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Abstract Background The mortality rate of patients with cardiogenic shock (CS) requiring veno-arterial extracorporeal membrane oxygenation (VA-ECMO) combined with Impella (ECPELLA) support remains high. Inhaled nitric oxide (iNO) improves right ventricular (RV) function, resulting in increased Impella flow, which may facilitate early withdrawal of VA-ECMO and improve survival. This study investigated the prognostic impact of iNO therapy in ECPELLA patients. Methods We retrospectively analyzed the data of consecutive patients with CS supported by ECPELLA from September 2019 to March 2024 at our hospital. Changes in pulmonary artery pulsatility index (PAPi) and Impella flow over time were evaluated, and VA-ECMO withdrawal rate, time to withdrawal, and 30-day survival were compared between ECPELLA patients with and without iNO therapy. Results Of the 48 ECPELLA patients, 25 were treated with iNO. There were no significant differences between the groups in baseline characteristics or lactate levels at mechanical circulatory support induction. Patients with iNO therapy demonstrated significant improvements in the PAPi over time and a trend toward increased Impella flow, as well as a significantly higher VA-ECMO withdrawal rate (88% vs. 48%, P = 0.002) and a shorter time to VA-ECMO withdrawal (5 [3–6] days vs. 7 [6–13] days, P = 0.0008) than those without iNO therapy. Kaplan–Meier analysis demonstrated that the 30-day survival rate was significantly higher in patients with iNO than in those without (76% vs. 26%, P = 0.0002). Conclusions iNO therapy in patients with CS requiring ECPELLA was associated with short-term prognosis by improving RV function and facilitating weaning from VA-ECMO. Trial registration Retrospectively registered in UMIN-CTR (Reference No. R00006352).

Abstract Background Age and sex differences in sarcopenic dysphagia are unknown. The purpose is to characterize age and sex differences in sarcopenic dysphagia. Methods A cross‐sectional and retrospective cohort study using information from the Japanese database on sarcopenic dysphagia was performed. We investigated age and sex differences between sarcopenic dysphagia and other forms of dysphagia. We investigated whether differences in prognosis for swallowing function, as assessed by the Food Intake Level Scale, and activities of daily living (ADL), as assessed by the Barthel Index were influenced by age and sex in patients with sarcopenic dysphagia. Results The study included 460 patients, including 229 men and 231 women, with a mean age of 81 ± 10 years. Fifty‐eight percent of the patients had sarcopenic dysphagia. Age was independently associated with sarcopenic dysphagia (odds ratio (OR): 1.056, 95% confidence interval (CI): 1.035, 1.078), although sarcopenic dysphagia could also be seen in those younger than 65 years. Sex was not independently associated with sarcopenic dysphagia. The age cut‐off for the diagnosis of sarcopenic dysphagia was 82 years in all patients (sensitivity, 0.660; specificity, 0.644), 80 years in men (sensitivity, 0.619; specificity, 0.631), and 83 years in women (sensitivity, 0.723; specificity, 0.577). Sarcopenic dysphagia showed no significant differences in the improvement of swallowing function and ADL based on age and sex. Conclusions Sarcopenic dysphagia was most common in older adults in their 80s or older. The possibility of sarcopenic dysphagia should be considered when dysphagia is present in people 80 years of age or older.

Abstract Background Symptomatic heart failure (HF) negatively affects the quantity and quality of skeletal muscles. However, the association between asymptomatic HF and skeletal muscle function remains unclear. We aimed to use ultrasonography to elucidate the association between asymptomatic HF and skeletal muscle function in community-dwelling older adults. Methods This cross-sectional study comprised community-dwelling older adults aged ≥ 60 years who could perform activities of daily living independently and had never had symptomatic HF (n = 52, 76.3 ± 6.1 years). The participants were classified into three groups namely, non-HF (n = 26), stage A (n = 19), and stage B (n = 7) according to the HF stage criteria of the American Heart Association /American College of Cardiology /Heart Failure Society of America guideline. Skeletal muscle quantity and quality were assessed using ultrasonography (thickness and echo intensity) of the rectus femoris (RF) and vastus intermedius (VI) muscles. The group effects on muscle thickness and echo intensity in each group were assessed using a multivariate analysis. Results Both muscles consistently demonstrated significant group effects on the thickness and echo intensity. Thicknesses of the RF (p = 0.020) and VI (p = 0.035) were lower in the stage B group than that in the non-HF group. The echo intensities in the RF (p = 0.006) and VI (p = 0.009) were higher in the stage B group than that in the non-HF group. Conclusion Asymptomatic HF negatively associated with the characteristics of skeletal muscle function, as assessed by ultrasonography in community-dwelling older adults. The stage B HF contributes to reduced skeletal muscle function as well as symptomatic HF.

Abstract The quasi-stationary jet, a branch of the Kuroshio Extension, transports warm saline water in the mixed water region of the western North Pacific. Around the subarctic front between the quasi-stationary jet and Oyashio and its downstream area is a biologically productive area including small pelagic fishes. However, how nutrient is supplied to the euphotic zone in this region remains elusive, especially into the quasi-stationary jet. Using high-resolution hydrography sections across the jet, we showed that Oyashio water isopycnally intrudes under the jet around 26.5–26.8 σθ and forms nutrient-rich intermediate water. Upwelling associated with ageostrophic secondary circulation across the front, caused by confluence, uplifts the intermediate water. A local nitrate maximum was also identified inside the jet by the hydrographic observation. Upwelling has been suggested as a precondition for nutrient supply from nutrient-rich intermediate water to the jet through water mixing which potentially sustains high biological production in the downstream.

Abstract Background With the aging of the population worldwide, extending healthy life expectancy is an urgent issue. Muscle mass has been reported to be associated with physical independence and longevity. This study aimed to investigate the characteristics of food intake in urban community-dwelling older adults with low muscle mass. Methods This cross-sectional study used baseline data from the Bunkyo Health Study, which included 1618 urban community-dwelling older adults aged 65–84 years. All participants underwent measurement of body composition using bioelectrical impedance analysis and evaluation of nutrient and food intake using the brief-type self-administered diet history questionnaire. Participants were stratified by sex and divided into robust or low skeletal muscle mass index (SMI) groups according to the Asian Working Group for Sarcopenia criteria to compare differences in nutrient and food intake. Results The mean age and body mass index were 73.1 ± 5.4 years and 22.6 ± 3.1 kg/m2, respectively. The prevalence of low SMI was 31.1% in men and 43.3% in women. In men, all food intake, including total energy intake, was similar between the low SMI group and the robust group. In women, the low SMI group had less total energy intake, and consumed lower amounts of energy-producing nutrients (protein, fat, and carbohydrates), but there were only small differences in the intake of specific foods. Conclusions There were sex differences in food intake characteristics between urban community-dwelling older adults with low SMI and those who were robust. Advising women to increase their energy intake may be important in preventing muscle loss, and further research is needed in men.

IntroductionExercise is a crucial method for preventing geriatric depression. In this cross-sectional study, we investigated the associations between exercise habits in adolescence and old age and geriatric depressive symptoms.MethodsThis study used baseline data from the Bunkyo Health Study, a prospective observational cohort study investigating the preventive effects of physical activity on causative diseases requiring long-term care. This analysis included 1,629 older adults (687 men and 942 women) aged 65–84 years who participated in the Bunkyo Health Study. Participants were divided into four groups according to their exercise habits in adolescence and old age: never exercised (none-none; NN), exercised only in old age (none-active; NA), exercised only in adolescence (active-none; AN), and exercised in adolescence and old age (active-active; AA). Geriatric depressive symptoms were defined as the short version of the Geriatric Depression Scale score ≥ 5, including depression tendency. Multivariate-adjusted logistic regression models were used to estimate the odds ratios (ORs) and associated 95% confidence intervals in each group for the prevalence of geriatric depressive symptoms compared with the NN group.ResultsThe ORs for geriatric depressive symptoms were notably lower in the AN, NA, and AA groups than in the NN group in both older men and older women.ConclusionThese results indicate that older adults with exercise habits in adolescence and/or in old age exhibit a lower prevalence of geriatric depressive symptoms.

BackgroundExercise in adolescence and old age improves cognitive function in older adults, but the combined effect of exercise habits in both periods is controversial. This study aimed to clarify the relationship between exercise habits in adolescence and old age and mild cognitive impairment (MCI) and to compare regional brain volumes and blood biochemical markers associated with cognitive function in older adults.MethodsBaseline data of 1615 participants aged 65–84 years from the Bunkyo Health Study were analyzed. MCI was diagnosed using the Japanese version of the Montreal Cognitive Assessment. Participants were divided into four groups based on their exercise habits in adolescence (13–18 years) and old age: no exercise in either period (None-None), exercise in adolescence only (Active-None), exercise in old age only (None-Active), and exercise in both periods (Active-Active). Logistic regression models estimated the odds ratios (ORs) of MCI prevalence. Regional brain volumes, such as the prefrontal cortex, temporal lobe, parietal cortex, and hippocampus, and blood biochemical markers, such as BDNF, IGF-1, and homocysteine, were compared between groups.ResultsThe OR for MCI was significantly lower in the Active-Active group than in the None-None group (OR, 0.62; 95% CI, 0.41–0.94). However, there were no significant differences in regional brain volumes and blood biochemical markers between the Active-Active and None-None groups.ConclusionsOlder adults with exercise habits in both adolescence and old age have a lower risk of MCI. However, specific regional brain volumes and biochemical markers may not be associated with differences in cognitive function in older adults.

Background: Metabolic syndrome involves health problems influenced by aging and genetics. The glucokinase regulatory protein ( GCKR ) rs1260326 polymorphism (Leu446) is associated with metabolic traits. This study explores the impact of the GCKR rs1260326 polymorphism on metabolic traits in older Japanese with focusing on sex-specific differences. Methods: This cross-sectional study from the Bunkyo Health Study in Tokyo, Japan, examined 883 participants aged 65–84 years. Participants were excluded with diabetes, or on drug treatment for diabetes or dyslipidemia. The GCKR P446L polymorphism was analyzed and compared their characteristics of physical activity, dietary intake, body composition, and metabolic parameters. Results: Study participants with GCKR rs1260326 genotypes (C/C 20.7%, C/T 47.6%, T/T 31.7%) had a median age of 72 years, and 60.4% were women. Men with the T/T genotype, as compared to the C/C genotype, had a lower body weight, body mass index (BMI), and skeletal mass index. This genotype also associated with lower fasting insulin, homeostasis model assessment of insulin resistance index (HOMA-IR), and higher Matsuda index, but not after adjustment for age, BMI, and physical activity. In contrast, women with the T/T genotype, compared to the C/C genotype, showed higher C-reactive protein, fibroblast growth factor 21, and Matsuda index. They also had lower fasting insulin, insulin area under the curve, and HOMA-IR; with these associations being independent of age, BMI, and physical activity. Conclusion: The GCKR rs1260326 genotype-affected metabolic traits differentially by sex in older Japanese. This highlights the need to consider sex differences in GCKR -related metabolic outcomes.

Abstract Sarcopenia is a common skeletal muscle disease in older people. Lower limb muscle strength is a good predictive value for sarcopenia; however, little is known about its genetic components. Here, we conducted a genome-wide association study (GWAS) for knee extension strength in a total of 3452 Japanese aged 60 years or older from two independent cohorts. We identified a significant locus, rs10749438 which is an intronic variant in TACC2 (transforming acidic coiled-coil-containing 2) (P = 4.2 × 10−8). TACC2, encoding a cytoskeleton-related protein, is highly expressed in skeletal muscle, and is reported as a target of myotonic dystrophy 1-associated splicing alterations. These suggest that changes in TACC2 expression are associated with variations in muscle strength in older people. The association was consistently observed in young and middle-aged subjects. Our findings would shed light on genetic components of lower limb muscle strength and indicate TACC2 as a potential therapeutic target for sarcopenia.

Preheating is important to improve the mechanical properties of nickel-based superalloys processed by additive manufacturing. The microstructure of IN718 was found to be influenced by the preheating temperature. Different preheating temperatures affect mechanical properties by changing microstructures. This work aims to clarify the thermal behavior for two preheated base plate temperatures (200 °C and 600 °C) on the IN718 superalloy built by the selective laser melting (SLM) process using the finite element method and experiments. The simulation findings indicate that the preheated 600 °C model has a deeper melt pool, a slower transformation of liquid to solid, and a slower cooling rate compared to the 200 °C model. As a result, the interdendritic Niobium (Nb) segregation of IN718 is reduced, thus improving the mechanical properties of additive-manufactured IN718 using the laser. The solidification map derived from the simulation indicates a columnar microstructure for the IN718 superalloy. Preheating increased the size of the dendrite structure and reduced elemental segregation, but it did not affect the morphology or size of crystal grains. We focused on comparing the temperature gradient and cooling rate for the two preheated base plate temperatures using the solidification map of IN718. The simulation confirmed that preheating does not affect the grain structure.

Sarcopenic dysphagia is characterized by weakness of swallowing-related muscles associated with whole-body sarcopenia. As the number of patients with sarcopenia increases with the aging of the world, the number of patients with sarcopenic dysphagia is also increasing. The prevalence of sarcopenic dysphagia is high in the institutionalized older people and in patients hospitalized for pneumonia with dysphagia in acute care hospitals. Prevention, early detection and intervention of sarcopenic dysphagia with rehabilitation nutrition are essential. The diagnosis of sarcopenic dysphagia is based on skeletal and swallowing muscle strength and muscle mass. A reliable and validated diagnostic algorithm for sarcopenic dysphagia is used. Sarcopenic dysphagia is associated with malnutrition, which leads to mortality and Activities of Daily Living (ADL) decline. The rehabilitation nutrition approach improves swallowing function, nutrition status, and ADL. A combination of aggressive nutrition therapy to improve nutrition status, dysphagia rehabilitation, physical therapy, and other interventions can be effective for sarcopenic dysphagia. The rehabilitation nutrition care process is used to assess and problem solve the patient’s pathology, sarcopenia, and nutrition status. The simplified rehabilitation nutrition care process consists of a nutrition cycle and a rehabilitation cycle, each with five steps: assessment, diagnosis, goal setting, intervention, and monitoring. Nutrition professionals and teams implement the nutrition cycle. Rehabilitation professionals and teams implement the rehabilitation cycle. Both cycles should be done simultaneously. The nutrition diagnosis of undernutrition, overnutrition/obesity, sarcopenia, and goal setting of rehabilitation and body weight are implemented collaboratively.