Clinical values of diaphragmatic movement in patients with chronic obstructive pulmonary disease.

BACKGROUND: The limitation of activity due to dyspnea in chronic obstructive pulmonary disease (COPD) patients is affected by diaphragmatic dysfunction and reduced lung function. This study aimed to analyze the association between diaphragm function variables and forced expiratory volume in the first second (FEV1) and to estimate the clinical significance of diaphragm function in the correlation between COPD severity and lung function. METHODS: This prospective, single-center, cross-sectional observational study enrolled 60 COPD patients in a respiratory outpatient clinic. Data for baseline characteristics and the dyspnea scale were collected. Participants underwent a pulmonary function test (PFT), a 6-minute walk test (6MWT), and diaphragm function by ultrasonography. RESULTS: The right excursion at forced breathing showed the most significant correlation with FEV1 (r = 0.370, p = 0.004). The cutoff value was 6.7 cm of the right diaphragmatic excursion at forced breathing to identify the FEV1 above 50% group. In the group with a right diaphragmatic excursion at forced breathing < 6.7 cm, modified Medical Research Council (mMRC), St. George's Respiratory Questionnaire and the total distance of 6MWT showed no difference between groups with FEV1 under and above 50% (p > 0.05). In the group with ≥ 6.7 cm, mMRC and the total distance of 6MWT showed a significant difference between FEV1 under and above 50% (p = 0.014, 456.7 ± 69.7 m vs. 513.9 ± 60.3 m, p = 0.018, respectively). CONCLUSION: The right diaphragmatic forced excursion was closely related to FEV1, and analysis according to the right diaphragmatic forced excursion-based cut-off value showed a significant difference between both groups. When the diaphragm function was maintained, there was a lot of difference in the 6MWT's factors according to the FEV1 value. Our data suggest that diaphragmatic function should be performed when interpreting PFT.

Effects of a new respiratory muscle training device in community-dwelling elderly men: an open-label, randomized, non-inferiority trial.

BACKGROUND: Respiratory muscle training (RMT) has various clinical benefits in older adults; however, the low adherence to training remains a challenging issue. The present study aimed to confirm the efficacy of a new device that combines inspiratory muscle training and a positive expiratory pressure (IMT/PEP) compared to that of a Threshold IMT device (Philips Respironics Inc), and to determine whether home-based training differed from rehabilitation center training. METHODS: This four-arm, multicenter, parallel, non-inferiority trial randomized 80 active community-dwelling older men (mean age = 72.93 ± 5.02 years) to center-based groups (new IMT/PEP device or Threshold IMT device; 16 supervised sessions) or home-based groups (new IMT/PEP device or Threshold IMT device; 2 supervised sessions and individual sessions). Participants in all groups performed RMT twice a day for 8 weeks. Assessments were performed at baseline and post-training. The primary outcomes were maximum inspiratory pressure and maximal expiratory pressure. The secondary outcomes included forced vital capacity and forced expiratory volume in the first second, peak cough flow, diaphragm thickness, VO2 peak, the International Physical Activity Questionnaire score, electromyographic activities of the sternocleidomastoid muscle, and skeletal muscle mass and phase angle as measured by bioimpedance analysis. In addition, rates of adherence to each protocol were also compared. RESULTS: Among all groups, the maximal inspiratory pressure was improved post-training, while the maximal expiratory pressure showed improvement only in the IMT/PEP groups. The overall non-inferiority of the IMT/PEP device was thus validated. A statistically significant improvement in diaphragm thickness was found. However, no consistent improvement was shown in other secondary outcomes. No significant difference in training adherence rate between protocols was observed (mean adherence rate of 91-99%). CONCLUSION: Compared to the Threshold IMT, the new IMT/PEP device did not result in a significant difference in maximal inspiratory pressure but did improve maximal expiratory pressure in older men. The IMT/PEP device's improved usability, which is associated with exercise adherence, provided distinct advantages in this cohort. If proper education is first provided, home-based RMT alone may provide sufficient effects in older individuals. TRIAL REGISTRATION: This trial was registered in the database cris.nih.go.kr (registration number KCT0003901 ) on 10/05/2019.

Prevalence and Severity of Dysphagia Using Videofluoroscopic Swallowing Study in Patients with Aspiration Pneumonia.

INTRODUCTION: The purpose of this study was to identify the prevalence and severity of dysphagia in patients diagnosed with aspiration pneumonia, with and without neurologic disorders. METHODS: We retrospectively reviewed the medical records of inpatients with aspiration pneumonia who underwent a videofluoroscopic swallowing study (VFSS) for evaluation of dysphagia. Patients were divided into two groups based on the presence or absence of neurologic disorders. The prevalence and severity of aspiration and pharyngeal residue due to dysphagia were assessed using the penetration-aspiration scale (PAS) and pharyngeal residue grade (PRG). RESULTS: A total of 784 patients were enrolled; of these, 58.7% were males and the mean age was 76.12 ± 6.69. Penetration-aspiration-related dysphagia (PAS scores 3-8) was seen in 56.5% of all subjects, and 32.5% showed silent aspiration (PAS 8). Pharyngeal residue-related dysphagia (PRG scores 2-3) was seen in 65.2% of all patients, and the PAS and PRG were positively correlated. On dividing the subjects into two groups based on the presence of neurologic disorders, there was no significant difference in prevalence of the dysphagia between groups (PAS: p = 0.641; PRG: p = 0.872) with the proportion of silent aspiration (p = 0.720). CONCLUSION: In patients hospitalized for aspiration pneumonia, there was a high prevalence of dysphagia. There were no differences in the prevalence and severity of dysphagia in patients with aspiration pneumonia based on the presence or absence of a neurologic disorder. Therefore, diagnostic evaluation of dysphagia is necessary regardless of the presence of neurologic disorders.

Recovery target priorities of people with spinal cord injuries in Korea compared with other countries: a survey.

STUDY DESIGN: Cross-sectional survey. OBJECTIVES: To identify which functional areas are important in recovery and which psychosocial factors influence life quality among persons with spinal cord injuries in Korea and to compare our results with similar studies from other countries. SETTING: University-affiliated rehabilitation hospital. METHODS: The survey was distributed to people with spinal cord injuries and captured their targeted functional recoveries and psychosocial goals that can affect life quality. The respondents were asked to place these in order of priority. Participants were also asked questions regarding factors they felt were important for restoring function, their expectations for recovery and to evaluate their health status and satisfaction with their quality of life. RESULTS: Fifty-five people were tetraplegia and 45 people were paraplegia. The primary functional recovery goals included the recovery of upper extremity functions in tetraplegic persons and restoration of bladder and bowel functions in paraplegic persons. For psychosocial goals, stress management was the most important factor among both tetraplegic and paraplegic people. The two most important factors for restoring function were proper physical therapy and relationship with their clinician. About half of the respondents had no expectation of restoring their functions. CONCLUSIONS: Restoring upper extremity function, sexual function, and bladder and bowel function has been a common concern in previous studies. Our result, however, showed sexual function was less important. Coping with stress was important for life quality, another finding that differed from other studies. Thus, there may be cultural and social differences in the priorities of the target functions.

Determinants of prolonged baseline blood pressure restoration following autonomic dysreflexia for individuals with spinal cord injuries.

OBJECTIVE: This study aimed to identify the determinants affecting the time required for blood pressure (BP) restoration after autonomic dysreflexia (AD) and to propose a new method for BP measurement in individuals with cervical spinal cord injury (SCI) who experience AD. METHODS: In a prospective, single-center observational study, participants' bladders were filled with body-temperature saline until reaching cystometric capacity, as confirmed by previous urodynamic studies. Restoration time (RT), defined as the time from the onset of voiding until BP returned to baseline, was measured during the morning voiding session. This session involved the use of a 10F hydrophilic transurethral catheter. Data were then compared with various clinical determinants including demographic, urodynamic, and cystographic variables. RESULTS: The study included 29 individuals with cervical SCI. Notable variations in RT were observed among individuals with differing levels of detrusor overactivity (DO) and bladder compliance. An inverse correlation was noted between RT and bladder compliance, whereas positive correlations were identified with maximal detrusor pressure, peak systolic BP (SBP), and the magnitude of BP changes. Factors associated with prolonged RT included injury completeness, bladder trabeculation, vesicoureteral reflux (VUR), DO, and changes in SBP. CONCLUSIONS: A significant association was found between BP elevation and prolonged RT. Determinants such as the severity of the SCI, bladder trabeculation, VUR, and DO were correlated with prolonged RT, considering their importance in the assessment of baseline BP following AD.

Current Status and Barriers of Exercise in Individuals with Spinal Cord Injuries in Korea: A Survey.

This study investigated exercise participation, health status, and barriers to exercise in 109 individuals with spinal cord injury (SCI) using a self-report questionnaire. The responses of the exercise and non-exercise groups were statistically analyzed using t-tests or Fisher's exact test. Significant differences were observed in the cause of injury and the American Spinal Injury Association Impairment Scale between the groups. The non-exercise group had a higher incidence of traumatic and complete injuries. Demographic factors such as gender, age, income level, and marital status did not significantly influence exercise participation. The exercise group reported lower pain scores, less inconvenience from complications, and higher activity and participation scores. However, less than half of the individuals with SCI met the recommended exercise intensity, and community facility usage was low. Barriers to exercise participation included severe disabilities, lack of time, insufficient exercise information, and lack of facility accessibility. To enhance exercise among individuals with SCI, it is essential to develop and extend exercise programs tailored to individual physical factors and a comprehensive understanding of barriers. Prioritizing community-based data management, alongside developing social systems and health policies, is crucial to overcome barriers to exercise participation for individuals with SCI.

Status and Barriers of Physical Activity and Exercise in Community-Dwelling Stroke Patients in South Korea: A Survey-Based Study.

This study aimed to examine the physical activity and exercise status of stroke patients in the community after discharge and the need for community-based exercises. This study included 100 community-dwelling patients with stroke in South Korea. The survey investigated the self-assessment of health status and physical activity, demand for community-based exercise after discharge, quality of life, and social participation. Overall, 96% of the respondents recognized the need to exercise, and two-thirds exercised. The third who did not exercise cited disability (29%), lack of facilities (22%), and health concerns (13%); only 21% of participants had ever used a community exercise facility, and their satisfaction with the facility was low. The main reasons for not using community exercise facilities were concerns about accidents during exercise and accessibility issues. Among real-world community stroke patients, those who exercised regularly had higher EuroQol-5D and reintegration to normal living indices than those who did not exercise (p < 0.05). Although community-dwelling stroke patients were highly aware of the need for physical activity and exercise, few engaged in adequate exercise. This lack of engagement is directly linked to identifiable personal and socio-structural barriers. Addressing these barriers will improve the quality of life and social participation of patients with stroke.

Heart rate variability and its association with symptoms of orthostatic hypotension in spinal cord injury.

CONTEXT/OBJECTIVE: To assess differences in autonomic function using heart rate variability (HRV) parameters between people with and without orthostatic hypotension (OH), and to determine symptoms of OH in people with spinal cord injury (SCI). METHODS: R-R interval and blood pressure (BP) data were recorded using Finometer PRO® in both the supine position and at a 60-degree tilt using a tilt table, each lasting for 6 minutes. R-R interval data were processed using the Kubios HRV analysis software to convert R-R interval into time and frequency domains for further analysis. RESULTS: Compared to the non-OH group, the SCI group with OH exhibited lower values for root mean square of the successive differences (RMSSD) and standard deviation of normal-to-normal interval (SDNN), along with an elevated heart rate during tilt-up. Participants with OH symptoms had a lower average heart rate in the supine and 60-degree positions compared to asymptomatic participants. Logistic regression analysis indicated that SDNN in the supine position correlated with the presence of OH, and that the mean heart rate in the 60-degree position was related to the presence of symptoms. CONCLUSIONS: Differences in HRV parameters were observed in people with SCI and OH, suggesting a reduced parasympathetic activity in the supine position, likely as a response to maintain homeostasis in BP regulation. Despite the presence or absence of OH symptoms, there was no difference in HRV parameters. This finding suggests that autonomic function may not be the primary determinant of these symptoms, with other factors likely being more influential.

Quantitative Analysis of the Head Tilt Using Three-Dimensional Temporal Scan in Children with Torticollis.

The head tilt of patients with torticollis is usually evaluated subjectively in clinical practice and measuring it in young children is very limited due to poor cooperation. No study has yet evaluated the head tilt using a three-dimensional (3D) scan and compared it with other measurement methods. Therefore, this study aimed to objectively demonstrate head tilt through clinical measurements and a 3D scan in children with torticollis. A total of 52 children (30 males, 22 females; age 4.6 ± 3.2 years) diagnosed with torticollis and 52 adults (26 men, 26 women; age 34.42 ± 10.4 years) without torticollis participated in this study. The clinical measurements were performed using a goniometer and still photography methods. Additionally, the head tilt was analyzed using a 3D scanner (3dMD scan, 3dMD Inc., Atlanta, GA, USA). There was a high correlation between the other methods and 3D angles, and the cut-off value of the 3D angles for the diagnosis of torticollis was also presented. The area under the curve of the 3D angle was 0.872, which was confirmed by a moderately accurate test and showed a strong correlation compared with other conventional tests. Therefore, we suggest that measuring the degree of torticollis three-dimensionally is significant.

Effects of walking with a portable oxygen concentrator on muscle oxygenation while performing normal or pursed-lip breathing in patients with interstitial lung disease: a randomized crossover trial.

BACKGROUND: In patients with interstitial lung disease (ILD), decreased oxygen saturation (SpO2) reduces physical performance and causes exertional dyspnea. Portable oxygen concentrator (POC) and pursed-lip breathing (PLB) have the potential to improve these parameters in ILD patients. OBJECTIVE: To evaluate the effects of PLB while using a POC during walking in ILD patients. DESIGN: Prospective, randomized crossover trial. METHODS: We compared two breathing techniques. Participants not trained in PLB received a familiarization session before the first 6-min walking test (6MWT). During the first visit, patients performed the 6MWT under natural breathing (NB1) without oxygen (O2); during the second visit, they performed the 6MWT twice, once each with PLB (PLB1) and natural breathing (NB2) under O2 supplementation, to compare the effectiveness of NB and PLB. RESULTS: Twenty participants were recruited; half had exercise-induced desaturation (EID) and half normal SpO2. In the normoxemia group (NG), the difference in the 6-min walking distance (6MWD) between NB1 and PLB1 was 28.8 ± 24.0 m, indicating reduced exercise capacity in PLB1. There were no significant differences in the quadriceps tissue saturation index (TSI), SpO2, and 6MWD between the PLB1 and NB2 in any patient or subgroup. All participants showed a significant increase in the SpO2 at rest, nadir SpO2, and mean SpO2 during the 6MWT with PLB and NB2 using a POC than with NB1. TSI showed a significant improvement at the beginning of 6MWT in ILD patients with EID in the PLB and NB2 condition. CONCLUSION: Acute exposure to PLB did not improve symptoms, muscle oxygenation, or SpO2; however, it decreased the walking distance in the normoxemia group. POC improved leg muscle oxygenation in ILD patients with EID. The use of PLB and POC should be prescribed according to disease characteristics and severity.

Urodynamic Study in Multiple System Atrophy: A Retrospective Observational Study.

This retrospective study aimed to evaluate the characteristics of neurogenic bladder in patients with multiple systemic atrophy and distinguish between cerebellar and parkinsonian-type urodynamic patterns. We reviewed 19 patients diagnosed with multiple systemic atrophy with low urinary tract symptoms who underwent an urodynamic study at Pusan National University Yangsan Hospital between March 2010 and February 2022. This study did not account for the differences observed between the multiple system atrophy subtypes in the voiding phase. Urodynamic study is an effective tool to understand the complicated bladder pattern in patients with multiple system atrophy.

Epidemiology and Assessment of Traumatic Spinal Cord Injury With Concomitant Brain Injury: An Observational Study in a Regional Trauma Center.

OBJECTIVE: : To analyze the epidemiological information of patients with traumatic spinal cord injury (SCI) and concomitant traumatic brain injury (TBI) and to suggest points to be aware of during the initial physical examination of patients with SCI. METHODS: : This study was a retrospective, observational study conducted in a regional trauma center. All the records of patients diagnosed with traumatic SCI between 2016 and 2020 were reviewed. A total of 627 patients with confirmed traumatic SCI were hospitalized. A retrospective study was conducted on 363 individuals. RESULTS: : The epidemiological data of 363 individuals were investigated. Changes in American Spinal Injury Association Impairment Scale (AIS) scores in patients with SCI were evaluated. The initial evaluation was performed on average 11 days after the injury, and a follow-up examination was performed 43 days after. Fourteen of the 24 patients identified as having AIS A and SCI with concomitant TBI in the initial evaluation showed neurologic level of injury (NLI) recovery with AIS B or more. The conversion rate in patients with SCI and concomitant TBI exceeded that reported in previous studies in individuals with SCI. CONCLUSIONS: : Physical, cognitive, and emotional impairments caused by TBI present significant challenges in rehabilitating patients with SCI. In this study, the influence of concomitant TBI lesions could have caused the initial AIS assessment to be incorrect.

The Effects of Autonomic Dysfunction on Functional Outcomes in Patients with Acute Stroke.

Autonomic dysfunction is a common complication of acute stroke, which impairs functional outcomes and increases mortality. There is a lack of well-established knowledge regarding the influence of autonomic dysfunction in patients with acute stroke. This study aims to investigate the impact of the severity of autonomic dysfunction on functional outcomes in patients with acute stroke. A retrospective analysis was conducted at a single center, involving 22 patients diagnosed with acute stroke. The severity of autonomic dysfunction was evaluated based on the Composite Autonomic Scoring Scale (CASS). The modified Barthel Index, Berg Balance Scale, Functional Ambulatory Category, and modified Rankin Scale were designated as functional outcome measures. The impact of the severity of autonomic dysfunction on functional outcomes was analyzed using one-way analysis of covariance (ANCOVA). A statistically significant difference was observed between the initial and follow-up functional outcomes based on the severity of autonomic dysfunction. This study presents evidence that the severity of autonomic dysfunction influences functional prognosis in patients with acute stroke. The findings will serve as additional considerations for the rehabilitation of patients with acute stroke.

Clinical impact of preoperative diaphragm dysfunction on early outcomes and ventilation function in lung transplant: a single-center retrospective study.

BACKGROUND: Clinical impact of preoperative diaphragm dysfunction on lung transplantation has not been studied. We aimed to evaluate how preoperative diaphragm dysfunction affects clinical outcomes and ventilation function after transplantation. METHODS: We retrospectively enrolled 102 patients. Ultrasound for diagnosis of diaphragm dysfunction was performed on all patients both before and after lung transplantation. The primary outcome was to compare prolonged mechanical ventilation after transplantation according to the preoperative diaphragm dysfunction. Secondary outcomes compared global inhomogeneity index and lung volume after transplantation. Multivariate regression analysis were used to evaluate the association between preoperative diaphragm dysfunction and prolonged mechanical ventilation after transplantation. RESULTS: A total of 33 patients (32.4%) had preoperative diaphragm dysfunction, and half of them (n = 18) recovered their diaphragm function after transplantation. In contrast, 15 patients (45.5%) showed postoperative diaphragm dysfunction. The ratio of prolonged mechanical ventilation after transplantation was significantly higher in the preoperative diaphragm dysfunction group (p = 0.035). The postoperative durations of mechanical ventilation, intensive care unit and hospital stays were higher in the preoperative diaphragm dysfunction group, respectively (p < 0.05). In the multivariate regression analysis, preoperative diaphragm dysfunction was significantly associated with prolonged mechanical ventilation after transplantation (Odds ratio 2.79, 95% confidence interval 1.07-7.32, p = 0.037). As well, the preoperative diaphragm dysfunction group showed more inhomogeneous ventilation (p < 0.05) and lower total lung volume (p < 0.05) after transplantation. In addition, at 1 month and 3 months after transplantation, FVC was significantly lower in the preoperative diaphragm dysfunction group (p < 0.05). CONCLUSIONS: Preoperative diaphragm dysfunction was associated with prolonged mechanical ventilation after lung transplantation.

Ergonomics and Personalization of Noninvasive Ventilation Masks.

Although noninvasive ventilation (NIV) is administered to manage respiratory failure due to various causes, safety and effectiveness issues associated with the use of NIV masks have been reported. The present article aims to provide health professionals with a comprehensive review of the ergonomic considerations of NIV masks in terms of design, evaluation, and personalization. Based on a review of 93 papers, we provide guidelines for mask selection and troubleshooting during mask use as well as ergonomic approaches including face anthropometry, sizing systems, mask design, evaluation, and personalization. The comprehensive information presented in this review provides ergonomic perspectives to identify and prevent safety and usability problems associated with the use of NIV masks. Ergonomic improvement and personalization are important goals in order to facilitate the success of NIV treatment.

Feasibility of dance therapy using telerehabilitation on trunk control and balance training in patients with stroke: A pilot study.

BACKGROUND: This randomized controlled trial aimed to investigate the effects of dance therapy using telerehabilitation on trunk control and balance training in patients with stroke and compare them with the effects of conventional treatment. METHODS: We enrolled 17 patients with subacute or chronic stroke who were randomly assigned to either an experimental or a control group. In addition to conventional physical therapy, the experimental group (n = 9) participated in 40-minute, non-face-to-face, dance-therapy sessions and the control group (n = 8) received conventional physical therapy. The primary outcome measures were the Trunk Impairment Scale (TIS) scores to assess trunk control and balance function between the 2 groups as a measure of change from baseline to after the intervention. RESULTS: We found that the TIS scores of the patients in the experimental group significantly improved (P = .017). The TIS results indicated non-inferiority within a predefined margin for dance therapy using telerehabilitation (difference = -0.86, 95% confidence interval [CI] = -2.21 to 0.50). CONCLUSION: Dance therapy using telerehabilitation significantly improved the TIS scores in the experimental group and was not inferior to conventional rehabilitation treatment when compared in a non-inferiority test. The remote dance program may therefore have similar effects to those of conventional treatment regarding trunk-control improvement in patients with stroke.

Non-traumatic spinal cord infarction of the conus medullaris in a child: a case report.

INTRODUCTION: The etiologies of pediatric spinal cord infarction are commonly cardiovascular problems resulting from hypotensive events from trauma and abdominal aortic surgery. Non-traumatic spinal cord infarction in children is rare and remains difficult to diagnose. We report a case of non-traumatic spinal cord infarction of the conus medullaris in a child who recovered after receiving only rehabilitative treatment. CASE PRESENTATION: A 12-year-old female patient experienced sudden low back pain for 2 days, followed by weakness in the lower extremities and difficulties in micturition. On admission, magnetic resonance imaging indicated spinal cord infarction of the conus medullaris. After initial treatment with prednisone and mannitol, a few weeks of intensive rehabilitation was recommended. Physical therapy focused on improving lower limb strength. A plastic solid ankle-foot orthosis was used with Lofstrand crutches throughout the period of rehabilitation. After 2 months of rigorous therapy, she was able to walk independently. DISCUSSION: Non-traumatic spinal cord infarction of the conus medullaris in children is extremely rare. The current case is unique because it involves a patient who presented with pediatric spinal cord infarction of the conus medullaris and showed remarkable neurological recovery after rehabilitation. The case describes a rare spinal cord infarction in a pediatric patient and emphasizes the importance of providing an accurate diagnosis and treatment.

Utilizing Pulmonary Function Parameters to Predict Dysphagia in Individuals With Cervical Spinal Cord Injuries.

OBJECTIVE: To utilize pulmonary function parameters as predictive factors for dysphagia in individuals with cervical spinal cord injuries (CSCIs). METHODS: Medical records of 78 individuals with CSCIs were retrospectively reviewed. The pulmonary function was evaluated using spirometry and peak flow meter, whereas the swallowing function was assessed using a videofluoroscopic swallowing study. Participants were divided into the non-penetration-aspiration group (score 1 on the Penetration-Aspiration Scale [PAS]) and penetration-aspiration group (scores 2-8 on the PAS). Individuals with pharyngeal residue grade scores >1 were included in the pharyngeal residue group. RESULTS: The mean age was significantly higher in the penetration-aspiration and pharyngeal residue groups. In this study, individuals with clinical features, such as advanced age, history of tracheostomy, anterior surgical approach, and higher neurological level of injury, had significantly more penetration-aspiration or pharyngeal residue. Individuals in the penetration-aspiration group had significantly lower peak cough flow (PCF) levels. Individuals in the pharyngeal residue group had a significantly lower forced expiratory volume in 1 second (FEV1). According to the receiver operating characteristic curve analysis of PCF and FEV1 on the PAS, the cutoff value was 140 L/min and 37.5% of the predicted value, respectively. CONCLUSION: Low PCF and FEV1 values may predict the risk of dysphagia in individuals with CSCIs. In these individuals, active evaluation of swallowing is recommended to confirm dysphagia.

Unilateral Diaphragm Paralysis Associated With Neurosyphilis: A Case Report.

Diaphragm dysfunction can originate from various etiologies, and bilaterality of the dysfunction depends on the cause. Symptoms of diaphragm dysfunction vary depending on the degree of phrenic nerve denervation, spinal cord lesion, and involvement of the diaphragm. Several infectious diaphragmatic dysfunctions have been reported, including the human immunodeficiency virus, poliovirus, West Nile virus, and dengue virus. Here, we report a case of unilateral diaphragm paralysis in a 34-year-old man with neurosyphilis.

ICU rehabilitation is associated with reduced long-term mortality from sepsis in patients with low skeletal muscle mass: a case control study.

BACKGROUND: It is unclear whether intensive care unit (ICU)-rehabilitation reduces mortality from sepsis in low skeletal muscle mass. We evaluated whether the association of ICU-rehabilitation with mortality from sepsis differs between patients with and without low skeletal muscle mass. METHODS: We retrospectively reviewed 516 patients with sepsis who were admitted to the ICU between June 2011 and August 2017. The skeletal muscle area at the level of the third lumbar vertebra was measured with CT on admission. Patients were divided into two groups (low skeletal muscle mass and non-low skeletal muscle mass), and clinical outcomes were compared in patients treated with ICU-rehabilitation and without ICU-rehabilitation within each subgroup. We used Cox regression to examine factors associated with 1-year mortality in each subgroup. RESULTS: Low skeletal muscle mass was diagnosed in 421 (81.6%). ICU-rehabilitation was conducted to 51.1% low skeletal muscle mass patients and 54.7% non-low skeletal muscle mass patients. In the low skeletal muscle mass subgroup, in-hospital mortality (26.0% vs. 39.8%, P=0.003) and 6-month mortality (38.6% vs. 51.5%, P=0.008) were lower in the ICU-rehabilitation group. However, there were no differences in the non-low skeletal muscle mass group. In the multivariate analysis, ICU-rehabilitation was independently associated with reduced 1-year mortality in low skeletal muscle mass patients (HR: 0.66, 95% CI: 0.49-0.87, P=0.003), but not in non-low skeletal muscle mass patients. CONCLUSIONS: ICU-rehabilitation was independently associated with reduced 1-year mortality from sepsis among low skeletal muscle mass patients, but not among non-low skeletal muscle mass patients. Therefore, the delayed initiation of ICU-rehabilitation should be avoided, especially in low skeletal muscle mass patients.