Establishing minimal clinically important differences and cut-off values for the lower limb motricity index and trunk control test in older patients with acute stroke: a prospective cohort study.

OBJECTIVE: To establish the Minimal Clinically Important Differences (MCIDs) for lower limb strength measured by the Motricity Index (LLMI) and trunk function assessed by the Trunk Control Test (TCT) in the acute phase of stroke in older patients. Further, the study sought to determine the cutoff values predicting functional prognosis at discharge for both the LLMI and TCT. METHODS: This prospective cohort study was conducted for older patients (≥65 years) admitted for acute stroke, receiving guideline-based stroke care that includes early rehabilitation. The LLMI and TCT were measured within 7 days of admission and at discharge. The MCID was derived from receiving operating characteristic curves, based on a ≥ 1 point shift in the modified Rankin Scale (mRS) from admission to discharge. A good functional prognosis at discharge was defined as an mRS score of ≤ 3. RESULTS: A total of 201 older patients with acute stroke were included. The TCT achieved an MCID of 13 (area under the curve [AUC] = 0.704, 95% confidence interval [CI]: 0.633-0.775), whereas the LLMI lacked the precision to produce a significant MCID. The optimal cutoff points for predicting a good outcome were found to be an LLMI score of 65 (AUC = 0.770, 95% CI: 0.705-0.835) and a TCT score of 25 (AUC = 0.827, 95% CI: 0.768-0.887) upon admission. CONCLUSIONS: This study identified a valid MCID for the TCT, failed to do so for the LLMI, and established cutoff values for both the LLMI and TCT that can predict good outcomes in older patients with acute stroke.

Impact of possible sarcopenia on functional prognosis in patients with acute stroke with premorbid disability.

AIM: How possible sarcopenia affects functional prognosis in patients with premorbid disability remains unclear. This study aimed to compare and investigate the impact of possible sarcopenia at admission on functional outcomes at discharge in patients with acute stroke with and without premorbid disability. METHODS: This cohort study enrolled patients who were consecutively admitted to a single center for acute stroke. Calf circumference and grip strength were measured within 7 days of admission, and possible sarcopenia was determined using the Asian Working Group for Sarcopenia 2019 criteria. The Functional Independence Measure (FIM) score at discharge during the acute phase was the primary outcome. To examine the impact of possible sarcopenia on FIM scores at discharge, patients were divided into two groups according to being with or without premorbid disability according to the modified Rankin Scale, and multiple linear regression analysis was performed in each group. RESULTS: This study included 456 patients with acute stroke (median age, 80 years). In the premorbid-disability group (n = 166), possible sarcopenia was present in 140 patients (84%). Patients without possible sarcopenia had significantly higher FIM scores at discharge compared with those with possible sarcopenia (P < 0.001). However, multiple linear regression analysis showed that possible sarcopenia was not associated with FIM scores at discharge in the premorbid-disability group (ß = -0.054, P = 0.346). CONCLUSIONS: The results of this study demonstrated that a high rate of possible sarcopenia was observed in patients with stroke with premorbid disability; however, this did not affect functional prognosis. Geriatr Gerontol Int 2024; 24: 359-363.

Malnutrition on admission is associated with trunk function recovery but not with lower limb muscle strength recovery in patients with acute stroke: an observational cohort study.

OBJECTIVES: The aim of this study was to determine the effects of malnutrition on trunk function and lower leg muscle strength in patients with acute stroke upon hospitalization. METHODS: This prospective cohort study included hospitalized patients with acute stroke. Nutritional status was assessed using the Global Leadership Initiative on Malnutrition criteria. Trunk function and lower leg muscle strength were assessed using the trunk control test (TCT) and Motricity Index (MI), respectively, on admission and at discharge. Logistic regression analysis was performed to examine the relationship between malnutrition and poor improvement in TCT and MI scores at discharge. RESULTS: Patients (N = 241) with acute stroke (median age 79 y) were included in this study. In adjusted logistic regression analysis, malnutrition was independently associated with poor TCT score improvement (adjusted odds ratio, 3.82; 95% confidence interval, 1.11-13.20; P = 0.03). In contrast, malnutrition was not independently associated with poor MI score improvement (adjusted odds ratio, 0.86; 95% confidence interval, 0.30-2.52; P = 0.79). CONCLUSION: Malnutrition on admission leads to poor trunk function, but not lower leg muscle strength, in patients with acute stroke.

Comparison of bubble removal performances of five membrane oxygenators with and without a pre-filter.

When employing minimal invasive extracorporeal circulation (MiECC), the removal of bubbles in the circuit is important to prevent air embolism. We investigated the bubble removal performance of the FHP oxygenator with a pre-filter and compared it with that of four oxygenators, including the Fusion oxygenator, Quadrox oxygenator, Inspire oxygenator, and FX oxygenator. A closed test circuit filled with an aqueous glycerin solution was used. Air injection (10 mL) was performed prior to the oxygenator, and the number and volume of the bubbles were measured at the inlet and outlet of each oxygenator. At the inlet of the five oxygenators, there were no significant differences in the total number of bubbles detected. At the outlet, bubbles were classified into two groups according to the bubble size: ≥100 µm and <100 µm. Tests were performed at pump flow rates of 4 and 5 L/min. For bubbles ≥100 µm, which are considered clinically detrimental, the FHP was the lowest number and volume of bubbles at both pump flow rates compared to the other oxygenators. Regarding the bubbles <100 µm, the number of bubbles was higher in the FHP than those in others; however, the volume of bubbles was significantly lower at 4 L/min and tended to be lower at 5 L/min. The use of the FHP with the pre-filter removed more bubbles ≥100 µm in the circuit than that by the other oxygenators.

[Two cases of urolithiasis induced by topiramate].

Topiramate is an antiepileptic medicine that has been used adjunctively in the treatment of refractory seizures in Japan since 2007. Topiramate has been shown to inhibit specific carbonic anhydrase activity in the kidney and may induce a distal type of renal tubular acidosis. Case 1 : A 22-year-old male was referred to our hospital after complaining of left flank pain. He developed a seizure disorder and had been using topiramate for 4 months. Drip infusion pyelography showed a left ureteral stone. Case 2 : A 7-year-old boy presented with gross hematuria. He developed West syndrome and had been using topiramate for 6 months. A computed tomographic scan showed a right kidney stone.

Ground state lasing at 1.30 microm from InAs/GaAs quantum dot lasers grown by metal-organic chemical vapor deposition.

We investigated the effects of post-growth annealing on the photoluminescence (PL) characteristics of InAs/GaAs quantum dots (QDs) grown by metal-organic chemical vapor deposition (MOCVD). The onset temperature at which both the peak linewidth and the PL intensity degraded and the blueshift of the ground state emission wavelength occurred was found to depend on both the QD density and the In composition of the capping layer. This behavior is particularly important in view of QD integration in photonic devices. From the knowledge of the dependences of the PL characteristics after annealing on the QD and capping growth conditions, ground state lasing at 1.30 microm could be demonstrated from InAs/GaAs QDs grown by MOCVD. Finally, we compared the laser characteristics of InAs/GaAs QDs with those of InAs/Sb:GaAs QDs, grown according to the antimony-mediated growth technique, and showed that InAs/Sb:GaAs QDs are more appropriate for laser fabrication at 1.3 microm by MOCVD.