessed using Fried's frailty criteria composed of shrinking, weakness, slowness, low activity, and exhaustion at both baseline and follow-up surveys. Frailty incident was defined as the presence of ≥3 components at the follow-up survey. At baseline, information about exercise and dietary habits were obtained from all participants through a face-to-face interview. Participants were grouped into two categories, high (≥2) and low (<2) exercise varieties, assessed by the number of participations in 17 exercise types. By dietary variety, assessed using Dietary Variety Score (range, 0 to 10), participants were grouped into two, high (≥4 points) and low (<4 points) dietary varieties. Binary logistic regression analyses were applied to obtain adjusted odds ratios (ORs) and 95% confident intervals (CIs) of the incidence of frailty in the 4 groups (low-exercise and low-dietary varieties [low EV + low DV] as reference; low-exercise and high-dietary varieties [low EV + high DV]; high-exercise and low-dietary varieties [high EV + low DV]; and high-exercise and high-dietary varieties [high EV + high DV]). RESULTS: Frailty incidence rate was 9.3% over the 2-year follow-up period. Incidence rates of frailty in the 4 groups were as follows: 23.7%, 10.1%, 6.5%, and 7.7% in the low EV + low DV, low EV + high DV, high EV + low DV, and high EV + high DV groups, respectively. After adjustment for covariates, only the high EV + high DV group was associated with a significantly lower OR (0.38; 95% CI 0.15-0.92) of frailty incidence compared with the low EV + low DV group. CONCLUSION: Higher variety of exercise and diet was significantly associated with lower incidence of frailty. Thus, the combination of variety-rich exercise and dietary program may be useful in preventing the incidence of frailty in older women.

Development of the Nutrition and Functionality Assessment (NFA) among Older Adults in Japan.

OBJECTIVE: Develop and evaluate the feasibility and validity of the Nutrition and Functionality Assessment (NFA) which identifies "target" older adults who could benefit from a personalized program following evaluation of their nutrition status and physical functionality. DESIGN: Cross-sectional study. SETTING: Community and geriatric day-care centers and university in Japan. PARTICIPANTS: 267 older adults aged 65-90. MEASUREMENTS: The "target" individuals were screened based on gait speed (0.6-1.5 m/s). Nutrition (Mini Nutrition Assessment-short form and protein intake), strength (30s chair sit-to-stand and hand-grip strength) and endurance (6-minute walk) were assessed. Physical activity was monitored using a tri-axil accelerometer for a week. Fried frailty phenotype was also assessed. RESULTS: Out of 267 individuals, 185 (69%) had gait speed between 0.6-1.5 m/s, corresponding to our "target" group from which, 184 (95%) completed the nutrition and physical functionality assessments with the physical activity monitoring. The NFA was completed in approximately 30 minutes. No adverse events directly due to the NFA were reported. NFA physical functionality and global scores were significantly related to frailty phenotype but nutrition score was not related to frailty phenotype. CONCLUSION: The study demonstrated that the NFA is a safe and feasible tool to screen target older adults and simultaneously evaluate their nutritional status and physical functionality. Validity of the NFA was partially confirmed by the significant association of the global and physical functionality scores with frailty phenotype. More studies are required to validate and maximize the applicability of the NFA in communities and institutions in Japan and elsewhere.

Effects of Aerobic and Resistance Training Combined with Fortified Milk on Muscle Mass, Muscle Strength, and Physical Performance in Older Adults: A Randomized Controlled Trial.

OBJECTIVES: Fortified milk and resistance training (RT) increase muscle mass, muscle strength, and physical performance in older adults, but it remains unclear whether RT combined with aerobic training (AT) would have stronger effects on these outcomes. The purpose of this study was to examine the effects of aerobic and resistance training (ART) combined with fortified milk consumption on muscle mass, muscle strength, and physical performance in older adults. DESIGN: Open-labeled randomized controlled trial. SETTING: University of Tsukuba. PARTICIPANTS: Fifty-six older adults aged 65-79. INTERVENTION: Participants were randomly allocated into resistance training (RT + fortified milk, n = 28) and aerobic and resistance training (ART + fortified milk, n = 28) groups. All participants attended supervised exercise programs twice a week at University of Tsukuba and ingested fortified milk every day for 12 weeks. Skeletal muscle index ([SMI]: appendicular lean mass/height2) was assessed using dual-energy X-ray absorptiometry as a muscle mass measure. One-repetition maximum strength was measured using four kinds of resistance training machines (chest press, leg extension, leg curl, and leg press) as muscle strength measures. Sit-to-stand and arm curl tests were also assessed as physical performance measures. MEASUREMENTS: The primary measurements were muscle mass and strength. The secondary outcomes were physical performance, blood samples, habitual diet, habitual physical activity, and medication use. RESULTS: Although the muscle strength and physical performance measures significantly improved in both groups, SMI significantly improved in only the RT group. There was no significant difference in the change in SMI and muscle strength measures between the two groups. However, the change in sit-to-stand and arm curl measures in the ART group were significantly higher than those in the RT group. CONCLUSIONS: These results suggest that AT before RT combined with fortified milk consumption has similar effects on skeletal muscle mass and strength compared with RT alone, but it may be a more useful strategy to improve physical performance in older adults. Although the mechanism of our intervention is uncertain, our program would be an effective prevention for sarcopenia in older adults.

Obesity and Muscle Weakness as Risk Factors for Mobility Limitation in Community-Dwelling Older Japanese Women: A Two-Year Follow-Up Investigation.

OBJECTIVES: To examine the combined association of obesity and low muscle strength with mobility limitation in older adults. DESIGN, SETTING AND PARTICIPANTS: This two-year follow-up longitudinal study included pooled data from 283 older community-dwelling Japanese women without mobility limitations who were 65 to 87 years of age (mean age 72.2 ± 5.0 years). MEASUREMENTS: Muscle strength was measured by hand-grip strength (HGS). The participants were categorized by HGS (high muscle strength: HGS ≥19.6 kg, low muscle strength: HGS <19.6 kg) and body mass index (BMI) (obese: BMI ≥25 kg/m2, normal weight: BMI <25 kg/m2). The main outcome was mobility limitation, assessed by a self-reported questionnaire (difficulty walking one-half mile or climbing 10 steps without resting). Multivariate logistic regression analysis was performed to determine the combined effect of HGS and BMI on mobility limitation, adjusting for age, exercise habits, medications, and knee pain. RESULTS: During the follow-up period, 82 of 283 participants (29.0%) developed mobility limitation. The adjusted odds ratios (95% confidence interval) for the incidence of mobility limitation were 1.53 (0.86-2.73) and 2.05 (1.08-3.91) in the obese and low muscle strength groups, respectively. Obesity combined with low muscle strength exhibited a significant and strong association with mobility limitation (odds ratio: 3.88, 1.08-13.91) compared with participants with normal weight and high muscle strength. CONCLUSION: Among community-dwelling older Japanese women, obesity alone was not associated with the incidence of mobility limitation, but when combined with low muscle weakness, the risk of developing mobility limitation was 3.9-fold greater than for the reference group.

The functional role of 55- and 75-kDa tumour necrosis factor receptors in human polymorphonuclear cells in vitro.

The expression and biological role of 55- and 75-kDa tumour necrosis factor-receptors (TNF-RI and TNF-RII) in human polymorphonuclear cells (PMN) in vitro were studied using agonistic rabbit polyclonal anti-TNF-R antibodies. PMN express TNF-RII predominantly, and release the superoxide anion on stimulation by human recombinant lymphotoxin (LT) in vitro. Anti-TNF-RI but not anti-TNF-RII antibody stimulated the superoxide release mimicking LT. Release of the elastase from azurophilic granule of PMN was augmented by LT in vitro. Anti-TNF-RI but not anti-TNF-RII antibody augmented the elastase release. Release of the lactoferrin from the specific granules of PMN was enhanced by LT in vitro. Anti-TNF-RI but not anti-TNF-RII antibody augmented the elastase release. Release of the lactoferrin from the specific granules of PMN was enhanced by LT in vitro. Anti-TNF-RI but not anti-TNF-RII antibody enhanced the lactoferrin release. These antibodies failed to co-stimulate these PMN functions. The adhesiveness of PMN to a plastic plate and the expression of Mac-1 on PMN were upregulated by LT in vitro. Anti-TNF-RI but not anti-TNF-RII antibody upregulated the adhesiveness and Mac-1 expression of PMN mimicking LT. Though anti-TNF-RII antibody by itself did not alter the adhesiveness and marginally suppressed Mac-1 expression, it maintained the adhesiveness and adhesion molecule expression in the presence of anti-TNF-RI antibody. In summary, PMN predominantly express TNF-RII, the signalling of LT (and TNF) in PMN is mediated mainly by TNF-RI, and the adhesion function can be modulated also by TNF-RII when TNF-RI is stimulated.

Accurate diagnosis of metastatic cardiac leiomyosarcoma with infundibular stenosis and cardiac tamponade by transesophageal echocardiography and Gd-DTPA magnetic resonance imaging--report of a case.

We present a patient with metastatic cardiac leiomyosarcoma that was diagnosed antemortem by transesophageal echocardiography (TEE) and ECG-gated magnetic resonance imaging with gadolinium diethylene triaminepentaacetic acid (Gd-DTPA MRI). TEE and Gd-DTPA MRI clearly revealed the morphological characteristics of infundibular stenosis and cardiac tamponade. Our patient has survived about 30 months after cardiac surgery. Since sarcoma is usually associated with a very poor prognosis, surgical treatment should be performed as soon as possible. TEE with color Doppler imaging and Gd-DTPA MRI are very useful diagnostic methods for determining the precise anatomical characterization of cardiac tumor, and these procedures are prerequisite to precise therapy.

Role of 55- and 75-kDa tumor necrosis factor membrane receptors in the regulation of intercellular adhesion molecules-1 expression by HL-60 human promyelocytic leukemia cells in vitro.

Most human cells express two TNF and lymphotoxin (LT) membrane receptors (TNF-R), of 55 and 75 kDa. The regulatory effect of these two receptors on intercellular adhesion molecules (ICAM-1) expression was examined in various human cell lines in vitro, including human lymphokine-activated killer T cells (T-LAK) cells and HL-60 cells. Rabbit antihuman TNF-R antisera specific for each receptor were employed as probes to selectively stimulate 55- and 75-kDa TNF/LT membrane receptor production. These antisera compete with TNF/LT binding to each specific cell membrane receptor and have been found to bind to specific membrane receptors on various human cell lines in vitro. In the present study, we demonstrated biologic activity for anti-55-kDa TNF-R antiserum. For example, antibodies that bind to the 55-kDa TNF-R caused cytolysis of HeLa and ME-180 human cervical cancer cells and induced proliferation of MRC-5 human fibroblasts. In contrast, however, anti-75-kDa TNF-R antiserum demonstrated no bioactivity in these assays. In addition, no synergy or costimulation was observed when a combination of both anti-55- and anti-75-kDa TNF-R antisera were tested in these assay systems. Anti-55-kDa TNF-R antiserum up-regulated ICAM-1 expression on human HL-60, T-LAK, and THP-1 cells, whereas anti-75-kDa TNF-R antiserum had no effect. Unexpectedly, however, ICAM-1 expression was greatly enhanced by the addition of anti-75-kDa TNF-R to the anti-55-kDa TNF-R containing culture. This enhancing effect was also observed with human T-LAK cells and THP-1 monocytic leukemia cell, in vitro.

Aortic valvular disease and right coronary artery stenosis induced by mediastinal irradiation--report of a case.

This report presents a case of aortic valvular dysfunction and right coronary artery disease following radiation therapy on the mediastinum. A 61-year-old woman had received mediastinal radiation for the treatment of right mammary cancer 20 years previously. She developed symptoms of congestive heart failure 6 months ago. The patient was found to have aortic valvular dysfunction and proximal stenosis of the right coronary artery. Surgical aortic valve replacement improved cardiac status, and vasodilator treatment reduced ischemia due to right coronary artery stenosis.

Operative stress potentiates the inductivity of membrane associated lymphotoxin (mLT) on lymphokine activated killer (LAK) cells in vitro.

Membrane-associated lymphotoxin (mLT) is induced in human peripheral blood mononuclear cells when cultured with interleukin 2, in the form of lymphokine-activated killer (LAK) cells. The inductivity of mLT is thought to be dependent upon the differentiation potential of LAK cell precursors, being T cells and natural killer cells. In this study, we investigated the inductivity of mLT on LAK cells from surgical patients. The preoperative values of mLT inductivity were found to be generally higher in malignant than benign cases, and the postoperative time course of mLT inductivity showed a transient decrease immediately after the operation followed by gradual increase over 2 weeks. Moreover, patients with an intraoperative bleeding volume of more than 1,000 ml showed a delay in the postoperative increase of mLT inductivity. These data suggest that operative stress potentiates the inductivity of mLT on LAK cells; however, excess stress may cause a delay in the restoration of mLT inductivity.

Natural human IgG inhibits the production of tumor necrosis factor-alpha and interleukin-1 alpha through the Fc portion.

The overproduction of cytokines such as the tumor necrosis factor-alpha (TNF-alpha) and interleukin-1 alpha (IL-1 alpha) may cause further deterioration in the already critical condition of patients with shock, sepsis, and acute inflammation. The effectiveness of infusion therapy of natural human IgG to such patients is suggested to depend partly upon the inhibition of the productivity of these cytokines. In this study, we investigated the modulation effects of IgG and its fragments on the production of TNF-alpha and IL-1 alpha, on human peripheral blood mononuclear cells (PBMC). The production of TNF-alpha and IL-1 alpha was found to be dose-dependently inhibited by IgG when stimulated by lipopolysaccharide (LPS), phytohemagglutinin (PHA), concanavalin A (Con A), and interleukin-2 (IL-2). However, no inhibition was seen when stimulated by phorbormyristate acetate (PMA). The F(ab')2 fragment showed enhancing effects on cytokine production by LPS, while the Fc fragment showed not as much inhibitory effect as whole intact IgG. IgG showed no direct cytotoxic effect on PBMC. These data suggest that natural human IgG inhibits TNF-alpha and IL-1 alpha production by PBMC through the Fc portion. The results of this study led us to conclude that whole intact IgG may be the best form of therapeutic delivery.

Transforming growth factor-beta 1 down-regulates expression of membrane-associated lymphotoxin and secretion of soluble lymphotoxin by human lymphokine-activated killer T cells in vitro.

Lymphokine-activated T killer lymphocytes (T-LAK) are important effector cells in various diseases of tissue destructive reactions. They require stimulation with various cytokines to proliferate and mature into function effector cells. We have examined the role of various endogenously and exogenously added cytokines, and tumor necrosis factor (TNF)/lymphotoxin (LT) receptors in this process in vitro. The present report is a continuation of these studies. We found that human T-LAK cells express membrane-associated LT (mLT) but not TNF, and secrete high amount of soluble LT (sLT) but low levels of TNF. When added to the initial cultures or immature T-LAK cells, transforming growth factor-beta 1 (TGF-beta 1) suppressed both mLT expression and sLT secretion by 30-40%. Coculture of mature T-LAK cells with TGF-beta 1 caused 35% down-regulation of both mLT expression and sLT secretion after 18 h of incubation. Kinetic experiments indicated reduction of LT mRNA synthesis could occur in as little as 1 h when cocultured with 5 ng/ml of TGF-beta 1. TGF-beta 1 also reduced mLT induced T-LAK cell cytolytic activity on L929 cells in vitro. It appears TGF-beta 1 can down-regulate LT mRNA syntheses, mLT expression, and sLT secretion of human T-LAK cells in vitro.

Studies of membrane-associated and soluble (secreted) lymphotoxin in human lymphokine-activated T-killer cells in vitro.

The expression, release, and cytolytic activity of membrane-associated lymphotoxin was examined in cultures of phytohemagglutinin-P (PHA-P) and interleukin 2 (IL-2)-stimulated human T-lymphokine-activated killer (T-LAK) cells in vitro. Lymphotoxin (LT/TNF-beta) was identified on the membrane of T-LAK cells using flow cytometry. The membrane form of LT (mLT) is detected not only on T-LAK cells but also on LT-secreting human B-cell lymphoid cell lines, RPMI 1788 and Raji, but not on U937 or K562 cells. Maximum expression of mLT on T-LAK cells and the secretion of LT into the supernatant depended on the concentration of IL-2. Expression of mLT on T-LAK cells was reduced by stimulation with PHA-P; however, supernatant LT levels greatly increased. Both expression of mLT and release of soluble LT was reduced after incubation of T-LAK cells with actinomycin D (ActD) or cycloheximide (CHx). Paraformaldehyde-fixed T-LAK cells caused cytolysis of WEHI 164 cells in vitro, which was blocked by anti-LT but not anti-TNF antibody. These data support the concept that mLT may be an intermediate form to secreted LT, and that the mLT form is cytolytically active.

Diagnosis and surgical treatment of five cases of triple shunt (ASD + VSD + PDA).

Five patients with triple shunt (atrial septal defect, ventricular septal defect, and patent ductus arteriosus) were treated surgically during the past twelve years (1978-1989). They developed severe cardiac and respiratory failure in the neonatal period and/or in early infancy. Simultaneous repair of the triple shunt was performed, but initially two patients suffering severe cardiac failure were lost immediately after operation. The following three patients were operated on relatively soon after establishing a definitive diagnosis and a successful outcome was able to be achieved. Repeated evaluation of the patient with echocardiography was necessary for diagnosis. Early primary operation is, therefore, considered to be the treatment of choice after confirming the diagnosis.

Thoracoabdominal aortic aneurysm associated with Marfan's syndrome--report of a case.

A case of Marfan's syndrome associated with thoracoabdominal aortic aneurysm and mitral regurgitation in a 29 year old male is reported herein. The aneurysm was replaced with a Y-shaped graft using Crawford's technique, while the major branches of the abdominal aorta were separately cannulated from inside the aneurysm and perfused via partial extracorporeal circulation using a left femoro-femoral bypass. We found this technique useful in the prevention of tissue ischemia during the operation. The patient's postoperative course was uneventful and he has encountered no problems in the year and half since his operation.

[Intravenous leiomyomatosis of the uterus with extension into the heart].

A case was reported concerning a successful removal of a leiomyoma with extension into the right atrium through the right ovarian vein and the inferior vena cava. The patient was a 72 year-old woman who had suddenly suffered dyspnea and palpitation. She was hospitalized, and a mass in the right atrium and the inferior vena cava was discovered using echocardiography and magnetic resonance imaging. A myxoma in the right atrium with a thrombus in the inferior vena cava was diagnosed preoperatively. The operation was performed in July 1987 by means of cardio-pulmonary bypass. During atriotomy of the right atrium, a large sausage-shaped mass of milky-pinkish color was found. Though the root of the mass was centered beyond the periphery of the inferior vena cava, most of it was removed through the right atrium. Immediately after extirpation of the tumor, hypotension and abdominal distention occurred in the patient, and emergency laparotomy was carried out. Retroperitoneal bleeding from the right ovarian vein occurred and the similar tumors were observed in the right ovarian vein. Intravenous leiomyomatosis of the uterus with extension into the heart is very rare, this being only the seventeenth case reported in literature. To the best of our knowledge, this was also the oldest patient on record. The good surgical method for this tumor seems to be total removal using cardio-pulmonary bypass and laparotomy at the same time.