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This study used the nationally representative prospective study of the Household, Income and Labour Dynamics in Australia (HILDA) survey cohort to examine the association of pet ownership (dog, cat, bird, fish, and others) with the risk of all-cause mortality using propensity score matching based on a wide range of factors. The study sample included 15,735 participants who completed the questionnaire on pet ownership in 2018. The HILDA survey sample was matched to the National Death Index through 2022 to assess death during the follow-up period. Statistical analysis was weighted by the inverse of the propensity score in the generalized estimating equation. During the 4-year follow-up period, 377 of 15,735 (2.4%) participants died. The odds ratios (ORs) for all-cause mortality were 0.77 (95%CI: 0.59–0.99) for dog owners compared to non-pet owners after controlling for related socio-demographic, physical, psychological, and social factors. The Sobel test showed a partial mediating effect of physical activity level on the relationship between dog ownership and all-cause mortality. Ownership of cats, birds, fish, and others showed no clear association with mortality, despite owners having similar socio-demographics characteristics to dog owners. Companionship and exercise of a pet dog may be recommended as a component of health promotion policy, and may have an important role to play in promoting health aging. [ABSTRACT FROM AUTHOR]

Pulmonary tumor thrombotic microangiopathy (PTTM) is a rare and critical malignancy‐related disease characterized by acute progressive pulmonary hypertension (PH). In most cases of PTTM, the cancer can be diagnosed in advance. Identification of the primary cancer is valuable for PTTM diagnosis. Here, we present the case of a patient with PTTM due to early gastric carcinoma in whom the diagnosis of malignant cancer was not revealed until macroscopic autopsy findings. This case highlights the importance of recognizing causative occult early gastric cancer leading to PTTM in cases of acute progressive PH. [ABSTRACT FROM AUTHOR]

Findings on the relationship between pet exposure and asthma in western countries are inconsistent. This retrospective study examined the association of owning a dog or cat with the onset of asthma in Japanese people. We also investigated whether there is a critical window during which exposure to dogs and cats can reduce the risk of asthma by stratifying the analysis by the age at which pet ownership began. We analyzed data collected in an internet survey conducted by the Japan Pet Food Association in 2021. Valid data were obtained from 4290 participants for analysis of dog ownership and 4308 participants for analysis of cat ownership. In these respective groups, 41.2% had owned a dog and 26.5% had owned a cat. During the follow-up period, 5.7% of dog owners and 14.8% of non-dog owners developed asthma, as did 5.6% of cat owners and 13.5% of non-cat owners. On binomial logistic regression analysis, participants who had not owned a dog had an odds ratio (OR) of 2.01 (95% confidence interval (CI): 1.45–2.78) of developing asthma compared to those who had owned a dog after adjustment for sociodemographic characteristics. The corresponding OR of asthma onset among participants who had not owned a cat was 2.24 (95%CI: 1.56–3.23). Stratified analysis showed that while younger participants who had not owned a dog had higher ORs of developing asthma, those who had not owned a cat had similar ORs of asthma onset across all age categories. These results suggest that while there may be a critical window in early life during which exposure to dogs can prevent asthma onset, the protective effect of cat exposure is constant across all ages in Japan. [ABSTRACT FROM AUTHOR]

This study examined the differences in medical and long-term care costs over 18 months between pet owners and non-owners among community-dwelling older Japanese. Pet ownership data were collected from 460 community-dwelling adults age 65 years and older. These data were matched with data from the National Health Insurance, health insurance for older people, and Long-Term Care Insurance beneficiaries for 17 months back from the survey on pet ownership. Pet-ownership group-specific trajectories in monthly medical and long-term care costs were modeled by a generalized estimating equation. Among pet owners (n = 96, 20.9%) and non-pet owners (n = 364, 79.1%) there were no significant differences in baseline demographic or health characteristics including chronic disease and self-reported long-term care level. At baseline, pet owners had estimated monthly medical costs of ¥48,054 (SE = 0.11; $418), compared to ¥42,260 (SE = 0.06; $367) for non-pet owners. The monthly medical costs did not differ significantly between the two groups during the 18-month follow-up period. At baseline, estimated monthly long-term care costs of pet owners and non-pet owners were ¥676 (SE = 0.75; $6) and ¥1,420 (SE = 0.52; $12), respectively. During the follow-up period, the non-pet owner to owner ratio of monthly long-term care costs was 1.2 at minimum and 2.3 at maximum. This study showed that monthly long-term care costs for pet owners were approximately half those of non-pet owners. Pet owners might use long-term care services less frequently, or use lighter care services. [ABSTRACT FROM AUTHOR]

Menopause and related changes may be associated with frailty and contribute to higher frailty risk. This systematic review of the literature on the association between menopause and frailty combines the findings from studies of community-dwelling women. PubMed was systematically searched in March 2021 with a time frame from 2000 to March 2021 without language restriction. Potentially eligible studies were those that provided cross-sectional or prospective observational data on associations between menopause and frailty in community-dwelling women. Reference lists of relevant articles and the included studies were reviewed for additional studies. The same effect sizes were combined using a meta-analysis using the generic inverse variance method. From 131 studies identified, cross-sectional data on age at menopause from 3 studies and longitudinal data on surgical menopause from 2 studies were used for meta-analysis. Each one-year increase in age at menopause was significantly associated with a 2 % decreased risk of prevalent frailty (pooled odds ratio = 0.98, 95%CI (confidence interval) = 0.96-0.99, p < 0.001). Surgical menopause did not predict incident frailty (pooled OR = 1.02, 95%CI = 0.82-1.28, p = 0.23). This systematic review and meta-analysis showed that later age at menopause was significantly associated with a lower risk of prevalent frailty. In a clinical setting, age at menopause can be useful information to help clinicians to evaluate and stratify frailty risk in postmenopausal women. Hormonal changes after menopause may be related to the link between age at menopause and frailty and thus warrant further investigation. [ABSTRACT FROM AUTHOR]

Background: Oral health is a key factor of overall health and closely associated with well-being and quality of life. Mastication is one the most important oral functions and may deteriorate with aging. Evidence on association between masticatory dysfunction and frailty in the literature is scarce and not coherent. Methods: A search strategy was developed to conduct a systematic review of the literature in PubMed, CINAHL, and AMED in accordance with the PRISMA 2020 guidelines. We searched for studies published in 2000 or later that examined associations between self-reported masticatory dysfunction and frailty risk. The reference lists of the relevant articles were reviewed for additional studies. We calculated pooled odds ratios (OR) of association between self-reported masticatory dysfunction and the risk of frailty by fixed-effects meta-analysis. The Joanna Briggs Institute Critical Appraisal Checklist was used to assess risk of bias. Publication bias was assessed by visually inspecting a funnel plot. Results: A total of 285 studies were identified by the literature search. Among 5 studies selected for this review, 4 cross-sectional studies including a total of 7425 individuals were used for meta-analysis. The pooled results by a fixed-effects model showed that there was a significant association between self-reported masticatory dysfunction and frailty risk (pooled OR = 1.83, 95%CI = 1.55–2.18, p<0.00001). There was no evidence of publication bias observed. Conclusions: This systematic review and meta-analysis highlighted pooled cross-sectional evidence that community-dwelling older people who report masticatory dysfunction are significantly more likely to be frail than those who do not. The limitations of this study are: inclusion of only cross-sectional studies, no gold standard to measure masticatory functions, self-reported information on masticatory function, and the limited number of included studies. More longitudinal studies are warranted for further understanding of the causal pathways and elucidate underlying mechanisms. Registration: PROSPERO CRD42021277173 [ABSTRACT FROM AUTHOR]

Background: Although it is well known that women have higher risk of frailty, mechanisms are not clear. Reproductive history may be related to the sex difference in frailty. Methods: A total of 1249 community‐dwelling women aged ≥60 in England were examined for associations between age at menopause and risk of developing frailty. Frailty defined by the frailty phenotype was measured at baseline and 4 years later. Age at menopause was used as a continuous variable and categorical groups: premature/early (10–45 years), normal (46–55 years), and late (56 years or older). Men with comparable conditions from the same cohort were also used as a comparison. Results: Earlier age at menopause was significantly associated with higher risk of incident frailty. One year later menopause age was associated with a 3% decrease in incident frailty risk (Odds ratio [OR] = 0.97, 95%CI = 0.95–1.00, p = 0.02). Women with premature or early menopause had a significantly higher risk of developing frailty compared with those with normal menopause (OR = 1.90, 95%CI = 1.28–2.81, p = 0.001), while those with late menopause did not. In a supplementary analysis with older men, older women with premature or early menopause were more likely to develop frailty compared with older men (OR = 2.29, 95%CI = 151–3.48, p < 0.001), however, there was no significant difference between women with normal or late menopause. Conclusions: Earlier menopause was significantly associated with higher risk of developing frailty. Our findings suggest that menopause or its related factors, such as decline in estrogen after menopause, potentially play an important role in the sex difference in frailty. [ABSTRACT FROM AUTHOR]

Background: Poor subpleural perfusion (PSP) on dual-energy computed tomography (DE-CT) suggests microvasculopathy in chronic thromboembolic pulmonary hypertension (CTEPH). However, whether the microvasculopathy findings are equivalent to those in pulmonary arterial hypertension (PAH) remains unclear. The aim of this study was to elucidate the characteristics of microvasculopathy in CTEPH compared to those of that in PAH. Methods: We retrospectively reviewed subpleural perfusion on DE-CT and the hemodynamics of 23 patients with PAH and 113 with inoperable CTEPH. Subpleural perfusion on DE-CT was classified as poor (subpleural spaces in all segments with little or no perfusion) or normal. Results: PSP was observed in 51% of patients with CTEPH and in 4% of those with PAH (p < 0.01). CTEPH patients with PSP had poorer baseline hemodynamics and lower diffusing capacity for carbon monoxide divided by the alveolar volume (DLCO/VA) than those with CTEPH with normal perfusion (pulmonary vascular resistance [PVR]: 768 ± 445 dynes-sec/cm5 vs. 463 ± 284 dynes-sec/cm5, p < 0.01; DLCO/VA, 60.4 ± 16.8% vs. 75.9 ± 15.7%, p < 0.001). Despite the existence of PSP, hemodynamics improved to nearly normal in both groups after balloon pulmonary angioplasty. Conclusions: PSP on DE-CT, which is one of the specific imaging findings in CTEPH, might suggest a different mechanism of microvasculopathy from that in PAH. [ABSTRACT FROM AUTHOR]

Objectives: This study examined the association between dog and cat ownership, the onset of disability and all-cause mortality in an older population. Dog and cat owners take more regular exercise and have closer social relationships than non-owners. We further assess the beneficial effects of these moderating variables on the onset of disability and mortality. Methods: Dog and cat ownership data were collected from 11233 community-dwelling adults age 65 years and older. These data were matched with data about the onset of disability held by the Japanese long-term care insurance system. Local registry data were used to ascertain all-cause mortality. Results: During the approximately 3.5 year follow-up period, 17.1% of the sample suffered onset of disability, and 5.2% died. Logistic regression analysis indicated that, compared with a reference group of those who had never owned a dog (odds ratio fixed at 1.0), older adults who were currently dog owners had a significantly lower odds ratio of onset of disability (OR = 0.54 95% CI: 0.37–0.79). Our results further show that regular exercise interacts with dog ownership to reduce the risk of disability. The association of dog and/or cat ownership with all-cause mortality was not statistically significant. Conclusions: Dog ownership appears to protect against incident disability among older Japanese adults. Additional benefits are gained from ownership combined with regular exercise. Daily dog care may have an important role to play in health promotion and successful aging. [ABSTRACT FROM AUTHOR]

The efficacy of balloon pulmonary angioplasty (BPA) in patients with inoperable chronic thromboembolic pulmonary hypertension would be promising. However, some patients showed residual dyspnea or symptoms, despite normalized hemodynamics. We aimed to clarify the clinical impact of oxygenation parameters on BPA outcome. Ninety-nine consecutive patients who underwent BPA from September 2011 to December 2019 were enrolled. We evaluated hemodynamics with right heart catheterization, arterial blood gas examination, New York Heart Association functional class (NYHA-FC), respiratory function tests, nocturnal oximetry, and exercise capacity (6-min walk test and cardiopulmonary exercise testing) at baseline and after BPA. Nearly normal hemodynamics was achieved after BPA (mean pulmonary artery pressure (PAP): 37.5 ± 10.0 to 20.6 ± 4.9 mmHg, p < 0.01). Oxygenation slightly improved (partial pressure of arterial oxygen; 61.5 ± 12.3 to 67.7 ± 12.7 mmHg, p < 0.01). Exertional desaturation remained unchanged (−8.1 ± 4.8 to −7.8 ± 5.1, p = 0.59), and this was associated with residual symptom (NYHA-FC ≥ 2) after BPA (OR 0.591, 95% CI 0.416–0.840, p = 0.003) in multivariate regression analyses. Lower vital capacity (r2 = 0.03, p = 0.01), higher mean PAP (r2 = 0.08, p = 0.02), and higher minute ventilation/carbon dioxide production (VE/VCO 2) slope (r2 = 0.18, p < 0.01), the marker of ventilatory inefficiency, were correlated with exertional desaturation after BPA in multivariate linear analyses. Although hemodynamics nearly normalized, oxygenation did not. Moreover, exertional desaturation remained unchanged. This might cause residual symptom after BPA. Residual pulmonary hypertension suggesting incurable arteriopathy, and higher VE/VCO 2 slope suggesting ventilation-perfusion mismatch might be related to exertional desaturation. Domiciliary oxygen therapy should be continued, if necessary. • Oxygenation remained impaired, and exertional or nocturnal desaturation remained unchanged after BPA. • Sustained desaturation was associated with residual symptoms despite nearly normalized hemodynamics after BPA. • Sustained desaturation was associated with residual symptoms despite nearly normalized hemodynamics after BPA. [ABSTRACT FROM AUTHOR]

The management of non-operable chronic thromboembolic pulmonary hypertension (CTEPH) has evolved with the availability of balloon pulmonary angioplasty (BPA) and pulmonary vasodilators. We launched the BPA program in 2011. The aim was to analyze the survival and treatment efficacy of our CTEPH treatment program in the modern management era. We retrospectively reviewed data from 143 consecutive CTEPH patients diagnosed from January 2011 (i.e. after the availability of BPA) to December 2019. Of forty-one patients who underwent pulmonary endarterectomy (PEA), 25 underwent additional BPA (Combination group) and the others were treated with only PEA (PEA group). Ninety patients underwent BPA (BPA group). The remaining 12 patients did not undergo any interventional treatments. The 1- and 5-year survival rates of operated patients (n = 41) were 97.4% and 90.0%, compared to 96.9% and 86.9% in not-operated patients (n = 102), respectively (p = 0.579). There was no mortality in the Combination group. Mean pulmonary artery pressure after treatments in the PEA only, Combination, and BPA only groups was 20.5 ± 6.7, 17.9 ± 4.9, and 20.7 ± 4.6 mmHg, respectively (p = 0.067, one-way ANOVA). Percent decrease of pulmonary vascular resistance in each treatment groups was −73.7 ± 11.3%, −74.3 ± 11.8%, and − 54.9 ± 22.5%, respectively (p < 0.01, one-way ANOVA). There was no significant difference in long-term survival between operated and not-operated CTEPH. Moreover, the Combination approach might have the potential to introduce notable improvements in the prognosis of CTEPH. BPA and PEA appear to be mutually complementary therapies in the modern management era. • Almost all CTEPH can be treated mechanically with PEA or BPA or both, and this may lead to a notable improvement in the prognosis. [ABSTRACT FROM AUTHOR]

Aim: Using up to 13 years of repeated‐measures data, we identified aging trajectories for an index in frailty score among older Japanese undergoing health checkups. In addition, we examined whether these trajectories were associated with all‐cause and cause‐specific mortality and healthcare costs. Methods: In total, 1698 adults aged ≥65 years completed annual assessments during 2002–2014. During follow‐up, the average number of follow‐up assessments was 3.9, and the total number of observations was 6373. Frailty was defined by using the following criteria from Fried's phenotype: slowness, weakness, exhaustion, low physical activity and weight loss. Results: We identified four aging trajectories for frailty. Specifically, 6.5%, 47.3%, 30.3% and 16.0% of participants were in the high, second, third and low trajectory groups, respectively. As compared with the low trajectory group, the high trajectory group had greater risks of cardiovascular disease (adjusted hazard ratios of 3.42) and other‐cause death (adjusted hazard ratios of 3.04). The high trajectory group had the highest medical costs until late in the eighth decade of life, costs decreased after age 70 years and were lowest at age 90 years (estimated at $116.7); however, medical and long‐term care costs greatly increased after age 80 years in the second and third trajectory groups. Conclusions: Higher aging trajectories in frailty score were associated with elevated risks for cardiovascular, other‐cause and all‐cause death among older Japanese receiving health checkups. Medical and care needs greatly increased for the second and third trajectory groups when their frailty level was progressed in later life. Geriatr Gerontol Int 2020; 20: 1072–1078.. [ABSTRACT FROM AUTHOR]

Objectives: No previous study has used repeated measures data to examine the associations of dog/cat ownership with wheezing and asthma prevalence among children. This prospective study used repeated measurers analysis to determine whether dog/cat ownership in childhood is an independent risk factor for wheezing and asthma, after adjustment for gestational, socio-economical, and demographical confounders confounders, in Japan. Methods: We conducted a multicenter pilot study of the Japan Environment and Children's Study (JECS) during 2009–2010. Among 440 newborn infants enrolled, 410 (52.8% males) were evaluated for dog/cat ownership in the home and history of wheezing and asthma in five follow-up questionnaire surveys (until age 6 years). Dog/cat ownership during follow-up period was categorized into four groups: 7.6% were long-term dog/cat owners, 5.9% were toddler-age owners, 5.9% were preschool-age owners, and 80.7% were never owners. Results: The prevalence of wheezing during follow-up period increased from 20.8% to 35.4% and the prevalence of asthma increased from 1.3% to 16.3%. A fitted logistic generalized estimating equation models including important confounders showed no significant associations of the interaction between dog and/or cat ownership and follow-up time with the risks of wheezing and asthma. However, the risks of wheezing and asthma were slightly lower for long-term and toddler-age dog/cat owners than for preschool-age and never owners. Conclusions: The present findings suggest that dog and cat ownership from toddler-age does not increase the risks of wheezing and asthma compared with never owners among Japanese children. [ABSTRACT FROM AUTHOR]

Background: No study has reported trajectories of kidney function in later life. This long-term prospective study attempted to classify trajectories of estimated glomerular filtration rate (eGFR) and identify factors associated with these trajectories. Methods: We collected data from annual geriatric health checkups conducted during 2002–2017 in Kusatsu Town, Gunma Prefecture, Japan. The participants were 1990 adults aged 65–90 years (mean [SD] age, 71.0 [5.7] years; 57.0% women), and the total number of observations was 9291. Data were analyzed with a group-based semiparametric mixture model and age-adjusted univariable cumulative logit models. Results: Trajectory of kidney function, as determined by eGFR, was classified as low, middle, and high (4.8%, 38.9%, and 56.3% of men, respectively, and 5.2%, 31.5%, and 63.3% of women). Among men and women in the low trajectory group, chronic kidney disease (CKD) stage worsened from stage G3a (51.8 ml/min/1.73 m2 in men and 53.6 in women) at age 65 years to stage G4 (28.0 ml/min/1.73 m2 in men and 28.5 in women) by age 85 years. A history of hypertension (men and women) and heart disease (men) were more likely in the low trajectory group than in the middle and high trajectory groups. Conclusions: About 5% of community-dwelling older adults had an eGFR < 30 later in life. Our findings suggest that those with stage G3a CKD at age 65 years should be managed intensively, to control risk factors for CKD progression. [ABSTRACT FROM AUTHOR]

Aim: Cognitive decline increases mortality risk through dementia‐related pathways and might be associated with increased healthcare costs. Using up to 12 years of repeated measures data, we identified trajectories in cognitive function among community‐dwelling older Japanese adults. We then examined whether these trajectories were associated with all‐cause and cause‐specific mortality, and differences in healthcare costs. Methods: A total of 1736 adults aged ≥65 years who were free of disabling dementia completed annual assessments during 2002–2014. Cognitive function was assessed with the Mini‐Mental State Examination. The average number of follow‐up assessments was 3.9, and the total number of observations was 6824 during the follow‐up period. Results: We identified five trajectory patterns in cognitive function (high, second, third, fourth, and low) during the 12‐year follow‐up period. The low (2.0%) and fourth (2.2%) trajectory groups had higher hazard ratios for cardiovascular disease mortality, and hazard ratios for other cause mortality were significantly higher for the third (16.8%) and second (38.8%) trajectory groups than for the high trajectory group (40.3%). Until 5 years of follow up, participants in the two lower‐trajectory groups had higher mean combined monthly medical and long‐term care costs. After 8 years of follow up, mean costs were highest for the third trajectory. Conclusions: The risk of death from cardiovascular disease was higher in the two lower‐trajectory groups in cognitive function, and they showed higher healthcare costs during the first 5 years of follow up. After 8 years of follow up, the third trajectory had the highest healthcare costs, perhaps because of hospitalizations attributable to gradual cognitive decline. Geriatr Gerontol Int 2019; 19: 1236–1242. [ABSTRACT FROM AUTHOR]

Treatment options for inoperable chronic thromboembolic pulmonary hypertension (CTEPH) have recently evolved with the availability of balloon pulmonary angioplasty (BPA) and pulmonary vasodilators. Our aim was to analyze the prognostic variables associated with long-term outcome in a cohort of patients with not-operated CTEPH. From January 2006 to December 2016, 343 newly diagnosed consecutive patients with not-operated CTEPH were diagnosed and followed up in the French Reference Center for Pulmonary Hypertension. Overall long-term survival and prognostic factors according to the diagnosis period (early period, 2006–2012, vs recent period, since 2013, i.e., one year before availability of BPA) were analyzed. In the overall population, baseline New York Heart Association functional class, right atrial pressure, 6-minute walk distance (6MWD), and diagnosis period were independent predictors of survival. The 1- and 3-year survival rates of patients diagnosed in the recent period (n = 170) were 91.6% and 85.0%, compared with 89.0% and 74.3% in patients diagnosed in the early period (n = 173), respectively (p = 0.030). Multivariate analysis from patients diagnosed in the recent period found that baseline 6MWD (per 20 m increase in distance) (hazard ratio [HR], 0.879; 95% confidence interval [CI], 0.832–0.928, p < 0.001) and BPA (HR, 0.307; 95% CI, 0.099–0.957; p = 0.042) were independently associated with survival. Survival of not-operated patients with CTEPH has significantly improved in the recent management era. New treatment options, including BPA, might have the potential to improve the prognosis of patients with inoperable CTEPH. [ABSTRACT FROM AUTHOR]

Aim: Evidence is limited on how frailty affects the association between diabetes and adverse outcomes at the population level. The present community‐based study aimed to clarify the relative risks of death and disability in older Japanese adults with diabetes, frailty, both or neither. Methods: The present prospective study analyzed data from 1271 Japanese residents aged ≥65 years in Kusatsu town in Gunma Prefecture, Japan, who participated in annual health checkups carried out between 2002 and 2011, and were initially free of disability. A Cox proportional hazards regression model was used to identify associations of diabetes and frailty with all‐cause mortality and incident disability. Results: Among the 1271 participants, 176 (14%) had diabetes (mean hemoglobin A1c 7.5%, body mass index 24.2 kg/m2, 45% using diabetes medications) and 151 (12%) had frailty at baseline. Compared with non‐frail participants without diabetes, those with diabetes and frailty had higher risks of mortality (multivariable hazard ratio 5.0, 95% CI 2.4–10.3) and incident disability (hazard ratio 3.9, 95% CI 2.1–7.3). In contrast, non‐frail participants with diabetes did not have a significantly increased risk of mortality, although they had a higher tendency for the incidence of disability, as compared with non‐frail participants without diabetes. Conclusions: At the population level, the risks of death and disability in persons with mild diabetes were strongly affected by the presence of frailty. From a community‐based perspective, diabetes‐related mortality and disability incidence might be reduced by preventing or improving frailty in conjunction with glycemic control. Geriatr Gerontol Int 2019; 19: 423–428. [ABSTRACT FROM AUTHOR]

Background: Serum albumin and hemoglobin levels are independently associated with subsequent cognitive deterioration in older adults. This prospective study used repeated measures analysis to identify aging trajectories in serum albumin and hemoglobin levels and investigated if these trajectories were associated with incident disabling dementia among community-dwelling older Japanese. Methods: A total of 2,005 adults aged 65–90 years participated in annual geriatric health assessments during the period from June 2002 through July 2017; the total number of observations was 9,330. A review of a municipal database of the Japanese public long-term care insurance system identified 1,999 of 2,005 adults without dementia at baseline, 278 (13.9%) of whom developed disabling dementia during the follow-up period (June 2002 through December 2017). Results: We identified three trajectory patterns (high, moderate, and low) for serum albumin and hemoglobin levels for the age period 65 through 90 years. After controlling for potential confounders, participants with moderate and low trajectories for serum albumin level had hazard ratios of 1.27 (95% confidence interval 0.94–1.72) and 2.07 (1.37–3.11), respectively, for the development of incident disabling dementia, with the high trajectory group as reference. The respective hazard ratios for hemoglobin level were 1.31 (0.93–1.85) and 1.58 (1.04–2.40), respectively. Conclusion: Dementia risk was higher for individuals with low trajectories for serum albumin and hemoglobin levels. This finding highlights the importance of interventions that improve nutritional status and control relevant diseases in middle-aged and older adults with low serum albumin and hemoglobin levels. [ABSTRACT FROM AUTHOR]

Objectives: Recent studies reported that several gait parameters were associated with lower cognitive function or cognitive decline, however, known gait parameters were limited and no study has used large-scale data. We identified the characteristics for gait parameters of community-dwelling elderly Japanese with lower cognitive function. Methods: 1,240 community-dwelling adults (mean [SD] age, 77.2 [4.8] years; women, 59.4%) aged 70 or older participated in geriatric health assessments in 2016. We measured comprehensive gait parameters using resistive pressure platform. Cognition was assessed by Mini-Mental State Examination (MMSE). Results: There are possible correlations between gait measures (gait speed, stride length, step length, step width, average foot pressure, double support duration, and single support duration) and CVs (CV of stride length, step length, average foot pressure, and single support duration) with MMSE score, respectively. After adjustment for important confounders, multiple regression models showed that gait speed (β = .080, p = 0.006), stride length (β = .123, p<0.001), step length (β = .123, p<0.001), average foot pressure (β = .060, p = 0.040), double support duration (β = -.082, p = 0.004), single support duration (β = .086, p = 0.003), CV of stride length (β = -.091, p<0.001), CV of step length (β = -.090, p<0.001), and CV of single support duration (β = -.058, p = 0.037) had significant association with MMSE score, respectively. Conclusions: Our findings suggest that person with lower cognitive function tend to have unsteady gait such as erratic length and time of one step, in addition to decreasing the vertical displacement of the center of gravity and slower speed. [ABSTRACT FROM AUTHOR]

Highlights • Relatively little is known about the dynamic nature of frailty. • 16 studies provided data on transition of frailty defined by the phenotype. • Older people were found to make dynamic transitions across frailty categories. • 14% improved, 29% worsened and 57% did not change frailty status. Abstract Frailty is a well-established risk factor for adverse health outcomes. However, comparatively little is known about the dynamic nature of frailty and the extent to which it can improve. The purposes of this study were to systematically search for studies examining frailty transitions over time among community-dwelling older people, and to synthesise pooled frailty transitions rates. Four electronic databases (Medline, Embase, PsycINFO and CINAHL) were searched in July 2018. Inclusion criteria were: prospective design, community-dwelling older people with mean age > 60, using 5-item frailty phenotype criteria to define three states: robust, prefrail and frail and the numbers of participants with 9 frailty transition patterns based on frailty status at baseline and follow-up. Exclusion criteria were: selected populations, using fewer than 5 frailty phenotype criteria. Two investigators independently screened 504 studies for eligibility and identified 16 studies for this review. Data were extracted by the two investigators independently. Pooled rates of frailty transition patterns were calculated by random-effects meta-analysis. Among 42,775 community-dwelling older people from 16 studies with a mean follow-up of 3.9 years (range: 1–10 years), 13.7% (95%CI = 11.7–15.8%) improved, 29.1% (95%CI = 25.9–32.5%) worsened and 56.5% (95%CI = 54.2–58.8%) maintained the same frailty status. Among those who were robust at baseline, pooled rates of remaining robust or transitioning to prefrail and frail were 54.0% (95%CI = 48.8–59.1%), 40.6% (95%CI = 36.7–44.7%) and 4.5% (95%CI = 3.2–6.1%), respectively. Among those who were prefrail at baseline, corresponding rates to robust, prefrail and frail were 23.1% (95%CI = 18.8–27.6%), 58.2% (95%CI = 55.6–60.7%) and 18.2% (95%CI = 14.9–21.7%), respectively. Among those who were frail at baseline, pooled rates of transitioning to robust, prefrail and remaining frail were 3.3% (95%CI = 1.6–5.5%), 40.3% (95%CI = 34.6–46.1%) and 54.5% (95%CI = 47.6–61.3%), respectively. Stratified and meta-regression analyses showed age, gender and follow-up period were associated with frailty transition patterns. Older people make dynamic changes in their frailty status. Given that while one quarter of prefrail older people improved to robust only 3% of frail older people did, early interventions should be considered. [ABSTRACT FROM AUTHOR]

Background: Higher-level functional capacity is crucial component for independent living in later life. We used repeated-measures analysis to identify aging trajectories in higher-level functional capacity. We then determined whether these trajectories were associated with all-cause mortality and examined differences in medical and long-term care costs between trajectories among community-dwelling older Japanese.Methods: 2,675 adults aged 65-90 years participated in annual geriatric health assessments and biennial health monitoring surveys during the period from October 2001 through August 2011. The average number of follow-up assessments was 4.0, and the total number of observations was 10,609. Higher-level functional capacity, which correspond to the fourth and fifth sublevels of Lawton's hierarchical model, was assessed with the Tokyo Metropolitan Institute of Gerontology-Index of Competence (TMIG-IC).Results: We identified four distinct trajectory patterns (high-stable, late-onset decreasing, early-onset decreasing, and low-decreasing) on the TMIG-IC through age 65-90 years. As compared with the high-stable trajectory group, participants in the late-onset decreasing, early-onset decreasing, and low-decreasing TMIG-IC trajectory groups had adjusted hazard ratios for mortality of 1.22 (95% confidence interval: 1.01-1.47), 1.90 (1.53-2.36), and 2.87 (2.14-3.84), respectively. Participants with high-stable and late-onset decreasing higher-level functional capacity trajectories had lower mean monthly medical costs and long-term care costs. In contrast, mean total costs were higher for those with low-decreasing trajectories, after excluding the large increase in such costs at the end of life.Conclusions: People with a low-decreasing aging trajectory in higher-level functional capacity had higher risks of death and had high monthly total costs. [ABSTRACT FROM AUTHOR]

Objectives: Previous studies examined the physical characteristics of older dog owners. However, associations of health-related factors with dog/cat ownership have not been comprehensively evaluated. This cross-sectional study examined physical function, physical activity, social function, and psychological function of a population of community-dwelling older Japanese dog and cat owners after controlling for important confounders. Methods: The analysis included data from 11,233 community-dwelling adults aged 65 years or older (51.5% women; 52.3% aged 75–84), in Ota City, Tokyo, Japan. Pet ownership experience and pet species owned were determined by self-reported questionnaire, and current, past, and never dog/cat ownership was analyzed. Results: Analysis of variables related to physical function and physical activity showed that motor fitness scale and walking activity were significantly associated with experience of dog ownership, after adjustment for important sociodemographic and health characteristics. Analysis of social function showed that interaction with neighbors, social isolation, and trust in neighbors were significantly associated with experience of dog ownership and cat ownership. Conclusions: As compared with respondents with no history of pet ownership, motor fitness and walking activity are greater for dog owners and social function is higher for dog and cat owners. Caring for a dog or cat might be an effective health promotion strategy to increase physical activity and facilitate social participation among older adults. [ABSTRACT FROM AUTHOR]

Background: Poor subpleural perfusion (PSP) in the capillary phase of pulmonary angiography predicts worse outcomes following pulmonary endarterectomy in operable chronic thromboembolic pulmonary hypertension (CTEPH). Balloon pulmonary angioplasty (BPA) has emerged as a treatment for nonoperable CTEPH. The goal of the present article was to assess the association between PSP and BPA failure.Methods: Subpleural perfusion was classified as poor (defined as subpleural spaces either not perfused or minimally perfused in all segments) or normal. We retrospectively reviewed PSP and hemodynamic variables of 101 consecutive patients who underwent BPA from February 2014 to August 2016. The total cross-sectional area of bronchial arteries was also measured by using CT scanning. Patients were categorized according to hemodynamic results after the last BPA: a failure group (defined as mean pulmonary arterial pressure > 30 mm Hg and a decrease in pulmonary vascular resistance < 30% [n = 15]) or a success group (n = 86).Results: Although baseline hemodynamic variables were similar between the two groups, PSP was observed in 46.7% of patients in the failure group vs 13.9% in the success group (P = .003). Multivariate analysis revealed that PSP was the only predictor of BPA failure (OR, 4.02 [95% CI, 1.17-13.89]; P = .028). Patients with PSP exhibited poorly developed bronchial arteries compared with patients with normal perfusion (7.0 [5.8-9.6] mm2 vs 8.7 [6.9-11.3] mm2; P = .032).Conclusions: PSP in the capillary phase, suggesting the presence of small vessel disease with diffuse distal thrombosis, is a predictor of BPA failure. PSP was also associated with less developed bronchial arteries, which suggests a key role of bronchial-pulmonary anastomoses in maintaining the pulmonary capillary bed open downstream of the pulmonary arterial obstruction. PSP affected approximately 15% of patients with nonoperable CTEPH who underwent BPA. [ABSTRACT FROM AUTHOR]

Aim: Aortic pulse wave velocity (PWV) is a strong predictor of all‐cause mortality in later life. The present prospective study used repeated measures analysis to examine sex‐specific age trends in brachial‐ankle PWV (baPWV), identify baPWV trajectories and determine whether potential baPWV trajectories were associated with all‐cause mortality among community‐dwelling older Japanese. Methods: A total of 1744 adults (mean age 71.0 years [SD 5.8 years]; 57.0% women) aged 65–90 years participated in annual geriatric health assessments during the period from April 2003 through July 2015. The average number of follow‐up assessments was 4.3, and the total number of observations was 7419. We checked local registries to identify deaths from any cause; 289 (16.6%) participants died during the period through December 2015. Results: baPWV similarly and significantly increased with advancing age in men and women. We identified four distinct trajectory patterns (very high, high, moderate, and low) in adults aged 65–90 years, and these trajectories showed parallel increases. After adjusting for important confounders, participants in the moderate, high and very high baPWV trajectory groups had hazard ratios of 1.12 (95% CI 0.84–1.44), 1.04 (95% CI 0.74–1.45) and 1.98 (95% CI 1.20–3.29), respectively, for all‐cause mortality, as compared with those in the low trajectory group. Conclusions: baPWV increased with age in men and women, and there was no significance between sexes in later life. This prospective study identified four major baPWV trajectory patterns in community‐dwelling older adults. Individuals in the very high baPWV trajectory group, especially younger seniors, had a higher mortality risk. Geriatr Gerontol Int 2018; 18: 1108–1113. [ABSTRACT FROM AUTHOR]

A subpubic cartilaginous cyst is a rare mass lesion derived from the pubic symphysis, which can cause acute or subacute urinary retention. We report a case of a subpubic cartilaginous cyst in a 62-year-old woman that caused lower abdominal pain and subacute urinary retention, requiring surgical resection. On physical examination, a hard, 7exible, nontender mass, 4 cm in diameter, was palpable along the lower border of the pubic bone, extending to the perineum. Magnetic resonance imaging revealed a clearly distinct (3.8 cm × 3.8 cm × 7.2 cm) mass on the midpelvic side of the pelvis, centered on the pubic joint. We proceeded with en bloc resection of the mass, including a resection margin of 1 cm on either side. The bony defect was

Aim The present prospective study used repeated measures analysis to identify potential Mini-Mental State Examination (MMSE) score trajectories and determine whether MMSE trajectory was associated with incident disabling dementia among community-dwelling older Japanese adults. Methods A total of 1724 non-demented adults (mean age 71.4 years [SD 5.7]; 56.7% women) aged 65-90 years participated in annual geriatric health assessments during the period from June 2002 through July 2014. The total number of observations was 6755, and the average number of follow-up assessments was 3.9. A review of municipal databases in the Japanese public long-term care insurance system showed that 205 (11.9%) participants developed disabling dementia through December 2014. Results We identified three distinct MMSE score trajectory patterns (high, middle and low) in adults aged 65-90 years. After adjusting for important confounders, participants with middle (42.8%) and low (5.1%) MMSE trajectories had hazard ratios of 2.46 (95% confidence interval 1.64-3.68) and 10.73 (95% confidence interval 4.91-23.45), respectively, for incident disabling dementia, as compared with those in the high (52.1%) trajectory group. Conclusions Approximately half of the participants were classified as having a high MMSE trajectory, whereas 43% and 5% had middle and low MMSE trajectories, respectively, in this population. Individuals with middle and low MMSE trajectories had a higher risk for incident disabling dementia, which suggests that a high-risk approach to dementia prevention should target people with mild and more rapid cognitive decline. Geriatr Gerontol Int 2017; 17: 1928-1935. [ABSTRACT FROM AUTHOR]

Objective: Physical performance measures (PPMs) are good predictors of adverse health outcomes in later life. This prospective study used repeated measures analysis to examine sex-specific age trends in PPMs, identify potential PPM trajectory patterns, and determine whether PPM trajectory patterns were associated with all-cause mortality among older Japanese.Methods: Among 1,524 adults aged 65 years or older who participated in a baseline survey, 1,048 adults (mean [SD] age, 71.6 [5.4] years; women, 57.0%) were followed up at least once. The total number of observations was 4,747, and the average number of follow-up assessments was 4.5 during the period from 2002 through 2011. The PPMs studied were handgrip strength, usual gait speed, and one-leg standing time. We checked local registries to identify deaths from any cause; 89 (8.5%) participants died during follow-up.Results: All PPMs significantly decreased with advancing age, and handgrip strength and usual gait speed showed sex-specific age trends. We identified three distinct trajectory patterns (high, middle, and low trajectory groups) for each PPM in adults aged 65-90 years, and the trajectories for handgrip strength and usual gait speed showed parallel declines in men and women, respectively. After adjusting for important confounders, the trajectory groups for handgrip strength and one-leg standing time were independent predictors of all-cause mortality.Conclusions: Regardless of baseline level, the PPMs tended to show similar age-related changes in later life. However, individuals in low PPM trajectory groups had a higher mortality risk, which highlights the importance of interventions that maintain or improve physical performance, even among older adults with low physical performance. [ABSTRACT FROM AUTHOR]

Objective To perform a systematic search of the literature for currently available evidence on frailty as a predictor of dementia and to conduct a meta-analysis to synthesize the pooled risk estimates among community-dwelling older people. Design A systematic review and meta-analysis. Data Sources Embase, MEDLINE, CINAHL Plus, PsycINFO, and the Cochrane Library from 2000 to January 2016, and reference lists of relevant articles. Eligibility Criteria Any studies that prospectively examined the incident risks of dementia with frailty among community-dwelling older people without language restriction. Results Of 2565 studies identified through the systematic review, 7 studies were included in this review. Of these, 4 studies reported hazard ratios (HR) of incident dementia for physical frailty defined by Cardiovascular Health Study criteria and were included in a meta-analysis. Frailty was a significant predictor of incident Alzheimer disease (4 studies: pooled HR = 1.28, 95% confidence interval (95% CI) = 1.00–1.63, P = .05), vascular dementia (2 studies: pooled HR 2.70, 95% CI 1.40–5.23, P = .003), and all dementia (3 studies: pooled HR 1.33, 95% CI 1.07–1.67, P = .01). Heterogeneity across the studies was low to modest (I 2 = 0%–51%). A random-effects meta-regression analysis showed that the female proportion of the cohort primarily mediated the association of frailty with Alzheimer disease (female proportion coefficient = 0.04, 95%CI = 0.01–0.08, P = .01). Conclusion This systematic review and meta-analysis suggests that frailty was a significant predictor of Alzheimer disease, vascular dementia, and all dementia among community-dwelling older people. Frail women may have a higher risk of incident Alzheimer disease than frail men. [ABSTRACT FROM AUTHOR]

We and other have recently shown that growth differentiation factor 15 ( GDF15) is a useful diagnostic marker for mitochondrial diseases, which are inherited disorders caused by mitochondrial or nuclear genomic mutations that lead to impaired energy production. As the primary cause of mitochondrial diseases is mitochondrial dysfunction, the blood level of GDF15 might reflect mitochondrial function in patients, and thus could be a marker for mitochondrial dysfunction. GDF15 has been implicated in aging and various age-related disorders, such as cardiovascular diseases and diabetes, the blood level of which is reportedly elevated in older adults as well as in patients. Although GDF15 might be induced as a result of various cellular stresses and dysfunctions, it would also be possible that the blood GDF15 level reflects at least in part mitochondrial dysfunction in aging and age-related disorders. In the present review, we summarized the current literature regarding GDF15 in aging and age-related disorders from the perspective of biomarkers, with a particular focus on mitochondrial dysfunction. Geriatr Gerontol Int 2016; 16 (Suppl. 1): 17-29. [ABSTRACT FROM AUTHOR]

Older adults may be at increased risk of loneliness. Frailty is also common in older adults, however, associations between loneliness and frailty have been understudied. This systematic review and meta-analysis aimed to explore evidence on how loneliness and frailty are correlated. A systematic search of the literature was conducted using 4 electronic databases in February 2022 for any studies published in 2000 or later that provided cross-sectional or longitudinal associations between loneliness and physical frailty in community-dwelling older adults. A meta-analysis was attempted to combine data when possible. From 1386 studies identified by the initial search, 16 studies were included for this review. Standardized mean difference (SMD) meta-analysis based on mean loneliness score across 3 frailty groups provided by 6 cross-sectional studies showed that worse frailty status was significantly associated with a higher degree of loneliness (SMD between frail and robust, frail and prefrail, and prefrail and robust were 0.77 (95% confidence interval (CI)= 0.57–0.96), 0.37 (95%CI=0.25–0.50), and 0.30 (95%CI=0.20–0.40), respectively.) Meta-analyses combining cross-sectional data from 6 studies revealed that frailty was significantly associated with a higher risk of loneliness compared with robustness (3 studies: pooled OR=3.51, 95%CI=2.70–4.56 for frailty, pooled OR=1.88, 95%CI=1.57–2.25 for prefrailty) and compared with non-frailty (4 studies: pooled OR=2.05, 95%CI=1.76–2.39). A meta-analysis involving two longitudinal studies showed that baseline loneliness was associated with a significantly higher risk of worsening frailty (2 studies: pooled OR=1.41, 95%CI=1.16–1.72). This systematic review and meta-analysis was the first, to our knowledge, to quantitatively demonstrate significant cross-sectional and longitudinal associations between loneliness and frailty in community-dwelling older adults. • Older adults are at increased risks of loneliness and frailty. • Associations between frailty and loneliness have been understudied. • Worse frailty status was significantly associated with higher degree of loneliness. • Loneliness was associated with significantly higher risk of worsening frailty. [ABSTRACT FROM AUTHOR]

The sex of the conceived child is a significant concern for parents. To verify whether there women have pregnancy bias toward boys or girls, we investigated whether the history of continuous same-sex pregnancy was associated with the subsequent child's sex. We prospectively analyzed data from the Japan Environment and Children's Study, a birth cohort study. We included all cases of singleton live births (n = 98 412). Women with pregnancy due to infertility treatment were excluded (n = 6255); Similarly, women with a history of miscarriage, artificial abortion, stillbirth, and multiple pregnancies, and those with missing data on the sex of the previous child were excluded. Altogether, 62 718 women were included. For the first live birth, a male-biased sex ratio of 1.055 was observed. Further, no significant difference was found in the sex ratio of the conceived child between women with one boy and those with one girl previously. However, when there were more than two children previously, the subsequently conceived child's male/female sex ratio was significantly higher among boy-only mothers than among girl-only mothers. The results indicated that several pregnant women are biased toward conceiving either boys or girls. [ABSTRACT FROM AUTHOR]

BACKGROUND: Micronutrients are associated with dementia and cognitive decline among older adults. However, nutritional biomarkers of such decline have not been identified. We attempted to identify nutritional biomarkers that were independent risk markers of cognitive decline in a population of older Japanese. METHODS: Among 873 cognitively intact adults aged 70 years or older at baseline, 682 (mean age [standard deviation], 75.5 [4.4] years; women 59.7%) were followed for a period of up to 4 years, and nutritional biomarkers in a blood panel were assessed, namely, red blood cell count, hematocrit, mean corpuscular volume, hemoglobin, total cholesterol, high-density lipoprotein cholesterol, hemoglobin A1c, creatinine, albumin, blood glucose, [gamma]-glutamyl transpeptidase, triglyceride, and white blood cell count. Cognition was assessed by the Mini-Mental State Examination, and cognitive decline was defined as a decrease of at least three points on the Mini-Mental State Examination. RESULTS: During an average follow-up of 2.7 years, 115 adults (16.9%) developed cognitive decline. After controlling for important confounders, the odds ratios for cognitive decline in the lowest and middle tertiles of red blood cell count were 2.62 (95% confidence interval: 1.44-4.74) and 2.18 (1.20-3.96), respectively, as compared with the highest tertile. The corresponding odds ratios were 1.81 (1.05-3.22) and 1.03 (0.58-1.83), respectively, for high-density lipoprotein cholesterol and 2.06 (1.14-3.77) and 1.02 (0.54-1.94) for albumin. CONCLUSIONS: Low red blood cell count, high-density lipoprotein cholesterol, and albumin were independent risk markers for subsequent cognitive decline in a general population of older adults and may be useful in early clinical screening. [ABSTRACT FROM AUTHOR]

Background. Micronutrients are associated with dementia and cognitive decline among older adults. However, nutritional biomarkers of such decline have not been identified. We attempted to identify nutritional biomarkers that were independent risk markers of cognitive decline in a population of older Japanese. Methods. Among 873 cognitively intact adults aged 70 years or older at baseline, 682 (mean age [standard deviation], 75.5 [4.4] years; women 59.7%) were followed for a period of up to 4 years, and nutritional biomarkers in a blood panel were assessed, namely, red blood cell count, hematocrit, mean corpuscular volume, hemoglobin, total cholesterol, high-density lipoprotein cholesterol, hemoglobin A1c, creatinine, albumin, blood glucose, γ-glutamyl transpeptidase, triglyceride, and white blood cell count. Cognition was assessed by the Mini-Mental State Examination, and cognitive decline was defined as a decrease of at least three points on the Mini-Mental State Examination. Results. During an average follow-up of 2.7 years, 115 adults (16.9%) developed cognitive decline. After controlling for important confounders, the odds ratios for cognitive decline in the lowest and middle tertiles of red blood cell count were 2.62 (95% confidence interval: 1.44–4.74) and 2.18 (1.20–3.96), respectively, as compared with the highest tertile. The corresponding odds ratios were 1.81 (1.05–3.22) and 1.03 (0.58–1.83), respectively, for high-density lipoprotein cholesterol and 2.06 (1.14–3.77) and 1.02 (0.54–1.94) for albumin. Conclusions. Low red blood cell count, high-density lipoprotein cholesterol, and albumin were independent risk markers for subsequent cognitive decline in a general population of older adults and may be useful in early clinical screening. [ABSTRACT FROM PUBLISHER]

Secundum atrial septal defect (ASD) is the most common form of congenital heart disease in adults. Surgical and transcatheter closures of ASD are widely accepted therapeutic approaches. In patients with severe pulmonary arterial hypertension (PAH), however, the closure of the defect is still controversial. We report two cases of ASD patients with severe PAH successfully repaired subsequent to effective medical therapy. Subsequent shunt closure after targeted medical therapy can be an effective strategy in selected ASD patients with severe PAH. [ABSTRACT FROM AUTHOR]

SUMMARY This paper describes the estimation of the optimal measurement position by discriminant analysis based on Wilks' lambda for myoelectric hand control. In previous studies, for motion discrimination, the myoelectric signals were measured at the same positions. However, the optimal measurement positions of the myoelectric signals for motion discrimination differ depending on the remaining muscles of amputees. Therefore, the purpose of this study is to estimate the optimal and fewer measurement positions for precise motion discrimination of a human forearm. This study proposes a method for estimating the optimal measurement positions by discriminant analysis based on Wilks' lambda, using the myoelectric signals measured at multiple positions. The results of some experiments on the myoelectric hand simulator show the effectiveness of the proposed optimal measurement position estimation method. © 2013 Wiley Periodicals, Inc. Electron Comm Jpn, 96(8): 32-40, 2013; Published online in Wiley Online Library (wileyonlinelibrary.com). DOI 10.1002/ecj.11465 [ABSTRACT FROM AUTHOR]

Background. Gait speed is a good predictor of cognitive decline in later life. However, it is not known whether step length or step frequency is better for predicting such decline. This study aimed to compare the predictive value for cognitive decline of gait performance measures in a population of older Japanese. Methods. Among 853 cognitively intact adults aged 70 years or older who participated in a baseline survey, 666 (mean age, 75.5 [SD 4.4] years; women, 59.3%) were reevaluated at least once during the subsequent 4-year period. Cognition was assessed by Mini-Mental State Examination (MMSE), and cognitive decline was defined as a decrease of three points or more on the Mini-Mental State Examination during follow-up. Results. During a median follow-up of 2.7 years, 110 adults (16.5%) had cognitive decline. Among the measures of gait performance (speed, step length, and frequency), step length was the most predictive of cognitive decline. After controlling for important confounders, older men in the lowest and middle tertiles of step length at maximum speed and older women in the lowest and middle tertiles of step length at usual speed were 4.42 (95% confidence interval: 1.65–11.8), 2.17 (0.82–5.71), 5.76 (2.15–15.4), and 2.44 (0.94–6.35) times as likely to develop cognitive decline, respectively, as those of the same sex and walking speed who were in the highest tertile. Conclusions. Step length was an independent predictor of cognitive decline in a general population of older adults and may be a better predictor than overall gait speed of such decline. [ABSTRACT FROM PUBLISHER]

Many genetic risk factors for major mental disorders have key roles in brain development. Thus, exploring the roles for these genetic factors for brain development at the molecular, cellular, and neuronal circuit level is crucial for discovering how genetic disturbances affect high brain functions, which ultimately lead to disease pathologies. However, it is a tremendously difficult task, given that most mental disorders have genetic complexities in which many genetic risk factors have multiple roles in different cell types and brain regions over a time-course dependent manner. Furthermore, some genetic risk factors are likely to act epistatically in common molecular pathways. For this reason, a technique for spatial and temporal manipulation of multiple genes is necessary for understanding how genetic disturbances contribute to disease etiology. Here, the authors will review the said technique, in utero electroporation, which investigates the molecular disease pathways in rodent models for major mental disorders. This technique is also useful to examine the effect of genetic risks at the behavioral level. Furthermore, the authors will discuss the recent progress of this technology, such as inducible and cell type-specific targeting, as well as nonepisomal genetic manipulation, which provide further availability of this technique for research on major mental disorders. [ABSTRACT FROM PUBLISHER]

A letter to the editor is presented in response to an article about the significant association of cadaveric dura mater grafting with subpial Aß deposition and meningeal amyloid angiopathy.

Simple Summary: The COVID-19 pandemic may have accelerated social isolation, particularly of older adults who are at increased risk of severe illness, while practicing physical distancing and self-quarantine. This study conducted in a metropolitan area of Japan hopes to provide stronger cross-cultural evidence of the positive impact of pet ownership on the psychological health of socially isolated owners with its large sample of older adults comparing two types of pet ownership (i.e., dog or cat). In this study, experience of dog or cat ownership and the presence or absence of social isolation were categorized into four groups to compare psychological health of each group. After adjusting for demographic and potential confounders, we found that socially isolated older adults who never owned a dog were more likely to report lower psychological health in comparison to socially isolated current or past dog owners. Our findings have practical implications that pets, particularly dogs, can play a role in increasing opportunities for engaging in physical and social activities and providing emotional support and thereby reducing a sense of social isolation and loneliness and improving psychological health among older adults. The psychological health effects of pet ownership have been widely studied, but only a few studies investigated its impact among socially isolated older adults. The present study aims to investigate the psychological health of older adults with or without the experience of pet (i.e., dog or cat) ownership who are socially isolated or not socially isolated. This study used cross-sectional data from 9856 community-dwelling older adults in a metropolitan area of Japan. Social and non-social isolation and type of pet ownership (i.e., dog or cat) were stratified to examine the psychological health. Logistic regression models indicated that, after adjusting for demographic and potential confounders, socially isolated older adults who never owned a dog were 1.22 times more likely to report lower psychological health in comparison to socially isolated current or past dog owners. No such difference was observed among cat owners. The results suggest that the experience of dog ownership may be effective to improve the psychological health among socially isolated older adult. [ABSTRACT FROM AUTHOR]

The article explores the relationship between subjective age and mortality among older adults in Japan over a five-year period. It mentions that while previous studies from Western countries suggest that feeling younger than one's chronological age is associated with better health and longevity, this study investigates whether similar associations exist in Japan, where welfare systems differ.

• Living alone has been considered as social vulnerability. • Information on living alone and frailty is scarce in the literature. • Living alone is cross-sectionally associated with physical frailty. • Men living alone are more likely to be frail while women are not. • No significant longitudinal association is observed. To examine the association of living alone with frailty in cross-sectional and longitudinal studies by a systematic review and meta-analysis. Systematic review and meta-analysis. Community-dwelling older adults with a mean age of > 60 years. A systematic search of the literature was conducted according to the PRISMA guidelines. We searched PubMed in February 2019 without language restriction for cohort studies that examined the associations between living alone and frailty. The reference lists of the relevant articles and the included articles were reviewed for additional studies. We calculated pooled odds ratios (OR) of the presence and incidence of frailty for living alone from cross-sectional and longitudinal studies. Among the 203 studies identified, data of 44 cross-sectional studies (46 cohorts) and 6 longitudinal studies were included in this review. The meta-analysis showed that older adults living alone were more likely to be frail than those who were not (46 cohorts: pooled OR = 1.28, 95 % confidence interval (CI) = 1.13–1.45, p < 0.001). Gender-stratified analysis showed that only men living alone were at an increased risk of being frail (20 cohorts: pooled OR = 1.71, 95 %CI = 1.49–1.96), while women were not (22 cohorts: pooled OR = 1.00, 95 %CI = 0.83–1.20). No significant association was observed in a meta-analysis of longitudinal studies (6 cohorts: pooled OR = 0.88, 95 %CI = 0.76–1.03). The present systematic review and meta-analysis showed a significant cross-sectional association between living alone and frailty, especially in men. However, living alone did not predict incident frailty. More studies controlling for important confounders, such as social networks, are needed to further enhance our understanding of how living alone is associated with frailty among older adults. [ABSTRACT FROM AUTHOR]

Accumulating evidence from studies of human–animal interaction highlights the physiological, psychological, and social benefits for older owners of dogs and cats. This longitudinal study examined whether experience of dog/cat ownership protects against incident frailty in a population of community-dwelling older Japanese. Among 7881 non-frail community-dwelling adults aged 65 years or older who completed a mail survey in 2016, 6,197 (mean [SD] age, 73.6 [5.3] years; 53.6% women) were reevaluated in a 2018 follow-up survey. Frailty was assessed with the Kaigo-Yobo Checklist. Incident frailty was defined as a score of four or higher in the follow-up survey. Overall, 870 (14.0%) were current dog/cat owners, 1878 (30.3%) were past owners and 3449 (55.7%) were never owners. During the 2-year follow-up period, 918 (14.8%) developed incident frailty. Mixed-effects logistic regression models showed that the odds ratio for incident frailty among dog/cat owners, as compared with never owners, current owners were 0.87 (95% confidence interval [CI]: 0.69–1.09) and past owner were 0.84 (0.71–0.98), after controlling for important confounders at baseline. In stratified analysis, the risk of incident frailty was lower for past dog owners than for cat owners. Longer experience of caring for a dog requires physical activity and increases time outdoors spent dog walking and thus may have an important role in maintaining physical and social function and reducing frailty risk among older adults. [ABSTRACT FROM AUTHOR]

Background: Intra-articular platelet-rich plasma (PRP) injections have been proposed for the treatment of knee osteoarthritis (OA); however, their effectiveness in Japanese patients remains unclear. Purpose: To investigate whether 3 intra-articular injections of leukocyte-poor PRP (LP-PRP) improve symptoms and joint function in symptomatic Japanese patients with mild to moderate knee OA. Study Design: Randomized controlled trial; Level of evidence, 1. Methods: Of 72 patients screened, 30 were included and randomized to receive LP-PRP (n = 15) or saline (placebo; n = 15) injections between March 2019 and February 2023. Patients attended a screening visit and 3 treatment visits at 1 week apart, followed by 3 follow-up visits (at 4, 12, and 24 weeks) after the initial treatment visit. The primary efficacy outcome measure was the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score, whereas the secondary efficacy outcome measures were the proportion of patients showing a visual analog scale (VAS) improvement of ≥50%. Magnetic resonance imaging was performed to evaluate joint effusion and bone marrow lesions using the Whole-Organ Magnetic Resonance Imaging Score. Patients were followed for 24 weeks. Results: Patients in the PRP group (mean age, 65.9 years) had a mean hip-knee-ankle angle of 5.1°, with 7 and 8 patients demonstrating Kellgren-Lawrence grade 2 and 3 knee OA, respectively. Patients in the placebo group (mean age, 67.9 years) had a mean hip-knee-ankle angle of 3.8°, with 6 and 9 patients showing Kellgren-Lawrence grade 2 and 3 knee OA, respectively. No significant differences were identified in any baseline factors. The percentage change in Western Ontario and McMaster Universities Osteoarthritis Index scores from baseline to 24 weeks was significantly different (P=.032) between the PRP (median, 75.9%; quantile 1 [Q1], 49.6; quantile 3 [Q3], 94.1]) and placebo (median, 27.7%; Q1, –9.4; Q3, 80.9]) groups. Overall, 73.3% and 28.6% of the PRP group and placebo group, respectively, exhibited an improvement in visual analog scale scores of ≥50%, with a significant improvement observed in the PRP group (P =.027). Changes in bone marrow lesions from baseline to 24 weeks, as assessed on magnetic resonance imaging, significantly differed between groups (P =.017), with no significant differences in other secondary endpoints. Conclusion: In Japanese patients with knee OA, 3 intra-articular LP-PRP injections led to clinical improvements at 24-week follow-up and significant functional improvements and pain relief after 24 weeks. [ABSTRACT FROM AUTHOR]

Introduction: Xanthoma disseminatum is a very rare disease classified as a benign non-Langerhans cell histiocytosis, which is rarely associated with osteoarticular lesions. There is only a report of tumor abrasion during treatment of osteoarticular lesions of this disease, artificial joint replacement has not been reported. We describe a patient in whom bilateral total joint replacement was performed for disseminated xanthoma lesions of the hip joints.Case Presentation: A 34-year-old Japanese woman had a chief complaint of bilateral coxalgia. She had been diagnosed as having disseminated xanthoma. Radiographs showed numerous 5-mm radiolucent bands that resembled worm-eaten tracks in the lower part of the femoral heads adjacent to the joint surface. In addition, short tau inversion recovery imaging scans showed high-intensity areas from the femoral head to the neck in both femurs, suggesting bone marrow edema. Total hip arthroplasty was performed for hip arthrosis on both hip joints caused by disseminated xanthoma. Deflection of the implants was a concern from the early stages postoperatively, but both the imaging and clinical findings have been satisfactory for 4 years of follow-up.Conclusions: A very unusual hip joint lesion of xanthoma disseminatum was replaced with a total artificial joint replacement, and the course over 4 years was good. Our patient's course will continue to be followed carefully. [ABSTRACT FROM AUTHOR]

Pulmonary arterial hypertension (PAH) remains a significant challenge in cardiology, necessitating advancements in treatment strategies. This study explores the safety and efficacy of transitioning patients from beraprost to selexipag, a novel selective prostacyclin receptor agonist, within a Japanese cohort. Employing a multicenter, open-label, prospective design, 25 PAH patients inadequately managed on beraprost were switched to selexipag. Key inclusion criteria included ongoing beraprost therapy for ≥3 months, a diagnosis of PAH confirmed by mean pulmonary artery pressure (mPAP) ≥ 25 mmHg, and current treatment with endothelin receptor antagonists and/or phosphodiesterase type 5 inhibitors. Outcomes assessed were changes in hemodynamic parameters (mPAP, cardiac index, pulmonary vascular resistance) and the 6 min walk distance (6-MWD) over 3–6 months. The study found no statistically significant changes in these parameters post-switch. However, a subset of patients, defined as responders, demonstrated improvements in all measured hemodynamic parameters, suggesting a potential benefit in carefully selected patients. The transition was generally well-tolerated with no serious adverse events reported. This investigation underscores the importance of personalized treatment strategies in PAH, highlighting that certain patients may benefit from switching to selexipag, particularly those previously on higher doses of beraprost. Further research is needed to elucidate the predictors of positive response to selexipag and optimize treatment regimens for this complex condition. [ABSTRACT FROM AUTHOR]

Background and purpose: Mean pulmonary artery pressure (mPAP) is a key index for chronic thromboembolic pulmonary hypertension (CTEPH). Using machine learning, we attempted to construct an accurate prediction model for mPAP in patients with CTEPH. Methods: A total of 136 patients diagnosed with CTEPH were included, for whom mPAP was measured. The following patient data were used as explanatory variables in the model: basic patient information (age and sex), blood tests (brain natriuretic peptide (BNP)), echocardiography (tricuspid valve pressure gradient (TRPG)), and chest radiography (cardiothoracic ratio (CTR), right second arc ratio, and presence of avascular area). Seven machine learning methods including linear regression were used for the multivariable prediction models. Additionally, prediction models were constructed using the AutoML software. Among the 136 patients, 2/3 and 1/3 were used as training and validation sets, respectively. The average of R squared was obtained from 10 different data splittings of the training and validation sets. Results: The optimal machine learning model was linear regression (averaged R squared, 0.360). The optimal combination of explanatory variables with linear regression was age, BNP level, TRPG level, and CTR (averaged R squared, 0.388). The R squared of the optimal multivariable linear regression model was higher than that of the univariable linear regression model with only TRPG. Conclusion: We constructed a more accurate prediction model for mPAP in patients with CTEPH than a model of TRPG only. The prediction performance of our model was improved by selecting the optimal machine learning method and combination of explanatory variables. [ABSTRACT FROM AUTHOR]

Objectives To explore comparability of Kihon Checklist (KCL) and Kaigo-Yobo Checklist (KYCL) to Frailty Index (FI) in predicting risks of long-term care insurance (LTCI) certification and/or mortality over 3 years. Design Prospective cohort study. Setting and Participants 1023 Japanese community-dwelling older adults from the Kusatsu Longitudinal Study of Aging and Health. Measures Frailty status was quantified at baseline using KCL, KYCL, and 32-deficit and 68-deficit FI. Relationships of the measures were examined using Spearman rank correlation coefficients. Cox regression models examined the risk of new certification of LTCI or mortality according to KCL, KYCL, and FI. Predictive abilities of KCL and KYCL were compared with FI using area under the receiver operating characteristic curve (AUC), C statistics, net reclassification improvement (NRI), and integrated discrimination improvement (IDI). Results Mean age was 74.7 years and 57.6% were women. KCL and KYCL were significantly correlated to 32-FI (r = 0.60 and 0.36, respectively) and to 68-FI (r = 0.88 and 0.61, respectively). During the follow-up period, 92 participants (9%) were newly certified for LTCI or died. Fully adjusted Cox models showed that higher KCL, KYCL, 32-FI, and 68-FI were all significantly associated with elevated risks [hazard ratio (HR) = 1.03, 95% CI = 1.01-1.04, P < .001; HR = 1.04, 95% CI = 1.02-1.05, P < .001; HR = 1.03, 95% CI = 1.01-1.05, P = .001; HR = 1.04, 95% CI = 1.02-1.06, P < .001, respectively, per 1/100 increase of max score]. AUC and C-statistics of KCL and KYCL were not different statistically from those of 32-FI and 68-FI. Predictive abilities of KCL were superior to 32-FI in NRI and IDI but inferior to 68-FI in category-free NRI, and those of KYCL were superior to 32-FI in IDI but inferior to 68-FI in NRI. Conclusions Although KCL and KYCL include smaller numbers of items than standard FI, both tools were shown to be highly correlated with FI, significant predictors of LTCI certification and/or mortality, and compatible to FI in the risk prediction. [ABSTRACT FROM AUTHOR]