Evaluating the effects of delivering integrated kinesthetic and tactile cues to individuals with unilateral hemiparetic stroke during overground walking

Integration of kinesthetic and tactile cues for application to post-stroke gait rehabilitation is a novel concept which needs to be explored. The combined provision of haptic cues may result in collective impr...

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Is patient-reported outcome improved by nalfurafine hydrochloride in patients with primary biliary cholangitis and refractory pruritus? A post-marketing, single-arm, prospective study

Abstract

Background

Patients with primary biliary cholangitis (PBC) frequently suffer from pruritus, which can severely impair their health-related quality of life (HRQOL). Nalfurafine hydrochloride, a selective κ-opioid receptor agonist, was recently approved in Japan for refractory pruritus in patients with chronic liver diseases, but it still remains unclear whether this treatment improves the patient-reported outcome (PRO) in PBC patients with refractory pruritus. Herein, we conducted a multicenter, post-marketing, single-arm prospective study to investigate the efficacy of nalfurafine in terms of PRO, and the associations of the efficacy with any clinical characteristics.

Methods

After screening for pruritus in 496 patients with PBC using PBC-40 and the visual analog scale (VAS), we identified 141 patients with moderate to severe pruritus; these were invited to participate in the study. The participants received 2.5 μg nalfurafine once daily for 12 weeks, and pruritus and HRQOL were assessed in week 12 of this treatment. Generic HRQOL, short form 36, blood chemistries, and serum autotaxin levels were also measured at baseline and at week 12.

Results

Forty-four patients participated in this study. The mean PBC-40 itch domain scores and VAS declined during the study period, from 8.56 to 7.63 (P = 0.041) and from 42.9 to 29.3 (P = 0.001) at baseline and at week 12, respectively, indicating a significant effect of nalfurafine. The other domains of PBC-40 and all domains of SF-36 were not significantly altered by this treatment. We failed to find any association between the change in VAS and PBC-40 itch scores and any clinical variable. Serum autotaxin levels were significantly increased during the study period.

Conclusions

This study demonstrated that nalfurafine improved pruritus in patients with PBC, independent of their clinical characteristics, but had a limited effect on the PRO.

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Do We Need a Cool-Down After Exercise? A Narrative Review of the Psychophysiological Effects and the Effects on Performance, Injuries and the Long-Term Adaptive Response

Abstract

It is widely believed that an active cool-down is more effective for promoting post-exercise recovery than a passive cool-down involving no activity. However, research on this topic has never been synthesized and it therefore remains largely unknown whether this belief is correct. This review compares the effects of various types of active cool-downs with passive cool-downs on sports performance, injuries, long-term adaptive responses, and psychophysiological markers of post-exercise recovery. An active cool-down is largely ineffective with respect to enhancing same-day and next-day(s) sports performance, but some beneficial effects on next-day(s) performance have been reported. Active cool-downs do not appear to prevent injuries, and preliminary evidence suggests that performing an active cool-down on a regular basis does not attenuate the long-term adaptive response. Active cool-downs accelerate recovery of lactate in blood, but not necessarily in muscle tissue. Performing active cool-downs may partially prevent immune system depression and promote faster recovery of the cardiovascular and respiratory systems. However, it is unknown whether this reduces the likelihood of post-exercise illnesses, syncope, and cardiovascular complications. Most evidence indicates that active cool-downs do not significantly reduce muscle soreness, or improve the recovery of indirect markers of muscle damage, neuromuscular contractile properties, musculotendinous stiffness, range of motion, systemic hormonal concentrations, or measures of psychological recovery. It can also interfere with muscle glycogen resynthesis. In summary, based on the empirical evidence currently available, active cool-downs are largely ineffective for improving most psychophysiological markers of post-exercise recovery, but may nevertheless offer some benefits compared with a passive cool-down.

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Impact of age on postoperative complication rates among elderly patients with hip fracture: a retrospective matched study

Abstract

This study was performed to assess the impact of age of ≥ 90 years on predicting postoperative complications. We retrospectively identified all patients aged ≥ 65 years who underwent surgical repair of hip fractures over a 4.5-year period in our hospital. In total, 261 patients were identified (mean age, 86.2 ± 6.8 years). Ninety-one patients were aged ≥ 90 years (oldest-old group), and the remaining 170 were aged < 89 years (control old group). Postoperative complications developed in 54 of 261 patients (20.7%). The oldest-old group had a significantly higher proportion of patients with a Japanese long-term care insurance need level and trochanteric fracture than the control group. Spinal anesthesia was more frequently performed in the oldest-old group. After propensity adjustment for these characteristics, postoperative complication rates in the oldest-old group remained significantly higher than those in the matched control group (odds ratio (OR) 2.76, 95% confidence interval (95% CI) 1.24–6.49; P = 0.011). Major complications also developed more frequently in the oldest-old group than control group (OR 9.78, 95% CI 1.31–4.36; P = 0.018). Anesthesiologists and surgeons should pay attention to potential complications following hip fracture surgery for patients aged ≥ 90 years regardless of American Society of Anesthesiologists class or social dependency.

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Poorly differentiated ductal adenocarcinoma of the pancreas with rapid progression in a young man

Abstract

Pancreatic cancer in young adults is very rare. We report a case of young-onset poorly differentiated pancreatic ductal adenocarcinoma with rapid progression and poor prognosis in a 31-year-old Japanese man with no obvious family history of malignancy. Preoperative examinations revealed a mass lesion in the body of the pancreas, accompanied by a slightly dilated main pancreatic duct distal to the mass lesion. Pancreatic cancer with acute pancreatitis was suspected because of an elevation of serum pancreatic enzyme and tumor marker, along with imaging findings. Distal pancreatectomy with resection of the common hepatic artery and splenectomy along with lymph node dissection was performed. Microscopically, the tumor was mainly composed of poorly differentiated ductal adenocarcinoma. The postoperative course was uneventful, but the patient had multiple liver metastases 2 months postoperatively, in spite of adjuvant chemotherapy, and died 8 months postoperatively. This case may represent a rare instance of young-onset poorly differentiated ductal adenocarcinoma with rapid progression and may indicate potential risk factors of pancreatic cancer in young adults.

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Comparison of running and cycling economy in runners, cyclists, and triathletes

Abstract

Purpose

Exercise economy is one of the main physiological factors determining performance in endurance sports. Running economy (RE) can be improved with running-specific training, while the improvement of cycling economy (CE) with cycling-specific training is controversial. We investigated whether exercise economy reflects sport-specific skills/adaptations or is determined by overall physiological factors.

Methods

We compared RE and CE in 10 runners, 9 cyclists and 9 triathletes for running at 12 km/h and cycling at 200 W. Gross rates of oxygen consumption and carbon dioxide production were collected and used to calculate gross metabolic rate in watts for both running and cycling.

Results

Runners had better RE than cyclists (917 ± 107 W vs. 1111 ± 159 W) (p < 0.01). Triathletes had intermediate RE values (1004 ± 98 W) not different from runners or cyclists. CE was not different (p = 0.20) between the three groups (runners: 945 ± 60 W; cyclists: 982 ± 44 W; triathletes: 979 ± 54 W).

Conclusion

RE can be enhanced with running-specific training, but CE is independent of cycling-specific training.

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Couple honor fallen responders with cross-county 'Move Over' campaign

By Bill Hand Sun Journal HAVELOCK, N.C. — It's the law: slow down and move over. The message, American Towman Magazine believes, should go a long way toward protecting first responders, and it has made the slogan its mission, sending a husband and wife team across the country in a special RV, carrying a symbolic coffin, to remind drivers of what happens when they don't give emergency personnel ...

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