Efficacy of combined ultrasound-guided hydrodilatation with hyaluronic acid and physical therapy in patients with adhesive capsulitis: A randomised controlled trial.

OBJECTIVE: To evaluate the therapeutic effect of combining ultrasound-guided hydrodilatation with hyaluronic acid and physical therapy compared with physical therapy alone in patients with adhesive capsulitis. DESIGN: A prospective, single-blinded, randomised controlled trial. SETTING: Single medical centre. PARTICIPANTS: Patients with adhesive capsulitis (N = 62) were divided into group A: ultrasound-guided hydrodilatation with hyaluronic acid + physical therapy (N = 31) and group B: physical therapy alone (N = 31). INTERVENTIONS: Group A received three doses of ultrasound-guided hydrodilatation with hyaluronic acid-based injectates (20 mL in total). Both groups underwent structured physical therapy. OUTCOME MEASURES: The primary outcome measure was Constant score, while secondary outcomes included Shoulder Pain and Disability Index score, numerical rating scale (at rest, night, and during motion), 36-item Short Form Health Survey, and range of motion of the shoulder. All measurements were collected at baseline, 6 weeks, and 12 weeks post-injection. RESULTS: At week 12, the Constant scores were 68.29 ± 14.55 and 62.77 ± 14.44 for groups A and B, respectively. There was a greater reduction in the Constant score, Shoulder Pain and Disability Index, and numerical rating scale between the baseline and 6 weeks and between the baseline and 12 weeks in group A (Constant score: p < 0.05, Shoulder Pain and Disability Index: p < 0.01, and numerical rating scale: p < 0.05). CONCLUSION: The combination of ultrasound-guided hydrodilatation with hyaluronic acid in conjunction with physical therapy provides additional benefits compared to physical therapy alone for the treatment of adhesive capsulitis at up to 12 weeks. TRIAL REGISTRATION: ClinicalTrials.gov: NCT02708706.

Associations of air pollutant concentrations with longitudinal kidney function changes in patients with chronic kidney disease.

This longitudinal cohort study investigated the associations of air pollutant exposures, including CO, NO, NO2, NOx, O3, PM10, PM2.5, and SO2, with long-term kidney function changes in patients with chronic kidney disease (CKD). We enrolled 447 CKD patients who took part in a universal hospital pre-ESRD care program during 2011-2015. The daily average air pollutant exposures and temperature were estimated for each patient, with different levels of air pollutant concentrations defined by 5-knot and restricted cubic spline function. Predicted annual estimated glomerular filtration (eGFR) slope values by one mixed model were considered as the study outcome. The average age of the study population was 77.1 ± 12.6 years, and the median annual eGFR decreased by 2.1 ml/min/1.73 m2 per year from 30 ml/min/1.73 m2 at baseline during a mean follow-up time of 3.4 years. The univariable and multivariable analyses revealed no significant linear and non-linear associations between 5-knot air pollutant concentrations and annual eGFR slope. In addition, the visualized spline effect plots show insignificant variation patterns in annual eGFR slope values with increased air pollutant concentrations. These results encourage more extensive studies to clarify the causal relationships and mechanisms of long-term specific air pollutant exposures and longitudinal kidney function change, especially in CKD populations.

Integration of Virtual Reality into Transcranial Magnetic Stimulation Improves Cognitive Function in Patients with Parkinson's Disease with Cognitive Impairment: A Proof-of-Concept Study.

BACKGROUND: Emerging evidence has indicated the positive effects of repetitive transcranial magnetic stimulation (rTMS) on patients with Parkinson's disease (PD) for the treatment of mild cognitive impairment (MCI). OBJECTIVE: Investigating whether combining virtual reality (VR) training with rTMS can further enhance cognitive improvement induced by rTMS treatment. METHODS: We randomly assigned 40 patients with PD and MCI into three groups, namely the rTMS-VR group (n = 13), rTMS group (n = 11), and sham rTMS group (n = 16). rTMS was administered as 10 consecutive sessions of intermittent theta burst stimulation (iTBS) over the left dorsolateral prefrontal cortex. In the rTMS-VR group, VR training was administered immediately after each rTMS session. Cognitive function was measured using the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) and Montreal Cognitive Assessment (MoCA) at baseline, immediately after intervention, and at 3-month follow-up. RESULTS: Compared with the rTMS group, the rTMS-VR group exhibited significantly more improvements in total and delayed memory scores of the RBANS and the visuospatial/executive function score of the MoCA after intervention (p = 0.000∼0.046) and the delayed memory score of the RBANS at 3-month follow-up (p = 0.028). CONCLUSION: The integrated rTMS-VR protocol achieved a superior outcome in global cognitive function, more effectively enhancing working memory and visuospatial executive function than did the rTMS protocol alone. The combination of VR and rTMS can be an effective regimen for improving the cognitive function of patients with PD.

The applicability of D, MTLD, and MATTR in Mandarin-speaking children.

PURPOSE: The purpose of this study is to evaluate the applicability of D, the Measure of Textual Lexical Diversity (MTLD), and Moving ¬Average Type ¬Token Ratio (MATTR) for measuring lexical diversity of Mandarin-speaking preschoolers. This study examined if D, MTLD, and MATTR can be used to differentiate two different age groups (children age 3 and 4 years) and two language ability groups (typically developing children and children with language delay). METHOD: Seventy-eight Mandarin-speaking typically developing children and 56 Mandarin-speaking children with language delay participated in this study. The researchers collected, transcribed, and analyzed language samples from these children. RESULTS: The findings showed that D and MTLD were sensitive LD measures for assessing the Mandarin-speaking preschoolers. D and MTLD differentiated the two different age groups and language ability groups. The D and MTLD scores of typically developing children were significantly higher than those of children with language delay. Also, 4-year-olds had significantly higher D and MTLD scores than 3-year-olds. MATTR differentiated the two language ability groups but not the two age groups. Possible factors influencing the sensitivity of lexical diversity measures were discussed. CONCLUSIONS: The findings indicated that D and MTLD were sensitive for assessing Mandarin-speaking preschoolers from Taiwan. MATTR can be used to identify children with language delay in this study.

A web-based decision support system for slopeland hazard warning.

A WebGIS decision support system for slopeland hazard warning based on real-time monitored rainfall is introduced herein. This paper presents its framework, database, processes of setting up the threshold line for debris flow triggering and the calculation algorithm implemented in the system. The web-based GIS via the Microsoft Internet Explorer is designed for analysis of areas prone to debris flows outburst and landslides during torrential rain. Its function is to provide suggestions to commander for immediate response to the possibility of slopeland hazards, and determine if pre-evacuation is necessary. The defining characteristics of the internet-based decision support system is not to automatically show the dangerous areas but acts as part of the decision process via information collection to help experts judge the prone debris flow creeks and the tendency of landslides initiation. The combination with real-time rainfall estimation by the QPESUMS radar system is suggested for further enhancement.