研究者詳細 - 辻　哲也

論文 - 辻　哲也

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Effect of Prism Adaptation Therapy on the Activities of Daily Living and Awareness for Spatial Neglect: A Secondary Analysis of the Randomized, Controlled Trial

Mizuno, K; Tsujimoto, K; Tsuji, T

BRAIN SCIENCES 11 （ 3 ） 2021年03月

ISSN 2076-3425

BACKGROUND: Rehabilitation for unilateral spatial neglect (USN) using prism adaptation (PA) is one of the most widely used methods, and the effectiveness of PA is well-evidenced. Although the effect of PA generalized various neglect symptoms, the effectiveness for some aspects of neglect is not fully proven. The Catherine Bergego Scale (CBS) was developed to identify problems with the activities of daily living (ADL) caused by USN. The CBS is composed of 10 observation assessments and a self-assessment questionnaire. To assess the self-awareness of USN, the anosognosia score is calculated as the difference between the observational scores and the self-assessment scores. To investigate how PA affects ADL and self-awareness in subacute USN patients during rehabilitation, we analyzed each item of the CBS and self-awareness from a randomized, controlled trial (RCT) that we previously conducted (Mizuno et al., 2011). METHODS: A double-masked randomized, controlled trial was conducted to evaluate the effects of a 2-week PA therapy on USN in 8 hospitals in Japan. We compared each item of the CBS, anosognosia score, and absolute value of the anosognosia score between the prism group and the control group. RESULTS: Two of ten items (gaze orientation and exploration of personal belongings) were significantly improved in the prism group compared with those in the control group. The absolute value of the anosognosia score was significantly improved by PA. CONCLUSIONS: Improvement of oculomotor exploration by PA may generalize the behavioral level in a daily living environment. This study suggested that PA could accelerate the self-awareness of neglect during subacute rehabilitation.

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Iwasawa, T; Fukui, S; Kawakami, M; Kawakami, T; Kataoka, M; Yuasa, S; Fukuda, K; Fujiwara, T; Tsuji, T

CHRONIC RESPIRATORY DISEASE （SAGE Publications） 18 147997312110466 - 147997312110466 2021年01月

ISSN 1479-9731

Instrumental activities of daily living (IADL) are significantly related to quality of life and mortality among individuals with heart disease. However, few reports have examined IADL in persons with chronic thromboembolic pulmonary hypertension (CTEPH). The aim of this study was to clarify factors related to IADL in persons with CTEPH. This retrospective, observational study enrolled 163 persons with CTEPH (mean ± standard deviation age = 65 ± 13 years; 68% female) admitted to the Department of Cardiology at Keio University Hospital between January 2015 and July 2019. The Frenchay Activities Index (FAI) was used to assess IADL. Age, sex, body mass index, World Health Organization functional class (WHO-FC), cardiac function (mean pulmonary arterial pressure, mean right atrial pressure, pulmonary capillary wedge pressure, and cardiac index), pulmonary function (percentage vital capacity, percentage forced expiratory volume in 1 s, diffusion capacity of carbon monoxide (DLCO)/alveolar volume (VA)), physical function (knee extension strength and walking speed), and 6-min walking distance (6MWD) were assessed. Multiple regression analysis was performed to identify factors significantly associated with FAI. Mean FAI was 25 ± 8. Univariate analysis showed that sex, WHO-FC, DLCO/VA, walking speed, and 6MWD were correlated with FAI. Multiple regression analysis showed that 6MWD (sβ = 0.338, 95% CI 0.014–0.034, p < .001), sex (sβ = 0.268, 95% CI 2.238–7.165, p < .001), and DLCO/VA (sβ = 0.257, 95% CI 1.011–3.528, p < .001) were significantly correlated with FAI ( R2 = 0.261). IADL were associated with exercise tolerance, sex, and DLCO/VA in persons with CTEPH. In the future, more details of IADL are expected to be clarified by analyzing individual components of IADL and investigating social background characteristics, including living environment.

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Tashiro, S; Kuroki, M; Okuyama, K; Oshima, O; Ogura, M; Hijikata, N; Nakamura, T; Oka, A; Kawakami, M; Tsuji, T; Liu, MG

PLOS ONE 16 （ 3 ） e0247998 2021年

ISSN 1932-6203

AIMS: The present study aimed to determine factors associated with the frequency of paralyzed upper extremity (UE) use in chronic stroke patients with severe UE functional deficiency. METHODS: We retrospectively reviewed the medical records of 138 consecutive patients, and 117 was analyzed (median age, 55 [range, 18-85] years; median stroke duration, 24.5 [range, 7-302] months) with chronic hemiparetic stroke who were admitted to our hospital for intensive upper extremity rehabilitation. The mean Fugl-Meyer Assessment (FMA) UE score was 28.6. All of them are independent in their activity of daily living (ADL) and without remarkable cognitive deficits. Amount-of-use score of Motor Activity Log-14 (MAL-AOU) was applied as the index of daily use of affected UE. The following parameters were examined as the explanatory variables: demographics, proximal and distal sub-scores of FMA UE, Modified Ashworth Scale (MAS), and sensory function scores in the Stroke Impairment Assessment Set (SIAS). RESULTS: The median MAL-AOU score was 0.57 [range, 0.28-0.80]. Ordinal regression analysis revealed that FMA proximal, FMA distal, and SIAS sensory function (touch) were associated with AOU score of MAL-14 (Pseudo R-square = 0.460). CONCLUSION: Not only motor but also sensory function, especially tactile sensation, play a crucial role in the daily use of affected UE in chronic stroke patients with severe UE hemiparesis.

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Do somatosensory deficits predict efficacy of neurorehabilitation using neuromuscular electrical stimulation for moderate to severe motor paralysis of the upper limb in chronic stroke?

Tsuzuki, K; Kawakami, M; Nakamura, T; Oshima, O; Hijikata, N; Suda, M; Yamada, Y; Okuyama, K; Tsuji, T

THERAPEUTIC ADVANCES IN NEUROLOGICAL DISORDERS 14 17562864211039335 - 17562864211039335 2021年

ISSN 1756-2856

Background: Various neurorehabilitation programs have been developed to promote recovery from motor impairment of upper extremities. However, the response of patients with chronic-phase stroke varies greatly. Prediction of the treatment response is important to provide appropriate and efficient rehabilitation. This study aimed to clarify whether clinical assessments, such as motor impairments and somatosensory deficits, before treatment could predict the treatment response in neurorehabilitation. Methods: The data from patients who underwent neurorehabilitation using closed-loop electromyography (EMG)-controlled neuromuscular electrical stimulation were retrospectively analyzed. A total of 66 patients with chronic-phase stroke with moderate to severe paralysis were included. The changes from baseline in the Fugl-Meyer Assessment-Upper Extremity (FMA-UE) and the Motor Activity Log-14 (MAL-14) of amount of use (AOU) and quality of movement (QOM) were used to assess treatment response, and multivariate logistic regression analysis was performed using the extracted candidate predictors, such as baseline clinical assessments, to identify predictors of FMA-UE and MAL-14 improvement. Results: FMA-UE and MAL-14 scores improved significantly after the intervention (FMA-UE p < 0.01, AOU p < 0.01, QOM p < 0.01). On multivariate logistic regression analysis, tactile sensory (p = 0.043) and hand function (p = 0.030) were both identified as significant predictors of FMA-UE improvement, tactile sensory (p = 0.047) was a significant predictor of AOU improvement, and hand function (p = 0.026) was a significant predictor of QOM improvement. The regression equations explained 71.2% of the variance in the improvement of FMA-UE, 69.7% of AOU, and 69.7% of QOM. Conclusion: Both motor and tactile sensory impairments predict improvement in motor function, tactile sensory impairment predicts improvement in the amount of paralytic hand use, and motor impairment predicts improvement in the quality of paralytic hand use following neurorehabilitation treatment in patients with moderate to severe paralysis in chronic-phase stroke. These findings may help select the appropriate treatment for patients with more severe paralysis and to maximize the treatment effect.

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Behavioral Assessment of Unilateral Spatial Neglect with the Catherine Bergego Scale (CBS) Using the Kessler Foundation Neglect Assessment Process (KF-NAP) in Patients with Subacute Stroke during Rehabilitation in Japan

Nishida, D; Mizuno, K; Tahara, M; Shindo, S; Watanabe, Y; Ebata, H; Tsuji, T

BEHAVIOURAL NEUROLOGY 2021 8825192 - 8825192 2021年

ISSN 0953-4180

The Kessler Foundation Neglect Assessment Process (KF-NAP) is an assessment tool for unilateral spatial neglect (USN), which is the scoring method for the Catherine Bergego Scale (CBS) based on detailed instructions. This study is aimed at determining the reliability and validity of the Japanese version of the KF-NAP (KF-NAP-J), evaluating the improvement of neglect assessment with KF-NAP-J, and comparing it with the original CBS for subacute stroke patients. We assessed subacute stroke patients admitted to our intensive rehabilitation hospital. Two KF-NAP-trained occupational therapists (OTs) assessed 22 patients. Before implementing the KF-NAP at the hospital, two other OTs assessed the other 23 patients using the CBS. We evaluated the interrater reliability of the KF-NAP and CBS using intraclass correlation coefficients (ICC) for the total scores, weighted kappa statistics for each subscale, and internal consistency using Cronbach's alpha. We assessed the validity of the KF-NAP against the Behavioral Inattention Test (BIT) and Functional Independence Measure (FIM) using Spearman's correlation coefficient. The reliability of both the KF-NAP and CBS was excellent. The weighted kappa results demonstrated that each subscale was in better agreement with the KF-NAP than with the CBS. In the KF-NAP, all eight subscales in which weighted kappa could be calculated were in significant agreement, and two were almost in perfect agreement. The KF-NAP moderately correlated with the subscales of BIT and FIM representing USN and activities of daily living. The USN detection rates of KF-NAP and BIT in the KF-NAP group were 63.6% and 22.7%, respectively. These results suggest that the KF-NAP, as well as the CBS, is useful to assess USN, which strongly impacts the rehabilitation outcomes in subacute stroke patients.

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Association of preoperative sarcopenia with postoperative dysphagia in patients with thoracic esophageal cancer

Mayanagi, S; Ishikawa, A; Matsui, K; Matsuda, S; Irino, T; Nakamura, R; Fukuda, K; Wada, N; Kawakubo, H; Hijikata, N; Ando, M; Tsuji, T; Kitagawa, Y

DISEASES OF THE ESOPHAGUS 34 （ 9 ） 2020年12月

ISSN 1120-8694

BACKGROUND: The purpose of the current study was to clarify the relationship between clinical features of dysphagia after esophagectomy and preoperative sarcopenia. METHODS: A total of 187 cases were included in the current study. The psoas cross-sectional area on pre-treatment computed tomography was measured in thoracic esophageal cancer patients who underwent curative resection. The psoas muscle index (PMI) cut-off levels for sarcopenia were 6.36 cm2/m2 for men and 3.92 cm2/m2 for women. Swallowing function was evaluated using videofluoroscopic swallowing study (VFSS) and fiberoptic endoscopic evaluation of swallowing (FEES) at postoperative days 7-15, and classified according to the food intake level scale (FILS). Perioperative swallowing rehabilitation was performed in all cases. RESULTS: In the 187 included patients, the median PMI was 5.42 cm2/m2 for men and 3.43 cm2/m2 for women, and 133 cases (71%) met the sarcopenia criteria. The FILS <4 (no oral intake) was 15% in the non-sarcopenia group, and 38% in the sarcopenia group (P = 0.003). There was no significant difference in the incidence of postoperative complications, including pneumonia and re-admission due to pneumonia, between the two groups. Preoperative sarcopenia and recurrent laryngeal nerve palsy were be independent risk factors for postoperative dysphagia. CONCLUSIONS: Sarcopenic patients with esophageal cancer develop postoperative dysphagia more often than non-sarcopenic patients. Prehabilitation and nutritional support for patients with preoperative sarcopenia could play an important role to mitigate postoperative dysphagia.

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Quality of life and the prevalence of urinary incontinence after surgical treatment for gynecologic cancer: a questionnaire survey

Nakayama Noriko, Tsuji Tetsuya, Aoyama Makoto, Fujino Takafumi, Liu Meigen

BMC WOMENS HEALTH 20 （ 1 ） 148 2020年07月

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Rehabilitation for Cancer Patients in Inpatient Hospices/Palliative Care Units and Achievement of a Good Death: Analyses of Combined Data From Nationwide Surveys Among Bereaved Family Members.

Hasegawa T, Sekine R, Akechi T, Osaga S, Tsuji T, Okuyama T, Sakurai H, Masukawa K, Aoyama M, Morita T, Kizawa Y, Tsuneto S, Shima Y, Miyashita M

Journal of pain and symptom management 2020年06月

ISSN 0885-3924

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Subcutaneous lymphatic vessels in the lower extremities: Comparison between photoacoustic lymphangiography and near-infrared fluorescence lymphangiography

Suzuki Y., Kajita H., Konishi N., Oh A., Urano M., Watanabe S., Asao Y., Imanishi N., Tsuji T., Jinzaki M., Aiso S., Kishi K.

Radiology （Radiology） 295 （ 2 ） 469 - 474 2020年05月

ISSN 00338419

© RSNA, 2020. Background: Detailed visualization of the lymphatic vessels would greatly assist in the diagnosis and monitoring of lymphatic diseases and aid in preoperative planning of lymphedema surgery and postoperative evaluation. Purpose: To evaluate the usefulness of photoacoustic imaging (PAI) for obtaining three-dimensional images of both lymphatic vessels and surrounding venules. Materials and Methods: In this prospective study, the authors recruited healthy participants from March 2018 to January 2019 and imaged lymphatic vessels in the lower limbs. Indocyanine green (5.0 mg/mL) was injected into the subcutaneous tissue of the first and fourth web spaces of the toes and below the lateral malleolus. After confirmation of the lymphatic flow with near-infrared fluorescence (NIRF) imaging as the reference standard, PAI was performed over a field of view of 270 3 180 mm. Subsequently, the number of enhancing lymphatic vessels was counted in both proximal and distal areas of the calf and compared between PAI and NIRF. Results: Images of the lower limbs were obtained with PAI and NIRF in 15 participants (three men, 12 women; average age, 42 years 6 12 [standard deviation]). All participants exhibited a linear pattern on NIRF images, which is generally considered a reflection of good lymphatic function. A greater number of lymphatic vessels were observed with PAI than with NIRF in both the distal (mean: 3.6 vessels 6 1.2 vs 2.0 vessels 6 1.1, respectively; P , .05) and proximal (mean: 6.5 vessels 6 2.6 vs 2.6 vessels 6 1.6; P , .05) regions of the calf. Conclusion: Compared with near-infrared fluorescence imaging, photoacoustic imaging provided a detailed, three-dimensional representation of the lymphatic vessels and facilitated an increased understanding of their relationship with the surrounding venules.

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Physical exercise is safe and feasible in thrombocytopenic patients with hematologic malignancies: a narrative review

Morishita S., Nakano J., Fu J.B., Tsuji T.

Hematology (United Kingdom) （Hematology (United Kingdom)） 25 （ 1 ） 95 - 100 2020年01月

ISSN 10245332

© 2020, © 2020 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group. Many studies have reported that physical exercise can improve the levels of function, quality of life (QoL), and fatigue in patients with hematologic malignancies. However, exercises should be prescribed with caution in patients with thrombocytopenia to prevent exercise-related bleeding. Some studies have suggested threshold platelet counts at which physical exercise can safely be performed. Herein, we review the current literature to determine the platelet count thresholds and types of physical exercise that may be prescribed to reduce the risk of exercise-related bleeding in those with hematological malignancies while undergoing chemotherapy.

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緩和ケア主体の時期のがんリハビリテーション診療

辻哲也

The Japanese Journal of Rehabilitation Medicine （公益社団法人日本リハビリテーション医学会） 57 （ 9 ） 828 - 835 2020年

ISSN 1881-3526

支持・緩和療法

奥坂拓志, 保田知生, 眞島喜幸, 小川朝生, 余宮きのみ, 辻哲也, 森雅紀, 鈴木賢一, 丹藤雄介, 藤森麻衣子, 坂本はと恵

膵臓（日本膵臓学会） 35 （ 1 ） 79 - 82 2020年

ISSN 0913-0071

癌患者に必要とされる支持・緩和療法は多岐にわたり，その一部については専門学会からのガイドラインも出版されているが，膵癌患者に特に重要と考えられる臨床的疑問については本ガイドラインにおいて指針を提示することが必要との議論がなされ，2016年版より精神心理的苦痛への対応方法，上腹部痛・背部痛に対する治療法，栄養療法，が取り上げられることとなった．2019年版ではさらに，膵癌術後患者に対する運動療法，アドバンス・ケア・プランニング，化学療法における末梢神経障害への対応方法，を新たなCQとして設定し，エビデンスの収集と推奨の提言を行った．また，悪液質を伴う膵癌患者における栄養支持療法，患者向け資材（パンフレット），コミュニケーション・スキル，心理的・社会的・経済的問題に対する支援，患者会，についてコラムで取り上げて情報提供を行うこととした．

Risk factors of impairment of shoulder function after axillary dissection for breast cancer

Kikuuchi M., Akezaki Y., Nakata E., Yamashita N., Tominaga R., Kurokawa H., Hamada M., Aogi K., Ohsumi S., Tsuji T., Sugihara S.

Supportive Care in Cancer （Supportive Care in Cancer） 2020年

ISSN 09414355

© 2020, Springer-Verlag GmbH Germany, part of Springer Nature. Objectives: Postoperative shoulder joint dysfunction has been observed at a certain rate after breast cancer surgery with axillary lymph node dissection. The purposes of this study were to verify the feasibility and effects of home-based exercise using a DVD and clarify the target of intensive intervention with physiotherapy by identifying the factors that cause postoperative shoulder dysfunction. Methods: The study comprised 237 female patients who underwent breast cancer surgery with axillary lymph node dissection, whose data were acquired until 3 months postoperatively. All patients were instructed to exercise at home using a DVD. Range of motion (ROM) of shoulder flexion and abduction and the disability of the arm, shoulder, and hand (DASH) score were measured before surgery, 1 week and 1, 2, and 3 months after surgery. As factors influencing the recovery of shoulder ROM at 3 months after surgery, the presence or absence of radiation and factors up to 1 month after surgery (age, body mass index, the relationship between operated side and dominant side of the hand, treatment modalities, and complications). Results: Shoulder ROM and DASH scores had gradually recovered from 1 week to 3 months postoperatively. As the results of the multivariate analysis, the factors that were associated with the recovery of ROM of shoulder flexion at 3 months were the side of surgery corresponding to the dominant hand (negative factor) and the presence of paresthesia at 1 week postoperatively (positive factor) (p < 0.05). Radiation therapy and the side of surgery corresponding to the dominant hand were negative factors for the recovery of shoulder abduction (p < 0.01). Regarding the feasibility of the home exercise, 214/229 (93.4%), 172/210 (81.9%), and 139/206 (67.5%) of patients performed exercise at least once a day at 1, 2, and 3 months after surgery, respectively. Conclusion: Our result indicated that the side of surgery corresponding to the dominant hand was the inhibiting factor for recovery for both shoulder flexion and abduction at 3 months after surgery. Home-based exercise with DVD was considered feasible. For the verification of this effectiveness, a randomized control study should be planned in the future.

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Landscape of education and clinical practice in geriatric oncology: a Japanese nationwide survey

Nishijima Tomohiro F., Tamura Kazuo, Nagashima Fumio, Aiba Keisuke, Saito Mitsue, Saeki Toshiaki, Karasawa Kumiko, Uchitomi Yosuke, Takahashi Takao, Kaibori Masaki, Sakuda Hiromi, Imamura Chiyo, Tsuji Tetsuya

JAPANESE JOURNAL OF CLINICAL ONCOLOGY 49 （ 12 ） 1114 - 1119 2019年12月

ISSN 0368-2811

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Assessment of the Mini-Balance Evaluation Systems Test, Timed Up and Go test, and body sway test between cancer survivors and healthy participants

Morishita S., Hirabayashi R., Tsubaki A., Aoki O., Fu J., Onishi H., Tsuji T.

Clinical Biomechanics （Clinical Biomechanics） 69 28 - 33 2019年10月

ISSN 02680033

© 2019 Elsevier Ltd Background: Cancer survivors experience late and long-term effects of treatment; also, the disease itself might be responsible for persisting functional impairments. The purpose of this study was to investigate muscle strength, balance function using the Mini-Balance Evaluation Systems Test and Timed Up and Go test with single and cognitive dual tasks and body sway in breast cancer survivors and healthy women and non-breast cancer survivors and healthy participants. Methods: Twenty-six cancer survivors and 19 healthy participants were assessed for grip and knee extension strength with the Mini-Balance Evaluation Systems Test, Timed Up and Go, and body sway test performance. Findings: Breast cancer survivors had significantly lower hand grip strength (p < .05) and Mini-Balance Evaluation Systems Test scores than healthy women (p < .05). Additionally, in breast cancer survivors, hand grip strength had a significant relationship with Mini-Balance Evaluation Systems Test and Timed Up and Go scores (p < .05) but had no relationship with the total center of pressure length. Hand grip strength and Mini-Balance Evaluation Systems Test scores were not significantly different in non-breast cancer survivors and healthy participants. In non-breast cancer survivors, knee extension strength had a significant relationship with the Timed Up and Go scores (p < .05). Interpretation: The relationship between muscle strength and balance function may be characterized by the different diagnoses in cancer survivors. The current findings showed the changes in balance function and muscle strength among cancer survivors.

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A randomized phase II study of nutritional and exercise treatment for elderly patients with advanced non-small cell lung or pancreatic cancer: The NEXTAC-TWO study protocol

Miura S., Naito T., Mitsunaga S., Omae K., Mori K., Inano T., Yamaguchi T., Tatematsu N., Okayama T., Morikawa A., Mouri T., Tanaka H., Kimura M., Imai H., Mizukami T., Imoto A., Kondoh C., Shiotsu S., Okuyama H., Ueno M., Takahashi T., Tsuji T., Aragane H., Inui A., Higashiguchi T., Takayama K.

BMC Cancer （BMC Cancer） 19 （ 1 ） 528 - 528 2019年05月

ISSN 1471-2407

© 2019 The Author(s). Background: Most advanced elderly cancer patients experience fatigue, anorexia, and declining physical function due to cancer cachexia, for which effective interventions have not been established. We performed a phase I study of a new nonpharmacological multimodal intervention called the nutritional and exercise treatment for advanced cancer (NEXTAC) program and reported the excellent feasibility of and compliance with this program in elderly patients with advanced cancer who were at risk for cancer cachexia. We report here the background, hypothesis, and design of the next-step multicenter, randomized phase II study to evaluate the efficacy of the program, the NEXTAC-TWO study. Methods: Patients with chemo-naïve advanced non-small cell lung cancer or pancreatic cancer, age ≥ 70 years, performance status ≤2, with adequate organ function and without disability according to the modified Katz index will be eligible. In total, 130 participants will be recruited from 15 Japanese institutions and will be randomized into either the intervention group or a control group. Computer-generated random numbers are allocated to each participant. Stratification factors include performance status (0 to 1 vs. 2), site of primary cancer (lung vs. pancreas), stage (III vs. IV), and type of chemotherapy (cytotoxic vs. others). Interventions and assessment will be performed 4 times every 4 ± 2 weeks from the date of randomization. Interventions will consist of nutritional counseling, nutritional supplements (rich in branched-chain amino acids), and a home-based exercise program. The exercise program will include low-intensity daily muscle training and lifestyle education to promote physical activity. The primary endpoint is disability-free survival. It is defined as the period from the date of randomization to the date of developing disability or death due to any cause. This trial also plans to evaluate the improvements in nutritional status, physical condition, quality of life, activities of daily living, overall survival, and safety as secondary endpoints. Enrollment began in August 2017. The study results will demonstrate the efficacy of multimodal interventions for elderly cancer patients and their application for the maintenance of physical and nutritional conditions in patients with cancer cachexia. This work is supported by a grant-in-aid from the Japan Agency for Medical Research and Development. Discussion: This is the first randomized trial to evaluate the efficacy and safety of a multimodal intervention specific for elderly patients with advanced cancer.

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Factors affecting lower limb muscle strength and cardiopulmonary fitness after allogeneic hematopoietic stem cell transplantation

Ishikawa A., Otaka Y., Kamisako M., Suzuki T., Miyata C., Tsuji T., Matsumoto H., Kato J., Mori T., Okamoto S., Liu M.

Supportive Care in Cancer （Supportive Care in Cancer） 27 （ 5 ） 1793 - 1800 2019年05月

査読有り, ISSN 09414355

© 2018, The Author(s). Purpose: The aim of this study is to clarify the factors affecting physical function after allogeneic hematopoietic stem cell transplantation (HSCT). Methods: We retrospectively analyzed 88 patients (median age, 44.5 years) who received allogeneic HSCT. Leg extension torque and peak oxygen consumption (VO 2 ) were evaluated before and after HSCT. Patient factors (age, sex, underlying diseases, hemoglobin, serum albumin, and Karnofsky performance status score before transplant) and transplant factors (conditioning regimen, days to neutrophil engraftment, grades of acute graft-versus-host disease [GVHD], infections, and the interval between pre- and post-evaluation) were collected via chart review, and were used for correlational and comparison analyses in order to identify the variables associated with reduced post-HSCT leg extension torque and peak VO 2 . Stepwise multiple regression analyses for post-HSCT leg extension torque and post-HSCT peak VO 2 were performed using age, sex, and the related variables with a p value < 0.2 in the correlational and comparison analyses. Results: Leg extension torque and peak VO 2 were significantly reduced after HSCT (p < 0.001). Pre-HSCT leg extension torque, grades of acute GVHD, age, and the interval between pre- and post-evaluation were identified as significant factors associated with reduced post-HSCT leg extension torque. However, none of these factors were significantly associated with reduced post-HSCT peak VO 2 , and only its pre-transplant value was identified as a significant factor. Conclusions: These findings suggest that improvements in muscle strength and cardiopulmonary fitness before HSCT are crucial for maintaining post-treatment physical function, especially in elderly individuals with acute GVHD requiring a long-term stay in a protective environment.

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Feasibility of early multimodal interventions for elderly patients with advanced pancreatic and non-small-cell lung cancer

Naito T., Mitsunaga S., Miura S., Tatematsu N., Inano T., Mouri T., Tsuji T., Higashiguchi T., Inui A., Okayama T., Yamaguchi T., Morikawa A., Mori N., Takahashi T., Strasser F., Omae K., Mori K., Takayama K.

Journal of Cachexia, Sarcopenia and Muscle （Journal of Cachexia, Sarcopenia and Muscle） 10 （ 1 ） 73 - 83 2019年02月

ISSN 21905991

© 2018 The Authors. Journal of Cachexia, Sarcopenia and Muscle published by John Wiley & Sons Ltd on behalf of the Society on Sarcopenia, Cachexia and Wasting Disorders Background: Combinations of exercise and nutritional interventions might improve the functional prognosis for cachectic cancer patients. However, high attrition and poor compliance with interventions limit their efficacy. We aimed to test the feasibility of the early induction of new multimodal interventions specific for elderly patients with advanced cancer Nutrition and Exercise Treatment for Advanced Cancer (NEXTAC) programme. Methods: This was a multicentre prospective single-arm study. We recruited 30 of 46 screened patients aged ≥70 years scheduled to receive first-line chemotherapy for newly diagnosed, advanced pancreatic, or non-small-cell lung cancer. Physical activity was measured using pedometers/accelerometer (Lifecorder ® , Suzuken Co., Ltd., Japan). An 8 week educational intervention comprised three exercise and three nutritional sessions. The exercise interventions combined home-based low-intensity resistance training and counselling to promote physical activity. Nutritional interventions included standard nutritional counselling and instruction on how to manage symptoms that interfere with patient's appetite and oral intake. Supplements rich in branched-chain amino acids (Inner Power ® , Otsuka Pharmaceutical Co., Ltd., Japan) were provided. The primary endpoint of the study was feasibility, which was defined as the proportion of patients attending ≥4 of six sessions. Secondary endpoints included compliance and safety. Results: The median patient age was 75 years (range, 70–84). Twelve patients (40%) were cachectic at baseline. Twenty-nine patients attended ≥4 of the six planned sessions (96.7%, 95% confidence interval, 83.3 to 99.4). One patient dropped out due to deteriorating health status. The median proportion of days of compliance with supplement consumption and exercise performance were 99% and 91%, respectively. Adverse events possibly related to the NEXTAC programme were observed in five patients and included muscle pain (Grade 1 in two patients), arthralgia (Grade 1 in one patient), dyspnoea on exertion (Grade 1 in one patient), and plantar aponeurositis (Grade 1 in one patient). Conclusions: The early induction of multimodal interventions showed excellent compliance and safety in elderly patients with newly diagnosed pancreatic and non-small-cell lung cancer receiving concurrent chemotherapy. We are now conducting a randomized phase II study to measure the impact of these interventions on functional prognosis.

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Risk Factors for Lymphedema in Breast Cancer Survivors Following Axillary Lymph Node Dissection

Akezaki Yoshiteru, Sugihara Shinsuke, Tominaga Ritsuko, Kikuuchi Masato, Kurokawa Hideaki, Hamada Makiko, Aogi Kenjiro, Ohsumi Shozo, Tsuji Tetsuya, Kawamura Susumu

Progress in Rehabilitation Medicine （公益社団法人日本リハビリテーション医学会） 4 （ 0 ） 20190021 2019年

Objective: The aim of the current study was to assess the risk factors for developing lymphedema following breast cancer treatment. Methods: The subjects of this study were 238 consecutive patients who underwent axillary lymph node dissection for breast cancer at Shikoku Cancer Center. The study variables were the occurrence of lymphedema, the body mass index, the follow-up period, the drain removal time, the level of lymph node dissection, the presence or absence of co-resident household members, radiation therapy, neoadjuvant chemotherapy, and adjuvant chemotherapy. Results: We observed lymphedema in 23.9% of patients after axillary lymph node dissection for breast cancer. Neoadjuvant chemotherapy and adjuvant chemotherapy using docetaxel and cyclophosphamide increased the risk of developing lymphedema (P <0.05). Conclusions: Those patients treated with neoadjuvant chemotherapy and adjuvant chemotherapy using docetaxel and cyclophosphamide should be observed closely after axillary lymph node dissection, and appropriate intervention should be considered from an early stage.

Neuromuscular electrical stimulation-enhanced rehabilitation is associated with not only motor but also somatosensory cortical plasticity in chronic stroke patients: an interventional study

Tashiro S., Mizuno K., Kawakami M., Takahashi O., Nakamura T., Suda M., Haruyama K., Otaka Y., Tsuji T., Liu M.

Therapeutic Advances in Chronic Disease （Therapeutic Advances in Chronic Disease） 10 2040622319889259 2019年

ISSN 20406223

© The Author(s), 2019. Background: Somatosensory function has been frequently overlooked in clinics and research in the field of chronic stroke. The effects of neurorehabilitation interventions on sensory processing have still to be investigated using electrophysiological means. This study investigated the effect of hybrid assistive neuromuscular dynamic stimulation (HANDS) therapy utilizing closed-loop electromyography-controlled neuromuscular electrical stimulation (NMES), on sensory changes and cortical plasticity among patients with chronic stroke. Methods: This study was a prespecified analysis of 23 participants involved in an ongoing large interventional study. Patients with severe upper limb hemiplegia dues to chronic stroke underwent 3 weeks of inpatient HANDS therapy, where daily treatment consisted of 8 h of NMES combined with wrist splinting, 90 min of comprehensive occupational therapy, and the practice of bimanual activities of daily living. Somatosensory evoked potentials (SEPs) and functional sensory assessments, including the Semmes–Weinstein monofilament test (SWMT) and thumb localizing test (TLT), were compared pre and post-treatment. Results: While no significant recovery of tactile sensation was observed, significant improvements in proprioception and motor function were induced. The number of cortical peaks significantly increased in the median nerve, but not in the tibial nerve. A total of 9 out of 11 participants who initially lacked certain peaks responded to treatment. Further analysis revealed a significant improvement in latency and amplitude of SEP peaks. Conclusions: Our results suggest that NMES-based neurorehabilitation induces certain plastic changes in the primary sensory cortex and in cortices associated with sensorimotor processing in people with chronic stroke sequelae, which may explain the observed improvements in proprioception.

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