Prediction of Oral Intake at Discharge with Early Assessment of Swallowing Function within 24 h after Admission: A Retrospective Cohort Study.

Dysphagia is one of the most common symptoms of stroke and can lead to other complications such as pneumonia, dehydration, and malnutrition. This retrospective cohort study evaluated the predictive value of a comprehensive swallowing assessment tool, the Mann Assessment of Swallowing Ability (MASA), in the acute phase of stroke for oral intake status at discharge. Among 1,133 consecutive patients with acute stroke, 512 patients whose swallowing function was assessed using the MASA within 24 h of admission were included. Data including demographic information, stroke severity, MASA, Oral Health Assessment Tool, body mass index, and serum albumin level were collected. Predictive factors for oral intake were analyzed using a multiple logistic regression model, and the receiver operating characteristic (ROC) curve analysis was used to determine the cutoff values of the MASA score for determining oral intake at discharge. Oral intake at discharge was established in 69.1% of the cohort (354/512). The multiple logistic regression analysis identified a higher MASA score, younger age, and higher serum albumin level as significant predictors of oral intake at discharge. The cutoff value of the MASA score for oral intake was 136.5 points, with an area under the ROC curve of 0.87. These findings suggest that the MASA is a valid tool for predicting oral intake in patients with dysphagia during the acute phase of stroke.

Blind Spots in Hospital Fall Prevention: Falls in Stroke Patients Occurred Not Only in Those at a High Risk of Falling.

OBJECTIVES: Although the standard falls prevention strategy is to identify and respond to patients with high-risk conditions, it remains unclear whether falls in patients with high fall risk account for most observed falls. In this study, fall risk and number of falls were calculated based on patients' motor and cognitive abilities, and the relationship between the two was examined. DESIGN: We conducted a retrospective cohort study. SETTING AND PARTICIPANTS: We included 2518 consecutive patients with stroke who were admitted to a rehabilitation hospital. METHODS: Data on falls during hospitalization and biweekly assessed Functional Independence Measure scores were retrieved from the medical records. The average Functional Independence Measure scores for the motor and cognitive items were obtained and categorized as complete dependence, modified dependence, and independence. The fall rate (falls/1000 person-days) and number of observed falls in each combined condition were investigated. RESULTS: Modified dependence on motor ability and complete dependence on cognitive ability had the highest risk of falls, with a fall rate of 10.8/1000 person-days and 51 fall observations, which accounted for 4.3% of all falls. Independent motor and cognitive ability had the lowest risk of falls, a fall rate of 2.6/1000 person-days and 146 observed falls, accounting for 12.4% of all falls, which was 2.8 times higher than the number of falls observed in the highest risk of falls condition. CONCLUSIONS AND IMPLICATIONS: The combined motor-cognitive ability with the highest risk of falls in stroke inpatients did not have the highest number of observed falls. Rather, the combined motor-cognitive ability with the lowest risk of falls tended to have a high number of observed falls. A different strategy is needed to reduce the total number of falls.

Differences in the difficulty of subtasks comprising the toileting task among patients with subacute stroke: A cohort study.

INTRODUCTION: Toileting comprises multiple subtasks, and the difficulty of each is critical to determining the target and priority of intervention. The study aimed to examine the difficulty of subtasks that comprise toileting upon admission and the reacquisition of skills of subtasks during hospitalization. MATERIALS AND METHODS: This was a single-center prospective cohort study. We enrolled 101 consecutive stroke patients (mean age: 69.3 years) admitted to subacute rehabilitation wards. The independence in each of the 24 toileting subtasks was assessed using the Toileting Tasks Assessment Form (TTAF) every two or four weeks. The number of patients who were independent upon admission, as well as those who were not independent upon admission but became independent during hospitalization, was examined in each subtask. RESULTS: The most difficult subtask upon admission was "Lock the wheelchair brakes" (16.8% of patients were independent), followed by "Turn while standing (before urination/defecation)" (17.8%), "Pull the lower garments down" (18.0%), "Turn while standing (after urination/defecation)" (18.8%), "Pull the lower garments up and adjust them" (18.8%), and "Maintain a standing position (before urination/defecation)" (18.8%). The most difficult subtask for those who were not independent but became independent was "Dispose of incontinence pad/sanitary items" (19.3%), followed by "Press the nurse call button (after urination/defecation)" (28.3%), "Take the foot off the footrest and place it on the ground" (28.6%), and "Clean up after urination/defecation" (29.0%). CONCLUSIONS: The difficult subtasks upon admission and those for reacquired skills were different. The most difficult subtasks upon admission were main tasks, and the difficult subtasks in reacquiring skills were preparatory tasks.

Difficulty of the subtasks comprising bed-wheelchair transfer in patients with subacute strokes: A cohort study.

OBJECTIVE: Bed-wheelchair transfer comprises multiple subtasks; hence, it is important to know the difficulty of each subtask to identify and prioritize subtasks that must be practiced. This study aimed to investigate the difficulty of the subtasks that comprise bed-wheelchair transfer upon admission and reacquiring subtask skills during hospitalization. MATERIALS AND METHODS: This was a single-center prospective cohort study. We enrolled 137 consecutive stroke patients (mean age: 69.8 years) admitted to subacute rehabilitation wards who used wheelchairs upon admission. The degree of independence in each of the 25 subtasks that comprised transferring was assessed using the Bed-wheelchair transfer Tasks Assessment Form every 2 weeks. The number of patients who were independent in the subtasks upon admission and those who were not but became independent during hospitalization were examined. RESULTS: The most difficult subtask for independent patients upon admission was "Manipulate the handrail for the bed" (18.3%), followed by "Ready the wheelchair for transfer" (19.3%), "Maneuver the wheelchair toward the appropriate place for transfer to the bed" (20.6%), "Wear shoes/brace" (24.8%), and "Turn while standing" (25.5%). The most difficult subtask for those who were not independent but became independent was "Ready the wheelchair for transfer" (32.1%), followed by "Manipulate the handrail for the bed" (32.9%), "Press the nurse call button" (36.4%), "Press the nurse call button (wheelchair-to-bed)" (36.7%), and "Lock the wheelchair brakes" (37.3%). CONCLUSIONS: Subtasks related to preparation for transfer were difficult upon admission, and this tendency became more pronounced during the skill acquisition process.

Cumulative Risk And Associated Factors For Fall-Related Fractures In Stroke Survivors After Discharge From Rehabilitation Wards: A Retrospective Study With A 6-Year Follow-Up.

OBJECTIVE: To investigate the long-term cumulative risk and factors associated with fall-related fractures in stroke survivors discharged from convalescent rehabilitation wards. DESIGN: Retrospective cohort study. PARTICIPANTS: A total of 786 stroke survivors discharged from a rehabilitation hospital. METHODS: Data regarding fall-related fractures posthospital discharge were collected using self-reported questionnaires. The Kaplan-Meier method was used to calculate the cumulative incidence of fall-related fractures, and risk factors were analysed using Cox proportional hazard regression analysis. RESULTS: Of 1,861 consecutive stroke survivors who had been discharged from hospital, 786 (42.2%) provided information concerning fall-related fractures. Duration from time of discharge to time of collection of questionnaires ranged from 1 to 6 years (mean 38.0 months). The cumulative incidence of fall-related fractures at 1-, 2-, 3-, 4-, and 5-years post-discharge was 4.2%, 7.9%, 10.8%, 12.5% and 13.7%, respectively. Cox proportional hazard regression analysis indicated that female sex (hazard ratio (HR) 1.69) and moderate lower limb paresis (HR 3.08) were significant risk factors. CONCLUSION: The cumulative risk of fall-related fractures in stroke survivors post-discharge from a rehabilitation hospital was notably high. Intensive preventive intervention should be considered for female stroke survivors with moderate lower limb paresis.

Rehabilitation in Acute COVID-19 Patients: A Japanese Retrospective, Observational, Multi-Institutional Survey.

OBJECTIVE: To investigate the changes in activities of daily living (ADLs) and the conditions of rehabilitation for acute COVID-19 patients in Japan. DESIGN: Retrospective, observational survey. SETTING: Four tertiary hospitals with intensive care units and one secondary hospital in Japan. PARTICIPANTS: COVID-19 patients (N=478) admitted to 5 hospitals INTERVENTIONS: : Not applicable. MAIN OUTCOME MEASURES: Walking ability and swallowing status were assessed using the FIM locomotion item and Food Intake Scale at admission and discharge. The physiatrists of each hospital were also surveyed regarding the factors that influenced decisions to provide rehabilitation. RESULTS: Excluding patients who died, the proportion of critical patients who could walk independently at discharge was 63%, and the proportion of those who were able to take 3 meals orally at discharge was 90%. Rehabilitation was provided to 13.4% of all patients and to 58.3% of patients with critical symptoms. CONCLUSIONS: After COVID-19 treatment, patients, especially those with critical symptoms, still have functional disabilities related to walking and swallowing. It is possible that sufficient rehabilitation could not be provided during the period studied.

Factors associated with cognitive improvement in subacute stroke survivors.

OBJECTIVE: To elucidate the characteristics of subacute stroke survivors with post-stroke cognitive impairment, and examine the factors associated with cognitive recovery. DESIGN: Retrospective cohort study. PARTICIPANTS: A total of 218 consecutive stroke survivors, who were admitted to a rehabilitation hospital between April 2014 and March 2015, were included. METHODS: The prevalence of post-stroke cognitive impairment, defined as having a Mini-Mental State Examination (MMSE) score < 24 was investigated. Among those with post-stroke cognitive impairment, the characteristics of patients with clinically significant improvement in MMSE scores (change ≥ 4) were explored. Univariable and multivariable regression analyses were performed to examine the relationship between Functional Independence Measure (FIM) items and improvement in post-stroke cognitive impairment. RESULTS: Post-stroke cognitive impairment occurred in 47.7% of participants. The mean improvement in their MMSE scores was 3.43. Participants who showed improvement had significantly higher FIM scores at discharge than those who did not show improvement. Regarding FIM items, eating (odds ratio 1.3; 95% confidence interval 1.0-1.7; p = 0.041) and social interaction (odds ratio 1.5, 95% CI 1.1-2.1, p = 0.010) were associated with cognitive improvement. CONCLUSION: Approximately half of subacute stroke survivors have post-stroke cognitive impairment. Eating and social interaction are significantly associated with cognitive improvement.

Light-Driven Crystal-Polymer Hybrid Actuators.

Recently, soft robots, which are made of soft and light organic materials, have attracted much attention because of improved safety for daily interactions with humans. Mechanically responsive materials that can move macroscopically by external stimuli, such as light and heat, have been studied extensively over the past two decades, and they are expected to be applicable to soft robots. Among them, mechanically responsive crystals are attractive in terms of a larger Young's modulus and faster response speed compared with polymers and gels. However, it is impractical to use one piece of a single crystal as a crystal machine; it is difficult to control the size of crystals and obtain large crystals. Hybridization of crystals with polymers is one way to create actuators with more realistic movements. Herein, we report a hybrid crystal assembly in which plate-like salicylideneaniline crystals are aligned in polymer films by a "rubbing" technique, a new approach which is inexpensive, easy, and applicable to a wide range of crystals and polymers. The hybrid films bent reversibly upon alternate irradiation with ultraviolet and visible light. The hybrid films bent as fast as single crystals, even when larger than single-crystal size, showing great mechanical performance originating from the advantages of both molecular crystals (fast response time) and polymers (large size). This work enriches the development of light-driven hybrid actuators composed of molecular crystals and polymers.

Poststroke Fatigue at Admission is Associated With Independence Levels of Activities of Daily Living at Discharge From Subacute Rehabilitation Wards.

OBJECTIVE: To determine whether poststroke fatigue at admission is associated with the degree of independence in activities of daily living in patients with stroke at discharge from subacute rehabilitation wards. DESIGN: Retrospective cohort study. SETTING: Subacute rehabilitation hospital. PARTICIPANTS: A consecutive sample of patients (N=156) with stroke who were admitted to a subacute rehabilitation ward between December 2012 and November 2013 were enrolled in the study. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Poststroke fatigue was assessed using the Fatigue Severity Scale within 2 weeks of admission. Poststroke fatigue was defined as the mean score of 4 points or more from among 9 items in the Fatigue Severity Scale. Functional outcome was assessed by using FIM motor items. RESULTS: Fifty-six (35.9%) of the 156 participants had poststroke fatigue at admission. The scores of the FIM motor items at admission and discharge were significantly lower in the fatigue group than in the nonfatigue group (P<.05). Multiple regression analysis with potentially confounding variables revealed that poststroke fatigue was a significant independent factor for discharge FIM motor items score (P<.05). CONCLUSION: Poststroke fatigue at admission was significantly associated with functional outcome at discharge from subacute rehabilitation wards. Our findings emphasize that rehabilitation professionals need to manage poststroke fatigue in addition to providing the interventions to improve daily activities in patients with subacute stroke.

High-current density and high-asymmetry MIIM diode based on oxygen-non-stoichiometry controlled homointerface structure for optical rectenna.

Optical rectennas are expected to be applied as power sources for energy harvesting because they can convert a wide range of electromagnetic waves, from visible light to infrared. The critical element in these systems is a diode, which can respond to the changes in electrical polarity in the optical frequency. By considering trade-off relationship between current density and asymmetry of IV characteristic, we reveal the efficiency limitations of MIM diodes for the optical rectenna and suggest a novel tunnel diode using a double insulator with an oxygen-non-stoichiometry controlled homointerface structure (MOx/MOx-y). A double-insulator diode composed of Pt/TiO2/TiO1.4/Ti, in which a natural oxide layer of TiO1.4 is formed by annealing under atmosphere. The diode has as high-current-density of 4.6 × 106 A/m2, which is 400 times higher than the theoretical one obtained using Pt/TiO2/Ti MIM diodes. In addition, a high-asymmetry of 7.3 is realized simultaneously. These are expected to increase the optical rectenna efficiency by more than 1,000 times, compared to the state-of-the art system. Further, by optimizing the thickness of the double insulator layer, it is demonstrated that this diode can attain a current density of 108 A/m2 and asymmetry of 9.0, which are expected to increase the optical rectenna efficiency by 10,000.

Prevalence, Effect on Functional Outcome, and Treatment of Sleep-Disordered Breathing in Patients With Subacute Stroke.

STUDY OBJECTIVES: We aimed to elucidate the prevalence of sleep-disordered breathing (SDB), effect of SDB severity on the functional outcome, and feasibility of continuous positive airway pressure (CPAP) therapy in patients with subacute stroke. METHODS: We recruited 433 consecutive patients (mean age: 66.5 years, 271 men) admitted to our rehabilitation wards for subacute stroke (8 to 90 days after onset) from August 2011-November 2013, who had undergone at least one successful sleep study within 4 weeks after admission to the wards. We investigated the prevalence of SDB, defined as a respiratory event index (REI) ≥ 5 events/h; the relationship between SDB severity and the functional outcome at discharge; and the number of patients receiving and adhering to CPAP therapy. RESULTS: REIs ≥ 5 and ≥ 15 events/h were observed for 87.3% (n = 378) and 46.4% (n = 201) of patients, respectively. The Functional Independence Measure score at discharge was significantly lower for patients with REI ≥ 15 events/h than for those with REI < 15 events/h. However, REI was not an independent factor for functional outcome after adjustment for potential confounders, irrespective of stroke types. CPAP therapy was administered to 41 patients (9.5%). During the mean follow-up period of 21.6 months, 20 patients (48.8%) dropped out from the CPAP therapy. Among the 23 patients who continued CPAP therapy until discharge, 17 (74%) continued its use throughout the follow-up period or discontinued therapy because of improvement. CONCLUSIONS: SDB prevalence was high in patients with subacute stroke at admission. However, SDB severity was not significantly related to functional outcome at discharge. Although the overall adherence was not good, relatively good adherence to CPAP therapy after discharge was observed when CPAP was successfully introduced during hospitalization.

Direct Formylation of Fluorine-Containing Aromatics with Dichloromethyl Alkyl Ethers.

Formylations of fluorine-containing aromatic compounds with dichloromethyl alkyl ethers have been investigated. Dichloromethyl propyl ether and dichloromethyl butyl ether have been applied for the formylation of fluorine-containing anisoles to give the corresponding aldehydes in good yields. Application of these ethers is preferable to that of methyl ether, which is prepared from volatile methyl formate. Reaction of fluorine-containing phenols with these dichloromethyl alkyl ethers did not give salicylaldehyde derivatives, leading instead to corresponding aryl formates in high yields. A plausible mechanism is discussed.

Allergic contact dermatitis caused by isobornyl acrylate when using the FreeStyle® Libre.

We present the case of an 8-year-old girl with type 1 diabetes who developed severe allergic contact dermatitis by using FreeStyle® Libre. A patch test was carried out using a piece of the adhesive part of the sensor of the FreeStyle® Libre, and subsequently by using the potential contact allergens in the sensor, isobornyl acrylate. She reacted positively to the adhesive part of the sensor, and also reacted positively to isobornyl acrylate with three different concentrations, 0.1%, 0.05% and 0.01%, over 48-h, 72-h and 7-day periods. The FreeStyle® Libre is a useful and less invasive device that can be used for continuous glucose monitoring in patients with diabetes. In contrast to the remarkable advantages, allergic contact dermatitis caused by isobornyl acrylate in the adhesive part of FreeStyle® Libre is one of the potential adverse events.

Young's Modulus of Fullerene C60-C70 Alloy Crystalline Nanowhiskers.

Crystalline nanowhiskers (NWs) composed of fullerene C60 and C70 molecules, i.e., alloy NWs, were synthesized by a liquid-liquid interfacial precipitation method. The nominal composition of C70 ranged from 0 to 40 mass%. The bending tests of the alloy NWs were performed inside a high-resolution transmission electron microscope, and the deformation behavior was observed in situ. The bending force acting on the NWs were measured simultaneously by an optical deflection method, and the Young's modulus was estimated from the resulting force-flexure curves. The average Young's modulus was found to increase to approximately 30 GPa as the C70 composition was increased to the solubility limit. In contrast, the Young's modulus decreased with increasing NW diameter caused by the addition of C70.

Inhibitory Effects of Polyacetylene Compounds from Panax ginseng on Neurotrophin Receptor-Mediated Hair Growth.

Neurotrophins play an important role in the control of the hair growth cycle. Therefore, neurotrophin receptor antagonists have therapeutic potential for the treatment of hair growth disorders. In this study, we investigated the inhibitory effect of Panax ginseng, a medicinal plant commonly used to treat alopecia, on the binding of neurotrophins to their receptors. In addition, we isolated and characterized the bioactive compounds of P. ginseng extracts. P. ginseng hexane extracts strongly inhibited brain-derived neurotrophic factor (BDNF)-TrkB and ß-nerve growth factor (ß-NGF)-p75 neurotrophin receptor (p75NTR) binding. Furthermore, we identified the following 6 polyacetylene compounds as the bioactive components in P. ginseng hexane extract: panaxynol (1), panaxydol (2), panaxydol chlorohydrin (3), 1,8-heptadecadiene-4,6-diyne-3,10-diol (4), panaxytriol (5), and dihydropanaxacol (6). In particular, compounds 4, 5, and 6 significantly inhibited BDNF-TrkB binding in a dose-dependent manner. To identify the structural component mediating the inhibitory effect, we investigated the effects of the hydroxyl moiety in these compounds. We found that the inhibitory effect of panaxytriol (5) was strong, whereas the inhibitory effect of Ac-panaxytriol (7) was relatively weak. Our findings suggest that P. ginseng-derived polyacetylenes with a hydroxyl moiety might provide therapeutic benefits to patients with hair growth disorders such as alopecia by inhibiting the binding of neurotrophins to their receptors. Although saponins have been proposed to be the primary mediators of the effects of P. ginseng on hair growth, this study revealed that polyacetylene compounds exert similar effects.

Linear immunoglobulin A/G bullous dermatosis associated with ulcerative colitis.

Linear immunoglobulin (Ig)A/G bullous dermatosis (LAGBD) is an autoimmune bullous disease characterized by formation of subepidermal blisters and linear deposition of IgA and IgG antibodies along the basement membrane zone (BMZ). The association between linear IgA bullous dermatosis and ulcerative colitis (UC) is well recognized, but reports of UC-associated LAGBD are lacking. We have reported a 24-year-old man suffering from LAGBD associated with UC, which occurred before exacerbations of skin rash. A skin biopsy indicated a subepidermal blister with an infiltration of primarily neutrophils and eosinophils in the dermis. Direct immunofluorescence (IF) studies showed a linear deposition of IgA, IgG and C3c. Indirect IF of human skin revealed IgA and IgG anti-BMZ autoantibodies. Indirect IF of 1 M NaCl-split human skin demonstrated reactivity of IgA and IgG antibodies at the epidermal side. Immunoblotting showed that IgG antibodies reacted to the BP180 NC16a domain and 120-kDa linear IgA dermatosis-1, and enzyme-linked immunoassay detected IgG anti-BP230 antibodies. Administration of prednisolone and diaminodiphenyl sulfone (DDS) via the p.o. route improved skin lesions and bowel conditions. These results suggest that the bowel inflammation observed in UC may have a causative effect of initiation of the immune response to the skin and development of the bullous skin lesions in LAGBD. A combination of DDS and corticosteroid could be a recommended therapeutic option for patients with LAGBD with UC.

Age, Body Mass Index, and White Blood Cell Count Predict the Resumption of Oral Intake in Subacute Stroke Patients.

OBJECTIVE: To identify the predictors for the resumption of oral feeding at discharge among tube feeding-dependent stroke patients admitted to rehabilitation wards. MATERIALS AND METHODS: This study was a retrospective analysis of 107 stroke patients (mean age, 72.1 years) dependent on tube feeds at admission to a rehabilitation ward. Data analyzed included demographic information, severity of impairments, functional independence, body mass index, nutritional and inflammatory laboratory markers at admission, and videofluoroscopic examination findings, if conducted. The variables were compared between the groups with and without resumption of oral intake. The predictive factors for resumption of oral intake were analyzed by using a stepwise multiple logistic regression model. RESULTS: At discharge, 69.2% (74 of 107) of the patients resumed oral intake. There were significant differences in age, the Functional Independence Measure, body mass index, serum albumin, C-reactive protein, white blood cell count, and duration of stroke onset at admission between the 2 groups. Multiple logistic regression analysis identified age (odds ratio [OR] .55; 95% confidence interval [CI] .31-.95), body mass index (OR 1.34; 95% CI 1.12-1.60), and white blood cell count (OR .76; 95% CI .60-.97) as significant predictors for the resumption of oral intake in these patients. CONCLUSION: Older age, lower body mass index, and higher white blood cell count were significant independent negative predictors for the resumption of oral feeding among stroke patients dependent on tube feeding at admission to rehabilitation wards.

Electrical conductivity of single molecular junctions assembled from Co- and Co3C-encapsulating carbon nanocapsules.

Single molecular junctions (SMJs) were assembled from cobalt (Co)- and Co carbide (Co3C)-encapsulating carbon nanocapsules (CNCs) and two gold electrodes inside a high-resolution transmission electron microscope equipped with a specimen-piezomanipulation system. The structure and electrical transport properties of the SMJs were investigated in situ. The current density depended on the perimeter of the contact area between CNCs and the electrodes, showing that the current flowed not through the encapsulated region but rather along the graphene layers of CNCs. It was demonstrated that the properties of graphene can be applied to nanodevices using CNCs irrespective of the encapsulating materials.

The atomic configuration of graphene/vanadium carbide interfaces in vanadium carbide-encapsulating carbon nanocapsules.

Carbon nanocapsules (CNCs) encapsulating vanadium carbide (VC) nanocrystals with a NaCI structure were synthesized by a gas-evaporation method using arc-discharge heating. The CNCs were observed by high-resolution transmission electron microscopy. The VC nanocrystals within the nanospaces of CNCs were truncated by low-index facets and were coated with several graphene layers, forming graphene/VC interfaces. The atomic configuration and interlayer spacings at the interfaces were found.