Non-improved Group Research Articles

The role of extracranial carotid duplex in predicting functional outcome in first time lacunae strokes

ABSTRACT Background Stroke is the third largest cause of death both worldwide and in Taiwan. Among the various stroke subtypes, lacunae strokes account for 20 to 30% of the total stroke population. Through vigorous risk control factors, the effective prevention and the long-term functional outcome remains are yet to be investigated. Carotid duplex is a non-invasive neuroimaging modality that is routinely applied to stroke patients. In the current research, we correlate baseline carotid duplex examination parameters with functional outcome assessment in an attempt to ascertain important variables for early outcome prediction. Method We retrospectively recruited lacunae ischemic stroke patients from the Department of Neurology, Changhua Christian Hospital. Patient baseline demographics, biochemistry, neuroimaging, and outcome assessments were thoroughly evaluated via a modified Rankin Scale (mRS), NIHSS, and Barthel index scores, both prior and subsequent to patient discharge for a period of up to one year. Patients were divided into two groups based on their functional recovery status. This current study utilizes the Kaplan–Meier method to draw the survival curve and adopts the Cox proportional hazards model to estimate the hazard ratio between the two groups. The risk modeling method is also applied to formulate the best fit in seeking and identifying the variables, which has the most impact on determining theoutcome predictor. All statistical analyses were performed using R for Windows (version 3.6.3), with p < 0.05 meaning statistical significance and 0.05 < p < 0.1 denoting marginal statistical significance. Results One hundred forty-one ischemic lacunae stroke patients are included in the study, of which the follow-ups of 69 patients showed no physical functionality improvement, whereas 72 patients demonstrated favorable functional outcomes. In terms of underlying diseases, more than 80% of the patients suffered from hyperlipidemia upon hospitalization and more than 40% of the patients suffered from diabetes mellitus and heart disease. There was a significant difference in pulmonary disease between improvement and non-improvement in disability (1.4% vs 10.1%, p = 0.034). The average age of the improved group was lower than that of the non-improved group (65.5 vs. 72, p = 0.014), and the WBC was higher (8 vs 6.95, p = 0.005); furthermore, higher NIHSS scores (6.5 vs 3, p = 0.001) and lower Barthel index scores (47.5 vs 80, p < 0.001) were also noted. The group with improved mRS required a longer hospital stay (with a median of 10 days), while their un-improved counterpart required 8 days (p < 0.05). The majority of patients were discharged within 30 days, and there was a slight difference between the two survival curves (marginal statistical significance, 0.05 < p < 0.1). The hazard ratio of the improved group was 0.7188. There was a difference in the end diastolic velocity (EDV) of common carotid artery (CCA) between the lesion and non-lesion sides of the patients (p < 0.05). Risk-stratifying models indicate that diabetes mellitus, peak systolic velocity (PSV) of the internal carotid artery (ICA) on the lesion side, the diameter of the ICA on the non-lesion side, and the pulsatility index (PI) of the ICA and external carotid artery (ECA) were selected as the most important factors affecting the end diastolic velocity (EDV) of the common carotid artery (CCA) in all four models. Conclusion In the current study, the most suitable length of stay in hospital for lacunae stroke patients to fully recuperate is ten days. Additionally, CCA EDV might be the key determinant, with baseline diabetes mellitus acting in a medium role, capable of altering long-term outcome functionality and recovery.

Effectiveness of endovascular thrombectomy in patients over 80 years of age

Objective: Endovascular thrombectomy (EVT), with or without intravenous thrombolysis, has become the standard treatment for acute ischemic stroke, especially in large vessel occlusions. This study provides valuable insights about the effectiveness of EVT in these patients.Methods: We retrospectively reviewed patients who underwent EVT for acute ischemic stroke at age 80 or over between 2014 and 2022. Procedural and functional outcomes were assessed with the thrombolysis in cerebral infarction (TICI) score and National Institutes of Health Stroke Scale (NIHSS) after EVT, in comparison with the initial NIHSS. We divided patients into the improved NIHSS group, the non-improved group, and the expired group.Results: Eighty patients who underwent EVT from 2014 to 2022 were analyzed. Fifty-seven patients improved, whereas 23 patients did not improve or expired after EVT. Successful recanalization (TICI IIb or III) was reported in 88.7% of cases. The locations of occlusion differed among the groups. The most frequently discovered location of occlusion was the sphenoidal segment of the middle cerebral artery, and occlusions were most frequently discovered in the internal carotid artery in the group without NIHSS improvements.Conclusion: This study revealed that EVT in elderly patients was effective, and occlusion of a distal vessel could be a good prognostic factor. Reducing puncture time was also identified as the most important factor in elderly patients. Lastly, if TICI IIb reperfusion is discovered during the procedure, additional reperfusion attempts should be avoided.

Clinical impact of improving sarcopenia through cardiac rehabilitation in patients with heart failure

Abstract Background Sarcopenia is highly prevalent in patients with heart failure (HF) and is associated with a poor prognosis and a low quality of life. On the other hand, cardiac rehabilitation (CR) has improved clinical outcomes in patients with HF. However, the clinical impact of improving sarcopenia after CR in patients with HF is unclear. Purpose This study aimed to investigate whether improved or not improved sarcopenia is associated with mortality and the number of readmissions for HF in patients with HF. Methods We reviewed a total of 647 patients who were admitted for HF treatment and underwent a 5-month outpatient CR after discharge. We assessed sarcopenia at discharge, 3 months and 5 months of outpatient CR, based on Asian Working Group for Sarcopenia 2019 diagnostic criteria. For subjects assessed for sarcopenia at both 3 and 5 months, the assessment results at 5 months were used in the analysis. All patients were classified according to the presence of sarcopenia at baseline and the time of outpatient CR as follows: patients without sarcopenia were the robust group, those with sarcopenia at baseline but improving at the time of outpatient CR were the improved group, and those with sarcopenia at baseline and at the time of outpatient CR were the non-improved group. To assess mortality between the robust, improved, and non-improved groups, we used multivariate Cox proportional hazard analyses. Additionally, we used multivariate Poisson regression analyses to assess the number of readmissions for HF between the robust, improved, and non-improved groups. Moreover, as a subgroup analysis, the same Cox proportional hazards analysis was evaluated by categorizing patients with HF with reduced ejection fraction (HFrEF) and preserved ejection fraction (HFpEF). The endpoint was all-cause death or rehospitalization for HF. Results Of the 647 patients, 381 (58.9%) were in the robust group, 103 (15.9%) were in the improved group, and 163 (25.2%) were in the non-improved group. In multivariate Cox proportional hazard analyses, the non-improved group had significantly higher mortality compared to the robust group [adjusted hazard ratio (HR): 2.71, 95% confidence interval (CI): 1.58–4.66] after adjusting for severity of HF (Figure 1-A). In addition, both HFrEF and HFpEF groups had significantly higher mortality in the non-improved group compared to the robust group (HFrEF; HR: 2.41, 95% CI: 1.22–4.76, HFpEF; HR: 2.86, 95% CI: 1.01–8.09) (Figure 1-B and 1-C, respectively). In multivariate Poisson regression analyses, the non-improved group had a high incidence of readmissions for HF compared to the robust group (adjusted incident rate ratio: 1.56, 95% CI: 1.20–2.02) (Figure 2). Conclusions A lack of improvement in sarcopenia after CR in patients with HF has affected the life expectancy and the number of readmissions for HF. Funding Acknowledgement Type of funding sources: None.

The impact of right atrium and left atrium reverse remodeling for functional regurgitation of atrioventricular valve among patients who were underwent ablation for atrial fibrillation

Abstract Background Atrial fibrillation (AF) is a risk factor of Regurgitation of Atrioventricular Valve and Regurgitation of Atrioventricular Valve is improved after ablation for AF. However, Mechanism of improvement of Tricuspid regurgitation (TR) and Mitral regurgitation (MR) after ablation for AF were unclear. Methods The one hundred fifty-seven cases consecutive patients who were underwent ablation for persistent AF were examined in this study. These patients were performed Holter ECG and Echocardiography 6 months after ablation for persistent AF. The area of the Right Atrium (RA), Left Atrium (LA), diameter of the tricuspid valve anulus and Mitral valve annulus, were measured by echocardiography at before and 6 months after ablation for AF. The reverse remodeling index (RRI) was defined as divided post area of RA and LA by pre area of RA and LA. The Improved group was defined as one or more than regurgitation grade improvements. Results TR improved in 56 cases (35.7%) of 157 cases and MR improved in 25 (16.6%) cases of 157 cases. The ratio of improved TR was significantly higher than ratio of improved MR (p&amp;lt;0.01). The difference in tricuspid annulus diameter before and after ablation for AF was significantly longer in TR improved group than in TR non-improved group. (4.9±5.3 mm vs 1.6±5.4 mm, p&amp;lt;0.01). The RRI of RA in TR improved group was significantly smaller than in TR non-improved group (0.73±0.19 vs 0.89±0.26 p&amp;lt;0.01). The difference in mitral annulus diameter before and after ablation for AF was not significant differences between MR improved group and MR non-improved group. The RRI of LA in MR improved group was significantly smaller than in MR non-improved group (0.79±0.22 vs 0.90±0.25 p&amp;lt;0.01). The RRI of RA was significantly smaller than RRI of LA among patients who were able to maintain sinus rhythm after ablation for persistent AF (0.79±0.23 vs 0.85±0.24 p=0.04). Conclusion Reverse remodeling of RA was higher than Reverse remodeling of LA among patients who were able to maintain sinus rhythm after ablation for persistent AF and Reverse remodeling of RA and LA were important factors of improvement of TR and MR after ablation for persistent AF. These results considered to be the cause why the improvement rate of TR was higher than the Improvement rate of MR after persistent AF. Funding Acknowledgement Type of funding sources: None.

Radiographic predictors for recurrence of lumbar symptoms after prioritized cervical surgery in patients with tandem spinal stenosis.

The purpose of the current study was to explore radiographic predictors for recurrence of lumbar symptoms after prioritized cervical surgery in patients with tandem spinal stenosis (TSS). The current retrospective cohort study included 74 patients with TSS, who underwent prioritized cervical surgery. Based on presence or absence of improvement in lower limb symptoms, patients were grouped into improved and non-improved groups. Medical records and radiological parameters including age, sex, body mass index, cervical and lumbar parameters were analyzed. In improved group, patients were divided into relapsed and non-relapsed groups based on recurrence in lower limb symptoms. Lumbar symptoms improved in 70.1% (n = 52) of patients. Comparison between the improved and non-improved group showed that there were no statistically significant differences in cervical parameters while comparisons between the relapsed and non-relapsed groups showed significant differences in redundant nerve roots (RNRs) (p = 0.029), narrow segment (p = 0.042) and lumbar stenosis index (LSI) (p = 0.003). In multivariate logistic regression analysis, LSI > 10 (p = 0.016) was independently associated with recurrence of lumbar symptoms. Finding of the current study indicated that LSI > 10 was associated with recurrence of lumbar symptoms in TSS patients following cervical surgery.

Limitations of minimally invasive posterior cervical foraminotomy—a decompression method of posteriorly shifting the nerve root—in cases of large anterior osteophytes in cervical radiculopathy: A retrospective multicenter cohort study

BackgroundPosterior cervical foraminotomy against anterior osteophyte is an indirect decompression procedure but less invasive compared to anterior cervical discectomy and fusion. Residual compression to the nerve root may lead to poor surgical outcomes. Although clinical results of posterior cervical foraminotomy for osteophytes are not considered better than those of disk herniation, osteophyte size and the association of the decompression area with poor surgical outcomes remain unclear. This study aimed to identify the limitations of minimally invasive posterior cervical foraminotomy for cervical radiculopathy and discuss the methods to improve surgical outcomes. MethodsWe analyzed 55 consecutive patients with degenerative cervical radiculopathy who underwent minimally invasive posterior cervical foraminotomy. Minimum postoperative follow-up duration was 1 year. We divided the patients into nonimproved and improved groups. The cutoff value between preoperative and postoperative Neck Disability Index scores was 30% improvement. Preoperative imaging data comprised disk height, local kyphosis, spinal cord compression, anterior osteophytes in the foramen, and anterior osteophytes of >50% of the intervertebral foramen diameter. Postoperative imaging data comprised craniocaudal length and lateral width of decompressed lamina, preserved superior facet width, and area of decompressed lamina. ResultsFifty-five patients were divided into two groups: nonimproved (n = 19) and improved (n = 36). The presence of osteophytes itself was not significant; however, the presence of osteophytes of >50% of the foramen diameter increased in the nonimproved group (P = 0.004). Mean lateral width and mean area of decompressed lamina after surgery significantly increased in the improved group (P = 0.001, P = 0.03). ConclusionThe presence of anterior osteophytes >50% of the diameter of the foramen led to poor improvement of clinical outcomes in minimally invasive posterior cervical foraminotomy. However, the larger the lateral width and area of the decompressed lamina, the better the surgical outcome.

116-OR: Changes in Glucose Tolerance and Related Factors after Renal Transplantation in Recipients with Impaired Glucose Tolerance

Background and Aims: Our previous study revealed that more than half of patients with impaired glucose tolerance (IGT) before renal transplantation improved to normal glucose tolerance after transplantation. However, the mechanism was not clear. This study aimed to investigate whether changes in glucose tolerance were associated with insulin secretion and resistance in Japanese renal transplant recipients diagnosed with IGT before transplantation. Materials and Methods: We analyzed data for 179 patients ≥20 years of age who received their first renal transplantation in our hospital from April 2005-October 20 and had no history of diabetes before transplantation. A total of 54 recipients who received the oral glucose tolerance test (OGTT) before and 1 year after transplantation and were diagnosed with IGT before transplantation. Patients were divided into two groups according to negative or positive changes in area under the blood glucose curves from 0-120 min after ingestion: improved group and non-improved group, respectively. Insulin secretion was estimated by the insulin secretion sensitivity index-2 (ISSI-2) and insulin sensitivity was estimated by the Matsuda index (MI) and homeostasis model assessment of insulin resistance (HOMA-IR) . Results: Thirty and 24 patients were in the improved and non-improved groups, respectively. ISSI-2 significantly increased from 1.67±0.44 to 2.00±0.60 (P&amp;lt;0.01) after transplantation in the improved group, but not in the non-improved group. ΔISSI-2 was significantly associated with the 60-min blood glucose level of the OGTT and ISSI-2 level before transplantation (β=0.01, P&amp;lt;0. and β=−0.59, P&amp;lt;0.01, respectively) . There were no differences in MI or HOMA-IR before and after transplantation between these two groups. Conclusion: Improvement of glucose tolerance after renal transplantation in patients diagnosed with IGT before transplantation is related to improvement of insulin secretion. Disclosure M. Kusumi: None. A. Nakamura: Research Support; Kissei Pharmaceutical Co., Ltd., MSD, Nippon Boehringer Ingelheim, Taisho Pharmaceutical Holdings Co., Ltd. H. Nomoto: None. H. Kameda: None. K. Cho: None. H. Miyoshi: Research Support; Abbott Japan Co., Ltd., Boehringer Ingelheim International GmbH, Daiichi Sankyo, Kowa Company, Ltd., LifeScan, Mitsubishi Tanabe Pharma Corporation, Novo Nordisk, Ono Pharmaceutical Co., Ltd., Sumitomo Dainippon Pharma Co., Ltd., Taisho Pharmaceutical Holdings Co., Ltd. Speaker's Bureau; Astellas Pharma Inc., Boehringer Ingelheim International GmbH, Eli Lilly and Company, Kowa Company, Ltd., Merck &amp; Co., Inc., Mitsubishi Tanabe Pharma Corporation, Novo Nordisk, Ono Pharmaceutical Co., Ltd., Sanofi K.K., Sumitomo Dainippon Pharma Co., Ltd., Taisho Pharmaceutical Holdings Co., Ltd. T. Atsumi: Consultant; AbbVie Inc., AstraZeneca, MEDICAL &amp; BIOLOGICAL LABORATORIES CO., Nippon Boehringer Ingelheim Co. Ltd., Novartis Pharma K.K., Ono Pharmaceutical Co., Ltd., Pfizer Inc. Research Support; AbbVie Inc., Alexion Pharmaceuticals, Inc., Astellas Pharma Inc., Chugai Pharmaceutical Co., Ltd., Daiichi Sankyo, Mitsubishi Tanabe Pharma Corporation, Nippon Boehringer Ingelheim Co. Ltd., Otsuka Pharmaceutical Co., Ltd., Pfizer Inc., Taiho Pharmaceutical Co. Ltd., Takeda Pharmaceutical Company Limited, Teijin Pharma Limited. Speaker's Bureau; AbbVie Inc., Astellas Pharma Inc., Bristol-Myers Squibb Company, Chugai Pharmaceutical Co., Ltd., Daiichi Sankyo, Eisai Co., Ltd., Eli Lilly and Company, Kyowa Kirin Co., Ltd., Mitsubishi Tanabe Pharma Corporation, Novartis Pharma K.K., Pfizer Inc., Taiho Pharmaceutical Co. Ltd., Takeda Pharmaceutical Company Limited, UCB, Inc.

Investigation of intracranial pressure in intensive care unit patients with delirium assessed by bedside ultrasound

To explore the changes of intracranial pressure in intensive care unit (ICU) patients during the occurrence and evolution of delirium by using bedside ultrasound to measure the optic nerve sheath diameter (ONSD) to evaluate intracranial pressure. A retrospective observational study was conducted. Adult patients who developed delirium during hospitalization in the general ICU of Beihai People's Hospital from October 2020 to November 2021 were enrolled, and patients who did not have ultrasonographic ONSD records within 24 hours after the diagnosis of delirium were excluded. The ONSD measured before delirium was recorded as ONSD0, the ONSD measured within 24 hours of the onset of delirium recorded as ONSD1, and the ONSD reexamined after ONSD1 recorded as ONSD2. Patients were divided into intracranial hypertension group (ONSD1 > 5 mm) and normal intracranial pressure group (ONSD1 ≤ 5 mm) according to the size of ONSD1. According to the outcome of delirium, the patients were divided into cured, improved, and non-improved groups. The reduction ratio of ONSD2 to ONSD1 in the three groups were calculated and compared. Pearson correlation test was used to analyze the correlation between fluid balance and ONSD changes after delirium. There were 43 patients, including 40 cases in the intracranial hypertension group (the incidence rate was 93.0%), 3 cases in the normal intracranial pressure group, 23 cases were cured, 13 cases were improved, and 7 cases were not improved. In the intracranial hypertension group, 11 cases had ONSD0 and ONSD1 records, and ONSD1 was significantly higher than ONSD0 [mm: 5.88±0.61 vs. 5.34±0.57, 95% confidence interval (95%CI) -0.85 to -0.23, P = 0.003]. The reduction ratio of ONSD2 to ONSD1 in the cured group was significantly higher than that in the improved group and the non-improved group [(12.04±6.20)% vs. (5.68±4.10)%, (0.17±3.96)%; 95%CI were 2.37 to 10.33, 6.41 to 17.31, P values were 0.003 and 0.000, respectively]. The correlation analysis showed that the reduction ratio of ONSD2 to ONSD1 was negatively correlated with fluid balance (r = -0.42, 95%CI was -0.66 to -0.10, P = 0.012). The incidence of intracranial hypertension in ICU delirium patients is high. A more pronounced decrease in intracranial pressure predicts a better delirium outcome. Dynamic ONSD measurement can provide valuable information for the prevention and treatment of delirium.

Efficacy of nebulized magnesium sulfate in moderate bronchiolitis

Background: Bronchiolitis is a common cause of illness and hospitalization in infants and young children. The effectiveness of various bronchodilators remains unclear. This study was conducted to assess the efficacy of nebulized magnesium sulfate in hospitalized children with moderate bronchiolitis in the age group of 1–24 months. Subjects and Methods: This was a prospective observational study done from December 2018 to June 2020. All children with moderate bronchiolitis (clinical severity score [CSS]-4–8) meeting inclusion/exclusion criteria were enrolled. A detailed history, demographic profile, CSS and oxygen saturation in room air, and heart rate were recorded. They were given two doses of magnesium sulfate in the form of nebulization for 10 min each, at 30 min apart. The children were assessed for CSS at 0 h, 1 h, and 4 h after nebulization. The children were considered improved if CSS &lt;4 at the end of 4 h. The children were monitored for adverse reactions of magnesium sulfate. Results: Sixty children were enrolled. The mean age was 7.5 ± 6.47 months. Most children (51.7%) were in 1–6 months. The mean CSS scores at 0 h, 1 h, and 4 h were 6 ± 1.008, 2.95 ± 1.395, and 2.40 ± 1.564, respectively (P = &lt; 0.001). Fifty-three (88.3%) children improved and seven (11.7%) children did not improve. In nonimproved group, subanalysis was done and found hypoxia (odds ratio − 12.6) as a significant risk factor. Flushing was the most common adverse effect noticed in eight (13.3%) children. Conclusions: Children with moderate bronchiolitis were improved with nebulized magnesium sulfate.

Dose-response Rehabilitation Organized By Pror In Out-patients With Chronic Cerebrovascular Disorder: A single-center retrospective cohort study

PurposeWe aimed to investigate whether out-patient rehabilitation with the same concept as physiatrist and registered therapist operating rehabilitation (PROr) would improve activities of daily living in out-patients with chronic cerebrovascular disorder and whether the improvements were related to the frequency and/or time of therapy. MethodsOut-patients with chronic cerebrovascular disorder, who visited a clinic affiliated with a university hospital for at least a month between April 2010–September 2020, were retrospectively selected. Changes in the functional independence measure (FIM) from the first visit to the 12th month were calculated. Patients were stratified into two subgroups: improved and non-improved groups. The frequency and time of physical and occupational therapies and total rehabilitation were compared between the groups. ResultsInitially, 174 patients were selected and 125 were excluded based on the exclusion criteria. Three patients terminated rehabilitation because of improvements. In 18 of 49 patients, FIM improved at the 12th month by 4.9 [3.1-6.8] (mean [95% CI]). The frequency was ∼2 times/week with no differences between the groups. Physical therapy time/day was higher in the improved group (74.7 [66.7-82.7] min) than the non-improved group (50.7 [44.3-57.0] min; P<0. 001). The total rehabilitation time/day was 121.9 [107.8-136.0] min in the improved group, which was higher than the non-improved group: 97.9 [87.7-107.9] (P=0.001). ConclusionsApproximately 40% of the patients displayed improved FIM even during the chronic phase, and the improved out-patients took PROr for at least 108 min/day and twice a week. A longer rehabilitation time would be reinforced by patients’ motivation.

Effect of omalizumab as add-on therapy to Quality of Life Questionnaire for Korean Asthmatics (KAQLQ) in Korean patients with severe persistent allergic asthma.

Background/AimsOmalizumab is the first biologic known to be effective in patients with severe allergic asthma.MethodsThis study was conducted as a multicenter, single-group, open trial to evaluate the improvement in the quality of life with the additional administration of omalizumab for 24 weeks in Korean patients with severe persistent allergic asthma.ResultsOf the 44 patients, 31.8% were men and the mean age was 49.8 ± 11.8 years. A score improvement of 0.5 points or more in the Quality of Life Questionnaire for Korean Asthmatics (KAQLQ) was noted in 50.0% (22/44) of the patinets. In the improved group, the baseline total immunoglobulin E (IgE) level and the amount of omalizumab used were higher, and the day and night asthma symptoms were more severe, compared to those in the non-improved group. According to the Global Evaluation of Treatment Effectiveness, favorable outcomes were found in 78.6% of patients. The Korean asthma control test (p < 0.005) and forced expiratory volume in 1 second % predicted (FEV1%; p < 0.01) improved significantly in patients who received omalizumab treatment, compared to that at week 0, and the total dose of rescue systemic corticosteroids significantly decreased (p < 0.05). The improved group on KAQLQ showed a significant improvement in FEV1% (p < 0.001).ConclusionsOmalizumab can be considered a biological treatment for Korean patients with severe allergic asthma. It is recommended to consider omalizumab as add-on therapy in patients with high baseline total IgE levels and severe asthma symptoms.

비중격 미부 교정을 위한 부분 절단 봉합술의 장기적인 효과 분석

Background and Objectives: Correcting the caudal septal deviation is one of the most difficult challenges of rhinologists. The purpose of this study is to evaluate the long-term effect of the partial cutting and suture technique for its correction. Materials and Methods: Korean version Nasal Obstructive Symptoms Evaluation (NOSE) scale score were compared and analyzed before surgery and three months and about two years after surgery in patients who underwent caudal septoplasty using the partial cutting and suture technique. Results: A total of 29 patients were included in this study. The average NOSE scale score before surgery was 43.97, which improved to 12.93 (p&lt;0.001) at three months after surgery and finally 15.69 (p&lt;0.001). The high dorsal deviation was observed in 75% in the non-improved group and 47.6% in the improved group. Conclusions: Correcting the caudal septal deviation through the partial cutting and suture technique showed excellent results in the long-term evaluation. (J Clinical Otolaryngol 2021;32:47-52)

There is an Association between Gingival Inflammation and Obesity in Japanese Male Adolescents

Background: There are few studies showing the association between obesity and gingivitis in young male adolescents. The aim of this study is to investigate the association between gingivitis and obesity in addition to life style habits among male high school students. Materials and Methods: The participants in this study were 1,027 1st-year male high school students (15-16 years old) in Tokushima Prefecture, Japan. Regular health checkup and oral examination were performed. Items regarding oral health behavior and eating habits were investigated through a self-reported questionnaire. Binomial logistic regression analysis was used to analyze the cross-sectional data. Moreover, 513 students who were recalled after two years were divided into 2 groups according to changes of BMI (<25 or ≥25) and their gingival condition, were investigated. Results: Binomial logistic regression analysis showed that gingival inflammation was significantly associated with obesity (OR=1.78, 95% CI: 1.08-2.95) in addition to malalignment and plaque accumulation. From this longitudinal study, a significant improvement of gingival conditions was observed in the improved group (McNemar's test, p<0.05) whereas no difference was observed in the non-improved group. Conclusions: These results indicate that gingival inflammation was associated with obesity. Furthermore, improvement in the management of obesity might be effective for the prevention of gingival inflammation.

Primary cervical decompression surgery may improve lumbar symptoms in patients with tandem spinal stenosis.

Tandem spinal stenosis (TSS) refers to coexisting lumbar and cervical canal stenosis. Evidence regarding whether cervical decompression improves lumbar symptoms in TSS is insufficient. Therefore, we determined the effectiveness of cervical decompression surgery for patients with lumbar spinal stenosis (LSS) and cervical spinal stenosis. The records of 64 patients with TSS experiencing lumbar symptoms who underwent cervical decompression surgery between April 2013 and July 2017 at a single institution were retrospectively reviewed. We categorized patients into the Non-improved (n = 20), Relapsed (n = 30), and Maintained-improvement (n = 14) groups according to the presence or absence of improvement and relapse in lower limb symptoms in TSS following cervical decompression surgeries. Of 64 patients, 44 (69%) showed improved lower limb or low back symptoms, with 14 (22%) patients maintaining improvement. The preoperative cervical myelopathy-Japanese Orthopedic Association score and the preoperative number of steps determined using the 10-s step test were significantly lower in the Non-improved group than in the Maintained-improvement group. Receiver operating characteristic curve of preoperative 10-s step test results revealed 12 steps as a predictor for maintained improvement. The improvement of LSS symptoms following cervical decompression surgeries may be associated with the severity of cervical myelopathy as determined in clinical findings rather than in imaging findings. Patients with TSS having a 10-s step test result of < 12 steps were more likely to experience a relapse of lower limb symptoms following cervical decompression surgeries.

Decreases in Circulating Concentrations of Short-Chain Acylcarnitines are Associated with Systolic Function Improvement After Decompensated Heart Failure.

Impaired fatty acid metabolism is associated with heart failure (HF) prognosis. However, specific changes in acylcarnitine profiles and their potential clinical value have not been well explored in patients recovering from acute decompensation.This study recruited 79 HF patients hospitalized because of acute decompensation with a left ventricular ejection fraction (LVEF) of < 40% and 51 normal controls. Patients were dichotomized into two groups, namely, the "improved (IMP) " and the "non-improved (NIMP) " groups, as defined by the changes in LVEF from baseline to 12 months after discharge. Mass spectrometry was used to quantify the acylcarnitine concentrations at baseline and 6 and 12 months after discharge. The IMP and NIMP groups contained 42 and 37 patients, respectively. At baseline, HF patients had higher plasma concentrations of specific long-, medium-, and short-chain acylcarnitines compared to normal controls. From baseline to 12 months post-discharge, the IMP group showed significant decreases in long- and short-chain acylcarnitine concentrations, but significant increases in medium-chain acylcarnitines. In the NIMP group, none of the acylcarnitines significantly decreased, and significant increases were noted in long-, medium-, and short-chain acylcarnitines. Generalized estimating equations demonstrated that nine acylcarnitines could discriminate the IMP group from the NIMP group, including three long-chain (C18:1, C16, and C16:1) and six short-chain acylcarnitines (C5, C5-OH, C4, C4:1-DC, C3, and C2). After adjusting for age, the six short-chain acylcarnitines remained significant. Changes in short-chain acylcarnitine profiles are independently associated with the improvement in cardiac systolic function after acute decompensation.

Preprocedural valvuloarterial impedance as a predictor of left ventricular ejection fraction improvement after transcatheter aortic valve replacement in patients with reduced left ventricular ejection fraction.

Predictors of left ventricular ejection fraction (LVEF) improvement after transcatheter aortic valve replacement (TAVR) in patients with a preoperative reduced LVEF are limited. This study aimed to investigate the relationship between preprocedural valuvuloarterial impedance (ZVa), which represents the global LV afterload, and LVEF improvement after TAVR. This was a single-center, retrospective study, which included patients with symptomatic aortic valve stenosis (AS) with a reduced baseline LVEF (< 50%) underwent TAVR. Based on the difference in the LVEF before and 1month after the procedure, they were divided into two groups: improved group (≥ 10% improvement) and non-improved group (< 10% improvement or worsening). Preprocedural ZVa and clinical outcomes were then compared. ZVa was calculated using preprocedural transthoracic echocardiography data. Among 473 cases of TAVR performed from May 2012 to July 2017 at Queen's Medical Center (Honolulu, HI, USA), 99 patients (improved group, n = 42; mean age 82.0 ± 8.6years vs. non-improved group, n = 57, mean age 81.4 ± 9.5years) were included. The improved group had a higher baseline ZVa {4.83 (4.15-6.89)mmHg/ml/m2 vs. 4.04 (3.56-4.63)mmHg/ml/m2, respectively, p = 0.0009} and prevalence of ZVa > 5mmHg/ml/m2 (45.2% vs. 17.5%, respectively, p = 0.0028). Multivariable analysis of predictors of LVEF improvement ≥ 10% at 1month identified ZVa > 5mmHg/ml/m2 [odds ratio (OR): 3.31, 95% confidence interval (CI): 1.05-11.8] as a predictor. The improved group had a lower readmission rate due to heart failure than the non-improved group (log-rank test, p = 0.043). In conclusion, Zva is a simple, noninvasive marker that shows promise as a predictor of LVEF improvement after TAVR in reduced LVEF patients.

Depressive Symptoms and Cognitive Improvement in Patients with Dementia with Lewy Bodies.

Although dementia with Lewy bodies (DLB) is a degenerative disease involving irreversible pathological changes and subsequent progressive cognitive decline, some patients have presented with improved cognitive function at follow-ups. Their clinical and neuropsychological characteristics and the factors influencing this improvement remain unclear. To investigate differences in clinical and neuropsychological characteristics between DLB patients with and without cognitive improvement at a one-year follow-up, and to identify predictive factors of cognitive improvement. This retrospective study included 60 DLB patients, 28 patients in the improved group, and 32 patients in the non-improved group. A multiple linear regression model was used to compare changes in cognitive function test scores between groups over the course of one year. Binary logistic regression analysis was performed to determine the odds ratios (ORs) of depressive symptoms as a predictor for cognitive improvement. The improved group showed significant increases in immediate and delayed verbal memory function in one year over the non-improved group. We also found that baseline depressive symptoms were associated with an increased probability of cognitive improvement (OR 1.234, CI 1.043- 1.460). Depressive symptoms at baseline were related to a higher probability of a cognitive improvement at one-year follow-up. In addition, immediate and delayed verbal memory function showed significant improvement during one year in improved patients compared to non-improved patients.

P5577Preoperative transaortic pressure gradient predicts renal functional improvement after transcatheter aortic valve implantation in patients with chronic kidney disease

Abstract Introduction Transcatheter aortic valve implantation (TAVI) theoretically increases renal blood flow through increasing cardiac output by relieving aortic valvular obstruction of blood flow from left ventricle, resulting in a renal functional recovery in patients with severe aortic valve stenosis (AS). However, procedural steps of TAVI including contrast use potentially damages renal medulla and may deteriorate renal function. Purpose The aim of this study was to investigate renal functional change and clarify preoperative predictors for renal functional improvement after TAVI in chronic kidney disease (CKD) patients with severe AS. Methods A total of 88 consecutive severe AS patients with CKD (grade &gt;3) who underwent TAVI from 2015 to 2018 was enrolled in this observational study. They were divided into two groups depending on their renal functional improvement after TAVI that was defined as more than 10% increase in estimated glomerular filtration rate (eGFR) at discharge from their preoperative level. Results Among the whole candidates, 49 patients (55.7%) were improved their renal function. Patients with the lowest preoperative eGFR achieved the highest increase in eGFR after TAVI (CKD grade &gt;4: +22.7±23.7%, Figure). Patients in the Improved group had lower hemoglobin level, higher mean transaortic pressure gradient (TAPG), and higher aortic valve gradient before TAVI, compared to those in the Non-improved group. However, contrast volume during the procedure was not significantly different between the groups. Multivariate logistic regression analysis revealed that high mean TAPG and low left ventricular ejection fraction (LVEF) before TAVI were independent predictors for the improvement of renal function (odds ratio (OR): 1.04, 95% confidence interval (CI): 1.00–1.08; OR: 0.94, 95% CI: 0.89–0.99, respectively), even after the adjustment of baseline eGFR level and hemoglobin level that were statistically significant on univariate logistic regression analysis. Receiver Operating Characteristic (ROC) curve showed the cut-off level of preoperative mean TAPG in renal functional improvement after TAVI as 47.0 mmHg (Sensitivity: 47.9%, Specificity: 79.5%, area under the curve: 0.62). Correlation between CKDgrade and ΔeGFR Conclusions Preoperative high mean TAPG may predict renal functional improvement after TAVI in patients with deteriorated renal function. This non-invasive predictor may help clinicians to consider to perform TAVI in a challenging case with severe CKD.

1307P - Interstitial lung disease associated with immune-checkpoint inhibitors in malignant diseases

BackgroundImmune-checkpoint inhibitors (ICI) have recently been used in many types of cancers including non-small cell lung cancer (NSCLC). Interstitial lung disease associated with ICI (ICI-ILD) is a serious immune-related adverse event. However, comprehensive clinical characterization of ICI-ILD is still lacking. MethodsWe retrospectively analyzed clinical and imaging data of all consecutive ICI treated patients in Kurashiki Central Hospital (Okayama, Japan) between January 2016 and March 2019. We elucidated clinical characteristics, radiopathological patterns, therapeutic strategies and outcomes of ICI-ILD and analyzed the prognostic factor of ICI-ILD. ResultsAmong 316 (222 NSCLC and 94 non-NSCLC) treated with ICI, 35 (11.1%) were diagnosed as ICI-ILD. Of those, NSCLC/gastric cancer/urinary cancer/head and neck cancer/malignant lymphoma were 26/2/2/4/1, respectively: mean age was 69.3±9.0 years; 29 (82.9%) were men; 19 (54.3%) received Nivolumab monotherapy and 10 (28.6%) received Pembrolizumab monotherapy; Best objective response rate until ICI-ILD diagnosis was 48.6% (11/35); The median time (range) from ICI introduction to ICI-ILD was 57 (22-155) days. CTCAE grade 1/2/3+4/5 was 10 (28.6%)/14 (40.0%)/7 (20.0%)/4 (11.4%), respectively; Organizing pneumonia was found in 57.1% (20/35) in CT and 66.7% (4/6) in transbronchial lung biopsy; Lymphocyte differential count of bronchoalveolar lavage fluid (range) was 41 (33-60) %; 26 (74.3%) were treated with corticosteroid; 29 (82.9%) had ICI-ILD improved but 6 (17.1%) did not. The median survival time was significantly different between ILD improved group and non-improved group (17.1 months vs 0.8 months, p<0.001). Multivariate Cox regression analysis demonstrated that only ICI-ILD improvement is a significant prognostic factor (HR: 0.03; 95% CI, 0.003-0.305; p=0.003). ConclusionsIn our real-world experience, half of ICI-ILD patients had a response toward malignancy. Organizing pneumonia was the most common radiopathological pattern and lymphocyte differential count of bronchoalveolar lavage fluid was elevated in ICI-ILD. If ICI-ILD does not improve, its prognosis may be very poor. Legal entity responsible for the studyThe authors. FundingHas not received any funding. DisclosureAll authors have declared no conflicts of interest.

Daytime physical activity at admission is associated with improvement of gait independence 1 month later in people with subacute stroke: a longitudinal study

ABSTRACTBackground: Little is known about the benefits of daytime physical activity on gait ability in subacute stroke.Objectives: We investigated association between daytime physical activity at hospital admission and improvement of gait independence 1 month later in subacute stroke.Methods: Thirty-four participants with subacute stroke who could not walk independently were assessed. An accelerometer (HJA 350-IT, OMRON) was used to record the mean duration of light-intensity physical activity (LIPA) and moderate-to-vigorous-intensity physical activity (MVPA). LIPA and MVPA were recorded for 12 h per day for 7 consecutive days, and at three different time periods (daytime, therapy time, non-therapy time) at rehabilitation hospital admission (baseline). Gait independence was assessed by the functional ambulation category (FAC) at baseline and 1 month later. Participants were categorized into two groups based on the change of gait independence, as follows: the improved group, in which the FAC increased by ≥1; the non-improved group, in which the FAC did not increase.Results: Compared with the non-improved group, the improved group demonstrated significantly higher values of all physical activity variables, except for non-therapy time MVPA (p < .05). Logistic regression analysis showed that higher daytime LIPA was significantly associated with FAC improvement (OR = 1.068, 95% CI 1.009 to 1.140). In particular, higher non-therapy time LIPA was closely associated with FAC improvement (OR = 1.253, 95% CI 1.002 to 1.568).Conclusions: To promote recovery of gait independence in first month from admission, increasing daytime physical activity, especially LIPA during daytime or non-therapy time, is an important treatment target in subacute stroke.