Oral health conditions and swallowing in patients with Parkinson\u27s disease

Objective: The purpose of the present study was to investigate oral health conditions, oral health behavior, and swallowing among patients with Parkinson\u27s disease (PD) in Hokkaido, Japan. Materials and methods: We investigated 223 PD patients in the Kushiro area of Hokkaido, Japan by mail in 2020. From 112 respondents, we used 71 PD patients from 50 to 79 years old as cases. Four hundred and forty-three persons over 40 years of age underwent dental examinations conducted by Kushiro city from 2018 to 2019. We retrospectively selected 141 persons from 50 to 79 years old as control. Controls were matched to cases for sex and age. We compared oral health conditions and related factors between 71 PD patients and 141 controls. The logistic regression model was used for adjusting for sex and age. We also conducted stratified analysis by sex while adjusting for age using this model. Results: Compared with the controls, PD patients had more complaints of chewing difficulties, gingival bleeding, annoying teeth alignment, food impaction, swollen gums or mucosa and tooth movement. Among PD patients, 66.2% had problems with swallowing. Conclusion: We found that PD patients had more complaints about oral health and troubles with swallowing

Exome sequencing reveals a novel TTC19 mutation in an autosomal recessive spinocerebellar ataxia patient

BACKGROUND: Spinocerebellar ataxias (SCAs) are heterogeneous diseases characterized by progressive cerebellar ataxia associated with dysarthria, oculomotor abnormalities, and mental impairment. To identify the causative gene, we performed exome sequencing on a Japanese patient clinically diagnosed with recessive SCA. METHOD: The patient is a 37-year-old Japanese woman with consanguineous parents. The head magnetic resonance imaging (MRI) showed cerebellar atrophy and T1 low/T2 high intensity at the bilateral inferior olives. Single-nucleotide polymorphism (SNP) genotyping and next-generation sequencing were performed, and the variants obtained were filtered and prioritized. RESULTS: After these manipulations, we identified a homozygous nonsense mutation of the TTC19 gene (p.Q277*). TTC19 has been reported to be a causative gene of a neurodegenerative disease in Italian and Portuguese families and to be involved in the pathogenesis of mitochondrial respiratory chain complex III (cIII) deficiency. This report is the first description of a TTC19 mutation in an Asian population. Clinical symptoms and neuroimaging are consistent with previous reports. The head MRI already showed abnormal features four years before her blood lactate and pyruvate levels were elevated. CONCLUSIONS: We should consider the genetic analysis of TTC19 when we observe such characteristic MRI abnormalities. Genes associated with mitochondrial function cause many types of SCAs; the mutation we identified should help to elucidate the pathology of these disorders

Effectiveness of Influenza vaccines in reducing risk of acute febrile illness among community-dwelling elderly, 2006-07 seasons : Population-based cohort study in Japan

Background: Annual vaccinations are recommended for groups with high-risk medical conditions, as well as the residents of nursing homes. In general, little is known about the vaccine effectiveness of vaccines for Influenza-like illness (ILI) in community-dwelling elderly. Methods: A population based cohort study was conducted during the 2006-2007 (06/07) influenza season to examine the effectiveness of an influenza vaccine among community-dwelling elderly. We selected 1,000 elderly citizens ranging from 65 to 74 years old randomly from a population registry of Sapporo in September 2006. Baseline survey for them was conducted in October or November 2006, and 542 (54.2%) subjects responded with an informed consent. We excluded one person because he passed away before the follow-up survey. Thus, we analyzed 541 subjects. We followed-up the participants concerning acute febrile illnesses, hospitalizations, and so on every prior month from December 2006 to April 2007 though telephone interviews. The Chi-square test and Mann-Whitney U-test were used to compare vaccinated group to non-vaccinated group, and Cox’s hazard model was conducted to control for potential confounding factors. Results: After adjusting for confounders, the vaccination decreased acute fevers higher than or equal to 37.5°C (Hazard ratio (HR) =0.42, 95% confidence interval (CI)=(0.20, 0.90)) from December 2006 to March 2007, but was not associated with the risk of ILI (HR=1.25, 95%CI=(0.29, 5.37)). Conclusion: An influenza vaccination may decrease an acute fever during an influenza epidemic season in community-dwelling elderly

Anti-viral actions and viral dynamics in the early phase of three different regimens of interferon treatment for chronic hepatitis C: differences between the twice-daily administration of interferon-beta treatment and the combination therapy with interferon-alpha plus ribavirin.

To improve the efficacy of interferon (IFN) treatment for chronic hepatitis C, we have proposed the twice-daily administration of IFN-beta as a promising induction therapy. In this study, we demonstrated differences between the clearance of circulating HCV-RNA and the induction of anti-viral actions during the first 2 weeks of treatment. Nine patients with a high viral load and genotype 1b were randomly assigned to 3 groups: group A received 3MU of IFN-beta twice a day at intervals of 5 and 19 h; group B received 3MU of IFN-beta twice a day at intervals of 10 and 14 h; group C received 6MU of IFN-alpha once a day with ribavirin. The expression of OAS2, PKR, and MxA in peripheral blood mononuclear cells (PBMCs) were quantified by real-time polymerase chain reaction method. The viral clearance showed a bi-phasic pattern, and those in the second phase of groups A and B were significantly steeper than that of group C. The peak level of OAS2 during the first phase was correlated with the first phase decay. The MxA expression tended to be higher in group A and B than in group C. The expression of these 3 proteins tended to decrease at day 6 in group C, but increase in groups A and B. These might make differences in the viral decay during the second phase</p

Factors influencing attitudes toward end-of-life care by care workers at special nursing homes for the elderly A Cross-sectional study in Japan

Objectives: The purpose of this study was to clarify factors influencing care workers\u27 attitudes toward end-of-life (EOL) care characteristics at special nursing homes (SNHs). Methods: A questionnaire was initially sent to 630 care workers at 19 SNHs in October 2012. Written informed consent was obtained from 253 of these workers (40.2%), who then completed and returned the questionnaires. Participants were asked to reply to questions covering demographic data, work environment, depression status, experiences/education concerning EOL, communication skills, and attitudes toward EOL care. The Japanese version of the Frommelt Attitude Toward Care of the Dying Scale, Form B (FATCOD-B-J) assessment instrument was used in the analysis of the data received. Using the median value of the FATCOD-B-J score, 130 subjects were allocated to the high score (HS) group (FATCOD-B-J?23) and 123 to the low score (LS) group (FATCOD-B-J<23). In the LS group, the odds ratios (ORs) and their 95% confidence intervals (95% CIs) of participants exhibiting relatively negative attitudes toward EOL care were calculated and adjusted for potential confounding factors using multivariate logistic regression model analysis. Results: Length of employment in the facilities of between 5 and 9 years (OR 0.37, 95% CI 0.16-0.87) as well as over 10 years (OR 0.39, 95% CI 0.16-0.96) was significantly associated with a decreased risk of placement in the LS group. Furthermore, moderate (OR 0.44, 95% CI 0.24-0.80) as well as high (OR 0.35, 95%CI 0.17-0.75) communication skills in accepting other opinions, were significantly associated with decreased risk of placement in the LS group. Conclusions: After adjustments for potential confounding variables, results indicated that extended experience as a care worker and higher communication skills in accepting other opinions were significantly associated with a reduced risk of negative attitudes toward EOL care

特別養護老人ホームにおける介護職の看取りに対する態度に影響尾及ぼす要因 : 日本における縦断研究

Aim: The aim of the present study was to clarify that the effects of accumulated experience in end-of-life care and communication skill on the attitudes of care workers’ toward end-of-life care. Methods: A study implemented 2012 to 2014. Two hundred and fifty-three questionnaires were returned (40.2%), and 170 were fully completed by care workers in special nursing homes. We sorted the responses into two groups by experience level: the experienced end-of-life care (EE) group and the inexperience end-of-life care (IE) group. Responses were also sorted by communication skill level: a high score communication (HSC) group and a low score communication (LSC) group. A two-way repeated measure analysis of variance was used for the statistical analysis. Results: The EE group was more likely to be younger (P = .04), to have a longer duration of employment (P < .001), and to have participated in an EOL care seminar in their facility (P = .02) than the IE group. Attitudes toward end-of-life care were significantly different between the EE and IE groups (df = 2, F = 3.35, P < .05). Attitudes toward end-of-life care were not significantly different when comparing the HSC and LSC groups (df = 2, F = 0.17, P = .85). The communication skill between the HSC and LSC groups differed significantly at 2012, 2013, and 2014. Conclusions: The accumulation of end-of-life care experience prompted a positive change in attitudes toward end-of-life care. Meanwhile, communication skill had no significant effect to change attitudes toward end-of-life care

Circulating T follicular helper 2 cells, T follicular regulatory cells and regulatory B cells are effective biomarkers for predicting the response to house dust mite sublingual immunotherapy in patients with allergic respiratory diseases

The relationships between T follicular helper (Tfh) cells and antigen-specific immunoglobulins (sIgs) in patients with allergic respiratory diseases who are receiving antigen immunotherapy (AIT) have not been fully clarified. Therefore, we started to perform house dust mite sublingual immunotherapy (HDM-SLIT) for 20 patients with atopic asthma comorbid with allergic rhinitis (AA+AR) who were already receiving ordinary treatments including inhaled corticosteroid (ICS). We examined percentages of circulating T follicular helper (cTfh) and regulatory (cTfr) cells and percentages of circulating regulatory T (cTreg) and B (cBreg) cells by FACS and we examined levels of Der-p/f sIgs by ELISA. Based on the symptom score (asthma control questionnaire: ACQ) and medication score ((global initiative for asthma: GINA) treatment step score) in patients with AA, the patients were divided into responders and non-responders. The percentage of cTfh2 cells significantly decreased and the percentage of cTfh1 cells significantly increased within the first year. Der-p/f sIgEs decreased after a transient elevation at 3 months in both groups. Notably, the percentage of cTfh2 cells and the ratio of cTfh2/cBreg cells and Der-p/f sIgEs greatly decreased in responders from 6 months to 12 months. The percentages of cTfr and cTreg cells showed significant negative correlations with the percentage of cTfh2 cells. The percentage of IL-4+ cTfh cells were significantly decreased and the percentage of IFN-γ+ cTfh cells were increased before treatment to 24 months in 6 patients examined (4 responders and 2 non-responders). We performed multi plelogistic regression analysis based on these results, the ratios of cTfh2/cTfr cells and cTfh2/cBreg cells at the start of therapy were statistically effective biomarkers for predicting the response to HDM-SLIT in patients with AA+AR

A case of VEXAS syndrome (vacuoles, E1 enzyme, X-linked, autoinflammatory, somatic) with decreased oxidative stress levels after oral prednisone and tocilizumab treatment

VEXAS (vacuoles, E1 enzyme, X-linked, autoinflammatory, somatic) syndrome has recently been described as an autoinflammatory disease associated with severe adult-onset inflammatory manifestations. The various clinical manifestations include recurrent high-grade fever, neutrophilic dermatoses, cutaneous vasculitis, chondritis of the ear and nose, pulmonary infiltrates, cytopenia, uveitis, gastrointestinal pain or inflammation, aortitis, hepatosplenomegaly, and hematological disorders. VEXAS syndrome is caused by somatic mutations of the ubiquitin-like modifier activating enzyme 1 (UBA1) gene in myeloid-lineage cells. It is characterized by vacuolated myeloid and erythroid progenitor cells seen by bone marrow biopsy. We report the case of a 64-year-old Japanese man with VEXAS syndrome. At age 63, he was referred to us with a recurrent erythema on the hands associated with a general fever of 38–40°C that had persisted for 4 or 5 days and had recurred about once a month for a year. The skin rash appeared 2 or 3 days after the onset of each fever episode. Computed tomography (CT) of the chest revealed bilateral hilar lymphadenopathy (BHL), and the mediastinal lymph nodes were swollen. Sarcoidosis was suspected but was ruled out by several tests. Laboratory examinations showed elevated inflammatory markers. Bone marrow examination showed the vacuolization of myeloid precursor cells. A skin biopsy revealed dense dermal, predominantly perivascular, infiltrates. These consisted of mature neutrophils admixed with myeloperoxidase-positive CD163-positive myeloid cells, lymphoid cells and eosinophils. Sequencing analysis identified the somatic UBA1 variant c.122T &gt; C, which results in p.Met41Thr. Treatment with oral prednisone (15 mg/day) and monthly intravenous tocilizumab injections (400 mg) completely resolved the symptoms. Neutrophils are a major source of reactive oxygen species, and the present case demonstrated numerous neutrophilic infiltrates. We hypothesize that the patient might have had elevated derivatives of reactive oxygen metabolites (d-ROMs). d-ROM quantification is a simple method for detecting hydroperoxide levels, and clinical trials have proven it useful for evaluating oxidative stress. In this study, we measured serum d-ROM before and after oral prednisone and tocilizumab treatment. The levels decreased significantly during treatment