Relationship between near‐infrared spectroscopy,and subcutaneous fat and muscle thickness measured by ultrasonography in Japanese community‐dwelling elderly

Aim: Near‐infrared spectroscopy (NIRS) allows estimation of the percentage of body fat (%BF) regardless of the patient's posture; thus, it is useful for assessment of elderly patients with severe decline of basic activity who cannot hold a standing position. However, the accuracy by which the near‐infrared light emitted from NIRS reflects subcutaneous tissue is unknown. The aim of this study was to assess how correctly NIRS reflects the subcutaneous fat and muscle thickness derived from ultrasonography in community‐dwelling elderly. Methods: A total of 93 community‐dwelling older adults aged 65 years and older were enrolled in this study (mean 75.8 years, 6.7 SD). Participants were assessed according to optical density (OD) measurements by NIRS, subcutaneous fat and muscle thickness by ultrasonography, and muscle strength. Pearson's correlation coefficients were calculated for each sex. Stepwise multiple regression analysis was used to identify factors that contributed to OD for each sex. Results: OD measured at the forearm and thigh were significantly correlated with subcutaneous fat thickness. In stepwise multiple regression analyses, subcutaneous fat thickness was found to be a significant determinant of OD in men (forearm β = −0.37, P = 0.01; thigh β = −0.63, P < 0.001) and women (forearm β = −0.50, P < 0.001; thigh: β = −0.52, P < 0.001). Conclusions: These results suggest that NIRS can appropriately estimate fat‐free mass. By adding other variables to OD as the predictive variable, skeletal muscle mass might be estimated in the elderly population. Geriatr Gerontol Int 2013; 13: 351–357 .     

Automated versus Manual Measurement of the QT Interval and Corrected QT Interval

Background: The International Conference on Harmonization E14 Guideline specifies detailed assessment of QT interval or corrected QT interval prolongation when developing new drugs. We recently devised new software to precisely measure the QT interval. Methods and Results: The QT intervals of all leads for a selected single heart beat were compared between automated measurement with the new software from Fukuda Denshi and manual measurement. With both automated and manual measurement, QT intervals obtained by the tangent method were shorter than those obtained by the differential threshold method, but the extent of correction was smaller. QT interval data obtained by the differential threshold method were more similar to values obtained by visual measurement than were data obtained by the tangent method, but the extent of correction was larger. Variability was related to the T‐wave amplitude and to setting the baseline and tangent in the tangent method, while skeletal muscle potential noise affected the differential threshold method. Drift, low‐amplitude recordings, and T‐wave morphology were problems for both methods. Among the 12 leads, corrections were less frequent for leads II and V₃–V₆. Conclusion: We conclude that, for a thorough assessment of the QT/QTc interval, the tangent method or the differential threshold method appears to be suitable because of smaller interreader differences and better reproducibility. Correction of data should be done by readers who are experienced in measuring the QT interval. It is also important for electrocardiograms to have little noise and for a suitable heart rate and appropriate leads to be selected. Ann Noninvasive Electrocardiol 2011;16(2):156–164     

Aicardi–Goutières syndrome with systemic lupus erythematosus and hypothyroidism

We report a case of Aicardi–Goutières syndrome with systemic lupus erythematosus and hypothyroidism. A 3-year-old girl, diagnosed with Aicardi–Goutières syndrome at 9 months, was transferred to our hospital for fever of unknown origin. Severe spasticity with dystonic posturing and flexion contracture of the limbs were noted. Interstitial pneumonia with pleural effusion was evident. Immunological investigations revealed positive antinuclear antibodies and reduced thyroid function. Prompt treatment with steroids, cyclophosphamide, and levothyroxine sodium hydrate elicited a good response. It is necessary to emphasize that its possible relationship between Aicardi–Goutières syndrome and systemic lupus erythematosus and/or hypothyroidism.     

Primary cutaneous diffuse large B‐cell lymphoma,leg type,with features simulating POEMS syndrome

A 91‐year‐old woman presented with a rapidly proliferative cutaneous lesion on the left lower limb, which was identified as a primary cutaneous diffuse large B‐cell lymphoma (PCLBCL), leg type, on biopsy. The patient also showed complications of hepatomegaly, endocrinopathy, edema, skin change, and polyneuropathy without monoclonal plasma cell proliferative disorder, and was therefore diagnosed with POEMS‐like syndrome owing to the lack of monoclonal plasma cell proliferative disorder. Levels of serum vascular endothelial growth factor (VEGF) and interleukin‐6 (IL‐6) were high with the lymphoma cells immunostained positively for VEGF and IL‐6. To the best of our knowledge, this is the first case report of PCLBCL, leg type, with POEMS‐like syndrome. The findings in this case suggest that the symptoms of POEMS‐like syndrome might be caused by the cytokines produced by the lymphoma cells. Furthermore, a wider range of diagnostic criteria associated with the result of abnormal secretion of cytokine may have to be considered for the diagnosis and evaluation of patients with possible POEMS syndrome, as against the present criteria specifying monoclonal plasma cell proliferative disorder as the essential criterion.