Background: No consensus exists regarding which anthropometric measurements are related to bone mineral density (BMD), and this relationship may vary according to sex and age. A large Japanese cohort was analyzed to provide an understanding of the relationship between BMD and anthropometry while adjusting for known confounding factors. Methods: Our cohort included 10,827 participants who underwent multiple medical checkups including distal forearm BMD scans. Participants were stratified into four groups according to age (≥50 years or <50 years) and sex. The BMD values were adjusted for confounding factors, after which single and partial correlation analyses were performed. The prevalence of osteopenia was plotted for each weight index (weight or body mass index [BMI]) class. Results: Cross-sectional studies revealed that weight was more favorably correlated than BMI in the older group (R=0.278 and 0.212 in men and R=0.304 and 0.220 in women, respectively), whereas weight and BMI were weakly correlated in the younger age groups. The prevalence of osteopenia exhibited a negative linear relationship with weight among older women ≥50 years of age, and an accelerated increase was observed with decreasing weight in older men weighing <50 kg and younger women weighing <60 kg. When weight was replaced with BMI, the prevalence was low in most subgroups classified by weight. Conclusions Weight, rather than BMI, was the most important indicator of osteopenia but it might not be predictive of future bone loss.

Background: Massive rotator cuff tears (MRCTs) with subscapularis (SSC) tears cause severe shoulder dysfunction. In the present study, the influence of SSC tears on three-dimensional (3D) shoulder kinematics during scapular plane abduction in patients with MRCTs was examined. Methods: This study included 15 patients who were divided into two groups: supraspinatus (SSP) and infraspinatus (ISP) tears with SSC tear (torn SSC group: 10 shoulders) or without SSC tear (intact SSC group: 5 shoulders). Single-plane fluoroscopic images during scapular plane elevation and computed tomography (CT)-derived 3D bone models were matched to the fluoroscopic images using two-dimensional (2D)/3D registration techniques. Changes in 3D kinematic results were compared. Results: The humeral head center at the beginning of arm elevation was significantly higher in the torn SSC group than in the intact SSC group (1.8±3.4 mm vs. −1.1±1.6 mm, p<0.05). In the torn SSC group, the center of the humeral head migrated superiorly, then significantly downward at 60° arm elevation (p<0.05). In the intact SSC group, significant difference was not observed in the superior-inferior translation of the humeral head between the elevation angles. Conclusions In cases of MRCTs with a torn SSC, the center of the humeral head showed a superior translation at the initial phase of scapular plane abduction followed by inferior translation. These findings indicate the SSC muscle plays an important role in determining the dynamic stability of the glenohumeral joint in a superior-inferior direction in patients with MRCTs.

Purpose：This study investigated the factors associated with rehabilitation service satisfaction in convalescent stroke patients.Methods：This cross-sectional study included 41 participants (mean age 50.5 ± 9.3 years；73.2％ were male). Patients with severe cognitive impairment who were unable to respond to questionnaires were excluded from the study. At discharge, patient satisfaction was assessed using the Customer Satisfaction Scale based on Need Satisfaction (CSSNS) tool. We also evaluated physical function using the Stroke Impairment Assessment Set-Motor (SIAS-M) gain tool, activities of daily living (ADL) using the Motor-Functional Independence Measure (M-FIM) effectiveness tool, depressive symptoms using the Japan Stroke Scale-Depression (JSS-D) tool, optimism using the revised Life Orientation Test (LOT-R), and service quality using the SERVPERF model. Stepwise regression analysis was performed to identify factors that were significantly associated with CSSNS scores.Results：The mean CSSNS score of participants was 55.5 ± 8.3 points. Stepwise multiple regression analysis showed that M-FIM effectiveness (β＝0.48, p＜0.01) and SERVPERF scores (β＝0.48, p＜0.01) were significantly associated with CSSNS scores.Conclusion：This study revealed that favorable improvements in ADL and better service quality were associated with higher rehabilitation service satisfaction in convalescent stroke patients.

Purpose：This study investigated the factors associated with rehabilitation service satisfaction in convalescent stroke patients.Methods：This cross-sectional study included 41 participants (mean age 50.5 ± 9.3 years；73.2％ were male). Patients with severe cognitive impairment who were unable to respond to questionnaires were excluded from the study. At discharge, patient satisfaction was assessed using the Customer Satisfaction Scale based on Need Satisfaction (CSSNS) tool. We also evaluated physical function using the Stroke Impairment Assessment Set-Motor (SIAS-M) gain tool, activities of daily living (ADL) using the Motor-Functional Independence Measure (M-FIM) effectiveness tool, depressive symptoms using the Japan Stroke Scale-Depression (JSS-D) tool, optimism using the revised Life Orientation Test (LOT-R), and service quality using the SERVPERF model. Stepwise regression analysis was performed to identify factors that were significantly associated with CSSNS scores.Results：The mean CSSNS score of participants was 55.5 ± 8.3 points. Stepwise multiple regression analysis showed that M-FIM effectiveness (β＝0.48, p＜0.01) and SERVPERF scores (β＝0.48, p＜0.01) were significantly associated with CSSNS scores.Conclusion：This study revealed that favorable improvements in ADL and better service quality were associated with higher rehabilitation service satisfaction in convalescent stroke patients.

BACKGROUND: The burden of dementia is growing rapidly and has become a medical and social problem in Japan. Prospective cohort studies have been considered an effective methodology to clarify the risk factors and the etiology of dementia. We aimed to perform a large-scale dementia cohort study to elucidate environmental and genetic risk factors for dementia, as well as their interaction. METHODS: The Japan Prospective Studies Collaboration for Aging and Dementia (JPSC-AD) is a multisite, population-based prospective cohort study of dementia, which was designed to enroll approximately 10,000 community-dwelling residents aged 65 years or older from 8 sites in Japan and to follow them up prospectively for at least 5 years. Baseline exposure data, including lifestyles, medical information, diets, physical activities, blood pressure, cognitive function, blood test, brain magnetic resonance imaging (MRI), and DNA samples, were collected with a pre-specified protocol and standardized measurement methods. The primary outcome was the development of dementia and its subtypes. The diagnosis of dementia was adjudicated by an endpoint adjudication committee using standard criteria and clinical information according to the Diagnostic and Statistical Manual of Mental Disorders, 3rd Revised Edition. For brain MRI, three-dimensional acquisition of T1-weighted images was performed. Individual participant data were pooled for data analyses. RESULTS: The baseline survey was conducted from 2016 to 2018. The follow-up surveys are ongoing. A total of 11,410 individuals aged 65 years or older participated in the study. The mean age was 74.4 years, and 41.9% were male. The prevalence of dementia at baseline was 8.5% in overall participants. However, it was 16.4% among three sites where additional home visit and/or nursing home visit surveys were performed. Approximately two-thirds of dementia cases at baseline were Alzheimer's disease. CONCLUSIONS The prospective cohort data from the JPSC-AD will provide valuable insights regarding the risk factors and etiology of dementia as well as for the development of predictive models and diagnostic markers for the future onset of dementia. The findings of this study will improve our understanding of dementia and provide helpful information to establish effective preventive strategies for dementia in Japan.
Aged ; Alzheimer Disease/genetics* ; Dementia/genetics* ; Environment ; Female ; Humans ; Incidence ; Japan/epidemiology* ; Male ; Middle Aged ; Prevalence ; Prospective Studies ; Risk Factors

We report the case of a 3-year-old boy with a history of repeated neutropenia and infection along with a significant family medical history. The diagnosis was cyclic neutropenia based on genetic testing. He had experienced frequent repeated episodes of fever since age 8 months, and he was found to have neutropenia when hospitalized due to acute otitis media at age 13 months. We obtained serial data of complete blood cell counts for 6 weeks when he was 3 years and 4 months old, which confirmed a cyclic increase and decrease in the number of neutrophils. ELANE gene testing was performed after obtaining written informed consent from the parents. A missense mutation was identified. At the parents’ request, we ran further testing and identified the same mutation in the father and paternal grandmother. Thus, 3 generations of kindred had the ELANE gene mutation. Because of repeated infections, prophylactic sulfamethoxazole trimethoprim was started from age 3 years and 10 months, resulting in a considerable decrease in the frequency of infections. Since age 4 years and 11 months, cyclic neutrophil over about 3 weeks has persisted, but there have been no serious infections requiring hospitalization.

BACKGROUND/AIMS: Our physicians work to expand the possibilities to treat female patients with inflammatory bowel disease (IBD) who wish to become pregnant. Although many drugs, including 5-aminosalicylate (5-ASA), corticosteroids, immunomodulators, and biologics, are used safely during pregnancy, few reports have described the therapeutic regimen throughout pregnancy and the management of patients who relapse during pregnancy precisely. The aim of this study was to assess the management of patients with IBD during pregnancy. METHODS: We identified 19 patients (five with Crohn's disease and 14 with ulcerative colitis [UC]) who became pregnant with a total of 23 pregnancies between May 2005 and May 2015 by reviewing the medical records of Kyoto University Hospital. The following data were collected: the maternal variables, the IBD treatment type, the disease activity, the pregnancy outcome, and the mode of delivery. RESULTS: Among the 19 patients, 18 had become pregnant after being diagnosed with IBD, while one had developed UC newly after pregnancy. Throughout the gestation, all patients were treated with probiotics, 5-ASA, prednisolone, cytapheresis, or infliximab. The relapse rate during pregnancy was 21.7% (5/23 cases). The five patients who experienced a relapse were able to pursue their pregnancy after intensification of their treatments. There were no adverse fetal or neonatal problems, except in one case that required an emergency Caesarean section because of placental dysfunction and in which a very low-birth-weight infant was born preterm. CONCLUSIONS: Our present data confirmed that even if the disease flares up during pregnancy, good pregnancy outcomes can be achieved with an optimal intensification of the patient's treatment.
Adrenal Cortex Hormones ; Asian Continental Ancestry Group* ; Biological Products ; Cesarean Section ; Colitis, Ulcerative ; Crohn Disease ; Cytapheresis ; Emergencies ; Female ; Humans ; Immunologic Factors ; Infant, Low Birth Weight ; Infant, Newborn ; Inflammatory Bowel Diseases* ; Infliximab ; Medical Records ; Mesalamine ; Prednisolone ; Pregnancy ; Pregnancy Outcome ; Probiotics ; Recurrence

A 75-year-old man was admitted to our hospital with sudden onset of vomiting and abdominal distension. The patient was taking medication for arrhythmia. Computed tomography showed stenosis of the ileum and a small bowel dilatation on the oral side from the region of stenosis. A transnasal ileus tube was placed. Enteroclysis using contrast medium revealed an approximately 6-cm afferent tubular stenosis 10 cm from the terminal ileum and thumbprinting in the proximal bowel. Transanal double-balloon enteroscopy showed a circumferential shallow ulcer with a smooth margin and edema of the surrounding mucosa. The stenosis was so extensive that we could not perform endoscopic balloon dilation therapy. During hospitalization, the patient's nutritional status deteriorated. In response, we surgically resected the region of stenosis. Histologic examination revealed disappearance of the mucosal layer and transmural ulceration with marked fibrosis, especially in the submucosal layer. Hemosiderin staining revealed sideroferous cells in the submucosal layers. Based on the pathologic findings, the patient was diagnosed with ischemic enteritis. The patient's postoperative course was uneventful.
Aged ; Arrhythmias, Cardiac ; Constriction, Pathologic* ; Dilatation ; Double-Balloon Enteroscopy ; Edema ; Enteritis* ; Fibrosis ; Hemosiderin ; Hospitalization ; Humans ; Ileum ; Ileus ; Intestines ; Ischemia ; Mucous Membrane ; Nutritional Status ; Ulcer ; Vomiting

BACKGROUND/AIMS: Early use of biologics in patients with Crohn's disease (CD) improves quality of life. However, the effects of the early use of immunomodulators on long-term outcomes remain unclear. This study aimed to evaluate the effects of immunomodulators in patients with CD. METHODS: Between January 2004 and December 2011, 47 biologic-naive CD patients treated with thiopurines alone for remission maintenance were analyzed. The patients were classified into 2 groups depending on the presence or absence of digestive complications. We evaluated the efficacy of and predictive factors for thiopurine use for remission maintenance. RESULTS: The cumulative relapse rates at 24 and 60 months were 13.7% and 35.4%, respectively. Regarding patient characteristics, there was a significant difference in patient history of surgery between the non-relapse and relapse groups (P=0.021). The cumulative relapse rate was lower in patients without a history of surgery than in those with such a history (27.2% and 52.9% at 60.0 months, respectively). Multivariate analysis suggested that the prevalence of stricturing and penetrating complications is an independent factor for relapse. The cumulative relapse rate in patients without a history of surgery was significantly lower in the non-stricturing and non-penetrating group than in the stricturing and penetrating group (11.8% at 85.0 months vs. 58.5% at 69.0 months; P=0.036). CONCLUSIONS: Thiopurine use might be beneficial for the long-term maintenance of remission in biologic-naive Crohn's disease patients without digestive complications and a history of surgery.
Asian Continental Ancestry Group* ; Biological Products ; Crohn Disease* ; Humans ; Immunologic Factors ; Multivariate Analysis ; Prevalence ; Quality of Life ; Recurrence