Background Decreased pulmonary function and poor deglutition are a major risk factor for poststroke aspiration pneumonia. We analyzed the benefits of pulmonary training on pulmonary function, deglutition, and quality of life (QOL) in community‐dwelling, frail elderly people with chronic stroke. Method This study was designed as an open, randomized, controlled pilot trial. The participants, who were frail older adults with a history of stroke, were randomized to 2 rehabilitation groups: intervention group (n = 15) and control (n = 15). All participants (65–94 years) attended twelve 20‐min sessions twice a week for 6 weeks of either standard rehabilitation (control group) or standard rehabilitation with pulmonary training including home pulmonary exercise (intervention group). The main outcome measures were pulmonary function (%MIP), deglutition (DRACE), and QOL (SF8・PCS), while secondary outcomes were muscle strength (grip and abdominal), thorax flexibility, 6‐min walk distance, and activities in daily living. All outcomes were measured both prior to training and after the 12 sessions. Results The intervention group showed significant improvement in %MIP (95% CI, 2.9–31.6; p < 0.01), DRACE (95% CI, −4.1–0.1; p < 0.01), and SF8・PCS (95% CI, 2.5–7.2; p < 0.01) compared with controls. There were no cognitive function decline and higher brain dysfunction. Conclusions These results suggest that the addition of pulmonary training including home pulmonary exercise to a standard rehabilitation program could improve pulmonary function, deglutition, and QOL in frail elderly people with chronic stroke.
Background. Air leakage still remains a major problem in lung resection despite the introduction of surgical sealants. We have developed a novel sealant based on hydrophobically modified Alaska pollock-derived gelatin (ApGltn), which showed high adhesive quality in vitro. In this study, we evaluated the adhesive quality and conformability of our ApGltn sealant compared with a fibrin sealant.Methods. The adhesive quality of the sealants was evaluated using excised porcine lungs with ventilation. Pleural defects were created, to which the ApGltn sealant or fibrin sealant was applied. Pressure resistance was assessed using a stepwise increase of airway pressure. Conformability was evaluated by measuring the area of the sealant for its maximum conformity on the gradually inflated lung surface.Results. Leak and burst pressures of the ApGltn sealant were significantly higher than those of the fibrin
In performing surgery for lung cancer, emphysema is a risk factor related to postoperative respiratory complications (PRC). However, few studies have addressed the risk of radiological emphysematous volume affecting PRC. The aim of this study was to investigate the relationship between emphysematous volume as measured on 3-dimensional computed tomography and PRC. Patients and Methods: We reviewed 342 lung cancer patients undergoing lobectomy between 2013 and 2018. The percentage of low attenuation area (LAA%) was defined as the percentage of the lung area showing attenuation of −950 Hounsfield units or lower. Preoperative factors including age, sex, body mass index, smoking index, respiratory function, tumour histology, and LAA% were evaluated. PRC included pneumonia, atelectasis, prolonged air leakage, empyema, hypoxia, ischemic bronchitis, bronchopleural fistula, and exacerbation of interstitial pneumonia. Uni-and multivariable analyses were performed to investigate the relationship between independent clinical variables and postoperative adverse events. Results: Median LAA% was 5.0% (range, 0-40%) and PRC was observed in 50 patients (14.6%). Patients who presented with PRC showed significantly high LAA% compared to those without complications (median: 8.1% vs 3.8%; p < 0.001). Based on univariable analysis, age, sex, smoking index, percentage of forced expiratory volume in 1 s (FEV 1.0 %), histology, and LAA% were significant predictors for PRC. Multivariable analysis revealed higher LAA% as a significant risk factor for PRC (odds ratio = 1.040; 95% confidence interval, 1.001-1.080; p = 0.046). Conclusion:In addition to respiratory function with spirometry, LAA% can be used as a predictor of PRC.
[Purpose] The aim of this study was to investigate factors associated with changes in both the physical and mental components of quality of life (QOL) in of community-dwelling frail older persons in long-term care and to clarify which aspects are important to maintaining physical and mental components of QOL. [Participants and Methods] In this 1 year follow-up cohort study, participants were older persons from a single day care rehabilitation center in Japan. The Medical Outcome Study 8-Item Short-Form Health Survey (MOS-SF8), which gives both physical component summary (PCS) and mental component summary (MCS) scores, was used as the main QOL assessment. Participants were divided according to their level of QOL maintenance according to changes in PCS and MCS scores over the study period, and the variables were compared between the groups. [Results] PCS domain was significantly associated with forced vital capacity and the MCS domain was significantly associated with the Geriatric Depression Scale and Dysphagia Risk Assessment for the Community-Dwelling Elderly Test. [Conclusion] Depression, reduced pulmonary function, and reduced deglutition ability were independently related to low QOL. Assessment of these factors could be beneficial for maintaining the physical and mental components of QOL in community-dwelling frail older persons in long-term care.
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