Impact of the Coronavirus Disease 2019 Outbreak on Activity and Exercise Levels among Older Patients.

OBJECTIVES: This study aimed to clarify the impact of the coronavirus disease 2019 outbreak on the levels of activity among older patients with frailty or underlying diseases. A total of 175 patients (79.0±7.0 years) undergoing outpatient or home-based rehabilitation, stratified into groups, based on frailty status. The percentage of patients who went out at least once a week decreased after the outbreak from 91% to 87%, from 65% to 46%, and from 47% to 36% in the non-frail, frail, and nursing care requirement groups, respectively. The proportion of older patients participating in exercise during the outbreak was 75%, 51%, and 41% in the non-frail, frail, and nursing care requirement groups, respectively. The proportion of older patients participating in voluntary exercise after instruction was lowest in the frail group (35%). Older patients with frailty are susceptible to the negative effects of refraining from physical activity and require careful management.

Preliminary Study on Prevalence and Associated Factors with Sarcopenia in a Geriatric Hospitalized Rehabilitation Setting.

The reported prevalence of sarcopenia has shown a wide range, crucially based on the diagnostic criteria and setting. This cross-sectional study evaluated the prevalence of sarcopenia and sought to identify factors associated with sarcopenia on admission in a specialized geriatric rehabilitation setting based on the newly developed the Asian Working Group for Sarcopenia algorithm. Among 87 participants (mean age, 76.05 ± 7.57 years), 35 (40.2%) were classified as showing sarcopenia on admission. Prevalence was high, particularly among participants ≥80 years old, with tendencies toward lower body mass index, smoking habit, lower cognitive function, and greater functional impairment compared with the non-sarcopenic group. Identification of sarcopenia in elderly patients before rehabilitation and consideration of risk factors may prove helpful in achieving rehabilitation outcomes.

Functional outcome in patients with pontine infarction after acute rehabilitation.

We examined the clinical features of patients with pontine infarction in the acute stage and the factors affecting functional prognosis and outcome. Lesions, neurological manifestations at initial physical status examinations, cognitive function, swallowing function and outcome [activities of daily living (ADL), status of nutritional intake at discharge and destination after discharge] were evaluated in 68 patients (47 males and 21 females) who had pontine lesions with acute phase cerebral infarction. The mean length of stay was 24.4 days. The symptoms (number of patients) observed included paralysis (50), dysarthria (47), ataxia (18), diplopia (11), dysphagia (49) and poor cognitive performance (37). The types of lesions (number of patients) included lacunar infarcts in the ventral pontine area (15), lacunar infarcts in the dorsal pontine area (13) and large lacunar infarcts (LLIs) (41). After hospital discharge, 23 patients were discharged home, 44 were transferred to another hospital and 1 died. Twenty-three patients were on a regular diet, 22 were receiving a dysphagia diet and 22 were on enteral feeding at discharge. Patients with LLIs more frequently had poor cognitive performance, paralysis, dysphagia at discharge and a tendency for a longer length of stay compared with patients who had lacunar infarct. Most patients who returned home were those who were younger in age, had fewer neurological symptoms, had better cognitive function and ADL performance, and could ingest food. In an acute hospital, age, neurological symptoms, ADL, cognitive function, and dysphagia were considered important factors for determining the outcome in patients with pontine infarction.

Functional dissociation between Kana and Kanji: agraphia following a thalamic hemorrhage.

We report the case of a 61-year-old woman with a left thalamic hemorrhage causing agraphia of Kanji (morphograms). Single-photon emission computed tomography (SPECT) showed a decrease in the blood flow in the left thalamus from the superior temporal convolution to the parietal lobe, as well as in the frontal lobe while computed tomography showed no remarkable lesions in the cortex. The agraphia in this case may be due to the thalamic lesion itself, but the SPECT findings strongly suggest that a secondary cortical lesion may be involved in producing the higher cognitive disorder.

Family participation can improve unilateral spatial neglect in patients with acute right hemispheric stroke.

OBJECTIVE: Unilateral spatial neglect (USN) is one of the major behavioral disturbances in patients with cerebral lesions and often impairs the patients' independence in activities of daily living (ADL). Although many studies have addressed the mechanism and assessment of USN, there have been only few reports on rehabilitation strategies for patients with USN. The present study examined whether family participation can contribute to an improvement in USN following an acute stroke. DESIGN: This study compared the improvement at 3 weeks among patients treated with conventional exercise sessions and a program including the participation of family members. The study followed 34 stroke patients with hemiparesis and USN. Twenty had family participation in their therapy. The severity of USN was measured using the Behavioral Inattention Test (BIT) and a laterality index (LI). Mobility was assessed using the Rivermead Mobility Index (RMI), and ADL were assessed using the Barthel index. RESULTS: The results showed a relationship between BIT score improvement and family participation, and the BIT score improvement reflected the LI improvement. The RMI and BIT scores showed that ADL improved more with than without family participation. CONCLUSION: Family participation improved not only the mobility but also USN, suggesting that it can make important contributions to acute stroke rehabilitation.

Diffusion-weighted MRI of subdural and epidural empyemas.

We reviewed diffusion-weighted images (DWI) from eight patients with subdural and four with epidural empyemas to assess the possibility of differentiating between these lesions by DWI. The signal intensities of the empyemas on DWI, and maps of the apparent diffusion coefficient (ADC) were analysed in seven patients. In seven of the eight patients with subdural empyema, the lesions appeared as areas of high signal. The ADC maps confirmed that these areas were the result of restricted diffusion. (In the remaining patient, the lesion showed a mixture of high and low signal.) The epidural empyemas contained areas of low signal in all four patients; part of the empyema was isointense or gave high signal in two. DWI may be an adjunct to conventional sequences for differentiating between subdural and epidural empyemas.

Chromophobe renal cell carcinoma with sarcomatoid change. A case report.

Chromophobe renal cell carcinoma (RCC) is a newly established entity of renal neoplasm with histological and molecular biological features different from those of common RCCs. Chromophobe RCC shows characteristically cloudy and reticular cytoplasm and cellular features resembling distal nephron. Its prognosis has been reported to be more favorable than that of common RCCs. Recently, however, several cases have been reported which showed sarcomatoid change to present poor prognosis. Here we present a case of chromophobe RCC with sarcomatoid change which was once resected surgically. The surgically resected tumor was histologically composed of chromophobe epithelial cell sheets and sarcomatoid elements. The former showed positivity for colloid iron staining, and was immunohistochemically positive for E-cadherin and epithelial membrane antigen (EMA), whereas the latter was positive for vimentin instead of colloid iron and E-cadherin. EMA was focally positive in the sarcomatoid element. The patient died with systemic metastases 14 months after the operation. Histologically, the metastatic tumors were composed only of sarcomatoid element lacking epithelial element. Based on these findings and previous reports, this case supports the existence of a tumor progression pathway from chromophobe to sarcomatoid RCC. It is necessary to perform careful postoperative investigation of chromophobe RCC due to its possible histological progression to the sarcomatoid subtype.

Catalytic asymmetric syntheses and biological activities of singly dehydroxylated 19-nor-1alpha,25-dihydroxyvitamin D(3) A-ring analogs in cancer cell differentiation and apoptosis.

BACKGROUND: 1alpha,25-Dihydroxyvitamin D(3) (1alpha,25(OH)(2)D(3)) has been shown to modulate not only proliferation and differentiation, but also apoptosis in malignant cells, indicating that it could be useful for treating cancer. Little information is available concerning the structural motifs of the 1alpha, 25(OH)(2)D(3) molecule responsible for modulation of differentiation and apoptosis, however. We set out to synthesize singly dehydroxylated A-ring analogs of 19-nor-1alpha,25(OH)(2)D(3) in a catalytic asymmetric fashion, and to investigate their biological activities in leukemia HL-60 cells. RESULTS: A series of singly dehydroxylated 19-nor-1alpha,25-dihydroxyvitamin D(3) A-ring analogs were synthesized using a combinatiorial sequence of regioselective propiolate-ene reaction and catalytic asymmetric carbonyl-ene cyclization. Surprisingly, the analogs could be clearly divided into two categories; one group, bearing 1alpha-hydroxy or 3beta-hydroxy groups in the A-ring, were potent differentiators and the second group, bearing 1beta-hydroxy or 3alpha-hydroxy groups, were potent stimulators of apoptosis. CONCLUSIONS: We have clearly identified the structural motifs of 19-nor-1alpha,25(OH)(2)D(3) analogs responsible for differentiation and apoptosis in HL-60 cells. These findings will provide useful information not only for development of therapeutic agents for treatment of leukemia and other cancers, but also for structure-function studies of 1alpha,25(OH)(2)D(3).

Above- and belowground biomass and primary productivity of a Larix gmelinii stand near Tura, central Siberia.

We assessed above- and belowground biomass and net primary production (NPP) of a mature Larix gmelinii (Rupr.) Rupr. forest (240-280 years old) established on permafrost soils in central Siberia. Specifically, we investigated annual carbon budgets in roots in relation to root system development and availability of soil resources. Total stand biomass estimated by allometry was about 39 Mg per ha. Root biomass (17 Mg per ha) comprised about 43% of total biomass. Coarse root (>/= 5 mm in diameter) biomass was about twice that of fine roots (< 5 mm). The aboveground biomass/root biomass ratio (T/R) of the larch stand was about unity, which is much less than that of other boreal and subalpine conifer forests. The proportion of fine roots in total root biomass (35%) was relatively high compared with other cold-climate evergreen conifer forests. Total NPP, defined as the sum of annual biomass increment of woody parts and needle biomass, was estimated to be 1.8 Mg per ha per year. Allocation of total NPP to needle production was 56%. The proportion of total NPP in belowground production (27%) was less than for evergreen taiga forests. However, belowground NPP was probably under-estimated because root mortality was excluded. We conclude that L. gmelinii trees invested annual carbon gains largely into needle production or roots, or both, at the expense of growth of aboveground woody parts. This carbon allocation pattern, which resulted in the construction of exploitative root networks, appeared to be a positive growth response to the nutrient-poor permafrost soil of central Siberia.

Effect of oxygen deficiency on response of CR-39 on board scientific balloons.

We should be careful about the effect of oxygen deficiency on polymeric track detectors even at balloon altitude. Results of balloon experiments and calibration experiments in a vacuum chamber at different pressures show that the effect of oxygen deficiency becomes serious at a pressure below 10 hPa.

Singly dehydroxylated A-ring analogues of 19-nor-1alpha,25-dihydroxyvitamin D3 and 19-nor-22-oxa-1alpha,25-dihydroxyvitamin D3: novel vitamin D3 analogues with potent transcriptional activity but extremely low affinity for vitamin D receptor.

1Alpha,25-dihydroxyvitamin D3 [1alpha,25(OH)2D3] mediates its biological activities through specific binding to the nuclear vitamin D receptor (VDR). The VDR, bound to 1alpha,25(OH)2D3, forms a heterodimer with a nuclear accessory factor, retinoid X receptor (RXR), and the complex subsequently binds to specific nucleotide sequences or a vitamin D-responsive element (VDRE) to induce gene transcriptions. Thus, an ideal analogue of 1alpha,25(OH)2D3 for therapeutic applications has been considered to be one which has a high binding affinity for VDR, thus forming a stable VDR/RXR complex, and binding strongly to VDRE. By contrast, we report here evidence contrary to this hypothesis. Several singly dehydroxylated A-ring analogues of 19-nor-1alpha,25-dihydroxyvitamin D3 and 19-nor-22-oxa-1alpha,25-dihydroxyvitamin D3, all of which have an extremely low binding affinity for VDR, and some of which lack the 1alpha-hydroxyl group that is considered to be essential for VDR-mediated gene expression, have greater or equivalent potencies to 1alpha,25(OH)2D3 for inhibiting the proliferation and inducing the differentiation of HL-60 cells, as well as inducing the transactivation of a luciferase reporter gene combining a rat 25-hydroxyvitamin D3 24-hydroxylase gene promoter containing two VDREs. The present findings open interesting possibilities as to the role of the VDR in the genomic action of 1alpha,25(OH)2D3 and the development of new 19-nor-analogues of 1alpha,25(OH)2D3.

Production of crystallizable human chymase from a Bacillus subtilis system.

A Bacillus subtilis strain deficient in seven extracellular proteases was used to produce human mast cell chymase and is a viable expression system for serine proteases and other classes of proteins. Chymase is produced at 0.3-0.5 mg/l and is purified by three chromatography steps. Two crystal forms of PMSF-treated chymase were optimized. The first is C2 with a=47.94 A, b=85.23 A, c=174.18 A, beta=96.74 degrees, and diffracts to at least 2.1 A, while the second is P212121, with cell dimensions a=43.93 A, b=58.16 A, and c=86.09 A, and a diffraction limit of approximately 1.9 A. The first crystal form has either three or four molecules/asymmetric unit, while the second has one molecule/asymmetric unit.

[Prognosis of renal cell carcinoma coexisting with renal cystic diseases--results of nation-wide survey in Japan].

OBJECTIVE: To study the outcome of the patients with renal cell carcinoma (RCC) coexisting with renal cystic disease. SUBJECTS AND METHODS: The nation-wide survey conducted in 1989 enrolled 223 patients with RCC coexisting with renal cystic disease. Of those 223, we could follow up 216 patients in the second survey in 1994. RESULTS: Renal cystic diseases coexisting with RCC included simple renal cysts in 69 cases, acquired cystic disease of the kidney (ACDK) in 61, cystic RCC in 54, multilocular renal cysts in 19, polycystic kidney in 3, miscellaneous cysts in 9, and unspecified cyst in 1. The overall 5-year survival was 84%. The mean survival of the patients without any symptoms was significantly higher than that of those with symptoms. The survival of those with ACDK was lowest, and that will cystic RCC was highest. The survival was significantly different between the two groups, however the disease specific survival excluding the effect of dialysis was not significantly different between the two groups. Regarding TNM category, those with pT1 or pT2, comprising 87% of the subjects, carried a prognosis more favorable than those with pT3 or pT4. Among those undergoing cyst puncture (47 patients), positive cytology resulted in poorer prognosis. However, there was no such difference in the prognosis between punctured group and non-punctured group. CONCLUSION: Those with RCC coexisting with renal cystic disease carried a favorable prognosis. Cyst puncture were not concluded to exert an unfavorable effect on the prognosis at least in this study.

[Evidence for association between renal cell carcinomas and renal cystic diseases: nationwide survey in Japan].

OBJECTIVE: A scanty evidence previously reported regarding renal cell carcinomas occurring in association with renal cystic diseases prompted us to conduct a nationwide survey in July 1991. METHODS: A total of 507 hospitals responded to the questionnaire inquiring the clinical and pathological characteristics of renal cell carcinoma associated with renal cystic diseases over the previous 2 years. RESULTS: Renal cystic diseases were identified in 223 (3.9%) of 5,721 patients with renal cell carcinoma. The patients consisted of 181 men and 42 women who had a mean age of 55.2 +/- 12.5 years (SD). The renal cystic diseases comprised simple renal cysts in 72 patients (32%), acquired cystic diseases of the kidney (ACDK) in 62 (28%), cystic renal cell carcinoma in 56 (25%), multilocular renal cysts in 20 (9%), polycystic kidney in 3 (1.3%), miscellaneous cysts in 9 (4.0%), and unspecified cysts in 1 (0.4%). Simple renal cysts were more common in older patients, while ACDK and multilocular cysts were more predominant in younger patients. They included 71 dialysis patients (32%), of whom 62 (87%) had ACDK. Renal cell carcinoma occurred bilaterally in 12 patients (17%) on dialysis. Young male patients over a longer dialysis period were more susceptible to renal cell carcinoma. Low stage tumor, papillary type and granular cell subtype were more common in those on dialysis than in those without dialysis. In consideration of the Japanese general and dialysis population, we confirmed that dialysis patients with ACDK are more susceptible to renal cell carcinoma and those with polycystic kidney are less so. CONCLUSION: Renal cystic diseases may be associated with about 4% of renal carcinoma. Young male patients over a longer dialysis period who are diagnosed to have renal cysts should be regularly and closely followed by imaging study.

Increased risk of cardiovascular disease with erythropoietin in chronic dialysis patients.

Recombinant human erythropoietin is widely used in chronic dialysis patients. However, the long-term effect, especially on the incidence of cardiovascular disease, has not been critically evaluated. We observed the annual incidence of stroke and acute myocardial infarction from April 1988 through March 1993 in Okinawa, Japan. Until April 1990, erythropoietin was not generally used. Therefore, we have two periods: pre-erythropoietin, April 1988 through March 1990, and post-erythropoietin, April 1990 through March 1993. Two thousand one hundred and sixteen patients (1,219 males and 897 females) were on chronic dialysis during the study period by March 31, 1993. Every case of stroke and acute myocardial infarction during the study period was registered. The odds ratio was calculated using the data of the general population in each sex and age class obtained in the same area. A total of 86 cases of stroke and 15 cases of acute myocardial infarction were registered during the study period. The annual incidence, per 1,000 patient-years, of stroke was 12.5 (1988), 10.5 (1989), 12.7 (1990), 14.0 (1991), and 17.5 (1992). The incidence of stroke was increased in the post-erythropoietin period compared to the pre-erythropoietin period, odds ratio 1.22 and 95% confidence interval (95% CI 1.06-1.41, p < 0.01). The annual incidence of acute myocardial infarction was 1.0 (1988), 1.8 (1989), 0.8 (1990), 2.9 (1991) and 4.7 (1992). The incidence of acute myocardial infarction was increased significantly in the post-erythropoietin period compared to the pre-erythropoietin period, odds ratio 1.87 (95% CI 1.66-2.10, p < 0.01). The odds ratio of stroke to the general population was 4.25 (95% CI 3.10-5.82) in the pre-erythropoietin and 4.58 (95% CI 2.14-9.80) in the post-erythropoietin period. In acute myocardial infarction, it was 2.98 (95% CI 2.84-3.12) and 3.81 (95% CI 3.18-4.56). The odds ratio of acute myocardial infarction was significantly increased (p < 0.01). The introduction of erythropoietin was associated with an increased risk of cardiovascular disease, especially acute myocardial infarction. Erythropoietin may unmask the sclerotic lesion in chronic dialysis patients.

Exact documentation of location and size of bladder tumor with a three-dimensional mapping device.

BACKGROUND: Cystoscopy is one of the most important devices for diagnosing bladder tumor, but has a crucial shortcoming--the size of observed objects cannot be measured. This paper describes a new method to measure the position and size of a bladder tumor using a three-dimensional mapping device. METHODS: The three-dimensional mapping device, which is connected to an endoscope prior to use, can precisely measure the size and show the position of a bladder tumor. It consists of several arms connected by an angle sensor mounted on the articular site. One end of the device is fixed to the table and the other end is connected to the eye piece of an endoscope. Weight balancers keep each arm in a well balanced position, so urologists can freely manipulate the endoscope. Data from the angle sensor is sent to a personal computer (PC), which computes data such as three-dimensional coordination and diameter of a tumor. The diameter of a tumor is calculated by the PC according to the Pythagorean theorem. CONCLUSION: The position and size of a bladder tumor can be measured using our three-dimensional mapping device.

Pilot-scale harvest of recombinant yeast employing microfiltration: a case study.

In order to develop a cost-effective recovery process for an intracellular product, crossflow microfiltration was studied for the harvest of a recombinant yeast under severe time constraint. It was required to process yeast broth in a short period of time to minimize the risk for product degradation. Preliminary microfiltration studies employing flat sheet membranes showed high throughout with initial fluxes on the order of water fluxes (> 1000 LMH, regime I, < 2 min), followed by a rapid decay towards a low pseudo-steady state flux (20 LMH, regime II, > 2 min). Exploitation of these high fluxes and control of their eventual decline were crucial in establishing a rapid crossflow filtration process. The effect of several parameters, such as initial cell concentration, shear rate, transmembrane pressure, membrane pore size and medium composition on filtration performance were investigated to better understand the flux decline mechanisms. We found that the major contributor to flux decay was reversible fouling by the cake formation on the membrane surface. Within the operating boundaries of our microfiltration system, large-pore membrane (0.65 micron) was much more desirable for harvesting our yeast (10 microns size) without cell leakage than smaller pore ones (0.22 micron and 0.45 micron). Among adjustable operating parameters, feed flow rate (i.e., shear rate) exerted significant impact on average flux, whereas manipulation of transmembrane pressure afforded little improvement. Although initial cell concentration affected adversely the permeation rates, growth medium components, especially soy-peptone, was deemed pivotal in determining the characteristics of cell cake, thus controlling yeast microfiltration.