Dysphagia is an independent predictor of hospital-acquired disability in older patients with heart failure: a propensity score-matched analysis : Predictors of HAD in older HF patients.

This study aims to identify the relationship between dysphagia and developing hospital-acquired disability (HAD) in older patients with heart failure (HF). This single-center retrospective cohort study included 360 patients (median age, 84 years: 58.1% female, 41.9% male) who had undergone rehabilitation and were aged 65 years and older. Patients were divided into dysphagia and non-dysphagia groups and compared based on the Functional Oral Intake Scale score. HAD was defined as a decline in the Barthel Index score (indication of daily activity levels) at discharge relative to that before admission. The relationship between dysphagia and HAD was analyzed using bivariate analysis after adjusting for age, sex, body mass index, medical history, clinical and laboratory data, short physical performance battery (SPPB), and cognitive function at the start of rehabilitation, using propensity score matching. HAD was observed in 38.1% of the patients. Patients with dysphagia were significantly older, and had lower body mass index and physical and cognitive function than those without. After propensity score matching, the prevalence of HAD was significantly higher in the dysphagia group than in the non-dysphagia group (61.9% vs. 42.9%, P = 0.032). Dysphagia at the start of rehabilitation was an independent predictor of HAD. The results of this study may contribute to risk stratification of HAD.

Physical performance and maximum tongue pressure associated with oral intake independence: a retrospective study on hospitalized patients with heart failure.

Dysphagia in patients with heart failure leads to poorer outcomes during hospitalization and after discharge. Therefore, addressing dysphagia is critical for improving patient prognosis. This retrospective observational study aimed to evaluate associations between improvements in swallowing dysfunction at the time of hospital discharge and the physical function, cognitive function, nutritional status, and maximum tongue pressure (MTP). Overall, 111 patients who underwent cardiac rehabilitation and were deemed to have oral intake impairment were included. The exclusion criteria comprised the following: pre-admission diagnosis of dysphagia, in-hospital death, and missing data. Patients were categorized based on whether they did (n = 65) or did not (n = 46) exhibit improvements in oral intake impairment, which were determined from the functional oral intake scale (FOIS) score at discharge. Associations between potential explanatory variables and the FOIS score at discharge were assessed using a linear regression model. After adjusting for covariates, such as age, sex, heart failure severity, short physical performance battery score, Mini-Mental State Examination score, transthyretin level, and provision of swallowing therapy, the FOIS score at discharge was significantly associated with the MTP (P = 0.024, confidence interval: 0.006-0.046). In conclusion, the MTP was independently associated with improvements in FOIS in patients with heart failure.

Mild cognitive impairment in patients with acute heart failure does not limit the effectiveness of early phase II cardiac rehabilitation.

BACKGROUND: Cardiac rehabilitation (CR) is commonly performed in patients with heart failure (HF) with mild cognitive impairment (MCI). However, whether MCI diminishes the benefit of early phase II CR is unclear. AIM: This study aimed to clarify whether MCI diminishes the benefit of early phase II CR in patients hospitalized for HF. DESIGN: The design of the work is a case-control study. SETTING: All HF patients who underwent CR in acute care hospitals in Japan from April 2016 to March 2021. POPULATION: Among the 574 patients who underwent CR, 204 were included in this study. Exclusion criteria were age <65 years, dependence for activities of daily living (ADLs) prior to admission, diagnosis of dementia or delirium, mini-mental state examination (MMSE) score at the commencement of CR<19, missing data, in-hospital death, and transfer to another department during hospitalization. METHODS: Patients were divided into two groups, those with MCI (MCI group, N.=134) and those without MCI (non-MCI group, N.=70), based on MMSE score at the commencement of CR. Cognitive impairment was defined as a score of <19. MCI was defined as an MMSE score between 19 and 26, and normal cognitive function was defined as MMSE >26. The primary outcomes were the 6-minute walking distance (6MWD), Barthel Index (BI), and Short Physical Performance Battery (SPPB). All patients underwent guideline-based CR programs. RESULTS: On admission, MCI patients had significantly lower BI (P<0.01, confidence interval [CI]: 4.9-20.4) and SPPB (P<0.01, CI: 1.1-3.1), despite being independent for ADLs before admission. In addition, 6MWD (P<0.01, CI: 31.2-97.2), BI (P=0.01, CI: 1.0-8.4), and SPPB (P<0.01, CI: 0.6-2.5) were significantly lower in the MCI group at the time of discharge. However, after propensity score matching to adjust for baseline characteristics, no significant differences in any primary outcome were found between the two groups. CONCLUSIONS: The BI, SPPB, and 6MWD improvements due to CR were similar, regardless of MCI. CLINICAL REHABILITATION IMPACT: Our results may inform the selection of appropriate rehabilitation interventions for patients with HF and MCI.

Bond strength between a veneering composite resin and zirconia frameworks with attached mechanical retentive devices.

The effects of mechanical retentive devices and various surface treatments on the shear bond strength between a veneering composite resin and zirconia was investigated. Zirconia disks were classified into three surface-treatment groups: airborne-particle abrasion, overglazing, and overglazing with white alumina particles of three different grain sizes (50, 70, and 105 µm) attached onto zirconia disks (ZR-50, ZR-70, and ZR-105, respectively). They were further divided into four groups (n=44): unprimed, Clearfil Porcelain Bond Activator (CA), Clearfil Photo Bond (CB), and CA+CB. An indirect composite resin was bonded to zirconia specimens. Shear bond strengths were measured. For the ZR-70 and ZR-105 groups, the CB and CA+CB specimens exhibited higher bond strengths than the other two specimens after thermocycling. The ZR-70 and ZR-105 groups achieved micromechanical interlocking, and priming with a phosphate monomer (MDP) yielded stable bond strengths between the composite resin and zirconia with alumina particles attached as retentive devices.

Dysphagia and malnutrition limit activities of daily living improvement in phase i cardiac rehabilitation: a prospective cohort study for acute phase heart failure patients.

Dysphagia and malnutrition combinations in hospitalized patients with acute heart failure (AHF) may affect activities of daily living (ADL) after hospital discharge more than dysphagia or malnutrition alone. The aim of the present study to clarify the impact of the combination of dysphagia and malnutrition on ADL in hospitalized patients with acute phase heart failure who have undergone cardiac rehabilitation (CR). Prospective cohort study. Acute care hospital. Participants were 224 AHF patients undergoing CR. Barthel index (BI), functional oral intake scale (FOIS), controlling nutritional status (CONUT), short physical performance battery (SPPB), and mini-mental state examination were evaluated at baseline. We examined primary effects of predictors (CONUT) and the moderator (FOIS) and the interaction effect of FOIS and CONUT (FOIS × CONUT) using hierarchical linear regression model and simple-slope tests. The ADL independence dropped in 29.5% of the patients on hospitalization; however, 82.6% of the patients successfully regained their independence at discharge. Based on the FOIS score and nutritional status on admission, 58.5% of the patients were classified into the non-dysphagia and non-malnutrition categories, 21.0% into non-dysphagia and malnutrition, 15.2% into dysphagia and non-malnutrition, and 5.3% into dysphagia and malnutrition. Lower FOIS and SPPB scores as well as the FOIS × CONUT interaction predicted a significantly lower BI but not CONUT. Simple slope test revealed a negative association between CONUT and BI with low-level FOIS (B = - 2.917, P < .001) but not with high-level FOIS (B = .476, P = .512). Thus, patients with dysphagia and malnutrition in combination had a greater risk of failed recovery of ADL after cardiac rehabilitation than those without this combination. In hospitalized AHF patients, FOIS and CONUT had an interactive effect on BI at hospital discharge in cases with low-level FOIS. Early detection of dysphagia might improve the accurate identification of hospitalized AHF patients at higher risk of ADL dependence at discharge.

Examination of independent predictors of discharge disposition in acute phase hospitalized heart failure patients undergoing phase I cardiac rehabilitation.

BACKGROUND: Increasing acute heart failure (HF) population is very common. Discharge disposition is one of the major cardiac rehabilitation (CR) outcomes. However, there were few data exist on home discharge criteria in acute phase HF patients who were underwent CR. AIM: The aim of this study was to clarify the predictors of home discharge in acute phase hospitalized HF patients who were underwent guideline-based CR. DESIGN: The study was designed as an intervention study. SETTING: This study took place in acute-hospital setting. POPULATION: Participants were 320 hospitalized acute phase HF patients who were underwent Japanese guideline-based CR. METHODS: Knee extension strength (KES), exercise tolerance, short physical performance battery (SPPB), Barthel Index (BI), mini-mental state examination (MMSE) and controlling nutritional status (CONUT) were evaluated on hospital admission and at hospital discharge, respectively. At hospital discharge, patients were divided into the home group (N.=255) and the non-home group (N.=65) based on discharge disposition. The independent predictors of home discharge and cut-off value were evaluated using logistic regression analysis and receiver operating curve. RESULTS: At the time of hospital admission, KES, exercise tolerance, SPPB, BI and MMSE is significantly higher in the home group. However, there were no significant differences in HF severity and CONUT on hospital admission between the groups. At hospital discharge, KES, exercise tolerance, SPPB, BI and MMSE were significantly higher and CONUT was significantly lower in the home group than in the non-home group. Multivariate analysis showed KES and SPPB on hospital admission, length of hospital stay and BI at hospital discharge were the independent predictors of home discharge. Cut-off values for predicting home discharge were KES on hospital admission ≥12.1 kg, SPPB on hospital admission ≥3 points, and BI at hospital discharge ≥80 points. CONCLUSIONS: The present study suggested that KES and SPPB on hospital admission may contributed to early detection of the patients who are difficult to return home. Additionally, there is a possibility that CR goal setting of BI ≥80 points is effective to home discharge in acute phase hospitalized HF patients. CLINICAL REHABILITATION IMPACT: This study may contribute to early detection of the patients who are predicted to be difficult to return home and to appropriate rehabilitation goals setting.

Stalobacin: Discovery of Novel Lipopeptide Antibiotics with Potent Antibacterial Activity against Multidrug-Resistant Bacteria.

A novel lipopeptide antibiotic, stalobacin I (1), was discovered from a culture broth of an unidentified Gram-negative bacterium. Stalobacin I (1) had a unique chemical architecture composed of an upper and a lower half peptide sequence, which were linked via a hemiaminal methylene moiety. The sequence of 1 contained an unusual amino acid, carnosadine, 3,4-dihydroxyariginine, 3-hydroxyisoleucine, and 3-hydroxyaspartic acid, and a novel cyclopropyl fatty acid. The antibacterial activity of 1 against a broad range of drug-resistant Gram-positive bacteria was much stronger than those of "last resort" antibiotics such as vancomycin, linezolid, and telavancin (MIC 0.004-0.016 µg/mL). Furthermore, compound 1 induced a characteristic morphological change in Gram-positive and Gram-negative strains by inflating the bacterial cell body. The absolute configuration of a cyclopropyl amino acid, carnosadine, was determined by the synthetic study of its stereoisomers, which was an essential component for the strong activity of 1.

Fracture loads of screw-retained implant-supported zirconia prostheses after thermal and mechanical stress.

PURPOSE: The objective of the present study was to evaluate fracture loads of screw-retained implant-supported zirconia prostheses after artificial aging. METHODS: Four types of screw-retained implant-supported prostheses were fabricated (n=11 each); porcelain-veneered zirconia prosthesis (PVZ), indirect composite-veneered zirconia prosthesis (IVZ), porcelain-fused-to-metal prosthesis (PFM), and monolithic zirconia prosthesis (ML). The specimens were subjected to 10,000 thermocycles and cyclic loading for 1.2 million cycles. Fracture loads were measured, and the data were analyzed with the Kruskal-Wallis and Steel-Dwass tests (α=0.05). RESULTS: All specimens survived the artificial aging procedures. The fracture loads for the PVZ (1.52kN), IVZ (1.62kN), and PFM groups (1.53kN) did not significantly differ; however, the fracture load for the ML group (6.61kN) was significantly higher than those for the other groups. The fracture load for the IVZ group was comparable to those for the PVZ and PFM groups. CONCLUSIONS: The monolithic zirconia prostheses exhibited significantly higher fracture loads than the bilayered prostheses. All the investigated types of screw-retained implant-supported zirconia prostheses appear sufficient to resist posterior masticatory forces during long-term clinical use.

Functional gene expression of dopamine receptors in the male reproductive organ during sexual maturation in the honey bee (Apis mellifera L.).

Dopamine is a potential integrator between the central nervous system and reproductive system in insects. To test for a possible action of dopamine on the male reproductive organ via hemolymph in honey bees, relative expression levels of dopamine receptor genes and second messenger levels responding to dopamine in the reproductive organ were quantified. Protein content of the three parts of the reproductive organ (testes, seminal vesicles, and mucus glands) differed depending on the age of bees: the protein content of the testes decreased, whereas that of the seminal vesicles and mucus glands increased as males aged. Relative expression levels of dopamine receptor genes (Amdop1, Amdop2, Amdop3 and Amgpcr19) in each part of the reproductive organ were detected and were lower than those in the brain. Expression of all these genes was significantly higher in the seminal vesicles than in testes and mucus glands. Expression of Amgpcr19 was significantly higher in testes of 8-day-old males than in males of other ages, and was highest in the seminal vesicles of 4-day-old males. Cyclic adenosine monophosphate (cAMP) levels responding to dopamine in seminal vesicles were significantly higher in 10-3 M dopamine immersion than in 10-4 M, 10-5 M dopamine, and controls. However, no significant differences in cAMP levels between control and dopamine immersion were detected in testes and mucus glands. These results suggest that the dopamine receptors in seminal vesicles can be driven by dopamine for reproduction, including sperm transfer and storage in the male reproductive organ.

A hybrid strategy using global analysis of oxidized fatty acids and bioconversion by Bacillus circulans.

RATIONALE: Targeted oxidized fatty acid analysis has been widely used to understand the roles of fatty acids in the development of diseases. However, because of the extensive structural diversity of fatty acids, it is considered that unknown lipid metabolites will remain undetected. Here, to discover and identify unknown lipid metabolites in biological samples, a global analytical system and a method of synthesizing lipid standards were investigated. METHODS: Oxidized fatty acids in mouse lung tissues were extracted using mixed-mode spin columns. Separation was achieved via ultra-high-performance liquid chromatography, mass spectrometric (MS) analysis was conducted in full scan mode using a Q Exactive Plus instrument equipped with an electrospray ionization probe, and structure analysis was carried out by high-resolution data-dependent tandem mass spectrometry (dd-MS(2)). In addition, lipid standards, which are not commercially available, were synthesized by bioconversion using Bacillus circulans. RESULTS: Oxidized fatty acids in mouse lung tissues were analyzed by high-resolution accurate-mass analysis, and multiple unknown molecules were discovered and tentatively identified using high-resolution dd-MS(2). Among these molecules, 21-hydroxydocosahexaenoic acid (21-HDoHE) and 22-HDoHE, which are not commercially available, were synthesized by bioconversion. By comparing the exact masses, retention times, and characteristic fragment ions of the synthesized standards, 21-HDoHE and 22-HDoHE were definitively identified in the mouse lung tissue. CONCLUSIONS: Our strategy of global analysis and bioconversion can be used for the discovery and identification of unknown lipid molecules.