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This study is to evaluate the impact of cooperation between acute care hospital and rehabilitation hospital on physical function, exercise tolerance, activities of daily living (ADL), health-related quality of life (HR-QOL), and psychological function in heart disease patients undergoing cardiac rehabilitation. Among patients undergoing concurrent medical treatment and cardiac rehabilitation starting early in acute care hospitalization, we selected 30 patients who required continued cardiac rehabilitation in rehabilitation hospitals as subjects. At the time of admission and discharge from the rehabilitation hospital, we measured and compared physical function [grip strength, knee extension strength, and the short physical performance battery (SPPB)], ADL ability using the Functional Independence Measure (FIM), exercise tolerance [six-minute walking distance (6MD)], and psychological functions such as the MOS 36-Item Short-Form Health Survey (SF-36). The average age of the subjects was 76.8 years and 60% were women. In 70% of cases, musculoskeletal causes were the reasons for continued cardiac rehabilitation in a rehabilitation hospital. In evaluations before and after hospitalization, significant improvements were observed in knee extension strength and the results of the SPPB (p

Background Adverse effects of dietary intake of trans-fatty acids (TFA) on the incidence of coronary artery disease (CAD) are well recognized in Western countries. The risk of TFA, however, has not been well clarified in Japan. We investigated the association of serum TFA concentration with serum lipid profile, coronary risk factors, and prevalence of CAD. Methods and results A total of 902 patients, who were hospitalized at Kobe University Hospital from July 2008 to March 2012 and gave written informed consent, were enrolled in this study. Among them, 463 patients had CAD, and 318 patients had metabolic syndrome (MetS). Serum TFA, elaidic acid (trans-9-C18:1) and linolelaidic acid (trans-9, 12-C18:2), were measured on gas chromatography/mass spectrometry. Serum TFA level had a positive correlation with body mass index, waist circumference, low-density lipoprotein cholesterol, triglycerides, and apolipoprotein B48, and an inverse correlation with age and high-density lipoprotein cholesterol. Fasting serum TFA, by age quartile in the young generation with CAD and/or MetS, was higher than that in patients without CAD and/or MetS. On multivariate logistic regression, TFA was identified as a CAD risk after adjustment for classical risk factors. Conclusions Serum TFA concentration was elevated in young patients with CAD and/or MetS. Diet-derived TFA may cause a serious health problem, particularly in the young generation in Japan.

Objective : It has been reported that high-density lipoprotein (HDL) loses anti-inflammatory function and promotes atherosclerosis under pathological conditions. However, no pharmacological therapy to improve HDL function is currently available. We aimed to evaluate the effect of oral administration of eicosapentaenoic acid (EPA) on HDL function. Methods : Japanese patients with dyslipidemia were treated with EPA (1800 mg/day, 4 weeks), and anti-inflammatory functions of HDL were assessed utilizing in vitro cell-based assays. Results : The EPA treatment did not change serum cholesterol and triglyceride levels, but it significantly increased EPA concentrations in the serum and HDL fraction. The EPA/arachidonic acid ratio in the HDL was in proportion to that in the serum, suggesting that the orally administered EPA was efficiently incorporated into the HDL particles. The HDL after EPA treatment showed significantly increased activity of anti-oxidative enzyme, paraoxonase-1. In addition, the EPA-rich HDL significantly improved endothelial cell migration, and markedly inhibited cytokine-induced expression of vascular cell adhesion molecule-1, in human umbilical vein endothelial cells, compared to HDL before the EPA treatment. Moreover, the EPA-rich HDL augmented cholesterol efflux capacity from macrophages. Conclusion : Oral administration of EPA regenerated anti-oxidative and anti-inflammatory functions of HDL, and promoted cholesterol efflux from macrophages. Therefore, EPA may transform “dysfunctional HDL” to “functional”, in patients with coronary risk factors.

The textural properties of different forms of food, classified on the basis of eating effort by the elderly, were measured at Sugenosato Nursing Home for the elderly.The results demonstrate that the forms of food that require little mastication effort and with a texture most easily lumped together within the oral cavity were all soft and high in both adhesiveness and cohesiveness.It was also indicated that a consistent jellied food texture, which is a property helpful for people with swallowing difficulties, was soft and low in both adhesiveness and cohesiveness, and that it took a form that required neither mastication nor lumping together in the oral cavity.Among the various forms of food studied, thin rice gruel and gruel prepared with a blender, which constitute staple food at the nursing home, were found to be the softest and the highest in adhesiveness and cohesiveness.These findings imply that eating the main and side dishes (meat, fish, vegetables, etc.) simultaneously with the staple food (thin rice gruel and gruel prepared with a blender) makes it easier for the elderly to lump the food together in the oral cavity to form a bolus.A commercially developed and marketed boil-in-the-bag meal series, classified according to the Food Category Table for the Elderly drawn up by Japan Care Food Conference, was demonstrated to have textural properties similar to those of the meals served at the nursing home, where the food is prepared according to the eating ability of each elderly person.These results indicate the importance of measuring the textural parameters of the food served at hospitals and nursing homes for the elderly to identify whether or not an individual with deteriorated eating ability will be able to take in food in a safe manner.

Objective: Previous studies have reported that inflammation converts high-density lipoprotein (HDL) to dysfunctional form lacking its anti-inflammatory properties. However, little is known about pharmacological therapy to improve HDL function. It has been recently postulated that fatty acid component in HDL-phospholipids modulates HDL functions. We investigated the effect of oral administration of high dose eicosapentaenoic acid (EPA) on HDL functions. Methods: Patients with dyslipidemia were treated with 1800 mg/day EPA for 4 weeks, and HDL fractions were isolated by ultracentrifuge before and after the EPA treatment. HDL functions were evaluated by multiple in vitro cell-based assays. Results: The EPA treatment did not affect the quantity in the serum lipid profile including serum cholesterol, triglyceride and apolipoprotein levels, but significantly increased EPA concentrations both in the serum and HDL fraction. The EPA/arachidonic acid ratio in the HDL was in proportion to that in the serum, suggesting that EPA was incorporated in HDL particles. The HDL after EPA treatment possessed high activity of paraoxonase-1, an HDL-associated anti-oxidative enzyme, compared to HDL before EPA treatment. In addition, the EPA-rich HDL significantly improved endothelial cell migration, and markedly inhibited cytokine-induced expression of vascular cell adhesion molecule-1 in human umbilical vein endothelial cells, compared to HDL before the EPA treatment. Moreover, the EPA-rich HDL had high capacity of cholesterol efflux capacity from macrophages. Conclusion: Administration of high dose EPA improves anti-inflammatory, anti-oxidative, and cholesterol efflux capacity of HDL in dyslipidemic patients. Thus, EPA may transform “dysfunctional HDL” to “functional”, in patients with coronary risk factors.

To identify new therapeutic targets for coronary artery disease (CAD), we investigated whether fasting serum concentration of apolipoprotein (apo) B48 could be a marker for CAD.Patients with CAD were divided into those with new-onset CAD [i.e., those receiving percutaneous coronary intervention (PCI) for the first time] and those with chronic CAD (i.e., those receiving follow-up coronary angiography). Fasting serum biochemical analyses were performed on admission and 6 months after the PCI.On admission, serum LDL-C concentrations in patients with chronic CAD (n=138), presumably receiving statin treatment, were lower than in patients with new-onset CAD (n=50, p0.02) or without CAD (n=71, p0.001). Nevertheless, apoB48 was higher in CAD patients than in those without CAD (p0.001). After adjusting for classic cardiovascular risk factors, multivariate logistic regression analyses showed apoB48 to be an independent predictor of coronary risk in new-onset or chronic CAD, irrespective of the LDL-C levels. Moreover, apoB48 was markedly increased during the follow-up period in CAD patients having new lesion progression after the prior PCI.Fasting serum apoB48 concentration could be a marker of new onset as well as chronic CAD, and predict new lesion progression in secondary prevention.

It has been recently postulated that not only the quantity but also quality of HDL play an important role in the progression and regression of atherosclerosis. Pitavastatin is a unique statin that possesses both LDL–decreasing and HDL–increasing effects. To clarify whether the HDL increased by