AI-Based Automatic System for Assessing Upper-Limb Spasticity of Patients with Stroke Through Voluntary Movement.

Spasticity is a common complication for patients with stroke, but only few studies investigate the relation between spasticity and voluntary movement. This study proposed a novel automatic system for assessing the severity of spasticity (SS) of four upper-limb joints, including the elbow, wrist, thumb, and fingers, through voluntary movements. A wearable system which combined 19 inertial measurement units and a pressure ball was proposed to collect the kinematic and force information when the participants perform four tasks, namely cone stacking (CS), fast flexion and extension (FFE), slow ball squeezing (SBS), and fast ball squeezing (FBS). Several time and frequency domain features were extracted from the collected data, and two feature selection approaches based on recursive feature elimination were adopted to select the most influential features. The selected features were input into five machine learning techniques for assessing the SS for each joint. The results indicated that using CS task to assess the SS of elbow and fingers and using FBS task to assess the SS of thumb and wrist can reach the highest weighted-average F1-score. Furthermore, the study also concluded that FBS is the optimal task for assessing all the four upper-limb joints. The overall result shown that the proposed automatic system can assess four upper-limb joints through voluntary movements accurately, which is a breakthrough of finding the relation between spasticity and voluntary movement.

Design of a Multi-Sensor System for Exploring the Relation between Finger Spasticity and Voluntary Movement in Patients with Stroke.

A novel wearable multi-sensor data glove system is developed to explore the relation between finger spasticity and voluntary movement in patients with stroke. Many stroke patients suffer from finger spasticity, which is detrimental to their manual dexterity. Diagnosing and assessing the degrees of spasticity require neurological testing performed by trained professionals to estimate finger spasticity scores via the modified Ashworth scale (MAS). The proposed system offers an objective, quantitative solution to assess the finger spasticity of patients with stroke and complements the manual neurological test. In this work, the hardware and software components of this system are described. By requiring patients to perform five designated tasks, biomechanical measurements including linear and angular speed, acceleration, and pressure at every finger joint and upper limb are recorded, making up more than 1000 features for each task. We conducted a preliminary clinical test with 14 subjects using this system. Statistical analysis is performed on the acquired measurements to identify a small subset of features that are most likely to discriminate a healthy patient from patients suffering from finger spasticity. This encouraging result validates the feasibility of this proposed system to quantitatively and objectively assess finger spasticity.

Work-related musculoskeletal disorders among physical therapists in Taiwan.

ABSTRACT: Work-related musculoskeletal disorders (WMSD) refer to musculoskeletal injuries caused by the occupation. Physical therapists (PTs) suffer from a high risk of WMSD despite their extensive knowledge in ergometrics and injury prevention. This study aims to discover the incidence and prevalence of WMSD among PTs using Taiwan's nationwide claims database. The trend of annual patients seeking rehabilitation and the prevalence of WMSD among PTs were presented. The age- and gender-specific incidence of WMSD were also calculated. The prevalence of WMSD in PTs varied from 6.1% to 75.2%, and the incidence ranged from 6.1 to 29.1 per 100 person-years during 1997 and 2012. For those aged ≤30 years, the incidence was higher in females than males (incidence rate ratio  = 1.08, 95% confidence interval [CI]: 1.02-1.14, P = .011), whereas for those aged from 31 to40 years, females had lower incidence of WMSD than males (incidence rate ratio  = 0.88, 95% CI: 0.80-0.96, P = .007). The patients/PTs ratio was higher (270.56-337.74) in 1998 and 2004 to 2007 and became stable (245.93-252.82) in 2008 to 2012, correlating with a rise in the WMSD prevalence in 1999 to 2007 and a steady prevalence after 2008 (63.5%-66.3%) in PTs. In conclusion, the risk of WMSD among PTs was positively correlated to the frequency of patients seeking rehabilitation service. In addition, age and gender were important risk factors for developing WMSD among PTs.

Risk of dementia in colorectal cancer patients receiving chemotherapy: A nationwide cohort study.

BACKGROUND: Studies have reported conflicting evidence regarding whether chemotherapy leads to dementia. This study aimed to determine whether chemotherapy increases dementia risk in Taiwanese patients with colorectal cancer (CRC). METHODS: Data from the Taiwan Cancer Registry and National Health Insurance Research Database were used. Patients newly diagnosed as having CRC between 2007 and 2015 without prior history of dementia or neurodegenerative disorders were identified. Based on whether they underwent chemotherapy, patients were divided into chemotherapy and non-chemotherapy groups. Those who later developed dementia were identified using validated diagnostic codes. The Fine and Gray subdistribution hazard model for all-cause dementia with competing risk of death was applied for all patients or each stratified group. RESULTS: A total of 76,130 patients with CRC were included, with 45,872 (60.25%) in the chemotherapy group and 30,258 (39.75%) in the non-chemotherapy group. A higher incidence of dementia was observed in the non-chemotherapy group compared with the chemotherapy group (3.75% vs. 2.40%, p < 0.0001), but the risk of dementia did not differ between the groups (adjusted subdistribution hazard ratio [HRSD] = 0.97, 95% confidence interval [CI]: 0.88-1.06, p = 0.492). In the stratified analysis, chemotherapy was a risk factor for dementia in patients aged > 80 years (adjusted HRSD = 1.20, 95% CI: 1.03-1.40, p = 0.0190), whereas gender, clinical cancer stage, comorbidities, surgery, and radiation therapy had no impact on the risk of dementia. CONCLUSION: Chemotherapy increased the risk of dementia in elderly patients with CRC, highlighting the necessity to monitor their cognitive function after chemotherapy.

Correlations between subjective rating and objective assessment of balance function in individuals with stroke.

PURPOSE: To examine the relationships among therapist-reported, patient-reported, and objective assessment scores of balance function. METHODS: Inpatients with stroke and occupational therapists were recruited. The objective balance scores were measured using the Balance Computerized Adaptive Testing (Balance CAT) system. The therapist and patient-reported scores were evaluated using a visual analogue scale (VAS) and Likert-type scale. RESULTS: Eighty-eight patients and 16 therapists participated. The correlations (r= 0.64 and 0.65; R-squared about 0.42 at baseline and follow-up assessments, respectively) between the therapist-reported VAS scores and the Balance CAT system were larger than those (r = 0.31 and 0.21) between the patient-reported VAS scores and the Balance CAT system. Low correlations (r = 0.27 and 0.26 for VAS and Likert-type scores, respectively) were found between the therapist-reported and patient-reported change scores. Low correlations (r = 0.12-0.17) were found between the change scores of therapist- and patient-reported ratings and those of the Balance CAT system. CONCLUSIONS: The therapists' judgments explained <50% of variance of the Balance CAT system scores. Neither therapist-reported nor patient-reported change scores reflected the changes demonstrated by the objective assessments. Further studies are warranted to confirm our findings.Implications for RehabilitationNeither therapist- nor patient-reported balance function and change could effectively reflect the scores resulting from objective assessments.The routine use of objective balance assessments should not be replaced by therapists' subjective judgments.Communications regarding the balance function measured by objective assessments between therapists and patients can help patients to better understand their balance function and progress.

An Assessment System for Post-Stroke Manual Dexterity Using Principal Component Analysis and Logistic Regression.

Hand function assessment is crucial for patients with stroke, who must perform regular repetitive tasks during rehabilitation. However, the conventional evaluation method is subjective and not uniform among physicians. A novel method is proposed in this paper to analyze raw data from a data glove equipped with 16 six-axis inertial measurement units. The proposed method can provide accurate assistance to physicians and objectively assess patients' hand function. Three tasks (the thumb task, the grip task, and the card-turning task) were conducted to evaluate participants' hand function. Representative parameters of hand function in each task and overall evaluation were extracted through principal component analysis and used to develop logistic regression models. The results revealed that all three tasks can be used to perfectly predict healthy subjects and subjects with stroke, with the thumb task exhibiting the highest predictive accuracy for the severity of hand dysfunction. Overall, the proposed method can serve as an efficient method for physicians to assess the hand function of patients with stroke.

Responsiveness and predictive validity of the Tablet-based Symbol Digit Modalities Test in patients with stroke.

BACKGROUND: The responsiveness and predictive validity of the Tablet-based Symbol Digit Modalities Test (T-SDMT) are unknown, which limits the utility of the T-SDMT in both clinical and research settings. AIM: The purpose of this study was to examine the responsiveness and predictive validity of the T-SDMT in inpatients with stroke. DESIGN: A follow-up, repeated-assessments design. SETTING: One rehabilitation unit at a local medical center. POPULATION: A total of 50 inpatients receiving rehabilitation completed T-SDMT assessments at admission to and discharge from a rehabilitation ward. METHODS: The median follow-up period was 14 days. The Barthel index (BI) was assessed at discharge and was used as the criterion of the predictive validity. RESULTS: The mean changes in the T-SDMT scores between admission and discharge were statistically significant (paired t-test = 3.46, P=0.001). The T-SDMT scores showed a nearly moderate standardized response mean (0.49). A moderate association (Pearson's r =0.47) was found between the scores of the T-SDMT at admission and those of the BI at discharge, indicating good predictive validity of the T-SDMT. CONCLUSIONS: Our results support the responsiveness and predictive validity of the T-SDMT in patients with stroke receiving rehabilitation in hospitals. CLINICAL REHABILITATION IMPACT: This study provides empirical evidence supporting the use of the T-SDMT as an outcome measure for assessing processing speed in inpatients with stroke. The scores of the T-SDMT could be used to predict basic activities of daily living function in inpatients with stroke.

Bulnesia sarmientoi Supercritical Fluid Extract Exhibits Necroptotic Effects and Anti-Metastatic Activity on Lung Cancer Cells.

Bulnesia sarmientoi (BS) has long been used as an analgesic, wound-healing and anti-inflammatory medicinal plant. The aqueous extract of its bark has been demonstrated to have anti-cancer activity. This study investigated the anti-proliferative and anti-metastatic effects of BS supercritical fluid extract (BSE) on the A549 and H661 lung cancer cell lines. The cytotoxicity on cancer cells was assessed by an MTT assay. After 72 h treatment of A549 and H661 cells, the IC50 values were 18.1 and 24.7 µg/mL, respectively. The cytotoxicity on MRC-5 normal cells was relatively lower (IC50 = 61.1 µg/mL). BSE arrested lung cancer cells at the S and G2/M growth phase. Necrosis of A549 and H661 cells was detected by flow cytometry with Annexin V-FITC/PI double staining. Moreover, the cytotoxic effect of BSE on cancer cells was significantly reverted by Nec-1 pretreatment, and BSE induced TNF-α and RIP-1 expression in the absence of caspase-8 activity. These evidences further support that BSE exhibited necroptotic effects on lung cancer cells. By wound healing and Boyden chamber assays, the inhibitory effects of BSE on the migration and invasion of lung cancer cells were elucidated. Furthermore, the chemical composition of BSE was examined by gas chromatography-mass analysis where ten constituents of BSE were identified. α-Guaiene, (-)-guaiol and ß-caryophyllene are responsible for most of the cytotoxic activity of BSE against these two cancer cell lines. Since BSE possesses significant cytotoxicity and anti-metastatic activity on A549 and H661 cells, it may serve as a potential target for the treatment of lung cancer.

Acute effects of Kinesio taping on pain, disability and back extensor muscle endurance in patients with low back pain caused by magnetic resonance imaging-confirmed lumbar disc degeneration.

BACKGROUND: Individuals with disc degeneration experience associated pain and disability. Considering its safety and affordability, Kinesio tape (KT) may be a viable treatment. However, most KT studies have demonstrated its effects in healthy adults and patients with nonspecific low back pain. The efficacy of KT in patients with disc degeneration is yet to be investigated. OBJECTIVES: To examine the acute effects of KT on patients with lumbar disc degeneration confirmed through magnetic resonance imaging. METHODS: A total of 31 eligible patients (aged 25-64 years) with low back pain caused by lumbar disc degeneration were divided into mild and moderate-to-severe pain groups. KT was applied to the painful lumbar region in a lumbar brace-like pattern for 1 day. A visual analogue scale for pain and the Oswestry disability index were analysed before and after 1 day of taping. The Biering-Sorensen test for trunk muscle endurance was performed before, immediately after, and 1 day after taping as well as immediately after tape removal. RESULTS: After taping, both groups showed significant pain reduction (p< 0.001), but the reduction was of minimal clinical importance in the moderate-to-severe pain group. The magnitude of treatment (i.e. effect size) was higher in the moderate-to-severe pain group. Disability significantly decreased in both groups, particularly in the moderate-to-severe pain group, but the improvement was not clinically worthwhile. Trunk muscle endurance significantly improved in both groups with in situ taping, but it decreased after tape removal. CONCLUSIONS: KT may be adopted as an assistive aid for immediate pain reduction, particularly in lumbar disc degeneration patients with moderate-to-severe pain; however, its effects on disability and trunk muscle endurance are not clinically worthwhile. The long-term effects of KT, with or without active exercise, warrant further assessment.

Data Glove System Embedded With Inertial Measurement Units for Hand Function Evaluation in Stroke Patients.

This paper proposes a data glove system integrated with six-axis inertial measurement unit sensors for evaluating the hand function of patients who have suffered a stroke. The modular design of this data glove facilitates its use for stroke patients. The proposed system can use the hand's accelerations, angular velocities, and joint angles as calculated by a quaternion algorithm, to help physicians gain new insights into rehabilitation treatments. A clinical experiment was performed on 15 healthy subjects and 15 stroke patients whose Brunnstrom stages (BSs) ranged from 4 to 6. In this experiment, the participants were subjected to a grip task, thumb task, and card turning task to produce raw data and three features, namely, the average rotation speed, variation of movement completion time, and quality of movement; these features were extracted from the recorded data to form 2-D and 3-D scatter plots. These scatter plots can provide reference information and guidance to physicians who must determine the BSs of stroke patients. The proposed system demonstrated a hit rate of 70.22% on average. Therefore, this system can effectively reduce physicians' load and provide them with detailed information about hand function to help them adjust rehabilitation strategies for stroke patients.

TCH1036, a indeno[1,2-c]quinoline derivative, potentially inhibited the growth of human brain malignant glioma (GBM) 8401 cells via suppression of the expression of Suv39h1 and PARP.

A newly synthesized Indeno[1,2-c]quinoline derivative, which has previously been found to potentially trap DNA-topoisomerase cleavage complexes more effectively than camptothecin, could effectively inhibit the proliferation of a variety of cancers, such as breast cancer treated with TCH1030. In this study, we further explore the activity of the TCH1036, TCH1259 and TCH1030 compounds in suppressing the growth of human brain malignant glioma (GBM) 8401 cells, in addition to elucidating the related mechanisms. According to tests of cytotoxicity, the GBM cells were more sensitive to the inhibitory effects of the TCH1036 compound than to those of the other two compounds. Moreover, the accumulation of GBM cells in the sub-G1 and G2/M phases was clearly induced by the TCH1036 compound in a dose-dependent manner. A screening of the majority of histone-modifier enzymes indicated that the expression of Suv39h1 in the GBM cells was attenuated by treatment with each of the TCH compounds, an observation which was further confirmed by Western blotting. The increase in active-form caspase 3 in the GBM cells treated with TCH compounds caused a high degree of poly (ADP-ribose) polymerase (PARP) cleavage and also enhanced the high ratio of hypodiploid GBM cells in the sub-G1 phase. In molecular docking simulations, it was observed that the stable forms of the TCH compounds could successfully insert into the catalytic pocket of PARP, with the highest affinity being between PARP and the TCH1036 compound. These findings suggested that the TCH1036 compound would be a promising compound in the treatment of brain malignant glioma.

Antioxidant and anti-inflammatory activities of Lonicera japonica Thunb. var. sempervillosa Hayata flower bud extracts prepared by water, ethanol and supercritical fluid extraction techniques.

Lonicera japonica Thunberg (LJ) has long been used as an antipyretic, anti-inflammatory and anti-infectious agent in East Asia. The subspecies L. japonica Thunb. var. sempervillosa Hayata (LJv) is a variant that mainly grows in Taiwan. This study examined the antioxidant and anti-inflammatory activities of the extracts from the flower buds of these two species. The extracts were obtained by three extraction methods: water extraction, ethanol extraction, and supercritical-CO2 fluid extraction (SFE). The antioxidant activities of dry LJ (dLJ) extracts were superior to those of LJv extracts. Water extracts possessed higher activities than that prepared by ethanol or SFE. The total polyphenols content, total flavonoids content, and the amount of chlorogenic acid and luteolin-7-O-glucoside were all higher in the water extracts compared to the other two. The SFE extracts of these two species all exhibited excellent anti-inflammatory activities. Although the water and ethanol extracts of dLJ extracts had higher anti-inflammatory activity than that of LJv extracts, the SFE extracts prepared from fresh LJv flower buds (fLJv) exhibited the highest activity among all extracts. The SFE effectively isolates the bioactive components of L. japonica and can obtain the L. japonica extracts with high anti-inflammatory activity.

Design and Implementation of a Set-Top Box-Based Homecare System Using Hybrid Cloud.

INTRODUCTION: Telemedicine has become a prevalent topic in recent years, and several telemedicine systems have been proposed; however, such systems are an unsuitable fit for the daily requirements of users. MATERIALS AND METHODS: The system proposed in this study was developed as a set-top box integrated with the Android™ (Google, Mountain View, CA) operating system to provide a convenient and user-friendly interface. The proposed system can assist with family healthcare management, telemedicine service delivery, and information exchange among hospitals. To manage the system, a novel type of hybrid cloud architecture was also developed. RESULTS: Updated information is stored on a public cloud, enabling medical staff members to rapidly access information when diagnosing patients. In the long term, the stored data can be reduced to improve the efficiency of the database. CONCLUSIONS: The proposed design offers a robust architecture for storing data in a homecare system and can thus resolve network overload and congestion resulting from accumulating data, which are inherent problems in centralized architectures, thereby improving system efficiency.

Risk of breast cancer recurrence in patients receiving manual lymphatic drainage: a hospital-based cohort study.

BACKGROUND: This retrospective cohort study evaluated whether manual lymphatic drainage (MLD) therapy increases the risk of recurrence of breast cancer. METHODS: We analyzed 1,106 women who were diagnosed with stage 0-3 breast cancer between 2007 and 2011 and experienced remission after surgery and adjuvant therapy. The patients were divided into two groups: group A (n=996), in which patients did not participate in any MLD therapy, regardless of whether they developed breast cancer-related lymphedema (BCRL) after cancer treatment; and group B (n=110), in which patients participated in MLD therapy for BCRL. All patients were monitored until October 2013 to determine whether breast cancer recurrence developed, including local or regional recurrence and distant metastasis. Patients who developed cancer recurrence prior to MLD therapy were excluded from analysis. Risk factors associated with cancer recurrence were evaluated using Cox proportional hazards models. RESULTS: During the monitoring period, 166 patients (15.0%) developed cancer recurrence, including 154 (15.5%) in group A and 12 (10.9%) in group B. The median period from surgery to cancer recurrence was 1.85 (interquartile range 1.18-2.93) years. Independent risk factors for cancer recurrence were tumor histological grading of grade 3, high number (≥3) of axillary lymph node invasion, and a large tumor size (>5 cm). Factors protecting against recurrence were positive progesterone receptor status and receiving radiation therapy. Receiving MLD therapy was not an outcome factor in multivariate analyses (hazard ratio 0.71, 95% confidence interval 0.39-1.29, P=0.259). CONCLUSION: MLD is a gentle procedure that does not increase the risk of breast cancer recurrence in patients who develop BCRL.

Role of physiotherapy and patient education in lymphedema control following breast cancer surgery.

INTRODUCTION: This retrospective cohort study evaluated whether education in combination with physiotherapy can reduce the risk of breast cancer-related lymphedema (BCRL). METHODS: We analyzed 1,217 women diagnosed with unilateral breast cancer between January 2007 and December 2011 who underwent tumor resection and axillary lymph node dissection. The patients were divided into three groups: Group A (n=415), who received neither education nor physiotherapy postsurgery; Group B (n=672), who received an educational program on BCRL between Days 0 and 7 postsurgery; and Group C (n=130), who received an educational program on BCRL between Days 0 and 7 postsurgery, followed by a physiotherapy program. All patients were monitored until October 2013 to determine whether BCRL developed. BCRL risk factors were evaluated using Cox proportional hazards models. RESULTS: During the follow-up, 188 patients (15.4%) developed lymphedema, including 77 (18.6%) in Group A, 101 (15.0%) in Group B, and 10 (7.7%) in Group C (P=0.010). The median period from surgery to lymphedema was 0.54 years (interquartile range =0.18-1.78). The independent risk factors for BCRL included positive axillary lymph node invasion, a higher (>20) number of dissected axillary lymph nodes, and having undergone radiation therapy, whereas receiving an educational program followed by physiotherapy was a protective factor against BCRL (hazard ratio =0.35, 95% confidence interval =0.18-0.67, P=0.002). CONCLUSION: Patient education that begins within the first week postsurgery and is followed by physiotherapy is effective in reducing the risk of BCRL in women with breast cancer.

The benefit of early rehabilitation following tendon repair of the hand: A population-based claims database analysis.

STUDY DESIGN: A retrospective cohort. INTRODUCTION: The benefits of early rehabilitation after hand tendon repair have not been analyzed using population-based datasets. PURPOSE OF THE STUDY: to analyze whether early rehabilitation reduces the resurgery risk and the use of rehabilitation resources. METHODS: Patients (n = 1219) who underwent hand tendon repairs followed by rehabilitation were identified from a nationwide claims database and divided into 3 groups: early (<1 wk after tendon repair), intermediate (1-6 wk), or late (>6 wk) rehabilitation. The resurgery rate and the use of rehabilitation resources after tendon repair were calculated. Cox proportional hazards models were used to evaluate the relevant predictors of resurgery. RESULTS: The early rehabilitation group exhibited the lowest resurgery rate and used the fewest rehabilitation resources. Compared with late rehabilitation, early or intermediate rehabilitation conferred protective effects against resurgery in patients without a concomitant upper-limb fracture. CONCLUSION: Our findings suggest the benefit of early rehabilitation after hand tendon repair. LEVEL OF EVIDENCE: 4.

Image denoising with dominant sets by a coalitional game approach.

Dominant sets are a new graph partition method for pairwise data clustering proposed by Pavan and Pelillo. We address the problem of dominant sets with a coalitional game model, in which each data point is treated as a player and similar data points are encouraged to group together for cooperation. We propose betrayal and hermit rules to describe the cooperative behaviors among the players. After applying the betrayal and hermit rules, an optimal and stable graph partition emerges, and all the players in the partition will not change their groups. For computational feasibility, we design an approximate algorithm for finding a dominant set of mutually similar players and then apply the algorithm to an application such as image denoising. In image denoising, every pixel is treated as a player who seeks similar partners according to its patch appearance in its local neighborhood. By averaging the noisy effects with the similar pixels in the dominant sets, we improve nonlocal means image denoising to restore the intrinsic structure of the original images and achieve competitive denoising results with the state-of-the-art methods in visual and quantitative qualities.