Outcomes of regenerative treatment for over 200 patients with tympanic membrane perforation.

OBJECTIVE: To evaluate outcomes of a regenerative treatment (RT) for over 200 patients with tympanic membrane perforation (TMP). The RT-TMP method involves a gelatin sponge, basic fibroblast growth factor (bFGF) and fibrin glue. METHODS: The study population included 216 patients and 234 ears (male: female =100:116; age 1-93 years). All enrolled patients were treated with RT-TMP in which TMP edges were disrupted mechanically and a gelatin sponge immersed in bFGF was inserted into the perforation. Fibrin glue was then dripped over the sponge. Patient outcomes including TMP closure rates, change in hearing level, and complications were obtained from retrospective medical chart reviews. The TMP was examined three or more weeks after surgery. The treatment was repeated up to 4 times until complete TMP closure was achieved. RESULTS: After mechanical disruption, the perforation size was Grade I, ≤1/3 of entire TM area in 22 ears (9.4 %), Grade II, 1/3-2/3 of entire TM in 77 ears (32.9 %) and Grade III, ≥2/3 of entire TM area in 135 ears (57.7 %). The overall TMP closure rates were 97.0 % (227/234). Complete TMP closure was achieved in 68.8 % (161/234), 22.6 % (53/234), 4.7 % (11/234) and 0.9 % (2/234) of ears after 1, 2, 3 and 4 treatments, respectively. In 7 of 234 ears (3.0 %), the TMPs were not closed completely after 4 treatments. There was no correlation between TMP size after mechanical disruption and number of treatments required to achieve complete closure (Fisher's exact test p = 0.70). The mean air-conduction hearing threshold at low frequency improved from 57.3 ± 16.7 dB before treatment to 37.3 ± 16.0 dB (p < 0.0001) after closure of TMPs. For middle and high frequencies, the improvement was 49.0 ± 19.3 dB to 36.9 ± 17.9 dB (p < 0.0001) and 57.7 ± 22.9 dB to 49.2 ± 23.3 dB (p < 0.0001), respectively. The mean air-bone gaps also improved significantly, and were within 10 dB at 250 Hz, 500 Hz and 1 kHz, and 11 dB at 2 kHz. One or more complications occurred in 32 patients (32/216; 14.8 %). The most common complication was formation of an epithelial pearl (16 ears; 6.8 %), followed by severe TM retraction (9 ears; 3.8 %) and otitis media with effusion (6 ears; 2.6 %). There were no serious complications that caused deterioration of the patient's general condition. CONCLUSION: Our results showed that RT-TMP had high success rates for TMP closure and good hearing improvement and produced no severe complications that could affect general health status. This novel therapy is simple, safe and minimally invasive, and could help improve the quality of life in patients with TMP.

An Experimental Study on the Addition of Bacteria to Residual Anticancer Drugs: Evaluation of the Effect on Bacterial Growth.

Using anticancer drugs as examples, we examined the possibility of reusing residual drugs. The use of residual drugs is not widespread owing to concerns regarding bacterial contamination. We combined anticancer drugs and bacteria to investigate their effects on bacterial growth. The anticancer drugs carboplatin, paclitaxel, etoposide, irinotecan, methotrexate, and 5-fluorouracil (5-FU) were mixed with Staphylococcus aureus, Enterococcus faecalis, Serratia marcescens, and Escherichia coli. After a certain period, the bacteria were counted. Irinotecan showed no antibacterial activity, whereas 5-FU exhibited high antibacterial activity against the tested bacteria. The 5-FU also showed a minimum inhibitory concentration value in the range of 8-80 µg/mL, depending on the bacterial species. 5-FU dose-dependently inhibited S. aureus growth at more than 0.8 µg/mL. Because protein synthesis systems are reportedly antibiotic targets, we used a cell-free protein synthesis system to confirm the mechanism of the antibacterial activity of the anticancer agent. 5-FU and methotrexate had direct inhibitory effects on protein synthesis. It has been suggested that even if residual drugs are contaminated with bacteria, there will be no microbial growth, or the microbes will be killed by the drug. With careful monitoring, 5-FU can potentially be used for antimicrobial purposes.

Age-associated effects of intradialytic exercise on physical function and nutritional status in patients receiving ambulatory hemodialysis: A multicenter cohort study.

INTRODUCTION: Intradialytic exercise is essential for improving physical function for older patients. This study aimed to examine the relationship between the effects of exercise therapy and aging. METHODS: This multicenter cohort study included 1176 patients aged 40-89 years, who participated in an intradialytic exercise program, comprising stretching and resistance training, three times per week for 12 months. Isometric knee extension strength (IKES), 10-m walking speed, Short Physical Performance Battery (SPPB), and Geriatric Nutritional Risk Index (GNRI) were measured at baseline and after 12 months. The patients were divided according to age as follows: 40-59, 60-69, 70-79, and 80-89 years. A linear mixed-effects model examined the improvement within-group and between-control differences, as the 40-59 age group was the control group. FINDINGS: The 40-59, 60-69, 70-79, and 80-89 age groups comprised 180, 317, 466, and 213 participants, respectively. Within-group differences, all the age groups significantly improved IKES and SPPB. The 10-m walking speed [0.02 (0.02) m/s] and GNRI [0.38 (0.33)] did not improved only in the 80-89 age group despite other age groups significantly improved. Between-control differences, IKES of the 70-79 age group [-0.24 (-0.42 to -0.06) %] was significantly lower improvement than control. GNRI of all the older groups were significantly smaller improvement than control (p < 0.05). DISCUSSION: The older group demonstrated difficulty in improving walking ability and nutritional status compared with the younger groups. Clinicians need to consider the difference in effectiveness due to age and prescribe intradialytic exercises accordingly.

Differences in the purpose of exercise between hemodialysis patients who continued or dropped out of exercise programs: a multicenter cohort study.

BACKGROUND: Selecting suitable exercise goals is crucial for fostering adherence to, and maintenance of, exercise therapy. We aimed to evaluate the variance in exercise objectives between individuals who continued and those who dropped out of a 6-month intradialytic exercise program by analyzing an open-ended questionnaire administered to patients undergoing hemodialysis. METHODS: The study consisted of outpatients (n = 541; mean age, 70 years) undergoing maintenance hemodialysis, who had been informed of an intradialytic exercise program and voluntarily agreed to participate. The primary outcome was the exercise purpose. The difference in exercise purpose was quantitatively analyzed between the exercise continuation and dropout groups. A co-occurrence network was created and concepts were constructed. The basic attributes were compared using chi-squared and independent t-tests. RESULTS: Over 6 months, 154 patients (28.5%) dropped out of the intradialytic exercise program. Concepts related to the goals of the program were: (1) physical function and condition, (2) addressing limitations, (3) maintaining daily life activities, and (4) physical condition recognition. Co-occurrence network analysis showed that the exercise continuation group established their objectives based on the health benefits of exercise, and proactively set goals rooted in comprehending their current issues and problems. The dropout group tended to perceive treatment passively as an extension of daily clinical practice, rather than actively formulating exercise objectives. CONCLUSION: The exercise objectives of those who continued the exercise program differed from those who dropped out. Patients in the exercise continuation group set more affirmative and specific exercise objectives, whereas those in the dropout group set more passive and abstract exercise objectives.

Factors associated with dropout from an intradialytic exercise program among patients undergoing maintenance hemodialysis.

BACKGROUND: Continuation of an intradialytic exercise program is necessary to improve and maintain physical function in patients undergoing hemodialysis. Factors associated with dropout must be identified to ensure program continuation. This study aimed to investigate the dropout rates from an intradialytic exercise program at 6 and 12 months in patients undergoing hemodialysis and to identify dropout predictors. METHODS: This was a multicenter, retrospective observational study. Overall, 980 patients were enrolled in this study. Grip strength, 10-m walking speed, physical function, demographics and blood sampling data were measured at baseline, and dropouts were observed. Patients were classified as either continued or dropped out of the program at 6 and 12 months. The dropout rate was calculated for each time point. Multivariate logistic regression analysis was performed to identify the predictors of dropout. RESULTS: The dropout rate was 26.4% (n = 259) after 6 months, 24.1% (n = 172) between 6 and 12 months, and 44.3% (n = 424) overall at 1 year. Significant predictors of dropout after 6 months were slower 10-m walking speed, older age and high C-reactive protein level. Predictors of dropout after 12 months were slower 10-m walking speed and lower standardized dialysis volume. CONCLUSIONS: Walking capacity, age, inflammation and hemodialysis volume were determinants of dropout from the exercise program. Our findings provide new and important insights into the potential risk factors for dropout from long-term intradialytic exercise programs in patients undergoing hemodialysis.

Influence of Malnutrition on the Improvement of Physical Function by Intradialytic Resistance Exercise in Patients Undergoing Hemodialysis.

OBJECTIVE: Intradialytic exercise improves physical function. However, malnutrition may be an essential factor affecting the effectiveness of exercise to improve physical function. Few studies of the relationship between malnutrition and the effectiveness of intradialytic exercise to improve physical function exist. Therefore, this study investigated malnutrition at the beginning of intradialytic exercise and how it affects the subsequent improvement in physical function. METHODS: Patients who performed intradialytic exercise for 12 months were enrolled in this study. A Geriatric Nutritional Risk Index of 91.2 was defined as malnutrition. Patients were assigned to 2 groups using propensity score matching to adjust for confounding factors. Physical function outcomes were handgrip strength, isometric knee extension strength, short physical performance battery, and 10-m walking speed; these were compared at baseline, 3 months, 6 months, and 12 months. The 2 groups were further divided into another 2 groups as per whether the nutritional status had improved after 12 months; therefore, a total of 4 groups were analyzed. RESULTS: After matching, the data of 154 patients in each group were analyzed. During the intragroup comparison, isometric knee extension strength, short physical performance battery, and 10-m walking speed improved significantly in both groups after intradialytic exercise was started compared with before intradialytic exercise was started. However, there was no significant improvement in handgrip strength in the malnutrition group. There were no significant differences in any of the physical function measurements or changes from the baseline values among the 4 groups divided as per subsequent recovery of the nutritional status. CONCLUSION: Malnutrition may not impact the effectiveness of intradialytic exercise to improve lower-leg physical function. Its effect on the improvement of handgrip strength requires further investigation.

Decline in Walking Independence and Related Factors in Hospitalization for Dialysis Initiation: A Retrospective Cohort Study.

Patients with chronic kidney disease require intervention planning because their physical function declines with worsening disease. Providers can work closely with patients during the induction phase of dialysis. This single-center, retrospective observational study aimed to investigate the rate of decline in walking independence during the induction phase of dialysis and the factors that influence this decline, and to provide information on prevention and treatment during this period. Of the 354 patients who were newly initiated on hemodialysis between April 2018 and January 2022, 285 were included in the analysis. The functional independence measure-walking score was used to sort patients into decreased walking independence (DWI; n = 46) and maintained walking independence (no DWI; n = 239) groups, and patient characteristics were compared. After adjusting for various factors by logistic regression analysis, we observed that age, high Charlson comorbidity index (CCI), C-reactive protein, and emergency dialysis start (EDS) were significant predictors of DWI. Even during the very short period of dialysis induction, as many as 16.1% of patients had DWI, which was associated with older age, higher CCI, higher inflammation, and EDS. Therefore, we recommend the early identification of patients with these characteristics and early rehabilitation.

Predictive factors of acute sensorineural hearing loss in adult Japanese patients for clinical application by primary care doctors: a cross-sectional study.

BACKGROUND: Several methods are used for hearing loss screening; however, their benefits are uncertain. In this study, we aimed to determine the predictive factors of acute sensorineural hearing loss for clinical application by primary care doctors. METHODS: This retrospective, cross-sectional study included 365 patients with acute sensorineural hearing loss without prior therapy. The patients' clinical data, demographic information, and medical histories were obtained, and they were asked about comorbidities. In addition, we assessed lifestyle factors such as stress level, alcohol consumption, marital status, and socioeconomic level. Logistic regression analysis was performed to investigate the diagnostic predictive ability of the selected factors associated with acute sensorineural hearing loss. The hearing levels of all patients were evaluated using pure tone audiometry. RESULTS: We identified significant predictive factors for acute sensorineural hearing loss. The absence of hyperacusis was a predictive factor for sudden sensorineural hearing loss. Younger age, female sex, and marital status were predictive factors for acute low-tone hearing loss. High body mass index, high socioeconomic level, low alcohol consumption, high stress level, hyperacusis, and vertigo/dizziness were predictive factors for Ménière's disease. High body mass index and ear fullness were predictive factors for perilymph fistula. Low stress level was a predictive factor for acoustic tumours. CONCLUSIONS: Our findings can be used to distinguish between the types of acute sensorineural hearing loss. Symptoms, physical status, and lifestyle factors identified during this study are useful markers for predicting acute sensorineural hearing loss occurrence.

Temporal virtual reality-guided, dual-task, trunk balance training in a sitting position improves persistent postural-perceptual dizziness: proof of concept.

BACKGROUND: Persistent postural-perceptual dizziness (PPPD) is a newly defined disorder characterized by functional dizziness. Due to its recent discovery, definitive treatment for PPPD has not been established; therefore, this study aimed to assess the effectiveness of virtual reality (VR)-guided, dual-task, trunk balance training for the management of PPPD using the mediVR KAGURA system. METHODS: We analyzed data of patients who presented with PPPD from January 1, 2021, to February 28, 2021. The VR group included patients who underwent mediVR KAGURA-guided training for 100 tasks (10 min). Patients with PPPD who received standard treatment and rehabilitation were assigned to the control group. Equilibrium tests were performed at baseline and immediately after mediVR KAGURA-guided training to examine its effectiveness in improving static and dynamic balance. Additionally, clinical questionnaires related to balance disorders were administered at baseline and 1 week after mediVR KAGURA-guided training to examine its effects on balance-related symptoms. The primary outcome was improvements in static and dynamic balance and Niigata PPPD Questionnaire (NPQ) scores. RESULTS: VR-guided training using mediVR KAGURA improved objective outcomes, including static and dynamic postural stability, after a single 10-min training session. Additionally, mediVR KAGURA-guided training improved scores on the Hospital Anxiety and Depression Scale and NPQ 1 week after the 10-min training session. CONCLUSION: VR-guided training using mediVR KAGURA represents a viable method for managing balancing ability, anxiety, and symptoms in patients with PPPD. Such training provides a safe and cost-effective solution for PPPD management. Further studies are required to evaluate the clinical efficacy of this strategy. TRIAL REGISTRATION: Institutional Ethics Committee of Kitano Hospital, approval number: 1911003. Registered 18 December 2019, https://kitano.bvits.com/rinri/publish_document.aspx?ID=426 .

Diagnosis of Spontaneous Cerebrospinal Fluid Rhinorrhea Using Thin-Slice Computed Tomographic Images With Multiplanar Reconstruction and Three-Dimensional Virtual View Endoscopy.

Spontaneous cerebrospinal fluid (CSF) rhinorrhea represents an important clinical entity, which is associated with elevated intracranial pressure and is rarely treated successfully without surgical intervention. Here we report a case of spontaneous CSF rhinorrhea. The patient was a 54-year-old male, who presented with bacterial meningitis and was referred to the Department of Otorhinolaryngology for a detailed examination of the nose and sinuses. Reconstructed thin-slice computed tomography (CT) revealed multiple fistulae on the clivus. The defect was successfully repaired by transnasal endoscopic surgery, with the assistance of virtual endoscopic images, which were created by the surgical planning and navigation system from thin-slice CT images. This incremental improvement in the imaging technique helped with the diagnosis and surgical treatment of CSF rhinorrhea.

Influence of sex differences in maintenance-hemodialysis participants on motivation of exercise therapy implementation: a multicenter cross-sectional study.

BACKGROUND: Exercising requires continuing training and maintenance of motivation. Support for exercise continuation by setting sex-appropriate goals is needed. However, this has not been investigated in patients undergoing hemodialysis. This study aimed to investigate sex differences in exercise motivation by analyzing an open-ended questionnaire of patients undergoing hemodialysis. METHODS: This multicenter, cross-sectional study was conducted among participants undergoing outpatient hemodialysis at 21 dialysis clinics. Before the intradialytic exercise program, a self-reported questionnaire was used to assess exercise purpose using open-label questions. Exercise purpose was analyzed between sexes by quantitative analysis of text, extracting frequently occurring words, creating a co-occurrence network, and constructing concepts. The basic attributes of the two groups were compared using the chi-squared and independent t tests. RESULTS: The analysis of 669 participants who attended an exercise program showed that the common words for exercise purpose in both sexes were strength, maintenance, walking, exercise, and muscle strength. Significant differences were observed in exercise purpose. Concepts related to the purpose of exercise were categorized into (1) physical function and condition, (2) addressing limitations, and (3) maintaining daily life activities. Physical appearance was important in both sexes. The main purpose of exercise for men was to increase physical fitness and muscle strength, while that for women was to maintain or improve their current functional status and prevent limb weakness. Women had significantly weaker muscle strength and poorer exercise habits than men and had more difficulty in daily life, suggesting that their purpose for exercise was to reduce difficulties in daily life and the burden on family. Women had significantly weaker muscle strength and poorer exercise habits than men and had more difficulty in daily life, suggesting that their purpose for exercise was to reduce difficulties in daily life and the burden on family. Furthermore, fear of falls was higher in women and prevention of falls may be a key for motivation. CONCLUSION: Exercise purpose in patients undergoing hemodialysis was summarized into the categories of physical function and condition, exercise, and daily life. Men aimed to maintain and increase their current physical status, and women aimed to reduce anxiety regarding their lower limbs and lack of exercise. It is necessary to consider sex differences in exercise purpose when designing exercise regimens and motivating participants.

Classification of PD-L1 expression in various cancers and macrophages based on immunohistocytological analysis.

Programmed death (PD)-1/PD-ligand 1 (PD-L1) antibodies have shown an intense clinical effect in some patients with PD-L1+ tumors, and their applications have rapidly expanded to various cancer types with or without the application of new companion diagnostics (CDx) with a lower cutoff value and inclusion of macrophage evaluation. However, the pathological background explaining the difference in the cutoff value remains unknown. To address this, we evaluated tissue array samples from 231 patients with lung adenocarcinoma, 186 with lung squamous cell carcinoma, and 38 with renal cell carcinoma (RCC) who were not receiving PD-1/PD-L1 antibodies to investigate the relationship between PD-L1 expression on tumor cells and CD8+ T-cell infiltration in tumor tissues. PD-L1 expression in RCC was clearly lower than that in non-small-cell lung cancer (NSCLC) tissue, whereas CD8+ T-cell infiltration was low in all cancers. We next analyzed PD-L1 expression by interferon (α, ß, and γ) and LPS stimulation in both macrophages and 41 cancer cell lines derived from various organs and histological types. The PD-L1 expression patterns were classified into three types, which differed depending on each organ or tissue type. Interestingly, NSCLC cell lines showed highly diverse PD-L1 expression patterns compared with RCC cell lines. Conversely, PD-L1 expression was stronger and more prolonged in macrophages than in typical cell lines. Here, we revealed the diversity of the PD-L1 expression patterns in tumor cells and macrophages, demonstrating the pathological and cytological significance of the transition of cutoff values in PD-L1 CDx for PD-1/PD-L1 antibody administration.

Effect of intradialytic exercise on geriatric issues in older patients undergoing hemodialysis: a single-center non-randomized controlled study.

PURPOSE: This study investigated the effect of 1 year of intradialytic exercise on older hemodialysis patients with geriatric issues. METHODS: Forty-six patients aged ≥ 70 years were non-randomly assigned to two groups (exercise group: 27, control group: 19). Intradialytic exercise consisted of 30 min of aerobic exercise using a cycle ergometer, and resistance training comprising four exercises using an elastic tube three times per week for 1 year. Handgrip strength, leg extremity muscle strength, 10-m walk speed, short physical performance battery, serum albumin, Geriatric Nutritional Risk Index (GNRI), geriatric depression scale, frailty, and mobility were each assessed before and after the intervention. RESULTS: The control group exhibited a significant reduction in handgrip strength, 10-m walking speed, serum albumin, and GNRI after intervention compared to baseline (p < 0.05). Conversely, no significant reductions were observed in the exercise group. The ΔGNRI (effect size, 0.69; 95% confidence interval [CI] - 5.21, - 0.1; p < 0.05) and Δserum albumin (effect size, 0.72; 95% CI - 0.31, - 0.02; p < 0.05) before and after the intervention declined significantly less in the exercise group than in the control group. Other between-group values were not significantly different. The number of frail patients and patients requiring walking assistance exhibited no significant intra-group or between-group differences before and after the intervention. CONCLUSION: Intradialytic exercise prevented the worsening of nutritional status and physical function in the exercise group compared to the control group. Exercise therapy during dialysis is an important aspect of patient care that helps prevent functional decline in older patients.

Investigation of presenteeism, physical function, and exercise habits in workers with CKD: three case reports with literature review.

Management of presenteeism in the context of chronic kidney disease (CKD) is essential for disease management, ensuring the workforce's availability, and reducing health-related costs. The purpose of this case study was to investigate presenteeism, physical function, and exercise habits in three working patients with CKD and discuss their effects. Case 1 was a 71-year-old male security guard; Case 2 was a 72-year-old male agricultural worker; and Case 3 was an 83-year-old male civil engineering employee. Presenteeism was measured using the work functioning impairment scale (WFun), and physical function was measured using grip strength, skeletal muscle mass index, 10 m walk test, short physical performance battery, and exercise habits. The WFun assessment showed that only Case 3 had moderate presenteeism, and the barrier to employment was fatigue. Each value of physical function was higher than the reference value, but Case 3 had the lowest physical function values. All three patients had no exercise habits and were in the interest stage of behavior change. This case report indicates the existence of workers with CKD who need care for presenteeism, even if they have no problems with physical function or activities of daily living. To ensure work productivity in workers with CKD, clinicians may need to evaluate presenteeism, physical function, and exercise habits in addition to popular treatment and care.

Association between timing of speech and language therapy initiation and outcomes among post-extubation dysphagia patients: a multicenter retrospective cohort study.

BACKGROUND: Post-extubation dysphagia (PED) is recognized as a common complication in the intensive care unit (ICU). Speech and language therapy (SLT) can potentially help improve PED; however, the impact of the timing of SLT initiation on persistent PED has not been well investigated. This study aimed to examine the timing of SLT initiation and its effect on patient outcomes after extubation in the ICU. METHODS: We conducted this multicenter, retrospective, cohort study, collecting data from eight ICUs in Japan. Patients aged ≥ 20 years with orotracheal intubation and mechanical ventilation for longer than 48 h, and those who received SLT due to PED, defined as patients with modified water swallowing test scores of 3 or lower, were included. The primary outcome was dysphagia at hospital discharge, defined as functional oral intake scale score < 5 or death after extubation. Secondary outcomes included dysphagia or death at the seventh, 14th, or 28th day after extubation, aspiration pneumonia, and in-hospital mortality. Associations between the timing of SLT initiation and outcomes were determined using multivariable logistic regression. RESULTS: A total of 272 patients were included. Of them, 82 (30.1%) patients exhibited dysphagia or death at hospital discharge, and their time spans from extubation to SLT initiation were 1.0 days. The primary outcome revealed that every day of delay in SLT initiation post-extubation was associated with dysphagia or death at hospital discharge (adjusted odds ratio (AOR), 1.09; 95% CI, 1.02-1.18). Similarly, secondary outcomes showed associations between this per day delay in SLT initiation and dysphagia or death at the seventh day (AOR, 1.28; 95% CI, 1.05-1.55), 14th day (AOR, 1.34; 95% CI, 1.13-1.58), or 28th day (AOR, 1.21; 95% CI, 1.07-1.36) after extubation and occurrence of aspiration pneumonia (AOR, 1.09; 95% CI, 1.02-1.17), while per day delay in post-extubation SLT initiation did not affect in-hospital mortality (AOR, 1.04; 95% CI, 0.97-1.12). CONCLUSIONS: Delayed initiation of SLT in PED patients was associated with persistent dysphagia or death. Early initiation of SLT may prevent this complication post-extubation. A randomized controlled study is needed to validate these results.

Factors affecting health-related quality of life in older patients with chronic kidney disease: a single-center cross-sectional study.

BACKGROUND: Health-related quality of life (HRQoL) assessment is important for patients with chronic kidney disease (CKD). However, few studies have examined factors related to HRQoL, such as physical function, in older patients with predialysis CKD. This study evaluated the relationship between physical function, renal function, and nutritional status on the HRQoL in this patient group. METHODS: This cross-sectional study included 61 patients aged ≥ 65 years with stages 3-5 predialysis CKD who were admitted for CKD education purposes. Using the EuroQoL 5-dimension 5-level (EQ-5D-5L) health status measure, the percentages of each EQ-5D-5L item were investigated. Physical function was measured using the short physical performance battery (SPPB) and grip strength, and characteristics, such as age, sex, diabetes mellitus, estimated glomerular filtration rate, and Geriatric Nutrition Risk Index, were investigated. Factors associated with EQ-5D-5L were identified using multiple regression analysis. RESULTS: More than half of respondents (34/61, 55.7%) selected the second or higher level "have a problem" for the pain/discomfort section. The EQ-5D-5L score was significantly correlated with grip strength (r = 0.34, p = 0.01) and SPPB (r = 0.59, p = 0.00) in a single correlation analysis. Only SPPB (ß = 0.67, p = 0.00) remained a significant factor after adjustment for grip strength, SPPB, age, sex, diabetes mellitus, and estimated glomerular filtration rate. CONCLUSION: Physical function may be an important factor influencing HRQoL in older patients with predialysis CKD.

Factors associated with dropout from physical function assessment programs among participants receiving maintenance hemodialysis: A retrospective observational cohort study.

We aimed to investigate the factors associated with dropout from a physical function assessment program among participants receiving outpatient hemodialysis (HD). The participants were divided into continuation and dropout groups and followed up for 3 years after the initial physical function assessment. Multivariate logistic regression analyses were used to estimate odds ratios (ORs) and 95% confidence intervals (CIs) for the dropout group to determine the factors associated with dropout from the physical function assessment program. The continuation and dropout groups included 43 and 58 participants, respectively. The continuation group had a significantly higher self-efficacy (SE) and age than the dropout group (p = 0.001, p = 0.047). Multivariate logistic regression analysis indicated that only SE (OR: 1.202, 95% CI: 1.082-1.334) remained a significant predictor after adjustment (p < 0.05). There is a need to evaluate SE to prevent dropout from physical functioning assessment programs.

Application of artificial intelligence using a convolutional neural network for detecting cholesteatoma in endoscopic enhanced images.

OBJECTIVE: We examined whether artificial intelligence (AI) used with the novel digital image enhancement system modalities (CLARA+CHROMA, SPECTRA A, and SPECTRA B) could distinguish the cholesteatoma matrix, cholesteatoma debris, and normal middle ear mucosa, and observe the middle ear cavity during middle ear cholesteatoma surgery. METHODS: A convolutional neural network (CNN) was trained with a set of images chosen by an otologist. To evaluate the diagnostic accuracy of the constructed CNN, an independent test data set of middle ear images was collected from 14 consecutive patients with 26 cholesteatoma matrix lesions, who underwent transcanal endoscopic ear surgery at a single hospital from August 2018 to September 2019. The final test data set included 58 total images, with 1‒5 images from each modality for each case. RESULTS: The CNN required only 10 s to analyze more than 58 test images. Using SPECTRA A and SPECTRA B, the CNN correctly diagnosed 15 and 15 of 26 cholesteatoma matrix lesions, with a sensitivity of 34.6% and 42.3%, and with a specificity of 81.3% and 87.5%, respectively. CONCLUSION: Our preliminary study revealed that AI and novel imaging modalities are potentially useful tools for identifying and visualizing the cholesteatoma matrix during endoscopic ear surgery. The diagnostic ability of the CNN is not yet appropriate for implementation in daily clinical practice, based on our study findings. However, in the future, these techniques and AI tools could help to reduce the burden on surgeons and will facilitate telemedicine in remote and rural areas, as well as in developing countries where the number of surgeons is limited.

Effects of intradialytic exercise for advanced-age patients undergoing hemodialysis: A randomized controlled trial.

Previous reports have shown the benefits of intradialytic exercise to patients undergoing hemodialysis. However, most of those studies assessed the effects of exercise in middle-aged patients and little is known about advanced-age patients undergoing hemodialysis. Therefore, the present randomized controlled trial was performed to determine the effectiveness of exercise therapy in advanced-age patients undergoing hemodialysis. This non-blinded, randomized controlled parallel trial enrolled a total of 101 patients who were randomly assigned to intradialytic exercise (n = 51) or usual care (n = 50) groups. The training program included both resistance and aerobic exercises and was performed three times per week for 6 months. The aerobic exercise intensity was adjusted to a target Borg score of 13 for 20 minutes. Four types of resistance exercises were performed using elastic tubing, with three sets of 10 exercises performed at moderate intensity (13/20 on the Borg scale). The usual care group received standard care. Lower extremity muscle strength, Short Physical Performance Battery score, and 10-m walking speed were the outcomes and were evaluated before the hemodialysis session and after 6 months of training. There were statistically significant improvements in Short Physical Performance Battery score (effect size, 0.57; 95% confidence interval, 0.15‒1.95) in the exercise group relative to the control group. There were no statistically significant differences in lower extremity muscle strength or in the 10-m walking speed between the two groups. These findings suggest that 6 months of intradialytic training could improve physical function in older patients undergoing hemodialysis.