Dysphagia Rehabilitation in Dysphagic Patients with Acute or Critical Illness: A Systematic Review and Meta-Analysis.

Dysphagia or swallowing dysfunction is common in patients with acute or critical illness, and diverse methods of dysphagia rehabilitation are provided worldwide. We aimed to examine the efficacy of rehabilitation to treat dysphagia in patients with acute or critical illness. We searched PubMed, ICHUSHI, and Cochrane Central Register of Controlled Trials databases from inception to November 22, 2023 for relevant randomized controlled trials. We focused on dysphagic patients with acute or critical illness who were not orotracheally intubated. Our target intervention included conventional rehabilitation and nerve stimulation/neuromodulation techniques as dysphagia rehabilitation. Comparators were conventional or standard care or no dysphagia interventions. Primary outcomes included mortality, incidence of pneumonia during the study period, and health-related quality of life (HRQoL) scores within 90 days of hospital discharge. We pooled the data using a random-effects model, and classified the certainty of evidence based on the Grading of Recommendations, Assessment, Development, and Evaluation system. Nineteen randomized controlled trials involving 1,096 participants were included. Dysphagia rehabilitation was associated with a reduced incidence of pneumonia (risk ratio [RR], 0.66; 95% confidence interval [CI], 0.54-0.81; moderate certainty), but not with reduced mortality (RR, 0.92; 95% CI, 0.61-1.39; very low certainty) or improved HRQoL scores (mean difference, -0.20; 95% CI, -20.34 to 19.94; very low certainty). Based on the available moderate- or very low- quality evidence, while dysphagia rehabilitation had no impact on mortality or HRQoL, they might reduce the incidence of pneumonia in dysphagic patients with acute or critical illness.

Japanese Clinical Practice Guidelines for Rehabilitation in Critically Ill Patients 2023 (J-ReCIP 2023).

Providing standardized, high-quality rehabilitation for critically ill patients is a crucial issue. In 2017, the Japanese Society of Intensive Care Medicine (JSICM) promulgated the "Evidence-Based Expert Consensus for Early Rehabilitation in the Intensive Care Unit" to advocate for the early initiation of rehabilitations in Japanese intensive care settings. Building upon this seminal work, JSICM has recently conducted a rigorous systematic review utilizing the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) methodology. This endeavor resulted in the formulation of Clinical Practice Guidelines (CPGs), designed to elucidate best practices in early ICU rehabilitation. The primary objective of this guideline is to augment clinical understanding and thereby facilitate evidence-based decision-making, ultimately contributing to the enhancement of patient outcomes in critical care settings. No previous CPGs in the world has focused specifically on rehabilitation of critically ill patients, using the GRADE approach. Multidisciplinary collaboration is extremely important in rehabilitation. Thus, the CPGs were developed by 73 members of a Guideline Development Group consisting of a working group, a systematic review group, and an academic guideline promotion group, with the Committee for the Clinical Practice Guidelines of Early Mobilization and Rehabilitation in Intensive Care of the JSICM at its core. Many members contributed to the development of the guideline, including physicians and healthcare professionals with multiple and diverse specialties, as well as a person who had been patients in ICU. Based on discussions among the group members, eight important clinical areas of focus for this CPG were identified. Fourteen important clinical questions (CQs) were then developed for each area. The public was invited to comment twice, and the answers to the CQs were presented in the form of 10 GRADE recommendations and commentary on the four background questions. In addition, information for each CQ has been created as a visual clinical flow to ensure that the positioning of each CQ can be easily understood. We hope that the CPGs will be a useful tool in the rehabilitation of critically ill patients for multiple professions.

Effects of the different periods and magnitude of COVID-19 infection spread on cancer operations: Interrupted time series analysis of medical claims data.

BACKGROUND: No clear evidence exists regarding the effects of the different periods and magnitude of spread of the COVID-19 infection on cancer treatments. This study investigated the effects of the different periods and magnitude of COVID-19 infection spread on in-hospital cancer operations. METHODS: Medical claims data from 17 hospitals where in-hospital operations for patients with malignant neoplasms were performed between 1 April 2017 and 31 March 2021 in Yamagata were extracted and analyzed. The critical time points as exposure used to evaluate the impact of different COVID-19 infection spread periods on cancer operations were (1) April 2020 (emergency declaration introduced by the government) and (2) December 2020 (the second wave). From April to November 2020 and December 2020 to March 21, the number of confirmed COVID-19 cases was 130 and 840, respectively. The 17 hospitals were classified into intervention or control groups based on whether in-hospital treatments for patients with COVID-19 were provided. RESULTS: The interrupted time series analysis reported that the difference in the trend of pre-COVID-19 and postsecond wave (March 2020 to December 2020) periods was statistically significant between groups, with 50.67 fewer operations (95% confidence interval [CI] = 12.19-89.15) performed per month in the intervention group compared with the control group. Moreover, the immediate change in the number of operations in April 2020 (beginning of the first wave) was statistically significant between groups, with 80.14 operations (95% CI = 39.62-120.67) less immediately after the first wave in the intervention group compared with the control group. CONCLUSION: Our findings suggest that a statement of emergency by the government and the COVID-19 infection spread are both associated with the number of cancer operations performed in the Yamagata prefecture during the COVID-19 pandemic.

Optimal Task Allocation Algorithm Based on Queueing Theory for Future Internet Application in Mobile Edge Computing Platform.

For 5G and future Internet, in this paper, we propose a task allocation method for future Internet application to reduce the total latency in a mobile edge computing (MEC) platform with three types of servers: a dedicated MEC server, a shared MEC server, and a cloud server. For this platform, we first calculate the delay between sending a task and receiving a response for the dedicated MEC server, shared MEC server, and cloud server by considering the processing time and transmission delay. Here, the transmission delay for the shared MEC server is derived using queueing theory. Then, we formulate an optimization problem for task allocation to minimize the total latency for all tasks. By solving this optimization problem, tasks can be allocated to the MEC servers and cloud server appropriately. In addition, we propose a heuristic algorithm to obtain the approximate optimal solution in a shorter time. This heuristic algorithm consists of four algorithms: a main algorithm and three additional algorithms. In this algorithm, tasks are divided into two groups, and task allocation is executed for each group. We compare the performance of our proposed heuristic algorithm with the solution obtained by three other methods and investigate the effectiveness of our algorithm. Numerical examples are used to demonstrate the effectiveness of our proposed heuristic algorithm. From some results, we observe that our proposed heuristic algorithm can perform task allocation in a short time and can effectively reduce the total latency in a short time. We conclude that our proposed heuristic algorithm is effective for task allocation in a MEC platform with multiple types of MEC servers.

Personal protective equipment use by health-care workers in intensive care units during the COVID-19 pandemic in Japan: comparative analysis with the PPE-SAFE survey.

Aim: We investigated personal protective equipment (PPE) use and supply shortage, training, and adverse events among health-care workers (HCWs) in the intensive care unit (ICU) during the coronavirus disease (COVID-19) pandemic in Japan and compared the results with an international survey that used the same methodology. Methods: This Web-based survey was carried out from 14 April to 6 May, 2020, in Japan and included HCWs directly involved in ICU management of COVID-19 patients. A survey invitation was emailed using the Japanese Society of Intensive Care Medicine's mailing list. Results: We analyzed 460 valid responses from among 976 responses. The N95/FFP2 mask (77%) was the most frequently used, although half of our respondents reported reuse of single-use N95/FFP2 masks. The median duration (1 h) of uninterrupted PPE use per shift was less than that in the international study. The most common PPE-related adverse event was experiencing intense heat (75%). Logistic regression analysis revealed that being a nurse was independently associated with experiencing intense heat. Conclusion: Shortage of PPE and frequent mask reuse were prevalent during the COVID-19 pandemic in Japan. Intense heat is the most significant symptom, especially for nurses, even with short-duration PPE use. Strategies to protect HCWs from dehydration and intense heatstroke are needed.

Solution structure of the general transcription factor 2I domain in mouse TFII-I protein.

The general transcription factor TFII-I, with the corresponding gene name GTF2I, is an unusual transcriptional regulator that associates with both basal and signal-induced transcription factors. TFII-I consists of six GTF2I repeat domains, called I-repeats R1-R6. The structure and function of the GTF2I domain are not clearly understood, even though it contains a helix-loop-helix motif, which is considered to be the protein-protein interaction area, based on biochemical analyses. Here, we report the solution structure of the fifth repeat of the six GTF2I repeat domains from murine TFII-I, which was determined by heteronuclear multidimensional NMR spectroscopy (PDB code 1Q60). The three-dimensional structure of the GTF2I domain is classified as a new fold, consisting of four helices (residues 8-24, 34-39, 63-71, and 83-91), two antiparallel beta strands (residues 44-47 and 77-80), and a well-defined loop containing two beta-turns between sheet 1 and helix 3. All of the repeats probably have similar folds to that of repeat 5, because the conserved residues in the GTF2I repeat domains are assembled on the hydrophobic core, turns, and secondary structure elements, as revealed by a comparison of the sequences of the first through the sixth GTF2I repeats in TFII-I.

Crystal structure of a novel polyisoprenoid-binding protein from Thermus thermophilus HB8.

The isoprenoid quinones exist widely among prokaryotes and eukaryotes. They play essential roles in respiratory electron transport and in controlling oxidative stress and gene regulation. In the isoprenoid quinone biosynthetic pathway, polyprenyl pyrophosphates are used as isoprenoid side-chain precursors. Here we report the crystal structure of a novel polyprenyl pyrophosphate binding protein, TT1927b, from Thermus thermophilus HB8, complexed with its ligand. This protein belongs to the YceI-like family in the Pfam database, and its sequence homologs are present in a broad range of bacteria and archaea. The structure consists of an extended, eight-stranded, antiparallel beta-barrel. In the hydrophobic pore of the barrel, the protein binds the polyisoprenoid chain by hydrophobic interactions. Its overall structure resembles the lipocalin fold, but there is no sequence homology between TT1927b and the lipocalin family of proteins.