Correlation between phase angle and the number of medications in older inpatients: A cross-sectional study.

Background: Muscle weakness in older adults elevates mortality risk and impairs quality of life, with the phase angle (PhA) indicating cellular health. Polypharmacy, common in geriatric care, could influence PhA. This investigates whether the number of medications and polypharmacy with PhA as a biomarker of muscle quality in older inpatients aged ≧ 65 and determines the extent to which multiple medications contribute to the risk of reduced muscle quality. Methods: This retrospective cross-sectional study analyzed data from older inpatients requiring rehabilitation. PhA was measured using bioelectrical impedance analysis. The number of medications taken by each patient was recorded at admission. Polypharmacy was defined as the concurrent use of five or more medications at admission. Results: In this study of 517 hospitalized older adults (median age: 75 years; 47.4% men), 178 patients (34.4%) were diagnosed with sarcopenia. Polypharmacy was present in 66% of patients. The median PhA was 4.9° in men and 4.3° in women. Multivariate linear regression analysis was performed separately for men and women. In men, PhA was negatively correlated with the number of medications (ß = -0.104, p=0.041) and polypharmacy (ß = -0.045, p=0.383). In women, PhA was negatively correlated with the number of medications (ß = -0.119, p=0.026) and polypharmacy (ß = -0.098, p=0.063). Analyses were adjusted for age, BMI, sarcopenia, CRP, and hemoglobin levels. Conclusions: The number of medications at admission negatively impacted PhA in older inpatients, highlighting the importance of reviewing prescribed drugs and their interactions.

Low phase angle is associated with swallowing outcomes in patients with acute stroke.

BACKGROUND AND PURPOSE: Stroke-induced dysphagia is a critical complication that can lead to severe secondary worldwide health issues. This retrospective cohort study investigated the association between phase angle (PhA) and swallowing function in the acute phase of stroke. We aim to establish whether nutritional and muscular interventions associated with PhA could enhance swallowing recovery and reduce related risks post-stroke. METHODS: Stroke patients requiring rehabilitation were assessed for the association between low PhA-with cutoff values for low PhA defined as less than 5.28 for men and 4.32 for women-and swallowing function using a functional oral intake scale (FOIS) on Day 7 after admission and after the completion of acute stroke treatment. RESULTS: In this study of 140 acute stroke patients (median age 74[69-81], and 85 men and 55 women), 76 patients with low PhA significantly exhibited older age, lower body mass index, more decline in skeletal muscle mass index, and lower premorbid modified Rankin Scale scores compared to 64 patients with high PhA. Multivariate linear regression revealed that low PhA was independently associated with FOIS scores on Day 7 after admission (ß=-0.143 and p=0.036) and after the completion of acute stroke treatment (ß=-0.513 and p=0.024), even when adjusting for confounding factors. CONCLUSIONS: Low PhA is associated with swallowing function in patients with acute stroke. Nutritional and physical interventions improving PhA may lead to a reduction of the risk associated with stroke sequelae.

Probable Respiratory Sarcopenia Decreases Activities of Daily Living in Older Patients Hospitalized with Respiratory Diseases: A Cross-sectional Study.

Objectives: Respiratory sarcopenia is characterized by low respiratory muscle mass and respiratory muscle strength, but its impact on activities of daily living (ADL) remains unknown. We aimed to investigate the association between respiratory sarcopenia and decreased ADL. Methods: This retrospective cross-sectional study included older inpatients (≥65 years old) with respiratory diseases who underwent rehabilitation. Because the evaluation of respiratory muscle mass is challenging, probable respiratory sarcopenia was defined according to low appendicular skeletal muscle index (<7 kg/m2 for men, <5.7 kg/m2 for women) and peak expiratory flow rate (<4.4 L/s for men, <3.21 L/s for women). ADL was assessed on the first day of rehabilitation using the baseline Barthel Index (BI). Results: Of 111 inpatients (median age 75 years; 57 women), 13 (11.7%) had probable respiratory sarcopenia. Forty-five patients (40.5%) had sarcopenia and 12 of these had probable respiratory sarcopenia. Pulmonary functions (Forced Vital Capacity and expiratory volume in 1 s) were significantly lower in patients with probable respiratory sarcopenia than those without. Spearman's rank coefficient analysis showed probable respiratory sarcopenia did not significantly correlate with age, phase angle, Charlson Comorbidity Index (CCI), or hemoglobin (Hb). Multivariate linear regression analysis with baseline BI revealed probable respiratory sarcopenia (ß -0.279 and P=0.004) was the significant factor after adjusting for age, sex, body mass index, chronic obstructive pulmonary disease, CCI, and Hb. Conclusions: Probable respiratory sarcopenia was independently associated with decreased ADL in patients aged 65 years and older who were hospitalized with respiratory diseases.

Impact of Presarcopenic Dysphagia on 1-Year Mortality After Videofluoroscopic Swallowing Study in Patients with Cancer.

Sarcopenic dysphagia is the term for swallowing difficulty associated with loss of mass, strength, and physical performance, which leads to increased pharyngeal residues. Unlike sarcopenia, presarcopenia is characterized by low muscle mass without decreased muscle strength or physical performance and can develop into dysphagia due to low skeletal muscle mass. This retrospective study investigated the impact of presarcopenic dysphagia (PSD) on 1-year mortality in patients with cancer and dysphagia who underwent a videofluoroscopic swallowing study (VFSS). An operational definition of PSD based on presarcopenia and pharyngeal residues was adopted. The psoas muscle mass index (cm2/height [m2]), calculated by the psoas muscle area at the third lumber vertebra via abdominal computed tomography (CT) and related to height, was used to assess presarcopenia with cutoff values of 4.62 for men and 2.66 for women. Pharyngeal residues were assessed using a VFSS to evaluate dysphagia. Patients' medical charts were analyzed to investigate 1-year mortality after a VFSS. Out of 111 consecutive patients with cancer, 53 (47.7%) were defined as having PSD. In a forward-stepwise Cox proportional regression analysis, PSD (HR 2.599; 95% CI 1.158-5.834; p = 0.021) was significantly associated with 1-year mortality after a VFSS, even after adjusting for the factors of operation, Functional Oral Intake Scale (FOIS) scores at discharge, and modified Barthel Index (BI) scores at discharge. PSD, defined as CT-based presarcopenia and pharyngeal residues observed during a VFSS, is associated with increased 1-year mortality in patients with cancer and dysphagia.

Survey of patients with stroke in the Kitakyushu Area, Japan: a 12-year retrospective analysis of the critical pathway.

OBJECTIVES: We aimed to clarify the incidence, clinical profile, outcome, and activities of daily living of patients with stroke using the Kitakyushu clinical pathway database and to investigate the characteristics of patients with stroke in the Kitakyushu medical area in Japan. MATERIALS AND METHODS: The clinical data of patients with stroke registered in the Kitakyushu database between April 1, 2009 and December 31, 2021 were retrospectively examined. The National Institutes of Health Stroke Scale was used to classify stroke severity. A descriptive analysis of basic variables, including age, stroke type, length of hospital stay, and activities of daily living, according to stroke severity was conducted. RESULTS: There were 7,487 acute care hospital patients and 5,441 rehabilitation hospital patients. Compared with patients in similar cities in Japan, patients in the Kitakyushu area tended to be older at the time of stroke onset with a higher proportion of cases of hemorrhagic stroke. Length of hospital stay in both acute and rehabilitation hospitals increased with stroke severity. The Functional Independence Measure gain was highest in patients with moderate disability. CONCLUSIONS: Compared with patients in similar cities in Japan, in the Kitakyushu area, patients with stroke were older and the proportion of patients with hemorrhagic stroke was higher. Stroke rehabilitation therapy is effective for patients with moderately severe stroke.

Negative impact of computed tomography-based low skeletal muscle mass on swallowing recovery in patients with post-stroke dysphagia.

OBJECTIVES: Dysphagia due to stroke has a high prevalence, and evaluating the swallowing function of dysphagia and promoting oral intake is essential in patients with stroke. The psoas muscle mass index（cm2/height2（m2））, calculated by the psoas muscle area at the L3 level via abdominal computed tomography （CT）, can predict the development of dysphagia. However, knowledge about the impact of CT-based skeletal muscle mass on swallowing recovery, remains unknown. Therefore, we investigated whether CT-based low skeletal muscle mass impacted swallowing recovery. METHODS: A retrospective cohort study was conducted on patients with post-stroke dysphagia who underwent acute treatments along with a videofluoroscopic swallowing study（VFSS）. Swallowing recovery was identified as the improvement of the Functional Oral Intake Scale （FOIS） from the time of VFSS to discharge（observational period: ObPd）. The psoas muscle mass index's cut-off values for low skeletal muscle mass were 3.74 cm2/m2 and 2.29 cm2/m2 for men and women respectively. RESULTS: There were 53 subjects （36 male, median age 73.9）. The median during the ObPd was 26 days, and the median days from onset to admission and admission to VFSS were 0 and 18, respectively. Sixteen patients had low skeletal muscle mass. The median improvement of FOIS during the ObPd was 2, and the median length of hospital stay was 51 days. In the stepwise multiple linear regression analysis for the improvement of FOIS during the ObPd, low skeletal muscle mass （ߠ- 0.245; 95% confidence interval - 2.248 to - 0.127; p = 0.029） was a significant factor, even adjusted for serum albumin at admission, disturbance of consciousness at VFSS, FOIS at VFSS, and aspiration during VFSS. CONCLUSION: CT-based low skeletal muscle mass negatively impacted swallowing recovery during the ObPd in patients with post-stroke dysphagia.

Applicability of non-destructive equipment for radioactivity measurement to screening radio-cesium in foods.

This study aimed to evaluate the applicability of non-destructive radioactivity measurement equipments for screening radio-cesium in whole foods without sample preparation procedures. Wild mushrooms and bamboo shoots were collected and studied using five different non-destructive radioactivity devices, and activity concentration was determined by conventional gamma-ray spectrometry using a Ge-detector. Linear regression analyses of activity concentrations were conducted and prediction intervals determined as uncertainties. Overall, non-destructive radioactivity measurement devices found to be suitable for screening radioactive cesium contamination in foods with an effective screening level.

Estimation of dietary intake of 90Sr in Japan after the Fukushima Daiichi Nuclear Power Plant accident: market basket study, 2013-2018.

Radionuclide contamination in foods has been a public concern in Japan after the Fukushima Daiichi Nuclear Power Plant (FDNPP) accident. To estimate time and regional trends of daily intake and annual committed effective dose of strontium-90 (90Sr) after the accident, we analysed Market basket samples using a low background 2π gas-flow counter. Samples were collected from six regions, once a year from 2013 to 2018. There appeared to be little variation in estimated daily intake and annual committed effective dose of 90Sr across the time periods and regions. The estimated maximum annual committed effective dose of 90Sr was 0.00076 mSv/year, a value sufficiently lower than the intervention exemption level, 1 mSv/year, in foods in Japan. There was no noticeable difference between the range of estimated daily intake of 90Sr in this study compared with daily intake measured before the FDNPP accident. These results suggested that no obvious increase in dietary intake of 90Sr was observed after the FDNPP accident, and that the effects on commercial foods from 90Sr due to the FDNPP accident were negligible.

Comprehensive analysis of a decade of cumulative radiocesium testing data for foodstuffs throughout Japan after the 2011 Fukushima Daiichi Nuclear Power Plant accident.

The unexpected accident at the Fukushima Daiichi Nuclear Power Station in Japan, which occurred on March 11th, 2011, after the Great East Japan Earthquake and tsunami struck the north-eastern coast of Japan, released radionuclides into the environment. Today, because of the amounts of radionuclides released and their relatively long half-life, the levels of radiocesium contaminating foodstuffs remain a significant food safety concern. Foodstuffs in Japan have been sampled and monitored for 134,137Cs since the accident. More than 2.5 million samples of foodstuffs have been examined with the results reported monthly during each Japanese fiscal year (FY, from April 1st to March 31st) from 2012 to 2021. A total of 5,695 samples of foodstuffs within the "general foodstuffs" category collected during this whole period and 13 foodstuffs within the "drinking water including soft drinks containing tea as a raw material" category sampled in FY 2012 were found to exceed the Japanese maximum permitted level (JML) set at 100 and 10 Bq/kg, respectively. No samples from the "milk and infant foodstuffs" category exceeded the JML (50 Bq/kg). The annual proportions of foodstuffs exceeding the JML in the "general foodstuffs" category varied between 0.37% and 2.57%, and were highest in FY 2012. The 134,137Cs concentration for more than 99% of the foodstuffs monitored and reported has been low and not exceeding the JML in recent years, except for those foodstuffs that are difficult to cultivate, feed or manage, such as wild mushrooms, plants, animals and fish. The monitoring data for foodstuffs show the current status of food safety risks from 134,137Cs contamination, particularly for cultured and aquaculture foodstuffs on the market in Japan.

A new method to quantify innervation of the ulnar intrinsic hand muscles by the anterior interosseous nerve in Martin-Gruber anastomosis and nerve transfer surgery.

INTRODUCTION/AIMS: It is important to quantify the amount of crossover innervation from the anterior interosseous nerve (AIN) through Martin-Gruber anastomosis (MGA) particularly in patients with high ulnar nerve injury who undergo nerve transfer surgery. The objective of this study is to describe a novel electrophysiological method for quantifying innervation from the AIN that can be done using conventional nerve conduction study setup and commonly available software for analysis. METHODS: Seven subjects with MGA and nine patients who had undergone AIN to ulnar nerve transfer underwent conventional motor nerve conduction studies. Recording was done over the hypothenar and first dorsal interosseous muscles while stimulating the median and ulnar nerves at the wrist and elbow. Datapoint-by-datapoint subtraction of the compound muscle action potentials evoked at the elbow and wrist was performed after they had been onset-aligned. The results were compared to the collision technique and innervation ratio method. RESULT: Results from the digital subtraction method were highly correlated with the collision technique (r = 0.96, p < 0.05). In contrast, its correlation with the innervation ratio method is substantially lower. DISCUSSION: In comparison to previously described techniques, the digital subtraction method has a number of practical advantages. It uses conventional nerve conduction study setup, and the added step of digital alignment and subtraction can be done through commonly available software. With the increasing use of nerve transfer surgery in severe high ulnar nerve injury, this could be a useful method to identify the presence of MGA prior to surgery and for evaluating nerve recovery following surgery.

Radiocesium Concentration in Commercially-Available Foods Produced in Japan: 2017-2019.

We investigated the concentration of radioactive cesium (r-Cs: 134Cs and 137Cs) in commercially-available foods to confirm the effectiveness of pre-shipment radioactive material inspections mainly conducted by local governments. We focused on selected production areas and foods with high probability of r-Cs detection. To this end, we evaluated 715, 685, and 683 samples using scintillation spectrometer and high-purity germanium γ-spectrometer in fiscal years 2017, 2018, and 2019, respectively. The results accounted for 9 samples (1.3%), 10 samples (1.5%), and 5 samples (0.7%) for each fiscal year exceeded the standard limit of radioactive material (100 Bq/kg as r-Cs concentration for general foods). Although we selected and evaluated foods with high probability of r-Cs detection, percentage of samples exceeding the standard limit in each fiscal year was very low, less than 2% to be exact. This suggests that food management system, including pre-shipment inspections, were effectively functioning. In addition, samples exceeding the standard limit were bound to edible wild plants and wild mushrooms, and log-cultivated mushrooms. The former is consider to be difficult for cultivation/feeding control, and the latter was know to be parts of foods greatly affected by radioactive materials. This suggests that the concentration of r-Cs in these items remains at relatively high levels. In contrast, r-Cs was not detected in items with controalble cultivation/feeding. Based on these observations, it is better to be inspected on more difficult-to-cotrol cultivation/feeding items, in order to achieve further streamlining and improving of inspection efficiency. Our results indicate that r-Cs concentration in commercially-available foods of easy-to cultivation/feeding control, such as general vegetables, fruits, and meat, have been well-controlled in Japan, however, difficult-to-cultivation/feeding control items need to be more paid attention to r-Cs concentrations.

Molecular and Clinical Elucidation of the Mechanism of Action of Steroids in Idiopathic Carpal Tunnel Syndrome.

BACKGROUND: Carpal tunnel steroid injection is a nonoperative intervention for the treatment for idiopathic carpal tunnel syndrome (CTS). The antifibrotic, anti-inflammatory, and antiedematous properties of steroids account for their therapeutic effects in the context of CTS; however, their relative contribution has not been clarified. METHODS: Fibroblasts from subsynovial connective tissues (SSCT) were intraoperatively collected from patients with idiopathic CTS and were incubated with or without the steroid triamcinolone acetonide (TA) for 1, 3, and 7 days; the expression of fibrosis-related genes and inflammatory cytokines was evaluated using quantitative reverse transcription-polymerase chain reaction. A clinical prospective study was conducted with patients who received carpal tunnel TA injections. We performed clinical and electrophysiological evaluations before and 1, 3, and 5 months after TA injection; and we compared the median nerve, flexor tendon, and SSCT areas and the median nerve flattening ratio before and 1 month after TA injection using 3-T magnetic resonance imaging (MRI). RESULTS: TA induced downregulation of the fibrosis-related genes Col1A1 (collagen type I alpha 1 chain), Col1A2, and Col3A1 but not the inflammation-related genes. The nerve flattening ratio did not change after TA injection according to the MRI-based observation of the median nerve, flexor tendon, and SSCT areas. CONCLUSIONS: The therapeutic effects of injected TA are apparently mediated by its antifibrotic rather than its anti-inflammatory and antiedematous properties. TA probably alters the properties but not the morphology of SSCT. LEVEL OF EVIDENCE: Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.

Statins repress needle-like carbon nanotube- or cholesterol crystal-stimulated IL-1ß production by inhibiting the uptake of crystals by macrophages.

Statins are 3-hydroxy-3-methylglutaryl-CoA reductase inhibitors that lower atherogenic LDL-cholesterol levels. Statins exert clinically relevant anti-inflammatory effects; however, the underlying molecular mechanism remains unclear. Studies have shown that endogenous and exogenous pathogenic crystals, such as cholesterol and monosodium urate (MSU), and needle-like nanomaterials, such as multi-wall carbon nanotubes (MWCNT), induce the production of IL-1ß and play a critical role in the development of crystal-associated sterile inflammatory pathologies. In this study, we evaluated the effect of statins on crystal-induced IL-1ß production in macrophages. We found that various statins, including pitavastatin, atorvastatin, fluvastatin, and lovastatin, but not squalene synthase inhibitor, repressed IL-1ß release upon MWCNT stimulation. In addition, IL-1ß production induced by cholesterol crystals and MSU crystals, but not by ATP or nigericin, was diminished. MWCNT-stimulated IL-1ß release was dependent on the expression of NLRP3, but not AIM2, NLRC4, or MEFV. Statin-induced repression was accompanied by reduced levels of mature caspase-1 and decreased uptake of MWCNT into cells. Supplementation of mevalonate, geranylgeranyl pyrophosphate, or farnesyl pyrophosphate prevented the reduction in IL-1ß release, suggesting a crucial role of protein prenylation, but not cholesterol synthesis. The statin-induced repression of MWCNT-elicited IL-1ß release was observed in THP-1-derived and mouse peritoneal macrophages, but not in bone marrow-derived macrophages where statins act in synergy with lipopolysaccharide to enhance the expression of IL-1ß precursor protein. In summary, we describe a novel anti-inflammatory mechanism through which statins repress mature IL-1ß release induced by pathogenic crystals and nanoneedles by inhibiting the internalization of crystals by macrophages.

Continuous Estimation of Annual Committed Effective Dose of Radioactive Cesium by Market Basket Study in Japan from 2013 to 2019 after Fukushima Daiichi Nuclear Power Plant Accident.

Radionuclide contamination in foods has been a great concern after the Fukushima Daiichi Nuclear Power Plant (FDNPP) accident. To estimate time trends of daily intake and annual committed effective dose of radionuclides after the accident, radioactive cesium (r-Cs; 134Cs and 137Cs) and potassium-40 (40K) in market basket (MB) samples prepared at 6-month intervals in periods from September 2013 to March 2019 in 15 regions of Japan were analyzed using γ-ray spectrometry. The annual committed effective dose of r-Cs, calculated at non-detected radionuclide levels assumed to be half the limit of detection (LOD), appeared to decrease gradually in 11 regions close to the FDNPP that were more likely to be affected by the accident. Differences in doses among the 15 regions were large just after the accident, but gradually decreased. In particular, 134Cs has not been detected in any MB sample in any region since September 2018, and annual committed effective dose from 134Cs in all regions was mostly constant at around 0.3 µSv/year (given the respective LODs). The maximum annual committed effective dose of r-Cs in this study was decreased from 2.7 µSv/year in September 2013 to 1.0 µSv/year in March 2019. In contrast, the range of annual committed effective dose of 40K varied from approximately 150 to 200 µSv/year during that time frame and did not change much throughout the period of this study. Although annual committed effective doses of r-Cs in regions close to the FDNPP appeared to be higher than in regions far from the FDNPP, doses in all regions are remaining at a much lower levels than the intervention exemption level, 1 mSv/year, in foods in Japan.

[Development of a Rapid Determination Method for Strontium-90 in Foods Using a Strontium Extraction Column for Use during Emergency Events].

To ensure food safety during emergency events such as nuclear disasters, we developed a practical rapid determination method for strontium-90 (Sr-90) in foods. Purification of Sr from foods was simplified using a commercial Sr-extraction column. We also reduced the waiting time to achieve radiative equilibrium between Sr-90 and Y-90. Finally, we developed a rapid determination method for Sr-90 that can be completed in about a week. Using the new method, stable Sr recoveries exceeded 85%. The trueness of the method ranged from 109 to 115% and the detection limit of Sr-90 was estimated to be 0.07 Bq/kg fresh weight according to a performance evaluation using standard materials. Sr-90 radioactivity concentrations in food samples determined by the new method were highly correlated and nearly equal to concentrations determined by the conventional method. The present study suggests that the new method offers highly sensitive and rapid detection of Sr-90 which are necessary attributes for food tests during emergency events.

PERFORMANCE EVALUATION OF THE EQUIPMENT FOR MEASURING RADIOACTIVITY IN WHOLE FOODSTUFFS WITHOUT DESTRUCTIVE SAMPLE PREPARATION DEVELOPED AFTER THE FUKUSHIMA NPP ACCIDENT.

Recently, several types of instruments for measuring radioactivity in whole foodstuff were developed by manufacturers, in which any sample preparation technique such as machining was avoided, and such types of instruments are employed by agricultural producers or municipality radioactivity testing stations in Fukushima. In this study, radioactivity in various kinds of 91 samples collected by residents were measured by use of instruments for radioactivity measurement in whole samples, and the activity in each sample was also measured by use of the conventional gamma-ray spectrometry technique using calibrated Ge detectors after the sample machining procedure. The results obtained by instruments for measurement in whole samples were roughly proportional to the result obtained by a conventional technique, although large differences or unexpected variations were found in some specimens.

A modified multiple point stimulation method for motor unit number estimation of the hypothenar muscles.

INTRODUCTION: The goal of this study is to test the hypothesis that single motor unit action potentials (SMUPs) originating from other ulnar nerve-innervated intrinsic hand muscles can inflate the motor unit number estimation (MUNE) of the hypothenar muscles. METHODS: Using the multiple point stimulation method, SMUPs recorded over the hypothenar muscles from distant origins were characterized through multichannel recordings. The MUNE calculated using only the hypothenar SMUPs was compared with estimations based on the whole ensemble. RESULTS: Of the 41 studies performed, distant SMUPs represented 17 ± 9.5% (mean ± SD) of the overall sample. MUNE calculated using only hypothenar SMUPs was 423 ± 204, compared with 537 ± 290 if all SMUPs were included (P < 0.05). The extent of increase in MUNE was highly correlated with the proportion of distant SMUPs found (r = 0.89, P < 0.05). DISCUSSION: Erroneous inclusion of SMUPs from distant muscles can significantly distort the MUNE results. Muscle Nerve 59:337-341, 2019.

Acetyl-L-Carnitine to Enhance Nerve Regeneration in Carpal Tunnel Syndrome: A Double-Blind, Randomized, Controlled Trial.

BACKGROUND: Carpal tunnel syndrome is very common. Although surgery is effective in mild and moderate cases, recovery is often incomplete in severe cases. Therefore, adjuvant therapy to improve nerve regeneration in those patients is much needed. Acetyl-L-carnitine has been shown to be effective in other neuropathies. The goal of this study is to test the hypothesis that acetyl-L-carnitine can promote nerve regeneration and improve function in patients with severe carpal tunnel syndrome. METHODS: In this proof-of-principle, double-blind, randomized, placebo-controlled trial, adults with severe carpal tunnel syndrome were randomized to receive 3000 mg/day of acetyl-L-carnitine orally or placebo following carpal tunnel release surgery for 2 months. Outcomes were assessed at baseline and at 3, 6, and 12 months postoperatively. Symptom severity and functional outcomes were assessed using the Boston Carpal Tunnel Questionnaire and a wide range of physiologic and functional outcome measures. Patient safety was monitored by physical examination, blood work, and serum drug levels. The outcomes were analyzed using repeated measure two-way analysis of variance. RESULTS: Twenty patients with similar baseline characteristics were assigned randomly to the treatment or placebo group in a 1:1 ratio. Sixty percent were women with a mean age ± SD of 59 ± 2. The treatment was safe with no major adverse events reported. Although patients in both groups showed improvements postoperatively, there was no significant difference in any of the outcome measures between the groups. CONCLUSION: Although acetyl-L-carnitine was well tolerated, it did not improve nerve regeneration or functional recovery in patients with severe carpal tunnel syndrome. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, II.

[Concentration of Radioactive Cesium in Domestic Foods Collected from the Japanese Market in Fiscal Years 2014-2016].

Between fiscal years 2014 and 2016, we surveyed the concentration of radioactive cesium in commercial foods produced in areas where there is a risk of radiation contamination due to the Fukushima Daiichi nuclear disaster. The number of samples with a concentration of radioactive cesium that exceeded the regulatory limit （100 Bq/kg for general foods） was 9 out of 1,516 （0.6％） in fiscal 2014, 12 out of 900 （1.3％） in fiscal 2015, and 10 out of 654 （1.5％） in fiscal 2016. Even though some samples were expected to be contaminated with radioactive cesium, because wild mushrooms and edible wild plants were intentionally included in this survey, the percentage of samples that exceeded the regulatory limit was only around 1％. The surveillance results confirmed that the pre-shipment food monitoring conducted by local governments was properly and efficiently performed, although continuous monitoring of the concentration of radioactive cesium in cultivated and wild mushrooms, edible wild plants, and wild animal meats is still required.