STUDY DESIGN.Prospective, multicenter international cohort.
OBJECTIVE.To evaluate outcomes of surgical decompression for cervical spondylotic myelopathy (CSM) at a global level.
SUMMARY OF BACKGROUND ...DATA.CSM is a degenerative spine disease and the most common cause of spinal cord dysfunction worldwide. Surgery is increasingly recommended as the preferred treatment strategy for CSM to improve neurological and functional status and quality of life. The outcomes of surgical intervention for CSM have never been evaluated at an international level.
METHODS.Between October 2007 and January 2011, 479 symptomatic patients with image evidence of CSM were enrolled in the prospective, multicenter AOSpine CSM-International study from 16 global sites. Preoperative and postoperative clinical status, functional impairment, and quality of life were evaluated using the modified Japanese Orthopaedic Assessment Scale, Nurick Scale, Neck Disability Index, and Short-Form-36v2. Preoperative and 12- and 24-month postoperative outcomes were compared using mixed-model analysis of covariance for repeated measurements.
RESULTS.The study cohort consisted of 310 males and 169 females, with a mean age of 56.37 ± 11.91 years. There were significant differences in age, etiology, and surgical approaches between the regions. At 24 months postoperatively, the mean modified Japanese Orthopaedic Assessment Scale score improved from 12.50 (95% confidence interval CI, 12.24–12.76) to 14.90 (95% CI, 14.64–15.16); the Neck Disability Index improved from 36.38 (95% CI, 34.33–38.43) to 23.20 (95% CI, 21.24–25.15); and the SF36v2 Physical Component Score and Mental Composite Score improved from 34.28 (95% CI, 33.46–35.10) to 40.76 (95% CI, 39.71–41.81) and 39.45 (95% CI, 38.25–40.64) to 46.24 (95% CI, 44.94–47.55), respectively. The rate of neurological complications was 3.13%.
CONCLUSION.Surgical decompression for CSM is safe and results in improved functional status and quality of life in patients around the world, irrespective of differences in medical systems and sociocultural determinants of health.Level of Evidence3
Due to its debilitating character pneumonectomy this is last-resort procedure. Preoperative results of the 6-min walking test (6MWT) help to identify high risk of postoperative complications and ...increased mortality in patients undergoing lobectomy for lung cancer. The aim of the study was to validate the value of 500 m in 6MWT as an indicator, which differentiates risk of complications in patients undergoing pneumonectomy. 125 patients who underwent pneumonectomy at Thoracic Surgery Department between 2009 and 2018. On the day preceding the surgery, patients underwent 6MWT. The patients were in median age of 63 years. The cut-off value of 500 m identified patients with increased 90-day mortality 17.9% vs. 3.5%, odds ratio (OR) 6.271, 95% confidence interval (CI) 1.528-25.739, first-year mortality (30.7% vs. 11.6%, OR 3.378, 95%CI 1.310-8.709), and overall survival (
= 0.02). Patients who covered a distance ≤ 500 m had an increased risk of atrial fibrillation (35.9% vs. 16.3%, OR 2.880, 95%CI 1.207-6.870) and cardiac complications (38.4% vs. 19.8%, OR 2.537, 95%CI 1.100-5.849). Patients unable to reach 500 m in 6MWT are in a high risk of postoperative death after pneumonectomy, what may be a result of increased frequency of postoperative cardiac complications. Poor result of 6MWT is a predictor of worse overall survival.
•Sodium valproate (VS) stimulates expression of BGP in GSDV animal models.•An open label study of VS in GSDV showed no benefit in people with GSDV.•VS did not stimulate the expression of BGP in ...people with GSDV.
McArdle disease results from a lack of muscle glycogen phosphorylase in skeletal muscle tissue. Regenerating skeletal muscle fibres can express the brain glycogen phosphorylase isoenzyme. Stimulating expression of this enzyme could be a therapeutic strategy. Animal model studies indicate that sodium valproate (VPA) can increase expression of phosphorylase in skeletal muscle affected with McArdle disease. This study was designed to assess whether VPA can modify expression of brain phosphorylase isoenzyme in people with McArdle disease. This phase II, open label, feasibility pilot study to assess efficacy of six months treatment with VPA (20 mg/kg/day) included 16 people with McArdle disease. Primary outcome assessed changes in VO2peak during an incremental cycle test. Secondary outcomes included: phosphorylase enzyme expression in post-treatment muscle biopsy, total distance walked in 12 min, plasma lactate change (forearm exercise test) and quality of life (SF36). Safety parameters. 14 participants completed the trial, VPA treatment was well tolerated; weight gain was the most frequently reported drug-related adverse event. There was no clinically meaningful change in any of the primary or secondary outcome measures including: VO2peak, 12 min walk test and muscle biopsy to look for a change in the number of phosphorylase positive fibres between baseline and 6 months of treatment. Although this was a small open label feasibility study, it suggests that a larger randomised controlled study of VPA, may not be worthwhile.
Reduced functional ability and exercise tolerance in patients with heart failure (HF) are associated with poor quality of life and a worse prognosis. The 6-minute walking test (6MWT) is a widely ...available and well-tolerated test for the assessment of the functional capacity of patients with HF. Although the cardiopulmonary exercise test (a maximal exercise test) remains the gold standard for the evaluation of exercise capacity in patients with HF, the 6MWT (submaximal exercise test) may provide reliable information about the patient’s daily activity. The current review summarizes the value of 6MWT in patients with HF and identifies its usefulness and limitations in everyday clinical practice in populations of HF. We aimed to investigate potential associations of 6MWD with other measures of functional status and determinants of 6MWD in patients with HF as well as to review its prognostic role and changes to various interventions in these patients.
Survivors of severe COVID-19 related respiratory failure may experience durable functional impairments. We aimed at investigating health-related quality of life (HR-QoL), physical functioning, ...fatigue, and cognitive outcomes in COVID-19 patients who received invasive mechanical ventilation (IMV).
Case-series, prospective, observational cohort study at 18 months from hospital discharge. Patients referring to the Intensive Care Unit (ICU) of Humanitas Research Hospital (Milan, Italy) were recruited if they needed IMV due to COVID-19 related respiratory failure. After 18 months, these patients underwent the 6-min walking test (6MWT), the Italian version of the 5-level EQ-5D questionnaire (EQ-5D-5L), the Functional Assessment of Chronic Illness Therapy – Fatigue questionnaire (FACIT-F), the Trail Making Test-B (TMT-B) and the Montreal Cognitive Assessment-BLIND test (MoCA-BLIND).
105 patients were studied. The population's age was 60 ± 10 years on average, with a median Frailty Scale of 2 (Hodgson et al., 2017; Carenzo et al., 2021a 2,3). EQ-VAS was 80 70–90 out of 100, walked distance was 406 331–465 meters, corresponding to about 74 ± 19,1% of the predicted value. FACIT-F score was 43 36–49 out of 52, and MoCa-BLIND score was 19 (DeSalvo et al., 2006; von Elm et al., 2008; Herdman et al., 2011; Scalone et al., 2015 16-20) out of 22. The median TMT-B time was 90 62–120 seconds. We found a possible age and gender specific effect on HR-QoL and fatigue.
After 18 months from ICU discharge, survivors of severe COVID-19 respiratory failure experience a moderate reduction in HR-QoL, and a severe reduction in physical functioning. Fatigue prevalence is higher in younger patients and in females. Finally, cognitive impairment was present at a low frequency.
•ICU COVID-19 survivors face cognitive, physical and mental health issues, emphasizing the need for targeted interventions.•18 months post-ICU discharge survivors show moderate reductions in quality of life.•At 18 months post-ICU discharge, survivors show fatigue, mild cognitive decline, and moderate to severe physical limitations.
To determine the impact of exercise on functional capacity, measured through the “Six minutes walking test” (6MWT) in patients with advanced cancer stage.
Systematic research on PubMed, Cochrane ...Library, and SportDiscus was conducted. Randomized controlled trials were eligible if they examined the effect of exercise on 6MWT.
Overall, a total of ten trials were included in the primary analysis. Compared to the controls, the exercise intervention was associated with an increase in functional capacity (+20.86 m; CI: −5.90 to 47.72, p = 0.12) although not reaching the statistical significance. Sensitivity analysis revealed an improvement for studies proposing a supervised exercise intervention towards the statistical significance. Few adverse events were associated with exercise training, and the median withdrawals rate was 17%.
Exercise may have a beneficial role on functional capacity in patients with advanced cancer, especially if supervised.
Display omitted
Bronchodilation and exercise training (ExT) improve exercise tolerance in patients with chronic obstructive pulmonary disease (COPD); however, behavior modification is required to impact daily ...physical activity (PA).
To assess whether tiotropium/olodaterol, with or without ExT, would improve exercise endurance time (EET) and PA compared with placebo in patients participating in a self-management behavior-modification (SMBM) program.
This was a 12-week, randomized, partially double-blind, placebo-controlled, parallel-group trial in patients with COPD (PHYSACTO; NCT02085161). All patients were enrolled into SMBM and randomized 1:1:1:1 to once-daily placebo, tiotropium 5 μg, tiotropium/olodaterol 5/5 μg, or tiotropium/olodaterol 5/5 μg plus 8 weeks ExT. EET, measured by endurance shuttle walk test after 8 weeks, was the primary endpoint. Additional endpoints assessed downstream effects on PA (measured via accelerometry), and activity-related dyspnea and difficulty (using validated patient-reported questionnaires).
SMBM plus tiotropium/olodaterol, with or without ExT, significantly improved EET at Week 8 versus SMBM plus placebo (treatment ratio vs. placebo: with ExT, 1.46; 95% confidence interval, 1.20-1.78; P = 0.0002; without ExT, 1.29; 95% confidence interval, 1.06-1.57; P = 0.0109). No significant increases in steps per day from baseline were observed over SMBM plus placebo at Week 12 (increase of 1,098) when other therapies were added. Adding tiotropium/olodaterol, with or without ExT, to SMBM reduced activity-related dyspnea versus placebo, whereas adding tiotropium/olodaterol plus ExT reduced activity-related difficulty.
Tiotropium/olodaterol, with or without ExT, improved EET in patients with COPD taking part in an SMBM program. Combination bronchodilation, with or without ExT, did not provide additional increases in objective PA compared with SMBM alone but did reduce PA-related dyspnea and difficulty. Clinical trial registered with www.clinicaltrials.gov (NCT02085161).
To address the significance of enhancing myelination for functional recovery after white matter injury (WMI) in preterm infants, we characterized hypomyelination associated with chronic hypoxia and ...identified structural and functional deficits of excitatory cortical synapses with a prolonged motor deficit. We demonstrate that genetically delaying myelination phenocopies the synaptic and functional deficits observed in mice after hypoxia, suggesting that myelination may possibly facilitate excitatory presynaptic innervation. As a gain-of-function experiment, we specifically ablated the muscarinic receptor 1 (M1R), a negative regulator of oligodendrocyte differentiation in oligodendrocyte precursor cells. Genetically enhancing oligodendrocyte differentiation and myelination rescued the synaptic loss after chronic hypoxia and promoted functional recovery. As a proof of concept, drug-based myelination therapies also resulted in accelerated differentiation and myelination with functional recovery after chronic hypoxia. Together, our data indicate that myelination-enhancing strategies in preterm infants may represent a promising therapeutic approach for structural/functional recovery after hypoxic WMI.
Display omitted
•Chronic hypoxia causes hypomyelination, synaptic loss, and functional deficits•Hypomyelination results in synaptic and functional deficits•Enhancing myelination rescues hypoxia-induced synaptic and functional deficits•Myelination-enhancing drugs improve functional recovery against hypoxia
Wang et al. demonstrate that hypomyelination specifically contributes to the significant loss of excitatory synapses and prolonged functional deficits after chronic hypoxia and that myelination-enhancing strategies represent a promising approach for functional recovery following hypoxic WMI.
Background
Low cardiopulmonary fitness, measured by oxygen uptake peak (VO
2pk
), is associated with postoperative complications and mortality. Obese people have difficulty in performing the ...cardiopulmonary exercise test, which requires maximal exertion. The incremental shuttle walking test (ISWT) and 6-min walking test (6MWT) have been used to assess cardiorespiratory capacity, mortality, and complications in the postoperative phase. However, the physiological response elicited by these tests in obese people is unknown. This study analyzed and compared cardiopulmonary fitness (oxygen uptake VO
2
and CO
2
output VCO
2
) in the ISWT and 6MWT in obese adults using a telemetry system.
Methods
Fifteen obese patients (10 women; mean age 39.4 ± 10.1 years; mean body mass index 43.5 ± 6.8 kg/m
2
) with normal forced vital capacity (% FVC 93.7) performed the 6MWT and ISWT in the field in this cross-sectional study. Metabolic (VO
2pk
, VCO
2
) and respiratory (minute ventilation; VE) variables were recorded using telemetry.
Results
Obese patients performed the ISWT with an incremental and exponential cardiopulmonary response, with higher VO
2pk
(15.4 ± 2.9 ml/kg/min), VCO
2
(1.7 ± 0.7 l/min), and VE (51.4 ± 21.3 l/min) than the 6MWT (VO
2pk
= 13.2 ± 2.59 ml/kg/min, VCO
2
= 1.4 ± 0.6 l/min; VE = 41.2 ± 16.6 l/min (all
p
< 0.01). They also demonstrated more effort intensity, assessed by VO
2
, (
p
= 0.006) and heart rate (
p
= 0.04) in the ISWT than the 6MWT. In the 6MWT, patients showed a fast rise in ventilatory and metabolic response, reaching a plateau.
Conclusion
The ISWT test generated superior metabolic and ventilatory stress than the 6MWT and may be more suitable for assessing cardiopulmonary fitness than self-paced tests.
Background:Evidence for the prognostic value of gait speed is largely based on a single measure at baseline, so we investigated the prognostic significance of change in gait speed in hospitalized ...older acute heart failure (AHF) patients.Methods and Results:This retrospective study was performed in a cohort of 388 AHF patients ≥60 years old (mean age: 74.8±7.8 years, 228 men). Routine geriatric assessment included gait speed measurement at baseline and at discharge. The primary outcome of this study was all-cause death. Gait speed increased from 0.74±0.25 m/s to 0.98±0.27 m/s after 13.5±11.0 days. Older age, shorter height and lower hemoglobin level at admission, prior HF admission, and higher baseline gait speed were independently associated with lesser improvement in gait speed. A total of 80 patients died and 137 patients were readmitted for HF over a mean follow-up period of 2.1±1.9 years. In multivariate analyses, change in gait speed showed inverse associations with all-cause death (hazard ratio HR per 0.1 m/s increase: 0.83; 95% confidence interval CI: 0.73 to 0.95; P=0.006) and with risk of readmission for HF (HR: 0.91; 95% CI: 0.83 to 0.99; P=0.036).Conclusions:Short-term improvement in gait speed during hospitalization was associated with reduced risks of death and readmission for HF in older patients with AHF.
PDF
