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BA.2 is a subvariant of the SARS-CoV-2 Omicron variant. XBB.1.5 and XBB.1.16, recombinants of the BA.2.10.1 and BA.2.75 sublineages, were circulating SARS-CoV-2 variants of interest in July 2023 (1,2), but [...]

BA.5 is a subvariant of the SARS-CoV-2 Omicron variant (1). Since July 2022, Omicron BA.5 has been the dominant variant in Japan (2,3). According to Japan's Infectious Diseases Control Law, [...]

Aims: Constipation is a common gastrointestinal disorder that is associated with a high cardiovascular event rate in the general population. Although constipation is common in patients with cardiovascular diseases, only a few studies have examined the relationship between constipation and the prognosis of patients with heart failure. This study aimed to evaluate the effects of constipation on the prognosis of patients with acute heart failure. Methods and results: We investigated 397 patients admitted to our hospital from December 2020 to December 2022 with acute heart failure (mean age, 81 ± 13 years; 54% men). Patients with constipation were defined as those either taking laxatives regularly or diagnosed with constipation according to the International Statistical Classification of Diseases and Related Health Problems. During the follow‐up periods (median, 173 days), 35 patients died, and 74 experienced readmission due to heart failure. Kaplan–Meier analysis before and after propensity score matching using 14 variables revealed that the risk of readmission due to heart failure was significantly higher in patients with constipation than in those without (before: log‐rank P = 0.014, after: log‐rank P = 0.0027). The adjusted Cox proportional hazards analysis revealed that the hazard ratio for readmission due to heart failure was 2.61 (95% confidence interval, 1.38–4.94, P = 0.0032). The risk of all‐cause death was not significantly different between the two groups (hazard ratio, 1.76; 95% confidence interval, 0.61–5.06; P = 0.30). Conclusions: Constipation status was strongly associated with a higher risk of readmission for heart failure in patients with acute heart failure. [ABSTRACT FROM AUTHOR]

Background: Despite the advances in the treatment of cardiovascular diseases, effective treatment remains to be established to improve the quality of life and prognosis of patients with chronic coronary syndromes. This study was aimed to evaluate the effectiveness and safety of the low-intensity pulsed ultrasound (LIPUS) therapy, which we have developed as a novel non-invasive angiogenic therapy through upregulation of endothelial nitric oxide synthase (eNOS). Methods and findings: We conducted a randomized, double-blind, placebo-controlled (RCT) pilot trial of the LIPUS therapy for patients with refractory angina pectoris. The patients who received optimal medical therapy without indication of PCI or CABG due to the lack of graftability or complexity of coronary lesions were enrolled. They were randomly divided into the LIPUS treatment group (N = 31) and the placebo group (N = 25) in a 1:1 fashion. The LIPUS therapy was performed in a transthoracic manner for 20 min for 3 sections each (mitral, papillary muscle, and apex levels) under the conditions that we identified; frequency 1.875 MHz, intensity 0.25 MPa, and 32 cycles. The primary endpoint was weekly use of nitroglycerin. Secondary endpoints included stress myocardial perfusion imaging and others. The average weekly nitroglycerin use (times/week) was decreased from 5.50 to 2.44 in the LIPUS group and from 5.94 to 2.83 in the placebo group. The changes in the average weekly nitroglycerin use were comparable; -3.06 (95% CI: -4.481 to -1.648) in the LIPUS group (P<0.01) and -3.10 (95% CI: -4.848 to -1.356) in the placebo group (P<0.01). No adverse effects were noted. Conclusions: In the present study, the LIPUS therapy did not further ameliorate chest pain as compared with optimal medications alone in patients with refractory angina pectoris. The present findings need to be confirmed in another trial with a large number of patients. (Registration ID: UMIN000012369). [ABSTRACT FROM AUTHOR]

Background: The question of whether Parkinson's disease (PD) patients have nocturnal polyuria (NP) has not yet been fully answered. Objectives: To determine whether NP was present in PD patients and if so, what its relevant factors were. Methods: This was a retrospective analysis. We had 36 consecutive referred PD patients: age, 71.5 years (range, 54–83 years); 24 men, 12 women; mean disease duration, 2.5 years (1.0–4.5 years); Hoehn and Yahr motor scale, 3.0 (2.0–3.5); all ambulatory; all on treatment. All the PD patients completed a lower urinary tract symptom (LUTS questionnaire) and a bladder diary, and underwent urodynamics testing. Results: NP was identified in 56% of patients. NP was more common in patients with nocturia (p < 0.05), and in patients with urodynamic detrusor overactivity (p < 0.01). There was no relation between NP and gender, age, PD medications, blood pressure, or comorbid diabetes. Conclusions: A total of 56% of PD patients had NP, which had a close relation with detrusor overactivity (p < 0.01). These findings suggest that in PD, the loss of dopaminergic neurons leads to NP (hypothalamic circuit) and detrusor overactivity (nigrostriatal circuit). [ABSTRACT FROM AUTHOR]

The present article reviewed autonomic dysfunction in older individuals. The following estimated incidences are reported among octogenarians (age >80 years): white matter disease (WMD), 80%; Alzheimer's disease (AD), 33%; and dementia with Lewy bodies (DLB), 7%–8%. A combination of AD + WMD is the most common. The estimated incidence in octogenarians of diabetes that produces small fiber neuropathy is 30%. Orthostatic hypotension, overactive bladder, and bowel motility dysfunction also increase with age. The links between all of these disorders are still obscure, but associations have been postulated between orthostatic hypotension with DLB and diabetes, between overactive bladder with WMD and DLB (AD in part), and between bowel motility dysfunction with DLB and diabetes. Management and care of autonomic dysfunction is thus necessary to maximize the quality of life of older individuals and avoid emergency of syncope, urinary retention, or ileus. [ABSTRACT FROM AUTHOR]

Aim of study: While Lewy body diseases (LBDs, comprising Parkinson's disease, dementia with Lewy bodies) and white matter diseases (WMD) coexist pathologically, it is uncertain to what extent each disease and the combination of the two manifests clinically, particularly regarding gait disorders. To answer this question, we performed neuroimaging‐assisted analysis. Methods: This was a retrospective cohort study (215 patients with gait, cognitive, or sleep‐autonomic disorders who were referred to our department within a 2‐year period). The inclusion criteria were apparent gait disorder; age >65 years; WMD observed on MRI; and LBD observed on both DAT and MIBG for clarity. Results: We had 39 patients with LBD; 31 with WMD; and 52 with dual diseases. The types of motor disorder in LBD varied (purely akinetic, akineto‐rigid, and tremor forms), whereas in WMD it was purely akinetic with a wide‐based gait. Those with dual diseases showed a clinical combination of the two. Cognitive disorders of LBD‐only and of dual diseases were more severe than WMD only. Sleep disorder and postural hypotension occurred only in LBD‐only and in dual diseases; constipation was common in LBD and dual groups. However, none of the differences reached statistical significance. Conclusion: Among the patients, 23%‐50% of LBD and those of dual diseases had the purely akinetic form, which might be indistinguishable from WMD. In such cases, additional motor (subtle upper‐half akinesia, abnormal posture) and nonmotor (cognitive‐sleep‐autonomic) signatures may help in diagnosing (comorbid) LBD cases that require treatment. [ABSTRACT FROM AUTHOR]

Objective: Age‐related brain symptoms (gait, speech and swallowing difficulties, and dementia) increase the risk of aspiration pneumonia (AP). It is not known which types of brain disease underlie AP most closely. Our neurogeriatric team addressed this issue herein. Patients and Methods: We retrospectively analyzed the cases of in‐patients diagnosed with AP at our multi‐faculty university hospital within a 12‐month recruiting period, with a 3.0 ± 2.5‐week follow‐up and ≥1×/week visits. We determined the patients' organic and neural disorders with neuroimaging to the extent possible. Results: The AP patients (n = 136) were generally old (mean age 75 years, range 3‐98 years) and male‐dominant (81 males, 55 females). All patients showed gait and attention/cognitive problems at admission, suggestive of encephalopathy/delirium. They were treated in 11 hospital wards: neurology (N) or non‐N (ratio ~1:1.3). The ratio of organic disorders (esophageal carcinoma, etc) vs neural disorders was ~1:30. Most of the neural disorders were age‐related brain diseases, eg, a combination of white matter disease (WMD) and Alzheimer's disease (AD), followed by dementia with Lewy bodies (DLB). In total, they were WMD in 111, AD in 102, DLB in 20. Conclusion: A combination of premorbid age‐related brain diseases (a combination of WMD and AD, DLB, etc) with encephalopathy/delirium (and intrinsic brain diseases) might lead to AP. [ABSTRACT FROM AUTHOR]

• We demonstrated a significant indirect protective effect of COVID-19 vaccination. • The indirect protective effect of COVID-19 vaccination were attributed to an additive effect together with the direct effect. • These findings emphasize the importance of herd immunity by COVID-19 vaccination for not only unvaccinated but vaccinated individuals. There is little information on relationships between indirect and direct protection by COVID-19 vaccination on close contacts of the vaccinees. Here, we assessed effect modification of direct–indirect action influencing the protective effects of vaccination. Secondary attack rates (SARs) in household contacts (n = 2422) depending on vaccination status of the index cases (n = 1112) with known vaccination history during the delta variant-dominant period (August 2–November 2, 2021) in two public health jurisdictions were calculated using multivariable logistic regression analysis to assess indirect protection by COVID-19 vaccination as adjusted odds ratios (aORs) for SARs. The impact of the time of index case vaccination on indirect-direct protective effects was also assessed. Contacts of index cases receiving 2× COVID-19 vaccinations showed significantly lower SARs than contacts of unvaccinated index cases (aOR:0.48, 95 %CI = 0.32–0.74). Relative to contacts where neither index cases nor contacts themselves were vaccinated (0,0), those with (2,0), (0,2) and (2,2) had lower SARs (0.45, 95 %CI = 0.24–0.82, 0.24, 95 %CI = 0.17-0.032, 0.11, 95 %CI = 0.06–0.20, respectively. No significant interactions on the SARs regarding times of vaccination between index cases and household contacts were observed, indicating additive but not synergistic protection. The indirect protective effects of COVID-19 vaccination were attributed to an additive effect together with the direct effect on onward transmission in the household setting. These findings emphasize the importance of herd immunity by COVID-19 vaccination not only for unvaccinated but also vaccinated individuals. [ABSTRACT FROM AUTHOR]

We assessed case fatality rates (CFRs) in cases aged ≥70 years in 10 Japanese prefectures (14.8 million residents) diagnosed between January 2022 and March 2023, when the Omicron variant was dominant in Japan. We selected incident reports on 283,052 study subjects from participating Public Health Centers adhering to the Infectious Diseases Control Law. Cases were passively followed up until the end of their isolation, date of death or 28 days after the COVID-19 diagnosis, whichever occurred first. We calculated age-standardized CFRs with 95% confidence intervals (CI) using the Japanese population aged 70-79, 80-89 and ≥90 in 2022 divided into 16 subgroups according to the period of COVID-19 diagnosis. The total overall CFR was 1.59% (95% CI 1.55-1.64); it ranged between 0.67% (95% CI 0.38-0.96, May 23-June 19) and 2.58% (95% CI 2.36-2.80, January 31-February 27). We observed three peaks of age-standardized CFRs paralleling the 6 th , 7 th and 8 th endemic COVID-19 waves driven by Omicron in Japan (2.2% January 31-February 27, 1.0% July 18-August 14 and 1.6% December 26-January 22, 2023, respectively). Population-based CFRs for Omicron variant COVID-19 in Japanese aged ≥70 years remained <3% throughout the period January 2022-March 2023, including during three large endemic waves in this country.

Urinary dysfunction includes an overactive bladder (OAB), post-void residual (PVR)/retention, or both entities. Brain diseases cause OAB, peripheral neuropathies are associated with significant PVR/retention, and multisystem atrophy/spinal cord diseases result in a combination of OAB and PVR/retention. Selective beta 3 adrenergic receptor agonists or anticholinergic agents are the first-choice treatment for OAB and clean intermittent self-catheterization, alpha-blocker and cholinergic stimulant therapy for significant PVR/retention. These therapies may be useful to maximize patients' quality of life and prevent serious complications, such as urosepsis or kidney dysfunction.

We reviewed the autonomic dysfunction in multiple system atrophy (MSA) with reference to the new MDS criteria. MSA is a major neurodegenerative disorder that presents with autonomic and motor dysfunctions (cerebellar ataxia and/or parkinsonism). Autonomic dysfunction in MSA affects urinary, cardiac, gastrointestinal, otorhinolaryngologic, and respiratory functions. Therefore, autonomic dysfunction in MSA should be recognized, collaborating with each faculty for the treatment and care of the patients. Moreover, it is highly recommended that neurologists request for an ultrasound measurement of the post-void residual urine volume. MSA has no cure; hence, active participation in the treatment and care of autonomic dysfunction in MSA patients is warranted.