Predictors of Water Turnover in Older Adults: A Doubly Labeled Water- and Triaxial Accelerometer-Based Study.

BACKGROUND: Water is one of the most essential nutrients for life. The water turnover (WT), total body water (TBW), and total energy expenditure (TEE) can be measured using the doubly labeled water (DLW) method. WT and TBW are lower in older adults than in young adults, and the former are susceptible to dehydration, necessitating to identify predictors of the WT in older adults. OBJECTIVES: The current study aimed to examine the association between WT and physical activity, physical function, and body composition in Japanese adults aged ≥65 y and identify predictors for WT in this population. METHODS: This study enrolled 133 older adults (women, n = 61; men, n = 72) aged 65-88 y. WT, TBW, TEE, fat-free mass (FFM), and percent body fat (%Fat) were determined using the DLW method. The fitness age score (FAS) was obtained from 5 physical fitness tests. Physical activity and the step count were assessed using a previously validated triaxial accelerometer. Multiple regression analyses were performed with WT as the dependent variable. RESULTS: WT was positively associated with weight, physical activity level (PAL), moderate-vigorous physical activity, and TEE, and negatively associated with sedentary behavior. We examined potential predictors for WT using age, sex, height, weight, FFM, %Fat, TEE, PAL, and FAS in older Japanese adults. CONCLUSIONS: Our results confirmed that age, sex, weight, FFM, TEE, and PAL are the potential predictors of WT in older Japanese adults aged ≥65 y.

Oral frailty is associated with mortality independently of physical and psychological frailty among older adults.

BACKGROUND: Although oral frailty is independently associated with an increased risk of mortality, evidence for the usefulness of screening tools for oral frailty is less than that for physical frailty screening tools. We aimed to investigate the relationship between oral frailty and mortality in older adults. METHODS: This prospective cohort study included 11,374 adults aged ≥65 years, who provided valid responses to a baseline mail survey questionnaire from the Kyoto-Kameoka study. Oral frailty status was evaluated using the Oral Frailty Index-8 (range, 0 [best] to 10 [worst]). Participants were classified into four categories according to the Oral Frailty Index-8: robust (score, 0-2), oral pre-frailty (score, 3), oral frailty (score, 4-6), and oral severe frailty (score ≥ 7). Physical and psychological frailty were evaluated using the validated frailty-screening index and defined as a score of ≥3 out of a possible 5 points. Mortality data were collected from 30 July 2011 to 30 November 2016. Hazard ratios (HR) for all-cause mortality were calculated using a multivariable Cox proportional hazards model. RESULTS: During the 5.3-year median follow-up period (57,157 person-years), 1184 deaths were recorded. After adjusting for confounders, including physical and psychological frailty, medical history, and lifestyle, in comparison with a robust oral status, oral pre-frailty (HR, 1.29; 95 % confidence interval [CI], 1.02-1.63), oral frailty (HR, 1.22; 95 % CI, 1.01-1.48), and oral severe frailty (HR, 1.43; 95 % CI, 1.16-1.76) were associated with higher HRs of mortality (p for trend = 0.002). CONCLUSION: Oral frailty is associated with mortality independent of physical and psychological frailty in older adults. The Oral Frailty Index-8 may be useful for identifying individuals at high risk of mortality.

Home-based resistance training performed at either fast or slow speeds improves power output in older adults.

PURPOSE: We investigated the effect of an unsupervised, body mass- home-based resistance training program in older adults performed at either a fast or slow contractile speed on changes to muscle-power, -volume, -architecture, and fatigue resistance of the knee extensors. METHODS: Thirty-two male older adults (age 65-88 years) were separated into 1) fast-speed exercise (Fast-group), 2) slow-speed exercise (Slow-group), and 3) no exercise (Control-group) groups. Participants in the exercise groups performed 30-45 repetitions of knee-extension and sit-to-stand exercises 3 times a week for 8 weeks with different exercise speed between the groups. Before and after the intervention period, the following variables were measured: Isotonic power, isometric strength, twitch contractile properties, muscle-activity, -architecture, and -quality, neuromuscular fatigue resistance of the knee extensors, and thigh muscle volume. RESULTS: Peak power was increased in both the Fast-group (+24 %, P < 0.01, d = 0.65) and Slow-group (+12 %, P < 0.05, d = 0.33) but not in the Control-group. Training increased pennation angle of the vastus lateralis in both the Fast-group (+8 %, P < 0.01, d = 0.42) and Slow-group (+8 %, P < 0.01, d = 0.42), while only the Fast-group showed increase in pennation angle of the rectus femoris (+12 %, P < 0.01, d = 0.64) and thigh muscle volume (+16 %, P < 0.01, d = 0.52). There was no time × group interaction effect for the other neuromuscular measures. CONCLUSIONS: Unsupervised, body mass- and home-based resistance training performed at either fast or slow speeds can improve muscle power in older adults, while fast-speed exercise may be preferable over slow-speed owing to the relatively greater improvement of muscle-power, -volume, -architecture, and better time efficiency.

Association of marital relationship with quality of life among older adults with mild cognitive impairment and mild dementia.

The marital relationship is associated with the quality of life among those with cognitive impairment, but sarcopenia status seems to play an important role in the association.

A case of laparoscopic lymphadenectomy for adenocarcinoma of unknown primary incidentally detected as a solitary enlarged lymph node along the common hepatic artery.

BACKGROUND: Even in cancer of unknown primary (CUP), which is rare clinical condition, solitary anterosuperior lymph node (LN) along the common hepatic artery (No.8a LN) enlargement diagnosed as metastatic adenocarcinoma has never been reported. CASE PRESENTATION: A 68-year-old Japanese male, with a history of early gastric cancer that had been completely treated by endoscopic submucosal dissection 26 years ago, was detected a single enlarged nodule along the common hepatic artery, No.8a LN, incidentally by computed tomography performed for monitoring of interstitial pneumonia. Endoscopic ultra-sound-guided fine needle aspiration revealed that this nodule was adenocarcinoma suggestive of metastasis, but other imaging studies, including upper and lower gastrointestinal endoscopy, positron emission tomography, and ultrasonography did not detect any primary cancer. We have finally diagnosed as the LN metastasis of CUP and performed laparoscopic lymphadenectomy for this tumor. The tumor was approximately 5 cm in size, was in close proximity to the pancreas, and involved part of the right gastric artery and vein. LNs in the No.5 and No.8a areas, including this tumor, were dissected laparoscopically, and radical resection was achieved. The patient had no postoperative complication and was discharged on postoperative day 10. Immunohistopathological findings revealed that the tumor was poorly differentiated adenocarcinoma, and different from the histology of gastric cancer resected 26 years ago, although the tumor was suggestive of gastrointestinal origin. Imaging studies performed 2 and 6 months after discharge also did not reveal a primary site. CONCLUSION: We reported a case of solitary No.8a LN adenocarcinoma of CUP. For diagnostic and therapeutic purposes, radical resection is recommended for single enlarged intra-abdominal LN of CUP.

Remarkable remission of symptomatic dermatomyositis after curative breast cancer surgery.

Dermatomyositis (DM) is an autoimmune disease that causes proximal muscle weakness in the extremities leading to severe immobility and dysphagia. Approximately 20% of patients with DM are positive for anti-TIF-1γ antibody and frequently accompanied by malignant tumors. Although DM remission after tumor resection has been reported, the indications for surgery in patients with severe DM are unknown. Herein, we report a case of a 79-year-old Japanese woman who presented with breast cancer and anti-TIF-1γ antibody-positive DM. She became bedridden shortly after DM onset. Although pulsed steroid therapy, intravenous immunoglobulin, tacrolimus, and endocrine therapy with fulvestrant did not improve her symptoms, tumor resection with axillary lymph node dissection resulted in complete remission of the DM after 8 months. Immunohistochemistry revealed high expression of TIF-1γ in cancer cells, both in the primary tumor and axillary lymph nodes. Since the serum levels of anti-TIF-1γ antibody decreased after the surgery, the existence of breast cancer with TIF-1γ expression may have contributed to the worsening of DM. The present case suggests that curative surgery should be considered as a treatment option even if the patient has severe symptoms, such as immobility and dysphagia. Careful discussions with patients and multidisciplinary collaboration are essential to make surgery feasible, particularly for those with severe symptomatic DM.

Examination of changes in the breathing intolerance index to determine the respiratory support needs of very low birth weight infants.

BACKGROUND: The breathing intolerance index (BITI) is used to evaluate respiratory muscle tolerance. The higher the ratio of the inspiratory time to the total breathing time and the ratio of the tidal volume to the vital capacity, the more easily the respiratory muscles become fatigued. The BITI is high with chronic respiratory failure, and values of 0.15 or more indicate the need for assisted ventilation. OBJECTIVE: This study aimed to examine the changes in the BITI of very low birth weight infants (VLBWIs) and determine whether it is possible to use the BITI as an objective indicator of the timing of noninvasive respiratory support (NRS) withdrawal. METHODS: VLBWIs admitted to our neonatal intensive care unit between July 2020 and July 2022 under NRS at 36 weeks' postmenstrual age (PMA). If the BITI was less than 0.15, then we attempted to determine whether NRS could be withdrawn. RESULTS: Sixteen infants with a median gestational age and birth weight of 30.9 weeks and 1249 g, respectively, were eligible. The median PMA at the time of the first examination was 36.6 weeks. The BITI of two VLBWIs was less than 0.15. For 11 of the other VLBWIs, the BITI decreased over time to less than 0.15 at 39 weeks' PMA. After confirming that the BITI was less than 0.15, weaning from NRS was attempted. Weaning from NRS was possible except one VLBWI. CONCLUSION: The BITI can help evaluate respiratory tolerance and could be an objective indicator of the timing of NRS withdrawal.

Impact of Vascular Access Flow Suppression Surgery on Cervical Artery Circulation: A Retrospective Observational Study.

Vascular access (VA) flow suppression surgery augments VA flow resistance and can increase other circulation flows hindered by high-flow VA. However, whether VA flow suppression surgery affects cervical circulation has rarely been reported. We aimed to determine the effect of VA flow suppression surgery on the cervical circulation in patients with high-flow VA. This single-center, retrospective, observational study included 85 hemodialysis patients who underwent VA flow suppression surgery at the Kanno Dialysis and Access Clinic between 2009 and 2018. Blood flow in the VA, bilateral vertebral arteries, and common carotid artery was measured before and after VA flow suppression surgery. The VA flow decreased from 1548 mL/min to 693 mL/min postoperatively. The flow of the vertebral artery on the VA side increased from 55 mL/min to 81 mL/min. The flow in the bilateral common carotid arteries also increased. Patients whose symptoms improved postoperatively showed better improvement in the vertebral artery on the VA side. VA flow suppression surgery in patients with high-flow VA increases the flow of the vertebral artery on the VA side and of the bilateral common carotid arteries. High-flow VA can hinder the vertebral and common carotid circulation.

Expression of FOXI1 and POU2F3 varies among different salivary gland neoplasms and is higher in Warthin tumor.

PURPOSE: Salivary gland tumors are histologically diverse. Ionocytes and tuft cells, rare epithelial cells found in normal salivary glands, might be associated with salivary tumors. Here, we explored the expression of FOXI1 and POU2F3, master regulators of ionocytes and tuft cells, respectively, for common salivary neoplasms using immunohistochemistry. METHODS: We analyzed normal salivary tissues and nine salivary gland tumors; Warthin tumors (WT), pleomorphic adenomas (PA), basal cell adenomas, and oncocytomas were benign, whereas mucoepidermoid, adenoid cystic, acinic cell, salivary duct carcinomas, and polymorphous adenocarcinomas were malignant. RESULTS: Normal salivary glands contained a few FOXI1- and POU2F3-positive cells in the ducts instead of the acini, consistent with ionocytes and tuft cells, respectively. Among the benign tumors, only WTs and PAs consistently expressed FOXI1 (10/10 and 9/10, respectively). The median H-score of WTs was significantly higher than that of PAs (17.5 vs. 4, P = 0.01). While WTs and PAs harbored POU2F3-positive cells (10/10 and 9/10, respectively), the median H-score was higher in WTs than in PAs (10.5 vs 4, respectively). Furthermore, WTs exhibited a unique staining pattern of FOXI1- and POU2F3-positive cells, which were present in luminal and abluminal locations, respectively. Whereas none of the malignant tumors expressed FOXI1, only adenoid cystic carcinoma consistently expressed POU2F3 (5/5), with a median H-score of 4. CONCLUSION: The expression patterns of the characteristic transcription factors found in ionocytes and tuft cells vary among salivary gland tumor types and are higher in WT, which might be relevant for understanding and diagnosing salivary gland neoplasms.

Frailty modifies the association of body mass index with mortality among older adults: Kyoto-Kameoka study.

BACKGROUND & AIMS: The differences in the association of body mass index (BMI) with mortality between older adults with and without frailty remain unclear. This study investigated this association in community-dwelling older adults with and without frailty. METHODS: This prospective study included 10,912 adults aged ≥65 years who provided valid responses to a baseline mail survey questionnaire in the Kyoto-Kameoka Study in Japan. The BMI was calculated based on self-reported height and body weight and classified into four categories: <18.5, 18.5-21.4, 21.5-24.9, and ≥25.0 kg/m2. Frailty was evaluated using the validated Kihon Checklist and defined as a score of 7 or higher out of a possible 25 points. Mortality data were collected from 30 July 2011 to 30 November 2016. Hazard ratios (HR) for all-cause mortality were calculated using a multivariable Cox proportional hazards model. RESULTS: During the 5.3 year median follow-up period (54,084 person-years), 1352 deaths were recorded. After adjusting for confounders, including lifestyle and medical history, compared with participants with a BMI of 21.5-24.9 kg/m2, those in the lower BMI category had a higher mortality HR, while those with a higher BMI displayed an inverse association with mortality (<18.5 kg/m2: HR: 1.85, 95% confidence interval [CI]: 1.58-2.17; 18.5-21.4 kg/m2: HR: 1.38, 95% CI: 1.21-1.58; and ≥25.0 kg/m2: HR: 0.80, 95% CI: 0.67-0.96). In a model stratified by frailty status, the BMI range with the lowest HR for mortality was 23.0-24.0 kg/m2 in non-frail older adults; however, in frail older adults, a higher BMI was inversely associated with mortality. CONCLUSIONS: The relationship between BMI and mortality varies between individuals with and without frailty, with those experiencing frailty potentially benefiting from a higher BMI compared to those without frailty. This study suggests that frailty should be assessed when considering the optimal BMI for the lowest mortality risk among older adults.

Effect of overweight/obesity and metabolic syndrome on frailty in middle-aged and older Japanese adults.

Background: The potential for developing frailty exists in middle-aged and older adults. While obesity and metabolic syndrome (MetS) increase the risk of frailty in older adults, this relationship remains unclear in middle-aged adults, who are prone to developing lifestyle-related diseases. Objective: To examine the effect of overweight/obesity and MetS on frailty development in middle-aged and older Japanese adults using real-world data. Methods: This nationwide cohort study used exhaustive health insurance claims data of 3,958,708 Japanese people from 2015 to 2019 provided by the Japan Health Insurance Association. Participants aged ≥35 and < 70 years who received health checkups in 2015 were included. Multivariate logistic regression was used to assess the effect of body mass index (BMI) and MetS or MetS components (i.e., diabetes, hypertension, and dyslipidemia) in 2015 on frailty risk assessed using the hospital frailty risk score in 2019. Additionally, a subgroup analysis was performed to examine the interaction effects of MetS components and 4-year weight change (%) on frailty risk among participants who were overweight and obese (BMI ≥25 kg/m2). Results: In 2019, 7204 (0.2%) and 253,671 (6.4%) participants were at high and intermediate frailty risks, respectively. Obesity and MetS were independently associated with intermediate/high frailty risk (odds ratio (OR) 1.36, p < 0.05; OR 1.23, p < 0.05, respectively) and high frailty risk (OR 1.80, p < 0.05; OR 1.37, p < 0.05, respectively) in all participants. Although all MetS components were frailty risk factors, these effects diminished with age in both sexes. Subgroup analysis of patients with diabetes revealed that 5%-10% weight loss was associated with reduced frailty risk in both sexes. Conclusions: Obesity, MetS, and MetS components were independent frailty risk factors in middle-aged and older Japanese adults. Weight loss of up to 10% over 4 years prevented frailty in patients with diabetes who were overweight and obese.

Relationship between cognitive function and phase angle measured with a bioelectrical impedance system.

PURPOSE: The purpose of this study was to investigate the relationship between cognitive function and phase angle (PhA), an indicator of muscle quality. METHODS: This cross-sectional study enrolled outpatients who visited a memory clinic at the Nagoya University hospital from January 2016 to June 2022. We enrolled 153 participants with body composition measurements. Inclusion criteria were a Mini-Mental State Examination score of 20-30 and a clinical diagnosis of Alzheimer's dementia (AD) or amnesic mild cognitive impairment (aMCI). The background characteristics of the participants were compared according to AD and aMCI. Next, linear regression analysis was performed with PhA as the objective variable. In addition, logistic regression analysis was performed for AD diagnosis. RESULTS: PhA was lower in the AD group (P = 0.009). In linear regression analysis, PhA consistently decreased with worsening ADAS score. In logistic regression analysis, high PhA was associated with absence of AD. Gender-specific analyses showed these associations existed only in men. CONCLUSIONS: Our study of patients with AD and aMCI found that PhA decreased with worsening of cognitive function. Compared with aMCI, AD was associated with significantly lower PhA. Our results strengthen the limited evidence in the literature showing that low muscle quality is associated with poor cognitive function.

Association Between the Appendicular Extracellular-to-Intracellular Water Ratio and All-Cause Mortality: A 10-Year Longitudinal Study.

The appendicular extracellular-to-intracellular water ratio (A-E/I) is a potential marker of skeletal muscle quality, reflecting the balance of water distribution between the extracellular and intracellular compartments of the appendicular limb regions. A-E/I has been increasingly used in recent studies; however, its association with adverse outcomes remains unclear. This study investigated the potential association between A-E/I and all-cause mortality. A prospective cohort study of 8 015 middle-aged and older adults (comprised of 4 755 women, aged 45-74 years) residing in a Japanese community was conducted. The baseline assessment was performed between 2010 and 2012, and the follow-up period lasted until July 2022. A-E/I and skeletal muscle mass were measured using segmental bioelectrical impedance spectroscopy. Handgrip strength (HGS) was measured using a Smedley-type dynamometer. Lifestyle, medical history, and physical activity were assessed by questionnaire and accelerometer. Hazard ratios (HRs) and 95% confidence intervals (95% CIs) for each quartile (Q) of A-E/I were estimated using the multivariable Cox regression model. During a 10.5-year median follow-up, the mortality rates were 8.9 and 3.6 per 1 000 person-years for men (292 deaths) and women (174 deaths), respectively. A-E/I quartiles were positively associated with all-cause mortality in both sexes (men: Q1, HR: 1.0 [95% CI: reference], Q4, HR: 1.8 [1.1-2.9], ptrend < .05; women, Q4, HR: 2.2 [1.3-3.8], ptrend < .01). This association remained significant after further adjustment for skeletal muscle mass and HGS (ptrend < .05). Our findings suggest that A-E/I serves as an early predictive marker for mortality in middle-aged and older Japanese adults.

Thigh muscle thickness on ultrasonography for diagnosing sarcopenia: The Kyoto-Kameoka study.

AIM: The Asian Working Group for Sarcopenia 2019 consensus reported that evidence for the diagnosis of sarcopenia based on ultrasonography findings is lacking. The revised European Working Group on Sarcopenia in Older People consensus stated that ultrasonography is reliable and valid for assessing muscle size in older adults. The present study aimed to determine the predictive accuracy of ultrasonography for sarcopenia in older adults in Japan. METHODS: A total of 1229 participants aged 65-91 years were included in this cross-sectional study. The thickness of the anterior compartment of the right thigh was assessed using B-mode ultrasonography. The measurement position was at the midpoint of the thigh. In addition, the grip strength, gait speed, Five-Time Sit-to-Stand Test, Short Physical Performance Battery score and skeletal muscle mass index were evaluated. Sarcopenia was diagnosed based on the Asian Working Group for Sarcopenia 2019 algorithm. We calculated the area under the receiver operating characteristic curve. RESULTS: The area under the receiver operating characteristic curves (95% confidence intervals) and cutoff values for the thigh muscle thickness in sarcopenia were 0.901 (0.856-0.946) and 4.0 cm in men, respectively, and 0.923 (0.851-0.995) and 3.1 cm in women, respectively. The area under the receiver operating characteristic curve for each subdomain of sarcopenia, such as grip strength and gait speed, ranged from 0.618 to 0.872. CONCLUSIONS: In the present study, the suggested cutoff mid-thigh muscle thicknesses on ultrasonography for predicting sarcopenia were 4.0 cm in men and 3.1 cm in women. Geriatr Gerontol Int 2024; 24: 156-161.

Hemoglobin Glycation Index: A Novel Risk Factor for Incident Chronic Kidney Disease in an Apparently Healthy Population.

CONTEXT: Chronic kidney disease (CKD) is a worldwide health problem. Recent literature has shown an association of hemoglobin glycation index (HGI) and CKD in patients with dysglycemia. OBJECTIVE: The aim of this study was to reveal the impact of HGI as a predictor for incident CKD in the general population. METHODS: CKD was defined as dipstick proteinuria or estimated glomerular rate (eGFR) < 60 mL/min/1.73 m2. Impact of HGI on incident CKD was assessed using the data from CKD-free health examinees (N = 23 467, 4.1% with diabetes) followed for a mean of 5.1 years: Cox proportional hazards model was employed with multivariate adjustment for age, systolic blood pressure, eGFR, fasting plasma glucose, body mass index, log[alanine aminotransferase], log[triglycerides], high-density lipoprotein cholesterol, platelet counts, smoking, and sex. Elevated level of HGI in subjects with CKD was ascertained after propensity score matching of another group of health examinees (N = 2580, 7.6% with diabetes). RESULTS: In the former group, CKD developed in 2540 subjects and HGI was the second most robust predictor for CKD, following low eGFR. With adjustment for the 11 covariates, the hazard ratio of HGI (95% CI) for CKD was 1.293 (1.238 to 1.349) (P < .0001). The population attributable risk of HGI for CKD was 4.2%. In the latter group, among 708 subjects matched 1:1 for 9 covariates, HGI was significantly elevated in subjects with CKD (median [interquartile range] -0.208 [-0.504 to -0.156] vs -0.284 [-0.582 to 0.052], P = .03). CONCLUSION: HGI was a novel risk factor for CKD in the general population.

Association of skeletal muscle function, quantity, and quality with gut microbiota in Japanese adults: A cross-sectional study.

AIM: The gut microbiota has emerged as a new intervention target for sarcopenia. Prior studies in humans have focused on the association between gut microbiota and skeletal muscle quantity, while the evidence on muscle function and quality is lacking. This study aimed to identify gut microbiota genera associated with skeletal muscle function, quantity, and quality in a general population of Japanese adults. METHODS: This cross-sectional study included 164 participants aged 35-80 years, women and men recruited from urban areas of Japan. Fecal samples were collected and analyzed using 16S rRNA gene amplicon sequencing. Skeletal muscle function was measured using handgrip strength and leg extension power (LEP), while skeletal muscle mass was estimated using bioelectrical impedance analysis. Phase angle was used as a measure of skeletal muscle quality. Multivariate linear regression analysis stratified by age group was used to examine the association between the dominant genera of the gut microbiota and skeletal muscle variables. RESULTS: A significant association was found between Bacteroides and Prevotella 9 with LEP only in the ≥60 years group. When both Bacteroides and Prevotella 9 were included in the same regression model, only Bacteroides remained consistently and significantly associated with LEP. No significant associations were observed between skeletal muscle mass, handgrip strength, and phase angle and major gut microbiota genera. CONCLUSIONS: In this study, we observed a significant positive association between Bacteroides and leg muscle function in older adults. Further studies are required to elucidate the underlying mechanisms linking Bacteroides to lower-extremity muscle function. Geriatr Gerontol Int 2024; 24: 53-60.

Age-related change in gait efficacy and predictors of its decline: A 3-year longitudinal study.

AIM: This study aimed to calculate the minimal clinically important difference (MCID) for a modified Gait Efficacy Scale (mGES) over 3 years and to clarify the predictors of mGES decline. METHODS: In total, 87 community-dwelling older adults were enrolled in this 3-year longitudinal study. The mGES, fall history and physical function (chair stand frequency, open-eyes one-leg stand, open-close stepping test, walking speed, walking endurance [shuttle stamina walk test] and physical activity) were assessed at baseline. After a 3-year follow-up period, the mGES and Global Rating of Change Scale were assessed. The MCID was calculated using anchor-based methods, with the Global Rating of Change Scale as an anchor. The participants were classified into the decline and keep groups based on whether the changes in the mGES were greater than the MCID. A logistic regression analysis was conducted using the mGES as the dependent variable and physical characteristics, fall history, and physical function as independent variables. RESULTS: The MCID for the mGES over 3 years was -7.38 points. A logistic regression analysis identified low open-close stepping (odds ratio, 0.87; 95% confidence interval, 0.782-0.985; P = 0.027) and the shuttle stamina walk test (odds ratio, 0.974; 95% confidence interval, 0.949-1.000; P = 0.049) as predictors of the mGES decline. CONCLUSION: These findings suggest that a change of 7.38 points in the mGES was clinically significant and that poor agility and walking endurance can predict future decline in the mGES. Geriatr Gerontol Int 2024; 24: 90-94.

Relation of leg phase angle from bioelectrical impedance analysis with voluntary and evoked contractile properties of the plantar flexors.

Introduction: Bioelectrical impedance analysis (BIA) can noninvasively and quickly assess electrical properties of the body, such as the phase angle. Phase angle is regarded as the quantity and/or quality of skeletal muscle and is associated with exercise performance, such as jump height and walking speed. Although the phase angle derived from BIA is assumed to be a useful way to assess muscle function, the relationship between the phase angle and neuromuscular properties has not been fully investigated. The purpose of this study was to investigate the association of phase angle with voluntary and evoked contractile properties in 60 adults (age, 21-83 years; 30 females and 30 males). Methods: The phase angle of the right leg at 50 kHz was evaluated using BIA. The twitch contractile properties (peak twitch torque [PTtwitch], rate of twitch torque development [RTDtwitch], and time-to-PTtwitch [TPTtwitch]) of the plantar flexors were measured using tibial nerve electrical stimulation. Maximal voluntary isometric contractions (MVICs) were performed to measure the maximal muscle strength and explosive muscle strength, from which the peak MVIC torque (PTMVIC) and rate of torque development (RTD) over a time interval of 0-200 ms were assessed, respectively. The root mean square (RMS) values of electromyographic (EMG) activity during the PTMVIC and RTD measurements (EMG-RMSMVIC and EMG-RMSRTD, respectively) were calculated. The RTD and EMG-RMSRTD were normalized using PTMVIC and EMG-RMSMVIC, respectively. Results and discussion: Phase angle significantly correlated with twitch contractile properties (|r| ≥ 0.444, p < 0.001), PTMVIC (r = 0.532, p < 0.001), and RTD (r = 0.514, p < 0.001), but not with normalized RTD (r = 0.242, p = 0.065) or normalized EMG-RMSRTD (r = -0.055, p = 0.676). When comparing measurement variables between the low- and high-phase angle groups while controlling for sex and age effects, the high-phase angle group showed greater PTtwitch, RTDtwitch, PTMVIC, and RTD (p < 0.001) and shorter TPTtwitch (p < 0.001) but not normalized RTD (p = 0.184) or normalized EMG-RMSRTD (p = 0.317). These results suggest that the leg phase angle can be an indicator of voluntary and evoked muscle contractile properties but not the neuromuscular activity of the plantar flexors, irrespective of sex and age.

Pathological snapshots of thymic epithelial tumors with invasion into neighboring structures: preparing for the forthcoming revision of the TNM classification.

Treatment decision-making of thymic epithelial tumors (TETs) after surgery is based on the pathological stage. Currently, most institutions use both the Masaoka-Koga system and the 8th edition of the tumor, node, metastasis (TNM) classification. Because these two systems separate each stage according to the same concept, namely, the "levels" of tumor extension, precise pathological evaluation of the presence or absence of tumor invasion into stage-defining structures is necessary. This review provides representative pathological snapshots of tumors invading neighboring structures to provide references that might be helpful to readers; the snapshots will cover features that correspond to those of "locally advanced TETs", the topic of this series. Tumor subtype, whether thymoma or thymic carcinoma, is another factor influencing treatment decisions. Accumulating evidence has indicated that most thymomas and thymic carcinomas have biologically distinct features. Representative results were achieved by a study conducted as part of The Cancer Genome Atlas (TCGA) project, and subsequent studies with the help of the TCGA data have further reported on these distinctive features. Here, we also introduce newly recognized features of TETs, mainly focusing on the difference between epithelial-rich thymomas and thymic squamous cell carcinoma. The new (9th) edition of the TNM classification will be launched in January 2024. Therefore, sharing current pathological features of TETs will help readers, not only in their daily practice but also in preparing for the upcoming classification system.

Serum sulfatide level is associated with severe systemic vasculitis with kidney involvement.

Sulfatides are a type of sulfated glycosphingolipid that are secreted with lipoproteins into the serum. These molecules are involved in the inflammatory pathway of vessels in addition to coagulation and platelet aggregation. Previous studies have proposed that sulfatides play a pivotal role in regulating inflammation-related disorders. Systemic vasculitis (SV) diseases are generally caused by autoimmune diseases and often involve kidney vasculitis, which may lead to rapidly progressive kidney dysfunction and end-stage kidney disease. Our earlier pilot study revealed that the level of serum sulfatides (SSs) was significantly decreased in patients with anti-neutrophil cytoplasmic antibody-associated vasculitis (AAV), a representative disease-causing SV with kidney involvement (SVKI), especially in patients exhibiting active crescentic findings on kidney biopsy. To further explore the clinical significance of an association between SS and SVKI, we analyzed and compared the SS level of patients with various SVKI diseases in this retrospective cohort study. Among patients admitted to our hospital between 2008 and 2021, we ultimately enrolled 26 patients with IgA vasculitis (IgAV), 62 patients with AAV, and 10 patients with anti-glomerular basement membrane disease (GBM) as examples of SVKI diseases, as well as 50 patients with IgA nephropathy (IgAN) and 23 donors for living kidney transplantation as controls. The mean ± standard deviation SS level in the donor, IgAN, IgAV, AAV, and GBM groups was 8.26 ± 1.72, 8.01 ± 2.21, 6.01 ± 1.73, 5.37 ± 1.97, and 2.73 ± 0.99 nmol/mL, respectively. Analysis of patients in the SVKI disease group showed that those with the crescentic class kidney biopsy finding exhibited a significantly lower SS level than did those with other class biopsy features. Additionally, the SS level had a higher detection ability for SVKI patients with crescentic class kidney biopsy findings (area under the receiver operating characteristic curve 0.90, 95% confidence interval 0.82-0.99) than did several other predictor candidates. Our results indicate that the SS level is decreased in more severe SVKI diseases and may be associated with active glomerular lesions in SVKI kidney biopsy samples.