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Abstract Peak oxygen uptake (VO2), evaluated as exercise tolerance, is a strong predictor of life prognosis regardless of health condition. Several previous studies have reported that peak VO2 is higher in those with a greater decrease in muscle oxygen saturation (SmO2) in the active muscles during incremental exercise. However, the skeletal muscle characteristics of individuals exhibiting a greater decrease in SmO2 during active muscle engagement in incremental exercise remain unclear. This study aimed to clarify the relationship among muscle strength, muscle endurance, and skeletal muscle oxygenation dynamics in active leg muscles during incremental exercise. Twenty-four healthy young men were included and categorized into the non-moderate-to-high muscular strength and endurance group (those with low leg muscle strength, endurance, or both; n = 11) and the moderate-to-high muscular strength and endurance group (those with both moderate-to-high leg muscle strength and endurance; n = 13). All participants underwent cardiopulmonary exercise testing combined with near-infrared spectroscopy to assess whole-body peak VO2 and the change in SmO2 at the lateral vastus lateralis from rest to each exercise stage as skeletal muscle oxygenation dynamics. A linear mixed-effects model, with the change in SmO2 from rest to each stage as the dependent variable, individual participants as random effects, and group and exercise load as fixed effects, revealed significant main effects for both group (P = 0.001) and exercise load (P

Abstract Providing standardized, high-quality rehabilitation for critically ill patients is a crucial issue. In 2017, the Japanese Society of Intensive Care Medicine (JSICM) promulgated the “Evidence-Based Expert Consensus for Early Rehabilitation in the Intensive Care Unit” to advocate for the early initiation of rehabilitations in Japanese intensive care settings. Building upon this seminal work, JSICM has recently conducted a rigorous systematic review utilizing the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) methodology. This endeavor resulted in the formulation of Clinical Practice Guidelines (CPGs), designed to elucidate best practices in early ICU rehabilitation. The primary objective of this guideline is to augment clinical understanding and thereby facilitate evidence-based decision-making, ultimately contributing to the enhancement of patient outcomes in critical care settings. No previous CPGs in the world has focused specifically on rehabilitation of critically ill patients, using the GRADE approach. Multidisciplinary collaboration is extremely important in rehabilitation. Thus, the CPGs were developed by 73 members of a Guideline Development Group consisting of a working group, a systematic review group, and an academic guideline promotion group, with the Committee for the Clinical Practice Guidelines of Early Mobilization and Rehabilitation in Intensive Care of the JSICM at its core. Many members contributed to the development of the guideline, including physicians and healthcare professionals with multiple and diverse specialties, as well as a person who had been patients in ICU. Based on discussions among the group members, eight important clinical areas of focus for this CPG were identified. Fourteen important clinical questions (CQs) were then developed for each area. The public was invited to comment twice, and the answers to the CQs were presented in the form of 10 GRADE recommendations and commentary on the four background questions. In addition, information for each CQ has been created as a visual clinical flow to ensure that the positioning of each CQ can be easily understood. We hope that the CPGs will be a useful tool in the rehabilitation of critically ill patients for multiple professions. Graphical Abstract

Abstract Background and Aims Mechanical ventilation is associated with several risks, including barotrauma, ventilator‐associated pneumonia, and ventilator‐induced diaphragmatic dysfunction. A delay in weaning from mechanical ventilation increases these risks, and prolonged weaning has been shown to increase hospital mortality. Various tools have been used in clinical practice to predict successful weaning from mechanical ventilation; however, they have a low prognostic accuracy. The use of ultrasonography in intensive care units is an area of growing interest since it is a noninvasive, convenient, and safe modality. Since ultrasonography can provide real‐time assessment of diaphragmatic morphology and function, it may have clinical utility in predicting successful mechanical ventilator weaning. This study aimed to describe a protocol to assess the effectiveness of diaphragmatic ultrasonography in the decision‐making process for ventilator weaning in terms of its impact on clinical outcomes. Methods This systematic review of published analytical research will use an aggregative thematic approach according to the Preferred Reporting Items for Systematic Review and Meta‐Analysis Protocols guidelines. We will perform a comprehensive search for studies on the MEDLINE, Embase, and Cochrane Central Register of Controlled Trials databases. Two authors will independently perform abstract and full‐text screening and data extraction. Additionally, a meta‐analysis and the risk of bias evaluation will be conducted, as appropriate. Conclusion Systematic reviews on the effectiveness of diaphragmatic ultrasonography in the decision‐making process for ventilator weaning in terms of its impact on clinical outcomes are lacking. The results of this systematic review may serve as a basis for future clinical trials. Systematic review registration: This protocol was registered with the Open Science Framework: https://osf.io/cn8xf.

Introduction The current treatment for heart disease consists of exercise therapy in addition to pharmacotherapy, nutritional support and lifestyle guidance. In general, nutritional support focuses on protein, salt and energy restrictions, with no active protein or amino acid intake in cases involving moderate or higher renal failure. From this perspective, patients with cardiac disease are at high risk of frailty.Beta-hydroxy beta-methyl butyrate (HMB) is a metabolite of leucine. HMB is widely used for muscle strengthening and can be safely ingested even by patients with renal failure. The proposed study protocol will investigate the effects of HMB-calcium (HMB-Ca) administered in combination with comprehensive cardiac rehabilitation for muscle strength, muscle mass and cardiac function in patients with cardiac disease during the convalescent period. The primary outcome will be knee extensor strength. Secondary outcomes will be gross isometric limb strength and skeletal muscle mass.Methods and analysis This study will be a single-blinded, randomised, controlled trial with parallel comparisons between two groups. The study period will be 60 days from the start of outpatient cardiac rehabilitation. Participants will be randomly divided into two groups: an HMB group consuming HMB-Ca one time per day for 60 days; and a Placebo group consuming reduced maltose once one time per day for 60 days. Exercise therapy will be performed by both groups.Ethics and dissemination The study protocol will be published in a peer-reviewed journal. Ethics approval was provided by the Showa University Clinical Research Review Board.Trial registration number jRCTs031220139; Japan Registry of Clinical Trails.

During the COVID-19 pandemic, infection protection/control education has become increasingly important for not only healthcare professionals but also students undertaking medical, nursing, physical therapy, occupational therapy, and other related courses. A review of the literature on infection control education reveals that the target participants often comprise healthcare workers, and very few studies of infection control education focus on students. We have developed a protocol for the systematic review of the literature on simulation-based infection prevention/control education for students undertaking medical, nursing, rehabilitation, and other related courses. The protocol for the systematic review and meta-analysis has been drafted in alignment with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement. Systematic literature search will be performed for the period between 1990 (January) and 2022 (September) using the CENTRAL, MEDLINE, and Scopus databases. We will qualitatively and quantitatively examine the effects of simulation-based infection education for students in this systematic review and meta-analysis. Two investigators will independently search the databases according to the defined search strategy. The full-text of the selected articles will be screened independently keeping in mind the inclusion criteria by a pair of reviewers. Descriptive data will be extracted from each study regarding: study design, methods, participants, and outcomes. A meta-analysis will be performed if the quantitative data is suitable. Heterogeneity will be assessed using the standard χ2. Odds ratio for categorical data and weighted mean differences for continuous data and their 95% confidence intervals will be calculated and used for analysis. Where statistical pooling is not possible, the findings of the quantitative papers will be presented in narrative form. The qualitative aspect will employ narrative (descriptive) synthesis. Our review will make a valuable contribution to the domain of simulation-based infection prevention/control for students enrolled in medical and/or related courses.