Predictors associated with poor outcomes

This study aimed to determine predictive factors associated with poor outcomes among older adult inpatients in the convalescent rehabilitation ward. We also examined the validity of factors that were identified as predictive of poor outcomes. Study subjects were 104 older adult inpatients in the convalescent rehabilitation ward, divided into two groups based on outcome at discharge. Group I included the outcomes of death or transfer to an acute care hospital and Group II included all other outcomes. Data were retrospectively collected from older adults’ medical records, including: activities of daily living, swallowing grade, nutritional index, and blood biochemistry data. Logistic regression analysis was used to extract predictive factors associated with poor outcomes. Next, we calculated the Stratum-specific likelihood ratio (SSLR) for each extracted factor. Two items were extracted as predictive factors with AUCs ≥ 0.7 : N-terminal pro-brain natriuretic peptide (NT-proBNP) and days from onset to hospitalization. The SSLRs showed the risk for a poor outcome increased when NT-proBNP was ≥ 2500 pg / ml, and when there were ≥ 35 days from onset to hospitalization. Our findings suggest these predictive factors provide a valid index to predict poor outcomes among older adults from the early stage of admission

長期療養病棟入院の摂食嚥下障害患者における嚥下反射と誤嚥性肺炎の発症率との関連性 : 60日間の前向きコホート研究

Objective: To investigate the association between the Simple Swallowing Provocation Test (SSPT) and the incidence of aspiration pneumonia in patients with dysphagia in long-term care (LTC) wards. Design: The study design was a prospective cohort study. Participants were followed for 60 days from admission. Setting: LTC wards. Participants: Study participants were patients with dysphagia aged ≥65 years who were admitted to LTC wards between August 2018 and August 2019. In total, 39 participants were included in the analysis (N=39; 20 male, 19 female; mean age, 83.8±8.5y). Participants were divided into 2 groups based on SSPT results: normal swallowing reflex (SSPT normal group) and abnormal swallowing reflex (SSPT abnormal group). The covariates were age and sex, primary disease, history of cerebrovascular disease, Glasgow Coma Scale, body mass index, Geriatric Nutritional Risk Index, the Mann Assessment of Swallowing Ability, Food Intake Level Scale, FIM, and Oral Health Assessment Tool. Interventions: Not applicable. Main Outcome Measures: The outcome was the incidence of aspiration pneumonia during the first 60 days of hospitalization, and the predictive factor was SSPT: 0.4 mL. Results: The incidence of aspiration pneumonia was 33.3% in the SSPT normal group and 76.2% in the SSPT abnormal group. The φ coefficient (a measure of association for 2 binary variables) was 0.43, the risk ratio (the ratio of the probability of an outcome in an exposed group to the probability of an outcome in an unexposed group) was 2.29, and the 95% confidence interval was 1.14-4.58 for the SSPT abnormal group. Conclusions: Our findings suggest that the SSPT provides a valid index for the development of aspiration pneumonia in older patients with dysphagia admitted to LTC wards

Relationships between Skeletal Muscle Mass and Strength, and Jaw-Opening Force in Japanese Community-Dwelling Elderly

【目的】要介護高齢者の一要因である骨格筋量の低下や筋力低下は，嚥下関連筋にも影響を及ぼし，摂食嚥下機能を低下させることが疑われる．本研究では，地域在宅高齢者の骨格筋量・骨格筋力と，口腔機能・摂食嚥下機能との関連性を明らかにすることを目的として，調査を実施した． 【対象と方法】対象は，65歳以上の地域在宅高齢者24名（男性3名，女性21名，平均年齢77.0±5.0 歳）とした．骨格筋量は骨格筋指数（以下，SMI）を，骨格筋力は握力を評価項目として用いた．口腔機能・摂食嚥下機能は開口力・オーラルディアドコキネシス（以下，OD）/ タ/ と/ カ/・RSST・MWST を測定し，骨格筋量と骨格筋力との関連性を検討した．各項目の相関関係をスピアマンの順位相関係数にて解析した．その後，有意な関連のあった項目に年齢，性別を加え，重回帰分析（ステップワイズ法）を行った．さらに，握力の値から，筋力健常群と筋力低下群（男性＜ 26 kg，女性＜ 18 kg）の2群に分類し，口腔機能・摂食嚥下機能の各項目について比較した．2群間比較には，マン・ホイットニーのU 検定を用いて統計解析した． 【結果と考察】SMI と開口力，握力と開口力・OD / タ/ に有意な相関関係が認められた（r＝0.578，p＝0.003；r＝0.640，p＝0.001；r＝0.447，p＝0.029）．重回帰分析の結果，開口力に影響を与える因子としてSMI が挙げられた．また，筋力低下群の開口力は，筋力健常群よりも有意に低い値を示した（p＝0.011）．全身の骨格筋量，骨格筋力の低下は，開口力やOD / タ/ の低下に関連する可能性が考えられた． 【結論】地域在宅高齢者の骨格筋量と骨格筋力は，開口力や舌運動機能に関連する可能性が示唆された．Skeletal muscle mass decreasing and muscle weakness can cause long-term care needs for elderly people. The relationship between skeletal muscle status and muscles relevant to oral function has been little reported. Therefore, the aim of the present study was to survey skeletal muscle status, oral function, and the relationship between the two in community-dwelling elderly people. Twenty-four community-dwelling elderly from two elderly associations in N city, T prefecture enrolled in the present survey (3 males, 21 females; mean age, 77.0±5.0 years). Skeletal muscle index (SMI) was used to assess skeletal muscle mass, grasping power to assess skeletal muscle strength. Oral function was evaluated in terms of jaw-opening force, diadochokinesis, the repetitive saliva swallowing test (RSST), and the modified water swallowing test (MWST). Correlations between parameters were analyzed using Spearman’s correlation coefficient. Consequently stepwise regression analysis was performed with jaw-opening force as objective variable and SMI, grasping force, age and sex as explanatory variables. The subjects were divided into two groups according to standards for grasping force: healthy and muscle weakness (male: ＜26 kgw; female: ＜18 kgw). Parameters were statistically compared between the two groups using the Mann-Whitney U test. There were statistical relationships between SMI and jaw-opening force (r＝0.578, p＝0.003), grasping force and jaw-opening force (r＝0.640, p＝0.001), grasping force and the number of diadochokinetic movement of /ta/ (r＝0.447, p＝0.029). As a result of stepwise regression analysis, SMI was a factor that affects jaw-opening force. In the muscle weakness group, jaw-opening force was less than the value in the healthy group ( p＝ 0.011). It is reasonable that an overall decrease in muscle mass would evoke decreases in muscle strength in both the extremities and the jaw-opening muscles. We confirmed significant relationships between skeletal muscle mass, skeletal muscle strength, and oral function (i.e., jaw-opening force and tongue skilled movement) in Japanese community-dwelling elderly

Embodied bidirectional simulation of a spiking cortico-basal ganglia-cerebellar-thalamic brain model and a mouse musculoskeletal body model distributed across computers including the supercomputer Fugaku

Embodied simulation with a digital brain model and a realistic musculoskeletal body model provides a means to understand animal behavior and behavioral change. Such simulation can be too large and complex to conduct on a single computer, and so distributed simulation across multiple computers over the Internet is necessary. In this study, we report our joint effort on developing a spiking brain model and a mouse body model, connecting over the Internet, and conducting bidirectional simulation while synchronizing them. Specifically, the brain model consisted of multiple regions including secondary motor cortex, primary motor and somatosensory cortices, basal ganglia, cerebellum and thalamus, whereas the mouse body model, provided by the Neurorobotics Platform of the Human Brain Project, had a movable forelimb with three joints and six antagonistic muscles to act in a virtual environment. Those were simulated in a distributed manner across multiple computers including the supercomputer Fugaku, which is the flagship supercomputer in Japan, while communicating via Robot Operating System (ROS). To incorporate models written in C/C++ in the distributed simulation, we developed a C++ version of the rosbridge library from scratch, which has been released under an open source license. These results provide necessary tools for distributed embodied simulation, and demonstrate its possibility and usefulness toward understanding animal behavior and behavioral change

A family with type A insulin resistance syndrome caused by a novel insulin receptor mutation

Summary:A 17-year-old boy was referred to our endocrinology clinic for a clinical investigation of hyperinsulinemia. An oral glucose tolerance test showed plasma glucose concentrations in the normal range. However, insulin concentrations were considerably elevated (0 min: 71 μU/mL; 60 min: 953 μU/mL), suggesting severe insulin resistance. An insulin tolerance test confirmed that he had insulin resistance. There was no apparent hormonal or metabolic cause, including obesity. The patient had no outward features of hyperinsulinemia, including acanthosis nigricans or hirsutism. However, his mother and grandfather also had hyperinsulinemia. Genetic testing showed that the patient (proband), his mother, and his grandfather had a novel p.Val1086del heterozygous mutation in exon 17 of the insulin receptor gene (INSR). Although all three family members have the same mutation, their clinical courses have been different. The onset of the mother\u27s diabetes was estimated at 50 years, whereas the grandfather developed diabetes at 77 years.Learning points:Type A insulin resistance syndrome is caused by mutations in the insulin receptor (INSR) gene and results in severe insulin resistance. Genetic evaluation should be considered in adolescents or young adults with dysglycemia when an atypical phenotype, such as severe insulin resistance, or a relevant family history is observed. Clinical courses may differ even if the same genetic mutation is found in a family

Relationship between the swallowing function and jaw-opening muscle strength in elderly cerebrovascular disease patients

目的：舌骨上筋群を含む開口筋は嚥下機能時の舌骨挙動に重要な役割を担うことから，本研究では，高齢脳血管疾患患者を対象に摂食嚥下機能と開口力の関係を明らかにすることを目的とした．方法：60歳以上の脳血管疾患入院患者の中から，嚥下障害と診断された者を対象とした．患者基本情報に関する情報はカルテから収集した．摂食嚥下機能は摂食嚥下障害臨床的重症度分類（以下DSS）を用いて評価を行うとともに，開口力は開口力測定器（TK2014）による測定を行った．開口力の性差はMann-WhitneyのU検定にて，DSSと開口力の相関関係はSpearmanの順位相関係数の検定にて解析した．また，DSSを正常範囲群と軽度障害群，誤嚥あり群の3群に分類し，Kruskal-Wallis検定にて開口力を比較した．結果：対象者は52名（男性25名，女性27名，平均年齢78.8±8.2歳），開口力の中央値は男性4.8 kg，女性3.0 kgであり，性差を認めた（p＝0.004）．全対象者および男性には年齢と開口力に有意な負の相関が認められた（r＝－0.362，p＝0.008；r＝－0.548，p＝0.005）．全てにおいてDSSと開口力には有意な正の相関関係を認めた（全対象者：r＝0.560，p＝0.000，男性：r＝0.636，女性：r＝0.587，ともにp＝0.001）．また，全対象者，男女ともに，正常範囲群に比べ，誤嚥あり群の開口力は有意に小さかった（全対象者：p＝0.006，男性：p＝0.024，女性：p＝0.015）．結論：高齢脳血管疾患患者において嚥下機能と開口力には有意な正の相関関係があり，誤嚥のある者は嚥下機能が正常範囲の者に比べ，開口力が低値であることが示唆された．Aim: In this study, we aimed to clarify the relationship between the swallowing function and the jaw-opening force after cerebrovascular disease. Methods: Elderly patients with a history of cerebrovascular disease with swallowing disability were enrolled in the present study. The swallowing function was evaluated using the Dysphagia Severity Scale (DSS), and the jaw-opening force was measured using Jaw-Opening Sthenometer (TK2014). The correlation between the DSS and jaw-opening force was analyzed using Spearman's correlation coefficient. Patients were also classified into three groups according to the DSS: normal, dysphagia, and aspiration groups. The jaw-opening forces of the three groups were compared using the Kruskal-Wallis test. Results: Fifty-two patients (27 women, average age 78.8±8.2 years) were recruited. A significant negative correlation was found between the patient age and jaw-opening force in all subjects (r=−0.362, p=0.008) as well as in men (r=−0.548, p=0.005). A significant positive correlation was found between the DSS and jaw-opening force in all subjects (r=0.560, p=0.000) and in both men (r=0.636, p=0.001) and women (r=0.587, p=0.001). The jaw-opening force of the aspiration group was significantly lower than that of the normal group in all subjects (p=0.006), as well as in men (p=0.024) and women (p=0.015). Conclusions: The DSS and jaw-opening force may have a significant positive correlation. Furthermore, it was shown that the jaw-opening force of the aspiration group was significantly lower than that of the normal-swallowing group

Image_1_Embodied bidirectional simulation of a spiking cortico-basal ganglia-cerebellar-thalamic brain model and a mouse musculoskeletal body model distributed across computers including the supercomputer Fugaku.JPEG

Embodied simulation with a digital brain model and a realistic musculoskeletal body model provides a means to understand animal behavior and behavioral change. Such simulation can be too large and complex to conduct on a single computer, and so distributed simulation across multiple computers over the Internet is necessary. In this study, we report our joint effort on developing a spiking brain model and a mouse body model, connecting over the Internet, and conducting bidirectional simulation while synchronizing them. Specifically, the brain model consisted of multiple regions including secondary motor cortex, primary motor and somatosensory cortices, basal ganglia, cerebellum and thalamus, whereas the mouse body model, provided by the Neurorobotics Platform of the Human Brain Project, had a movable forelimb with three joints and six antagonistic muscles to act in a virtual environment. Those were simulated in a distributed manner across multiple computers including the supercomputer Fugaku, which is the flagship supercomputer in Japan, while communicating via Robot Operating System (ROS). To incorporate models written in C/C++ in the distributed simulation, we developed a C++ version of the rosbridge library from scratch, which has been released under an open source license. These results provide necessary tools for distributed embodied simulation, and demonstrate its possibility and usefulness toward understanding animal behavior and behavioral change.</p