The phosphatidyl inositol 3 kinase pathway does not suppress activation of the ARF and BIM genes by deregulated E2F1 activity.

The transcription factor E2F plays crucial roles in tumor suppression by activating pro-apoptotic genes such as the tumor suppressor ARF. The regulation of the ARF gene is distinct from that of growth-related E2F targets, in that it is specifically activated by deregulated E2F activity, induced by over-expression of E2F or forced inactivation of pRB, but not by physiological E2F activity induced by growth stimulation. The phosphatidyl inositol 3 kinase (PI3K) pathway was reported to suppress expression of some atypical pro-apoptotic genes by over-expressed E2F1. However, the effects of the PI3K pathway on the distinct regulation of typical pro-apoptotic E2F targets have not been elucidated. We examined whether the PI3K pathway suppressed activation of the typical pro-apoptotic E2F targets ARF and BIM. Activation of the PI3K pathway by growth stimulation or introduction of a constitutively active Akt/PKB did not reduce induction of ARF or BIM gene expression or activation of their promoters by over-expressed E2F1. These results suggest that the PI3K pathway does not suppress induction of typical pro-apoptotic genes that are selectively activated by deregulated E2F1.

Identification of novel target genes specifically activated by deregulated E2F in human normal fibroblasts.

The transcription factor E2F is the principal target of the tumor suppressor pRB. E2F plays crucial roles not only in cell proliferation by activating growth-related genes but also in tumor suppression by activating pro-apoptotic and growth-suppressive genes. We previously reported that, in human normal fibroblasts, the tumor suppressor genes ARF, p27(Kip1) and TAp73 are activated by deregulated E2F activity induced by forced inactivation of pRB, but not by physiological E2F activity induced by growth stimulation. In contrast, growth-related E2F targets are activated by both E2F activities, underscoring the roles of deregulated E2F in tumor suppression in the context of dysfunctional pRB. In this study, to further understand the roles of deregulated E2F, we explored new targets that are specifically activated by deregulated E2F using DNA microarray. The analysis identified nine novel targets (BIM, RASSF1, PPP1R13B, JMY, MOAP1, RBM38, ABTB1, RBBP4 and RBBP7), many of which are involved in the p53 and RB tumor suppressor pathways. Among these genes, the BIM gene was shown to be activated via atypical E2F-responsive promoter elements and to contribute to E2F1-mediated apoptosis. Our results underscore crucial roles of deregulated E2F in growth suppression to counteract loss of pRB function.

[Evaluation of the association between cognitive impairment and the vitamin D levels among community-dwelling Japanese pre-frail elderly individuals].

AIM: Cognitive impairment is the second leading cause of long-term care, and the number of cognitively impaired elderly individuals is increasing. Cognitive impairment has been reported to be associated with a low vitamin D level. However, many elderly individuals are deficient in vitamin D due to undernutrition and a house-bound status. It is unknown whether cognitive impairment is independently associated with the vitamin D level. The aim of this study was to examine the association between cognitive impairment and the levels of vitamin D among community-dwelling Japanese pre-frail elderly individuals. METHODS: A cross-sectional survey was conducted in two towns (latitude: 36 degrees north) from June 2006 to January 2011. The subjects included 316 community-dwelling pre-frail elderly individuals 65 years of age or older (mean±SD: 77.0±5.7 yr) who attended a program for nursing care prevention. A questionnaire-based interview was conducted regarding activities of daily living. The serum levels of intact parathyroid hormone (iPTH), 25-hydroxyvitamin D (25(OH)D) and 1,25-dihydroxyvitamin D (1,25(OH)2D) were measured. Age and gender were recorded, as well as the presence of cognitive impairment determined according to the Mini Mental State Examination (MMSE). The factors associated with an MMSE score of ≤23 were examined using a multiple logistic regression analysis. RESULTS: Of the subjects, 21.2% were men and 30.6% had an MMSE score of ≤23. The mean MMSE score was 25.3±3.7. The prevalence of severe deficiency of 25(OH)D was 1.7%, and only 14.0% of the participants had a sufficient vitamin D level. The multiple logistic regression analysis suggested that an MMSE score of less than 23 was significantly associated with the levels of iPTH and 25(OH)D among the pre-frail men, but not the women. CONCLUSIONS: Our data suggest that the vitamin D level is significantly associated with cognitive impairment in pre-frail elderly men.

Effects of gait rehabilitation with a footpad-type locomotion interface in patients with chronic post-stroke hemiparesis: a pilot study.

OBJECTIVE: We developed a footpad-type locomotion interface called the GaitMaster. The purpose of this pilot study was to examine the effects of gait rehabilitation using the GaitMaster in chronic stroke patients. DESIGN: Randomized cross-over design. SETTING: An outpatient department. SUBJECTS: Twelve patients with chronic post-stroke hemiparesis. INTERVENTION: In group A, patients underwent an 'intervention phase' followed by a 'non-intervention phase', whereas in group B, patients underwent the non-intervention phase first, followed by the intervention phase. In the four- or six-week intervention phase, participants underwent twelve 20-minute sessions of gait rehabilitation using the GaitMaster4. MAIN OUTCOME MEASURES: We measured gait speed and timed up-and-go test. RESULTS: No differences between the two groups were observed in the baseline clinical data. For the combined groups A and B, the maximum gait and timed up-and-go test speeds improved significantly only in the intervention phase (P = 0.0001 and P = 0.003, respectively). The percentages of improvement from baseline at the end of GaitMaster training were 16.6% for the maximum gait speed and 8.3% for the timed up-and-go test. The effect size for GaitMaster4 training was 0.58 on the maximum gait speed and 0.43 on the timed up-and-go test. CONCLUSIONS: This pilot study showed that gait rehabilitation using the GaitMaster4 was a feasible training method for chronic stroke patients. Calculation of the sample size indicated that a sample size of 38 participants would be adequate to test a null hypothesis of nil benefit additional to routine rehabilitation for chronic stroke patients in a future randomized controlled trial.

[Intervention effects of inclusive support in an "exercise and a nutritional community-based prevention program" for pre-frail elderly individuals].

OBJECTIVES: The purpose of this study was to examine intervention effects of a community-based prevention program for pre-frail elderly individuals by comparing an intervention group (exercise with nutritional care) with a control group (exercise without nutritional care). METHODS: The study was conducted in Y town and S city in Ibaraki Prefecture in Japan. The subjects comprised 161 pre-frail elderly individuals in the community-based prevention program, who were divided into two groups, the intervention group (N = 81, Y town, mean age : 76.2 +/- 5.7 years), and the control group (N = 81, S city, mean age 76.2 +/- 4.7 years). The items surveyed included age, gender, activities of daily living, functional capacity, and dietary variety score (DVS). Functional fitness measurement items (grip strength, alternate step, 5-repetition sit-to-stand, one-leg balance with eyes open, tandem stance, functional reach (FR), sit and reach, 5-m habitual walk, and timed up and go (TUG)) and blood data were assessed at the beginning and end of the intervention. RESULTS: The DVS of the intervention group was significantly improved compared to that of the control group (P < 0.01). In particular, the food frequencies of fish and shellfish, meat, eggs, milk, fruits, and fat and oil (P < 0.01) were significantly increased in the intervention group, as were those of soybean products, seaweed, and potatoes (P < 0.05). On the other hand, significant increases were seen only in the frequencies of fish and shellfish, meat, and milk in the control group. The intervention group showed significant improvement in five-repetition sit-to-stand, tandem stance, FR, sit and reach, and TUG by the end of the intervention. In addition, the intervention group's performance on one-leg balance with eyes open (P < 0.05) was significantly improved even after adjusting for age, gender, and the functional fitness measurement items which were different at the beginning of the study. CONCLUSION: This study suggests that a combined exercise and nutrition program for pre-frail elderly individuals improves their food intake and functional fitness.

[Examination of effects of alfacalcidol vitamin D supplement and renal function on improvement in the physical fitness of pre-frail elderly persons attending a nursing care prevention class].

AIM: A characteristic condition of pre-frail elderly people is decreased mobility, which is associated with vitamin D levels and renal function. The aim of this study was to examine the association between physical fitness improvement and vitamin D levels, vitamin D supplements, and renal function in pre-frail elderly people. METHODS: We conducted a longitudinal study in 2 towns from June 2006 to December 2009. Subjects consisted of 177 community-dwelling pre-frail elderly people aged 65 years and over (mean±standard deviation [SD]: 76.4±5.5 yrs) who attended a nursing care prevention program for 3 months. An interview was conducted based on a questionnaire. Serum levels of intact parathyroid hormone (iPTH), 25-hydroxyvitamin D(25(OH)D), 1,25-dihydroxyvitamin D (1,25(OH)(2)D), creatinine, and calcium were measured. eGFR (ml/min/1.73 m(2)) was calculated using a new formula. Alfacalcidol 1 µg/day was administered to subjects for 3 months, and we assumed that the elderly who took vitamin D (VD) of more than 80% of the recommended daily allowance to be the VD group. Walking ability, balance, and muscle strength physical fitness tests were performed. RESULTS: The prevalence of eGFR <60.0 ml/min/1.73 m(2) was about 24.3%, and that of 25(OH)D <75 nmol/L was 86.4%. Pre-eGFR level and vitamin D supplementation with FR, pre-eGFR and pre 25(OH)D ≥45 nmol/L were associated with improvement in the timed up and go (TUG) test, pre-25(OH)D level (<50 nmol/L, ≥50 nmol/L) was associated with the tandem stance test, pre 25(OH)D level (<67.5 nmol/L, ≥67.5 nmol/L) was associated with the alternate step and 5 chair sit-to-stands tests, and post 1,25(OH)(2)D (<44 pg/ml, ≥44 pg/ml) was associated with the tandem walk tests. CONCLUSIONS: These results suggest that the assessment of renal function and maintenance of appropriate vitamin D levels are important for the independent living of pre-frail elderly people. Ideally, a 25(OH)D level greater than 67.5 nmol/L is preferable.

[Factors affecting burden of caregivers for the elderly of Han Chinese and the Korean minority living in a community in northeast China].

UNLABELLED: Objective In the People's Republic of China (China), caregivers carry a large burden because of the rapid aging of the population, the one-child policy and the uncertainty of the social security system. The situation is further complicated by the fact of 56 ethnic groups in the country. Few studies on caregiver burden in different ethnic groups have been reported, although different customs, cultures and methods of caring for the elderly do certainly exist. The aim of the present study was to compare the caregiver burden for the elderly among Han Chinese and the Korean Minority living in a community and to examine the factors affecting this burden. METHODS: An investigation was conducted using a questionnaire for 76 pairs of elderly people and their caregivers in Yanji City, China (Korean Minority pairs 52, Han pairs 24). The questionnaires for the elderly included their characteristics, economic conditions, ADL, behavioral disturbances associated with dementia, etc. For the caregivers, their characteristics, the state of their health, daily length of care time, social support, intent to continue home care, and Zarit Caregiver Burden Interview (ZBI) score were investigated. RESULTS: The rate (70.8%) of caregivers with a "high caregiver burden," i.e., those with a median ZBI total score of 33 or more, and the personal strain scores of the Han Chinese were significantly higher than in the Korean Minority. As for who was a suitable caregiver, a high percentage of Han caregivers answered the "children" of the elderly, while Korean Minority caregivers answered the "spouses". When the caregiver was a child of the elderly receiving care, the Hans' ZBI score was higher than that for the Korean Minority. Factors most affecting caregiver burden in the Korean Minority were behavioral disturbances associated with dementia of the elderly, ADL, and degree of life independence of the elderly, along with disorders, sex and health state of the caregivers, relations, length of daily care time, number of vice-caregivers, and social support. Factors affecting caregiver burden in the Han group were the presence of private rooms for the elderly, their life satisfaction and family economic conditions. About 80% of caregivers of both groups had the intention to continue home care, and about 50% of the elderly of both groups answered that entering an institution was not acceptable. CONCLUSION: Factors affecting caregiver burden differ between these two ethnic groups, although in both cases about 80% of caregivers intend to continue home care. Therefore, it is necessary to support the elderly and caregivers in ways that suit their ethnic characteristics.

Alternative items for identifying hierarchical levels of physical disability by using physical performance tests in women aged 75 years and older.

AIM: To identify individuals at hierarchical levels of physical disability by using physical performance tests and to determine threshold values for the discriminating of levels of physical disability in women aged 75 years or older. METHODS: A cross-sectional observational study was conducted on 306 community-dwelling women aged 75 years or order (range, 75-99 years). Physical disability was categorized into no disability, mobility disability and activities of daily living (ADL) disability, by evaluating selected ADL and mobility-related functional tasks. Physical function tests comprised nine items (such as strength, balance, mobility and walking ability). To assess the observed threshold values, receiver-operator curves were prepared for all the scales. RESULTS: The results revealed significant differences among all the pairwise group comparisons in all the performance tests, except in the one-legged stance, tandem stance and tandem walk tests. The individuals with ADL disability were unable to perform the one-legged stance (28.9%), tandem stance (32.5%), functional reach (19.3%), tandem walk (61.4%), alternate step (53.0%) and 5-chair sit-to-stand (31.3%) tests. The observed thresholds for discriminating between the no disability and mobility disability groups and between the mobility disability and ADL disability groups were as follows: timed Up & Go test, 8.5 s and 12.7 s; usual gait speed, 1.05 m/s and 0.79 m/s; and grip strength, 19.5 kg and 16.3 kg, respectively. CONCLUSION: Tests for balance and lower extremity strength can be used together to identify or monitor the characteristics of the hierarchical levels of physical disability in women aged 75 years or older.

Effects of serum 25-hydroxyvitamin D(3) levels on physical fitness in community-dwelling frail women.

The aim of this study was to evaluate the effects of a combination of serum 25-hydroxyvitamin D(3) (25(OH)D(3)) levels and exercise on physical fitness in community-dwelling frail elderly in Japan. A longitudinal survey was conducted in a town (latitude 36 degrees north). Eighty women aged 65 years and over attended a 3-month exercise class. A face-to-face interview was conducted based on a questionnaire. The serum levels of 25(OH)D(3), intact parathyroid hormone (iPTH), were measured. Nine physical fitness tests were performed at baseline and at the end of a 3-month follow-up period. Among 80 subjects, 56.3% experienced falls, and 71.3% experienced stumbling more than once during the past year. The prevalence of 25(OH)D(3)<50 nmol/l or 25(OH)D(3)<75 nmol/l was 27.5% and 88.8%, respectively. Significantly greater improvements in alternate step, functional reach (FR), "timed up & go" (TUG), and 5-m walk, and superior functional capacity for the subjects with 25(OH)D(3) levels greater than 67.5 nmol/l (highest quartile) was observed at the end of the class. In contrast, the subjects with 25(OH)D(3) levels <47.5 nmol/l (lowest quartile) did not improve their physical fitness. A serum 25(OH)D(3) level of greater than 47.5 nmol/l may therefore be necessary to maintain walking ability and balance. Greater than 67.5 nmol/l appears to be preferable for lower extremity strength in Japanese frail elderly women.

[A functional fitness test battery for pre-frail older adults (so-called "specified elderly individuals")].

BACKGROUND: In Japan, an exercise program for pre-frail older adults (so-called "specified elderly individuals") (SEIs) has been prescribed under the newly developed long-term care insurance system. Three functional fitness measures (grip strength, one-leg balance with eyes open, and 5-m habitual walk) are used in the system; however, it has yet to be determined if applying these measures to SEIs is appropriate. PURPOSE: The purpose of this study was to develop a new test battery assessing functional fitness for SEIs, and to determine cross-validity and responsiveness of these measures. METHODS: One hundred and twenty seven SEIs (76.6 +/- 5.9 yr) and 315 healthy older adults (HOAs) (72.2 +/- 5.8 yr) completed twelve functional fitness tests related to activities of daily living (ADL) and mobility. The SEI was defined by the Japanese Ministry of Health, Labour and Welfare in 2005. The test battery items were selected by logistic regression analysis. A functional fitness score (FFS) equation was developed by principal component analysis. The cross-validity of the FFS equation was then tested using a different set of 28 SEIs (77.5 +/- 6.5 yr) and 143 HOAs (71.5 +/- 4.7 yr). Responsiveness of the FFS was also assessed in 62 SEIs (76.7 +/- 5.9 yr) after a 3-month exercise program. RESULTS: The following 4 test items were selected for assessment of functional fitness in SEIs: tandem stance, 5-repetition sit-to-stand, alternate step, and timed up and go. Applying principal component analysis to the 4 selected functional fitness items, the first principal component was interpreted as total functional fitness. The following equation was developed to estimate FFS based on the first principal component coefficient of each variable: FFS = 0.031X1-0.106X2-0.192X3-0.096X4 + 1.672, X1 = tandem stance(s), X2 = 5-repetition sit-to-stand (s), X3 = alternate step(s), X4 = timed up and go(s). The cut-off value to distinguish SEIs from HOAs using receiver operating characteristic ROC) curve was 0.065 (sensitivity 82.2%, specificity 81.9%). The cross-validity and responsiveness of the FFS equation was considered acceptable. CONCLUSION This newly developed test battery should be a useful tool for comprehensively evaluating functional fitness in SEIs.

[Evaluation of the association between impaired renal function and physical function among community-dwelling Japanese frail elderly based on the estimated glomerular filtration rate (eGFR)].

AIM: Falls are major risk factors in nursing care and reported to be associated with low vitamin D levels or impaired renal function. It is unknown whether physical function is associated with impaired renal function. The aim of this study was to examine the association between estimated glomerular filtration rate (eGFR) (ml/min/1.73 m(2)), vitamin D, and physical function in Japanese frail elderly. METHODS: A cross-sectional survey was conducted in two towns (latitude 36 degrees north) from June 2006 to January 2008. Subjects counted of 109 community-dwelling frail elderly, aged 65 years and over (mean+/-SD: 75.8+/-5.2 yr) who attended a program for nursing care prevention. An interview was conducted based on a questionnaire. The serum levels of intact parathyroid hormone (iPTH), 25-hydroxyvitamin D (25 (OH) D), 1,25-dihydroxyvitamin D (1,25 (OH)(2)D), and creatinine were measured. eGFR (ml/min/1.73 m(2)) was calculated using the Modification of Diet in Renal Disease formula. The following functional fitness tests were performed: timed up and go (TUG), a 5-meter walk, functional reach (FR), one leg stance, tandem stance, and grip strength. RESULTS: Of the subjects, 59.6% experienced falls, 75.2% experienced stumbling at least once during the past year. eGFR was 68.0+/-14.1 ml/min/1.73 m(2) in the subjects. The prevalence of eGFR<60.0 ml/min/1.73 m(2) was 30%. The subjects with eGFR> or =60 ml/min/1.73 m(2) showed significantly better results for FR, one leg stance, and tandem stance than those with eGFR<60 ml/min/1.73 m(2). Multiple liner regression analysis suggested that FR and tandem stance were significantly affected by eGFR. CONCLUSIONS: Our data suggest that assessment of renal function seems to be significant when we consider balance ability in the frail elderly.

[Determinant factors encouraging work motivation: a study of care staff working in health services facilities for elderly people].

PURPOSE: Work motivation among care workers influences the quality of care for facility residents. The purpose of this study was to identify related factors in care staff. METHOD: Sixty hundred and seven care staff working at 25 health services facilities for elderly people participated in this study. We applied a theoretically derived model of specific relationships among work motivation, jobsatisfaction, profession identity, job competence, interprofessional working and profession image. These factor relationships were then tested using a structural equation modeling technique. RESULTS: Profession identity, job competence and the profession image of caring were shown to have direct influences on work motivation. In addition, job satisfaction, inter professional working, profession images of nursing and rehabilitation responsibilities were shown to have indirect influences. CONCLUSION: These data suggest that improving profession identity, job competence and the profession image of caring are important to enhance work motivation of care staff.

Validation of lower extremity performance tests for determining the mobility limitation levels in community-dwelling older women.

BACKGROUND AND AIMS: Assessment of mobility status among community-dwelling older people is important for preventing further deterioration of mobility and identifying changes in mobility as early as possible. We attempted to identify the optimal cut-off values for eight lower extremity performance (LEP) tests in community-dwelling older women with mobility limitation (ML) levels. METHODS: The ML levels of 433 community-dwelling older women, mean age 73.2 years (SD 5.7, range 65-93) were classified according to selfreports. ML levels were identified by face-to-face interviews and according to self-reported difficulty in walking one-quarter of a mile or climbing 10 steps without resting. The LEP tests comprised one-legged stance, tandem stance, functional reach, tandem walk, alternate step, five chair sit-to-stands, timed up-and-go (TUG) and usual gait speed. Receiver-operating characteristic curves were obtained for all scales to assess optimal cut-off values. RESULTS: The optimal cut-off value of 6.52 (s) for the TUG test was shown by the highest sensitivity (74%) and specificity (71%) in the discrimination of no ML from moderate ML, whereas the optimal cut-off value of 1.05 (m/s) in the usual gait speed test showed the highest sensitivity (73%) and specificity (67%) in the discrimination of moderate ML from severe ML. CONCLUSIONS: Among community-dwelling older women, TUG and usual gait speed had the highest sensitivity and specificity in discriminating ML levels.

[Correlation between vitamin D and functional capacity, physical function among Japanese frail elderly living in the community].

AIM: To examine the distribution of 25-hydroxyvitamin D(3) [25(OH)D] levels among the Japanese frail elderly, and to explore any association in these subjects between 25 (OH)D levels and functional capacity or physical performance. METHODS: A cross-sectional survey was conducted in a town (latitude 36 degrees north) in June 2005 to September 2006. The 76 participants were community-dwelling elderly aged 65 years and over who attended a class for nursing care prevention. An interview was conducted based on a questionnaire. The serum levels of 25(OH)D, intact parathyroid hormone (iPTH) and calcium were measured. The following physical tests were performed: timed up and go (TUG), a 5-meter walk, functional reach, trunk flexion, and grip strength. Functional capacity and physical performance were compared between the subjects with 25(OH)D>or=50 nmol/L and those with 25(OH)D<50 nmol/L. RESULTS: About 52.6% experienced falls, 75.0% experienced stumbling or body sway more than once during the past year, and 20.0% were housebound. The mean 25(OH)D level (+/-SD) was 60.4+/-13.6 nmol/L (range: 27.5-87.5). The ratio of the 25(OH)D level below 50.0 nmol/L was significantly higher in the group of subjects who had lower mobility or body imbalance or were housebound. The risk factor for stumbling or body sway was 25(OH)D<50 nmol/L (OR: 4.41, 95%CI: 1.31-14.86). CONCLUSION: The prevalence of 25(OH)D<50 nmol/L was 21% among Japanese frail elderly, and 25(OH)D deficiency is associated with lower mobility or body imbalance. It is suggested that the level of 25(OH)D should be needed over 50 nmol/L for nursing care prevention in the frail elderly and that measurements of 25(OH)D for the frail elderly are needed.

[Factors that influence home return from health care facilities for the elderly--related to the attitude of family caregivers].

AIM: The number of users of long-term care insurance has been increasing rapidly since it started in 2000. The number of those who want to enter the long-term care insurance facilities has increased. Although the basic philosophy of long-term care insurance is independence support and self-decision, to enter a facility or home return from facilities is likely to be decided by family caregivers, not by the elderly themselves. Moreover, the number of elderly who return home from welfare facilities is decreasing. We investigated the intension of caregivers who are willing to accept the institutionalized elderly at home and analyzed the factors affecting the acceptance of caregivers. METHODS: Subjects were elderly who were in long-term care insurance facility in June 2004, and their caregivers. The study was conducted between June 2004 and September 2004 in Ibaraki Prefecture in Japan. A face-to-face interview based on a questionnaire was conducted for the institutionalized elderly and by the mail for the caregivers. RESULTS: The caregivers of 34.6% of the elderly who hoped to return home intended to accept them home. There were differences between the plans of the elderly and caregivers. The risk factors (OR, 95% CI) to make the intention of the caregivers to accept the institutionalized elderly home difficult were level of cooperation with other family members to take care of elderly (OR 15.37, 2.05-115.24), dementia behavior disturbance category with more than one (OR 8.34, 1.02-68.05), time spending in bed of a day (OR 1.31, 1.01-1.71), few knowledge of long-term care insurance system of caregivers (OR 3.65,0.81-16.38). CONCLUSION: It has been suggested that more physical activities in the facility, establishment of a care-system for the demented elderly living in the community and an educational campaign by the long-term care insurance system are necessary to increase the willingness of caregivers to accept home return of institutionalized elderly.

Efficacy of continuous regional arterial infusion of a protease inhibitor and antibiotic for severe acute pancreatitis in patients admitted to an intensive care unit.

To investigate the efficacy of continuous regional arterial infusion (CRAI) of a protease inhibitor and antibiotic for severe acute pancreatitis (SAP) in patients admitted to an intensive care unit (ICU). A total of 51 patients with SAP requiring admission to an ICU were studied. The patients were divided into two groups: one received the protease inhibitor nafamostat mesylate and the antibiotic imipenem by continuous regional arterial infusion (CRAI group) and the other received protease inhibitors and antibiotics by intravenous infusion (non-CRAI group). To evaluate the therapeutic usefulness of CRAI of a protease inhibitor and antibiotic for SAP, the rate of surgery and the cumulative survival rate were compared between the non-CRAI group and the CRAI group. The rate of surgery was 32% in the non-CRAI group and 9% in the CRAI group (P = 0.08). Cumulative survival rates at 1, 6, and 12 months were 77.9%, 48.9%, and 48.9% in the non-CRAI group compared with 100.0%, 100.0%, and 87.1% in the CRAI group. Outcome was thus significantly better in the CRAI group than in the non-CRAI group (P = 0.002). CRAI of a protease inhibitor and antibiotic may decrease the need for surgical therapy and reduce mortality in patients with SAP.

Cognitive impairment and nocturnal blood pressure fall in treated elderly hypertensives.

OBJECTIVES: We investigated the association between the fall of nocturnal blood pressure (BP) and cognitive impairment in elderly subjects. METHODS: The study was a cross-sectional survey of 204 elderly subjects who had no cerebrovasucular episodes. Ambulatory BP monitoring and assessments of cognitive functions using the Mini-Mental State Examination (MMSE) were performed at the subjects' homes. We classified, the subjects treated with antihypertensive drugs into three groups: non-dippers (nocturnal fall<10% of the mean day diastolic BP; n=51), normal dippers (10% to less than 20%; n=58), and extreme dippers (20% or more; n=17). The subjects not treated with antihypertensive drugs were also classified as non-dippers (n=40), normal dippers (n=24), and extreme dippers (n=14). RESULTS: The mean age of participants was 75.2±7.2 years, and 126 (61.7%) were being treated with antihypertensive drugs. In the group of antihypertensive drug users, the number with MMSE≤23 was 30 and the adjusted odds ratio for cognitive impairment in those with an extreme dip in diastolic BP (DBP) was 4.18 (95% CI, 1.07-16.40) in reference to the normal dippers. In contrast, no association was observed between cognitive function and nocturnal BP fall in the group no using antihypertensive drugs. CONCLUSIONS: Cognitive impairment was associated with an extreme dip in DBP in the antihypertensive drug users only. It remains to be seen whether careful monitoring of nighttime BP as well as daytime BP may reduce the risk of cognitive impairment in antihypertensive drug users.

Treated hypertensives with good medication compliance are still in a state of uncontrolled blood pressure in the Japanese elderly.

OBJECTIVES: Blood pressure (BP) is poorly controlled in many countries. Poor compliance was suggested as the main cause for poor BP control. The purpose of this study was to examine the association between compliance and the control of both casual blood pressure (BP) and 24-hr ambulatory BP in a Japanese elderly population. METHODS: The study was a cross-sectional survey. Casual BP and 24-hr ambulatory BP were measured at home. Hypertension was defined as casual systolic BP (SBP)≧140 and/or diastolic BP (DBP)≧90 mmHg, or as treated hypertension. A compliance rate of greater than 80% by the pill count method was defined as good compliance. RESULTS: Of the 178 treated hypertensives, 82.6% showed good compliance. Between the treated hypertensives with good compliance and those with poor compliance, no significant difference was found in either casual BP or ambulatory BP. Of the treated hypertensives with good compliance, the prevalence of achieved target ambulatory BP, i.e., daytime BP<135/85 mmHg, nighttime BP<120/75 mmHg, and 24-hr BP<125/80 mmHg, was, respectively, 35.4%, 43.5%, and 20.4%. CONCLUSIONS: Casual BP and 24-hr ambulatory BP were poorly controlled in the community-living elderly although many of the treated hypertensives showed good compliance. It is unlikely that this inadequate control of hypertension is due to poor compliance on the part of the subjects.