Implementation Rate of Physical Rehabilitation in Neonatal Intensive Care Units in Japan: A Retrospective Observational Study.

Background and Objective: The benefits of physical rehabilitation for very-low-birth-weight infants (VLBWI) have been reported in previous studies; however, the implementation rate of physical rehabilitation in this population remains to be clarified. This study aimed to examine the implementation rate of physical rehabilitation among VLBWI admitted to the neonatal intensive care unit (NICU) using real-world data. Material and Methods: This observational study obtained data from a nationwide administrative database associated with the diagnostic procedure combination (DPC) system in Japan (2014-2019). The participants were 30,464 infants admitted to the NICU between 2014 and 2019. The overall NICU physical rehabilitation rates and background factors of the participants were examined. Results: The overall physical rehabilitation rate in NICUs was 18%. Infants born at <28 weeks of age and extremely low birth weight infants (ELBWI) were more likely to receive physical rehabilitation interventions. The length of stay at the NICU and hospital, as well as the rate of discharge, were higher in patients who received physical rehabilitation than those in infants who did not. Conclusions: One-fifth of all patients admitted to the NICU received physical rehabilitation interventions. Extremely preterm infants and ELBWI were more likely to receive physical rehabilitation interventions. We need to consider ways to increase physical rehabilitation intervention rates in the NICU.

Preoperative decline in skeletal muscle strength of patients with cardiovascular disease affects postoperative pulmonary complication occurrence: a single-center retrospective study.

BACKGROUND: Dynapenia, defined as age-related skeletal muscle strength decline, has been reported as a poor prognostic factor in patients with cardiovascular disease. Decline in skeletal muscle strength (DS), the main symptom of dynapenia, may be an important clinical indicator in patients undergoing cardiac surgery. However, the relationship between DS and postoperative pulmonary complication occurrence is unclear. Herein, we investigated the relationship between preoperative DS and postoperative pulmonary complication occurrence in patients undergoing cardiac surgery. METHODS: We enrolled 125 patients who underwent cardiac surgery. DS was determined by low grip strength and quadriceps isometric strength. The patients were divided into DS and non-DS groups. The relationship between the clinical characteristics and preoperative physical function was compared, and factors associated with postoperative pulmonary complication occurrence were investigated using multivariate logistic regression analysis. RESULTS: There were 42 (33.6%) patients in the DS group and 83 (66.4%) patients in the non-DS group. Compared with the non-DS group, the DS group was significantly older and had a higher body mass index and Japan SCORE (operative mortality rate and major complication rate). The DS group also had a lower estimated glomerular filtration rate and preoperative Barthel index than the non-DS group. Furthermore the DS group had a significantly higher incidence of postoperative pulmonary complications and length of intensive care unit stay, and their postoperative rehabilitation was prolonged compared to the non-DS group. Multivariate logistic regression analysis revealed that DS was a determinant of postoperative pulmonary complications (odds ratio 4.26, 95% confidence interval 1.63‒11.14). CONCLUSIONS: We showed that preoperative DS was an independent risk factor for postoperative pulmonary complications in patients undergoing cardiac surgery. Skeletal muscle strength before cardiac surgery may be an important clinical indicator for predicting the prognosis of patients from post-surgery to discharge and for planning postoperative rehabilitation programs.

Fruit setting rewires central metabolism via gibberellin cascades.

Fruit set is the process whereby ovaries develop into fruits after pollination and fertilization. The process is induced by the phytohormone gibberellin (GA) in tomatoes, as determined by the constitutive GA response mutant procera However, the role of GA on the metabolic behavior in fruit-setting ovaries remains largely unknown. This study explored the biochemical mechanisms of fruit set using a network analysis of integrated transcriptome, proteome, metabolome, and enzyme activity data. Our results revealed that fruit set involves the activation of central carbon metabolism, with increased hexoses, hexose phosphates, and downstream metabolites, including intermediates and derivatives of glycolysis, the tricarboxylic acid cycle, and associated organic and amino acids. The network analysis also identified the transcriptional hub gene SlHB15A, that coordinated metabolic activation. Furthermore, a kinetic model of sucrose metabolism predicted that the sucrose cycle had high activity levels in unpollinated ovaries, whereas it was shut down when sugars rapidly accumulated in vacuoles in fruit-setting ovaries, in a time-dependent manner via tonoplastic sugar carriers. Moreover, fruit set at least partly required the activity of fructokinase, which may pull fructose out of the vacuole, and this could feed the downstream pathways. Collectively, our results indicate that GA cascades enhance sink capacities, by up-regulating central metabolic enzyme capacities at both transcriptional and posttranscriptional levels. This leads to increased sucrose uptake and carbon fluxes for the production of the constituents of biomass and energy that are essential for rapid ovary growth during the initiation of fruit set.

The Relationship Between Preoperative Frailty Risk as Assessed by the Hospital Frailty Risk Score and the Outcome at Discharge in Coronary Artery Bypass Grafting (CABG) Patients: A Retrospective Observational Study Using the Diagnosis Procedure Combination Database.

The relationship between the Hospital Frailty Risk Score (HFRS)-based frailty risk and outcomes after coronary artery bypass grafting (CABG) is yet unclear. The objective of this study was to investigate the relationship between preoperative frailty risk as assessed by the HFRS and postoperative outcomes in patients undergoing CABG. This observational study used the diagnosis procedure combination (DPC) system in Japan (2014-2017). In total, 35,015 adults aged ≥ 65 years and diagnosed with angina pectoris and acute myocardial infarction who had undergone CABG were enrolled. We investigated the association between the HFRS-based frailty risk and the home discharge rate, as well as the prevalence of complications. Multilevel logistic regression analysis revealed that having an HFRS ≥ 5 was a determinant of lower home discharge rate (odds ratio [OR] 0.60, 95% confidence interval [CI] 0.49-0.74, P <0.01), aspiration pneumonia (OR 2.25, 95%CI 1.27-3.96, P <0.01) and disuse syndrome (OR 1.90, 95%CI 1.23-2.94, P <0.01). Preoperative stratification of frailty risk using HFRS may help in predicting postoperative progress and in planning postoperative rehabilitation.

Pre-operative Physical Performance Is Associated With Early Return to Work in Peri-operative Lung Cancer Patients.

Little is known about the factors related to return to work (RTW) in patients with peri-operative lung cancer (LC). This study aimed to investigate whether pre-operative physical performance is associated with early RTW in patients with peri-operative LC. A total of 59 patients who wished to resume work after lung resection surgery were included and were divided into three groups: early RTW (within 14 days after discharge), delayed RTW (within 15-90 days), and non-RTW (failure of RTW within 90 days). The early RTW group had significantly lower scores on the modified Medical Research Council dyspnea scale (mMRC) and significantly higher scores on the Euro Quality of Life 5-Dimension 3-Level (EQ-5D-3L) than the non-RTW group. Multivariate logistic regression analysis showed that EQ-5D-3L scores were significantly associated with early RTW, and mMRC scores and knee extensor strength tended to be associated with early RTW. Better pre-operative quality of life, mild dyspnea, and greater lower limb muscle strength tended to be associated with early RTW in patients with peri-operative LC.

[Achievements and Future Challenges in the Support of the Balance of Work and Medical Treatment at the Hospital of the University of Occupational and Environmental Health, Japan, in 2018-2020].

The Japanese government is making full-scale efforts to support working people who suffer from cancer and/or other diseases, as it seeks to support a balance of work and receiving medical treatment. The Hospital of the University of Occupational and Environmental Health, Japan, opened its Support Center of Treatment and Work Balance in 2018. This is a multi-disciplinary department for supporting the balance of work and medical treatment. It also opened its Department of Occupational Medicine, the first such department in Japan to provide medical diagnosis and treatment dedicated to supporting that same balance. Our team has supported 704 patients through our activities over the past 3 years. The number of patients supported has increased each year, while the number of departments providing support has also trended upward. There has also been an increase in opinions by attending physicians regarding employment, as well as the number of cases covered by public medical insurance. Here we suggest two factors in our hospital's growth in these activities: (1) many of the clinicians are qualified as occupational physicians, and (2) the organizational strength of our team, which has a vision for balancing support and subsequently promotes that vision. We hope that this report will lead to the balance of support activities in Japan and contribute to the model internationally.

Perioperative Rehabilitation in Collaboration with the Department of Occupational Medicine for Patients with Cholangiocarcinoma: A Case Report.

INTRODUCTION: Although the number of cancer survivors has increased, the role of physical therapy in return to work (RTW) for employed patients with cancer remains unclear. CASE PRESENTATION: The patient is a 50-year-old man diagnosed with cholangiocarcinoma who worked as a liquefied petroleum gas station filler. He started perioperative rehabilitation and underwent pancreaticoduodenectomy for cholangiocarcinoma. He developed a postoperative pancreatic fistula, which improved with conservative treatment over 40 days. Although he achieved independence regarding day-to-day activities, his physical condition and workability worsened, as his skeletal muscle index decreased from 8.7 to 7.7, 6-min walk distance from 518 to 460 m, and work ability index (WAI) from 37 to 20 points. His physical therapist was concerned about his RTW and recommended that he receive RTW support from the Department of Occupational Medicine (DOM). The DOM employed a team approach for the RTW strategy, and the primary physician, occupational physician, and company collaborated to support the patient. After the outpatient treatment protocol and RTW support plans were formulated, the patient was discharged. The physical therapist reported declining physical performance and WAI at the DOM's multidisciplinary conference. After consulting with multiple professionals, the team recommended work resumption in stages: part-time for three months and full-time for four months after surgery while undergoing oral adjuvant chemotherapy. The WAI improved to 35 points after RTW. CONCLUSION: This case report suggests that physical therapists are vital in providing continuous patient support, from perioperative rehabilitation to DOM intervention, to build physical strength for return to work.

Identification of major facilitator transporters involved in cellulase production during lactose culture of Trichoderma reesei PC-3-7.

Although lactose is a preferred cellulase inducer in the industrial production of cellulase by Trichoderma reesei, the mechanism of induction is not fully understood. Because sugar transporters might be involved at an early step of induction by oligosaccharides, we sought permeases associated with cellulase induction by lactose. Two such MFS sugar transporters in the T. reesei hyper-cellulolytic PC-3-7 strain, an industrial cellulase producer developed in Japan, were identified in a screening for lactose permeases. Disruption of the genes encoding these two transporters resulted in decreased lactose uptake and delayed growth in lactose culture. Further, the deletion strains produced less cellulase when cultivated on lactose. No substantial differences were observed in cellulase production when PC-3-7 was cultivated in cellulose-based medium. The present work provides evidence that these transporters are critical for cellulase production in lactose culture.

Excessive Workload Beyond Measured Exercise Tolerance Affects Post-Discharge Mental Health in Workers With Heart Disease: A Case-Based Observational Study.

OBJECTIVE: We evaluated work intensity, exercise tolerance, and mental health among workers with heart disease and assessed the relationship between return to work (RTW) status and changes in mental health 3 months post-discharge. METHODS: Patients were enrolled from 2014 to 2019. Data were collected on admission and 3 months post-discharge. Mental health was assessed using the Hospital Anxiety and Depression Scale. Jobs were defined as "reasonable workload (RW)" or "over workload (OW)" based on metabolic equivalents. RESULTS: Twenty-six patients responded (81.3%). RTW after 3 months was higher in the RW group (100%) than in the OW group (63.6%). Mental health in the OW group significantly deteriorated compared with baseline and was higher than that in the RW group. CONCLUSIONS: Patients whose work intensity was higher than their exercise tolerance had worsened mental health 3 months post-discharge.

Effect of online physical therapy on workplace accident-related outcomes in nursing care worker: study protocol of a multicentre randomised controlled trial.

INTRODUCTION: According to the 2017 data, occupational accidents are more common in social welfare facilities compared with other industries; in particular, the number of occupational accidents resulting in four or more days of absence from work due to low back pain (LBP) or falls has increased and is considered problematic. Although physical therapy has been demonstrated to be effective in preventing LBP and falls in older adults living in the community, no randomised controlled trials have examined whether individual online physical therapy can prevent LBP and falls in nursing care workers (NCW). METHODS AND ANALYSIS: A total of 120 NCW aged 20 years or older will be randomly assigned to an online individualised therapy group (ITG) or usual group (UG) after obtaining informed consent. We defined an NCW as a person who assists disabled and elderly persons with eating, bathing and toileting activities in social welfare facilities. We will follow-up the participants 12 months after the start of the intervention and compare the results at 3, 6 and 12 months. The primary endpoint will be the Oswestry Disability Index (ODI); ITG participants will receive professional advice on LBP and musculoskeletal problems from a physical therapist via online interview and email as often as they wish over a 6-month period; UG participants will only have access to brochures and video feeds related to LBP and fall prevention. Owing to the nature of the study, blinding the participants and interventionists is not possible; however, the outcomes will be assessed via a web-based questionnaire to prevent detection bias. The null hypothesis is that there is no clinically important difference in the primary outcome between the two treatment groups and that a decrease in the ODI score of at least 20% is clinically meaningful. ETHICS AND DISSEMINATION: The Ethics Committee of the Japanese Society of Occupational Medicine approved the protocol of this study. The results of this study will be disseminated through peer-reviewed journals and conference presentations. TRIAL REGISTRATION NUMBER: jRCT1070210128.

A survey of the implementation rate of cardiac rehabilitation for patients with heart disease undergoing device implantation in Japan.

Background: The effect of cardiac rehabilitation (CR) on patients undergoing device implantation (DI) for arrhythmias has been reported; however, the implementation status of these patients has not been clarified. This study aimed to verify the implementation status of CR for patients with heart disease who have undergone DI using real-world data. Methods: This was an observational study using a nationwide administrative database associated with the diagnosis procedure combination (DPC) system in Japan (2014-2018). Subjects were patients with heart disease (70 667 cases) who underwent DI during the above scheduled hospitalization period. The overall rate of CR and the background factors of the subjects were verified. Results: The CR rate for patients with heart disease who underwent DI during hospitalization was 23%, and the CR rate for patients with comorbid heart failure who underwent DI was only 32%. It was confirmed that progressing age was associated with a higher CR implementation rate. The lower the Barthel index score at the time of admission, the higher the CR implementation rate. Conclusions: CR was performed for only one-quarter of all the patients during admission for DI and just one-third of the patients for DI with heart failure. Most of these patients were elderly and had a decreased ability to perform activities of daily living. The DPC data are subject to various limitations, and further research is necessary.

[Palliative rehabilitation of two patients with terminal stage cancer: a visit to patient's home and the provision of advice by a nurse and rehabilitation staff members before discharge--from physical therapist's perspective].

We report two patients with terminal stage cancer who spent some days at their home after a physical therapist, occupational therapist, nurse, and medical social worker all visited the patients' homes and advised the patients' family in regard to the appropriate care before the patients were discharged as a strategy for palliative rehabilitation. Case 1: A patient suffering from terminal stage cancer was bed-ridden because of a pathological fracture of the femur. After palliative rehabilitation, the patient was able to get out of the bed and improved her daily living activity level through physical therapy. She spent some days at home according to the results of the pre-discharge home visit guidance to her family. Case 2: A patient suffering from terminal stage cancer manifested symptoms of fatigue and generalized muscular weakness. After palliative rehabilitation, her muscle strength and physical endurance were improved by physical therapy and adjustment of the bed height. Because she was eager to go home, we took her to her home before being discharged, and she was able to spend a few hours at home. Pre-discharge home visit guidance by a nurse and rehabilitation staff members to the patient' s family in regard to appropriate home care may therefore be a good means of satisfying such patients' desire to see their home once more and thereby improve their quality of life.

Effectiveness of workplace exercise supervised by a physical therapist among nurses conducting shift work: A randomized controlled trial.

OBJECTIVES: This study aimed to evaluate the effectiveness of supervised exercise among nurses conducting shift work for health promotion. METHODS: A total of 30 healthy female nurses conducting shift work participated in this study and they were randomly assigned to one of the following 2 groups: The supervised exercise group (SG; participants exercised under the supervision of a physical therapist (PT)) and the voluntary exercise group (VG; participants exercised without supervision). The study participants were asked to exercise twice/week for 12 weeks for 24 sessions. The primary outcome was aerobic fitness, and the secondary outcomes were muscle strength, anthropometric data, biochemical parameters, and mental health. We compared all the outcomes before and after the intervention within each group and between both groups at follow-up. RESULTS: Aerobic fitness increased in the SG whereas it decreased in the VG, but these changes were not statistically significant (p=0.053 and 0.073, respectively). However, the between-group difference was significant in the intervention effect (p=0.010). Muscle strength, high-density lipoprotein cholesterol and metabolic profile (high-molecular weight adiponectin), and depressive symptom significantly improved in the SG over time, even though the SG exercised less as compared with the VG. Moreover, significant differences in muscle strength, and low-density lipoprotein cholesterol and reactive oxygen metabolite levels were observed between both groups, and these parameters were better in the SG than in the VG. CONCLUSIONS: Our data-suggest the effectiveness of exercise supervised by a PT at the workplace of nurses conducting shift work for health promotion.

Use of segment-based microarray in the analysis of global gene expression in response to various environmental stresses in the cyanobacterium Anabaena sp. PCC 7120.

We prepared microarrays that contain genomic sequences of a heterocyst-forming filamentous cyanobacterium Anabaena sp. PCC 7120. The complete genome of this cyanobacterium codes for about 5,368 protein-coding genes in the main chromosome of 6.4 Mbp. In total, 2,407 DNA segments were selected from the sequencing clones, and amplified by PCR, then spotted on glass slides in duplicate. These microarrays differ from the widely used commercial or custom-made ones for other microorganisms in that each DNA segment was 3-4 kbp long, and contained about 3-4 predicted genes on average. This feature, however, did not decrease the usefulness of the microarrays, since we were able to detect a number of potentially novel genes that are induced in response to nitrogen deprivation, low temperature and drought. In addition, we found some genomic regions in which dozens of contiguous genes are simultaneously regulated. These results suggest that these segment-based microarrays are useful especially for such large genomes as Anabaena, for which the number of genes exceeds either technical or practical limitations.