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Purpose: This study examined respiratory and circulatory responses during low-intensity resistance exercise using a KAATSU device, which results in moderate blood flow restriction, in both healthy male adults and male patients with cardiovascular disease.Methods: Healthy males (n = 10, 29.8 ± 7.0 years) and male patients in cardiac rehabilitation (n = 10, 76.9 ± 3.4 years) performed leg extensions (3 sets of 15 repetitions at low-intensity [20% of a 1-repetition maximum]) not using and using a KAATSU device. We measured expiratory gas and impedance cardiography before (baseline) and during exercise, as well as dyspnea and rate of perceived exertion (RPE) during knee extensor effort immediately after each set of repetitions.Results: The patients were older than the healthy participants. At baseline, although heart rates and ventilatory equivalents did not differ between groups, oxygen uptake, carbon dioxide output, and left cardiac work index (LCWi) were lower in patients than in healthy participants. There were no GROUP × KAATSU interactions in terms of respiratory and circulatory responses during low-intensity resistance exercise. Dyspnea and RPE increased with exercise set repetitions and the KAATSU device augmented the RPE in both groups.Conclusions: There were no patient-specific changes in respiratory and circulatory responses, dyspnea, and responses to knee extensor effort using the KAATSU device during low-intensity resistance exercise, despite patients being older than healthy participants and exhibiting a lower respiratory function and LCWi at baseline than them. These results suggest that low-intensity resistance exercise using a KAATSU device can be a safe and useful training method for cardiac rehabilitation.

Limb-sparing surgery is important treatment for soft tissue sarcoma, but resection of major muscles in the lower extremities causes motor and gait dysfunction. However, we have experienced limb-sparing patients who have had significant improvement in their ability to walk.We present the case of a 52-year-old woman who had limb-sparing surgery for soft tissue sarcoma that removed hamstring muscles (biceps femoris, semimembranosus, and semitendinosus). After surgery, the patient suffered from gait disturbance but was able to stabilize her gait by wearing ankle-foot orthosis. The patient underwent knee flexor strength testing and gait analysis with and without the ankle-foot orthosis. The maximum torque of the knee flexor muscles was higher when the patient used the ankle-foot orthosis than without it. Gait analysis demonstrated improvement of knee flexion with the ankle-foot orthosis. The surface electromyogram showed that gastrocnemius activity was increased markedly by using the ankle-foot orthosis.The ankle-foot orthosis not only fixed the ankle in place to avoid foot drop, but also allowed gastrocnemius to act effectively as a knee flexor muscle after hamstring resection. We recommend using an ankle-foot orthosis to improve the gait of patients who have undergone hamstring resection because of a soft tissue tumor, infection, or trauma.

Whether poststroke rehabilitation improves muscle mass and quality along with the recovery of muscle strength is not clear. In this study, we examined the changes in muscle strength, muscle mass, and muscle quality in patients undergoing poststroke rehabilitation and assessed the relationship of these variables with improvement in activities of daily living (ADL). This prospective study was conducted at stroke rehabilitation unit in Japan. Muscle mass and quality were assessed using bioelectrical impedance analysis (BIA). ADLs were assessed using the functional independence measure (FIM). Grip strength of the nonaffected and affected sides was measured using hand dynamometer. All measurements were performed at admission to the stroke rehabilitation unit and at 4 weeks thereafter. We assessed changes in motor FIM items and examined the relationships among the measured variables. This study included 179 patients. Patients received stroke rehabilitation 7 days a week individually. Muscle strength and quality significantly increased after 4 weeks on both the sides. Muscle mass decreased after 4 weeks; however, there was no significant difference between the two time points. Changes in muscle strength and quality showed a significant correlation with improvement in ADLs [r = 0.66 (male), 0.45 (female) and 0.55 (male), 0.31 (female), respectively]; however, muscle mass showed no correlation with improvement in ADLs. Poststroke rehabilitation improves muscle strength and quality, as well as ADLs. Muscle mass is not an appropriate measure to assess the effects of stroke rehabilitation; it is desirable to instead use muscle strength and quality to assess stroke rehabilitation.

Objectives To clarify the factors inhibiting dysphagia rehabilitation in cardiovascular patients treated with invasive and non-invasive mechanical ventilation (MV). Methods The subjects were patients with dysphagia and cardiovascular disease treated with MV who were admitted to our hospital between April 2019-December 2021. Age, sex, walking ability, Geriatric Nutritional Risk Index (GNRI), primary heart disease, Charlson Comorbidity Index (CCI), invasive or non-invasive MV, Sequential Organ Failure Assessment (SOFA) at the start of MV, duration of MV, days from the withdrawal of MV to the start of rehabilitation, Functional Oral Intake Scale (FOIS) at the start of rehabilitation and discharge, length of hospital stay, pneumonia after the start of rehabilitation, and death during hospitalization were retrospectively surveyed. Results Ninety-six of the 105 patients survived, and 37 patients recovered from dysphagia. Twenty-two patients needed alternative nutrition at the start of rehabilitation, which was significantly associated with the duration of MV, length of hospital stay, and pneumonia after the start of rehabilitation. Death during hospitalization was significantly associated with lower GNRI scores, a history of chronic pulmonary disease, lower FOIS scores at the start of rehabilitation, and pneumonia developed during hospitalization. Dysphagia at discharge was significantly associated with older age, walking disability, lower GNRI scores, congestive heart failure, higher CCI scores, non-invasive MV, and higher SOFA scores. Conclusions The factors inhibiting dysphagia rehabilitation in cardiovascular patients treated with MV differed between the initial evaluation and outcomes and between vital and functional outcomes. Nutritional risk is a common risk factor for vital and functional outcomes.

The standard first-line treatment for human epidermal growth factor receptor type 2 (HER2)-positive advanced gastric cancer (AGC) is trastuzumab in combination with cisplatin and fluoropyrimidines. We evaluated the efficacy and safety of S-1 and oxaliplatin (100 mg/m2) (SOX100) combined with trastuzumab, a monoclonal antibody against HER2 for HER2-positive AGC. In this single-arm, multicenter phase II study, patients with HER2-positive AGC received S-1 (80–120 mg per day) orally on days 1–14, oxaliplatin (100 mg/m2) intravenously on day 1, and trastuzumab (8 mg/kg on day 1 of the first cycle, followed by 6 mg/kg every 3 weeks) intravenously. The primary end point was 1-year survival rate. The secondary end points included overall survival (OS), progression-free survival (PFS), overall response rate (ORR), and safety. A total of 25 patients from six centers were enrolled from December 2015 to March 2020. In the 25 patients evaluable for analysis, the 1-year survival rate was 70.8% [90% confidence interval (CI) = 55.5–86.1%], whereas the median OS, PFS, and ORR were 17.8 (95% CI 10.5–22.9) months, 7.6 (95% CI 5.0–10.9) months, and 75.0% (95% CI 53.3–90.2), respectively. Major grade 3/4 adverse events included anorexia (20%), anemia (16%), peripheral sensory neuropathy (16%), and diarrhea (15%). SOX100 combined with trastuzumab was effective with a favorable safety profile in patients with HER2-positive AGC.

Endoscopic clipping closure after colorectal endoscopic submucosal dissection (ESD) did not reduce the incidence of post-ESD coagulation syndrome (PECS) in our recent randomized controlled trial (RCT); however, the definition of PECS is still controversial. The aim of this study is to establish optimal definition of PECS with additional analysis of RCT based on another definition. In this multicenter, single-blind RCT, individuals were randomly assigned to colorectal ESD followed by endoscopic clipping closure or non-closure. In this post hoc analysis, the definition of PECS was modified as both localized abdominal pain on visual analogue scale and inflammatory response (fever or leukocytosis), from either localized abdominal pain or inflammatory response in the original study. All participants underwent a computed tomography after ESD, and PECS was classified into type I, conventional PECS without extra-luminal air, and type II, PECS with peri-luminal air. A total of 155 patients (84 in the non-closure group and 71 in the closure group) were analyzed. As a result of criteria modification, 21 type I PECS and four type II PECS cases in the original study, which included patients with clear pain and inflammatory response, were downgraded to no adverse event and simple peri-luminal air, respectively. The frequency of PECS showed no significant difference between non-closure and closure groups. Clipping closure after colorectal ESD does not reduce the incidence of PECS regardless of the diagnostic criteria. Either localized abdominal pain or inflammatory response might be optimal criteria of PECS (UMIN000027031). UMIN000027031 April 18, 2017

Sarcopenia is a major issue among the elderly. However, the effects of nutritional status and body composition on functional recovery in patients with proximal femur fractures (PFF) remain unclear. Hence, this study aimed to investigate the effects of nutritional status, body composition (skeletal muscle mass and muscle quality measured by phase angle [PhA] values), and muscle strength on the improvement in activities of daily living (ADL) in patients with PFF. We enrolled patients with PFF admitted to a rehabilitation unit. Nutritional status, body composition, grip strength, and motor Functional Independence Measure (FIM) score were assessed on admission day and at 4 weeks thereafter. Of 148 patients, 84 had femoral neck fractures, and 64 had trochanteric fractures. The mean motor FIM score was 49.2 points at admission and 64.9 points after 4 weeks. In multivariate analysis, higher geriatric nutritional risk index and PhA measured by anthropometry were associated with a significantly higher FIM score after 4 weeks. Muscle strength and quality changes significantly correlated with ADL improvement. Poor nutritional status and decreased muscle strength and quality interfered with ADL recovery. Nutritional management before injury and from the acute phase, and rehabilitation to maintain skeletal muscle status, are important for ADL recovery.

Purpose The standard first-line treatment for human epidermal growth factor receptor type 2 (HER2)-positive advanced gastric cancer (AGC) is trastuzumab in combination with cisplatin and fluoropyrimidines. We evaluated the efficacy and safety of S-1 and oxaliplatin (100 mg/m2) (SOX100) combined with trastuzumab, a monoclonal antibody against HER2 for HER2-positive AGC.Methods In this single-arm, multicenter phase II study, patients with HER2-positive AGC received S-1 (80–120 mg per day) orally on days 1–14, oxaliplatin (100 mg/m2) intravenously on day 1, and trastuzumab (8 mg/kg on day 1 of the first cycle, followed by 6 mg/kg every 3 weeks) intravenously. The primary end point was 1-year survival rate. The secondary end points included overall survival (OS), progression-free survival (PFS), overall response rate (ORR), and safety. Results A total of 25 patients from six centers were enrolled from December 2015 to March 2020. In the 25 patients evaluable for analysis, the 1-year survival rate was 70.8% [90% confidence interval (CI) = 55.5%–86.1%], whereas the median OS, PFS, and ORR were 17.8 (95% CI 10.5–22.9) months, 7.6 (95% CI 5.0–10.9) months, and 75.0 (95% CI 53.3–90.2) %, respectively. Major grade 3/4 adverse events included anorexia (20%), anemia (16%), peripheral sensory neuropathy (16%), and diarrhea (15%). Conclusion SOX100 combined with trastuzumab was effective with a favorable safety profile in patients with HER2-positive AGC.

[Purpose] We aimed to detect muscle activity during a forearm pronation exercise using a 0.2 T MRI system. [Participants and Methods] We recruited healthy adult volunteers (7 males, 4 females). Transverse relaxation time (T2) values for 10 forearm muscles were obtained from transverse multiple-spin-echo MR images of one-third of the ulna, lengthwise from the olecranon, in the resting state and after isotonic forearm pronation exercise at three strength levels (5, 15, and 25% of the maximum voluntary contraction). Z values were calculated as (T2e - T2r)/SDr, where T2e, T2r and SDr were T2 after exercise, 34 ms, and 3 ms, respectively. A Z value of 2.56 was used as the threshold for defining muscle activation. [Results] T2 values increased significantly in the pronator teres muscle (agonist), while those in the supinator muscle (antagonist) showed no change. The sensitivity and specificity values obtained were high and low, respectively, for all of the three exercise strength levels employed. In some of the participants, activity was detected in the flexor carpi radialis, extensor carpi ulnaris, and extensor digitorum. [Conclusion] Using T2-map MRI, we detected activity in primary and secondary mover muscles. We also found individual variations in the use of forearm muscles during pronation.

Background/Aims: Adalimumab dose escalation is one of the most important options in refractory Crohn’s disease patients with loss of response to adalimumab. The goal of this study was to evaluate the effectiveness of adalimumab dose escalation in Crohn’s disease patients with loss of response to adalimumab, since there are few reports of adalimumab dose escalation, especially in East Asia. Methods: The clinical response to adalimumab dose escalation in Crohn’s disease patients with loss of response to adalimumab was evaluated retrospectively, using the Crohn’s disease activity index score, serum C-reactive protein levels, and endoscopic analyses. Results: Of the 203 Crohn’s disease patients treated with anti-tumor necrosis factor, 14 refractory Crohn’s disease patients with loss of response to adalimumab received adalimumab dose-escalation therapy. The C-reactive protein level was significantly reduced from the start to weeks 12 and 52 of adalimumab dose escalation in the whole group, although there were no significant reductions of Crohn’s disease activity index scores. Both Crohn’s disease activity index scores and C-reactive protein levels were significantly reduced from the start to weeks 12 and 52 of adalimumab dose escalation in patients without previous infliximab treatment, although C-reactive protein levels were positive in all cases with previous infliximab exposure at weeks 12 and 52. Endoscopic mucosal healing was achieved with adalimumab dose escalation in 2 cases without previous infliximab treatment. Conclusions: Adalimumab dose-escalation therapy is effective in refractory Crohn’s disease patients with loss of response to adalimumab, especially in cases without previous infliximab treatment.

High doses of glucocorticoids induce skeletal muscle weakness. The aim of this study was to evaluate the effects of exercise therapy on skeletal muscle strength, mass, and exercise capacity in patients with connective tissue disease treated with high doses of glucocorticoids. This prospective, observational, single-center, cohort study included 35 patients aged ≥ 15 years diagnosed with connective tissue disease who received high-dose glucocorticoids and physical training. Exercise therapy, including moderate aerobic and strength training, was performed five times a week. Knee extension strength, skeletal muscle mass, anaerobic threshold, and peak oxygen consumption were measured at the beginning of exercise therapy and at discharge. After 6 weeks of aerobic and strength exercises, skeletal muscle mass significantly decreased by 5.5%, right knee extension decreased by 11.6%, and left knee extension decreased by 9.7%. The anaerobic threshold and peak oxygen consumption significantly increased by 13.0% and 9.0%, respectively. The increase in glucocorticoid dose was inversely correlated with changes in knee extension strength. In patients with connective tissue disease being treated with high-dose glucocorticoids, exercise therapy might attenuate the decrease in skeletal muscle mass and strength and increase the anaerobic threshold and peak oxygen consumption, thus moderating the side effects of high-dose glucocorticoid treatment. Trial registration The trial is registered with UMIN (University Hospital Medical Information Network), ID number UMIN000038836.

Objective: Knee valgus during jump landing is a cause of knee injuries during sports activities. Body recognition is important for maintaining the knees and other body parts in their proper positions. The aim of this study was to investigate whether knee valgus during jump landing in healthy young women is related to the inaccuracy of recognition of bilateral knee positions in the squatting position. Methods: In 39 healthy young women, the degree of knee valgus was evaluated during the drop vertical jump test using the ratio of the knee separation distance to the ankle separation distance. The accuracy of recognition of bilateral knee positions in the squatting position was evaluated by having the blindfolded subjects indicate with their index fingers the subjective positions of their bilateral patellae by placing their fingers on a horizontal bar positioned in front of them 3 cm below the navel. The difference ratio of the recognized distance to the actual distance between the bilateral patellae was measured as an inaccuracy index. Results: The degree of knee valgus during the drop vertical jump test was positively correlated with the degree of inaccuracy of the recognized knee position with the knees in the neutral position (r=0.358, P=0.025). Conclusions: In healthy young women, knee valgus during jump landing was significantly correlated with the inaccuracy in knee position recognition in the squatting posture. This finding suggests that the assessment of knee position recognition in the squatting position could be useful as a screening tool for preventing knee injuries on jump landing during sports activities.

Endoscopic clipping closure after colorectal endoscopic submucosal dissection (ESD) did not reduce the incidence of post-ESD coagulation syndrome (PECS) in our recent randomized controlled trial (RCT); however, the definition of PECS is still controversial. The aim of this study is to establish optimal definition of PECS with additional analysis of RCT based on another definition.In this multicenter, single-blind RCT, individuals were randomly assigned to colorectal ESD followed by endoscopic clipping closure or non-closure. In this post hoc analysis, the definition of PECS was modified as both localized abdominal pain on visual analogue scale and inflammatory response (fever or leukocytosis), from either localized abdominal pain or inflammatory response in the original study. All participants underwent a computed tomography after ESD, and PECS was classified into type I, conventional PECS without extra-luminal air, and type II, PECS with peri-luminal air.A total of 155 patients (84 in the non-closure group and 71 in the closure group) were analyzed. As a result of criteria modification, 21 type I PECS and four type II PECS cases in the original study, which included patients with clear pain and inflammatory response, were downgraded to no adverse event and simple peri-luminal air, respectively. The frequency of PECS showed no significant difference between non-closure and closure groups.Clipping closure after colorectal ESD does not reduce the incidence of PECS regardless of the diagnostic criteria. Either localized abdominal pain or inflammatory response might be optimal criteria of PECS (UMIN000027031).UMIN000027031 DATE OF REGISTRATION: April 18, 2017.

A 38-year-old man visited our hospital with a complaint of diarrhea and abdominal pain. Contrast-enhanced computed tomography showed that the ileocecal site was intussuscepted to the transverse colon without ischemia. After we reduced intussusception with an enema using a water-soluble contrast agent, his abdominal pain disappeared. Colonoscopy was performed immediately after reduction and showed erosion and edema at the ileocecal site without tumor. The stool culture at admission revealed verotoxin 1 producing Escherichia coli O-26;therefore, we established a diagnosis of intussusception associated with Escherichia coli enterocolitis. Bacterial enteritis should be considered as a potential cause in adult patients with intussusception.

We examined the safety and the effects of low-intensity resistance training (RT) with moderate blood flow restriction (KAATSU RT) on muscle strength and size in patients early after cardiac surgery. Cardiac patients (age 69.6 ± 12.6 years, n = 21, M = 18) were randomly assigned to the control (n = 10) and the KAATSU RT group (n = 11). All patients had received a standard aerobic cardiac rehabilitation program. The KAATSU RT group additionally executed low-intensity leg extension and leg press exercises with moderate blood flow restriction twice a week for 3 months. RT-intensity and volume were increased gradually. We evaluated the anterior mid-thigh thickness (MTH), skeletal muscle mass index (SMI), handgrip strength, knee extensor strength, and walking speed at baseline, 5–7 days after cardiac surgery, and after 3 months. A physician monitored the electrocardiogram, rate of perceived exertion, and the color of the lower limbs during KAATSU RT. Creatine phosphokinase (CPK) and D-dimer were measured at baseline and after 3 months. There were no side effects during KAATSU RT. CPK and D-dimer were normal after 3 months. MTH, SMI, walking speed, and knee extensor strength increased after 3 months with KAATSU RT compared with baseline. Relatively low vs. high physical functioning patients tended to increase physical function more after 3 months with KAATSU RT. Low-intensity KAATSU RT as an adjuvant to standard cardiac rehabilitation can safely increase skeletal muscle strength and size in cardiovascular surgery patients.

Malnutrition is associated with sarcopenia, cachexia, and prognosis. We investigated the usefulness of phase angle (PhA) as a marker of sarcopenia, cachexia, and malnutrition in 412 hospitalized patients with cardiovascular disease. We analyzed body composition with bioelectrical impedance analysis, and nutritional status such as controlling nutritional status (CONUT) score. Both skeletal muscle mass index (SMI) and PhA correlated with age, grip strength and knee extension strength (p &lt, 0.0001) in both sexes. The SMI value correlated with CONUT score, Hb, and Alb in males. Phase angle also correlated with CONUT score, Hb, and Alb in males, and more strongly associated with these nutritional aspects. In females, PhA was correlated with Hb and Alb (p &lt, 0.001). In both sexes, sarcopenia incidence was 31.6% and 32.4%, PhA cut-off in patients with sarcopenia was 4.55&deg, and 4.25&deg, and cachexia incidence was 11.5% and 14.1%, respectively. The PhA cut-off in males with cachexia was 4.15&deg, Multivariate regression analysis showed that grip strength and brain natriuretic peptide (BNP) were independent determinants of SMI, whereas grip strength, BNP, and Hb were independent determinants of PhA. Thus, PhA appears to be a useful marker for sarcopenia, malnutrition, and cachexia in hospitalized patients with cardiovascular disease.

Previous studies have suggested that the nutritional status after stroke is independently associated with long-term outcomes and that sarcopenia delays poststroke rehabilitation and worsens the prognosis. However, many stroke patients have a deteriorated nutritional status and a decreased muscle mass in the acute phase. This prospective study included 179 patients who were admitted to the stroke rehabilitation unit. We performed bioelectrical impedance analysis and determined the Geriatric Nutritional Risk Index (GNRI) to assess muscle mass and the nutritional status on admission. Furthermore, we analyzed the activities of daily living using the Functional Independence Measure (FIM) at the time of admission and four weeks later. Furthermore, we evaluated the change in motor FIM items and examined the relationship with the data. Multiple regression analysis revealed that a high muscle rate (skeletal muscle mass/body weight) (odds ratio OR = 2.43), high phase angle (OR = 3.32), and high GNRI (OR = 2.57) were significantly associated with motor FIM items at four weeks in male and female patients. Muscle mass maintenance through nutritional management and early rehabilitation in the acute period of stroke is essential for functional recovery in stroke patients.

Gastrointestinal decompression is generally applied to a non-strangulated acute small bowel obstruction (NSASBO). Although long tube (LT) placement and administration of Gastrografin through a nasogastric tube (NGT-G) have shown advantages over NGT alone in previous studies, no studies appear to have compared LT and NGT-G. In this multicenter, randomized controlled trial, patients with NSASBO were randomly assigned to receive LT or NGT-G between July 2016 and November 2018 at 11 Japanese institutions. The primary endpoint was non-inferiority of NGT-G compared to LT for non-surgery rate, and the lower limit of the 95% confidence interval for the non-surgery rate (−15%) was set as the lower margin for inferiority of NGT-G compared to LT. In total, 223 patients (LT group, n = 111; NGT-G group, n = 112) were analyzed in the present trial. The non-surgery rate was 87.4% in the LT group and 91.1% in the NGT-G group, with a 3.7% difference between NGT-G and LT (95.3%CI − 5.55 to 12.91; non-inferiority P = 0.00002923). On the other hand, the non-surgery rate with pure NGT-G alone (76.8%) that represents non-cross-over NGT-G without subsequent LT was significantly lower than that with LT (P = 0.039). Median procedure time was significantly shorter with NGT-G (1 min) than with LT (25 min; P

Introduction: After stroke, paralysis reduces muscle strength on the affected side. The lost muscle strength can be partially restored through stroke rehabilitation. However, even if muscle strength is restored, it is not clear whether muscle mass and quality improve. In recent years, it has become possible to measure muscle mass noninvasively using bioelectrical impedance analysis. Additionally, it is known that the phase angle measured by bioelectrical impedance analysis reflects muscle quality. We measured changes in muscle strength, mass, and quality using a hand dynamometer and bioelectrical impedance analysis in patients undergoing rehabilitation after stroke and examined their relationships with activities of daily living (ADLs) improvement. Hypothesis: Post-stroke rehabilitation improves muscle strength, mass, and quality, as well as ADLs. Methods: This retrospective study was performed at two stroke rehabilitation units from January 2017 to March 2019. Muscle mass and quality were assessed using bioelectrical impedance analysis. ADLs were assessed using the functional independence measure (FIM). We measured the grip strength of the non-affected and affected sides as muscle strength. Each measurement was performed at admission and 4 weeks later. We assessed changes in motor FIM items and examined relationships among data. Results and Conclusions: This study included 179 patients (mean age, 75.5±13.0 years; male/female, 89/90; mean duration after stroke, 27.6±8.7 days). Patients received stroke rehabilitation (159.8±21.6 min/day) 7 days a week individually. Muscle strength and quality significantly increased after 4 weeks on both the non-affected and affected sides. Muscle mass decreased, but there was no significant difference. The results were similar when analyzed by sex. Changes in muscle strength and quality were significantly correlated with ADLs improvement (r=0.56 and 0.43, respectively), but muscle mass was not correlated with ADLs improvement. Thus, post-stroke rehabilitation improves muscle strength and quality, as well as ADLs. Muscle mass is not appropriate to measure the effects of stroke rehabilitation, and it is desirable to instead use muscle strength and quality to assess stroke rehabilitation.

Background and Aims Post endoscopic submucosal dissection coagulation syndrome (PECS) occasionally occurs after colorectal endoscopic submucosal dissection (ESD), presenting with localized abdominal pain and inflammation. We conducted a randomized controlled trial (RCT) to assess the usefulness of endoscopic clipping closure to prevent PECS and delayed perforation (DP). Methods This is a multicenter, single-blind RCT. Prospectively enrolled patients undergoing colorectal ESD were randomly allocated to endoscopic clipping closure and nonclosure after ESD, stratifying by institution and tumor size. All participants underwent a computed tomography scan after ESD. PECS was defined as visual analog scale (VAS) ≥30 mm, an increase in VAS ≥20 mm from baseline, body temperature ≥37.5°C or white blood cells ≥10,000/μL after colorectal ESD. DP was defined as PECS accompanied by extraluminal air. The preplanned sample size was 320 patients, and the primary endpoint was the rate of PECS/DP. Results At the planned interim analysis, this trial was terminated by recommendation of the independent data and safety monitoring committee because conditional power with superiority was lower than the preplanned futility limit. Finally, 155 patients were analyzed. The rate of PECS/DP was 16% (95% confidence interval [CI], 8%-23%) in the nonclosure group and 24% (95% CI, 14%-34%) in the closure group (P = .184). All cases of DP were within minor criteria, and all PECS/DP patients were managed conservatively without surgical treatment. Simple periluminal air without PECS was observed in 16% (95% CI, 8%-23%) in the nonclosure group and 10% (95% CI, 3%-17%) in the closure group. Conclusion Endoscopic clipping closure could not reduce the high incidence of PECS/DP after colorectal ESD. (University Hospital Medical Network Clinical Trials Registry number: UMIN000027031.)

Blood flow restriction (BFR) has the potential to augment muscle activation, which underlies strengthening and hypertrophic effects of exercise on skeletal muscle. We quantified the effects of BFR on muscle activation in the rectus femoris (RF), the vastus lateralis (VL), and the vastus medialis (VM) in concentric and eccentric contraction phases of low-intensity (10% and 20% of one repetition maximum) leg extension in seven cardiovascular patients who performed leg extension in four conditions: at 10% and 20% intensities with and without BFR. Each condition consisted of three sets of 30 trials with 30 s of rest between sets and 5 min of rest between conditions. Electromyographic activity (EMG) from RF, VL, and VM for 30 repetitions was divided into blocks of 10 trials and averaged for each block in each muscle. At 10% intensity, BFR increased EMG of all muscles across the three blocks in both concentric and eccentric contraction phases. At 20% intensity, EMG activity in response to BFR tended to not to increase further than what it was at 10% intensity. We concluded that very low 10% intensity exercise with BFR may maximize the benefits of BFR on muscle activation and minimize exercise burden on cardiovascular patients.

Background: The 2-min walk test (2MWT) may be a simple and easy measurement of exercise tolerance for vertebral compression fracture (VCF) patients. But, the validity and reliability of the 2MWT in patients with VCFs have not been verified. The aim of this pilot study was to investigate the validity and reliability of the 2MWT in VCF patients. Methods: Ten patients with VCFs were selected from the inpatient convalescence rehabilitation ward. These patients were required to walk for a minimum of 6 minutes. The study was conducted over three test days. On the first and second test days, the participants completed one trial of the 2MWT each day. These data were used in the analyses for an intra-class correlation coefficient (ICC [1,1]). On the third test day, participants completed the 6-min walk test (6MWT). These data assessed the construct validity of the 2MWT. Participants completed testing on 3 days within a 5-day period. Results: A significant correlation was found between the 2MWT and the 6MWT (r=0.945; p

Introduction: Previous studies suggest that the nutritional status after stroke is independently associated with long-term outcome and that sarcopenia delays post-stroke rehabilitation and worsens prognosis. However, many patients who have suffered from stroke have deteriorated nutritional status and decreased muscle mass in the acute phase. Here, we assessed the correlation of body composition and nutritional status with functional recovery in patients undergoing subacute stroke rehabilitation. Hypothesis: Decrease in muscle mass and malnutrition will prolong functional recovery in patients undergoing stroke rehabilitation. Methods: This retrospective study performed in 2 stroke rehabilitation units from January 2017 to June 2018. We performed bioelectrical impedance analysis and determined the Geriatric Nutritional Risk Index (GNRI) for detecting muscle mass and nutritional status on admission. We analyzed actibities of daily living (ADL) using the Functional Independence Measure (FIM) at the time of admission and 4 weeks later. We described changes in motor FIM items and examined relationships between data. Results and Conclusions: The study included 179 patients (mean age 75.5 ± 13.0 years, male/female: 89/90, and mean average of 27.6 ± 8.7 days after stroke). The patients received individual stroke rehabilitation program (159.8 ± 21.6 minutes per day) 7 days a week. Multiple regression analysis revealed that patients with high body muscle percentage (skeletal muscle mass/body weight) (odds ratio = 2.42), bioelectrical impedance analysis-derived phase angle (odds ratio = 3.23), and GNRI (odds ratio = 2.57) were significantly correlated with motor FIM items at 4 weeks. In conclusion, it was clarified that muscle mass maintenance by nutritional management and early rehabilitation in the acute period of stroke is essential for functional recovery in patients who have suffered from stroke.