著者

Yumi Yamada Hiroshi Shamoto Keisuke Maeda Hidetaka Wakabayashi

出版者

The Japanese Association of Rehabilitation Medicine

雑誌

Progress in Rehabilitation Medicine (ISSN:24321354)

巻号頁・発行日

vol.3, pp.20180019, 2018 (Released:2018-11-20)

参考文献数

18

被引用文献数

7

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Background: Sarcopenic dysphagia is caused by decreased muscle mass and muscle weakness in the swallowing muscles that occurs because of sarcopenia. The key to treating sarcopenic dysphagia is combined therapy with rehabilitation and aggressive nutrition management. However, to our knowledge, no studies based in a home medical care setting have yet been published. Case: A 72-year-old man with Parkinson’s disease developed sarcopenia and possible sarcopenic dysphagia during hospitalization for drug adjustment. At discharge, the patient’s body weight was 39.0 kg (−33.8%/4 months, body mass index: 15.3 kg/m2), the Barthel Index was 45, Functional Oral Intake Scale was level 4, and Dysphagia Severity Scale was 4. Sarcopenia was confirmed by a calf circumference of 23.8 cm, a handgrip strength of 22 kg, and a gait speed of 0.5 m/s. The patient was diagnosed with sarcopenic dysphagia, according to the consensus diagnostic criteria for sarcopenic dysphagia. After the patient was discharged, he underwent a combination of dysphagia rehabilitation, daily activity training, and aggressive nutrition management, which started from 1200 kcal/day and reached a maximum of 2800 kcal/day. Four months after discharge, the patient’s swallowing function returned to normal (Functional Oral Intake Scale: 7, Dysphagia Severity Scale: 6) and his weight increased by 31% (body mass index: 20.1 kg/m2). Increases in muscle mass (calf circumference: 32 cm), muscle strength (handgrip strength: 34 kg), physical function (gait speed: 1 m/s), and activities of daily living (Barthel Index: 90) indicated recovery from sarcopenia. Discussion: Sarcopenic dysphagia may be a complication of Parkinson’s disease, and home-based combined therapy with rehabilitation and aggressive nutrition management may be effective for treating this condition.

著者

Hiroki Maki Hidetaka Wakabayashi Keisuke Maeda Mariko Nakamichi Kazumi Kubota Ryo Momosaki

出版者

Society for Clinical Epidemiology

雑誌

Annals of Clinical Epidemiology (ISSN:24344338)

巻号頁・発行日

vol.5, no.3, pp.88-94, 2023 (Released:2023-07-04)

参考文献数

22

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BACKGROUNDThe Comorbidity Polypharmacy Score (CPS) is calculated by the number of drugs carried plus the number of comorbidities on admission and divided into three categories (minor, 0–7; moderate, 8–14; and severe, 15+). This study investigates whether CPS can predict the clinical outcomes in older patients with hip fractures undergoing surgery.METHODSThis retrospective longitudinal study used a multicenter hospital-based database containing the Diagnosis Procedure Combination. Consecutive patients with hip fractures (ICD-10 codes S720 and S721) who were aged ≥65 years between April 2014 and August 2020 were included. We evaluated the predictive association between the CPS and Barthel Index (BI) efficiency. The primary outcome was defined as the BI efficiency, and the secondary outcome was the length of hospital stay.RESULTSWe enrolled 11,564 patients, and 80.5% of them were female. The mean age was 83.9 ± 6.5 years. The BI efficiency was the lowest in the CPS severe group with a median [interquartile range] of 0.67 [0.10, 1.43]. The length of hospital stay was the highest in the CPS severe group, with a median of 35 [21, 58]. Additionally, multiple linear regression analysis revealed that the CPS was independently associated with the BI efficiency (β = −0.100, 95% CI: −0.040, −0.029; P < 0.001) and the length of hospital stay (β = 0.047, 95% CI: 0.199, 0.366; P < 0.001).CONCLUSIONSAn increased CPS score is associated with low BI efficiency and longer length of hospital stay in patients with hip fractures.

著者

Sakura Nakatani Keisuke Maeda Junji Akagi Misato Ichigi Marina Murakami Yoshihiko Harada Sara Utsumi Masaki Fukunaga Yuki Narita Yuki Kondo Yoichi Ishitsuka Tetsumi Irie Daisuke Kadowaki Sumio Hirata

出版者

The Pharmaceutical Society of Japan

雑誌

Biological and Pharmaceutical Bulletin (ISSN:09186158)

巻号頁・発行日

vol.42, no.8, pp.1350-1357, 2019-08-01 (Released:2019-08-01)

参考文献数

30

被引用文献数

1 7

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Creatinine (Cr) levels are strongly affected by muscle mass, and the estimated glomerular filtration rate (eGFR), a measure based on serum creatinine (SCr), is often overestimated in patients with sarcopenia. To evaluate the coefficient of determination (R2) between eGFR and the actual measured value, we performed a linear regression analysis of a modified GFR (mGFR: measured Cr clearance × 0.715) and various renal function estimates adjusted for muscle mass in 19 patients with sarcopenia. The eGFR values based on SCr (eGFRcr) were higher than those based on mGFR, although a high R2 (0.704; p < 0.001) was found between these values. There was no deviation between eGFR based on serum cystatin C (eGFRcys) and mGFR, although the R2 value 0.691 was equivalent to that of eGFRcr. In the equation used to calculate eGFRcr not adjusted for body surface area (mL/min), muscle mass parameters obtained from bioelectrical impedance analysis were used instead of actual body weight to recalculate the eGFRcr. The R2 between this eGFRcr and mGFR did not improve, although there was less deviation. However, assuming that all patients were female by using female coefficients for all patients, the R2 between eGFRcr-fcc (eGFRcr with female coefficient correction) and mGFR improved and was the highest (0.808) on substitution of appendicular skeletal muscle mass. The correlation between eGFRcr-fcc and mGFR improved over eGFRcys when muscle mass was substituted for body weight in the equation used to estimate eGFR in patients with sarcopenia and sex differences were removed.

著者

Ryosuke Fujii Hiroya Yamada Eiji Munetsuna Mirai Yamazaki Koji Ohashi Hiroaki Ishikawa Keisuke Maeda Chiharu Hagiwara Yoshitaka Ando Shuji Hashimoto Nobuyuki Hamajima Koji Suzuki

出版者

Japan Epidemiological Association

雑誌

Journal of Epidemiology (ISSN:09175040)

巻号頁・発行日

vol.30, no.4, pp.177-182, 2020-04-05 (Released:2020-04-05)

参考文献数

63

被引用文献数

13

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Background: MicroRNAs (miRNAs) play crucial roles in the development of various diseases, including chronic kidney disease (CKD). Although previous studies in clinically severe patients have investigated associations between CKD and miRNAs, with particular attention on renal fibrosis, relationships in a general population have yet to be established. The aim of this study was to examine the relationship between expression level of circulating miRNAs and CKD in a middle-aged Japanese population.Methods: A final total of 513 individuals (216 men and 297 women) who participated in the health check-up program in 2012 were included in our analysis. Quantitative real-time polymerase chain reaction was used to determine expression levels of 22 miRNAs. Estimated glomerular filtration rate (eGFR) was calculated based on serum creatinine level, sex, and age. Participants with eGFR <60 mL/min/1.73 m2 were defined as having CKD.Results: Three different miRNAs (miR-17, miR-21, and miR-150) showed significant correlations with eGFR after Bonferroni correction and were selected for further analyses. Expression levels of miR-17, miR-21, and miR-150 miRNAs were positively associated with eGFR after adjusting for potential confounders (P = 0.004, 0.002, and 0.004, respectively). Logistic regression analyses showed significantly lower odds ratios for CKD (eGFR <60 mL/min/1.73 m2) in the highest tertile of all three miRNAs (miR-17, miR-21, and miR-150) compared with the lowest tertile (P = 0.003, 0.01, and 0.02, respectively).Conclusions: We found that three circulating miRNAs were significantly associated with CKD in a general Japanese population, which suggested that these miRNAs may be biomarkers for CKD among general adults.