Association of Psoas Muscle Mass at Intensive Care Unit Admission With Physical Function and Post-discharge Destination in Survivors of Critical Illness.

OBJECTIVE: Survivors of critical illness may have physical impairments, known as post-intensive care syndrome (PICS). Early screening for the risk of PICS is recommended to prevent PICS. Skeletal muscle mass is a clinically important indicator associated with various outcomes. This study aimed to examine the association of psoas muscle mass at intensive care unit (ICU) admission with the destination and physical function at hospital discharge. METHODS: In this single-center retrospective cohort study, we reviewed the medical records of adult patients who had required emergency ICU admission and who had been intubated and mechanically ventilated. Psoas major muscle was measured as an indicator of skeletal muscle mass from abdominal computed tomography images at ICU admission. Physical function was assessed using the functional status score for the ICU and ICU mobility scale at hospital discharge. Multinomial logistic and multivariable linear regression were used to analyze the associations of the psoas muscle mass with the discharge destination and physical function at discharge. RESULTS: We enrolled 124 patients (79 men and 45 women) with a median (interquartile range) age of 72.0 (62.0-80.0) years; 39 (31.5%) were discharged to home, 50 (40.3%) were transferred to rehabilitation wards, and 35 (28.2%) were transferred to long-term care settings. The psoas muscle area and volume were 16.9 (11.3-20.6) cm2 and 228.3 (180.2-282.0) cm3 in home discharge patients, 17.5 (11.5-21.5) cm2 and 248.4 (162.0-311.4) cm3 in rehabilitation ward patients, and 15.9 (10.3-19.5) cm2 and 184.0 (137.0-251.1) cm3 in long-term care patients. The areas and volumes of the psoas muscle were not significantly different in the three groups. Furthermore, psoas muscle mass was not significantly associated with the discharge destination and physical function. CONCLUSIONS: Discharge destination and physical function at hospital discharge were not significantly associated with psoas muscle mass at ICU admission.

Postoperative Rehabilitation for Thoracic Disc Herniation in a Professional Rugby Player: A Case Report.

Thoracic disc herniation (TDH) is a very rare condition compared to cervical and lumbar disc herniation. Patients commonly attend rehabilitation programs after surgery, and the beneficial effects of rehabilitation for cervical and lumbar disc herniation have been reported. However, a postoperative rehabilitation program for patients with TDH has not yet been reported. This case report describes a postoperative rehabilitation program and chronological changes in physical function after surgery for TDH in a professional rugby player. We report the case of a 31-year-old male professional rugby player diagnosed with TDH at T1-T3 and ossification of the yellow ligament at T2-T3. It was difficult for the patient to walk because of the severe spasticity in the lower extremities. The patient underwent surgery to remove the ossified yellow ligament at T2-T3 and posterior thoracic interbody fusion (PTIF) at T1-T3. Rehabilitation programs such as joint mobilization and stability training were initiated after surgery. Spasticity gradually decreased, and the patient could walk unassisted three weeks after surgery and return to field training four months after surgery. This case report suggests that a postoperative rehabilitation program could be safely provided to patients with TDH in the early postoperative period, which may be effective in improving physical function.

<b>A Report on an Annual Kampo Medicine Conference Held by Medical Students in the Hokkaido and Tohoku A</b><b>reas</b> / 日本東洋医学雑誌

<p>Since students who would like to study Kampo medicine more have no opportunity to communicate each other in Northern Japanese Universities, we newly started joint study conferences held by medical students in 2013. The objectives of this paper are to report on these annually held student-based Kampo study conferences in the Hokkaido and Tohoku areas, and the ways each university studies Kampo medicine. In the conference, the students reported on their club activities. Then they studied the history of Kampo medicine and simulation of abdominal diagnosis, and performed group work on case reports together. The number of student participants in these conferences has tripled over 3 years from 18 to 58 (for a total of 111 participants). All members were satisfied with the content. And this reflects medical students' need for a wider perception of Kampo medicine, rather than a limited one gained in their university club activities. We hope this conference will play a major role in other nationwide student-based Kampo study conferences in the years to come.</p>