IntroductionPrevious studies showed that homocysteine, a thromboatherogenic and atherogenic agent, inhibits an endothelial thrombomodulin-protein C anticoagulant pathway. We examined whether homocysteine might affect another endothelial anticoagulant mechanism; i.e., heparin-like glycosamino-glycan-antithrombin III interactions. Incubations of porcine aortic endothelial cell cultures with homocysteine reduced the amount of antithrombin III bound to the cell surface in a dose-and timedependent fashion. The inhibitory effect was observed at a homocysteine concentration as low as 0.1 mM, and the maximal suppression occurred at 1 mM of homocysteine after 24 h. In contrast with a marked reduction in the maximal antithrombin III binding capacity (-30% of control), the radioactivity of I35Slsulfate incorporated into heparan sulfate on the cell surface was minimally (< 15%) reduced. The cells remained viable after homocysteine treatment. Although neither net negative charge nor proportion in total glycosaminoglycans of cell surface heparan sulfate was altered by homocysteine treatment, a substantial reduction in antithrombin III binding capacity of heparan sulfate isolated from homocysteine-treated endothelial cells was found using both affinity chromatography and dot blot assay techniques. The antithrombin III binding activity of endothelial cells decreased after preincubation with 1 mM homocysteine, cysteine, or 2-mercaptoethanol; no reduction in binding activity was observed after preincubation with the same concentration of methionine, alanine, or valine. This sulfhydryl effect may be caused by generation of hydrogen peroxide, as incubation of catalase, but not superoxide dismutase, with homocysteine-treated endothelial cells prevented this reduction, whereas copper augmented the inhibitory effects of the metabolite. Thus, our data suggest that the inhibited expression of anticoagulant heparan sulfate may contribute to the thrombogenic property resulting from the homocysteine-induced endothelial cell perturbation, mediated by generation of hydrogen peroxide through alteration of the redox potential. (J. Clin.

We have evaluated the association between trunk deformities of the sagittal plane and functional impairment of daily living in community-dwelling elderly subjects. The analysis involved a detailed assessment of indoor and outdoor activities of daily living, satisfaction with life, and mental status. The participants in this study were 236 community-dwelling older adults, aged 65 years and older, living in Kahoku district of Kochi in Japan. The participants were classified based on their posture, which was assessed using photographs of the subjects, and interviewed to assess their basic activities of daily living (BADL), instrumental ADL (IADL), and cognitive well-being in the cross-sectional study. The statistical analysis was performed using the Mann-Whitney U-test. The lumbar kyphosis group received significantly lower BADL and IADL scores than the normal group. The trunk deformity group which were defined as kyphosis, flat back, and lumbar lordosis groups exhibited decreases in activities that included going out, shopping, depositing and withdrawing money, and visiting friends in the hospital. These activities require going outdoors; thus, this study showed that the trunk deformity group had limitations in outdoor activities. There was no significant difference between the geriatric depression score (GDS) and the pattern of posture. The abnormal trunk deformity groups tended to score lower than the normal group with regard to subjective healthiness and life satisfaction measures, including subjective health condition, everyday feeling, satisfaction with human relationships, satisfaction with economic condition, and satisfaction with present life.

Elderly patients with a V592fs/8 mutation in the MyBPC gene may evolve into the "end-stage" HCM, characterized by left ventricular systolic dysfunction, cavity dilation, and irreversible heart failure. The clinical course in patients with this mutation is not benign in the long run, with progressive left ventricular remodeling with advancing age.

Background: The aim of the present paper was to establish a new objective scale to measure vitality related to activities of daily living in elderly patients with dementia. Methods: Cross‐sectional and longitudinal observational studies were carried out on patients and residents in long‐term care facilities. Reliability of the scale was examined by determining test–retest reliability, interrater reliability and internal consistency. Validity of the scale was evaluated with respect to criterion validity and predictive validity. Clinical usefulness of the scale was tested by measuring the time taken to perform scoring and evaluating the changes in the score before and after behavioral therapy for functional urinary incontinence. Results: The test–retest correlation coefficient was 0.98. Mean kappa coefficient of Vitality Index was 0.63. Interrater coefficient of variation was 0.14. Cronbach α of the Index was 0.88. Vitality Index was negatively correlated with Geriatric Depression Scale (GDS) (P < 0.01). A low score was an independent risk factor for survival. Behavioral therapy for functional urinary incontinence increased Activities of Daily Living (ADL) (P < 0.05) and Vitality Index (P < 0.05). Conclusion: Vitality Index could be a new tool to assess patients with dementia.

A validation study of the continuous noninvasive tonometric blood pressure monitor called JENTOW was performed in 20 normotensive subjects and 10 hypertensive patients. Tonometric and intra-arterial blood pressures were simultaneously recorded at supine rest and during a Valsalva maneuver and tilting test The results of the strict evaluation of the instrument's capacity for reproducing intra-arterial blood pressure were as follows: 1) The overall frequency response of the transcutaneous blood pressuremonitoring system based on arterial tonometry was flat, with negligible delay to intra-arterial blood pressure in the range of 0-5 Hz.2) The largest discrepancy between intra-arterial and tonometric pressure waveforms was found at the early systolic phase; except for this phase, the tonometric waveform was almost equal to the intra-arterial waveform.3) The beat-to-beat variability of tonometric pressure corresponded to that of intra-arterial pressure almost perfectly in the physiologically significant frequency range of 0-0.5 Hz. 4) During resting conditions, the averages of the systolic and diastolic values measured tonometrically corresponded well to those measured intra-arterially. 5) The changes in the betweenmethod discrepancy of blood pressure values during the Valsalva maneuver were statistically significant but small (<5 mm Hg). 6) No significant effect of postural tilting was found on the between-method discrepancy. We conclude that this method is clinically acceptable and reliable except for its limited capacity for recording the higher frequency intra-arterial waveform and for responding to the relatively rapid and large transient changes in blood pressure. invasive methods for continuously monitoring arterial blood pressure has been expected for many years. A noninvasive technique, arterial tonometry, was invented in 1963. ^ A tonometric device has been recently improved and has resulted in an instrument called JENTOW. The objective of this study was to evaluate the accuracy of the tonometer JENTOW in reproducing intra-arterial blood pressure. Our interests in the comparison of the blood pressures measured by the two methods were focused on the following points: 1) the correspondence of the waveforms of blood pressure, 2) the correlation of beat-to-beat variabilities, and 3) the agreement of blood pressure values during resting conditions and during laboratory maneuvers that induced rapid and large transient changes in blood pressure. This study demonstrated the reliability and limitations of this noninvasive method for reproducing intra-arterial blood pressure. Methods SubjectsTwenty normotensive volunteers and 10 patients with uncomplicated essential hypertension (26 men, four women; mean age, 42.3 years; range, 20-74 years) were