Physical activity in patients with non-small cell lung cancer after lung resection.

BACKGROUND: Lung resection is the standard of care for patients with clinical stage I/II non-small cell lung cancer. This surgery reduces both the duration and quality of patients' daily ambulatory activities 1 month after surgery. However, little is known about physical activity after lung resection in patients with lung cancer. To evaluate the recovery process of physical activity with pulmonary rehabilitation in patients after lung resection and examine whether physical activity is affected by age. METHODS: In this prospective, observational study, we measured and analysed participants' postoperative physical activity using a uniaxial accelerometer daily from postoperative day 1 to 30. FINDINGS: We analysed 99 patients who underwent thoracic surgery. The number of walking steps significantly increased until day 4 and then reached a plateau thereafter. The duration of exercise at <3 metabolic equivalents significantly increased until day 3, and no significant difference was observed thereafter. Exercise at >3 metabolic equivalents significantly increased until day 4 and reached a plateau thereafter. A significant correlation was observed between age and number of steps after day 4. Compared with video-assisted thoracoscopic surgery, thoracotomy significantly decreased the number of steps from day 3 to 4. INTERPRETATION: We found that the level of physical activity varied by index in patients with non-small cell lung cancer who underwent lung resection. Age and surgical procedure affect different periods with the increase in post-operative walking steps.

Enhancing exercise tolerance in interstitial lung disease with high-flow nasal cannula oxygen therapy: A randomized crossover trial.

BACKGROUND AND OBJECTIVE: Interstitial lung disease (ILD) is characterized by dyspnoea on exertion and exercise-induced hypoxaemia. High-flow nasal cannula (HFNC) therapy reduces the respiratory workload through higher gas flow and oxygen supplementation, which may affect exercise tolerance. This study aimed to examine the effects of oxygen and gas flow rates through HFNC therapy on exercise tolerance in ILD patients. METHODS: We conducted three-treatment crossover study. All ILD patients performed the exercises on room air (ROOM AIR setting: flow, 0 L/min; fraction of inspired oxygen [FiO2], 0.21), HFNC (FLOW setting: flow 40 L/min, FiO2 0.21), and HFNC with oxygen supplementation (FLOW + OXYGEN setting: flow 40 L/min, FiO2 0.6). The primary endpoint was the endurance time, measured using constant-load cycle ergometry exercise testing at a peak work rate of 80%. RESULTS: Twenty-five participants (10 men, 71.2 ± 6.7 years) were enrolled. The increase in exercise duration between the ROOM AIR and FLOW was 46.3 s (95% CI, -6.1 to 98.7; p = 0.083), and the FLOW and FLOW + OXYGEN was 91.5 s (39.1-143.9; p < 0.001). The percutaneous oxygen saturation (SpO2) at rest was significantly higher with the FLOW + OXYGEN setting than with the ROOM AIR and FLOW settings, and the difference persisted during exercise. At equivalent time points during exercise, the SpO2 with the FLOW setting was significantly higher than that with the ROOM AIR setting. CONCLUSION: Oxygen supplementation in HFNC therapy improved exercise tolerance and SpO2. We found that gas flow alone did not improve exercise tolerance, but improved SpO2 during exercise.

Risk factors for decreased walking ability in hospitalized patients with aspiration pneumonia.

OBJECTIVE: To evaluate the factors that influence walking ability in patients hospitalized due to aspiration pneumonia. METHODS: This retrospective observational study evaluated patients hospitalized with aspiration pneumonia. The primary endpoint was preservation of walking ability. Univariate and multivariate logistic regression analyses were performed with the preservation of walking ability as the dependent variable. RESULTS: A total of 143 patients were enrolled in this study. The patients were divided into two groups: those whose walking ability decreased after hospitalization (n = 61) and those whose walking ability was maintained after hospitalization (n = 82). Multivariate logistic regression analyses showed that A-DROP (odds ratio [OR] 3.006; 95% confidence interval [CI] 1.452, 6.541; P < 0.01), the Geriatric Nutritional Risk Index (OR 0.919; 95% CI 0.875, 0.960; P < 0.001) and days to initial mobilization (OR 1.221; 95% CI 1.036, 1.531; P < 0.05) were the independent early predictors for preservation of walking ability. CONCLUSION: Nutritional status and early mobilization were important risk factors affecting the maintenance of walking ability in patients hospitalized due to aspiration pneumonia. Thus, a combination of nutrition and early rehabilitation is needed for these patients. REGISTRY OF RESEARCH STUDIES INVOLVING HUMAN SUBJECTS: This study was registered with the University Hospital Medical Information Network Clinical Trial Registry (UMIN 000046923).

A Case of Dysphagia and Dysarthria Improved by Flexible-palatal Lift/augmentation Combination Prosthesis.

Background: Palatal augmentation prosthesis (PAP) and palatal lift prosthesis (PLP) have been used to improve dysphagia and dysarthria. However, to date, there are few reports on their combined use. We report a quantitative evaluation of the effectiveness of a flexible-palatal lift/augmentation combination prosthesis (fPL/ACP) based on videofluoroscopic swallowing study (VFSS) and speech intelligibility testing. Case: An 83-year-old woman was admitted to our hospital with a hip fracture. She developed aspiration pneumonia at 1 month after partial hip replacement. Oral motor function tests revealed a motor deficit of the tongue and soft palate. VFSS showed delayed oral transit, nasopharyngeal reflux, and excessive pharyngeal residue. The cause of her dysphagia was assumed to be pre-existing diffuse large B-cell lymphoma and sarcopenia. To improve the dysphagia, an fPL/ACP was fabricated and applied. It improved the patient's oral and pharyngeal swallowing and speech intelligibility. In addition to prosthetic treatment, rehabilitation and nutritional support allowed her to be discharged. Discussion: The effects of fPL/ACP in the present case were similar to those of flexible-PLP and PAP. f-PLP assists in elevation of the soft palate and improved the nasopharyngeal reflux and hypernasal speech. PAP promotes tongue movement and results in improved oral transit and speech intelligibility. Therefore, fPL/ACP may be effective in patients with motor deficits in both the tongue and soft palate. To maximize the effect of the intraoral prosthesis, a transdisciplinary approach with concurrent swallowing rehabilitation, nutritional support, and physical and occupational therapy is necessary.

The severity of nutrition and pneumonia predicts survival in patients with aspiration pneumonia: A retrospective observational study.

INTRODUCTION: Aspiration pneumonia is a common problem among older adults; it has a high mortality rate and the prevalence is increasing. Reports on the risk factors for mortality in patients with aspiration pneumonia are limited. This study aimed to evaluate the risk factors for 90-day survival in patients with aspiration pneumonia. METHODS: This retrospective observational study was conducted at Seirei Mikatahara General Hospital between 1 April 2015 and 31 March 2016. Patients with aspiration pneumonia who had dysphagia or aspiration confirmed by modified water swallow test or VideoEndoscopic examination of swallowing were included. The primary endpoint was 90-day survival. We performed univariate and multivariate logistic regression analyses with survival and non-survival at 90 days as the independent variables. RESULTS: A total of 276 patients were recruited for this study. The A-DROP score (odds ratio [OR] = 2.440; 95% confidence interval [CI], 1.400-4.270; p < 0.01), Geriatric Nutritional Risk Index score (OR = 0.383; 95% CI, 0.178-0.824; p < 0.05) and sex (OR = 0.365; 95% CI, 0.153-0.869; p < 0.05) were independent early predictors of mortality. CONCLUSION: The results suggest that nutritional status and the severity of pneumonia are important factors that predict life expectancy in patients with aspiration pneumonia.

Effects of different high-flow nasal cannula flow rates on swallowing function.

BACKGROUND: High-flow nasal cannula therapy is used as a noninvasive treatment for people with acute respiratory disease. The aim of this study was to assess the impact of high-flow nasal cannula different flow rates on different characteristics of swallowing in healthy volunteers. METHODS: A prospective cohort study where healthy adult volunteers were subject to high-flow nasal cannula at different flow rates (0, 10, 20, 30, 40, and 50 L/min, in random order). The 30-mL water swallow test, repetitive saliva swallowing test, and 0-100 mm visual analog scale assessed aspiration, swallow frequency and effort, respectively. FINDINGS: Thirty subjects (mean age 30 years) were enrolled. Nine subjects (30.0%) choked at 10, 40 and 50 L/min during the 30-mL water swallow test (p < 0.05). Swallowing effort was increased during flow rates ≥20 compared to 10 L/min (p < 0.05). Flow rates ≥20 L/min resulted in lower number of swallows during the repetitive saliva swallowing test compared to 0 and 10 L/min (p < 0.05). INTERPRETATION: High-flow nasal cannula flow rates above 40 L/min associated with choking (increased risk of aspiration), and was associated with decreased swallowing function in healthy volunteers. It may be important to assess swallowing function in patients with various clinical conditions and treated with high-flow nasal cannula, especially those at risk of aspiration pneumonia.

Effect of dentures on pharyngeal swallowing function in patients with dysphagia.

AIM: Dentures play an important role in improving masticatory and oropharyngeal swallowing functions in some edentulous patients without dysphagia. However, few studies have been conducted on patients with dysphagia. This study investigated the effect of dentures on pharyngeal swallowing function in patients with dysphagia. METHODS: Older inpatients with dysphagia who used well-fitting dentures were included in the study. Videofluoroscopic swallowing study findings with and without dentures were compared. Pharyngeal residue and area as spatial, the distance between the maxilla and mandible, hyoid bone/laryngeal displacement, and upper esophageal sphincter opening as kinematics, oral/pharyngeal transit time as temporal measurements, and patient-reported symptoms were evaluated. The primary outcome was the pharyngeal residue measured using the normalized residue ratio scale. Comparisons were made using the paired t-test, Wilcoxon signed-rank test and Fisher's exact test. RESULTS: The mean age of the 27 participants was 86.1 ± 6.8 years. The vallecular residue was more in those without dentures (with dentures: 0.01 [0-0.02], without dentures: 0.03 [0-0.08]; P = 0.003). The pyriform sinus residue showed no significant difference. Denture removal significantly increased the pharyngeal area. The distance between the maxilla and mandible decreased in the absence of dentures, and other kinematic measurements showed no significant differences. Oral/pharyngeal transit time was prolonged without dentures. CONCLUSIONS: Morphological changes caused by the removal of dentures led to pharyngeal expansion, which may result in increased vallecular residue. A treatment plan that considers the effect of dentures on pharyngeal swallowing function may provide rehabilitation that is more effective. Geriatr Gerontol Int 2021; 21: 907-912.

Palatal lift prosthesis for bolus transport in a patient with dysphagia: A clinical report.

A palatal lift prosthesis (PLP) is an intraoral device that provides lift for the soft palate. The usual purpose of a PLP is to reduce nasopharyngeal reflux and the hypernasal speech caused by velopharyngeal incompetence. However, for this patient, the main purpose was to relieve a functional blockage at the oropharyngeal isthmus by suspending the soft palate. A PLP with soft and flexible lift was applied in a patient with a traumatic brain injury and dysphagia. The PLP improved oropharyngeal bolus transit time by relieving the blockage at the oropharyngeal isthmus. This type of PLP may help to improve bolus transport for patients with dysphagia.

Cortical activation during solid bolus swallowing.

Specific areas of cortical activity during solid bolus swallowing in humans are unknown. We tested the hypothesis that cortical representations of swallowing in humans may vary by bolus type. Twenty-one normal subjects swallowed three kinds of food: agar (solid), a capsule and water. We followed the same countdown method for identification of the cortical representations during swallowing performances as a previous study (Tanaka et al., 2006). Functional magnetic resonance imaging (fMRI) showed that the precentral gyrus, postcentral gyrus, medial temporal gyrus, superior temporal gyrus and cingulate gyrus were activated when swallowing an agar bolus (p<0.001). The subcortex was not activated. The cerebellum was activated only during capsule swallowing (P<0.001). Water bolus swallowing activations were similar to agar bolus swallowing. The cluster size of water swallowing was larger than the agar swallowing. We conclude that the cortical representations for swallowing are variable by food type.