Sarcopenia is associated with worse recovery of physical function and dysphagia and a lower rate of home discharge in Japanese hospitalized adults undergoing convalescent rehabilitation.

OBJECTIVE: The aim of this study was to evaluate the effect of sarcopenia on functional outcomes, including activities of daily living (ADLs); dysphagia status; and the rate of home discharge, among hospitalized adults receiving convalescent rehabilitation. METHODS: A retrospective cohort study was conducted with 898 patients newly admitted to in-hospital convalescent rehabilitation wards at a single rehabilitation hospital in Japan. Baseline sarcopenia was diagnosed using muscle mass index and handgrip strength according to the criteria of the European Working Group on Sarcopenia in Older People, with the cutoff values of the Asian Working Group for Sarcopenia. The primary outcome was ADLs, assessed by Functional Independence Measure motor (FIM-motor) score at hospital discharge. The secondary outcomes included dysphagia, assessed by the Food Intake Level Scale (FILS), at discharge, and the rate of home discharge. Three multivariate analyses revealed an association between sarcopenia and the clinical outcomes. Each analysis adjusted for the following confounders: age, sex, time from onset, premorbid ADLs, comorbidities, cognitive level, nutritional status, major drugs, and admission diagnoses. RESULTS: After enrollment, 795 patients (mean age 74.9 ± 13.2 y; 59% women) were included in the final analysis. Admission diagnoses included stroke (n = 276; 34.7%), musculoskeletal disorders (n = 382; 48.1%), and hospital-associated deconditioning (n = 137; 17.2%). Of the 795 patients examined, 402 (50.6%) had sarcopenia. The multiple linear regression analysis showed that sarcopenia was independently associated with FIM motor score at discharge in patients with all disease types (ß = -0.189 [stroke], -0.240 [musculoskeletal disorders], -0.230 [hospital-associated deconditioning]; all P < 0.05), with FILS score at discharge only in patients with musculoskeletal disorders (ß = -0.271, P < 0.001), but not in patients with stroke (ß = -0.061, P = 0.375) or those with hospital-associated deconditioning (ß = -0.131, P = 0.070). The multiple logistic regression analysis showed that sarcopenia was associated with rate of home discharge in all disease types (odds ratio [OR], 0.201; 95% confidence interval [CI], 0.067-0.597 for stroke; OR, 0.242; 95% CI, 0.076-0.772 for musculoskeletal disorders; OR, 0.121; 95% CI, 0.110-0.347 for hospital-associated deconditioning; all P < 0.05). CONCLUSIONS: Sarcopenia is associated with worse recovery of ADLs and dysphagia and a lower rate of home discharge in hospitalized adults undergoing convalescent rehabilitation. Early detection of sarcopenia and treatment by rehabilitation nutrition should be implemented in this population.

Effects of branched-chain amino acids and vitamin D supplementation on physical function, muscle mass and strength, and nutritional status in sarcopenic older adults undergoing hospital-based rehabilitation: A multicenter randomized controlled trial.

AIM: To investigate the effects of branched-chain amino acids and vitamin D supplementation on physical function, muscle strength, muscle mass, and nutritional status in sarcopenic older adults undergoing hospital-based rehabilitation. METHODS: We carried out an 8-week, multicenter, randomized, controlled, blinded outcome, two-cohort parallel group intervention trial of sarcopenic older adults undergoing in-hospital rehabilitation. The eligibility criteria included older adults (aged ≥65 years) with low muscle strength (handgrip strength) and low muscle mass (calf circumference) according to the cut-off values for older Asians. The intervention group received branched-chain amino acids and vitamin D supplementation, whereas the control group did not. Both groups underwent low-intensity resistance training in addition to the post-acute rehabilitation program. The primary outcome of physical function (Functional Independence Measure-motor scores), and the secondary outcomes of muscle strength (handgrip strength), muscle mass (calf circumference) and nutritional status (body mass index) were measured at baseline and at the end of the intervention. RESULTS: Finally, a total of 68 patients were analyzed (intention-to-treat analysis): 35 in the intervention group and 33 in the control group. Functional Independence Measure-motor scores increased significantly in both groups over time (P < 0.05). However, no treatment-by-time effects were observed (median estimated difference 2.4, 95% confidence interval -1.2 to 7.1). Handgrip strength, calf circumference and body mass index increased significantly in both groups over time (P < 0.05), with significantly greater improvements in the intervention group (P = 0.041, 0.033 and 0.035, respectively). CONCLUSIONS: We showed that an 8-week intervention of branched-chain amino acids and vitamin D supplementation with low-intensity resistance training improves muscle-related outcomes in sarcopenic older adults undergoing hospital-based rehabilitation (UMIN000006238). Geriatr Gerontol Int 2019; 19: 12-17.

Hospital dental hygienist intervention improves activities of daily living, home discharge and mortality in post-acute rehabilitation.

AIM: To examine the effects of oral management provided by dental hygienists (DH) on patient outcomes in post-acute rehabilitation. METHODS: We carried out a retrospective cohort study with 1056 patients newly admitted to a post-rehabilitation hospital in Japan. DH care was defined as two or more consecutive instances of oral management provided by a ward DH during hospitalization. The primary outcome was the motor domain of Functional Independence Measure score at discharge. Other outcomes included the rate of home discharge; length of stay, all-cause in-hospital mortality, and oral, swallowing and nutritional status at discharge. Propensity score matching was carried out to control and adjust for patients' backgrounds to compare outcomes between patients who did or did not receive DH care. RESULTS: Of 1056 patients enrolled (mean age 71 years; 52.0% women; 73.1% with oral problems), 415 (39.3%) received DH care. Multivariate analyses using pair-matched patients showed that DH care was significantly associated with higher motor domain of Functional Independence Measure score at discharge (ß = 0.281, P = 0.041), shorter length of stay (ß = 0.446, P = 0.044), higher rate of home discharge (odds ratio 1.202, 95% confidence interval 1.026-1.491, P = 0.037) and lower mortality (hazard ratio 0.818, 95% confidence interval 0.738-0.952, P = 0.037) after adjusting for potential covariates. CONCLUSIONS: DH oral management improves patient outcomes, including activities of daily living, home discharge and in-hospital mortality in post-acute rehabilitation. Early detection of oral problems, early oral treatment by dental professionals, and cooperation between medical and dental professionals should be implemented. Geriatr Gerontol Int 2019; 19: 189-196.

Systemic Inflammation in the Recovery Stage of Stroke: Its Association with Sarcopenia and Poor Functional Rehabilitation Outcomes.

OBJECTIVE: The aim of our study was to investigate how systemic inflammation relates to sarcopenia and its impact on functional outcomes in the recovery stages of stroke. METHODS: A retrospective cohort study was performed in consecutive patients admitted to convalescent rehabilitation wards following stroke. Patients with acute or chronic high-grade inflammatory diseases were excluded. Systemic inflammation was evaluated using the modified Glasgow Prognostic Score (mGPS). Sarcopenia was defined as a loss of skeletal muscle mass and decreased muscle strength, with the cut-off values set by the Asian Working Group for Sarcopenia. The primary outcome was the motor domain of the Functional Independence Measure (FIM-motor). Univariate and multivariate analyses were used to determine whether mGPS was associated with sarcopenia and FIM-motor at discharge. RESULTS: The study included 204 patients (mean age 74.1 years, 109 men). mGPS scores of 0, 1, and 2 were assigned to 149 (73.0%), 40 (19.6%), and 13 (6.4%) patients, respectively. Sarcopenia was diagnosed in 81 (39.7%) patients and was independently associated with stroke history (odds ratio [OR] 1.890, P=0.027), premorbid modified Rankin scale (OR 1.520, P=0.040), body mass index (OR 0.858, P=0.022), and mGPS score (OR 1.380, P=0.021). Furthermore, the mGPS score was independently associated with sarcopenia (OR 1.380, P=0.021) and FIM-motor at discharge (ß=-0.131, P=0.031). CONCLUSION: Systemic inflammation is closely associated with sarcopenia and poor functional outcomes in the recovery stage of stroke. Early detection of systemic inflammation and sarcopenia can help promote both adequate exercise and nutritional support to restore muscle mass and improve post-stroke functional recovery.

The pattern of norepinephrine release in the hypothalamic paraventricular nucleus in response to repeated peripheral nerve injury differs in the acute and chronic stage in conscious rats.

We investigated the change in norepinephrine (NE) release in the hypothalamic paraventricular nucleus (PVN) in response to ligature of the median and ulnar nerves using a brain microdialysis technique in conscious rats. Primary ligature was performed of the right median and ulnar nerves, and then repeated injury was performed on the left nerves 6 h or 3 weeks after the primary ligature. Primary ligature of the nerves produced a significant increase that peaked at a mean 330% above basal NE release in the first 20 min. The NE release after reinjury 6 h later was significantly higher (a peak of 650%) than after primary nerve injury, although that at 3 weeks was significantly lower (a peak of 280%). The present study demonstrated that peripheral nerve injury induces an elevated response of the PVN, which is an integral center of the autonomic nervous system. NE release after reinjury differed in the acute and chronic stages.

Shoulder-strengthening exercise with an orthosis for multidirectional shoulder instability: quantitative evaluation of rotational shoulder strength before and after the exercise program.

We evaluated the results of shoulder-strengthening exercises with our novel shoulder orthosis to stabilize the scapula in 46 patients with multidirectional shoulder instability. We quantified the changes in muscle strength produced by our rehabilitation program. Our study included 34 female patients and 12 male patients (mean age, 20 years) with 73 affected shoulders. All patients performed the prescribed exercise program for 8 weeks. Their mean total scores on the modified Rowe grading system significantly increased from 51.9 to 74.9 points (P <.001). The mean peak torque of internal and external rotation, measured with an isokinetic dynamometer, significantly increased (P <.05); the mean external/internal peak torque ratios significantly decreased (P <.05) and were normalized upon completion of the rehabilitation program. Because of failure of conservative treatment, 3 patients underwent surgery at a mean follow-up duration of 7 years. We conclude that the prescribed shoulder-strengthening exercise represents a useful treatment option for patients with multidirectional shoulder instability.

The effect of perfusion with UW solution on the skeletal muscle and vascular endothelial exocrine function in rat hindlimbs.

BACKGROUND: The effect of University of Wisconsin (UW) solution perfusion for extremity preservation is still unknown although it is widely used. The purpose of this study is to examine the effect of UW solution perfusion on skeletal muscle preservation in a rat model. MATERIALS AND METHODS: Rat hindlimbs were amputated and either preserved with UW solution perfusion (UW perfusion group) or given no perfusion (no-perfusion group) for 5 h at 25 degrees C. They were then transplanted to other isogeneic rats. ATP in the muscle and serum creatine phosphokinase were measured after 24 h of reperfusion. The vascular endothelial function of the femoral artery rings was measured before and after 24 h of reperfusion in the presence or absence of indomethacin (cyclooxygenase inhibitor) and L-NMMA (nitric oxide synthase inhibitor). TEA (calcium-activated potassium channel inhibitor) was also used to verify the vasodilator function. Reperfusion blood flow was monitored during the first 2 h of reperfusion. RESULTS: ATP in the UW perfusion group was significantly decreased after 24 h of reperfusion, while that in the no-perfusion group recovered. Reperfusion blood flow in the UW solution perfusion group was significantly lower than that in the no-perfusion group. Acetylcholine-induced relaxation in the UW perfusion group was significantly reduced before and after 24 h of reperfusion compared to that in the no-perfusion group and was mostly diminished by indomethacin and L-NMMA administration. CONCLUSIONS: Skeletal muscle injury is augmented by UW solution perfusion, probably due to deterioration of the vascular endothelial function resulting in blood supply diminution.

Acute changes in the axonal cytoskeleton after mild stretching of the rat brachial plexus.

We have developed an animal model to investigate acute changes in the axonal cytoskeleton caused by a mild stretching of the peripheral nerve in the upper limbs of rats. Rat forelimbs were continuously stretched at 2 N for 1 h. Thereafter, a part of the brachial plexus and median nerve were harvested and processed for electron microscopic analysis. The total number of microtubules in the brachial plexus decreased to 55% of that of the control animals (p<0.05) without change in the number of neurofilaments. No significant changes in microtubules or neurofilaments were observed in the median nerve. By Western blotting analysis, the amount of tau protein in the stretch group significantly decreased in the brachial plexus but not in the median nerve. However, no significant changes in the amount of tubulin protein were observed in either the brachial plexus or median nerve. These results suggest that the microtubules were depolymerized by stretching of the brachial plexus and that the depolymerization may have been mediated by the decrease in the tau protein.

Effect of nitric oxide on the contractile function of rat reperfused skeletal muscle.

BACKGROUND: The involvement of nitric oxide (NO) in ischemia-reperfusion injury remains controversial and has been reported to be both beneficial and deleterious. The purpose of this study was to examine the contribution of NO and superoxide to skeletal muscle function using an ischemic revascularized hind limb model in rats. PATIENTS AND MATERIALS: Warm ischemia produced by vascular pedicle clamping was sustained for 3 h. The animals were divided into four groups according to the solution administrated: (1) saline, (2) N-methyl-L-arginine acetate (L-NMMA), (3) L-NMMA + N-(N-L-g-glutamyl-S-nitroso-l-cysteinyl)glycine (S-nitrosoglutathione), or (4) superoxide dismutase (SOD). Saline, L-NMMA, or L-NMMA + S-nitrosoglutathione was infused for the first 2 h of reperfusion. The SOD was administered as an intravenous bolus 5 min before the onset of reperfusion. Postischemic blood flow was measured by a Doppler flow meter. Muscle contractile function was determined after 24 h of reperfusion. RESULTS: Postischemic blood flow was significantly decreased by the L-NMMA infusion compared with that in the saline-treated group. No significant difference in postischemic blood flow was noted in the saline-, L-NMMA + S-nitrosoglutathione-, and SOD-treated groups. Contractile function of the gastrocnemius muscle in the L-NMMA-and SOD-treated groups, but not in the L-NMMA + S-nitrosoglutathione group, was significantly better than that in the saline-treated group. CONCLUSION: Limiting postischemic blood flow and SOD infusion are both beneficial in decreasing the ischemia-reperfusion injury of skeletal muscle. S-Nitrosoglutathione infusion following suppression of endogenous NO production does not reduce ischemia-reperfusion injury.