Pneumonia ranks as the third leading cause of death in Japan. About 97% of patients who die because of pneumonia are elderly, with aspiration generally thought to be involved in the majority of cases of pneumonia in elderly. Once an elderly individual contracts pneumonia, their physical function often declines and their activities of daily living diminish with hospital admission, even in individuals with no underlying disorders. Prolonged confinement to a bed and immobility leads to weakening of the legs and back, making it difficult for elderly patients to attend daily outpatient clinics, often leading to admission to nursing facilities for the aged instead of returning to their own home, even after curative treatment for pneumonia. Most such patients repeatedly develop pneumonia and repeated antibiotic treatment enhances the risk of the emergence of resistant organisms. It is beyond doubt, therefore, that prevention of pneumonia is of vital importance in the elderly.

Periodontal diseases are a major public health problem affecting over half of the adult population worldwide. Lipopolysaccharide (LPS) produced by the periodontopathic bacterium Porphyromonas gingivalis induces the expression of inflammatory cytokines that promote inflammatory bone destruction. Mounting evidence supports that periodontal diseases are involved in the onset and progression of several systemic diseases, such as aspiration pneumonia and diabetes. Although treatment of periodontal diseases by removing the periodontopathic bacteria by brushing is a standard practice, it has limitations and is not effective in all cases. Therefore, a new method to replace or complement brushing is needed for the treatment of periodontal diseases. In this study, we investigated the anti-inflammatory effects of an extract from Cynara scolymus L. and its pharmacologically effective compound cynaropicrin, a sesquiterpene lactone, on human gingival fibroblasts (HGFs) stimulated by LPS and the potential anti-osteoclastogenic effects on RAW264.7 cells induced by receptor activator of NF-κB ligand (RANKL). We found that cynaropicrin inhibited IL-8 and IL-6 mRNA and protein synthesis in LPS-stimulated HGFs in a dose-dependent manner. P. gingivalis LPS-induced degradation of IκBα and phosphorylation of NF-κB p65 were also suppressed by cynaropicrin, as was LPS-stimulated NF-κB transactivation. Thus, cynaropicrin's inhibition of P. gingivalis LPS-induced IL-8 and IL-6 expression may be due to the inhibition of the NF-κB pathway. Furthermore, we showed that cynaropicrin dramatically reduced RANKL-induced osteoclast differentiation. These results suggest that cynaropicrin may be useful for preventing periodontal diseases and could prove valuable in the development of more effective preventative approaches for periodontal diseases.

Extramammary Paget's disease (EMPD) is a rare cutaneous malignancy that mainly affects the senior population. There is a relatively high risk of postoperative complications from surgery in the senior population, such as disuse syndrome, deep vein thrombosis and postoperative delirium. To prevent such postoperative complications, early ambulation is recommended. However, EMPD often requires extensive skin grafting because of the need for a large resection margin. To avoid skin graft failure, many institutions require that patients have several days of postoperative bedrest. For these reasons, there has been no consensus on standard postoperative rest for EMPD. In this study, we defined 20 patients who walked from the day after surgery as an "early ambulation group" and 23 patients with 5 days postoperative bedrest as a "control group". We evaluated the skin graft survival, postoperative complications and the duration of hospitalization for both groups. Skin graft survival and complications related to the surgical wounds (infection and hemorrhage) in the early ambulation group were found to be comparable with those in the control group. Of note, the other complications (aspiration pneumonia, ileus, delirium, orthostatic hypotension and insomnia) were less frequent (P < 0.001) and the duration of postoperative hospitalization was shorter (P = 0.013) in the early ambulation group than in the control group. Our study suggests that early ambulation after surgery for EMPD does not impair skin graft survival but reduces postoperative complications and the duration of hospitalization.

Recurrent aspiration pneumonia can impede the continuation of enteral nutrition. Semi-solid feeds have been demonstrated to reduce the incidence of aspiration pneumonia but are difficult to administer via the nasogastric tube. A novel semi-solidifying enteral formula may be used instead to avoid the occurrence of severe gastroesophageal reflux.