Publications by authors named "Naoki Akazawa"

25 Publications

  • Page 1 of 1

Ability of artificial intelligence to detect T1 esophageal squamous cell carcinoma from endoscopic videos and the effects of real-time assistance.

Sci Rep 2021 Apr 8;11(1):7759. Epub 2021 Apr 8.

Department of Gastroenterology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, 3-8-31, Ariake, Koto-ku, Tokyo, 135-8550, Japan.

Diagnosis using artificial intelligence (AI) with deep learning could be useful in endoscopic examinations. We investigated the ability of AI to detect superficial esophageal squamous cell carcinoma (ESCC) from esophagogastroduodenoscopy (EGD) videos. We retrospectively collected 8428 EGD images of esophageal cancer to develop a convolutional neural network through deep learning. We evaluated the detection accuracy of the AI diagnosing system compared with that of 18 endoscopists. We used 144 EGD videos for the two validation sets. First, we used 64 EGD observation videos of ESCCs using both white light imaging (WLI) and narrow-band imaging (NBI). We then evaluated the system using 80 EGD videos from 40 patients (20 with superficial ESCC and 20 with non-ESCC). In the first set, the AI system correctly diagnosed 100% ESCCs. In the second set, it correctly detected 85% (17/20) ESCCs. Of these, 75% (15/20) and 55% (11/22) were detected by WLI and NBI, respectively, and the positive predictive value was 36.7%. The endoscopists correctly detected 45% (25-70%) ESCCs. With AI real-time assistance, the sensitivities of the endoscopists were significantly improved without AI assistance (p < 0.05). AI can detect superficial ESCCs from EGD videos with high sensitivity and the sensitivity of the endoscopist was improved with AI real-time support.
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http://dx.doi.org/10.1038/s41598-021-87405-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8032773PMC
April 2021

Increased total body extracellular-to-intracellular water ratio in community-dwelling elderly women is associated with decreased handgrip strength and gait speed.

Nutrition 2021 Jan 29;86:111175. Epub 2021 Jan 29.

Yoshinogawa Hospital, Itano-gun, Japan.

Objective: As the extracellular-to-intracellular water (ECW/ICW) ratio of the thigh is negatively associated with knee extension strength or gait speed in the elderly, an increase in the total body ECW/ICW ratio in the elderly is considered to be related to a decrease in physical function. However, these relationships have not been properly investigated. The aim of this study was to investigate the relationship of handgrip strength and gait speed with the total body ECW/ICW ratio in community-dwelling elderly women.

Methods: The present study used a cross-sectional design. We enrolled 71 community-dwelling women, ≥65 y of age, who could independently perform activities of daily living. The total body ECW/ICW ratio was measured using bioelectrical impedance analysis. Relationships between the total body ECW/ICW ratio and grip strength and gait speed were assessed using Pearson's correlation coefficient. Additionally, stepwise multiple regression analysis was used to identify the factors that were independently associated with handgrip strength and gait speed. The independent variables considered were the total body ECW/ICW ratio, age, body mass index, number of medications, presence of pain, and a history of certain conditions.

Results: The results indicated that an increased total body ECW/ICW ratio in community-dwelling elderly women was associated with a decreased handgrip strength and gait speed. Furthermore, the total body ECW/ICW ratio was significantly, independently associated with handgrip strength even after adjusting for confounding factors.

Conclusion: These findings suggest that the total body ECW/ICW ratio may indicate health conditions in community-dwelling elderly women.
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http://dx.doi.org/10.1016/j.nut.2021.111175DOI Listing
January 2021

Changes in Quadriceps Thickness and Echo Intensity in Chronic Stroke Survivors: A 3-Year Longitudinal Study.

J Stroke Cerebrovasc Dis 2021 Mar 17;30(3):105543. Epub 2020 Dec 17.

Life and Medical Sciences Area, Health Sciences Discipline, Kobe University, Kobe, Hyogo, Japan.

Objectives: The aim of the current study was to examine longitudinal changes in quadriceps muscle mass and intramuscular adipose tissue in chronic stroke survivors.

Materials And Methods: In this longitudinal study included 34 chronic stroke survivors who lived in the community. Ultimately, 20 chronic stroke survivors received an after 3-year assessment. Fourteen chronic stroke survivors were lost at follow-up. Chronic stroke survivors who were followed and not followed during 3 years were categorized as follow-up group and lost follow-up group, respectively. The quadriceps muscle mass and intramuscular adipose tissue were assessed at baseline and after 3-year assessments based on muscle thickness and echo intensity in ultrasound images, respectively.

Results: No significant differences in any characteristics were observed between the flow-up and lost follow-up groups. In the follow-up group, there was a significant decrease in quadriceps thickness on the paretic (10.3% decrease) and non-paretic (17.0% decrease) sides at follow-up after 3 years compared with baseline. There was a significant increase in quadriceps echo intensity on the paretic (20.0% increase) and non-paretic (24.9% increase) sides at follow-up after 3 years compared with baseline. There were significant positive relationships between changes in body weight and changes in quadriceps thickness on the paretic and non-paretic sides. Chronic stroke survivors with greater reductions in body weight showed a trend towards a greater decrease in quadriceps thickness on the paretic and non-paretic sides.

Conclusions: The current results suggest marked longitudinal changes in the skeletal muscles in chronic stroke survivors. Preventing secondary changes in skeletal muscles and limiting decreases in body weight are essential for improving outcomes in chronic stroke survivors.
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http://dx.doi.org/10.1016/j.jstrokecerebrovasdis.2020.105543DOI Listing
March 2021

Relationship Between Aging and Intramuscular Adipose Tissue in Older Inpatients.

J Am Med Dir Assoc 2020 Oct 27. Epub 2020 Oct 27.

Life and Medical Sciences Area, Health Sciences Discipline, Kobe University, Kobe, Hyogo, Japan.

Objective: Although older inpatients are known to develop various conditions, whether aging affects intramuscular adipose tissue in older inpatients remains unclear. In particular, an increase in intramuscular adipose tissue in persons aged ≥85 years has previously not been revealed in either older inpatients or community-dwelling older individuals. This study therefore aimed to examine whether aging affects intramuscular adipose tissue in older inpatients.

Design: Cross-sectional study.

Setting And Participants: This study was clinical-based and included 404 inpatients aged ≥65 years.

Methods: We divided the participants into the following age groups: 65-74 years (n = 63), 75-84 years (n = 171), and ≥85 years (n = 170). B-mode ultrasound imaging was performed, and the intramuscular adipose tissue of the quadriceps was assessed based on echo intensity. One-way analysis of variance and analysis of covariance were used to compare the echo intensity of the quadriceps between the 65-74-year, 75-84-year, and ≥85-year groups.

Results: The median (25th-75th percentile) ages of the 65-74-year group, 75-84-year group, and ≥85-year group were 70.0 (68.0-73.0), 80.0 (77.0-82.0), and 89.0 (87.0-91.0), respectively. In the one-way analysis of variance, the quadriceps echo intensity of the ≥85-year group was significantly higher than that of the 65-74-year and 75-84-year groups. In addition, the ≥85-year group had significantly higher quadriceps echo intensity than the 65-74-year group, even after adjusting for other confounding factors.

Conclusions And Implications: The current study revealed that intramuscular adipose tissue in older inpatients increases with age, and the levels of intramuscular adipose tissue of older inpatients aged ≥85 years is higher than those of older inpatients aged 65-74 years.
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http://dx.doi.org/10.1016/j.jamda.2020.09.017DOI Listing
October 2020

Longitudinal Relationship Between Intramuscular Fat in the Quadriceps and Gait Independence in Convalescent Stroke Patients.

J Stroke Cerebrovasc Dis 2020 Nov 3;29(11):105287. Epub 2020 Sep 3.

Department of Physical Therapy, Faculty of Health and Welfare, Tokushima Bunri University, Tokushima, Tokushima, Japan. Electronic address:

Background And Aim: In a cross-sectional study, intramuscular fat in the quadriceps of stroke patients has been associated with gait independence. However, the longitudinal relationship between intramuscular fat and gait independence remain unclear. If these relationships are clarified, it can be demonstrated that improvement in gait independence eventually contributes to improved intramuscular fat in the quadriceps of stroke patients. The aim of this study was to investigate the longitudinal relationship between intramuscular fat in the quadriceps and gait independence in convalescent stroke patients.

Methods: Eleven stroke patients participated in this study. Gait independence was assessed using the Functional Independence Measure (FIM) gait score. The intramuscular fat in the quadriceps was assessed using ultrasound echo intensity, whereas higher echo intensity indicated greater intramuscular fat. The baseline and discharge assessment values for the echo intensity of the quadriceps were compared using a paired t-test. Correlation analysis of the FIM gait score gain and echo intensity changes in the quadriceps on the paretic and non-paretic sides was performed using Kendall's rank correlation coefficient.

Results: For quadriceps on the paretic side, echo intensity values at discharge were significantly lower than those at admission. However there was no significant difference for quadriceps on the non-paretic side (paretic side: 19.9% decrease; non-paretic side: 8.0% decrease). We observed that the change in the echo intensity of quadriceps on the non-paretic side was negatively corelated with FIM gait score gain.

Conclusions: Our results revealed a strong correlation between longitudinal change in intramuscular fat in the quadriceps and gait independence, implying that improved gait independence in convalescent stroke patients might have a positive effect on improvements in intramuscular fat.
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http://dx.doi.org/10.1016/j.jstrokecerebrovasdis.2020.105287DOI Listing
November 2020

Increased intramuscular adipose tissue of the quadriceps is more strongly related to declines in ADL than is loss of muscle mass in older inpatients.

Clin Nutr 2021 Mar 3;40(3):1381-1387. Epub 2020 Sep 3.

Life and Medical Sciences Area, Health Sciences Discipline, Kobe University, Kobe, Hyogo, Japan.

Background & Aims: Recent studies have shown that increased intramuscular adipose tissue of the quadriceps in older people is more strongly related to decreased muscle strength, sit-up and sit-down ability, and gait ability than is loss of muscle mass. However, whether increased intramuscular adipose tissue of the quadriceps is more strongly related to declines in activities of daily living (ADL) than is loss of muscle mass in older inpatients remains unclear. This study was performed to examine the relationships of intramuscular adipose tissue and muscle mass of the quadriceps with ADL in older inpatients.

Methods: This cross-sectional study included 371 inpatients aged ≥65 years. The primary outcomes were ADL and intramuscular adipose tissue of the quadriceps. ADL were assessed using the motor-Functional Independence Measure (FIM). Ultrasound images were acquired using B-mode ultrasound imaging. Intramuscular adipose tissue and muscle mass of the quadriceps were assessed based on echo intensity and muscle thickness, respectively. A stepwise multiple regression analysis was performed to identify factors independently associated with the motor-FIM score. The independent variables were the echo intensity and muscle thickness of the quadriceps, age, sex, length of hospital stay, Food Intake Level Scale (FILS), Geriatric Nutritional Risk Index (GNRI) score, C-reactive protein (CRP) concentration, updated Charlson comorbidity index (UCCI), number of medications, and subcutaneous fat thickness of the thigh.

Results: Quadriceps echo intensity (β = - 0.17), FILS (β = 0.38), GNRI score (β = 0.24), UCCI (β = - 0.16), subcutaneous fat thickness of the thigh (β = - 0.11), and length of hospital stay (β = 0.09) were independently and significantly associated with the motor-FIM score. Quadriceps thickness (β = 0.10), age (β = - 0.07), sex (β = - 0.04), CRP concentration (β = - 0.04), and number of medications (β = 0.03) were not associated with the motor-FIM score.

Conclusions: Increased intramuscular adipose tissue of the quadriceps is more strongly related to declines in ADL than is loss of muscle mass. Randomized controlled trials are needed to determine whether decreasing intramuscular adipose tissue of the quadriceps in older inpatients leads to improvement of ADL.
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http://dx.doi.org/10.1016/j.clnu.2020.08.029DOI Listing
March 2021

Using GLIM criteria, cutoff value for low BMI in Asian populations discriminates high or low muscle mass: A cross-sectional study.

Nutrition 2021 01 3;81:110928. Epub 2020 Jul 3.

Life and Medical Sciences Area, Health Sciences Discipline, Kobe University, Kobe, Hyogo, Japan.

Objectives: The aim of this study was to examine whether differences in muscle mass and intramuscular adipose tissue are present between patients with a moderately and severely low body mass index (BMI) as discriminated by the cutoff value for a low BMI among patients ≥70 y of age in Asian populations according to the Global Leadership Initiative on Malnutrition (GLIM) criteria.

Methods: This cross-sectional study included 345 inpatients ≥70 y of age. The participants were placed into one of the following three groups: severely low BMI (<17.8 kg/m; n = 96), moderately low BMI (≥17.8 to <20 kg/m; n = 81), and normal BMI (≥20 kg/m; n = 168). Ultrasound images were obtained with B-mode ultrasound imaging. Muscle mass and intramuscular adipose tissue of the quadriceps were assessed based on the muscle thickness and echo intensity, respectively. Analysis of covariance was used to examine the differences in the quadriceps thickness and echo intensity among the three groups.

Results: The quadriceps thickness and echo intensity in the severely low, moderately low, and normal BMI groups were 0.9 ± 0.3, 1.1 ± 0.4, and 1.4 ± 0.5 cm and 93.3 ± 20.8, 91.3 ± 19.3, 80.1 ± 21.6, respectively. The quadriceps thickness in the severely low BMI group was statistically significantly lower than that in the moderately low BMI (P < 0.001) and normal BMI (P < 0.001) groups, and the quadriceps thickness in the moderately low BMI group was also statistically significantly lower than that in the normal BMI group (P < 0.001). The quadriceps echo intensity showed no significant differences among the three groups.

Conclusions: The cutoff value for a low BMI discriminates high or low muscle mass. Results of this study supported the validity of 17.8 kg/m as the cutoff value for a low BMI with which to grade the severity of malnutrition in Asian populations ≥70 y of age according to the GLIM criteria from the perspective of muscle mass.
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http://dx.doi.org/10.1016/j.nut.2020.110928DOI Listing
January 2021

Action observation treatment improves gait ability in subacute to convalescent stroke patients.

J Clin Neurosci 2020 May 28;75:55-61. Epub 2020 Mar 28.

Yoshinogawa Hospital, Itano-gun, Japan.

The aim of this study was to investigate the effects of action observation treatment (AOT) on gait ability in patients with subacute to convalescent stroke. Sixteen patients with subacute stroke were divided into a control group (n = 8) and AOT group (n = 8) when admitted to the convalescent ward. The control group received a conventional rehabilitation only. In addition to conventional rehabilitation, the AOT received AOT for 3 months (30 min per day 5 times per week). The AOT involved observing the action of another subject in a comfortable gait situation from the front, sides, and back via video and conducting the actual action. All participants were assessed during the main-assessment period, which included a baseline (i.e., when admitted to the convalescent ward) and 1, 2, and 3 months after baseline. The sub-assessment period at 2 and 3 months after baseline was conducted with participants who could walk independently. The main outcomes of the main-assessment and sub-assessment periods were Functional Ambulation Classification (FAC) and the 10-m walk test (10MWT), respectively. With respect to the FAC, we used a split plot design analysis of covariance to test the interaction between assessment time and group. There was no significant interaction between assessment time and group in FAC. However, a significant improvement of the 10MWT in the sub-assessment period was observed in the AOT group, but not the control group. Our results indicate that AOT may be an effective therapy for patients with subacute to convalescent stroke who can walk independently.
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http://dx.doi.org/10.1016/j.jocn.2020.03.031DOI Listing
May 2020

Quantitative features of intramuscular adipose tissue of the quadriceps and their association with gait independence in older inpatients: A cross-sectional study.

Nutrition 2020 03 21;71:110600. Epub 2019 Oct 21.

Life and Medical Sciences Area, Health Sciences Discipline, Kobe University, Kobe, Hyogo, Japan.

Objective: The aim of this study was to examine the quantitative features of intramuscular adipose tissue of the quadriceps and their association with gait independence in older inpatients.

Methods: This was a cross-sectional study with 216 inpatients ≥65 y of age. We also recruited 40 community-dwelling healthy individuals in the same age group who were able to walk independently for matched-pair analysis to determine the quantitative features of intramuscular adipose tissue in older inpatients. Participants were assigned to total assistance (Functional Independence Measure [FIM] gait score 1 or 2), partial assistance (FIM gait score 3-5), and independent (FIM gait score 6 or 7) groups. Ultrasound images were acquired using B-mode ultrasound imaging. Intramuscular adipose tissue and muscle mass of the quadriceps were assessed based on echo intensity and muscle thickness, respectively.

Results: Echo intensity of the quadriceps of older inpatients was increased to ~1.66 times that of matched healthy older people. Echo intensity of the independent group was significantly lower than that of the total and partial assistance groups. No differences were found in quadricep thickness among the three groups.

Conclusions: The results from the present study suggested that intramuscular adipose tissue of the quadriceps of older inpatients was increased to ~1.7 times that of healthy older individuals matched for demographic characteristics. More intramuscular adipose tissue of the quadriceps was observed among older inpatients who were unable to walk independently compared with older inpatients who were able to walk independently.
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http://dx.doi.org/10.1016/j.nut.2019.110600DOI Listing
March 2020

Higher malnutrition risk is related to increased intramuscular adipose tissue of the quadriceps in older inpatients: A cross-sectional study.

Clin Nutr 2020 Aug 22;39(8):2586-2592. Epub 2019 Nov 22.

Life and Medical Sciences Area, Health Sciences Discipline, Kobe University, Kobe, Hyogo, Japan.

Background & Aims: The relationship between malnutrition risk and intramuscular adipose tissue of the quadriceps in older inpatients remains unclear, although a high rate of malnutrition risk has been observed in these patients. Understanding this relationship would be necessary for a management plans for older inpatients. This study aimed to examine the relationship between malnutrition risk and intramuscular adipose tissue of the quadriceps in older inpatients.

Methods: Three-hundred and twenty-three older inpatients participated in this cross-sectional study. Malnutrition risk was assessed using the Geriatric Nutritional Risk Index (GNRI). Intramuscular adipose tissue of the quadriceps was assessed based on ultrasound echo intensity. Higher echo-intensity indicates greater amounts of intramuscular adipose tissue. Multiple regression analysis was used to identify the factors that were independently associated with quadriceps echo intensity. GNRI, age, sex (male = 1, female = 2), number of medications, C-reactive protein, updated Charlson comorbidity index, Food Intake Level Scale, the subcutaneous fat thickness of the thigh, motor-Functional Independence Measures, and length of hospital stay were set as the independent variables.

Results: GNRI (β = -0.18), age (β = 0.18), sex (β = 0.22), number of medications (β = 0.09), the subcutaneous fat thickness of the thigh (β = -0.29), motor-FIM (β = -0.12), and length of hospital stay (β = 0.11) were significantly and independently associated with the quadriceps echo intensity.

Conclusions: The current results revealed that higher malnutrition risk was associated with increased intramuscular adipose tissue of the quadriceps of older inpatients even after adjusting for other characteristics. Nutritional intervention may be necessary for decreasing intramuscular adipose tissue of the quadriceps in older inpatients who have higher malnutrition risk.
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http://dx.doi.org/10.1016/j.clnu.2019.11.028DOI Listing
August 2020

Dysphagia is more strongly associated with increased intramuscular adipose tissue of the quadriceps than with loss of muscle mass in older inpatients.

Nutr Res 2019 05 1;65:71-78. Epub 2019 Mar 1.

Life and Medical Sciences Area, Health Sciences Discipline, Kobe University, Tomogaoka 7-10-2, Suma-ku, Kobe 654-0142, Japan.

The purpose of this study was to examine the relationship between intramuscular adipose tissue of the quadriceps and dysphagia in older inpatients. We hypothesized that increased intramuscular adipose tissue of the thigh may indirectly reflect severe dysphagia in older inpatients. This study was cross-sectional, and 103 older inpatients participated. Patients who had stroke that was the obvious cause of dysphagia were excluded. Primary outcomes were intramuscular adipose tissue of the quadriceps and severity of dysphagia. Transverse ultrasound images were acquired using B-mode ultrasound imaging. Intramuscular adipose tissue and muscle mass of the quadriceps were assessed based on echo intensity and muscle thickness, respectively. Severity of dysphagia was assessed using the Food Intake Level Scale (FILS). We used multiple regression analysis to identify the factors that were independently associated with FILS scores. Echo intensity, age, sex, body mass index, number of medications, C-reactive protein, Geriatric Nutritional Risk Index (GNRI), updated Charlson Comorbidity Index, muscle thickness, subcutaneous fat thickness of the thigh, and length of hospital stay were the independent variables. Echo intensity (β = -0.28), number of medications (β = 0.22), GNRI (β = 0.27), and subcutaneous fat thickness of the thigh (β = -0.29) were significantly independently associated with FILS scores. Muscle thickness was not significantly independently related to FILS scores (β = 0.08). In conclusion, our results suggest that increased intramuscular adipose tissue of the quadriceps in older inpatients is associated with dysphagia. Furthermore, this relationship was stronger than that between loss of muscle mass and dysphagia.
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http://dx.doi.org/10.1016/j.nutres.2019.02.006DOI Listing
May 2019

Low body mass index negatively affects muscle mass and intramuscular fat of chronic stroke survivors.

PLoS One 2019 18;14(1):e0211145. Epub 2019 Jan 18.

Life and Medical Sciences Area, Health Sciences Discipline, Kobe University, Kobe, Hyogo, Japan.

Objective: Relationship between secondary changes in skeletal muscle and body weight in chronic stroke survivors has not yet been carefully examined. The objective of this study was to clarify the relationships between muscle mass, intramuscular fat, and body weight in chronic stroke survivors.

Methods: Seventy-two chronic stroke survivors participated in this study. Transverse ultrasound images were acquired using B-mode ultrasound imaging. Quadriceps muscle mass and intramuscular fat were assessed based on muscle thickness and echo intensity, respectively. We used a stepwise multiple regression analysis to identify the factors that were independently associated with the body mass index. We entered quadriceps thickness and echo intensity of the paretic and non-paretic sides into another stepwise multiple regression model to avoid multicollinearity. Age, sex, type of stroke, time since stroke, thigh length, number of medications, and an updated Charlson comorbidity index were included as the independent variables.

Results: The quadriceps thickness and echo intensity of the paretic and non-paretic sides were significantly independently associated with the body mass index: quadriceps thickness of the paretic side, β = 0.52; quadriceps thickness of the non-paretic side, β = 0.55; quadriceps echo intensity of the paretic side, β = -0.35; quadriceps echo intensity of the non-paretic side, β = -0.27).

Conclusions: Our results suggest that low body mass index is associated with loss of muscle mass and increased intramuscular fat on both the paretic and non-paretic sides of chronic stroke survivors. Further studies examining whether appropriate weight management, along with targeted rehabilitation programs aimed at increasing muscle mass and decreasing intramuscular fat, achieves good outcomes in chronic stroke survivors are warranted.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0211145PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6338377PMC
October 2019

Activation of mirror neuron system during gait observation in sub-acute stroke patients and healthy persons.

J Clin Neurosci 2019 Feb 11;60:79-83. Epub 2018 Oct 11.

Tokushima University Hospital, Tokushima, Japan.

The observation of walking improves gait ability in chronic stroke survivors. It has also been suggested that activation of the mirror neuron system contributes to this effect. However, activation of the mirror neuron system during gait observation has not yet been assessed in sub-acute stroke patients. The objective of this study was to clarify the activation of mirror neuron system during gait observation in sub-acute stroke patients and healthy persons. In this study, we sequentially enrolled five sub-acute stroke patients who had undergone gait training and nine healthy persons. We used fMRI to detect neuronal activation during gait observation. During the observation period in the stroke group, neural activity in the left inferior parietal lobule, right and left inferior frontal gyrus was significantly higher than during the rest period. In the healthy group, neural activity in the left inferior parietal lobule, left inferior frontal gyrus, left middle frontal gyrus, left superior temporal lobule and right and left middle temporal gyrus was significantly higher than during the rest period. The results indicate that the mirror neuron system was activated during gait observation in sub-acute stroke patients who had undergone gait training and also in healthy persons. Our findings suggest that gait observation treatment may provide a promising therapeutic strategy in sub-acute stroke patients who have experienced gait training.
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http://dx.doi.org/10.1016/j.jocn.2018.09.035DOI Listing
February 2019

Muscle mass and intramuscular fat of the quadriceps are related to muscle strength in non-ambulatory chronic stroke survivors: A cross-sectional study.

PLoS One 2018 2;13(8):e0201789. Epub 2018 Aug 2.

Life and Medical Sciences Area, Health Sciences Discipline, Kobe University, Kobe, Hyogo, Japan.

Objective: Improving muscle mass and intramuscular fat in the mid-thigh increases the muscle strength of the paretic and non-paretic limbs in ambulatory chronic stroke survivors. There is a remarkable decrease in muscle mass and muscle strength and an increase in intramuscular fat in the quadriceps of both limbs of non-ambulatory compared with ambulatory survivors. Therefore, given that paretic lower extremity function does not recover sufficiently in the chronic phase, it may be helpful to improve muscle mass and intramuscular fat to increase muscle strength in the quadriceps of non-ambulatory chronic stroke survivors. However, these relationships remain unclear. The purpose of this study was to clarify the relationships between muscle strength, muscle mass, and intramuscular fat of the quadriceps in non-ambulatory chronic stroke survivors.

Methods: Study design: A cross-sectional study. Participants: Fifty non-ambulatory chronic stroke survivors. Main outcome measures: Quadriceps muscle strength was measured using a handheld dynamometer. Transverse ultrasound images were acquired using B-mode ultrasound imaging. Muscle mass and intramuscular fat of the quadriceps were assessed based on muscle thickness and echo intensity, respectively. Data analysis: Stepwise multiple regression analyses were used to identify the factors independently associated with the quadriceps muscle strength of the paretic and non-paretic limbs. To avoid multicollinearity, muscle thickness and echo intensity were entered into separate multiple regression models. Muscle thickness or echo intensity of the paretic or non-paretic limbs and other confounding factors were set as the independent variables.

Results: Muscle thickness was positively related and echo intensity was negatively related to the quadriceps muscle strength of the paretic and non-paretic limbs.

Conclusions: Muscle mass and intramuscular fat of the quadriceps are related to muscle strength in non-ambulatory chronic stroke survivors. Increasing muscle mass and decreasing intramuscular fat of the quadriceps of both limbs may improve muscle strength.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0201789PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6072321PMC
January 2019

Relationships between muscle mass, intramuscular adipose and fibrous tissues of the quadriceps, and gait independence in chronic stroke survivors: a cross-sectional study.

Physiotherapy 2018 12 1;104(4):438-445. Epub 2017 Dec 1.

Life and Medical Sciences Area, Health Sciences Discipline, Kobe University, Kobe, Hyogo, Japan.

Objective: To examine the relationships between muscle mass, intramuscular adipose and fibrous tissues of the quadriceps, and gait independence in chronic stroke survivors.

Design: Cross-sectional study.

Setting: Hospital-based research.

Participants: Seventeen chronic stroke survivors who were unable to walk independently (non-independent walker group) and 11 chronic stroke survivors who were able to walk independently (independent walker group) participated in this study. In addition, 25 healthy older adults (healthy group) were enrolled.

Interventions: None.

Main Outcome Measures: The muscle mass and intramuscular adipose and fibrous tissues of the rectus femoris and vastus intermedius were assessed based on muscle thickness and echo intensity of ultrasound images, respectively.

Results: The thicknesses of the rectus femoris and vastus intermedius on the paretic and non-paretic sides in the non-independent walker group were significantly lower than those in the healthy group (mean difference -0.5 to -0.2cm; P<0.001-0.037). The paretic side in the non-independent walker group had significantly higher rectus femoris and vastus intermedius echo intensity compared with the healthy group (mean difference 15.8-17.4; P=0.007-0.025). The thickness of the rectus femoris on the non-paretic side was significantly lower in the independent walker group than in the healthy group (mean difference -0.3cm; P=0.001).

Conclusions: These results suggest that chronic stroke survivors who are unable to walk independently are likely to experience secondary changes in skeletal muscle on both the paretic and non-paretic sides.
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http://dx.doi.org/10.1016/j.physio.2017.08.009DOI Listing
December 2018

Usefulness of a novel higher brain dysfunction screening test for evaluating higher brain function in healthy persons.

J Med Invest 2017 ;64(3.4):280-285

Department of Neurosurgery, Institute of Biomedical Sciences, Tokushima University, Graduate School.

To accurately and rapidly screen for higher brain dysfunction, we developed a screening test named the "higher brain dysfunction screening test" (HIBRID-ST). Previous studies have reported a decrease in higher brain function with age. However, whether HIBRID-ST can detect a decrease in higher brain function in healthy persons remains unclear. We aimed to assess the usefulness of HIBRID-ST for evaluating higher brain function in healthy persons. We recruited 60 persons without physiological abnormalities and divided them into six equal groups based on their age (20s-70s). HIBRID-ST addresses orientation, short-term memory, word recall, situational awareness, visual short-term memory, and graphic replication and includes the Trail Making and Kana-hiroi tests. There was a significant negative correlation between the participants' age and their total HIBRID-ST score (ρ = -0.68, p < 0.01). The total HIBRID-ST score of participants in their 70s was significantly lower than that of participants in their 20s-60s; the total HIBRID-ST score of participants in their 60s was significantly lower than that of participants in their 20s-50s. Our findings show that HIBRID-ST accurately detects an age-related decline in higher brain function. Further studies are needed to examine the usefulness of HIBRID-ST in patients with higher brain dysfunction. J. Med. Invest. 64: 280-285, August, 2017.
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http://dx.doi.org/10.2152/jmi.64.280DOI Listing
June 2018

Determining the cut-off value for knee extensor strength for identifying independence in gait in chronic stroke survivors.

J Rehabil Med 2017 Nov;49(9):765-767

Department of Physical Therapy, Faculty of Health and Welfare, , Tokushima Bunri University, 770-8514 Tokushima, Japan.

Objective: To determine the cut-off values for knee extensor strength on the paretic and non-paretic sides and both sides combined for identifying independence in gait in chronic stroke survivors.

Design: Cross-sectional study.

Patients: Sixty chronic stroke survivors.

Methods: Functional Independence Measure (FIM) gait scores were measured, and the participants were allocated to the independent group (FIM gait score 6 or 7) or the dependent group (FIM gait score 1-5). Knee extensor strength on the paretic and non-paretic sides was measured using a handheld dynamometer.

Results: Eighteen stroke survivors were allocated to the independent group and 42 to the dependent group. The receiver operating characteristic curve analyses revealed that the cut-off values for knee extensor strength were 0.46 Nm/kg (sensitivity 83% and specificity 67%; area under the curve (AUC) 0.816) on the paretic side, 0.65 Nm/kg (sensitivity 89% and specificity 55%; AUC 0.738) on the non-paretic side and 1.31 Nm/kg (sensitivity 83% and specificity 74%; AUC 0.811) for both sides combined.

Conclusion: These cut-off values could help to identify stroke survivors who are no longer independent in gait because of decreasing knee extensor strength on the paretic and non-paretic sides.
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http://dx.doi.org/10.2340/16501977-2279DOI Listing
November 2017

Relationships between intramuscular fat, muscle strength and gait independence in older women: A cross-sectional study.

Geriatr Gerontol Int 2017 Oct 10;17(10):1683-1688. Epub 2016 Aug 10.

Department of Rehabilitation Science, Graduate School of Health Sciences, Kobe University, Kobe, Japan.

Aim: The objectives of the present study were to examine the relationships between intramuscular fat, muscle strength and gait independence, as well as to clarify the intramuscular fat characteristics of dependent older women.

Methods: A total of 25 older women who were unable to walk with or without assistance (dependent group), 22 frail older women (frail group) and 22 healthy older women (healthy group) participated in the present study. The frail participants could walk independently, but showed three or more of the following characteristics: slowness, weakness, weight loss, exhaustion and low physical activity. Outcome measures were quadriceps intramuscular fat determined by ultrasound echo intensity, and quadriceps muscle strength of the dependent, frail and healthy groups. In addition, the degree of gait independence (functional independence measures gait score) was assessed in the dependent and frail groups.

Results: Echo intensity in the dependent group was significantly negatively correlated with muscle strength and the functional independence measure gait score (correlation coefficients -0.635 and -0.344, respectively). Furthermore, echo intensity in the dependent group was significantly higher than in the healthy group. There was no significant difference in echo intensity between the dependent and frail groups.

Conclusions: The present results suggest negative relationships between intramuscular fat and muscle strength, and intramuscular fat and degree of gait independence in dependent older women. In addition, dependent older women have more intramuscular fat than healthy older women. Geriatr Gerontol Int 2017; 17: 1683-1688.
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http://dx.doi.org/10.1111/ggi.12869DOI Listing
October 2017

A case of intraductal papillary mucinous neoplasm with high serum pepsinogen II level.

Nihon Shokakibyo Gakkai Zasshi 2016 08;113(8):1416-24

Department of Gastroenterology and Hepatology, Kohnodai Hospital, National Center for Global Health and Medicine.

We report the case of a 65-year-old woman who had a high level of serum pepsinogen II. Several months earlier, she had found a mass on the right side of her upper abdomen. Esophagogastroduodenoscopy did not reveal atrophic or inflammatory findings. She had not taken proton pump inhibitors, and there was no indication of renal dysfunction. Imaging tests showed a mass of approximately 80mm in the pancreatic head. We performed pancreatoduodenectomy, and the histopathological examination revealed an intraductal papillary mucinous neoplasm (IPMN) of gastric type. Serum pepsinogen II levels substantially lowered after surgery. To the best of our knowledge, this is the first report on a relationship between IPMN and serum pepsinogen II.
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http://dx.doi.org/10.11405/nisshoshi.113.1416DOI Listing
August 2016

Effects of long-term self-massage at the musculotendinous junction on hamstring extensibility, stiffness, stretch tolerance, and structural indices: A randomized controlled trial.

Phys Ther Sport 2016 Sep 28;21:38-45. Epub 2016 Jan 28.

Department of Rehabilitation Science, Graduate School of Health Sciences, Kobe University, Tomogaoka 7-10-2, Suma-ku, Kobe 654-0142, Japan. Electronic address:

Objectives: The purpose of this study was to examine the effect of long-term self-massage at the musculotendinous junction on hamstring extensibility, stiffness, stretch tolerance, and structural indices.

Design: Single-blind, randomized, controlled trial.

Setting: Laboratory.

Participants: Thirty-seven healthy men.

Intervention: The right or left leg of each participant was randomly assigned to the massage group, and the other leg was assigned to the control group. The participants conducted self-massage at the musculotendinous junction for 3 min daily, five times per week, for 12 weeks.

Main Outcome Measures: Hamstring extensibility, stiffness, stretch tolerance, and structural indices were measured by a blinded examiner prior to the massage intervention and after 6 and 12 weeks of intervention.

Results: The maximum hip flexion angle (HFA) and the maximum passive pressure after 6 and 12 weeks of intervention in the massage group were significantly higher than prior to intervention. The visual analog scale (for pain perception) at maximum HFA, the stiffness of the hamstring, and the structural indices did not differ in either group over the 12 week period.

Conclusions: Our results suggest that long-term self-massage at the musculotendinous junction increases hamstring extensibility by improving stretch tolerance. However, this intervention does not change hamstring stiffness.

Clinical Trial Registration Number: University Hospital Medical Information Network registration number UMIN000011233.
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http://dx.doi.org/10.1016/j.ptsp.2016.01.003DOI Listing
September 2016

Marked decrease in serum pepsinogen II levels resulting from endoscopic resection of a large duodenal tumor.

Clin J Gastroenterol 2014 Dec 7;7(6):484-9. Epub 2014 Nov 7.

Department of Gastroenterology, Kohnodai Hospital, National Center for Global Health and Medicine, 1-7-1 Kohnodai, Ichikawa, Chiba, 272-8516, Japan,

Studies have indicated that serum pepsinogen (PG) levels are not only markers for chronic atrophic gastritis but also predictive risk factors for gastric cancer. However, serum PG levels can change because of pathological conditions other than gastritis. We report the first case in which abnormally high serum PG II levels (168.8 ng/mL) led to the discovery of a large tumor covering a wide area in the duodenum, and after resection of the tumor, the serum PG II levels markedly decreased. Because endoscopic and histopathological examinations showed no indications of atrophic changes, inflammation of the gastric mucosa, or Helicobacter pylori infection, the serum PG II levels eventually returned to normal (10.1 ng/mL). The preoperative abnormally high PG II levels were probably caused by the large duodenal tumor that prevented PG II (which is produced by the duodenal Brunner's glands) from being secreted into the lumen, a condition that increased the amount transferred to the bloodstream. No previous reports have investigated serum PG II levels before and after resection of a large duodenal tumor. We believe this case provides valuable insight regarding the dynamics of PG II in the body and has important diagnostic implications.
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http://dx.doi.org/10.1007/s12328-014-0534-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4261135PMC
December 2014

Accuracy of endoscopic diagnosis of Helicobacter pylori infection according to level of endoscopic experience and the effect of training.

BMC Gastroenterol 2013 Aug 15;13:128. Epub 2013 Aug 15.

Department of Gastroenterology and Hepatology, National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku-ku, Tokyo 162-8655, Japan.

Background: Accurate prediction of Helicobacter pylori infection status on endoscopic images can contribute to early detection of gastric cancer, especially in Asia. We identified the diagnostic yield of endoscopy for H. pylori infection at various endoscopist career levels and the effect of two years of training on diagnostic yield.

Methods: A total of 77 consecutive patients who underwent endoscopy were analyzed. H. pylori infection status was determined by histology, serology, and the urea breast test and categorized as H. pylori-uninfected, -infected, or -eradicated. Distinctive endoscopic findings were judged by six physicians at different career levels: beginner (<500 endoscopies), intermediate (1500-5000), and advanced (>5000). Diagnostic yield and inter- and intra-observer agreement on H. pylori infection status were evaluated. Values were compared between the two beginners after two years of training. The kappa (K) statistic was used to calculate agreement.

Results: For all physicians, the diagnostic yield was 88.9% for H. pylori-uninfected, 62.1% for H. pylori-infected, and 55.8% for H. pylori-eradicated. Intra-observer agreement for H. pylori infection status was good (K > 0.6) for all physicians, while inter-observer agreement was lower (K = 0.46) for beginners than for intermediate and advanced (K > 0.6). For all physicians, good inter-observer agreement in endoscopic findings was seen for atrophic change (K = 0.69), regular arrangement of collecting venules (K = 0.63), and hemorrhage (K = 0.62). For beginners, the diagnostic yield of H. pylori-infected/eradicated status and inter-observer agreement of endoscopic findings were improved after two years of training.

Conclusions: The diagnostic yield of endoscopic diagnosis was high for H. pylori-uninfected cases, but was low for H. pylori-eradicated cases. In beginners, daily training on endoscopic findings improved the low diagnostic yield.
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http://dx.doi.org/10.1186/1471-230X-13-128DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3765341PMC
August 2013

Erythropoietic protoporphyria.

Clin Gastroenterol Hepatol 2010 Aug 11;8(8):e82. Epub 2010 Mar 11.

Department of Gastroenterology, International Medical Center of Japan, Tokyo, Japan.

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http://dx.doi.org/10.1016/j.cgh.2010.02.019DOI Listing
August 2010

[The usefulness and limitations of the new Japanese criteria for severity assessment in acute pancreatitis].

Nihon Shokakibyo Gakkai Zasshi 2010 Jan;107(1):48-60

Department of Gastroenterology, Toyama Hospital, International Medical Center of Japan.

New Japanese criteria for severity assessment in acute pancreatitis were introduced in October 2008. The new criteria are simpler than the previous ones, and are also expected to be more useful for the severity assessment. We retrospectively analyzed the clinical factors in our patients to predict prognosis, and evaluated the usefulness and limitations of the new criteria. There were few missing data in the new criteria compared with the previous criteria. The areas under the receiver operating characteristic (ROC) curves for mortality prediction were 0.870 for the new criteria and 0.884 for the previous criteria. However, there were more patients whose disease severity on admission were underestimated using the new criteria and who finally progressed to worse stages including death. This evidence strongly suggests the lower sensitivity of the new criteria in mortality prediction. Repeated assessment of severity after admission will be indispensable in the proper treatment of patients with acute pancreatitis.
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January 2010

[A case of HIV coinfected with hepatitis B virus treated by entecavir].

Nihon Shokakibyo Gakkai Zasshi 2009 Dec;106(12):1758-63

Division of Gastroenterology, Toyama Hospital, International Medical Center of Japan, Japan.

A 45-year-old male active homosexual was given a diagnosis of HIV-1 and acute hepatitis B in August 2007. Since his liver function became rapidly impaired, anti-HBV therapy with oral administration of entecavir (ETV) was started, and resulted in a favorable outcome. However, serum concentration of HIV-RNA decreased by log 1.26 within 60 days, which strongly suggested the inhibition of HIV proliferation by ETV. To prevent the appearance of mutated HIV, novel therapeutic strategies should be established in HIV/HBV-coinfected patients.
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December 2009