Distal airway dysfunction in obese subjects corrects after bariatric surgery

BackgroundObesity is frequently associated with respiratory symptoms despite normal large airway function as assessed by spirometry. However, reduced functional residual capacity and expiratory reserve volume are common and might reflect distal airway dysfunction. Impulse oscillometry (IOS) might identify distal airway abnormalities not detected using routine spirometry screening. Our objective was to test the hypothesis that excess body weight will result in distal airway dysfunction detected by IOS that reverses after bariatric surgery. The setting was a university hospital.MethodsA total of 342 subjects underwent spirometry, plethysmography, and IOS before bariatric surgery. Of these patients, 75 repeated the testing after the loss of 20% of the total body weight. The data from 47 subjects with normal baseline spirometry and complete pre- and postoperative data were analyzed.ResultsIOS detected preoperative distal airway dysfunction despite normal spirometry findings by an abnormal airway resistance at an oscillation frequency of 20 Hz (4.75 ± 1.2 cm H₂O/L/s), frequency dependence of resistance from 5 to 20 Hz (2.20 ± 1.6 cm H₂O/L/s), and reactance at 5 Hz (?3.47 ± 2.1 cm H₂O/L/s). Postoperatively, the subjects demonstrated 57% ± 15% excess weight loss. The body mass index decreased (from 44 ± 6 to 32 ± 5 kg/m², P < .001). Improvements in functional residual capacity (from 59% ± 11% to 75% ± 20% predicted, P < .001) and expiratory reserve volume (from 41% ± 20% to 75% ± 20% predicted, P < .001) were demonstrated. Distal airway function also improved: airway resistance at an oscillation frequency of 20 Hz (3.91 ± .9, P < .001), frequency dependence of resistance from 5 to 20 Hz (1.17 ± .9, P < .001), and reactance at 5 Hz (?1.85 ± .9, P < .001).ConclusionThe present study detected significant distal airway dysfunction despite normal preoperative spirometry findings. The effect of increased body weight was likely the main mechanism for these abnormalities. However, the inflammatory state of obesity or associated respiratory disease could also be invoked. These abnormalities improved significantly toward normal after weight loss. The results of the present study highlight the importance of bariatric surgery as an effective intervention in reversing these respiratory abnormalities.     

Comparison of Lung Volume Measurements In Individuals With Spinal Cord Injury By Two Different Methods

Abstract

Background/Objective: Few detailed studies have been performed among subjects with spinal cord injury (SCI) using whole body plethysmography for measurement of static lung volumes. Because abdominal gas volumes and respiratory patterns among subjects with varying Ieveis of SCI may differ significantly from able-bodied individuals, methodological concerns related to this technique could conceivably Iead to inaccuracies in lung volume measurements. The purpose of this study was to compare lung volume parameters obtained by whole body plethysmography with those determined by the commonly used nitrogen washaut technique among individuals with SCI.

Participants: Twenty-nine clinically stable men, 14 with chronic tetraplegia (injury C4-C7) and 15 with paraplegia (injury below T5) participated in the study.

Methods: Lung volumes were obtained using whole body plethysmography and the open-circuit nitrogen washout technique. Within both study groups, data were evaluated by the paired Student’st test and by determination of correlation coefficients.

Results: No statistically significant differences for any lung volume parameter were found within either group. ln subjects with tetraplegia on paraplegia, respectively, strong correlation coefficients were found for measurements of totallung capacity (.8 6 and .97), functional residual capacity (.87 and .96), and residual volume (.77 and .85).

Conclusion: These findings indicate that body plethysmography is a valid technique for determining lung volumes among subjects with SCI. Because airway resistance measurements can also be obtained du ring same study sessions for assessment of airway caliber and bronchial responsiveness, body plethysmography is a useful tool for examining multiple aspects of pulmonary physiology in this population.     

Reproducibility and effect of posture on impulse oscillation parameters in persons with spinal cord injury

Background

The impulse oscillation system (IOS) offers significant value in the assessment of airway dynamics in persons with spinal cord injury (SCI) because of minimal patient effort but measurement reproducibility in SCI is unknown.

Objective

To evaluate between-day reproducibility and the effect of posture on airway resistance [respiratory resistances at 5 Hz (R5) and 20 Hz (R20)] in subjects with tetraplegia, paraplegia and able-bodied controls.

Methods

Ten subjects with tetraplegia, 10 subjects with paraplegia and 11 able-bodied individuals were evaluated using IOS. Three 30 second trials were obtained in each while in the seated and supine position on Day 1, and repeated on Day 2.

Results

The within-day coefficient of variation (CV%) for R5 and R20 were comparable in the 3 study groups in the seated and supine positions. Compared to controls, the between-day CV% for the combined data was higher in subjects with tetraplegia and paraplegia for R5 seated, and was higher in subjects with tetraplegia for R5 supine.

Conclusions

IOS has applicability to the study of within-day respiratory resistance in SCI. However, performing longer-term studies in subjects with tetraplegia and paraplegia may be problematic because of the greater variability for R5 when compared to able-bodied individuals.     

Self-reported effects of cold temperature exposure in persons with tetraplegia

Objective: Cervical spinal cord injury (tetraplegia) is known to interrupt sympathetic vasculature control, thereby preventing shunting of blood from the periphery to central organs when exposed to cold temperatures. As a result, persons with tetraplegia are at risk to develop hypothermia. However, information regarding the discomfort experienced during the cooler months (late fall, winter, early spring) is overwhelmingly anecdotal. It is not known, with any certainty, how those with tetraplegia perceive cold and if discomfort in colder environments restricts them from performing activities that they routinely would perform.

Design: Prospective, two-group, self-report surveys.

Setting: VA Medical Center and Kessler Institute for Rehabilitation.

Participants: Forty-four subjects with tetraplegia; 41 matched non-SCI controls.

Outcome Measures: Tetraplegic and control groups responded “yes” or “no” when asked whether cold seasonal temperatures allowed comfort or negatively affected participation in routine activities.

Results: Percentage of responses of tetraplegia compared to controls was different as to whether they felt cold when others in the same room were comfortable (82 vs. 24%; χ²?=?28.2, P?2?=?6.8, P?=?0.009), or whether cold negatively affected bathing routines (55 vs. 15%; χ²?=?14.8, P?=?0.0001), keeping physician appointments (46 vs. 12%; χ²?=?11.3, P?=?0.0008), thinking clearly (41 vs. 7%; χ²?=?12.9, P?=?0.0003), and completing usual work duties (46 vs. 10%; χ²?=?13.3, P?=?0.0003).

Conclusion: Cold seasonal temperatures have a reported greater negative impact on personal comfort and ability to perform vital activities in persons with tetraplegia than that of non-SCI controls. These findings highlight the need to address thermoregulatory impairment in persons with tetraplegia.     

Cholinergic bronchomotor tone and airway caliber in tetraplegic patients

STUDY DESIGN: Case-control study. OBJECTIVES: To evaluate the resting airway caliber in subjects with tetraplegia; to define the participation of cholinergic innervation in this condition; and to determine if baclofen modifies this pattern. SETTING: A rehabilitation hospital, Brasília, Brazil. METHODS: We studied 18 tetraplegic patients, with complete motor loss between C4 and C8, and 18 healthy control subjects by measuring airway conductance, before and after inhaled ipratropium bromide. RESULTS: At baseline, the pulmonary function parameters revealed mild-to-moderate restrictive impairment in tetraplegic patients as defined by decreases in total lung capacity and predicted percent of slow vital capacity. The average baseline specific airway conductance (sGaw) was less in tetraplegic patients (0.25+/-0.11) than in the control group (0.41+/-0.10 l/s/cm H(2)O) (P<0.0001). All patients had improved post-bronchodilator sGaw >or=40% compared with only four of the 18 controls (P<0.001). The average increase for tetraplegic patients was 235% (+/-93) versus 25% (+/-24) for controls (P<0.0001). Analysis of variance for repeated measurements showed significant difference in sGaw between the control and spinal cord injury (SCI) groups (P<0.0001) following bronchodilator challenge, but found no difference for total gas volume. No difference for mean basal sGaw and bronchodilator challenge was encountered comparing tetraplegic patients using baclofen to those not using it. CONCLUSIONS: Cervical SCI patients have a reduced baseline conductance compared to controls. Marked improvement occurs after an inhaled anticholinergic drug. This behavior was not affected by the use of baclofen. The study adds support to the hypothesis of an increased cholinergic bronchomotor tone in tetraplegic patients.     

Prevalence of Chronic Obstructive Pulmonary Disease in the Canary Islands

IntroductionThe prevalence of chronic obstructive pulmonary disease (COPD) varies significantly among the different geographical areas reported. In Spain, two epidemiological studies have shown a prevalence of 9–10% in the population aged over 40. However, neither of these studies included the Canary Islands, which are of interest due to their climatic conditions and high incidence of smoking.Materials and methodsA random group of 1353 subjects aged between 40 and 70 years was selected from a sample population of 596 478 individuals. Participants completed a questionnaire and then performed spirometry with bronchodilator testing if obstruction was observed. COPD was diagnosed when the post-bronchodilator FEV₁/FVC ratio was less than 0.70.ResultsThe prevalence of COPD was 7.3% (95%CI: 5.5–9.5) and was higher in males than in females (8.7% vs 6.3%, P=.134). The incidence of smoking was 29.4% (95%CI: 25.4–33.1) and was also higher in males than in females (35.1% vs 25.4%, P<.001). The prevalence of COPD stratified by severity of obstruction, according to the GOLD criteria, was 16% in group I, 69.9% in group II, 10.4% in group III and 3.3% in group IV. 71.6% of the subjects were underdiagnosed and 63.5% undertreated.ConclusionsDespite having one of the highest rates of smoking in Spain, the prevalence of COPD in the Canary Islands is lower than in most of the Spanish regions studied.     

Forced Oscillation Technique and Small Airway Involvement in Chronic Hypersensitivity Pneumonitis

ObjectiveHypersensitivity pneumonitis (HP) is an interstitial lung disease caused by the inhalation of specific organic antigens or low-molecular weight substances in genetically susceptible individuals. Although small airway involvement is prominent in patients with chronic HP, conventional pulmonary function tests (PFTs) are relatively insensitive to identify it. Thus, the authors aimed to evaluate resistance (R5) and reactance (X5) values at 5 Hz on inspiration, expiration, and whole breath, as well as small airway resistance (R_5•19) values using a forced oscillation technique (FOT) in patients with chronic HP, and their responses after bronchodilator. In addition, R5 and X5 values according to the presence or absence of mosaic attenuation on computed tomography (CT) were compared.MethodsPFTs with plethysmography, diffusing capacity of the lungs for carbon monoxide (DL_CO) and FOT measurements were performed pre-bronchodilator and post-bronchodilator. High-resolution CT was performed at the same visit, and classified according to the presence or absence of mosaic attenuation. R5 and X5 values were then compared according to the presence or absence of mosaic attenuation on CT.ResultsTwenty-eight patients with chronic HP (57.1% female; mean age, 56 ± 11.5 years; mean forced vital capacity 57 ± 17% predicted) were evaluated. All patients had low X5 values, reflecting lower lung compliance, and only three (8%) demonstrated elevated R5 (whole-breath) values. No patients exhibited bronchodilator response in R5, X5 and R_5•19 values. In patients who exhibited greater extension of mosaic attenuation (n = 11), R5 and X5 values could not discriminate those with a greater presence of these areas on CT.ConclusionsThe results suggest that FOT does not help to additionally characterise concomitant small airway involvement in patients with chronic fibrotic HP who demonstrate restrictive ventilatory pattern in conventional PFTs. Nevertheless, FOT appeared to better characterise decreased lung compliance due to fibrosis through X5. Bronchodilator therapy did not appear to induce an acute response in chronic HP patients with restrictive disease. The precise role of FOT in subacute HP and obstructive chronic HP, therefore, must be evaluated.     

Regional estimates of cortical thickness in brain areas involved in control of surgically restored limb movement in patients with tetraplegia

Context/Objective: Spinal cord injury (SCI) causes atrophy of brain regions linked to motor function. We aimed to estimate cortical thickness in brain regions that control surgically restored limb movement in individuals with tetraplegia.

Design: Cross-sectional study.

Setting: Sahlgrenska University hospital, Gothenburg, Sweden.

Participants: Six individuals with tetraplegia who had undergone surgical restoration of grip function by surgical transfer of one elbow ?exor (brachioradialis), to the paralyzed thumb ?exor (?exor pollicis longus). All subjects were males, with a SCI at the C6 or C7 level, and a mean age of 40 years (range?=?31–48). The average number of years elapsed since the SCI was 13 (range?=?6–26).

Outcome measures: We used structural magnetic resonance imaging (MRI) to estimate the thickness of selected motor cortices and compared these measurements to those of six matched control subjects. The pinch grip control area was defined in a previous functional MRI study.

Results: Compared to controls, the cortical thickness in the functionally defined pinch grip control area was not significantly reduced (P?=?0.591), and thickness showed a non-significant but positive correlation with years since surgery in the individuals with tetraplegia. In contrast, the anatomically defined primary motor cortex as a whole exhibited substantial atrophy (P?=?0.013), with a weak negative correlation with years since surgery.

Conclusion: Individuals with tetraplegia do not seem to have reduced cortical thickness in brain regions involved in control of surgically restored limb movement. However, the studied sample is very small and further studies with larger samples are required to establish these findings.     

Transcranial direct current stimulation (tDCS) paired with massed practice training to promote adaptive plasticity and motor recovery in chronic incomplete tetraplegia: A pilot study

Objective: Our goal was to determine if pairing transcranial direct current stimulation (tDCS) with rehabilitation for two weeks could augment adaptive plasticity offered by these residual pathways to elicit longer-lasting improvements in motor function in incomplete spinal cord injury (iSCI).

Design: Longitudinal, randomized, controlled, double-blinded cohort study.

Setting: Cleveland Clinic Foundation, Cleveland, Ohio, USA.

Participants: Eight male subjects with chronic incomplete motor tetraplegia.

Interventions: Massed practice (MP) training with or without tDCS for 2 hrs, 5 times a week.

Outcome Measures: We assessed neurophysiologic and functional outcomes before, after and three months following intervention. Neurophysiologic measures were collected with transcranial magnetic stimulation (TMS). TMS measures included excitability, representational volume, area and distribution of a weaker and stronger muscle motor map. Functional assessments included a manual muscle test (MMT), upper extremity motor score (UEMS), action research arm test (ARAT) and nine hole peg test (NHPT).

Results: We observed that subjects receiving training paired with tDCS had more increased strength of weak proximal (15% vs 10%), wrist (22% vs 10%) and hand (39% vs. 16%) muscles immediately and three months after intervention compared to the sham group. Our observed changes in muscle strength were related to decreases in strong muscle map volume (r=0.851), reduced weak muscle excitability (r=0.808), a more focused weak muscle motor map (r=0.675) and movement of weak muscle motor map (r=0.935).

Conclusion: Overall, our results encourage the establishment of larger clinical trials to confirm the potential benefit of pairing tDCS with training to improve the effectiveness of rehabilitation interventions for individuals with SCI.

Trial Registration: NCT01539109     

Five-Year Longitudinal Bone Evaluations In Individuals With Chronic Complete Spinal Cord Injury

Background/Objectives:Knowledge of spinal cord injury (SCI) bone changes has been derived primarilythrough cross-sectional studies, many of which are controvertible. Longitudinal studies are sparse, and longtermlongitudinal chronic studies are unavailable. The objective of this study was to provide a clearerperception of chronic longitudinal bone variations in people with complete SCI.

Methods:Bone status of 31 individuals with chronic, complete SCI was assessed twice using dual-energy xrayabsorptiometry at an average interval of 5.06 ± 0.9 years. Because the sample of women was small (4),the primary analyses of change and comparisons of those with paraplegia vs tetraplegia were confined to themale participants.

Results: Spine Z-scores showed a significant increase (P < 0.0001 ). The average Z-scores, initial and followup,were within the normal range. Hip Z-scores also showed a significant increase (P < 0.0001 ), and hipbone mineral density (BMD) increased in 48% of the participants. Knee BMD and lower extremity total bonemineral showed significant decreases (P < 0.003 and P < 0.02, respectively), but increases were seen in 33% and 26% at the respective sites. Individuals with tetraplegia had significantly lower values across all regions(P < 0.0001 ), and changes were significantly different compared with paraplegia (P < 0.0001 ). Bone valuesand changes in men vs women, despite the small sample of women, showed highly significant differences(P < 0.003?0.002).

Conclusion:Chronic effects of complete SCI do not exclusively result in continued loss of BMD or a staticstate of lowered BMD; gain in BMD may occur. The nature and magnitude of the effects of complete SCI on BMD vary by site, with sex and level of injury, which has implications for treatment and its assessment.     

Shoulder Emg During Depression Raise In Men With Spinal Cord Injury: The Influence Of Lesion Level

Abstract

Background & Objective: The depression-style raise maneuver is commonly performed by persons with spinal cord injury (SCI) to relieve skin pressures and avoid skin ulceration. The demands of this critical activity, however, are not fully documented for individuals with higher spinal cord lesions. The purpose of this investigation was to determine the influence of SCI lesion level on shoulder muscle activity during a depression raise maneuver.

Experimental Design: Sample of convenience, group comparison.

Methods: Fine-wire intramuscular electrodes recorded electromyographic (EMG) activity from 1 2 shoulder muscles in 57 men with SCI while they performed depression raises (C6 tetraplegia, n = 1 0; C7 tetraplegia, n = 1 8; high paraplegia, n = 1 6; low paraplegia, n = 1 3). EMG intensity was normalized to a manual muscle test (MMT) effort.

Results: For persons with paraplegia and C7 tetraplegia, dominant EMG activity was recorded from latissimus dorsi, sternal pectoralis major, and triceps muscles (31 %-69% MMT) . Tetraplegic groups had significantly greater anterior deltoid activity (C6 = 53%, C7 = 22% MMT) than that recorded in paraplegic groups (high paraplegia = 1 0%, low paraplegia = 3% MMT). Participants with tetraplegia also had increased infraspinatus activity (C6 = 50%, C7 = 32% MMT) compared with participants with low paraplegia (7% MMT). All other muscles had low or very low EMG activity during the depression raise.

Conclusions: Persons with tetraplegia lack normal strength of the primary muscles used by participants with paraplegia for the depression raise (ie, latissimus dorsi, sternal pectoralis major, and triceps muscles) . Although increased anterior deltoid activation assisted with elbow extension, it potentially contributes to glenohumeral joint impingement. Alternate methods of pressure relief should be considered for persons with tetraplegia.

J Spinal Cord Med. 2003;26:59-64     

Quality of Pulmonary Function Tests in Participants with Down Syndrome

IntroductionPeople with Down syndrome (DS) have high respiratory morbidity, evaluating their respiratory health with standardized, objective tests is desirable. Thus, the objective of this study was to evaluate the technical quality of Pulmonary Function Tests (PFTs) to determine which ones are most suitable for this population.MethodsParticipants included children, teenagers and adults with DS, 5 years of age or older (n = 302). The technical quality of the impulse oscillometry system (IOS), forced spirometry, lung-diffusing capacity for carbon monoxide (DL_CO), and 6-min walk test (6MWT) were analyzed by age group. Capnography and pulse oximetry were included in the study. Technical quality was determined on the basis of current international PFTs standards.ResultsFifty-one percent of participants were males. A total of 184 participants (71%) who completed the IOS fulfilled the quality criteria, while 210 (70%) completed the 6MWT. Performance on forced spirometry and DL_CO was poor. All pulse oximetries and 96% percent heart rates obtained had good quality, but exhaled carbon dioxide (PetCO₂) and respiratory rate (RR) showed deficient repeatability.ConclusionsIOS appears to be the most reliable instrument for evaluating lung mechanics in individuals with DS.     

Comparison of lung volume measurements in individuals with spinal cord injury by two different methods

BACKGROUND/OBJECTIVE: Few detailed studies have been performed among subjects with spinal cord injury (SCI) using whole body plethysmography for measurement of static lung volumes. Because abdominal gas volumes and respiratory patterns among subjects with varying levels of SCI may differ significantly from able-bodied individuals, methodological concerns related to this technique could conceivably lead to inaccuracies in lung volume measurements. The purpose of this study was to compare lung volume parameters obtained by whole body plethysmography with those determined by the commonly used nitrogen washout technique among individuals with SCI. PARTICIPANTS: Twenty-nine clinically stable men, 14 with chronic tetraplegia (injury C4-C7) and 15 with paraplegia (injury below T5) participated in the study. METHODS: Lung volumes were obtained using whole body plethysmography and the open-circuit nitrogen washout technique. Within both study groups, data were evaluated by the paired Student's t test and by determination of correlation coefficients. RESULTS: No statistically significant differences for any lung volume parameter were found within either group. In subjects with tetraplegia on paraplegia, respectively, strong correlation coefficients were found for measurements of total lung capacity (.86 and .97), functional residual capacity (.87 and .96), and residual volume (.77 and .85). CONCLUSION: These findings indicate that body plethysmography is a valid technique for determining lung volumes among subjects with SCI. Because airway resistance measurements can also be obtained during same study sessions for assessment of airway caliber and bronchial responsiveness, body plethysmography is a useful tool for examining multiple aspects of pulmonary physiology in this population.     

A Comparative Study Of Outcomes And Expenses Following Tetraplegia And Paraplegia

Abstract

Objective: A study was designed to directly compare individuals with tetraplegia and paraplegia to further explore neurological and functional outcomes and their impact on theexpense of rehabilitation when controlling for level of completeness, age at the time ofinjury, and length of stay.

Methods: A sample was drawn from the National Spinal Cord Injury Database consisting of 2069 individuals, 1005 with paraplegia and 1064 with tetraplegia.

Results: Significant demographic differences were found between the 2 groups with regard to age, ethnicity, marital status, and employment status. Significant differences werefound between the groups withregard to all individual outcome variables (p<.001) and expenses (p<.05). On average,patients with paraplegic injuries evidenced greater change and efficiency on a functionalindependence measure than patients with tetraplegia. In contrast, patients with tetraplegia showed greater changes and efficiency with regard to ASIAMotor Index scores. Higherrehabilitation expenses were found for patients with tetraplegia.     

Intraductal Papilloma of the Breast: Prevalence of Malignancy and Natural History Under Active Surveillance

Background

The optimal management of intraductal papillomas (IPs) without atypia diagnosed on needle core biopsy (NCB) is unclear. This study analyzed the malignancy risk of immediately excised IPs and characterized the behavior of IPs under active surveillance (AS).

Methods

We retrospectively reviewed the pathology and imaging records of patients diagnosed with IPs without atypia on NCB during a 10-year period (1999–2019). The malignancy upgrade rate was assessed in patients who had an immediate surgical excision, and the rates of both radiographic progression and development of malignancy were assessed in a cohort of patients undergoing AS.

Results

The inclusion criteria were met in 152 patients with 175 IPs with a mean age of 51?±?13 years. The average size of the IPs on initial imaging was 8?±?4 mm. Most of the lesions (57%, n?=?99) were immediately excised, whereas 76 (43%) underwent AS with interval imaging with a median follow-up period of 15 months (range, 5–111 months). Among the immediately excised IPs, surgical pathology revealed benign findings in 97% (n?=?96) and ductal carcinoma in situ in 3% (n?=?3). In the AS cohort, 72% (n?=?55) of the IPs remained stable, and 25% (n?=?19) resolved or decreased in size. At 2 years, 4% had increased in size on imaging and were subsequently excised, with ductal carcinoma in situ (DCIS, n?=?1) and benign pathology (n?=?1) noted on final pathology.

Conclusions

In a large series of breast IPs without atypia, no invasive carcinoma was observed after immediate excision, and 96% of the lesions had not progressed on AS. This suggests that patients with IP shown on NCB can safely undergo AS, with surgery reserved for radiographic lesion progression.

     

A Review: Frustrations and Needs in Clinical Care of Spinal Cord Injury Patients

Abstract

Background: Systems of functional electrical stimulation (FES) have been demonstrated to enable some persons with paraplegia to stand and ambulate limited distances. However, the energy costs and acute physiologic responses associated with FES standing activities have not been well investigated.

Objective: To compare the physiologic responses of persons with paraplegia to active FES-assisted standing (AS) and frame-supported passive standing (PS).

Methods: Fifteen persons with paraplegia (T6-T11) previously habituated to FES ambulation, completed physiologic testing of PS and AS. The AS assessments were performed using a commercial FES system (Parastep-1; Altimed, Fresno, Calif); the PS tests used a commercial standing frame (Easy Stand 5 000; Altimed, Fresno, Calif) . Participants also performed a peak arm-cranking exercise (ACE) test using a progressive graded protocol in 3 -minute stages and 1 0-watt power output increments to exhaustion. During all assessments, metabolic activity and heart rate (HR) were measured via open-circuit spirometry and 12-lead electrocardiography, respectively. Absolute physiologic responses toPS and AS were averaged over 1-minute periods at 5-minute intervals (5 , 10, 15, 20, 25, and 30 minutes) and adjusted relative to peak values displayed during ACE to determine percentage of peak (%opk) values. Absolute and relative responses were compared between test conditions (AS and PS) and across time using two-way analysis of variance.

Results: The AS produced significantly greater values of V02 (43%pk) than did PS (20%pk). The mean HR responses to PS (100-102 beats per minute [bpm] throughout) were significantly lower than during AS, which ranged from 108 bpm at 5 minutes to 132 bpm at test termination.

Conclusion: Standing with FES requires significantly more energy than does AS and may provide a cardiorespiratory stress sufficient to meet minimal requirements for exercise conditioning.     

Opinions on the Treatment of People With Tetraplegia: Contrasting Perceptions of Physiatrists and Hand Surgeons

Abstract

Background/Objective: Upper-extremity reconstruction for people with tetraplegia is underused, and we felt that physicians' beliefs could be contributing to this phenomenon. This research sought to determine whether (a) physicians underestimate the importance of upper-extremity function for people with tetraplegia, (b) physiatrists and hand surgeons disagree on the quality of life of those with tetraplegia, (c) surgeons believe that social issues make people with tetraplegia poor surgical candidates, and (d) the 2 specialties disagree on the benefits of upper-extremity reconstruction.

Methods: A self-administered questionnaire was mailed to a national sample of 384 physiatrists and 379 hand surgeons. The data were analyzed with bivariate statistics.

Results: The response rate was 62%. 65% of surgeons and 49% of physiatrists (P < 0.001) ranked upper- extremity function as the most important rehabilitative goal for people with tetraplegia. Both specialties believed the quality of life with tetraplegia was low (less than 60 on a scale of 0 to 100, with 100 representing perfect health). The 2 specialties have significantly different opinions regarding patient compliance, social support, and the effectiveness of surgery.

Conclusions: The majority of physicians believe that upper-extremity function is a rehabilitative priority for people with tetraplegia. However, physiatrists and hand surgeons have significantly different views about people with tetraplegia and the benefits of reconstructive surgery. Physician preconceptions and interdisciplinary divergence may be contributing to the underuse of these procedures, and these issues should be considered when designing programs to improve access to these procedures.     

No difference in renal function outcomes for patients with oncocytoma managed with active surveillance vs. partial nephrectomy

ObjectivesTo investigate the difference in renal function outcomes for patients with oncocytomas undergoing active surveillance (AS) vs. partial nephrectomy (PN).MethodsWe reviewed our institutional database for patients with biopsy/surgically confirmed oncocytoma from 2000-2020. The primary outcome was to assess for differences in renal function outcomes in patients undergoing AS vs. PN. We fit two generalized estimating equation (GEE) with an interaction term between follow up time and management strategy to predict 1) mean eGFR for patients managed with AS and PN and 2) the probability of progression to CKD stage III or greater.ResultsWe identified 114 eligible patients, of which 32 were managed with AS. Median follow-up was 21 months vs. 44 months for PN vs. AS patients. AS patients tended to be older (median: 72 years vs. 65 years, P<0.001) and have lower baseline renal function (median: eGFR: 71 mL/min/1.73m² vs. 82 mL/min/1.73m², P<0.001) compared with PN patients. Renal mass size from baseline imaging was similar between patients undergoing PN vs. AS (2.8 cm vs. 2.9 cm, P=0.634). For patients undergoing PN vs. AS, there was not a significant difference in predicted longitudinal eGFR (-0.079, 95% CI -0.18-0.023, P=0.129) or predicted probability of progression to CKD stage III or greater (OR: 0.61, 95% CI: 0.16-2.33, P=0.47).ConclusionsIn our institutional dataset, patients undergoing AS or PN with an oncocytoma had similar long-term renal function outcomes. Given similar renal function outcomes in patients undergoing AS and PN, surgery should remain reserved for select patients with oncocytomas.     

Short-term effects of respiratory muscle training combined with the abdominal drawing-in maneuver on the decreased pulmonary function of individuals with chronic spinal cord injury: A pilot randomized controlled trial

Objective: To investigate the effects of respiratory muscle training (RMT) combined with the abdominal drawing-in maneuver (ADIM) on the pulmonary function in patients with chronic spinal cord injury (SCI).

Methods: Thirty-seven subjects with SCI (level of injury: C4–T6, time since injury: 4–5 years) were randomly allocated to three groups; the integrated training group (ITG), the RMT group (RMTG), and the control group (CG). The ITG performed RMT using an incentive respiratory spirometer (IRS) and the ADIM using a stabilizer. The RMTG received only RMT using an IRS. Subjects in the CG received alternative and routine physical therapy or usual care. The interventions were conducted over an eight-week period. Pulmonary function was evaluated using spirometry to measure the forced vital capacity (FVC) and forced expiratory volume in 1 second (FEV₁).

Results: The differences between the pre- and post-test values for FVC (0.47?±?0.05 versus 0.15?±?0.06 versus –0.03?±?0.01) and FEV₁ (0.74?±?0.07 versus 0.27?±?0.17 versus 0.02?±?0.67)were significant among the groups. Post-test, in the ITG, the FVC and FEV₁ values showed significant differences from those in the RMTG and CG (F?=?11.48 and 11.49, P?=?0.002 and 0.001). Furthermore, following the 8­week intervention, the change ratio values of the FVC and FEV₁ of the ITG were increased further by an average of 9.75% and 7.91%, respectively, compared with those of the RMTG.

Conclusion: These findings suggest positive evidence that RMT with additional ADIM training can improve pulmonary function in SCI pulmonary rehabilitation.