研究者詳細 - 辻　哲也

論文 - 辻　哲也

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Factors associated with ADL-defined disability-free survival among patients with advanced cancer in a palliative care setting: a retrospective cohort study

Soeda, R; Kawakami, M; Nagashima, K; Harada, T; Yamaguchi, T; Furukawa, Y; Tsuji, T

BMC PALLIATIVE CARE 24 （ 1 ） 206 - 206 2025年07月

ISSN 1472-684X

OBJECTIVES: Disability-free survival (DFS) focusing on essential activities of daily living (ADL) is a critical outcome for patients with advanced cancer receiving palliative care, yet remains underexplored. This study aimed to examine DFS for core ADL components (eating, toileting, and walking) in patients admitted to the palliative care unit (PCU) and to identify associated factors using a competing risk model. Understanding these factors may guide targeted interventions to preserve functional independence and enhance quality of life. METHODS: This retrospective cohort study included advanced cancer patients admitted to the PCU between August 2018 and September 2022, excluding those discharged home. The primary endpoint was DFS, defined as the period from admission to an event resulting in a Functional Independence Measure (FIM™) score below 6 in eating, toileting, or walking. FIM™ is a widely used tool for assessing functional independence across multiple domains. DFS was estimated using a competing risk model to account for death as a competing event, and Fine–Gray regression analysis was conducted to identify factors associated with DFS. RESULTS: A total of 143, 48, and 46 patients were analyzed for eating, toileting, and walking, respectively. The median DFS (95% confidence interval) was 4 (3–5) weeks for eating, 3.5 (3–6) weeks for toileting, and 3 (2–6) weeks for walking. Cognitive function (FIM™ cognitive items) and the cachexia (modified Glasgow Prognostic Score) at admission were commonly associated with DFS. Neutrophil-to-lymphocyte ratio was specifically associated with DFS for eating, and bone and liver metastases were associated with DFS for toileting and walking. CONCLUSIONS: Monitoring ADL-defined DFS and key factors such as cognitive function and inflammation-nutritional status may enable timely interventions, optimize care strategies, and support quality of life for patients with advanced cancer in palliative care settings. Future studies could explore prospective validation of these findings and investigate whether early interventions targeting these factors can extend disability-free survival. In addition, integrating rehabilitation strategies and routine cognitive assessments may further enhance the benefits of individualized care in this population. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12904-025-01847-7.

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Factors responsible for the decline in physical fitness during neoadjuvant chemotherapy in older patients with esophageal cancer: an exploratory prospective cohort study

Harada, T; Tsuji, T; Ueno, J; Konishi, N; Yanagisawa, T; Hijikata, N; Ishikawa, A; Hashimoto, K; Kagaya, H; Tatematsu, N; Zenda, S; Kotani, D; Kojima, T; Fujita, T

SUPPORTIVE CARE IN CANCER （Springer Science and Business Media LLC） 33 （ 5 ） 428 2025年04月

ISSN 0941-4355

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Combining therapeutic strategies with rehabilitation improves motor recovery in animal models of spinal cord injury: A systematic review and meta-analysis

Zhang, L; Yamada, S; Nagoshi, N; Shinozaki, M; Tsuji, T; Nakamura, M; Okano, H; Tashiro, S

ANNALS OF PHYSICAL AND REHABILITATION MEDICINE 68 （ 3 ） 101911 - 101911 2025年04月

ISSN 1877-0657

BACKGROUND: Despite the lack of clinically validated strategies for treating spinal cord injury (SCI), combining therapeutic strategies with rehabilitation is believed to promote recovery of motor function; however, current research findings are inconsistent. OBJECTIVES: To explore whether combination therapy involving therapy and rehabilitative training (CIRT) has a synergistic effect on motor function recovery in animal models of SCI. METHODS: We conducted a systematic review and meta-analysis of studies identified in a keyword search of 6 databases and extracted open-field motor scores from the Basso Mouse Scale (BMS) and the Basso, Beattie, and Bresnahan Locomotor Rating Scale (BBB) for meta-analysis using a weighted mean difference (WMD) and 95 % CI. We also performed qualitative synthesis and analysis of secondary outcome measures related to histological improvements and adverse effects. RESULTS: Eighty-seven preclinical studies were included. Combination treatment with treadmill training resulted in a significant improvement in motor function (1.40, 95 % CI 0.82 to 1.98, P < 0.01, I2 = 49 %), especially when initiated 1-2 weeks post-injury (1.77, 95 % CI 1.10 to 2.45, P < 0.01, I2 = 33 %) in rats. In mice, CIRT lasting <6 weeks may enhance recovery (0.95, 95 % CI 0.49 to 1.40, P < 0.01, I2 = 33 %). Although there is a trend toward better outcomes in the chronic phase, insufficient sample sizes prevent definitive conclusions from being drawn. Combined therapy also enhances the reorganization of inhibitory synaptic structures and functions, without aggravating allodynia or spasticity. CONCLUSIONS: This systematic review and meta-analysis suggest that CIRT can lead to superior motor function recovery compared to single-modality therapy (SMT) in animal models of SCI, with no significant adverse effects on allodynia or spasticity. However, the efficacy of CIRT depends on various factors, and further research is needed to establish optimal treatment strategies and understand the underlying mechanisms of recovery.

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Current status of prehabilitation before esophagectomy for patients with esophageal cancer among board-certified hospitals by the Japan Esophageal Society

Harada, T; Tsuji, T; Fukushima, T; Konishi, N; Nakajima, H; Suzuki, K; Ikeda, T; Toyama, S; Matsumori, K; Yanagisawa, T; Hashimoto, K; Kagaya, H; Zenda, S; Kojima, T; Fujita, T; Ueno, J; Hijikata, N; Ishikawa, A; Hayashi, R

ESOPHAGUS （Springer Science and Business Media LLC） 22 （ 3 ） 340 - 348 2025年03月

ISSN 1612-9059

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[Current Status and Future Perspectives of Cancer Rehabilitation].

Tsuji T

Gan to kagaku ryoho. Cancer & chemotherapy 52 （ 2 ） 89 - 95 2025年02月

ISSN 0385-0684

Characteristics of dysarthria in patients with spinocerebellar degeneration and multiple system atrophy: a cross-sectional and longitudinal study using the Frenchay Dysarthria Assessment Second Edition (FDA-2).

Kawabata A, Wada A, Kawakami M, Kaji K, Nakanishi K, Otsuka T, Tsuji T

Frontiers in neurology 16 1734012 - 1734012 2025年

ISSN 1664-2295

PURPOSE: The purpose of this study was to evaluate the dysarthria of patients with spinocerebellar degeneration and multiple system atrophy (SCD/MSA) cross-sectionally and longitudinally using the Frenchay Dysarthria Assessment Second Edition (FDA-2), which provides a comprehensive assessment of dysarthria, and to clarify characteristic patterns and longitudinal changes. MATERIALS AND METHODS: A total of 21 patients with SCD and MSA were included. Patients' dysarthria was assessed using the FDA-2 and the Scale for the Assessment and Rating of Ataxia (SARA) item 4(SARA speech) at intervals of ≥ 12 months. Changes over time were examined with a paired t-test and Wilcoxon's signed-rank test. Multiple regression analysis explored determinants of speech intelligibility, with FDA-2 intelligibility as the dependent variable and respiration, lips, palate, laryngeal, and tongue subscores as predictors. RESULTS: The number of patients according to disease types was SCA2 in 1, SCA3 in 8, SCA31 in 1, MSA-C in 8, and an undetermined disease type in 3. The examination interval was 31.1 ± 15.6 months. FDA-2 scores were lower for repetitive-movement or speech items than for rest items. Lips and palate subscores were relatively higher, whereas laryngeal and tongue subscores were lower. Over time, reflex, lips, laryngeal, tongue, and total scores declined significantly, whereas the palate, respiration, and intelligibility scores remained stable. Multiple regression identified the laryngeal subscores as the only significant predictor of intelligibility (Sβ = 0.77, p = 0.047). CONCLUSION: The FDA-2 revealed a distinct dysarthria profile in SCD/MSA. Longitudinal FDA-2 monitoring may facilitate early detection and targeted intervention.

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Current Status and Future Perspectives of Cancer Rehabilitation

辻哲也

Gan To Kagaku Ryoho 52 89 - 95 2025年

CiNii Research

Association of Preoperative Physical Fitness With Post-Esophagectomy Pneumonia in Older With Locally Advanced Esophageal Cancer: An Exploratory Prospective Study

Harada, T; Tsuji, T; Ueno, J; Konishi, N; Yanagisawa, T; Hijikata, N; Ishikawa, A; Hashimoto, K; Kagaya, H; Tatematsu, N; Zenda, S; Kotani, D; Kojima, T; Fujita, T

JOURNAL OF SURGICAL ONCOLOGY （Wiley） 131 （ 7 ） 1284 - 1292 2024年12月

ISSN 0022-4790

ABSTRACT

Backgrounds

Currently, there is a lack of evidence of prehabilitation during neoadjuvant chemotherapy (NAC) to prevent pneumonia of older patients. This study aimed to investigate the association of preoperative physical fitness after NAC with post‐esophagectomy pneumonia in older patients with locally advanced esophageal cancer (LAEC).

Methods

This single‐center exploratory prospective cohort study included 80 patients aged ≥ 65 years with LAEC scheduled for curative esophagectomy after NAC between 2021 and 2023. The post‐NAC short incremental shuttle walk test (ISWT) by sex was established using the Youden index. The association of the post‐NAC short ISWT with postoperative pneumonia was investigated via Firth's penalized logistic regression model with statistical significance set as two‐tailed p < 0.05.

Results

A total of 69 patients were analyzed. The mean post‐NAC ISWT values were 353.5 m. Short ISWT distance was defined as ≤ 395 and ≤ 195 m for men and women, respectively. Postoperative pneumonia developed in 17 (25%) patients. Short post‐NAC ISWT distance was significantly associated with postoperative pneumonia (adjusted odds ratio: 1.840, 95%CI: 1.760–28.440, p = 0.004).

Conclusions

Decline in physical fitness was associated with post‐esophagectomy pneumonia, which may be a key targeted factor of prehabilitation during NAC for older patients with LAEC.

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Development of a quantitative assessment for abnormal flexor synergy index in patients with stroke: a validity and responsiveness study

Ito, D; Kawakami, M; Hosoi, Y; Kamimoto, T; Yamada, Y; Takemura, R; Tsuji, T

JOURNAL OF NEUROENGINEERING AND REHABILITATION 21 （ 1 ） 229 - 229 2024年12月

BACKGROUND: Arm-lifting movements (shoulder flexion) are essential for upper extremity rehabilitation after a stroke. Abnormal flexor synergy (elbow flexion) is frequently observed during shoulder flexion, impeding functional improvement. However, no quantitative method exists for assessing abnormal flexor synergy. This study investigated the validity and responsiveness of a newly developed index to quantitatively evaluate abnormal flexor synergy. METHODS: Participants included 103 patients (mean age: 58.0 ± 10.1 years; 64 men, 39 women) with stroke. Using three-dimensional coordinate data during shoulder flexion obtained from a depth sensor camera, we calculated the abnormal flexor synergy based on our developed index. The abnormal flexor synergy index decreases with increasing flexion of the elbow joint during shoulder flexion (the maximum value is 100% without abnormal flexor synergy). The validity of the abnormal flexor synergy index was assessed by analyzing the correlation between the index and both the Fugl-Meyer Assessment of the Upper Extremity (FMA-UE) four-category scores and the Modified Ashworth Scale (MAS) scores for elbow, wrist, and finger flexors, using Pearson's and Spearman's correlation coefficients. Responsiveness was studied in 17 inpatients (mean age: 59.5 ± 8.1 years; 7 men, 10 women) who underwent proximal upper extremity intervention for approximately 3 weeks, evaluating change from admission to discharge using the standardized response mean (SRM). RESULTS: Significant correlations were observed between the abnormal flexor synergy index and FMA-UE scores: A (r = 0.625, p < 0.001), B (r = 0.433, p < 0.001), C (r = 0.418, p < 0.001), and D (r = 0.411, p < 0.001), as well as MAS scores for elbow flexors (r = -0.283, p = 0.004) and proximal interphalangeal flexors (r = -0.201, p = 0.042). The highest responsiveness was observed in the FMA-UE A score (SRM = 0.81), followed by the abnormal flexor synergy index (SRM = 0.79). CONCLUSIONS: The newly developed index for assessing abnormal flexor synergy demonstrated superior validity and high responsiveness. These results suggest the potential for using this index to evaluate upper extremity function in patients with stroke.

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Efficacy of Cognitive Stimulation Therapy for Cognition in Patients with Vascular Cognitive Impairment: A Pilot Randomized Controlled Trial.

Mori N, Otaka Y, Ito D, Shimizu A, Narita A, Honaga K, Matsuura D, Kondo K, Liu M, Tsuji T

The Keio journal of medicine 73 （ 4 ） 39 - 46 2024年12月

ISSN 0022-9717

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Cognitive effect of passively induced kinesthetic perception associated with virtual body augmentation modulates spinal reflex

Okada, K; Okawada, M; Yoneta, M; Kuwahara, W; Unai, K; Kawakami, M; Tsuji, T; Kaneko, F

JOURNAL OF NEUROPHYSIOLOGY （American Physiological Society） 133 （ 1 ） 69 - 77 2024年11月

ISSN 0022-3077

The virtual movement of an augmented body, perceived as part of oneself, forms the basis of kinesthetic perception induced by visual stimulation (KINVIS). KINVIS is a visually induced virtual kinesthetic perception that clinically suppresses spasticity. The present study hypothesized that central neural network activity during KINVIS affects subcortical neural circuits. The present study aimed to elucidate whether reciprocal and presynaptic inhibition occurs during KINVIS. Seventeen healthy participants were recruited (mean age: 27.9 ± 3.6 years), and their soleus Hoffmann-reflexes (H-reflexs) were recorded by peripheral nerve stimulation while perceiving the dorsiflexion kinesthetic illusion in the right-side foot (seated in a comfortable chair). Two control conditions were set to observe the same foot video without the kinesthetic illusion while focusing on the static foot image. Unconditioned H-reflex and two types of conditioned H-reflexes were measured: Ia (reciprocal inhibition) and D1 (presynaptic inhibition). Reciprocal Ia and D1 inhibition of the soleus muscle was significantly enhanced during the kinesthetic illusion compared to the condition without kinesthetic illusion (a post-hoc analysis using the Bonferroni test: Ia inhibition, p = 0.002; D1 inhibition, p = 0.049). This study indicates that kinesthetic illusion elicits an inhibitory effect on the monosynaptic reflex loop of Ia afferents, potentially inhibiting the hyperexcitability of the stretch reflex. These findings demonstrate that brain activity associated with visually induced kinesthetic illusions acts on spinal inhibition circuits. These insights may be valuable in clinical rehabilitation practice, specifically for the treatment of spasticity.

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Clinical mechanism of muscle mass loss during neoadjuvant chemotherapy in older patients with esophageal cancer: a prospective cohort study

Harada, T; Tsuji, T; Ueno, J; Konishi, N; Yanagisawa, T; Hijikata, N; Ishikawa, A; Hashimoto, K; Kagaya, H; Tatematsu, N; Zenda, S; Kotani, D; Kojima, T; Fujita, T

DISEASES OF THE ESOPHAGUS （Oxford University Press (OUP)） 38 （ 1 ） 2024年11月

ISSN 1120-8694

Abstract

In older patients with locally advanced esophageal cancer (LAEC), loss of skeletal muscle mass during neoadjuvant chemotherapy (NAC) is associated with poor clinical outcomes. This study aimed to investigate factors associated with loss of skeletal muscle mass during NAC in older patients with LAEC. This was a single-center exploratory prospective cohort study. Consecutive patients aged ≥65 years with LAEC scheduled for curative esophagectomy after NAC were enrolled between October 2021 and December 2023. As a primary endpoint, loss of skeletal muscle mass index (ΔSMI: pre-NAC minus post-NAC value) was calculated from computed tomography images before and after NAC. Significant pre-NAC and during-NAC factors with ΔSMI were detected with a multivariate regression model. Statistical significance was considered as two-tailed P &lt;0.05. A total of 69 patients were analyzed. The mean age was 72.9 years, and 53 (77%) were male. Mean SMI before and after NAC was 43.1 and 40.9 cm2/m2, and mean ΔSMI was 2.2 cm2/m2. In multivariate analysis, ΔSMI was associated with increased sitting time during NAC (per 1 min/day, adjusted coefficient 0.007, 95% confidence interval [CI] 0.001 to 0.013, P = 0.016), decreased Geriatric Nutritional Risk Index during NAC (per 1 score, adjusted coefficient −0.146, 95% CI −0.213 to −0.013, P = 0.002), and worsening decreased appetite during NAC (vs. no worsening, adjusted coefficient 1.571, 95% CI 0.279 to 2.862, P = 0.018). It was hypothesized that the inactivity-related mechanism and malnutrition-related mechanism are important for skeletal muscle mass loss during NAC in older patients with LAEC.

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Efficacy of Cognitive Stimulation Therapy for Cognition in Patients with Vascular Cognitive Impairment: A Pilot Randomized Controlled Trial

Mori, N; Otaka, Y; Ito, D; Shimizu, A; Narita, A; Honaga, K; Matsuura, D; Kondo, K; Liu, MG; Tsuji, T

KEIO JOURNAL OF MEDICINE 2024年08月

ISSN 0022-9717

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Efficacy of Cognitive Stimulation Therapy for Cognition in Patients with Vascular Cognitive Impairment: A Pilot Randomized Controlled Trial.

Naoki Mori, Yohei Otaka, Daisuke Ito, Ayaka Shimizu, Ayako Narita, Kaoru Honaga, Daisuke Matsuura, Kunitsugu Kondo, Meigen Liu, Tetsuya Tsuji

The Keio journal of medicine 2024年08月

The efficacy of cognitive stimulation therapy (CST) in patients with vascular cognitive impairment has not been explored, and no studies investigating CST in the convalescent rehabilitation phase have been reported. This study examined the effect of CST on the cognitive function of patients with vascular cognitive impairment. A randomized controlled, assessor-blinded, single-centered trial with two parallel groups was conducted in a convalescent rehabilitation hospital. Twenty participants were randomly allocated to CST (n=10) and control (n=10) groups. Participants in the CST group underwent two CST sessions a day, five times a week for 8 weeks, in addition to conventional rehabilitation. Participants in the control group underwent conventional rehabilitation only. The primary outcome was the Mini-Mental State Examination (MMSE) score, and the outcome between the groups was compared using a generalized linear mixed model (GLMM). The mean (standard deviation) scores of MMSE increased by 3.50 (3.08) points and 4.50 (1.61) points from baseline to the end of the study (week 8) in the CST and control groups, respectively. The GLMM showed a significant effect of TIME on MMSE (F=21.121, P<0.001), whereas no significant effect on MMSE was observed for GROUP (intervention vs. control, P=0.817) or the interaction term (TIME×GROUP, P=0.649). Although a significant improvement in cognitive function was observed in each group, no significant effect of CST was evident. This result indicates that the effect may have been masked by improvements caused by natural history or rehabilitation. Future studies with a sufficient sample size are required to confirm the findings.

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Feasibility of a Neurorehabilitation Pipeline and an Automated Algorithm to Select Appropriate Treatments for Upper Extremity Motor Paralysis in Individuals With Chronic Stroke

Kuwahara, W; Kawakami, M; Okawada, M; Tanamachi, K; Sasaki, S; Kamimoto, T; Yamada, Y; Tsuji, T; Kaneko, F

AMERICAN JOURNAL OF PHYSICAL MEDICINE & REHABILITATION （Ovid Technologies (Wolters Kluwer Health)） 104 （ 2 ） 117 - 126 2024年07月

ISSN 0894-9115

Abstract

Objective

This study aimed to investigate the feasibility of a neurorehabilitation pipeline and develop an algorithm to automatically select the appropriate treatment for individuals with upper extremity motor paralysis after stroke in the chronic phase.

Design

In Experiment 1, eight post-stroke participants in the chronic phase who underwent treatment sustaining two to three phases were assessed before and after treatment. In Experiment 2, a decision tree analysis was performed in which the dependent variable was set as the treatment option determined by a board-certified physiatrist for 95 post-stroke participants; the independent variables were only motor function scores or both motor function scores and electromyogram variables.

Results

In Experiment 1, the clinical assessment scores were improved significantly after treatment. Experiment 2 showed that the agreements of the model with only motor function scores as the dependent variable and with motor function scores and electromyogram variables as the dependent variables were 75.8% and 82.1%, respectively.

Conclusions

This novel treatment package is feasible for improvement of motor function in post-stroke individuals with severe motor paralysis. The study also established an automated algorithm for selecting appropriate treatments for upper extremity motor paralysis after stroke, identifying standard values of key variables, including electromyography variables.

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Do Pharmacological Treatments Act in Collaboration with Rehabilitation in Spinal Cord Injury Treatment? A Review of Preclinical Studies

Tashiro, S; Shibata, S; Nagoshi, N; Zhang, L; Yamada, S; Tsuji, T; Nakamura, M; Okano, H

CELLS 13 （ 5 ） 2024年02月

査読有り

There is no choice other than rehabilitation as a practical medical treatment to restore impairments or improve activities after acute treatment in people with spinal cord injury (SCI); however, the effect is unremarkable. Therefore, researchers have been seeking effective pharmacological treatments. These will, hopefully, exert a greater effect when combined with rehabilitation. However, no review has specifically summarized the combinatorial effects of rehabilitation with various medical agents. In the current review, which included 43 articles, we summarized the combinatorial effects according to the properties of the medical agents, namely neuromodulation, neurotrophic factors, counteraction to inhibitory factors, and others. The recovery processes promoted by rehabilitation include the regeneration of tracts, neuroprotection, scar tissue reorganization, plasticity of spinal circuits, microenvironmental change in the spinal cord, and enforcement of the musculoskeletal system, which are additive, complementary, or even synergistic with medication in many cases. However, there are some cases that lack interaction or even demonstrate competition between medication and rehabilitation. A large fraction of the combinatorial mechanisms remains to be elucidated, and very few studies have investigated complex combinations of these agents or targeted chronically injured spinal cords.

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Chronic Spinal Cord Injury Regeneration with Combined Therapy Comprising Neural Stem/Progenitor Cell Transplantation, Rehabilitation, and Semaphorin 3A Inhibitor

Yoshida, T; Tashiro, S; Nagoshi, N; Shinozaki, M; Shibata, T; Inoue, M; Ogawa, S; Shibata, S; Tsuji, T; Okano, H; Nakamura, M

ENEURO 11 （ 2 ） 2024年02月

Spinal cord injury (SCI) often results in various long-term sequelae, and chronically injured spinal cords exhibit a refractory feature, showing a limited response to cell transplantation therapies. To our knowledge, no preclinical studies have reported a treatment approach with results surpassing those of treatment comprising rehabilitation alone. In this study of rats with SCI, we propose a novel combined therapy involving a semaphorin 3A inhibitor (Sema3Ai), which enhances axonal regeneration, as the third treatment element in combination with neural stem/progenitor cell transplantation and rehabilitation. This comprehensive therapeutic strategy achieved significant improvements in host-derived neuronal and oligodendrocyte differentiation at the SCI epicenter and promoted axonal regeneration even in the chronically injured spinal cord. The elongated axons established functional electrical connections, contributing to significant enhancements in locomotor mobility when compared with animals treated with transplantation and rehabilitation. As a result, our combined transplantation, Sema3Ai, and rehabilitation treatment have the potential to serve as a critical step forward for chronic SCI patients, improving their ability to regain motor function.