SARC-F Predicts Mortality Risk of Older Adults during Hospitalization.

OBJECTIVES: To determine the association between SARC-F scores and the in-hospital mortality risk among older patients admitted to acute care hospitals. DESIGN: Single-center retrospective study. SETTING: A university hospital. PARTICIPANTS: All consecutive patients aged older than 65 were admitted and discharged from the study hospital between July 2019 and September 2019. MEASUREMENTS: Relevant patient data included age, sex, body mass index, nutritional status, fat-free mass, disease, activities of daily living (ADL), duration of hospital stay, SARC-F, and occurrence of death within 30 days of hospitalization. The diseases that caused hospitalization and comorbidities (Charlson Comorbidity Index; CCI) were obtained from medical records. The Eastern Cooperative Oncology Group-performance status (PS) was used to determine ADL, and the in-hospital mortality rate within 30 days of hospitalization as the outcome. RESULTS: We analyzed 2,424 patients. The mean age was 75.9±6.9 and 55.5% were male. Fifty-three in-hospital mortalities occurred among the participants within the first 30 days of hospitalization. Patients who died in-hospital were older, had poorer nutritional status and severer PS scores, and more comorbidities than those who did not. A SARC-F score of ≥4 predicted a higher mortality risk within those 30 days with the following precision: sensitivity 0.792 and specificity 0.805. There were significantly more deaths in Kaplan-Meier curves regarding a score of SARC-F≥4 than a score of SARC-F<4 (p<0.001). Cox proportional hazard analysis was used to identify the clinical indicators most associated with in-hospital mortality. SARC-F≥4 (Hazard Ratio: HR 5.65, p<0.001), CCI scores (HR1.11, p=0.004), and infectious and parasitic diseases (HR3.13, p=0.031) were associated with in-hospital mortality. The SARC-F items with significant in-hospital mortality effects were assistance with walking (HR 2.55, p<0.001) and climbing stairs (HR 2.46, p=0.002). CONCLUSION: The SARC-F questionnaire is a useful prognostic indicator for older adults because a SARC-F ≥4 score during admission to an acute care hospital predicts in-hospital mortality within 30 days of hospitalization.

SARC-F as a Screening Tool for Sarcopenia and Possible Sarcopenia Proposed by AWGS 2019 in Hospitalized Older Adults.

OBJECT: The SARC-F questionnaire is a sarcopenia screening tool. However, the validity of the SARC-F score ≥4 (SARC-F≥4) for the evaluation of sarcopenia in the hospital setting has not been investigated. This study investigated the validity of SARC-F≥4 as a screening tool for sarcopenia among hospitalized older adults. DESIGN: Cross-sectional retrospective study. SETTING: A university hospital. PARTICIPANTS: This study included older adult patients (age ≥65 years) who were hospitalized at, and subsequently discharged from, the hospital between April and September 2019 and underwent a nutritional assessment by the nutrition support team during their hospitalization. MEASUREMENTS: SARC-F was recorded at the time of admission, and the criteria specified by the Asia Working Group for Sarcopenia in 2019 (AWGS 2019) were applied to diagnose sarcopenia and possible sarcopenia. Appendicular muscle mass was estimated through validated equations, and three different models were developed for sarcopenia diagnosis. The sensitivity, specificity, and positive/negative likelihood ratios were calculated to analyze the accuracy of the SARC-F≥4 for sarcopenia and possible sarcopenia. Receiver-operating characteristic analyses were conducted to calculate the area under the curve (AUC). RESULTS: In total, 1,689 patients (mean age: 77.2±7.3 years; male: 54.4%) were analyzed, and 636 patients (37.7%) had SARC-F≥4. Patients with SARC-F≥4 had a statistically significant higher prevalence of AWGS 2019-defined sarcopenia than patients with SARC-F <4 in the models (65.4-78.9% vs 40.9-45.2%, p<0.001). The sensitivity, specificity, and positive/negative likelihood ratios of SARC-F≥4 for sarcopenia and possible sarcopenia were 49.1-51.3%, 73.9-81.2%, and 1.88-2.72/0.60-0.69 and 48.0%, 84.5%, and 3.11/0.62, respectively. The AUC for sarcopenia and possible sarcopenia were 0.644-0.695 and 0.708, respectively. The AUC of SARC-F for possible sarcopenia was equivalent to or larger than that for sarcopenia (DeLong test p=0.438, 0.088, and <0.001 vs the three models). CONCLUSIONS: SARC-F≥4 is suitable as a screening tool for sarcopenia in hospitalized older adults. SARC-F assessment could facilitate the detection and exclusion of sarcopenia at hospitalization and may lead to early adoption of a therapeutic and preventive approach.

Changes in the immune cell population and cell proliferation in peripheral blood after gemcitabine-based chemotherapy for pancreatic cancer.

PURPOSE: Regulatory T cells (Tregs) play a role in the immunosuppressive state in pancreatic cancer patients. We aimed to evaluate the changes of immune cells population including Tregs caused by gemcitabine (GEM)-based chemotherapy. METHODS: Fifty-three patients with pancreatic cancer were enrolled in this study, of which 32 received GEM- based chemotherapy. Blood samples were collected before and at least 2 weeks after the last dose of chemotherapy. The peripheral blood mononuclear cells (PBMCs) were subjected to flow cytometry analysis after labeling with anti-CD4, anti-CD25, and anti-Foxp3 antibodies. Other lymphocytes and NK cell markers were also measured. The proliferative capacity of PBMCs stimulated with anti-CD3 was analyzed using H(3) thymidine. RESULTS: The percentage and number of Tregs were significantly decreased after chemotherapy (p = 0.032, p = 0.003, respectively). The other immune cells and the proliferative capacity did not change. CONCLUSION: This study showed that GEM-based chemotherapy produced an immunomodulatory effect via the depletion of Tregs.

[Henoch-Schönlein nephritis with nephrotic syndrome during pregnancy].

We report a 33-year-old female with nephrotic syndrome associated with Henoch-Schönlein nephritis (HSN) during pregnancy. She presented purpura in the legs at 20 weeks in her third pregnancy. A biopsy of her purpuric skin lesion showed leukocytoclastic vasculitis. After a month she was admitted to Sapporo City General Hospital because of development of a nephrotic syndrome. She was treated with heparin as anticoagulants therapy and delivered of a healthy girl by Cesarean section at 34 weeks. Renal biopsy, carried out beyond a month after delivery, revealed diffuse proliferative glomerulonephritis with prominent IgA deposits, which made the diagnosis of HSN (grade III of classification of the renal histopathology of HSN from the International Study of Kidney Disease in Childhood). Prednisolone 40 mg, dipyridamole 300 mg per day and pulse doses of steroid were administrated. Two months later proteinuria was not detected. A sister of the patient had also Henoch-Schönlein Purpura in her childhood. They shared HLA DR 4, DQ 4 which are known to be associated with IgA nephropathy. Fifty percent of pregnant women with chronic glomerulonephritis shows increased proteinuria. Pregnancy may have influence on the increased proteinuria in this case.

[Massive ascites as an initial sign, plasmacytoma of the cervical supine, and hyperammonemic consciousness disturbance in a patient with biclonal type multiple myeloma].

A 69-year-old male presented with fever, ascites and leg edema in February, 1994. He had a pathological fracture of cervical supine in October. Pathological findings at operation showed plasmacytoma. Bone marrow aspiration showed 16.2% myeloma cells. So he was diagnosed as multiple myeloma presenting biclonal gammopathy of IgA-L and IgD-K. Ascites was massive and drainage of 2 to 4 liter per week was required. Ascites was supposed to be related to multiple myeloma, because the IL-6 level in the ascites was increased (2,440 pg/ml), although repeated cytologic studies were negative. After the operation, he developed hyperammonemic drowsiness. It was also suggested that hyperammonemia was associated with multiple myeloma. In addition to radiation therapy for the cervical lesion, MP therapy, Interferon-alpha, VAD therapy and intraperitoneal cyclophosphamide infusion were administered. But no improvement of ascites or hyperammonemia were noticed. Here we described a case of multiple myeloma with very notable clinical features.

[Four cases of noncardiac surgery after PTCA].

Malignant tumors were detected in four patients who had been hospitalized for acute myocardial infarction and/or postinfarction angina. All of them underwent curative operations after successful percutaneous transluminal coronary angioplasty (PTCA). Operations performed were partial colectomy on the first patient, low anterior rectal resection on the second patient, left pulmonary upper lobectomy on the third patient and partial colectomy with cholecystectomy on the fourth patient. There were no complications in the perioperative periods except the first patient in which postoperative electrocardiogram showed transient peaked T wave in leads II, III, AVf, V5 and V6. Forty six days after colectomy (55 days after PTCA), the first patient underwent emergency PTCA for restenosis. Prior PTCA, as well as CABG, is considered to have decreased cardiac complications in patients with ischemic heart disease. But when a non-cardiac operation should be done after PTCA, we should take restenosis into consideration.

[Hemophagocytic syndrome with syndrome of inappropriate secretion of antidiuretic hormone (SIADH)].

A 69-year-old female was admitted to the hospital because of fever, hyponatremia and anemia. Laboratory data showed hemoglobin 8.6 g/dl, indirect bilirubin 1.9 mg/dl and Na 122 mEq/l. Urine osmolality was elevated and urinary excretion of sodium was increased. Furthermore, antidiuretic hormone (ADH) level was elevated. Renal function and hormonal data were within normal limit. Therefore, she was diagnosed as having syndrome of inappropriate secretion of antidiuretic hormone (SIADH). On the other hand, bone marrow aspiration showed hemophagocytosis and the diagnosis of hemophagocytic syndrome (HPS) was also made. High dose prednisolone and pulse therapy of cyclophosphamide were administered, nevertheless high grade fever persisted. Fever alleviation was acquired by Etoposide. But she died of pneumonia. An autopsy revealed hemophagocytosis in bone marrow, lymphnodes and spleen, but malignant tumor was not detected. And hypophysis was intact. The pathogenesis of SIADH in this case was not clarified. This report is seemed to be the first case of HPS associated with SIADH.

[Primary biliary cirrhosis, rheumatoid arthritis and Sjögren's syndrome following implantation of ventriculoperitoneal shunt tube--an aged male case report].

A 73-year old male was received implantation of ventriculoperitoneal shunt tube (made with silicone) following subarachnoid hemorrhage in March 1991. Alkaline phosphatase was elevated gradually and he was diagnosed as having primary biliary cirrhosis by antimitochondria antibody and liver biopsy. He had been taking urso acid after that time on. He was admitted to our hospital because of stiffness and edema of both hands in November 1993. He was diagnosed as rheumatoid arthritis by morning stiffness with duration of few hours bilateral swelling of metacarpal, proxymal intrapharangeal and wrist joints and positive rheumatoid factor. In addition he felt dry mouth and laboratory data revealed that antinuclear antibody was 640x, centromere type, anti-SS-A antibody positive and elevation of circulating immune complex. A salivary gland disfunction was showed by gum test and salivary gland scintigraphy. Therefore the diagnosis of Sjögren's syndrome was made also. Connective tissue diseases have been reported to occur following cosmetic surgery with injection of the foreign substances paraffin and silicone. Now it is supposed to be the first case tcat connective tissue disease following ventriculoperitoneal shunt tube implantation.

[An autopsy case report of hemolytic uremic syndrome after allogeneic bone marrow transplantation].

A 27-year-old male with acute lymphoblastic leukemia (L2) received allogeneic bone marrow transplantation on June, 7 1990. He was conditioned with cyclophosphamide, Ara-C and total body irradiation. GVHD prophylaxis consisted of cyclosporin and short term methotrexate. He was diagnosed as having hemolytic uremic syndrome (HUS) on the basis of microangiopathic hemolytic anemia, thrombocytopenia and renal dysfunction on day 224. Cyclosporin was discontinued and FFP was transfused and plasma exchange was performed. He died of heart failure and sepsis on day 582. Autopsy confirmed the findings of HUS.

[Acute lymphocytic leukemia with thrombophlebitis of lower limbs and translocation (4;11)].

On November 22, 1985, a 54-year-old male was admitted to the cardiovascular department of our hospital suffering from thrombophlebitis, with redness, swelling and pain around the right ankle and left knee. He was transferred to our department on Nov. 26, because of hyperleukocytosis. Peripheral blood examination revealed hyperleukocytosis with 93.0% blastic cells and thrombocytopenia. The bone marrow aspirate was hypercellular and almost all cells were consistent with peroxidase negative blastic cells. The blastic cells were Leu M1 positive and Leu M2, M3 and lymphocytic markers were negative. The patient was diagnosed to have acute lymphocytic leukemia with Leu M1 positive blast cells. BH-AC/DMP therapy was began on the 1st hospital day but he died of cerebral haemorrhage on the 4th hospital day. An autopsy revealed systemic infiltration of leukemic cells including thrombophlebitis of the legs. Chromosome analysis of the bone marrow cells showed t(4;11)(q21;q23).

Immunoblot analysis of antibodies in human strongyloidiasis.

An electrophoretic transfer technique was used to investigate qualitatively the production of antibodies to Strongyloides stercoralis larvae in 56 patients with strongyloidiasis. SDS-PAGE analysis of the larval extract revealed the presence of at least 33-39 polypeptide bands under either reducing or non-reducing condition. In the immunoblot analysis, almost all patients showed positive reactivity to the polypeptide bands. The reactivity, however, revealed significant variation among the patients, ranging in number of bands from only one to more than 18. Among the bands, 4 with molecular sizes of 97, 66, 41 and 26 kDa were frequently recognized by the patients' sera, indicating that these antigenic components may form an available antigen for immunological testing for strongyloidiasis. On the other hand, the reactivities were very faint in cases of overwhelming strongyloidiasis.

[Kaposi's sarcoma developing during corticosteroid therapy in idiopathic thrombocytopenic purpura].

A case of Kaposi's sarcoma developing during corticosteroid therapy for idiopathic thrombocytopenic purpura is reported. The patient is a 58-year-old female who was admitted to Sapporo City General Hospital for bleeding tendency in March 1987. She had been treated before admission with prednisolone (over 40 mg/day) for idiopathic thrombocytopenic purpura since October 1986, but her platelet count was below 40,000/microliters. In April 1987, several dark red or blue nodules appeared on the tip of her nose, left forearm, right shoulder, trunk and tongue. These nodules rapidly grew. Biopsy specimens from the nodule of the left forearm showed the histologic changes of Kaposi's sarcoma. She was treated with irradiation. Splenectomy was done in May 1987 and prednisolone was decreased to 5 mg/day. Her platelet count was continually kept 50,000/microliters or more. Her Kaposi's sarcoma completely regressed in January 1988. The relationship of immunosuppressive therapy to Kaposi's sarcoma is discussed.