P183 Arterial stiffness was inversely associated with left ventricular diastolic function in indigenous Papuan populations

Background

Age-related increase in systolic pressure is known to be absent in indigenous Papuan populations, partially because of their life-long low-sodium and high-potassium diets.

Purpose

The aim of this study was to investigate the age-related change in left ventricular (LV) systolic and diastolic function and the relationship with arterial hemodynamics among the indigenous Papuan highland people. 

Methods

Indices of arterial hemodynamics were measured using oscillometric brachial cuff-based sphygmomanometer (Mobil-O-Graph). Brachial-ankle pulse wave velocity (baPWV) was measured using a semiautomatic device (form ABI/baPWV). LV systolic and diastolic function was evaluated by 2-dimensional echocardiography and tissue-Doppler imaging using Vivid iq.

Results

A total of 81 native Papuans (median age 42 years, 47% women) were enrolled in this study. None of the subjects took any medicines, particularly antihypertensive drugs. All participants presented in sinus rhythm. With ageing, LV mass index remained unchanged, and LV ejection fraction increased, but mildly reduced (40–50%) in 3 participants. Transmitral E-wave velocity slightly decrease but the change was not significant. Transmitral A-wave velocity markedly increased (ρ=0.60, P < 0.001) and E/A ratio decreased with age (ρ=-0.52, P < 0.001). Age-related change of E-wave deceleration time was not significant. Septal e′ (ρ=-0.60, P < 0.001) and lateral e′ decreased (ρ=-0.53, P < 0.001) and average E/e′ increased with age (ρ=0.44, P < 0.001). Left atrial volume index did not change significantly with age. In multivariate regression analysis, baPWV was independently associated with E/e" ratio both before and after adjustment for age, sex, body mass index, mean arterial pressure, and heart rate; however, indices of wave reflection including augmentation index and reflection magnitude were not associated with E/e′. Only age and heart rate were inversely associated with E/A ratio. 

Conclusion

LV systolic function was preserved in indigenous Papuan populations; however, LV diastolic function decreased with ageing. Age-related arterial stiffening, not wave reflection, was inversely related to LV diastolic function.

Association between dental status and food diversity among older Japanese

OBJECTIVE

To investigate the relationship of dental status to food diversity among older Japanese.

DESIGN AND SETTING

A community-based cross-sectional study conducted in the town of Tosa, Kochi Prefecture, Japan.

METHODS

The study participants were 252 Japanese (84 men and 168 women, average age 81.2 years) and dentate participants were classified into three groups: 1-9 teeth, 10-19 teeth and 20 or more teeth. Food diversity was assessed as a validated measure of dietary quality using the 11-item Food Diversity Score Kyoto (FDSK-11), which evaluates frequency of consumption of 11 main food groups. Multivariable analysis of the differences in FDSK-11 score ranging from 0 to 11, with a higher score indicating greater food diversity, among the three dental status groups was conducted using general linear models. All the performed analyses were stratified by gender.

RESULTS

There was no association between dental status and food diversity score in models for men. In contrast, women with ≤ 9 teeth and with 10-19 teeth had significantly lower FDSK-11 scores than women with ≥ 20 teeth after adjusting for confounders (p < 0.001 and p = 0.009, respectively). Additionally, there was a trend toward lower scores for FDSK-11 with fewer teeth (p = 0.001).

CONCLUSION

A less varied diet, as indicated by low FDSK-11 score, was observed in female participants with fewer teeth. Tooth loss was associated with poor diet quality among older Japanese women.

Eating alone among community-dwelling Japanese elderly: association with depression and food diversity

Eating alone is an emerging social concern these days along with the background of serious aging population growth and increasing number of single-dwellers in Japan. However, little study is focused eating alone and its relation to the health status of community-dwelling elderly.

OBJECTIVES

To clarify the relations between eating alone and geriatric functions such as depression, quantitative subjective quality of life (QOL), activities of daily living (ADL) and dietary status of community-dwelling Japanese elderly.

DESIGN

A cross-sectional study.

SETTINGS

Tosa town, one of the "super-aged" towns in Japan.

PARTICIPANTS

The study population consisted of 856 community-dwelling elderly aged ≥65 living in Tosa town.

MEASUREMENTS

Eating alone and living arrangement was defined by the questionnaire. Geriatric functions were assessed by measuring activities of daily living (ADL), depressive symptom using 15-item geriatric depression scale (GDS-15), and quality of life (QOL). Food diversity was investigated as a measure of dietary quality using 11-item Food Diversity Score Kyoto (FDSK-11). Body mass index (BMI) was calculated using height and body weight during a medical assessment.

RESULTS

The proportion of the elderly who usually eat alone was 33.2% in this study population. Even among 697 elderly subjects who live with others, 136 persons (19.5%) ate alone. The participants who ate alone were significantly depressed according to the assessment using GDS-15 score (5.7±4.3 vs. 4.4±3.8, P<0.001). Those who ate alone have lower scores of QOL items than those who ate with others (Subjective sense of health: 52.5±21.9 vs. 55.7±20.2 P=0.035, Relationship with family: 74.1±23.5 vs. 78.9±18.6 P<0.001, Subjective happiness: 58.5±22.7 vs. 62.2±21.1 P=0.019). A significant close association was found between eating alone and lower food diversity (FDSK-11 score 9.9±1.3 vs. 10.2±1.3, P=0.002). BMI was lower in the elderly subjects who ate alone than those with others. By the multivariate analysis, depression was independently associated with eating alone in the logistic regression model adjusted for age, sex, BMI and food diversity as confounding factors (OR: 1.42, CI: 1.00-2.11, P=0.043). Food diversity was also significantly associated even after the adjustment of these confounding factors.

CONCLUSION

Eating alone is an important issue related to depression and QOL as well as dietary status of community-dwellingl elderly in Japan. This study shows the simple and inexpensive way "eating together" may contribute to improve depressive mood of elderly persons, with a strong message that supports of family, friends and neighbors are very important.

Common carotid intima-media thickness is predictive of all-cause and cardiovascular mortality in elderly community-dwelling people: Longitudinal Investigation for the Longevity and Aging in Hokkaido County (LILAC) study

Several cohort studies have examined the association of carotid intima-media thickness (IMT) with the risk of stroke or myocardial infarction in apparently healthy persons. We investigated the predictive value of IMT of cardiovascular mortality in elderly community-dwelling people, beyond the prediction provided by age and MMSE, assessed by means of a multivariate Cox model. Carotid IMT and plaque were evaluated bilaterally with ultrasonography in 298 people older than 75 years (120 men and 178 women, average age: 79.6 years). The LILAC study started on July 25, 2000. Consultations were repeated every year. The follow-up ended on November 30, 2004. During the mean follow-up span of 1152 days, 30 subjects (21 men and nine women) died. Nine deaths were attributable to cardiovascular causes (myocardial infarction: two men and three women; stroke: two men and two women). The age- and MMSE-adjusted relative risk (RR) and 95% confidence interval (95% CI) of developing all-cause mortality was assessed. A 0.3 mm increase in left IMT was associated with a RR of predicted 1.647 (1.075-2.524), and a similar increase in right IMT with a RR of 3.327 (1.429-7.746). For cardiovascular mortality, the corresponding RR values were 2.351 (1.029-5.372) and 2.890 (1.059-7.891), respectively. Carotid IMT assessed by ultrasonography is positively associated with an increased risk of all-cause and cardiovascular death in elderly community-dwelling people.

Effect of aging on blood pressure in Leh, Ladakh, a high-altitude (3524 m) community, by comparison with a Japanese town

The effect of aging on blood pressure (BP) and heart rate (HR) was investigated in a cross-sectional study in the high-altitude community of Leh, Ladakh (altitude: 3524 m) and a Japanese community in U town, Hokkaido (altitude: 25 m). BP and HR were obtained in a sitting position from 332 subjects 13-81 years of age in Ladakh, and from 216 Japanese citizens, 24-79 years of age. Measurements were taken after a 2-min rest, using a semi-automated BP device (UA-767 PC, A and D Co. LTD, Tokyo). High-altitude people showed higher diastolic BP and HR values than lowland people (83.2 vs. 76.9 mmHg and 78.6 vs. 69.2 bpm, P < 0.001), but no difference in systolic BP. Highland people also showed a steeper BP increase with age than the lowland people (systolic BP: 0.7476 vs. 0.3179 mmHg/year, P < 0.0005; diastolic BP: 0.3196 vs. 0.0750 mmHg/year, P < 0.001). This chronoecologic investigation in Ladakh examined the circulation as a physiological system at high-altitude. Our data indicate the need for a more comprehensive cardiovascular assessment for a better diagnosis and a more fruitful treatment. Longitudinal observations of effects of socio-ecologic factors on the cardiovascular system should help prevent strokes and other cardiovascular events, especially at high altitude.

Depressive mood is independently related to stroke and cardiovascular events in a community

By means of a multivariate Cox model, we investigated the predictive value of a depressive mood on vascular disease risk in middle-aged community-dwelling people. In 224 people (88 men and 136 women; mean age: 56.8 +/- 11.2 years) of U town, Hokkaido (latitude: 43.45 degrees N, longitude: 141.85 degrees E), a chronoecological health watch was started in April 2001. Consultations were repeated every 3 months. Results at the November 30, 2004 follow-up are presented herein. 7-day/24-h blood pressure (BP) and heart rate (HR) monitoring started on a Thursday, with readings taken at 30-min intervals between 07:00 h and 22:00 h and at 60-min intervals between 22:00 h and 07:00 h. Data stored in the memory of the monitor (TM-2430-15, A and D company, Japan) were retrieved and analyzed on a personal computer with a commercial software for this device. Subjects were asked to answer a self-administered questionnaire inquiring about 15 items of a depression scale, at the start of study and again after 1-2 years. Subjects with a score higher by at least two points at the second versus first screening were classified as having a depressive mood. The other subjects served as the control group. The mean follow-up time was 1064 days, during which four subjects suffered an adverse vascular outcome (myocardial infarction: one man and one woman; stroke: two men). Among the variables used in the Cox proportional hazard models, a depressive mood, assessed by the Geriatric Depression Scale (GDS), as well as the MESOR of diastolic (D) BP (DBP-MESOR) and the circadian amplitude of systolic (S) BP (SBP-Amplitude) showed a statistically significant association with the occurrence of adverse vascular outcomes. The GDS score during the second but not during the first session was statistically significantly associated with the adverse vascular outcome. In univariate analyses, the relative risk (RR) of developing outcomes was predicted by a three-point increase in the GDS scale (RR = 3.088, 95% CI: 1.375-6.935, P = 0.0063). Increases of 5 mmHg in DBP-MESOR and of 3 mmHg in SBP-Amplitude were associated with RRs of 2.143 (95% CI: 1.232-3.727, P = 0.0070) and 0.700 (95% CI: 0.495-0.989, P = 0.0430), respectively. In multivariate analyses, when both the second GDS score and the DBP-MESOR were used as continuous variables in the same model, GDS remained statistically significantly associated with the occurrence of cardiovascular death. After adjustment for DBP-MESOR, a three-point increase in GDS score was associated with a RR of 2.172 (95% CI: 1.123-4.200). Monday endpoints of the 7-day profile showed a statistically significant association with adverse vascular outcomes. A 5 mmHg increase in DBP on Monday was associated with a RR of 1.576 (95% CI: 1.011-2.457, P = 0.0446). The main result of the present study is that in middle-aged community-dwelling people, a depressive mood predicted the occurrence of vascular diseases beyond the prediction provided by age, gender, ABP, lifestyle and environmental conditions, as assessed by means of a multivariate Cox model. A depressive mood, especially enhanced for 1-2 years, was associated with adverse vascular outcomes. Results herein suggest the clinical importance of repetitive assessments of a depressive mood and the need to take sufficient care of depressed subjects. Another result herein is that circadian and circaseptan characteristics of BP variability measured 7-day/24-h predicted the occurrence of vascular disease beyond the prediction provided by age, gender, depressive mood and lifestyle, as assessed by means of a multivariate Cox model. Earlier, we showed that the morning surge in BP on Mondays was statistically significantly higher compared with other weekdays. Although a direct association between the Monday surge in BP and cardiovascular events could not be demonstrated herein, it is possible that the BP surge on Monday mornings may also trigger cardiovascular events. We have shown that depressive people exhibit a more prominent circaseptan variation in SBP, DBP and the double product (DP) compared to non-depressed subjects. In view of the strong relation between depression and adverse cardiac events, studies should be done to ascertain that depression is properly diagnosed and treated. Chronodiagnosis and chronotherapy can reduce an elevated blood pressure and improve the altered variability in BP and HR, thus reducing the incidence of adverse cardiac events. This recommendation stands at the basis of chronomics, focusing on prehabilitation in preference to rehabilitation, as a public service offered in several Japanese towns.

Arterial stiffness independently predicts cardiovascular events in an elderly community — Longitudinal Investigation for the Longevity and Aging in Hokkaido County (LILAC) study

We investigated the predictive value of arterial stiffness to assess cardiovascular risk in elderly community-dwelling people by means of a multivariate Cox model. In 298 people older than 75 years (120 men and 178 women, average age: 79.6 years), brachial-ankle pulse wave velocity (baPWV) was measured between the right arm and ankle in a supine position. The LILAC study started on July 25, 2000, consultation was repeated yearly, and the last follow-up ended on November 30, 2004. During this follow-up span of 1227 days, there were nine cardiovascular deaths, the cause of death being myocardial infarction for two men and three women or stroke for two men and two women. In Cox proportional hazard models, baPWV as well as age, Mini-Mental State Examination (MMSE), Hasegawa Dementia Scale Revised (HDSR) and the low-frequency/high-frequency (LF/HF) ratio showed a statistically significant association with the occurrence of cardiovascular death. A two-point increase in MMSE and HDSR score significantly protected against cardiovascular death, the relative risk (RR) being 0.776 (P = 0.0369) and 0.753 (P = 0.0029), respectively. The LF/HF ratio also was significant (P = 0.025), but the other indices of HRV were not. After adjustment for age and HDSR, a 200 cm/s increase in baPWV was associated with a 30.2% increase in risk (RR = 1.302, 95% CI: 1.110-1.525), and a 500 cm/s increase in baPWV with a 93.3% increase in risk (RR = 1.933, 95% CI: 1.300-2.874, P = 0.0011), whereas the LF/HF ratio was no longer associated with a statistically significant increase in cardiovascular mortality. In elderly community-dwelling people, arterial stiffness measured by means of baPWV predicted the occurrence of cardiovascular death beyond the prediction provided by age, gender, blood pressure and cognitive functions. baPWV should be added to the cardiovascular assessment in various clinical settings, including field medical surveys and preventive screening. The early detection of risk by chronomics allows the timely institution of prophylactic measures, thereby shifting the focus from rehabilitation to prehabilitation medicine, as a public service to several Japanese towns.

Chronoecological health watch of arterial stiffness and neuro-cardio-pulmonary function in elderly community at high altitude (3524 m), compared with Japanese town

Effects of high altitude on arterial stiffness and neuro-cardio-pulmonary function were studied. Blood pressure (BP) and heart rate (HR) were measured in a sitting position on resting Ladakhis, living at an altitude of 3250-4647 m (Phey village, 3250 m: 17 men and 55 women; Chumathang village, 4193 m: 29 men and 47 women; Sumdo village, 4540 m: 38 men and 57 women; and Korzok village, 4647 m: 84 men and 70 women). The neuro-cardio-pulmonary function, including the Kohs block design test, the Up and Go, the Functional Reach and the Button tests, was examined in 40 elderly subjects (19 men and 21 women, mean age: 74.7 +/- 3.3 years) in Leh, Ladakh (altitude: 3524 m), for comparison with 324 elderly citizens (97 men and 227 women, mean age: 80.7 +/- 4.7 years) of Tosa, Japan (altitude: 250 m). Cardio-Ankle Vascular Index (CAVI) was measured as the heart-ankle pulse wave velocity (PWV) in these subjects using a VaSera CAVI instrument (Fukuda Denshi, Tokyo). SpO(2) decreased while Hb and diastolic BP increased with increasing altitude. At higher altitude, residents were younger and leaner. Women in Leh vs. Tosa had a poorer cognitive function, estimated by the Kohs block design test (3.7 +/- 3.6 vs. 16.4 +/- 9.6 points, P < 0.0001) and poorer ADL functions (Functional Reach: 13.7 +/- 7.0 cm vs. 25.3 +/- 8.7 cm, P < 0.0001; Button test: 22.5 +/- 4.8 vs. 14.8 +/- 5.7 s, P < 0.0001). Time estimation was shorter at high altitude (60-s estimation with counting: 41.1% shorter in men and 23.0% shorter in women). A higher voltage of the QRS complex was observed in the ECG of Leh residents, but two times measurement of CAVI showed no statistically significant differences between Leh and Tosa (two times of CAVI measures; 9.49 vs. 10.01 m/s and 9.41 vs. 10.05 m/s, respectively), suggesting that most residents succeed to adapt sufficiently to the high-altitude environment. However, correlation of CAVI with age shows several cases who show an extreme increase in CAVI. Thus, for the prevention of stroke and other adverse cardiovascular outcomes, including dementia, CAVI may be very useful, especially at high altitude. In conclusion, elderly people living at high altitude have a higher risk of cardiovascular disease than low-latitude peers. To determine how these indices are associated with maintained cognitive function deserves further study by the longitudinal follow-up of these communities in terms of longevity and aging in relation to their neuro-cardio-pulmonary function.

Fractal analysis of heart rate variability and mortality in elderly community-dwelling people — Longitudinal Investigation for the Longevity and Aging in Hokkaido County (LILAC) study

AIM

Fractal analysis of heart rate (HR) variability (HRV) has been used as a new approach to evaluate the risk of mortality in various patient groups. Aim of this study is to examine the prognostic power of detrended fluctuation analysis (DFA) and traditional time- and frequency-domain analyses of HR dynamics as predictors of mortality among elderly people in a community.

METHODS

We examined 298 people older than 75 years (average age: 79.6 years) and 1-h ambulatory ECG was monitored. During the last 10 min, deep respiration (6-s expiration and 4-s inspiration) was repeated six times in a supine position. Time-domain and frequency-domain measures were determined by the maximum entropy method. Scaling exponents of short-term (<11 beats, alpha 1) and longer-term (>11 beats, alpha 2) were determined by the DFA method. Six estimates, obtained from 10-min segments, were averaged to derive mean values for the entire recording span. These average values were denoted Alpha 1 and Alpha 2, estimates obtained during the first 10-min segment Alpha 1 S and Alpha 2 S, and those during the last 10-min segment Alpha 1E and Alpha 2E, respectively. The LILAC study started on July 25, 2000 and ended on November 30, 2004. We used Cox regression analysis to calculate relative risk (RR) and 95% confidence interval (CI) for all-cause mortality. Significance was considered at a value of P < 0.05.

RESULTS

Gender, age and Alpha 2E showed a statistically significant association with all-cause mortality. In univariate analyses, gender was significantly associated with all-cause mortality, being associated with a RR of 3.59 (P = 0.00136). Age also significantly predicted all-cause mortality and a 5-year increase in age was associated with a RR of 1.49 (P = 0.01809). The RR of developing all-cause mortality predicted by a 0.2-unit increase in Alpha 2E was 0.58 (P = 0.00390). Other indices of fractal analysis of HRV did not have predictive value. In multivariate analyses, when both Alpha 2E and gender were used as continuous variables in the same model, Alpha 2E remained significantly associated with the occurrence of all-cause mortality (P = 0.02999). After adjustment for both gender and age, a 0.2-unit increase in Alpha 2E was associated with a RR of 0.61 (95% CI: 0.42-0.90, p = 0.01151).

CONCLUSION

An intermediate-term fractal-like scaling exponent of RR intervals was a better predictor of death than the traditional measures of HR variability in elderly community-dwelling people. It is noteworthy that the longer-term (alpha 2) rather than the short-term fractal component (alpha 1) showed predictive value for all-cause mortality, which suggests that an increase in the randomness of intermediate-term HR behavior may be a specific marker of neurohumoral and sympathetic activation and therefore may also be associated with an increased risk of mortality.

Laparoscopic cholecystofistulectomy for preoperatively diagnosed cholecystoduodenal fistula

The presence of cholecystoduodenal fistula, a rare condition, has been one of the reasons for conversion from laparoscopic cholecystectomy to open cholecystectomy. Here we report a patient with cholecystocholedocholithiasis complicated by cholecystoduodenal fistula, diagnosed preoperatively and treated by combined endoscopic sphincterotomy and laparoscopic cholecystofistulectomy. After the removal of multiple bile-duct stones by endoscopic sphincterotomy, the patient underwent laparoscopic cholecystofistulectomy. We were able to resect the fistula without cleavage, using an endoscopic linear stapling device, because we had been able to confirm the site of the fistula preoperatively. The patient's postoperative course was uneventful. We conclude that laparoscopic cholecystofistulectomy by skilled laparoscopic surgeons can be adopted as a first-choice treatment for cholecystoduodenal fistula.

[The comparison of blood pressure of community-dwelling elderly subjects in Okinawa and Shikoku]

In Japan hypertension is frequent, but the prevalence of hypertension in Okinawa has been known to be lower than in other areas in Japan. Now it has been almost 30 years since Okinawa reverted to Japan. So we investigated to know whether the prevalence of hypertension was still lower today or not. We compared the differences of prevalence of hypertension and blood pressure (BP) levels between the two community-dwelling elderly subjects aged 75 years or more: 305 in Ie in Okinawa (M:F = 107:198, mean age: 81 years old), and 99 in Omogo in Ehime, Shikoku (M:F = 45:54, mean age: 81 years old). We visited the homes of the elderly and measured their BP twice in a sitting position and asked them whether they were taking medicine for hypertension or not. According to the 1999 revised guidelines on the treatment of hypertension in the elderly by the Japanese Society of Geriatrics, we defined hypertension as systolic BP (SBP) > or = 160 mmHg or diastolic BP (DBP) > or = 90 mmHg or taking medicine for hypertension, and normotension as SBP < 160 mmHg and DBP < 90 mmHg and not taking medicine for hypertension. Hypertension rates were 52% in Ie, and 59% in Omogo, indicating no significant difference. However, in Ie only 54% of the elderly with hypertension were taking medicine for hypertension, as opposed to 74% in Omogo. These results suggest the possibility that in Okinawa hypertension is thought to be less important than in other districts in Japan.

A U-shaped association between home systolic blood pressure and four-year mortality in community-dwelling older men

BACKGROUND

Several studies in older people have found a U-shaped or J-shaped association of blood pressure with mortality. The increased mortality associated with the lowest levels of blood pressure in older people have been explained by concurrent illnesses and frailty, but previous studies used blood pressure measured on a single occasion. Such a casual value is different from the long-term average of blood pressure. We investigated the relation between the average level of 5-day consecutive home blood pressure and mortality in older people while adjusting for potential confounding factors including morbidity and frailty at baseline.

METHODS

In 1992, 1186 community residents of a rural Japanese town, Kahoku, aged 65 or older, measured their blood pressure in their homes 20 times (four times per day, 5 consecutive days). The mean value of the 20 measurements was used to examine the association between home BP and subsequent 4-year mortality. A proportional hazards model was fitted while adjusting for activities of daily living impairment, medical history, antihypertensive medication, smoking, use of alcohol, and depression.

RESULTS

A total of 134 persons died during the four-year follow-up period. There was no significant evidence that frailty is more prevalent in the lowest or highest systolic BP group than in intermediate groups. A U-shaped association between the average level of home systolic blood pressure and mortality was found in men while adjusting for potential confounding factors, including morbidity and frailty. We also showed the U-shaped curve of the association of systolic BP with all cause and noncardiovascular mortality in the whole population and the linear association of systolic BP with cardiovascular mortality.

CONCLUSIONS

We showed a U-shaped association between the average level of systolic blood pressure measured at home and mortality in older men while adjusting for potential confounding factors including morbidity and frailty. Not only high home systolic BP, but also low home systolic BP, is an independent risk factor for mortality in older men. The mechanisms underlying the association between BP and mortality differ by levels of systolic BP. Cardiovascular deaths tended to be higher in the highest SBP group, and only noncardiovascular deaths were increased in the lowest SBP group. The latter finding suggests that low SBP may be not only an independent risk of mortality but also an indicator of a subclinical noncardiovascular comorbid condition.

Immunohistochemical localization of tryptophan hydroxylase in the human and rat gastrointestinal tracts

Because few previous studies have shown the immunohistochemical localization of tryptophan 5-hydroxylase (TPH) in the gastrointestinal tract, we developed a specific antibody against TPH purified from mouse mastocytoma P-815 and stained human and rat gastrointestinal tracts. The specificity of the antibody was examined by Western blotting and by immunohistochemistry in brain sections. Human ileum and colon specimens, rat stomach, duodenum, jejunum, ileum and colon specimens, with and without colchicine treatment were prepared for immunohistochemistry. Immunoelectron microscopic double staining of TPH and serotonin/chromogranin A and immunofluorescence double staining of TPH and serotonin were performed to identify the cell types. Epithelial enterochromaffin (EC) cells, mast cells in the lamina propria and submucosa, and varicose fibers in the submucosa and muscle layer showed positive immunoreactivity in all segments examined from human and normal rat specimens. In colchicine-treated rat specimens, nerve cell bodies in the myenteric plexus were stained. Because the antibody does not cross react with tyrosine hydroxylase as defined in Western blotting or brain sections, these positive structures may contain TPH. The present results show evidence that EC cells, mast cells, and nerve cell bodies and fibers in the gastrointestinal tracts of both the human and the rat contain TPH and therefore may have the ability to synthesize serotonin from tryptophan.

Immunoelectron microscopic study of the luminal release of chromogranin A from rat enterochromaffin cells

Recently we found that raising the intraluminal pressure caused an increase in the luminal release of serotonin from enterochromaffin (EC) cells and serotonin immunoreactivity normally restricted within the secretory granules was diffusely scattered over the extragranular matrix. In the present study we investigated the intracellular localization of chromogranin A, a protein co-stored with serotonin in the EC cells, after stimulating the luminal release of serotonin. In situ vascularly and luminally perfused rat duodenum was exposed to intraluminal pressure and fixed for immunoelectron microscopic study. For immunoelectron microscopy, the pre-embedding DAB reaction for serotonin combined with the postembedding immunogold reaction for chromogranin A was used. Results showed that a number of secretory granules labeled with immunogold chromogranin A immunoreactivity located close to the apical plasma membrane. Some EC cells showed that one part of the apical cytoplasm was protruded into the lumen and a number of secretory granules with immunogold labeling were included in the protruded cytoplasm. These results suggest that EC cells may release chromogranin A into the intestinal lumen together with serotonin, by means of a different manner of secretion from that in serotonin.

Post-stroke hypertension correlates with neurologic recovery in patients with acute ischemic stroke

To examine the clinical implications of post-stroke hypertension, defined as the rise in blood pressure on admission after the onset of ischemic stroke as compared with the blood pressure before stroke, and to assess the relationship between the value of post-stroke hypertension and neurologic recovery, we retrospectively studied 28 patients admitted to the hospital within 24 h (mean+/-SD, 6.7+/-7.0 h) after a first-ever, acute non-embolic ischemic stroke, whose blood pressure had been recorded at the outpatient clinic within 3 mo before stroke. The Canadian Neurological Scale was used to assess stroke severity, and neurologic recovery during the acute phase was calculated. The average duration of hospitalization was 18+/-9 d. The value of post-stroke hypertension and stroke severity on admission independently and significantly correlated with neurologic recovery (odds ratio, 1.06; 95% confidence interval, 1.00-1.12 and odd ratio, 0.20; 95% confidence interval, 0.06-0.72, respectively). There was also a significant linear correlation between the value of post-stroke hypertension and neurologic recovery (r= 0.50, p< 0.01). Furthermore, blood pressure after the onset of ischemic stroke was quite independent of blood pressure before stroke. We conclude that the value of post-stroke hypertension correlates with neurologic recovery in patients with acute non-embolic ischemic stroke. These results suggest that blood pressure control mechanisms change after the onset of acute ischemic stroke.

Immuno-electron microscopic study of differential localization of motilin and serotonin in the rabbit duodenal epithelium

A guinea pig antibody against rabbit motilin was generated to study the localization of motilin-containing cells in the rabbit small intestine with special reference to the co-localization of motilin and serotonin. A pre- and post-embedding technique for immuno-electron microscopy was used; duodenal sections were stained with either motilin or serotonin in the pre-embedding DAB-nickel reaction, followed by subsequent staining of ultrathin sections of positive cells with either motilin or serotonin in the post-embedding immunogold reaction. Samples were divided into four groups: 1) pre-motilin, post-motilin, 2) pre-motilin, post-serotonin, 3) pre-serotonin, post-serotonin, and 4) pre-serotonin, post-motilin. Motilin-containing cells in the rabbit duodenum were characterized by round granules (395.3 +/- 66.1 nm in diameter) with medium electron density, located basally or in the perinuclear cytoplasm. In contrast, serotonin-containing cells were characterized by round to pleomorphic secretory granules (344.5 +/- 90.5 nm in diameter with electron dense cores and prominent halos. In motilin-containing cells, massive aggregations of immunogold particles reacted to motilin occurred over secretory granules. A few immunogold particles scattered diffusely over the cytoplasm reacted to serotonin; however, this reaction appeared to be background staining because the density was not changed if the section was treated by preabsorption. In serotonin-containing cells, immunogold particles reacted to serotonin were aggregated over the secretory granules and a large number of gold particles were scattered diffusely at the extragranular cytoplasm; however, very few or no immunogold particles were observed within the cells which reacted to motilin. Results of the present study indicate that motilin and serotonin are not co-localized in the epithelial endocrine cells of the rabbit intestine.

Postural dysregulation in systolic blood pressure is associated with worsened scoring on neurobehavioral function tests and leukoaraiosis in the older elderly living in a community

BACKGROUND AND PURPOSE

Postural hypotension, which occurs frequently in community-living, apparently healthy elderly adults, is usually asymptomatic. However, the relation between postural changes in blood pressure and quantitative higher cerebral function or silent brain lesions remains unclear. We examined the association of exaggerated postural changes in systolic blood pressure with cognitive and quantitative neurobehavioral functions and with brain lesions on MRI in the community-dwelling older elderly.

METHODS

The study population consisted of 334 community-dwelling elderly adults, aged 75 years or older (mean age, 80 years). Postural changes in systolic blood pressure (SBP) were assessed using an autosphygmomanometer (BP-203 I). By the difference between the mean of two measurements of SBP at standing and at supine position (dSBP = SBP at upright-SBP at supine position), we divided the subjects into three groups: (1) 20 subjects with postural hypotension (d-SBP < or = -20 mm Hg), (2) 29 subjects with postural hypertension (dSBP > or = 20 mm Hg), and (3) 285 subjects with postural normotension (20 < dSBP < 20 mm Hg). We defined the former two groups as the postural dysregulation group. Scores in four neurobehavioral function tests (Mini-Mental State Exam. Hasegawa Dementia Scale Revised, computer-assisted visuospatial cognitive performance score, and the Up and Go Test) and activities of daily living were compared among the three groups. Brain lesions on MRI, including number of lacunes and periventricular hyperintense lesions, were compared among 15 age- and sex-matched control subjects with postural hypotension, 15 with postural hypertension, and 30 with postural normotension.

RESULTS

Twenty subjects (6.0%) exhibited postural hypotension and 29 (8.7%) postural hypertension. Scores in neurobehavioral functions and activities of daily living were significantly lower in the postural dysregulation group (both postural hypotension and hypertension groups) than in the postural normotension group. The postural dysregulation group exhibited significantly more advanced periventricular hyperintensities than the normotension group.

CONCLUSIONS

Asymptomatic community dwelling elderly individuals with postural hypotension as well as those with postural hypertension had poorer scores on neurobehavioral function tests and more advanced leukoaraiosis demonstrated on MRI than those without exaggerated postural changes in SBP.

Immunoelectron microscopic study of the luminal release of serotonin from rat enterochromaffin cells induced by high intraluminal pressure

Since definitive morphological studies showing the luminal release of serotonin have not been reported, we used a perfused system which allows physiological monitoring and biochemical as well as morphological evidence indicating release of serotonin from enterochromaffin cells. Isolated vascularly and luminally perfused rat duodenums exposed to 5-35 cmH2O of luminal pressure were measured for release of serotonin into the blood vessels and intestinal lumen. Immediately after raising the luminal pressure, the duodenum was fixed for immunoelectron microscopic localization of serotonin. Peristaltic contraction and serotonin content of the perfusates were continuously measured. The luminal release of serotonin increased with elevated intraluminal pressure, but the vascular release of serotonin was not altered. Tetrodotoxin had no effect on the pressure-stimulated luminal serotonin release. Enterochromaffin cells in control animals without increased luminal pressure contained immunogold-labeled secretory granules in the apical and basal cytoplasm. After intraluminal pressure increased, many apical secretory granules were no longer dense and immunogold particles were localized over the cytoplasmic matrix and microvilli. These findings indicate that luminal serotonin release is increased after raising the intraluminal pressure and serotonin, normally stored in the secretory granules of enterochromaffin cells, appears to be released into the cytoplasmic matrix and then diffuses or is transported into the intestinal lumen.

Distribution of serotonin-immunoreactive nerve cells and fibers in the rat gastrointestinal tract

The distribution of serotonin-immunoreactive (5HT-IR) nerve cells and fibers was thoroughly investigated immunohistochemically in the rat stomach, duodenum, jejunum, ileum, and colon. The immunoreactivity of the 5HT neurons was compared between non-treated controls and animals treated with colchicine, colchicine plus 5-hydroxytryptophan (5HTP), colchicine plus pargyline, and reserpine. The intensity of immunoreactivity in nerve fibers as well as nerve cell bodies was enhanced mostly in colchicine plus pargyline treated animals, therefore these animals were used for an observation of precise localization of 5HT in the rat gastrointestinal (GI) tract. Immunoreactivity in the nerve cell bodies and fibers was completely abolished in the GI tract of reserpine treated animals. The pattern of localization and projection of 5HT-IR neurons was similar in all segments of the rat GI tract: 5HT-IR nerve cell bodies were located in the myenteric plexus and showed the distinctive features of Dogiel type I neurons. Prominent bundles of varicose fibers traversed the myenteric ganglia and some of them surrounded the cell bodies of immunopositive and immunonegative neurons. 5HT-IR nerve fibers were located in the submucous plexus, densely entwined about the submucosal blood vessels. Most characteristically, 5HT-IR nerve fibers invaded the lamina propria of mucosa where they underlay the crypt epithelium. In conclusion, the present study showed that 5HT-IR neurons located in the myenteric plexus projected fibers widely in the rat GI tract. The localization of fibers in the lamina propria of mucosa implies that this neuron may exert an important role in the epithelial function of the GI tract.

Effects of exercise on neurobehavioral function in community-dwelling older people more than 75 years of age

OBJECTIVE

We evaluated the effects of exercise on neurobehavioral function in healthy older people more than 75 years of age.

DESIGN

A randomized controlled trial with 6-month follow-up was conducted.

SETTING

The study was performed in the rural town of Kahoku, Japan, the population of which is considered representative of the older population of Japan.

PARTICIPANTS

We studied 42 healthy volunteers (18 men and 24 women; mean age, 79 years (range 75 to 87 years)) who were randomly assigned to one of two groups, exercise or control.

INTERVENTION

Subjects assigned to the exercise group were instructed to exercise for 60 minutes twice a week for 6 months. Subjects in the control group were not instructed to engage in an specific exercise regimen.

MEASUREMENTS

The following measurements were recorded for both groups at baseline and at 6-month follow-up: (1) Neurobehavioral function as determined by the following tests: Mini-Mental State Exam (MMSE), Hasegawa Dementia Scale Revised (HDSR), Visuospatial Cognitive Performance Test (VCP-test), Button score, Up & Go test, and Functional Reach; and (2) Body mass index and blood pressure.

RESULTS

The effects of exercise were shown in the Up & Go test, and Functional Reach (ANOVA with repeated measures).

CONCLUSION

This study demonstrates the acceptability and effectiveness of exercise on neurobehavioral function, even in older people more than 75 years of age.

Change in subcellular localization of gastrin-like immunoreactivity in epithelial cells of rat duodenum induced by carbachol

The present study provides morphological evidence to support the contention of exocrine secretion from duodenal gastrin-containing cells. The isolated vascularly perfused duodenal preparation with or without carbachol stimulation was used. At the end of perfusion, tissue was fixed and prepared for electron microscopic examination. For immunoelectron microscopic study for gastrin, postembedding immunogold reaction combined with preembedding DAB staining was used. In saline-treated controls, DAB reaction was restricted to the basal cytoplasm and immunogold labeling was concentrated over electron-dense cores of secretory granules packed at the basal cytoplasm. However, in carbachol-stimulated animals, immunogold labeling as well as DAB reactions were accumulated at the apical portion of the cytoplasm, suggesting that a high concentration of gastrin was involved in the apical cytoplasm. In carbachol-stimulated cells, aggregation of small vesicles was observed beneath the microvilli, and most of these vesicles had no cores but were similar in size to the basal secretory granules. Immunogold particles were diffusely scattered at the cytoplasm outside these vesicles. These findings suggest that the gastrin-like immunoreactivity was pooled at the matrix of apical cytoplasm in carbachol-stimulated cells, which might be derived from the secretory granules migrated from the basal cytoplasm into apical portion of the cells. In conclusion, the present study demonstrated the change in subcellular localization of gastrin-like immunoreactivity in intestinal gastrin cells after stimulation with carbachol. Aggregation of immunoreactivity at the apical portion of the cells suggests that gastrin may be released into the intestinal lumen.

[Comparative study of activity of daily living in the elderly between in Kahoku and in Yaku]

A comparative community-based study of physical activity in the elderly was carried out between two Japanese rural towns, Kahoku and Yaku. This study included a questionnaire about activity of daily living (ADL) and information-related functions in relation to lifestyle. Subjects were all the eligible elderly aged over 65 years of each community (1618 and 704 subjects in Kahoku and Yaku respectively). The ratio of the eligible elderly aged over 65 years were 32% in Kahoku and 2% in Yaku. The response rates were 91% in Kahoku and 51% in Yaku. Common findings in both towns were as below; 1) scores in ADL decreased with advancing age, 2) information-related functions were similar in each town, and between genders, 3) marital condition among males was similar in both towns, 4) ADL scores were higher in the financially rich group than in the poor one, 5) ADL scores were higher in female subjects whose husbands were alive than in widows, 6) ADL scores were higher in subjects who walked every day than those who did not, 7) ADL scores were lower in subjects who took medicine every day than those who did not, however, this finding did not apply to antihypertensive drugs, 8) ADL scores were higher in subjects who drank in beverages than in those who never imbibed. The different results between Kahoku and Yaku were supposed to be due to differences in lifestyle.(ABSTRACT TRUNCATED AT 250 WORDS)

[Comparative study of neurobehavioral function in the elderly between in Kahoku and Yaku]

A comparative study of neurobehavioral functions in the elderly was carried out between two Japanese rural towns, Kahoku and in Yaku. To evaluate of neurobehavioral functions, we used 1) Mini Mental State Examination (MMS), 2) Hasegawa Dementia Scale Revised (HDSR), 3) Kohs block design test, 4) Visuospatial cognitive performance score (VCPS), 5) Button Score (Button-S), 6) Up & Go test, and 7) Functional reach (FR). A questionnaire about ADL, information-related function and lifestyle was also done. Subjects consisted of all the eligible 332 elderly aged over 75 in Kahoku and 194 elderly aged over 75 in Yaku. In Kahoku, each function test had a significant correlation with age. However, in Yaku, the Up & Go, FR, MMS and HDSR results showed no significant correlation with age. Scores in cognitive function tests such as MMS, VCPS, and the Kohs test were better in kahoku than in Yaku, although scores in behavioral function tests such as FR were better in Yaku than in Kahoku. MMS, HDSR and Kohs tests significantly correlated with information-related function while Button-S, Up Go and FR tests had significant correlation one with ADL in both areas. Scores on function tests were better in the living-alone group and the group who had a daily work than in other groups in Kahoku. However, differences in scores in function tests between these two types of groups failed to reach a level of significance in Yaku. These data suggested that the difference in life-style influenced neurobehavioral functions in the elderly.

[Comparative study of quality of life in the elderly between in Kahoku and in Yaku]

A comparative community-based study of quality of life (QOL) in the elderly was carried out between two Japanese rural towns, Kahoku and Yaku.QOL, which included the subjective sense of health, appetite, sleep at night, mood, memory, family relationships, friendship, economic condition, life satisfaction and happiness was assessed using a visual analogue scale (VAS) as well a Geriatric depression Scale (GDS), a variety of neurobehavioral function tests, and a questionnaire about activity of daily living (ADL). Subjects were all the eligible elderly aged over 75 years in both communities. Inter-rater reproducibility in VSA was more reliable than that in GDS. Life satisfaction and a subjective sense of happiness highly correlated with mood, family relationships, friendship and economic condition. GDS and VAS significantly correlated with family relationships, active participation in a group and economic condition, however, they did not correlated with age. The subjective sense of happiness correlated with ADL and steadiness of walk as assessed by neurobehavioral function tests. Living style correlated with VAS in the male elderly, but not female. Each score in VAS for family relationships, friendship, economic condition, life satisfaction and subjective sense of happiness was significantly higher in the elderly in Yaku than in Kohoku. The diseases which elderly people wanted to avoid were dimentia cancer, stroke, and cardiovascular disease in that order. In conclusion, QOL in the elderly population was influenced by disease, neurobehavioral functions, especially walking function, gender difference, lifestyle as well as cultural environment.

[Longitudinal change in independence in the elderly--Kahoku Longitudinal Aging Study (KLAS)]

A community based study named Kahoku Longitudinal Aging Study (KLAS) was conducted since 1990 for the purpose of evaluating the comprehensive geriatric functional assessment (CGA) and preventing a decline in CGA in the community-dwelling elderly population. It was carried out in a Japanese rural town, in which 32% of the population was over 65 years of age. This study included a questionnaire about activity of daily living (ADL), information-related physical function, mental (cognitive and affective) and social functional domains. In addition to subjective informative instruments, various types of objective assessment such as quantitative neuro-behavioral function tests and medical examinations were performed. Subjects were all the eligible elderly aged over 65 years in the community. Although the ratio of subjects who were independent in ADL decreased with advancing age in both 1991 and 1993, the ratio of the independent elderly in ADL became significant higher (74%) in 1993 than in 1991 (71%). Scores on 2 kinds of neurobehavioral function tests in the 159 subjects aged over 75 years who attended the examination every year showed a significant and slight decrease during two years. However, some test indices significantly improved during the 2 years. These results suggested that age-related dependency in ADL and some kind of neurobehavioral functions might be prevented, in part, by health promoting education and improvement of life style.

[Comparative study of blood pressure variability in the elderly in Kahoku and in Yaku]

A comparative community-based study of blood pressure (BP) variability in the elderly was carried out in the Japanese rural towns of Kahoku and Yaku. The prevalence of hypertension, orthostatic hypotension and use of antihypertensive drugs, effects of postute on BP and the "white coat" effect in BP were examined in each town. There was no difference in the prevalence of hypertension between in the two towns. Orthostatic increase in BP and pulse rate was more common in elderly females than in elderly males in both towns, indicating that standing itself was a load for subjects and activated sympathetic nervous tone in the female elderly. The prevalence of orthostatic hypotension was 8.5% and 12% in Kahoku and Yaku respectively, and the "white coat" effect on BP was demonstrated in the elderly in each town. In conclusion, we should take orthostatic change and the "white coat" effect into consideration in the evaluation of BP among the elderly.

[Comparative study of serum lipids and other blood chemistry factors in the elderly in Kahoku and Yaku]

A comparative community-based study of serum lipids and other blood chemistry data in the elderly was carried out in two Japanese rural towns, Kahoku and Yaku. We studied the following blood chemistry factors; total proteins (TP), albumin (Alb), blood glucose (glucose), urea nitrogen (BUN), uric acid (UA), total cholesterol (T-Cho), high density lipoprotein (HDL-C) and lipoprotein (a) (Lp(a)). Subjects were the 312 eligible elderly aged over 75 years in Kahoku, and 172 similar elderly in Yaku. There were no significant differences in TP, Alb, glucose, BUN and UA of the elderly in the two areas. Mean HDL-C level was significantly lower and mean Lp(a) concentration was significantly higher in the elderly in Kahoku than in Yaku, Mean value of T-Cho did not differ significantly between the elderly in the two areas, however, the ratio of subjects whose T-Cho concentrations were over 220 mg/dl was significantly higher in Kahoku than in Yaku. These data suggested that the risk of atherosclerosis from the standpoint of view of serum lipids was higher in the elderly in Kahoku than in those in Yaku. Epidemiological data of Kochi and Kagoshima prefecture indicated that the mortality ratio from ischemic heart disease was higher in Kahoku than in Yaku, although that from cerebral infarction was lower in Kahoku than in Yaku. Comparative study of laboratory data in various districts is useful to investigate the relationship between lifestyle and diseases.

Effect of reserpine on 5-hydroxytryptophan (5HTP)-immunoreactive neurons in the rat brain

By immunohistochemistry of rat brain in conjunction with a specific antibody against 5-hydroxytryptophan (5HTP), we examined immunoreactivity to 5HTP in neurons, from which 5-hydroxytryptamine (5HT; serotonin) was depleted by reserpine treatment. The distribution patterns of 5HTP-positive neurons overlapped with those of 5HT neurons. Treatment with reserpine (5 mg/kg, 90 min before death) caused a complete suppression of 5HT-positive staining, but 5HTP-immunostaining remained in perikarya of the nuclei raphe dorsalis, centralis superior and obscurus. Treatment with reserpine (25 mg/kg, 90 min before death) suppressed the 5HTP-immunoreaction in certain perikarya (e.g. of the nucleus raphe dorsalis) and fibres; however, 5HTP-immunostaining remained in perikarya of the nuclei centralis superior and raphe obscurus. This suggests that these neurons synthesize more 5HTP by a process which appears to be stimulated by reserpine.