A study on the reliability and validity of the Japanese version of the Scenario Test for people with chronic stroke-induced aphasia: A cross-sectional study.

BACKGROUND: The Scenario Test is recognised for its effectiveness in assessing the interactive aspects of functional communication in people with post-stroke aphasia (PWA). AIMS: To develop a Japanese version of the Scenario Test (Scenario Test-JP) and assess its reliability and validity. METHODS & PROCEDURES: Among 66 participants, we selected 61 individuals: 34 PWA and 27 healthy controls (HCs). We modified the Scenario Test-JP based on the UK version and subsequently evaluated its reliability (internal consistency, test-retest and intra-rater and inter-rater reliabilities) and validity (convergent and discriminant) by comparing PWA and HCs. OUTCOMES & RESULTS: The Scenario Test-JP showed strong reliability with a Cronbach's α of 0.93, test-retest reliability with an intraclass correlation coefficient (ICC) of 0.97, intra-rater reliability with an ICC of 0.95-1.00, and inter-rater reliability with an ICC of 0.96. The validity of the test was confirmed with concurrent scores ranging from ρ = 0.37 to 0.76 (p < 0.05) and known-groups validity (p < 0.001, r = -0.56). CONCLUSIONS & IMPLICATIONS: The reliability and validity of the Scenario Test-JP align with those of the original Dutch version and the UK and Greek versions. Additionally, the assessment can now include extended alternative communication methods, such as digital devices, indicating the potential of the Scenario Test-JP for modern Japanese speech-language therapy. WHAT THIS PAPER ADDS: What is already known on the subject Interactive communication is a facet of functional communication and is crucial for evaluating engagement and participation of people with aphasia (PWA) in speech-language therapy. The Scenario Test provides valuable information for planning speech-language treatment strategies by assessing dialogic communication. What this study adds This study describes the development of the Scenario Test-JP for use with Japanese speakers and Japanese PWA, which is adapted from the Scenario Test UK version. This study evaluated the reliability and validity of this assessment tool and provided supporting evidence. What are the clinical implications of this work? The reliability and validity of the Scenario Test-JP were consistent with those of the Dutch, UK and Greek versions. The Scenario Test-JP contributes to speech-language therapy in Japan, where high-quality support for the activities and participation of PWA is required. PRACTITIONER POINTS: Insights from the Scenario Test The Scenario Test plays a crucial role in evaluating the functional communication skills of people with post-stroke aphasia (PWA). Enhancing functional communication has been linked to improved social engagement among PWA, which in turn influences their overall quality of life (QOL). Issues addressed by the Scenario Test The Scenario Test aids in delineating rehabilitation objectives for activities and participation among PWA, particularly concerning functional communication. The test facilitates tailored support for PWAs' interactive communication and forms the foundation for appropriate speech-language therapy interventions. Transformation of speech-language therapy (SLT) in Japan through the introduction of the Scenario Test-JP The integration of the Scenario Test-JP could enhance the SLT services provided to PWA in Japan. With Japan experiencing an unprecedented ageing population, the prevalence of social isolation and diminished QOL resulting from communication disorders like stroke-induced aphasia is expected to rise. Consequently, the SLT rehabilitation sector in Japan is actively seeking effective interventions to support functional communication among PWA. Hence, the adoption of the Scenario Test-JP is anticipated to streamline the evaluation of functional communication, facilitating the judicious selection and timely provision of assistance to PWA in SLT, including guidance on communication partner support and communication skill training.

Influence of Spinal Sagittal Alignment in Sitting Posture on the Swallowing Speed of Older Adult Women: A Cross-Sectional Study.

Thoracolumbar kyphosis in sitting posture is associated with forward head posture and may adversely affect swallowing function. However, few studies have investigated the effect of spinal alignment in the sitting posture on the swallowing function of older adults. This cross-sectional study aimed to investigate whether spinal alignment in the sitting posture influences the swallowing function of older adult women. Overall, 18 older adult women (mean age, 69.78 ± 3.66 years) without dysphagia were enrolled. Participants were positioned in two sitting postures, namely, comfortable sitting (CS) and thoracic upright sitting (TUS). In each sitting posture, the kyphosis index (using a flexicurve), sagittal angles (head, cervical, shoulder, and pelvic angles; using a digital camera), and cervical range of motion (ROM) were evaluated. Swallowing speed (100-mL water swallowing test), maximum tongue pressure (MTP), and oral diadochokinesis (ODK) were also evaluated. Compared with TUS, CS showed a greater kyphosis index, anterior head translation, and posterior pelvic tilt. CS had greater flexion (p < 0.001) and less extension (p < 0.001) of cervical ROM than TUS. Swallowing speed was significantly decreased in CS compared with TUS (p = 0.008). MTP and ODK were not significantly different between CS and TUS. Thus, changes in sitting posture with spinal alignment may affect swallowing speed. Consequently, adjustments to reduce sitting postural kyphosis in older adult women may improve swallowing speed.

Accuracy of rating scales for evaluating aphasic patients' psychological aspects and language function: A scoping review protocol.

Aphasia nearly affects half of all poststroke patients. Furthermore, aphasia affects all language functions, well-being, and quality of life of patients. Therefore, rehabilitation of patients with aphasia requires an accurate assessment of language function and psychological aspects. However, assessment scales for language function and psychological aspects of patients with aphasia are said to be inaccurate. In Japan, this sign is more prominent than in English-speaking countries. Therefore, we are putting together a scoping review of research articles published in English and Japanese to date, with the aim of summarizing the accuracy of rating scales for language function and psychological aspects of people with aphasia. The scoping review was intended to be a comprehensive examination of the accuracy of rating scales for people with aphasia. We will search the article databases PubMed, MEDLINE, Embase, PsycINFO, Web of Science, and the Medical Journal Web (Japan). The observational studies that describe the reliability and validity of the rating scales in adult aphasic after stroke will be searched for. There will be no publication date for the articles that will be searched. We believe that this scoping review aims to assess the accuracy of rating scales used to measure different aspects of aphasia, with a focus on research conducted in English-speaking countries and Japan. By conducting this review, we believe to identify any problems with rating scales used in English and Japanese research and improve their accuracy.

Effect of Spinal Sagittal Alignment in Sitting Posture on Swallowing Function in Healthy Adult Women: A Cross-Sectional Study.

Swallowing function is both directly and indirectly related to postures, such as head and cervical angle and body position. However, the effects of different sitting postures on oropharyngeal swallowing have not been investigated. This study aimed to investigate whether the change in thoracolumbar alignment affected the oropharyngeal swallowing. A total of 58 healthy adult women (mean age 22.2 ± 1.67 years) without dysphagia were enrolled in this cross-sectional study. Participants were positioned in three sitting postures: comfortable sitting (CS), thoracic upright sitting (TUS), and slump sitting (SS). In each sitting posture, the kyphosis index (using a flexicurve), head and cervical angles (using a digital camera), swallowing speed (100-ml water swallowing test), and oral and articulatory function [by maximum tongue pressure (MTP) and oral diadochokinesis (ODK)] were evaluated. SS showed the largest kyphosis index and was associated with a greater anterior translation of the head. Swallowing speed was significantly decreased in SS compared with CS (p = 0.002) and TUS (p = 0.020) and ODK was significantly decreased in SS compared with other postures, for both /ta/ (p = 0.004) and /ka/ (p < 0.001) syllables. Further, MTP tended to decrease in SS compared with TUS (p = 0.064). Our results suggest that changes in sitting posture with different thoracolumbar alignments affect swallowing speed and oral and articulatory function. Consequently, adjustments to reduce sitting postural kyphosis may improve swallowing speed and oral and articulatory function.

[Multilingual Aphasia].

Multilingual aphasia is synonymous with polyglot aphasia and is often indistinguishable from bilingual aphasia. Multilingual aphasia, including bilingual aphasia, has been of interest from the perspectives of impairment and recovery patterns in each language, factors involved in recovery, and variations in cerebral lateralization of language function in each language. Early premorbid language proficiency and language use have been shown to play a crucial role in the manifestation of bilingual aphasia. Paradis (1989) classified the recovery pattern from bilingual aphasia into nine patterns and demonstrated that multiple variables, including age of language acquisition and language proficiency are involved in multiple dimensions. Previous studies on crossed aphasia have suggested the involvement of the right hemisphere in the cerebral lateralization of language function. However, a subsequent meta-analysis demonstrated that early bilingual individuals who acquired both languages by the age of 6 years had a bilateral organization of both languages. In contrast, late bilingual and monolingual individuals who acquired a second language after the age of 6 years had the lateralization of language function in the left hemisphere for both languages.

Effects of Tongue-Strengthening Self-Exercises in Healthy Older Adults: A Non-Randomized Controlled Trial.

Tongue-strengthening exercises (TSE) using a device have been proposed as an intervention for improving tongue strength and endurance. However, devices for TSE have been expensive and difficult to manipulate and are not commonly used in home or clinical settings. This study therefore aimed to investigate whether tongue-strengthening self-exercises (TSsE) using a tongue-strengthening self-exercise tool at home can improve tongue strength in healthy older adults. This study included 27 participants (exercise group, η = 16, 7 men, 9 women, median age 84.5 years; control group, n = 11, 2 men, 9 women, median age 79.0 years). Exercises in the exercise group consisted of pushing the anterior tongue against the hard palate 30 times, 3 times a day, 5 days a week, for 8 weeks using a tongue-strengthening self-exercise tool. This tool is available in five levels of hardness. The most suitable hardness of the tool for each participant was calculated based on 60% of maximum tongue pressure (MTP) during the first 2 weeks of the training period and 80% of MTP for the remainder of the training period, as assessed using a tongue pressure-measuring device. The exercise group showed a significant improvement of 4.1 kPa in MTP (an 11.53% increase) and 4.53 s in endurance of tongue pressure (ETP) (a 99.86% increase). Furthermore, adherence in the exercise group was 99.2%. In conclusion, performing TSsE for 8 weeks was effective for increasing MTP and ETP in healthy older adults. This indicates that TSsE may be useful in older individuals at home to prevent age-related tongue muscle weakness.

Safety of transcutaneous electrical sensory stimulation of the neck in terms of vital parameters in dysphagia rehabilitation.

Transcutaneous electrical sensory stimulation (TESS) devices are approved for use in Japan, but their safety when used through the neck skin for dysphagia rehabilitation has not been reported. This study aimed to verify the safety of TESS use through the neck skin. Twenty patients (mean age 86.5 ± 5.1 years) with aspiration pneumonia undergoing dysphagia rehabilitation were included in this retrospective observational and matched control study. We compared vital signs in 10 subjects who underwent swallowing rehabilitation with the TESS device, and matched control patients over 7 days. The results were the following: tachycardia, 0.60 ± 1.07 vs. 0.70 ± 0.67 days; high blood pressure, 0.40 ± 0.70 vs. 0.50 ± 1.08 days; low blood pressure, 0.40 ± 0.70 vs. 0.10 ± 0.32 days; low oxygen saturation, 0.60 ± 1.58 vs. 0.50 ± 1.08 days, p = 0.870; oxygen administration, 0.80 ± 2.20 vs. 1.20 ± 2.15 days; tachypnea, 0.50 ± 0.71 vs. 0.50 ± 0.53 days; elevated body temperature, 2.00 ± 1.41 vs. 1.60 ± 1.96 days. There were no significant differences in clinical stability between the TESS and control groups of patients with aspiration pneumonia. TESS through the neck appears safe as an intervention in dysphagia rehabilitation.

Auditory agnosia associated with bilateral putaminal hemorrhage: A case report of clinical course of recovery.

A 45-year-old right-handed man with a past history (10 years) of putaminal hemorrage presented with auditory agnosia associated with left putaminal hemorrhage. It was suspected that the auditory agnosia was due to bilateral damage in the acoustic radiations. Generalized auditory agnosia, verbal and non-verbal (music and environmental), was diagnosed by neuropsychological examinations. It improved 4 months after the onset. However, the clinical assessment of attention remained poor. The cognition for speech sounds improved slowly, but once it started to improve, the progress of improvement was rapid. Subsequently, the cognition for music sounds also improved, while the recovery of the cognition for environmental sounds remained delayed. There was a dissociation in recovery between these cognitions. He was able to return to work a year after the onset. We also reviewed the literature for cases with auditory agnosia and discuss their course of recovery in this report.

Ion-Free and Ion-Pairing Assemblies of Anion-Responsive π-Electronic Systems Possessing Directly Linked Alkyl Chains.

Alkyl-substituted pyrrole-based anion-responsive π-electronic systems formed supramolecular gels and liquid crystals through effective π-π stacking and van der Waals interactions. The addition of chloride as a planar cation salt afforded ion-pairing assemblies as soft materials comprising planar receptor-Cl(-) complexes and the cation.

Predictive value of expression of ERCC 1 and GST-p for 5-fluorouracil/oxaliplatin chemotherapy in advanced colorectal cancer.

BACKGROUND/AIMS: The aim of this study was to determine whether expression of the excision repair cross complementing protein (ERCC1), glutathione S-transferase pi (GST-p) and thymidylate synthase (TS) predict response in patients with advanced colorectal cancer treated with 5-fluorouracil/oxaliplatin chemotherapy. METHODOLOGY: The study population consisted of 39 patients with advanced colorectal cancer (median age, 65 years). Patients were treated with the modified FOLFOX 6 regimen. The expression of ERCC-1, GST-p and TS of primary tumors were examined by immunohistochemistry. RESULTS: The response rate of modified FOLFOX 6 chemotherapy was 51.3%. The positive rates of ERCC-1, GST-p and TS were 43.6%, 33.3% and 66.7%, respectively. The patients without ERCC-1 (p=0.0248) or GST-p? (p=0.0019) expression were more likely to respond to chemotherapy. TS expression did not correlate with chemotherapeutic response. CONCLUSIONS: Immunohistochemical studies for ERCC-1 and GST-p may be useful in prediction of the response to 5-fluorouracil/oxaliplatin chemotherapy in advanced colorectal cancer patients.

Clinical significance of the expression of connexin26 in colorectal cancer.

BACKGROUND: Connexin26 (Cx26) is one of the connexins (Cxs) family members which form gap junction channels. Cx26 is considered to be a tumor suppressor gene. However, recent studies revealed that over expression of Cx26 is associated with a poor prognosis in several human cancers. This study investigated the correlation between Cx26 expression and the clinicopathological features and P53 expression in colorectal cancer. METHODS: One hundred and fifty-three patients who underwent a curative resection were studied. Tissue samples were investigated by immunohistochemical staining using antibodies for Cx26 and P53. Moreover, apoptotic cells were detected by terminal deoxynucleotidyl transferase-mediated dUTP-biotin nick end-labeling (TUNEL) staining. RESULTS: Cx26 expression was found in 83 cases (54.2%) and P53 expression in 71 cases (46.4%). A correlation was observed between the Cx26 expression and recurrence, histology, and p53 expression (P < 0.05). Cx26 positive tumors had significantly longer survival than Cx26 negative tumors (P < 0.05). A multivariate Cox analysis demonstrated that Cx26 expression was an independent prognostic factor (P < 0.05). However, no significant correlation was observed between Cx26 and AI. CONCLUSION: This study suggests that Cx26 expression is an independent prognostic factor in patients that undergo a curative resection of colorectal cancer.

Chemokine receptor CCR7 expression correlates with lymph node metastasis in pancreatic cancer.

AIMS: The clinical significance of chemokine receptor CCR7 expression in pancreatic ductal cancer was investigated. METHODS: Immunohistochemical staining of 89 pancreatic cancers treated macroscopically with curative resection without hematogenous metastases or peritoneal dissemination were analyzed in association with clinicopathological data. RESULTS: The positivity of CCR7 in pancreatic cancer was 32.6% (29/89). A significant correlation was detected between CCR7-positive expression and lymph node metastasis. Patients with CCR7-positive tumors had significantly shorter survival times than those with CCR7-negative tumors (median, 12.8 vs. 21.9 months, respectively; p = 0.0039). CCR7 expression was an independent prognostic factor (hazard ratio, 1.949; p = 0.0364) by multivariate survival analysis; however, it was not an indicator for any particular site of recurrence. CONCLUSION: The survival impact of CCR7 expression on resectable pancreatic cancer may be associated with lymphatic spread. The results from the present study should foster further investigation of treatments using an inhibitor for the CCR7 protein to improve the survival of pancreatic cancer.

[Efficacy of m-FOLFOX6 therapy for colorectal cancer in elderly patients].

Combination chemotherapy of oxaliplatin, fluorouracil/leucovorin (FOLFOX) has reportedly become a standard regimen for colorectal cancer. In this study, we investigated the efficacies and adverse effects of modified FOLFOX6 (m-FOLFOX6) regimen in elderly patients. Thirty-nine patients with colorectal cancer, who received m-FOLFOX6 in our institution, were studied. Ten of the 39 patients, were older than 70 (elderly patients). Efficacies and adverse effects of m-FOLFOX6 were compared between patients over 70 years of age and those younger than 69 (younger patients). In terms of the response rate, there were no differences between the older and younger elderly patients. Moreover, the grade and frequency of adverse events were similar between them. We concluded that m-FOLFOX6 may bring about the same response rate in older and younger elderly patients. Moreover, m-FOLFOX6 may be given safely regardless of patient age.

Neuropsychological changes in patients with carotid stenosis after carotid endarterectomy.

We investigated changes in neuropsychological function in patients with carotid stenosis following carotid endarterectomy (CEA) in relation to cerebral hemodynamics. The subjects were 24 patients who underwent CEA and 17 healthy controls matched by age, educational level, gender and handedness. Cerebral angiography, single-photon emission computed tomography (SPECT) and neuropsychological tests were performed approximately 1 week before and 3 weeks after CEA in all patients. In the patient group, the categories achieved in the new modified Wisconsin Card Sorting Test (WCST) improved significantly after CEA (4.0 +/- 2.0; before CEA: 2.3 +/- 2.1, p < 0.01). The perseverative errors of Nelson in the WCST improved significantly (before CEA: 9.1 +/- 6.9, after CEA: 3.3 +/- 3.4, p < 0.01). The difficulty maintaining set in the WCST improved significantly (before CEA: 2.3 +/- 1.9, after CEA: 1.3 +/- 1.7, p < 0.05). In the control group, none of the test scores showed significant improvement between the first and second tests. Moreover, frontal lobe function improved significantly in those patients with baseline carotid artery diameter of more than 70% of normal, or whose preoperative cerebral perfusion reserve was reduced by less than 15% of a response to acetazolamide. Our results suggest that CEA improves frontal lobe function in patients with severe carotid stenosis or reduced cerebral perfusion reserve.

[A case of gastric cancer with umbilical metastasis that responded to TS-1 with low-dose cis-platinum].

An umbilical metastasis of gastric cancer is known as Sister Mary Joseph's nodule. It ordinarily indicates a poor prognosis because umbilical metastasis often develops with peritoneal dissemination. Herein, we report a case of umbilical metastasis of gastric cancer that showed good response to chemotherapy, including the oral anticancer agent TS-1. The patient was a 55-year-old man in which gastric cancer was found by upper gastrointestinal series. Physical examination revealed an umbilical nodule that had an irregular surface and a hard consistency. Ultrasonography showed a 15 x 10 mm hypoechoic mass under the umbilicus. Core needle biopsy of the umbilical mass revealed adenocarcinoma. Peritoneal dissemination was proved by diagnostic laparoscopy. Oral anticancer agent TS-1 was administered with low-dose cis-platinum. The gastric lesion and umbilical nodule showed marked response to the chemotherapy and the response continued for 20 months. The patient died of disease progression 31 months after the initiation of the treatment.

Pseudomyxoma peritonei of appendiceal cancer with metastasis to the stomach: report of a case.

Appendiceal cancer associated with pseudomyxoma peritonei is a relatively low-grade malignancy rarely associated with extraperitoneal metastasis. We report herein the case of a 71-year-old man in whom a metastasis was found in the stomach 2 years after he underwent surgery for pseudomyxoma peritonei of appendiceal cancer. He was referred to our hospital after presenting with anorexia and vomiting. Gastrofiberscopy, abdominal computed tomography, and ultrasound examination all revealed a mass 4 x 4cm in size, containing a small ulcer, in the antrum of the greater curvature of the stomach. The histopathological diagnosis made from a biopsy of the tumor was mucinous cystadenocarcinoma. A distal partial gastrectomy was performed and the resected specimens from the appendiceal cancer resected 2 years earlier showed the same histological pattern as that of the gastric lesion. To the best of our knowledge, this is only the second report of pseudomyxoma peritonei secondary to mucinous cystadenocarcinoma of the appendix that metastasized to the stomach.