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1.
Lancet Diabetes Endocrinol ; 9(5): 304-317, 2021 05.
Artículo en Inglés | MEDLINE | ID: mdl-33864810

RESUMEN

There has been substantial progress in the knowledge of exercise and type 1 diabetes, with the development of guidelines for optimal glucose management. In addition, an increasing number of people living with type 1 diabetes are pushing their physical limits to compete at the highest level of sport. However, the post-exercise recovery routine, particularly with a focus on sporting performance, has received little attention within the scientific literature, with most of the focus being placed on insulin or nutritional adaptations to manage glycaemia before and during the exercise bout. The post-exercise recovery period presents an opportunity for maximising training adaption and recovery, and the clinical management of glycaemia through the rest of the day and overnight. The absence of clear guidance for the post-exercise period means that people with type 1 diabetes should either develop their own recovery strategies on the basis of individual trial and error, or adhere to guidelines that have been developed for people without diabetes. This Review provides an up-to-date consensus on post-exercise recovery and glucose management for individuals living with type 1 diabetes. We aim to: (1) outline the principles and time course of post-exercise recovery, highlighting the implications and challenges for endurance athletes living with type 1 diabetes; (2) provide an overview of potential strategies for post-exercise recovery that could be used by athletes with type 1 diabetes to optimise recovery and adaptation, alongside improved glycaemic monitoring and management; and (3) highlight the potential for technology to ease the burden of managing glycaemia in the post-exercise recovery period.


Asunto(s)
Atletas , Consenso , Diabetes Mellitus Tipo 1/metabolismo , Metabolismo Energético/fisiología , Ejercicio Físico/fisiología , Recuperación de la Función/fisiología , Adaptación Fisiológica/fisiología , Glucemia/metabolismo , Diabetes Mellitus Tipo 1/diagnóstico , Humanos , Resistencia Física/fisiología
2.
World J Surg Oncol ; 19(1): 130, 2021 Apr 21.
Artículo en Inglés | MEDLINE | ID: mdl-33882952

RESUMEN

BACKGROUND: The application of side-to-end anastomosis (SEA) in sphincter-preserving resection (SPR) is controversial. We performed a meta-analysis to compare the safety and efficacy of SEA with colonic J-pouch (CJP) anastomosis, which had been proven effective in improving postoperative bowel function. METHODS: The protocol was registered in PROSPERO under number CRD42020206764. PubMed, Embase, Web of Science, and the Cochrane Register of Controlled Trials databases were searched. The inclusion criteria were randomized controlled trials (RCTs) that evaluated the safety or efficacy of SEA in comparison with CJP anastomosis. The outcomes included the pooled risk ratio (RR) for dichotomous variables and weighted mean differences (WMDs) for continuous variables. All outcomes were calculated with 95% confidence intervals (CI) by STATA software (Stata 14, Stata Corporation, TX, USA). RESULTS: A total of 864 patients from 10 RCTs were included in the meta-analysis. Patients undergoing SEA had a higher defecation frequency at 12 months after SPR (WMD = 0.20; 95% CI, 0.14-0.26; P < 0.01) than those undergoing CJP anastomosis with low heterogeneity (I2 = 0%, P = 0.54) and a lower incidence of incomplete defecation at 3 months after surgery (RR = 0.28; 95% CI, 0.09-0.86; P = 0.03). A shorter operating time (WMD = - 17.65; 95% CI, - 23.28 to - 12.02; P < 0.01) was also observed in the SEA group without significant heterogeneity (I2 = 0%, P = 0.54). A higher anorectal resting pressure (WMD = 6.25; 95% CI, 0.17-12.32; P = 0.04) was found in the SEA group but the heterogeneity was high (I2 = 84.5%, P = 0.84). No significant differences were observed between the groups in terms of efficacy outcomes including defecation frequency, the incidence of urgency, incomplete defecation, the use of pads, enema, medications, anorectal squeeze pressure and maximum rectal volume, or safety outcomes including operating time, blood loss, the use of protective stoma, postoperative complications, clinical outcomes, and oncological outcomes. CONCLUSIONS: The present evidence suggests that SEA is an effective anastomotic strategy to achieve similar postoperative bowel function without increasing the risk of complications compared with CJP anastomosis. The advantages of SEA include a shorter operating time, a lower incidence of incomplete defecation at 3 months after surgery, and better sphincter function. However, close attention should be paid to the long-term defecation frequency after SPR.


Asunto(s)
Anastomosis Quirúrgica/métodos , Reservorios Cólicos , Neoplasias del Recto , Canal Anal/cirugía , Anastomosis Quirúrgica/efectos adversos , Humanos , Pronóstico , Ensayos Clínicos Controlados Aleatorios como Asunto , Recuperación de la Función , Neoplasias del Recto/cirugía , Resultado del Tratamiento
3.
Sensors (Basel) ; 21(6)2021 Mar 15.
Artículo en Inglés | MEDLINE | ID: mdl-33804247

RESUMEN

Leap Motion Controller (LMC) is a virtual reality device that can be used in the rehabilitation of central nervous system disease (CNSD) motor impairments. This review aimed to evaluate the effect of video game-based therapy with LMC on the recovery of upper extremity (UE) motor function in patients with CNSD. A systematic review with meta-analysis was performed in PubMed Medline, Web of Science, Scopus, CINAHL, and PEDro. We included five randomized controlled trials (RCTs) of patients with CNSD in which LMC was used as experimental therapy compared to conventional therapy (CT) to restore UE motor function. Pooled effects were estimated with Cohen's standardized mean difference (SMD) and its 95% confidence interval (95% CI). At first, in patients with stroke, LMC showed low-quality evidence of a large effect on UE mobility (SMD = 0.96; 95% CI = 0.47, 1.45). In combination with CT, LMC showed very low-quality evidence of a large effect on UE mobility (SMD = 1.34; 95% CI = 0.49, 2.19) and the UE mobility-oriented task (SMD = 1.26; 95% CI = 0.42, 2.10). Second, in patients with non-acute CNSD (cerebral palsy, multiple sclerosis, and Parkinson's disease), LMC showed low-quality evidence of a medium effect on grip strength (GS) (SMD = 0.47; 95% CI = 0.03, 0.90) and on gross motor dexterity (GMD) (SMD = 0.73; 95% CI = 0.28, 1.17) in the most affected UE. In combination with CT, LMC showed very low-quality evidence of a high effect in the most affected UE on GMD (SMD = 0.80; 95% CI = 0.06, 1.15) and fine motor dexterity (FMD) (SMD = 0.82; 95% CI = 0.07, 1.57). In stroke, LMC improved UE mobility and UE mobility-oriented tasks, and in non-acute CNSD, LMC improved the GS and GMD of the most affected UE and FMD when it was used with CT.


Asunto(s)
Rehabilitación de Accidente Cerebrovascular , Accidente Cerebrovascular , Juegos de Video , Realidad Virtual , Humanos , Recuperación de la Función , Extremidad Superior
4.
Bone Joint J ; 103-B(4): 711-717, 2021 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-33789466

RESUMEN

AIMS: Patients with a triangular fibrocartilage complex (TFCC) injury report ulnar-sided wrist pain and impaired function. The surgical procedure of TFCC reinsertion aims to improve function in patients with this injury in whom conservative treatment has failed. The purpose of this study was to investigate the outcomes of open TFCC reinsertion. METHODS: The study involved 274 patients who underwent open repair of the TFCC between December 2013 and December 2018. The patients completed the Patient-Rated Wrist Evaluation (PRWE) questionnaire, and scored pain and function using a visual analogue scale (VAS). Range of motion (ROM) was assessed by experienced hand therapists. RESULTS: Clinically significant improvements were reported in pain, function, and grip strength in 220 patients (80%) three and 12 months postoperatively. CONCLUSION: These data will help surgeons to make decisions about the outcomes of open repair of the TFCC and to counsel patients appropriately. Level of evidence: III Cite this article: Bone Joint J 2021;103-B(4):711-717.


Asunto(s)
Medición de Resultados Informados por el Paciente , Fibrocartílago Triangular/lesiones , Fibrocartílago Triangular/cirugía , Adulto , Femenino , Fuerza de la Mano , Humanos , Masculino , Dimensión del Dolor , Rango del Movimiento Articular , Recuperación de la Función , Encuestas y Cuestionarios
5.
Bone Joint J ; 103-B(4): 619-626, 2021 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-33789470

RESUMEN

AIMS: Meeting preoperative expectations is known to be of major influence on postoperative satisfaction after total knee arthroplasty (TKA). Improved management of expectation, resulting in more realistic expectations can potentially lead to higher postoperative satisfaction. The objective of this study was to assess the effect of an additional preoperative education module, addressing realistic expectations for long-term functional recovery, on postoperative satisfaction and expectation fulfilment. METHODS: In total, 204 primary TKA patients with osteoarthritis were enrolled in this randomized controlled trial (RCT). Patients were allocated to either usual preoperative education (control group) or usual education plus an additional module on realistic expectations (intervention group). Primary outcome was being very satisfied (numerical rating scale for satisfaction ≥ 8) with the treatment result at 12 months' follow-up. Other outcomes were change in preoperative expectations and postoperative expectation fulfilment. RESULTS: A total of 187 patients (91.7%) were available for analysis at follow-up. In the intention-to-treat analysis, 58.5% (55/94) of patients were very satisfied with the treatment result in the control group, and 69.9% (65/93) of patients in the intervention group (adjusted odds ratio (AOR) 1.72, 95% confidence interval (CI) 0.90 to 3.29). A per-protocol analysis for patients who attended the education session (92.0%, n = 172) showed that 56.9% (49/86) of patients were very satisfied in the control group and 74.4% (61/86) in the intervention group (AOR 2.44, 95% CI 1.21 to 4.91). After preoperative education, the expectation scores in the intervention group were significantly lower (mean difference -6.9 (95% CI -10.2 to -3.6)) and did not alter in the control group (mean difference 0.5 (95% CI -2.9 to 3.9)). Overall, fulfilment of expectations at 12 months was significantly higher in the intervention group (mean difference 11.4% (95% CI 2.3 to 20.5)). CONCLUSION: Improved preoperative patient education can modify patient expectations, resulting in higher postoperative fulfilment of expectation and higher satisfaction in the group that attended the preoperative education. This is the first RCT to confirm the potential of improved expectation management on satisfaction after TKA. Cite this article: Bone Joint J 2021;103-B(4):619-626.


Asunto(s)
Artroplastia de Reemplazo de Rodilla/métodos , Osteoartritis de la Rodilla/cirugía , Educación del Paciente como Asunto , Satisfacción del Paciente , Anciano , Femenino , Humanos , Masculino , Recuperación de la Función
6.
Bone Joint J ; 103-B(4): 635-643, 2021 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-33789473

RESUMEN

AIMS: Debate continues regarding the optimum management of periprosthetic distal femoral fractures (PDFFs). This study aims to determine which operative treatment is associated with the lowest perioperative morbidity and mortality when treating low (Su type II and III) PDFFs comparing lateral locking plate fixation (LLP-ORIF) or distal femoral arthroplasty (DFA). METHODS: This was a retrospective cohort study of 60 consecutive unilateral (PDFFs) of Su types II (40/60) and III (20/60) in patients aged ≥ 60 years: 33 underwent LLP-ORIF (mean age 81.3 years (SD 10.5), BMI 26.7 (SD 5.5); 29/33 female); and 27 underwent DFA (mean age 78.8 years (SD 8.3); BMI 26.7 (SD 6.6); 19/27 female). The primary outcome measure was reoperation. Secondary outcomes included perioperative complications, calculated blood loss, transfusion requirements, functional mobility status, length of acute hospital stay, discharge destination and mortality. Kaplan-Meier survival analysis was performed. Cox multivariate regression analysis was performed to identify risk factors for reoperation after LLP-ORIF. RESULTS: Follow-up was at mean 3.8 years (1.0 to 10.4). One-year mortality was 13% (8/60). Reoperation was more common following LLP-ORIF: 7/33 versus 0/27 (p = 0.008). Five-year survival for reoperation was significantly better following DFA; 100% compared to 70.8% (95% confidence interval (CI) 51.8% to 89.8%, p = 0.006). There was no difference for the endpoint mechanical failure (including radiological loosening); ORIF 74.5% (56.3 to 92.7), and DFA 78.2% (52.3 to 100, p = 0.182). Reoperation following LLP-ORIF was independently associated with medial comminution; hazard ratio (HR) 10.7 (1.45 to 79.5, p = 0.020). Anatomical reduction was protective against reoperation; HR 0.11 (0.013 to 0.96, p = 0.046). When inadequately fixed fractures were excluded, there was no difference in five-year survival for either reoperation (p = 0.156) or mechanical failure (p = 0.453). CONCLUSION: Absolute reoperation rates are higher following LLP fixation of low PDFFs compared to DFA. Where LLP-ORIF was well performed with augmentation of medial comminution, there was no difference in survival compared to DFA. Though necessary in very low fractures, DFA should be used with caution in patients with greater life expectancies due to the risk of longer term aseptic loosening. Cite this article: Bone Joint J 2021;103-B(4):635-643.


Asunto(s)
Fracturas del Fémur/cirugía , Fijación Interna de Fracturas/métodos , Fracturas Periprotésicas/cirugía , Anciano , Anciano de 80 o más Años , Artroplastia de Reemplazo de Cadera , Pérdida de Sangre Quirúrgica/prevención & control , Pérdida de Sangre Quirúrgica/estadística & datos numéricos , Placas Óseas , Femenino , Fracturas del Fémur/mortalidad , Humanos , Tiempo de Internación/estadística & datos numéricos , Masculino , Persona de Mediana Edad , Fracturas Periprotésicas/mortalidad , Complicaciones Posoperatorias/epidemiología , Falla de Prótesis , Recuperación de la Función , Reoperación/estadística & datos numéricos , Estudios Retrospectivos , Factores de Riesgo , Tasa de Supervivencia
7.
Bone Joint J ; 103-B(4): 762-768, 2021 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-33789482

RESUMEN

AIMS: To compare the functionality of adults with displaced mid-shaft clavicular fractures treated either operatively or nonoperatively and to compare the relative risk of nonunion and reoperation between the two groups. METHODS: Based on specific eligibility criteria, 120 adults (median age 37.5 years (interquartile range (18 to 61)) and 84% males (n = 101)) diagnosed with an acute displaced mid-shaft fracture were recruited, and randomized to either the operative (n = 60) or nonoperative (n = 60) treatment group. This randomized controlled, partially blinded trial followed patients for 12 months following initial treatment. Functionality was assessed by the Constant score (CS) (assessor blinded to treatment) and Disability of the Arm, Shoulder and Hand (DASH) score. Clinical and radiological evaluation, and review of patient files for complications and reoperations, were added as secondary outcomes. RESULTS: At 12 months, 87.5% of patients (n = 105) were available for analysis. The two groups were well balanced based on demographic and fracture-related characteristics. At six weeks of follow-up a significant difference in DASH score (p < 0.001) was found in favour of operative treatment. The functionality at 12 months of follow-up based on CS and DASH was excellent in both groups (CS > 90 points and DASH < 10 points) with no significant difference (p = 0.277 for DASH and p = 0.184 for CS) between the two groups. The risk of symptomatic nonunion was significantly higher in the nonoperative group (p = 0.014), with a relative risk of 9.47 (95% confidence interval (CI) 1.26 to 71.53) in this group compared to the operative group. The number-needed-to-treat to avoid one symptomatic nonunion was 6.2. Initial treatment and age were factors significantly associated with nonunion in a logistic analysis. There were 26% in both groups (n = 14 in operative group and n = 15 in nonoperative group) who required secondary surgery, with most indications in the nonoperative group mandatory due to nonunion compared to most relative indications in the operative group requiring intervention due to implant irritation. CONCLUSION: Superiority was not identified with either an all-operative or all-nonoperative approach. The functionality at short term (within six weeks) seems igreater following operative treatment but was not found at one year. The risk of nonunion is significantly higher with nonoperative treatment. However, an all-operative approach to lower the nonunion risk may result in unnecessary surgery and is not recommended. Cite this article: Bone Joint J 2021;103-B(4):762-768.


Asunto(s)
Clavícula/lesiones , Fijación de Fractura/métodos , Fracturas Óseas/terapia , Fracturas no Consolidadas/terapia , Adolescente , Adulto , Dinamarca , Evaluación de la Discapacidad , Femenino , Curación de Fractura , Humanos , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias , Recuperación de la Función , Reoperación
8.
Artículo en Ruso | MEDLINE | ID: mdl-33834717

RESUMEN

OBJECTIVE: To evaluate the efficacy of the intravenous form of dimephosphon at the first stage of rehabilitation in patients with ischemic stroke in the carotid system. MATERIAL AND METHODS: The article presents the results of examination of 60 patients in the acute period of ischemic stroke in the carotid system (30 patients were treated with dimephosphon and 30 patients were in the comparison group). The dynamics of the clinical picture (according to the NIHSS), functional dependence in self-service (according to the modified Rankin scale), state of autonomic response using spectral analysis of heart rate variability, cerebrovascular reactivity using functional tests were assessed during the treatment. RESULTS: A significant decrease in NIHSS points was recorded (on average by 60% from the initial level) in the main group, relative to the comparison group (on average by 33% from the initial points). On the 10th day of therapy, there was a significantly more improvement in cerebrovascular reactivity to hypercapnic and hypocapnic loads, the index of vasomotor reactivity, as well as the state of cerebral blood flow autoregulation in the main group compared with the comparison group. In addition, by the 10th day of therapy relative to the initial values in the main group, a statistically significant increase (by 30%) was revealed in the number of patients with adaptive sympathicotonic type of autonomic regulation with a decrease in the number of patients with hypersympathetic and asymptomatic types of autonomic regulation after orthostatic test (by 10% and 20%, respectively). By the 10th day of hospitalization, there were more patients with no or mild signs of disability (0-2 points according to the modified Rankin scale) in the main group (83%) compared with the comparison group (60%). CONCLUSION: The use of the multimodal drug dimephosphon in complex therapy in patients in the acute period of ischemic stroke in the carotid system contributes to the normalization of the regulatory mechanisms of cerebral circulation and autonomic regulation. This helps to improve functional recovery and enhance the rehabilitation potential of patients.


Asunto(s)
Isquemia Encefálica , Accidente Cerebrovascular , Isquemia Encefálica/complicaciones , Isquemia Encefálica/tratamiento farmacológico , Circulación Cerebrovascular , Humanos , Recuperación de la Función , Accidente Cerebrovascular/tratamiento farmacológico , Resultado del Tratamiento
9.
BMC Pulm Med ; 21(1): 136, 2021 Apr 26.
Artículo en Inglés | MEDLINE | ID: mdl-33902513

RESUMEN

BACKGROUND: All over the world, SARS-CoV-2 pneumonia is causing a significant short-term morbidity and mortality, but the medium-term impact on lung function and quality of life of affected patients are still unknown. METHODS: In this prospective observational study, 39 patients with SARS-CoV-2 pneumonia were recruited from a single COVID-19 hospital in Southern Switzerland. At three months patients underwent radiological and functional follow-up through CT scan, lung function tests, and 6 min walking test. Furthermore, quality of life was assessed through self-reported questionnaires. RESULTS: Among 39 patients with SARS-CoV-2 pneumonia, 32 (82% of all participants) presented abnormalities in CT scan and 25 (64.1%) had lung function tests impairment at three months. Moreover, 31 patients (79.5%) reported a perception of poor health due to respiratory symptoms and all 39 patients showed an overall decreased quality of life. CONCLUSIONS: Medium-term follow up at three months of patients diagnosed with SARS-CoV-2 pneumonia shows the persistence of abnormalities in CT scans, a significant functional impairment assessed by lung function tests and a decreased quality of life in affected patients. Further studies evaluating the long-term impact are warranted to guarantee an appropriate follow-up to patients recovering from SARS-CoV-2 pneumonia.


Asunto(s)
/fisiopatología , Pulmón/fisiopatología , Calidad de Vida , Anciano , Convalecencia , Femenino , Volumen Espiratorio Forzado , Estado de Salud , Humanos , Tiempo de Internación , Pulmón/diagnóstico por imagen , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Capacidad de Difusión Pulmonar , Recuperación de la Función , Pruebas de Función Respiratoria , Suiza , Tomografía Computarizada por Rayos X , Capacidad Vital , Prueba de Paso
10.
Int J Mol Sci ; 22(5)2021 Mar 04.
Artículo en Inglés | MEDLINE | ID: mdl-33806636

RESUMEN

Stem cell-based therapeutics are amongst the most promising next-generation therapeutic approaches for the treatment of spinal cord injury (SCI), as they may promote the repair or regeneration of damaged spinal cord tissues. However, preclinical optimization should be performed before clinical application to guarantee safety and therapeutic effect. Here, we investigated the optimal injection route and dose for adult human multipotent neural cells (ahMNCs) from patients with hemorrhagic stroke using an SCI animal model. ahMNCs demonstrate several characteristics associated with neural stem cells (NSCs), including the expression of NSC-specific markers, self-renewal, and multi neural cell lineage differentiation potential. When ahMNCs were transplanted into the lateral ventricle of the SCI animal model, they specifically migrated within 24 h of injection to the damaged spinal cord, where they survived for at least 5 weeks after injection. Although ahMNC transplantation promoted significant locomotor recovery, the injection dose was shown to influence treatment outcomes, with a 1 × 106 (medium) dose of ahMNCs producing significantly better functional recovery than a 3 × 105 (low) dose. There was no significant gain in effect with the 3 × 106 ahMNCs dose. Histological analysis suggested that ahMNCs exert their effects by modulating glial scar formation, neuroprotection, and/or angiogenesis. These data indicate that ahMNCs from patients with hemorrhagic stroke could be used to develop stem cell therapies for SCI and that the indirect injection route could be clinically relevant. Moreover, the optimal transplantation dose of ahMNCs defined in this preclinical study might be helpful in calculating its optimal injection dose for patients with SCI in the future.


Asunto(s)
Células Madre Multipotentes/patología , Células-Madre Neurales/patología , Traumatismos de la Médula Espinal/patología , Médula Espinal/patología , Adulto , Animales , Diferenciación Celular/fisiología , Células Cultivadas , Femenino , Humanos , Ratas , Ratas Sprague-Dawley , Recuperación de la Función/fisiología , Trasplante de Células Madre/métodos
11.
Medicine (Baltimore) ; 100(14): e25431, 2021 Apr 09.
Artículo en Inglés | MEDLINE | ID: mdl-33832145

RESUMEN

BACKGROUND: To our knowledge, there have been no published clinical trials to assess the synergistic effects of applying pulsed radiofrequency (PRF) stimulation of the suprascapular nerve (SSN) plus physical therapy on pain and function in patients with adhesive capsulitis. Therefore, we will conduct this present randomized, double-blind study to evaluate the synergistic effects of applying PRF stimulation of the SSN plus physical therapy on pain and function in patients with adhesive capsulitis. METHODS: The study protocol is a randomized, controlled, double-blind design. Recruitment will be started in March 2021 and completed in October 2022. The treating surgeon will assess 90 patients for eligibility. The study protocol was approved through Institutional Review Board in the People's Hospital of Beilun district of Ningbo. Each patient will be randomized into 3 treatment groups, receiving PRF stimulation of the SSN or physical therapy or both of them. After baseline examination, all patients will be given a full explanation of the treatment protocol and will be required to sign a written informed consent for study participation and for publication of the results. All the data collectors, surgeons, statistical analysts, as well as result assessors are not aware of grouping assignment. The outcomes include Constant score, visual analog scale score, range of motion, and strength. RESULTS: This protocol will provide a reliable theoretical basis for the following research. CONCLUSION: It is assumed that there will be a remarkable difference in postoperative outcomes between the intervention and control groups. TRIAL REGISTRATION NUMBER: 10.17605/OSF.IO/PZ9ES.


Asunto(s)
Bursitis/terapia , Modalidades de Fisioterapia , Tratamiento de Radiofrecuencia Pulsada/métodos , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Bursitis/complicaciones , Bursitis/fisiopatología , Protocolos Clínicos , Terapia Combinada , Método Doble Ciego , Femenino , Humanos , Masculino , Persona de Mediana Edad , Dolor Musculoesquelético/etiología , Dolor Musculoesquelético/terapia , Estudios Prospectivos , Recuperación de la Función , Escápula/inervación , Resultado del Tratamiento , Adulto Joven
12.
Int J Mol Sci ; 22(6)2021 Mar 16.
Artículo en Inglés | MEDLINE | ID: mdl-33809413

RESUMEN

Stroke-induced cognitive impairments affect the long-term quality of life. High-intensity interval training (HIIT) is now considered a promising strategy to enhance cognitive functions. This review is designed to examine the role of HIIT in promoting neuroplasticity processes and/or cognitive functions after stroke. The various methodological limitations related to the clinical relevance of studies on the exercise recommendations in individuals with stroke are first discussed. Then, the relevance of HIIT in improving neurotrophic factors expression, neurogenesis and synaptic plasticity is debated in both stroke and healthy individuals (humans and rodents). Moreover, HIIT may have a preventive role on stroke severity, as found in rodents. The potential role of HIIT in stroke rehabilitation is reinforced by findings showing its powerful neurogenic effect that might potentiate cognitive benefits induced by cognitive tasks. In addition, the clinical role of neuroplasticity observed in each hemisphere needs to be clarified by coupling more frequently to cellular/molecular measurements and behavioral testing.


Asunto(s)
Cognición/fisiología , Entrenamiento de Intervalos de Alta Intensidad , Plasticidad Neuronal/fisiología , Accidente Cerebrovascular/fisiopatología , Accidente Cerebrovascular/terapia , Humanos , Resistencia Física , Recuperación de la Función
13.
Zhonghua Yi Xue Za Zhi ; 101(15): 1083-1087, 2021 Apr 20.
Artículo en Chino | MEDLINE | ID: mdl-33878836

RESUMEN

Objective: To compare the postoperative outcomes and urinary continence recovery time between standard robotic-assisted laparoscopic radical prostatectomy (RARP) and Retzius-sparing robotic-assisted laparoscopic radical prostatectomy (RsRARP). Methods: A total of 92 patients with low to intermediate-risk prostate cancer who underwent RARP (n=52) and RsRARP (n=40) in Sir Run Run Shaw Hospital from October, 2016 to January, 2018 were retrospectively reviewed. Perioperative data (operative time, estimated blood loss, complications, postoperative staging, postoperative Gleason score) and surgical outcomes (rate of margin positive, urinary continence recovery time) of RARP and RsRARP group were comparatively analyzed. Results: All 92 cases were successfully performed with robot. RARP group had a significantly shorter mean operative time when compared with that in RsRARP group ((103±23) min vs (130±26) min, P<0.05). The two groups had comparable estimated blood loss ((100±54) ml vs (103±64) ml, P>0.05), rate of postoperative infection (5.8% (3/52) vs 5.0% (2/40), P>0.05) and rate of postoperative urine leakage (3.8%(2/52) vs 2.5%(1/40), P>0.05). The two groups had a comparable rate of margin positive (7.7%(4/52) vs 12.5%(5/40), P>0.05). Compared with RsRARP group, the RARP group had a lower rate of urinary continence recovery immediately after the catheter removing at 1 week, 1 month and 3 months after the operation (all P>0.05). The two group had a comparable rate of urinary continence recovery at 6 months after the operation (P>0.05). Conclusion: The RsRARP technique has a good tumor control and obvious advantage of early urinary continence recovery compared with the standard RARP technique. RsRARP technique is safe and effective for the treatment of localized prostate cancer.


Asunto(s)
Laparoscopía , Neoplasias de la Próstata , Procedimientos Quirúrgicos Robotizados , Robótica , Humanos , Masculino , Complicaciones Posoperatorias/epidemiología , Prostatectomía , Neoplasias de la Próstata/cirugía , Recuperación de la Función , Estándares de Referencia , Estudios Retrospectivos , Resultado del Tratamiento
14.
Medicine (Baltimore) ; 100(16): e25212, 2021 Apr 23.
Artículo en Inglés | MEDLINE | ID: mdl-33879656

RESUMEN

ABSTRACT: Gait rehabilitations have been abundantly performed for post-stroke patients, because gait is the most important factor for the return of post-stroke patients to daily life. However, conventional uniform gait rehabilitations tend to be tedious and reduce motivation. The aim of this study was to contribute to the development of personalized rehabilitation of gait by identifying differences in gait recovery pattern according to the paralyzed side of post-stroke patients.The gait analysis was performed on stroke patients who are right-handed and can walk independently. We retrospectively analyzed the results of pelvic movements and displacement of center of pressure (COP) during gait using corresponding equipments. To show the difference of gait recovery pattern according to the paralyzed side, we divided subjects into two groups, right (n = 19) and left (n = 20) hemiparesis group. The measured variables were as follows: tilt, obliquity, and rotation symmetries of pelvis; area, velocity, and lateral symmetry of COP.First, in the left hemiparesis group, obliquity (P < .01) and rotation (P < .01) symmetries of the movement of the pelvis were significantly improved in the follow-up compared to the initial gait analysis. In the right hemiparesis group, tilt (P < .001), obliquity (P < .001), and rotation (P < .05) symmetries were significantly improved in the follow-up compared to the initial gait analysis. Second, COP area and COP velocity values in the follow-up were significantly smaller than those in the initial gait analysis in the left (P < .001, P < .05) and right (P < .001, P < .01) hemiparesis groups. The positive value of lateral symmetry increased, although not a significant difference statistically, as walking ability improved in both groups. In the correlation analysis among variables obtained using Treadmill, there were significant positive linear relationships between the lateral symmetry and the COP area (P < .05), and between the COP velocity and the lateral symmetry (P < .001) of the follow-up gait analysis in the right hemiparesis group.It was confirmed that the gait recovery pattern differs according to the paralyzed side of post-stroke patients and the role of the intact side, such as moving the COP to the intact side, is important for the improvement of gait function in both groups.This study was registered with the Clinical Research Information Service (CRIS) of the Korea National Institute of Health (NIH), Republic of Korea (KCT0002984) and was approved by the Institutional Review Board (IRB) of the WKUGH (WKIRB [2018-25], November 28, 2018).


Asunto(s)
Trastornos Neurológicos de la Marcha/rehabilitación , Paresia/rehabilitación , Recuperación de la Función , Rehabilitación de Accidente Cerebrovascular/estadística & datos numéricos , Accidente Cerebrovascular/fisiopatología , Anciano , Prueba de Esfuerzo , Femenino , Lateralidad Funcional , Marcha/fisiología , Análisis de la Marcha , Trastornos Neurológicos de la Marcha/etiología , Humanos , Masculino , Persona de Mediana Edad , Movimiento , Paresia/etiología , Pelvis/fisiopatología , República de Corea , Estudios Retrospectivos , Resultado del Tratamiento
15.
BMJ Open Respir Res ; 8(1)2021 04.
Artículo en Inglés | MEDLINE | ID: mdl-33827856

RESUMEN

BACKGROUND: The symptoms, radiography, biochemistry and healthcare utilisation of patients with COVID-19 following discharge from hospital have not been well described. METHODS: Retrospective analysis of 401 adult patients attending a clinic following an index hospital admission or emergency department attendance with COVID-19. Regression models were used to assess the association between characteristics and persistent abnormal chest radiographs or breathlessness. RESULTS: 75.1% of patients were symptomatic at a median of 53 days post discharge and 72 days after symptom onset and chest radiographs were abnormal in 47.4%. Symptoms and radiographic abnormalities were similar in PCR-positive and PCR-negative patients. Severity of COVID-19 was significantly associated with persistent radiographic abnormalities and breathlessness. 18.5% of patients had unscheduled healthcare visits in the 30 days post discharge. CONCLUSIONS: Patients with COVID-19 experience persistent symptoms and abnormal blood biomarkers with a gradual resolution of radiological abnormalities over time. These findings can inform patients and clinicians about expected recovery times and plan services for follow-up of patients with COVID-19.


Asunto(s)
Cuidados Posteriores , Biomarcadores/análisis , Alta del Paciente/normas , Radiografía Torácica , Evaluación de Síntomas , Cuidados Posteriores/métodos , Cuidados Posteriores/organización & administración , /diagnóstico por imagen , /fisiopatología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Aceptación de la Atención de Salud/estadística & datos numéricos , Radiografía Torácica/métodos , Radiografía Torácica/estadística & datos numéricos , Recuperación de la Función , Estudios Retrospectivos , Índice de Severidad de la Enfermedad , Evaluación de Síntomas/métodos , Evaluación de Síntomas/estadística & datos numéricos , Factores de Tiempo , Reino Unido/epidemiología
16.
Artículo en Inglés | MEDLINE | ID: mdl-33800775

RESUMEN

More innovative technologies are used worldwide in patient's rehabilitation after stroke, as it represents a significant cause of disability. The majority of the studies use a single type of therapy in therapeutic protocols. We aimed to identify if the association of virtual reality (VR) therapy and mirror therapy (MT) exercises have better outcomes in lower extremity rehabilitation in post-stroke patients compared to standard physiotherapy. Fifty-nine inpatients from 76 initially identified were included in the research. One experimental group (n = 31) received VR therapy and MT, while the control group (n = 28) received standard physiotherapy. Each group performed seventy minutes of therapy per day for ten days. Statistical analysis was performed with nonparametric tests. Wilcoxon Signed-Rank test showed that both groups registered significant differences between pre-and post-therapy clinical status for the range of motion and muscle strength (p < 0.001 and Cohen's d between 0.324 and 0.645). Motor Fugl Meyer Lower Extremity Assessment also suggested significant differences pre-and post-therapy for both groups (p < 0.05 and Cohen's d 0.254 for the control group and 0.685 for the experimental group). Mann-Whitney results suggested that VR and MT as a therapeutic intervention have better outcomes than standard physiotherapy in range of motion (p < 0.05, Cohen's d 0.693), muscle strength (p < 0.05, Cohen's d 0.924), lower extremity functionality (p < 0.05, Cohen's d 0.984) and postural balance (p < 0.05, Cohen's d 0.936). Our research suggests that VR therapy associated with MT may successfully substitute classic physiotherapy in lower extremity rehabilitation after stroke.


Asunto(s)
Rehabilitación de Accidente Cerebrovascular , Accidente Cerebrovascular , Terapia de Exposición Mediante Realidad Virtual , Realidad Virtual , Humanos , Extremidad Inferior , Recuperación de la Función , Resultado del Tratamiento , Extremidad Superior
18.
JAMA Netw Open ; 4(3): e2037968, 2021 03 01.
Artículo en Inglés | MEDLINE | ID: mdl-33724390

RESUMEN

Importance: A substantial number of patients discharged to skilled nursing facilities (SNFs) after heart failure (HF) hospitalization experience regression in function or do not improve. Delirium is one of few modifiable risk factors in this patient population. Therefore, understanding the role of delirium in functional recovery may be useful for improving outcomes. Objective: To assess the association of delirium with 30-day functional improvement in patients discharged to SNFs after HF hospitalization. Design, Setting, and Participants: This retrospective cohort study included patients hospitalized for HF in 129 US Department of Veterans Affairs hospitals who were discharged to SNFs from October 1, 2010, to September 30, 2015. Data were analyzed from June 14 to December 18, 2020. Exposures: Delirium, as determined by the Minimum Data Set (MDS) 3.0 Confusion Assessment Method, with dementia as a covariate, determined via International Classification of Diseases, Ninth Revision (ICD-9) coding. Main Outcomes and Measures: The difference between admission and 30-day MDS 3.0 Activities of Daily Living (ADL) scores. Results: A total of 20 495 patients (mean [SD] age, 78 [10.3] years; 78.9% White; and 97% male) were included in the analysis. Of the total sample, 882 patients (4.3%) had delirium on an SNF admission. The mean (SD) baseline ADL score on admission to SNF was significantly worse among patients with delirium than without (18.3 [4.7] vs 16.1 [5.2]; P < .001; d = 0.44.). On the 30-day repeated assessment, mean (SD) function (ADL scores) improved for both patients with delirium (0.6 [2.9]) and without delirium (1.8 [3.6]) (P < .001; d = -0.38). In the multivariate adjusted model, delirium was associated with statistically significant lower ADL improvement (difference in ADL score, -1.07; 95% CI, -1.31 to -0.83; P < .001). Conclusions and Relevance: In this retrospective cohort study, patients with HF discharged to SNFs with delirium were less likely to show improvement in function compared with patients without delirium. Findings suggest a potential need to reexamine how and when health care professionals assess delirium in HF patients throughout their hospitalization and SNF course. Identifying and treating delirium for HF patients earlier in their care trajectory may play an important role in improving care and long-term functional outcomes in this population. Future research is warranted to further investigate the association between delirium and functional recovery for HF and other patient populations.


Asunto(s)
Actividades Cotidianas , Delirio , Insuficiencia Cardíaca/rehabilitación , Hospitalización , Recuperación de la Función , Instituciones de Cuidados Especializados de Enfermería , Anciano , Anciano de 80 o más Años , Demencia , Femenino , Insuficiencia Cardíaca/psicología , Insuficiencia Cardíaca/terapia , Humanos , Masculino , Alta del Paciente , Readmisión del Paciente , Estudios Retrospectivos , Estados Unidos
19.
Am J Sports Med ; 49(5): 1236-1243, 2021 04.
Artículo en Inglés | MEDLINE | ID: mdl-33656938

RESUMEN

BACKGROUND: Knowledge about the predictive value of return to sport (RTS) test batteries applied after anterior cruciate ligament reconstruction (ACLR) is limited. Adding assessment of psychological readiness has been recommended, but knowledge of how this affects the predictive ability of test batteries is lacking. PURPOSE: To examine the predictive ability of a RTS test battery on return to preinjury level of sport and reinjury when evaluation of psychological readiness was incorporated. STUDY DESIGN: Cohort study; Level of evidence, 2. METHODS: A total of 129 patients were recruited 9 months after ACLR. Inclusion criteria were age ≥16 years and engagement in sports before injury. Patients with concomitant ligamentous surgery or ACL revision surgery were excluded. Baseline testing included single-leg hop tests, isokinetic strength tests, the International Knee Documentation Committee (IKDC) Subjective Knee Form 2000, a custom-made RTS questionnaire, and the Anterior Cruciate Ligament-Return to Sport after Injury (ACL-RSI) scale. The RTS criteria were IKDC 2000 score ≥85% and ≥85% leg symmetry index on hop and strength test. At a 2-year follow-up evaluation, further knee surgery and reinjuries were registered and the RTS questionnaire was completed again. Regression analyses and receiver operating characteristic analyses were performed to study the predictive ability of the test battery. RESULTS: Out of the 103 patients who completed the 2-year follow-up, 42% returned to their preinjury level of sport. ACL-RSI 9 months after surgery (odds ratio [OR], 1.03) and age (OR, 1.05) predicted RTS. An ACL-RSI score <47 indicated that a patient was at risk of not returning to sport (area under the curve 0.69; 95% CI, 0.58-0.79), with 85% sensitivity and 45% specificity. The functional tests did not predict RTS. Six patients sustained ACL reinjuries and 7 underwent surgery for other knee complaints/injuries after RTS testing. None of the 29 patients who passed all RTS criteria, and were therefore cleared for RTS, sustained a second knee injury. CONCLUSION: ACL-RSI and age were predictors of 2-year RTS, while functional tests were not informative. Another main finding was that none of the patients who passed the 85% RTS criteria sustained another knee injury.


Asunto(s)
Lesiones del Ligamento Cruzado Anterior , Reconstrucción del Ligamento Cruzado Anterior , Adolescente , Lesiones del Ligamento Cruzado Anterior/cirugía , Estudios de Cohortes , Humanos , Recuperación de la Función , Volver al Deporte
20.
J Neurol Phys Ther ; 45(2): 70-78, 2021 04 01.
Artículo en Inglés | MEDLINE | ID: mdl-33707402

RESUMEN

BACKGROUND AND PURPOSE: Recovery of arm function poststroke is highly variable with some people experiencing rapid recovery but many experiencing slower or limited functional improvement. Current stroke prediction models provide some guidance for clinicians regarding expected motor outcomes poststroke but do not address recovery rates, complicating discharge planning. This study developed a novel approach to defining recovery groups based on arm motor recovery trajectories poststroke. In addition, between-group differences in baseline characteristics and therapy hours were explored. METHODS: A retrospective cohort analysis was conducted where 40 participants with arm weakness were assessed 1 week, 6 weeks, 3 months, and 6 months after an ischemic stroke. Arm recovery trajectory groups were defined on the basis of timing of changes in the Fugl-Meyer Assessment Upper Extremity (FMA-UE), at least the minimal clinically important difference (MCID), 1 week to 6 weeks or 6 weeks to 6 months. Three recovery trajectory groups were defined: Fast (n = 19), Extended (n = 12), and Limited (n = 9). Between-group differences in baseline characteristics and therapy hours were assessed. Associations between baseline characteristics and group membership were also determined. RESULTS: Three baseline characteristics were associated with trajectory group membership: FMA-UE, NIH Stroke Scale, and Barthel Index. The Fast Recovery group received the least therapy hours 6 weeks to 6 months. No differences in therapy hours were observed between Extended and Limited Recovery groups at any time points. DISCUSSION AND CONCLUSIONS: Three clinically relevant recovery trajectory groups were defined using the FMA-UE MCID. Baseline impairment, overall stroke severity, and dependence in activities of daily living were associated with group membership and therapy hours differed between groups. Stratifying individuals by recovery trajectory early poststroke could offer additional guidance to clinicians in discharge planning.(See Supplemental Digital Content 1 for Video Abstract, available at: http://links.lww.com/JNPT/A337.).


Asunto(s)
Isquemia Encefálica , Rehabilitación de Accidente Cerebrovascular , Accidente Cerebrovascular , Actividades Cotidianas , Brazo , Isquemia Encefálica/complicaciones , Humanos , Recuperación de la Función , Estudios Retrospectivos , Accidente Cerebrovascular/complicaciones , Extremidad Superior
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