Faculty Profiles - NAKASHIMA Hiroaki

Association between advanced glycation end-products and fall risk in older adults: The Yakumo Study Reviewed Open Access

Iida, H; Takegami, Y; Osawa, Y; Funahashi, H; Ozawa, Y; Ido, H; Asamoto, T; Otaka, K; Tanaka, S; Nakashima, H; Ishizuka, S; Seki, T; Hasegawa, Y; Imagama, S

GERIATRICS & GERONTOLOGY INTERNATIONAL Vol. 24 ( 6 ) page： 517 - 522 2024.6

Language：English Publisher：Geriatrics and Gerontology International

Aim: Advanced glycation end-products (AGEs) are irreversibly and heterogeneously formed compounds during the non-enzymatic modification of macromolecules, such as proteins. Aging and lifestyle habits, such as high-fat and high-protein diets, and smoking, promote AGEs accumulation. This study aimed to investigate the relationship between fall risk and AGEs in community-dwelling older adults. Methods: This cross-sectional study included patients from the 2022 Yakumo Study who were evaluated for fall risk index 5-items version, locomotive syndrome stage and AGEs. AGEs were evaluated using Skin autofluorescence (SAF) measured by the AGE reader (DiagnOptics Technologies BV, Groningen, the Netherlands). We divided the participants into two groups according to the presence or absence of fall risk (fall risk index 5-items version ≥6 or not), and investigated the factors associated with fall risk. Results: The fall risk group had a higher age and SAF, and a higher proportion of locomotive syndrome stage >2 than the without fall risk group in patients aged ≥65 years (P < 0.01). The multivariate logistic regression analysis after adjustment of age, sex and body mass index showed that locomotive syndrome stage ≥2 and SAF were independent associators of fall risk in older adults (odds ratio 3.26, P < 0.01, odds ratio 2.96, P < 0.05, respectively). The optimal cutoff value of the SAF for fall risk was 2.4 (area under the curve 0.631; 95% CI 0.53–0.733; sensitivity 0.415; specificity 0.814; P < 0.05). Conclusion: The accumulation of AGEs in skin tissues can be used to screen for fall risk comprehensively. Geriatr Gerontol Int 2024; 24: 517–522.

DOI： 10.1111/ggi.14871

Epidemiology of Cervical Fracture/Cervical Spinal Cord Injury and Changes in Surgical Treatment Modalities in Elderly Individuals During a 10-year Period: A Nationwide Multicenter Study in Japan Reviewed

Segi, N; Nakashima, H; Machino, M; Ito, S; Yokogawa, N; Sasagawa, T; Funayama, T; Eto, F; Watanabe, K; Nori, S; Furuya, T; Yunde, A; Nakajima, H; Hasegawa, T; Yamada, T; Terashima, Y; Hirota, R; Suzuki, H; Imajo, Y; Ikegami, S; Uehara, M; Tonomura, H; Sakata, M; Hashimoto, K; Onoda, Y; Kawaguchi, K; Haruta, Y; Suzuki, N; Kato, K; Uei, H; Sawada, H; Nakanishi, K; Misaki, K; Terai, H; Tamai, K; Inoue, G; Shirasawa, E; Kakutani, K; Iizuka, Y; Takasawa, E; Akeda, K; Kiyasu, K; Tominaga, H; Tokumoto, H; Funao, H; Oshima, Y; Yoshii, T; Kaito, T; Sakai, D; Ohba, T; Seki, S; Otsuki, B; Ishihara, M; Miyazaki, M; Okada, S; Imagama, S; Kato, S

GLOBAL SPINE JOURNAL Vol. 14 ( 5 ) page： 1583 - 1594 2024.6

Language：English Publisher：Global Spine Journal

Study Design: Retrospective multicenter study Objectives: To investigate changes over a 10-years period in the profile of cervical spine and spinal cord injuries among the elderly in Japan. Methods: The current multicenter study was a retrospective analysis of inpatients aged ≥65 years, suffering cervical fracture (CF) and/or cervical spinal cord injury (CSCI). We analyzed 1413 patients’ epidemiology (from 2010 to 2019). Moreover, 727 patients who underwent surgical treatment were analyzed in 2 groups: the early (2010-2014) and late period (2015-2019). Results: Both the number of patients and number of surgical patients showed a significant increasing trend (P <.001), while the mean age, the distribution of injury levels and paralysis severity, and the proportion of surgical indications remained the same. The number of surgical patients doubled from 228 to 499 from the early to late periods. Posterior surgery was the most common approach (90.4%), instrumentation surgery with screws increased significantly, and the range of fusion was significantly longer in the late period (2.1 vs 2.7 levels, P =.001). Significantly worsening neurological symptoms were recorded in the late period (1.3% vs 5.8%, P =.006), with C5 palsy being the major one. Otherwise, perioperative, major, and other complications, including mortality, did not differ significantly in incidence. Conclusions: Both the number of elderly CF and/or CSCI patients and number of patients undergoing surgery increased dramatically over the decade without any change in profile. Instrumentation surgeries with screws increased, without an increase in systemic complications.

DOI： 10.1177/21925682231151643

Is spinopelvic compensation associated with unstable gait?: Analysis using whole spine X-rays and a two-point accelerometer during gait in healthy adults Reviewed

Segi, N; Nakashima, H; Ito, S; Ouchida, J; Kayamoto, A; Oishi, R; Yamauchi, I; Takegami, Y; Ishizuka, S; Seki, T; Hasegawa, Y; Imagama, S

GAIT & POSTURE Vol. 111 page： 22 - 29 2024.6

Language：English Publisher：Gait and Posture

Background: Pelvic incidence (PI)–lumbar lordosis (LL) mismatch has a significant destabilizing effect on the center of gravity sway in the static standing position. However, the association between spinopelvic alignment and balance during gait in healthy volunteers is poorly understood. Research question: The degree of PI–LL mismatch and trunk anterior tilt in the static standing posture influences dynamic balance during gait. Methods: In this study, 131 healthy volunteers were divided into two groups: harmonious group (PI − LL ≤ 10°; n = 91) and unharmonious group (PI − LL > 10°; n = 40). A two-point accelerometer system was used for gait analysis; accelerometers were attached to the pelvis and upper trunk to measure acceleration in the forward–backward, right–left, and vertical directions so that sagittal (front–back) deviation width, coronal (right–left) width, and vertical width and their ratios were calculated. Measurements were compared between the two groups, and correlations between alignment and accelerometer data were examined. Results: The harmonious group showed a negative correlation between pelvic sagittal width and PI – LL, pelvic tilt (PT), and sagittal vertical axis (SVA) (correlation coefficient ρ = −0.42, −0.38, and −0.4, respectively), and a positive correlation between sagittal ratio and PI − LL (ρ = 0.35). The unharmonious group showed a positive correlation between pelvic sagittal width and PI and PT (ρ = 0.43 and 0.33, respectively) and between sagittal ratio and SVA (ρ = 0.32). The unharmonious group showed a positive correlation between upper trunk sagittal width and PI − LL and PT (ρ = 0.38 and 0.36, respectively). Significance: The association between spinal alignment and gait parameters differs depending on the presence or absence of PI–LL mismatch. The degree of pelvic compensation and trunk anterior tilt during static standing were associated with unstable gait balance.

DOI： 10.1016/j.gaitpost.2024.04.013

Reply to "Letter to the Editor Concerning 'Implant-Related Complications After Spinal Fusion: A Multicenter Study.' by Koshimizu et al." Reviewed

Koshimizu, H; Nakashima, H; Ohara, T; Tauchi, R; Kanemura, T; Shinjo, R; Machino, M; Ito, S; Ando, K; Imagama, S

GLOBAL SPINE JOURNAL Vol. 14 ( 5 ) page： 1682 - 1683 2024.6

整形トピックス胸椎靱帯骨化症に対する後方除圧固定術と最近の進歩

中島宏彰

整形外科 Vol. 75 ( 5 ) page： 464 - 464 2024.5

Relationship between locomotive syndrome and advanced glycation end products measured by skin autofluorescence in community-dwelling patients: the Yakumo Study Reviewed

Ozawa, Y; Takegami, Y; Seki, T; Osawa, Y; Iida, H; Okamoto, M; Nakashima, H; Ishizuka, S; Hasegawa, Y; Imagama, S

NAGOYA JOURNAL OF MEDICAL SCIENCE Vol. 86 ( 2 ) page： 314 - 325 2024.5

Language：English Publisher：Nagoya Journal of Medical Science

Advanced glycation end products (AGEs) have been reported to be associated with osteoporosis, aging, sarcopenia, and frailty. This study aimed to investigate the association AGEs with locomotive syndrome (LS). Participants were Japanese individuals aged 39 years or older who participated in the Yakumo Study (n=230). AGEs were measured by skin autofluorescence (SAF) using an AGE reader. We investigated SAF values for each locomotive stage. Multivariate logistic regression models were used to calculate the odds ratios of LS-associated factors. The relationships between SAF and physical performance and bone mineral density (BMD) were investigated. A receiver operating characteristic (ROC) curves were generated to determine the optimal cut-off value of SAF for predicting LS. SAF values tended to increase correspondingly with LS severity. SAF was an independently explanatory factor for LS (odds ratio 2.70; 95% confidence interval [CI] 1.040–6.990). SAF was positively correlated with the 10-m walking speed, The Timed Up and Go test results, and was negatively correlated with BMD. ROC curve represented by SAF for the presence or absence of LS risk had an area under the curve of 0.648 (95% CI: 0.571–0.726). High SAF values were identified as an independent risk factor for LS. AGEs could be a potential screening tool for people for LS.

DOI： 10.18999/nagjms.86.2.314

Comparing short vs. intermediate and long nails in elderly patients with unstable multifragmental femoral trochanteric fractures (AO type A2): Multicenter (TRON group) retrospective study Reviewed

Tsugeno, H; Takegami, Y; Tokutake, K; Mishima, K; Nakashima, H; Kobayashi, K; Imagama, S

INJURY-INTERNATIONAL JOURNAL OF THE CARE OF THE INJURED Vol. 55 ( 4 ) page： 111420 2024.4

Language：English Publisher：Injury

Background: Unstable femoral trochanteric fractures (FTFs), especially Arbeitsgemeinschaft für Osteosynthesefragen/ the Orthopedic Trauma Association (AO/OTA) 31-A2 fractures, which are multifragment fractures, occur in elderly individuals with osteoporosis and are associated with high mortality and complication rates due to prolonged immobilization. Longer nails (LNs) were developed to obtain superior fracture site stabilization in unstable FTFs. We hypothesized that the postoperative outcomes of elderly patients with unstable FTFs treated with LNs would be superior to those of patients treated with short nails (SNs), with fewer complications. Methods: This multicenter retrospective study aimed to compare the outcomes of SNs versus LNs in elderly patients with unstable FTFs. From the Trauma Research Group of our university (TRON) database, 1854 trochanteric fractures treated between January 2016 and December 2020 were extracted. A total of 174 patients>65 years of age with AO/OTA 31-A2 fractures were included in the present study. They were divided into the SN group and the LN group and matched for age and sex. Parameters such as operative time, blood loss, survival rate, Parker Mobility Score (PMS), and numerical rating scale (NRS) for pain, complications, and radiographic findings were analyzed. Results: Both groups included 67 patients with an average age of 87.32 years. The LN group had a longer operative time (76.52 min vs. 51.61 min, P < 0.001) and more blood loss (106.79 mL vs. 49.98 mL, P = 0.014) in comparison to the SN group. However, the 1-year survival rate, PMS, and NRS for pain did not differ to a statistically significant extent between the groups. The rates of complications, including screw cutout, nonunion, implant breakage, osteonecrosis of the femoral head, and surgical site infections, were comparable. The radiographic findings, including the nail/canal ratio, progression of varus, and sliding distance, were also similar. Conclusion: Although LNs are associated with longer operative times and increased blood loss, the overall outcomes and complication rates are comparable to those of SNs in elderly patients with AO/OTA 31-A2 type unstable FTFs. The use of LNs did not confer any distinct advantages for this specific type of fracture.

DOI： 10.1016/j.injury.2024.111420

Neurological recovery rate and predictive factors of incomplete AIS grade C spinal cord injury in the older aged population Reviewed

Tamai, K; Terai, H; Nakamura, H; Yokogawa, N; Sasagawa, T; Nakashima, H; Segi, N; Ito, S; Funayama, T; Eto, F; Yamaji, A; Watanabe, K; Yamane, J; Takeda, K; Furuya, T; Yunde, A; Nakajima, H; Yamada, T; Hasegawa, T; Terashima, Y; Hirota, R; Suzuki, H; Imajo, Y; Ikegami, S; Uehara, M; Tonomura, H; Sakata, M; Hashimoto, K; Onoda, Y; Kawaguchi, K; Haruta, Y; Suzuki, N; Kato, K; Uei, H; Sawada, H; Nakanishi, K; Misaki, K; Kuroda, A; Inoue, G; Kakutani, K; Kakiuchi, Y; Kiyasu, K; Tominaga, H; Tokumoto, H; Iizuka, Y; Takasawa, E; Akeda, K; Takegami, N; Funao, H; Oshima, Y; Kaito, T; Sakai, D; Yoshii, T; Ohba, T; Otsuki, B; Seki, S; Miyazaki, M; Ishihara, M; Okada, S; Imagama, S; Kato, S

SPINAL CORD Vol. 62 ( 4 ) page： 149 - 155 2024.4

Language：English Publisher：Spinal Cord

Study design: Retrospective cohort study. Objectives: To define the prognosis and predictive factors for neurological improvement in older patients with incomplete spinal cord injury (SCI) of American Spinal Injury Association Impairment Scale grade C (AIS-C). Settings: Multi-institutions in Japan. Methods: We included patients aged ≥65 years with traumatic SCI of AIS-C who were treated conservatively or surgically with >3 follow-up months. To identify factors related to neurological improvement, patients were divided into three groups according to their neurological status at the final follow-up, with univariate among-group comparisons of demographics, radiographic, and therapeutic factors. Significant variables were included in the multivariate logistic regression analysis. Results: Overall, 296 older patients with SCI of AIS-C on admission were identified (average age: 75.2 years, average follow-up: 18.7 months). Among them, 190 (64.2%) patients improved to AIS-D and 21 (7.1%) patients improved to AIS-E at final follow-up. There were significant among-group differences in age (p = 0.026), body mass index (p = 0.007), status of pre-traumatic activities of daily living (ADL) (p = 0.037), and serum albumin concentrations (p = 0.011). Logistic regression analysis showed no significant differences in variables in the stratified group of patients who improved to AIS-D. Meanwhile, serum albumin was a significant variable in patients who improved to AIS-E (p = 0.026; OR: 6.20, pre-traumatic ADL was omitted due to data skewness). Conclusions: Most older patients with incomplete AIS-C SCI demonstrated at least 1 grade of neurological improvement. However, <10% of patients achieved complete recovery. Key predictors of complete recovery were high serum albumin levels on admission and independent pre-traumatic ADL. Sponsorship: No funding was received for this study.

DOI： 10.1038/s41393-024-00963-0

Obesity Is Associated with Asymptomatic Vertebral Fractures: A Yakumo Study Reviewed

Miyairi, Y; Nakashima, H; Ito, S; Segi, N; Ouchida, J; Oishi, R; Yamauchi, I; Machino, M; Seki, T; Ishizuka, S; Takegami, Y; Hasegawa, Y; Imagama, S

JOURNAL OF CLINICAL MEDICINE Vol. 13 ( 7 ) 2024.4

Language：English Publisher：Journal of Clinical Medicine

(1) Background: Patients with primary vertebral fracture (VF) are at high risk of re-fracture and mortality. However, approximately two-thirds of patients with VFs receive minimal clinical attention. (2) Methods: The current study aimed to investigate the factors associated with asymptomatic VFs in middle-aged and elderly individuals who underwent resident health examinations. (3) Results: The current study included 217 participants aged > 50 years. VFs were diagnosed based on lateral radiographic images using Genant’s semiquantitative (SQ) method. The participants were divided into non-VF (N; SQ grade 0) and asymptomatic VF (F; SQ grades 1–3) groups. Data on body composition, blood tests, quality of life measures, and radiographic parameters were assessed. A total of 195 participants were included in the N group (mean age, 64.8 ± 7.8 years), and 22 were in the F group (mean age, 66.1 ± 7.9 years). The F group had a significantly higher body mass index (BMI), body fat percentage (BF%), and proportion of patients with knee osteoarthritis (KOA) than the N group. The F group had a significantly higher knee joint pain visual analog scale (VAS) score and painDETECT score than the N group. Logistic regression analysis showed that BF% was associated with asymptomatic VFs. (4) Conclusions: Middle-aged and elderly individuals with asymptomatic VF presented with high BMIs, BF%, and incidence of KOA.

DOI： 10.3390/jcm13072063