Takaaki Asamura

Adiponectin in plasma and cerebrospinal fluid in MCI and Alzheimer's disease.

Background and purpose:  Life style‐related disorders such as hypertension, diabetes, dyslipidemia, and obesity are reported to be a great risk of dementia. Adipocytokines released from adipose tissue are thought to modulate some brain functions including memory and cognition. We here analysed adiponectin, one of the most important adipocytokines, in plasma and cerebrospinal fluid (CSF) from cognitive normal controls (NC), mild cognitive impairment (MCI) subjects, and patients with Alzheimer’s disease (AD) and discussed if/how adiponectin could relate to the pathogenesis of AD.

A Randomized, Single-Blind Study of Lansoprazole for the Prevention of Exacerbations of Chronic Obstructive Pulmonary Disease in Older Patients

OBJECTIVES: To investigate whether proton pump inhibitor (PPI) therapy reduces the frequency of common colds and exacerbations in patients with chronic obstructive pulmonary disease (COPD).

Impaired urge-to-cough in elderly patients with aspiration pneumonia

BackgroundThe down-regulation of the cough reflex in patients with aspiration pneumonia can involve both cortical facilitatory pathways for cough and medullary reflex pathways. In order to study the possible involvement of the supramedullary system in the down-regulation of cough reflex, we evaluated the urge-to-cough in patients with aspiration pneumonia.MethodsCough reflex sensitivity and the urge-to-cough to inhaled citric acid were evaluated in patients with at least a history of aspiration pneumonia and age-matched healthy elderly people. The cough reflex sensitivities were defined as the lowest concentration of citric acid that elicited two or more coughs (C2) and five or more coughs (C5). The urge-to-cough scores at the concentration of C2 and C5, and at the concentration of two times dilution of C2 (C2/2) and C5 (C5/2) were estimated for each subject.ResultsBoth C2 and C5 in the control subjects were significantly greater than those for patients with aspiration pneumonia. There were no significant differences in the urge-to-cough at C2 and C5 between control subjects and patients with aspiration pneumonia. However, the urge-to-cough scores at both C2/2 and C5/2 in patients with aspiration pneumonia were significantly lower than those in control subjects. The number of coughs at C5/2 was significantly greater in the control subjects than those in the patients with aspiration pneumonia whereas the number of coughs at C2/2 did not show a significant difference between the control subjects and the patients with aspiration pneumonia.ConclusionThe study suggests the involvement of supramedullary dysfunction in the etiology of aspiration pneumonia in the elderly. Therefore, restoration of the cough motivation system could be a new strategy to prevent aspiration pneumonia in the elderly.

Shelter-Acquired Pneumonia After a Catastrophic Earthquake in Japan

daily. Her swallowing reflex latency time normalized after ACE inhibitor treatment. She had been hospitalized three times because of COPD exacerbations in the previous year and experienced two exacerbations during the 6.1 years of follow-up. In addition to the regular treatment of COPD, ACE inhibitor treatment improved the swallowing reflexes of these individuals and reduced the frequency of COPD exacerbations (from 3 to 0.46 per year in case 1, and from 3 to 0.33 per year in case 2). The patients had not recognized their impaired swallowing reflexes, because they were on entirely oral diets without complaints of dysphagia and had no prior history of symptomatic stroke or oropharyngeal or esophageal abnormalities. Aspiration is associated with impairment of swallowing and cough reflex, which is mediated through substance P. ACE inhibitors decrease the catabolism of substance P, resulting in prevention of aspiration and protection against pneumonia in older adults. The findings of the current study suggest that ACE inhibitors protect against aspiration tracheobronchitis and exacerbations of COPD. ACE inhibitors have also been demonstrated to have beneficial effects on the heart, although the follow-up examination of these individuals, including electrocardiogram and echocardiogram, did not indicate a significant change. The blood pressure of these individual did not decrease significantly during the follow-up period. Although symptomatic hypotension has been reported to be rare, one should be careful about adverse effects of ACE inhibitor treatment in older adults. ACE inhibitor therapy is a potential option for preventing COPD exacerbations in selected individuals with impaired swallowing reflexes. Large randomized controlled clinical trials will be useful.

Low Serum 1,25-Dihydroxyvitamin D Level and Risk of Respiratory Infections in Institutionalized Older People

measured serum concentrations of 1,25dihydroxyvitamin D and albumin, performed a tuberculin skin test (TST), an indicator of cellular immunity [7] , and retrospectively assessed the incidence of both febrile respiratory illnesses and pneumonia [8] . Study participants more than 65 years of age were recruited from a long-term care facility in Sendai, Japan. They were resident in the facility for at least 6 months and were disabled because of cerebral infarction, but had no conditions known to interfere with VD metabolism [2] . Individuals were excluded if they had malnutrition, renal failure, hepatic failure, hyperor hypoparathyroidism, active tuberculosis, malignant diseases, or if they took corticosteroids or supplementary VD [2, 6] . A blood sample was drawn for baseline assay and a TST was performed according to the national guidelines [7, 9] , both in the elderly residents and in the nursing staff of the facility as a control. Serum levels of 1,25-dihydroxyvitamin D were determined by radioimmunoassay [10] . Since there is no consensus on the optimal serum levels of 1,25-dihydroxyvitamin D [2] , we divided the elderly residents into 2 To the Editor, Pneumonia is a common cause of death among older people despite the availability of potent new antimicrobials [1] . It might be quite important to find unknown risk factors for respiratory tract infections to prevent pneumonia in the elderly. Vitamin D (VD) is both a vitamin and a hormone and is recently reported to have diverse actions [2] . VD deficiency is especially common in institutionalized elderly people probably due to limited sun exposure, skin diseases and problems of dietary intake and is associated with hip fractures and higher mortality from life-threatening conditions such as cardiovascular diseases, cancer and diabetes mellitus [2–6] . Recently, 1,25-dihydroxyvitamin D, a biologically active form of VD, was reported to be a potent immune modulator of the adaptive immune system and to stimulate the innate immune response upon infection [2] . However, the clinical significance of endogenous 1,25-dihydroxyvitamin D has not been fully studied [2, 6] . The aim of this study was to examine whether VD deficiency correlates with depressed cellular immunity and increases susceptibility to respiratory tract infections among older residents of long-term care facilities. We Received: August 12, 2009 Accepted: December 4, 2009 Published online: January 12, 2010

Exhaled carbon monoxide levels in preschool-age children with episodic asthma.

Background:  The concentration of exhaled carbon monoxide (eCO) in young children with stable asthma and during acute asthma attack is not known.

Contents Vol. 56, 2010

Behavioural Science Section K.J. Anstey, Canberra L. Clare, Bangor D. Gerstorf, University Park, Pa. J.D. Henry, Sydney T. Hess, Raleigh, N.C. S.M. Hofer, Victoria I. Kryspin Exner, Wien D.C. Park, Dallas, Tex. K. Ritchie, Montpellier J. Smith, Ann Arbor, Mich. Experimental Section C. Bertoni-Freddari, Ancona R. Faragher, Brighton C. Franceschi, Bologna T. Fülöp, Sherbrooke L. Gavrilov, Chicago, Ill. L. Haynes, Saranac Lake, N.Y. K. Hirokawa, Tokyo G.J. Lithgow, Novato, Calif. M. Rose, Irvine, Calif. A. Viidik, Wien J. Vijg, Bronx, N.Y.