Long-term Functional Capacity Research Articles

Exercise response in post-acute coronary syndrome patients survived to COVID-19 infection

AimsMany studies evaluated the functional response in post-Covid-19 patients; however, they systematically excluded patients with concomitant acute coronary syndrome (ACS).We evaluated the long-term functional capacity assessed by cardiopulmonary exercise test (CPET) in patients hospitalized for ACS and concomitant SARS-CoV2 infection. The secondary aim was to investigate the functional response in patients with symptoms related to “long COVID-19 syndrome” (LCS). MethodsThis cross-sectional case-control study compared 20 patients with ACS and concomitant SARS-COV2 infection with 20 patients without COVID-19. At the follow-up visit (between 6 and 12 months after revascularization procedure) all patients underwent a CPET. ResultsPatients with previous ACS and concomitant COVID-19 showed a reduced O2 consumption than controls (predicted peak V̇O2 74.00% vs 86.70%; p = 0.01) with a high degree of ventilatory inefficiency (VE/ V̇CO2 slope 38.04 vs 30.31; p = 0.002).50% of subjects with previous COVID-19 disease showed symptoms related to “LCS”; this subgroup demarcates the characteristic reduced exercise capacity found in the entire COVID + group. ConclusionsThis study is the first in literature having analyzed the long-term functional capacity phenotype in a population of ACS patients and concomitant SARS-CoV2 infection. Severe ventilatory inefficiency emerged as the functional signature of these patients. Moreover, the subset of patients with symptoms related to LCS has the most compromised long term reduced exercise capacity and an altered ventilation control.

Effects of photobiomodulation therapy on the functional performance of healthy individuals: a systematic review with meta-analysis.

The aim of this study is to assess the effect of photobiomodulation therapy (PBMT) on functional performance concerning strength, fatigue, and functional capacity in healthy individuals. This systematic review with meta-analysis involved searches on data platforms and active searches of randomized clinical trials, focusing on PBMT as the sole intervention. Primary outcomes assessed included strength, fatigue, and functional capacity. Three reviewers screened studies by title and abstract using Rayyan, and data were extracted using a specific form. Bias risk was assessed using RoB2, and confidence in the evidence was evaluated using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE). The RevMan was used for meta-analysis. Sixteen studies were included, totaling 340 individuals (183 males and 157 women). Most articles presented a low risk of bias. Variability was observed in device types and application domains, including wavelengths (655-905nm), power (10-200 nW), energy (0.6-30J per point), and time (30-100s per point). PBMT improved fatigue recovery (mean difference: 5.87; 95% CI 3.83, 7.91). There was no enhancement in strength (peak torque: mean difference 12.40; 95% CI -5.55, 30.55; one-repetition maximum test: mean difference 39.97, 95% CI -2.44, 82.38; isometric and isokinetic strength: mean difference 2.77, 95% CI -14.90, 20.44) nor improvement in short-term (mean difference 0.67, 95% CI -0.58, 1.91) and long-term (mean difference 18.44, 95% CI -55.65, 92.54) functional capacity. PBMT may aid in favoring fatigue recovery in healthy individuals; however, there's no evidence to support PBMT enhancing strength or improving functional capacity.

INFLUENCE OF PHYSICAL THERAPY REHABILITATION ON FUNCTIONAL RECOVERY OF OLDER PEOPLE AFTER COVID-19

Abstract Retrospective cohort conducted through an online survey sent to older people (≥60 years) of both sexes, with confirmed diagnosis of Covid-19 registered in the Municipal Health Department of Sao Paulo, Brazil. Individuals with cognitive limitations and those who refused to participate were excluded. Functional capacity was assessed using Katz and Lawton Indices for pre-Covid, immediate post-Covid, and current time points, and characteristics of post-Covid physiotherapeutic rehabilitation were collected. Statistical analysis was performed using JASP-0.17.3 software, and group comparisons were made using repeated measures ANOVA, considering alpha=0.05. From March to August 2023, 86 individuals participated, with median age of 66.5 [62.3-71.0] and 57.0% (n=49) male. Among them, 39.5% (n=34) received recommendations for physiotherapeutic rehabilitation and 88.2% (n=30) of them were rehabilitated, while 11.8% (n=4) did not receive treatment. Older people with recommendation for physiotherapy post-Covid-19 demonstrated worse functional status (p< 0.001). Older people who received treatment were functionally equivalent to those who did not attend physiotherapy rehabilitation (p=1.000 for Katz Index and p=0.812 for Lawton Index). The primary indication for post-Covid-19 physiotherapy was muscular fatigue (70.0%, n=21), and domiciliary care was the predominant modality received (46.7%, n=14). Older people who were recommended for physiotherapy showed worse functional status after Covid-19, but there was no difference in long-term functional capacity. This suggests the potential importance of physiotherapeutic rehabilitation for functional recovery after Covid-19.

Long-term assessment of functional capacity, muscle function, lung function, and quality of life in survivors of ventilator-associated pneumonia

Background and objectiveThe many patients who develop ventilator-associated pneumonia (VAP) have generated numerous VAP survivors who are not followed up in the long term. This study aimed, primarily, to evaluate the long-term functional capacity, as measured using the Glittre-ADL test (TGlittre), of VAP survivors and, secondarily, to calculate the correlations of TGlittre with muscle and lung function. MethodsThis cross-sectional study evaluated 30 VAP survivors 10 months after discharge from the intensive care unit. The participants underwent the following assessments: TGlittre; respiratory muscle strength; handgrip strength (HGS); spirometry; Functional Assessment of Chronic Therapy (FACIT-F); and Short Form-36 (SF-36). ResultsThe median TGlittre time was 95 (81–130)% of predicted, and 30 % of the participants performed poorly on TGlittre. One-third of the participants had abnormal spirometry results. TGlittre time was correlated with weight (rs = −0.412, P = 0.023), body index mass (BMI, rs = −0.400, P = 0.029), forced vital capacity (FVC, rs = −0.401, P = 0.030), HGS (rs = −0.571, P = 0.0009), FACIT-F score (rs = −0.405, P = 0.026), and different SF-36 domain scores. Participants who returned to work had a shorter TGlittre time than those who did not (89 (69–104) vs. 129 (102–183)% predicted). Multiple linear regression indicated that FVC and BMI explained 39 % of TGlittre variability. ConclusionVAP survivors had suboptimal functional capacity, low lung function, and general fatigue 10 months after discharge. The longer the TGlittre time was, the worse the lung function, muscle function, general fatigue, and quality of life were and the less likely the patient was to have returned to work.

Prehabilitation in older patients prior to elective cardiac procedures (PRECOVERY): study protocol of a multicenter randomized controlled trial

BackgroundPrevious studies have demonstrated the efficacy of rehabilitation after a cardiovascular procedure. Especially older and multimorbid patients benefit from rehabilitation after a cardiac procedure. Prehabilitation prior to cardiac procedures may also have positive effects on patients’ pre- and postoperative outcomes. Results of a current meta-analysis show that prehabilitation prior to cardiac procedures can improve perioperative outcomes and alleviate adverse effects. Germany currently lacks a structured cardiac prehabilitation program for older patients, which is coordinated across healthcare sectors.MethodsIn a randomized, controlled, two-arm parallel group, assessor-blinded multicenter intervention trial (PRECOVERY), we will randomize 422 patients aged 75 years or older scheduled for an elective cardiac procedure (e.g., coronary artery bypass graft surgery or transcatheter aortic valve replacement). In PRECOVERY, patients randomized to the intervention group participate in a 2-week multimodal prehabilitation intervention conducted in selected cardiac-specific rehabilitation facilities. The multimodal prehabilitation includes seven modules: exercise therapy, occupational therapy, cognitive training, psychosocial intervention, disease-specific education, education with relatives, and nutritional intervention. Participants in the control group receive standard medical care. The co-primary outcomes are quality of life (QoL) and mortality after 12 months. QoL will be measured by the EuroQol 5-dimensional questionnaire (EQ-5D-5L). A health economic evaluation using health insurance data will measure cost-effectiveness. A mixed-methods process evaluation will accompany the randomized, controlled trial to evaluate dose, reach, fidelity and adaptions of the intervention.DiscussionIn this study, we investigate whether a tailored prehabilitation program can improve long-term survival, QoL and functional capacity. Additionally, we will analyze whether the intervention is cost-effective. This is the largest cardiac prehabilitation trial targeting the wide implementation of a new form of care for geriatric cardiac patients.Trial registrationGerman Clinical Trials Register (DRKS; http://www.drks.de; DRKS00030526). Registered on 30 January 2023.

Long-term survival, functional capacity and quality of life after refractory out-of-hospital cardiac arrest treated with mechanical circulatory support

IntroductionStudies on long-term outcomes after refractory out-of-hospital cardiac arrest (OHCA) treated with mechanical circulatory support (MCS) are limited. This study aimed to evaluate long-term neurologically intact survival, functional capacity and quality of life after refractory OHCA treated with MCS. MethodsThis was a follow-up study of survivors after refractory OHCA treated with MCS. Follow-up examinations comprised clinical assessment with transthoracic echocardiography and cardiopulmonary exercise test (CPX). Neurological and cognitive screening was evaluated with the Cerebral Performance Category (CPC) and Montreal Cognitive Assessment (MoCA test). A good neurological outcome was defined as CPC 1 or CPC 2. Health-related quality of life was measured by questionnaires (Short Form-36 (SF-36)). ResultsA total of 101 patients with refractory OHCA were treated with MCS at Aarhus University Hospital between 2015 and 2019. The total low-flow time was median 105 min [IQR, 94–123] minutes. The hospital discharge rate was 27%. At a mean follow-up time of 4.8 years ± 1.6 (range 2.8–6.1 years), 21 patients remained alive of whom 15 consented to participate in the present study. Good neurological outcome with CPC 1–2 was found in 93% (14/15) patients. No severe cognitive function was discovered; mean MoCA score of 26.4 ± 3.1. Functional capacity examined by CPX showed acceptable VO2 max values (23.9 ± 6.3 mL/kg/min). Mean SF-36 scores revealed an overall high level of quality of life in long-term survivors. ConclusionsLong-term survival with a good neurological outcome with functional recovery was high in patients with refractory OHCA treated with MCS. These patients may expect a reasonable quality of life after discharge despite prolonged resuscitation.

Functional assessment and mortality in underweight critically ill patients one year after hospital discharge: A prospective cohort study

There in no data regarding outcomes after hospital discharge for underweight critically ill patients. This study aimed to assess long-term survival and functional capacity in underweight critically ill patients. Prospective observational study that included underweight critically ill patients (BMI <20kg/cm2) followed-up one year after hospital discharge. To assess functional capacity, we interviewed patients or caregivers and performed Katz index (KI) and Lawton scale. Patients were divided into two groups: (1) poor functional capacity, if the patient had less points than the median of the Katz and IADL score, and (2) good functional capacity, if at least one score was above the median. Extremely low weight defined as less than 45kg. We assessed the vital status of 103 patients. Mortality was 38.8% (median 362 [136, 422] days of follow-up). We interviewed 62 patients or proxies. No difference was observed between survivors and non-survivors regarding weight and BMI at intensive care unit admission and nutritional therapy received in the first days of intensive care admission. Patients with poor functional capacity had lower admission weight (43.9 vs 52±7.9kg, p<0.001) and BMI (17±2.1 vs 18.2±1.8kg/cm2, p=0.028). In a multivariate logistic regression, weight under 45kg was independently associated with poor functional capacity (OR=13.6, 95%CI, 3.7 to 66.5) CONCLUSION: Underweight critically ill patients have high mortality and a persistent functional impairment, the last being more important in extremely low weight. ClinicalTrials.gov number NCT03398343.

Long-Term Survival, Functional Capacity, and Quality of Life after Refractory Out-Of-Hospital Cardiac Arrest Treated with Mechanical Circulatory Support

Long-Term Survival, Functional Capacity, and Quality of Life after Refractory Out-Of-Hospital Cardiac Arrest Treated with Mechanical Circulatory Support

DREADD-mediated amygdala activation is sufficient to induce anxiety-like responses in young nonhuman primates

Anxiety disorders are among the most prevalent psychiatric disorders, with symptoms often beginning early in life. To model the pathophysiology of human pathological anxiety, we utilized Designer Receptors Exclusively Activated by Designer Drugs (DREADDs) in a nonhuman primate model of anxious temperament to selectively increase neuronal activity of the amygdala. Subjects included 10 young rhesus macaques; 5 received bilateral infusions of AAV5-hSyn-HA-hM3Dq into the dorsal amygdala, and 5 served as controls. Subjects underwent behavioral testing in the human intruder paradigm following clozapine or vehicle administration, prior to and following surgery. Behavioral results indicated that clozapine treatment post-surgery increased freezing across different threat-related contexts in hM3Dq subjects. This effect was again observed approximately 1.9 years following surgery, indicating the long-term functional capacity of DREADD-induced neuronal activation. [11C]deschloroclozapine PET imaging demonstrated amygdala hM3Dq-HA specific binding, and immunohistochemistry revealed that hM3Dq-HA expression was most prominent in basolateral nuclei. Electron microscopy confirmed expression was predominantly on neuronal membranes. Together, these data demonstrate that activation of primate amygdala neurons is sufficient to induce increased anxiety-related behaviors, which could serve as a model to investigate pathological anxiety in humans.

Long-term reduced functional capacity and quality of life in hospitalized COVID-19 patients.

Persistent symptoms and exercise intolerance have been reported after COVID-19, even months after the acute disease. Although, the long-term impact on exercise capacity and health-related quality of life (HRQoL) is still unclear. To assess the long-term functional capacity and HRQoL in patients hospitalized due to COVID-19. This is a prospective cohort study, conducted at two centers in Brazil, that included post-discharge COVID-19 patients and paired controls. The cohort was paired by age, sex, body mass index and comorbidities, using propensity score matching in a 1:3 ratio. Patients were eligible if signs or symptoms suggestive of COVID-19 and pulmonary involvement on chest computed tomography. All patients underwent cardiopulmonary exercise testing (CPET) and a HRQoL questionnaire (SF-36) 6 months after the COVID-19. The main outcome was the percentage of predicted peak oxygen consumption (ppVO2). Secondary outcomes included other CPET measures and HRQoL. The study sample comprised 47 post-discharge COVID-19 patients and 141 healthy controls. The mean age of COVID-19 patients was 54 ± 14 years, with 19 (40%) females, and a mean body mass index of 31 kg/m2 (SD, 6). The median follow-up was 7 months (IQR, 6.5-8.0) after hospital discharge. PpVO2 in COVID-19 patients was lower than in controls (83% vs. 95%, p = 0.002) with an effect size of 0.38 ([95%CI], 0.04-0.70). Mean peak VO2 (22 vs. 25 mL/kg/min, p = 0.04) and OUES (2,122 vs. 2,380, p = 0.027) were also reduced in the COVID-19 patients in comparison to controls. Dysfunctional breathing (DB) was present in 51%. HRQoL was significantly reduced in post COVID patients and positively correlated to peak exercise capacity. Hospitalized COVID-19 patients presented, 7 months after discharge, with a reduction in functional capacity and HRQoL when compared to historical controls. HRQoL were reduced and correlated with the reduced peak VO2 in our population.

Can the Combination of Rehabilitation and Vitamin D Supplementation Improve Fibromyalgia Symptoms at All Ages?

Several studies have indicated a correlation between vitamin D deficiency and widespread chronic pain syndromes, such as fibromyalgia. During this study, the effect of supplementation with vitamin D in association with physical exercise in patients with fibromyalgia was evaluated, in terms of improvement of pain, functional capacity and quality of life, also evaluating the presence of any differences in age. A single-center, observational, comparative study was conducted in 80 fibromyalgia patients. They are randomized into 2 groups: Group A, consisting of patients ≤50 years; and group B, consisting of patients >50 years. Both received weekly supplementation with 50,000 IU cholecalciferol for 3 months in association with a rehabilitation protocol. Patients were assessed at enrollment (T0), 3 months (T1), and 6 months (T2) from the initial assessment with blood vitamin D dosage and administration of rating scales (NRS, FIQ, and SF-12). From the comparison between the two groups, we have seen that in young people, supplementation with high-dose vitamin D improves short-term musculoskeletal pain and long-term functional capacity. Conversely, musculoskeletal pain and long-term quality of life improve in the elderly. Supplementing with high doses of vitamin D in fibromyalgia patients improves the quality of life and pain in the elderly and also the functional capacity in the young.

Long-term effects of high-intensity interval training, moderate-to-vigorous intensity continuous training and Nordic walking on physical and mental health in patients with coronary artery disease

Abstract Funding Acknowledgements Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Canadian Institutes of Health Research (CIHR) Postdoctoral Fellowship Background/Introduction Twelve weeks of high-intensity interval training (HIIT), moderate-to-vigorous intensity continuous training (MICT) and Nordic walking (NW) have been shown to improve functional capacity, quality of life (QoL) and depression in patients with coronary artery disease (CAD). However, their long-term effects are unknown. Purpose The primary purpose was to compare the long-term effects and sustainability of 12 weeks of HIIT, MICT and NW on functional capacity. The secondary purpose was to assess the long-term effects and sustainability of 12 weeks of HIIT, MICT and NW on QoL and depression severity. Methods Patients with CAD were randomized to a 12-week HIIT, MICT or NW program. Functional capacity, QoL and depression severity were measured at baseline, at the end of 12 weeks of intervention, and following 14 weeks of observation phase (week 26). Functional capacity was measured with a 6-minute walk test (6MWT); QoL was assessed by the HeartQoL and Short-Form-36; and depression severity by the Beck Depression Inventory-II (BDI-II). The long-term effects (changes between baseline and week 26) and sustainability (changes between week 12 and week 26) were assessed by linear mixed models for repeated measures. Results Of 130 participants randomized, 86 (HIIT: n=29, MICT: n=27, NW: n=30) completed week 26 assessments. There were significant improvements in 6MWT distance (F=149.657, p&amp;lt;0.001), QoL and depression severity (both p&amp;lt;0.05) from baseline to week 26; the increase in 6MWT distance was greater for NW when compared to MICT (F=7.021, p=0.010) and HIIT (F=5.279, p=0.025, Figure). Between week 12 and week 26, 6MWT distance (F=10.863, p=0.001) and physical QoL (physical component summary [PCS]; F=4.084, p=0.047) increased significantly, whereas mental QoL significantly decreased (mental component summary [MCS]; F=4.052, p=0.047). Conclusion HIIT, MICT and NW have positive long-term impacts on functional capacity, QoL and depression severity. However, NW was shown to confer additional benefits in increasing long-term functional capacity. The positive effects of the 12-week exercise programs were sustained at week 26 except for mental QoL.

Factors stimulating value micro-businesses attribute to digital marketing technology (DMT) adoption.

Most micro-business managers in Nigeria do not see the adoption of digital marketing technology (DMT) as vital for business. Many consider it as a precondition to support managerial or operational activities, not as a tactical and/or strategic tool. Although most studies focused on large organisations, the outcome of such research may not be appropriate to micro-businesses. This is informed by the negligence of micro-businesses’ idiosyncrasies and their thought of digitalization as a precondition for managerial activities without considering the value small businesses attached to these devices in terms of aiding the use as strategic tools. This renders micro-businesses’ digitalization an under-reflected phenomenon. Yet, studies spend less on examining the factors that specifically stimulate the value micro-businesses attach to these applications, leading to constant adoption and usage. Hence, there is a need for a thorough exploration of the factors that shape the value of digital marketing applications in micro-businesses in Nigeria. The study is qualitative in nature and interviews (unstructured and semi-structured) were carried out with 26 micro-businesses which was drawn purposefully from the online database and underpinned by Technology, Organisation and Environment (TOE) framework. The study revealed eleven (11) critical success factors stimulating value micro-businesses attribute to digital marketing technology (DMT) adoption. These factors include long-term functional capacity, integration capacity, expansion capacity which are related to technology context. Collective capability, collaborative experience are linked to the organisation context while adaptive training, service delivery, customer fulfilment are linked to environmental context. The study also unveiled expectancy context which is linked to budget, growth and profitability and aid in the extension of the TOE framework. This study will be of importance to academics and practitioners because it provides further awareness into DMT adoption framework, factors critical to the DMT adoption and may assist in reducing the number of resources spent in search of information aimed at helping DMT adoption by micro-businesses.

Impacts of reducing fallow periods on indicators of soil function in subtropical dryland farming systems

Seasonal fallows – periods with no living plant cover – are frequently implemented in dryland cropping systems to allow recharge of soil moisture for the subsequent cash crop. Over time, repeated fallow periods deplete soil organic matter, a foundation of soil health that affects the long-term functional capacity of soils. Reducing fallow periods by growing cover crops (non-harvested crops terminated prior to reproductive development), double cropping (increasing the frequency of harvested crops), or rotating to ley pasture for several years, were investigated for their potential to improve or maintain soil functional attributes. These ‘reduced fallow’ systems were compared against a conventional cereal-based production system with seasonal fallows as well as against a permanent fallow. Soil in the reduced fallow systems had higher concentrations of total nitrogen and mineral-associated nitrogen compared with the conventional system and permanent fallow. Reduced fallow systems also had higher concentrations of total organic carbon and mineral-associated carbon than the permanent fallow, but not the conventional system. These changes were associated with greater soil microbial respiration and improved surface soil moisture storage at cash crop planting. The conventional, cover crop and ley pasture systems had similar soil structure with greater abundance of mega-aggregates. In contrast, the double crop system had greater abundance of micro- and macro-aggregates as did the ley pasture systems that were subject to tillage after three years in preparation for a return to cropping. The ley pasture also had substantially greater numbers of root-lesion nematodes (Pratylenchus thornei), surpassing the 2000 nematodes kg-1 threshold for economic damage. The results demonstrate that different methods for reducing fallow periods can generate a range of outcomes that are not uniformly desirable in terms of soil functional attributes. Across the indicators assessed, the cover crop system generated the widest range of improvements in soil fertility and function compared with the conventional system. This suggests cover cropping may be a valuable tool for promoting soil health in subtropical dryland farming systems.

The Fate of the Tricuspid Valve in Rheumatic Mitral Valve Surgery: When and How to Touch?

Objective: Indications for concomitant surgery for tricuspid valve involvement in rheumatic mitral valve surgery is limited in the literature. We aimed to investigate the long-term course of unrepaired tricuspid valves during rheumatic mitral valve surgery in addition to characteristics of surgical technique in tricuspid repair. Methods: The data of all patients who underwent mitral valve replacement due to rheumatic pathology between January 2011 and December 2014 were evaluated. Besides mitral valve replacement, patients were divided into three groups: non-repair (Group I), concomitant tricuspid valve repair either with DeVega annuloplasty (Group II) or ring annuloplasty (Group III). A total of 333 patients were included in the study. Primary outcomes as; the rate of severe tricuspid valve regurgitation in long-term, re-intervention requirement for the tricuspid valve, and long-term functional capacity of the patients were assessed. Results: The mean age was 45.2±9.7 years (min 18, max 60, female 69.1%). Tricuspid valve repair was performed in 178 patients (53.4%). Of them, 100 patients (30%) received De Vega suture annuloplasty, while 78 (23.4%) were treated with the ring annuloplasty. In the late period, severe tricuspid valve regurgitation and the need for reintervention were not observed in group III, also there was a statistically significant difference compared to the other groups (p <0.001 and 0.05; group I and II, respectively). In terms of functional capacity, the incidence of NYHA III and IV in group III was significantly lower in the late-term compared to the other groups(p= 0.02). Conclusions: Simultaneous tricuspid valve surgery should be performed with mitral valve surgery in patients with rheumatic heart disease. The long-term results of ring annuloplasty are superior to the suture (de Vega) annuloplasty for rheumatic tricuspid regurgitation. Table. Long term results according to tricuspid valve intervention type (in surviving patients) Non repair(n=151) TDVA(n=94) Ring annuloplasty(n=75) p-value Follow-up (years) 3.7 (2.3-4.7) 3.7 (2.1-4.2) 3.1 (2.3-4.4) 0.59 NYHA Class III/IV 47 (31.1) 32 (34.0) 12 (16.0) 0.02* Echocardiography findings EF (%) 60 (50-65) 60 (55-65) 60 (50-65) 0.55 LVESD (cm) 3.6 (3.0-4.3) 3.2 (3.0-3.9) 3.2 (3.0-4.0) 0.11 LVEDD (cm) 5.0 (4.6-5.5) 5.0 (4.6-5.2) 4.9 (4.7-5.2) 0.53 LAD (cm) 4.2 (3.9-4.7) 4.5 (4.0-4.8) 4.6 (4.2-5.2) <0.001* PAP (mmHg) 35 (1-45) 35 (35-45) 30 (25-35) <0.001* TR degreeMildModerateSevere 81 (53.6)36 (23.8)23 (15.6) 54 (57.4)28 (29.8)8 (8.5) 39 (52.0)15 (20.0)0 <0.001* Need for reintervention for the tricuspid valve 7 (4.6) 2 (2.1) 0 0.05* EF: ejection fraction, NYHA: New York Heart Association, PAP: pulmonary artery pressure, LAD: left atrium diameter, LVESD: left ventricular end-systolic diameter, LVEDD: left ventricular end-diastolic diameter, TDVA: tricuspid de Vega annuloplasty, TR: tricuspid regurgitation.

Respiratory follow-up of patients with COVID-19 pneumonia

The COVID-19 pandemic has led to an unprecedented surge in hospitalised patients with viral pneumonia. The most severely affected patients are older men, individuals of black and Asian minority ethnicity...

Spinal cord injury causes chronic bone marrow failure

Spinal cord injury (SCI) causes immune dysfunction, increasing the risk of infectious morbidity and mortality. Since bone marrow hematopoiesis is essential for proper immune function, we hypothesize that SCI disrupts bone marrow hematopoiesis. Indeed, SCI causes excessive proliferation of bone marrow hematopoietic stem and progenitor cells (HSPC), but these cells cannot leave the bone marrow, even after challenging the host with a potent inflammatory stimulus. Sequestration of HSPCs in bone marrow after SCI is linked to aberrant chemotactic signaling that can be reversed by post-injury injections of Plerixafor (AMD3100), a small molecule inhibitor of CXCR4. Even though Plerixafor liberates HSPCs and mature immune cells from bone marrow, competitive repopulation assays show that the intrinsic long-term functional capacity of HSPCs is still impaired in SCI mice. Together, our data suggest that SCI causes an acquired bone marrow failure syndrome that may contribute to chronic immune dysfunction.

Five-year impact of ICU-acquired neuromuscular complications: a prospective, observational study.

To assess the independent association between ICU-acquired neuromuscular complications and 5-year mortality and morbidity. To explore the optimal threshold of the Medical Research Council (MRC) sum score, assessing weakness, for the prediction of 5-year outcomes. Sub-analyses of a prospective, 5-year follow-up study including 883 EPaNIC patients (Early versus LateParenteral Nutrition in Intensive Care) (Clinicaltrials.gov:NCT00512122), systematically screened in ICU for neuromuscular complications with MRC sum score ('MRC-cohort', N = 600), electrophysiology on day 8 ± 1 to quantify compound muscle action potential ('CMAP-cohort', N = 689), or both ('MRC&CMAP-cohort', N = 415). Associations between ICU-acquired neuromuscular complications and 5-year mortality, hand-grip strength (HGF, %predicted), 6-min-walk distance (6-MWD, %predicted) and physical function of the SF-36 quality-of-life questionnaire (PF-SF-36) at 5-years were assessed with Cox regression and linear regression, adjusted for confounders. The optimal threshold for MRC at ICU discharge to predict 5-year outcomes was determined by martingale residual plots (survival) and scatterplots (morbidity). Both lower MRC sum score at ICU discharge, indicating less strength [HR, per-point-increase: 0.946 (95% CI 0.928-0.968), p = 0.001], and abnormal CMAP, indicating nerve/muscle dysfunction [HR: 1.568 (95% CI 1.165-2.186), p = 0.004], independently associated with increased 5-year mortality. In the MRC&CMAP-cohort, MRC [HR: 0.956 (95% CI 0.934-0.980), p = 0.001] but not CMAP [HR: 1.478 (95% CI 0.875-2.838), p = 0.088] independently associated with 5-year mortality. Among 205 survivors, low MRC independently associated with low HGF [0.866 (95% CI 0.237-1.527), p = 0.004], low 6-MWD [105.1 (95% CI 12.1-212.9), p = 0.043] and low PF-SF-36 [- 0.119 (95% CI - 0.186 to - 0.057), p = 0.002], whereas abnormal CMAP did not correlate with these morbidity endpoints. Exploratory analyses suggested that MRC ≤ 55 best predicted poor long-term morbidity and mortality. Both MRC ≤ 55 and abnormal CMAP independently associated with 5-year mortality. ICU-acquired neuromuscular complications may impact 5-year morbidity and mortality. MRC sum score, even if slightly reduced, may affect long-term mortality, strength, functional capacity and physical function, whereas abnormal CMAP only related to long-term mortality.

Adequacy of enteral nutritional support in intensive care units does not affect the short- and long-term prognosis of mechanically ventilated patients: a pilot study.

ObjectiveTo correlate short-term (duration of mechanical ventilation and length of intensive care unit stay) and long-term (functional capacity) clinical outcomes of patients who reached nutritional adequacy ≥ 70% of predicted in the first 72 hours of hospitalization in the intensive care unit.MethodsThis was a prospective observational pilot study conducted in an 18-bed intensive care unit. A total of 100 mechanically ventilated patients receiving exclusive enteral nutritional support and receiving intensive care for more than 72 hours were included. Patients who never received enteral nutrition, those with spinal cord trauma, pregnant women, organ donors and cases of family refusal were excluded. The variables studied were nutritional adequacy ≥ 70% of predicted in the first 72 hours of hospitalization, length of intensive care unit stay, duration of mechanical ventilation and the ability to perform activities of daily living after 12 months, assessed via telephone contact using the Lawton Activities of Daily Living Scale.ResultsThe mean duration of mechanical ventilation was 18 ± 9 days, and the mean intensive care unit length of stay was 19 ± 8 days. Only 45% of the patients received more than 70% of the target nutrition in 72 hours. There was no association between nutritional adequacy and short-term (duration of mechanical ventilation, length of stay in the intensive care unit and mortality) or long-term (functional capacity and mortality) clinical outcomes.ConclusionCritically ill patients receiving caloric intake ≥ 70% in the first 72 hours of hospitalization did not present better outcomes in the short term or after 1 year.

Femoral nerve catheter vs local infiltration for analgesia in fast track total knee arthroplasty: short-term and long-term outcomes

BackgroundThe aim was to compare the effects on short-term and long-term pain and functional outcome of periarticular local anaesthetic infiltration (LIA) with LIA of the posterior knee capsule in combination with a femoral nerve block (FNB) catheter in patients undergoing total knee arthroplasty. MethodsEighty patients were randomised to one of two groups: Subjects in group LIA received periarticular LIA with ropivacaine 0.2% for postoperative analgesia; subjects in group FNB received LIA of the posterior capsule and a FNB catheter. The primary outcome parameter was functional capacity of the knee 12 months after surgery. Secondary parameters included mobility as determined by accelerometer data, pain, satisfaction with the analgesic regimen, hospital length of stay, and use of pain medication 3 and 12 months after surgery. ResultsThere were no differences between groups in long-term functional capacity, patient satisfaction and hospital length of stay. In the first 2 days, subjects in group FNB had slightly lower pain scores and used less opioids, and subjects in group LIA had a higher level of accelerometer activity. Three and 12 months after surgery, subjects in group FNB had lower maximum pain scores and were less likely to use any pain medication 12 months after surgery. ConclusionsBoth techniques were similar regarding long-term functional outcome. Subjects in group FNB had slightly lower pain scores and lower opioid consumption after operation, lower maximum pain scores at 3 and 12 months, and were less likely to use any pain medication at 12 months. Clinical trial registrationNCT01966263.