Increase In Walking Distance Research Articles

Effects of Supervised Exercise Therapy on Muscle Function During Walking in Patients with Peripheral Artery Disease.

Although supervised exercise therapy (SET) is a primary treatment for peripheral artery disease (PAD), the current literature is limited regarding the mechanisms contributing to increased walking distances, including how lower extremity muscle function is altered after SET. This study aimed to investigate the effects of SET on lower extremity muscle function during walking in patients with PAD. Twelve patients with PAD participated in a 6-month SET program consisting of three weekly exercise sessions (a total of 72 sessions) and adhered to the American College of Sports Medicine's (ACSM) recommendations. Each session started with a 5 min warm-up of mild walking and static stretching of upper and lower body muscles, followed by 50 min of intermitted exercise on a treadmill, and then finished with 5 min of cool-down activities similar to the warm-up. Each patient walked across a 10 m pathway with reflective markers on their lower limbs twice: before (baseline) and after six months of participation in SET (post-exercise). Marker coordinates and ground reaction forces were recorded and imported to OpenSim software (version 4.0) for gait simulations. Muscle force, muscle power, and metabolic rate were estimated from OpenSim and compared between the baseline and post-exercise. The mean plantar flexor force was not altered after SET. However, individuals' plantar flexor muscles demonstrated improvements in force production (lateral gastrocnemius: 75-80% of stance, Cohen's d = 0.20-0.43; medial gastrocnemius: 65-85% of stance, Cohen's d = 0.20-0.71; soleus: 90-95% of stance, Cohen's d = 0.20-0.26). Furthermore, plantar flexor power increased (80-95% of stance, Cohen's d = 0.20-0.39) and this was attributed to increased power in the lateral gastrocnemius (80-85% of stance, Cohen's d = 0.20-0.47), medial gastrocnemius (80-90% of stance, Cohen's d = 0.22-0.60), and soleus muscles (85-95% of stance, Cohen's d = 0.20-0.49). Similarly, other muscle groups (knee extensors, knee flexors, hip abductors, hip adductors, hip extensors, and hip flexors) also exhibited force and power increases after SET. Additionally, force and power variances were significantly decreased in several muscle groups (plantar flexors, knee extensors, hip abductors, hip external rotators, hip extensors, and hip flexors). Total metabolic rate also increased during the stance period where muscle force and power were elevated after SET (early stance: 5-25%, Cohen's d = 0.20-0.82; mid stance: 35-45%, Cohen's d = 0.20-0.47; late stance: 75-80%, Cohen's d = 0.20-0.36). Our results suggest that from a biomechanics perspective, muscle functions during walking are improved in patients with PAD after SET; however, the improvements were generally small and were not reflected by all muscle groups.

The role of exercised-based cardiac rehabilitation in unrevascularized complex coronary artery disease patients: a case series

Background: Coronary artery disease (CAD) is a common type of heart disease that elevates the risk of morbidity and mortality significantly. Although revascularization techniques like coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI) are advised for CAD patients, some people may not be eligible for or choose not to undergo revascularization. Even though cardiac rehabilitation (CR) enhances cardiovascular outcomes, quality of life, and general well-being, the utilization of CR is still very low. Case illustration: The first patient was a 72-year-old man, and the second patient was a 60-year-old man. They were referred for CR after refusing revascularization, and both are left-main and three-vessel disease patients. The first patient underwent CR for six months and the second patient for 18 months, then the Six Minutes Walking Test (6MWT) and 36-Item Short Form Health Survey (SF-36) were performed before and following CR. The evaluation is an increase in walking distance and patient quality of life. Conclusion: By enhancing quality of life, exercised-based CR programs offer an approach to managing CAD, especially in those who may not be suitable candidates for or choose to avoid revascularization procedures. Keyword: cardiac rehabilitation, coronary artery disease, six minutes walking test, quality of life

Anti-CD19 CAR-T cells are effective in severe idiopathic Lambert-Eaton myasthenic syndrome

Lambert-Eaton myasthenic syndrome (LEMS) is an autoantibody-mediated disease of the neuromuscular junction characterized by muscular weakness. Autoantibodies to presynaptic P/Q-type voltage-gated calcium channels (VGCCs) induce defective neuromuscular function. In severe cases, current immunosuppressive and immunomodulatory treatment strategies are often insufficient. First reports show beneficial effects of anti-CD19 chimeric antigen receptor (CAR)-T cell therapy in patients with autoantibody-mediated myasthenia gravis. We report a patient with isolated idiopathic LEMS treated with autologous anti-CD19-CAR-T cells. In this patient, CAR-T infusion leads to expansion of predominantly CD4+ CAR-T cells with a terminally differentiated effector memory cells re-expressing CD45RA (TEMRA)-like phenotype indicating cytotoxic capabilities and subsequent B cell depletion. VGCC antibody titers decrease, resulting in a clinical improvement of LEMS symptoms, e.g., 8-fold increase in walking distance. The patient does not show relevant side effects except for cytokine release syndrome grade 2 and intermittent neutropenia suggesting that anti-CD19 CAR-T cell therapy may be a treatment option in patients with LEMS.

Dynamics of the functional state of the cardiovascular system in individuals after cholecystectomy under the influence of a rehabilitation program in sanatorium-resort conditions.

The article discusses the dynamics of the functional state of the cardiovascular system (CVS) in individuals after laparoscopic cholecystectomy (LCС) under the influence of a rehabilitation program in SANATORIUM-RESORT CONDITIONS. The study involved 79 individuals after LCC aged 45 to 59 years. The individuals were divided into 2 groups: group A (n=39) and group B (n=40). Individuals in group A received rehabilitation services according to the clinical protocol (diet, hydrotherapy, mineral or coniferous baths, and physical therapy, etc.) In group B, individual rehabilitation programs were formed depending on the existing dysfunctions and the tolerance of the CVS to physical activity. In group B, the rehabilitation intervention to increase the function of endurance and physical performance was applied Nordic walking (NW). The initial examination in both groups revealed an increase in resting heart rate (RHR), diastolic (DBP) and systolic (SBP) blood pressure, a decrease in the performance of a 6- minute walk test and the presence of a feeling of shortness of breath during the test. The implementation of a physical rehabilitation (physical therapy) program in group B, which used Nordic walking to increase physical activity, tolerance to physical activity, and improve cardiovascular function, was effective. The use of NW in sanatorium-resort conditions of rehabilitation (lasting at least 18 days) has a positive effect and leads to a statistically significant decrease in RHR, SBP, DBP, an increase in walking distance in 6 minutes and a decrease in the feeling of shortness of breath when walking, compared to the control group. It was established that diet therapy, hydrotherapy, mineral or coniferous baths, and other water procedures, classical abdominal and back massage, group daily therapeutic gymnastics in group A did not have a positive effect on increasing the level of physical activity tolerance, CVS functioning in patients after LCC.

Decompression alone or decompression with fusion for lumbar spinal stenosis: five-year clinical results from a randomized clinical trial.

We compared decompression alone to decompression with fusion surgery for lumbar spinal stenosis, with or without degenerative spondylolisthesis (DS). The aim was to evaluate if five-year outcomes differed between the groups. The two-year results from the same trial revealed no differences. The Swedish Spinal Stenosis Study was a multicentre randomized controlled trial with recruitment from September 2006 to February 2012. A total of 247 patients with one- or two-level central lumbar spinal stenosis, stratified by the presence of DS, were randomized to decompression alone or decompression with fusion. The five-year Oswestry Disability Index (ODI) was the primary outcome. Secondary outcomes were the EuroQol five-dimension questionnaire (EQ-5D), visual analogue scales for back and leg pain, and patient-reported satisfaction, decreased pain, and increased walking distance. The reoperation rate was recorded. Five-year follow-up was completed by 213 (95%) of the eligible patients (mean age 67 years; 155 female (67%)). After five years, ODI was similar irrespective of treatment, with a mean of 25 (SD 18) for decompression alone and 28 (SD 22) for decompression with fusion (p = 0.226). Mean EQ-5D was higher for decompression alone than for fusion (0.69 (SD 0.28) vs 0.59 (SD 0.34); p = 0.027). In the no-DS subset, fewer patients reported decreased leg pain after fusion (58%) than with decompression alone (80%) (relative risk (RR) 0.71 (95% confidence interval (CI) 0.53 to 0.97). The frequency of subsequent spinal surgery was 24% for decompression with fusion and 22% for decompression alone (RR 1.1 (95% CI 0.69 to 1.8)). Adding fusion to decompression in spinal stenosis surgery, with or without spondylolisthesis, does not improve the five-year ODI, which is consistent with our two-year report. Three secondary outcomes that did not differ at two years favoured decompression alone at five years. Our results support decompression alone as the preferred method for operating on spinal stenosis.

Transcutaneous Electrical Spinal Cord Stimulation Increased Target-Specific Muscle Strength and Locomotion in Chronic Spinal Cord Injury.

The recovery of locomotion is greatly prioritized, and neuromodulation has been emerging as a promising approach in recent times. Single-subject research design. A laboratory at The Hong Kong Polytechnic University. To investigate the effects of augmenting activity-based therapy (ABT) to transcutaneous electrical spinal cord stimulation (TSCS) on enhancing specific lower limb muscle strength and improving locomotor ability in an individual with chronic incomplete spinal cord injury (iSCI). An individual with iSCI underwent two phases of treatment, ABT alone followed by combined ABT+TSCS, each for a period of 10 weeks. The TSCS stimulated T10-T11 and T12-L1 segments with a frequency of 30 Hz at an intensity between 105 mA and 130 mA. Manual muscle testing, 6 min walk test (6MWT), and surface electromyography (EMG) responses of specific lower limb muscles were measured. Additionally, spasticity and sensorimotor examinations were conducted every two weeks, while pain tolerance was recorded after each treatment session. After the ABT+TSCS treatment, there was an increase in overall muscle strength grading (from 1.8 ± 0.3 to 2.2 ± 0.6 out of 5.0). The 6MWT showed a greater increase in walking distance (3.5 m to 10 m) after combined treatment than ABT alone. In addition, the EMG response of the anterior rectus femoris, biceps femoris, medial gastrocnemius, and tibialis anterior after ABT+TSCS increased more than after ABT alone. The spasticity grade was reduced (from 0.8 ± 0.7 to 0.5 ± 0.6) whereas the average lower limb motor score increased from 17 to 23 points. No adverse effects were reported. ABT+TSCS increased the target-specific lower limb muscle strength and walking ability more than ABT alone in an individual with chronic iSCI.

Physical exercise in haemodialysis patients: which type of exercise is more convenient?

Randomized intra-haemodialysis and home-based exercise trials have demonstrated similar efficacy in improving physical performance, particularly in increasing walking distance. During dialysis sessions, patients can engage in structured, supervised activities such as cycling or resistance exercises, ensuring safety and immediate feedback from healthcare professionals. This structured nature can significantly enhance adherence, making exercise a regular part of the patient's treatment schedule. Home-based exercise offers flexibility and convenience. Patients can incorporate activities like walking, stretching or using resistance bands into their daily lives. This flexibility allows patients to exercise at their own pace and according to their preferences, fostering independence and self-management. By continuing physical activity at home, patients can maintain continuity in their exercise regimen, which is crucial for long-term health benefits. Combining both intra-haemodialysis and home-based exercises has the potential to improve overall adherence to exercise programs. Strategies such as patient education, customized plans, monitoring and feedback, and support systems can help combine these two exercise types. By integrating these two modalities, healthcare providers can create a comprehensive and balanced exercise regimen that enhances adherence, promotes independence and maximizes health benefits for dialysis patients, fostering long-term health and well-being through sustained physical activity. However, this dual approach, which caters to both the need for medical supervision and the desire for personal autonomy, has yet to be tested in randomized trials.

The effectiveness of cardiac contractility modulation: results of two-year follow-up

Aim. To evaluate the survival and dynamics of clinical and instrumental data in patients with chronic heart failure (CHF), atrial fibrillation (AF) and cardiac contractility modulation (CCM).Methods. There were included 54 patients (40 men, median age 59.7 [56.6; 63.9] years) with signs of CHF II (n=27, 50%) functional class and III (n=27, 50%) NYHA functional class, significantly decreased left ventricular ejection fraction (LVEF=30 [24,7; 35,5]%), LV dilatation and paroxysmal (n=27, 50%) or permanent (n=27, 50%) AF. In all patients, devices for CCM were implanted. The dynamics of clinical and instrumental parameters were assessed in 2, 6, 12 and 24 months after implantation. The actual survival patients with CCM was compared with the predicted survival calculated using the Seattle model of heart failure and MAGGIC risk score.Results. In 14 (28%) of patients CCM resulted in significantly increased clinical, echocardiographic parameters (increase in LVEF by 15 [11; 20]%, decrease in end-systolic volume by 68,5[37.5;104.5] ml and end-diastolic volume by 44 [30,100] мл), increase in walking distance during 6-minute walking test and decrease of NT-proBNP. The only factor significant for maximal response was non-ischemic etiology of CHF (χ2=4.54, p=0.034). During 2 years 21 (42%) patients died. The all-cause mortality in patients with CCM to the first year of observation was 16%, two-year all-cause mortality - 40%. These figures turned out to be significantly higher than predicted according to the Seattle model (χ2=10.93, p=0.001). The predicted and actual risk of death at 12-month follow-up turned out to be comparable when assessing survival parameters according to the MAGGIC scale. (χ2=2.24, p=0.134).Conclusion. CCM therapy in some patients with CHF of non-ischemic etiology can lead to an improvement of all clinical and instrumental characteristics. At the same time, there is no effect of CCM on the prognosis of patients with CHF. This fact may suggest the need of additional studies with increased number of cases.

Secondary Prevention of Multifocal Atherosclerosis Combined with Chronic Obstructive Pulmonary Disease

The problem of secondary prevention of multifocal atherosclerosis (MAS) combined with chronic obstructive pulmonary disease (COPD), is a leading cause of death in the world. Therefore, the search for drugs capable of affecting the destructive mechanisms underlying both MAS and COPD is an extremely urgent problem today. Objective — to reduce the risks of destabilization of atherosclerotic plaques by reducing the levels of metallomatrix metalloproteases (MMP)-2 and MMP-9 in patients on MAS combined with COPD. Materials and methods. The study included 62 men (68.1 ± 4.2) years old with MAS. All patients with MAS had clinical and functional signs of injury in coronary, cerebral and femoral vascular territories, 30 of these patients (group MAS-2) additionally had clinical and functional signs of COPD (GOLD-2). The control group (CG) consisted of 18 practically healthy men, aged (65.4 ± 3.7) years. Examination of the patients included echocardiography, dopplerography of the vessels of the neck and arteries of the lower extremities, determination of walking distance and ankle-brachial index, Holter ECG monitoring, spirography and determination of MMP-2 and MMP-9 levels in blood. Patients of both groups were prescribed cilostazol (50 mg twice a day) and GABA aminalon (250 mg twice a day) on the background of basic treatment. The course of treatment lasted 16 weeks. Results and discussion. During the initial examination of patients, MAS-2 group showed significantly (p < 0.001) lower volumetric blood flow in the studied arteries, and significantly (p < 0.01) higher levels of MMP-2 and MMP-9, as compared to CG, as well as with patients of the MAS-1 group. After 16 weeks of treatment, with the addition of cilostazol and aminalon, the level of MMP in the blood significantly (p < 0.05) decreased in both groups, in particular, in the MAS-2 group, in patients with the combined pathology of MAS and COPD, a significant decrease was found MMP-2 by 23.6 % (p < 0.01), and MMP-9 by 12.1 % (p < 0.05). Volumetric blood flow indicators increased significantly (p < 0.05) in all studied vascular territories, which led to improvement in clinical manifestations of the disease — a decrease in the number of painful and painless episodes of myocardial ischemia, and an increase in walking distance. Conclusions. The use of a complex therapy of statins, cilostazol and GABA in patients with MAS combined with COPD allows to reduce significantly the levels of MMP-2 and MMP-9, which ensures the stability of atheromatous plaques and significantly improves blood supply in vascular territories with atherosclerotic lesions.

Effects of Intracerebral Aminophylline Dosing on Catalepsy and Gait in an Animal Model of Parkinson's Disease.

Parkinson's disease (PD) is a progressive disorder characterized by the apoptosis of dopaminergic neurons in the basal ganglia. This study explored the potential effects of aminophylline, a non-selective adenosine A1 and A2A receptor antagonist, on catalepsy and gait in a haloperidol-induced PD model. Sixty adult male Swiss mice were surgically implanted with guide cannulas that targeted the basal ganglia. After seven days, the mice received intraperitoneal injections of either haloperidol (experimental group, PD-induced model) or saline solution (control group, non-PD-induced model), followed by intracerebral infusions of aminophylline. The assessments included catalepsy testing on the bar and gait analysis using the Open Field Maze. A two-way repeated-measures analysis of variance (ANOVA), followed by Tukey's post hoc tests, was employed to evaluate the impact of groups (experimental × control), aminophylline (60 nM × 120 nM × saline/placebo), and interactions. Significance was set at 5%. The results revealed that the systemic administration of haloperidol in the experimental group increased catalepsy and dysfunction of gait that paralleled the observations in PD. Co-treatment with aminophylline at 60 nM and 120 nM reversed catalepsy in the experimental group but did not restore the normal gait pattern of the animals. In the non-PD induced group, which did not present any signs of catalepsy or motor dysfunctions, the intracerebral dose of aminophylline did not exert any interference on reaction time for catalepsy but increased walking distance in the Open Field Maze. Considering the results, this study highlights important adenosine interactions in the basal ganglia of animals with and without signs comparable to those of PD. These findings offer valuable insights into the neurobiology of PD and emphasize the importance of exploring novel therapeutic strategies to improve patient's catalepsy and gait.

Retrospective Study to Compare the Effectiveness of Minimally Invasive Microscopic Unilateral Laminotomy with Microscopic Bilateral Laminotomy for Bilateral Decompression in the Early Postoperative Period in 142 Patients with Single-Level Lumbar Spinal Stenosis.

BACKGROUND We aimed to compare the effectiveness of microscopic unilateral laminotomy for bilateral decompression (ULBD) and microscopic bilateral laminotomy for bilateral decompression (BLBD) in the early postoperative period among patients with single-level lumbar spinal stenosis (LSS). MATERIAL AND METHODS A retrospective cohort study was conducted on patients with LSS who underwent ULBD or BLBD between January 2020 and December 2023, including 94 patients who underwent ULBD and 58 who underwent BLBD. Patient demographics, comorbidities, smoking status, and data related to LSS were reviewed. Preoperative and postoperative assessments on day 10 included back pain visual analog scale (VAS), walking distance, and Odom criteria. Disability was evaluated using the self-assessment Oswestry Disability Index (ODI) preoperatively and on day 30. Additionally, wound infection, postoperative modified MacNab criteria, and pain (back, leg, and hip) were recorded. RESULTS Age and sex were similar in the 2 groups. Both surgeries significantly reduced low back pain, increased walking distance, and improved Odom category on day 10, compared with baseline (P<0.001 for all). A significant decrease in 30-day ODI, compared with baseline, was observed in both groups (P<0.001 for both). The ULBD group had a significantly higher percentage of patients with wound infection (P=0.014); however, the ODI score among ULBD recipients was significantly lower (better) on day 30 (P=0.047). CONCLUSIONS ULBD may represent a less invasive, more effective, and safer surgical alternative than BLBD and classical laminectomy in patients with single-level LSS, but precautions are essential concerning wound infection.

Autologous transplantation of P63+ lung progenitor cells for chronic obstructive pulmonary disease therapy.

Adult lung resident stem/progenitor cells, including P63+ progenitor cells, have demonstrated the capacity for regeneration of lung epithelium in preclinical models. Here, we report a clinical trial of intrapulmonary P63+ progenitor cell transplantation in 28 participants with stage II to IV chronic obstructive pulmonary disease (COPD). Autologous P63+ progenitor cells were isolated from the airway basal layer of participants in the intervention group via bronchoscopic brushing, cultured for 3 to 5 weeks, and then transplanted back into the lungs via bronchoscopy at 0.7 × 106 to 5.2 × 106 cells per kilogram of body weight. Twenty patients were evaluable at the end of the study (intervention group, n = 17; control group, n = 3). No grade 3 to 5 adverse events (AEs) or serious AEs occurred. Although bronchoscopy-associated AEs were recorded in participants in the intervention group, other AEs were not substantial different between groups. Twenty-four weeks after transplantation, participants in the intervention group displayed improvement in gas transfer capacity [diffusing capacity of the lung for carbon monoxide (DLCO) change from baseline: +18.2%], whereas the control group experienced a decrease (DLCO change from baseline: -17.4%; P = 0.008). Furthermore, participants in the intervention group showed >30-meter increase in walking distance within 6 minutes. Transcriptomic analysis of progenitor cells isolated from responding and nonresponding individuals in the intervention group showed that higher expression of P63 was associated with treatment efficacy. In conclusion, transplantation of cultured P63+ lung progenitor cells was safe and might represent a potential therapeutic strategy for COPD.

Investigating the impact of stop network designs on DRT operation

Modern on-demand mobility concepts have the potential to drive the mobility transition. Increasing attention is being paid to DRT (Demand Responsive Transportation) services that enable the bundling of trips with the help of dynamic routing algorithms. Many providers use a stop-based operating concept for this purpose. The transport between so-called virtual stops promises a higher fraction of shared trips and shorter vehicle detours. The aim of this paper is to investigate multiple stop network designs and their impacts on the efficiency of the operation. For this purpose, three stop network generation approaches were derived from literature and applied to the simulation environment MATSim. A scenario in the city center of Berlin is simulated, where all inner car trips are replaced by DRT. Comparing the stop network design against a door-to-door service, the results suggest a trade-off between a reduction of vehicle kilometers (up to 18%) and increased walking distances (up to 250 meters on average).

Связь степени поражения легочной ткани с функциональными возможностями пациентов, переболевших коронавирусной пневмонией

Many COVID-19 survivors face various functional disorders. The purpose of this article was to determine the association between the degree of lung tissue damage and functional capacity of patients after COVID-19 pneumonia. Materials and methods. We examined patients (n = 264) aged 46–86 years that had suffered moderate or severe COVID-19 and undergone treatment for bilateral multisegmental pneumonia followed by rehabilitation. Functional capacity was measured using a walk test (at a normal pace to the first signs of exhaustion), taking into account heart rate (HR) and peripheral oxygen saturation (SpO2). The association between the degree of lung tissue damage and test results was analysed using simple and multiple regression analysis. Regression models included the following variables: walking distance, HR and SpO2 at rest and after the test, as well as demographic and clinical characteristics of patients. Results. At normal values of resting SpO2(96.3 ± 1.6 %) and resting HR (81.4 ± 12.1 bpm), fatigue occurred after walking the distance of 130.3 ± 96.4 m, SpO2 decreased to 93.8 ± 3.5 %, HR increased to 96.8 ± 14.0 bpm, the Borg score was 6 ± 3 points. Simple regression analysis showed a negative association of the degree of lung tissue damage with walking distance as well as with resting and after-test SpO2 and a positive association with resting HR. Multiple regression analysis indicated a tendency towards a greater decrease in walking distance and a larger increase in resting HR in men compared to women as well as an increase in walking distance and a reduction in resting HR in patients with chronic diabetes as the degree of lung tissue damage increased. Thus, greater degree of lung tissue damage is associated with decreased functional capacity in patients; however, the extent of this decrease may depend on their burdened history and sex.

Improved Quality of Life upon Shifting from Darbepoetin to Luspatercept in Patients with Low-Risk Myelodysplastic Syndrome (MDS)

Introduction: Low-risk MDS is characterized by refractory anemia due to Dyserythropoiesis 1. Standard of care treatment is mainly Erythropoiesis stimulating agents (ESA) or blood transfusion or both 1. Response to ESA is achieved in some patients whose erythropoietin (EPO) level is less than 500 mu/ml 2. Luspatercept is a red cell maturing agent that may lead to an increase in Hb of up to 3 g/dL 3 in responders. Response to ESA can be enhanced with the addition of Luspatercept 4. Hereby we are reporting successful shifting of two patients from Darbepoietin to Luspatercept with significant increase in Hb level and improvement in quality of life. Case 1: A 62-year-old man without previous illness presented in April 2018 with progressive symptomatic anemia. His body weight was 107 kg, and his physical examination was unremarkable other than pallor and tachycardia. The laboratory investigation revealed WBC, 5.62 x 10 3/uL, RBC 2.2 x 10 3/uL, Hb 7.8 g/dL, MCV 110.4 fl, platelets 706 x 10 3/uL, and reticulocytes 1%. Blood film showed reduced RBC count with numerous macrocytes and no other abnormalities. Bone marrow revealed 80% cellularity with Dyserythropoiesis, 16% ring sideroblasts, and 2% blasts. The Ferritin level, B12 levels were elevated (table). EPO level was elevated but less than 500 mlU/ml and the cytogenetic analysis showed normal karyotype. However his molecular profiling demonstrated SF3B1 and TET2 mutations. At the time of diagnosis, the Revised International Prognostic Scoring System (IPSS-R) was 2.0, indicating low risk MDS. He was given darbepoetin 300 mcg SC weekly for four weeks without any improvement, then darbepoetin dose was escalated to 500 mcg weekly with a good response. Hb level remained at 8.5 - 9.5 g/dl for three years. The patient's physical performance improved moderately, with an increase in walking distance on flat surfaces from 20 to 35 minutes. In August 2022, he was switched to Luspatercept 100 mcg SC on a three-weekly schedule. Within three months, his hemoglobin level increased to 10.8 g/dl and he experienced significant improvement in physical performance and mental well-being, along with a significant reduction in fatigue, enabling him to increase his walking distance to 76 minutes. Case 2: A 77-year-old man with type 2 diabetes mellitus and mild renal impairment who developed an unexplained progressive anemia. His body weight was 79 kg, and his physical examination was unremarkable other than pallor. His laboratory investigations showed WBC 4.5 x 10 3/uL, RBC 1.5 x 10 6/uL, Hb 5.2 g/dL, MCV 96 fl, platelets 706 x 10 3/uL, and reticulocytes 0.8 %. Blood film showed reduced RBC count, normocytic anemia, and no other abnormalities. Bone marrow revealed 60% cellularity with Dyserythropoiesis, 17% ring sideroblasts, and 1% blasts. His baseline serum creatinine was 1.8 mg/dl, and HbA1C 10.0. Two units of packed red blood cells were transfused every 2- 4 week to keep his Hb level around 8 g/dL. Darbepoetin 80 mcg SC weekly for four weeks,150 mcg weekly for 4 weeks and 300 mcg weekly for further 4 weeks without any response. Eventually, he responded to 500 mcg of Darbepoetin per week. As a result, his Hb increased to the range of 8.6-9.4 g/dl for one year, with moderate improvements in performance status. Darbepoetin was switched to Luspatercept 75 mcg three-weekly in January 2023, resulting in an increase in his hemoglobin level to 10.3 g/dl, with significant improvement in his energy level and overall well-being. Discussion: Blood transfusion and ESA have traditionally been used as standard treatments for low-risk MDS. Recently, Luspatercept in combination with ESA has shown enhanced effectiveness in elevating Hb levels. Both of our patients had significant increases in Hb levels along with a noticeable improvement in quality of life because of Luspatercept alone. Conclusion: Following the switch from Darbepoetin to Luspatercept, there was a significant improvement in Hb level and in quality of life in our 2 patients. This finding needs to be confirmed with larger studies.

Adding Non-Invasive Positive Pressure Ventilation to Supplemental Oxygen During Exercise Training in Severe Chronic Obstructive Pulmonary Disease: A Randomized Controlled Study.

Chronic obstructive pulmonary disease is currently the fourth leading cause of death in the world. Pulmonary rehabilitation is recommended for chronic obstructive pulmonary disease. This study aimed to evaluate the effects of non-invasive ventilation, supplemental oxygen, and exercise training and supplemental oxygen during exercise training during pulmonary rehabilitation practice in comparison with only exercise training on lung functions, blood gases, lactate levels, respiratory muscle pressures, dyspnea, walking distances, quality of life, and depression in patients with severe chronic obstructive pulmonary disease. The main outcome measure is exercise capacity (6-minute walk test), and the secondary end-point included quality of life. Thirty-five patients (mean ± SD age, 65.4 ± 6.5 years) with a mean bronchodilator forced expiratory volume in the first second of expiration of 39.4 ± 7%, undergoing an 8-week outpatient pulmonary rehabilitation, were randomized to either non-invasive ventilation, supplemental oxygen, and exercise training, supplemental oxygen during exercise training, or exercise training groups. The improvements in respiratory muscle strength were higher in non-invasive ventilation, supplemental oxygen, and exercise training patients than the moderate improvements in the exercise training group. Both non-invasive ventilation, supplemental oxygen, and exercise training and supplemental oxygen during exercise training groups showed significant increases in the 6-minute walk test and incremental shuttle walk test. However, the increase in walking distance was better in non-invasive ventilation, supplemental oxygen, and exercise training group (69.8 ± 53.2 m in 6-minute walk test and 66.6 ± 65.2 m in incremental shuttle walk test, P = .001 and P = .005, respectively) compared to supplemental oxygen during exercise training group (42.5+55.5 m in 6-minute walk test and 53.5+70.2 m in incremental shuttle walk test, P = .01 each, respectively). The total St. George's Respiratory Questionnaire score was similar in all study groups after the intervention. Symptoms of depression significantly improved only in non-invasive ventilation, supplemental oxygen, and exercise training group (-2.8+2.8, P = .006). Non-invasive positive-pressure ventilation (NIPPV) added to supplemental oxygen during exercise training was associated with better physiological adaptations than other modalities.

Effects of whole body vibration on functional capacity and respiratory functions in individuals with stroke: A randomized controlled study.

Management of respiratory-related functional problems using sensory rehabilitation strategies has been poorly researched in patients with stroke. This study aimed to investigate whether whole body vibration (WBV) training has an effect on functional capacity and respiratory functions in patients with stroke. In the randomized-controlled study, 28 participants were randomized into two groups: one receiving neurodevelopmental treatment (NDT; n = 13) and one receiving both NDT and WBV (NDT + WBV; n = 15). The primary outcome measures were 6-minute walking test (6MWT) and pulmonary function test which evaluate functional and respiratory capacity. Secondary outcome included the chest circumference measurement to evaluate the thoracic expansion ability. Both groups showed positive significant changes in walking distance and maximum oxygen consumption volume (VO2max), inspiratory capacity, vital capacity and chest circumference measurement scores (p < 0.05). While the NDT +WBV group showed a significantly greater increase in walking distance and VO2max levels than the NDT group (p < 0.05), there were no significant group differences in respiratory function flow and volume parameters, and chest circumference measurement. The addition of WBV training to the treatment program has some incremental benefits on increasing functional capacity and thoracic expansion, and rehabilitating respiratory dysfunction.

EARLY MOBILIZATION AND THE ELASTIC BAND, AN EFFICIENT SOLUTION FOR AN INTUBATED SUBJECT: A CASE STUDY

ABSTRACT. Introduction: In severely ill patients, weakness acquired in the intensive care unit is a frequent consequence. The advantages of early mobilization for adult intensive care unit patients include shorter stays in the intensive care unit and hospitals, a shorter need for mechanical ventilation, fewer days of harmful bedrest, fewer negative or dangerous occurrences, and increased walking distance. Early mobilization and rehabilitation programs using elastic bands for patients with severe illnesses in intensive care units enhance the weaning success and shorten ventilation times while also enhancing arm muscular power. Objective: This study case aimed to present the fact that early mobilization and elastic band exercises were efficient solutions for an intubated subject from the intensive care unit. Methods: A mechanically ventilated subject postoperatively for hiatal hernia and suspected phrenic nerve paresis, benefited from early mobilization and elastic band exercises and was assessed for the state of consciousness with the Richmond Agitation Scale, and muscle strength for the upper limb with the EH101 digital dynamometer. Results: Muscle strength at the level of the upper limbs increased from weak to normal and the subject was successfully extubated. Conclusions: In this case study we consider that early mobilization and the elastic band exercises program were effective, safe, inexpensive, and suitable for an intensive care unit, and it was the right solution for the success of weaning from the ventilator.

Influence of single-room accommodation on nursing care: A realistic evaluation.

Nowadays, it is common that newly built hospitals are designed with single-room accommodation, unlike in the past, where shared accommodation was the favoured standard. Despite this change in hospital design, very little is known about how single-room accommodation affects nurses' work environment and nursing care. This study evaluates how the single-room design affects nurses and nursing care in the single-room hospital design. Nurses working in the single-room design predominantly work alone with little opportunity for peer training, interaction and reflection. In addition, the single-room design affects the nurses' work environment due to changes in sensory stimulation and increased walking distances. Furthermore, a change in the discourse, namely, regarding the single room as the patient's home, makes the nurses react to queries, demands and tasks in a new way. Overall, the new hospital design forces the nurses into a more reactive role and affect their way of providing nursing care. Despite this, the nurses find single-room accommodation beneficial for the patients and their nursing care.

Changes in pain scores and walking distance after transforaminal epidural steroid injection in patients with lumbar foraminal spinal stenosis.

Transforaminal epidural steroid injections (TFESI) are widely used in patients with lumbar foraminal spinal stenosis. Previous studies have evaluated the effects of TFESI on lumbar foraminal spinal stenosis using only pain scores. However, no study has evaluated the effect of TFESI on pain scores and walking distance in patients with lumbar foraminal spinal stenosis. This study aimed to assess the effect of TFESI on pain scores and walking distance in patients with lumbar foraminal spinal stenosis stratified according to disease severity. This retrospective study reviewed the medical records of patients who received TFESI for lumbar foraminal spinal stenosis. A total of 128 patients were divided into the moderate and severe groups based on the extent of fat obliteration and the presence of nerve root compression. A significant decrease in the numeric rating scale (NRS) scores was observed in the moderate and severe groups compared with the corresponding baseline values 4 weeks after TFESI; however, the NRS pain scores were lower in the moderate group than those in the severe group. In addition, the proportion of patients who experienced pain reduction (≥50%) was higher in the moderate group than that in the severe group. The moderate and severe groups showed a significant increase in walking distance compared with the baseline values 4 weeks after the treatment. However, the walking distance values did not differ significantly between the moderate and severe groups. Furthermore, the degree of satisfaction was higher in the moderate group than that in the severe group. Lumbar TFESI may reduce pain scores and increase walking distance in patients with moderate or severe lumbar foraminal spinal stenosis. Patients with moderate foraminal stenosis had better pain relief outcomes than those with severe foraminal stenosis.