How the Post-Fracture Rehabilitation Choice Affects Brain Function in Older People?

Background: We investigated how the type of rehabilitation affects brain function and antioxidant potential. Methods: Twenty-eight patients hospitalized for fall-related fractures were assigned to either a physical therapy group or an occupational therapy group. Cognition was assessed using the Touch Panel-type Dementia Assessment Scale (TDAS) and oxidative stress with serum pentosidine levels. Spectral analysis and coherence analysis were also performed. Results: Changes in TDAS scores and serum pentosidine levels did not differ significantly between the 2 therapies. Power spectral analysis revealed a significant intergroup difference in δ waves. Coherence analysis showed significant intergroup differences in the activities of δ waves and β waves. Conclusions: Cognitive function and antioxidant potential did not differ between the 2 types of rehabilitation. However, the impact on cerebral neuronal activity may have differed

レミフェンタニル麻酔中の１％糖負荷が高齢者の代謝に与える影響 : 無作為対照比較試験

Background: Previous studies showed that remifentanil-induced anesthesia can inhibit surgical stress response in non-diabetic adult patients and that low-dose glucose loading during anesthesia may attenuate fat catabolism. However, little is known about the influence of glucose loading on metabolism in elderly patients, whose condition may be influenced by decreased basal metabolism and increased insulin resistance. We hypothesized that, in elderly patients, intraoperative low glucose infusion may attenuate the catabolism of fat without causing harmful hyperglycemia during remifentanil-induced anesthesia. Methods: Elderly, non-diabetic patients scheduled to undergo elective surgery were enrolled and randomized to receive no glucose (0G group) or low-dose glucose infusion (0.1 g/kg/hr. for 1 h followed by 0.05 g/kg/hr. for 1 h; LG group) during surgery. Glucose, adrenocorticotropic hormone (ACTH), 3-methylhistidine (3-MH), insulin, cortisol, free fatty acid (FFA), creatinine (Cr), and ketone body levels were measured pre-anesthesia, 1 h post-glucose infusion, at the end of surgery, and on the following morning. Results: A total of 31 patients (aged 75–85) were included (0G, n = 16; LG, n = 15). ACTH levels during anesthesia decreased significantly in both groups. In the LG group, glucose levels increased significantly after glucose loading but hyperglycemia was not observed. During surgery, ketone bodies and FFA were significantly lower in the LG group than the 0G group. There were no significant differences in insulin, Cr, 3-MH, and 3-MH/Cr between the two groups. Conclusion: Remifentanil-induced anesthesia inhibited surgical stress response in elderly patients. Intraoperative low-dose glucose infusion attenuated catabolism of fat without inducing hyperglycemia

Post-fracture Rehabilitation Effects on Brain Function in Older People

[Background] Deterioration of cognitive function is an underlying cause of older people’s fractures. The purpose of this study was to evaluate electroencephalogram and cognitive function in patients hospitalized with fractures, both at admission (before intervention) and at the time of discharge (after intervention), to investigate the effects of rehabilitation on brain function. [Methods] A total of 24 patients hospitalized with fracture due to a fall were enrolled in this study. All the subjects received 140 minutes of rehabilitation every day during hospitalization. Touch Panel-type Dementia Assessment Scale (TDAS) was used to test their cognitive function. In electroencephalography (EEG), the Neuronal Activity Topography (NAT) system was used to calculate the “Alzheimer’s disease (AD) - normal controls (NLc) differential similarity” in sNAT, ie, a numerical index to show the proximity to AD or normal NLc. [Results] There was no significant difference in the total TDAS score among subjects who were examined before and after intervention, but 12 subjects who were observed with deterioration of cognitive functionat at before intervention had a significant improvement in “word-recognition,” a sub-item in TDAS (P < 0.05). In addition, the NAT analysis findings showed that the differential similarity in sNAT significantly approached the NLc pattern (P < 0.05). [Conclusion] EEGs in patients with fractures resulting from a fall became more similar to NL patterns at the time of discharge. In addition, recent-memory function of patients who had decline in cognitive function improved

Measurement of the total neutron scattering cross section ratios of noble gases of natural isotopic composition using a pulsed neutron beam

Precision measurements of slow neutron cross sections with atoms have several scientific applications. In particular the n-$^{4}$He s-wave scattering length is important to know both for helping to constrain the nuclear three-body interaction and for the proper interpretation of several ongoing slow neutron experiments searching for other types of neutron-atom interactions. We present new measurements of the ratios of the neutron differential scattering cross sections for natural isotopic-abundance mixtures of the noble gases He, Ar, Kr, and Xe to natural isotopic abundance Ne. These measurements were performed using a recently developed neutron scattering apparatus for gas samples located on a pulsed slow neutron beamline which was designed to search for possible exotic neutron-atom interactions and employs both neutron time of flight information and a position-sensitive neutron detector for scattering event reconstruction. We found agreement with the literature values of scattering cross sections inferred from Ar/Ne, Kr/Ne and Xe/Ne differential cross section ratios over the $q$ range of $1 - 7$ nm$^{-1}$. However for the case of He/Ne we find that the cross section inferred differs by 11.3% (7.6 $\sigma$) from previously-reported values inferred from neutron phase shift measurements, but is in reasonable agreement with values from other measurements. The very large discrepancy in the He/Ne ratio calls for a new precision measurement of the n-$^{4}$He scattering length using neutron interferometry

A role for fungal β-glucans and their receptor Dectin-1 in the induction of autoimmune arthritis in genetically susceptible mice

A combination of genetic and environmental factors can cause autoimmune disease in animals. SKG mice, which are genetically prone to develop autoimmune arthritis, fail to develop the disease under a microbially clean condition, despite active thymic production of arthritogenic autoimmune T cells and their persistence in the periphery. However, in the clean environment, a single intraperitoneal injection of zymosan, a crude fungal β-glucan, or purified β-glucans such as curdlan and laminarin can trigger severe chronic arthritis in SKG mice, but only transient arthritis in normal mice. Blockade of Dectin-1, a major β-glucan receptor, can prevent SKG arthritis triggered by β-glucans, which strongly activate dendritic cells in vitro in a Dectin-1–dependent but Toll-like receptor-independent manner. Furthermore, antibiotic treatment against fungi can prevent SKG arthritis in an arthritis-prone microbial environment. Multiple injections of polyinosinic-polycytidylic acid double-stranded RNA also elicit mild arthritis in SKG mice. Thus, specific microbes, including fungi and viruses, may evoke autoimmune arthritis such as rheumatoid arthritis by stimulating innate immunity in individuals who harbor potentially arthritogenic autoimmune T cells as a result of genetic anomalies or variations

Low-grade B-cell lymphoma presenting primarily in the bone marrow

Cases of low-grade B-cell lymphoma presenting primarily in the bone marrow are rare, and its clinicopathology remains unclear. We retrospectively examined patients with low-grade B-cell lymphoma presenting primarily in the bone marrow. Fourteen patients met the inclusion criteria, including 5 with lymphoplasmacytic lymphoma (LPL), 3 with chronic lymphocytic leukemia/small lymphocytic lymphoma, 2 with follicular lymphoma (FL), and 4 with low-grade B-cell lymphoma not otherwise specified (LGBCL-NOS). The median age was 69.5 years (range, 42-89 years), and a slight male predominance was noted (9 men and 5 women, 1.8: 1). Immunohistochemically, all cases were positive for CD20. One case was positive for CD138. Both cases of FL were positive for CD10 and B-cell lymphoma 2 (BCL-2), and immunoglobulin heavy locus (IgH)/B-cell lymphoma 2 rearrangement was observed by fluorescence in situ hybridization. The myeloid differentiation primary response gene (88) leucine to proline mutation was observed in 3 of 5 LPL, 1 of 2 FL, and 2 of 4 LGBCL-NOS patients. Paraproteinemia was observed in 10 patients; IgM and IgG paraproteinemia were observed in 6 and 3 patients, respectively. In this patient series, 3 patients had died at a median follow-up of 36.5 months; the cause of death of 1 LPL patient was malignant lymphoma itself. Thus, low-grade B-cell lymphoma presenting primarily in the bone marrow has various subtypes, and approximately one-third of the patients had LGBCL-NOS. The immunophenotypic features and myeloid differentiation primary response gene (88) leucine to proline mutation data of LGBCL-NOS suggested that some cases present with characteristics similar to those of LPL or marginal zone lymphoma

A case of placenta percreta with massive hemorrhage during cesarean section

We describe a case of a 39-year-old woman diagnosed with placenta percreta complicated by massive hemorrhage during a cesarean section. At 27 weeks of gestation, she underwent an emergency cesarean section under general anesthesia for vaginal bleeding and an intrauterine infection. Soon after delivery, a massive hemorrhage was encountered while attempting to separate the placenta percreta from the bladder wall. Although total abdominal hysterectomy and partial cystectomy were performed, massive hemorrhaging persisted. Bleeding was finally controlled following bilateral internal iliac artery embolization. We used a cell salvage device and a rapid infuser for hemodynamics stabilization. Total blood loss was 47,000 mL, and anesthesia time was 12 h and 47 min. The patient was discharged on the 32nd postoperative day without major complications. Placenta accreta can be associated with life-threatening hemorrhage and it is vital to plan accordingly preoperatively