Nutrition, Exercise, and Skin Integrity among Frail Older Adults in Taiwan.

OBJECTIVE: The purpose was to determine the correlation between nutrition status and skin integrity in the frail older adult population. DESIGN AND SETTING: Participants (N = 94) in this cross-sectional study were recruited through convenience sampling from the neurology and geriatrics outpatient department at a regional teaching hospital in Northern Taiwan. Study tools included a Basic Participant Profile Fill-in Sheet, which assesses demographic and exercise habit; the Comorbidity Index; Skin Integrity Evaluation Chart; Mini-Nutritional Assessment-Short Form; and Taiwan International Physical Activity Questionnaire Form. Data were analyzed by independent-samples t tests, χ tests, linear regressions, and logistic regression analyses. RESULTS: Significant correlations were found among nutrition status, aging, and exercise habits, as well as between participants' demographics and their skin integrity. Logistic linear regression showed that the decline of skin integrity can be predicted by nutrition status. CONCLUSIONS: Exercise programs and a balanced diet should be planned for frail older adults, and their nutrition status should be monitored closely. Those with declining nutrition status should be provided with nutrition supplements. In addition, clinicians should evaluate the skin condition of frail older adults to prevent the development of pressure injuries.

Involvement of nigrostriatal pathway in Japanese encephalitis with movement disorders: evidence from 99mTc-TRODAT-1 and 123I-IBZM SPECT imagings.

PURPOSE: The purpose of this study was to evaluate molecular evidence of nigrostriatal pathway involvement in Japanese encephalitis (JE) survivors with movement complications. METHODS: Three JE patients were recruited. All had cranial magnetic resonance imaging (MRI) and single-photon emission computed tomography (SPECT) studies with (99m)Tc-TRODAT-1 and (123)I-IBZM. RESULTS: Cranial MRI revealed involvement of bilateral thalami, substantia nigra, and medial temporal lobes in all three patients, but only case 1 had additional bilateral basal ganglia involvement. The (99m)Tc-TRODAT-1 SPECT for presynaptic dopamine transporter imaging disclosed asymmetrical decreases in bilateral striatal uptake in all three patients. However, the (123)I-IBZM SPECT imaging for postsynaptic D2 dopamine receptors (D2Rs) revealed inconsistent abnormalities including asymmetrical bilateral decreases (case 1), unilateral decrease (case 2), and bilateral increases (case 3) in striatal uptakes. CONCLUSION: Data have suggested that presynaptic dopaminergic neurons in JE patients are more susceptible to JE virus than postsynaptic striatal neurons. The degree of movement impairment was more closely correlated to the degree of D2Rs disruption seen in (123)I-IBZM SPECT imaging.

Midodrine improves chronic hypotension in hemodialysis patients.

BACKGROUND: The effects of midodrine on chronic hypotension in hemodialysis (HD) patients have not been well investigated. METHODS: We evaluated midodrine's effect on autonomic function and hemodynamics in 12 HD patients who had chronic systolic blood pressure less than 100 mm Hg. Midodrine (5.0 mg) twice a day was given for 4 weeks. Another 12 age- and sex-matched HD patients with normotension were selected as a control group. Autonomic function tests included the heart-rate responses to the Valsalva maneuver and 30:15 ratio as well as supine and standing blood pressure (BP) and sustained hand-grip test. Hemodynamic changes included 24-hour blood pressure, cardiac output, total peripheral resistance (TPR), and plasma renin and aldosterone concentrations. RESULTS: Compared with the control subjects, HD patients with chronic hypotension had more severe autonomic dysfunction and significantly lower TPR. After 4 weeks of midodrine therapy, sympathetic function (orthostatic and hand-grip tests) improved in conjunction with significant increases in mean arterial pressure (MAP) (79.5 +/- 4.9 to 85.0 +/- 5.1 mm Hg, P < 0.05) and TPR (768 +/- 37 versus 1097 +/- 72 dyne/sec/cm-5, P < 0.01) despite no significant change in Valsalva ratio, 30:15 ratio, and cardiac output. MAP changes were positively correlated with TPR changes (r = 0.82, P < 0.001). Supine plasma renin activity was significantly increased. In addition, MAP during HD was also significantly increased during midodrine therapy. CONCLUSIONS: Midodrine improves chronic hypotension in HD patients by modulating autonomic function and its direct effects on peripheral vessels.