Computer-Assisted Rehabilitation Shows Greater Efficacy Than Traditional in Visuospatial Skills and Cognition in Neglect Patients.

This study is crucial for improving unilateral spatial neglect (USN) treatments, focusing on comparing the effectiveness of computer-assisted cognitive rehabilitation (CACR) against conventional rehabilitation (CR) methods. It aimed to address a significant research gap and improve patient outcomes by evaluating the impact of CACR versus CR on visuospatial perception, visual field and attention, and visual memory in patients with USN. This study was a randomized controlled trial. Forty-five consecutive patients with USN from a university rehabilitation center were divided into two groups: 22 patients received CACR with Rehacom software, focusing on saccadic eye movement, visual field, and visual-motor coordination, while 23 underwent CR that combined hemispheric activation approach, mental imagery training, and vibration therapy. Assessments included the Motor-Free Visual Perception Test (MVPT), Line Bisection Test (LBT), Visual Span Test (VST), and Visual Recognition Test (VRT). The study employed ANCOVA and effect size calculations to evaluate the effectiveness of CACR compared to CR in treating patients with USN. Results indicated that CACR significantly outperformed CR in improving visuospatial perception, visual field, attention, and memory, showcasing its effectiveness in treating USN. These findings demonstrate the superiority of CACR over CR, particularly in enhancing visual memory and attention, as evidenced by the large effect size in VRT and moderate effects in LBT and VST. This suggests CACR's potential as a more effective approach for rehabilitation in patients with USN due to brain injuries.

Global burden of gout in 1990-2019: A systematic analysis of the Global Burden of Disease study 2019.

BACKGROUND AND AIMS: Although gout is one of the most common rheumatic diseases, world data are lacking because most studies have focused on industrialized countries. Therefore, we aimed to investigate the global burden of gout and its associations with the year of diagnosis, age, geographical region, sociodemographic status and various further risk factors. METHODS: Retrospective data from the Global Burden of Disease (GBD) were used, initially collected between 1990 and 2019. Raw numbers and age-standardized rates (per 100,000 persons) of prevalence, incidence and years lived with disability (YLDs) of gout were extracted from GBD 2019 for 204 countries and territories and stratified by sex, age, year, sociodemographic index and geographic region. Correlations between gout and other chronic diseases were identified, and the burden attributable to high body mass index (BMI) and kidney dysfunction was described. RESULTS: The total number of patients and gout age-standardized prevalence rate increased between 1990 and 2019. Gout was most prevalent in Australasia and high-income North America, and a higher sociodemographic index (SDI) was associated with higher age-standardized prevalence, incidence and YLDs. High BMI and kidney dysfunction were risk factors for gout, while gout was correlated with other kidney diseases. CONCLUSIONS: The global prevalence of gout, as well as incidence, and YLDs increased worldwide from 1990 to 2019 and had a significant association with sex, age, geographic region, SDI and risk factors. Understanding the complex interplay of environmental, sociodemographic and geographic risk factors is essential in mitigating the ever-rising disease burden of gout.

Predictors of the effect of an arm sling on gait efficiency in stroke patients with shoulder subluxation: a pre-post design clinical trial.

BACKGROUND: The predictors affecting the gait efficiency were not known for the arm sling, including general and stroke-related characteristics. PURPOSE: This study investigated the predictors of gait efficiency when walking with and without an arm sling in individuals with hemiplegia with shoulder subluxation. METHODS: A total of 57 individuals with shoulder subluxation were recruited. Individuals assigned odd numbers walked with the arm sling first and those with even numbers walked without the arm sling first in a pre-post design. Outcome measures were the energy cost, energy consumption, and heart rate during a 6-min walk test and a 10-m walk test. Gait efficiency is defined as energy consumption divided by the distance walked, with lower energy costs reflecting higher gait efficiency. Age, MMSE scores adjusted for education, and significant variables (p < .01) in the univariate analyses were entered into multiple regression analyses, to identify the predictors of changes of gait efficiency. RESULTS: Energy cost and energy consumption were lower and walking endurance was higher when walking with an arm sling than when without an arm sling. Spasticity (p = .02), shoulder pain (p = .03), consistency of handedness and sling position worn (p = .02), function of upper extremity (p = .03) and walking aids (p = .01) were predictors of gait efficiency. CONCLUSION: An arm sling may improve gait efficiency in individuals with hemiplegia and shoulder subluxation able to walk with a single cane, who have consistency in handedness and sling position, and with good upper extremity function, including no shoulder pain and reduced spasticity.

Hepatic Steatosis Alleviated in Diabetic Mice upon Dietary Exposure to Fibroin via Transgenic Rice: Potential STAMP2 Involvement in Hepatocytes.

Many benefits of silk protein fibroin (SPF) have been suggested in biomedical applications; and notably, significant SPF effects have been observed for metabolic syndromes that are directly linked to insulin resistance, such as type 2 diabetes mellitus (T2DM). Based on our previous findings, we believe that SPF from spiders exhibits outstanding glucose-lowering effects in diabetic BKS.Cg-m+/+Leprdb mice. In order to evaluate the dietary effects of SPF in diabetic animals, we generated several lines of transgenic rice (TR) that expresses SPF, and the feeding of TR-SPF to diabetic animals decreased blood glucose levels, but did not change insulin levels. Western blot analyses of hepatic proteins showed that AMP-activated protein kinase (AMPK) expression and phosphorylation both decreased in TR-SPF-fed groups, compared with controls. This finding suggests that the glucose-lowering effects in this diabetic animal model might be AMPK-independent. In contrast, six-transmembrane protein of prostate 2 (STAMP2) was upregulated after TR-SPF exposure. Together with STAMP2, the Akt protein phosphorylation increased after TR-SPF exposure, which indicates that STAMP2 leads to Akt phosphorylation and thus increases insulin sensitivity in hepatocytes. Importantly, the hepatic steatosis that was seen in the liver of diabetic mice was remarkably alleviated in TR-SPF-fed mice. Hepatocytes that were immunopositive for STAMP2 were overwhelmingly observed in hepatic tissues from TR-SPF-fed mice compared to the control. Taken together, these results suggest that feeding diabetic mice with TR-SPF upregulates STAMP2 expression and increases Akt phosphorylation in hepatic tissues and thus potentially alleviates insulin resistance and hepatic steatosis.

Dietary Exposure to Transgenic Rice Expressing the Spider Silk Protein Fibroin Reduces Blood Glucose Levels in Diabetic Mice: The Potential Role of Insulin Receptor Substrate-1 Phosphorylation in Adipocytes.

Type 2 diabetes mellitus (T2DM) is characterized by insulin resistance (IR). T2DM is correlated with obesity and most T2DM medications have been developed for enhancing insulin sensitivity. Silk protein fibroin (SPF) from spiders has been suggested as an attractive biomaterial for medical purposes. We generated transgenic rice (TR) expressing SPF and fed it to diabetic BKS.Cg-m+/+Leprdb mice to monitor the changes in blood glucose levels and adipose tissue proteins associated with energy metabolism and insulin signaling. In the present study, the adipocyte size in abdominal fat in TR-SPF-fed mice was remarkably smaller than that of the control. Whereas the adenosine monophosphate-activated protein kinase (AMPK)-activated protein kinase and insulin receptor substrate 1 (IRS1) protein levels were increased in abdominal adipose tissues after TR-SPF feeding, levels of six-transmembrane protein of prostate 2 (STAMP2) proteins decreased. Phosphorylation of AMPK at threonine 172 and IRS1 at serine 307 and tyrosine 632 were both increased in adipose tissues from TR-SPF-fed mice. Increased expression and phosphorylation of IRS1 at both serine 307 and tyrosine 632 in adipose tissues indicated that adipocytes obtained from abdominal fat in TR-SPF-fed mice were more susceptible to insulin signaling than that of the control. STAMP2 protein levels decreased in adipose tissues from TR-SPF-fed mice, indicating that STAMP2 proteins were reducing adipocytes that were undergoing lipolysis. Taken together, this study showed that TR-SPF was effective in reducing blood glucose levels in diabetic mice and that concurrent lipolysis in abdominal adipocytes was associated with alterations of AMPK, IRS1, and STAMP2. Increased IRS1 expression and its phosphorylation by TR-SFP were considered to be particularly important in the induction of lipolysis in adipocytes, as well as in reducing blood glucose levels in this animal model.

Remediation approach for organic compounds and arsenic co-contaminated soil using the pressurized hot water extraction process.

Successful remediation of soil with co-existing organics contaminants and arsenic (As) is a challenge as the chemical and remediation technologies are different for each group of pollutants. In this study, the treatment effectiveness of the pressurized hot water (PHW) extraction process was investigated for remediation of soil co-contaminated with phenol, crude oil, polycyclic aromatic hydrocarbons (PAHs), and As. An elimination percentage of about 99% was achieved for phenol, and in the range of 63-100% was observed for the PAHs at 260°C for 90 min operation. The performance of PHW extraction in the removal of total petroleum hydrocarbons was found to be 86%. Of the 87 mg/kg of As in untreated soil, 67% of which was eliminated after treatment. The removal of organic contaminants was mainly via desorption, dissolution and degradation in subcritical water, while As was eliminated probably by oxidation and dissolution of arsenic-bearing minerals. According to the experimental results, the PHW extraction process can be suggested as an alternative cleaning technology, instead of using any organic solvents for remediation of such co-contaminated soil.

The effect of an arm sling used for shoulder support on gait efficiency in hemiplegic patients with stroke using walking aids.

BACKGROUND: The effects of an arm sling on the physiological costs of walking are not known. Even though a previous study reported that an arm sling can improve gait efficiency, its entrance criteria was only hemiparetic patients able to walk without walking aids independently. AIM: The aim of this study was to investigate the effect of shoulder support by an arm sling on gait efficiency in hemiplegic stroke patients using walking aids. DESIGN: Randomized crossover design. SETTING: Rehabilitation department of a university hospital. POPULATION: A total of 57 hemiplegic patients with shoulder subluxation dependent on canes were grouped into single cane (N.=30) and quad cane groups (N.=27) as walking aids. METHODS: All patients performed a walk with their own walking aid with and without an arm sling in randomized order, on the same day. We measured the energy cost and energy expenditure using a portable gas analyzer and heart rate during a 6-minutes Walk Test and a 10-m Walk Test. We analyzed all outcomes measures with and without an arm sling between the patients who were grouped according to their walking aids using 2-way repeated ANOVA. RESULTS: The energy cost (0.068±0.023 mL/kg/m) and oxygen expenditure (8.609±2.155 mL/kg/minutes) were lower with the arm sling (P<0.05) than without the arm sling (0.074±0.029 mL/kg/m, and 9.109±2.406 mL/kg/minutes, respectively), and the walking endurance (138.942±47.043 m) were longer (P<0.05) with the arm sling among the hemiplegic patients with single cane. CONCLUSIONS: Among the hemiplegic patients with a single cane, the walking endurance achieved with an arm sling significantly improved than those achieved without an arm sling, and the energy expenditure and energy cost was significantly lower. CLINICAL REHABILITATION IMPACT: The hemiplegic arm support with an arm sling may be beneficial for gait efficiency in hemiplegic patients using a single cane, which lead to decreased oxygen use at a given speed.

Effect of chronic knee osteoarthritis on flexion-relaxation phenomenon of the erector spinae in elderly females.

[Purpose] This study investigated the flexion-relaxation phenomenon of the erector spinae in elderly women with chronic knee osteoarthritis and determined whether the flexion-relaxation phenomenon can be used as a pain evaluation tool in such cases. [Subjects and Methods] Seventeen elderly females with chronic knee osteoarthritis and 13 healthy young females voluntarily participated in this study. They performed three postural positions in 15 s: trunk flexion, complete trunk flexion, and trunk extension, each for 5 s. While these positions were held, muscle activation of the thoracic and lumbar erector spinae were measured using surface electromyography. The flexion-relaxation rate was determined by dividing the values for trunk extension by those of complete trunk flexion and by dividing the values for trunk flexion by those of complete trunk flexion. [Results] According to our results, the flexion-relaxation phenomenon was different between healthy young and elderly females with chronic knee osteoarthritis. Specifically, there was a difference in the left thoracic erector spinae muscle, but not in the left and right lumbar erector spinae or right thoracic spinae muscle. [Conclusion] Our study demonstrated that the erector spinae muscle flexion-relaxation phenomenon can be used as a pain evaluation tool in elderly females with chronic knee osteoarthritis.

Effects of proprioceptive neuromuscular facilitation stretching and deep-breathing exercises on upper extremity lymphedema in stroke patients.

[Purpose] The purpose of this study was to determine the effects of deep-breathing and proprioceptive neuromuscular facilitation stretching exercises on upper limb lymphedema in stroke patients. [Subjects and Methods] The study consisted of 10 patients with lymphedema that had occurred after stroke. Neurodevelopmental treatment was applied in the same manner as that used for the existing treatment. The subjects performed deep-breathing and stretching exercises three times per week for 4 weeks (12 sessions total). Body water volume in the upper limbs was measured before and after exercise by using an InBody S10 analyzer. [Results] Performance of deep-breathing and stretching exercises significantly reduced body water volume in both the affected and unaffected arms. The extracellular-to-total cellular fluid volume ratio in the affected arm improved to 0.379 after exercise, although this change was not significant. [Conclusion] The results of the present study show that deep-breathing and proprioceptive neuromuscular facilitation stretching exercises reduce upper extremity lymphedema in stroke patients.

The mediating effect of caregiver burden on the caregivers' quality of life.

[Purpose] Quality of life (QoL) can be closely related to caregiver burden, which may be a potential mediating effect on the relationships among stroke patient caregivers. This study investigated the predictors of caregiver's QoL based on patient and caregiver characteristics, with caregiver burden as a mediator. [Methods] This study was conducted using surveys, a literature review, and interviews. Survey data were collected from 238 subjects, who were diagnosed with stroke, and their family caregivers from October 2013 to April 2014. [Results] Caregiver health status, income, spouses caring for patients, and duration of hospitalization were identified as significant predictors of caregivers' QoL with a mediating effect of caregiver burden. The time spent on caregiving per day and patient education level were the only direct predictors of caregivers' QoL. [Conclusion] The responsibility of caring for patients with stroke, in particular for a spouse, must be administered by means of a holistic family-centered rehabilitation program. In addition, financial support and availability of various health and social service programs must be comprehensively provided in order to maintain caregivers' well-being.

A randomized comparison of energy consumption when using different canes, inpatients after stroke.

OBJECTIVES: To investigate the differences in oxygen consumption associated with gait in hemiplegic patients according to the type of cane they use. DESIGN: A randomized crossover design. SETTING: University hospital-based rehabilitation center, Korea. SUBJECTS: Thirty consecutive patients (mean ± SD age, 56.3 ± 3.2 years) with chronic stroke, 17 (56.7%) males and 13 (43.3%) females. INTERVENTIONS: At approximately the same time of day for three consecutive days, each participant completed a walk with one of three randomly assigned types of canes: a single-point cane, a quad cane, and a hemi-walker. MAIN OUTCOME MEASURE: Energy expenditure (O2 rate, mL/kg/min), energy cost (O2 cost, mL/kg/m), and heart rate (HR) via a portable gas analyzer, a 10-meter walk test (10MWT), and a 6-minute walk test (6MWT). RESULTS: Energy expenditure, gait endurance, and gait velocity for a single-point cane were higher (p<0.001 or p=0.005) than for any other type of cane. Energy cost (0.5 ± 0.2 mL/kg/m vs. 0.6 ± 0.2 mL/kg/m vs. 0.6 ± 0.2 ml/kg/m, respectively, p=0.001) was lower for the single-point cane, except for HR (p ≥ 0.05) after the Bonferroni correction (0.05/5=0.01). CONCLUSIONS: A single-point cane requires less oxygen use at a given speed, or permits greater speed for the same oxygen consumption.

Which type of cane is the most efficient, based on oxygen consumption and balance capacity, in chronic stroke patients?

Canes are widely prescribed as walking aids, but little is known about the effects of canes on the physiological cost of walking. The purpose of this study was to investigate the differences in oxygen consumption associated with the gaits of hemiplegic patients in terms of balance capacity according to the type of cane used. Twenty-nine patients with chronic stroke were divided into poor-balance (n=15) and relatively-better-balance groups (n=14) based on a cutoff score of 49 on the Berg balance scale (BBS). Each patient completed three consecutive days of walking with a randomly assigned singlepoint cane, quad cane, or hemi-walker. We measured the oxygen expenditure and oxygen cost using a portable gas analyzer and heart rate during a 6-min walk test (6MWT) and a 10-m walk test (10MWT). The oxygen expenditure, gait endurance, and gait velocity were higher with the single-point cane (p<0.01) than with any of the other cane types, and the oxygen costs were lower (p<0.01) with the single-point cane among the patients with relatively better balance. The oxygen cost for the quad cane was lower (p<0.01) than that found for any the other cane types among the patients with relatively poor balance. Our study revealed that single-point canes require less oxygen use at a given speed and permits greater speed at the same oxygen consumption for hemiplegic patients with good balance. Walking aids with a greater base support may be more suitable than those with a smaller base support for patients with relatively poor balance. However, our conclusions are only preliminary because of the small sample size (KCT0001076).

The Relationship between Rehabilitation and Changes in Depression in Stroke Patients.

[Purpose] This study investigated the primary factors behind changes in depressive symptoms among stroke patients after 8 weeks of rehabilitation (physical, occupational, and cognitive therapy). [Methods] This study was conducted using a literature review, and electronic medical records from January, 2008 to December, 2009. Data were collected for 120 subjects with chronic stroke. [Results] Cardiac disorder, left-brain lesion, early-stage depression, activities of daily living, and cognitive function were significant predictors of the changes in depression in chronic stroke patients. [Conclusion] Post-stroke depression can be controlled by rehabilitation. Also, clinicians should comprehend and share the psychological and physical affliction, develop back-up programs, and make them comprehensively available to support the psychological and physical health of subjects with chronic stroke.

Effect of social support on parenting stress of korean mothers of children with cerebral palsy.

[Purpose] This study investigated the effect of perceived social support on the parenting stress of mothers who have children with cerebral palsy (CP). [Methods] This study was conducted using surveys, literature review, and interviews. Survey data were collected from 181 mothers of children (under 18 years of age) with CP. [Results] Level of disability, mother's health status and social support were significant predictors of the parenting stress of mothers. [Conclusion] We have to comprehend and share the psychological and physical affliction of mothers having much difficulty nurturing children with CP. Also, the government should take social responsibility for the upbringing of their children, developing back-up programs for mothers and making them comprehensively available to support the psychological and physical health of mothers of children with CP.