Prevalence and clinical predictors of dysphagia after heart transplantation.

INTRODUCTION: Dysphagia is a common complication after heart transplantation (HTPL), but few studies exist on dysphagia after HTPL, and the prevalence is unknown. The objective of our current study was to establish the prevalence and risk factors for dysphagia after HTPL and to classify its characteristics through Videofluoroscopic Swallowing Studies (VFSS). METHODS: The recipients of HTPL carried out at a single center from January 2011 to November 2019 were assessed retrospectively. Dysphagia was evaluated by a bedside swallowing exam and VFSS to evaluate for evidence of aspiration. The duration of ventilator and preoperative extracorporeal membrane oxygenation (ECMO) support, intensive care unit, hospital stay, the progress of oral feeding after surgery, the presence of a tracheostomy, and vocal cord palsy were analyzed. On the third and seventh days following surgery, we looked at the relationship between risk factors and oral feeding progress, respectively. Additionally, we contrasted these risk variables with the no penetration/aspiration (PA) group and the PA group on VFSS. RESULTS: Among the study cohort of 421 patients, 222 (52.7%) patients had access to oral feeding on the third day of surgery. The number of patients who underwent VFSS due to clinically suspected dysphagia was 96 (22.8%). Of these, 54 (56.2%) had aspiration or penetration (PA group), while 42 (43.8%) had no abnormal findings (No-PA group). In the multivariable regression model, preoperative ECMO support, vocal cord abnormalities, tracheostomy, and emergent need for HTPL were identified as independent risk variables for oral feeding progress on postoperative days (PODs) 3 and 7. Among these factors, preoperative ECMO support had the highest odds ratio (OR) at PODs 3 (OR: 4.73, CI: 1.997, 11.203, p < .001) and 7 (OR: 5.143, CI: 2.294, 11.53, p < .001). CONCLUSION: We identified the prevalence and potential risk factors for postoperative dysphagia in this retrospective analysis of 421 heart transplant recipients. The pathophysiology of postoperative dysphagia was multifactorial, and it was more common than the incidence after general cardiothoracic surgery.

Effects of robot (SUBAR)-assisted gait training in patients with chronic stroke: Randomized controlled trial.

BACKGROUND: SUBAR is a new ground walking exoskeletal robot. The objective of this study is to investigate SUBAR-assisted gait training's effects in patients with chronic stroke. METHODS: This preliminary study is a prospective randomized controlled trial. Thirty adults were enrolled 6 months after the onset of stroke with functional ambulation category scores ≥ 3. Patients were randomly assigned to receive robot-assisted gait training (SUBAR group, n = 15) or conventional physiotherapy (control group, n = 15). All patients received a total of 10 treatment sessions of 30 minutes each for 3 weeks. Before and after the 10-treatment sessions, patients were evaluated. The primary outcome is the 10 meter walk test and the secondary outcomes were the functional ambulation category scale, the Motricity Index-Lower, Modified Ashworth Scale (MAS), timed up and go, Rivermead Mobility Index, Berg Balance Scale (BBS), and gait analysis. RESULTS: In the SUBAR group, MAS and step length were significantly improved between pre- and posttreatment measurements (Δmean ±â€ŠSD: -1.1 ±â€Š1.6 and 5.5 ±â€Š7.6, P = .019 and .016, respectively). The SUBAR group improved the stride length and step length of the affected limb but not significantly. The control group had significant improvements in the BBS, MAS, and stride length between pre- and posttreatment measurements (Δmean ±â€ŠSD: 3.5 ±â€Š4.6, -0.8 ±â€Š1.5, and 6.5 ±â€Š9.5; P = .004, .031, and .035, respectively). The BBS improved more in the control group than in the SUBAR group. There were no other differences between the SUBAR group and the control group. CONCLUSION: Our results suggest that SUBAR-assisted gait training improved gait parameters in patients with chronic stroke. However, there was no significant difference in most outcome measures compared to conventional physiotherapy. Further research is warranted to measure the effects of SUBAR-assisted gait training.

Prognostic Factors of Quantitative Lymphoscintigraphic Findings in Patients with Breast Cancer-Related Lymphedema.

Background: To evaluate the usefulness of quantitative findings of pretherapy lymphoscintigraphy in predicting the effects of complex decongestive therapy (CDT) in patients with upper extremity lymphedema after breast cancer treatment. Methods and Results: We retrospectively analyzed patients with unilateral breast cancer-related lymphedema (BCRL) who underwent pretherapy lymphoscintigraphy and completed 2 weeks of CDT. A total of 18 patients with unilateral BCRL clinical stage II underwent 30-minute sessions of CDT five times per week for 2 weeks. The quantitative asymmetry index (QAI) of the upper extremity, axillary lymph node (LN) uptake, and axillary plus supraclavicular LN uptake from lymphoscintigraphy were calculated. The volume of lymphedema was calculated by percentage excess volume (PEV) at initial and posttreatment. The CDT response was assessed using percentage reduction in excess volume (PREV). Correlation analyses were conducted using Kendall tau rank correlation. There was positive correlation between upper extremity QAI at 2 hours and initial PEV. Negative correlations were found between axillary LN QAI at 1, 2 hours, and initial PEV, and between axillary plus supraclavicular LN QAI at 1, 2 hours, and initial PEV. The PREV showed a positive correlation with axillary LN QAI at 2 hours after injection (tau-b = 0.354, p = 0.041). Conclusion: Quantitative findings of pretherapy lymphoscintigraphy have potential value for use in predicting the response to CDT in patients with upper extremity lymphedema after breast cancer treatment. Using QAIs from lymphoscintigraphy, we could estimate the excess volume of lymphedema.

Clinical Factors Associated with Deep Vein Thrombosis in Rehabilitation Patients Suspected of Thromboembolism after Cerebral Infarction.

The aim of this study is to investigate the association between characteristics of cerebral infarction lesion (vascular territory, etiology, and size), functional status and the occurrence of thromboembolism in patients suspected of having thromboembolism in a rehabilitation setting after cerebral infarction. Cerebral infarction patients who were suspected of having thromboembolism and who had undergone deep vein thrombosis (DVT) evaluation were included in analyses. Of the total 916 cerebral infarction patients, 65 patients were suspected of having DVT; 27 patients belonged to the DVT group and 38 patients belonged to the non-DVT group. The DVT (+) group was more likely to have a higher ratio of female, previous DVT history, middle cerebral artery (MCA) infarction, large arterial disease, modified Rankin Scale (mRS) score 5, abnormal speech and higher D-dimer. In multivariate logistic regression analysis, female sex, MCA infarction and mRS score 5 were significantly associated with the occurrence of thromboembolism in patients suspected of having thromboembolism. In contrast, other functional status, cerebral infarction etiology (Trial of ORG 10172 in Acute Stroke Treatment [TOAST] classification), and infarct volume were not associated with the occurrence of thromboembolism. In this study, female gender, MCA infarction, and mRS score 5 could be potential risk factors for thromboembolism in rehabilitation patients after cerebral infarction.