Relationship among Falls, Fear of Falling, and Physical Activity Level in Patients on Hemodialysis

OBJECTIVE

Patients on hemodialysis are highly susceptible to falls and fractures. Amplified apprehension regarding the fear of falling (FOF) constitutes a risk factor that restricts physical activity and escalates the probability of falls among the elderly population. This study aimed to elucidate the association between falls and FOF and physical activity in patients on hemodialysis.

METHODS

A prospective cohort study was conducted across 9 centers. FOF was assessed using the Falls Efficacy Scale-International (FES-I). Physical activity was assessed using the Japanese version of the International Physical Activity Questionnaire short form. Subsequently, falls were monitored over a duration of 1 year. Logistic regression analysis was performed to evaluate the relationship between falls and FOF and physical activity. In addition, in the receiver operating characteristic analysis, the cutoff value of FES-I that predicts falls was determined using the Youden Index. A restricted cubic spline curve was utilized to analyze the nonlinear association between falls and the FES-I.

RESULTS

A total of 253 patients on hemodialysis (70.0 [59.0-77.0] years old; 105 female [41.5%]) were included in the analysis. During the 1-year observation period, 90 (35.6%) patients experienced accidental falls. The median FES-I score was 36.0 (24.0-47.0) points, and patients with higher FES-I scores had more falls. Following adjusted logistic regression analysis, FES-I exhibited an independent association with falls (OR = 1.04; 95% CI = 1.01-1.06), but physical activity was not. The area under the receiver operating characteristic curve was 0.70 (95% CI = 0.64-0.77), and the FES-I threshold value for distinguishing fallers from non-fallers was determined as 37.5 points (sensitivity 65.6%, specificity 35.0%). A nonlinear relationship between falls and FES-I was observed.

CONCLUSION

FOF was associated with the incidence of falls in patients on hemodialysis.

IMPACT

The evaluation and implementation of interventions targeting the FOF may mitigate the risk of falls.

Early Ambulation Shortened the Length of Hospital Stay in ICU Patients after Abdominal Surgery

The optimal time to ambulation remains unclear for intensive care unit (ICU) patients following abdominal surgery. While previous studies have explored various mobilization techniques, a direct comparison between ambulation and other early mobilization methods is lacking. Additionally, the impact of time to ambulation on complications and disuse syndrome prevention requires further investigation. This study aimed to identify the optimal time to ambulation for ICU patients after abdominal surgery and considered its potential influence on complications and disuse syndrome. We examined the relationship between time to ambulation and hospital length of stay (LOS). Patients were categorized into the nondelayed (discharge within the protocol time) and delayed (discharge later than expected) groups. Data regarding preoperative functioning, postoperative complications, and time to discharge were retrospectively collected and analyzed. Of the 274 postsurgical patients managed in the ICU at our hospital between 2018 and 2020, 188 were included. Time to ambulation was a significant prognostic factor for both groups, even after adjusting for operative time and complications. The area under the curve was 0.72, and the cutoff value for time to ambulation was 22 h (sensitivity, 68%; specificity, 77%). A correlation between time to ambulation and complications was observed, with both impacting the hospital LOS (model 1: p < 0.01, r = 0.22; model 2: p < 0.01, r = 0.29). Specific cutoff values for time to ambulation will contribute to better surgical protocols.

Influence of patients' walking ability at one-week post-proximal femur fracture surgery on the choice of discharge destination in Japan

[Purpose] With the innovation of healthcare delivery systems, a need for early determination of patients' discharge outcomes arises after proximal femur fracture surgery, to reduce the burden on healthcare infrastructure. Several studies have examined the extent of walking ability early in the postoperative period to predict the outcome destination. In this study, as an additional validation of these studies, we examined the effect of walking ability on the hospital discharge prognosis of patients in the first week after proximal femur fracture surgery in Japan. [Participants and Methods] Medical records of 228 patients with proximal femur fractures, aged ≥75 years old, admitted between April 2015 and March 2019, were retrospectively analyzed. The objective variable was discharge destination. The main evaluation factor was walking ability one-week post-surgery. [Results] Good walking ability and the company of a relative living together one week post-surgery were significant determining factors of discharge destination. [Conclusion] The ability to walk and the presence of a co-resident one week after surgery increased the likelihood of proximal femur fracture patients to be discharged directly to home. Our findings may help rehabilitation professionals make better decisions regarding discharge destination.

Differences between the Sexes in the Relationship between Chronic Pain, Fatigue, and QuickDASH among Community-Dwelling Elderly People in Japan

Chronic pain and fatigue have negative effects on the health, ADL, work, and hobbies of the elderly. As the proportion of people 65 years of age and older in the population increases, chronic pain and disability research regarding this group is receiving more consideration. However, little empirical evidence of the association between chronic pain, fatigue, and physical disability between the sexes is available. This study investigated the association between chronic pain, fatigue, and instrumental activities of daily living among community-dwelling elderly people by sex in Japan. Concerning the presence of chronic pain, 61% of males and 78% of females reported chronic pain, indicating that many elderly people living in the community suffer from chronic pain and fatigue on a daily basis. The number of sites of chronic pain was higher in females than in males (p = 0.016), with more chronic pain in the knees (p < 0.001) and upper arms (p = 0.014). Regarding chronic pain, males showed a higher correlation with QuickDASH-DS (rs = 0.433, p = 0.017) and QuickDASH-SM (rs = 0.643, p = 0.018) than females. Furthermore, fatigue also showed a higher correlation with QuickDASH-W (rs = 0.531, p = 0.003) in males than in females. These results indicate that the association between chronic pain, fatigue, and QuickDASH differed between the sexes among community-dwelling elderly people in Japan. A better understanding of the risk factors for elderly chronic pain and fatigue among sexes will facilitate the development of elderly healthcare welfare and policies.

Validation of the shoulder36 for the activities of daily living with shoulder disorders

[Purpose] The Shoulder36 (V 1. 3) is a regional questionnaire in Japan that has not been validated as a functional evaluation of the shoulder via a thorough comparison with other questionnaires (e.g., QuickDASH). The purpose of this study was to test the reliability, validity, and responsiveness of the Shoulder36 (V 1. 3). [Subjects and Methods] A series of 46 patients with upper extremity disorders completed the Shoulder36 (V 1. 3) and the QuickDASH Japanese version (QuickDASH-JSSH). The reliability of the Shoulder36 was assessed for consistency and validity. The correlation coefficients between the Shoulder36 (V 1. 3) and the QuickDASH-JSSH were obtained. [Results] The total of the Cronbach’s alpha coefficients for the Shoulder36 (V 1. 3) was 0.98. The intraclass correlation coefficients for the six domains of the Shoulder36 (V 1. 3) were similarly high, ranging from 0.81 to 0.94. The correlations between the six domains of the Shoulder36 (V 1. 3) and the three domains of the QuickDASH subscales ranged from −0.43 to −0.78. [Conclusion] The Shoulder36 (V 1. 3) was able to evaluate the relationship between activities of daily living and shoulder joint function with the same degree of accuracy but in more detail than QuickDASH-JSSH. Therefore, it should prove to be a valuable asset in physiotherapy plans and have multiple research applications.

Sample-sample and wavenumber-wavenumber two-dimensional correlation analyses of attenuated total reflection infrared spectra of polycondensation reaction of bis(hydroxyethyl terephthalate)

Polycondensation reaction of bis(hydroxyethylterephthalate) was monitored in situ by attenuated total reflection (ATR)/infrared (IR) spectroscopy. The obtained spectra are analyzed by means of generalized two-dimensional (2D) sample-sample and wavenumber-wavenumber correlation spectroscopies. The sample-sample correlation analysis reveals the correlations among the concentration features of the components, and the wavenumber-wavenumber correlation analysis elucidates the relations among the spectral features. Before the experimental data are analyzed by the 2D correlation spectroscopies, a synthetic two-component spectral model composed of the first and the last experimental spectra, is examined. The results of an analysis of the real data are related to those obtained from the synthetic data. It is found that the sample-sample correlation analysis of the IR data of polycondensation explains the concentration variance in the system and classifies two groups of the samples. The wavenumber-wavenumber correlations are derived upon the results of the sample-sample correlations and explained in terms of the spectral variations of three components. The convolute patterns in both types of correlations are attributed to the weak presence of ethylene glycol.

Hypersensitivity pneumonitis induced by spores of Lyophyllum aggregatum

OBJECTIVES

Lyophyllum aggregatum (LA) is called Shimeji in Japanese and is eaten commonly as a mushroom. Shimeji mushrooms are cultivated in an indoor environment all year round. This study aimed to clarify the clinical features of hypersensitivity pneumonitis (HP) induced by LA.

PATIENTS AND SETTING

Ten patients showed mild respiratory symptoms including dry cough, sputum, and low-grade fever. We tried to characterize the clinical features and the findings using chest high-resolution CT (HRCT), pulmonary function tests (PFTs), and BAL fluid (BALF) tests in patients with HP induced by LA. HP was diagnosed from clinical features, HRCT findings, BALF findings, lung histology, and lymphocyte stimulation tests (LSTs) for LA.

RESULTS

Laboratory findings showed mean (+/- SD) elevated levels of C-reactive protein (0.78 +/- 1.3 mg/dL), erythrocyte sedimentation rate (48 +/- 23 mm/h), and gamma-globulin (26.9 +/- 7.6%). PFTs revealed a slight decrease in the percentage diffusing capacity of the lung for carbon monoxide, possibly due to the presence of epithelial granulomas in the alveoli. Although 4 of 10 patients showed normal findings on the chest radiograph (CXR), chest HRCT findings of all patients showed centrilobular small nodules and diffuse ground-glass opacities. The BALF testing revealed an increase in total cell counts, showing predominantly activated T lymphocytes. The CD4/CD8 cell ratio was significantly decreased (0.5 +/- 0.3). The results of the LSTs were positive in seven of seven cases.

CONCLUSIONS

Since patients with HP induced by LA typically have mild respiratory symptoms and sometimes normal CXR findings, their conditions might remain undiagnosed. However, the chest HRCT images showed the typical subacute phase of HP.

[A case of acute eosinophilic pneumonia induced by inhalation of acetylene]

A 17-year-old high school student, while carrying out soldering one morning, inhaled 100% acetylene, and experienced nausea and bilateral lower limb numbness several hours later. In the evening his symptoms worsened, dyspnea followed, and the patient was referred to our hospital the next day. On admission chest radiography and CT scanning revealed peripheral ground-glass opacity, patchy infiltrate and Kerley's B line in the right lung fields, and bilateral pleural effusion. Since the laboratory findings revealed leukocytosis without eosinophilia, increased CRP, and hypoxemia, bronchoalveolar lavage (BAL) and transbronchial biopsy (TBLB) was subsequently performed. Fluid analysis revealed marked increases in the total cell and eosinophil counts, and the biopsy result showed eosinophilic and lymphocytic infiltration of the alveolar septa. As a result, the case was diagnosed as acute eosinophilic pneumonia (AEP). Although inhalation of acetylene is known to induce pulmonary edema, all the typical findings of AEP but pulmonary edema were seen. This case demonstrates that AEP may be induced by inhalation of acetylene.

Helicity redistribution during relaxation of astrophysical plasmas

We present the first 3D numerical MHD simulations that show that Taylor's relaxation conjecture is not satisfied in some MHD evolution of magnetic configurations encountered in solar physics. We show that magnetic helicity can be slowly injected through the boundary into a magnetic configuration which then evolves into a MHD disruption, with the formation in finite time of a current sheet through which reconnection occurs, leading to a release of magnetic energy. While helicity is well conserved during the process, it is shown that the relaxed state is far from the constant- alpha linear force-free field that would be predicted by Taylor's conjecture.

A Twisted Flux Rope Model for Coronal Mass Ejections and Two-Ribbon Flares

We present a new approach to the theory of large-scale solar eruptive phenomena such as coronal mass ejections and two-ribbon flares, in which twisted flux tubes play a crucial role. We show that it is possible to create a highly nonlinear three-dimensional force-free configuration consisting of a twisted magnetic flux rope representing the magnetic structure of a prominence (surrounded by an overlaying, almost potential, arcade) and exhibiting an S-shaped structure, as observed in soft X-ray sigmoid structures. We also show that this magnetic configuration cannot stay in equilibrium and that a considerable amount of magnetic energy is released during its disruption. Unlike most previous models, the amount of magnetic energy stored in the configuration prior to its disruption is so large that it may become comparable to the energy of the open field.

A 21-aminosteroid, U-74006F, attenuates endotoxin-induced lung injury in awake sheep

The purpose of the present study was to examine the efficacy of U-74006F, a 21-aminosteroid, on lung dysfunction induced by endotoxaemia in awake sheep with lung lymph fistula and haemodynamic monitoring. We measured pulmonary haemodynamics, lung lymph balance, circulating leucocyte count, arterial blood gas tensions, and levels of thromboxane (Tx) B2 and 6-keto-prostaglandin (PG) F1 alpha in plasma and lung lymph. We performed two experiments. In experiment 1 (n = 6), we intravenously infused Escherichia coli lipopolysaccharide endotoxin (1 microgram/kg) over 30 min and observed the parameters over 5 h. In experiment 2 (n = 6), we pretreated sheep with an intravenous bolus of U-74006F (2 mg/kg) 30 min before the infusion of endotoxin in the same manner of experiment 1, and continuously infused U-74006F (0.5 mg/kg per h) over 5 h after the bolus during the experiment. The U-74006F significantly suppressed the early pulmonary hypertension, the late increase in pulmonary permeability and the elevations of TxB2 and 6-keto-PGF1 alpha levels in plasma and lung lymph during the early period following endotoxaemia, although the compound did not change the time course of leucocytopenia and hypoxaemia. These findings suggest that the administration of U-74006F attenuates the lung dysfunction induced by endotoxaemia in awake sheep.

Effects of recombinant human superoxide dismutase on tumor necrosis factor-induced lung injury in awake sheep

Tumor necrosis factor alpha (TNF) is a mediator of acute lung injury after endotoxemia, but the precise mechanism of TNF-induced lung injury remains unclear. To clarify the role of oxygen radicals, especially superoxide anion, in TNF-induced lung injury, we examined the effects of recombinant human superoxide dismutase (rhSOD; 4,200 U/mg) on lung physiological and biochemical changes after TNF infusion in awake sheep (n = 17). We prepared chronically instrumented sheep for lung lymph collection and hemodynamic monitoring. Recombinant human TNF (3.5 micrograms/kg iv) induced a biphasic response in awake sheep. Pulmonary hypertension peaked within 15 min of initiation of TNF and remained elevated for 3 h, followed by increased lung vascular permeability. rhSOD attenuated the pulmonary hypertension in both early and late phases but caused no change in the timing or magnitude of lung fluid balance changes during the late phase. Thromboxane A2 (thromboxane B2) and prostacyclin (6-ketoprostaglandin F1 alpha) metabolite levels in plasma and lymph increased after the TNF infusion, and rhSOD attenuated these changes. The intravenous infusion of rhSOD resulted in the appearance of significant levels of SOD activity in both plasma and lung lymph before and after TNF infusion. These findings suggest that superoxide anion may be implicated in the pathogenesis of the pulmonary hypertension induced by TNF in sheep.

Pharmacokinetic evaluation of (glycolato-O,O')diammine platinum(II) in lung lymph in sheep

The pharmacokinetics of (glycolato-O,O')diammine platinum(II) (254-S), especially the distribution and behavior in the lung lymph in sheep, was investigated and compared with that of cis-diamminedichloroplatinum(II) (CDDP). The blood and lung lymph fluid were collected from the carotid artery and a lung lymph fistula, respectively, in conscious sheep following intravenous infusion of 100 mg/body of 254-S and CDDP for 30 min. The concentrations of these platinum complexes were measured by using atomic absorption spectrometry. We analyzed the data using an anatomically based model including part of the lymphatic circulation. The ultrafilterable platinum of 254-S showed much larger area under the curve (AUC) and transfer rate constants than that of CDDP, even though the mean residence times were the same. The total platinum showed the opposite pharmacokinetic behavior. In anesthetized sheep, when lung tissue samples were obtained by biopsy at the same times as those of blood and lung lymph sampling after infusion of these drugs, 254-S distributed in lung tissue appeared to move more easily into lung lymph than CDDP, which tended to be retained in lung tissue. These differences in pharmacokinetic behavior between 254-S and CDDP seemed to be caused by differences in their strength of protein binding; the association constants of 254-S for plasma and lymph protein were much less than those of CDDP. From these results, 254-S may have favorable therapeutic effects on intrathoracic malignancies such as lung cancer and lymph metastasis.

[Primary plasma cell leukemia associated with hypercalcemia]

A 34-year-old male was admitted to our hospital because of anorexia and nausea in September, 1987. On admission, anemia, thrombocytopenia and hypercalcemia were observed, and the peripheral blood showed leukocytosis with atypical plasma cells (50%). Bone marrow aspiration showed hypercellularity, with a presence of atypical plasma cells (82%). The M-type protein in the serum and urine was identified as lambda Bence Jones protein by immunoelectrophoresis. On systemic skeletal X-rays, osteolytic lesions were not detected. Thus, a diagnosis of plasma cell leukemia associated with hypercalcemia was made. Hypercalcemia was treated successfully with overhydration. However the disease was refractory to combination chemotherapy, and at 10 months after diagnosis, he died of septic candidiasis. Hypercalcemia associated with plasma cell leukemia in its initial stage is rare.