Background: This study aimed to clarify the association between the co-existence of possible sarcopenia (PS) and dysphagia in patients with acute stroke and the functional outcomes 12 months after stroke. Methods: This multicenter retrospective cohort study was conducted on patients with stroke admitted to two acute care hospitals in Japan between November 2020 and October 2023. PS was defined based on grip strength (males <28 kg, females <18 kg) and calf circumference (males <34 cm, females <33 cm) on admission. Dysphagia was defined as a Functional Oral Intake Scale score of less than 4. The outcome was defined as a composite of either poor functional outcome (modified Rankin Scale [mRS] score of 3–6) or failure to recover to the premorbid mRS at 12 months after stroke onset. Modified Poisson regression analysis was used to examine the association between the co-existence of PS and dysphagia and poor functional outcomes. Results: This study included 604 patients (median age 76 years; 367 men). Compared with the non-PS and non-dysphagia group, the PS and dysphagia group had a higher proportion of poor functional outcomes. Subsequently, modified Poisson regression analysis was performed. The interaction between PS and dysphagia was significantly associated with poor functional outcomes (risk ratio=4.348, 95% confidence interval 2.683–7.046). Conclusion In patients with acute stroke, the co-existence of PS and dysphagia was associated with poor functional outcomes 12 months after stroke. Future multicenter prospective interventional studies are required to clarify the effectiveness of multifaceted intervention programs in high-risk patients.

Background: Evidence on the effectiveness of exercise for cognitive recovery in patients with sarcopenia is limited. This study examined the association between group-based chair-stand exercise and cognitive improvement during convalescent rehabilitation. Methods: This retrospective cohort study included stroke patients with sarcopenia and impaired cognitive level, defined as a Functional Independence Measure (FIM)-cognitive score ≤23, admitted between 2016 and 2023. All patients received standard rehabilitation and participated in group-based chair-stand exercise twice daily. The frequency of exercise during hospitalization was recorded. The primary outcome was FIM-cognitive score at discharge. Secondary outcomes were handgrip strength (HG) and FIM-motor score. Multivariate linear regression analysis was used to examine associations between exercise frequency and outcomes, adjusting for potential confounders. Results: Of the 1,220 patients admitted, 273 sarcopenic stroke patients with reduced cognitive level (mean age 80 years; 48% male) were included in the final analysis dataset; the median frequency of performing chair-stand exercise per day was 43 (interquartile range, 20–71). Higher exercise frequency was independently associated with better FIM-cognitive score at discharge (β=0.217, p<0.001), greater HG (β=0.146, p=0.008), and improved FIM-motor score (β=0.295, p<0.001). Conclusion Frequent participation in group-based chair-stand exercise was associated with improvements in cognitive and physical function in sarcopenic stroke patients. Incorporating simple, repetitive resistance exercises into rehabilitation programs may enhance recovery outcomes in this vulnerable population.

The Japan Society of Gynecologic Oncology (JSGO) guideline for the treatment of uterine body neoplasm are revised from the 2018 guideline. This guideline aimed to provide standardized care for uterine body neoplasm, indicate appropriate current treatment methods for uterine body neoplasm, minimize variances in treatment methods among institutions, improve disease prognosis and treatment safety, reduce the economic and psychosomatic burden on patients by promoting the performance of appropriate treatment, and enhance mutual understanding between patients and healthcare professionals. The guidelines were prepared through the consensus of the JSGO guideline committee, based on a careful review of evidence from the literature searches and the medical health insurance system and actual clinical practice situations in Japan. The main features of the 2023 revision are as follows: 1) The Guidelines Formulation Committee members were asked to understand Minds' medical guideline development method in advance. 2) The clinical question (CQ) was changed to Patient, Intervention, Comparison, Outcome format as much as possible. 3) Introduced the "body of evidence," which summarizes the results of research reports collected for the CQs by outcome and study design, and the strength of evidence for each body of evidence was rated from levels A to D. 4) Introduction of systematic reviews in some CQs. 5) The strength of evidence, the balance of benefits and harms, value and hope for patients, and clinical applicability were considered while drafting recommendations. Herein, we present the English version of the JSGO guidelines 2023 for the treatment of uterine body neoplasm.

Background: Sarcopenia negatively affects the short-term prognosis of hospitalized older adults. However, no evidence currently supports a direct relationship between sarcopenia and readmission among individuals who have experienced an acute stroke. Therefore, we investigated whether sarcopenia is associated with readmission after discharge. Methods: This retrospective cohort study included patients who had experienced acute stroke. Sarcopenia was defined as the coexistence of low skeletal muscle mass index (SMI) and grip strength. We applied the log-rank test and Cox proportional hazards regression analysis to analyze whether sarcopenia, low SMI, and low grip strength were associated with readmission within 6 months. Results: Among 228 included patients (mean age, 72.8 years; 146 males), the prevalence of sarcopenia was 24.6% (n=56; male 17.8%; female 36.6%). Cox proportional hazards regression analysis using the propensity score as a covariate revealed that sarcopenia (hazard ratio [HR]=7.21; 95% confidence interval [CI] 1.45–35.8; p=0.016) and low skeletal muscle mass (HR=7.40; 95% CI 1.14–48.1; p=0.036), but not low grip strength (HR=1.42; 95% CI 0.281–7.21; p=0.670), were significantly associated with readmission for stroke within 6 months. Conclusions Sarcopenia was negatively associated with readmission within 6 months of stroke onset in patients in Japan who had experienced an acute stroke. These findings suggest that the identification of sarcopenia may facilitate prognostic prediction from the acute stage and intervention(s) to prevent rehospitalization.

The aims of this study were (1) to develop and validate the scale to measure evidence-based nursing practice in cancer pain management and (2) to identify associated factors. We developed potential items based on the 2014 version of Japanese Clinical Guidelines for Cancer Pain Management and administered anonymous questionnaire for 189 oncology nurses in a designated cancer center. We conducted a re-test to test reliability.167 nurses participated in the study. As a result of item analysis and exploratory factor analysis, we developed a nursing practice scale of cancer pain management and its shortened version. This scale consists of 1 domain 50 items The Cronbach’s α coefficient showing internal consistency was 0.98 (shortened version 0.88). The intra-class correlation coefficient of reliability was 0.52 (shortened version 0.77). Concurrent validity was confirmed by the correlation between the total score of the whole scale and the total score of the practice of palliative care, knowledge, difficulty, self-confidence scale. We concluded that this scale was valid and reliable. Factors related to the nursing practice of cancer pain management were years of experience in cancer nursing, opportunities of postgraduate education, and satisfaction with postgraduate education. This scale can be used for evaluation of daily clinical practice and practice evaluation after educational efforts such as cancer pain nursing training.

Objectives: The purpose of this study is to investigate the stage of chronic kidney disease (CKD) in adenine-induced CKD model rats by serum analyses, and to examine bone mineral density (BMD), bone strength, and microstructure of trabecular and cortical bone in these rats. Methods: Eight-week-old, male Wistar rats (n = 42) were divided into 2 groups: those fed a 0.75% adenine diet for 4 weeks until 12 weeks of age to generate CKD model rats (CKD group); and sham rats. The CKD and sham groups were sacrificed at 12, 16, and 20 weeks of age (n = 7 in each group and at 12, 16, and 20 weeks), and various parameters were evaluated, including body weight, renal wet weight, muscle wet weight, renal histology, biochemical tests, BMD, biomechanical testing, and micro-computed tomography (CT). The parameters were compared between the 2 groups at the various time points. Results: In the CKD model rats, at 20 weeks of age, serum creatinine, phosphorus, and intact-PTH levels were elevated, and serum calcium levels were normal, indicating that the CKD was stage IV and associated with secondary hyperparathyroidism. Decreased BMDs of the whole body and the femur were observed as bone changes, and micro-CT analysis showed deterioration of bone microstructure of the cortical bone that resulted in decreased bone strength in the cortical and trabecular bone. Conclusions These CKD model rats showed stage IV CKD and appear appropriate for evaluating the effects of several treatments for CKD-related osteoporosis and mineral bone disorder.

STUDY DESIGN: Retrospective and comparative study. PURPOSE: We assessed surgical treatment outcomes in patients with thoracic myelopathy due to ossification of the ligamentum flavum (OLF), and OLF combined with ossification of the posterior longitudinal ligament (OPLL) or vertebral fracture (VF) at the same level. OVERVIEW OF LITERATURE: OLF and OPLL cause severe thoracic myelopathy. Osteoporotic VF commonly occurs at the thoracolumbar junction. There have been no investigations of thoracic myelopathy due to OLF and VF. METHODS: Forty patients were divided among three groups: the OLF group (n=23): myelopathy due to OLF, the OLF+OPLL group (n=12): myelopathy due to OLF and OPLL, and the OLF+VF group (n=5): myelopathy due to OLF and VF. We recorded OLF, OPLL, and VF sites and operative procedures. Each patient’s neurological status, according to the Japanese Orthopaedic Association (JOA) score, and walking ability were evaluated pre- and postoperatively. RESULTS: Patients in the OLF+OPLL group were significantly younger than those in the other two groups. The preoperative JOA score was significantly lower in the OLF+VF than OLF group. The final JOA score was significantly lower in the OLF+VF than OLF and OLF+OPLL groups. The JOA score recovery rate was significantly lower in the OLF+VF than OLF group. Final walking ability was significantly worse in the OLF+OPLL and OLF+VF groups than in the OLF group and significantly worse in the OLF+VF than OLF+OPLL group. CONCLUSIONS: Thoracic myelopathy due to OLF+VF occurs primarily in older females, who also exhibit worse preoperative and postoperative neurological status, and worse walking ability, than patients with thoracic myelopathy due to OLF or OLF+OPLL.

OBJECTIVES: The purpose of this study is to evaluate the effects of teriparatide (TPTD) on bone mineral density (BMD), bone strength, and bone quality in Akita mouse models of diabetes mellitus. METHODS: Twelve-week-old female Akita mice and control mice (C57/BL/6NCrSlc) were divided into 4 groups: control mice treated with vehicle (n = 7) or TPTD (n = 6); and Akita mice treated with vehicle (n = 6) or TPTD (n = 7). TPTD or vehicle was administered subcutaneously 3 times a week for 8 weeks. Blood glucose, serum sclerostin, total tibial BMD, femoral shaft bone strength, and bone quality using Fourier-transform infrared spectroscopy imaging were evaluated. RESULTS: No significant differences in serum sclerostin levels were evident among these groups after 8 weeks of treatment. TPTD significantly increased BMD in control mice (+12.7%, P = 0.02) and Akita mice (+29.2%, P = 0.001) compared with vehicle. Maximum load and stiffness were significantly higher in Akita mice treated with TPTD than in Akita mice treated with vehicle (+56.6%, P = 0.03 and + 90.5%, P = 0.02, respectively). On Fourier-transform infrared spectroscopy imaging, the mineral/matrix ratio was significantly lower in Akita mice treated with vehicle than in control mice (−12.2%, P = 0.02), and TPTD treatment significantly increased the mineral/matrix ratio (P = 0.003). CONCLUSIONS TPTD thus improved BMD and bone strength in both control mice and Akita mice, with improvements in the mineral/matrix ratio among Akita mice.

OBJECTIVES: Rheumatoid arthritis (RA) is characterized by chronic inflammation of the synovium, progressive erosion of the articular cartilage, and joint destruction. RA also causes secondary osteoporosis and muscle wasting. We investigated the effects of ibandronate (IBN), a bisphosphonate; eldecalcitol (ELD), an active vitamin D3 derivative; and combination treatment with both agents on secondary osteoporosis and muscle wasting using adjuvant-induced arthritis rats. METHODS: Arthritis was induced in 8-week-old male Lewis rats. Rats were randomized into 4 treatment groups and an untreated normal control group: IBN (subcutaneously, once every 2 weeks, 10 µg/kg), ELD (orally, once daily, 30 ng/kg/day), IBN + ELD, vehicle, and control. Paw thickness measurements were performed for evaluation of arthritis. The femur was scanned using dual-energy X-ray absorptiometry. Cross-sectional areas of left tibialis and anterior muscle fibers and the expression of MuRF1, atrogin-1, MyoD, and myogenin in the gastrocnemius muscle were measured to evaluate muscle wasting. RESULTS: IBN and/or ELD increased bone mineral density (BMD) in the femur. In addition, there was an additive effect of combination treatment compared with single treatments for BMD. However, IBN and/or ELD did not inhibit muscle wasting in adjuvant-induced arthritis rats. CONCLUSIONS: Combination treatment with IBN and ELD may be effective for secondary osteoporosis associated with RA. Other treatments are necessary for muscle wasting associated with RA. Studies in humans are needed to confirm these findings.
Absorptiometry, Photon ; Animals ; Arthritis ; Arthritis, Rheumatoid ; Bone Density ; Cartilage, Articular ; Cholecalciferol ; Femur ; Humans ; Inflammation ; Joints ; Male ; Muscle, Skeletal ; Myogenin ; Osteoporosis ; Rats ; Synovial Membrane ; Vitamin D

OBJECTIVE: To evaluate the clinical efficiency of identifying patients with suspicious severe lesions by conization among prediagnosed cervical intraepithelial neoplasia (CIN) 1 and 2 patients in Japan. METHODS: The data in a Japanese nation-wide registry for cervical cancer (2009 and 2011) was collected to analyze the clinical efficacy of pre- and postdiagnosis for 13,215 Japanese women who underwent treatment by conization. Their preoperative and postoperative histologic findings and clinical outcomes were evaluated using standard statistical procedures including clinical and demographic characteristics. RESULTS: Almost half of 1,536 women who were treated by conization after the prediagnosis of CIN1 and 2 because the lesions showed no evidence of natural regression actually contained CIN1–2 (45.0%), CIN3 (47%), or invasive cancer (2.7%) in their cervical tissue. They underwent conization either for therapeutic (treatment) (78.5%) or diagnostic (21.5%) reasons. Invasive disease was diagnosed postoperatively more often in diagnostic cases (6.1%) than in therapeutic cases (2.8%). All the patients survived their diagnostic and therapeutic conization after approximately 30 months of follow up. CONCLUSION: Our study shows that the continuous observation of the prediagnosed CIN1 and 2 cases by the combination of cytology, colposcopy and histology in Japan has worked successfully to identify severe lesions by using conization as well in the process.
Asian Continental Ancestry Group ; Cervical Intraepithelial Neoplasia ; Colposcopy ; Conization* ; Female ; Follow-Up Studies ; Humans ; Japan* ; Treatment Outcome ; Uterine Cervical Neoplasms