Determinants of quality of life in elderly rehabilitation users at a day care service center.

[Purpose] We investigated the relationship of quality of life (QOL) with cognitive function, physical function, and activity ability, and aimed to identify functions related to QOL improvement, among elderly people who use day-care rehabilitation. [Participants and Methods] The participants were 37 elderly rehabilitation users, whose QOL was assessed using the Health Organization QOL26 (WHOQOL26), which consists of a 26-item self-report questionnaire. Cognitive function was assessed using the Mini-Mental State Examination, while physical function was assessed with seated forward bending, knee extension, grip, 30-second chair stand test, timed up and go test, and gait speed. Activity ability was assessed using the Tokyo Metropolitan Institute of Gerontology Index of Competence (TMIG index). [Results] A positive correlation was found between five WHOQOL26 categories (psychological QOL, social QOL, environmental QOL, total QOL, and QOL average) and social role in the TMIG index. There was also a positive correlation between four WHOQOL26 categories (psychological QOL, social QOL, environmental QOL, and QOL average) and instrumental activity of daily living in the TMIG index. To identify factors influencing the QOL score, association with TMIG index was investigated. Social role in the TMIG index was a positive factor in psychological and social QOL. [Conclusion] Enhancing social role is important to improve QOL of elderly rehabilitation users.

The relationship between frailty and motor function among living in the community elderly females.

[Purpose] This study aimed to investigate the prevalence of frailty among community-dwelling elderly females, and to examine its relation to motor function and the main risk factors of frailty. [Participants and Methods] The participants were 67 community-dwelling elderly females, aged 76.2 ± 7.7 years. We performed measurements of physical parameters, motor functions (such as grip strength), timed up and go test (TUG), walking speed, and frailty (measured using the Kihon Checklist [KCL]). [Results] KCL scores were 31.3%, 31.3%, and 37.3% in the frailty, pre-frailty, and robust groups, respectively. The frailty group was older than the pre-frailty and robust groups. Additionally, the different groups showed significant differences in grip strength, TUG, and walking speed. The highest median KCL score was for depression, followed by physical function. As a results, frailty was evident even among health-conscious elderly people. [Conclusion] It is essential to identify frailty at an early stage and identify its preventive factors, in order to extend the healthy life expectancy of the local population.

Dysregulation of dopamine neurotransmission in the nucleus accumbens in immobilization-induced hypersensitivity.

Cast immobilization causes sensory hypersensitivity, which is also a symptom of neuropathic pain and chronic pain. However, the mechanisms underlying immobilization-induced hypersensitivity remain unclear. The present study investigated the role of dopamine neurotransmission in the nucleus accumbens shell (NAcSh) of rats with cast immobilization-induced mechanical hypersensitivity using in vivo microdialysis. Cast immobilization of the hind limb decreased the paw withdrawal threshold (PWT). Mechanical stimulation of the cast-immobilized hind limb induced a decrease in dopamine in the NAcSh, and this decrease was associated with the upregulation of presynaptic D2-like receptors. A D2-like receptor antagonist infused into the NAcSh reversed the decrease in PWT in rats with cast immobilization, whereas a D2-like receptor agonist infused into the NAcSh induced a decrease in PWT in control rats. In addition, the expression of the D2 receptor (Drd2) mRNA in the NAcSh was increased by cast immobilization. Importantly, systemic administration of the D2-like receptor antagonist reversed the decrease in PWT in rats with cast immobilization. As dopamine levels regulated by presynaptic D2-like receptors did not correlate with the PWT, it is presumed that the D2-like receptor antagonist or agonist acts on postsynaptic D2-like receptors. These results suggest that immobilization-induced mechanical hypersensitivity is attributable to the upregulation of postsynaptic D2-like receptors in the NAc. Blockade of D2-like receptors in the NAcSh is a potential therapeutic strategy for immobilization-induced hypersensitivity.

Effects of pain-related catastrophic thinking, anxiety, and depression on pain intensity and quality of life in patients with knee and low back pain.

[Purpose] We aimed to examine the effects of pain-related catastrophic thoughts and anxiety/depression on pain intensity and quality of life (QOL), and how these effects (relationships) vary with pain location, in outpatients with chronic pain. [Participants and Methods] We recruited 14 participants with low back pain (2 males and 12 females) and 14 with knee joint pain (3 males and 11 females). We used the following evaluation tools: the visual analog scale (to evaluate pain intensity), pain catastrophizing scale (in which scores are categorized into helplessness, rumination, and magnification), Hospital Anxiety and Depression Scale (for psychodynamic evaluation), and a questionnaire for QOL evaluation. [Results] There was no difference in pain intensity between the groups. The "low back pain" group showed a positive correlation between pain intensity and anxiety, while the "knee pain" group showed a positive correlation between pain intensity and helplessness. The "low back pain" group showed a negative correlation between health in QOL assessment items and helplessness, and between health and magnification. However, in the "knee pain" group, there was a negative correlation between health and rumination, between health and anxiety, and between positive mental attitude and magnification. [Conclusion] Mental status varied depending on the pain location, regardless of the intensity of the pain. This suggests that a psychological approach dependent on pain location is needed during physical therapy.

Use of the Tokyo Cognitive Assessment for mild cognitive impairment to characterize elderly people that use day care services in Japan.

[Purpose] This study compared the motor skills and cognitive functions of elderly participants who required support with those who did not require support. We aimed to evaluate the characteristics of impairment in sub-items of cognitive function in patients who needed support to predict future clinical issues. [Participants and Methods] We surveyed 31 participants requiring support under the day care service insurance system for which they attended day care service centers in Japan (rehabilitation users) and 10 healthy participants who attended a university for lifelong learning (healthy elders). Data on personal attributes of the participants were collected, and the Cardio-Ankle Vascular Index and motor and cognitive functions were assessed. [Results] Although the participants undergoing rehabilitation were, on average, 6 years older than the healthy elders, we found no significant differences between the two groups in closed-eye, one-legged standing, grip strength, or quadriceps muscle strength. In terms of the Tokyo Cognitive Assessment for mild cognitive impairment, we found no significant differences between those undergoing rehabilitation and healthy elders in clock drawing performance, serial 7 task performance, or orientation; however, there were significant differences in erase character, copy of triangular pyramid, composition, read of digits, go/no-go, word recall, story reproduction, ToCA total score. [Conclusion] We believe that it is imperative for day care service centers to conduct programs that maintain cognitive function in addition to programs for improvement of physical function.

In vitro blood compatibility evaluation method: incubating while rotating hemodialyzers filled with fresh human blood.

One of the often-used methods for in vitro evaluation of the blood compatibility of hemodialysis membranes is the circulation of human blood through a miniaturized hemodialyzer. The use of a rather small amount of human blood in its evaluation is one advantage of this method. However, because it is manufactured by a different process than actual ones, a miniaturized hemodialyzer membrane cannot always preserve the properties of actual hemodialyzers. To address this problem, we established a new experimental method that uses a relatively small amount of human blood and actual dialyzers. In this method, a test hemodialyzer and a control hemodialyzer filled with human blood obtained from the same donor is slowly rotated to prevent spontaneous blood cell sedimentation for 4 h at 37 °C. By use of this method, we were able to compare blood compatibility between a polysulfone (PS) membrane and a vitamin E (VE)-bonded PS membrane in terms of their relative antithrombotic, antioxidative, and anti-inflammatory properties. Consistent with many previous reports, the results clearly showed that compared with the PS membrane, VE-bonded PS membrane is more blood compatible. These findings suggest that our method is applicable, at least to in vitro blood compatibility evaluation of PS type dialysis membranes.

Long-Term Citalopram Treatment Alters the Stress Responses of the Cortical Dopamine and Noradrenaline Systems: the Role of Cortical 5-HT1A Receptors.

BACKGROUND: Cortical dopamine and noradrenaline are involved in the stress response. Citalopram, a selective serotonin reuptake inhibitor, has direct and indirect effects on the serotonergic system. Furthermore, long-term treatment with citalopram affects the dopamine and noradrenaline systems, which could contribute to the therapeutic action of antidepressants. METHODS: The effects of long-term treatment with citalopram on the responses of the dopamine and noradrenaline systems in the rat prefrontal cortex to acute handling stress were evaluated using in vivo microdialysis. RESULTS: Acute handling stress increased dopamine and noradrenaline levels in the prefrontal cortex. The dopamine and noradrenaline responses were suppressed by local infusion of a 5-HT1A receptor agonist, 7-(Dipropylamino)-5,6,7,8-tetrahydronaphthalen-1-ol;hydrobromide, into the prefrontal cortex. The dopamine response was abolished by long-term treatment with citalopram, and the abolished dopamine response was reversed by local infusion of a 5-HT1A receptor antagonist, (Z)-but-2-enedioic acid;N-[2-[4-(2-methoxyphenyl)piperazin-1-yl]ethyl]-N-pyridin-2-ylcyclohexanecarboxamide into the prefrontal cortex. On the other hand, long-term treatment with citalopram reduced the basal noradrenaline levels (approximately 40% of the controls), but not the basal dopamine levels. The noradrenaline response was maintained despite the low basal noradrenaline levels. Signaling from the 5-HT1A receptors and α2-adrenoceptors was not involved in the decrease in the basal noradrenaline levels but partially affected the noradrenaline response. CONCLUSIONS: Chronic citalopram treatment differentially suppresses the dopamine and noradrenaline systems in the prefrontal cortex, and the dopamine stress response was preferentially controlled by upregulating 5-HT1A receptor signaling. Our findings provide insight into how antidepressants modulate the dopamine and noradrenaline systems to overcome acute stress.

The spontaneously hypertensive rat/Izm (SHR/Izm) shows attention deficit/hyperactivity disorder-like behaviors but without impulsive behavior: therapeutic implications of low-dose methylphenidate.

The spontaneously hypertensive rat (SHR) has been used as a genetic animal model of attention deficit/hyperactivity disorder (ADHD). SHR/Izm is derived from stroke-resistant SHR as SHR/NIH and SHR/NCrl but from 22nd to 23rd generation descendants of the SHR/NIH ancestor and therefore may show different behavioral phenotypes compared to other SHR sub-strains. In this study, ADHD-like behaviors in SHR/Izm were evaluated compared to Wistar rats. SHR/Izm showed high locomotor activity in the habituation phase in a novel environment, although locomotor activity in the initial exploratory phase was low. In a behavioral test for attention, spontaneous alternation behavior in the Y-maze test was impaired in SHR/Izm. However, impulsive behavior in the elevated-plus maze test, which is designed to detect anxiety-related behavior but also reflects impulsivity for novelty seeking, was comparable to Wistar rats. Hyperactivity and inattention, detected as ADHD-like behaviors in SHR/Izm, were ameliorated with methylphenidate at a low dose (0.05mg/kg, i.p.). Therefore, SHR/Izm represents a unique animal model of ADHD without anxiety-related impulsive behavior.

Dielectric relaxation for studying molecular dynamics of pullulan in water.

We performed an experiment of broadband dielectric relaxation spectroscopy (BDS) to study the molecular dynamics of an aqueous pullulan solution as a function of pullulan concentration. The frequency range of the BDS experiment is 40 Hz to 50 GHz, and the solution temperature is set at T = 25.0 °C. Two relaxation processes originating from pullulan and water molecules are obtained in the megahertz and gigahertz regions, respectively. Additionally, the electrode polarization and the contribution of dc conductivity are also observed at lower frequencies. The relaxation process at a frequency higher than 10 GHz is associated with the primary process of water (h-process), and that at 100 MHz is attributed to the local chain motion of pullulan (m-process). Impurities in the aqueous solutions, which are practically disregarded in the analysis of polysaccharide solutions, affect the quality of the relaxation spectrum. Thus, the purification of pullulan sample is carried out by methanol precipitation from aqueous pullulan solution. This iterative purification reduces the contributions of electrode polarization and DC conductivity, which enables the clear observation of the relaxation of the m-process. It was found that the relaxation times of the m- and h-processes increase with pullulan concentration. The relaxation strength of the m-process shows increasing behavior with increasing pullulan concentration, whereas the relaxation strength of the h-process decreases with increasing pullulan concentration. It is suggested that the relaxation strength of the m-process is mainly determined by the magnitude of the dipole moment of solvent molecules. The relaxation process of water (h-process) is affected by the interactions of pullulan chains. The interdependence between the h- and m-processes is discussed with respect to the findings of recent dielectric relaxation studies on aqueous polymer solutions.

Upregulation of the dorsal raphe nucleus-prefrontal cortex serotonin system by chronic treatment with escitalopram in hyposerotonergic Wistar-Kyoto rats.

Wistar-Kyoto (WKY) rats are sensitive to chronic stressors and exhibit depression-like behavior. Dorsal raphe nucleus (DRN) serotonin (5-HT) neurons projecting to the prefrontal cortex (PFC) comprise the important neurocircuitry underlying the pathophysiology of depression. To evaluate the DRN-PFC 5-HT system in WKY rats, we examined the effects of escitalopram (ESCIT) on the extracellular 5-HT level in comparison with Wistar rats using dual-probe microdialysis. The basal levels of 5-HT in the DRN, but not in the PFC, in WKY rats was reduced as low as 30% of Wistar rats. Responses of 5-HT in the DRN and PFC to ESCIT administered systemically and locally were attenuated in WKY rats. Feedback inhibition of DRN 5-HT release induced by ESCIT into the PFC was also attenuated in WKY rats. Chronic ESCIT induced upregulation of the DRN-PFC 5-HT system in WKY rats, with increases in basal 5-HT in the DRN, responsiveness to ESCIT in the DRN and PFC, and feedback inhibition, whereas downregulation of these effects was induced in Wistar rats. Thus, the WKY rat is an animal model of depression with low activity of the DRN-PFC 5HT system. The finding that chronic ESCIT upregulates the 5-HT system in hyposerotonergic WKY rats may contribute to improved understanding of mechanisms of action of antidepressants, especially in depression with 5-HT deficiency.

Food reward-sensitive interaction of ghrelin and opioid receptor pathways in mesolimbic dopamine system.

Ghrelin is a stomach-derived orexigenic peptide. The goal of the study was to investigate the roles of mu and kappa opioid receptors in systemic ghrelin-mediated regulation of the mesolimbic dopamine system. To evaluate the interaction of systemic ghrelin with values of food reward, rats were exposed to food removal, regular food or palatable food after systemic ghrelin administration. Extracellular dopamine levels were quantified in the nucleus accumbens (NAc) and receptor-specific compounds were infused into the ventral tegmental area (VTA) using dual-probe microdialysis. Consumption of regular or palatable food without systemic ghrelin administration induced an increase in dopamine levels in the NAc via activation of mu opioid receptors in the VTA. Systemic ghrelin administration (3 nmol, i.v.) followed by no food induced a decrease in dopamine levels via activation of kappa opioid receptors in the VTA. Systemic ghrelin administration followed by consumption of regular food induced an increase in dopamine levels via preferential activation of mu opioid receptors, whereas systemic ghrelin administration followed by consumption of palatable food suppressed the increase in dopamine levels via preferential activation of kappa opioid receptors. Thus, natural food reward and systemic ghrelin activate mu and kappa opioid receptor pathways in the VTA, respectively, resulting in opposite influences on dopamine release in the NAc. Furthermore, systemic ghrelin induces switching of the dominant opioid receptor pathway for highly rewarding food from mu to kappa, resulting in suppression of the mesolimbic dopamine system. These novel findings might provide insights into the neural pathways involved in eating disorders.

Temperature dependence of thermal diffusion for aqueous solutions of monosaccharides, oligosaccharides, and polysaccharides.

We studied the thermal diffusion behavior for binary aqueous solutions of glucose, maltotriose, maltohexaose, pullulan, and dextran by means of thermal diffusion forced Rayleigh scattering (TDFRS). The investigated saccharides with molar masses between 0.180 and 440 kg mol(-1) were studied in the temperature range between 15 and 55 °C. The thermal diffusion coefficient D(T) and the Soret coefficient S(T) of all solutions increase with increasing temperature. For maltohexaose and the polymers the thermal diffusion coefficient changes sign from negative to positive with increasing temperature, whereas glucose and maltotriose show only positive values in the entire investigated temperature range. While we were able to find a master curve to describe the temperature dependence of D(T), we were not able to find a similar expression for S(T). This comprehensive study allows for the first time the determination of the interaction parameters for the polymer and the solvent within the theoretical framework suggested by Würger [Phys. Rev. Lett., 2009, 102, 078302].

Temperature dependence of soret coefficient in aqueous and nonaqueous solutions of pullulan.

We present experimental results of the temperature dependence of the Ludwig-Soret effect for pullulan solutions. The Soret coefficients of 5.0 g L(-1) pullulan in water and in dimethyl sulfoxide (DMSO) were determined in the experimental temperature range between 20.0 and 50.0 degrees C by means of thermal diffusion Forced Rayleigh scattering (TDFRS). The sign of the Soret coefficient of pullulan in water is negative at room temperature, which indicates that the pullulan molecules migrate to the warm side of the fluid. The Soret coefficient of pullulan increases steeply with increase of the solution temperature and shows a sign change from negative to positive at 41.7 degrees C. The positive sign of the Soret coefficient means the pullulan molecules move to the cold side. In contrast to the aqueous solution, the solution of pullulan in DMSO shows a very weak temperature dependence of the Soret coefficient and has always a positive sign. In addition to the TDFRS experiments, we also performed light scattering (LS) experiments for the pullulan solutions under homogeneous temperature condition in a temperature range between 20.0 and 55.0 degrees C. The thermodynamic properties of pullulan solutions obtained by LS show no pronounced correlation with the thermal diffusion behavior of pullulan. These results indicate the existence of a special role of interactions due to solvation on the temperature dependence of the thermal diffusion behavior of polysaccharide solutions.

[Bacillus cereus sepsis and subarachnoid hemorrhage following consolidation chemotherapy for acute myelogenous leukemia].

A 64-year-old man with acute myelogenous leukemia (FAB classification, M7) in remission received consolidation chemotherapy with mitoxantrone/cytosine arabinoside. WBC counts decreased to 0/microl on day 14, and fever (39.3 degrees C) and epigastralgia developed on day 15. Cefozopran was instituted for febrile neutropenia; however, on day 16, he was found to be in cardiac arrest. CT scan on day 16 revealed subarachnoid hemorrhage. Gram-positive rods were isolated from blood cultures on day 15, and were later identified as B.cereus. He recovered transiently, but eventually died on day 19. Postmortem examination demonstrated many colonies of B. cereus in the cerebrum, cerebellum, lung, and liver. Hepatocyte necrosis was also observed in the liver. Bacterial aneurysms or septic emboli were not identified in the arachnoid vessels, but necrosis of cerebral vessels was prominent, which was considered to be the cause of subarachnoid hemorrhage. Fatal subarachnoid hemorrhage has been reported to be associated with B. cereus sepsis, which developed at nadir following chemotherapy for leukemia patients. Because of the aggressive clinical course of B. cereus sepsis, including the risk for subarachnoid hemorrhage, early treatment with effective antibiotics for B. cereus sepsis would be important in the management of leukemia patients after chemotherapy.