Swallowing Disorders in Patients with Stroke

Swallowing disturbance often causes by stroke and may predispose patients to malnutrition and dehydration, as well as increases the risk of such complications as suffocation and aspiration pneumonia. As an initial evaluation, the water swallowing test can be easily carried out, but not all of the aspiration can be excluded. Therefore, videofluorography (VF) and videoendoscopic examination (VE) of swallowing should be performed to find a safety method of oral intake for providing visualization of the pharynx and larynx dysfunction. Clinical severity scale is important because once the severity is determined, the treatment strategy is also known. Swallowing training can be divided into indirect training without food (basic training) and direct training with food (eating training). In general, it is important to select conditions and training diets that are easy to swallow and have a low risk of aspiration while using indirect training and direct training that aim at gradually improving the level of oral intake

Overarching Goal and Intervention for Healthy Aging in Older People during and after the COVID-19 Pandemic: Impact of Rehabilitation

The coronavirus disease 2019 (COVID-19) pandemic has had a major impact on society and our lives. Many older people and those with underlying medical conditions have refrained from social activities and become housebound, increasing the risk of frailty. Therefore, we developed the Home Exercise Program for Older People, a multidisciplinary program that makes it easier for older people to exercise at home. We also provide outpatient rehabilitation for not only those affected by COVID-19, but also older people with frailty who have become confined under the COVID-19 pandemic. In this chapter, we overview the situations and lives of older people in Japan under the COVID-19 pandemic and discuss preventive strategies

MUTYH Gln324His gene polymorphism and genetic susceptibility for lung cancer in a Japanese population

<p>Abstract</p> <p>Background</p> <p>Genetic polymorphisms of DNA repair enzymes in the base excision repair (BER) pathway, may lead to genetic instability and lung cancer carcinogenesis. We investigated the interactions among the gene polymorphisms in DNA repair genes and lung cancer.</p> <p>Methods</p> <p>We analyzed associations among <it>OGG1 </it>Ser326Cys and <it>MUTYH </it>Gln324His gene polymorphisms in relation to lung cancer risk using PCR-RFLP. The study involved 108 lung cancer patients and 121 non-cancer controls divided into non-smokers, smokers according to pack-years smoked in Japanese.</p> <p>Results</p> <p>The results showed that the <it>MUTYH His/His </it>genotype compared with <it>Gln/Gln </it>genotype showed an increased risk for lung cancer (adjusted odds ratio [OR] 3.03, confidence interval [95%CI], 1.31–7.00, p = 0.010), whereas there was no significant increase for the <it>Gln/His </it>genotype (adjusted OR 1.35, 95%CI 0.70–2.61, p = 0.376). The <it>MUTYH His/His </it>genotype was at a borderline increased risk for both adenocarcinoma and squamous cell carcinoma (adjusted OR 2.50, 95%CI 0.95–6.62, p = 0.065 for adenocarcinoma; adjusted OR 3.20, 95%CI 0.89–11.49, p = 0.075 for squamous cell carcinoma, respectively). However, the <it>OGG1 Ser/Cys </it>or <it>Cys/Cys </it>genotypes compared with the <it>Ser/Ser </it>genotype did not have significantly increased risk for lung cancer, containing either adenocarcinoma or squamous cell carcinoma. The joint effect of tobacco exposure and the <it>MUTYH His/His </it>genotype compared with the <it>Gln/Gln </it>genotype showed a significant association with lung cancer risk in smokers, and there was not significantly increased in non-smokers (adjusted OR 3.82, 95%CI 1.22–12.00, p = 0.022 for smokers; adjusted OR 2.60, 95%CI 0.60–11.25, p = 0.200 for non-smokers, respectively). The effect of tobacco exposure and the <it>OGG1 </it>Ser326Cys showed also no significant risk for lung cancer.</p> <p>Conclusion</p> <p>Our findings suggest that the <it>MUTYH </it>Gln324His polymorphism appear to play an important role in modifying the risk for lung cancer in the Japanese population.</p

Association of MUTYH Gln324His and APEX1 Asp148Glu with colorectal cancer and smoking in a Japanese population

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Memory impairment caused by cerebral hematoma in the left medial temporal lobe due to ruptured posterior cerebral artery aneurysm

BACKGROUND: Cognitive disorders, such as memory disturbances, are often observed following a subarachnoid hemorrhage. We present a very rare case where rupture of a posterior cerebral artery aneurysm caused restricted damage to the hippocampus unilaterally, and caused memory disturbances. CASE PRESENTATION: A 56-year-old, right-handed man, with a formal education history of 16 years and company employees was admitted to our hospital because of a consciousness disturbance. He was diagnosed as having a subarachnoid hemorrhage due to a left posterior cerebral artery dissecting aneurysm, and coil embolization was performed. Subsequently, he had neither motor paresis nor sensory disturbances, but he showed disorientation, and both retrograde and anterograde amnesia. Although immediate recall and remote memory were almost intact, his recent memory was moderately impaired. Both verbal and non-verbal memories were impaired. Brain computed tomography (CT) and magnetic resonance imaging (MRI) revealed a cerebral hematoma in the left temporal lobe involving the hippocampus and parahippocampal gyrus, and single-photon emission computed tomography (SPECT) demonstrated low perfusion areas in the left medial temporal lobe. CONCLUSIONS: We suggest that the memory impairment was caused by local tissue destruction of Papez’s circuit in the dominant hemisphere due to the cerebral hematoma

Efficacy of a hybrid assistive limb in post-stroke hemiplegic patients: a preliminary report

<p>Abstract</p> <p>Background</p> <p>Robotic devices are expected to be widely used in various applications including support for the independent mobility of the elderly with muscle weakness and people with impaired motor function as well as support for nursing care that involves heavy laborious work. We evaluated the effects of a hybrid assistive limb robot suit on the gait of stroke patients undergoing rehabilitation.</p> <p>Methods</p> <p>The study group comprised 16 stroke patients with severe hemiplegia. All patients underwent gait training. Four patients required assistance, and 12 needed supervision while walking. The stride length, walking speed and physiological cost index on wearing the hybrid assistive limb suit and a knee-ankle-foot orthosis were compared.</p> <p>Results</p> <p>The hybrid assistive limb suit increased the stride length and walking speed in 4 of 16 patients. The patients whose walking speed decreased on wearing the hybrid assistive limb suit either had not received sufficient gait training or had an established gait pattern with a knee-ankle-foot orthosis using a quad cane. The physiological cost index increased after wearing the hybrid assistive limb suit in 12 patients, but removal of the suit led to a decrease in the physiological cost index values to equivalent levels prior to the use of the suit.</p> <p>Conclusions</p> <p>Although the hybrid assistive limb suit is not useful for all hemiplegic patients, it may increase the walking speed and affect the walking ability. Further investigation would clarify its indication for the possibility of gait training.</p

Prediction of early falls using adherence and balance assessments in a convalescent rehabilitation ward

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