Prealbumin level is a predictor of activities of daily living at discharge in older patients with heart failure who became ADL-independent after hospitalization: - Acute and early recovery cardiac rehabilitation trials.

Chiba T, Yokota J, Takahashi R, Sasaki K, Suzuki H. Prealbumin level is a predictor of activities of daily living at discharge in older patients with heart failure who became ADL-independent after hospitalization - Acute and early recovery cardiac rehabilitation trials. Jpn J Compr Rehabil Sci 2023; 14: 69-77. Objective: To determine the relationship between prealbumin level and activities of daily living (ADL) at discharge in patients with heart failure (HF) and assess the usefulness of prealbumin measurement in predicting discharge Barthel Index (BI) in older patients with HF who become non-independent in ADL after hospital admission. Methods: Patients with HF, aged ≥75 years, who were admitted to an acute hospital and underwent acute and early recovery cardiac rehabilitation (CR) were studied retrospectively. The exclusion criteria were non-independent ADL before admission (BI < 85 points) and independent ADL at the start of CR (BI ≥ 85 points). The usefulness of prealbumin level in predicting discharge BI was compared between four models. Albumin and Controlling Nutritional Status (CONUT) were used as comparison variables. The models and independent variables were model 1 (covariates only), model 2 (prealbumin + covariates), model 3 (albumin + covariates), and model 4 (CONUT score + covariates). Adjusted R2, a measure of model fit, was used to compare predictive ability. Results: A total of 152 patients were included in the analysis. Prealbumin level was a significant variable for BI at discharge but not albumin or CONUT. The adjusted R2 was higher in model 2 with the addition of prealbumin than that in model 1 (0.362 vs. 0.347). Conclusion: Prealbumin levels are useful in predicting discharge BI in older patients with HF who become non-independent in ADL after hospitalization.

Dysphagia is an independent predictor of hospital-acquired disability in older patients with heart failure: a propensity score-matched analysis : Predictors of HAD in older HF patients.

This study aims to identify the relationship between dysphagia and developing hospital-acquired disability (HAD) in older patients with heart failure (HF). This single-center retrospective cohort study included 360 patients (median age, 84 years: 58.1% female, 41.9% male) who had undergone rehabilitation and were aged 65 years and older. Patients were divided into dysphagia and non-dysphagia groups and compared based on the Functional Oral Intake Scale score. HAD was defined as a decline in the Barthel Index score (indication of daily activity levels) at discharge relative to that before admission. The relationship between dysphagia and HAD was analyzed using bivariate analysis after adjusting for age, sex, body mass index, medical history, clinical and laboratory data, short physical performance battery (SPPB), and cognitive function at the start of rehabilitation, using propensity score matching. HAD was observed in 38.1% of the patients. Patients with dysphagia were significantly older, and had lower body mass index and physical and cognitive function than those without. After propensity score matching, the prevalence of HAD was significantly higher in the dysphagia group than in the non-dysphagia group (61.9% vs. 42.9%, P = 0.032). Dysphagia at the start of rehabilitation was an independent predictor of HAD. The results of this study may contribute to risk stratification of HAD.

Physical performance and maximum tongue pressure associated with oral intake independence: a retrospective study on hospitalized patients with heart failure.

Dysphagia in patients with heart failure leads to poorer outcomes during hospitalization and after discharge. Therefore, addressing dysphagia is critical for improving patient prognosis. This retrospective observational study aimed to evaluate associations between improvements in swallowing dysfunction at the time of hospital discharge and the physical function, cognitive function, nutritional status, and maximum tongue pressure (MTP). Overall, 111 patients who underwent cardiac rehabilitation and were deemed to have oral intake impairment were included. The exclusion criteria comprised the following: pre-admission diagnosis of dysphagia, in-hospital death, and missing data. Patients were categorized based on whether they did (n = 65) or did not (n = 46) exhibit improvements in oral intake impairment, which were determined from the functional oral intake scale (FOIS) score at discharge. Associations between potential explanatory variables and the FOIS score at discharge were assessed using a linear regression model. After adjusting for covariates, such as age, sex, heart failure severity, short physical performance battery score, Mini-Mental State Examination score, transthyretin level, and provision of swallowing therapy, the FOIS score at discharge was significantly associated with the MTP (P = 0.024, confidence interval: 0.006-0.046). In conclusion, the MTP was independently associated with improvements in FOIS in patients with heart failure.

Mild cognitive impairment in patients with acute heart failure does not limit the effectiveness of early phase II cardiac rehabilitation.

BACKGROUND: Cardiac rehabilitation (CR) is commonly performed in patients with heart failure (HF) with mild cognitive impairment (MCI). However, whether MCI diminishes the benefit of early phase II CR is unclear. AIM: This study aimed to clarify whether MCI diminishes the benefit of early phase II CR in patients hospitalized for HF. DESIGN: The design of the work is a case-control study. SETTING: All HF patients who underwent CR in acute care hospitals in Japan from April 2016 to March 2021. POPULATION: Among the 574 patients who underwent CR, 204 were included in this study. Exclusion criteria were age <65 years, dependence for activities of daily living (ADLs) prior to admission, diagnosis of dementia or delirium, mini-mental state examination (MMSE) score at the commencement of CR<19, missing data, in-hospital death, and transfer to another department during hospitalization. METHODS: Patients were divided into two groups, those with MCI (MCI group, N.=134) and those without MCI (non-MCI group, N.=70), based on MMSE score at the commencement of CR. Cognitive impairment was defined as a score of <19. MCI was defined as an MMSE score between 19 and 26, and normal cognitive function was defined as MMSE >26. The primary outcomes were the 6-minute walking distance (6MWD), Barthel Index (BI), and Short Physical Performance Battery (SPPB). All patients underwent guideline-based CR programs. RESULTS: On admission, MCI patients had significantly lower BI (P<0.01, confidence interval [CI]: 4.9-20.4) and SPPB (P<0.01, CI: 1.1-3.1), despite being independent for ADLs before admission. In addition, 6MWD (P<0.01, CI: 31.2-97.2), BI (P=0.01, CI: 1.0-8.4), and SPPB (P<0.01, CI: 0.6-2.5) were significantly lower in the MCI group at the time of discharge. However, after propensity score matching to adjust for baseline characteristics, no significant differences in any primary outcome were found between the two groups. CONCLUSIONS: The BI, SPPB, and 6MWD improvements due to CR were similar, regardless of MCI. CLINICAL REHABILITATION IMPACT: Our results may inform the selection of appropriate rehabilitation interventions for patients with HF and MCI.

Single-Walled Carbon Nanotube Film as Electrode in Indium-Free Planar Heterojunction Perovskite Solar Cells: Investigation of Electron-Blocking Layers and Dopants.

In this work, we fabricated indium-free perovskite solar cells (SCs) using direct- and dry-transferred aerosol single-walled carbon nanotubes (SWNTs). We investigated diverse methodologies to solve SWNTs' hydrophobicity and doping issues in SC devices. These include changing wettability of poly(3,4-ethylenedioxythiophene)/poly(styrenesulfonate) ( PEDOT: PSS), MoO3 thermal doping, and HNO3(aq) doping with various dilutions from 15 to 70 v/v% to minimize its instability and toxic nature. We discovered that isopropanol (IPA) modified PEDOT: PSS works better than surfactant modified PEDOT: PSS as an electron-blocking layer on SWNTs in perovskite SCs due to superior wettability, whereas MoO3 is not compatible owing to energy level mismatching. Diluted HNO3 (35 v/v%)-doped SWNT-based device produced the highest PCE of 6.32% among SWNT-based perovskite SCs, which is 70% of an indium tin oxide (ITO)-based device (9.05%). Its flexible application showed a PCE of 5.38% on polyethylene terephthalate (PET) substrate.

Structured Single-Walled Carbon Nanotubes and Graphene for Solar Cells.

We propose the concept of structured single-walled carbon nanotubes (SWNTs) for the applications of heterojunction solar cells and dye-sensitized solar cells (DSSCs). The structure of SWNTs was controlled and modified by a simple water vapor treatment, which was originally developed by our group. Compared with the graphene-Si solar cell and the SWNT-Si solar cell using the random-oriented SWNT film, the pristine micro-honeycomb structured SWNT-Si solar cell shows a significant improvement in terms of fill factor and the greater potential to obtain high power conversion efficiency (PCE). Moreover, the performance of the pristine micro-honeycomb structured SWNT-Si solar cells is stable in ambient condition. In addition, the PCE and fill factor of the DSSC with the micro-honeycomb structured SWNT counter electrode are 3.90% and 0.61, respectively, which are comparable to those of the DSSC with Pt as the counter electrode. This result shows that the micro-honeycomb networked SWNTs provide a low-cost alternative to replace Pt in DSSCs.

Direct and Dry Deposited Single-Walled Carbon Nanotube Films Doped with MoO(x) as Electron-Blocking Transparent Electrodes for Flexible Organic Solar Cells.

Organic solar cells have been regarded as a promising electrical energy source. Transparent and conductive carbon nanotube film offers an alternative to commonly used ITO in photovoltaics with superior flexibility. This communication reports carbon nanotube-based indium-free organic solar cells and their flexible application. Direct and dry deposited carbon nanotube film doped with MoO(x) functions as an electron-blocking transparent electrode, and its performance is enhanced further by overcoating with PEDOT: PSS. The single-walled carbon nanotube organic solar cell in this work shows a power conversion efficiency of 6.04%. This value is 83% of the leading ITO-based device performance (7.48%). Flexible application shows 3.91% efficiency and is capable of withstanding a severe cyclic flex test.