Predictors for Failed Removal of Nasogastric Tube in Patients With Brain Insult.

OBJECTIVE: To construct a prognostic model for unsuccessful removal of nasogastric tube (NGT) was the aim of our study. METHODS: This study examined patients with swallowing disorders receiving NGT feeding due to stroke or traumatic brain injury in a regional hospital. Clinical data was collected, such as age, sex, body mass index (BMI), level of activities of daily living (ADLs) dependence. Additionally, gather information regarding the enhancement in Functional Oral Intake Scale (FOIS) levels and the increase in food types according to the International Dysphagia Diet Standardization Initiative (IDDSI) after one month of swallowing training. A stepwise logistic regression analysis model was employed to predict NGT removal failure using these parameters. RESULTS: Out of 203 patients, 53 patients (26.1%) had experienced a failed removal of NGT after six months of follow-up. The strongest predictors for failed removal were age over 60 years, underweight BMI, total dependence in ADLs, and ischemic stroke. The admission prediction model categorized patients into high, moderate, and low-risk groups for removal failure. The failure rate of NGT removal was high not only in the high-risk group but also in the moderate-risk groups when there was no improvement in FOIS levels and IDDSI food types. CONCLUSION: Our predictive model categorizes patients with brain insults into risk groups for swallowing disorders, enabling advanced interventions such as percutaneous endoscopic gastrostomy for high-risk patients struggling with NGT removal, while follow-up assessments using FOIS and IDDSI aid in guiding rehabilitation decisions for those at moderate risk.

Dynamic postural control during trunk bending and reaching in healthy adults and stroke patients.

OBJECTIVES: Postural stability is often task-demand-dependent and often impaired in stroke patients. The purposes of this study were (1) to compare the difference in the center of pressure measures during forward bending of the trunk and reaching on postural actions between normal subjects and stroke patients and (2) to examine the effects of task demands on the center of pressure measures in both groups. DESIGN: Thirteen normal subjects and 23 stroke patients performed two trials of forward bending of the trunk and reaching for each of the targets at six locations at floor level while standing on a 0.5-m-long pressure mat. Center of pressure excursion, center of pressure average velocity, and bilateral limb weight-bearing ratios characterized the postural actions. Mixed-design analysis of variance was used. RESULTS: A significant target location by group interaction effects was found for all variables except the center of pressure average velocity. All variables except center of pressure average velocity showed significant group differences. The center of pressure excursion and bilateral limb weight-bearing ratio were smaller, and the center of pressure average velocity was larger in stroke patients than in normal subjects. The effects of target location on variables measured were prominent in stroke patients. The posturography of stroke patients was less regular than that of normal subjects. Stroke patients tended to avoid shifting their center of pressure toward the affected side, even when highly necessary. CONCLUSIONS: The difference of postural actions between groups depended on task demands. Small center of pressure displacement and fast center of pressure velocity characterized decreased adaptive postural actions. The amount of center of pressure shift and center of pressure velocity were also dependent on the task demands for both groups.

Effects of Knight-Taylor brace on balance performance in osteoporotic patients with vertebral compression fracture.

OBJECTIVE: To assess the changes in static and dynamic balance and movement strategies in patients with severe osteoporotic vertebral compression fracture while wearing and not wearing the Knight-Taylor (K-T) spinal brace. SUBJECTS: 47 patients with severe osteoporotic vertebral compression fracture, which was confirmed on radiographs and with bone density measurements obtained by dual energy X-ray absorption. INTERVENTION: Patients were randomly subjected to computerized dynamic posturography, which contained sensory organization tests, motor control balance test at 75% limit of stability (LOS) in 8 movement directions, and left/right rhythmic weight shift test (L/R RWS), while wearing and not wearing the K-T spinal brace, respectively. RESULTS: Patients wearing the spinal brace had significantly increased average stability, significantly increased average maximal stability under the swayed vision with fixed support surface condition and under the eye open with swayed support surface condition, significantly increased ankle strategy and decreased average velocity of COG target sway under the eye open with swayed support surface condition, significantly reduced the frequency of falls under the eye closed with swayed support surface condition and swayed vision with swayed support surface condition, and significantly decreased in the percentage of directional control with no difference of reaction time in the LOS test, and an increase in the on-axis velocity in the L/R RWS test. CONCLUSIONS: The K-T spinal brace efficiently enables the subjects to maintain static and dynamic motor balance. Its use decreases the fall frequency but limits the directional control in severe osteoporotic patients with vertebral compression fracture.

A comparison of automatic fall detection by the cross-product and magnitude of tri-axial acceleration.

Falling is an important problem in the health maintenance of people above middle age. Portable accelerometer systems have been designed to detect falls. However, false alarms induced by some dynamic motions, such as walking and jumping, are difficult to avoid. Acceleration cross-product (AC)-related methods are proposed and examined by this study to seek solutions for detecting falls with less motion-evoked false alarms. A set of tri-axial acceleration data is collected during simulated falls, posture transfers and dynamic activities by wireless sensors for making methodological comparisons. The performance of fall detection is evaluated in aspects of parameter comparison, threshold selection, sensor placement and post-fall posture (PP) recruitment. By parameter comparison, AC leads to a larger area under the receiver operating characteristic (ROC) curve than acceleration magnitude (AM). Three strategies of threshold selection, for 100% sensitivity (Sen100), for 100% specificity (Spe100) and for the best sum (BS) of sensitivity and specificity, are evaluated. Selecting a threshold based on Sen100 and BS leads to more practicable results. Simultaneous data recording from sensors in the chest and waist is performed. Fall detection based on the data from the chest shows better global accuracy. PP recruitment leads to lower false alarm ratios (FR) for both AC- and AM-based methods.

Ciprofloxacin-mediated cell proliferation inhibition and G2/M cell cycle arrest in rat tendon cells.

OBJECTIVE: To investigate the effect of ciprofloxacin on the proliferation and cell cycle progression of tendon cells, and to explore the potential molecular mechanism of ciprofloxacin-associated tendinopathy by analyzing the expression of cell cycle-related cyclin and cyclin-dependent kinase (CDK). METHODS: Rat Achilles tendon cells were treated with ciprofloxacin and then assessed by MTT assay, flow cytometric analysis, and fluorescence confocal microscopy. Levels of messenger RNA (mRNA) for CDK-1 and cyclin B were determined by reverse transcriptase-polymerase chain reaction. Protein expression of CDK-1, cyclin B, checkpoint kinase 1 (CHK-1), and polo-like kinase 1 (PLK-1) was determined by Western blot analysis. RESULTS: Ciprofloxacin inhibited tendon cell proliferation and caused cell cycle arrest at the G2/M phase. Confocal microscopy revealed that chromosomes in ciprofloxacin-treated cells neither properly aligned along the equatorial planes nor segregated successfully during metaphase. Mitotic arrest, misaligned chromosomes, and poor bipolar spindle formation were observed in ciprofloxacin-treated cells. CDK-1 and cyclin B protein and mRNA were both down-regulated. CHK-1 protein expression was also suppressed, but PLK-1 protein expression was up-regulated by ciprofloxacin. CONCLUSION: Our findings suggest a possible mechanism of ciprofloxacin-associated tendinopathy. Down-regulation of CHK-1 and up-regulation of PLK-1 may account for mitotic arrest observed in ciprofloxacin-treated cells.

Ground reaction force patterns in stroke patients with various degrees of motor recovery determined by plantar dynamic analysis.

BACKGROUND: To study ground reaction force (GRF) patterns in stroke patients with various degrees of motor recovery, using plantar dynamic analysis. METHODS: Forty-three people with hemiplegic stroke and 20 healthy subjects were enrolled in the study. Motor impairment (motor recovery and muscle tone) and plantar dynamic data (GRF patterns, peak pressure, and walking speeds) were analyzed. GRF patterns were categorized into four patterns based on the force magnitude (spatial features) through time (temporal features) of the vertical GRF. Then stroke patients were classified into good (patterns III and IV) and poor groups (patterns I and II). RESULTS: Patients with hemiplegic stroke showed characteristic GRF patterns which could be categorized from bimodal (pattern IV) to pathological shapes (I-III). The peak pressures on the paretic side in the metatarsal and toe areas were reduced in stroke patients compared with those in healthy subjects. Walking speeds were higher in the good group than in the poor group (p < 0.05). The peak pressures on both sides in the metatarsal and midfoot areas were lower in the poor group than in the good group (p < 0.05). GRF patterns were highly correlated with walking speeds (r = 0.92, p < 0.01). GRF patterns and walking speeds were positively correlated with motor recovery of knee movement (r > 0.4, p < 0.01), but not with hip and ankle movement or muscle tone in the lower limb. CONCLUSIONS: GRF patterns, correlated with walking speeds, indicate underlying motor control of hemiplegic or hemiparetic gait. Knee motor control may be the most important factor in determining walking performance. Plantar dynamic analysis could allow clinicians an alternative assessment in detecting gait changes and planning therapeutic strategies in stroke patients.

Ultrasound stimulation of tendon cell proliferation and upregulation of proliferating cell nuclear antigen.

Therapeutic ultrasound has been widely used in sports-related tendon injuries. However, previous research has not examined the molecular mechanism of this therapeutic effect on tendon cell proliferation. This study was designed to determine the in vitro effect of ultrasound on the proliferation of tendon cells intrinsic to rat Achilles tendon. Furthermore, the existence of a correlation between this effect and the expression of the proliferating cell nuclear antigen (PCNA) was also examined. Using cultured tendon cells, cell viability was evaluated by MTT assay. The expression of PCNA protein in cells was evaluated by immunocytochemistry. The mRNA expression of PCNA was determined by reverse transcription-polymerase chain reaction (RT-PCR). A dose-dependent increase in the cellularity of tendon cells by either pulsed or continuous mode ultrasound was demonstrated by MTT assay (p=0.044 for the pulsed mode; p=0.004 for the continuous mode). Ten minutes of treatment achieved maximum cellularity compared to 5 min of treatment time (p=0.010 for pulsed ultrasound; p=0.004 for continuous ultrasound). Immunocyto-chemical staining revealed that ultrasound treated tendon cells were stained more strongly for PCNA than were control cells. Upregulation of PCNA at the mRNA level was also confirmed by RT-PCR. In conclusion, ultrasound stimulates tendon cell proliferation in a process that is probably mediated by the upregulation of PCNA.

Infrared-based communication augmentation system for people with multiple disabilities.

PURPOSE: This study describes an eyeglass-type infrared-based communication board for the nonspeaking with quadriplegia. METHOD: This system is composed of four major components: a headset, an infrared transmitting module, an infrared receiving/signal-processing module, and a main controller, the Intel-8951 microprocessor. This design concept was based on the use of an infrared remote module fastened to the eyeglasses which could allow the convenient control of the input motion on the keys of a communication board, which are all modified with infrared receiving/signal-processing modules. For system evaluation, 12 subjects (all men, 21-45 years old, six normal subjects as the control group and six nonspeaking with quadriplegia as the experimental group) were recruited. RESULTS: The average accuracy of the control group and the experimental group were 93.1 +/- 4.3% and 89.7 +/- 5.5%, respectively. The average time cost of the control group and the experimental group were 78.3 +/- 8.7 s and 89.9 +/- 10.2 s, respectively. An independent t-test revealed that the differences in the average accuracy and the average time cost of the control group and the experimental group were not significant (p>0.05). CONCLUSIONS: The increase of opportunity to communicate using the infrared-based communication board would help people with multiple disabilities to socialize actively.

Ibuprofen inhibition of tendon cell proliferation and upregulation of the cyclin kinase inhibitor p21CIP1.

Sports-related tendon injuries are commonly treated with nonsteroidal antiinflammatory drugs. This study was designed to determine the in vitro effect of ibuprofen on the proliferation of tendon cells intrinsic to rat Achilles tendon. Furthermore, the existence of a correlation between this effect and the expression of the cyclin kinase inhibitor p21(CIP1) and retinoblastoma (Rb) protein was also examined. Using cultured tendon cells, cell viability was evaluated by MTT assay. To determine whether apoptosis was related to the effect of ibuprofen, terminal deoxynucleotidyl transferase nick-end labeling (TUNEL) assay was used. The mitotic index (MI) was calculated from the number of cells in the mitotic phase as stained and identified by propidium iodide. The mRNA expression of p21(CIP1) was determined by reverse transcription-polymerase chain reaction (RT-PCR). Protein expressions of p21(CIP1) and Rb protein were determined by Western blot analysis. A dose-dependent decrease in the cellularity of tendon cells by ibuprofen was demonstrated by MTT assay (p<0.001). However, TUNEL assay revealed no evidence of apoptosis. Ibuprofen dose-dependently reduced the MI (p<0.001). Upregulation of p21(CIP1) both at the levels of mRNA expression and protein was revealed from RT-PCR and Western blot analyses. The inhibition of Rb protein phosphorylation was also noted in ibuprofen-treated cells. In conclusion, ibuprofen inhibits tendon cell proliferation in a process that is probably mediated by the upregulation of p21(CIP1) and reduced phosphorylation of Rb protein.

Effects of total contact insoles on the plantar stress redistribution: a finite element analysis.

OBJECTIVE: To investigate the effects of total contact insoles on the plantar stress redistribution using three-dimensional finite element analysis. DESIGN: The efficacies of stress reduction and redistribution of two total contact insoles with different material combinations were compared with those of a regular flat insole used as a baseline condition. BACKGROUND: Many specially designed total contact insoles are currently used to reduce the high plantar pressure in diabetic patients. However, the design of total contact insoles is mostly empirical and little scientific evidence is available to provide a guideline for persons who prescribe such insoles. METHODS: To use three-dimensional finite element models of the foot together with insoles to investigate the effects of total contact insoles on the foot plantar pressure redistributions. Nonlinear foam material properties for the different insole materials and the contact behavior in the foot-insole interface were considered in the finite element analysis. RESULTS: Results showed that the peak and the average normal stresses were reduced in most of the plantar regions except the midfoot and the hallux region when total contact insoles were worn compared with that of the flat insole condition. The reduction ratios of the peak normal stress ranged from 19.8% to 56.8%. CONCLUSIONS: Finite element analysis results showed that the two sets of total contact insoles used in the current study can both reduce high pressures at regions such as heel and metatarsal heads and can redistribute the pressure to the midfoot region when compared with the flat insole condition. RELEVANCE: It is possible to simulate foot deformities, change in material properties, different ambulatory loading conditions, and different orthotic conditions by altering the finite element model in a relatively easy manner and these may be of interests to the medical professionals who treat foot-related problems.

Inhibition of tendon cell migration by dexamethasone is correlated with reduced alpha-smooth muscle actin gene expression: a potential mechanism of delayed tendon healing.

Local corticosteroid injection is commonly used to treat sports-related tendon injuries. However, isolated cases of tendon rupture following injection suggest that this treatment may impair the healing process. Tendon healing requires the migration of tendon cells to the repair site, followed by the proliferation and synthesis of the extracellular matrix. This study was designed to determine the effect of dexamethasone on the migration of tendon cells intrinsic to rat Achilles tendon at concentrations similar to those typically used for local injection treatment. Furthermore, the existence of a correlation between this effect and the expression of the contractile actin isoform, alpha-smooth muscle (SM) actin, which is associated with cell motility, was also examined. Using cultured tendon cells, migration was evaluated by counting the number of initial outgrowths from the tendon explants and by transwell filter migration assay. The distribution and assembly of alpha-SM actin were assessed by immunocytochemistry. The mRNA and protein expressions of alpha-SM actin were determined by reverse transcription-polymerase chain reaction (RT-PCR) and Western blot analysis. Dose-dependent dexamethasone inhibition was demonstrated for both tendon cells outgrowth from the explants, ex vivo, and migration of tendon cells through the transwell filter, in vitro. Immunocytochemical staining revealed significant decreases in both the amount and assembly of alpha-SM actin in cells. Suppression of mRNA expression and protein level of alpha-SM actin was revealed from RT-PCR and Western blot analyses. In conclusion, dexamethasone inhibits tendon cell migration that is correlated with decreased gene expression of alpha-SM actin.

Postural control during sit-to stand and gait in stroke patients.

OBJECTIVE: To investigate the relationship of sit-to-stand and gait performance in hemiplegic stroke patients. DESIGN: A total of 40 chronic stroke patients with hemiplegia and 22 age-matched healthy subjects were included in this study. Data of a motion analysis system and three force platforms were collected in a rehabilitation unit of a medical center. RESULTS: Laboratory sit-to-stand measurement and gait analysis were evaluated in both groups via three AMTI (Advanced Mechanical Technology Inc.) force platforms and a Vicon 370 system (six high-resolution cameras and one AMTI force plate), respectively. The sit-to-stand and gait parameters of hemiplegic patients were correlated significantly, especially in rising speed and the maximal vertical force of both legs during rising. CONCLUSIONS: Hemiplegic stroke patients, who could stand up within 4.5 sec or who had a maximal vertical force difference of less than 30% of body weight between both legs, had better gait performance than the others did.

Decreased expression of proliferating cell nuclear antigen is associated with dexamethasone inhibition of the proliferation of rat tendon fibroblasts.

OBJECTIVE: To investigate the effects of dexamethasone (Dex) on the proliferation of cultured rat Achilles tendon fibroblasts at concentrations typically used for local injection treatment. METHODS: Fibroblasts cultured from rat Achilles tendons were treated with Dex at concentrations of 0, 10-4, 3 10-4, and 10-3 M. [3H]thymidine incorporation was used to measure the rate of cell proliferation. mRNA expression of proliferating cell nuclear antigen (PCNA) and cyclin kinase inhibitor p21CIP1 was determined by reverse transcription-polymerase chain reaction (RT-PCR). The protein levels of PCNA and p21CIP1 were investigated by Western blot analysis. RESULTS: An initial inhibitory effect on tendon fibroblast proliferation was observed at a concentration of 10-4 M. Further, a significant decline in [3H]thymidine incorporation as a function of Dex concentration was noted (p = 0.019). RT-PCR results revealed that PCNA mRNA expression was inhibited after Dex treatment. Western blot analysis of PCNA protein also revealed Dex downregulation. Gradual declines in the levels of PCNA mRNA expression and PCNA protein as a function of Dex concentration were noted. The expression of p21CIP1 both at mRNA and the protein levels remained constant. CONCLUSION: These results suggest that Dex inhibition of the proliferation of rat tendon fibroblasts is associated with a p21CIP1 independent decrease of the PCNA gene expression.

Visual spatial attention in children with attention deficit hyperactivity disorder.

BACKGROUND: Attention deficit hyperactivity disorder (ADHD) was characterized by deficit in the attention mechanism. Until now, the visual-spatial attention deficit in children with ADHD remains controversial. We report a study of the visual spatial attention to assess covert shifts of attention and sustained attention theoretically linked to two neuroanatomically defined attentional system in the posterior and anterior parts of the human brain. METHODS: Using the Neuroscan system, the reaction time (RT) was measured according to three different within-subject conditions including cueing (valid, invalid and neutral); delay (800 msec and 100 msec); side [right visual field (RVF) and left visual field (LVF)] as well as one between-subject condition (healthy, ADHD). RESULTS: The AHDH group showed slower RTs overall (RT = 760 msec) than the comparison group (RT = 650 msec) (p = 0.001). RTs in the delayed condition of 800 msec (RT = 680 msec) were faster than in the delayed condition of 100 msec (RT = 730 msec) in all children (p < 0.001). The ADHD group showed significant lateral differences in RT (RTRVF: 880 msec > RTLVF: 830 msec) in the 100 msec delay for the invalid cueing condition (p = 0.045) that was not found in the comparison group. CONCLUSION: General dysfunction including posterior-based covert shift of attention and anterior-based sustained attention was found in ADHD group. Furthermore, asymmetric left parietal dysfunction in the disengaged operation was noted in those with ADHD.