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Article: Utility of Lean Body Mass Equations and Body Mass Index for Predicting Outcomes in Critically Ill Adults with Sepsis: A Retrospective Study.

Shimizu, Rumiko / Nakanishi, Nobuto / Ishihara, Manabu / Oto, Jun / Kotani, Joji

2024 Volume 12, Issue 2

Abstract: Lean body mass is a significant component of survival from sepsis. Several equations can be used for calculating lean body mass based on age, sex, body weight, and height. We hypothesized that lean body mass is a better predictor of outcomes than the ... ...

Abstract	Lean body mass is a significant component of survival from sepsis. Several equations can be used for calculating lean body mass based on age, sex, body weight, and height. We hypothesized that lean body mass is a better predictor of outcomes than the body mass index (BMI). This study used a multicenter cohort study database. The inclusion criteria were age ≥18 years and a diagnosis of sepsis or septic shock. BMI was classified into four categories: underweight (<18.5 kg/m
Language	English
Publishing date	2024-01-26
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2720869-2
ISSN	2079-9721
ISSN	2079-9721
DOI	10.3390/diseases12020030
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Article ; Online: The Utility of Urinary Titin to Diagnose and Predict the Prognosis of Acute Myocardial Infarction.

Arase, Miharu / Nakanishi, Nobuto / Tsutsumi, Rie / Kawakami, Ayuka / Arai, Yuta / Sakaue, Hiroshi / Oto, Jun

International journal of molecular sciences

2024 Volume 25, Issue 1

Abstract: Early detection and management are crucial for better prognosis in acute myocardial infarction (AMI). Serum titin, a component of the sarcomere in cardiac and skeletal muscle, was associated with AMI. Thus, we hypothesized that urinary N-fragment titin ... ...

Abstract	Early detection and management are crucial for better prognosis in acute myocardial infarction (AMI). Serum titin, a component of the sarcomere in cardiac and skeletal muscle, was associated with AMI. Thus, we hypothesized that urinary N-fragment titin may be a biomarker for its diagnosis and prognosis. Between January 2021 and November 2021, we prospectively enrolled 83 patients with suspected AMI. Their urinary N-fragment titin, serum high-sensitivity troponin I (hsTnI), creatine kinase (CK), and creatine kinase-MB (CK-MB) were measured on admission. Then, urinary titin was assessed as diagnostic and prognostic biomarker in AMI. Among 83 enrolled patients, 51 patients were diagnosed as AMI. In AMI patients who were admitted as early as 3 h or longer after symptom onset, their urinary titin levels were significantly higher than non-AMI patients who are also admitted 3 h or longer after symptom onset (12.76 [IQR 5.87-16.68] pmol/mgCr (creatinine) and 5.13 [IQR 3.93-11.25] pmol/mgCr,
MeSH term(s)	Humans ; Biomarkers ; Connectin ; Creatine Kinase ; Creatine Kinase, MB Form ; Heart ; Myocardial Infarction/diagnosis
Chemical Substances	Biomarkers ; Connectin ; Creatine Kinase (EC 2.7.3.2) ; Creatine Kinase, MB Form (EC 2.7.3.2) ; TTN protein, human
Language	English
Publishing date	2024-01-01
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2019364-6
ISSN	1422-0067 ; 1422-0067 ; 1661-6596
ISSN (online)	1422-0067
ISSN	1422-0067 ; 1661-6596
DOI	10.3390/ijms25010573
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Article ; Online: Effects of Vibration Therapy on the Physical Function of Critically Ill Adults Trial: A Randomized Controlled Trial.

Doi, Satoshi / Nakanishi, Nobuto / Kawahara, Yoshimi / Nomura, Keiko / Shima, Mamiko / Shiraishi, Mie / Oto, Jun

Critical care medicine

2024 Volume 52, Issue 6, Page(s) 910–919

Abstract: Objectives: Vibration therapy uses vibration to rehabilitate physical functions. Recently, it has been demonstrated to be safe for critically ill patients. However, its effects on physical functions are unclear.: Design: Randomized controlled trial.!# ...

Abstract	Objectives: Vibration therapy uses vibration to rehabilitate physical functions. Recently, it has been demonstrated to be safe for critically ill patients. However, its effects on physical functions are unclear. Design: Randomized controlled trial. Setting: A single-center, ICU. Patients: Patients were randomly assigned to either vibration therapy coupled with protocolized mobilization or protocolized mobilization alone. We included patients who could sit at the edge of the bed or in a wheelchair during their ICU stay. The exclusion criteria were based on the early mobilization inhibition criteria. Interventions: The primary outcome was the Functional Status Score for the ICU (FSS-ICU) at ICU discharge. Secondary outcomes were the Medical Research Council score, ICU-acquired weakness, delirium, ICU Mobility Scale (IMS), and ventilator- and ICU-free days. For safety assessment, vital signs were monitored during the intervention. Measurements and main results: Among 180 patients, 86 and 90 patients remained in the vibration therapy and control groups, respectively. The mean age was 69 ± 13 vs. 67 ± 16 years in the vibration therapy and control groups, and the Acute Physiology and Chronic Health Evaluation (APACHE) II score was 19 (14-25) vs. 18 (13-23). The total FSS-ICU at ICU discharge was 24 (18-27) and 21 (17-26) in the intervention and control groups, respectively ( p = 0.09), and the supine-to-sit ability significantly improved in the intervention group ( p < 0.01). The secondary outcomes were not significantly different. Vital signs remained stable during vibration therapy. In the predefined subgroup analysis, FSS-ICU improved in the population with a higher body mass index (≥ 23 kg/m 2 ), lower APACHE II scores (< 19), and higher IMS scores (≥ 6). Conclusions: Vibration therapy did not improve the total FSS-ICU. However, the supine-to-sit ability in the FSS-ICU improved without any adverse event.
MeSH term(s)	Humans ; Vibration/therapeutic use ; Male ; Female ; Critical Illness/therapy ; Aged ; Middle Aged ; Intensive Care Units ; APACHE ; Aged, 80 and over ; Physical Therapy Modalities ; Early Ambulation/methods
Language	English
Publishing date	2024-01-26
Publishing country	United States
Document type	Journal Article ; Randomized Controlled Trial
ZDB-ID	197890-1
ISSN	1530-0293 ; 0090-3493
ISSN (online)	1530-0293
ISSN	0090-3493
DOI	10.1097/CCM.0000000000006210
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Article ; Online: The effect of high-flow nasal cannula on diaphragm dysfunction including paradoxical diaphragmatic contraction in the intensive care unit.

Takashima, Takuya / Nakanishi, Nobuto / Arai, Yuta / Oto, Jun

The journal of medical investigation : JMI

2021 Volume 68, Issue 1.2, Page(s) 159–164

Abstract: Background : Diaphragm dysfunction is a serious problem. However, a few management techniques exist for diaphragm dysfunction. Methods : Adult patients treated with high-flow nasal cannula (HFNC) in the intensive care unit were included in this study. ... ...

Abstract	Background : Diaphragm dysfunction is a serious problem. However, a few management techniques exist for diaphragm dysfunction. Methods : Adult patients treated with high-flow nasal cannula (HFNC) in the intensive care unit were included in this study. The diaphragm function was evaluated using ultrasound measurement of thickening fraction before and after HFNC liberation. Normal diaphragm contraction was defined as thickening fraction ≥ 15% without HFNC, whereas decreased or paradoxical diaphragm contractions were 0%-15% or < 0%, respectively. Results : Forty patients were enrolled, and 16 (40%) had normal diaphragm contraction, whereas 19 (48%) or 5 (13%) had decreased or paradoxical diaphragm contractions, respectively. Thickening fraction increased after HFNC liberation (27.0% ± 25.7% vs. 38.8% ± 34.5%, p = 0.03 in HFNC vs. no HFNC) in patients without diaphragm dysfunction. In patients with decreased diaphragm contraction, thickening fraction did not change with or without HFNC (8.9% ± 11.7% vs. 6.7% ± 5.2%, p = 0.35), whereas paradoxical contraction decreased with HFNC (1.0% ± 10.2% vs. -10.3% ± 2.7%, p = 0.04) in patients with paradoxical diaphragm contraction. Conclusions : The work of breathing decreased with HFNC in patients without diaphragm dysfunction, but did not decrease in patients with decreased diaphragm contraction. Paradoxical diaphragm contraction decreased with HFNC. J. Med. Invest. 68 : 159-164, February, 2021.
MeSH term(s)	Adult ; Cannula ; Diaphragm/diagnostic imaging ; Humans ; Intensive Care Units ; Ultrasonography
Language	English
Publishing date	2021-05-14
Publishing country	Japan
Document type	Journal Article
ZDB-ID	1435233-3
ISSN	1349-6867 ; 1343-1420
ISSN (online)	1349-6867
ISSN	1343-1420
DOI	10.2152/jmi.68.159
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Article: Early Initiation of Awake Veno-Venous Extracorporeal Membrane Oxygenation Can Attenuate Muscle Atrophy and Weakness in Acute Respiratory Distress Syndrome.

Nakanishi, Nobuto / Okamoto, Yuri / Okahisa, Tetsuya / Oto, Jun

Cureus

2020 Volume 12, Issue 8, Page(s) e9926

Abstract: Patients with acute respiratory distress syndrome (ARDS) exhibit prominent muscle atrophy and weakness. Although these patients often require deep sedation to perform lung-protective ventilation, extracorporeal membrane oxygenation (ECMO) can keep ... ...

Abstract	Patients with acute respiratory distress syndrome (ARDS) exhibit prominent muscle atrophy and weakness. Although these patients often require deep sedation to perform lung-protective ventilation, extracorporeal membrane oxygenation (ECMO) can keep patients awake and make mobilization possible. A 60-year-old man was treated with ECMO due to ARDS. A multidisciplinary team conducted mobilization with standing on day 3. During intensive care unit (ICU) stay, catabolism was ongoing (urinary titin: 24.1-38.4 pmol/mg Cr), but the rectus femoris muscle, measured by ultrasound, moderately decreased by 5.3%, 10.8%, and 13.0% on days 3, 5, and 7, respectively, with maintained Medical Research Council score of 58-60. Diaphragm thickness remained unchanged. On day 5, he was separated from ECMO. After ambulation training, he was discharged from ICU on day 7. He returned home without prominent physical dysfunction. Our experience indicates early initiation of awake ECMO can accompany mobilization and attenuate muscle atrophy and weakness in ARDS.
Language	English
Publishing date	2020-08-21
Publishing country	United States
Document type	Case Reports
ZDB-ID	2747273-5
ISSN	2168-8184
ISSN	2168-8184
DOI	10.7759/cureus.9926
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Article ; Online: Muscle atrophy in critically ill patients : a review of its cause, evaluation, and prevention.

Nakanishi, Nobuto / Takashima, Takuya / Oto, Jun

The journal of medical investigation : JMI

2020 Volume 67, Issue 1.2, Page(s) 1–10

Abstract: Critically ill patients exhibit prominent muscle atrophy, which occurs rapidly after ICU admission and leads to poor clinical outcomes. The extent of atrophy differs among muscles as follows: upper limb: 0.7%-2.4% per day, lower limb: 1.2%-3.0% per day, ... ...

Abstract	Critically ill patients exhibit prominent muscle atrophy, which occurs rapidly after ICU admission and leads to poor clinical outcomes. The extent of atrophy differs among muscles as follows: upper limb: 0.7%-2.4% per day, lower limb: 1.2%-3.0% per day, and diaphragm 1.1%-10.9% per day. This atrophy is caused by numerous risk factors such as inflammation, immobilization, nutrition, hyperglycemia, medication, and mechanical ventilation. Muscle atrophy should be monitored noninvasively by ultrasound at the bedside. Ultrasound can assess muscle mass in most patients, although physical assessment is limited to almost half of all critically ill patients due to impaired consciousness. Important strategies to prevent muscle atrophy are physical therapy and electrical muscular stimulation. Electrical muscular stimulation is especially effective for patients with limited physical therapy. Regarding diaphragm atrophy, mechanical ventilation should be adjusted to maintain spontaneous breathing and titrate inspiratory pressure. However, the sufficient timing and amount of nutritional intervention remain unclear. Further investigation is necessary to prevent muscle atrophy and improve long-term outcomes. J. Med. Invest. 67 : 1-10, February, 2020.
MeSH term(s)	Biomarkers ; Critical Illness ; Electric Stimulation Therapy ; Humans ; Muscular Atrophy/diagnosis ; Muscular Atrophy/etiology ; Muscular Atrophy/prevention & control ; Physical Therapy Modalities ; Ventilators, Mechanical
Chemical Substances	Biomarkers
Language	English
Publishing date	2020-06-02
Publishing country	Japan
Document type	Journal Article ; Review
ZDB-ID	1435233-3
ISSN	1349-6867 ; 1343-1420
ISSN (online)	1349-6867
ISSN	1343-1420
DOI	10.2152/jmi.67.1
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Zs.A 264: Show issues

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Article ; Online: Upper limb movements and the risk of unplanned device removal in mechanically ventilated patients.

Kawahara, Yoshimi / Nakanishi, Nobuto / Nomura, Keiko / Oto, Jun

Acute medicine & surgery

2020 Volume 7, Issue 1, Page(s) e572

Keywords	covid19
Language	English
Publishing date	2020-10-11
Publishing country	United States
Document type	Journal Article
ISSN	2052-8817
ISSN (online)	2052-8817
DOI	10.1002/ams2.572
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Article ; Online: Effect of vibration therapy on physical function in critically ill adults (VTICIA trial): protocol for a single-blinded randomised controlled trial.

Nakanishi, Nobuto / Doi, Satoshi / Kawahara, Yoshimi / Shiraishi, Mie / Oto, Jun

BMJ open

2021 Volume 11, Issue 3, Page(s) e043348

Abstract: Introduction: Vibration therapy has been used as an additional approach in passive rehabilitation. Recently, it has been demonstrated to be feasible and safe for critically ill patients, whose muscle weakness and intensive care unit (ICU)-acquired ... ...

Abstract	Introduction: Vibration therapy has been used as an additional approach in passive rehabilitation. Recently, it has been demonstrated to be feasible and safe for critically ill patients, whose muscle weakness and intensive care unit (ICU)-acquired weakness are serious problems. However, the effectiveness of vibration therapy in this population is unclear. Methods and analysis: This study will enrol 188 adult critically ill patients who require further ICU stay after they can achieve sitting at the edge of the bed or wheelchair. The sample size calculation is based on a 15% improvement of Functional Status Score for the ICU. They will be randomised to vibration therapy coupled with protocolised mobilisation or to protocolised mobilisation alone; outcomes will be compared between the two groups. Therapy will be administered using a low-frequency vibration device (5.6-13 Hz) for 15 min/day from when the patient first achieves a sitting position and onward until discharge from the ICU. Outcome assessments will be blinded to the intervention. Primary outcome will be measured using the Functional Status Score for the ICU during discharge. Secondary outcomes will be identified as follows: delirium, Medical Research Council Score, ICU-acquired weakness, the change of biceps brachii and rectus femoris muscle mass measured by ultrasound, ICU mobility scale and ventilator-free and ICU-free days (number of free days during 28 days after admission). For safety assessment, vital signs will be monitored during the intervention. Ethics and dissemination: This study has been approved by the Clinical Research Ethics Committee of Tokushima University Hospital. Results will be disseminated through publication in a peer-reviewed journal and presented at conferences. Trial registration number: UMIN000039616.
MeSH term(s)	Activities of Daily Living ; Adult ; Critical Illness/therapy ; Humans ; Intensive Care Units ; Physical Therapy Modalities ; Randomized Controlled Trials as Topic ; Vibration/therapeutic use
Language	English
Publishing date	2021-03-02
Publishing country	England
Document type	Clinical Trial Protocol ; Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2599832-8
ISSN	2044-6055 ; 2044-6055
ISSN (online)	2044-6055
ISSN	2044-6055
DOI	10.1136/bmjopen-2020-043348
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Article ; Online: Prognostic factors for acute large vessel occlusion with NIHSS 5 or lower.

Ishihara, Manabu / Kanematsu, Yasuhisa / Yamamoto, Nobuaki / Shimada, Kenji / Miyamoto, Takeshi / Yamaguchi, Izumi / Sogabe, Shu / Yamamoto, Yuki / Oto, Jun / Takagi, Yasushi

The journal of medical investigation : JMI

2023 Volume 70, Issue 1.2, Page(s) 22–27

Abstract: Background: Intravenous recombinant tissue plasminogen activator (IV rt-PA) and endovascular treatment have been performed for severe large vessel occlusion (LVO) and the results have been reported at high levels of evidence. However, acute treatment ... ...

Abstract	Background: Intravenous recombinant tissue plasminogen activator (IV rt-PA) and endovascular treatment have been performed for severe large vessel occlusion (LVO) and the results have been reported at high levels of evidence. However, acute treatment for LVO with mild symptom remains controversial. We retrospectively examined prognostic factors for LVO with mild symptoms. Method: We studied retrospectively the patients within 24 h of onset with large vessel occlusion with NIHSS score ??5. Outcomes were evaluated by modified Rankin Scale (mRS) at 90 days, with 0?2 defined as a good outcome and 3?6 as a poor outcome. Clinical characteristics of each case were examined. Result: Participants comprised 76 patients. Of the 76 patients. ICA occlusion showed good outcome in 17?/?19 cases (90%), whereas MCA occlusion showed good outcome in 36?/?54 cases (67%). Among the 14 cases showing positive results for distal intraarterial signal (d-IAS), outcomes were good in 6 cases (43%). On the other hand, the 32 d-IAS-negative cases showed good outcome in 28 cases (88%). Outcomes were thus significantly poorer for d-IAS-positive cases. Conclusion: MCA occlusion is associated with poor prognosis, even with NIHSS score ??5, and d-IAS may provide a predictor. J. Med. Invest. 70 : 22-27, February, 2023.
MeSH term(s)	Humans ; Tissue Plasminogen Activator/therapeutic use ; Stroke/diagnosis ; Stroke/drug therapy ; Prognosis ; Retrospective Studies ; Treatment Outcome
Chemical Substances	Tissue Plasminogen Activator (EC 3.4.21.68)
Language	English
Publishing date	2023-05-11
Publishing country	Japan
Document type	Journal Article
ZDB-ID	1435233-3
ISSN	1349-6867 ; 1343-1420
ISSN (online)	1349-6867
ISSN	1343-1420
DOI	10.2152/jmi.70.22
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Article ; Online: Ultrasound-based upper limb muscle thickness is useful for screening low muscularity during intensive care unit admission: A retrospective study.

Nakanishi, Nobuto / Inoue, Shigeaki / Ono, Yuko / Sugiyama, Jun / Takayama, Kazushi / Arai, Yuta / Nakamura, Kensuke / Oto, Jun / Kotani, Joji

Clinical nutrition ESPEN

2023 Volume 57, Page(s) 569–574

Abstract: Background & aims: Malnutrition is associated with poor outcomes. Muscle mass is an important malnutrition indicator included in Global Leadership Initiative on Malnutrition (GLIM) criteria. Although bioelectrical impedance analysis and dual-energy X- ... ...

Abstract	Background & aims: Malnutrition is associated with poor outcomes. Muscle mass is an important malnutrition indicator included in Global Leadership Initiative on Malnutrition (GLIM) criteria. Although bioelectrical impedance analysis and dual-energy X-ray absorptiometry are common muscle mass assessment methods, they are unreliable during intensive care unit (ICU) admission due to the influence of dynamic fluid changes. We hypothesized that ultrasound-based upper limb muscle assessment would be useful for assessing muscularity at ICU admission. Methods: We retrospectively analyzed prospectively obtained ultrasound data from patients admitted to an ICU. We excluded patients without computed tomography (CT) imaging of the third lumbar vertebra within 2 days of ICU admission. Primary outcomes were the diagnostic utility of ultrasound-based upper limb muscle thickness for assessing low muscularity by CT. Low muscularity was defined as a skeletal muscle index of 36.0 cm Results: Among 64 patients assessed by ultrasound, 52 had CT examination records and were included in the analysis. The mean age was 70 ± 13 years, and the mean body mass index was 23.3 ± 4.2 kg/m Conclusions: Ultrasound-based upper limb muscle thickness assessments can screen for low muscularity upon ICU admission.
MeSH term(s)	Female ; Male ; Humans ; Middle Aged ; Aged ; Aged, 80 and over ; Retrospective Studies ; Upper Extremity ; Muscle, Skeletal/diagnostic imaging ; Intensive Care Units ; Malnutrition
Language	English
Publishing date	2023-08-08
Publishing country	England
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ISSN	2405-4577
ISSN (online)	2405-4577
DOI	10.1016/j.clnesp.2023.07.089
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