Influence of behavioral and psychological symptoms of dementia (BPSD) and environment of care on caregivers' burden

With increasing population of older adults in need of care, caregiver's burden is becoming a major concern. We investigated the relative contributions of BPSD of care recipients, caregiver's background and the care environment to caregiver's burden assessed by using Zarit burden interview (ZBI). Among BPSD, inability of finding the way home, inability of managing money and fecal incontinence were the most difficult symptoms to cope with. A path analysis, by which we constructed a network model to clarify the contributions of the factors examined to the caregiver's burden, indicated that the severity of dementia, the feeling of "would rather die than be in the same condition" and the physical pain of the caregivers showed great direct influences on the score of the ZBI. In conclusion, we clarified kinetic and dynamic interactions of factors affecting caregiver's burden by using a path analysis. The model indicates that the caregiver's burden can be affected not merely by the illness of the care recipients but by the caregiver's background and the care environment.     

Awareness of dementia in older adults attending dementia-prevention programs in community healthcare centers

Recently, the dementia-prevention program hosted by the Ministry of Health, Welfare and Labor has been widely implemented. We administered a questionnaire to 347 elderly adults (mean age: 71, mean MMSE score: 27.2) who attended programs in community healthcare centers. The questionnaire consisted of questions concerning: (1) belongings (2) knowledge about dementia (3) opinions about revealing the diagnosis of dementia to patients (4) anxiety for own onset of dementia. Regarding the knowledge about dementia, 17% of the participants knew about drug therapy, and 13% of them knew about legal guardianship. The results indicated a limited knowledge about facilities where demented people can be placed (home: 39%, hospital: 43%, nursing home: 62%, group-home: 25%). As for revealing the diagnosis, 68% of the participants hoped they would be informed of the diagnosis if they become demented, while 66% of them felt anxiety about having dementia in the future. In terms of difference by age (> or = 70 v.s. < or = 69), while the older group had low knowledge about the facilities and felt more anxiety about their own onset of dementia (chi2 test p < 0.05, Mann-Whitney U test p < 0.05), there were no intergroup difference regarding their expectations of being told about the diagnosis of dementia. Overall, the results of the questionnaire suggest that appropriate education of dementia to older adults may contribute to early diagnosis of the community level, thereby may maximize the effect of therapeutic interventions.     

Histological changes in the rabbit kidney induced by transarterial injection of a hypertonic sodium chloride solution

PURPOSE: To evaluate histological changes in normal renal tissue induced by the injection of a hypertonic liquid. MATERIALS AND METHODS: Transarterial injection was performed in 17 healthy rabbits at various rates of infusion and amounts of isotonic and hypertonic (7%) sodium chloride solutions. In group 1, 10 cc of isotonic sodium chloride solution was injected. In groups 2 and 3, 1-10 cc of hypertonic solution was injected at rates of 1.0 cc/sec and 0.05 cc/sec, respectively. After 20 minutes of hemostasis, renal weight measurements and histological examinations were performed. In three rabbits that received 10 cc of 7% sodium chloride, lung samples were also obtained, and histological changes were reviewed. RESULTS: There was no tissue injury in group 1, and in groups 2 and 3 the histological changes for infusions of 4-10 cc were greater than those of 1-3 cc. There was no vascular endothelial cell damage in any case. None of the histological changes were dose dependent, and the lungs showed no clear histological alterations. CONCLUSION: Higher doses of a hypertonic sodium chloride solution cause irreversible histological changes in the rabbit kidney.     

In vivo insulin action in adrenodemedullated rats after voluntary running

The purpose of this study was to estimate the influence of epinephrine on in vivo insulin sensitivity and responsiveness after voluntary running. Wistar rats that had previously undergone adrenodemedullation or sham-operation were kept in a sedentary state or trained over a 4 week period. An euglycemic insulin clamp study was performed on adrenodemedullated sedentary rats (ADMX), adrenodemedullated voluntary running rats (ADMX-T), sham-operated voluntary running rats (SHAM-T), and control rats (C) at 18 h after the last bout of exercise. The insulin infusion rate was 3.0, 6.0, and 303.0 mU/(kg min), respectively. The blood glucose concentration was maintained constant at basal levels. Metabolic clearance rate of glucose (MCR) was calculated as an index of whole-body insulin action. In the presence of physiological hyperinsulinemia (an insulin infusion rate of 6.0 mU/(kg min)), MCR (ml/(kg min)) was significantly higher in ADMX-T rats (31.2 +/- 2.0) than in ADMX rats (19.8 +/- 0.8, P<0.001) and SHAM-T rats (23.8 +/- 0.8, P<0.05). Also, the MCR values of SHAM-T and ADMX rats were significantly (P<0.001, and P<0.05, respectively) greater than that of C rats (12.7 +/- 0.4). At maximal hyperinsulinemia (an insulin infusion rate of 303.0 mU/(kg min)), there was no difference of MCR between ADMX-T rats (49.8 +/- 4.3) and C rats (38.2 +/- 2.2). The GDR values of SHAM-T rats (43.5 +/- 3.7) and ADMX rats (43.5 +/- 2.1) were also not different from that of C rats. These results provide indirect evidence that epinephrine is one of factors that suppresses increased insulin sensitivity after physical training, although it seems to have no significant influence on insulin responsiveness.     

A prostate stem cell antigen-derived peptide immunogenic in HLA-A24- prostate cancer patients

BACKGROUND: We attempted to identify prostate stem cell antigen (PSCA)-derived peptides immunogenic in HLA-A24+ prostate cancer patients. METHODS: Peripheral blood mononuclear cells (PBMCs) were stimulated in vitro with each of three different PSCA-derived peptides, which were prepared based on the HLA-A24 binding motif, and their peptide-specific and HLA-A24-restricted anti-tumor responses were examined. Plasma levels of immunoglobulin G (IgG) against PSCA peptides were measured by enzyme-linked immunosorbent assay (ELISA). RESULTS: Among three PSCA peptides, the PSCA 76-84 peptide most effectively induced peptide-specific cytotoxic T lymphocytes (CTLs) from PBMCs of HLA-A24+ prostate cancer patients. Cytotoxicity was dependent on peptide-specific and CD8+ T cells. The PSCA 76-84 peptide-stimulated PBMCs showed a significant level of cytotoxicity against prostate cancer cells in an HLA-A24-restricted manner. IgG reactive to the PSCA 76-84 peptide was detected in half of patients. CONCLUSIONS: The PSCA 76-84 peptide should be considered for use in clinical trials of immunotherapy for HLA-A24+ patients.     

A case of schwannoma in the renal hilum

A 58-year-old female presented with a well-encapsulated tumor in the left renal hilum on computed tomography (CT). On magnetic resonance imaging (MRI), the tumor showed low intensity on the T1-weighted image, high intensity on the T2-weighted image. Laparoscopic radical nephrectomy was performed because we could not exclude the possibility of malignancy such as renal cell carcinoma. Histopathological examination revealed that the tumor was a benign Schwannoma. Although renal hilum is a common site of renal schwannoma, it is difficult to differentiate benign tumors from malignant ones, and then nephrectomy is usually performed.     

Pitavastatin, a 3-hydroxy-3-methylglutaryl-coenzyme A reductase inhibitor, blocks vascular smooth muscle cell populated-collagen lattice contraction

Constrictive arterial remodeling plays a major role in lumen narrowing following angioplasty. We investigated the effect of pitavastatin, a 3-hydroxy-3-methylglutaryl-CoA (HMG-CoA) reductase inhibitor, on vascular smooth muscle cell (SMC)-populated collagen lattice contraction, an in vitro model of vascular contraction. Type I collagen gel contraction by SMCs, which are cultured in collagen gel, was used as a model of vascular remodeling. Pitavastatin pretreatment inhibited 10% serum- or platelet-derived growth factor-BB (PDGF)-induced SMC-mediated collagen lattice contraction in a concentration-dependent manner. The effect of pitavastatin was prevented by mevalonate or geranylgeranyl pyrophosphate, but not by squalene, a precursor of cholesterol, or farnesyl pyrophosphate. The serum- or PDGF-induced SMC-mediated collagen gel contraction was inhibited by GGTI-298, a geranylgeranyltransferase inhibitor, C3 exoenzyme, an inhibitor of Rho, or Y27634, a Rho kinase inhibitor, but not by FTI-277, a farnesyltransferase inhibitor. Serum or PDGF treatment increased the stress fiber organization in SMCs, which was blocked by the pitavastatin pretreatment. Pitavastatin had no effect on the serum- and PDGF-induced lamelliopodia extension of SMC. These results may suggest that pitavastatin attenuates SMC-mediated collagen gel contraction probably via an inhibition of geranylgeranylated Rho protein and a disruption of actin cytoskeletal reorganization.     

(+)- and (-)-syn-2-isobutyl-4-methylazetidine-2,4-dicarboxylic acids from the extract of Monascus pilosus-fermented rice (red-mold rice)

The structures of two enantiomeric azetidine-type amino acids isolated from the n-butanol-soluble fraction of the 70% ethanol extract of red-mold rice fermented with Monascus pilosus were established to be (+)- [1; (+)-monascumic acid] and (-)-syn-2-isobutyl-4-methylazetidine-2,4-dicarboxylic acids [2; (-)-monascumic acid] based on spectroscopic methods.