BACKGROUND:Respiratory sarcopenia, defined as a combination of respiratory muscle weakness and decreased respiratory muscle mass, is a novel concept with unclear prevalence and clinical relevance in the chronic obstructive pulmonary disease (COPD) population. This study aimed to evaluate the prevalence of respiratory sarcopenia in a COPD-enriched smoking cohort and its association with clinical features. METHODS:This prospective observational study included smokers who were categorised into four groups based on respiratory muscle weakness (% maximal inspiratory pressure and/or % maximal expiratory pressure <80%) and low skeletal muscle index (<7.0 kg/m2 for men and <5.7 kg/m2 for women). Pulmonary function, physical function, and the 6-min walking distance (6MWD) were compared between the groups. RESULTS:A total of 184 smokers (79% with COPD) were classified into the following groups: normal (n = 77, 42%), muscle mass loss only (n = 32, 17%), respiratory muscle weakness only (n = 53, 29%), and probable respiratory sarcopenia (n = 22, 12%). The probable respiratory sarcopenia group demonstrated a significantly lower %FEV1 and elevated RV/TLC. Compared with the other groups, the probable respiratory sarcopenia group exhibited markedly impaired physical performance, with reduced gait speed, 6MWD, and knee extension strength. Multivariable regression analysis revealed that probable respiratory sarcopenia (β = -0.24; p = 0.02) was independently associated with a lower 6MWD after adjusting for age, sex, height, body mass index, smoking pack-year, and FEV1 (adjusted R2 = 0.48). CONCLUSIONS:Probable respiratory sarcopenia, which was identified in 12% of elderly smokers, was independently associated with exercise capacity and may be a clinical phenotype requiring early detection and intervention to prevent functional decline. Registered at UMIN (UMIN000049755).

Background Longitudinal changes in skeletal muscle mass and quality after allogeneic hematopoietic stem cell transplantation remain unclear. This study used bioelectrical impedance analysis to assess these changes and their associations with physical function, infection, and acute graft-versus-host disease. Methods This retrospective study included 111 adults who underwent allogeneic hematopoietic stem cell transplantation. Skeletal muscle mass index and phase angle, an indicator of muscle quality, were assessed by bioelectrical impedance analysis before transplantation, 4 weeks after transplantation, and at discharge. Patients were assigned to four combined categories based on normal or low muscle mass and quality. Outcomes included 6-minute walk distance, infection, and acute graft-versus-host disease. Results Skeletal muscle mass index and phase angle decreased significantly after transplantation (p < 0.05), with phase angle declining earlier and more markedly. At discharge, 53.1% of patients were classified as Category 3. At 4 weeks, the decline in 6-minute walk distance was significantly greater in Categories 2 and 3 than in Categories 0 and 1. In multivariable analyses, Categories 2 and 3 were independently associated with infection, whereas Category 3 was independently associated with acute graft-versus-host disease. Conclusion Skeletal muscle mass and quality deteriorated after allogeneic hematopoietic stem cell transplantation, and low muscle quality was more closely associated with adverse outcomes. Pre-transplant bioelectrical impedance analysis-based assessment of muscle quality may help identify patients at risk of infection, acute graft-versus-host disease, and delayed physical recovery and may support further evaluation of prehabilitation strategies.

PurposeThis study aimed to clarify changes in muscle morphology, including normal muscle, intramuscular fat, and low-density muscle after TKA.MethodsThe retrospective cohort study was conducted with 71 patients with TKA. The cross-sectional area (CSA) of the lower limb muscles was assessed using computed tomography images. The muscle tissues were divided based on Hounsfield Units (HU) into intramuscular fat (-190 to -30 HU), low-density muscle (-29 to 29 HU), and normal-density muscle (30 to 150 HU). These measurements and comparisons were performed before and more than six months after TKA.ResultsThe results revealed fat ratio (%) was significantly decreased in vastus lateralis, gluteus maximus, medius, minimus, and iliopsoas after TKA (2.0 to 1.9, 11.0 to 8.1, 3.5 to 2.7, 10.5 to 8.2, 2.4 to 1.8, respectively). In these muscles, intramuscular fat CSA also decreased, other than iliopsoas. The normal-density muscle CSA (cm2) increased in vastus lateralis, gluteus maximus, medius, minimus, iliopsoas, and gastrocnemius medial head (7.46 to 9.00, 3.74 to 5.47, 3.81 to 3.93, 3.27 to 3.64, 8.83 to 10.20, 5.70 to 6.03, respectively). The low-density muscle CSA increased in gluteus minimus and ankle plantar flexor muscles, except for gastrocnemius.ConclusionNormal-density muscle CSA increased in the vastus lateralis, gluteus muscles, iliopsoas, and gastrocnemius medial head, while intramuscular fat CSA decreased in the vastus lateralis and gluteus muscles. Future studies clarifying the TKA and muscle morphology causality incorporating control groups and functional outcome measures are required to determine the clinical relevance of these morphological changes.

PurposeThis study aimed to investigate the safety, feasibility, and effect on hemiparetic muscle activity during sit-to-stand exercises using the lumbar type HAL in patients with acute-phase lower limb hemiparesis caused by ischemic stroke, cerebral hemorrhage, or postoperative brain tumor.MethodsThis randomized crossover study included twelve participants (ischemic stroke: 6, cerebral hemorrhage: 2, brain tumor: 4) for part 1, which assessed safety and comfort of sit-to-stand exercise using HAL, and ten participants (ischemic stroke: 4, cerebral hemorrhage: 3, brain tumor: 3) for part 2, which investigated the effect of HAL on muscle activities during sit-to-stand exercises. Participants performed either five sets (part 1) or a single set (part 2) of ten repetitions of sit-to-stand exercises under two conditions: with and without HAL assistance. Outcome included vital signs (blood pressure, heart rate, and percutaneous oxygen saturation), fatigue level in part 1. Muscle activity of bilateral gluteus maximus, biceps femoris, and vastus lateralis during the exercises were assessed in part 2. Outcomes were compared between the two conditions.ResultsThe results demonstrated that there were no significant changes in vital signs and fatigue between two conditions. Furthermore, HAL effectively increased muscle activity (μV) in the hemiparetic side vastus lateralis during the exercises (median, quartile range: 101.1, 55.8-125.9 vs. 79.9, 52.0-103.3, p = 0.03).ConclusionsThese findings suggest that the lumbar type HAL can be safely and feasibly used in patients with acute brain injury-related lower limb paresis, with potential effects on hemiparetic muscle activation. However, these results should be interpreted cautiously as exploratory observations.Registry informationClinical utility of cybernic system for patients with neurological diseases causing who need comprehensive nursing care (Clinical utility of cybernic system for patients with neurological diseases causing who need comprehensive nursing care (CUCSPND)), https://jrct.niph.go.jp/en-latest-detail/jRCTs052180074, jRCTs052180074.The effect of motor therapy using robot suit HAL for the patients with damaged brain (motor therapy using robot suit HAL), https://jrct.niph.go.jp/en-latestdetail/jRCTs052180223, jRCTs052180223.

BACKGROUND:Kyoto University Substance (KUS) 121 is a novel modulator of valosin-containing protein (VCP), with reported protective effects against ischemia/reperfusion (I/R) injury across various organs. This study evaluated the therapeutic effect of KUS121 on axial pattern flaps subjected to I/R injury. METHODS:Axial pattern flaps nourished by superficial epigastric vessels were created in Sprague-Dawley rats, measuring 3 × 6 cm, and subjected to 8 hours of ischemia followed by reperfusion. KUS121 (100 mg/kg) was administered intraperitoneally 1 hour before flap elevation (KUS121-pretreated group) or immediately after reperfusion (KUS121-posttreated group), followed by once-daily administration from postoperative day 1 to 6. The control group received no KUS121. Flap survival was evaluated macroscopically on day 7. Histological and immunohistochemical evaluations were performed on day 3 in the KUS121-pretreated and control groups. RESULTS:Flap survival was significantly higher in the KUS121-pretreated group (80.7±7.8%) and KUS121-posttreated group (96.2±1.1%) than in the control group (48.8±5.3%; p=0.002 and p<0.001, respectively). On day 3, TdT-mediated dUTP-biotin nick-end labeling (TUNEL)-positive cells were significantly decreased in the KUS121-pretreated group compared to the control group in the distal flap region (2.3±0.5 vs. 7.7±1.1 cells/field; p<0.001) and in the middle region (2.3±0.4 vs. 9.0±1.1 cells/field; p<0.001). C/EBP homologous protein (CHOP)-positive cells were also significantly decreased in the KUS121-pretreated group compared with controls in the distal (9.0±1.5 vs. 21.4±1.8 cells/field; p<0.001) and middle (6.8±0.8 vs. 23.5±2.9 cells/field; p<0.001) regions. CONCLUSIONS:KUS121 markedly improves axial pattern flap survival by attenuating I/R-induced apoptosis and endoplasmic reticulum stress.

Sarcopenia is a common comorbidity in older adults. This study aimed to clarify the association between preoperative sarcopenia, based on the Asian Working Group 2025 (AWGS2025) criteria, and postoperative outcomes in older patients with early stage non-small cell lung cancer. This retrospective study included patients aged ≥ 75 years who underwent lung resection for clinical stage I lung cancer. Sarcopenia was diagnosed based on grip strength and bioelectrical impedance-derived muscle mass measured according to the AWGS2025 criteria. The primary outcomes were postoperative pulmonary complications (PPCs), defined as Clavien–Dindo classification Grade ≥ 2 within 30 days, and unplanned readmission within 90 days after surgery. A logistic regression analysis was used to identify the factors associated with postoperative outcomes. Among the 107 patients, 28 (26

Bioelectrical impedance analysis (BIA) has emerged as a simple, noninvasive method for evaluating skeletal muscle. However, BIA is sensitive to fluctuations in body water and can overestimate skeletal muscle mass, which may obscure true changes, particularly in the early post-transplant period, when body water content often increases. In this study, we explored whether correction formulas originally used in the dialysis field to estimate ideal dry weight could be applied to skeletal muscle measurements to reduce overestimation of skeletal muscle mass. This retrospective observational study included patients who underwent allogeneic hematopoietic stem cell transplantation. Physical function and body composition were assessed before transplantation and 4 weeks after transplantation. Physical function was evaluated using knee extensor strength and the six-minute walk distance (6MWD). Body composition was assessed using appendicular skeletal muscle mass (ASM) as an index of muscle quantity, phase angle as an index of muscle quality, and the extracellular-to-total body water ratio (ECW/TBW) as an indicator of fluid balance. A correction formula for estimating ideal dry body weight was applied to adjust ASM. Differences between unadjusted and adjusted ASM were compared at each time point. Pre- and post-transplant changes in phase angle and ECW/TBW were also evaluated. Sixty-four adult patients aged 20–70 years (median age, 51.5 years) were included. After transplantation, adjusted ASM differed significantly from unadjusted ASM. Knee extensor strength, 6MWD, and phase angle (median, 4.4°to 3.9°, p < 0.001) decreased significantly, whereas ECW/TBW increased significantly (median, 0.391 to 0.399; p < 0.001). Unadjusted ASM did not change significantly from pre- to post-transplantation (median, 17.7 to 17.5 kg; p = 0.17), whereas adjusted ASM decreased significantly (median, 17.6 to 17.2 kg; p = 0.01). Applying a dialysis-derived adjustment formula to skeletal muscle measurements may help correct overestimation of skeletal muscle mass due to increased body water content in the early post-transplant period. After transplantation, both adjusted ASM and phase angle decreased significantly. These results suggest that BIA may have potential utility during the immediate post-transplant period, although its clinical applicability requires further validation.

INTRODUCTION:Emphysema and airway disease are major pathological features in smokers, including those with chronic obstructive pulmonary disease (COPD); however, how these two distinct pathologies interact to impair exercise capacity remains poorly understood. This study aimed to comprehensively compare physical performance, body composition, and physical activity across four computed tomography (CT)-based phenotypes: emphysema-dominant (ED), airway disease-dominant (AD), both-dominant (Mixed), and neither-dominant (Mild). METHODS:This cross-sectional analysis used baseline data from a single-center prospective cohort of smokers enriched for COPD. Alongside spirometry and 6-minute walk distance (6MWD), chest CT was performed to quantify the low attenuation volume percentage (LAV%) and airway wall area (Pi10), which enabled classification into Mild, AD, ED, and Mixed phenotypes. RESULTS:A total of 181 smokers (77.9% with COPD) were categorized into Mild, AD, ED, and Mixed groups (n = 62/33/55/31, respectively). The Mixed group exhibited a significantly shorter 6MWD compared with the Mild group. Furthermore, the ED and Mixed phenotypes showed greater dyspnea and oxygen desaturation during exercise. In multivariable analysis, both LAV% and Pi10 were independently associated with 6MWD after adjusting for relevant clinical covariates and muscle strength. A significant interaction between LAV% and Pi10 was observed, demonstrating their synergistic detrimental effect on 6MWD. CONCLUSION:Emphysema and airway disease independently and synergistically contribute to impaired exercise tolerance in smokers. CT-based phenotyping, particularly identification of the Mixed phenotype, may be useful to stratify functional risk and guide targeted interventions for preserving physical function in this population.

Peripheral nerve injuries (PNIs) often cause persistent sensory and motor deficits that impair quality of life. To improve outcomes, cell-based therapies have been explored, and Schwann cells (SCs) are considered a promising option because of their essential roles in myelination and neurotrophic support. However, the clinical use of autologous SCs is limited by donor site morbidity and challenges in large-scale expansion, leading to growing interest in human induced pluripotent stem cell (iPSC)–derived SCs. This study aimed to verify the therapeutic effects of iPSC-derived SCs in vivo and to determine whether the differentiation stage of the SCs influences their efficacy. We generated dibutyryl-cAMP–treated mature SCs and untreated immature SCs from iPSCs and transplanted them into a rat sciatic nerve crush injury model. Morphometric analysis showed that myelinated fiber density (fibers/mm 2 ) was significantly higher in the mature SC group than in the control group (12 602 ± 1419 vs 10 105 ± 1673). Myelinated axon diameter (µm) was also significantly greater in the mature SC group (4.73 ± 0.25) compared with the immature SC (4.06 ± 0.28) and control (3.86 ± 0.15) groups. Electrophysiological testing demonstrated that compound muscle action potentials in the pedal adductor muscle were detected only in the mature SC group within 28 days after surgery. Western blot analysis of the tibialis anterior muscle showed significantly higher myosin heavy chain 1 (MYH1) expression in the mature SC group than in the control group. Quantitative reverse transcription-polymerase chain reaction revealed higher expression of bNGF , CCL2 , and LAMA2 in mature SCs than in immature SCs. Pathological analysis suggested accelerated Wallerian degeneration in the mature SC group. These results demonstrate that mature iPSC-derived Schwann cells, rather than immature ones, most effectively promote nerve regeneration both histologically and functionally in vivo, highlighting the critical importance of the SC differentiation stage for therapeutic efficacy.

OBJECTIVE:Selective intraindividual weakness in successive processing, which is a unique verbal working memory scale included in the Das-Naglieri Cognitive Assessment System (CAS), is considered one of the intrinsic neurocognitive characteristics in pediatric moyamoya disease (MMD). The aim of the study was to elucidate the association between cerebral blood flow (CBF) and weakness in successive processing, and to identify regions related to the weakness. METHODS:The present cross-sectional study included children who had been diagnosed with MMD and were assessed using neuropsychological tests before surgery between June 2016 and December 2023. According to the CAS manual, intraindividual difference was calculated by subtracting the mean of the 4 standard scores from each standard score. Each patient was classified as either manifesting "intraindividual weakness in successive processing" (intraindividual difference of successive processing < 0) or not (intraindividual difference of successive processing ≥ 0), and CBF acquired with resting-state SPECT was compared between groups. Three-dimensional stereotactic surface projection (3D-SSP) was also used for topographical comparison of CBF. RESULTS:Of 51 children (mean age ± SD at admission 8.0 ± 2.6 years) who underwent preoperative neuropsychological tests, 43 were included in the CBF analysis. Both standard scores and intraindividual difference of the CAS significantly varied across 4 domains (p = 0.006 and p < 0.001, respectively), and those of successive processing were the lowest. Of the children analyzed, 35 (68.7%) were classified as having intraindividual weakness in successive processing. Multiple logistic regression analysis revealed the severest ischemic grade was significantly associated with intraindividual weakness in successive processing (OR 5.49 [95% CI 1.12-27.06]). Three-dimensional SSP analysis demonstrated a significant CBF decrease in the left dorsolateral and medial prefrontal cortexes in the children showing intraindividual weakness in successive processing compared with those who did not. CONCLUSIONS:Intraindividual weakness in successive processing typical of MMD might be associated with reduced CBF in the dorsolateral and medial prefrontal cortex, predominantly in the left hemisphere. Further studies in this area could contribute to the improvement of long-term social outcomes for patients with MMD.

Background: Carpal tunnel syndrome (CTS), which is frequently encountered in orthopaedic practice, is an early symptom of wild-type transthyretin amyloidosis (ATTRwt). ATTRwt has a high misdiagnosis rate, making early detection difficult, which in turn delays treatment and results in a poor prognosis. Therefore, we herein investigated whether the early diagnosis of CTS leads to the early detection and treatment of ATTRwt, ultimately improving its prognosis. Methods: This study included 42 patients diagnosed with ATTRwt (34 males, 8 females; mean age: 77.7 years). We investigated the presence of a history of CTS, the affected side, the duration from the CTS diagnosis to ATTRwt confirmation, the number of deaths and the number of referrals from orthopaedic surgeons to cardiologists. Results: A history of CTS was present in 26 cases, with 15 being bilateral CTS. The average duration from the CTS diagnosis to ATTRwt confirmation was 6.4 years. Four patients died, and there were no referrals from orthopaedic surgeons to cardiologists. Conclusions: The present results showed that 61.9% of patients diagnosed with ATTRwt had a history of CTS, suggesting that CTS is a predictive factor for ATTRwt. However, the average duration from the CTS diagnosis to ATTRwt confirmation was 6.4 years, indicating a significant delay. One reason for this delay is that orthopaedic surgeons may not be aware of the relationship between CTS and ATTRwt, as suggested by the result showing no referrals from orthopaedic surgeons to cardiologists. Level of Evidence: Level IV (Diagnostic).

OBJECTIVES:To examine the factors predicting the recovery of post-stroke activities of daily living during the entire hospitalization period, focusing on skeletal muscle characteristics, nutrition, and physical activity in the acute phase. MATERIALS AND METHODS:This prospective observational study included 55 stroke patients (72.4 ± 8.9 years). The primary outcome measures were relative functional gain (RFG) and efficiency (RFE) calculated using the Functional Independence Measure motor items. The FIM was assessed upon admission to the acute hospital and on discharge from the acute or convalescent hospital. Phase angle upon admission were evaluated using a bioimpedance analyzer (InBody S10). The energy sufficiency ratio was evaluated using nutritional intake surveys for two weeks from the onset. Metabolic equivalents were measured using a tri-axial accelerometer (ActiGraph wGT3X-BT). Hierarchical multiple regression analyses were performed with RFG and RFE as the dependent variables. RESULTS:The FIM motor score increased from 34.7 ± 22.1 at admission to 81.5 ± 10.2 at discharge. Multiple regression analysis revealed that phase angle (β = 0.529) was significantly associated with RFG (R2 = 0.223). The phase angle (β = 0.314) and the energy sufficiency ratio (β = 0.312) were significantly associated with RFE (R2 = 0.319). The interaction between nutrition and physical activity was observed, with energy sufficiency ratio emerging as a significant predictor in participants with low levels of physical activity. CONCLUSIONS:Phase angle and nutritional management during the acute phase are important factors for improving activities of daily living during total hospital stay in stroke patients.

Tumor surgery or trauma in the maxillofacial region may cause injuries to peripheral nerves, such as facial nerves. The gold standard of treatment for peripheral nerve injury has been autologous nerve grafting. Since new peripheral nerve regeneration technologies are required, three-dimensional (3D) structures fabricated only from cells by using Bio 3D printers are attracting attention. Dental pulp stem cells (DPSCs) are a promising option as a cell source because of their high clonogenic, proliferative, and multidifferentiation potentials. In this study, nerve conduits were fabricated from DPSCs using a Bio 3D printer, and their potential for nerve regeneration was evaluated in a rat facial nerve injury model. DPSCs were obtained from wisdomteeth of patients and cultured. A 5 mm Bio 3D conduit was fabricated by using a Bio 3D printer. Six F344 rnu-/rnu- rats with immune deficiency (10 weeks old, body weight: 190-240 g) were divided into two groups: a Bio 3D group (n = 3) and a silicone tube group (n = 3). The 5 mm Bio 3D conduits and silicone tubes were transplanted into 4 mm defects. Evaluation was performed at 12 weeks after the surgery. The whiskers of immunodeficient rats in both groups were moving. The number of myelinated axons was larger in the Bio 3D group than in the silicone group. Myelinated axon diameter (MAD) and myelin thickness (MT) of regenerated axons in the Bio 3D group were significantly greater than those in the silicone group (MAD: p  < 0.01, MT: p  < 0.05). In this study, we confirmed the nerve regeneration potential of Bio 3D structures fabricated from DPSCs that were transplanted into a rat model of facial nerve injury.

Introduction: Carpal tunnel syndrome is a challenging condition when conventional carpal tunnel revision surgery fails to alleviate symptoms. This study aims to assess the outcomes of combining carpal tunnel revision surgery with a synovial wrap for cases of recurrent carpal tunnel syndrome in patients who had adhered median nerve, with a minimum 1-year follow-up. Patients and methods: A retrospective analysis was conducted on 10 patients (mean age: 73.7 years, nine females and one male) who underwent treatment for recurrent carpal tunnel syndrome. The approach involved carpal tunnel revision surgery coupled with a median nerve synovial wrap. Patients were followed up for a minimum of 1 year. The procedure involved harvesting a 3.5 cm x 4 cm section of the flexor synovial membrane with a distal ulnar pedicle, which was then wrapped around the adherent site of the median nerve. Physical assessments included the pain visual analogue scale (VAS), Tinel sign in the carpal tunnel, thenar muscle atrophy, the Semmes-Weinstein monofilament test (SW test), manual muscle test (MMT) as assessed on the 5-point British Medical Research Council Scale (5/5, normal; 0/5, absent), and the Disabilities of the Arm, Shoulder, and Hand (Quick DASH) questionnaire. The physical variables were compared before surgery and at final follow-up. Results: All patients showed some improvement in SW test. The MMT for the abductor pollicis brevis showed significant improvement at final follow-up (3 for four patients, 4 for four patients, and 5 for two patients) compared to pre-surgery assessments (2 for six patients, 3 for two patients, and 4 for two patients). The mean VAS score and DASH score at final follow-up (13.0 f 10.3, 19.3 f 12.7, respectively) were significantly lower than those recorded before surgery (76.5 f 11.1, 52.4 f 17.1, respectively). The Tinel sign and the thenar muscle atrophy significantly improved from before surgery to final follow-up. Conclusion: Carpal tunnel release with a synovial wrap demonstrated significant improvements in muscle strength, pain relief and function. The synovial wrap method is an effective procedure for treating recurrent carpal tunnel syndrome.

This observational cohort study aimed to comprehensively assess the muscle quality of gluteus, quadriceps femoris, and calf muscles. Seventy-seven patients with knee osteoarthritis scheduled for total knee arthroplasty participated in this retrospective cohort study. The cross-sectional area (CSA) of the lower limb muscles was assessed using computed tomography images, and muscular attenuation was evaluated in Hounsfield Units (HU). Muscle quality was categorized into four groups based on HU values: intramuscular fat tissue, very low-density muscle (VLDM), low-density muscle (LDM), and normal-density muscle. The ratio of the four tissue CSAs was calculated and compared between surgical scheduled side (affected side) and contralateral side or among gluteus, quadriceps femoris, and calf muscles. The results revealed affected side had a lower ratio of normal-density muscle in all muscle groups compared to contralateral side. In addition, gluteus had the highest intramuscular fat tissue CSA ratio, followed by the calf muscles and quadriceps femoris. Gluteus also had significantly higher ratios of VLDM and LDM than quadriceps femoris and calf muscles. The ratio of normal-density muscle CSA was the lowest in the gluteus, followed by the calf muscles and quadriceps femoris. This study provides a detailed characterization of lower limb muscle quality in patients with knee osteoarthritis, demonstrating that gluteus have higher fat infiltration and lower normal-density muscle compared to the quadriceps femoris and calf muscles. These findings highlight the importance of assessing muscle quality in gluteus, quadriceps femoris, and calf muscles for optimal rehabilitation planning in patients with knee osteoarthritis.

BACKGROUND:Recently, the immunomodulatory effects of mesenchymal stem cells have been reported in several studies. The purpose of this study was to evaluate the effect of the administration of human amnion-derived mesenchymal stem cells (hAm-MSCs) in a rat vascularized composite allotransplantation model. MATERIALS AND METHODS:A total of 18 Lewis (LEW) rats and 6 Brown-Norway (BN) rats were used. Sixteen LEW rats as recipients were divided randomly into four groups: Isograft (Iso), Untreated (UT), FK, and MSC groups (n = 4, each group). Hind limb transplantation was performed. In the Iso group, 2 LEW rats were used as donors. In the other groups, 6 BN rats were used as donors. In the UT group, no immunosuppressant was used. In the FK group, 0.2 mg/kg/day of FK506 (tacrolimus) was administered from day 0 to day 6. In the MSC group, 2 × 106 hAm-MSCs were administered on day 7 after tacrolimus administration (day 0-6). Graft survival was assessed by daily inspection, histology, and immunohistology with the TUNEL (terminal deoxynucleotidyl transferase dUTP nick-end labeling) assay. Cytokine mRNA expression analysis using real-time, reverse transcription PCR (RT-PCR) of the grafts was analyzed. RESULTS:Graft survival in the MSC group (14.8 days) was significantly prolonged compared with that of the FK group (13 days; p < 0.05). Histology and immunohistology with the TUNEL assay showed a significant reduction of mononuclear cell infiltration and apoptotic cells in the MSC group compared with the FK group (p < 0.05). RT-PCR analysis of cytokine mRNA expression showed a significant decrease of IL-2 and an increase of TGFβ in graft muscle (p < 0.05). CONCLUSIONS:hAm-MSCs prolonged graft survival in the rat vascularized composite allotransplantation model. hAm-MSCs could be an alternative immunomodulatory agent to avoid the side effects of conventional immunosuppressant.

PURPOSE:Late-onset non-infectious pulmonary complications (LONIPCs) represent significant sequelae of hematopoietic stem cell transplantation (HSCT), contributing to elevated non-relapse mortality rates. A comprehensive understanding of systemic conditions and prognostic indicators is essential for enhancing supportive care following onset. This study aims to compare respiratory and physical function between patients with LONIPCs and healthy controls, and to identify prognostic factors that influence survival outcomes in patients with LONIPCs. METHODS:This study included 41 LONIPCs patients admitted to Kyoto University Hospital for lung transplant evaluation. A healthy control group comprised matched living lung transplant donors. Comparisons included respiratory function tests, 6-min walk distance (6MWD), and erector spinae muscle cross-sectional area (ESMA). Multivariate Cox regression analysis was used to identify prognostic factors. RESULTS:LONIPCs patients demonstrated significantly reduced respiratory function and 6MWD compared to healthy controls. ESMA was also significantly lower in the patient group. Multivariate Cox regression revealed that decreased knee extensor strength and reduced ESMA were significant predictors of overall survival in patients with LONIPCs. CONCLUSION:Impairments in respiratory and physical function are evident in LONIPCs patients. Modifiable factors such as lower limb muscle strength and skeletal muscle mass, particularly ESMA, are associated with prognosis and should be prioritized in rehabilitation strategies to improve patient outcomes.

Motor function deterioration is a common postoperative complication in glioma patients, affecting daily activities. Although continuous rehabilitation is essential for motor recovery, the underlying cause of postoperative decline remains unclear. This case study investigates the temporal relationship between motor function, corticospinal tract (CST) fractional anisotropy (FA), and edema in a glioma patient following awake craniotomy. A 43-year-old Japanese man with recurrent left parietal glioma and right spastic hemiparesis underwent seven tumor resections over 12 years, culminating in an awake craniotomy. He experienced postoperative motor decline and underwent continuous rehabilitation. FA values of the CST and motor function were assessed preoperatively and on postoperative days 12, 29, and 134. Magnetic resonance imaging (MRI), T2 fluid-attenuated inversion recovery (FLAIR) was used to monitor edema progression. On postoperative day 12, a significant increase in edema was observed in the frontoparietal region, coinciding with a decline in FA and motor function. However, by postoperative days 29 and 134, edema had decreased, and both FA and motor function improved. The findings suggest that vasogenic edema contributed to the transient motor decline, as evidenced by the reversible FA changes, suggesting that CST integrity assessment via FA and edema monitoring may guide postoperative rehabilitation strategies.