Predictors for the Knee Extension Strength at 2 Yrs After Total Knee Arthroplasty Using Regression Tree Analysis.

OBJECTIVE: The aim of the study is to clarify the interactive combinations of clinical factors associated with knee extension strength 2 yrs after total knee arthroplasty. DESIGN: A retrospective cohort study was conducted on 264 patients who underwent total knee arthroplasty. Knee extension strength was assessed preoperatively, 3 wks, and 2 yrs after total knee arthroplasty. Physical functions were measured with 10-m walking test, Timed Up and Go test, one-leg standing time, isometric knee flexion strength, knee joint stability, knee pain, femora-tibial angle, and passive knee extension and flexion angle before surgery as a baseline and 3 wks after total knee arthroplasty as acute phase. Regression tree analysis was conducted to clarify the interactive combinations that accurately predict the knee extension strength 2 yrs after total knee arthroplasty. RESULTS: Operational side knee extension strength (>1.00 Nm/kg) at acute phase was the primal predictor for the highest knee extension strength at 2 yrs after total knee arthroplasty. Acute phase Timed Up and Go test (≤10.13 secs) and baseline 10-m walking test (≤11.72 secs) was the second predictor. Acute phase nonoperative side knee extension strength (>0.90 Nm/kg) was also selected as the predictor. CONCLUSIONS: This study demonstrated that knee extension strength or Timed Up and Go test in the acute phase and 10-m walking test before total knee arthroplasty are useful for estimating the knee extension strength after total knee arthroplasty. The results will help determine specific postoperative rehabilitation goals and training options.

Pre-transplant phase angle as a potential marker for predicting the development of infection after allogeneic hematopoietic stem cell transplantation.

BACKGROUND & AIMS: Nutritional assessment in allogeneic hematopoietic stem cell transplantation (allo-HSCT) is important and decreased skeletal muscle mass is a risk factor for the development of infection. Recently, it has become clear that qualitative rather than skeletal muscle mass loss is a marker that reflects post-transplant outcome, but its association with the development of infection remains unclear. Therefore, we assessed skeletal muscle status by body composition using bioelectrical impedance analysis (BIA) and investigated its association with the development of infection. METHODS: A retrospective cohort study was conducted to assess the quantity as well as quality of skeletal muscle using the body composition of BIA assessment. The quantitative (appendicular skeletal muscle mass index; ASM) and qualitative (phase angle; PhA) indicators of skeletal muscle calculated from body composition analysis were used to determine factors influencing the development of infection after allo-HSCT. RESULTS: In total, 80 adult patients, aged 20-70 years (median, 52) were included in this study. The ASM was mildly decreased after allo-HSCT and PhA was significantly decreased. Furthermore, low pre-transplant PhA was identified as an independent risk factor for the development of infection early after transplantation, with a cutoff value of 4.9°. CONCLUSION: In particular, pre-transplant PhA may predict the development of infection early after allo-HSCT, and muscle indices that can be assessed with pre-transplant body composition are a useful evaluation method that can discriminate post-transplant outcomes.

Minimal important difference of the 6-minute walk test after allogenic hematopoietic stem cell transplantation.

PURPOSE: The 6-min walk test (6MWT) of allogenic hematopoietic stem cell transplantation (allo-HSCT) recipients has been gaining attention; however, minimal differences have not been reported. This study aimed to determine the minimal important difference (MID) in the 6MWT among hospitalized patients with allo-HSCT. MATERIALS AND METHODS: The MID of the 6MWT was calculated using three different methodologies based on an anchor-based method; basic anchor-based methods, linear regression analysis, and receiver operating characteristic (ROC) curve analysis. The decrease in the score of Question 2 of the European Organization for Research and Treatment of Cancer Quality of life questionnaire core-30 was included as an anchor question for calculating the MID. Both actual and percentage changes in 6MWT values from baseline and at discharge were used in the MID calculations. In the actual and percentage change of the 6MWT, the one with the larger the area under the curve in the ROC curve was recommended as the MID. RESULTS: Among the three methods using actual values, the largest MID of the 6MWT was -37.5 m (sensitivity: 54%, specificity: 88%). CONCLUSION: More careful follow-up after discharge is necessary for allo-HSCT patients who show a reduction of 37.5 m or more in the acute illness phase.

Advancements in allogeneic hematopoietic stem cell transplantation have improved the survival rates of individuals with malignant hematological disorders, and efforts should now be focused on enhancing their physical function and quality of life.There is a problem that the physical performance of the patients is reduced by the side effects of treatment.More careful follow-up after discharge is necessary for allo-HSCT patients who show a reduction of 37.5 m or more in the acute illness phase.

Interactive Combinations Between Gait Speed and Physical Function at Acute Phase Can Predict the Physical Activity at 2 Years After Total Knee Arthroplasty Using Classification and Regression Tree Analysis.

OBJECTIVE: To clarify the interactive combinations of various clinical factors associated with physical activity (PA) at 2 years after total knee arthroplasty (TKA) using classification and regression tree (CART) analysis. DESIGN: A retrospective cohort study. SETTING: A single university hospital. PARTICIPANTS: 286 patients who underwent TKA (N=286). MAIN OUTCOME MEASURES: PA was assessed preoperatively, 3 weeks, and 2 years after TKA. Physical functions, namely, 10 m walking test (10MWT), timed Up and Go test, 1-leg standing time, isometric knee extension and flexion strength, knee joint stability, knee pain, femora-tibial angle, and the passive knee extension and flexion angle, were measured before surgery as a baseline and 3 weeks after TKA as acute phase. CART analysis was conducted to clarify the interactive combinations that accurately predict the PA at 2 years after TKA. RESULTS: The results of CART analysis indicated that gait speed (≥1.05 m/s) at the acute phase after TKA was the primal predictor for the postoperative PA at 2 years. The highest postoperative PA at 2 years was determined by gait speed (≥1.05 m/s) and PA (>74.5) at the acute phase. The PA at baseline and at acute phase, as well as the body mass index were also selected as predictors of postoperative PA at 2 years. CONCLUSION: The present study suggested that acquiring gait speed (≥1.05 m/s) and PA (>74.5) in the postoperative acute phase is the predictive of a high PA at 2 years after TKA.

Clinical Results of Arthroscopic Partial Trapeziectomy With Suture-Button Suspensionplasty for Thumb Carpometacarpal Arthritis.

BACKGROUND: This study represents the clinical results, especially range of motion (ROM) improvement, of arthroscopic partial trapeziectomy with suture-button suspensionplasty for symptomatic grade II and III thumb carpometacarpal arthritis with a minimum 1-year follow-up. METHODS: Thirty-two patients (mean: 67.5 years) with grade II and III thumb carpometacarpal arthritis treated with arthroscopic partial trapeziectomy with suture-button suspensionplasty were retrospectively followed up for at least 1 year. The physical assessments included ROM, pain visual analogue scale (VAS), strength, and the Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire. The physical variables were retrospectively compared before surgery and at the final follow-up. RESULTS: Preoperative radial abduction and palmar abduction (45.4 ± 16.4° and 54.3 ± 13.9°, respectively) were significantly increased at the final follow-up (59.7 ± 16.9° and 65.5 ± 14.2°, respectively). Preoperative VAS score, pinch strength, and DASH score (70.5 ± 14.0, 57.2 ± 24.8% and 36.8 ± 14.8, respectively) were also significantly improved at the final follow-up (7.9 ± 9.1, 91.0 ± 39.6%, and 11.7 ± 10.5, respectively). Complications involved 1 case of irritation of the superficial branch of the radial nerve and 1 case of dystonia. Two suture-buttons were removed due to patient discomfort. CONCLUSIONS: A significant increase in ROM and pain relief was obtained after suture-button suspensionplasty with arthroscopic partial trapeziectomy.

Reproducibility, criterion-related validity, and minimal clinically important difference of the stair negotiation test after total Hip arthroplasty.

OBJECTIVE: To determine the reproducibility, criterion-related validity, and minimal clinically important difference (MCID) of the stair negotiation test (SNT) after total hip arthroplasty (THA). METHODS: Sixty patients who underwent THA were included in this study. They performed the SNT and rated their difficulty in stair negotiation (question 7 of the Oxford Hip Score [OHSQ7]) before and 6 months after surgery. The SNT determined the time taken by a patient to ascend, turn around, and descend the stairs (15 cm × 4 steps) and was measured twice each time. As a measure of reproducibility, the intraclass correlation coefficient (ICC1,1) was calculated using the preoperative SNT. As an index of criterion-related validity, Spearman's rank correlation coefficient was used to evaluate the relationship between the better score of two trials in the preoperative SNT and the OHSQ7. The MCID of the SNT was calculated using the distribution-based method and the anchor-based method. The change in the OHSQ7 between before and after surgery was used as an anchor in the latter method. RESULTS: The ICC1,1 of the SNT was 0.97. The SNT was significantly correlated with the OHSQ7 (r = 0.40, p < .05). Moreover, the anchor-based MCID of the SNT was 1.98 seconds. CONCLUSION: The SNT is an objective assessable test of stair negotiation ability in post-THA patients that has good reproducibility and moderate criterion-related validity. Changes in the SNT beyond the MCID (1.98 seconds) represent clinically important changes in stair negotiation ability.

Effect of gait distance during robot training on walking independence after acute brain injury.

This study aimed to determine whether the distance of gait training using a hybrid assistive limb (HAL) is related to the improvement of walking independence in patients with acute brain injury. This was an exploratory, observational study. Thirty patients having hemiplegia (functional ambulation category, FAC score ≤2) with acute stroke or after brain tumor surgery were included. Patients performed 4 sessions of gait training using HAL (60 min/session), 1-3 sessions/week, combined with conventional physical therapy. The gait distance achieved in the four training sessions using HAL was measured. FAC score was measured before and after intervention. Patients were divided into groups A, B, and C, for FAC score improvements of 0, 1, and ≥2, respectively. Gait distance was compared among groups using one-way analysis of variance. Gait distance in group C was significantly longer than that ingroup A [mean (standard deviation): 2527 (1725) m vs. 608 (542) m]. This study suggested that the gait distance achieved during training using the HAL may be a clinical indicator of the effectiveness of the HAL on gait training in patients with acute brain injury.Clinical trial registration number: UMIN000012764 R000014756.

Belt Electrode-Skeletal Muscle Electrical Stimulation During Early Hematopoietic Post-Transplantation To Prevent Skeletal Muscle Atrophy and Weakness.

A decline in physical functions at the early stage of allogeneic hematopoietic stem cell transplantation (allo-HSCT) is a serious issue. Belt electrode-skeletal muscle electrical stimulation (B-SES) can induce significant muscle contractions with electrical stimulation and reduce muscle weakness. However, this approach has not been used in allo-HSCT patients. This study aimed to examine the effect of B-SES on physical function, and safety in patients during the early post-transplantation period. Forty-three adult patients who underwent B-SES after allo-HSCT were stratified into 2 groups based on the intensity of electrical stimulation (high versus low). B-SES was performed in combination with exercise therapy for 4 post-transplantation weeks. Knee extensor strength (KES) in the low B-SES group decreased significantly, whereas no change was observed in the high-intervention group. A significant positive correlation was observed between total intensity and ΔKES. A reduction in the 6-minute walking distance in the high B-SES group patients was lower than that of historical data. Two patients had B-SES-related complications including muscle pain. This study is the first to propose a new rehabilitation intervention strategy for allo-HSCT. Combined use of B-SES may be a new approach to reducing the decline of physical function in the early post-transplantation period.

Correlation between brain functional connectivity and neurocognitive function in patients with left frontal glioma.

The association between neurocognitive function (NCF) impairment and brain cortical functional connectivity in glioma patients remains unclear. The correlations between brain oscillatory activity or functional connectivity and NCF measured by the Wechsler Adult Intelligence Scale full-scale intelligence quotient scores (WAIS FSIQ), the Wechsler Memory Scale-revised general memory scores (WMS-R GM), and the Western aphasia battery aphasia quotient scores (WAB AQ) were evaluated in 18 patients with left frontal glioma using resting-state electroencephalography (EEG). Current source density (CSD) and lagged phase synchronization (LPS) were analyzed using exact low-resolution electromagnetic tomography (eLORETA). Although 2 and 2 patients scored in the borderline range of WAIS FSIQ and WMS-R GM, respectively, the mean WAIS FSIQ, WMS-R GM, and WAB AQ values of all patients were within normal limits, and none had aphasia. In the correlation analysis, lower WMS-R GM was associated with a higher LPS value between the right anterior prefrontal cortex and the left superior parietal lobule in the beta1 band (13-20 Hz, R = - 0.802, P = 0.012). These findings suggest that LPS evaluated by scalp EEG is associated with memory function in patients with left frontal glioma and mild NCF disorders.

Intramuscular Adipose Tissue Content Predicts Patient Outcomes after Allogeneic Hematopoietic Stem Cell Transplantation.

During clinical courses involving treatment with allogeneic hematopoietic stem cell transplantation (allo-HSCT), multidisciplinary patient assessment including physical function is indispensable, and quantitative skeletal muscle loss is a poor prognostic marker. Deteriorating quality of muscle from intramuscular adipose tissue degeneration can be important as well, because many patients are cachexic or sarcopenic before allo-HSCT, although this approach has not yet been used in such patients. We conducted this retrospective cohort study to evaluate the quality as well as quantity of skeletal muscle using computed tomography (CT) scans. The psoas muscle mass index (PMI) and radiographic density (RD) calculated by cross-sectional area and averaged CT values of the psoas major muscle at the umbilical level were used to determine the quantity and quality of muscle, respectively. A total of 186 adult patients, ranging in age from 17 to 68 years (median, 49 years), were included in this study, with 46 (24.7%) assigned to the lower PMI group and 49 (26.3%) assigned to the lower RD group. Low RD was identified as an independent risk factor for poor overall survival after allo-HSCT (adjusted hazard ratio [HR], 2.54; P < .01), whereas PMI was not significant. Decreased RD along with a reduced 6-min walking distance before transplantation were significant factors in increased nonrelapse mortality (HR, 2.69; P = .01). This study is the first to suggest the use of a qualitative skeletal muscle index to serve as a prognostic indicator following allo-HSCT. RD should be included in pretransplantation screening parameters, and approaches that include rehabilitation focused on improving both muscle quality and quantity may improve the prognosis of allo-HSCT.

Development of a Clinical Prediction Rule to Identify Physical Activity After Total Hip Arthroplasty.

OBJECTIVE: To develop clinical prediction rule (CPR) of physical activity 1 year after total hip arthroplasty (THA). DESIGN: Retrospective cohort study. SETTING: University hospital with orthopedic surgery. PARTICIPANTS: The study group included 321 patients (56 men) who underwent primary THA (N=321). INTERVENTION: Not applicable. MAIN OUTCOMES MEASURES: The data collected included age, body mass index, clinical score from the questionnaires, hip pain, range of motion, muscle strength, and Physical functions (10-meter walk test [10MWT], timed Up and Go test, sit-to-stand test). Patients were classified into sufficient and insufficient activity groups based on their University of California, Los Angeles (UCLA) activity score 1 year after THA. Variables measured preoperatively and 3 weeks postoperatively were analyzed using univariate and multivariate methods to derive CPR for physical activity. RESULTS: A CPR was developed using the following 5 factors and cutoffs: age 70.5 years or younger, preoperative UCLA activity score ≥3.5, preoperative hip abduction strength ≥0.54 Nm/kg, preoperative knee extension strength ≥1.04 Nm/kg, and 10MWT ≤8.49 seconds 3 weeks after surgery. The presence of 4 of the 5 factors predicted a sufficient physical activity level at 1 year, with a positive likelihood ratio of 5.94 and probability of 85.4%. The presence of 5 predictor variables increased the probability of sufficient physical activity after THA to 94.7%. CONCLUSIONS: This study developed a CPR for physical activity 1 year after THA. Having 4 or more of the 5 measurements were useful indicators for predicting of physical activity 1 year postoperatively.

Association of Physical Activity and Nutritional Intake with Muscle Quantity and Quality Changes in Acute Stroke Patients.

OBJECTIVES: To evaluate longitudinally the muscle properties of acute stroke patients and examine the association between physical activity and nutritional intake. MATERIALS AND METHODS: This study enrolled 21 stroke patients (72.7±10.4 years). Muscle quantity (fat-free mass, appendicular skeletal muscle mass) and quality (extracellular water/intracellular water ratio, phase angle) were assessed using a bioelectrical impedance device at baseline (within three days) and two weeks after stroke onset. Physical activity and sedentary were calculated from the accelerometer data. Total energy and protein intake were calculated from the dietary surveys as nutritional intake. The association of physical activity, sedentary, and nutritional intake with the rate of changes in muscle properties was examined. RESULTS: The fat-free mass significantly decreased (from 43.4±8.0 to 42.2±7.6 kg), and the skeletal muscle was unchanged (from 17.8±4.2 to 17.7±4.0 kg) after two weeks. The extracellular water/intracellular water ratio significantly increased (from 0.63±0.02 to 0.65±0.03) and the phase angle significantly decreased (from 5.1±0.6 to 4.9±0.8°), suggesting that the muscle quality have declined. Correlation analysis showed that the extracellular water/intracellular water ratio was significantly associated with physical activity [metabolic equivalents (ρ=-0.61)] and sedentary (ρ=0.67) and that the phase angle was significantly associated with physical activity [metabolic equivalents (ρ=0.69)], sedentary (ρ=-0.68), and nutritional intake [total energy (r=0.45), protein (r=0.45)]. CONCLUSIONS: The fat-free mass and muscle quality (extracellular water/intracellular water ratio and phase angle) declined two weeks after stroke. Physical activity and nutritional intake were lower in patients with decreased muscle quality, suggesting the importance of exercise and nutrition in the acute phase.

Effect of a Rehabilitation Program After Mesenchymal Stromal Cell Transplantation for Advanced Osteonecrosis of the Femoral Head: A 10-Year Follow-Up Study.

Objective: To assess the status of 10 patients with advanced osteonecrosis of the femoral head who underwent mesenchymal stromal cell transplants and a 12-week rehabilitation program 10 years earlier. Design: Retrospective study. Setting: University clinical research laboratory. Participants: Patients (N=10) who had undergone mesenchymal stromal cell transplantation and rehabilitation for a single hip osteonecrosis of the femoral head 10 years prior to the current study were recruited by telephone. The average age was 31.7 years and all participants were men; radiographic stages were 3A in 6 patients and 3B in 4 patients before treatment. Intervention: A 12-week rehabilitation program with follow-up once every 1 to 2 years was performed after mesenchymal stromal cell transplantation. Main Outcome Measures: Radiographic analysis, clinical score, timed Up and Go test, hip function (range of motion, muscle strength), and Short Form-36 scores were assessed before treatment and 1 and 10 years after treatment. Results: Upon imaging, 5 hips were found to be stable (stable group) and 5 had progressed (progressed group); 2 of the latter group required a total hip arthroplasty. The pretreatment radiographic stage of the progressed group was more advanced than that of the stable group. Body mass index was higher in the progressed group than in the stable group. Hip function and clinical score at 1 and 10 years after treatment improved in the hips of 8 patients without total hip arthroplasty. There were no severe adverse events during the rehabilitation. Conclusions: The 12-week rehabilitation program and annual follow-up after mesenchymal stromal cell transplantation for osteonecrosis of the femoral head was associated with pain reduction, maintaining hip muscle strength, widening range of motion, and improving quality of life. The level and timing of weight-bearing and social activity should be planned according to the individual's lifestyle and body composition.

Evaluation of indices for predicting recovery of exercise tolerance in patients surviving allogenic hematopoietic stem cell transplantation.

PURPOSE: Decline in physical function in the early stage after allogeneic hematopoietic stem cell transplantation (allo-HSCT) is a major challenge. Exercise tolerance tests, such as the 6-min walk test, are useful markers for predicting exercise tolerance and various other traits, including cardiometabolic risk and non-relapse mortality. This retrospective cohort study aimed to investigate and identify predictors of recovery of exercise tolerance in the early stage after allo-HSCT. METHODS: Ninety-eight patients were classified into recovery and non-recovery groups according to the median 6-min walk distance (6MWD) at discharge. RESULTS: Logistic regression analysis revealed that pre-post change in knee extensor strength (ΔKES) and hematopoietic cell transplantation comorbidity index were useful predictors of recovery of exercise tolerance at discharge and moderate predictors of 6MWD recovery in the early post-transplant period. Receiver operating characteristic analysis showed that pre-transplant ΔKES was an accurate predictor of 6MWD recovery in the early post-transplant period. The cutoff point for ΔKES calculated using the Youden index was - 1.17 Nm/kg. CONCLUSIONS: The results of this study emphasize the importance of the need for programs designed to prevent muscle weakness in the early period after allo-HSCT. The results from markers of recovery of exercise tolerance are promising and can be used for patient education in rehabilitation programs after allo-HSCT.

Changes in the health-related quality of life and social reintegration status after lung transplantation following hematopoietic stem cell transplantation.

PURPOSE: Late-onset non-infectious pulmonary complications (LONIPCs) after allogeneic hematopoietic stem cell transplantation are fatal; however, lung transplantation might achieve good survival. Nevertheless, improving the health-related quality of life (HRQoL) is still a major concern. This study aimed to investigate, in detail, the recovery in HRQoL and social reintegration status after lung transplantation in patients with LONIPC after allo-HSCT. METHODS: This prospective cohort study involving 18 patients examined changes in the health and social reintegration status after lung transplantation following LONIPC. RESULTS: Physical function and HRQoL were lowest before lung transplantation. Two years after lung transplantation, the dyspnea scores and performance status improved. Most patients had made a successful return to society, and patients who achieved social reintegration were significantly younger and had a good performance status. However, their Physical Functioning score and Physical Component Summary did not show significant improvement after lung transplantation. Moreover, recipients who were unemployed before lung transplantation were likely to remain unemployed and continued to show poor HRQoL. CONCLUSIONS: These results showed poor recovery of HRQoL, especially in terms of physical function, and the likelihood of failure to reintegrate into society within 2 years after lung transplantation. It is necessary to consider long-term follow-up and physical training to improve social reintegration and HRQoL.

Recovery of Muscle Atrophy and Fatty Infiltration in Patients With Acetabular Dysplasia After Total Hip Arthroplasty.

INTRODUCTION: Hip osteoarthritis (OA) with acetabular dysplasia negatively affects pelvic alignment and muscle function. We aimed to investigate the changes in muscle atrophy and fatty infiltration of the hip and trunk muscles 1 year after total hip arthroplasty (THA) in patients with hip OA with acetabular dysplasia. METHODS: This study included 51 female patients who underwent THA for unilateral hip OA with acetabular dysplasia. The cross-sectional area (CSA) and muscle density of the gluteus maximus, gluteus medius, gluteus minimus, piriformis, iliopsoas, rectus abdominis, and abdominal oblique muscles using computer tomography and pelvic inclination angle using radiographs were assessed before and 1 year after THA. RESULTS: At the 1-year follow-up, the CSA and muscle density of the gluteus medius (2,078 to 2,522 mm2 and 30.3 to 39.4 hounsfield units [HU]), iliopsoas (715 to 901 mm2 and 40.3 to 50.8 HU), and rectus abdominis (336 to 363 mm2 and 28.6 to 30.6 HU) of the affected limb had increased significantly (P < 0.05). The CSA and muscle density of the gluteus maximus (2,429 versus 2,884 mm2 and 23.7 versus 32.6 HU), gluteus minimus (636 versus 785 mm2 and 14.3 versus 37.1 HU), piriformis (505 versus 607 mm2 and 23.4 versus 31.6 HU), and iliopsoas (901 versus 997 mm2 and 50.8 versus 54.5 HU) in the affected limb were lower than those in the unaffected limb (P < 0.01). Postoperatively, the CSA and muscle density of the rectus abdominis were not significantly different between the limbs, and the pelvic inclination angle (35.2° to 32.1°, P < 0.01) was significantly decreased. DISCUSSION: Compared with the nonoperated limb, substantial atrophy and fatty infiltration of most hip muscles persisted in the operated limb 1 year after THA in patients with acetabular dysplasia; asymmetry in the rectus abdominis muscle fully resolved. In patients with acetabular dysplasia, the surgical technique and postoperative rehabilitation should be further considered to optimize hip muscle recovery.

Erector spinae muscle radiographic density is associated with survival after lung transplantation.

OBJECTIVE: The study objective was to verify whether low preoperative radiographic density of erector spinae muscles is associated with poor prognosis after lung transplantation. METHODS: Preoperative chest computed tomography scans for patients who underwent deceased-donor lung transplantation between 2013 and 2019 at Kyoto University Hospital were retrospectively retrieved. The radiographic density of erector spinae muscles was quantitatively evaluated as the mean attenuation of erector spinae muscles, and low mean radiographic density of the erector spinae muscles was defined as a mean radiographic density of the erector spinae muscles value below the median value for all patients. Overall survival and chronic lung allograft dysfunction-free survival with high and low mean radiographic density of the erector spinae muscles were estimated using the Kaplan-Meier method and evaluated by the log-rank test, as well as by univariate and multivariate Cox proportional hazard analyses. RESULTS: Of the 107 adult patients who underwent primary transplantation, 96 underwent at least 1 chest computed tomography scan within 24 hours before lung transplantation. The median mean radiographic density of the erector spinae muscles in these 96 patients was 49.2 Hounsfield units. A low mean radiographic density of the erector spinae muscles value was significantly associated with decreased overall survival (hazard ratio, 4.50; P = .030) and chronic lung allograft dysfunction-free survival (hazard ratio, 3.18; P = .028) in the multivariate analysis. Additionally, patients with preoperative steroid use and a low mean radiographic density of the erector spinae muscles value had a worse overall survival (P < .001) and chronic lung allograft dysfunction-free survival (P < .001) than patients with preoperative steroid use and a high mean radiographic density of the erector spinae muscles value and those without preoperative steroid use. CONCLUSIONS: Low mean radiographic density of the erector spinae muscles was closely associated with a poor prognosis after lung transplantation. The prognosis was particularly poor in patients with preoperative steroid use and a low mean radiographic density of the erector spinae muscles. These results may be useful when considering the indications for lung transplantation or preoperative interventions. VIDEO ABSTRACT.

Immediate family support is important to discharge home for cancer patient with bone metastasis after rehabilitation: A retrospective study.

ABSTRACT: The purpose of this study is to investigate the predictive factors of home discharge for rehabilitation patients with cancer bone metastasis.Cancer patients with bone metastasis who underwent rehabilitation between April 2014 and March 2017 were retrospectively enrolled. Data on discharge destination were collected from medical records as outcomes. Multiple regression analyses were carried out to investigate the predictive factors of home discharge.Ninety-eight patients (mean age: 68.6 years, 42 females and 56 males) were included. Fifty patients were discharged home, 38 patients were discharged to other facilities, and 10 patients died. There were no skeletal-related events among these patients during their hospital stay. The receiver-operating curve for the predictive factors for home discharge of the Barthel Index at admission, Eastern Cooperative Oncology Group Performance Status at admission, and number of immediate family members living at home were 60 points (area under the curve [AUC] = 0.74, sensitivity = 0.6400, 1-specificity = 0.2766), 2 score (AUC = 0.65, sensitivity = 0.5400, 1-specificity = 0.2222), and 1 family member (AUC = 0.65, sensitivity = 0.9592, 1-specificity = 0.7222), respectively.In order to plan for cancer patients with bone metastasis to be discharged home, it is important to take into consideration the patients' Barthel Index and Performance Status at the time of hospital admission and the number of immediate family members living at home.

Assessment of neurocognitive function in association with WHO grades in gliomas.

OBJECTIVE: High-grade gliomas are fast-growing and may exhibit more severe neurocognitive function (NCF) decline compared with low-grade gliomas. A comprehensive understanding of the NCF in patients with glioma may be critical for developing effective glioma treatments and rehabilitation interventions. This study evaluated NCF more comprehensively in patients with glioma using the Wechsler Adult Intelligence Scale-Third Edition (WAIS-III) and the Wechsler Memory Scale-Revised (WMS-R), and also determined the differences in NCF in relation with the WHO grades of gliomas. METHODS: Thirty-five patients with newly diagnosed glioma were reviewed in the present study. The patients were divided into three groups, Grade II, III, and IV, based on the World Health Organization's classification of tumors of the central nervous system. NCF was assessed using the WAIS-III and WMS-R. RESULTS: There were 14 (40.0%), 7 (20.0%), and 14 (40.0%) patients in the grade II, grade III, and grade IV groups, respectively. The results of the Kruskal-Wallis test showed significant differences in all the scores of the WAIS-III and WMS-R between grade II and grade IV. The scores of the WAIS-III and WMS-R in grade IV patients were borderline for NCF disorders, except in the attention/concentration domain. On the other hand, grade II and III groups had normal scores. CONCLUSION: Therefore, patients with a grade IV glioma presented NCF decline compared to grade II and III glioma. In contrast, the results of the WAIS-III and WMS-R indicated that the NCF of patients with grades II and III glioma was intact.

Analysis of factors associated with patient-reported physical functioning scores at discharge of allogeneic hematopoietic stem cell transplantation patients: a cross-sectional study.

PURPOSE: The purpose of this study was to clarify the independent factors related to patient-reported physical functioning (PF) scores at discharge of patients who underwent allogeneic hematopoietic stem cell transplantation (allo-HSCT). METHODS: A total of 103 patients who underwent allo-HSCT were included in this cross-sectional study. As a screening method, a single regression analysis was conducted with the PF domain in the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 at discharge as the dependent variable, and body mass index, adverse events related to HSCT, and objective physical functions as independent variables. Multiple regression analysis was performed with PF as the dependent variable and variables that passed the screening by single regression analysis and confounders as independent variables. RESULTS: The mean PF score at discharge of the patients was 76.5 (standard deviation: 15.2). Based on the results of screening by the single regression analysis, length of stay, infections (+ / -), acute graft-versus-host disease grade, brief fatigue inventory score (BFI), knee extensor strength, and 6-min walk distance (6MWD) were included in the multiple regression analysis. BFI (B = - 11.94, p < 0.001) and 6MWD (per 10 m) (B = 0.56, p = 0.001) were extracted as significant independent variables governing the PF at discharge in the multiple regression model (adjusted R2 = 0.59). CONCLUSION: Higher exercise tolerance and lower fatigue in patients who underwent allo-HSCT were associated independently with patient-reported better PF scores at discharge.