Association between salivary flow rate and depressive symptoms with adjustment for genetic and family environmental factors in Japanese twin study

Clinical Oral Investigations - The association between salivary flow rate (SFR) and depressive symptoms have been inconclusive. The present study aimed to investigate the association between SFR...     

Screening tests for predicting the prognosis of oral intake in elderly patients with acute pneumonia

Many elderly patients with pneumonia have aspiration pneumonia. Therefore they must temporarily abstain from oral intake. However, it is difficult to predict whether or not they will be able to start oral intake. The reason is the standard method to evaluate deglutition about pneumonia patients has not been established. In this study we aimed to develop a simple and convenient method that predicts the prognosis of oral intake as nutrition among elderly patients with acute stage pneumonia. Participants were 77 inpatients fasting due to aspiration risk with acute pneumonia. (86.0 ± 7.7 years; range 68–105 years; men: n = 34, women: n = 43) during September 2011 and August 2013. Their consciousness levels were determined by Glasgow coma scale (GCS) and swallowing function and cough reflex were evaluated by repetitive saliva swallowing test (RSST), modified water swallow test, simple swallowing provocation test and cough test. Oral intake status at discharge was considered as the objective variable, and these tests were considered as explanatory variables. Then receiver operating characteristic (ROC) curve and the area under the curve (AUC) for each was done. From the ROC curve analysis, GCS ≥14 had the largest AUC (0.79) with a sensitivity and specificity of 0.71 and 0.80. That was followed by RSST ≥1, AUC (0.77) with a sensitivity and specificity of 0.81 and 0.67. These results suggest that GCS and RSST could be useful screening tests for prognostic prediction of oral intake capability in elderly patients with acute pneumonia.     

Evaluation of endothelialization in the center part of graft using 3 cm vascular grafts implanted in the abdominal aortae of the rat

In order to develop small-diameter vascular grafts, it is necessary to evaluate endothelialization, especially, in the center part at early stage. For implantation of vascular grafts of 1 cm in length to abdominal aortae of rat, endothelial cells can be formed easily by stretching anastomosis. We evaluated the endothelialization in the center part of vascular grafts by implanting vascular grafts using transgenic (TG) silk fibroin (SF) of 3 cm in length. Vascular grafts were prepared 1.5 mm in diameter and 1 and 3 cm in length using wild type (WT) SF and TG SF by braiding structure, respectively. The grafts were removed after 2 weeks or 3 months and evaluated pathologically. Endothelialization was not confirmed totally after 3 months of implantation. However, endothelialization in the center part of grafts was significantly higher in TG SF than in WT SF. No significant difference was found regarding tissue infiltration and internal diameter. The TG SF revealed migration of the endothelial cells into the center part of the vessels at the early stage. Also, tissue infiltration and remodeling is expected using SF. The 3 cm length vascular grafts can be evaluated as a new experimental system.     

Differential dependence on nuclear factor‐κB‐inducing kinase among natural killer T‐cell subsets in their development

Natural killer T cells (NKT cells) are comprised of several subsets. However, the possible differences in their developmental mechanisms have not been fully investigated. To evaluate the dependence of some NKT subpopulations on nuclear factor-κB-inducing kinase (NIK) for their generation, we analysed the differentiation of NKT cells, dividing them into subsets in various tissues of alymphoplasia (aly/aly), a mutant mouse strain that lacks functional NIK. The results indicated that the efficient differentiation of both invariant NKT (iNKT) and non-iNKT cells relied on NIK expression in non-haematopoietic cells; however, the dependence of non-iNKT cells was lower than that of iNKT cells. Especially, the differentiation of CD8⁺ non-iNKT cells was markedly resistant to the aly mutation. The proportion of two other NKT cell subsets, NK1.1⁺ γδ T cells and NK1.1⁻ iNKT cells, was also significantly reduced in aly/aly mice, and this defect in their development was reversed in wild-type host mice given aly/aly bone marrow cells. In exerting effector functions, NIK in NKT-αβ cells appeared dispensable, as NIK-deficient NKT-αβ cells could secrete interleukin-4 or interferon-γ and exhibit cytolytic activity at a level comparable to that of aly/+ NKT-αβ cells. Collectively, these results imply that the NIK in thymic stroma may be critically involved in the differentiation of most NKT cell subsets (although the level of NIK dependence may vary among the subsets), and also that NIK in NKT-αβ cells may be dispensable for their effector function.     

Hemodynamic features and impaired arterial oxygenation in patients with portopulmonary hypertension.

Portopulmonary hypertension (P-PHT) is sporadically found in cirrhosis patients who have portal hypertension. We retrospectively investigated the clinical features of six patients with P-PHT and compared their hemodynamics and arterial oxygenation with data from 60 cirrhosis patients without pulmonary hypertension (non-PHT cirrhosis) admitted to our department. The mean pulmonary artery pressure and pulmonary vascular resistance index of P-PHT patients ranged from 25 to 57mmHg and from 399 to 1405dynesscm(-5)m(-2), respectively, and their arterial oxygenation was impaired. The systemic vascular resistance and cardiac index of P-PHT patients were similar level to those of patients with non-PHT cirrhosis. We found 10 patients with non-PHT cirrhosis in whom pulmonary vascular resistance exceeded the critical level for pre-capillary pulmonary hypertension (120dynesscm(-5)). These patients showed a distinctive hemodynamic profile, including a decrease of cardiac output due to contraction of the plasma volume and resultant elevation of systemic vascular resistance. However, the decrease of cardiac output contributed little to the elevation of pulmonary vascular resistance. Our findings suggested that certain factor(s) were acting to raise pulmonary vascular tone in these patients, which might cause chronic damage to the pulmonary vascular bed, leading to the onset of pulmonary hypertension.     

A case of anorexia nervosa with disseminated intravascular coagulation syndrome

A 36-year-old Japanese woman with anorexia nervosa (AN) was admitted to our department because of severe emaciation. Although we were thorough in her clinical management and were careful to avoid precipitating refeeding syndrome, disseminated intravascular coagulation (DIC) developed 3 weeks after hospitalization. We treated her for DIC with sepsis using anticoagulants, protease inhibitors, antithrombin, and platelet concentrate transfusion. To treat her bacterial infection, we administered antimicrobial drugs and immunoglobulin. We began probiotic and prebiotic (synbiotics) treatment for bacterial translocation. We think that the prevention of sepsis via bacterial translocation is an important aspect of care for patients with severe AN in addition to the prevention of refeeding syndrome.     

Hyperinsulinemia in obesity: Lack of relation to gastric emptying of glucose solution or to plasma somatostatin levels

To investigate some factors that may be related to the hyperinsulinemia of obesity, we measured fractional gastric emptying rates and changes of circulating levels of glucose, insulin, and somatostatin-like immunoreactivity (SLI) following the intragastric instillation of glucose in age-matched obese and nonobese Pima Indians with normal glucose tolerance. Results for the nonobese Pimas were also compared with findings for age- and weight-matched Caucasians with normal glucose tolerance. The levels of fasting plasma insulin and the integrated insulin response to glucose were significantly greater (P < 0.01) in obese than in nonobese Pimas. Mean rates of fractional gastric emptying, both in the basal state and after the glucose load, were similar for the three groups. The fractional gastric emptying rates after a glucose load were strongly correlated with the integrated responses of both plasma glucose and insulin in the nonobese Caucasians (r = 0.88, 0.90; P < 0.01) but not in either Pima group. There were no significant differences in peripheral plasma SLI for any of the three groups, either in the basal state or after the glucose load. These findings suggest that the hyperinsulinemia of established obesity is not mediated by alterations in the gastric emptying rate of liquids or by peripheral plasma SLI concentrations. They do not, however, exclude defects in gastric emptying of solid foods. Nor do they exclude the possibility that gastric or D-cell abnormalities exist during the period of fat accumulation but recede after obesity is established.