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Hiroshi Ikegami
2006 Volume 43 Issue 3 Pages
265-273
Published: May 25, 2006
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Yutaka Nishigaki, Noriyuki Fuku, Masashi Tanaka
2006 Volume 43 Issue 3 Pages
274-282
Published: May 25, 2006
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Reiko Hatakeyama, Aiko Hatakeyama, Atsuko Satoh, Yumiko Fukuoka, Hisas ...
2006 Volume 43 Issue 3 Pages
283-285
Published: May 25, 2006
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Hiroshi Shibata
2006 Volume 43 Issue 3 Pages
286-288
Published: May 25, 2006
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Sataro Goto
2006 Volume 43 Issue 3 Pages
289-292
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Hiroshi Uematsu
2006 Volume 43 Issue 3 Pages
293-296
Published: May 25, 2006
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As demographic aging continues even today, geriatric dentistry responsive to the times must be established. The greatest concern of elderly individuals is health, and as dentists, we care for the oral cavity as the gateway to the digestive organs. Stated briefly then, I believe that our primary role as dental health care providers in an elderly society is to maintain and promote health by preventing a decline in eating function.
Dentistry up to the present has pursued responses to disease. But in an elderly society, a decline in oral function accompanying aging is a problem. In other words, consistent with changes in the population structure, dentistry in the future should not end with the treatment of tooth decay, periodontal disease, or other such dental diseases; rather, it must pursue a shift to prevention of age-attendant decline in oral function and maintenance of healthy food intake and swallowing functions.
Nonetheless, dentistry is gradually declining in hospitals that admit elderly individuals. While urban dental clinics are regarded as too numerous, dentistry in hospitals is disappearing, and the thought of health care settings without dentistry is sobering. I believe we must eliminate a troubling situation in which our connection to dentistry is severed at a time when we most need dentistry. This should be the first step in establishing dentistry for maintenance of eating functions.
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Takahito Takeuchi
2006 Volume 43 Issue 3 Pages
297-298
Published: May 25, 2006
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Yoichiro Murakami
2006 Volume 43 Issue 3 Pages
299-300
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Hirooki Tashiro
2006 Volume 43 Issue 3 Pages
301-302
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Mihoko Sato
2006 Volume 43 Issue 3 Pages
303-305
Published: May 25, 2006
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Takeshi Tabira
2006 Volume 43 Issue 3 Pages
306-308
Published: May 25, 2006
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Yukiko Kurokawa
2006 Volume 43 Issue 3 Pages
309-310
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Tadato Oikawa
2006 Volume 43 Issue 3 Pages
311-313
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Koichiro Yasuhara
2006 Volume 43 Issue 3 Pages
314-317
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Kazuhiro Oshima
2006 Volume 43 Issue 3 Pages
318-321
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Toshinori Murayama
2006 Volume 43 Issue 3 Pages
322-325
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Yoshimitsu Kuroyanagi
2006 Volume 43 Issue 3 Pages
326-329
Published: May 25, 2006
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Tissue engineering is moving rapidly from fundamental research to commercial applications. The first product is an autologous cultured epidermal substitute. Other representative products are allogeneic cultured dermal substitute and allogeneic cultured skin substitute. Surgical closure with auto-skin grafting is the gold standard for treatment of victims with extensive deep skin defects. Therefore, the tissue engineers have to develop the cultured skin substitutes, taking into account the successful application of auto-skin grafting, Kuroyanagi developed an allogeneic cultured dermal substitute, which was composed of a 2-layered spongy matrix of hyaluronic acid and atelo-collagen containing fibroblasts. This product is able to release a number of biologically active substances that are necessary for wound healing. A multi-center clinical study on the use of this product has been performed at 30 hospitals across Japan as the Regenerating Medical Millennium Project of the Ministry of Health, Labor and Welfare.
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Jun Takahashi
2006 Volume 43 Issue 3 Pages
330-333
Published: May 25, 2006
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Mitsuo Ochi, Nobuo Adachi
2006 Volume 43 Issue 3 Pages
334-337
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Yoichi Yamada, Minoru Ueda
2006 Volume 43 Issue 3 Pages
338-341
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Yuichiro Saito, Masahiko Kurabayashi, Tetsuya Nakamura, Ryozo Nagai
2006 Volume 43 Issue 3 Pages
342-344
Published: May 25, 2006
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The
klotho gene, originally identified by insertional mutagenesis in mice, suppresses multiple aging phenotypes (e.g. arteriosclerosis, pulmonary emphysema, osteoporosis, infertility, skin atrophy). We have demonstrated that mice deficient for the
klotho gene show endothelial dysfunction as manifested by an attenuated response of aortic relaxation in response to acetylcholine stimulation. Systemic nitric oxide production was also significantly reduced in
klotho deficient mice. Oxidative stress was increased in
klotho deficient mice. The
klotho gene delivery improves multiple aging phenotypes. Our findings establish the basis for the therapeutic potential of
klotho gene delivery in age-related diseases.
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Masayuki Yoshida
2006 Volume 43 Issue 3 Pages
345-346
Published: May 25, 2006
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Tohru Minamino, Issei Komuro
2006 Volume 43 Issue 3 Pages
347-350
Published: May 25, 2006
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Vascular cells have a finite lifespan when cultured in vitro and eventually enter an irreversible growth arrest state called “cellular senescence.” It has been reported that many of the changes in senescent vascular cell behavior are consistent with the changes seen in age-related vascular diseases. Recently, senescent vascular cells have been demonstrated in human atherosclerotic lesions but not non-atherosclerotic lesions. Moreover, these cells express increased levels of proinflammatory molecules and decreased levels of endothelial nitric oxide synthase, suggesting that cellular senescence in vivo contributes to the pathogenesis of human atherosclerosis. One widely discussed hypothesis of senescence is the telomere hypothesis. An increasing body of evidence has established the critical role of the telomere in vascular cell senescence. More recent evidence suggests that telomere-independent mechanisms are implicated in vascular cell senescence. Activation of Ras, an important signaling molecule involved in atherogenic stimuli, induces vascular cell senescence and thereby promotes vascular inflammation in vitro and in vivo. Constitutive activation of Akt also induces vascular cell senescence. This novel role of Akt in regulating the cellular lifespan may contribute to various human diseases including atherosclerosis and diabetes mellitus. lthough a causal link between vascular aging and vascular cell senescence remains elusive, a large body of data is consistent with cellular senescence contributing to age-associated vascular disorders. This review considers the clinical relevance of vascular cell senescence in vivo and discusses the potential of antisenescence therapy for human atherosclerosis.
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Tatsuo Furuyama
2006 Volume 43 Issue 3 Pages
351-354
Published: May 25, 2006
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Dying elderly at home project
Yoshihisa Hirakawa, Yuichiro Masuda, Masafumi Kuzuya, Akihisa Iguchi, ...
2006 Volume 43 Issue 3 Pages
355-360
Published: May 25, 2006
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AIM: The aim of this study was to assess the frequency of symptoms and end-of-life care received in advanced dementia and advanced cancer elderly patients dying at home during the last two days of their lives and to evaluate the differences observed between the two groups.
METHODS: We used data from the Dying Elderly at Home (DEATH) project, which was a prospective study of home elderly patients dying with end-stage illness. Consecutive deceased subjects aged 65 or older who were seen at 16 study clinics belonging to the Japanese Society of Hospice and Home-care with diagnoses of all illnesses including advanced dementia and advanced cancer and died at home from October 2002 to September 2004 were included in the study. We evaluated 36 deceased subjects with advanced dementia and 116 with advanced cancer. We collected the following information: sociodemographics, ADLs, cognitive impairment, observed symptoms and end-of-life care provided during the last 48 hours of life.
RESULTS: Deceased subjects with advanced dementia were less likely to show symptoms of pain, acute confusion, or nausea/vomiting and more likely to display fever or cough than advanced cancer patients. Also, those with advanced dementia were more likely to receive intravenous drip injection or narcotic analgesia and more likely to be given sputum suction, or antibiotics.
CONCLUSION: We observed that the dying process and end-of-life care for advanced dementia elderly patients was different from that for advanced cancer elderly patients.
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Kikue Hidaka, Katsuko Kamiya, Motoka Masuda
2006 Volume 43 Issue 3 Pages
361-367
Published: May 25, 2006
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Aim: This study was aimed to evaluate the nourishment of patients with a disturbance of consciousness who received tube feeding, and to discuss nutritional markers to simplify evaluation in these patients at home or at facilities for the elderly.
Methods: The nourishment of 46 patients with a disturbance of consciousness who received tube feeding was evaluated by performing 1) physical measurements, 2) blood test, and 3) measurement of resting metabolic rate. Furthermore, the anemialike symptoms of the palpebral conjunctiva, which were supposed to be related with nourishment, were subjectively evaluated to clarify their relevance to the results of physical measurements and blood test.
Results: The average of triceps skinfold thickness (%TSF), which shows relative physical measurement data of patients with a disturbance of consciousness when compared to those of healthy people, was 105.7±39.8, which was almost equivalent to that of healthy people. The arm muscle circumference (%AMC) and calf circumference (%CC) were 87.5±11.5 and 73.6±9.4, respectively. In the blood test, the average Alb value was 3.3±0.5g/d
l, suggesting that 35 (76.1%) of the 46 patients with disturbance of consciousness had protein energy malnutrition (PEM). Since the relationship between anemia-like symptoms of the palpebral conjunctiva and Hb/Ht (
p<0.01,
p<0.01) and Alb (
p<0.05) was confirmed, there is a high possibility that these markers can be useful for easy evaluation of nourishment.
Conclusion: Because hypoalimentation is a more serious problem than overnutrition in patients with a disturbance of consciousness, we consider that the calorie count should be adjusted based on the measurement results of resting energy expenditure (REE) in individual patients, although the count for patients with tube feeding was set at individual levels of basal metabolism in the conventional method. Moreover, further discussion is required regarding alternative markers for nutritional evaluation to blood test data.
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Yasuko Inaba, Shuichi Obuchi, Takeshi Arai, Hiroshi Goto
2006 Volume 43 Issue 3 Pages
368-374
Published: May 25, 2006
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Aim: The purpose of the present study was to investigate the changes of physical functions of subjects who participated in a progressive resistance and balance training program named Comprehensive Geriatric Training (CGT) before and after training, and following lyear.
Methods: Sixty-three community-dwelling elderly participated in CGT. Subject's physical functions (muscle strength, balance, walking speed) were measured.
Moreover, we interviewed the subjects about their maintenance of exercise after training.
Results: Fifty-five subjects completed CGT, and physical functions were measured in 32 subjects. There were significant differences in all physical functions.
In the post-hoc test, there were significant differences between before and after one year (one leg standing with open eyes, flexibility, functional reach, maximum walking speed, timed up and go). Of the 32 subjects, 21 kept training 1 or more days per week after training (TR), but 11 were desisted from training (DT). Between the 2 groups, the main effect at Group, Time, Group×Time interaction were significant with Functional Reach. It was significantly improved after l year compared with before training in TR. No physical functions in after 1 year were significantly lower than before training.
Conclusion: The subjects improved, maintained the physical functions through CGT. Moreover, the physical functions after 1 year did not decrease significantly compared to before CGT. It is possible that this program controlled the decrease in physical functions at one year. This program provided an opportunity to begin and continue exercise training, because more than half of the subjects who did not previously exercise regularly continued resistance training.
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Ryutaro Takahashi
2006 Volume 43 Issue 3 Pages
375-382
Published: May 25, 2006
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Aim: To define degree of nutritional risk in community-dwelling older disabled adults using translated Nutrition Screening Initiative (NSI) checklist and to identify important underlying factors associated with high nutritional risk.
Methods: Community-based studies were conducted in Katsushika, Tokyo and Odate and Tashiro, Akita. A total of 695 and 381 older adults, respectively, designated for long-term care insurance were interviewed. Nutritional risk was measured using the Japanese-translated NSI checklist. Demographic information, ADL, IADL, MMSE, CES-D, PGC morale scale, self perceived health, loneliness, perceived caregiver's care burden, relationship with caregiver, perceived inadequacy of income, perceived burden of care cost were assessed using standardized instruments.
Results: Self-perceived health strongly related to high NSI score in both areas. Nutritional risk was considered ‘high’ when simply added NSI score was 3 points and over (NSI-10) and weighed NSI score was 6 points and over (NSI-21). Logistic regression analysis demonstrated that high levels of depression symptoms, poor self-perceived health, female and area (Odate/Tashiro) were associated with NSI-10-based high risk and high levels of depression symptoms, smaller family member, perceived inadequacy of income and area (Odate/Tashiro) were associated with NSI-21-based high risk. These results were completely same when CES-D scores were replaced with PGC morale scale scores.
Conclusion: It is concluded that emotional well-being is the important factor for maintaining nutritional environment in community-dwelling disabled older adults.
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Erkang Yu, Junichiro Mera, Masahiro Iijima, Kumiko Fujita, Fumio Eto
2006 Volume 43 Issue 3 Pages
383-389
Published: May 25, 2006
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Aim: The purpose of this study was to investigate the related factors of the health-related quality of life (HRQOL) measured by KDQOL-SF
TM version 1.3 (Japanese version) in chronic hemodialysis patients.
Methods: Using a cross-sectional survey design, we hand-delivered a self-administered questionnaire to the chronic hemodialysis patients and finally obtained 67 subjects' data to analyze. The response rate was 65.7%. Among the related factors, disease/dialysis-related factors and rehabilitation-related factors in addition to demographic factors were examined. The HRQOL was divided into a physical component summary (PCS) and a mental component summary (MCS).
Results: Multiple linear regression analysis revealed that the independent factors related to PCS were symptom score, serum albumin level, patients' satisfaction with dialysis care, and the work status. These four factors could explain 60% of PCS variance (adjusted R
2=0.601). The independent factors related to MCS were revealed to be quality of social interaction and understanding of effectiveness of self-exercise. These two factors could explain only a quarter of MCS variance (adjusted R
2=0.223).
Conclusion: These results suggest that highly satisfactory care of dialysis, improvement of dialysis-related symptoms, and good nutritional management are important for improving HRQOL in chronic hemodialysis patients, and that the promotion of social participation and interpersonal relationships as well as a positive attitude to self-exercise may lead to a beneficial outcome of rehabilitation for chronic hemodialysis patients.
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Hidenori Yano, Guang Yang, Saeko Wakai, Hideki Shimanuki, Kinue Nakaji ...
2006 Volume 43 Issue 3 Pages
390-397
Published: May 25, 2006
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Aim: To assess the effectiveness of ability grouping in a fall prevention structured exercise program for elderly people.
Methods: We enrolled 124 subjects from among 2, 582 elderly people aged 70 to 84 years living in the Tsurugaya district in Sendai City. Exclusion criteria were 1) motor fitness scale (MFS) score 9 points or more, 2) severe sensory, cognitive, or 3) physical disorders, and 4) nursing care grade 2 or more. Those ranked in the lower fourth and in the upper 3 fourths of the timed up & go test (TUGT) were each randomly assigned to 3 groups. Subjects in groups A and B had an exercise program for lower and higher fitness subjects separately, whereas all subjects in group C underwent a single exercise program. The exercise program, once a week for 12 weeks, consisted of strength and stability training. TUGT, lateral reach (LR), leg power per body weight and MFS were measured after the intervention and compared with the baseline values.
Results: There were no difference in the baseline characteristics among the groups. For group A, no significant changes in physical fitness measures, for group B a small but significant deterioration in LR, and for group C a small but significant deterioration in LR and TUGT were observed. MFS score improved significantly in all groups.
Conclusion: Ability grouping appeared to be effective for a short term exercise program in maintaining the physical ability, but the effectiveness did not reach statistical significance in the randomized controlled design.
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Fumiyo Tamura, Takeshi Kikutani, Keiko Nishiwaki, Reiko Enomoto, Shige ...
2006 Volume 43 Issue 3 Pages
398-402
Published: May 25, 2006
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Aim: The purpose of this study was to examine whether the improvement of oral functions could prevent increase in the level of care needed in the elderly by analyzing the relationship between the level of care needed and labial functions.
Methods: The subjects were 114 elderly people who were healthy or needing care (44 men, 70 women; average age 81.3±6.3 years), all of whom maintained posterior occlusal support with their natural dentition and had no defect in front teeth. They were divided into four groups; Group 1: healthy elderly, Group 2: elderly requiring assistance or Care Category 1, Group 3: elderly requiring Care Categories 2 and 3, Group 4: elderly requiring Care Categories 4 and 5, according to the classification of certification of eligibility for long-term care by the Japanese Ministry of Health, Labor and Welfare. Water-repellent pressure sensors (PS-2KA, Kyowa Electric Co, Japan) were embedded in an acrylic plate. The device was used to measure the labial-closing pressure during 1-gram yogurt ingestion, the maximum labial pressure with effort and the reserve capacity of pressure. Drooling of food as feeding/swallowing dysfunction of the subjects was surveyed.
Results: 1) The mean value of labial pressure with effort was 296.4±153.9Pa, and that of the reserve capacity of labial pressure was 209.6±152.3Pa. They showed significant declines in accordance with the aggravation level of needing care (p<0.01). 2) The labial pressure with effort and the reserve capacity of pressure in subjects who showed drooling of food symptom were significantly lower compared to those who showed no drooling of food symptom (p<0.05).
Conclusion: Labial functions declined in accordance with the increased level of care needed, and a relationship between drooling of food and labial-closing pressure was recognized. It was suggested that the improvement of labial functions might prevent increased need of care.
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2006 Volume 43 Issue 3 Pages
403-410
Published: May 25, 2006
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