Ryota Hamada

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 min 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 min 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.

Purpose 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. Methods 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. Results Among the 107 patients, 28 (26%) were diagnosed with sarcopenia. The incidence of PPCs (32% [9/28] vs. 8% [6/79], P = 0.003) and unplanned readmission (18% [5/28] vs. 3% [2/79], P = 0.013) was higher in the sarcopenia group. Sarcopenia independently predicted PPCs (odds ratio [OR], 5.00; P = 0.020) and unplanned readmissions (OR, 9.17; P = 0.019). Conclusions Preoperative sarcopenia, diagnosed using the AWGS2025 criteria, is closely associated with PPCs and unplanned readmissions in older patients. Preoperative screening may facilitate risk stratification and improve perioperative care.

Purpose 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. Methods 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. Results 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). Conclusion 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.

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.

Introduction: Patients undergoing chimeric antigen receptor (CAR) T‐cell therapy face prolonged treatment timelines and are prone to cytokine release syndrome (CRS) and immune effector cell‐associated neurotoxicity syndrome (ICANS) after infusion. Disabilities in physical function and the importance of rehabilitation during CAR‐T‐cell therapy to maintain physical function have been poorly documented.Method: We performed a retrospective cohort study to assess changes in exercise tolerance via differences in a 6‐min‐walking distance (Δ6MWD) and factors influencing it.Results: A total of 77 patients who underwent rehabilitation during CAR‐T‐cell therapy were enrolled, and their 6MWD was 450 m (median, range 180–705 m) before and 450.5 m (107.0–735.0 m) 30 days after CAR‐T treatment. No significant alteration in Δ6MWD was observed overall (11.0 m, 95% confidence interval, −56.1 to 88.2 m). Multiple regression analyses indicated that age (over vs. under 65 years) revealed no notable differences in Δ6MWD (20 vs. 10 m), while ΔHb (β = 0.24, p = 0.03), moderate/severe CRS (grade 1 with continuous fever or grade ≥2; β = −0.25, p = 0.03), and ICANS (any grade; β = −0.22, p = 0.04) were significantly associated with lower Δ6MWD.Conclusion: This real‐world study indicated that CAR‐T‐cell therapy is less likely to reduce physical function even in older patients if rehabilitation is properly performed, whereas CRS and ICANS can be risk factors to deprive exercise tolerance.

This study aims to investigate the effects of neuromuscular electrical stimulation (NMES) in addition to conventional early mobilization in the early postoperative period after living donor liver transplantation (LTx) on body composition and physical function. This was a retrospective single-center cohort study. Adult subjects who were admitted for living donor LTx from 2018 to 2023 were included in the analysis. After April 2020, patients underwent 4 weeks of NMES in addition to conventional rehabilitation. The skeletal muscle mass index, body cell mass, and physical function, including the 6-minute walking distance, were assessed before surgery and at discharge, and changes in these outcomes were compared before and after the introduction of NMES. Sixty-one patients were in the NMES group, and 53 patients before the introduction of NMES were in the control group. ANCOVA with etiology, obstructive ventilatory impairment, Child-Pugh classification, and initial body composition value as covariates demonstrated that there was a significantly smaller decline of body cell mass (−2.9±2.7 kg vs. −4.4±2.7 kg, p = 0.01), as well as of the skeletal muscle mass index (−0.78±0.73 kg/m² vs. −1.29±1.21 kg/m², p = 0.04), from baseline to discharge in the NMES group than in the control group; thus, the decline after surgery was suppressed in the NMES group. Four weeks of NMES, in addition to conventional rehabilitation in the early period after LTx, may attenuate the deterioration of muscle mass. It is suggested that NMES is an option for developing optimized rehabilitation programs in the acute postoperative period after LTx.

Purpose Steroid-related osteonecrosis of the femoral head (ONFH), arising from steroid administration for underlying diseases, represents a unique pathology for total hip arthroplasty (THA) and typically affects a younger demographic compared to osteoarthritis (OA). Given the significant age-related differences, this study aims to employ propensity score matching to align patient backgrounds between these two diseases and compare physical function. Additionally, our objective is to scrutinize the patterns of clinical score recovery over the course of one year following THA. Methods Using propensity score matching, 29 patients each with steroid-related ONFH and OA were selected. Muscle strength (hip abductor and knee extensor) were assessed before and after THA. Additionally, recovery of the Harris Hip Score (HHS) and Oxford Hip Score (OHS) up to one year postoperatively was analyzed. Results The steroid-related ONFH group exhibited gender bias and significantly younger age compared to the OA group. Propensity score matching achieved balanced patient backgrounds. Physical function showed trends of lower hip abduction and knee extensor strength on the operative side in the steroid-related ONFH group. Notably, nonoperative knee extensor strength decreased significantly after matching. HHS and OHS were poor in steroid-related ONFH up to three months postoperatively but recovered after six months. Conclusions Patients with steroid-related ONFH experience positive outcomes in clinical score following THA. Propensity score matching effectively identified muscle weakness on both operative and nonoperative sides, highlighting its utility in comparative analyses.