Associations Between Cognitive Function and Muscle Quality Among Community-Dwelling Older Adults: A Cross-Sectional Study.

OBJECTIVE: To investigate whether muscle quality is related to cognitive function in older adults living in the community. METHODS: The participants were 40 community-dwelling older adults without a diagnosis of dementia (mean age, 78.85 ± 6.40 years; 31 women). The dependent variable was the score on the mild cognitive impairment (MCI) index of the Japanese version of the Neurobehavioral Cognitive Status Examination Five (range: 0-6; higher scores indicate MCI or possible dementia). RESULTS: Multiple regression with Bayesian statistics was performed for analysis of muscle quality, as indicated by echo intensity (EI), with skeletal muscle mass index, gait speed, physical activity level, age, and sex as covariates. EI was significantly associated with the MCI index (expected a posterior = 0.04 [95% Bayesian confidence interval: 0.01, 0.07], t = 2.47, ß = 0.41, p = 0.019). CONCLUSIONS: The results suggest that EI may be related to the cognitive function of older adults living in the community. Future studies should examine whether focusing on EI can help prevent cognitive decline among older adults..

Longitudinal association between oral function and underweight onset among community-dwelling older adults: Role of regular self-weighing.

AIMS: Regular self-weighing is effective in weight management and may help to mitigate the risk of underweight among older adults. We examined which factors of oral function are associated with a risk for underweight among community-dwelling older adults and whether regular self-weighing can mitigate that risk. METHODS: This was a cohort study. Self-administered questionnaires were mailed to 7665 older adults in March 2019 (response rate 74.3%) and 7591 in March 2020 (response rate 74.7%). Among those who responded to both surveys, 3594 older adults who were not underweight in March 2019 were included (follow-up rate: 59.2%). We examined the association between dysphagia, poor masticatory function, and dry mouth and the development of underweight, and whether regular self-weighing reduced the risk for underweight. RESULTS: The average age ± standard deviation of participants was 71.1 ± 3.4 years. There was a significant association between swallowing difficulty and the occurrence of underweight (odds ratio = 1.65, p = .012). However, this relationship did not differ significantly with regular self-weighing (p = .477). CONCLUSIONS: These study findings suggest that to prevent underweight among community-dwelling older adults, it is important to focus on those with poor swallowing function.

Relationship between Phase Angle and Physical Activity Intensity among Community-Dwelling Older Adults in Japan: A Cross-Sectional Study.

This cross-sectional study aimed to determine the association between phase angle (PhA) and physical activity intensity in community-dwelling older Japanese adults. The intensity and time of physical activity for predicting high PhA were also examined. This study involved 67 community-dwelling older adults (mean age: 78.3 ± 5.5; female: 83.6%). We measured the physical activity and body composition of the participants. Physical activity was measured using a triaxial accelerometer, and light-intensity physical activity (LPA) and moderate-to-vigorous intensity physical activity (MVPA) hours per day were calculated from the results. Body composition was measured using Inbody S10, and the PhA was calculated from the measurements of the right side of the body. Bayesian statistical modeling revealed an association between PhA and MVPA (ß = 0.256; p = 0.022; 95% Bayesian confidence interval [CI] = 0.001, 0.012), but not LPA (ß = -0.113; p = 0.341; 95% Bayesian CI = -0.002, 0.001), even after adjustment for confounders. The cutoff value of MVPA predicting high PhA, calculated by the receiver operator characteristic curve, was 19.7 min/d (sensitivity = 0.906; specificity = 0.429). These results can be used to develop strategies to increase PhA in older adults and suggest that MVPA is important in this population.

Living Alone and Depressive Symptoms among Older Adults in the COVID-19 Pandemic: Role of Non-Face-to-Face Social Interactions.

OBJECTIVE: This study examined the association of living alone with changes in depressive symptom status and the moderating effect of non-face-to-face social interactions among older adults during the coronavirus disease (COVID-19) pandemic. DESIGN: A longitudinal study. SETTING AND PARTICIPANTS: This study recruited individuals aged ≥ 65 years without long-term care in one semi-urban city in Japan, who completed mailed questionnaires in March (baseline) and October 2020 (follow-up). METHODS: Based on depressive symptoms assessed by the Two-Question Screening at baseline and follow-up, participants were classified as: "non-case," "onset," "remission," and "persistence." Non-face-to-face social interactions during the pandemic, including phone calls or emails with separated families or friends, were dichotomized as "less than weekly interactions" and "weekly interactions." A multinomial logistic regression analysis was conducted to examine the association of living arrangement (living alone or together) with changes in depressive symptoms status. RESULTS: Data of 1001 participants were analyzed (mean age = 79.9 years). Of them, 13.8% lived alone. Overall, 40.6% participants were grouped as "non-case," 11.7% as "onset," 11.0% as "remission," and 27.1% as "persistence." Living alone was significantly associated with depressive symptom onset (odds ratio: 1.92; 95% CI: 1.03-3.56; P = .039), and a negative interaction (protective effect) was found between living alone and weekly non-face-to-face social interactions for depressive symptom onset. CONCLUSION AND IMPLICATIONS: During the pandemic, older adults living alone had a higher depressive symptom risk, but non-face-to-face social interactions may have buffered this risk. Our findings suggest the importance of supporting older adults living alone in times of social restrictions such as the pandemic, and furthermore, maintaining social connections, including non-face-to-face relationships, is necessary to protect their mental health.

Eating alone and weight change in community-dwelling older adults during the coronavirus pandemic: A longitudinal study.

OBJECTIVES: It is likely that the number of older adults who eat alone has increased during the COVID-19 pandemic. Older adults who eat alone tend to experience weight fluctuations. Weight loss and underweight in older adults cause health problems. The study objective was to longitudinally investigate the association between changes in eating alone or with others and body weight status in older adults. METHODS: This longitudinal cohort study was conducted in March and October 2020 in Minokamo City, Gifu Prefecture, Japan. Questionnaire data for 1071 community-dwelling older adults were analyzed. Multinomial logistic regression analysis was performed using changes in eating alone or with others as the independent variable and body weight status as the dependent variable. The analysis was adjusted for age, sex, living arrangements, educational level, diseases receiving medical treatment, cognitive status, depression, and instrumental activities of daily living. Missing data were imputed using multiple imputation. RESULTS: The average age of participants was 81.1 y (SD, 4.9 y). Individuals who reported eating alone in both surveys were more likely to report weight loss than those who reported eating with others in both surveys (adjusted model: odds ratio, 2.25; 95% confidence interval, 1.06-4.78; P = 0.04). CONCLUSIONS: These findings suggest that measures to prevent weight loss in older adults who eat alone are particularly important during the COVID-19 pandemic.

Social frailty and depressive symptoms during the COVID-19 pandemic among older adults in Japan: Role of home exercise habits.

OBJECTIVES: We examined the association between social frailty and depressive symptoms among community-dwelling older adults during the coronavirus disease 2019 pandemic. Additionally, we investigated whether home exercise habits moderated the impact of social frailty on depressive symptoms. METHODS: This cross-sectional study included 1,103 community-dwelling older adults (54.0% female, mean age [standard deviation] = 81.1 [5.0] years) from a semi-urban area of Japan who completed a mailed questionnaire survey in October 2020. Social frailty status was categorized as non-social frailty, pre-social frailty, and social frailty, which was assessed by financial difficulties, living alone, lack of social activity, and contact with neighbors. Depressive symptoms were defined as a Kessler 6 score ≥5. We performed a multivariable logistic regression analysis to examine the association between social frailty and depressive symptoms, and also conducted stratified analysis of home exercise habits during the pandemic. RESULTS: A total of 309 (28.0%) participants had depressive symptoms. Compared with non-social frailty, social frailty was associated with depressive symptoms (odds ratio [OR] = 1.80, 95% confidence interval [95%CI] = 1.16-2.79, p = 0.009). A similar relationship was observed in those who did not exercise at home (OR = 2.10, 95%CI = 1.14-3.84, p =0.017). However, no such relationship was observed in those who did exercise at home (OR = 1.50, 95%CI = 0.79-2.85, p =0.213). CONCLUSIONS: Social frailty was associated with a risk of depressive symptoms during the pandemic. In addition, our findings suggested that home exercise may buffer the association between social frailty and depressive symptoms.

Changes in psychosocial factors among community-dwelling older adults before and after Japan's declaration of a state of emergency over coronavirus disease 2019.

BACKGROUND: Social distancing measures to prevent the spread of coronavirus disease 2019 may cause changes in psychosocial factors. This study aimed to clarify changes in psychosocial factors among older adults before and after Japan's declaration of a state of emergency over coronavirus disease 2019. METHODS: This was a longitudinal cohort questionnaire study. A baseline survey was conducted in March 2020, and a follow-up survey was conducted in August 2020. The subjects were 1103 community-dwelling older adults not certified as having long-term care needs who responded to both the baseline and follow-up surveys. Changes in psychosocial factors before and after the state of emergency declaration were analysed by gender using the McNemar-Bowker test. RESULTS: Data for 397 men (mean age ± standard deviation: 80.6 ± 4.7 years) and 486 women (80.3 ± 4.3 years) were analysed in this study. The frequency of meeting friends increased over the study period for men (P = 0.04). An increasing number of women lived alone (P = 0.01). However, many people's financial status improved (P < 0.01), and the number of friends met in the previous month increased (P < 0.01). CONCLUSIONS: None of the examined psychosocial factors worsened, except for the increase in the number of women living alone. However, many of the study subjects refrained from engaging in certain activities. If the coronavirus disease 2019 pandemic persists, changes in psychosocial factors may occur. Therefore, a long-term investigation of the secondary psychosocial effects of coronavirus disease 2019 is necessary.

Association between family caregivers and depressive symptoms among community-dwelling older adults in Japan: A cross-sectional study during the COVID-19 pandemic.

OBJECTIVES: Novel coronavirus disease (COVID-19) pandemic could increase the mental health burden of family caregivers of older adults, but related reports are limited. We examined the association between family caregiving and changes in the depressive symptom status during the pandemic. METHODS: This cross-sectional study included 957 (mean age [standard deviation] = 80.8 [4.8] years; 53.5% females) community-dwelling older adults aged ≥ 65 years from a semi-urban area of Japan, who completed a mailed questionnaire. Based on the depressive symptom status assessed with the Two-Question Screen between March and October 2020, participants were classified into four groups: "non-depressive symptoms," "incidence of depressive symptoms," "remission from depressive symptoms," or "persistence of depressive symptoms." Participants were assessed in October 2020 for the family caregiving status, caregiving role, the severity of care recipients' needs, and increased caregiver burden during the pandemic, each with the simple question. Multinomial logistic regression analysis was applied to obtain the odds ratios (ORs) and 95% confidence intervals (CIs) for changes in depressive symptom status. RESULTS: Compared to non-caregivers, family caregivers were associated with the incidence (OR [95% CI] = 3.17 [1.55-6.51], p < 0.01) and persistence of depressive symptoms (OR [95% CI] = 2.39 [1.30-4.38], p < 0.01). Primary caregivers, caregivers for individuals with severe care needs, and caregivers with increased burden during the pandemic had a high risk of depressive symptoms. CONCLUSIONS: Family caregivers had a high risk of depressive symptoms during the pandemic. Our findings highlight the need for a support system for family caregivers.

Social Isolation and Self-Reported Cognitive Decline Among Older Adults in Japan: A Longitudinal Study in the COVID-19 Pandemic.

OBJECTIVES: We aimed to examine the association between the transition to social isolation and cognitive decline in older adults during the coronavirus disease 2019 (COVID-19) pandemic. DESIGN: Longitudinal study. SETTING AND PARTICIPANTS: The study included participants from a community in a semiurban area of Japan. We conducted a mailed questionnaire survey of 2000 noninstitutionalized older adults who were randomly sampled. Of those who completed both the baseline and follow-up surveys in March and October 2020, respectively, participants aged ≥70 years without cognitive impairment at baseline were included in the analysis. METHODS: Participants were classified into 4 groups based on their baseline and follow-up social isolation status, which were as follows: "remained nonisolated," "isolated from nonisolation," "nonisolated from isolation," and "consistent isolation." Self-reported cognitive function was assessed using the Cognitive Performance Scale, and level 2 (mild impairment) or higher (moderate to severe impairment) was defined as cognitive impairment. RESULTS: Ultimately, 955 older adults were analyzed. The mean age of the participants was 79.6 years (standard deviation = 4.7) and 54.7% were women. During the follow-up period, 54 (5.7%) participants developed cognitive impairment. Multivariable logistic regression analysis revealed that compared with the group that remained nonisolated, the isolated from nonisolation and consistent isolation groups were significantly associated with the onset of cognitive impairment [isolated from nonisolation: odds ratio (OR) = 2.74, 95% confidence interval (CI) = 1.13-6.61, P = .026; consistent isolation: OR = 2.33, 95% CI = 1.07-5.05, P = .033]. CONCLUSIONS AND IMPLICATIONS: Social isolation during the COVID-19 pandemic was associated with a decline in cognitive function among older adults. Attention to the social isolation process during the pandemic may be necessary to protect older adults' cognitive health.

Influence of seasonal variations on physical activity in older people living in mountainous agricultural areas.

Objectives: Increasing activity levels in older people is important for maintaining quality of life and ameliorating the risks of morbidity related to falls, depression, and dementia. This study aimed to clarify the seasonal variation effects on total energy expenditure, number of steps, time spent in low- and moderate- or high-intensity physical activities, and daily activities performed. Patients and Methods: This was a cross-sectional study of 22 community-dwelling older individuals (3 men, 19 women; mean age, 75.1 ± 7.3 years) living in three districts of Gero, Gifu, who participated in the Gero Salon Project hosted by the Social Welfare Councils. Evaluations were conducted in each season from September 2016 to August 2017. We used a uniaxial accelerometer, the Lifecorder device, which measures physical activity, and the Physical Activity Scale for the Elderly to evaluate activities of daily living. Data were analyzed using the multiple comparisons (Bonferroni correction) method. Results: Total energy expenditure and time spent in moderate- or high-intensity activities did not show seasonal variations. However, the lowest number of steps was taken during the winter, and the number of steps increased significantly from winter to spring. The time spent in low-intensity physical activities was significantly longer in the spring and summer than in the winter. There was no significant seasonal difference in total Physical Activity Scale for the Elderly score, leisure activities, domestic activities, or work-related activities. However, there was a significant difference between the summer and winter scores in "outdoor gardening," with the lowest score observed during the winter. Conclusions: With climate changes in the winter months, "outdoor gardening" becomes difficult, thus decreasing the number of steps taken. Therefore, it is necessary to identify other ways for older people to maintain physical activity during the winter season.

A Systematic Review of Multimodal Non-Pharmacological Interventions for Cognitive Function in Older People with Dementia in Nursing Homes.

INTRODUCTION: Multimodal non-pharmacological interventions (MNPIs) have been reported to be effective in improving the cognitive function. Therefore, it is necessary to study these interventions in older people with dementia (PWD) in nursing homes (NHs). AIMS: This study aimed to investigate the effects, contents, frequency, duration, length, and form of MNPIs on the global and specific cognitive functions of PWD in NHs through a systematic review, and to consider what kind of intervention design is most effective. METHODS: A systematic search of peer-reviewed literature published between January 2008 and October 2018 was performed on the PubMed, Cochrane Library, Web of Science and CINAHL databases. RESULTS: Six randomized controlled trials (RCTs) and one non-RCTs were extracted from electronic databases, and a review was carried out. CONCLUSION: Our review suggests that MNPIs may improve the global, executive function and memory of PWD in NHs. The combination of exercise, cognitive training and activities of daily living, and intervention at least 3 times a week over at least 8 weeks with, at least 30 min per session using the integrated form is recommended for improving the global and specific cognitive functions of PWD in NHs.

Necessity for a Significant Maintenance Dosage Reduction of Voriconazole in Patients with Severe Liver Cirrhosis (Child-Pugh Class C).

Therapeutic drug monitoring for voriconazole, an antifungal agent, is essential for maximizing efficacy and preventing toxicity. The aim of this study was to elucidate the optimal maintenance dose of voriconazole in patients with severe liver cirrhosis (Child-Pugh class C) by reviewing the plasma trough concentrations obtained by therapeutic drug monitoring and daily doses of voriconazole. We retrospectively evaluated 6 patients with Child-Pugh class C cirrhosis who received oral voriconazole treatment and were liver transplant recipients or were awaiting liver transplantation. We compared their voriconazole trough concentrations and daily maintenance doses to those of patients who did not have liver cirrhosis (n=56). We found that plasma voriconazole trough concentrations in all patients with Child-Pugh class C were almost within therapeutic range, and the median plasma trough concentration at steady state was not significantly different from that of patients who did not have liver cirrhosis. In addition, the median daily maintenance dose of voriconazole was significantly lower (2.13 mg/kg/d) than that of the control patients (6.27 mg/kg/d), suggesting that trough voriconazole concentrations are elevated in Child-Pugh class C patients. Thus, we conclude that oral voriconazole maintenance doses in patients with Child-Pugh class C should be reduced to approximately one-third that of patients with normal liver function, with the follow-up dose adjusted by therapeutic drug monitoring.

Validating the Effectiveness of Switching the Vancomycin TDM Analysis Software Based on the Predictive Accuracy.

Based on the predictive performance in our previous study, we switched the therapeutic drug monitoring (TDM) analysis software for dose setting of vancomycin (VCM) from "Vancomycin MEEK TDM analysis software Ver2.0" (MEEK) to "SHIONOGI-VCM-TDM ver.2009" (VCM-TDM) in January 2015. In the present study, our aim was to validate the effectiveness of the changing VCM TDM analysis software in initial dose setting of VCM. The enrolled patients were divided into two groups, each having 162 patients in total, who received VCM with the initial dose set using MEEK (MEEK group) or VCM-TDM (VCM-TDM group). We compared the rates of attaining the therapeutic range (trough value; 10-20 µg/mL) of serum VCM concentration between the groups. Multivariate logistic regression analysis was performed to confirm that changing the VCM TDM analysis software was an independent factor related to attaining the therapeutic range. Switching the VCM TDM analysis software from MEEK to VCM-TDM improved the rate of attaining the therapeutic range by 21.6% (MEEK group: 42.6% vs. VCM-TDM group: 64.2%, p<0.01). Patient age ≥65 years, concomitant medication (furosemide) and the TDM analysis software used VCM-TDM were considered to be independent factors for attaining the therapeutic range. These results demonstrated the effectiveness of switching the VCM TDM analysis software from MEEK to VCM-TDM for initial dose setting of VCM.

Upper-limb motor and sensory function in patients with hip fracture: Comparison with community-dwelling older adults.

BACKGROUND: Upper-limb function is important in patients with hip fracture so they can perform activities of daily living and participate in leisure activities. Upper-limb function of these patients, however, has not been thoroughly investigated. OBJECTIVE: The aim of this study was to evaluate the upper-limb motor and sensory functions in patients with hip fracture by comparing these functions with those of community-dwelling older adults (control group). METHODS: We compared the results of motor and sensory function tests of upper-limb function - range of motion, strength, sensibility, finger dexterity, comprehensive hand function - between patients with hip fracture (n= 32) and the control group (n= 32). RESULTS: Patients with hip fracture had significantly reduced grip strength, pinch strength, finger dexterity, and comprehensive hand function compared with the control group. CONCLUSIONS: Most upper-limb functions are impaired in the patients with hip fracture. Thus, upper-limb function of patients with hip fracture should be considered during treatment.

Exploring the factor on sensory motor function of upper limb associated with executive function in communitydwelling older adults.

Exercise, such as cardiovascular fitness training, has been shown to have utility in improving executive function but is difficult for older adults with low mobility to perform. Accordingly, there is interest in the development of regimens other than high mobility exercises for older adults with low mobility. The aim of the present study was to evaluate the association between sensory motor function of the upper limb and executive function in community-dwelling older adults. A cross-sectional study was conducted in 57 right-handed, independent, community-dwelling older adults. Sensory motor function of upper limb, including range of motion, strength, sensation, finger dexterity, and comprehensive hand function was measured in both hands. Executive function was assessed using the Delta Trail Making Test. Multiple regression analysis indicated the finger dexterity of the non-dominant hand as independently associated with executive function (ß = -0.414, P < 0.001). The findings of the present study may facilitate the development of exercise regimens for improving executive function that are more suitable for older adults with limited physical fitness levels. As this was a cross-sectional study, further studies are required to validate the efficacy of non-dominant finger dexterity training for improving executive function in older adults.

Factors affecting the discharge destination of hip fracture patients who live alone and have been admitted to an inpatient rehabilitation unit.

[Purpose] (1) The aim of this study was to examine relations between clinical and functional assessment and discharge destination and (2) to identify the optimal cutoff point for estimating discharge to home after inpatient rehabilitation. [Subjects] The subjects were 54 hip fracture patients (15 males, 39 females; mean age 81.3 ± 7.4 years) living alone. [Methods] The patients were classified into two groups: those discharged to home and those admitted to an institution. Age, gender, side of fracture, fracture type, number of comorbidities, Functional Independence Measure motor score, and Functional Independence Measure cognitive score were compared between groups. Multiple logistic regression analysis was conducted with discharge to home as the dependent variable and age, gender, side of fracture, fracture type, number of comorbidities, Functional Independence Measure motor score, and Functional Independence Measure cognitive score as independent variables. A receiver operating characteristic curve analysis was used to identify a cutoff point for classification of the patients into the two groups. [Results] Multiple logistic regression analysis showed that the Functional Independence Measure cognitive score was a significant variable affecting the discharge destination. The receiver operating characteristic curve analysis revealed that discharge to home was predicted accurately by a Functional Independence Measure cognitive score of 23.5. [Conclusion] Information from this study is expected to be useful for determining discharge plans and for the setting of treatment goals.

Effects of periodic task-specific test feedback on physical performance in older adults undertaking band-based resistance exercise.

The purpose of this study was to determine the effects of periodic task-specific test feedback on performance improvement in older adults undertaking community- and home-based resistance exercises (CHBRE). Fifty-two older adults (65-83 years) were assigned to a muscular perfsormance feedback group (MPG, n = 32) or a functional mobility feedback group (FMG, n = 20). Both groups received exactly the same 9-week CHBRE program comprising one community-based and two home-based sessions per week. Muscle performance included arm curls and chair stands in 30 seconds, while functional mobility was determined by the timed up and go (TUG) test. MPG received fortnightly test feedback only on muscle performance and FMG received feedback only on the TUG. Following training, there was a significant (P < 0.05) interaction for all performance tests with MPG improving more for the arm curls (MPG 31.4%, FMG 15.9%) and chair stands (MPG 33.7%, FMG 24.9%) while FMG improved more for the TUG (MPG-3.5%, FMG-9.7%). Results from this nonrandomized study suggest that periodic test feedback during resistance training may enhance task-specific physical performance in older persons, thereby augmenting reserve capacity or potentially reducing the time required to recover functional abilities.

Pattern of age-associated decline of static and dynamic balance in community-dwelling older women.

AIM: Falling is the leading cause of injury-related deaths in older adults, and a loss of balance is often the precursor to a fall. However, little is known about the rate at which balance declines with age. The objective of the present study was to determine whether there is an age-associated decline in static (SB) and/or dynamic (DB) balance in community-dwelling older women. METHOD: SB and DB were determined in 971 older women. Intraclass correlation coefficients (ICC) were used to determine test-retest reliability. Sway velocity was used to measure SB standing on a platform and foam with eyes open and closed. DB was characterized by limits of stability (LOS) that measured end-point excursion (EXE) and maximum excursion (MXE) of the body's center of pressure. RESULTS: ICC for EXE and MXE for the LOS test were excellent (EPE = 0.96, MXE = 0.96). ICC for SB tests, except for the eyes open firm surface condition (ICC = 0.10), showed a high level of reproducibility (ICC = 0.88 and 0.90). Relationships existed between age and SB (r = 0.31, P < 0.001), and between age and DB (r = -0.46--0.48, P < 0.001). The rate of decline for both DB and SB was approximately 1% per year. Age was significantly associated with all balance measures. DB got significantly lower with advancing age until 80 years, and then plateaued. SB did not decline with age until 80 years, and then decreased significantly thereafter. CONCLUSION: Although large individual variation was found with balance ability, an age-related decline was found with both dynamic and static balance for Japanese older women.

Sustained delivery of lidocaine into the cochlea using poly lactic/glycolic acid microparticles.

OBJECTIVES/HYPOTHESIS: Lidocaine is a local anesthetic that is known to suppress tinnitus via systemic or local application; however, this effect has only limited duration. The current study aimed to establish a method for the sustained delivery of lidocaine into the cochlea using poly lactic/glycolic acid (PLGA) microparticles. STUDY DESIGN: Experimental study. METHODS: Lidocaine-loaded PLGA microparticles were produced and their in vitro-release profiles were examined. The lidocaine concentrations in the perilymph were measured at different time points following the application of the lidocaine-loaded PLGA microparticles to the round-window membranes of guinea pigs. The possible adverse effects of the local application of lidocaine-loaded PLGA microparticles were also examined. RESULTS: The in vitro analyses revealed that the microparticles were capable of the sustained delivery of lidocaine. The in vivo experiments demonstrated the sustained delivery of lidocaine into the cochlear fluid, and the maintenance of high lidocaine concentrations in the perilymph for up to 3 days after application. Nystagmus and inflammation in the middle ear mucosa were not detected after the local application of lidocaine-loaded PLGA microparticles, although temporary hearing loss was observed. CONCLUSIONS: Lidocaine-loaded PLGA microparticles were shown to be capable of the sustained delivery of lidocaine into the cochlea, suggesting that they could be used for the attenuation of peripheral tinnitus.

[Pharmacokinetic study of amrubicin in a case of small lung cancer on hemodialysis].

Amrubicin is a new anticancer drug that has been shown to exert efficacy against small cell lung cancer. The pharmacokinetic parameters of amrubicin have not yet been investigated in hemodialysis patients, although it had been expected that amrubicin might not be cleared by hemodialysis because of its high lipid solubility, high protein binding rate and low urinary excretion rate. We encountered a case of small cell lung cancer on hemodialysis who was treated with amrubicin. We assayed the plasma concentrations of amrubicin and amrubicinol (its active metabolite) and analyzed the pharmacokinetic parameters of the drug in this hemodialysis patient. The results revealed that the pharmacokinetic parameters of the drug in this patient undergoing hemodialysis were similar to those in patients not on hemodialysis. Our results suggest that amrubicin and amrubicinol are cleared by hemodialysis, and that dose adjustment of amrubicin might not be required in hemodialysis patients.