Association of Admission Hyperglycemia with Clinical Outcomes in Japanese Patients with Acute Large Vessel Occlusion Stroke: A Post-hoc Analysis of the Recovery by Endovascular Salvage for Cerebral Ultra-acute Embolism Japan Registry 2

博士（医学）福島県立医科大

RELATIONSHIP BETWEEN SALT INTAKE AND GNRI IN ELDERLY DIALYSIS PATIENTS

While the recommended salt intake in dialysis patients is no more than 5g/day in the KDOQI guideline, and 6g/day in the JSH 2009 guideline, reducing salt consumption is difficult on the traditional Japanese diet. If a patient is malnourished, a low-salt diet poses a risk of aggravating the nutritional deficiency. Since elderly dialysis patients have nutritional deficiencies underlying their condition, the recommended low-salt diet may prevent these patients from receiving adequate nutrition. In the present study, factors associated with nutritional status in the elderly were assessed using the Geriatric Nutritional Risk Index (GNRI), which is considered to correlate with predictor of mortality among dialysis patients. Participating patients were anuric, had been maintained on dialysis for at least 2 years, and were 65 years of age or older. Factors assessed for their possible correlations with GNRI were primary disease, presence of spouse, presence of cohabiting family, weight gain, and estimated salt intake. We analyzed 36 patients (age 74.3±5.4 years, 50% males). GNRI was 90.9±7.7, and salt intake (8.02±1.94) correlated with GNRI (r=0.41, P=0.02). No correlations were detected for the presence of spouse or cohabiting family, which would have contributed to nutrition. In conclusion, the higher the salt intake, the better GNRI tended to be. This raised the possibility that it would be advantageous to avoid excessive salt restriction in nutritional training

examination of the effects of liraglutide on diabetic nephropathy

Liraglutide (Lira), a glucagon-like peptide-1 receptor agonist, can be administered to diabetic patients with renal failure without dose reduction, but experience with the use of Lira in these patients is limited. This study was designed to examine the effects of 6-month Lira administration on glucose metabolism, body mass index (BMI), and renal function in 18 patients with diabetic nephropathy (eGFR <60 ml/min). The study included 18 patients with diabetic nephropathy who were on insulin/oral hypoglycemic medications (6 men, 12 women; average age, 60 years; HbA1c, 8.4%; BMI, 29.4 ± 8.2; duration of diabetes, 12 years; eGFR, 55.2 ± 6.3 ml/min/1.73 m2). Lira was given either in combination or as monotherapy. After 6 months of Lira treatment, changes in HbA1c levels, casual blood glucose levels, BMI, and eGFR were examined. The average HbA1c and casual blood glucose levels were significantly decreased after 6-month Lira administration (HbA1c before administration 8.4%, 7.9% at Month 1, 7.4% at Month 2, 7.1% at Month 3, 7.1% at Month 6; p < 0.01 respectively, Paired T test). There were, however, no significant changes in renal function. In conclusion, these results suggest that the administration of Lira in patients with diabetic nephropathy may improve glucose metabolism and reduce BMI without affecting renal function or albuminuria in the short term

Detection of Atrial Fibrillation Using Insertable Cardiac Monitors in Patients With Cryptogenic Stroke in Japan (the LOOK Study): Protocol for a Prospective Multicenter Observational Study

BackgroundParoxysmal atrial fibrillation (AF) is a probable cause of cryptogenic stroke (CS), and its detection and treatment are important for the secondary prevention of stroke. Insertable cardiac monitors (ICMs) are clinically effective in screening for AF and are superior to conventional short-term cardiac monitoring. Japanese guidelines for determining clinical indications for ICMs in CS are stricter than those in Western countries. Differences between Japanese and Western guidelines may impact the detection rate and prediction of AF via ICMs in patients with CS. Available data on Japanese patients are limited to small retrospective studies. Furthermore, additional information about AF detection, including the number of episodes, cumulative episode duration, anticoagulation initiation (type and dose of regimen and time of initiation), rate of catheter ablation, role of atrial cardiomyopathy, and stroke recurrence (time of recurrence and cause of the recurrent event), was not provided in the vast majority of previously published studies. ObjectiveIn this study, we aim to identify the proportion and timing of AF detection and risk stratification criteria in patients with CS in real-world settings in Japan. MethodsThis is a multicenter, prospective, observational study that aims to use ICMs to evaluate the proportion, timing, and characteristics of AF detection in patients diagnosed with CS. We will investigate the first detection of AF within the initial 6, 12, and 24 months of follow-up after ICM implantation. Patient characteristics, laboratory data, atrial cardiomyopathy markers, serial magnetic resonance imaging findings at baseline, 6, 12, and 24 months after ICM implantation, electrocardiogram readings, transesophageal echocardiography findings, cognitive status, stroke recurrence, and functional outcomes will be compared between patients with AF and patients without AF. Furthermore, we will obtain additional information regarding the number of AF episodes, duration of cumulative AF episodes, and time of anticoagulation initiation. ResultsStudy recruitment began in February 2020, and thus far, 213 patients have provided written informed consent and are currently in the follow-up phase. The last recruited participant (May 2021) will have completed the 24-month follow-up in May 2023. The main results are expected to be submitted for publication in 2023. ConclusionsThe findings of this study will help identify AF markers and generate a risk scoring system with a novel and superior screening algorithm for occult AF detection while identifying candidates for ICM implantation and aiding the development of diagnostic criteria for CS in Japan. Trial RegistrationUMIN Clinical Trial Registry UMIN000039809; https://tinyurl.com/3jaewe6a International Registered Report Identifier (IRRID)DERR1-10.2196/3930

Global impact of COVID-19 on stroke care.

BACKGROUND: The COVID-19 pandemic led to profound changes in the organization of health care systems worldwide. AIMS: We sought to measure the global impact of the COVID-19 pandemic on the volumes for mechanical thrombectomy, stroke, and intracranial hemorrhage hospitalizations over a three-month period at the height of the pandemic (1 March-31 May 2020) compared with two control three-month periods (immediately preceding and one year prior). METHODS: Retrospective, observational, international study, across 6 continents, 40 countries, and 187 comprehensive stroke centers. The diagnoses were identified by their ICD-10 codes and/or classifications in stroke databases at participating centers. RESULTS: The hospitalization volumes for any stroke, intracranial hemorrhage, and mechanical thrombectomy were 26,699, 4002, and 5191 in the three months immediately before versus 21,576, 3540, and 4533 during the first three pandemic months, representing declines of 19.2% (95%CI, -19.7 to -18.7), 11.5% (95%CI, -12.6 to -10.6), and 12.7% (95%CI, -13.6 to -11.8), respectively. The decreases were noted across centers with high, mid, and low COVID-19 hospitalization burden, and also across high, mid, and low volume stroke/mechanical thrombectomy centers. High-volume COVID-19 centers (-20.5%) had greater declines in mechanical thrombectomy volumes than mid- (-10.1%) and low-volume (-8.7%) centers (p \u3c 0.0001). There was a 1.5% stroke rate across 54,366 COVID-19 hospitalizations. SARS-CoV-2 infection was noted in 3.9% (784/20,250) of all stroke admissions. CONCLUSION: The COVID-19 pandemic was associated with a global decline in the volume of overall stroke hospitalizations, mechanical thrombectomy procedures, and intracranial hemorrhage admission volumes. Despite geographic variations, these volume reductions were observed regardless of COVID-19 hospitalization burden and pre-pandemic stroke/mechanical thrombectomy volumes