Correlation between 10-meter walking speed and exercise capacity in patients with surgical resection for lung cancer.

Surgical resection for lung cancer adversely impacts exercise capacity. The 6-minute walk test (6MinWT) and cardiopulmonary exercise test (CPET) are commonly used to assess exercise capacity. However, these tests are difficult to use clinically because they must be performed by a trained technician using specialized equipment according to a prescribed method. This study aims to analyze correlations between walking speed in a 10-meter walk test and exercise capacity measured by the 6MinWT or CPET in patients with lung resection for lung cancer. A total of 50 patients who were diagnosed with lung cancer and underwent lung resection were included in the analysis. The 6MinWT and CPET were performed to measure exercise capacity, and the 10-meter walk test was used to evaluate the short-duration walking speed. The population was divided into 2 groups -low and high exercise capacity - based on threshold values (6MinWT, 500 m; CPET, 20 mL·kg-1·min-1); we analyzed the correlation according to the level of exercise capacity. In the correlation analysis between the 10-meter walking speed and exercise capacity, the 10-meter walking speed showed a strong correlation (R = 0.70, P < .001) with the 6MinWT and a moderate correlation (R = 0.47, P < .001) with the CPET, respectively. The low exercise capacity group showed a significant correlation (6MinWT, ρ = 0.70; CPET, ρ = 0.54) between the 10-meter walking speed and exercise capacity, while the high exercise capacity group did not. In patients who underwent lung resection for lung cancer, the 10-meter walking speed was significantly correlated with exercise capacity, especially in subjects with low exercise capacity that require pulmonary rehabilitation.

Association of Dual Sensory Impairment with Declining Physical Function in Community-Dwelling Older Adults.

Few studies have investigated whether dual sensory impairment (DSI) adversely affects the deterioration of physical function in older adults compared to single sensory impairment (SSI, visual or auditory). We studied the association between DSI and declining physical function by analyzing the data of 2780 Korean community-dwelling adults aged 70-84 years. Sensory impairment was assessed through pure tone audiometry and visual acuity testing. Muscle strength (handgrip strength) and physical performance (timed up and go test and short physical performance battery (SPPB)) were evaluated. In the cross-sectional analysis, DSI was associated with higher odds of having low muscle strength (odds ratio (OR), 1.78; 95% confidence interval (CI), 1.27-2.48) and poor physical performance (SPPB: OR, 2.04; 95% CI, 1.38-3.00) than SSI. Among all sensory impairment groups in the longitudinal analysis, DSI at baseline increased the risk of deteriorating physical performance during the follow-up period (OR, 1.94; 95% CI, 1.31-2.88; p < 0.01) the most. DSI showed a more severe adverse effect on the decline in physical function among community-dwelling older adults than SSI. More comprehensive care is needed to prevent the deterioration of physical function in older adults due to DSI.

Improvement in Fine Manual Dexterity in Children with Spinal Muscular Atrophy Type 2 after Nusinersen Injection: A Case Series.

Although nusinersen has been demonstrated to improve motor function in patients with spinal muscular atrophy (SMA), no studies have investigated its effect on fine manual dexterity. The present study aimed to investigate the ability of nusinersen to improve fine manual dexterity in patients with SMA type 2. A total of five patients with SMA type 2 were included. The Hammersmith Functional Motor Scale (expanded version) (HFMSE) and Purdue Pegboard (PP) tests were used to evaluate gross motor function and fine manual dexterity, respectively, until 18 months after nusinersen administration. HFMSE scores improved by 3-10 points (+13-53%) in all patients following nusinersen administration. PP scores also improved in all patients, from 4 to 9 points (+80-225%) in the preferred hand and from 3 to 7 points (+60-500%) in the non-preferred hand. These results suggest that nusinersen treatment improved both gross motor function and fine manual dexterity in children with SMA type 2. Addition of the PP test may aid in evaluating the fine manual dexterity essential for activities of daily living in these patients.

Longitudinal Changes in Body Composition of Long-Term Survivors of Pancreatic Head Cancer and Factors Affecting the Changes.

Previous studies on changes in body composition of pancreatic cancer patients have only focused on short-term survivors. We studied longitudinal body composition changes and factors affecting them in long-term survivors by analyzing many abdominal computed tomography images using artificial intelligence technology. Of 302 patients who survived for >36 months after surgery were analyzed. Multivariate logistic regression analysis for factors affecting body composition changes and repeated-measures analysis of variance to observe differences in the course of change according to each factor were performed. In logistic analysis, preoperative sarcopenia and recurrence were the main factors influencing body composition changes at 1 and 3 years after surgery, respectively. In changes of longitudinal body composition, the decrease in body composition was the greatest at 3-6 months postoperatively, and the preoperative status did not recover even 3 years after surgery. Especially, males showed a greater reduction in skeletal muscle (SKM) after surgery than females (p < 0.01). In addition, SKM (p < 0.001) and subcutaneous adipose tissue (p < 0.05) mass rapidly decreased in case of recurrence. In conclusion, long-term survivors of pancreatic cancer did not recover their preoperative body composition status, and preoperative sarcopenia and recurrence influenced body composition changes.

Impact of premature natural menopause on body composition and physical function in elderly women: A Korean frailty and aging cohort study.

ABSTRACT: Induced premature menopause accelerates the rate of body composition changes (decrease in skeletal muscle mass and increase in fat mass) and deteriorating physical function. However, few studies have focused on the impact of premature natural menopause. This study aimed to investigate the impact of age at natural menopause (ANM) on body composition and physical function in elderly women.Using data from the Korean Frailty and Aging Cohort Study, 765 community-dwelling elderly women aged 70 to 85 years who experienced natural menopause were recruited in this study. Body composition was measured using dual-energy X-ray absorptiometry. Physical function was evaluated by grip strength, the timed up and go test (TUG), and the short physical performance battery (SPPB). Participants were categorized into 4 groups according to their ANM: <40 (premature natural menopause, PNM), 40 to 44 (early natural menopause, ENM), 45 to 54 (normal menopause, NM), and ≥55 (late menopause, LM) years.There were no significant differences in the body composition parameters, such as the appendicular skeletal muscle mass index (PNM: 5.90 ±â€Š0.90 vs ENM: 5.91 ±â€Š0.70 vs NM: 5.85 ±â€Š0.73 vs LM: 5.90 ±â€Š0.75, kg/m2, P = .75) and trunk fat mass index (PNM: 19.4 ±â€Š3.9 vs ENM: 19.9 ±â€Š4.4 vs NM: 19.9 ±â€Š3.9 vs LM: 20.0 ±â€Š3.8, %, P = .87) between the groups. In the physical function evaluation, there was no significant difference between the groups in grip strength (PNM: 19.8 ±â€Š0.6 vs ENM: 20.3 ±â€Š0.4 vs NM: 20.6 ±â€Š0.2 vs LM: 20.6 ±â€Š0.4, kg, P = .53). However, in the TUG (PNM: 11.8 ±â€Š0.4 vs ENM: 10.3 ±â€Š0.3 vs NM: 10.6 ±â€Š0.1 vs LM: 10.2 ±â€Š0.3, seconds, P < .01) and SPPB (PNM: 10.0 ±â€Š0.2 vs ENM: 10.5 ±â€Š0.2 vs NM: 10.6 ±â€Š0.1 vs LM: 10.8 ±â€Š0.2, points, P < .05), the PNM group showed significantly lower values than the other groups did. There was no difference in physical function between the groups except the PNM.Premature natural menopause did not affect the body composition in elderly women but was associated with physical function deterioration. Therefore, more attention should be paid to the prevention of the physical function deterioration caused by premature natural menopause in elderly women.

Bilateral common peroneal neuropathy due to rapid and marked weight loss after biliary surgery: A case report.

BACKGROUND: The causes of peroneal neuropathy are various, but are rarely due to weight loss. Bilateral peroneal neuropathy caused by weight loss after surgery has been reported only after bariatric surgery and there were no reports associated with other abdominal surgery. In this report, we describe a case of the bilateral peroneal neuropathy that occurred due to marked weight loss after biliary surgery. CASE SUMMARY: A 58-year-old male did not receive adequate nutritional support after biliary surgery, and showed a massive weight loss over a short period of time (body mass index; 24.1 kg/m2 to 20.5 kg/m2 for 24 d). Then, foot drop occurred on both sides. Physical examination, electromyography (EMG) and magnetic resonance imaging studies were conducted and he was diagnosed as bilateral common peroneal neuropathy around the fibular head level. The patient was treated electrical stimulation therapy on both lower legs along with exercise therapy, and received sufficient oral nutritional support. The patient gradually recovered to his original weight, and the power of the dorsiflexor of bilateral ankles improved after conservative treatment. In addition, the follow-up EMG showed signs of improvement. CONCLUSION: Any abdominal surgery that may have rapid and marked weight loss can lead to peroneal neuropathy as a complication.

Epidural steroid injection versus conservative treatment for patients with lumbosacral radicular pain: A meta-analysis of randomized controlled trials.

BACKGROUND: Previous systemic reviews have examined the efficacy of individual therapeutic agents, but which type of treatment is superior to another has not been pooled or analyzed. The objective of the current study was to compare the clinical effectiveness of epidural steroid injection (ESI) versus conservative treatment for patients with lumbosacral radicular pain. METHODS: A systematic search was conducted with MEDLINE, EMBASE, and CENTRAL databases with a double-extraction technique for relevant studies published between 2000 and January 10, 2019. The randomized controlled trials which directly compared the efficacy of ESI with conservative treatment in patients with lumbosacral radicular pain were included. Outcomes included visual analog scale, numeric rating scale, Oswetry disability index, or successful events. Two reviewers extracted data and evaluated the methodological quality of papers using the Cochrane Collaboration Handbook. A meta-analysis was performed using Revman 5.2 software. The heterogeneity of the meta-analysis was also assessed. RESULTS: Of 1071 titles initially identified, 6 randomized controlled trials (249 patients with ESI and 241 patients with conservative treatment) were identified and included in this meta-analysis. The outcome of the pooled analysis showed that ESI was beneficial for pain relief at short-term and intermediate-term follow-up when compared with conservative treatment, but this effect was not maintained at long-term follow-up. Successful event rates were significantly higher in patients who received ESI than in patients who received conservative treatment. There were no statistically significant differences in functional improvement after ESI and conservative treatment at short-term and intermediate-term follow-up. The limitations of this meta-analysis resulted from the variation in types of interventions and small sample size. CONCLUSIONS: According to the results of this meta-analysis, the use of ESI is more effective for alleviating lumbosacral radicular pain than conservative treatments in terms of short-term and intermediate-term. Patients also reported more successful outcomes after receiving ESI when compared to conservative treatment. However, this effect was not maintained at long-term follow-up. This meta-analysis will help guide clinicians in making decisions for the treatment of patients with lumbosacral radicular pain, including the use of ESI, particularly in the management of pain at short-term.

Factors Affecting Compliance With Weight-Bearing Restriction and the Amount of Weight-Bearing in the Elderly With Femur or Pelvic Fractures.

OBJECTIVE: To determine the factors affecting the amount of weight-bearing during gait training in the elderly patients who underwent internal fixation after femur or pelvic fractures and how well they performed the weight-bearing restriction as directed by the physiatrist. METHODS: In this retrospective chart review study, we measured the amount of weight-bearing on the affected side in 50 patients undergoing internal fixation surgery and rehabilitation after femur or pelvic fracture using a force plate. Patients receiving non-weight-bearing or partial weight-bearing education were considered to perform weight-bearing restriction well when the amount of weight-bearing was <50 lb. Furthermore, regression analysis was performed to determine the effects of postoperative complications, age, cognitive function, and pain on weightbearing restriction. RESULTS: Variables affecting the amount of weight-bearing were age (r=0.581, p<0.001), weight-bearing education type (r=0.671, p<0.001), manual muscle strength of hip flexion on the non-affected side (r=-0.296, p=0.037), hip abduction (r=-0.326, p=0.021), knee extension (r=-0.374, p=0.007), ankle plantar flexion (r=-0.374, p=0.008), right hand grip strength (r=-0.535, p<0.001), Korean version of Mini-Mental State Examination (r=-0.496, p<0.001), Clinical Dementia Rating (r=0.308, p=0.03), and pain visual analog scale scores (r=0.318, p=0.024). The significant predictor of the amount of weight-bearing among these variables was age (ß=0.448, p=0.001). The weight-bearing restriction adherence rate was significantly lower, at 22%, for patients aged ≥65 years as compared to 73% for those <65 years. CONCLUSION: Age was a major variable affecting the amount of weight-bearing. Compliance with weight-bearing restriction was significantly lower in patients aged ≥65 years than in patients <65 years.

Effect of sarcopenic obesity on deterioration of physical function in the elderly.

BACKGROUND: Both sarcopenia and obesity are associated with decreased physical function of the elderly. Sarcopenic obesity (SO), which is the coexistence of sarcopenia and obesity, is expected to have a synergistic effect on physical function deterioration, but previous studies have shown varied results. This study aimed to investigate the impact of SO on the physical function of the elderly. METHODS: Community-dwelling elderly subjects (1091 males; 1212 females; 70-84 years) were recruited in South Korea (eight cities). Body composition was measured via dual-energy X-ray absorptiometry and physical function was measured by grip strength, timed up and go test, and short physical performance battery (SPPB). RESULTS: In males, grip strength and the total SPPB score in the SO group were significantly lower than those in the normal or pure obesity groups (p < 0.05). However, physical functions were not significantly different between the SO and the pure sarcopenia groups (p > 0.05). The trend for grip strength in females was similar to that in males, but the total SPPB score of the SO group was significantly lower than that of the other three groups (p < 0.05). Logistic regression analysis after covariate adjustment revealed that SO group males exhibited the highest risk of being in the lower SBBP score category (OR, 2.12; 95 % CI = 1.04-4.31); this trend was more prominent in females (OR, 3.75; 95 % CI = 2.01-7.00). CONCLUSION: SO has a synergistic effect on physical function deterioration in the elderly compared with sarcopenia or obesity alone. Additionally, such an effect is more remarkable in females.

A comparison of the effects between 2 computerized cognitive training programs, Bettercog and COMCOG, on elderly patients with MCI and mild dementia: A single-blind randomized controlled study.

BACKGROUND: A computerized cognitive rehabilitation program can be used to treat patients with mild cognitive impairment or dementia. We developed a new computerized cognitive rehabilitation program (Bettercog) that contained various treatment programs for cognitive training for mild cognitive impairment or dementia. This study was conducted to compare the clinical efficacy of Bettercog and computer-assisted cognitive rehabilitation (COMCOG) that has had clinical efficacy previously proven in patients with mild cognitive impairment or dementia. METHODS: Randomized, single-blind comparison pilot study of 20 elderly patients with cognitive decline-eight men and 12 women-with an average age of 74.3 years. Bettercog trains not only memory and attention but also orientation, calculation, executive function, language, comprehension, and spatiotemporal abilities. To retain subjects' interest, pictures, animations, and game elements were introduced. The subjects were divided into COMCOG and Bettercog groups by random assignment and underwent 12 sessions of a computerized cognitive rehabilitation program for three weeks. In a separate space, an independent clinical psychologist conducted the Seoul Neuropsychological Screening Battery 2nd edition (SNSB-II), Korean Mini-Mental State Examination (K-MMSE), Clinical Dementia Rating (CDR), and the Korean version of the Modified Barthel Index (K-MBI) before and after treatment. RESULTS: There was no significant difference between the two groups in baseline age, sex, illiteracy, years of education, and scores on the K-MMSE, CDR, SNSB-II, and K-MBI. In the posttreatment cognitive assessment, the K-MMSE scores of patients treated with Bettercog improved from 19.2 ±â€Š3.9 to 21.3 ±â€Š4.0 (P = .005). In the memory domain of the SNSB-II, the percentile score improved from 15.3 ±â€Š24.5 to 24.2 ±â€Š30.7 (P = .026). However, there was no statistically significant difference in the final K-MMSE, CDR, and SNSB-II scores between the two treatment groups. In both groups, K-MBI scores improved statistically significantly after treatment. CONCLUSIONS: Through this preliminary study, we verified that the newly developed computerized cognitive rehabilitation program is effective in improving cognitive function. However, 12 sessions are not enough to administer a variety of cognitive rehabilitation content to patients. It is, therefore, necessary to conduct a large-scale study using a computerized cognitive rehabilitation program that has various cognitive content.

Persistent cauda equina syndrome after caudal epidural injection under severe spinal stenosis: a case report.

Caudal epidural injection (CEI) is one of the most common treatments for low-back pain with sciatica. CEI rarely leads to neurologic complications. We report a case of persistent cauda equina syndrome after CEI. A 44-year-old male patient with severe L4 and L5 spinal ste-nosis underwent CEI for low-back pain and sciatica. The CEI solution consisted of bupivacaine, hyaluronidase, triamcinolone acetonide, and normal saline. He experienced motor weakness and sensory loss in both lower extremities and neurogenic bladder for more than 1 year after the procedure. His ankle dorsiflexors, big-toe extensors, and ankle plantar flexors on both sides were checked and categorized as motor-power Medical Research Council grade 0. His bilateral ankle-jerk reflection was absent. An electrophysiological study showed lumbosacral polyradiculopathy affecting both sides of the L5 and S1 nerve roots. A urodynamic study revealed hypoactive neurogenic bladder affecting both sacral roots.

The Differences in Cardiac Rehabilitation Outcomes by Age in Myocardial Infarction: A Preliminary Study.

OBJECTIVE: To determine the age-related changes in cardiac rehabilitation (CR) outcomes, which includes hemodynamic and metabolic factors, in patients with myocardial infarction (MI). METHODS: CR was administered for 8 weeks to 32 men (mean age, 54.0±8.8 years) who underwent percutaneous coronary intervention for acute MI between July 2012 and January 2016. The exercise tolerance tests were performed before and after the CR. The results were stratified based on a cut-off age of 55 years. RESULTS: In the whole patient group, the hemodynamic variables such as the resting heart rate (HRrest), systolic blood pressure (SBPrest), submaximal HR (HRsubmax), SBP (SBPsubmax), and rate pressure product (RPPsubmax) significantly decreased and the maximal HR (HRmax) and RPP (RPPmax) significantly increased. All metabolic variables displayed significant improvement, to include maximal oxygen consumption (VO2max) and ventilation (VEmax), anaerobic threshold (AT), and the maximal oxygen pulse (O2pulsemax). However, upon stratification by age, those who were younger than 55 years of age exhibited significant changes only in the HRrest and RPPsubmax and those aged 55 years old or greater displayed significant changes in all hemodynamic variables except diastolic BP. Both groups displayed significant increases in the VO2max, VEmax, and AT; the older group also exhibited a significant increase in O2pulsemax. The magnitude of the changes in the hemodynamic and metabolic variables before and after CR, based on age, did not differ between the groups; although, it tended to be greater among the older participants of this study's sample. CONCLUSION: Because the older participants tended to show greater hemodynamic and metabolic changes due to CR, a more aggressive CR program must be administered to elderly patients with MI.