ABSTRACT
Patients with severe coronavirus disease 2019 (COVID-19) have poor prognosis, with many cases being difficult to treat and many reports of neurological complications in patients who have been in the intensive care unit for a long time. Rehabilitation of patients with severe COVID-19 is important；however, no rehabilitation program has shown effectiveness. Thus, this study aimed to investigate the effects of a rehabilitation program developed and used at our hospital for patients with severe COVID-19. We enrolled 28 patients with severe COVID-19 (age 61［23-88］years；female/male, 9/19, body mass index, 25.0［18.0-33.6］kg/m2). We assessed the medical research council scoring (MRC) of the patients at the time of entry and exit from the ordinary ward using Wilcoxon signed-rank tests. MRC was significantly improved after exiting the ordinary ward compared with that on entering the ordinary ward (43 vs. 50 points；P＜.001). Moreover, Barthel index improved significantly after exiting the ordinary (32.5 vs. 77.5 points, P＜.001). Therefore, our acute rehabilitation treatment for patients with severe COVID-19 may be effective in improving their muscle strength and daily living.
ABSTRACT
Background and Aims：Sarcopenia is associated with autologous hematopoietic stem cell transplantation (auto-HSCT) -related outcomes in patients with malignant lymphoma (ML). The aims of this study were to investigate changes in skeletal muscle mass after auto-HSCT and risk profiles for sarcopenia after HSCT.Methods：We enrolled 25 patients with refractory ML (age, 57 years [20-69 years]；female/male, 11/14；body mass index, 21.7 kg/m2 [18.9-29.6 kg/m2]). Skeletal muscle mass was evaluated using the psoas muscle index (PMI) measured on computed tomography before and after auto-HSCT. In addition, visceral fat area (VFA) was also measured. Independent factors and profiles associated with a decrease in PMI were evaluated using multivariate and decision-tree analyses, respectively.Results：The PMI was significantly decreased after auto-HSCT (p＝0.0288). A logistic regression analysis revealed that the decreases in PMI and VFA were related. According to the decision-tree analysis, the PMI measured prior to auto-HSCT was selected as the initial branch. Of the patients with a PMI of＜3.74 cm2/m2, 84％ showed a decrease in PMI. Of the patients with a PMI of ≥3.74 cm2/m2, the VFA measured prior to auto-HSCT was the second branch. All the patients with a VFA of ≥115.0 cm2 had decreased PMI.Conclusions：We demonstrated that skeletal muscle mass decreased after auto-HSCT in the patients with ML. The patients with either a PMI of＜3.74 cm2/m2 or a VFA of ≥105.0 cm2 before auto-HSCT were at risk of decreased skeletal muscle mass.
ABSTRACT
Background and Aims：Sarcopenia is associated with autologous hematopoietic stem cell transplantation (auto-HSCT) -related outcomes in patients with malignant lymphoma (ML). The aims of this study were to investigate changes in skeletal muscle mass after auto-HSCT and risk profiles for sarcopenia after HSCT.Methods：We enrolled 25 patients with refractory ML (age, 57 years [20-69 years]；female/male, 11/14；body mass index, 21.7 kg/m2 [18.9-29.6 kg/m2]). Skeletal muscle mass was evaluated using the psoas muscle index (PMI) measured on computed tomography before and after auto-HSCT. In addition, visceral fat area (VFA) was also measured. Independent factors and profiles associated with a decrease in PMI were evaluated using multivariate and decision-tree analyses, respectively.Results：The PMI was significantly decreased after auto-HSCT (p＝0.0288). A logistic regression analysis revealed that the decreases in PMI and VFA were related. According to the decision-tree analysis, the PMI measured prior to auto-HSCT was selected as the initial branch. Of the patients with a PMI of＜3.74 cm2/m2, 84％ showed a decrease in PMI. Of the patients with a PMI of ≥3.74 cm2/m2, the VFA measured prior to auto-HSCT was the second branch. All the patients with a VFA of ≥115.0 cm2 had decreased PMI.Conclusions：We demonstrated that skeletal muscle mass decreased after auto-HSCT in the patients with ML. The patients with either a PMI of＜3.74 cm2/m2 or a VFA of ≥105.0 cm2 before auto-HSCT were at risk of decreased skeletal muscle mass.
ABSTRACT
Although papillary thyroid carcinoma (PTC)–type nuclear changes are the most reliable morphological feature in the diagnosis of PTC, the nuclear assessment used to identify these changes is highly subjective. Here, we report a noninvasive encapsulated thyroid tumor with a papillary growth pattern measuring 23 mm at its largest diameter with a nuclear score of 2 in a 26-year-old man. After undergoing left lobectomy, the patient was diagnosed with an encapsulated PTC. However, a second opinion consultation suggested an alternative diagnosis of follicular adenoma with papillary hyperplasia. When providing a third opinion, we identified a low MIB-1 labeling index and a heterozygous point mutation in the KRAS gene but not the BRAF gene. We speculated that this case is an example of a novel borderline tumor with a papillary structure. Introduction of the new terminology “noninvasive encapsulated papillary RAS-like thyroid tumor (NEPRAS)” without the word “cancer” might relieve the psychological burden of patients in a way similar to the phrase “noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP).”
Subject(s)
Adult , Humans , Adenoma , Diagnosis , Hyperplasia , Observer Variation , Point Mutation , Referral and Consultation , Thyroid Gland , Thyroid NeoplasmsABSTRACT
Objectives: International guidelines recommend the use of long-acting bronchodilators for the treatment of chronic obstructive pulmonary disease [COPD], but the usefulness of short-acting bronchodilator assist use for stable COPD remains uncertain. The purpose of the present study was to objectively demonstrate the effects of assist use of procaterol, a short-acting Beta[2]-agonist, on the respiratory mechanics of stable COPD patients treated with a long-acting
bronchodilator using forced oscillation technique [FOT] and conventional spirometry. We also confirmed the length of time for which procaterol assist could significantly improve the pulmonary function
Methods: We enrolled 28 outpatients with mild to severe COPD [Global Initiative for Obstructive Lung Disease stages I-III], who had used the same long-acting bronchodilator for longer than 3 months and who were in stable condition. All measures were performed using both FOT and spirometry sequentially from 15 min to 2 h after inhalation
Results: Compared to baseline, inhaled procaterol assist use modestly but significantly improved spirometric and FOT measurements within 2 h after inhalation. These significant effects continued for at least 2 h. Significant correlations were found between parameters measured by spirometry and those measured by FOT
Conclusions: Procaterol assist use modestly but significantly improved pulmonary function determined by spirometry and respiratory mechanics in patients with stable COPD treated with long-acting bronchodilators. Thus, inhaled procaterol has the potential for assist use for COPD
ABSTRACT
<p><b>BACKGROUND</b>Obesity is the most common metabolic disease in the world. However, the relationship between obesity and lung function is not fully understood. Although several longitudinal studies have shown that increases in body weight can lead to reductions in pulmonary function, whether this is the case with the Japanese population and whether high body mass index (BMI) status alone represents an appropriate predictor of obstructive lung dysfunction remains unclear. The purpose of present study was to estimate the effect of BMI on lung function measured by spirometry of Japanese patients in general clinics. We measured BMI and performed spirometry on screening patients who had consulted general clinics.</p><p><b>METHODS</b>Subjects comprised 1231 patients ≥ 40 years of age (mean age (65.0 ± 12.0) years, 525 men, 706 women) who had consulted clinics in Nagasaki Prefecture, Japan, for non-respiratory disease. BMI was calculated and lung function was measured by spirometry.</p><p><b>RESULTS</b>BMI was found to be positively correlated with forced expiratory volume in 1 second (FEV(1))/forced vital capacity (FVC) in men and with maximum mid-expiratory flow (MMF) in all subjects. Following adjustment for relevant factors, a significant positive correlation between BMI and FEV(1)/FVC was identified for all subjects. Comparison between subjects with normal BMI (18.5 - 25.0) and higher BMI (25.1 - 30.0) also demonstrated that FEV(1)/FVC and percentage of predicted maximum mid-expiratory flow (%MMF) were significantly higher in the latter subjects.</p><p><b>CONCLUSIONS</b>In a population without marked respiratory disease, higher BMI subjects showed less obstructive pulmonary dysfunction compared to normal BMI subjects. High BMI status alone may be inappropriate as a predictor of obstructive lung dysfunction, particularly in populations with a low prevalence of obesity.</p>