Validation of Vibration Exercises on Enhancing Muscle Strength and Upper Limb Functionality among Pre-Frail Community-Dwelling Older Adults.

Pre-frail older adults require appropriate exercise to enhance muscle strength as well as upper limb functionality. We developed a handheld vibrator and evaluated its effectiveness in enhancing muscle strength compared to conventional exercises among pre-frail community-dwelling older adults. Thirty-one pre-frail older adults (aged 75.5 ± 5.1 years) were recruited and randomly allocated to a vibration group (VG) and control group (CG). The VG underwent 20 minutes of vibration (frequency: 30 Hz, amplitude: 5 mm, horizontal vibration) using a handheld vibrator as well as 40 minutes of conventional exercise. The CG received 60 minutes of conventional exercise only. The primary outcome was muscle strength assessment (kg), and the secondary outcome included activities of daily living and instrumental activities of daily living scores. The comparisons between the outcome measures revealed no significant differences at the baseline level. Muscle strength of the dominant (ß = 2.49, p = 0.002) and non-dominant (ß = 1.89, p = 0.02) wrist flexion, brachioradialis (ß = 3.8, p = 0.01), and biceps brachii (ß = 3.02, p = 0.02) in the dominant upper limbs was significantly increased among the VG. The vibration intervention can enhance muscle strength in the upper limbs among pre-frail older adults.

Cervical lymphatic malformations amenable to transhairline robotic surgical excision in children: A case series.

ABSTRACT: Lymphatic malformations are rare benign malformations that predominantly occur in the head and neck region. The advent of surgical robots in head and neck surgery may provide beneficial outcomes for pediatric patients. Here, we describe our experiences with transhairline incisions for robot-assisted surgical resection of cervical lymphatic malformations in pediatric patients.In this prospective longitudinal cohort study, we recruited consecutive patients under 18 years of age who were diagnosed with congenital cervical lymphatic malformations and scheduled for transhairline approach robotic surgery at a single medical center. We documented the docking times, console times, surgical results, complications, and postoperative follow-up outcomes.The studied patients included 2 with mixed-type lymphatic malformations and 2 with macrocystic-type lymphatic malformations. In all 4 patients, the incision was hidden in the hairline; the incision length was <5 cm in 3 patients but was extended to 6 cm in 1 patient. Elevating the skin flap and securely positioning it with Yang retractor took <1 hour in all cases. The mean docking time was 5.5 minutes, and the mean console time was 1 hour and 46 minutes. All 4 surgeries were completed endoscopically with the robot. The average total drainage volume in the postoperative period was 21.75 mL. No patients required tracheotomy or nasogastric feeding tubes. Neither were adverse surgery-associated neurovascular sequelae observed. All 4 patients were successfully treated for their lymphatic malformations, primarily with robotic surgical excisions.Cervical lymphatic malformations in pediatric patients could be accessed, properly visualized, and safely resected with transhairline-approach robotic surgery. Transhairline-approach robotic surgery is an innovative method for meeting clinical needs and addressing esthetic concerns.

Clinical and genetic analysis of invasive and non-invasive group A streptococcal infections in central Taiwan.

To evaluate the clinical, bacteriologic, and genetic relatedness between invasive and non-invasive infections caused by group A Streptococcus (GAS), we retrospectively analyzed the GAS isolates in our hospital from the past decade. A total of 70 GAS-infected cases were enrolled in our study from the period 1993 to 2002. Twenty one cases had invasive disease, and 49 were non-invasive. Their medical records were reviewed, and demographic data were collected for analysis. Antimicrobial susceptibility testing was conducted according to the National Committee for Clinical Laboratory Standards for Streptococcus spp. Isolates were subjected to chromosomal SmaI (Invitrogen) digestion of pulsed-field gel electrophoresis (PFGE), and emm typing was also performed. The mean age of the invasive group was 41.1 +/- 22.4 years compared with 13.0 +/- 16.6 years for the non-invasive group (p<0.05). Eighty one percent of the invasive group had underlying diseases. Diabetes and malignancy were the 2 most common medical conditions. All isolates were susceptible to penicillin. The resistance rate was 42.8% and 55.1% for erythromycin in the invasive and non-invasive groups, respectively. A total of 51 different PFGE types were identified among the GAS isolates without particular genotypes. Serotype M12 was the most common one (28.4%), followed by M4 (19.4%). Our study demonstrated that the patients in the invasive group were older, with more underlying diseases, and with a higher mortality rate. Antimicrobial susceptibility of the isolates was the same in both groups. There was no epidemic strain, nor did PFGE reveal a more invasive clone.

Influenza B virus associated pneumonia: report of one case.

Influenza A virus is a more common cause of pneumonia than influenza B virus. Influenza virus pneumonia complicated with acute respiratory distress syndrome (ARDS) is rare and has a high mortality rate. In addition to pneumonia, influenza occasionally causes neurologic, cardiac, renal, or muscular complications. Hepatic involvement in influenza virus infection has been rarely reported. We reported the case of a 7-year-old girl who was initially treated for upper respiratory tract infection, but she was transferred to the pediatric intensive care unit for intubation and ventilation after her condition deteriorated to lobar pneumonia with ARDS and liver function impairment within 7 days. Influenza B virus infection was confirmed by virus culture and serological study. Respiratory viruses, such as respiratory syncytial virus, adenovirus, influenza virus, and parainfluenza virus, are common causes of pneumonia in children; moreover, they should be considered especially in the presence of persistent leukopenia, low CRP value, lack of growth of bacterial cultures, and poor response to antimicrobial therapy. We should describe its course, diagnosis, and treatments in detail; furthermore, we reported this case to emphasize that influenza B virus may cause transient liver dysfunction and it is an etiology of pneumonia as well as ARDS.

Is combination antimicrobial therapy required for urinary tract infection in children?

This retrospective study examined the characteristics of 338 pediatric patients presenting with a first episode of symptomatic urinary tract infection at Taichung Veterans General Hospital from November 1996 to December 2001. Escherichia coli was the most common pathogen (72.5%), followed by Proteus mirabilis (8.3%), Enterococcus (5.6%), and Klebsiella pneumoniae (4.7%). They were more susceptible to first-generation cephalosporin in comparison with other first-line antimicrobial agents such as trimethoprim/sulfamethoxazole, ampicillin, and gentamicin. Two hundred and eighty-seven (84.9%) of the 338 patients were divided into 3 groups according to the type of antibiotic treatment received, and the susceptibility rate and the averaged day of defervescence after effective antibiotic therapy were compared among the groups. Group 1 consisted of those patients treated with cefazolin or cephalexin alone (95%, 2.1 days); Group 2, cefazolin plus gentamicin (88.9%, 2.8 days); and Group 3, ampicillin plus gentamicin (76.1%, 2.3 days). A total of 38 (13.2%) cases from the 3 antibiotic groups did not respond to empiric antibiotics. For non-susceptible infections, when the antibiotic regimen was switched from cefazolin plus gentamicin to ampicillin alone, only 4 (20%) strains became susceptible, compared with 10 strains (62.5%) becoming susceptible after switching from ampicillin plus gentamicin to cefazolin alone (p < 0.01). The results indicated that first-generation cephalosporin alone is an appropriate treatment for pediatric cases of community-acquired urinary tract infection and suggest that antimicrobial combinations should be reserved for serious or critical cases.