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

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

Vendor-Specific Correction Software for Apparent Diffusion Coefficient Bias Due to Gradient Nonlinearity in Breast Diffusion-Weighted Imaging Using Ice-Water Phantom.

OBJECTIVE: This study aimed to evaluate a vendor-specific correction software for apparent diffusion coefficient (ADC) bias due to gradient nonlinearity in breast diffusion-weighted magnetic resonance imaging using an ice-water phantom. METHODS: The phantom consists of 5 plastic tubes with a length of 100 mm and a diameter of 15 mm, filled with distilled water and immersed in an ice-water bath. Diffusion-weighted images were acquired by echo-planar imaging sequence on a 3.0-T scanner. ADC maps with and without correction were calculated using 4 b-values (0, 100, 600, and 800 s/mm2). The mean ADCs were measured using a rectangular profile with 5 × 40 pixels in the anterior-posterior (AP) and a square region of interest with 5 × 5 pixels in the right-left (RL) and superior-inferior (SI) directions on the ADC map. ADC was compared with and without correction using a paired t test. Additionally, ADC of the ice-water phantom was measured at the magnet isocenter. RESULTS: ADC increased in the AP and RL directions and decreased in the SI direction with increasing distance from the isocenter before correction. After the correction, ADC at the off-center positions in the AP, RL, and SI directions was reduced to within 5% of the expected value. There were significant differences in the ADC at the off-center positions without and with correction (P < 0.001); however, ADC at the magnet isocenter did not vary after correction (1.08 ± 0.02 × 10-3 mm2/s). CONCLUSIONS: The vendor-specific software corrected the ADC bias due to gradient nonlinearity at the off-center positions in the AP, RL, and SI directions. Therefore, the software will contribute to the accurate ADC assessment in breast DWI.

Patient Positioning Assistive Technology Applicable to the Existing Computed Tomography System: Estimation by Pixel Value of Scout Image.

ABSTRACT: This study aimed to propose a patient positioning assistive technique using computed tomography (CT) scout images. A total of 210 patients who underwent CT scans in a single center, including on the upper abdomen, were divided into a study set of 127 patients for regression and 83 patients for verification. Linear regression analysis was performed to determine the R2 coefficient and the linear equation related to the mean pixel value of the scout image and ideal table height (TH ideal ). The average pixel values of the scout image were substituted into the regression equation to estimate the TH ideal . To verify the accuracy of this method, the distance between the estimated table height (TH est ) and TH ideal was measured. The medians of age (in years), gender (male/female), height (in centimeters), and body weight (in kilograms) for the regression and verification groups were 68 versus 70, 85/42 versus 55/28, 163.8 versus 163.0, and 59.9 versus 61.9, respectively. Linear regression analysis indicated a high coefficient of determination ( R2 = 0.91) between the mean pixel value of the scout image and TH ideal . The correlation coefficient between TH ideal and TH est was 0.95 (95% confidence interval, 0.92-0.97; P < 0.0001), systematic bias was 0.2 mm, and the limits of agreement were -5.4 to 5.9 ( P = 0.78). The offset of the table height with TH est was 2.8 ± 2.1 mm. The proposed estimation method using scout images could improve the automatic optimization of table height in CT, and it can be used as a general-purpose automatic positioning technique.

Comparison of Bioelectrical Impedance Indices for Skeletal Muscle Mass and Intracellular Water Measurements of Physically Active Young Men and Athletes.

BACKGROUND: Bioelectrical impedance analysis (BIA) is a minimally invasive, safe, easy, and quick technology used to determine body composition. OBJECTIVES: We compared the relationship among impedance indices obtained using single-frequency BIA, multi-frequency BIA, bioelectrical impedance spectroscopy (BIS), and skeletal muscle mass (SMM) of physically active young men and athletes using the creatine (methyl-d3) dilution method. We also compared the SMM and intracellular water (ICW) of athletes and active young men measured using a reference stable isotope dilution and BIS method, respectively. METHODS: We analyzed data from 28 men (mean age, 20 ± 2 y) who exercised regularly. Single-frequency BIA at 5 kHz and 50 kHz (R5 and R50), multi-frequency BIA (R250-5), and BIS (RICW) methods of determining the SMM were compared. The deuterium and sodium bromide dilution methods of obtaining the total body water, ICW, and extracellular water measurements were also used, and the results were compared to those acquired using bioimpedance methods. RESULTS: The correlation coefficients between SMM and L2/R5, L2/R50, L2/R250-5, and L2/RICW were 0.738, 0.762, 0.790, and 0.790, respectively (P < 0.01). The correlation coefficients between ICW and L2/R5, L2/R50, L2/R250-5, and L2/RICW were 0.660, 0.687, 0.758, and 0.730, respectively (P < 0.001). However, the correlation coefficients of L2/R50, L2/R250-5, and L2/RICW for SMM and ICW were not significantly different. CONCLUSIONS: Our findings suggest that single-frequency BIA at L2/R50, multi-frequency BIA, and BIS are valid for assessing the SMM of athletes and active young men. Additionally, we confirmed that the SMM and ICW were correlated with single-frequency BIA, multi-frequency BIA, and BIS. Bioimpedance technologies may be dependable and practical means for assessing SMM and hydration compartment status of active young adult males; however, cross-validation is needed.

Association between doubly labelled water-calibrated energy intake and objectively measured physical activity with mortality risk in older adults.

BACKGROUND: Physical activity or biomarker-calibrated energy intake (EI) alone is associated with mortality in older adults; the interaction relationship between the combined use of both factors and mortality has not been examined. We evaluated the relationship between mortality and calibrated EI and step counts in older adults. METHODS: This prospective study included 4,159 adults aged ≥65 years who participated in the Kyoto-Kameoka study in Japan and wore a triaxial accelerometer between 1 April and 15 November 2013. The calibrated EI was calculated based on a previously developed equation using EI biomarkers. The step count was obtained from the accelerometer ≥ 4 days. Participants were classified into the following four groups: low EI (LEI)/low step counts (LSC) group (EI: <2,400 kcal/day in men and <1,900 kcal/day in women; steps: <5,000 /day), n = 1,352; high EI (HEI)/LSC group (EI: ≥2,400 kcal/day in men and ≥1,900 kcal/day in women; steps: <5,000 /day), n = 1,586; LEI/high step counts (HSC) group (EI: <2,400 kcal/day in men and < 1,900 kcal/day in women; steps: ≥5,000 /day), n = 471; and HEI/HSC group (EI: ≥2,400 kcal/day in men and ≥1,900 kcal/day in women; steps: ≥5,000 /day), n = 750. Mortality-related data were collected until 30 November 2016. We performed a multivariable Cox proportional hazard analysis. RESULTS: The median follow-up period was 3.38 years (14,046 person-years), and 111 mortalities were recorded. After adjusting for confounders, the HEI/HSC group had the lowest all-cause mortality rate compared to other groups (LEI/LSC: reference; HEI/LSC: hazard ratio [HR]: 0.71, 95% confidence interval [CI]: 0.41-1.23; LEI/HSC: HR: 0.59, 95% CI: 0.29-1.19; and HEI/HSC: HR: 0.10, 95% CI: 0.01-0.76). No significant interaction was observed between the calibrated EI and steps with mortality. The spline model showed that 35-42 kcal/100 steps/day of EI/100 steps was associated with the lowest mortality risk. CONCLUSIONS: HR mortality risk was lowest at 35-42 kcal/100 steps/day, suggesting that very high (≥56 kcal) or low (<28 kcal) EI/100 steps are not inversely associated with mortality. Adherence to optimal EI and adequate physical activity may provide sufficient energy balance to explain the inverse association with mortality among older Japanese adults.

Combined Use of Sleep Quality and Duration Is More Closely Associated With Mortality Risk Among Older Adults: A Population-based Kyoto-Kameoka Prospective Cohort Study.

BACKGROUND: Whether sleep quality and duration assessed from multiple domains, either individually or in combination, are strongly associated with mortality risk in older adults remains unelucidated. We aimed to clarify these relationships. METHODS: We enrolled 7,668 older (age ≥65 years) Japanese adults in the Kyoto-Kameoka prospective cohort study who provided valid responses to the Pittsburgh Sleep Quality Index (PSQI) in a mail-in survey. Sleep quality and duration were classified into six groups using the previously validated PSQI: short sleep duration (SSD: <360 min/day)/sleep disturbance (SD: ≥5.5 PSQI points), n = 701; SSD/non-sleep disturbance (NSD: <5.5 PSQI points), n = 100; optimal sleep duration (OSD: 360-480 min/day)/NSD, n = 1,863; OSD/SD, n = 2,113; long sleep duration (LSD: >480 min/day)/NSD, n = 1,972; LSD/SD, n = 919. Mortality data were collected from February 15, 2012, to November 30, 2016. We evaluated the relationship between all-cause mortality risk and sleep quality and duration (and their combinations) using a multivariable Cox proportional hazards model that included baseline covariates. RESULTS: The median follow-up period was 4.75 years (34,826 person-years), with a total of 616 deaths. After adjusting for confounders, compared with other groups, SSD/SD and LSD/SD had the highest hazard ratio (HR) of mortality (SSD/SD: HR 1.56; 95% confidence interval [CI], 1.10-2.19; SSD/NSD: HR 1.27; 95% CI, 0.47-3.48; OSD/NSD: reference; OSD/SD: HR 1.20; 95% CI, 0.91-1.59; LSD/NSD: HR 1.35; 95% CI, 1.03-1.77; LSD/SD: HR 1.83; 95% CI, 1.37-2.45). However, mortality risk was not associated with the interaction between sleep quality and duration. CONCLUSION: Older adults with sleep disturbances involving SSD and LSD have a strong positive association with mortality risk, suggesting an additive effect between sleep quality and duration.

Endometritis risk factors after arterial embolisation for postpartum haemorrhage.

Various complications of arterial embolisation (AE) for postpartum haemorrhage (PPH) are reported. Endometritis (EM) frequently causes abscesses, increasing hysterectomy risk. However, risk factors for EM after AE for PPH are unclear. We explored these risk factors. We included patients who underwent AE for PPH in our hospital from 2005 to 2020 and compared those who did (EM group) and did not develop EM after AE (non-EM group) in a case-control study. Twenty patients met the study criteria; eight patients (40%) had EM. There were no differences in risk factors between groups involved in infection, such as premature rupture of membranes. However, the contrast medium extravasation rate on computed tomography scans before the AE procedure was significantly higher in the EM group (p=.019) compared to the non-EM group. The greatest EM risk factor was contrast medium extravasation before AE for PPH, determined by classification and regression tree modelling (relative risk: 4.5).Impact StatementWhat is already known on this subject? Reportedly, the clinical success rate of arterial embolisation (AE) for critical haemorrhage in obstetrics is high, around 90%. However, information regarding AE complications is limited. Endometritis is one of these complications, which not only causes prolonged hospitalisation but may also require further treatment, such as hysterectomy. However, the incidence rate and risk factors for EM remain unknown.What do the results of this study add? In this study, 40.0% of patients developed EM after AE for PPH. Extravasation of contrast medium was the top risk factor (relative risk: 4.5 compared to those without EM, p=.019). The second-leading risk factor was a bleeding volume greater than 2500 mL (relative risk: 4.5 compared to those without EM, p=.019).What are the implications of these findings for future clinical practice and/or future research? We created an EM prediction model using extravasation and a bleeding volume greater than 2500 mL. The model was 87.5% sensitive and 66.7% specific. This prediction model allows for the early detection and treatment of EM by recognising high-risk patients and providing intensive postpartum management.

The effectiveness of controlled ovarian stimulation with tamoxifen for patients with estrogen-sensitive breast cancer: A systematic review and meta-analysis.

Purpose: Tamoxifen is used for the suppression of estrogen-sensitive tumor recurrence in oocyte retrieval cycles. This meta-analysis aimed to evaluate the quality of controlled ovarian stimulation (COS) with co-administration of gonadotropins and tamoxifen (COS with tamoxifen). Methods: PubMed, Embase, and Cochrane Library were searched for articles on October 30, 2022. The authors included studies comparing COS with tamoxifen and COS with gonadotropins and letrozole (COS with letrozole) or gonadotropin only (COS with gonadotropin only) for fertility preservation in patients with breast cancer. The main outcome measures were the COS quality, total number of retrieved oocytes (TOR), total number of mature oocytes (TMO), and peak estradiol levels (PEL). Results: Four studies (348 patients, two randomized controlled trials, and two cohort studies) were included in our meta-analysis. There was no significant difference in TOR (95% CI, [-3.84, 2.90]) and TMO (95% CI, [-2.20, 2.64]) between COS with tamoxifen and COS with letrozole. There was also no difference in TOR (95% CI, [-6.14, 1.86]) between COS with tamoxifen and COS with gonadotropin only. Statistically significant decrease was observed in PEL during COS with letrozole compared with tamoxifen (95% CI, [1414.4, 4953.7]). Conclusions: The quality did not differ between COS with tamoxifen and COS with letrozole or gonadotropin only.

Adherence to the food-based Japanese dietary guidelines and prevalence of poor oral health-related quality of life among older Japanese adults in the Kyoto-Kameoka study.

Although better diet quality is inversely related to the risk of geriatric disorders, the association of adherence to dietary guidelines with oral health-related quality of life (OHRQoL) is unclear. We aimed to investigate this association in older Japanese adults. This cross-sectional study included 7984 Japanese participants aged ≥ 65 years from the population-based Kyoto-Kameoka study. Dietary intake was estimated using a validated self-administered FFQ. The scores for adherence to the Japanese Food Guide Spinning Top (range: 0 (worst) to 80 (best)) were calculated. These scores were stratified into quartiles (Qs). Poor OHRQoL was defined as a score ≤ 50 using a 12-item Geriatric Oral Health Assessment Index. The OR and 95 % CI were calculated using multivariable logistic regression and the spline model. Higher adherence score was associated with a lower prevalence of poor OHRQoL (Q1-Q4:36·0 %, 32·1 %, 27·9 % and 25·1 %, respectively). An inverse association was found between the score for adherence to the food-based Japanese dietary guidelines and the OR of poor OHRQoL among all the participants (Q1: reference; Q2: OR, 0·87 (95 % CI: 0·75, 1·00); Q3: OR, 0·77 (95 % CI: 0·66, 0·90); Q4: OR, 0·72 (95 % CI: 0·62, 0·85); Pfor trend < 0·001). These relationships were similar to the results in the spline model. Higher adherence to the food-based Japanese dietary guidelines is inversely associated with the prevalence of poor OHRQoL in older adults. Our results may provide useful insights to improve and maintain oral health.

Diet quality and physical or comprehensive frailty among older adults.

PURPOSE: While the association between diet quality and mortality has been previously demonstrated, the association between frailty and diet quality has not been evaluated well. This study aimed to investigate the association between diet quality and prevalence of both physical and comprehensive frailty, using two validated tools, in a community-based cohort of older adults. METHODS: We conducted cross-sectional analyses using baseline data of 7022 participants aged ≥ 65 years in the Kyoto-Kameoka study. Diet quality was assessed by calculating the adherence scores to the Japanese Food Guide Spinning Top using a validated questionnaire; the participants were stratified into quartile groups based on these scores. Physical and comprehensive frailty was assessed using the Fried phenotype model-based Frailty Screening Index and the Kihon Checklist, respectively. Multivariable logistic regression and the restricted cubic spline model were used to calculate odds ratios (ORs) and their 95% confidence intervals (CIs) for associations between adherence scores and frailty prevalence. RESULTS: Higher adherence scores signified a higher intake of vitamin C, vegetables, dairy products, and fruits. Physical and comprehensive frailty prevalence was 14.2 and 35.8%, respectively. In a multivariable adjusted model, compared with the bottom adherence score quartile, the top quartile was associated with lower ORs of physical (OR 0.64; 95% CI 0.52-0.80) and comprehensive frailty (OR 0.60; 95% CI 0.51-0.71). These relationships were similar to results in the spline model. CONCLUSIONS: This study shows an inverse dose-response relationship between diet quality and prevalence of both physical and comprehensive frailty in older adults.

Ultrahigh-Resolution Computed Tomography Improves Preoperative Computed Tomography Angiography for Deep Inferior Epigastric Artery Perforator Flap Reconstruction.

OBJECTIVE: The aim of the study was to compare computed tomography (CT) angiography (CTA) imaging of deep inferior epigastric artery perforator (DIEP) using the ultrahigh-resolution CT (UHRCT) and conventional multidetector CT (MDCT). METHODS: This retrospective study enrolled 20 patients who underwent CTA of DIEP flap with UHRCT and MDCT. Computed tomography values were measured at 4 large vessels (thoracic aorta, abdominal aorta, common iliac artery, and external iliac artery) and 5 peripheral vessels (proximal and distal internal thoracic artery, proximal and distal deep inferior epigastric artery, and DIEP). RESULTS: There were no significant differences in mean CT values of the major vessel between UHRCT and MDCT. Ultrahigh-resolution CT shows higher CT values of the peripheral vessels than MDCT (P < 0.05 for all). The median CT values of the DIEP in UHRCT were approximately 3 times higher than those in MDCT (P < 0.001). CONCLUSIONS: Ultrahigh-resolution CT provides higher-quality CTA of DIEP compared with MDCT.

Association of the interaction between physical activity and sitting time with mortality in older Japanese adults.

PURPOSE: To examine how physical activity (PA) and sitting time (ST) are associated with mortality in older Japanese adults. METHODOLOGY: We used the data of 10 233 older Japanese adults aged ≥65 years who provided valid responses to the International Physical Activity Questionnaire-Short Form (IPAQ-SF) by a mail survey. Both PA and ST were assessed using the IPAQ-SF. The results were classified into high or low categories using ≥3.0 metabolic equivalent PA (150 min/week) and ST (300 min/day) into the following four groups: High PA (HPA)/Low ST (LST), HPA/High ST (HST), Low PA (LPA)/LST, and LPA/HST. Mortality data were collected from July 30, 2011, to November 30, 2016. We assessed the interaction of PA and ST status with the risk of all-cause mortality using the multivariable Cox proportional-hazards model. RESULTS: A total of 1014 people were recorded to have died during a median follow-up period of 5.3 years (51 553 person-years). After adjustment for confounders, the risk of mortality was higher in the LPA/HST group than in all other groups (HPA/LST: reference; HPA/HST group: hazard ratio [HR] 0.86 (95% confidence interval [CI]: 0.66 to 1.12); LPA/LST group: HR 1.09 (95% CI: 0.88 to 1.35); LPA/HST group: HR 1.36 (95% CI: 1.10 to 1.67); and multiplicative interaction: HR 1.44 (95% CI: 1.07 to 1.94)). CONCLUSIONS: The risk of mortality associated with LPA/HST depends on the level of PA, duration of ST, and their interaction with each other. Our results may be useful in ameliorating the adverse effects leading to mortality in individuals with lower PA, by reducing ST.

Validation of the Kihon Checklist and the frailty screening index for frailty defined by the phenotype model in older Japanese adults.

BACKGROUND: The term "frailty" might appear simple, but the methods used to assess it differ among studies. Consequently, there is inconsistency in the classification of frailty and predictive capacity depending on the frailty assessment method utilised. We aimed to examine the diagnostic accuracy of several screening tools for frailty defined by the phenotype model in older Japanese adults. METHODS: This cross-sectional study included 1,306 older Japanese adults aged ≥ 65 years who underwent physical check-up by cluster random sampling as part of the Kyoto-Kameoka Study in Japan. We evaluated the diagnostic accuracy of several screening instruments for frailty using the revised Japanese version of the Cardiovascular Health Study criteria as the reference standard. These criteria are based on the Fried phenotype model and include five elements: unintentional weight loss, weakness (grip strength), exhaustion, slowness (normal gait speed), and low physical activity. The Kihon Checklist (KCL), frailty screening index (FSI), and self-reported health were evaluated using mailed surveys. We calculated the non-parametric area under the receiver operating characteristic curve (AUC ROC) for several screening tools against the reference standard. RESULTS: The participants' mean (standard deviation) age was 72.8 (5.5) years. The prevalence of frailty based on the Fried phenotype model was 12.2% in women and 10.3% in men. The AUC ROC was 0.861 (95% confidence interval: 0.832-0.889) for KCL, 0.860 (0.831-0.889) for FSI, and 0.668 (0.629-0.707) for self-reported health. The cut-off for identifying frail individuals was ≥ 7 points in the KCL and ≥ 2 points in the FSI. CONCLUSIONS: Our results indicated that the two instruments (KCL and FSI) had sufficient diagnostic accuracy for frailty based on the phenotype model for older Japanese adults. This may be useful for the early detection of frailty in high-risk older adults.

Muscle quality indices separately associate with joint-level power-related measures of the knee extensors in older males.

PURPOSE: The purpose of this study was to investigate associations of muscle quality indices with joint-level power-related measures in the knee extensors of thirty-two older males (65-88 years). METHODS: Muscle quality indices included: echo intensity, ratio of intracellular- to total water content (ICW/TW), and specific muscle strength. Echo intensity was acquired from the rectus femoris (EIRF) and vastus lateralis (EIVL) by ultrasonography. ICW/TW was computed from electrical resistance of the right thigh obtained by bioelectrical impedance spectroscopy. Specific muscle strength was determined as the normalized maximal voluntary isometric knee extension (MVIC) torque to estimated knee extensor volume. Isotonic maximal effort knee extensions with a load set to 20% MVIC torque were performed to obtain the knee extension power-related measures (peak power, rate of power development [RPD], and rate of velocity development [RVD]). Power and RPD were normalized to MVIC. RESULTS: There were no significant correlations between muscle quality indices except between EIRF and EIVL (|r|≤ 0.253, P ≥ 0.162). EIRF was negatively correlated with normalized RPD and RVD (r ≤ - 0.361, P ≤ 0.050). ICW/TW was positively correlated with normalized peak power (r = 0.421, P = 0.020). Specific muscle strength was positively correlated with absolute peak power and RPD (r ≥ 0.452, P ≤ 0.012). CONCLUSION: Knee extension power-related measures were lower in participants with higher EI, lower ICW/TW, and lower specific muscle strength, but the muscle quality indices may be determined by independent physiological characteristics.

Influence of Mg-doping on the characteristics of ZnO photoanodes in dye-sensitized solar cells.

Dye-sensitized solar cells (DSSCs) based on ZnO photoanodes have, despite extensive research, lagged behind cells based on TiO2, which is due to generally lower open-circuit voltages VOC and fill factors. Here, DSSCs have been prepared using Mg-doped ZnO (MZO) photoanodes based on nanoparticles, thin films or ZnO-MZO core-shell-type nanoparticles with varying Mg-concentration. The cells were studied in detailed photoelectrochemical and photoluminescence experiments. It was confirmed that VOC was significantly increased by Mg-doping. A clear influence of the Mg-concentration was also revealed on the transport and recombination of electrons in MZO, leading to a higher cell performance at low and lower cell performance at high concentrations of Mg in MZO. Nanoparticles with a pure ZnO core and an MZO shell offered a way to lower the influence of increased transport resistance in MZO and to capitalize on the significantly improved VOC.

Doubly labelled water-calibration approach attenuates the underestimation of energy intake calculated from self-reported dietary assessment data in Japanese older adults.

OBJECTIVE: Self-reported energy intake (EI) estimation may incur systematic errors that could be attenuated through biomarker calibration. We aimed to confirm whether calibrated EI was comparable to total energy expenditure (TEE) measured using the doubly labelled water (DLW) technique. DESIGN: Cross-sectional study. SETTING: General older population from the Kyoto-Kameoka Study, Japan. PARTICIPANTS: This study included sub- and main cohorts of 72 and 8058 participants aged≥ 65 years, respectively. EI was evaluated using a validated FFQ, and calibrated EI was obtained using a previously developed equation based on the DLW method. TEE was considered representative of true EI and also measured using the DLW method. We used a Wilcoxon signed-rank test and correlation analysis to compare the uncalibrated and calibrated EI with TEE. RESULTS: In the sub-cohort, the median TEE, uncalibrated EI and calibrated EI were 8559 kJ, 7088 kJ and 9269 kJ, respectively. The uncalibrated EI was significantly lower than the TEE (median difference = -1847 kJ; interquartile range (IQR): -2785 to -1096), although the calibrated EI was not (median difference = 463 kJ; IQR: -330 to 1541). The uncalibrated (r = 0·275) and calibrated EI (r = 0·517) significantly correlated with TEE. The reproducibility was higher for calibrated EI (interclass correlation coefficient (ICC) = 0·982) than for uncalibrated EI (ICC = 0·637). Similar findings were observed when stratifying the sample by sex. For medians, uncalibrated EI was lower (about 17 %) than calibrated EI in the main cohort. CONCLUSIONS: Biomarker calibration may improve the accuracy of self-reported dietary intake estimation.

Factors associated with sarcopenia screened by finger-circle test among middle-aged and older adults: a population-based multisite cross-sectional survey in Japan.

BACKGROUND: Previous epidemiological studies have demonstrated the prevalence and relationship of various factors associated with sarcopenia in older adults; however, few have examined the status of sarcopenia in middle-aged adults. In this study, we aimed to, 1) evaluate the validity of the finger-circle test, which is potentially a useful screening tool for sarcopenia, and 2) determine the prevalence and factors associated with sarcopenia in middle-aged and older adults. METHODS: We conducted face-to-face surveys of 525 adults, who were aged 40-91 years and resided in Settsu City, Osaka Prefecture, Japan to evaluate the validity of finger-circle test. The finger-circle test evaluated calf circumference by referring to an illustration printed on the survey form. The area under the receiver operating characteristic curves (AUROC) was plotted to evaluate the validity of the finger-circle test for screening sarcopenia and compared to that evaluated by skeletal muscle mass index (SMI) measured using bioimpedance. We also conducted multisite population-based cross-sectional anonymous mail surveys of 9337 adults, who were aged 40-97 years and resided in Settsu and Hannan Cities, Osaka Prefecture, Japan. Participants were selected through stratified random sampling by sex and age in the elementary school zones of their respective cities. We performed multiple logistic regression analysis to explore associations between characteristics and prevalence of sarcopenia. RESULTS: Sarcopenia, defined by SMI, was moderately predicted by a finger-circle test response showing that the subject's calf was smaller than their finger-circle (AUROC: 0.729, < 65 years; 0.653, ≥65 years); such subjects were considered to have sarcopenia. In mail surveys, prevalence of sarcopenia screened by finger-circle test was higher in older subjects (approximately 16%) than in middle-aged subjects (approximately 8-9%). In a multiple regression model, the factors associated with sarcopenia were age, body mass index, smoking status, self-reported health, and number of meals in all the participants. CONCLUSIONS: Sarcopenia, screened by the finger-circle test, was present not only among older adults but also among middle-aged adults. These results may provide useful indications for developing public health programs, not only for the prevention, but especially for the management of sarcopenia. TRIAL REGISTRATION: UMIN000036880, registered prospectively May 29, 2019,  https://upload.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000042027.

Effectiveness of 10% povidone-iodine formulation on preoperative vaginal irrigation.

AIM: To investigate the effectiveness of 10% povidone-iodine formulation as a vaginal irrigation agent in patients undergoing hysterectomy to prevent postoperative infection. METHODS: The prevalence of postoperative infection in 277 and 132 patients who underwent preoperative vaginal cleaning with 500 mL of distilled water and 20 mL of 10% povidone-iodine solution, respectively, were compared in this retrospective study. RESULTS: Postoperative infection was observed in 15.6% of the overall patient population. The rate of postoperative infection was significantly higher in patients treated with 10% povidone-iodine formulation than in those treated with distilled water (21.4% vs 12.8%, P = 0.040). Besides the agents of vaginal irrigation, operation time, length of hospital stay and rate of intraoperative complications affected the prevalence of postoperative infection. The multivariate analysis ranked the use of 10% povidone-iodine formulation for vaginal irrigation as the second top factor contributing to postoperative infection (relative risk: 1.9 when compared to distilled water). CONCLUSION: Preoperative vaginal irrigation with 10% povidone-iodine formulation led to a significantly higher rate of postoperative infection than did preoperative vaginal irrigation with distilled water. For vaginal irrigation with povidone-iodine, different concentrations and cleaning methods should be considered in the future.

[Prevalence of frailty and its related factors in community-dwelling middle-aged and elderly adults in Settsu and Hannan cities in Osaka prefecture].

Objectives　The purpose of this study was to examine the prevalence of frailty and its associated factors in community-dwelling middle-aged and elderly adults in Settsu and Hannan cities, which are located in the north and south of Osaka prefecture, respectively.Methods　We conducted a mailed, self-administered, questionnaire survey of individuals aged 40 years and older in Settsu city in 2019 and Hannan city in 2020. There are 10 primary school districts in Settsu city and 8 districts in Hannan city, from each of which 1,000 people were selected according to the age and sex structures of the districts. We included 5,134 individuals from Settsu city and 3,939 individuals from Hannan city. We defined frailty using self-reported questionnaires, the Kihon Checklist (KCL), and Simple Frailty Index (SFI). Multivariate logistic regression analysis was performed for each city to examine the association of frailty with age, sex, body mass index (BMI), family structure, subjective health, economic status, subjective physical fitness, sleeping status, smoking history, alcohol use, meal frequency and awareness of the word "frailty."Results　The average age (standard deviation) of participants was 62.7 (12.5) years in Settsu city and 63.4 (12.2) years in Hannan city. The prevalence of frailty by KCL was 18.7% and 17.9% for participants in their 40s, 18.2% and 14.6% for those in their 50s, 17.0% and 15.7% for those in their 60s, 25.4% and 20.8% for those in their 70s, 39.7% and 36.1% for those 80 years and older from Settsu and Hannan cities, respectively. Using SFI, the prevalence of frailty was 16.2% and 13.5% for participants in their 40s, 15.0% and 11.9% for those in their 50s, 12.5% and 10.0% for those in their 60s, 14.6% and 12.3% for those in their 70s, and 24.7% and 22.3% for those aged 80 years and older in Settsu and Hannan cities, respectively. Significant common independent variables associated with frailty as defined using the KCL and SFI in Settsu and Hannan cities were age, subjective health, economic status, subjective physical fitness, sleeping status, and awareness of the word "frailty."Conclusion　This study found some participants to be frail as early as their 40s or 50s. Thus, efforts must be made to prevent frailty in working-age populations, including those aged 40 years and older. Six factors were associated with frailty. Longitudinal or interventional studies are required to examine their causal relationships and public health significance.

Surgery for Pancreatic Neuroendocrine Tumor G3 and Carcinoma G3 Should be Considered Separately.

BACKGROUND: The role of surgery in pancreatic neuroendocrine neoplasm grade 3 (pNEN-G3) treatment remains unclear. We aimed to clarify the role of surgery for pNEN-G3, which has recently been reclassified as pancreatic neuroendocrine tumor-G3 (pNET-G3) and pancreatic neuroendocrine carcinoma-G3 (pNEC-G3), with and without metastases, respectively. METHODS: We analyzed a subgroup of patients from the Japanese pancreatic NEC study, a Japanese multicenter case-series study of pNEN-G3. Pathologists subclassified 67 patients as having pNET-G3 or pNEC-G3 based on morphological features. We compared the overall survival (OS) rates among patients who were grouped according to whether they had undergone tumor-targeted surgery for tumors without (SwoM) or with (SwM) metastases, or non-surgical procedures (NS). RESULTS: Data from 21 patients with pNET-G3 (SwoM, n = 6; SwM, n = 5; NS, n = 10) and 46 patients with pNEC-G3 (SwoM, n = 8; SwM, n = 5; NS, n = 33) were analyzed. OS of patients with pNET-G3 was significantly longer after SwoM and SwM than with NS (p = 0.018 and p = 0.022). In contrast, OS did not significantly differ between either SwoM or SwM and NS (p = 0.093 and p = 0.489) among patients with pNEC-G3. CONCLUSION: The role of surgery should be considered separately for pNET-G3 and pNEC-G3. Although SwoM and SwM can be considered for pNET-G3, caution is advised before considering SwM and SwoM for pNEC-G3.