Convergent Validity of Three Pressure Injury Risk Assessment Scales: Comparing the PPRA-Home (Pressure Injury Primary Risk Assessment Scale for Home Care) to Two Traditional Scales.

PURPOSE: The Pressure Injury Primary Risk Assessment Scale for Home Care (PPRA-Home) was developed to predict pressure injury risk in geriatric individuals requiring long-term care in home settings. This study aimed to compare the convergent validity of the PPRA-Home to that of the two other standardized pressure injury prevention scales: the Braden and Ohura-Hotta (OH) scales. METHODS: A multicenter, cross-sectional study was conducted with 34 home-based geriatric support service providers located in five Japanese districts. The study included 69 participants (30 had a pressure injury and 39 did not) who were at classified at care levels of 1 through 5 under Japan's long-term care insurance system. Care managers served as assessors for the PPRA-Home, while physicians or certified expert nurses served as assessors for the Braden and OH scales. Convergent validity was investigated by examining correlation coefficients between total scores on the PPRA-Home and the other two scales. Receiver operating curve analysis was used to quantify each scale's accuracy for the two groups: those with and without a pressure injury. RESULTS: The PPRA-Home was found to be negatively correlated with the Braden scale (r=-0.79, p<0.05), and positively correlated with the OH scale (r=0.58, p<0.05). The area under the curve (AUC) for the PPRA-Home, Braden scale, and OH scale were 0.737, 0.814, and 0.794, respectively. A PPRA-Home cutoff score of 4 had a sensitivity of 63.3% and specificity of 81.6%. CONCLUSION: The AUC for the PPRA-Home as scored by care managers was similar to those of the Braden and OH scales as scored by physicians or expert nurses. More research on the PPRA-Home's content and predictive validity is required.

Tailored feedback reduced prolonged sitting time and improved the health of housewives: a single-blind randomized controlled pilot study.

Reducing sitting time, independent of physical activity, is important for health. However, few reports have been published regarding physical activity of housewives compared to that of employed women. We examined strategies to shorten housewives' sitting time using a single-blind randomized controlled trial. Forty-eight housewives (38.0 ± 4.5 years old) were randomly assigned to one of three groups: pamphlet, self-feedback, and tailored feedback groups. All participants received a pamphlet describing the risks of prolonged sitting. The self-feedback and tailored feedback groups were also given feedback on sitting time by a smartphone application. The tailored feedback group received individual suggestions regarding lifestyle to shorten sitting time. We measured physical activity using an accelerometer and health-related quality of life using the Short-Form 8. The longest prolonged sitting time significantly decreased over time, a significant reduction was observed after the intervention only in the tailored feedback group. Vitality, mental health, and role emotional components of health-related quality of life showed a significant improvement with time but no significant differences were observed among the study groups. We suggested an easy approach to shortening prolonged sitting time in housewives using a pamphlet and feedback by smartphone. However, tailored consulting was necessary to yield a more effective result.

Custom-Made Daily Routine Increases the Number of Steps Taken by Frail Older Adults.

This study examined whether the number of steps taken by frail older adults increased after two types of interventions (custom-made daily routine [CDR] vs. exercise) were conducted over 12 weeks. The participants were 36 frail older adults aged 84.5 ± 6.0 years who attended a day-care center. They were assigned to one of three groups: CDR (n = 13), home-based exercise (HE, n = 10), or control (CON, n = 13). A wrist-worn accelerometer was used to measure their step count in 24 hr for 6 days. The CDR group demonstrated a daily step count change of approximately 25%, which was significantly higher than that of the CON group (effect size [r] = .51, p = .040). There were no significant changes in the HE group. Thus, a CDR might be useful for increasing the number of steps in frail older adults.

Instrumental activities of daily living and number of daily steps in frail older females.

[Purpose] Reportedly, males take fewer steps than females among frail older adults. The step count of frail older adults may be influenced by domestic roles in the instrumental activities of daily living. In this study, we aimed to investigate the association between instrumental activities of daily living and the number of steps in frail older females. [Participants and Methods] In this cross-sectional study, we included 27 frail older females aged 84.4 ± 6.5 years who attended a day-care center. We used the Fillenbaum's instrumental activities of daily living screener and measured the number of steps using an accelerometer, functional independence measure, grip strength, and short physical performance battery. We investigated the association between instrumental activities of daily living and daily steps. Furthermore, we compared the outcomes of the differences in the independence using a subscale of instrumental activities of daily living. [Results] Instrumental activities of daily living and step counts showed a significant correlation. Participants dependent on meal preparation and housework took significantly fewer steps per day. The dependence of their activities also caused low functional independence measure and weak grip strength. [Conclusion] In frail older females, decreased ability for instrumental activities of daily living were associated with fewer steps. Domestic roles may increase the daily steps in frail older adults.

Tailored education program using home floor plans for falls prevention in discharged older patients: A pilot randomized controlled trial.

OBJECTIVE: To investigate the effect of a tailored education program using home floor plans on falls prevention in discharged older patients. DESIGN: A single-center, parallel, pragmatic, pilot randomized controlled trial with equal allocation to the intervention and control groups. SETTING: Discharged hospital patients were followed-up in their home settings. PARTICIPANTS: All discharged orthopedic patients aged ≥65 years who experienced ≥1 fall(s) in the past year (n=60). INTERVENTIONS: Both groups received standard care (exercises) and the intervention group also received a tailored education program for falls prevention using home floor plans. MEASUREMENTS: Falls and near-falls at the participants' homes using a 1-month fall calendar during the 1-month period after discharge. The evaluators were blinded at the baseline assessment. RESULTS: Nine participants were withdrawn from the study, leaving 51 of 60 (85%) participants for the final analyses. No falls occurred in the intervention group (n=25) during follow-up. However, 2 participants (7.7%) fell in the control group (n=26). Near-falls were reported by 7 participants (28.0%) in the intervention group and 13 participants (50.0%) in the control group. The intervention group had 75% less near-falls compared with the control group, as assessed using a Cox proportional hazards model (hazard ratio, 0.25; 95% confidence interval, 0.09-0.75). CONCLUSIONS: The tailored education program using home floor plans at the hospital was effective for reducing falls and near-falls among discharged orthopedic patients. Registration of clinical trials: This study was registered with the Research Ethics Committee of University Hospital Medical Information Network (UMIN) Center (000018201).

Dual-tasking over an extended walking distance is associated with falls among community-dwelling older adults.

AIM: Dual-task methods, in which walking is the primary task, are not sufficient for accurately screening for the risk of falls among healthy older adults. Therefore, the goal of this research was to investigate whether using a dual-task method over an extended walking distance can predict falls among community-dwelling older adults. METHODS: We enrolled independent community-dwelling adults aged ≥65 years. Physical performance, cognitive function, psychological function, and a dual-task test were assessed at baseline. Our dual-task test required the subjects to walk 60 m while stepping over lines. The intervals between the lines ranged from 50-100 cm and were unequal. Falls and fall-related injuries were measured over a 12-month follow-up period using monthly postal surveys. RESULTS: Ninety-two of 118 subjects (mean age, 75.4±5.5 years) completed the 12-month follow-up. Sixteen (17.4%) of fallers had injurious falls or fell more than or equal to two times. There were no significant differences between the fallers and non-fallers, except in age and in the number of missteps during the dual-task test when walking ≥40 m. The Kaplan-Meier analysis revealed that those who had more than one misstep while walking ≥40 m had a significantly higher incidence of injurious or multiple falls than those who had no missteps. CONCLUSION: Our findings suggest that the dual-task method with an extended walking distance may be able to predict falls among community-dwelling older adults.

Effect of Posture during Trumpet and Marching Euphonium Performance on the Trunk and Lower Limb Musculoskeletal System.

[Purpose] The purpose of the present study was to investigate the effect of trumpet and marching euphonium performance posture on the trunk and lower limb musculoskeletal system. [Subjects] The subjects were 10 female university students. [Methods] Subjects maintained a resting position, a trumpet performance posture, and a marching euphonium performance posture. The angles and muscle activities of the trunk and lower limbs were then measured. [Results] The anterior tilt angle of the trunk decreased significantly in the trumpet and marching euphonium performance postures compared with the resting standing position, as well as in the marching euphonium performance posture compared with the trumpet performance posture. The muscle activity of the cervical paraspinal muscles, upper fibers of the trapezius, and lumbar paraspinal muscles increased significantly in the marching euphonium performance posture compared with the resting standing position, as well as in the marching euphonium performance posture compared with the trumpet performance posture. [Conclusion] The results suggest that the performance position for trumpet and the marching euphonium performance increases the load on the cervical and thoracic musculoskeletal system, which increases with greater instrument weight. However, the same instrument performance postures had no affect on the musculoskeletal system of the lower limbs.

Protective effects of branched-chain amino acids on hepatic ischemia-reperfusion-induced liver injury in rats: a direct attenuation of Kupffer cell activation.

We determined whether there is a protective effect of branched-chain amino acid (BCAA) on hepatic ischemia-reperfusion (I/R)-induced acute liver injury. Wister rats were divided into the following four groups: simple laparotomy with vehicle; simple laparotomy with BCAA (1 g/kg body wt orally); I/R (30 min clamp) with vehicle; and I/R with BCAA. Serum liver function tests and the gene expression of adhesion molecules (intercellular adhesion molecule and vascular cell adhesion molecule) and vasoconstrictor-related genes (endothelin-1) in the liver were examined. In the in vivo study, portal venous pressure, leukocyte adhesion, and hepatic microcirculation were evaluated. Furthermore, Kupffer cells were isolated and cultured with various concentrations of BCAA in the presence or absence of lipopolysaccharide (LPS). Increased levels of liver function tests following I/R were significantly attenuated by BCAA treatment. The increased expression of adhesion molecules and endothelin-1 was also significantly attenuated by BCAA treatment. Moreover, increased portal venous pressure, enhanced leukocyte adhesion, and deteriorated hepatic microcirculation following I/R were all improved by BCAA treatment. In the experiment using isolated Kupffer cells, the expression of interleukin-6, interleukin-1ß, and endothelin-1 in response to LPS stimulation was attenuated by BCAA in a dose-dependent fashion. These results indicate that perioperative oral administration of BCAA has excellent therapeutic potential to reduce I/R-induced liver injury. These beneficial effects may result from the direct attenuation of Kupffer cell activation under stressful conditions.

Carnosic acid, a pro-electrophilic compound, inhibits LPS-induced activation of microglia.

In the previous studies, we reported that carnosic acid (CA) protects cortical neurons by activating the Keap1/Nrf2 pathway, which activation is initiated by S-alkylation of the critical cysteine thiol of the Keap1 protein by the "electrophilic"quinone-type CA. Here, we found that the pro-electrophilic CA inhibited the in vitro lipopolysaccharide (LPS)-induced activation of cells of the mouse microglial cell line MG6. LPS induced the expression of IL-1ß and IL-6, typical inflammatory cytokines released from microglial cells. CA inhibited the NO production associated with a decrease in the level of inducible NO synthase. Neither CA nor LPS affected cell survival at the concentrations used here. These actions of CA seemed to be mediated by induction of phase 2 genes (gclc, gclm, nqo1 and xct). We propose that an inducer of phase 2 genes may be a critical regulator of microglial activation. Thus, CA is a unique pro-electrophilic compound that provides both a protective effect on neurons and an anti-inflammatory one on microglia through induction of phase 2 genes.

Phenylenediamine derivatives induce GDF-15/MIC-1 and inhibit adipocyte differentiation of mouse 3T3-L1 cells.

Phenylenediamine derivatives can function as a hydrogen donor and reportedly exert various biological actions including cytoprotective effects against oxidative stress, possibly by acting as an antioxidant. Previous studies showed that feeding of such compounds to mice reduced their body weight, but the precise mechanism remains unknown at present. Here, we found that these compounds inhibited the in vitro differentiation of mouse preadipocytes, 3T3-L1 cells, into adipocytes, suggesting that, at least in part, reduced generation of adipocytes might contribute to the observed weight loss in mice. Next, we performed array analysis and found that the expression of GDF-15/MIC-1, which is a TGFß superfamily cytokine, and Trib 3, an intracellular downstream effector of the cytokines, was up-regulated by these derivatives. Thus, we identified the compounds as inducers of GDF-15/MIC-1 and suggest that such induction may have led to inhibition of adipocyte differentiation, which could account for the weight-loss effect of these compounds.

Dual neuroprotective pathways of a pro-electrophilic compound via HSF-1-activated heat-shock proteins and Nrf2-activated phase 2 antioxidant response enzymes.

Activation of the Keap1/nuclear factor erythroid 2-related factor 2 (Nrf2) pathway and consequent induction of phase 2 antioxidant enzymes is known to afford neuroprotection. Here, we present a series of novel electrophilic compounds that protect neurons via this pathway. Natural products, such as carnosic acid (CA), are present in high amounts in the herbs rosemary and sage as ortho-dihydroquinones, and have attracted particular attention because they are converted by oxidative stress to their active form (ortho-quinone species) that stimulate the Keap1/Nrf2 transcriptional pathway. Once activated, this pathway leads to the production of a series of antioxidant phase 2 enzymes. Thus, such dihydroquinones function as redox-activated 'pro-electrophiles'. Here, we explored the concept that related para-dihydroquinones represent even more effective bioactive pro-electrophiles for the induction of phase 2 enzymes without producing toxic side effects. We synthesized several novel para-hydroquinone-type pro-electrophilic compounds (designated D1 and D2) to analyze their protective mechanism. DNA microarray, PCR, and western blot analyses showed that compound D1 induced expression of heat-shock proteins (HSPs), including HSP70, HSP27, and DnaJ, in addition to phase 2 enzymes such as hemeoxygenase-1 (HO-1), NADP(H) quinine-oxidoreductase1, and the Na(+)-independent cystine/glutamate exchanger (xCT). Treatment with D1 resulted in activation of Nrf2 and heat-shock transcription factor-1 (HSF-1) transcriptional elements, thus inducing phase 2 enzymes and HSPs, respectively. In this manner, D1 protected neuronal cells from both oxidative and endoplasmic reticulum (ER)-related stress. Additionally, D1 suppressed induction of 78 kDa glucose-regulated protein (GRP78), an ER chaperone protein, and inhibited hyperoxidation of peroxiredoxin 2 (PRX2), a molecule that is in its reduced state can protect from oxidative stress. These results suggest that D1 is a novel pro-electrophilic compound that activates both the Nrf2 and HSF-1 pathways, and may thus offer protection from oxidative and ER stress.

Segmental cholangitis impairs hepatic regeneration capacity after partial hepatectomy in rats.

BACKGROUND: Patients with hilar cholangiocarcinoma or hepatolithiasis often develop segmental cholangitis (SC), but it is unclear whether hepatectomy for patients with SC can be performed safely. METHODS: Rats were subjected to segmental bile duct ligation (SBDL) with LPS (SC group) or a saline (Sham group) infusion into the bile duct of the ligated lobes. The rats were sacrificed at 3, 24 and 48 h after the SBDL. For another experiment, the rats were subjected to partial hepatectomy (PHx) for the ligated lobes. Hepatic regeneration rates and the expression of regeneration-associated genes were evaluated. RESULTS: In the SC group, severe parenchymal damage was observed in the acute phase (3 h). Altered gene expression in the liver in response to biliary infection occurred not only in the infected lobes but also in the non-infected lobes. In the rats of the SC group, both the hepatic regeneration rate and serum HGF levels were significantly lower than in the Sham group. CONCLUSION: These results clearly demonstrate that SC impairs the regeneration capacity of the contralateral remnant liver. Therefore, hepatectomy should be avoided for patients with SC even if it occurs in the part of the liver to be resected.

Inchinkoto, an herbal medicine, exerts beneficial effects in the rat liver under stress with hepatic ischemia-reperfusion and subsequent hepatectomy.

OBJECTIVE: To investigate the beneficial effects of inchinkoto (ICKT) in the liver after 70% hepatectomy following ischemia reperfusion. METHODS: Wistar rats were divided into 3 groups: simple laparotomy and 70% hepatectomy (Hx), 70% hepatectomy following ischemia reperfusion (IR) with vehicle (IRHxV), 70% hepatectomy following IR with ICKT (1 or 2 g/kg of body weight; IRHxK). Vehicle or ICKT was administered for 3 days preoperatively. The hepatoduodenal ligament was clamped for 15 minutes before hepatectomy in the IRHx groups. Rats were killed 1 hours after hepatectomy. In other experiments, the hepatoduodenal ligament was clamped for 30 minutes, with or without ICKT treatment, to evaluate the effect of ICKT on IR injury-induced mortality. Serum transaminase levels and the gene expression of inflammatory cytokines and inducible nitric oxide synthase in the remnant liver were determined. Furthermore, the expression of antioxidant genes was evaluated by PCR array. RESULTS: The elevation of serum transaminase levels, the upregulation of genes for inflammatory cytokines and inducible nitric oxide synthase, and the increased formation of nitrotyrosine observed in the remnant livers of the IRHxV group were all significantly attenuated by preoperative administration of ICKT in the IRHxK group. The expression of antioxidant genes was also higher in the IRHxK group compared with that of the IRHxV group. Moreover, administration of ICKT significantly reduced the mortality induced by IRHx after 30-minute ischemia. CONCLUSIONS: Preoperative administration of ICKT provides beneficial effects through attenuating inflammatory responses and oxidative stress in the liver following IR and subsequent hepatectomy.

15-deoxy-delta 12,14-prostaglandin J2 prevents inflammatory response and endothelial cell damage in rats with acute obstructive cholangitis.

Acute obstructive cholangitis is a common disease with a high mortality rate. Ligands for peroxisome proliferator-activated receptor-gamma (PPARgamma), such as 15-deoxy-Delta(12,14)-prostaglandin J(2) (15D-PGJ(2)), have been proposed as a new class of anti-inflammatory compounds. This study investigated the effect of 15D-PGJ(2) treatment on lipopolysaccharide (LPS)-induced acute obstructive cholangitis. The rats were randomly assigned to five groups: sham operation (Sham; simple laparotomy), sham operation with intraperitoneal saline infusion (Sham+Saline), sham operation with intraperitoneal LPS infusion (Sham+LPS), bile duct ligation (BDL) with saline infusion into the bile duct (BDL+Saline), and BDL with LPS infusion into the bile duct (BDL+LPS). Biochemical assays of blood samples, histology of the liver, portal venous pressure, hyaluronic acid clearance, and expression of inflammation-associated genes in the liver were evaluated. Furthermore, the Sham+LPS and the BDL+LPS group were divided into two groups (with and without 15D-PGJ(2) treatment), and their survival rates were compared. Biochemical assays of blood samples, portal venous pressure, hyaluronic acid clearance, and expression of inflammation-associated genes in the liver were all significantly higher in the BDL+LPS group compared with those in the BDL+Saline group, indicating the presence of increased liver damage in the first group. However, preoperative administration of 15D-PGJ(2) significantly improved these outcomes. Furthermore, the survival rate after establishment of cholangitis was significantly improved by the administration of 15D-PGJ(2) in the BDL+LPS group. These results clearly demonstrate that 15D-PGJ(2) inhibits the inflammatory response and endothelial cell damage seen in acute obstructive cholangitis and could contribute to improve the outcome of this pathology.

Estrogen promotes hepatic regeneration via activating serotonin signal.

The aim of this study was to determine if estrogen plays any role in the process of hepatic regeneration of nonligated lobe after portal vein branch ligation (PBL). We also investigated whether estrogen has any association with serotonin action during liver regeneration. Ovariectomized female rats with (E group) or without (non-E group) estrogen pellet were subjected to PBL on the left and middle lobes. Thereafter, the rats were killed, and blood, liver, and small intestine were sampled and analyzed. Sham animals underwent only ovariectomy and laparotomy. The E group showed a significantly greater regeneration rate than the non-E group at days 1, 2, and 7 after PBL. The activation of hepatic regeneration-related genes (such as IL-6, TNF-alpha, hepatic growth factor, c-fos, and c-myc) was also significantly higher in the E group as compared with the non-E group. Gene expression of serotonin receptor (5-HT2A) in the liver and tryptophan hydroxylase 1 in the small intestine were also up-regulated in the E group, indicating an activation of serotonin system in the E group. Additionally, total intestinal flow, portal venous flow, and hepatic arterial flow determined by fluorescent microsphere were significantly higher in the E group compared with the non-E group. Moreover, serotonin receptor antagonist (ketanserin) significantly attenuated liver regeneration rate in the E group. These results indicated that estrogen plays an important role in the process of liver regeneration after PBL. Our results also indicated that estrogen is at least partly related to the activation of serotonin system, which is also important in the process of liver regeneration.

Up-regulated thromboxane production in the rat liver with biliary obstruction does not contribute to promote hepatic injury.

This study sought to determine whether in vivo inhibition of thromboxane A2 (TXA2) action contribute to attenuate hepatic damage after bile duct ligation (BDL). Male Wistar rats were assigned to sham operation or BDL. At the time of operation, infusion pump with saline, ozagrel natrium (TXA2 synthase inhibitor), or SQ29548 (TXA2 receptor antagonists) was implanted in the abdominal cavity. Plasma alanine aminotransferase, aspartate aminotransferase, hyaluronic acid, and total bilirubin levels were measured at 4 days after the operation. The levels of plasma TXB2, a stable metabolite of TXA2, were significantly increased after BDL. Gene expression of TXA2 synthase was also significantly upregulated in the liver. Nonetheless, either an inhibition of TXA2 synthesis by ozagrel natrium or a blockade of TXA2 receptor by SQ29548 has no effect in every measured parameter related to hepatic function. These results indicated that despite a highly increased production in the liver, TXA2 is not directly related to the hepatic injury in BDL rats.

Is there any effect of renal failure on the hepatic regeneration capacity following partial hepatectomy in rats?

The effects of renal dysfunction on liver regeneration capacity have not been fully elucidated before, although many patients with renal failure are subjected to hepatectomy due to hepatobiliary diseases. In this study, we sought to determine the effects of renal dysfunction on the hepatic regeneration capacity using rat chronic renal failure model. After establishing chronic renal failure (CRF group) by semi-total renal resection, the rats were subjected to 70% partial hepatectomy (PHx). Rats without renal failure were used as control (Sham group). The hepatic regeneration rate, histology of the liver, clearance of indocyanine green into the bile, and the expression of hepatic regeneration-associated genes in the liver were evaluated. The hepatic regeneration rate was lower in CRF group as compared to Sham group on day 1 after PHx. Mitotic index evaluated by histologic examination on day 1 after PHx was also significantly lower in CRF group. However, no difference in these indices was observed on day 2 and 7 between Sham and CRF. Indocyanine green clearance rate was almost identical between Sham and CRF on day 7 following PHx. The baseline expressions of the hepatic regeneration-associated genes, such as IL-6, TNF-alpha, HGF, c-fos, and c-jun, in the liver of CRF were significantly lower than those of Sham. However, the rate of upregulation of these genes was not significantly different between Sham and CRF. These results clearly demonstrate that the renal dysfunction, although initially delays the onset, does not suppress the total hepatic regeneration capacity following partial hepatectomy. The function of the regenerated liver on day 7 after PHx also was not different. Our results provide a possibility that the hepatectomy can be indicated even for the patient with a chronic renal failure.