Medical Research Council Scale Research Articles

The effect of preoperative deep breathing exercise with incentive spirometer initiated in the preoperative period on respiratory parameters and complications in patients underwent open heart surgery: a randomized controlled trial

BackgroundIncentive spirometer is used in lung expansion therapy to maintain alveolar patency and improve pulmonary volumes in postoperative cardiac surgical patients. Deep breathing exercises with an incentive spirometer significantly reduce the development of postoperative pulmonary complications after open-heart cardiac surgery.AimTo determine the effect of deep breathing exercises with an incentive spirometer initiated in the preoperative period on respiratory parameters and complications in patients who underwent open-heart surgery.MethodsThis randomized controlled study was conducted with a total of 66 participants. The participants were randomized into a deep breathing group (n = 32) and a control group (n = 34). The control group received hospital routine physiotherapy, and the deep breathing group started to perform deep breathing exercises with an incentive spirometer in the preoperative period. Data were collected with the Sociodemographic and Medical Data Form and Patient Follow-up Form (respiratory rate, oxygen saturation (SpO2) level, arterial blood gas parameters and posteroanterior chest X-ray were monitored with this form prepared by the investigators). The Medical Research Council Scale was used to determine the severity of dyspnea in the patients included in the study. Primary outcomes included respiratory rate, oxygen saturation, arterial blood gas parameters, posteroanterior chest X-ray, and evaluation of postoperative pulmonary complications development. Secondary outcomes included the mechanical ventilation time, length of intensive care unit stay, and length of hospital stay.ResultsThe incidence of postoperative pulmonary complications was 3.1% and 23.5% (p < 0.05) in the deep breathing and control groups, respectively. The mechanical ventilation time, length of hospital stay, and length of stay in the intensive care unit were significantly shorter in the deep breathing group (p < 0.05). In the deep breathing group, the mean SpO2 values evaluated before surgery, on the first day in the Cardiovascular Surgery Unit, and on the day of discharge were significantly higher than the control group (p < 0.05).ConclusionDeep breathing exercises with an incentive spirometer initiated in the preoperative period contribute to a reduction in postoperative pulmonary complication rates, shortening of mechanical ventilation time, length of stay in the intensive care unit, length of hospital stay, and improvement of pre- and postoperative oxygenation.Trial registrationThe trial was registered on June 17, 2022, at https://www.clinicaltrials.gov/, registration number NCT05428722.

Functional Independence and Elbow Strength in Tetraplegia: Analysis of Tendon Transfers

Background Over half of spinal cord injuries result in tetraplegia, profoundly impairing daily activities (ADLs). Objective To evaluate biceps-to-triceps (B-T) and deltoids-to-triceps (D-T) tendon transfers, comparing their impacts on elbow extension strength and ADL independence. Methods Retrospective review of tendon transfers performed between 2003 and 2023 at a neurorehabilitation center. Post-surgery muscle strength was assessed using the Medical Research Council (MRC) scale and ADL independence with the motor Functional Independence Measure (mFIM). We used ANOVA to identify post-surgery associations between MRC achieved scores and performance in ADLs. Results A total of 34 individuals (42 arms) underwent B-T or D-T surgeries, predominantly at C5 level (66.7%) with 69.0% classified as AIS A. Post-surgery, 81% of B-T and 76.2% of D-T achieved antigravity elbow extension (MRC 3–4), with mean MRC scores of 3.2 for both groups. The B-T group, older at surgery (39.9 vs. 27.8 years) and with shorter time since injury to surgery (2.3 vs. 5.0 years), showed significant post-surgery improvements in Self-care, Transfers, Locomotion, and total mFIM. In contrast, significant associations between MRC scores and mFIM outcomes in D-T transfers involved Self-care, Sphincter control, Transfers, and total mFIM. Conclusions MRC scores and ADLs were positively impacted by rehabilitation tendon transfers.

Assessment of upper GI motor activity and GI symptoms in patients with amyotrophic lateral sclerosis: an observational study.

Oro-pharyngeal dysfunction has been reported in Amyotrophic Lateral Sclerosis (ALS). We aimed to assess ALS patients upper gastrointestinal (GI) motor activity and GI symptoms according to bulbar and spinal onset and severity of ALS. ALS bulbar (B) and spinal (S) patients with ALS Functional Rating Scale (ALSFRS-r) ≥35, bulbar sub-score ≥10, and Forced Vital Capacity (FVC) >50%, underwent to: Fiberoptic Endoscopic Evaluation of Swallowing (FEES); esophageal manometry; gastric emptying; Rome symptom questionnaire. Medical Research Council Scale for Muscle Strength (MRC) was performed for the upper and lower limbs. Mann-Whitney's U, Fisher's ranks test, Pearson's test was used. Thirteen ALS patients were included (6 F; mean age 61.2 ± 13.7 years, range: 37-87), 5 with B and 8 with S onset (ALSFRS-R score 39.5 ± 4.9, MRC score 128.6 ± 23.3, disease duration 22.8 ± 17.9 months). FEES detected a high dysphagia score in 5 patients with no difference between S and B phenotype. Lower esophageal sphincter pressure was normal in all patients. Esophageal dysmotility was observed in three S and two B onset patients. Upper esophageal sphincter (UES) pressure was higher in all ALS patients. UES spasms and delayed gastric emptying were detected in two B and one S and in two B and four S patients, respectively. There was no correlation between esophagogastric motor abnormalities and clinical characteristics of ALS, nor GI symptoms. The presence of UES spasm and the delayed gastric emptying in a subgroup of ALS patients may suggest the role of ANS dysfunction in ALS.

The Feasibility of non-motorized Treadmill Training on Lower Extremity Muscle Strength, Balance, and Gait in Patients with Stroke: A Pilot Study

Background Non-motorized treadmills have been used for health improvement in healthy individuals and for enhancing physical fitness in athletes. However, there is a lack of research focusing on their use with patients with stroke. Objective This study aims to assess the impact of non-motorized treadmill training on lower limb strength, balance, and gait in patients with stroke, and compare it with flat ground walking training. Methods The participants included 22 patients with stroke, divided into two groups: non-motorized treadmill training group ( n = 11) and flat ground walking training group ( n = 11). All participants underwent 20 training sessions, 30 min each, five times a week for four weeks. Outcome measures included the digital dynamometer, Medical Research Council scale (MRC), Berg Balance Scale (BBS), Four Square Step Test (FSST), 6-Minute Walk Test (6MWT), and GAITRite. Results The non-motorized treadmill training group showed significant improvements compared to the flat ground walking group in hip abductor and extensor muscle strength, knee flexor and extensor muscle strength, MRC, BBS, FSST, 6MW and gait parameters ( p &lt; 0.05). Conclusions Non-motorized treadmill training may be considered an effective gait rehabilitation method in clinical settings for patients experiencing stroke with reduced lower limb strength, balance, and walking ability.

Addressing inhaler technique challenges in cognitively impaired chronic obstructive pulmonary disease patients: the impact of customized training programs.

Individuals with chronic obstructive pulmonary disease (COPD) and cognitive impairment (CI) often face difficulties accurately administering inhalers, which are essential for managing their respiratory condition. Many elderly individuals make major errors that prevent proper medicine administration. Maintaining proper inhaler use skills is critical in controlling COPD. Our goal was to examine and evaluate the inhaler use skills of CI patients with COPD during both the initial evaluation and subsequent appointments. The Respiratory Department of KLEs Dr. Prabhakar Kore Hospital and Medical Research Centre, Nehru Nagar, Belagavi, Karnataka, India, was the site of this prospective interventional study. Based on the Montreal Cognitive Assessment Scale (MoCA), a subset of patients with COPD exhibited mild CI. Patients exhibiting improper inhaler-using skills were detected, corrected, and trained. Inhaler techniques were reassessed immediately and at follow-up visits. The modified Medical Research Council scale score (mMRC), COPD assessment test (CAT) score, St. George Respiratory Questionnaire (SGRQ), and pulmonary function tests were reassessed. A total of 56 COPD and CI patients who had made at least one significant mistake when using an inhaler device were added to the study. The mean age was 66.89±9.85 years. When evaluated with MoCA, the mean score was 17.02±3.91. At baseline, the mean number of mistakes was 1.38±0.93, which decreased to 0.54±0.57 after face-to-face demonstration of correct inhaler techniques. Correlational analysis revealed MoCA scores were negatively associated with the number of mistakes (r=-0.344). At follow-up, CAT score (25±5.61 vs. 18.48±5.24 p=0.001), SGRQ score (53.82±20.59 vs. 37.61±22.17 p=0.001), mMRC score (3.21±0.76 vs. 3.20±0.75 p=0.001), and forced expiratory volume in 1 second/forced vital capacity score (66.86±9.35 vs. 70.08±9.07 p=0.001) had significantly improved in patients demonstrating the correct technique. Pharmacist-led interventions demonstrated improvements in health-associated quality of life and therapeutic outcomes for individuals with COPD and CI. The study highlighted the importance of cognitive evaluation in routine COPD therapy, identifying potential impediments to effective therapy, and offering face-to-face presentations of inhaler techniques. The best inhalers and methods for COPD patients experiencing CI should be further investigated, according to the study.

A case series on combining repetitive transcranial magnetic stimulation with conventional rehabilitation therapies for upper limb motor-function restoration

This case series reports the integration of repetitive transcranial magnetic stimulation (rTMS) with conventional rehabilitation therapies in three early subacute ischemic stroke patients with upper limb motor impairment. In Malaysia, data on the combination of rTMS with intensive rehabilitation for stroke patients remains limited. The three patients with completely paretic upper limb, began therapy on post-stroke day 20, 16, and 15, respectively. They received rTMS sessions with inhibitory protocols targeting the contralesional primary motor area (M1) at 1 Hz, 5 days per week for 2 weeks (10 sessions). Each session included 1800 pulses at 120% resting motor threshold for 40 minutes, followed by 60 minutes of upper limb motor-function training. Outpatient occupational therapy was then continued for 3 months. All patients showed neurological and functional recovery as measured by the Medical Research Council scale and Fugl-Meyer Assessment-Upper Extremity Motor. The gains were observed immediately after the 10 rTMS sessions and persisted at 3 months post-stroke. Furthermore, all patients also achieved total independence in daily activities, with Modified Barthel Index scores of 99-100. No serious adverse events were reported. This case series suggests that combining rTMS with conventional rehabilitation therapies during the early subacute phase may enhance upper limb motor function recovery in stroke patients.

Multimodal Inpatient Prehabilitation Prior to Heart or Lung Transplantation in a Latin American Transplant Reference Center.

Whether the implementation of a multimodal prehabilitation program is effective and safe for high-risk heart or lung transplantation candidates, whose condition prevents hospital discharge, is unclear. We conducted a retrospective study at a cardiothoracic transplant center in Chile. Two cohorts of hospitalized patients listed for heart or lung transplant were studied: the first underwent traditional (historical) and nonstructured prehabilitation, and the second underwent protocol-driven multimodal prehabilitation (MP). Adverse events and preoperative functional changes in the MP group were documented, as well as comparative postoperative outcomes between both cohorts. Between 2018 and 2023, 24 transplant recipients were analyzed. During the MP phase, significant improvement was observed in Medical Research Council scale (52.0 ± 7 to 58.7 ± 3; P = .042), sit-to-stand test (7.1 ± 7 to 15.9 ± 6; P = .018), and euthymic state (from 4 to 10 patients; P .036), without reported adverse events. Postoperatively, MP group demonstrated faster standing (1.9 ± 0.7 vs 1.3 ± 0.5 days; P = .05) and sitting times (2.0 ± 0.7 vs 1.2 ± 0.5 days; P = .007), with more early extubations (3 vs 11; P = .003) in comparison to the historical prehabilitation cohort. In this small retrospective study, MP in hospitalized patients awaiting heart or lung transplantation appears to be safe and associated with improvements in pre- and postoperative outcomes.

Time to Recovery of Radial Nerve Palsy After Surgically Treated Humeral Shaft Fractures.

The purpose of this study was to report a timeframe for neurologic recovery of complete radial nerve palsies in patients with humeral shaft fractures treated with internal fixation. We retrospectively analyzed the data of patients who underwent surgical treatment of a humeral shaft fracture between 2016 and 2021 at a level I trauma center. Patients with complete sensory and motor radial nerve palsy were identified. The time elapsed until detection of the first clinical signs of neurologic recovery, and then until full function (M5 according British Medical Research Council scale) was measured. Of 32 radial nerve palsies in 471 surgically treated humeral shaft fractures (6.8%), 17 were recorded at the time of injury and 15 were noted after surgery. Median patient age was 31.5 years (range, 19-58 years). Thirty patients recovered full motor function at a median time of 36 weeks (range, 6-83 weeks). Kaplan-Meier analyses showed that 90.6% of patients presented the first signs of nerve recovery in the initial 6 months of observation. At 12 and 18 months of follow-up, 84.3% and 94% of patients, respectively, had recovered full function of the hand and wrist. Surgically treated humeral shaft fractures associated with radial nerve palsies are expected to show signs of neurologic recovery during the first 6 months and should recover completely after 12 months of follow-up in almost all cases. Prognosis II.

A cross-sectional and longitudinal evaluation of serum creatinine as a biomarker in spinal muscular atrophy.

Spinal muscular atrophy (SMA) is an autosomal recessive neuromuscular disease characterized by proximal muscle weakness and atrophy. The increasing availability of disease-modifying therapies has prompted the development of biomarkers to facilitate clinical assessments. We explored the association between disease severity and serum creatinine (Crn) levels in SMA patients undergoing up to two years of treatment with nusinersen. We measured serum Crn levels and assessed function performance using the Hammersmith Functional Motor Scale-Expanded (HFMSE), Medical Research Council Scale (MRC), 6-Minute Walk Test (6MWT), ulnar Compound Muscle Action Potential (CMAP), and forced vital capacity (FVC) in a cohort comprising 28 adolescent and adult patients with SMA. The association between Crn and disease severity was investigated through partial rank correlation analysis and linear mixed models while accounting for age, gender, and BMI. Linear models were employed to predict functional performance. 28 SMA patients and 28 gender- and age-matched healthy controls (HCs) were included, resulting in a dataset of 185 visits. Compared to HCs, SMA patients exhibited significantly lower Crn values ​​(67.4 ± 14 vs. 23.7 ± 14.8 umol/L, p<0.0001). After adjusting for age, sex, and BMI, Crn showed positive correlations with the HFMSE (p<0.0001, r = 0.884), MRC (p<0.0001, r = 0.827), FVC (p = 0.002, r = 0.730), and ulnar CMAP (p<0.0001, r = 0.807). Patients with SMN2 copy number ≥ 4 had nearly twice as high Crn levels as those with SMN2 copy number < 4 (34.1 ± 3.75 vs. 17.2 ± 2.52 umol/L, p = 0.00145). Ambulant SMA patients had more than double the Crn levels compared to non-ambulant ones (32 ± 2.33 vs. 12.9 ± 2.38 umol/L, p<0.0001). Furthermore, Crn explained that up to 83.5% of the variance in functional performance measured by HFMSE, MRC, and 6MWT was significantly higher than that of traditional biomarkers. These findings suggest that Crn may be a potential biomarker for assessing disease severity in adolescents and adults with SMA, demonstrating its promise in clinical applications.

Risk factors of disease severity and mechanical ventilation requirement in childhood Guillain-Barré Syndrome.

This study aimed to investigate the risk factors associated with the severity of the disease, the need for mechanical ventilation (MV) and poor prognosis in the early stages of Guillain-Barré Syndrome (GBS). Data of children who met GBS diagnostic criteria were evaluated retrospectively. The sample was divided into three binary subgroups according to severe GBS (Hughes Functional Grading Scale [HFGS] ≥ 4 at admission), mechanical ventilation (MV) requirement, and poor prognosis (inability to walk independently, HFGS ≥ 3 after six months). Various clinical, laboratory and electrophysiological parameters were compared between these subgroups. The mean age of 63 children with GBS was 91.55±49.09 months. 13 (20.6%) patients required MV and 4 (6.3%) patients died. Associated risk factors for the need for MV in severe GBS were found to be autonomic dysfunction, bulbar palsy, sensory impairment, lowest total Medical Research Council (MRC) scale for muscle strength score at admission, high modified Erasmus GBS respiratory failure score (mEGRIS), high neutrophil-lymphocyte ratios (NLR) and high systemic immune-inflammation index (SII) values (p<0.001, p=0.003, p=0.033, p<0.001, p<0.001, p=0.037 and p=0.042, respectively). The lowest total MRC scale for muscle strength score at admission was a significant indicator of poor prognosis (p<0.001). Autonomic dysfunction, bulbar palsy, sensory impairment, lowest total MRC scale for muscle strength score at admission, high mEGRIS score, high NLR and SII values are potential risk factors for the need for MV in children with severe GBS. The lowest total MRC scale for muscle strength score at admission was associated with poor prognosis.

Trajectory and determinants of intensive care unit-acquired weakness in critical illness: A multicentre, prospective, longitudinal study.

Intensive care unit-acquired weakness (ICU-AW) is prevalent and adversely affects patient outcomes. Muscle strength progression and response to rehabilitation differ across ICU populations. However, the trajectories, determinants and prognoses of muscle strength changes remain unclear. This study aimed to investigate the trajectory and determinants of ICU-AW in critical illness and its impact on 60-day postadmission mortality. A multicentre prospective cohort study was conducted, involving critically ill patients from 10 ICUs across five tertiary hospitals in Fujian Province, China. Patients were evaluated using the Medical Research Council (MRC) scale at three time points: within 48 h of ICU admission or within 24 h of regaining consciousness (T1), within 24 h of ICU discharge (T2) and at the time of hospital discharge (T3). The latent class growth mixed model was utilized for data analysis, and multivariable logistic regression was employed to examine the determinants of muscle strength trajectories. This study encompassed 343 patients from five tertiary hospitals. Three latent trajectory groups were identified: a low-level decline group (5.83%), a medium-level stability group (25.36%) and a high-level recovery group (68.81%). Multivariable logistic regression revealed that Charlson comorbidity index (CCI) and alcohol consumption significantly influenced the trajectory of muscle strength development in ICU patients (p < .05). The mortality rate at 60 days was significantly higher in both the low-level decline and medium-level stability groups compared with the high-level recovery groups (p < .05). This study identified three muscle strength trajectories in ICU patients: low-level decline, medium-level stability and high-level recovery. CCI and alcohol consumption significantly influenced these trajectories. The lower 60-day mortality rate in the high-level recovery group underscores the need for early intervention and tailored care. Developing targeted rehabilitation strategies for those at risk of low-level decline or medium-level stability group is challenging and may potentially improve recovery and outcomes.

Bihemispheric Transcranial Direct Current Stimulation over Primary Motor Cortex Potentiates Improvement of Neurological but not Upper Limb Motor Functions in Ischemic Stroke Patients Treated with Routine Physical Therapy: A Randomized, Double-Blind, Sham-Controlled Trial.

We investigated the therapeutic effect of transcranial direct current stimulation (tDCS) combined with routine physiotherapy on the neurological and upper limb motor function in ischemic stroke patients with hemiplegia. In a Randomized double-blind controlled trial study, 52 eligible stroke patients were assigned to real tDCS receiving bihemispheric electrical current with 1.5 mA for 30 minutes over the primary motor cortex, and sham tDCS with a current intensity of 0.5 mA for 30 seconds. Both groups received routine physiotherapy, 5 sessions per week for two weeks. The National Institute of Health Stroke Scale (NIHSS) and the Medical Research Council Scale for Muscle Strength were used to assess the neurological and upper limb motor functions, respectively. Both therapeutic approaches begot a significant improvement in upper limb motor function and neurological impairment at the last session of therapy and follow-up study. However, the treatment-induced neurological amelioration at the last session of therapy in real tDCS was significantly more than sham, especially in those identified as female and under 60 years old. A gender and age-specific protocol of real tDCS combined with routine physiotherapy might be beneficial to improve neurological impairment but not upper limb motor dysfunction after stroke.

Evaluate Effect of Mirror Therapy on Upper Limb Motor Functions Among Patients with Stroke

Stroke sometimes called as a brain attack occurs when a clot blocks the blood supply to the brain or when a blood vessel in the brain bursts. Mirror therapy reduce spasticity, muscle pain, improve muscle strength and improves patient quality of life. In which inversion of visual feedback leads to additional activation of hemisphere contralateral to the perceived limb laterally. Sample size is 60 in which 30 samples covered for experimental group, 30 samples covered for control group and Non probability purposive sampling technique used. Medical research council (MRC) scale acts as a tool for measuring the level of muscle strength. The percentage distribution of muscle strength scores reveals that stroke patients in experimental group had significant resistance whereas in control group had no resistance in the muscle strength level. The findings of the study shows the significance difference between the mean and standard deviation of post test muscle strength scores of stroke patients of experimental and control group using ‘t’ test. The obtained ‘t’ value 5.887 is greater than table value 2.05 at 29 DF in 0.05 level of significance. Therefore the obtained ‘t’ value is found to be significant.

COMPARATIVE EFFECTIVENESS OF SENSORY-MOTOR INTEGRATION AND ROODS APPROACH ON SENSORY AND MOTOR ABNORMALITIES IN PATIENT WITH DIABETIC POLYNEUROPATHY

Background: Diabetic sensory-motor polyneuropathy causes a gradual loss of vibratory, thermal, tactile, and proprioceptive sensations, alongside motor symptoms such as reduced ankle reflexes, mild foot drop, and lower limb weakness, leading to functional limitations like frequent tripping and impaired pincer grasp. Effective therapeutic strategies are essential for managing these symptoms to enhance patients' quality of life. This study investigates the comparative effectiveness of sensory-motor integration and the Rood approach in managing diabetic polyneuropathy symptoms. Objective: To compare the effects of sensory-motor integration and the Rood approach in improving sensory and motor functions in patients with diabetic polyneuropathy. Methods: This single-blinded, randomized clinical trial included 64 patients with diabetic polyneuropathy recruited from Allied Hospital Faisalabad and Madina Teaching Hospital. Patients were randomly assigned to either a sensory-motor integration group or a Rood approach group. Both groups received 6 weeks of therapy, with three sessions per week. Sensory function was assessed using the Michigan Neuropathy Screening Instrument (MNSI), muscle strength via the Medical Research Council (MRC) scale, and functional mobility with the Walking Impairment Questionnaire (WIQ). Pre- and post-treatment data were analyzed using SPSS 20.0. Results: The Rood approach group demonstrated a significant improvement in MNSI History scores, decreasing from a mean of 9.26 ± 2.33 pre-treatment to 5.68 ± 1.49 post-treatment. The sensory-motor integration group showed a mean decrease from 10.21 ± 1.65 to 8.42 ± 1.43. For MRC scale scores, the Rood group improved from 46.95 ± 3.98 to 51.52 ± 3.67, while the sensory-motor integration group rose from 44.79 ± 4.05 to 46.63 ± 4.99. WIQ scores in the Rood group increased from 52.16 ± 9.19 pre-treatment to 62.47 ± 8.42 post-treatment, outperforming the sensory-motor integration group, which rose from 51.63 ± 6.63 to 54.26 ± 6.70. Conclusion: Both sensory-motor integration and the Rood approach significantly improved sensory and motor function in diabetic polyneuropathy patients. However, the Rood approach was more effective across all measured parameters, suggesting it as a preferable option for enhancing functionality and quality of life in this patient population.

Repair of Radiation Ulcers After Breast Cancer Surgery With Simple Local Random Flaps.

Radiation ulcers that develop after breast cancer surgery are mainly repaired with pedicled flaps or free flaps rather than local random flaps or skin grafts due to large skin defects and poor wound healing. Complicated surgical techniques and donor site reconstruction increase the risk of failure. We report our experience of using the local random long neck reading man flap (LNRMF) to cover large chest wall radiation ulcers, achieving good outcomes. Eight patients who developed chest radiation ulcers after breast cancer surgery and were treated between January 2024 and June 2024 were included. The duration of the wounds ranged from 8 to 35 days. Necrotic and ischemic tissues were completely surgically removed, and subsequent wounds were repaired with LNRMFs. The wounds ranged from 6 cm × 8 cm to 15 cm × 16 cm in size. Visual analog scale scores were recorded during therapy. Eight patients healed well after the first stage. The sutures were removed 10-17 days (average, 12.63 days) after surgery, and no infections, necrosis, or necrotic skin flaps were observed. The average Visual analog scale score was 2.5. The follow-up period was 2-6 months (mean, 4.7 months). Slight linear scarring was observed, and no limitations in shoulder elevation were observed in seven patients; however, 1 patient had slightly limited shoulder elevation. The average SCAR scale score was 3.88, and all sensation scores (according to the Medical Research Council scale) were S3+. LNRMFs are easily created and effectively repair secondary wounds that develop after the resection of radiation ulcers that develop after breast cancer surgery and large skin defects. These flaps can be widely used and should be promoted at the grassroots level.

Delirium and Weakness Acquired in the Intensive Care Unit: Individual and Combined Effects on 90-Day Mortality in Survivors of Critical Illness.

To compare the individual and combined effects on 90-day mortality among four critically ill survivor groups: normal (without ICU-acquired delirium or ICU-acquired weakness), delirium-only (with ICU-acquired delirium only), weakness-only (with ICU-acquired weakness only) and delirium-weakness (combined ICU-acquired delirium and weakness). A prospective cohort study consecutively recruited delirium-free critically ill patients admitted to six medical ICUs at a university hospital. Delirium was assessed once daily for 14 days (or until death or ICU discharge) using the Confusion Assessment Method for the ICU. Participants who were discharged from the ICUs were assessed for weakness using the Medical Research Council scale. A summed score below 48 defines ICU-acquired weakness. These survivors were evaluated again for 90-day mortality. The study is reported using the STROBE checklist. Delirium developed in 107 (43.2%) participants during their first 14 days of ICU stay; 55 (22.2%) met criteria for weakness by ICU discharge. Participants with delirium were at increased risk for also developing ICU-acquired weakness, and the 90-day mortality was 18.2%. Independent of age and Acute Physiology and Chronic Health Evaluation II score at ICU admission, delirium-only and weakness-only were not associated with higher 90-day mortality, while participants in the delirium-weakness group had a 3.69-fold higher risk of death, compared to those who were normal during the ICU stay. A non-significant interaction was found, suggesting the joint effect of delirium and weakness on mortality is not higher than the sum of both effects individually. Mortality is substantially high among critically ill survivors who experience both delirium and weakness, although no additive effect on mortality was observed when these conditions occur together. Our findings highlight the urgent need to optimise ICU care by prioritising the prevention, early identification and management of these two common ICU-acquired conditions. Study participation and completion of all assessments. ClinicalTrials.gov identifier: NCT04206306.

The Benefits of a Rehabilitation Program Following Medial Patellofemoral Ligament Reconstruction.

The medial patellofemoral ligament (MPFL) is critical for patellar stability. This study investigates the efficacy of a one-year physical therapy rehabilitation program following MPFL reconstruction using Synthetic Graft (SG) and Quadriceps Tendon Autograft (QTA). Thirty-five patients aged 18-38 underwent MPFL reconstruction (20 SG, 15 QTA). They participated in a structured rehabilitation program to improve their range of motion (ROM), muscle strength, pain management, and overall quality of life (QoL). The program included physiotherapy and MLS laser, Game Ready Therapy, EMS, TENS, TECAR, and lymphatic drainage. Before and after the program, assessments included knee flexion and extension using goniometry, muscle strength via the Medical Research Council (MRC) scale, knee circumference, pain intensity on the Visual Analogue Scale (VAS), and QoL with the EQ-5D instrument. Significant improvements were observed in knee flexion (37.57° vs. 114.71°, p < 0.001), muscle strength (MRC scale 1-4 points vs. 4-5 points, p < 0.001), and pain reduction (VAS 6.66 vs. 0.46, p < 0.001). The functional coefficient of mobility and QoL scores also markedly increased. Patients with QTA improved some parameters better than those with SG. These findings support the effectiveness of a comprehensive rehabilitation program in enhancing knee functionality, reducing pain, and improving QoL post-MPFL reconstruction. Personalized rehabilitation protocols are recommended to optimize recovery outcomes.

Preoperative nTMS analysis: a sensitive tool to detect imminent motor deficits in brain tumor patients.

One of the challenges in surgery of tumors in motor eloquent areas is the individual risk assessment for postoperative motor disorder. Previously a regression model was developed that permits estimation of the risk prior to surgery based on topographical and neurophysiological data derived from investigation with nTMS (navigated Transcranial Magnetic Stimulation). This study aims to analyze the impact of including additional neurophysiological TMS parameters into the established risk stratification model for motor outcome after brain tumor surgery. Biometric and clinical data of 170 patients with glioma in motor eloquent areas were collected prospectively. In addition, the following nTMS parameters were collected bihemispherically prior to surgery: resting motor threshold (RMT), recruitment curve (RC), cortical silent period (CSP) and a nTMS based fibertracking to measure the tumor tract distance (TTD). Motor function was quantified by Medical Research Council Scale (MRCS) preoperatively, seven days and three months postoperatively. Association between nTMS parameters and postoperative motor outcome was investigated in bivariate and multivariable analyses. The bivariate analysis confirmed the association of RMT ratio with the postoperative motor outcome after seven days with higher rates of worsening in patients with RMT ratio > 1.1 compared to patients with RMT ratio ≤ 1.1 (31.6% vs. 15.1%, p = 0.009). Similarly, an association between a pathological CSP ratio and a higher risk of new postoperative motor deficits after seven days was observed (35.3% vs. 16.7% worsening, p = 0.025). A pathological RC Ratio was associated postoperative deterioration of motor function after three months (42.9% vs. 16.2% worsening, p = 0.004). In multiple regression analysis, none of these associations were statistically robust. The current results suggest that the RC ratio, CSP ratio and RMT ratio individually are sensitive markers associated with the motor outcome 7days and 3months after tumor resection in a presumed motor eloquent location. They can therefore supply valuable information during preoperative risk-benefit-balancing. However, underlying neurophysiological mechanisms might be too similar to make the parameters meaningful in a combined model.

Expression of Epithelial Alarmin Receptor on Innate Lymphoid Cells Type 2 in Eosinophilic Chronic Obstructive Pulmonary Disease.

Studies have shown that eosinophilic COPD (eCOPD) is a distinct phenotype of the disease. It is well established that innate lymphoid cells are involved in the development of eosinophilic inflammation. Interleukin(IL)-25, thymic stromal lymphopoietin (TSLP) and IL-33 are a group of cytokines produced by epithelium in response to danger signals, e.g., cigarette smoke, and potent activators of ILC2s. In the present study, we examined circulating and sputum ILC2 numbers and expression of intracellular IL-5 as well as receptors for TSLP, IL-33 and IL-25 by ILC2s in non-atopic COPD patients with and without (neCOPD) airway eosinophilic inflammation and healthy smokers. In addition, we examined the association between ILC2s and clinical indicators of COPD burden (i.e., symptom intensity and risk of exacerbations). ILC2s were enumerated in peripheral blood and induced sputum by means of flow cytometry. We noted significantly greater numbers of airway IL-5+ILC2s and TSLPR+ILC2s in eCOPD compared with neCOPD (p < 0.05 and p < 0.01, respectively) and HSs (p < 0.001 for both). In addition, we showed that IL-5+ILC2s, IL-17RB+ILC2s and ST2+ILC2s are significantly increased in the sputum of eCOPD patients compared with HSs. In all COPD patients, sputum ILC2s positively correlated with sputum eosinophil percentage (r = 0.48, p = 0.002). We did not find any significant correlations between sputum ILC2s and dyspnea intensity as measured by the modified Medical Research Council scale (mMRC) and symptom intensity measured by the COPD Assessment Test (CAT). These results suggest the involvement of epithelial alarmin-activated ILC2s in the pathobiology of eosinophilic COPD.

An Exploratory Study on the Effects of Souchard Postural Gymnastics in Parkinson's Disease Patients with Camptocormia: A Quasi-Experimental Approach.

Background/Objective: Parkinson's disease (PD), a prevalent neurodegenerative disorder, leads to motor and non-motor impairments, affecting quality of life. Camptocormia can be one of the motor signs of PD, characterized by a severe and abnormal forward flexion of the thoracolumbar spine that typically occurs when walking or standing. The following study aims to verify whether postural gymnastics can be an effective treatment for trunk control, balance, activities of daily living, and general well-being in patients with early-stage PD and camptocormia. Methods: Nine participants (mean age 67.7 ± 7.8) with early PD (Hoehn and Yahr Scale ≤ 2) received 10 biweekly physiotherapy sessions. Outcomes were measured using the Parkinson's Disease Questionnaire (PDQ-39) and Berg Balance Scale (BBS) along with trunk mobility and muscle tests according to the Medical Research Council (MRC) scale. Results: Statistically significant results were noted in the PDQ-39 mobility, ADLs and emotional well-being subscales and in the BBS; statistically significant improvements were also seen in trunk mobility and muscle strength. Conclusions: This study shows that the postural gymnastic treatment, according to Souchard, in patients with PD's camptocormia has obtained good results and has the potential timprove mobility and balance, encouraging and motivating patients in their rehabilitation journeys.