Search

Background: The Asian Working Group for Sarcopenia 2019 (AWGS 2019) is the gold standard diagnostic criteria for sarcopenia in Asian populations. The calf circumference (CalF), the strength, assistance in walking, rising from a chair, climbing stairs, and falls (SARC-F) and the SARC-CalF questionnaires for sarcopenia screening have been used by AWGS 2019. The aim of this study was to assess accuracy of these three sarcopenia screening tools in patients with interstitial lung disease. Methods: In this cross-sectional study, stable patients with interstitial lung disease were enrolled. The SARC-F, SARC-CalF, and CalF, used in patients with interstitial lung disease, were compared to the diagnostic criteria proposed by AWGS 2019. The accuracy of screening tools was compared using sensitivity and specificity. Moreover, areas under the receiver operating characteristic curves (AUC) were computed. Results: Seventy eight patients were analyzed, and sarcopenia was identified in 25 (32.1%) patients with interstitial lung disease by the AWGS 2019 criteria. The sensitivity of the CalF was highest (96%) of the three screening tools, while the specificity was 60%. The sensitivity of SARC-F and SARC-CalF were 24% and 68%, while the specificity were 92% and 66%, respectively. The AUCs of CalF, SARC-F, and SARC-CalF in all patients were 0.78, 0.58, and 0.67, respectively. Conclusions: The CalF is most suitable for screening sarcopenia in patients with interstitial lung disease, while SARC-F and SARC-CalF are not., BMC Pulmonary Medicine, 22, art. no. 45; 2022

Interstitial lung disease (ILD) is a diverse group of chronic lung conditions characterized by dyspnea, exercise-induced hypoxemia (EIH), and exercise intolerance. Since activity limitations and impaired health-related quality of life (HRQoL) in ILD are similar to those in other chronic respiratory diseases, including chronic obstructive pulmonary disease (COPD), pulmonary rehabilitation is also indicated for patients with ILD. This rehabilitation program mainly comprises exercise training and self-management education. Exercise training is the most important component of pulmonary rehabilitation. It significantly improves dyspnea and enhances exercise capacity and HRQoL in patients with ILD. The standard exercise prescription used for COPD is also effective for ILD. However, considering that disease progression and exercise-limiting factors are different in patients with COPD is necessary. Severe EIH, the adverse effects of corticosteroid administration, and comorbidities often lead to difficulty in employing a sufficient exercise intensity. Some modifications in the exercise prescription for individual patients or strategies to minimize EIH and dyspnea are required to optimize training intensity. Since EIH is common and severe in patients with ILD, supplemental oxygen should be provided. In advanced and more severe patients, who have difficulty in performing exercises, energy conservation techniques and the use of energy-saving devices to improve and maintain the patients' activities of daily living may be effective．.

The length of hospital stay is an important outcome measure in patients who have undergone pancreaticoduodenectomy. Although postoperative complications are known to adversely affect the length of hospital stay (LOS), the influence of early mobilization on LOS has not been clarified yet. This study aimed to examine the impact of the initial ambulation day, which is one of the components of early mobilization, on LOS after pancreaticoduodenectomy. We retrospectively enrolled patients who underwent pancreaticoduodenectomy between January 2013 and December 2017. Postoperative complications were evaluated using the Clavien–Dindo classification (CDC) system. Patients were divided into two groups based on the median LOS (early and late-discharge groups) and compared to determine their characteristics. Multivariate logistic regression analysis was performed with LOS as the dependent variable. Patients in the late-discharge group were significantly older, had an initial ambulation delay, and had higher rates of advanced disease stages and a CDC grade ≥ IIIa than those in the early discharge group. In the multivariate logistic regression analysis, CDC grade ≥ IIIa, initial ambulation day, and age were found to be significant independent factors associated with LOS. Our results demonstrated that not only postoperative complications, but also the initial ambulation day, could affect LOS after pancreaticoduodenectomy, emphasizing the importance of early ambulation for patients who undergo this surgery., Tohoku Journal of Experimental Medicine, 254(4), pp. 287-294; 2021

Background and Objective: Interstitial lung diseases (ILD) patients tend to be limited of physical activity due to dyspnea and also muscle weakness caused by corticosteroid treatment. This study purposed to evaluate whether the effect of corticosteroid use on peripheral muscle force and exercise capacity according to different dyspnea level in ILD patients. Methods: This study was a cross-sectional observational study. We assessed dyspnea using modified Medical Research Council (mMRC) scale, isometric quadriceps force (QF) and handgrip force (HF), pulmonary function tests, 6-minute walk distance (6MWD), and compared between low dyspnea (mMRC grade 0-2) and higher dyspnea (3-4) groups. Results: QF, HF and 6MWD of patients with corticosteroid treatment in low mMRC group were significantly lower than without corticosteroid treatment (QF, 20 ± 9 vs. 30 ± 14 kgf, p=0.01; HF, 23 ± 8 vs. 28 ± 10 kg, p=0.03; 6MWD, 365 ± 72 vs. 408 ± 79 m, p=0.04, respectively). On the other hand, there were no significant differences of HF, QF and 6MWD between with and without corticosteroid treatment in higher mMRC group. Conclusions: These results suggest that corticosteroid use would be more affected peripheral muscle strength and exercise capacity in patients with mild ILD.

Objective: To evaluate the efficacy of neuromuscular electrical stimulation on quadriceps muscle strength and thickness in liver transplantation patients. Design: Phase-II, randomized, parallel-group, allocation-concealed, assessor-blinded, single-center controlled trial. Setting: Inpatient rehabilitation sector. Subjects: Patients following living donor liver transplantation. Interventions: The quadriceps muscle stimulation and the control groups received bilateral muscle electrical stimulation on the quadriceps and tibialis anterior muscles, respectively. Neuromuscular electrical stimulation sessions in both groups were conducted for 30 minutes per session, once per day for five weekdays over four weeks by a physical therapist. Main measures: Quadriceps muscle strength and quadriceps muscle thickness. Results: Neuromuscular electrical stimulation was applied to the quadriceps muscles group ( n = 23) or the tibialis anterior muscle in the control group ( n = 22). The decrease in quadriceps muscle thickness differed significantly between both groups on postoperative day 30 (median −3 vs −8, P Conclusion: Neuromuscular electrical stimulation of the quadriceps muscle for liver transplantation recipients was able to maintain the quadriceps muscle thickness after surgery. Future larger scale studies are needed to consider the effectiveness of neuromuscular electrical stimulation and how to incorporate this intervention in the overall strategy of the physical therapy program.

Background Interstitial lung diseases (ILDs) patients receiving steroid treatment tend to be immobilized by dyspnea and muscle weakness as the disease progresses. We therefore expected that steroid treatment for ILDs would have a greater effect on muscle function under severe dyspnea. To test this hypothesis, we evaluated whether the effect of corticosteroid treatment on peripheral muscle force and exercise capacity varied according to patients’ dyspnea severity. Methods In this retrospective cross-sectional study of 87 ILD patients enrolled between 2008 and 2017, quadriceps force (QF), handgrip force (HF), and 6-min walk distance (6 MWD) were compared between a low (grades 0–2) and a high (grades 3–4) modified-Medical Research Council (mMRC) dyspnea scale score group. Results In patients with lower levels of dyspnea, corticosteroid treatments were associated with lower QF and HF (20.0 vs. 30.0 kgf, p = 0.01; 22.5 vs. 28.4 kgf, p = 0.03, respectively) values; however, no significant differences were observed between the corticosteroid and control subgroups in the high mMRC group (QF: 18.5 vs. 17.3 kgf, p = 0.64; HF: 21.0 vs. 17.1 kgf, p = 0.24, respectively ). Analysis of covariance indicated that both corticosteroid treatment and mMRC dyspnea scale interacted with QF, HF, and 6 MWD. The effects of the corticosteroid treatment varied according to the level of dyspnea (interaction β = 7.52, p = 0.034; interaction β = 8.78, p = 0.048; interaction β = 131.08, p Conclusions Muscle weakness and exercise capacity in ILD patients in the low mMRC group were associated with corticosteroid treatment.

Highlights • We surgeons often operate on critically ill patients. • ICUAW involves systemic and prolonged muscle weakness in critically ill patients. • However, surgeons have not yet become sufficiently familiar with this disorder. • Early diagnosis and close cooperation among health care providers are crucial., Introduction Surgeons often perform surgery for patients who are critically ill. Intensive care unit (ICU)-acquired weakness (ICUAW) is a condition in which systemic and prolonged muscle weakness occurs and causes worse short-term and long-term outcomes. Presentation of case A 60-year-old woman with sudden nausea and vomiting presented to our hospital and developed shock. Abdominal CT showed thickness of the descending colon and ascites. She was diagnosed with sepsis due to descending colon cancer. Colectomy of the descending colon was performed due to necrosis, and a stoma was created. After surgery, she received intensive care in the ICU. It was difficult to wean her from the ventilator, and she developed severe flaccid weakness of the limbs. Her Medical Research Council (MRC) sum score was 0. Since other organic disorders causing prolonged paralysis were excluded, she was finally diagnosed as having ICUAW. Active rehabilitation, nutritional support, and glycemic control were continued. Now, 6 months after surgery, her MRC score has improved to 30. Discussion The treatment for ICUAW has been reported to include recovery from the critical illness, early rehabilitation, and nutritional support, and it requires close cooperation among health care providers. Conclusion All physicians and surgeons who care for critically ill patients should take active steps to diagnose ICUAW in order to avoid deterioration of patients’ activities of daily living.

Background: There are several factors associated with the worsening of health-related quality of life (QOL) in patients with after resection of non-small cell lung cancer (NSCLC). However, how the physical function in postoperative period affects the QOL are unknown. Methods: Forty-four patients with NSCLC who underwent surgical resection were enrolled. Skeletal muscle force (handgrip and quadriceps force; HF, QF) and 6-min walk distance (6MWD) were measured before and 1 week after resection, and QOL was prospectively assessed preoperatively and 1, and 3 months after surgery using the EORTC QLQ C-30 questionnaire. The patients were divided into two groups according to the decrease of minimum important difference in domain of physical function (PF): group 1 Results: The PF was deteriorated in 36 patients (82%) at 1 month, and 22 (50%) at 3 months. Differences between before and after surgery were 1.1±2.9kg vs. 2.1±2.5kg (p=.37) in HF, 4.3±10.8kgf vs. 0.8±8.2kgf (p=.75) in QF, and 56.4±53.9m vs. 40.6±43.0m (p=.44) in 6MWD at 1 month after surgery, and 1.0±2.3kg vs. 1.6±3.3kg (p=.43) in HF, 2.6±10.2kgf vs. 2.3±7.2kgf (p=.60) in QF, and 69.6±48.6m vs. 37.5±55.1m (p Conclusions: A decrease in functional exercise capacity after resection significantly affected QOL in patients who underwent surgical resection. These results suggest that exercise training in earlier postoperative period should be applied to improve QOL.