Impacts of increases and decreases of drugs on rehabilitation outcomes of subacute stroke patients.

OBJECTIVE: To examine changes in drugs for subacute stroke patients and elucidate the impact of medications on rehabilitation outcomes. MATERIALS AND METHODS: A total of 295 subacute stroke patients who were admitted to the convalescent rehabilitation ward between June 2018 and May 2019 were included. Polypharmacy was defined as five or more drugs at admission. The primary outcome was the Functional Independence Measure Total score (FIM-T) at discharge. Multiple regression analysis was performed to examine the relationships between the FIM-T at discharge and drug changes or other factors. This study was conducted in two stages. The first analysis included all stroke patients, and the second analysis included only stroke patients with polypharmacy. RESULTS: On multiple regression analysis, the number of drugs at admission (ß=-0.628) was associated with FIM-T at discharge of all stroke patients. Furthermore, the number of additional drugs during hospitalization (ß=-1.964) was associated with FIM-T at discharge in the 176 stroke patients with polypharmacy. CONCLUSION: This study suggested that the number of drugs at admission and the addition of drugs during hospitalization might have a negative impact on the rehabilitation outcomes of subacute stroke patients.

Relationship between initial nutritional status and functional independence measures at discharge in subacute stroke.

OBJECTIVE: This retrospective study examined the association between nutritional status at admission and functional independence measure (FIM™) at discharge. MATERIALS AND METHODS: This study included 205 patients, aged ≥ 65, discharged from a convalescent ward between April 2017 and March 2018. The primary outcome was discharge FIMTM, and the secondary outcomes were the length of stay (LOS) and FIM efficiency. The explanatory variables included demographic data, stroke type, admission FIMTM, body mass index (BMI), controlling nutritional status (CONUT), and Geriatric Nutritional Risk Index (GNRI). Patients were divided into three groups based on BMI and GNRI scores and four groups based on the CONUT score. Univariate and multiple regression analyses were performed to predict discharge FIMTM. Kruskal-Wallis and Dunn's tests were also performed for intergroup comparisons. RESULTS: In the univariate analyses, age, sex, onset-to-admission interval, admission FIMTM, GNRI, and BMI (all factors were p<0.001) were significant explanatory variables for discharge FIMTM. In the multiple linear regression analysis, admission FIMTM, LOS, age, and onset-to-admission interval were significant explanatory variables (adjusted R2 = 0.791; p<0.001). Although those with poor nutritional status required a longer hospital stay, they achieved the same FIM gain as those without poor nutritional status. CONCLUSIONS: Nutritional status on admission did not affect the FIMTM at discharge in the convalescent ward. Patients with subacute stroke require adequate rehabilitation regardless of their nutritional status.

Rehabilitation in Acute COVID-19 Patients: A Japanese Retrospective, Observational, Multi-Institutional Survey.

OBJECTIVE: To investigate the changes in activities of daily living (ADLs) and the conditions of rehabilitation for acute COVID-19 patients in Japan. DESIGN: Retrospective, observational survey. SETTING: Four tertiary hospitals with intensive care units and one secondary hospital in Japan. PARTICIPANTS: COVID-19 patients (N=478) admitted to 5 hospitals INTERVENTIONS: : Not applicable. MAIN OUTCOME MEASURES: Walking ability and swallowing status were assessed using the FIM locomotion item and Food Intake Scale at admission and discharge. The physiatrists of each hospital were also surveyed regarding the factors that influenced decisions to provide rehabilitation. RESULTS: Excluding patients who died, the proportion of critical patients who could walk independently at discharge was 63%, and the proportion of those who were able to take 3 meals orally at discharge was 90%. Rehabilitation was provided to 13.4% of all patients and to 58.3% of patients with critical symptoms. CONCLUSIONS: After COVID-19 treatment, patients, especially those with critical symptoms, still have functional disabilities related to walking and swallowing. It is possible that sufficient rehabilitation could not be provided during the period studied.

Identification of nuclear phosphoproteins as novel tobacco markers in mouse lung tissue following short-term exposure to tobacco smoke.

Smoking is a risk factor for lung diseases, including chronic obstructive pulmonary disease and lung cancer. However, the molecular mechanisms mediating the progression of these diseases remain unclear. Therefore, we sought to identify signaling pathways activated by tobacco-smoke exposure, by analyzing nuclear phosphoprotein expression using phosphoproteomic analysis of lung tissue from mice exposed to tobacco smoke. Sixteen mice were exposed to tobacco smoke for 1 or 7 days, and the expression of phosphorylated peptides was analyzed by mass spectrometry. A total of 253 phosphoproteins were identified, including FACT complex subunit SPT16 in the 1-day exposure group, keratin type 1 cytoskeletal 18 (K18), and adipocyte fatty acid-binding protein, in the 7-day exposure group, and peroxiredoxin-1 (OSF3) and spectrin ß chain brain 1 (SPTBN1), in both groups. Semi-quantitative analysis of the identified phosphoproteins revealed that 33 proteins were significantly differentially expressed between the control and exposed groups. The identified phosphoproteins were classified according to their biological functions. We found that the identified proteins were related to inflammation, regeneration, repair, proliferation, differentiation, morphogenesis, and response to stress and nicotine. In conclusion, we identified proteins, including OSF3 and SPTBN1, as candidate tobacco smoke-exposure markers; our results provide insights into the mechanisms of tobacco smoke-induced diseases.