Background and Purpose-We aimed to examine the concurrent effects of timing and intensity of rehabilitation on improving activities of daily living (ADL) among patients with ischemic stroke. Methods-Using the Japanese Diagnosis Procedure Combination inpatient database, we retrospectively analyzed consecutive patients with ischemic stroke at admission who received rehabilitation (n=100 719) from April 2012 to March 2014. Early rehabilitation was defined as that starting within 3 days after admission. The average rehabilitation intensity per day was calculated as the total units of rehabilitation during hospitalization divided by the length of hospital stay. A multivariable logistic regression analysis with multiple imputation and an instrumental variable analysis were performed to examine the association of early and intensive rehabilitation with the proportion of improved ADL score. Results-The proportion of improved ADL score was higher in the early and intensive rehabilitation group. The multivariable logistic regression analysis showed that significant improvements in ADL were observed for early rehabilitation (odds ratio: 1.08; 95% confidence interval: 1.04-1.13; P<0.01) and intensive rehabilitation of >5.0 U/d (odds ratio: 1.87; 95% confidence interval: 1.69-2.07; P<0.01). The instrumental variable analysis showed that an increased proportion of improved ADL was associated with early rehabilitation (risk difference: 2.8%; 95% confidence interval: 2.0-3.4%; P<0.001) and intensive rehabilitation (risk difference: 5.6%; 95% confidence interval: 4.6-6.6%; P<0.001). Conclusions-The

The present results suggest that early rehabilitation might improve ADL during hospitalization in patients with aspiration pneumonia. Geriatr Gerontol Int 2016; 16: 1181-1187.

Knee extension strength was significantly related to the lower extremity functions in people with dementia. Moreover, threshold levels of strength existed that could predict lower extremity dysfunctions in people with dementia.

The results of anatomical resection for grade IV is satisfactory, but additional strategies are still required for grade V.

Background Some academic organizations recommended that physicians intubate patients with COVID-19 with a relatively lower threshold of oxygen usage particularly in the early phase of pandemic. We aimed to elucidate whether early intubation is associated with decreased in-hospital mortality among patients with novel coronavirus disease 2019 (COVID-19) who required intubation. Methods A multicenter, retrospective, observational study was conducted at 66 hospitals in Japan where patients with moderate-to-severe COVID-19 were treated between January and September 2020. Patients who were diagnosed as COVID-19 with a positive reverse-transcription polymerase chain reaction test and intubated during admission were included. Early intubation was defined as intubation conducted in the setting of ≤ 6 L/min of oxygen usage. In-hospital mortality was compared between patients with early and non-early intubation. Inverse probability weighting analyses with propensity scores were performed to adjust patient demographics, comorbidities, hemodynamic status on admission and time at intubation, medications before intubation, severity of COVID-19, and institution characteristics. Subgroup analyses were conducted on the basis of age, severity of hypoxemia at intubation, and days from admission to intubation. Results Among 412 patients eligible for the study, 110 underwent early intubation. In-hospital mortality was lower in patients with early intubation than those with non-early intubation (18 [16.4%] vs. 88 [29.1%]; odds ratio, 0.48 [95% confidence interval 0.27–0.84]; p = 0.009, and adjusted odds ratio, 0.28 [95% confidence interval 0.19–0.42]; p < 0.001). The beneficial effects of early intubation were observed regardless of age and severity of hypoxemia at time of intubation; however, early intubation was associated with lower in-hospital mortality only among patients who were intubated later than 2 days after admission. Conclusions Early intubation in the setting of ≤ 6 L/min of oxygen usage was associated with decreased in-hospital mortality among patients with COVID-19 who required intubation. Trial Registration None.

SUMMARYThis study was undertaken in acute myocardial infarction (AMI) patients with noninsulin-dependent diabetes mellitus (type 2 DM) to investigate their impaired chronotropic response to exercise. Seventy-one AMI subjects entered the study, 30 with type 2 DM and 41 age-and body mass index-matched non-DM (control) patients. One month after the onset of AMI, these patients underwent cardiopulmonary exercise testing on a treadmill under a ramp protocol. Anaerobic threshold (AT) and peak oxygen uptake (peak VO 2 ) were determined as indicators of exercise capacity. Plasma norepinephrine (NE) concentration was measured in blood samples obtained at 2 time points: during pre-exercise rest and immediately after peak exercise. The change in NE concentration during exercise, as an index of sympathetic nervous activity, was calculated as a percentage: ∆NE = [(NE during exercise)-(resting value)]/(resting value) × 100. The change in heart rate (HR) during exercise was calculated as a simple difference: ∆HR = [(peak HR) -(rest HR)]. Index of chronotropic response to exercise was then quantified as the ∆HR/∆NE during exercise. No significant intergroup differences in ejection fraction at rest or HR at peak exercise were observed. However, VO 2 at AT, peak VO 2 , ∆HR, and ∆HR/∆NE were significantly lower in the type 2 DM group than in the non-DM group. ∆HR correlated with VO 2 at AT (r = 0.49, P < 0.001) and with peak VO 2 (r = 0.53, P < 0.001) in all subjects. Also, ∆HR/∆NE correlated with VO 2 at AT (r = 0.42, P < 0.001) and with peak VO 2 (r = 0.44, P < 0.001) in all subjects. AMI patients with type 2 DM had impaired cardiopulmonary responses to maximal and submaximal exercise testing and impaired chronotropic response to exercise, even though their cardiac function at rest was similar to that of non-DM AMI patients. The data suggest that one mechanism of impaired cardiopulmo-

No abstract

Our results of treatment for pediatric hepatoblastoma are presented with special emphasis on pulmonary metastasis. The pulmonary metastasis rate of hepatoblastoma was 44% (11/25). In 19 patients with resected hepatoblastomas, the 5-year survival rate without pulmonary metastasis was 90% (9/10); while with pulmonary metastasis it was 22% (2/9). Six patients with unresected hepatoblastomas all died within 4 months regardless of chemotherapy and/or metastasis. To improve survival in patients with hepatoblastoma, preoperative or postoperative chemotherapy was thought to be essential for tumors extending over 2 hepatic segments and having predictable factors for pulmonary metastasis (large size or histological evidence of capsular invasion). A long-term multidisciplinary approach including hepatic lobectomy, current multiagent chemotherapy (including CDDP, THP-ADR), and partial pulmonary resection for localized lung areas with metastases would ultimately be needed.