Prediction of Nursing Home Admission Using the FRAIL-NH Scale Among Older Adults in Post-Acute Care Settings.

OBJECTIVES: The FRAIL-NH scale was developed to identify frailty status in nursing home residents. The purpose of this study was to examine the utility of the FRAIL-NH scale for predicting nursing home admission among patients in post-acute care settings. Design/ Setting/ Participants: This single-center, prospective, observational cohort study included participants aged 65 years or older who were admitted to a community-based integrated care ward (CICW) between July 2015 and November 2020. MEASUREMENTS: Using the CICW database, we retrospectively classified participants as robust, prefrail, or frail based on the FRAIL-NH scale the score by identifying variables from our database that were most representative of each component. The following data were collected: examination findings, CICW admission and discharge information, length of CICW stay, and nursing home admission. The participants were divided into two groups based on whether or not they were admitted to a nursing home after CICW discharge. The hazard ratios (HRs) and 95% confidence intervals (CIs) for nursing home admission were calculated according to the FRAIL-NH categories using the Cox proportional hazards models with reference to the robust group. In the multivariate adjusted model, we adjusted for age, sex, nutritional status, cognitive function, living status, and economic status. RESULTS: Data of 550 older adults were analyzed, of which 118 were admitted and 432 were not admitted to a nursing home. The frail group had a higher risk of nursing home admission (HR, 2.22; 95% CI 1.32-3.76) than the robust group. CONCLUSIONS: This study showed that the FRAIL-NH scale was beneficial for predicting nursing home admission among older adults in the post-acute care setting. Thus, assessment using the FRAIL-NH scale may help to consider preparation and support for life after discharge.

Inhibition of leukotriene formation in human leukocytes by halothane.

The effects of an inhalation anesthetic, halothane (2-bromo-2-chloro-1,1,1-trifluoroethane) on the formation of 5-lipoxygenase metabolites such as leukotriene B4, 5(S)-hydroxyeicosatetraenoic acid (5-HETE), 6-trans-isomers of leukotriene B4 and leukotriene C4 were studied in human leukocytes stimulated with calcium ionophore A23187. Halothane inhibited the formation of all these metabolites dose dependently and the formation was restored by removal of the drug. The anesthetic also reversibly inhibited the release of [3H]arachidonic acid from neutrophils with a half-inhibition concentration of less than 0.19 mM. The formation of 5-lipoxygenase metabolites was not inhibited by the anesthetic when leukocytes were stimulated with the ionophore in the presence of exogenous arachidonic acid. These observations indicate that the inhibitory effect of halothane on the formation of 5-lipoxygenase metabolites in leukocytes is mainly due to the inhibition of arachidonic acid release.

Determination of phenobarbital by radioimmunoassay.

A radioimmunoassay for phenobarbital has been studied. Antiphenobarbital antisera were obtained by repeated immunization of rabbits with p-succinamidophenobarbital conjugated to bovine serum albumin. Less than 0.2 pmol of phenobarbital could be measured by this procedure. The specificity of the antibodies was directed to substituents on the nitrogen atoms of the barbituric ring as well as to substituents at the carbon 5-position of the ring.

Further production and characterization of antibodies reactive with pyrazolone derivatives.

A sensitive radioimmunoassay for pyrazolone derivatives has been developed. Anti-antipyrine antisera were produced in rabbits by repeated immunization with 4-succinamidoantipyrine coupled to bovine serum albumin. Less than 1 ng of antipyrine could be detected by this procedure. Various substituents on the carbon-4 position of the pyrazolone ring decreased the affinity for the antibody. The concentrations in ng of various pyrazolone derivatives required to inhibit [3H]antipyrine binding by 50% were: antipyrine, 6.8; aminopropylon, 8.5; sulpyrine, 35.5; isopropylantipyrine, 1320; and aminopyrine, 2820. The antibody showed no cross-reactivity with any other antipyretics such as pyrazolidine or aniline derivatives. The determination of antipyrine and sulpyrine concentrations in rat serum after i.p administration was also carried out.

Radioimmunoassay for pyrazolone derivatives.

The determination of pyrazolone derivatives by radioimmunoassay has been reported. Anti-antipyrine antisera were obtained by repeated immunization of rabbits with 4-azoantipyrine-conjugated bovine serum albumin. The level at least as low as 1.0 ng of antipyrine could be detected by this procedure. Various substituents on the carbon 4 position of the pyrazolone ring as well as the lack of methyl group on the nitrogen 2 position decreased the affinity for the antibody, and the antibody showed no cross-reaction with any pyrazolidine derivatives.

Effects of prostaglandins on the metabolism of cholesteryl ester in rat testes: changes in the synthesis and hydrolysis of cholesteryl ester and the activity of cholesterol side-chain cleavage enzyme.

The effects of prostaglandins on testicular synthesis and hydrolysis of cholesteryl esters, the activity of the enzyme involved in cleavage of the cholesterol side-chain and on serum levels of testosterone and LH have been studied. Subcutaneous administration of prostaglandins to male rats caused an increase in the concentration of cholesteryl esters in the testes, a decrease in testicular synthesis and hydrolysis of cholesteryl esters but no change in the activity of the cholesterol side-chain cleavage enzyme. There was also a significant decrease in the serum level of testosterone, but the level of LH was raised. Prostaglandins also affected the fatty acid composition of lipids in rat testicular tissue; cholesteryl esters were found to contain greater amounts of arachidonic (C20:4) and docosapentaenoic (C22:5) acids. These findings suggest that prostaglandins are involved in the turnover of cholesteryl esters in rat testicular tissue and regulate the production of androgens.

Basigin, a new, broadly distributed member of the immunoglobulin superfamily, has strong homology with both the immunoglobulin V domain and the beta-chain of major histocompatibility complex class II antigen.

Lotus tetragonolobus agglutinin (LTA) binds preferentially to early embryonic cells in the mouse. The affinity-purified antibody raised against LTA receptors from embryonal carcinoma cells were used to screen a lambda gt11 expression library of F9 embryonal carcinoma cells, resulting in detection of a cDNA clone specifying a new glycoprotein termed "basigin." The glycoprotein has been suggested to be a transmembrane one, and was found to be a new member of the immunoglobulin (Ig) superfamily. The molecular weight of basigin was largely in the range between 43,000 and 66,000, while that of the peptide portion with a putative signal sequence was inferred to be about 30,000. Significant levels of basigin mRNA were detected not only in embryonal carcinoma cells, but also in mouse embryos at 9-15 days of gestation and in various organs of the adult mouse. The Ig-like domain of basigin is unique, since it has strong homology to both the beta-chain of major histocompatibility class II antigen and the Ig V domain. The number of amino acids between the two conserved cysteine residues is intermediate between those of the Ig V and C domains. Therefore, basigin is an interesting protein in connection with the molecular evolution of the superfamily.

Clinical experience of 473 patients with the omnicarbon prosthetic heart valve.

BACKGROUND AND AIM OF THE STUDY: The long-term clinical experience of patients receiving Omnicarbon heart valve prostheses between January 1985 and December 1996 was investigated. METHODS: In total, 473 patients (255 males, 218 females; mean age 57.5 +/- 10.1 years (range: 20n-73 years) received 523 prostheses. These included 253 mitral (MVR), 170 atrial (AVR) and 50 double (DVR) valve replacements. RESULTS: The 30-day mortality rate was 4.7% (n = 22); in addition eight patients died more than 30 days after surgery, but during the same hospital stay. Mean follow up was 3.9 years (maximum 11 years and 7 months). Cumulative follow up was 1,750.1 patient-years (pt-yr); follow up was 97.5% complete. Among 39 late deaths, 20 were valve-related (seven cerebral infarction, seven cerebral bleeding, six endocarditis) and four cardiac-related. The overall five-year cumulative survival rate (excluding early mortality) was 90.2 +/- 11.7% (MVR 88.0 +/- 2.5%, AVR 93.1 +/- 2.3%, DVR 93.7 +/- 4.8%). At 10 years, the overall survival rate was 76.4 +/- 7.7%. Valve-related complications included thromboembolism (n = 13, 0.7%/pt-yr), anticoagulation-related hemorrhage (n = 12, 0.7%/pt-yr) and endocarditis (n = 7, 0.4%/pt-yr). Neither mechanical failure nor clinical hemolysis was observed. The overall valve-related event-free rate after five years was 89.3 +/- 2.0% (MVR 89.8 +/- 2.4%, AVR 93.5 +/- 2.6%, DVR 89.4 +/- 5.7%) and after 10 years it was 87.6 +/- 2.6% (MVR 85.4 +/- 3.7%, AVR 93.5 +/- 2.6%, DVR 82.5 +/-10.1%). CONCLUSIONS: These long-term results with the Omnicarbon valve are excellent; especially satisfactory results were achieved in terms of the low rate of thromboembolic complication.

Microvascularization of the free gingival autograft.

Nobuto has previously reported on the initial anastomosis involved in establishing circulation between a free gingival autograft and the recipient bed. This study will present observations on the maturation of new sinusoidal vessels involved in maintaining circulation to the graft and the resulting histovascular organization. Using 56 mongrel dogs, the ongoing processes were observed periodically over 84 days after grafting. For this purpose, vascular corrosion casts were examined with the scanning electron microscope. At the same time, employing both light microscopy and transmission electron microscopy, histopathological and ultrastructural observation on the developing three-dimensional vascular architecture were recorded with supporting photographs. Thus, the entire process from the development of a vascular plexus parallel to the bone surface on the seventh day to the transformation to a vertical dendritic vascular architecture firmly establishing the circulation to the graft by the 84th day, is provided in both descriptive and pictorial detail.

Ultrastructural changes of subepithelial capillaries following graft epithelialization.

This study investigated architectural changes in the nourishment-providing capillaries beneath the epithelium that accompany graft epithelialization. A total of 77 mongrel dogs underwent free gingival autografts involving the maxillary canine and its attached gingiva. Comparative investigations relating the architectural transformations and endothelial permeability of the capillaries were made histopathologically, with graft epithelialization as an indicator. Microscopic findings revealed that the subepithelial capillaries transformed from loop structure into glomus-like structures. The endothelium changed ultrastructurally from the continuous type to the fenestrated. This occurred during the most active graft epithelialization phase. By the time the epithelium of the graft had matured, the fenestrated microvascular structure reverted to the continuous type and changed from a glomus-like structure to a network capillary system. However, by the 84th postoperative day, the subepithelial capillaries, still exhibiting network structure, had not yet returned to the loop structure indigenous to the gingiva. Observations indicated that transformation of the structure of the nourishment-providing capillaries was attendant to and simultaneous with the changes brought about by graft epithelialization.

Periosteal microvasculature in the dog alveolar process.

Most periodontal surgery has been performed on the basis of the regenerating capacity of the periosteum. Recently it has been pointed out that the blood supply is important to the osteogenic and fibrogenic activity of the periosteum. The purpose of the present study was three-dimensional observation of blood vessels distributed within the gingival periosteum and the periosteum beneath the alveolar mucosa of adult mongrel dogs. Corrosion cast specimens of vessels were observed from three directions: mucosal side, bone side, and horizontal cut surface. It was revealed that the plexus distributed in the periosteum of the gingiva formed a coarse network structure, which consisted mainly of arterioles and venules. In contrast, in the periosteum of the alveolar mucosa, a dense network structure consisting of arterioles, capillaries, and venules formed a vascular bed. Thus, the mucogingival junction was easily located even in the plexus of periosteum which was distributed beneath the gingiva and the alveolar mucosa, suggesting that the difference in tissue specificity was reflected in the plexus of the periosteum.

Microvascularization of gingival wound healing using corrosion casts.

The healing process in a wound induced by removal of 6 X 6 mm of gingiva and periosteum from the maxillary attached gingiva of 48 adult mongrel dogs was observed to investigate the potential blood supply for grafts placed on denuded bone. Three-dimensional observations were performed over 12 weeks by scanning electron microscopy (SEM) following the manufacture of corrosion capillary casts by acrylic resin injection. Revascularization in the gingival wound was mainly through formation of new capillaries from those existing below the surrounding epithelium with little new capillary formation from the Volkmann canals. Moreover, the periodontium contributed greatly to the vascularization, which was fastest from the gingival margin. Further, simplification of new capillary loops was also fastest from this direction. Regeneration of the periosteum and periosteal vascular plexus was slow, taking about twice the time of connective tissue and capillaries below the epithelium. The results indicated that blood supply to grafts on denuded bone in the early postgraft period would mainly be provided by capillaries below the epithelium surrounding the recipient bed.

Possible involvement of bone cells in a new cementum formation.

Cells from the gingival lamina propria, bone-derived granular tissues and periodontal ligament (PDL) were isolated after periodontal surgery and subsequently cultured in vitro. The resulting cells were defined as gingival cells, bone cells and PDL cells, respectively. Under a phase contrast microscope, the cultured cells exhibited a spindle and/or a polyhedral shape. On the basis of their appearance under an electron microscope, spindle-shaped cells and polyhedral-shaped cells were identified as fibroblasts and osteoblasts, respectively. Bone cells, a homogeneous population of osteoblasts, had a more rapid growth ability than PDL cells, which were a heterogeneous population of fibroblasts and osteoblasts. Of particular interest was that only bone cells produced bone matrix in the multilayers in vitro. These results support the hypothesis that the phenotype expressed by cells from the alveolar bone establishes a new concept for progenitor cells in the formation of cementum.

Chemotactic response of fibroblasts to root surface components in wound healing following flap surgery.

The purpose of this study was two-fold; first to investigate the chemotactic response of periodontal cells to root surface components during wound healing following flap surgery; second, to investigate the chemoattractive effect of the root components on cell migration. Cells were obtained by culturing cells from monkey periodontal tissues and rat calvarial cells. Root surface components were obtained from teeth extracted at 4, 7, 10 and 14 days after flap surgery. The chemotactic response of the isolated cells to root surface components was quantitated by an in vitro assay using a 48 well microchemotaxis chamber. The effect of root components or other growth factors on the cell migration was evaluated using a three-dimensional gel system. Cemental components produced a strong chemotactic response for gingival fibroblasts, alveolar bone cells and rat calvarial cells. Kinetics of the chemotactic potential of cementum was characterized by an initial increase (up to 7 days after surgery), a transient decline (at 10 days after surgery) and a second increase (at 14 days after surgery). Cemental components obtained 7 days after surgery most profoundly facilitated invasion of gingival fibroblasts with comparable effects induced by PDGF and TGF-beta. These results suggest that cemental components influence the chemotactic migration of gingival fibroblasts at the initial stage of wound healing, and therefore, cementum plays an important role in periodontal regeneration.

Separation and identification of 9-chloro-10-methoxy (9-methoxy-10-chloro)hexadecanoic and octadecanoic acids in adipocere.

Two homologs of 9-chloro-10-methoxy(9-methoxy-10-chloro) fatty acids were found in adipocere from the human neonate, and identified as 9-chloro-10-methoxy(9-methoxy-10-chloro)hexadecanoic acid and 9-chloro-10-methoxy(9-methoxy-10-chloro)-octadecanoic acid. The chemical structures of these compounds were confirmed by thin-layer chromatography, gas-liquid chromatography, gas chromatography--mass spectrometry, nuclear magnetic resonance spectrometry and elemental analysis. The adipocere contained approximately 7.2% 9-chloro-10-methoxy(9-methoxy-10-chloro) fatty acids in the total fatty acids.

Modified application of intra-aortic balloon pump after repair of thoracic dissecting aneurysm.

We describe a patient who could not be weaned from cardiopulmonary bypass without mechanical circulatory assistance because of severe cardiac failure after surgical repair of a dissecting aneurysm of the descending aorta. Placement of an intra-aortic balloon in a conduit attached to the proximal aorta enabled the patient to recover from perioperative cardiac failure after all other measures had failed.

Experimental study of cardiac lymph dynamics and edema formation in ischemia/reperfusion injury--with reference to the effect of hyaluronidase.

This study is designed to evaluate the effect of hyaluronidase on the canine myocardial edema derived from ischemia/reperfusion injury. The mongrel dog's heart received 90 minutes of ischemia under cardiopulmonary bypass consisting of 30 minutes of normothermia alone and 60 minutes of hypothermia with cardioplegic arrest. Reperfusion for 60 minutes was added thereafter. Two kinds of cardioplegic solution, 4 degrees C St. Thomas' Hospital solution with or without 3000 units/L of hyaluronidase, were prepared. The solution was given antegradely every 30 minutes during cardioplegic arrest. Cardiac lymph was collected continuously from the afferent duct of the cardiac lymph node by cannulation. Hyaluronidase in the cardioplegic solution increased cardiac lymph volume significantly and improved postischemic recovery of cardiac function. A high level of adenosine triphosphate was maintained at that time. The myocardial water content at the end of reperfusion revealed a minimum increase with hyaluronidase use. Active drainage of cardiac lymph by hyaluronidase alleviates the myocardial edema formation, thereby preserving cardiac function.

Portal vein obstruction accompanied by intrahepatic stones.

This study was conducted to clarify the pathogenesis of portal vein obstruction (PVO) associated with intrahepatic stones. Five cases with PVO and intrahepatic stones were studied retrospectively. The coincidence rate of PVO in intrahepatic stones was 5.8% (5 of 86 cases), and that of intrahepatic stones in PVO, 45.5% (5 of 11 cases). All cases had one or more symptoms of cholangitis, such as high-grade fever, abdominal pain, and jaundice prior to diagnosis of PVO. The portal vein was occluded at the main trunk in 4 and in the left branch in 1. Intrahepatic stones were found in bilateral hepatic lobes in 3 and in the left lobe in 2. Numerous calcium bilirubinate stones were packed in dilatated intrahepatic bile ducts of an excised specimen of the liver. Microscopically, arterial structures could be seen, but the portal vein ceased to be evident about the involved bile duct. Based on the results of this study, persistent cholangitis and packed gallstones were concluded essential to the development of PVO accompanied by intrahepatic stones.

Retinal vasculitis revealed by fluorescein angiography in patients with inflammatory bowel disease.

Fluorescein angiography was performed to examine retinal vascular abnormalities in five consecutive patients with inflammatory bowel disease seen during the 2 years from April 1995 to March 1997, in a university hospital. All patients showed dye leakage from retinal capillaries in the peripheral fundi of both eyes. Other ocular findings included iritis in both eyes of two patients and clinically significant macular edema in the unilateral eye of one patient. This study indicates that subclinical retinal vasculitis, revealed only by fluorescein angiography, is present in patients with inflammatory bowel disease.

Clinical and angiographic characteristics of retinal manifestations in cat scratch disease.

PURPOSE: To elucidate clinical and angiographic features of retinal manifestations in cat scratch disease. METHODS: Clinical characteristics as well as fluorescein and indocyanine green (ICG) angiographic features were reviewed in 4 consecutive patients with retinal manifestations caused by serologically confirmed cat scratch disease. RESULTS: A subretinal to intraretinal granuloma at the upper margin of the optic disc was found in 3 patients, while 1 patient developed subretinal to intraretinal granuloma in the midperiphery with serous retinal detachment. Fluorescein angiography revealed the abnormal vascular network of the peripapillary granuloma in the early phase followed by its dye leakage toward the late phase. Indocyanine green angiography demonstrated more clearly the abnormal vascular network with its minimal dye leakage than did fluorescein angiography. In contrast, only the late dye leakage was noted from granuloma of the midperipheral fundus by fluorescein angiography in one patient. Indocyanine green angiography detected no choroidal lesions other than the retinal lesions delineated by fluorescein angiography. The granulomas disappeared in response to a 4-week course of sulfamethoxazole-trimethoprim combined with steroids. CONCLUSIONS: Granuloma with abnormal vascular network as revealed by fluorescein and ICG angiography is characteristic of retinal manifestations in cat scratch disease.