In vivo changes in microglial activation and amyloid deposits in brain regions with hypometabolism in Alzheimer��s disease

Purpose

Amyloid ?? protein (A??) is known as a pathological substance in Alzheimer??s disease (AD) and is assumed to coexist with a degree of activated microglia in the brain. However, it remains unclear whether these two events occur in parallel with characteristic hypometabolism in AD in vivo. The purpose of the present study was to clarify the in vivo relationship between A?? accumulation and neuroinflammation in those specific brain regions in early AD.

Methods

Eleven nootropic drug-na?ve AD patients underwent a series of positron emission tomography (PET) measurements with [¹¹C](R)PK11195, [¹¹C]PIB and [¹⁸F]FDG and a battery of cognitive tests within the same day. The binding potentials (BPs) of [¹¹C](R)PK11195 were directly compared with those of [¹¹C]PIB in the brain regions with reduced glucose metabolism.

Results

BPs of [¹¹C](R)PK11195 and [¹¹C]PIB were significantly higher in the parietotemporal regions of AD patients than in ten healthy controls. In AD patients, there was a negative correlation between dementia score and [¹¹C](R)PK11195 BPs, but not [¹¹C]PIB, in the limbic, precuneus and prefrontal regions. Direct comparisons showed a significant negative correlation between [¹¹C](R)PK11195 and [¹¹C]PIB BPs in the posterior cingulate cortex (PCC) (p?<?0.05, corrected) that manifested the most severe reduction in [¹⁸F]FDG uptake.

Conclusion

A lack of coupling between microglial activation and amyloid deposits may indicate that A?? accumulation shown by [¹¹C]PIB is not always the primary cause of microglial activation, but rather the negative correlation present in the PCC suggests that microglia can show higher activation during the production of A?? in early AD.     

Long-term outcomes of endoscopic management for biliary strictures after living donor liver transplantation with duct-to-duct reconstruction

Biliary strictures after living donor liver transplantation (LDLT) with duct-to-duct (D-D) reconstruction are associated with postoperative morbidity and mortality. The aims of this study were to evaluate the long-term outcomes of endoscopic deployment of plastic stents, and to investigate factors associated with the stent deployment failure. Between April 2001 and May 2007, 96 patients received LDLT with D-D reconstruction at Okayama University Hospital. Among them, 41 patients (43%) had anastomotic biliary strictures, and all were referred first for endoscopic retrograde cholangiography (ERC). When deployment was unsuccessful, a percutaneous transhepatic procedure was employed. Successful stent deployment was achieved in 35 out of total 41 patients (85%) by both procedures. Among the 35 patients, 28 had their stents removed as a result of strictures resolution. Eight patients underwent ERC and repeated stent deployment as a result of recurrence of the strictures. Finally, 21 out of 41 (51%) patients with biliary stricture were completely treated by endoscopic therapy during the observation period (median 873 days: range 77–2060). By multivariate analysis, biliary leakage was associated with stent deployment failure. Endoscopic deployment of plastic stents is a first-line therapy for patients with biliary stricture after LDLT.     

Incidence and risk factors for norovirus-related diarrhea in Japanese geriatric intermediate care facilities: A prospective cohort study

Aim

The risk of developing infectious diarrhea among elderly residents at Japanese geriatric intermediate care facilities is unclear. We investigated the incidence rate and risk factors of norovirus-related diarrhea at such facilities.

Methods

This prospective cohort study followed 1727 residents from November 2018 to April 2020 at 10 geriatric intermediate care facilities in Osaka, Japan regarding the occurrence of diarrhea. Resident data were collected from their medical records using structured forms at two to three of the following three time points: at recruitment, if they developed diarrhea, and when they left the facility. Residents who developed diarrhea were tested using rapid diagnostic tests for norovirus. Cox proportional hazard model was employed to hazard ratios (HRs) with 95% confidence intervals (CIs) to estimate the risk factors for norovirus-related diarrhea.

Results

During the study period, 74 residents developed diarrhea, 13 of whom were norovirus positive. The incidence rate of norovirus-related diarrhea was 10.11 per 1000 person-years (95% CI: 4.61–15.61). In terms of risk factors, people with care-needs level 3 were at a higher risk for developing norovirus-related diarrhea (adjusted HR [aHR] = 7.35, 95% CI: 1.45–37.30). Residents with hypertension (aHR = 3.41, 95% CI: 1.05–11.04) or stroke (aHR = 8.84, 95% CI: 2.46–31.83), and those who walked with canes (aHR = 16.68, 95% CI: 1.35–206.52) also had a significantly higher risk for norovirus-related diarrhea.

Conclusions

Throughout the study period, the incidence of development of diarrhea was low. Care-needs level 3, stroke, hypertension and use of a cane were identified as risk factors for norovirus-related diarrhea in Japanese geriatric intermediate care facilities. Geriatr Gerontol Int 2023; 23: 179–187 .