Intraoperative evoked potentials in patients with ossification of posterior longitudinal ligament.

Preoperative somatosensory evoked potentials (preSEPs) are used to evaluate the severity of myelopathy, and intraoperative neurophysiological monitoring (IONM) is used to reduce iatrogenic damage during operations. However, the correlation between preSEPs and IONM on postoperative neurologic deterioration (PND) in ossification of the posterior longitudinal ligament (OPLL) has not been studied. Thus, under the hypothesis that the patients with deteriorated preSEPs would be more likely to have significant changes in intraoperative SEPs (ioSEPs), and that this would be correlated with PND, we investigated the prognostic value of preSEPs on IONM and PND. This retrospective study included 265 patients who underwent preSEPs and IONM between January 2015 and July 2019. Muscle strength, the sensory scale of the Japanese Orthopaedic Association score examined within 3 days preoperatively, and at 48 h and 4 weeks postoperatively, was analysed. PreSEPs and intraoperative SEPs (ioSEPs) were recorded by stimulating the median and tibial nerves. Intraoperative motor evoked potentials (ioMEPs) were elicited by transcranial electrical stimulation over the motor cortex. PreSEPs latency prolongation of the median and tibial nerves showed significant correlations with ioSEPs. PMD at 48 h or 4 weeks after surgery correlated with ioSEPs and ioMEPs amplitudes. Postoperative sensory deterioration (PSD) at 48 h or 4 weeks after surgery correlated with latency prolongation of ioSEPs. There was a positive correlation between amount of blood loss and maximum percentage of ioSEPs latency prolongation and a negative correlation with PMD at 48 h and 4 weeks postoperatively. PreSEPs predict significant changes in ioSEPs. Furthermore, bleeding control is important to reduce PMD in OPLL.

Clinical Association Between Nasopharyngeal Reflux and Aspiration.

Nasopharyngeal reflux (NPR) is a disturbing phenomenon which interferes swallowing, and the occurrence of NPR is known to be related to aspiration prevalence. The aim of this study is to verify a hypothesis that aspiration will occur more severely in patients with severe NPR, and when it occurs before NPR. Through 2650 video review of videofluoroscopic swallowing study (VFSS) conducted between January 2013 and July 2017 in a tertiary hospital, 100 patients who presented with NPR (NPR group) and age/sex-matched 100 non-NPR patients were screened. The severities of NPR and that of aspiration were analyzed by using final refluxed space and Penetration-Aspiration Scale (PAS) scores. The mean PAS score was significantly higher in the NPR group than in the non-NPR group (p = 0.01). The mean PAS score was significantly high in patients who had a higher NPR grade (p < 0.01). The PAS score was higher when aspiration occurred before NPR (p = 0.02), whereas NPR was more severe when NPR preceded aspiration (p = 0.01). A high index of suspicion is necessary in patients with regurgitating symptom toward the nasopharynx and nasal cavity. Since the severity of the NPR and that of aspiration may differ according to the order of occurrence, biomechanical study through VFSS is important.

The Effects of Over-Ground Robot-Assisted Gait Training for Children with Ataxic Cerebral Palsy: A Case Report.

Poor balance and ataxic gait are major impediments to independent living in ataxic cerebral palsy (CP). Robot assisted-gait training (RAGT) has been shown to improve the postural balance and gait function in children with CP. However, there is no report on the application of RAGT for children with ataxic CP. Here, we report two cases of children with ataxic CP who underwent over-ground RAGT along with conventional therapy for 4 weeks. Outcome measures including the gross motor function measure (GMFM), pediatric balance scale, pediatric reach scale, one-minute walk test, and Timed Up and Go test were assessed before and after the 4-week intervention. Both cases were well adapted to the RAGT system without any significant adverse event. Improvements in the GMFM after RAGT, compared with that in the GMFM, after intensive conventional therapy have been reported previously. It is noteworthy that over-ground RAGT improved areas of the GMFM that did not improve with conventional therapy. In addition, over-ground RAGT with conventional therapy led to improvements in functional balance and walking capacity. These findings suggest that over-ground RAGT is feasible and may be a potential option for enhancing balance and functional walking capacity in children with ataxic CP.

Suitability of YouTube Videos for Learning Knee Stability Tests: A Cross-sectional Review.

OBJECTIVE: To verify the suitability and reliability of YouTube videos pertaining to the 5 most commonly used knee stability tests for educational purposes. DESIGN: Cross-sectional observational study. SETTING: YouTube videos were categorized into 2 groups according to their sources: professional and nonprofessional groups. Only videos that satisfied the purpose and procedure parts among comprehensiveness scores were defined as suitable for educational purposes. For evaluating the reliability, the modified DISCERN was used. One-way analysis of variance and Kruskal-Wallis test were used to compare continuous and categorical variables, respectively. PARTICIPANTS: Research on YouTube videos (N=218) from November 13, 2019, to November 17, 2019, was done using the following keywords: "anterior drawer test knee," "Lachman test knee," "posterior drawer test," "valgus knee test," and "varus knee test." INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Comprehensiveness score that focused on the purpose, procedure, interpretation, and limitations or precautions of the test were developed by the authors, and modified DISCERN score. RESULTS: In terms of the suitability for educational purposes, 126 videos (58%) were classified into the suitable group, and 92 (42%) were classified into the unsuitable group. Neither group had significantly more views, views per posting days, likes, dislikes, or posting days. When comparing the comprehensiveness and reliability scores of each group, significant differences between groups were identified. Only 47 videos met the limitations/precautions category. A total of 155 videos (71%) were from the professional group and 63 videos (29%) were from the nonprofessional group. Significant differences were found in views, views per posting days, likes, and dislikes between the professional group and nonprofessional group. CONCLUSIONS: YouTube should not be used for learning about knee stability tests. Professionals, especially those in rehabilitation medicine, should pay more attention to uploading high-quality videos with reliable content.

Prehabilitation Research: A Bibliometric Analysis of Past Trends and Future Directions.

OBJECTIVE: This study investigates the global research landscape of prehabilitation, identifying current trends, dominant disciplines, collaborative networks, and prominent articles in the field. DESIGN: For our analysis, we employed the published prehabilitation literature indexed in the Web of Science Core Collection database, spanning from 2002 to 2022. Additionally, we utilized CiteSpace (version 6.2; Drexel University), a widely used information visualization software to perform bibliometric analysis. RESULTS: Analyzing 553 research articles, we observe a consistent upward trend in prehabilitation publication and citation activity. Interdisciplinary co-occurrence analysis highlights strong connections with fields such as surgery, rehabilitation, oncology, sports sciences, orthopedics, gastroenterology, and hepatology. Initially centered around postoperative outcomes in major abdominal surgeries, particularly for colorectal, pancreatic, and prostate cancers, prehabilitation research expanded to include thoracic surgeries, focusing on conditions like lung cancer and aortic valve replacement. Preoperative exercise remains a core area, with increasing interest in multimodal prehabilitation and its effectiveness based on patient group characteristics. North America and Western Europe emerge as primary contributors to prehabilitation research. CONCLUSION: Current research concentrates on tailoring prehabilitation programs for specific groups, and broadening their geographical scope would enhance the studies, contributing valuable insights for medical practitioners shaping future research efforts.

Evaluation of YouTube Videos as a Source of Information on Pulmonary Rehabilitation for COPD.

BACKGROUND: The use of YouTube for providing medical information is increasing, and patients with COPD are likely to use digital media to obtain information for their conditions. This study aimed to analyze the reliability and quality of the videos that were most frequently viewed by patients with COPD who searched YouTube for information on pulmonary rehabilitation. METHODS: A YouTube search was conducted by using the keyword "pulmonary rehabilitation." All the videos were categorized into 2 groups according to source and purpose. For evaluating the reliability and quality, the modified DISCERN score and the pulmonary rehabilitation for COPD-specific score (PRSS) were used, respectively. Differences of the variables between the groups and associations across the groups were examined. The influence of the variables of the videos on the engagement of viewers and viewership was analyzed. RESULTS: In total, 62 videos were analyzed. Most of the videos (54/62 [87%]) were uploaded by professionals and the remainder (8/62 [13%] by non-professionals. According to their purposes, 35 of 62 (56%) were informational and 27 of 62 (44%) were non-informational. The mean ± SD modified DISCERN score and the mean ± SD total the PRSS were 3.76 ± 1.04 and 4.13 ± 3.73, respectively. When comparing the videos according to professionalism, significant differences only in the modified DISCERN scores were observed. The engagement of viewers, viewership, mean modified DISCERN, mean total of the PRSS were significantly higher in the informational group than in the non-informational group. Video duration was positively correlated with engagement of viewers and viewership. CONCLUSIONS: Popular YouTube videos on pulmonary rehabilitation for COPD were reliable; however, they were biased and of low quality in terms of providing content. Given YouTube's advantage of easy accessibility and disadvantage of vulnerability to poor-quality information, professionals should pay more attention to uploading comprehensive high-quality videos for informational purposes.

Reliability of the Modified Ashworth and Modified Tardieu Scales with Standardized Movement Speeds in Children with Spastic Cerebral Palsy.

The Modified Ashworth Scale (MAS) and Modified Tardieu Scale (MTS) are widely used to quantify spasticity. However, the reliability of their use for ankle plantar flexors has been questioned. In this study, we aimed to examine whether their reliabilities could be increased to acceptable levels for ankle plantar flexors using standardized movement speed in children with spastic cerebral palsy. The MAS and MTS scores for 92 limbs were assessed by two raters on two occasions, 1 week apart. A metronome was used to maintain the stretching velocity at 120 beats per minute. The intraclass correlation coefficients (ICCs) of the intra-rater reliabilities of the MAS and MTS and inter-rater reliability of the MAS were over 0.7. However, the ICCs for the inter-rater reliability of the MTS were <0.7 and >0.75 for the gastrocnemius and soleus muscles, respectively. The ICCs for the inter- and intra-rater reliabilities of the R1 angles ranged from 0.68 to 0.84, while those of the R2 angles ranged from 0.74 to 0.93. The reliabilities of the R2-R1 angles were not satisfactory. In conclusion, with a standardized movement speed, the reliability of the MAS for the ankle plantar flexors and the MTS for the soleus were satisfactory; however, that of the MTS for the gastrocnemius was not.

Predictive factors for the development of diabetes in cancer patients treated with phosphatidylinositol 3-kinase inhibitors.

PURPOSE: Targeted therapy using phosphatidylinositol 3-kinase (PI3K) inhibitors is used to treat cancer such as lymphoma. In animal studies, its use raised concern about alteration of glucose metabolism. To date, clinical data are inconclusive; therefore, we investigated the incidence and clinical manifestations of diabetes in cancer patients treated with PI3K inhibitors. METHODS: In a retrospective review of diabetes-free patients with advanced solid tumors treated with PI3K inhibitor, we performed Cox regression to identify independent predictors for the development of diabetes. RESULTS: Of 38 patients (mean age: 54.5 years, 23.7% female) having a mean duration of follow-up of 238.5 days who initiated PI3K inhibitors, 55.3% developed diabetes during treatment (mean 29.1 days); among these, 28.6% experienced remission of diabetes after discontinuing PI3K inhibitors (mean 72.1 days). Patients with incident diabetes had higher anti-hypertensive medication use, higher HbA1c levels and fasting glucose at baseline, and longer duration of PI3K inhibitor use (P = 0.024, P = 0.005, P = 0.008, and P = 0.023, respectively). Previous steroid use and lower baseline HbA1c level were significantly associated with development of diabetes (HR = 8.41, 95% CI 1.89-37.33; HR = 2.16, 95% CI 1.09-4.25, respectively). Patients whose diabetes remitted after discontinuing PI3K inhibitors were younger (P = 0.035) and had lower fasting glucose levels during PI3K inhibitor treatment (P = 0.001) compared to those non-remitters. CONCLUSIONS: Previous steroid use and lower baseline HbA1c level may be important predictors for developing diabetes in patients with advanced solid tumors treated with PI3K inhibitors, warranting close observation and careful intervention.