NRAS DNA G-quadruplex-targeting molecules for sequence-selective enzyme inhibition.

Sequence-selective G-quadruplex ligands are valuable for controlling gene expression. Here, we established a new fluorescence displacement assay using a NRAS G-quadruplex selective fluorescent probe to identify sequence-selective DNA G-quadruplex ligands. These sequence-selective NRAS G-quadruplex ligands retained their binding affinity even in the presence of excessive human telomeric DNA G-quadruplex and regulated enzymatic activities in a sequence-selective manner.

Association of Calf Circumference, Hand Grip Strength, and Physical Performance with Serious Adverse Events in Patients with Sub-Acute Stroke Hospitalized for Rehabilitation: An Observational Study.

OBJECTIVE: To determine whether calf circumference (CC), hand grip strength (HGS), and physical performance are linked to the incidence of serious adverse events (SAEs) in patients with sub-acute stroke. DESIGN: Retrospective cohort study. SETTING: Single rehabilitation hospital. PARTICIPANTS: Stroke patients admitted for rehabilitation hospital. INTERVENTION: Not applicable. MAIN OUTCOME MEASURES: The incidence of SAEs, such as death, cardiovascular events including recurrent stroke, and conditions requiring transfer to another hospital for specialized care or immediate treatment for an acute illness during hospitalization. RESULTS: A total of 341 patients (median age: 74 years) participated in this study, with 232 patients (68%) exhibiting low physical performance. In the adjusted model, low physical performance was significantly associated with SAEs (HR = 3.01, 95% CI = 1.04-8.68, p = 0.042). However, low CC (HR = 1.60, 95% CI = 0.76-3.38, p = 0.219) and low HGS (HR = 0.98, 95% CI = 0.39-2.42, p = 0.960) did not show an independent association. CONCLUSION: Low physical performance was independently associated with the occurrence of SAEs during hospitalization for rehabilitation in patients with sub-acute stroke.

A thiopyridine-bound mirror-image copper center in an artificial non-heme metalloenzyme.

Artificial metalloenzymes, in which a metal complex and protein matrix are combined, have been synthesized to catalyze stereoselective reactions using the chiral environment provided by the protein cavity. Artificial metalloenzymes can be engineered by the chemical modification and mutagenesis of the protein matrix. We developed artificial non-heme metalloenzymes using a cupin superfamily protein (TM1459) with a 4-His tetrad-metal-binding motif. The Cu-bound H52A/C106D mutant with 3-His triad showed a S-enantioselective Michael addition of nitromethane to α,ß-unsaturated ketone, 2-aza-chalcone 1. In this study, we demonstrated a chemical modification near the copper-binding site of this mutant to reverse its enantioselectivity. For chemical modification, the amino acid on the Si-face of the binding state of 1 to the copper center was replaced with Cys, followed by reaction with 4,4'-dithiopyridine (4-PDS) to form S-(pyridin-4-ylthio)cysteine (Cys-4py). Cu-bound I49C-4py/H52A/C106D showed reversal of the enantioselectivity from S-form to R-form (ee = 71%, (R)). The effect of steric hindrance of the amino acids at position 49 on enantioselectivity was investigated using I49X/H52A/C106D mutants (X = A, C, I, F, and W). Additionally, chemical modification with 2,2'-dithiopyridine (2-PDS) produced I49-2py/H52A/C106D, which showed lower R-enantioselectivity than I49-4py/H52A/C106D. Among the mutants, the 4py-modification on the Si-face was the most effective in reversing the enantioselectivity. By tuning the Re-face side, the H54A mutation introduced into the I49C-4py/H52A/C106D increased the R-enantioselectivity (ee = 88%, (R)). X-ray crystallography revealed a coordinated structure with ligation of thiopyridine in Cu-bound I49C-4py/H52A/H54A/C106D.

Establishing minimal clinically important differences and cut-off values for the lower limb motricity index and trunk control test in older patients with acute stroke: a prospective cohort study.

OBJECTIVE: To establish the Minimal Clinically Important Differences (MCIDs) for lower limb strength measured by the Motricity Index (LLMI) and trunk function assessed by the Trunk Control Test (TCT) in the acute phase of stroke in older patients. Further, the study sought to determine the cutoff values predicting functional prognosis at discharge for both the LLMI and TCT. METHODS: This prospective cohort study was conducted for older patients (≥65 years) admitted for acute stroke, receiving guideline-based stroke care that includes early rehabilitation. The LLMI and TCT were measured within 7 days of admission and at discharge. The MCID was derived from receiving operating characteristic curves, based on a ≥ 1 point shift in the modified Rankin Scale (mRS) from admission to discharge. A good functional prognosis at discharge was defined as an mRS score of ≤ 3. RESULTS: A total of 201 older patients with acute stroke were included. The TCT achieved an MCID of 13 (area under the curve [AUC] = 0.704, 95% confidence interval [CI]: 0.633-0.775), whereas the LLMI lacked the precision to produce a significant MCID. The optimal cutoff points for predicting a good outcome were found to be an LLMI score of 65 (AUC = 0.770, 95% CI: 0.705-0.835) and a TCT score of 25 (AUC = 0.827, 95% CI: 0.768-0.887) upon admission. CONCLUSIONS: This study identified a valid MCID for the TCT, failed to do so for the LLMI, and established cutoff values for both the LLMI and TCT that can predict good outcomes in older patients with acute stroke.

Validity and reliability of the 2-min step test in individuals with stroke and lower-limb musculoskeletal disorders.

Introduction: We investigated the reliability and validity of the 2-min step test (2MST) for assessing the exercise endurance of individuals with stroke and lower-limb musculoskeletal disorders. Participants and methods: The participants were 39 individuals with stroke and 42 with lower-limb musculoskeletal disorders (mainly hip fractures) from the convalescent rehabilitation wards of four hospitals. The concurrent validity and congruence between the 2MST and the 6-min walk test (6MWT) and construct validity by hypotheses testing, including mobility and lower limb muscle strength, were also confirmed. A subset of participants (stroke-group, n = 15; musculoskeletal-group, n = 19) underwent a retest 2MST for our evaluation of relative and absolute reliability using the intraclass correlation coefficient (ICC1,1) and Bland-Altman plot. Results: Both groups showed a moderate correlation between the 2MST and 6MWT (ρ = 0.55-0.60), but the congruence was not sufficient. The 6MWT was correlated with mobility in both groups and with muscle strength in the stroke group, whereas the 2MST did not show a significant correlation with mobility. The relative reliability was excellent in both groups (ICC1,1 > 0.9). In terms of absolute reliability, the width of the limit of agreement was 18.8% for the stroke group and 15.4% for the musculoskeletal group, relative to their respective sample means of 2MST. A fixed bias was identified in the stroke group, in which step counts increased by 6.5 steps upon retesting. Discussion: Our analyses revealed that the 2MST is a valid and reliable tool for assessing the exercise endurance of individuals with stroke or lower-limb musculoskeletal disorders. However, it is necessary to validate the absolute reliability observed herein by using a larger sample size. In addition, when assessing the exercise endurance of individuals with stroke, it may be necessary to consider the potential bias of an increased step count during retesting.

Muscle weakness is more strongly associated with functional outcomes in patients with stroke than sarcopenia or muscle wasting: an observational study.

BACKGROUND: Stroke-related sarcopenia is an important prognosis factor and an intervention target for improving outcomes in patients with stroke. AIM: This study aimed to identify the association between sarcopenia, possible sarcopenia, muscle weakness, muscle mass and calf circumference, and the functional outcomes 3 months after stroke. METHODS: In this single-centre prospective observational study, muscle strength, muscle mass, and calf circumference were measured in patients with acute stroke at hospital discharge. Diagnosis of sarcopenia, possible sarcopenia, muscle weakness, low muscle mass, and low calf circumference were defined according to the 2019 Asian Working Group for Sarcopenia criteria. The primary outcome measure was the modified Rankin Scale (mRS) score at 3 months, with an mRS score of 3 or higher indicating a poor outcome. Logistic regression analysis was conducted to examine independent associations between each assessment and functional outcomes. RESULTS: A total of 247 patients (median age: 73 years) were included in this study. The prevalence of sarcopenia was 28% (n = 70), and in the adjusted model, sarcopenia (aOR = 2.60, 95% CI 1.07-6.31, p = 0.034), muscle weakness (aOR = 3.40, 95% CI 1.36-8.52, p = 0.009), and low muscle mass (aOR = 2.61, 95% CI 1.04-6.52) were significantly associated with poor functional outcome. Nevertheless, other evaluations did not demonstrate an independent association with the outcome. CONCLUSION: Sarcopenia, muscle weakness, and low muscle mass were found to be independently associated with functional outcomes 3 months after stroke, and muscle weakness exhibited the strongest association with outcomes among them.

The Association between fatigue and physical activity in patients hospitalized with subacute stroke.

BACKGROUND: Little is known about the association between fatigue and physical activity in patients hospitalized with subacute stroke. OBJECTIVES: The aim of this study was to investigate the association between fatigue and physical activity in patients hospitalized with subacute stroke. METHODS: This cross-sectional study enrolled 244 consecutive patients with stroke who were admitted to a subacute rehabilitation ward at our hospital. We assessed fatigue with the Fatigue Assessment Scale (FAS) and used an accelerometer (Active style Pro HJA750-C, OMRON) to record the mean duration of sedentary behavior, light-intensity physical activity (LIPA), and moderate-to-vigorous-intensity physical activity (MVPA). We assessed all factors at 1 month after stroke. Multivariate linear regression analysis revealed the associations between FASscore and objectively measured physical activity. RESULTS: In total, we analyzed 85 patients. The duration of the sedentary behavior was significantly associated with the FAS score (ß = 1.46, p = 0.037) and the Functional Balance Scale score (ß = -1.35, p = 0.045). The LIPA time was significantly associated only with the FBS score (ß = 1.38, p = 0.045), whereas MVPA was not associated with any variable.

Sarcopenia in patients following stroke: Prevalence and associated factors.

BACKGROUND: This study aimed to investigate the prevalence and associated factors of sarcopenia in patients following stroke during acute hospitalisation. METHODS: This single-centre prospective observational cohort study assessed skeletal muscle mass using bioelectrical impedance analysis and muscle strength of patients with acute stroke at hospital discharge. Sarcopenia was diagnosed according to the AWGS-2019 criteria. Multiple logistic regression analyses were performed to identify associated factors of post stroke sarcopenia. RESULTS: A total of 286 participants (32% female; median age, 72 years) were included in this study. The prevalence of post-stroke sarcopenia was 32.5% (n = 93). In multiple logistic regression analysis, age (adjusted odds ratio [aOR]: 1.10; 95% confidence interval [CI]: 1.05-1.05), National Institute of Health Stroke Scale (aOR: 1.15; 95% CI: 1.04-1.27), body mass index (BMI) (aOR: 0.73; 95% CI: 0.64-0.84) and Functional Oral Intake Scale (aOR: 0.67; 95% CI: 0.51-0.89) were independently associated with post-stroke sarcopenia during acute hospitalisation. CONCLUSION: Approximately one-third of acute stroke patients were diagnosed with sarcopenia at hospital discharge, and older age, severe stroke, low BMI, and poor swallowing function are associated with sarcopenia following stroke during acute hospitalisation.

Association of Malnutrition With Physical Activity Intensity in Patients With Subacute Stroke.

OBJECTIVE: To investigate the relationship between nutritional status measured by the Global Leadership Initiative on Malnutrition (GLIM) criteria and the intensity of physical activity, and to determine the association between these factors and the activities of daily living (ADLs) in patients with subacute stroke during hospitalization. DESIGN: A cross-sectional study. SETTING: The study was conducted in the rehabilitation unit at a neurosurgical hospital. PARTICIPANTS: One hundred and twenty-eight patients with subacute stroke (N=128). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Nutritional status was assessed using GLIM criteria. Sedentary behavior (SB), light-intensity physical activity (LIPA), and moderate-to-vigorous physical activity (MVPA) were measured using an accelerometer. Multiple regression analysis was used to investigate the relationship between nutritional status and intensity of physical activity. Moreover, the association of nutritional status and physical activity intensity with ADLs was determined using multiple regression analysis and mediation analysis. RESULTS: Malnutrition was associated with SB time (B = 16.241, P=.009) and LIPA time (B = -17.656, P=.002), but not MVPA time (B = -0.472, P=.776). SB time (B = -0.063, P=.009) and LIPA time (B = 0.093, P<.001) were associated with functional independence measure for motor function, while MVPA time (B = -0.080, P=.379) was not. SB time (coefficient = -10.785, P<.001) and LIPA time (coefficient = -12.054, P<.001) were significant mediators between nutrition status and ADLs. CONCLUSIONS: Malnutrition was associated with a SB time and LIPA time, but not MVPA time, in patients with sub-acute stroke. SB and LIPA times were associated with ADLs and mediated between nutrition status and ADLs in these patients. The association of nutritional status on physical activity and ADLs should be considered in stroke rehabilitation.

Correlations between aerobic exercise time during physiotherapy and characteristics of patients with subacute stroke: A pilot cross-sectional study.

BACKGROUND: The amount of aerobic exercise time (AET) is an important factor for improving physical function in patients with stroke. However, there is a lack of evidence regarding the factors for AET during physiotherapy, particularly in stroke patients. OBJECTIVE: To investigate the correlation between AET during physiotherapy and characteristics of patients with subacute stroke. METHODS: In this cross-sectional study, 61 hospitalized subacute stroke patients (age = 72 (11) years, (median (interquartile range)) were enrolled and their exercise intensity was measured by wearable sensors (Mio Alpha 2) worn during physiotherapy sessions. All patients were divided into two groups, non-ambulatory group (functional ambulation classification (FAC); 0-2) and ambulatory group (FAC; 3-5). The correlations between AET and patient characteristics were assessed in each group. RESULTS: There was no significant difference in AET between the ambulatory and non-ambulatory groups (9 (12) min vs 5 (10) min, p = .27, respectively). There was a significant correlation between AET and the functional independent measures (FIM) motor score in the ambulatory group (r = 0.52, p = .005), and between AET and the FIM cognitive score in the non-ambulatory group (r = 0.44, p = .008). CONCLUSION: Correlations between AET and patient characteristics were different according to ambulation capacity in patients with subacute stroke.

Association between premorbid sarcopenia and neurological deterioration in patients with acute ischemic stroke.

OBJECTIVE: Sarcopenia is associated with poor outcomes in patients with stroke. This study aimed to investigate the association between premorbid sarcopenia and neurological deterioration (ND) in patients with acute ischemic stroke. To the best of our knowledge, there have been no studies on this topic. METHODS: In this prospective longitudinal study, we assessed premorbid sarcopenia using the SARC-F questionnaire, and the incidence of ND was defined by an increase of ≥ 1 point on the National Institutes of Health Stroke Scale (NIHSS) or the occurrence of any new neurological symptoms/signs. Logistic regression analysis was used to investigate the relationship between premorbid sarcopenia and ND. RESULTS: Of the 290 patients enrolled, 46 and 244 patients experienced and did not experience ND 1 week after admission (ND and non-ND groups, respectively). The prevalence of sarcopenia was significantly higher in the ND group than in the non-ND group (39% vs. 17%). In the adjusted model, premorbid sarcopenia was significantly associated with ND (adjusted odds ratio: 3.06, 95% confidence interval: 1.11-8.40; p = 0.03). CONCLUSION: Premorbid sarcopenia is independently associated with ND in patients with acute ischemic stroke. Therefore, it is necessary to detect premorbid sarcopenia to predict ND in these patients.

Value of the 3-min walk test and its association with motor functions in older adults.

BACKGROUND: The 3-min walk test (3MWT) has been used in the clinical setting. OBJECTIVE: To present the 3MWT value and investigate its association with motor and respiratory functions of healthy older adults. METHODS: Two hundred six older adults and 27 younger adults were enrolled. The 3MWT was assessed by the walking distance within 3 min. Knee extension muscle strength (KEMS), 5-repetition sit-to-stand (5 R-STS), Timed Up and Go (TUG), forced vital capacity (FVC), forced expiratory volume 1.0 (FEV1.0), maximal expiratory pressure (MEP), and maximal inspiratory pressure (MIP) were measured. The 3MWT distance was examined by age group (18-39, 60-69, 70-79, and 80-89 years). A multivariate regression analysis investigated the association between 3MWT and motor function test. RESULTS: The 3MWT values in each age group were 273-385, 233-414, 93-351, and 171-345 m for men and 215-375, 220-349, 198-325, and 174-332 m for women respectively. The 3MWT values were correlated with age, body mass index (BMI), KEMS, 5 R-STS, TUG, FVC, FEV1.0, MEP, and MIP. On the multivariate regression analysis, 3MWT was significantly associated with BMI (standard beta = -0.18; 95% confidence interval [CI], -3.20 to 0.83), KEMS (standard beta = 0.37; 95% CI, 0.06-0.13), 5 R-STS (standard beta = -0.13; 95% CI, -5.70 to -0.13), and TUG (standard beta = -0.36; 95% CI, -17.15 to -7.73) in older adults (adjusted R2 = 0.47). CONCLUSIONS: The 3MWT distance decreased with age and was associated with motor and respiratory functions. No range trends were observed among groups. Our findings suggest that 3MWT reflects functional capacity.

Association between the coexistence of premorbid sarcopenia, frailty, and disability and functional outcome in older patients with acute stroke.

AIM: To investigate the effects of coexisting conditions such as premorbid sarcopenia, frailty, and disability on functional outcomes in older patients with acute stroke. METHODS: This prospective cohort study included older patients (aged ≥65 years) hospitalized for acute stroke at a single neurosurgical hospital. Premorbid sarcopenia, frailty, and disability were diagnosed using the strength, assistance with walking, rising from a chair, climbing stairs, and falls (SARC-F) questionnaire, frailty index, and modified Rankin Scale (mRS) on admission. The primary outcome was the mRS score 3 months after stroke, and a poor outcome was defined as mRS ≥4. RESULTS: This study included 317 older patients with acute stroke (median [interquartile range] age: 76 [12] years). Premorbid sarcopenia, frailty, and disability (mRS = 2 or 3) were identified in 59 (19%), 27 (9%), and 54 (17%) patients, respectively. Two coexisting conditions were observed in 26 patients (8%), and three were observed in 18 patients (6%). Adjusted logistic regression analysis revealed that coexisting conditions were independently associated with poor outcomes (one condition, adjusted OR: 3.20 [95%CI: 0.98-10.45]; two conditions, adjusted OR: 6.57 [95%CI: 1.74-24.87]; three conditions, adjusted OR: 12.70 [95%CI: 2.65-60.91]). CONCLUSIONS: The coexistence of premorbid sarcopenia, frailty, and disability was associated with poor functional outcomes in older patients with acute stroke. Geriatr Gerontol Int 2022; 22: 642-647.

Daily steps are associated with walking ability in hospitalized patients with sub-acute stroke.

Increased physical activity is required in patients with stroke that are hospitalized in the rehabilitation unit. This study investigated the association between the daily number of steps and walking independence in order to determine the cutoff value of daily number of steps that can predict walking independence in hospitalized patients with sub-acute stroke. This cross-sectional observational study included 85 stroke patients admitted to the rehabilitation unit. The average daily number of steps was measured using Fitbit One for 4 days starting at 30 days after stroke onset. 6-min walk test, and Fugl-Meyer assessment of the lower extremities were measured The category of walking independence was classified using the Functional Ambulation Category (FAC). The subjects were divided into two groups according to the FAC score: a walking independence group (FAC ≥ 4) and a walking non-independence group (FAC ≤ 3). Logistic regression analysis was conducted to investigate the association of daily number of steps with walking independence and a receiver operating characteristic curve was used to identify the cutoff value of daily number of steps for predicting walking independence. The daily number of steps (per 1000 steps) was independently associated with walking independence (odds ratio (OR); 2.53, 95% confidence interval (CI); 1.40-5.73, p = 0.009). The cutoff value of daily number of steps for predicting independent walking was 4286 steps (area under the curve = 0.914, sensitivity of 0.731, and specificity of 0.949). The daily number of steps was associated with independent walking in hospitalized patients with sub-acute stroke. The daily number of steps may be a useful target in rehabilitation for patients with sub-acute stroke.

Care-needs Certification in the National Long-Term Care Insurance is Useful for Assessment of Premorbid Function in Older Japanese Patients with Stroke.

OBJECTIVE: To investigate the effects of premorbid long-term care insurance (LTCI) care-need certification on functional improvement during acute hospitalization in older patients with stroke. METHODS: In this single-center prospective cohort study, we assessed LTCI care-needs certification and the modified Rankin Scale (mRS) at the premorbid stage, on admission, and at hospital discharge in older patients with stroke. We also assessed adverse events during hospitalization. The main outcome was the presence of functional improvement during hospitalization (mRS on admission < mRS at discharge). Multivariate analysis was performed to investigate the relationship between functional improvement and premorbid LTCI care-need certification. RESULTS: In total, 246 older patients with stroke were enrolled in this study. There was a significant independent association between premorbid LTCI care-needs certification (care level 1 = odds ratio [OR]: 0.26, 95% CI: 0.10-0.72, p = 0.01; Care level 2 = OR: 0.27, 95% CI: 0.10-0.73, p = 0.01; care level 3-5 = OR: 0.21, 95% CI: 0.08-0.56, p = 0.002; Not applicable = reference) and functional improvement. CONCLUSIONS: Premorbid LTCI care-need certification is associated with short-term functional improvement in older patients with stroke. Assessment of premorbid LTCI care-needs certification is valid for predicting functional improvement in older patients with stroke.

Association between knee extensor force steadiness and postural stability against mechanical perturbation in patients with Parkinson's disease.

OBJECTIVE: Lower extremity force steadiness has been shown to decrease with aging and neuromotor dysfunction and to be associated with physical function and fall. Although patients with Parkinson's disease (PD) experience decreased force steadiness, whether the extent of force steadiness differs according to target force or whether this steadiness is associated with postural control remain unclear. Therefore, this study aimed to compare the force steadiness while steadily exerting low and moderate levels of knee extensor force between individuals with and without PD and to examine the association between force steadiness and postural instability against mechanical perturbation in PD. METHODS: A total of 33 patients with PD (mean age, 71.7 years) and 33 healthy controls (72.2 years) participated in this study. Participants with PD were classified into postural stability or instability groups based on the Movement Disorder Society-sponsored revision of the Unified Parkinson's Disease Rating Scale motor exam item 12. Participants performed steady task of the knee isometric extension at two levels (10% and 50% of maximal voluntary contraction [MVC]). RESULTS: Force steadiness at 10% MVC was lower in postural instability group than that in the control and postural stability groups (P < 0.05) after adjusting for age, sex, and body mass index, whereas it was not significantly different at 50% MVC among the three groups. DISCUSSION: These results suggest that the knee extensor force steadiness is affected in patients with PD having postural instability against mechanical perturbation during low intensity force exertion and is not affected regardless of the presence of postural instability during moderate intensity force exertion.

Different association between physical activity and physical function according to walking independence in hospital-based rehabilitation program patients with sub-acute stroke.

OBJECTIVE: To investigate the association between physical activity and physical function in ambulatory independent and non-independent patients with sub-acute stroke during hospitalization. METHODS: This cross-sectional observational study included 107 patients with stroke admitted to a rehabilitation unit. The average daily number of steps taken was considered as physical activity. Physical function was assessed using the 6 min walk test (6MWT), lower limb Fugl-Meyer assessment (FMA), and Berg balance scale (BBS). Walking independence was assessed using the functional ambulation category (FAC). The subjects were divided into a walking independence group (FAC ≥ 4) and a non-independence group (FAC ≤ 3). Multiple regression analysis was used to investigate the relationship between the daily number of steps and physical function in each group. RESULTS: The daily number of steps (p < 0.001), lower limb FMA (p < 0.001), 6MWT (p < 0.001), and BBS (p < 0.001) were higher in the independent walking group than in the non-walking group. The daily number of steps in the walking independence group was significantly associated with the 6MWT (standard ß = 0.489, p = 0.039). In the non-independence group, the daily number of steps was significantly associated with the BBS (standard ß = 0.594, p < 0.001). CONCLUSION: Physical activity was associated with walking endurance in patients with ambulatory independence, even though it was associated with balance function in patients with non-ambulatory independence.

Objectively measured physical activity was not associated with neighborhood walkability attributes in community-dwelling patients with stroke.

Although the built environment may affect physical activity, there is little evidence on how neighborhood walkability attributes influence post-stroke physical activity. This study aimed to explore associations between objectively measured physical activity and neighborhood walkability attributes in community-dwelling patients with stroke. This cross-sectional study recruited patients who could ambulate outside free of assistance. We assessed objectively measured physical activity comprising the number of steps taken and time spent in moderate-to-vigorous physical activity (MVPA) with an accelerometer. Neighborhood walkability attributes were evaluated using the Walk Score. Multiple linear regression analyses were used to determine whether the Walk Score was independently associated with the number of steps taken or MVPA. Eighty participants with a mean age of 65.9 ± 11.1 years were included. The participants took an average of 5900.6 ± 2947.3 steps/day and spent an average of 19.7 ± 21.7 min/day in MVPA. The mean Walk Score was 71.4 ± 17.2. Multiple linear regression analyses showed that no significant associations were found between the Walk Score and the number of steps taken or MVPA. No associations were found between objectively measured physical activity and neighborhood walkability attributes in community-dwelling patients with stroke in an Asian area.

Cachexia criteria in chronic illness associated with acute weight loss in patients with stroke.

OBJECTIVES: Weight loss after a stroke is associated with poor outcomes. However, the causes of weight loss in the acute phase of a stroke are not fully understood. The purpose of this study was to investigate the relationship between acute weight changes and cachexia criteria in patients with an acute stroke. METHODS: In this prospective-cohort study, we assessed patients' body weight change during hospitalization, and investigated the five cachexia criteria (muscle strength, fatigue, anorexia, skeletal muscle mass, and abnormal biochemistry) at time of discharge in patients with an acute stroke. A patient was defined as being cachectic if ≥3 cachexia criteria were met. A multivariate analysis was performed to investigate the relationship between weight changes and cachexia criteria. RESULTS: A total of 155 patients with an acute stroke were enrolled in this study, and 30 patients (19%) were found to have weight loss (≥5% weight loss). A univariate regression analysis found that the cachexia criteria were significantly associated with weight changes (ß = -0.338; P < 0.001). The multivariate analyses after adjusting for energy intake, age, sex, body mass index at time of admission, National Institutes of Health stroke scale score, inflammatory disease, length of hospital stay, length of bed rest, and swallowing function showed that the cachexia criteria were significantly associated with weight changes (ß = -0.154; P = 0.043). CONCLUSIONS: The cachexia criteria were independently associated with acute weight loss in patients with a stroke.