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BACKGROUND: Current principles of postoperative pain management are primarily based on the types and extent of surgical intervention. This clinical study measured patient's self-anticipated pain score before surgery, and compared the anticipated scores with the actual pain levels and analgesic requirements after surgery. METHODS: This prospective observational study recruited consecutive patients who received elective surgery in the E-Da Hospital, Taiwan from June to August 2018. Patients were asked to subjectively rate their highest anticipated pain level (numeric rating scale, NRS 0-10) for the scheduled surgical interventions during their preoperative anesthesia assessment. After the operation, the actual pain intensity (NRS 0-10) experienced by the patient in the post-anesthesia care unit and the total dose of opioids administered during the perioperative period were recorded. Pain scores ≥4 on NRS were regarded as being unacceptable levels for anticipated or postoperative pain that required more aggressive intervention. RESULTS: A total of 996 patients were included in the study. Most of the patients (86%) received general anesthesia and 73.9% of them had a history of previous operation. Female anticipated significantly higher overall pain intensities than the male patients (adjusted odd ratio 1.523, 95% confidence interval 1.126-2.061; P = 0.006). Patients who took regular benzodiazepine at bedtime (P = 0.037) and those scheduled to receive more invasive surgical procedures were most likely to anticipate for higher pain intensity at the preoperative period (P < 0.05). Higher anticipated pain scores (preoperative NRS ≥ 4) were associated with higher actual postoperative pain levels (P = 0.007) in the PACU and higher total equivalent opioid use (P < 0.001) for acute pain management during the perioperative period. CONCLUSION: This observational study found that patients who are female, use regular benzodiazepines at bedtime and scheduled for more invasive surgeries anticipate significantly higher surgery-related pain. Therefore, appropriate preoperative counseling for analgesic control and the management of exaggerated pain expectation in these patients is necessary to improve the quality of anesthesia delivered and patient's satisfaction.
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Analgésicos Opioides/uso terapéutico , Procedimientos Quirúrgicos Electivos , Dimensión del Dolor , Dolor Postoperatorio/tratamiento farmacológico , Benzodiazepinas/administración & dosificación , Utilización de Medicamentos/estadística & datos numéricos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Periodo Preoperatorio , Estudios Prospectivos , Factores SexualesRESUMEN
Background and objectives: Respiratory muscle fatigue is one of the important factors limiting sports performance due to the metaboreflex. This reflex will cause a decrease in blood flow to the extremities and accelerate exercising limb fatigue. Previous studies found that inspiratory muscle training (IMT) can effectively enhance the respiratory muscle endurance and reduce fatigue during long-duration exercise or aerobic exercise, thereby enhancing athletic performance. However, the mechanism between inspiratory muscle strength, change of limb blood flow and sports performance still requires investigation, especially in short-duration exercise, anaerobic or both aerobic and anaerobic exercise. The purpose of this study was to investigate the effects of 4-week inspiratory muscle training on respiratory muscle strength, limb blood flow change rate and sports performance in recreational 800-m college runners. Materials and Methods: Twenty healthy 800-m college runners randomized into the IMT group (11 subjects) and control group (9 subjects). IMT consisted of 30 inspiratory efforts twice daily, 5 days a week, with intensity at 50%, 60%, 70% and 80% of maximum inspiratory pressure (MIP) for 4 weeks, while a control group kept 50% of MIP for 4 weeks. An 800-m trial test, limb blood flow change rate by using Impedance Plethysmography, and MIP were as the outcome measured variables and be evaluated. All measured variables were assessed before and after 4-week IMT training. Two-way ANOVA was conducted for statistical analysis. Results: The results showed significantly interaction between groups and pre-posttest. IMT group significantly decreased limb blood flow change rate from 19.91 ± 11.65% to 9.63 ± 7.62% after received the IMT training program (p < 0.05). The MIP significantly improved from 112.95 ± 27.13 cmH2O to 131.09 ± 28.20 cm H2O in IMT group, and the 800-m trial test also shorted the running time from 162.97 ± 24.96 s to 156.75 ± 20.73 s. But the control group no significantly changed in MIP and 800-m trial test. Conclusions: Our results indicated that the 4-week IMT training (twice a day, 5 days a week) significantly improves participants' inspiratory muscle strength, 800-m running performance and decreases the limb blood flow change rate.
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Ejercicios Respiratorios , Músculos Respiratorios , Tolerancia al Ejercicio , Humanos , Fatiga Muscular , Fuerza MuscularRESUMEN
In this study, Kinesio tape (KT) was applied in two different directions to the gastrocnemius muscle, the most important muscle in stance stability, to investigate the effect of different taping directions on overall balance and sensation systems before versus after muscle fatigue. The participants, comprising 45 healthy athletes, were randomly divided into three groups: the placebo taping group (PTG), the facilitation KT group (FKTG), and the inhibition KT group (IKTG). The tests involved in this study were a balance test, a superficial sensory function test, and a combined cortical sensation test. The data from these tests were collected before taping, after taping and a 10-min rest, and immediately after continuous heel raises were performed to fatigue. The results of the balance tests showed no significant group × time interaction, whether subjects stood barefoot on one foot or stood on a soft mat with eyes open or closed (p > 0.05). Only the sway distance and sway velocity of the center of pressure (COP) when subjects stood barefoot on one foot with eyes open were significantly higher in the inhibition taping group than in the placebo taping group (p < 0.05). In addition, significant differences were noted in the sway area and sway distance of the COP before taping, after taping, and after exercise to fatigue when the participants stood on the soft mat with their eyes open (p < 0.05). When the participants stood on the soft mat on one foot with their eyes closed, no significant differences were noted among the groups. When subjects stood on a soft mat on one foot with eyes open, significant improvements were noted after fatiguing exercise versus before taping for all three groups (p < 0.05). The results of the superficial sensory test showed no significant group × time interaction and no difference among the three taping conditions or before/after taping and after fatiguing exercise. Only in the two-point discrimination test was a sensory difference observed, with the facilitation taping group having a significantly shorter discrimination distance than the placebo taping and inhibition taping groups (p < 0.05). The present study showed that KT application for a simple balance task (e.g., barefoot on a hard floor with eyes open) may slightly influence postural control, especially when the inhibition method is used. However, more difficult balance tasks (e.g., barefoot on a soft mat with eyes closed) show no effect of KT application-either the facilitation method or the inhibition method-on posture control.
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Cinta Atlética , Fatiga Muscular , Humanos , Fatiga Muscular/fisiología , Equilibrio Postural/fisiología , Músculo Esquelético/fisiología , AtletasRESUMEN
A previous study provided reference data on the age and gender distribution of anthropometric parameters in Taiwanese adults. However, there are very few large-scale analyses of anthropometric data of older adults in Taiwan. Therefore, the main purpose of this study was to describe gender- and age-specific distributions of anthropometric measurements and anthropometry assessments of Taiwanese older adults. This was a cross-sectional study conducted on 22,389 adults aged 65 years or older (8017 males and 14,372 females) who participated in Taiwan's National Physical Fitness Survey 2014-2015. All participants were recruited using stratified convenience sampling from 46 physical fitness test stations in 22 cities or counties in Taiwan. The anthropometric measurements and anthropometry assessments included in the present study were the assessments of height, weight, body mass index (BMI), waist circumference (WC), hip circumference (HC), and waist-to-hip ratio (WHR). The results showed statistically significant differences in weight, height, WC, and WHR across all age groups among both male and female individuals aged 65 years and older in Taiwan. However, there was no significant difference in BMI and HC between males and females in all age groups. Anthropometric status provides an initial assessment of the overall health of the population. This study uses a representative population of Taiwanese older adults over the age of 65 for analysis and provides detailed information on anthropometric data distribution.
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BACKGROUND: The pathological form of synaptic plasticity, ischemic long-term potentiation (iLTP), induced by oxygen and glucose deprivation (OGD), is implicated in the acute phase of stroke with the potentiation of N-methyl-D-aspartate receptor (NMDAR). While there has been widespread attention on the excitatory system, a recent study reported that γ-aminobutyric acid (GABA)ergic system is also involved in iLTP. Valproic acid (VPA), a histone deacetylase inhibitor, protects against ischemic damage. However, whether VPA regulates early phase plasticity in ischemic stroke remains unknown. The present study aims to investigate the potential role and mechanism of VPA in ischemic stroke. METHODS: A brief exposure of OGD on the hippocampal slices and the induction of photothrombotic ischemia (PTI) were used as ex vivo and in vivo models of ischemic stroke, respectively. RESULTS: Using extracellular recordings, iLTP was induced in the hippocampal Schaffer collateral pathway following OGD exposure. VPA treatment abolished hippocampal iLTP via GABAA receptor enhancement and extracellular signal-regulated kinase (ERK) phosphorylation. Administration of VPA reduced brain infarct volume and motor dysfunction in mice with PTI. Moreover, VPA protected against ischemic injury by upregulating the GABAergic system and ERK phosphorylation, as well as by reducing of matrix metalloproteinase in a PTI-induced ischemic stroke model. CONCLUSIONS: Together, this study revealed the protection of VPA in ex vivo OGD-induced pathological form of neuroplasticity and in vivo PTI-induced brain damage and motor dysfunction through rescuing GABAergic deficiency and the pathological hallmarks of ischemia.
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Background: High-intensity interval training (HIIT) features short, repeated bursts of relatively vigorous exercise with intermittent periods of rest or low-intensity exercise. High-intensity power training (HIPT), in combination with HIIT and traditional resistance training (TRT), is characterized as multijoint high-intensity resistance exercises with low interset rest periods. HIPT requires people to finish the exercise as fast as possible, which increases acute physiological demands. The aim of the study was to investigate the differences between eight-week HIPT or TRT on exercise performance. Methods: Twenty-four college students were recruited and randomly assigned to either the HIPT or TRT group in a counterbalanced order. The power of upper and lower limbs (50% 1RM bench press and vertical jump) and anaerobic power were tested before and after the training (weeks 0 and 9). The results were analyzed by two-way analysis of variance (ANOVA) or Friedman's test with a significance level of α = 0.05 to compare the effects of the intervention on exercise performance. Results: There were significant differences in the explosive force of the upper and lower limbs between the pretest and post-test in both the HIPT and TRT groups (p < 0.05). However, only the HIPT group showed a significant difference in the mean power on the Wingate anaerobic test between the pretest and post-test (p < 0.05). Conclusions: Both HIPT and TRT can improve upper and lower limb explosive force. HIPT is an efficient training protocol, which took less time and produced a better improvement in mean anaerobic power.
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Entrenamiento de Intervalos de Alta Intensidad , Entrenamiento de Fuerza , Ejercicio Físico , Prueba de Esfuerzo , Entrenamiento de Intervalos de Alta Intensidad/métodos , Humanos , Fuerza Muscular/fisiología , Entrenamiento de Fuerza/métodosRESUMEN
ABSTRACT: The purpose of the retrospective case-control study was to identify the causes of and risk factors for unplanned return to the operating room (uROR) within 24âhours in surgical patients.We examined 275 cases of 24-hour uROR in our hospital from January 2010 to December 2018. The reasons for 24-hour uROR were classified into several categories. Controls were randomly matched to cases in a 1:1 ratio with the selection criteria set for the same surgeon and operation code in the same corresponding year.The mortality rate was significantly higher in patients with 24-hour uROR (11.63% vs 5.23%). Bleeding was the most common etiology (172/275; 62.55%) and technical error (14.5%) also contributed to 24-hour uROR. The clinical factors that led to bleeding included a history of liver disease (Pâ=â.032), smoking (Pâ=â.002), low platelet count in preoperative screening (Pâ=â.012), and preoperative administration of antiplatelet or anticoagulant agents (Pâ=â.014).Clinicians should recognize the risk factors for bleeding and minimize errors to avoid the increase in patient morbidity and mortality that is associated with 24-hour uROR.Level of Evidence: Level IV.
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Hemorragia , Quirófanos/estadística & datos numéricos , Complicaciones Posoperatorias , Reoperación/efectos adversos , Adulto , Anciano , Anciano de 80 o más Años , Estudios de Casos y Controles , Hemorragia/prevención & control , Mortalidad Hospitalaria , Humanos , Persona de Mediana Edad , Complicaciones Posoperatorias/epidemiología , Estudios Retrospectivos , Factores de RiesgoRESUMEN
The aim of this study is to investigate the glycemic profile, oxidative stress, and antioxidant capacity in athletes after 12 weeks of ubiquinone supplementation. It was a double-blinded, randomized, parallel, placebo-controlled study. Thirty-one well-trained college athletes were randomly assigned to ubiquinone (300 mg/d, n = 17) or placebo group (n = 14). The glycemic profile [fasting glucose, glycated hemoglobin (HbA1c), homeostatic model assessment-insulin resistance (HOMA-IR), quantitative insulin sensitivity check index (QUICKI)], plasma and erythrocyte malondialdehyde (MDA), total antioxidant capacity (TAC), and ubiquinone status were measured. After supplementation, the plasma ubiquinone concentration was significantly increased (p < 0.05) and the level of erythrocyte MDA was significantly lower in the ubiquinone group than in the placebo group (p < 0.01). There was a significant correlation between white blood cell (WBC) ubiquinone and glycemic parameters [HbA1c, r = -0.46, p < 0.05; HOMA-IR, r = -0.67, p < 0.01; QUICKI, r = 0.67, p < 0.01]. In addition, athletes with higher WBC ubiquinone level (≥0.5 nmol/g) showed higher erythrocyte TAC and QUICKI and lower HOMA-IR. In conclusion, we demonstrated that athletes may show a better antioxidant capacity with higher ubiquinone status after 12 weeks of supplementation, which may further improve glycemic control.
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The purpose of the present study was to determine the association between health-related physical fitness (HRPF) performance and perceived happiness status among adults in Taiwan. A cross-sectional study was conducted, and data derived from the National Physical Fitness Survey in Taiwan 2014-2015 were reviewed. The participants included 27,930 men and 30,885 women, aged 23 to 64 years. Each participant completed a standardized, structured questionnaire and underwent anthropometric variable and HRPF measurements. The happiness outcome of an individual was obtained using the questionnaire, and the results were stratified into happy (very happy, quite happy, and fair) and unhappy (unhappy and not at all happy) groups for perceived happiness status. HRPF measurements were evaluated using cardiorespiratory endurance (3 min step test), muscle strength and endurance (1 min sit-up test), flexibility (sit-and-reach test), and body composition (body mass index (BMI) and waist-to-hip ratio). To determine the existence of a dose-response relationship between HRPF component levels and happiness status, four quartiles of HRPF components were analyzed using multiple logistic regression models. Multiple logistic regression results indicated that with the worst performance level of HRPF components as a baseline, significant associations were observed for the sit-and-reach test (third level: OR = 1.24, 95% CI: 1.02-1.49) and BMI (second level: OR = 0.78, 95% CI: 0.64-0.95) among men. For women, significant associations were observed for the 1 min sit-up test (second level: OR = 1.28, 95% CI: 1.03-1.60; third level: OR = 1.32, 95% CI: 1.04-1.67; fourth (the best) level: OR = 1.48, 95% CI: 1.12-1.95) and BMI (third level: OR = 0.73, 95% CI: 0.58-0.92). The current study suggested that higher values in flexibility and body composition, happiness-related factors, potentially improve the occurrence of happiness among men. Moreover, this positive effect of higher values of muscle strength, endurance, and BMI was observed for the occurrence of happiness in women. However, the relevant mechanism underlying this phenomenon must be further explored.
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Felicidad , Aptitud Física , Adulto , Índice de Masa Corporal , Estudios Transversales , Femenino , Humanos , Masculino , Persona de Mediana Edad , Taiwán , Relación Cintura-Cadera , Adulto JovenRESUMEN
The present study aims to investigate the associations between physical fitness performance and abdominal obesity risk among Taiwanese adults. We conducted a cross-sectional study and reviewed the data derived from the National Physical Fitness Survey in Taiwan (HPFSIT). Data from a total of 62,486 respondents aged 23-64 years were collected in this study. The participants completed a standardized structural questionnaire and a series of anthropometric characteristics (body mass index and waist-to-hip ratio) and physical fitness (3-min step tests, 1-min sit-up tests, and sit-and-reach tests) assessments. Waist circumference was used to define abdominal obesity status. A multiple logistic regression analysis was conducted. Our results presented almost entirely significant associations (except for women) on the 3-min step test. Moreover, the results suggest that muscular strength, endurance, and flexibility may be effective predictors of abdominal obesity among men and women, whereas cardiorespiratory fitness predicted abdominal obesity only in men. According to the results of this study, the fitness-abdominal obesity associations are minor based on a mixed population analysis. However, dose-response relationships have been observed. The present study provides a new perspective by using different types of fitness performance to predict abdominal obesity.
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Obesidad Abdominal , Aptitud Física , Adulto , Índice de Masa Corporal , Estudios Transversales , Femenino , Humanos , Masculino , Persona de Mediana Edad , Taiwán , Circunferencia de la Cintura , Adulto JovenRESUMEN
Research on relationships between physical fitness and sleep duration among older adults is scarce, especially in Taiwanese representative samples of elderly people who undergo physical fitness measurements. This study aimed to determine the associations between physical fitness and short and long sleep durations among older adults in Taiwan. We conducted a cross-sectional study and reviewed data derived from the National Physical Fitness Survey in Taiwan. A total of 24,125 Taiwanese adults aged 65 years and older participated in this study between October 2014 and March 2015. Each individual's sleep duration was recorded with a standard questionnaire method. Sleep duration data were stratified into short (≤5 h), normal (6-7 h), and long (≥8 h) sleep duration groups. Physical fitness was assessed by five components: aerobic endurance (2 min step test), muscle strength and endurance (30 s arm curl and 30 s chair stand tests), flexibility (back scratch and chair sit-and-reach tests), body composition (body mass index (BMI) and waist-to-hip ratio (WHR)), and balance (one-leg stance with eye open and 8-foot up-and-go tests). To understand whether a dose-response relationship exists between physical fitness and short or long sleep duration, we analyzed four levels of performance on the basis of quartiles of physical fitness measurements by using logistic regression. The first quartile of physical fitness performance was the baseline level. The odds ratio (OR) for short sleep duration for the third quartile of BMI was 0.8031 times (95% CI, 0.7119-0.9061) lower than the baseline. For the fourth quartile of BMI, the OR was 0.8660 times (95% CI, 0.7653-0.9800) lower than the baseline. The adjusted OR for long sleep duration significantly decreased in the second, third, and fourth quartiles of the 30 s chair stand, back scratch, chair sit-and-reach test, one-leg stance with one eye open, and BMI. The adjusted OR was increased in the third and fourth quartiles of the 8-foot up-and-go and WHR. The results of the current study suggest that physical fitness performance may influence sleep duration as an associated factor, and the relationship is much stronger for long sleep duration than for short sleep duration.
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Composición Corporal/fisiología , Fuerza Muscular/fisiología , Aptitud Física/fisiología , Sueño/fisiología , Anciano , Anciano de 80 o más Años , Índice de Masa Corporal , Estudios Transversales , Femenino , Encuestas Epidemiológicas , Humanos , Masculino , Encuestas y Cuestionarios , Taiwán , Relación Cintura-CaderaRESUMEN
BACKGROUND: Athletes with chronic ankle instability (CAI) often develop complications such as pain, instability, and reduced postural control and balance stability, all of which affect athletic performance. This study investigated the effects of a 4° medal wedge intervention on static and dynamic balance in athletes with CAI. METHODS: The participants were 24 healthy and 25 CAI athletes. Participants received a 4° medial wedge applied at the rear foot insole and completed the experiment measurements before and after the wedge intervention. The main outcome measures included the area and path length of the center of pressure when participants performed single-leg standing balance in the closed eye condition and the dynamic balance scores of a multiple single-leg hop stabilization test. RESULTS: The single-leg standing balance significantly improved in CAI (Pâ=â.027) and control groups (Pâ=â.005) after the medial wedge intervention. The dynamic balance scores significantly decreased from 53.00â±â25.22 to 41.24â±â21 48 (Pâ=â.015) in CAI group after medial wedge intervention. CONCLUSION: Wearing a 4° medial wedge applied at the rear foot insole improved static and dynamic balance immediately in athletes with CAI. We suggest that clinicians may provide the foot insole to improve balance deficit in athletes having CAI.
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Articulación del Tobillo , Traumatismos en Atletas/terapia , Ortesis del Pié , Inestabilidad de la Articulación/terapia , Trastornos de la Sensación/terapia , Traumatismos en Atletas/complicaciones , Enfermedad Crónica , Diseño de Equipo , Femenino , Talón , Humanos , Inestabilidad de la Articulación/complicaciones , Masculino , Trastornos de la Sensación/etiología , Resultado del Tratamiento , Adulto JovenRESUMEN
Deep brain stimulation (DBS) is a well-established technique for the treatment of movement and psychiatric disorders through the modulation of neural oscillatory activity and synaptic plasticity. The central thalamus (CT) has been indicated as a potential target for stimulation to enhance memory. However, the mechanisms underlying local field potential (LFP) oscillations and memory enhancement by CT-DBS remain unknown. In this study, we used CT-DBS to investigate the mechanisms underlying the changes in oscillatory communication between the CT and hippocampus, both of which are involved in spatial working memory. Local field potentials (LFPs) were recorded from microelectrode array implanted in the CT, dentate gyrus, cornu ammonis (CA) region 1, and CA region 3. Functional connectivity (FC) strength was assessed by LFP-LFP coherence calculations for these brain regions. In addition, a T-maze behavioral task using a rat model was performed to assess the performance of spatial working memory. In DBS group, our results revealed that theta oscillations significantly increased in the CT and hippocampus compared with that in sham controls. As indicated by coherence, the FC between the CT and hippocampus significantly increased in the theta band after CT-DBS. Moreover, Western blotting showed that the protein expressions of the dopamine D1 and α4-nicotinic acetylcholine receptors were enhanced, whereas that of the dopamine D2 receptor decreased in the DBS group. In conclusion, the use of CT-DBS resulted in elevated theta oscillations, increased FC between the CT and hippocampus, and altered synaptic plasticity in the hippocampus, suggesting that CT-DBS is an effective approach for improving spatial working memory.