Kei Matsuno

Background: Osteoporosis is a major health problem linked to population aging. Internal medicine outpatients often have multiple comorbidities and a high osteoporosis risk; however, osteoporosis prevalence and treatment rates remain unclear. We investigated osteoporosis prevalence and treatment rates in a large cohort of internal medicine outpatients. Methods: This single-center, cross-sectional study used baseline data from the ongoing JUSTICE-TOKYO prospective cohort study ( N = 1,078) of Japanese internal medicine outpatients aged ≥ 65 years. Demographic and clinical characteristics, osteoporosis prevalence, treatment rates, and risk assessment (Osteoporosis Self-assessment Tool for Asians [OSTA]) were assessed. Student’s t-test was used for between-sex comparisons of continuous variables and Pearson’s chi-square test for comparisons of categorical variables. Multivariable logistic regression analysis was performed to identify factors independently associated with osteoporosis. Results: After excluding missing data, 1,040 cases were analyzed. The mean age was 78.2 ± 6.1 years. Overall osteoporosis prevalence was 28.3%, and differed significantly between men (15.8%) and women (38.0%) ( p < 0.001). The treatment rate was 29.3% among osteoporosis patients, with a significant difference between men (12.5%) and women (34.7%) ( p < 0.001). In the primary multivariable model adjusted for age, sex, and body mass index (BMI), older age, female sex, and lower BMI were independently associated with osteoporosis. In an exploratory model additionally including grip strength, lower grip strength was independently associated with osteoporosis, whereas the association with female sex was attenuated after adjustment. Conclusion: In this cohort, osteoporosis was highly prevalent and substantially undertreated, particularly among men. Significant sex-specific disparities were observed in both osteoporosis prevalence and treatment rates.

Purpose Sarcopenia, characterized by loss of muscle mass and function, can affect the respiratory muscles and impair pulmonary function. However, evidence on the association between sarcopenia and respiratory function in older adults remains limited. This study examined the relationships among outpatients attending a hospital for older adult medicine. Methods Baseline data from 810 outpatients aged ≥ 65 in the JUSTICE-TOKYO study were analyzed. Individuals with asthma, chronic obstructive pulmonary disease, or interstitial lung disease were excluded. The mean age was 78.2 ± 6.1 years, and 341 (42.1%) were male Sarcopenia was diagnosed based on 2019 Asian Working Group for Sarcopenia criteria. Pulmonary function measures included vital capacity (% predicted), forced expiratory volume in one second (% predicted), FEV1/FVC ratio, and peak expiratory flow rate (PEFR). Receiver operating characteristic (ROC) curve analyses were performed to assess the diagnostic performance of VC (% predicted) and PEFR for sarcopenia. Results Sarcopenia was identified in 170 patients (21%; 102 men,68 women). Patients had a higher prevalence of myocardial infarction, heart failure, and malignancies. ROC curve analyses showed that VC (% predicted) had an optimal cutoff of 94.2% (sensitivity:0.653, specificity:0.613), and area under the curve(AUC) of 0.66. The diagnostic performance of VC (% predicted) was comparable to PEFR (AUC: 0.70 in men and 0.69 in women). Conclusion Respiratory function, particularly VC (% predicted), was significantly associated with sarcopenia in older adult outpatients. VC (% predicted) demonstrates diagnostic performance comparable to PEFR and may serve as a practical parameter for sarcopenia risk identification in clinical practice.

Background: Eosinophilic granulomatosis with polyangiitis (EGPA) is a rare systemic vasculitis characterized by eosinophilic inflammation and involvement of small- to medium-sized vessels. Given its heterogeneous clinical presentation, early diagnosis and appropriate management are critical. Although systemic corticosteroids remain the mainstay of therapy, concerns regarding their long-term adverse effects underscore the growing need for alternative treatment strategies. Case Presentation: A 70-year-old man with a medical history of sinusitis, eosinophilic pneumonia, and bronchial asthma was referred for assessment of pleural effusion, which resolved spontaneously at the time of presentation. The patient was observed without intervention, while continuing asthma management. Approximately 6 months later, the patient experienced exacerbation of asthma and recurrence of pleural effusion. Thoracentesis was performed for symptom relief and benralizumab (30 mg) was initiated, resulting in temporary clinical improvement. However, after the third dose, the patient developed abdominal pain, peripheral neuropathy, and a skin rash. Laboratory studies revealed peripheral eosinophilia and elevated levels of rheumatoid factor (RF), myeloperoxidase–anti-neutrophil cytoplasmic antibody (MPO–ANCA), and total immunoglobulin E (IgE). A second skin biopsy revealed granulomatous inflammation, confirming the diagnosis of EGPA. Mepolizumab treatment (300 mg) was initiated, resulting in clinical resolution. Conclusion: This case highlights that EGPA may develop during anti-IL-5 therapy. Close monitoring of clinical signs, along with biomarkers such as eosinophil count, RF, MPO–ANCA, and IgE, is essential for timely diagnosis. Furthermore, successful disease control by switching to mepolizumab monotherapy suggests the potential for managing EGPA using appropriate biologic regimens to minimize corticosteroid-related adverse effects. Further accumulation of similar cases and larger studies is warranted to inform future clinical practice.

Background: Japan is likely the world’s leading aging society, and when leveraged effectively, digital health services hold great potential for addressing health care system challenges. Appropriate development and facilitation of these services require the evaluation of users’ digital health literacy. However, the status of digital health literacy in Japan, especially among older adults, remains unclear, which limits efforts to effectively promote such services. Objective: This study aimed to translate the eHealth Literacy Questionnaire (eHLQ) into Japanese and test the translation’s reliability. Additionally, it aimed to examine eHLQ scores among Japan’s population, compare them across various backgrounds, and explore considerations for applying digital health systems to support Japan’s aging society. Methods: A sequential exploratory mixed methods design was employed. The translation process prioritized achieving conceptual equivalence with the source language. To evaluate the translation’s reliability, psychometric assessments by survey were conducted based on classical test theory and item response theory. Comparative statistical analysis was used to examine the impact of demographic factors. Results: A total of 504 individuals aged 18-88 years completed the survey, with 444 responding online and 60 in face-to-face interviews. The Japanese eHLQ showed good internal consistency, with Cronbach α values ≥0.78. The comparative fit index was >0.95, standardized root mean residual was ≤0.04, and standardized expected parameter change was ≤0.23, indicating good to acceptable fit. Item response theory analysis found adequate item location, discrimination, and factor loading. Boundary characteristic curve plotting demonstrated that all items fit well. Participants with more frequent digital health service use and better self-reported health status showed higher eHLQ scores across all 7 scales: (1) Using technology to process health information, (2) Understanding of health concepts and language, (3) Ability to actively engage with digital services, (4) Feel safe and in control, (5) Motivated to engage with digital services, (6) Access to digital services that work, and (7) Digital services that suit individual needs. Conclusions: The Japanese version of the eHLQ is robust and is likely to be a reliable and effective tool for assessing digital health literacy among Japan’s population. There were no notable differences between scores of those aged above and below 65 years, or those with and without chronic disease(s). The findings also suggest that current systems may be tailored to frequent digital health users. The Japanese version of the eHLQ is expected to be used to effectively monitor digital health literacy in Japan’s aging society.

Purpose Sarcopenia, characterized by the loss of skeletal muscle mass and function, can affect respiratory muscles and contribute to impaired pulmonary function. However, evidence on the association between sarcopenia and respiratory function in older adults remains limited. This study examined the relationship between sarcopenia and respiratory function in outpatients at a geriatric specialty hospital. Methods Baseline data from 810 outpatients aged 65 years or older enrolled in the JUSTICE-TOKYO study were analyzed. Patients with respiratory diseases such as asthma, chronic obstructive pulmonary disease, or interstitial lung disease were excluded. Sarcopenia was diagnosed using the 2019 Asian Working Group for Sarcopenia criteria. Pulmonary function measures included percent predicted vital capacity (%VC), percent predicted forced expiratory volume in one second (%FEV ₁ ), FEV ₁ /FVC ratio, and peak expiratory flow rate (PEFR). Receiver operating characteristic curve analyses were performed for %VC and PEFR to assess their diagnostic performance for sarcopenia. Results Sarcopenia was identified in 170 patients (21%; 102 men, 68 women). Patients with sarcopenia had a higher prevalence of myocardial infarction, heart failure, and malignancy. Receiver operating characteristic curve analyses showed that %VC had an optimal cutoff of 94.2%, with a sensitivity of 0.71, specificity of 0.63, and area under the curve of 0.66. The diagnostic performance of %VC was comparable to that of PEFR (area under the curve: 0.70 in men, 0.69 in women). Conclusion Respiratory function, particularly %VC, is significantly associated with sarcopenia in older outpatients. %VC may serve as a practical, standardized screening tool with diagnostic accuracy comparable to PEFR.

Objective: To clarify the relationship between constipation and depressive symptoms among the elderly. Methods: This single-center, cross-sectional study was performed using baseline data obtained at the time of enrollment in the prospective cohort of the JUSTICE-TOKYO study. Participants underwent assessments including patient profiling, drug use history, the Mini-Mental State Examination (MMSE), the Geriatric Depression Scale 15 (GDS-15), gastrointestinal-related quality of life (QOL), and the constipation scoring system (CSS). Geriatric depressive symptoms were evaluated based on GDS-15. We investigated correlations between GDS-15 scores and various abdominal symptoms and assessed risk factors for geriatric depressive symptoms using multiple regression analysis. Results: A total of 984 elderly participants (57% female, mean age 78.1 ± 6.1 year) were included. The GDS-15 scores were significantly correlated with body mass index (BMI) (r = −0.056) and MMSE (r = −0.092), reflex-related QOL (r = 0.253), pain-related QOL (r = 0.229), fullness-related QOL (r = 0.269), constipation-related QOL (r = 0.329), diarrhea-related QOL (r = 0.264), and CSS (r = 0.285) scores. Multiple regression analysis indicated that BMI (β = −0.069, p = 0.020) and MMSE (β = −0.074, p = 0.013), constipation-related QOL (β = 0.136, p = 0.002), reflex-related QOL (β = 0.126, p < 0.001), diarrhea-related QOL (β = 0.095, p = 0.006), and CSS (β = 0.098, p = 0.016) scores were significantly correlated with GDS-15 scores. Conclusions: Depressive symptoms among older individuals are associated with various abdominal symptoms, particularly constipation. However, the causality between depressive symptoms and constipation cannot be inferred due to the study’s cross-sectional design.

Background/Objectives: Reports on oral frailty as a risk factor for chronic constipation are scarce. In this study, we examined the relationship between Oral Frailty Index-8 (OFI-8) and constipation severity. Methods: This cross-sectional analysis involved patients aged ≥65 years (outpatients between November 2020 and November 2021). Patient background (age, sex, body mass index, medical history, lifestyle history, and oral medications), a constipation severity questionnaire (Constipation Scoring System [CSS]), grip strength, walking speed, skeletal muscle mass index (dual-energy X-ray absorptiometry), a frailty questionnaire, an oral frailty questionnaire (OFI-8), an abdominal symptoms quality of life (QOL) questionnaire (Izumo scale), a swallowing evaluation questionnaire (10-item Eating Assessment Tool [EAT-10]), a chronic obstructive pulmonary disease (COPD) evaluation questionnaire (COPD assessment test [CAT]), a simplified QOL evaluation (EuroQol-five dimensions [EQ-5D]), the Dietary Variety Score, a nutritional evaluation (CONtrolling NUTritional Status [CONUT] score), and the 15-item Geriatric Depression Scale (GDS-15) were analyzed. Risk factors for constipation severity (CSS) were examined using multivariate analysis. Patients with advanced gastrointestinal cancer, inflammatory bowel disease, and active gastroduodenal ulcer were excluded. Results: In total, 1029 patients (male/female: 450/579; mean age: 78.3 ± 6.1 years; mean body mass index: 22.9 ± 3) were included. Multivariate analysis demonstrated a significant association between CSS and OFI-8 (β = 0.065), EAT-10 (β = 0.061), sarcopenia (β = 0.050), laxative (β = 0.126), constipation-related QOL score (β = 0.625), diarrhea-related QOL score (β = −0.064), and CAT (β = 0.061). Conclusions: Comprehensive risk factors associated with CSS included a high oral frailty score, impaired swallowing (EAT-10), sarcopenia, laxative use, a high constipation QOL score, a low diarrhea QOL score, and COPD assessment through CAT.

Diffuse interstitial lung diseases (ILD) include conditions with identifiable causes such as chronic eosinophilic pneumonia (CEP), sarcoidosis (SAR), chronic hypersensitivity pneumonitis (CHP), and connective tissue disease-associated interstitial pneumonia (CTD), as well as idiopathic interstitial pneumonia (IIP) of unknown origin. In non-IIP diffuse lung diseases, bronchoalveolar lavage (BAL) fluid appearance is diagnostic. This study examines lymphocyte subsets in BAL fluid and peripheral blood of 56 patients with diffuse ILD, excluding idiopathic pulmonary fibrosis (IPF), who underwent BAL for diagnostic purposes. Patients were classified into CEP, SAR, CHP, CTD, and IIP groups, and clinical data, BAL cell analysis, and peripheral blood mononuclear cell analysis were compared. Eosinophils and type 3 innate lymphocytes (ILC3s) were significantly increased in the BAL fluid of the CEP group. Receiver operating characteristic curve analysis identified eosinophils ≥ 8% in BAL cells and ILC3s ≥ 0.0176% in the BAL lymphocyte fraction as thresholds distinguishing CEP. SAR patients exhibited significantly elevated CD4/CD8 ratios in the BAL fluid, with a ratio of 3.95 or higher and type 1 innate lymphoid cell frequency ≥ 0.254% as differentiation markers. High Th1 cell frequency (≥17.4%) in BAL lymphocytes in IIP, elevated serum KL-6 (≥2081 U/mL) and SP-D (≥261 ng/mL) in CHP, and increased BAL neutrophils (≥2.0%) or a low CD4/CD8 ratio (≤1.2) in CTD serve as distinguishing markers for each ILD. Excluding CEP and SAR, CD4⁺ T cell frequencies, including Th1, Th17, and Treg cells in peripheral blood, may differentiate IIP, CHP, and CTD.

Objective: To determine the prevalence of frailty and examine its association with gastrointestinal-related quality of life (QOL) among older outpatients in a geriatric hospital. Methods: This cross-sectional study involved 1042 outpatients (age: ≥65 years) diagnosed using the revised Japanese version of the cardiovascular health study criteria. Data collection was performed by a multidisciplinary team. Results: Of the 1039 eligible subjects (male: n = 460 [44.3%]; mean age: 78.2 ± 6.1 years), 172 (16.6%) had frailty (male: n = 77 [44.8%]; mean age: 80.9 ± 6.2 years). The multivariate analysis revealed that age (odds ratio [OR]: 1.070, p < 0.001), QOL (OR: 0.982, p = 0.009), a history of falls (OR: 1.702, p = 0.029), sarcopenia (OR: 4.708, p < 0.001), steroid use (OR: 3.741, p = 0.001), analgesic drug use (OR: 2.056, p = 0.014), Mini Mental State Examination (OR: 0.915, p = 0.011), Geriatric Depression Scale 15 (OR: 1.101, p = 0.008), fullness-related QOL score (OR: 1.119, p = 0.010), chronic obstructive pulmonary disease assessment test (OR: 1.048, p = 0.007), and 10-item Eating Assessment Tool (OR: 1.071, p = 0.009) were related to frailty. Conclusions: The prevalence rate of frailty in older outpatients at a university hospital specializing in geriatric medicine was higher than that previously reported in community-dwelling individuals. Our study clarified that the fullness-related QOL score was related to frailty.

Purpose: Omalizumab, the anti-IgE monoclonal antibody used to treat severe asthma, reduces asthma exacerbations, hospitalizations, and corticosteroid use. Although allergic asthma is a therapeutic target of omalizumab, omalizumab is not effective in all patients with severe allergic asthma and is not always available for long-term use. We retrospectively investigated factors related to long-term (≥ 2 years) use of omalizumab for severe asthma. Patients and Methods: Of the 116 patients treated with omalizumab for severe asthma at our hospital between 2009 and 2017, 82 were included in this retrospective analysis. Thirty-four were excluded because of adverse events, financial difficulties, or hospital transfers. The number of asthma exacerbations, unscheduled visits, corticosteroid doses, asthma control test scores, pulmonary function test results, and fractional exhaled nitric oxide levels were evaluated. Results: The median age of the study population was 58 years, with 66% female and 26% taking regular oral corticosteroids. After 2 years of treatment, 52 responders were identified using the global evaluation of treatment effectiveness (GETE) score. Improvements in asthma control test scores, airflow limitation, exacerbations, and oral corticosteroid use were observed in the responders. Multivariate analysis revealed that a peripheral blood eosinophil count of ≥ 200 or a perennial antigen-specific IgE antibody positivity of ≥ 2 predicted a response at the 2-year mark. However, Kaplan–Meier analysis demonstrated that neither high eosinophil counts nor perennial antigen-specific IgE positivity influenced the prolongation of treatment beyond 2 years, and responders at 2 years underwent omalizumab treatment for a significantly longer period than non-responders (HR = 9.89, p < 0.001), with GETE at 2 years being the only predictor of long-term omalizumab use. Conclusion: In this retrospective study the GETE after 2 years of omalizumab therapy emerged as the most meaningful predictor of the long-term effectiveness of omalizumab treatment in patients with severe asthma, highlighting the benefits of prolonged therapy in certain populations. These findings may guide future therapeutic strategies for severe asthma.