Background
Malnutrition may worsen clinical outcomes in stroke patients. Few malnutrition screening tools have been validated in the rehabilitation setting. The present study aimed to assess the ...concurrent and predictive validity of two malnutrition screening tools.
Methods
We retrospectively collected scores for the Mini Nutritional Assessment Short‐Form (MNA‐SF) and the Geriatric Nutritional Risk Index (GNRI) in consecutive stroke patients aged ≥65 years in a rehabilitation hospital. Concurrent validity was confirmed against the European Society for Clinical Nutrition and Metabolism diagnostic criteria for malnutrition (ESPEN‐DCM). Malnutrition risk within the ESPEN‐DCM process was assessed using the Malnutrition Universal Screening Tool. Cut‐off values with maximum Youden index, and with sensitivity (Se) >90% and specificity (Sp) >50%, were defined as appropriate for identification and screening of malnutrition, respectively. The Functional Independence Measure and discharge destination were used to explore predictive validity.
Results
Overall, 420 patients were analysed. Of these, we included 125 patients in the malnutrition group and 295 in the non‐malnutrition group based on the ESPEN‐DCM. Cut‐off values for the identification and screening of malnutrition were 5 (Se: 0.78; Sp: 0.85) and 7 (Se: 0.96; Sp: 0.57) for the MNA‐SF; 92 (Se: 0.74; Sp: 0.84) and 98 (Se: 0.93; Sp: 0.50) for the GNRI, respectively. The GNRI predicted discharge to acute care hospital, whereas the MNA‐SF did not predict all outcome measures.
Conclusions
The MNA‐SF and the GNRI have a fair concurrent validity in stroke patients, although lower cut‐off values than currently used were required for the MNA‐SF. The GNRI exhibits good predictive validity for discharge destination.
The Cute‐1.7+APD II, 10 × 15 × 20 cm3 in size and 5 kg in mass, is the third picosatellite developed by students at the Tokyo Institute of Technology. One of the primary goals of the Cute‐1.7+APD II ...mission is to validate the use of avalanche photodiodes (APDs) as a radiation detector for the first time in a space experiment. While the mission itself is immature compared to the forefront satellites of space plasma physics, use of APDs offers various possibilities regarding a brand‐new electron energy analyzer for medium‐energy electrons and ions (1–100 keV), as well as a high‐performance light sensor for the future X‐ray astronomy missions. The satellite was successfully launched by ISRO PSLV‐C9 rocket on 28 April 2008 and has since been in operation for more than a year. The Cute‐1.7+APD II carries two reverse‐type APDs to monitor the distribution of low‐energy particles (mainly electrons and protons) down to 9.2 keV trapped in a low Earth orbit (LEO), including the South Atlantic Anomaly (SAA) as well as aurora bands. We present the design parameters and various preflight tests of the APDs prior to launch, particularly, the high counting response and active gain control system for the Cute‐1.7+APD II mission. Examples of electron/proton distribution, obtained in continuous 12 h observations, will be presented to demonstrate the initial flight performance of the APDs in orbit.
Background: Ghrelin may stimulate gastric motility via the vagal nerve pathway. However, the mechanism of ghrelin-induced changes in gastrointestinal motility has not yet been clearly defined. The ...present study was designed to investigate whether ghrelin accelerates gastric emptying via capsaicin-sensitive afferent neurones and directly affects the enteric neuromuscular function. Methods: Gastric emptying of nutrient solids was assessed after intravenous administration of saline or ghrelin in conscious rats. The effects of ghrelin on gastric emptying were also examined in rats pretreated with capsaicin. Gastric emptying and intestinal transit of non-caloric liquids were evaluated using Formula: See TextCr solution. The effects of ghrelin on spontaneous contractile activities of isolated strips from stomach and jejunum were also investigated and the influence of ghrelin on motor responses to carbachol and electrical field stimulation was examined. Results: Ghrelin significantly accelerated gastric emptying of both nutrient solids and non-caloric liquids in conscious rats. The intestinal transit of non-caloric liquids was also enhanced by ghrelin. Pretreatment with capsaicin prevented the ghrelin-induced acceleration of gastric emptying of nutrient solids. Ghrelin did not modulate spontaneous and carbachol-induced contractions of strips of gastric body, gastric antrum and jejunum. However, electrical field stimulation-induced contractions were significantly enhanced by ghrelin in the gastric body. Conclusions: The results suggest that the stimulatory effects of ghrelin on gastric motility are mediated by direct stimulation of the enteric neural pathway and capsaicin-sensitive afferent neurones.
Spontaneous regression of hepatocellular carcinoma is a rare phenomenon. Abscopal regression of tumours resulting from the effect of irradiation of a tissue on a remote non-irradiated tissue is also ...rare. The case of a 76 year old Japanese man with hepatocellular carcinoma that regressed after radiotherapy for thoracic vertebral bone metastasis is described. Serum levels of tumour necrosis factor-α increased after radiotherapy. The findings suggests that such abscopal related regression may be associated with host immune response, involving cytokines such as tumour necrosis factor-α.
Summary
Background : There is currently no optimal second‐line treatment after failure of Helicobacter pylori triple therapy.
Aim : To determine effective salvage therapy after failure of ...lansoprazole–amoxicillin–clarithromycin.
Methods : After failure of lansoprazole–amoxicillin–clarithromycin 123 out‐patients were randomized to receive either 2‐week rabeprazole (20 mg b.d.) + amoxicillin (1000 mg b.d.) (RA group) or 1‐week rabeprazole (10 mg b.d.) + amoxicillin (750 mg twice b.d.) + metronidazole (250 mg b.d.) (RAM group). Eradication was assessed by the 13C‐urea breath test. We also evaluated cytochrome p450 (CYP) 2C19 genotype status, determined by polymerase chain reaction – restriction fragment length polymorphism, and susceptibility to clarithromycin and metronidazole.
Results : On an intention‐to‐treat basis, H. pylori infection cure was achieved in 37 of 63 (59%) patients in the RA group and in 49 of 60 (82%) patients in the RAM group. Per protocol‐based eradication rates in the RA and RAM groups were 66% (37/56) and 88% (49/56), respectively. In both analytic sets there were significant differences between the treatment groups (P < 0.01 in each). Mild adverse events were observed in eight and five patients from the RA and RAM groups, respectively. Genetic predisposition of CYP2C19 and antibiotic resistance did not influence the treatment outcome either regimen.
Conclusions : The rabeprazole + amoxicillin + metronidazole therapy yielded satisfactory results. In contrast, the cure rate in high‐dose rabeprazole + amoxicillin was below an acceptable level.
For the cryogenic tanks of next generation reusable launching vehicles, the laminated composite tank is one of the key technologies. For composite fuel tanks made from laminated carbon fibre ...reinforced polymers (CFRP), matrix cracking is a significant problem that may cause fuel leakage. In the present paper, an electrical resistance change method with integrated probes on a single side of the surface of a CFRP composite structure is adopted to detect the matrix cracking of the laminated composites. For a fuel tank structure made of a CFRP laminate, we cannot mount electrical probes on the end of structure or on the inside of the tank structure. We have to mount all probes only on the outside surface. The present method used finite element analyses (FEA) to search for the best placement of probes for matrix crack detection using a rectangular plate. To simulate the tank structure, all probes are placed on a single surface of the CFRP plate specimen. The present study adopted a four-probe method for measuring the electrical resistance change. The FEA revealed that the electrical resistance increases linearly with increase in the number of matrix cracks inside of the probes. By means of thin CFRP cross-ply laminate, the method was experimentally confirmed to be useful for detecting matrix crack density between the probes. Residual electrical resistance at the completely unloaded condition increased with increase in matrix crack density. Measurements of the residual electrical resistance enabled us to detect the matrix crack density without loading.
In a previous pilot study, we reported the usefulness of the modified the Cancer of the Liver Italian Program (CLIP) score for patients with hepatocellular carcinoma (HCC). To determine the best ...staging system for predicting the survival of HCC patients, we conducted a comparative analysis of prognosis using multivariate analysis in 210 Japanese HCC patients who underwent hepatic resection.
We compared the survival as predicted by various staging systems, including tumour node metastasis (TNM) stage of the American Joint Commission on Cancer (AJCC) and the Liver Cancer Study Group of Japan, the Japan Integrated Staging (JIS) score (Japanese TNM and Child-Pugh classification), CLIP score and our modified CLIP score using protein induced by vitamin K absence or antagonist II (PIVKA-II).
Univariate analysis showed that discrimination of disease-free survival in the early and advanced stages by the JIS score and modified CLIP score was clearer than by the Japanese or AJCC TNM or the original CLIP score. Discrimination between stages of overall survival by all staging systems was significant. Multivariate analysis showed that the JIS, CLIP and modified CLIP scores were better staging systems for predicting survival than the Japanese and AJCC TNM. The modified CLIP score showed the lowest Akaike information criteria statistical value for disease-free and overall survival, which means the best discrimination ability for patient survival compared with the JIS score and CLIP score.
A staging system that combines tumour factors, sensitive tumour marker(s) and hepatic function is the best predictor of prognosis of HCC patients.
Aim:
To determine whether a 5‐day regimen with rabeprazole, clarithromycin and amoxicillin (RCA) was as effective as a 7‐day regimen.
Methods:
A total of 139 H. pylori‐infected patients were ...randomized to receive either a 5‐day or 7‐day course of rabeprazole 10 mg b.d., clarithromycin 400 mg b.d. and amoxicillin 750 mg b.d. Eradication was assessed by CLO test, histology and 13C‐urea breath test.
Results:
On the intention‐to‐treat basis, eradication rates were 66% (46 out of 70) and 84% (58 out of 69) for the 5‐ and 7‐day regimens, respectively (P < 0.05). Using per protocol analysis, eradication rates were 70% (46 out of 66) and 91% (58 out of 64) for the 5‐ and 7‐day regimens, respectively (P < 0.01). Adverse events, which were observed in 14 patients from each group, caused discontinuation of treatment in only two patients, resulting in excellent compliance.
Conclusions:
Our 5‐day regimen of RCA yielded inferior results, whereas the 7‐day regimen achieved an eradication rate exceeding 90% on the per protocol basis. Therefore, treatment regimens of less than 7 days for proton pump inhibitor–clarithromycin–amoxicillin therapies cannot be recommended.
Background and Aims: Fatty liver is not uncommon in many countries, including Japan, and is mainly caused by alcohol usage and obesity. The aim of this study was to determine the incidence and ...causative factors of fatty liver in Japanese adults.
Methods: The clinical characteristics of 3432 Japanese adults who visited our hospital between January and December 2000 for thorough medical examinations were recorded including sex, age, body mass index (BMI), percentage body fat measurement using a bipedal bioimpedance instrument, history of alcohol intake, blood pressure, serum levels of aspartate aminotransferase, alanine aminotransferase (ALT), γ‐glutamyl transpeptidase, total cholesterol, triglyceride, uric acid, fasting blood glucose (FBG), and liver status by ultrasonography (USG).
Results: Of 3432 participants, 747 (21.8%) were diagnosed as having fatty liver by USG, 1873 (54.6%) were ‘daily alcohol drinkers’, and 698 (20.3%) were overweight (BMI ≥ 25 kg/m2). Fatty liver was more frequent in men and overweight subjects (P < 0.01), whereas there was no significant difference in the proportion of the ‘daily alcohol drinker’ between fatty liver and non‐fatty liver participants. The logistic regression analysis showed that BMI, ALT, and triglyceride were independent predictors of fatty liver in both sexes, and FBG, uric acid, percentage body fat, and total cholesterol were independent predictors of fatty liver only in men. It was noted that 319 (9.3%) were non‐alcoholic individuals with fatty liver, and 141 (4.1%) were non‐alcoholic and non‐overweight individuals with fatty liver. The logistic regression analysis showed that percentage body fat was an independent predictor of fatty liver in non‐alcoholic and non‐overweight participants in both sexes, although non‐significant in women in the whole group.
Conclusions: In our study population, 21.8% had fatty liver diagnosed by USG, 9.3% were non‐alcoholic with fatty liver, and 4.1% were non‐alcoholic and non‐overweight with fatty liver. Our results suggest that central body fat distribution can correlate with the development of fatty liver, and that measurement of percentage body fat is useful to assess the etiology of fatty liver in non‐alcoholic and non‐overweight participants, particularly women.
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