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1.
J Chin Med Assoc ; 2021 Oct 08.
Artigo em Inglês | MEDLINE | ID: mdl-34643619

RESUMO

Electrotherapy or electrical stimulation (ES) is a part of clinical intervention in the rehabilitation field. With rehabilitation intervention, electrotherapy may be provided as a treatment for pain relief, strengthening, muscle education, wound recovery, or functional training. Although these interventions may not be considered as the primary therapy for patients, the advantages of the ease of operation, lower costs, and lower risks render ES to be applied frequently in clinics. There have also been emerging ES tools for brain modulation in the past decade. ES interventions are not only considered analgesics but also as an important assistive therapy for motor improvement in orthopedic and neurological rehabilitation. In addition, during the coronavirus disease pandemic, lockdowns and self-quarantine policies have led to the discontinuation of orthopedic and neurological rehabilitation interventions. Therefore, the feasibility and effectiveness of home-based electrotherapy may provide opportunities for the prevention of deterioration or extension of the original therapy. The most common at-home applications in previous studies showed positive effects on pain relief, functional ES, muscle establishment, and motor training. Currently, there is a lack of certain products for at-home brain modulation; however, transcranial direct current stimulation has shown the potential of future home-based rehabilitation due to its relatively small and simple design. We have organized the features and applications of ES tools and expect the future potential of remote therapy during the viral pandemic.

2.
BMC Geriatr ; 21(1): 449, 2021 07 31.
Artigo em Inglês | MEDLINE | ID: mdl-34332537

RESUMO

BACKGROUND: Degenerative osteoarthritis (OA) often leads to pain and stiffness of the affected joints, which may affect the physical performance and decrease the quality of life of people with degenerative knee OA. Compared to traditional exercise, tai chi is a safe exercise with slow movements which can facilitate physical functioning and psychological well being, and might be suitable for improving the physical activities of older adults with knee OA. Therefore, this study investigated the impacts of tai chi exercise on the functional fitness of community-dwelling older adults with degenerative knee OA. METHODS: Sixty-eight community-dwelling older adults with knee OA were recruited from the local community to participate in this randomized controlled clinical trial. All subjects were randomly assigned to either an TCE group that practiced tai chi exercise (TCE) (n = 36) or a control group (CON) (n = 32) that received regular health education programs twice per week for 12 weeks. Outcome measurements were determined using functional fitness tests before and after the intervention, including a 30-s chair stand (number of repeats), 30-s arm-curl (number of repeats), 2-min step (number of steps), chair sit-and-reach (reaching distance, cm), back-scratch flexibility (distance between hands, cm), single-leg stand (time, s), functional reach (reaching distance, cm), 8-foot up-and-go (time, s), and 10-m walk tests (time, s). Pre-post comparisons of functional fitness were analyzed using the ANCOVA test with SPSS software version 18.0. RESULTS: Results revealed that participants' functional fitness in the TCE group had significantly higher adjusted mean post-tests scores than that in the CON group after the intervention, including the 8-foot up-and-go (s) (mean difference [MD]=-2.92 [-3.93, -1.91], p = 2.39*10- 7), 30-s arm curl (MD = 4.75 (2.76, 6.73), p = 1.11*10- 5), 2-min step (MD = 36.94 [23.53, 50.36], p = 7.08*10- 7), 30-s chair stand (MD = 4.66 [2.97, 6.36], p = 6.96*10- 7), functional-reach (MD = 5.86 [3.52, 8.20], p = 4.72*10- 6), single-leg stand with eyes closed (MD = 3.44 [1.92, 4.97], p = 2.74*10- 5), chair sit-and-reach (MD = 3.93 [1.72, 6.15], p = 0.001), and single-leg stand with eyes opened (MD = 17.07 [6.29, 27.85], p = 0.002), with large effect sizes (η²=0.14 ~ 0.34). CONCLUSIONS: Community-dwelling older adults with knee OA in the TCE group had better functional fitness performances after the 12-week tai chi intervention than those receiving only health education.


Assuntos
Osteoartrite do Joelho , Tai Ji , Idoso , Exercício Físico , Humanos , Vida Independente , Osteoartrite do Joelho/terapia , Aptidão Física , Qualidade de Vida
3.
Sensors (Basel) ; 21(11)2021 Jun 04.
Artigo em Inglês | MEDLINE | ID: mdl-34199926

RESUMO

Considering the trend of aging societies, accompanying technology can help frail, elderly individuals participate in daily activities. The ideal accompanying robot should accompany the user in a proper position according to the activity scenarios and context; the prerequisite is that the accompanying robot should quickly move to a designated position and closely maintain it regardless of the direction in which the user moves. This paper proposes a user local coordinate-based strategy to satisfy this need. As a proof of concept, a novel "string-pot" approach was utilized to measure the position difference between the robot and the target. We implemented the control strategy and assessed its performance in our gait lab. The results showed that the robot can follow the user in the designated position while the user performs forward, backward, and lateral movements, turning, and walking along a curve.


Assuntos
Robótica , Idoso , Idoso Fragilizado , Marcha , Humanos , Movimento , Caminhada
4.
J Chin Med Assoc ; 84(8): 754-756, 2021 08 01.
Artigo em Inglês | MEDLINE | ID: mdl-34145198

RESUMO

Osteoarthritis (OA) is a common degenerative disease; however, its exact pathophysiology and early diagnosis are still a challenge. Growing attention to the exosomes may inspire innovations that would make the current management of OA more effective. The exosomes in synovial fluid are relatively stable, and they can be easily isolated by the relatively noninvasive procedure of liquid biopsy to provide diagnostic and monitoring value. Some miRNAs (miR-504, miR-146a, miR-26a, miR-200c, and miR-210) have been known to be secreted in exosomes of OA patients. On the other hand, intraarticular injection of platelet-rich plasma (PRP) is becoming a popular therapy for OA patients. PRP is also a source of exosomes and their numerous contents. It is evident from the literature that PRP-derived exosomes can induce chondrogenic gene expression in OA chondrocytes. Here, we review the latest findings on the roles of exosomes in OA with the emphasis on PRP-derived exosomes and their potential applications for treating OA.

5.
Sci Rep ; 11(1): 4229, 2021 02 19.
Artigo em Inglês | MEDLINE | ID: mdl-33608568

RESUMO

A single-blind study to investigate the effects of noisy galvanic vestibular stimulation (nGVS) in straight walking and 2 Hz head yaw walking for healthy and bilateral vestibular hypofunction (BVH) participants in light and dark conditions. The optimal stimulation intensity for each participant was determined by calculating standing stability on a force plate while randomly applying six graded nGVS intensities (0-1000 µA). The chest-pelvic (C/P) ratio and lateral deviation of the center of mass (COM) were measured by motion capture during straight and 2 Hz head yaw walking in light and dark conditions. Participants were blinded to nGVS served randomly and imperceivably. Ten BVH patients and 16 healthy participants completed all trials. In the light condition, the COM lateral deviation significantly decreased only in straight walking (p = 0.037) with nGVS for the BVH. In the dark condition, both healthy (p = 0.026) and BVH (p = 0.017) exhibited decreased lateral deviation during nGVS. The C/P ratio decreased significantly in BVH for 2 Hz head yaw walking with nGVS (p = 0.005) in light conditions. This study demonstrated that nGVS effectively reduced walking deviations, especially in visual deprived condition for the BVH. Applying nGVS with different head rotation frequencies and light exposure levels may accelerate the rehabilitation process for patients with BVH.Clinical Trial Registration This clinical trial was prospectively registered at www.clinicaltrials.gov with the Unique identifier: NCT03554941. Date of registration: (13/06/2018).

6.
J Vestib Res ; 31(1): 23-32, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33325420

RESUMO

BACKGROUND: Embedded within most rapid head rotations are gaze shifts, which is an initial eye rotation to a target of interest, followed by a head rotation towards the same target. Gaze shifts are used to acquire an image that initially is outside of the participant's current field of vision. Currently, there are no tools available that evaluate the functional relevance of a gaze shift. OBJECTIVE: The purpose of our study was to measure dynamic visual acuity (DVA) while performing a gaze shift. METHODS: Seventy-one healthy participants (42.79±16.89 years) and 34 participants with unilateral vestibular hypofunction (UVH) (54.59±20.14 years) were tested while wearing an inertial measurement unit (IMU) sensor on the head and walking on a treadmill surrounded by three monitors. We measured visual acuity during three subcomponent tests: standing (static visual acuity), while performing an active head rotation gaze shift, and an active head rotation gaze shift while walking (gsDVAw). RESULTS: While doing gsDVAw, patients with Left UVH (n = 21) had scores worse (p = 0.023) for leftward (0.0446±0.0943 LogMAR) head rotation compared with the healthy controls (-0.0075±0.0410 LogMAR). Similarly, patients with right UVH (N = 13) had worse (p = 0.025) gsDVAw for rightward head motion (0.0307±0.0481 LogMAR) compared with healthy controls (-0.0047±0.0433 LogMAR). As a whole, gsDVAw scores were worse in UVH compared to the healthy controls when we included the ipsilesional head rotation on both sides gsDVAw (0.0061±0.0421 LogMAR healthy vs. 0.03926±0.0822 LogMAR UVH, p = 0.003). Controlling for age had no effect, the gsDVAw scores of the patients were always worse (p < 0.01). CONCLUSION: The gaze shift DVA test can distinguish gaze stability in patients with UVH from healthy controls. This test may be a useful measure of compensation for patients undergoing various therapies for their vestibular hypofunction.


Assuntos
Movimentos da Cabeça , Doenças Vestibulares , Humanos , Reflexo Vestíbulo-Ocular , Doenças Vestibulares/diagnóstico , Testes Visuais , Acuidade Visual , Caminhada
7.
Brain Sci ; 10(10)2020 Oct 15.
Artigo em Inglês | MEDLINE | ID: mdl-33076417

RESUMO

Patients with bilateral vestibular hypofunction (BVH) often suffer from imbalance, gait problems, and oscillopsia. Noisy galvanic vestibular stimulation (GVS), a technique that non-invasively stimulates the vestibular afferents, has been shown to enhance postural and walking stability. However, no study has investigated how it affects stability and neural activities while standing and walking with a 2 Hz head yaw turning. Herein, we investigated this issue by comparing differences in neural activities during standing and walking with a 2 Hz head turning, before and after noisy GVS. We applied zero-mean gaussian white noise signal stimulations in the mastoid processes of 10 healthy individuals and seven patients with BVH, and simultaneously recorded electroencephalography (EEG) signals with 32 channels. We analyzed the root mean square (RMS) of the center of pressure (COP) sway during 30 s of standing, utilizing AMTI force plates (Advanced Mechanical Technology Inc., Watertown, MA, USA). Head rotation quality when walking with a 2 Hz head yaw, with and without GVS, was analyzed using a VICON system (Vicon Motion Systems Ltd., Oxford, UK) to evaluate GVS effects on static and dynamic postural control. The RMS of COP sway was significantly reduced during GVS while standing, for both patients and healthy subjects. During walking, 2 Hz head yaw movements was significantly improved by noisy GVS in both groups. Accordingly, the EEG power of theta, alpha, beta, and gamma bands significantly increased in the left parietal lobe after noisy GVS during walking and standing in both groups. GVS post-stimulation effect changed EEG activities in the left and right precentral gyrus, and the right parietal lobe. After stimulation, EEG activity changes were greater in healthy subjects than in patients. Our findings reveal noisy GVS as a non-invasive therapeutic alternative to improve postural stability in patients with BVH. This novel approach provides insight to clinicians and researchers on brain activities during noisy GVS in standing and walking conditions in both healthy and BVH patients.

8.
J Chin Med Assoc ; 83(11): 1039-1047, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32773591

RESUMO

BACKGROUND: Frailty syndrome in older population generates formidable social cost. The early detection of "prefrail" stage is essential so that interventions could be performed to prevent deterioration. The purpose of this study was to organize appropriate physical performance tests into a computerized early frailty screening platform, called frailty assessment tools (FAT) system, to detect individuals who are in the prefrail stage. METHODS: Four switches, one distance meter, and one power measure were adopted to build the FAT system that could perform six physical performance tests including single leg standing (SLS), repeated chair rise, timed up and go, self-selected walking speed, functional reach, and grip power. Participants over 65 years old were recruited and classified into three groups according to Fried criteria. The differences in variables between prefrail and robust groups were compared by the χ test, independent samples t test, and Mann-Whitney U test, for nominal variables, normal, and non-normal distributive continuous variables, respectively. The statistically significant level was set at 0.05 (α = 0.05). RESULTS: Only SLS did not reach significance to distinguish prefrail from robust. Among 35 participants (73.23 ± 5.70 years old), the FAT score predicted that 90.73 ± 19.95% of pre-frail subjects and 15.01 ± 25.25% of robust subjects were in the prefrail stage. CONCLUSION: The FAT system, which provides results immediately, is an advantageous alternative to traditional manual measurements. The use of the FAT score for predicting the prefrail stage will help to provide early intervention to prevent individuals from progressing into frailty. The FAT system provides a more convenient and comprehensive frailty screening. Using this computerized automatic screening platform, it may be possible to expand the scope of frailty prevention.

9.
J Chin Med Assoc ; 83(11): 981-983, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32568967

RESUMO

Artificial intelligence (AI), Internet of Things (IoT), and telemedicine are deeply involved in our daily life and have also been extensively applied in the medical field, especially in ophthalmology. Clinical ophthalmologists are required to perform a vast array of image exams and analyze images containing complicated information, which allows them to diagnose the disease type and grade, make a decision on remedy, and predict treatment outcomes. AI has a great potential to assist ophthalmologists in their daily routine of image analysis and relieve their work burden. However, in spite of these prospects, the application of AI may also be controversial and associated with several legal, ethical, and sociological concerns. In spite of these issues, AI has indeed become an irresistible trend and is widely used by medical specialists in their daily routines in what we can call now, the era of AI. This review will encompass those issues and focus on recent research on the AI application in ophthalmology and telemedicine.

10.
Sensors (Basel) ; 20(12)2020 Jun 15.
Artigo em Inglês | MEDLINE | ID: mdl-32549401

RESUMO

This paper demonstrates the development of an automatic mobile trainer employing inertial movement units (IMUs). The device is inspired by Neuro-Developmental Treatment (NDT), which is an effective rehabilitation method for stroke patients that promotes the relearning of motor skills by repeated training. However, traditional NDT training is very labor intensive and time consuming for therapists, thus, stroke patients usually cannot receive sufficient rehabilitation training. Therefore, we developed a mobile assisted device that can automatically repeat the therapists' intervention and help increase patient training time. The proposed mobile trainer, which allows the users to move at their preferred speeds, consists of three systems: the gait detection system, the motor control system, and the movable mechanism. The gait detection system applies IMUs to detect the user's gait events and triggers the motor control system accordingly. The motor control system receives the triggering signals and imitates the therapist's intervention patterns by robust control. The movable mechanism integrates these first two systems to form a mobile gait-training device. Finally, we conducted preliminary tests and defined two performance indexes to evaluate the effectiveness of the proposed trainer. Based on the results, the mobile trainer is deemed successful at improving the testing subjects' walking ability.


Assuntos
Análise da Marcha/instrumentação , Transtornos Neurológicos da Marcha/diagnóstico , Reabilitação do Acidente Vascular Cerebral , Acidente Vascular Cerebral/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Caminhada
11.
J Chin Med Assoc ; 83(10): 898-899, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32520771

RESUMO

Artificial intelligence (AI) has been widely applied in the medical field and achieved enormous milestones in helping specialists to make diagnosis and remedy decisions, particularly in the field of eye diseases and ophthalmic screening. With the development of AI-based systems, the enormous hardware and software resources are required for optimal performance. In reality, there are many places on the planet where such resources are highly limited. Hence, the smartphone-based AI systems can be used to provide a remote control route to quickly screen eye diseases such as diabetic-related retinopathy or diabetic macular edema. However, the performance of such mobile-based AI systems is still uncharted territory. In this article, we discuss the issues of computing resource consumption and performance of the mobile device-based AI systems and highlight recent research on the feasibility and future potential of application of the mobile device-based AI systems in telemedicine.

12.
Front Neurol ; 11: 485, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32595589

RESUMO

To evaluate vestibular function in the clinic, current assessments are applied under static conditions, such as with the subject in a sitting or supine position. Considering the complexities of daily activities, the combination of dynamic activities, dynamic visual acuity (DVA) and postural control could produce an evaluation that better reflects vestibular function in daily activities. Objective: To develop a novel sensor-based system to investigate DVA, walking trajectory, head and trunk movements and the chest-pelvis rotation ratio during forward and backward overground walking in both healthy individuals and patients with vestibular hypofunction. Methods: Fifteen healthy subjects and 7 patients with bilateral vestibular hypofunction (BVH) were recruited for this study. Inertial measurement units were placed on each subject's head and torso. Each subject walked forward and backward for 5 m twice with 2 Hz head yaw. Our experiment comprised 2 stages. In stage 1, we measured forward (FW), backward (BW), and medial-lateral (MLW) walking trajectories; head and trunk movements; and the chest-pelvis rotation ratio. In stage 2, we measured standing and locomotion DVA (loDVA). Using Mann-Whitney U-test, we compared the abovementioned parameters between the 2 groups. Results: Patients exhibited an in-phase chest/pelvis reciprocal rotation ratio only in FW. The walking trajectory deviation, calculated by normalizing the summation of medial-lateral swaying with 1/2 body height (%), was significantly larger (FW mean ± standard deviation: 20.4 ± 7.1% (median (M)/interquartile range (IQR): 19.3/14.4-25.2)in healthy vs. 43.9 ± 27. 3% (M/IQR: 36.9/21.3-56.9) in patients, p = 0.020)/(BW mean ± standard deviation: 19.2 ± 11.5% (M/IQR: 13.6/10.4-25.3) in healthy vs. 29.3 ± 6.4% (M/IQR: 27.7/26.5-34.4) in patients, p = 0.026), and the walking DVA was also significantly higher (LogMAR score in the patient group [FW LogMAR: rightDVA: mean ± standard deviation:0.127 ± 0.081 (M/IQR: 0.127/0.036-0.159) in healthy vs. 0.243 ± 0.101 (M/IQR: 0.247/0.143-0.337) in patients (p = 0.013) and leftDVA: 0.136 ± 0.096 (M/IQR: 0.127/0.036-0.176) in healthy vs. 0.258 ± 0.092 (M/IQR: 0.247/0.176-0.301) in patients (p = 0.016); BW LogMAR: rightDVA: mean ± standard deviation: 0.162 ± 0.097 (M/IQR: 0.159/0.097-0.273) in healthy vs. 0.281 ± 0.130 (M/IQR: 0.273/0.176-0.418) in patients(p = 0.047) and leftDVA: 0.156 ± 0.101 (M/IQR: 0.159/0.097-0.198) in healthy vs. 0.298 ± 0.153 (M/IQR: 0.2730/0.159-0.484) in patients (p = 0.038)]. Conclusions: Our sensor-based vestibular evaluation system provided a more functionally relevant assessment for the identification of BVH patients.

14.
J Chin Med Assoc ; 82(7): 589-594, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31094860

RESUMO

BACKGROUND: The current study aims to compare the variability of positional control of the club in the starting period of downswing and the orientation of the clubface during impact in elite and intermediate golfers. METHODS: Seven elite and 13 intermediate golfers were recorded by an eight-camera VICON motion capture system while putting with a pitch club. Six retro-reflective markers were attached to the club to build a biomechanical model for analyzing swinging movements. Group comparisons of outcome variables regarding the turning point, sweet spot, elevation angle (EA), and azimuth angle (AA) of the club head were made between the elite and intermediate players. RESULTS: There were significant differences between groups in SDs of the location of the club tail along the x, y, and z axes at the turning point (x, p = 0.004; y, p = 0.015; and z, p = 0.035); the minimum distance between the center of the sweet spot and the ball at impact (p = 0.007); the EA (p = 0.001); and the AA (p = 0.001) of the club head. Results showed that the elite players displayed more converged locations of turning points, shorter distances between the center of the sweet spot and the ball at impact, greater EAs, and smaller AAs compared with those of the intermediate players. CONCLUSION: These findings proposed a biomechanical approach of a practical way to observe swing behaviors. These findings suggest that the stability of locations of turning points is a golden reference for differentiating levels of golfers' performance.


Assuntos
Golfe , Fenômenos Biomecânicos , Humanos
15.
J Chin Med Assoc ; 82(4): 328-334, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30946211

RESUMO

BACKGROUND: The technology of using inertial measurement units (IMUs) to detect motions in different body segments has drawn enormous attention to research and industry. In our previous research, we have applied IMUs in evaluating and treating patients with vestibular hypofunction. Furthermore, according to the research, when a person's head rotates over 60° on either side in the horizontal plane, and desires to focus vision on any targets, then the function of gaze shift comes in to operation. Herein, we aimed to use IMUs to build up a system to evaluate vestibular ocular reflex (VOR) during gaze shifting maneuver. METHODS: In this study, we developed a platform, which combines the features of gaze shift and computerized dynamic visual acuity (cDVA), called the gaze shift DVA (gsDVA) platform. The gsDVA platform measures the orientations of the subject's head by IMU, and executed the evaluation according to the algorithm that was developed by us. Finally, we used the VICON system to validate the performance of gsDVA platform. RESULTS: The performance of the accuracy was 2.41° ± 1.08°, the maximal sensor error was within 4.25°, and highly correlated between our platform and VICON (p < 0.05, R = 0.99). The intraclass correlation coefficient (ICC) of between-day and within-day was 0.984 and 0.999, respectively. Furthermore, the platform not only executed the evaluation automatically but also recorded other information besides the head orientation, such as rotation speed, rotation time, reaction time, and visual acuity. CONCLUSION: In this study, we demonstrated the utility of vestibular evaluation, and this platform can help to clarify the relationship between gaze shift and VOR. This methodology is useful and can be applied efficiently to different disease groups for interactive evaluation and rehabilitation programs.


Assuntos
Reflexo Vestíbulo-Ocular/fisiologia , Movimentos da Cabeça/fisiologia , Humanos , Tempo de Reação , Rotação , Doenças Vestibulares/fisiopatologia , Acuidade Visual
16.
J Chin Med Assoc ; 82(7): 599-602, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30893253

RESUMO

The implantation of the Argus II retinal prosthesis system in a 54-year-old woman with retinitis pigmentosa who presented with an eye of long axial length at 26.82 mm was successful. Postoperative examination revealed a gap of 700 µm between the electrode array and the retina, which caused decreased visual perception. A modified strategy with quad and quinary electrode stimulation was introduced to generate higher perceptual thresholds. The patient experienced visual functional changes during the first half of the year after surgery, although no remarkable difference was observed in terms of implant-retina distance. Fibrosis around the tack developed and extended between the gap with the retina elevated from the tack toward the center array, 8 months after the surgery. Schisis of the retina developed and filled the gap, resulting in decreased threshold, and the strategy was then shifted back to single electrode stimulation mode. Rehabilitation program is an evolving process that depends on the distance between the array and the retina in the eye with staphyloma. This study first showed the implantation in a patient with high myopia who presented with long axial length after surgery and rehabilitation program in Taiwan.


Assuntos
Miopia/cirurgia , Retinite Pigmentosa/cirurgia , Próteses Visuais , Feminino , Humanos , Pessoa de Meia-Idade , Miopia/fisiopatologia , Retinite Pigmentosa/fisiopatologia , Retinite Pigmentosa/reabilitação , Acuidade Visual , Próteses Visuais/efeitos adversos
17.
Medicine (Baltimore) ; 96(16): e6560, 2017 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-28422842

RESUMO

RATIONALE: Page kidney is an uncommon condition that hypertension occurs secondary to microvascular ischemia and alternation of small-vessel hemodynamics due to external compression of renal parenchyma and activation of the renin-angiotensin-aldosterone system. There are no specific guidelines for the management of Page kidney in the literatures. PATIENT CONCERNS: A 17-year-old teenager who had Fontan procedure for tricuspid and pulmonary atresia in early childhood suffered from sudden onset of severe left flank pain during cardiac catheterization procedure. Left renal artery active bleeding with renal parenchyma compression in association with renin-mediated hypertension led to the diagnosis of Page kidney. DIAGNOSES: Page kidney was diagnosed in this case. INTERVENTIONS: Urgent embolization was performed to treat left renal artery active bleeding. Because of decreased renal function with elevation of serum creatinine, inadequate blood pressure control with antihypertensive medication, and poor renal blood flow of left kidney, open drainage of perirenal hematoma was done 5 days after catheterization procedure. OUTCOMES: After the operation, glomerular filtration rate improved immediately, and left flank pain and hypertension resolved at discharge. LESSONS: The choice of the therapies for Page kidney depended on the clinical presentation of each case. This case pointed out the significance of renoscintigraphy and surgery in the management of Page kidney.


Assuntos
Drenagem/métodos , Hipertensão/etiologia , Nefropatias/complicações , Nefropatias/cirurgia , Adolescente , Pressão Sanguínea , Cateterismo Cardíaco/efeitos adversos , Técnica de Fontan , Humanos , Nefropatias/diagnóstico , Nefropatias/etiologia , Masculino , Atresia Pulmonar/cirurgia , Artéria Renal/patologia , Atresia Tricúspide/cirurgia
18.
J Clin Neurosci ; 29: 139-44, 2016 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-26976344

RESUMO

Humans must maintain head and trunk stability while walking. The purpose of this study was to compare the kinematics of healthy controls and patients with vestibular hypofunction (VH) when walking and making head rotations of different frequencies in both light and dark conditions. We recruited eight individuals with VH and nine healthy control subjects to perform four tasks at their preferred gait speed, being normal walk, walking and making yaw head rotations at 1.5Hz and 2Hz, and walking in the dark and making yaw head rotations at 1.5Hz. Linear kinematics as well as head, trunk, and pelvis angular velocities were captured using the Vicon motion analysis system (Vicon Motion Systems, Oxford, UK). We found no difference in walking velocities for any of the four walking conditions across groups. The lateral displacement of the center of mass was increased in VH patients. In the dark, patients had more head instability in pitch (larger amplitudes and velocities) even though they were walking and making active yaw head rotations. Patients also had a smaller relative phase angle (mean 3.50±standard deviation 2.13°) than controls (mean 10.31±standard deviation 2.70°) (p<0.01). Our data suggest that patients with VH have difficulty walking with a straight trajectory when turning their head. Additionally, patients with VH have an abnormal excursion of spontaneous pitch head rotation while walking and making active yaw head turns, which is dependent on vision. Rehabilitation for these patients should consider applying unique head rotation frequencies when training gait with head turns as well as alternating their exposure to light.


Assuntos
Movimentos da Cabeça , Movimento , Tronco/fisiopatologia , Doenças Vestibulares/fisiopatologia , Visão Ocular , Adulto , Fenômenos Biomecânicos , Testes Calóricos , Escuridão , Feminino , Marcha , Humanos , Luz , Masculino , Pessoa de Meia-Idade , Pelve/fisiopatologia , Doenças Vestibulares/reabilitação , Caminhada
19.
J Biochem ; 158(4): 299-308, 2015 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-25922201

RESUMO

Low back pain is a common clinical problem that causes disability and impaired quality of life. While the reason behind low back pain was largely considered to be of musculoskeletal origin, the contribution of inflammatory cytokines and oxidative stress could never be overlooked. Exercise has been proven to be an effective approach to treat low back pain. However, the mechanism of the exercise effect on the inflammatory cytokines and oxidative stress is still largely unknown. In this study, we revealed that exercise intervention reduces Toll-like receptor 4 (TLR-4) pathway and enhances Sirtuin 1 (SIRT1) expression in low back pain patients. We also confirmed that exercise up-regulates the expression of peroxisome proliferator-activated receptor-gamma, PPAR-γ coactivator-1 and FoxOs family proteins and also increases the activity of catalase and superoxide dismutase in patients with low back pain. Furthermore, we found that exercise intervention attenuates the oxidative stress, pro-inflammatory cytokine concentrations and p53 expression in patients with low back pain. This study demonstrates that exercise intervention improves low back pain symptoms through regulation of the SIRT1 axis with repression of oxidative stress and TLR-4 inhibition.


Assuntos
Regulação da Expressão Gênica , Dor Lombar/terapia , Exercícios de Alongamento Muscular , Estresse Oxidativo , Treinamento de Força , Sirtuína 1/metabolismo , Receptor 4 Toll-Like/metabolismo , Adulto , Estudos Transversais , Citocinas/sangue , Citocinas/metabolismo , Feminino , Proteína Forkhead Box O1 , Proteína Forkhead Box O3 , Fatores de Transcrição Forkhead/genética , Fatores de Transcrição Forkhead/metabolismo , Humanos , Dor Lombar/sangue , Dor Lombar/imunologia , Dor Lombar/metabolismo , Linfócitos/imunologia , Linfócitos/metabolismo , Masculino , Pessoa de Meia-Idade , PPAR gama/genética , PPAR gama/metabolismo , Medição da Dor , Sirtuína 1/genética , Taiwan , Receptor 4 Toll-Like/genética
20.
Gait Posture ; 40(3): 403-7, 2014 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-24974126

RESUMO

Sit-to-stand (STS) movements are essential for daily activities. Failure to perform STS movements efficiently and smoothly may lead to falls. In this study, we developed a forceplate to analyze vertical ground reaction force (VGRF), STS duration and generated muscle power to investigate which parameters were fall status predictors. A total of 105 participants were included in this study and were grouped into those (1) aged between 20 and 30 years (Young), (2) aged above 65 years without a history of falling (Non-fallers) and (3) aged above 65 with a history of falling in the past 12 months (Fallers). The results indicated a significantly higher maximal lower limb muscle power (MP) for the Young (9.05 ± 3.66 W/kg), followed by Non-fallers (5.50 ± 2.02W/kg) and Fallers (3.66 ± 1.45 W/kg) as well as higher modified falls efficacy scale (MFES) scores for the Young (Young: 9.88 ± 0.10; Non-fallers: 6.27 ± 1.40; Fallers: 4.83 ± 0.89) and shorter times for the five times sit-to-stand test (FSTST) for the young (Young: 6.09 ± 2.20 s; Non-fallers: 15.65 ± 3.30s; Fallers: 19.82 ± 4.46 s). There was a significant difference between the Young group and the Non-fallers in the maximal vertical ground reaction force (VGRF) (138.79 ± 24.20 N/BW in Young, 117.51 ± 8.57 N/BW in old Non-fallers, p < 0.01), and there was a significant difference between the Non-fallers and the Fallers in the duration of the STS movement (2.74 ± 0.87 s for the Non-fallers, 4.27 ± 2.56 s for the Fallers, p < 0.01). The regression analysis results further indicated that only MP and the STS stabilization phase could differentiate individuals who had past fall events. Therefore, the equipment we developed could potentially be useful in the assessment and monitoring of balance and the risk of falling in older people.


Assuntos
Acidentes por Quedas/prevenção & controle , Extremidade Inferior/fisiologia , Movimento/fisiologia , Força Muscular/fisiologia , Músculo Esquelético/fisiologia , Adulto , Idoso , Envelhecimento/fisiologia , Fenômenos Biomecânicos , Feminino , Humanos , Masculino , Valor Preditivo dos Testes , Pressão
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