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1.
Sci Rep ; 11(1): 21349, 2021 Nov 01.
Artigo em Inglês | MEDLINE | ID: mdl-34725397

RESUMO

Diffuse idiopathic skeletal hyperostosis (DISH) is frequently an incidental finding during X-ray examination. Although it has been shown to be associated with several chronic diseases, the hazard of cerebrovascular disease has seldom been explored. Our study aimed at determining the risk of stroke conferred by DISH, which is a retrospective cohort study adopting the largest medical database in Taiwan. Patients with a diagnosis of DISH at least three times from 2005 to 2010 were identified as the study group, and those in the control group were selected by matching age and gender. Patients were followed up until the end of 2015 to trace the incidence of stroke. Cox regression analysis was performed to compute the hazard ratio of stroke. Among the included 5300 patients, 1060 had a diagnosis of DISH. Significantly higher prevalence rates of stroke, hypertension, diabetes, and hyperlipidemia were noted in these patients. Overall, DISH conferred a 1.68 times higher risk of developing stroke. The significantly higher hazard ratio could be identified in both genders whether hypertension existed or not. Even in those without comorbidities, DISH still conferred a significantly higher risk of cerebrovascular disease in the future, which should never be ignored when encountered during clinical practice.

2.
World J Clin Cases ; 9(13): 3048-3055, 2021 May 06.
Artigo em Inglês | MEDLINE | ID: mdl-33969090

RESUMO

BACKGROUND: Delayed neurological sequelae (DNS) caused by carbon monoxide (CO) intoxication poses considerable treatment challenges for clinical practitioners. In this report, we used nuclear medicine imaging and the Mini-Mental State Examination (MMSE) to evaluate the effectiveness of intravascular laser irradiation of blood (ILIB) therapy for the management of DNS. CASE SUMMARY: A 51-year-old woman presented to our medical center experiencing progressive bradykinesia, rigidity of limbs, gait disturbance, and cognitive impairment. Based on her neurological deficits, laboratory tests and imaging findings, the patient was diagnosed with delayed neurological sequelae of CO intoxication. She received intensive rehabilitation and ILIB therapy during 30 sessions over 2 mo after diagnosis. Brain single-photon emission computed tomography was performed both prior to and after ILIB therapy. The original hypoperfusion area in bilateral striata, bilateral frontal lobe, right parietal lobe, and bilateral cerebellum showed considerable improvement after completion of therapy. The patient's MMSE score also increased markedly from 6/30 to 25/30. Symptoms of DNS became barely detectable, and the woman was able to carry out her daily living activities independently. CONCLUSION: ILIB therapy could facilitate recovery from delayed neurological sequelae in patients with CO intoxication, as demonstrated by improved cerebral blood flow and functional outcomes in our patient.

3.
Medicine (Baltimore) ; 100(6): e24631, 2021 Feb 12.
Artigo em Inglês | MEDLINE | ID: mdl-33578580

RESUMO

RATIONALE: The Pisa syndrome (PS) is defined as a kind of reversible postural deformity which causes a lateral trunk flexion of 10 degrees or more. A prevalence of approximately 7.4% to 10.3% of patients with Parkinson disease (PD) also have PS. Though unbalanced function of the basal ganglia network and impaired visual-spatial functions including parietal cortices in PS is known, the pathophysiology of PS remains to be unclear. PATIENT CONCERNS: A 67-year-old male patient with PD visited our Rehabilitation outpatient department because of his trunk which involuntarily deviated to the left side when he stood up. DIAGNOSES: Based on the history, physical examination, X-ray images, Tc-99m brain TRODAT-1 single-photon emission computed tomography (SPECT), and regional cerebral perfusion Tc-99m ethyl cysteinate dimer SPECT, the patient was diagnosed with PD with PS. INTERVENTIONS: The patient refused our recommendation of admission for pharmaceutical treatment due to personal reasons and was only willing to accept physical training programs at our outpatient department. OUTCOMES: We arranged functional neuroimaging of the brain to survey possible neurologic deficits. The patient's images of ethyl cysteinate dimer SPECT and TRODAT SPECT showed abnormalities, including hypoperfusion and diminished dopamine transporter uptake, in the areas of the basal ganglia network and other brain regions. LESSONS: Based on previous literature and the imaging of our patient, we hypothesize that PS results from unbalanced function of the basal ganglia network and impaired visual-spatial functions of bilateral parietal cortices.


Assuntos
Doença de Parkinson/diagnóstico por imagem , Idoso , Humanos , Masculino , Neuroimagem , Compostos de Organotecnécio , Doença de Parkinson/reabilitação , Compostos Radiofarmacêuticos , Síndrome , Tomografia Computadorizada de Emissão de Fóton Único , Tropanos
5.
J Formos Med Assoc ; 120(1 Pt 1): 83-92, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32863084

RESUMO

The COronaVIrus Disease 2019 (COVID-19), which developed into a pandemic in 2020, has become a major healthcare challenge for governments and healthcare workers worldwide. Despite several medical treatment protocols having been established, a comprehensive rehabilitation program that can promote functional recovery is still frequently ignored. An online consensus meeting of an expert panel comprising members of the Taiwan Academy of Cardiovascular and Pulmonary Rehabilitation was held to provide recommendations for rehabilitation protocols in each of the five COVID-19 stages, namely (1) outpatients with mild disease and no risk factors, (2) outpatients with mild disease and epidemiological risk factors, (3) hospitalized patients with moderate to severe disease, (4) ventilator-supported patients with clear cognitive function, and (5) ventilator-supported patients with impaired cognitive function. Apart from medications and life support care, a proper rehabilitation protocol that facilitates recovery from COVID-19 needs to be established and emphasized in clinical practice.


Assuntos
COVID-19 , Protocolos Clínicos/normas , Controle de Infecções , Reabilitação , COVID-19/epidemiologia , COVID-19/prevenção & controle , COVID-19/reabilitação , Consenso , Humanos , Controle de Infecções/métodos , Controle de Infecções/organização & administração , Recuperação de Função Fisiológica , Reabilitação/métodos , Reabilitação/normas , SARS-CoV-2/isolamento & purificação , Taiwan
6.
Arch Phys Med Rehabil ; 101(5): 762-769, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32084347

RESUMO

OBJECTIVE: To investigate whether strength or aerobic training can offer significantly more benefits with regarding the activities of daily living of elderly patients with dementia as well as to determine the effects of exercise on cognition, depression, and biochemical markers. DESIGN: Single-blind randomized controlled trial. SETTING: A nursing home for veterans. PARTICIPANTS: A volunteer sample of participants (N=80) whose scores on the Mini-Mental State Examination were between 15 and 26 were included. Because of cardiopulmonary or orthopedic conditions that prohibit exercise training, along with any cognitive problems that may impede answering the contents of our questionnaires, 11 participants were excluded. During the exercise training period, 8 participants voluntarily dropped out of the study. INTERVENTIONS: The participants were randomly assigned to perform either strength or aerobic training for a total of 4 weeks. MAIN OUTCOME MEASURES: The main outcome measure was the Barthel Index. Other outcome measures included the Mini-Mental State Examination, Montreal Cognitive Assessment, Geriatric Depression Scale, plasma monocyte chemotactic protein-1 levels, insulin-like growth factor-1 levels, and serum brain-derived neurotrophic factor levels. RESULTS: After completion of the program, we discovered a significant improvement in the patients' Barthel Index, Mini-Mental State Examination, Montreal Cognitive Assessment, and plasma monocyte chemotactic protein-1 levels in the strength-training group. For the patients who had received aerobic training, their serum brain-derived neurotrophic factor also improved significantly. However, the degree of improvement regarding these outcome measures did not achieve significant statistical difference between the 2 groups. CONCLUSIONS: Through our study, an intensive 4-week exercise program, whether it be strength or aerobic training, is evidenced to bring significant benefits to elderly patients with dementia, while the serum brain-derived neurotrophic factor was additionally improved through aerobic training.


Assuntos
Demência/reabilitação , Terapia por Exercício , Treinamento de Força , Atividades Cotidianas , Idoso , Idoso de 80 Anos ou mais , Biomarcadores/sangue , Fator Neurotrófico Derivado do Encéfalo/sangue , Quimiocina CCL2/sangue , Feminino , Humanos , Masculino , Testes de Estado Mental e Demência , Testes Neuropsicológicos , Método Simples-Cego , Taiwan
7.
PLoS One ; 15(1): e0227514, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31929568

RESUMO

BACKGROUND: Patients with rheumatoid arthritis are at higher risk of developing stroke due to augmented systemic inflammation. While regular exercise has been shown to reduce inflammation in human subjects, the purpose of our study is to determine whether increased frequency of rehabilitation is protective against stroke or not. METHODS: A total of 16,224 rheumatoid arthritis patients with a catastrophic illness certificate were identified in our database from 2000 to 2006, and 663 of them developed stroke before the end of 2013. After statistically matching for age, sex, and the time interval between the diagnosis of rheumatoid arthritis and stroke, 642 patients without stroke were identified as the control group. Analyses with Student's t test and Chi-square test were done to compare the clinical characteristics of patients with and without stroke, and logistic regression analysis was then performed to evaluate the odds ratio of stroke. RESULTS: Higher odds ratio of stroke was revealed in patients with hypertension, diabetes mellitus, and moderate degree of rheumatoid arthritis disease severity. Furthermore, more than 40 rehabilitation sessions per year reduced the risk of developing stroke in patients with moderate disease severity. CONCLUSIONS: Physical activities brought by more rehabilitation sessions are beneficial and should be encouraged in patients with rheumatoid arthritis, particularly for those with higher disease activity but not taking biologic agents.


Assuntos
Artrite Reumatoide/reabilitação , Acidente Vascular Cerebral/diagnóstico , Idoso , Artrite Reumatoide/complicações , Artrite Reumatoide/patologia , Estudos de Casos e Controles , Bases de Dados Factuais , Complicações do Diabetes , Diabetes Mellitus/patologia , Exercício Físico , Feminino , Humanos , Hipertensão/complicações , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Razão de Chances , Fatores de Risco , Índice de Gravidade de Doença , Acidente Vascular Cerebral/complicações
9.
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
10.
Medicine (Baltimore) ; 97(40): e12590, 2018 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-30290625

RESUMO

RATIONALE: The brain circulation of the dentato-rubro-thalamo-cortical tract (DRTT) has been reported for decade, but is rarely observed using nuclear medicine imaging tools, to analyze a patient with midbrain hemiatrophy syndrome. We present a case that revealed notable interruption in the middle of the DRTT. Finding out whether the superior cerebellar peduncle of the midbrain was injured was a decisive element for developing bidirectional effect of DRTT. PATIENT CONCERNS: A 34-year-old right-handed female presented with progressive weakness and bradykinesia in the left-sided limbs for about 6 months. She had difficulty with hand dexterity for activities of daily life and general tasks. She reported poor balance during walking and sitting. Muscle strength was 3 in the left hand and 4 in the foot due to atrophy of left limbs. The circumference of 10 cm proximally/distally from the lateral epicondyle of the humerus was 25.7/23.8 cm at right and 24.2/20.8 cm at left in the upper limbs, and 15 cm proximally/distally from the lateral joint space was 42.1/35.0 cm at right and 43/30.8 cm at left in the lower limbs. The brain magnetic resonance imaging study revealed a small-sized right midbrain. DIAGNOSIS: Based on the distinct features of limbs atrophy and the locations of the lesions on the magnetic resonance (MR) imaging, the patient was diagnosed with midbrain hemiatrophy syndrome. INTERVENTIONS: The patient was only willing to accept physical and occupational training programs at our outpatient clinic. OUTCOMES: We utilized serial anatomic and functional neuroimaging of the brain to survey the neurologic deficit. Brain perfusion single-photon emission computed tomography (SPECT) showed hypoperfusion over the left fronto-parietal regions, left anterior temporal region, and left occipital region, and also the left striatum and right cerebellum. Symptoms were gradually recovered with rehabilitation, and he was transferred to a rehabilitation facility on hospital day 40. LESSONS: This is the first report to demonstrate concurrent hypoperfusion of ipsilateral cerebellum and contralateral cerebral hemisphere observed on SPECT images in a case of midbrain hemiatrophy syndrome. In our case, with midbrain hemiatrophy syndrome could be explained as mutual direction effect of DRTT.


Assuntos
Encefalopatias/fisiopatologia , Cerebelo/fisiopatologia , Mesencéfalo/fisiopatologia , Adulto , Atrofia , Encefalopatias/reabilitação , Feminino , Humanos , Imageamento por Ressonância Magnética , Força Muscular/fisiologia , Equilíbrio Postural/fisiologia
11.
Clin Appl Thromb Hemost ; 24(9_suppl): 163S-170S, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30213203

RESUMO

Recurrent hemarthrosis in patients with hemophilia (PWH) results in chronic arthropathy requiring total joint replacement (TJR). This study aimed to compare the difference in TJR rate between patients with hemophilia A (HA) and hemophilia B (HB). A final total of 935 PWH (782 HA and 153 HB) without inhibitors were collected from the Taiwan's National Health Insurance Research Database between 1997 and 2013. Demographics, clinical characteristics, and TJR rate were compared between the 2 groups. The annual use of clotting factor concentrate was not different between HA and HB groups (P = .116). The rate of comorbidities except for 29 PWH having HIV who were all in the HA group was also not different between the 2 groups. A total of 99 (10.6%) PWH had undergone 142 TJR procedures during the study period. All of them had received on-demand therapy. No difference was found in the cumulative incidence of TJR between HA and HB (P = .787). After adjusting for various confounders including age, pyogenic arthritis, and HIV infection, no increased risk of TJR was found in patients with HA versus Patients with HB (hazard ratio: 0.92, 95% confidence interval 0.54-1.58). This finding suggests that the rate of TJR between patients with HA and HB is not significantly different.


Assuntos
Artrite , Artroplastia de Substituição , Fatores de Coagulação Sanguínea/administração & dosagem , Bases de Dados Factuais , Hemofilia A , Hemofilia B , Programas Nacionais de Saúde , Adolescente , Adulto , Fatores Etários , Artrite/epidemiologia , Artrite/terapia , Hemofilia A/epidemiologia , Hemofilia A/terapia , Hemofilia B/epidemiologia , Hemofilia B/terapia , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Fatores de Risco
12.
J Chin Med Assoc ; 81(10): 926-929, 2018 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-30017811

RESUMO

Perioperative management of persons with hemophilia (PWH) is a challenge for surgeons and hematologists. Reductions in mortality rate and complications have been achieved since the introduction of clotting factor concentrates (CFCs), which improve hemostatic control. However, there is no clear consensus on the optimal dosing of CFC administration. The aim of this study was to evaluate the outcome of PWH without inhibitors in patients undergoing invasive or surgical procedures. A total of 161 procedures, including 57 major and 104 minor ones were retrospectively reviewed. The characteristics of PWH, age at procedure, duration and total amount of CFC administration during the perioperative period, hemostatic adequacy, and complications were summarized. The study showed a low rate of bleeding (1.2%), infection (0%), thromboembolic event (0%), and inhibitor development (0%). The results revealed the doses and duration of CFC administration for several major and minor procedures which were capable of achieving excellent hemostatic control.


Assuntos
Hemofilia A/complicações , Hemostasia Cirúrgica/métodos , Assistência Perioperatória , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Fatores de Coagulação Sanguínea/uso terapêutico , Criança , Pré-Escolar , Humanos , Pessoa de Meia-Idade , Estudos Retrospectivos , Procedimentos Cirúrgicos Operatórios , Tromboembolia/prevenção & controle , Adulto Jovem
13.
BMJ Open ; 8(2): e017442, 2018 02 08.
Artigo em Inglês | MEDLINE | ID: mdl-29439066

RESUMO

OBJECTIVES: It has been proven that statin can protect synovial joints from developing osteoarthritis through its anti-inflammatory effects. However, studies on the effect of statins on spinal degenerative joint diseases are few and limited to in vitro studies. Therefore, we investigated the relationship between the statin dosage and the development of spinal degenerative joint diseases. DESIGN: A retrospective cohort study. SETTING: Patients registered in Taiwan National Health Insurance Research Database. PARTICIPANTS: Patients aged 40-65 years old from 2001 to 2010 were included. Those who received statin treatment before 2001, were diagnosed with spinal degenerative joint diseases or received any spinal surgery before 2004 or had any spinal trauma before 2011 were excluded. A total of 7238 statin users and 164 454 non-users were identified and followed up for the next 7 years to trace the development of spinal degenerative joint disease. OUTCOME MEASURES: The incident rate of spinal degenerative joint diseases and HRs among the groups treated with different statin dosages. RESULTS: A higher dosage of statins was associated with a significantly lower risk of developing spinal degenerative joint disease in patients with hypercholesterolaemia. Compared with the group receiving less than 5400 mg of a statin, the HR of the 11 900-28 000 mg group was 0.83 (95% CI 0.70 to 0.99), and that of the group receiving more than 28 000 mg was 0.81 (95% CI 0.68 to 0.97). Results of subgroup analysis showed a significantly lower risk in men, those aged 50-59 years and those with a monthly income less than US$600. CONCLUSIONS: Our study's findings clearly indicated that a higher dosage of statins can reduce the incidence of spinal degenerative joint disease in patients with hypercholesterolaemia, and it can be beneficial for people with a higher risk of spine degeneration.


Assuntos
Inibidores de Hidroximetilglutaril-CoA Redutases/administração & dosagem , Hiperlipidemias/complicações , Dor Lombar/fisiopatologia , Osteoartrite da Coluna Vertebral/epidemiologia , Osteoartrite da Coluna Vertebral/prevenção & controle , Adulto , Distribuição por Idade , Idoso , Comorbidade , Feminino , Seguimentos , Humanos , Incidência , Renda/estatística & dados numéricos , Estimativa de Kaplan-Meier , Dor Lombar/epidemiologia , Masculino , Pessoa de Meia-Idade , Modelos de Riscos Proporcionais , Estudos Retrospectivos , Medição de Risco , Distribuição por Sexo , Taiwan/epidemiologia
14.
J Stroke Cerebrovasc Dis ; 26(12): 2755-2762, 2017 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-28760410

RESUMO

BACKGROUND: Rehabilitation is essential for all poststroke patients to improve self-care ability. However, whether an increased frequency of rehabilitation reduces poststroke adverse events remains undetermined. METHODS: We recruited 4899 patients with newly diagnosed ischemic stroke between January 1, 2000, and December 31, 2008, from our database and divided them into 3 groups according to their Charlson Comorbidity Index, and they were further categorized into 3 groups of different rehabilitation frequencies during their first year after stroke. Clinical adverse events including recurrent stroke, hip fracture, pneumonia, and all-cause mortality were analyzed by Cox regression analysis to investigate the protective effects of aggressive rehabilitation. RESULTS: We discovered that aggressive rehabilitation in the first year after stroke was significantly associated with a lower incidence of recurrent stroke and all-cause mortality despite the severity of patients' comorbidities. Further Cox regression analysis revealed decreased hazard ratios to develop recurrent stroke and all-cause mortality in patients with more intensive rehabilitation (P for trend <.05). However, no significant associations between rehabilitation frequency and pneumonia and hip fracture were identified in our study. CONCLUSION: Intensive rehabilitation during the first year after stroke should be recommended to prevent detrimental adverse events for stroke survivors.


Assuntos
Reabilitação do Acidente Vascular Cerebral/métodos , Acidente Vascular Cerebral/terapia , Idoso , Causas de Morte , Comorbidade , Bases de Dados Factuais , Feminino , Fraturas do Quadril/epidemiologia , Humanos , Incidência , Masculino , Pneumonia/epidemiologia , Modelos de Riscos Proporcionais , Fatores de Proteção , Recidiva , Estudos Retrospectivos , Fatores de Risco , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/mortalidade , Acidente Vascular Cerebral/fisiopatologia , Reabilitação do Acidente Vascular Cerebral/efeitos adversos , Reabilitação do Acidente Vascular Cerebral/mortalidade , Taiwan/epidemiologia , Fatores de Tempo , Resultado do Tratamento
15.
Geriatr Gerontol Int ; 17(4): 645-652, 2017 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-27246701

RESUMO

AIM: The effect of health depreciation in older people on medical care demand is not well understood. We tried to assess the medical care demand with length of hospitalization and their impact on profits as a result of health depreciation. METHODS: All participants who underwent comprehensive geriatric assessment were from a prospective cohort study at a tertiary hospital. A total of 1191 cases between September 2008 to October 2012 were investigated. Three sets of qualitative response models were constructed to estimate the impact of older adults' health depreciation on multidisciplinary geriatric care services. Furthermore, we analyzed the factors affecting the composite end-point of rehospitalization within 14 days, re-admission to the emergency department within 3 days and patient death. RESULTS: Greater health depreciation in elderly patients was positively correlated with greater medical care demand. Three major components were defined as health depreciation: elderly adaptation function, geriatric syndromes and multiple chronic diseases. On admission, the better the basic living functions, the shorter the length of hospitalization (coefficient = -0.35, P < 0.001 in Poisson regression; coefficient = -0.33, P < 0.001 in order choice profit model; coefficient = -0.29, P < 0.001 in binary choice profit model). The major determinants for poor outcome were male sex, middle old age and length of hospitalization. However, factors that correlated with relatively good outcome were functional improvement after medical care services and level of disease education. CONCLUSIONS: An optimal allocation system for selection of cases into multidisciplinary geriatric care is required because of limited resources. Outcomes will improve with health promotion and preventive care services. Geriatr Gerontol Int 2017; 17: 645-652.


Assuntos
Necessidades e Demandas de Serviços de Saúde , Serviços de Saúde para Idosos/estatística & dados numéricos , Nível de Saúde , Atividades Cotidianas , Idoso , Idoso de 80 Anos ou mais , Progressão da Doença , Serviço Hospitalar de Emergência , Feminino , Avaliação Geriátrica , Hospitalização , Humanos , Masculino , Estudos Prospectivos
16.
Oncotarget ; 7(24): 35522-35534, 2016 Jun 14.
Artigo em Inglês | MEDLINE | ID: mdl-27203679

RESUMO

Benign paroxysmal positional vertigo (BPPV) is one of the most common complaints encountered in clinics and is strongly correlated with advanced age or, possibly, degeneration. Redistribution exercises are the most effective approaches to treat BPPV, and canalith repositioning procedure (CRP) cure most BPPV cases. However, the mechanisms through which the treatment modulates systemic molecules in BPPV patients remain largely unknown. In this study, we report that the miR-34a and Sirtuin 1 (SIRT1) genes correlated with the treatment effects of CRP in BPPV subjects. We found that miR-34a expression was largely inhibited and SIRT1 expression was significantly reversed after BPPV maneuver treatment. We also confirmed that the PPAR-γ, PGC-1 and FoxO gene expressions were decreased immediately after canalith repositioning procedure (CRP) for BPPV, and were largely increased after a complete cure of BPPV. Moreover, we observed that after a complete recovery of BPPV, the ROS concentrations, pro-inflammatory cytokine concentrations and p53 expression levels were attenuated. We conclude that BPPV treatment might involve some epigenetic regulations through the mediation of miR-34a, SIRT1 functions and repression of redox status.


Assuntos
Vertigem Posicional Paroxística Benigna/genética , Vertigem Posicional Paroxística Benigna/terapia , Epigênese Genética , Regulação da Expressão Gênica , MicroRNAs/metabolismo , Sirtuína 1/metabolismo , Fatores Etários , Idoso , Vertigem Posicional Paroxística Benigna/sangue , Citocinas/metabolismo , Terapia por Exercício , Proteína Forkhead Box O1/metabolismo , Humanos , MicroRNAs/sangue , Pessoa de Meia-Idade , Membrana dos Otólitos/fisiopatologia , PPAR gama/metabolismo , Coativador 1-alfa do Receptor gama Ativado por Proliferador de Peroxissomo/metabolismo , Espécies Reativas de Oxigênio/metabolismo , Canais Semicirculares/fisiopatologia , Resultado do Tratamento , Proteína Supressora de Tumor p53/metabolismo
17.
Neurobiol Aging ; 36(9): 2607-16, 2015 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-26130063

RESUMO

Benign paroxysmal positional vertigo (BPPV) is one of the most frequently encountered primary complaints in dizziness clinics. The incidence of BPPV has been proven to increase with age. The relationship between BPPV and another neurodegenerative disease, Parkinson's disease (PD), has not been previously discussed. This study aimed to investigate the relationship of BPPV and PD with oxidative stress. A total of 30,811 subjects participated in our cohort study. The study cohort comprised 5057 BPPV patients and a comparison cohort of 25,754 nonBPPV patients. SIRT1 axis gene expression was investigated in BPPV patient blood samples and a PD cell model of 6-hydroxydopamine (6-OHDA)-treated PC-12 cells to elucidate the potential in vitro and in vivo mechanisms of degeneration in PD and BPPV. Our data suggest that BPPV patients with histories of head injuries show a significantly higher hazard to develop subsequent PD (hazard ratio, 3.942; confidence interval, 1.523-10.205, p = 0.005). We also observed that oxidative status is increased in blood samples from patients with BPPV. Our in vitro study suggests that SIRT1 function is inhibited by oxidative stress, which thereby promotes 6-hydroxydopamine-induced cell death. We conclude that BPPV is independently associated with an increased risk of PD. This finding may be attributed to oxidative stress-mediated inhibition of SIRT1 expression levels.


Assuntos
Vertigem Posicional Paroxística Benigna/sangue , Vertigem Posicional Paroxística Benigna/epidemiologia , Estresse Oxidativo/genética , Doença de Parkinson/epidemiologia , Sirtuína 1/sangue , Adrenérgicos/farmacologia , Adulto , Fatores Etários , Idoso , Animais , Cromonas/farmacologia , Estudos de Coortes , Feminino , Regulação da Expressão Gênica/efeitos dos fármacos , Humanos , Masculino , Potencial da Membrana Mitocondrial/efeitos dos fármacos , Pessoa de Meia-Idade , Fator de Crescimento Neural/farmacologia , Estresse Oxidativo/efeitos dos fármacos , Oxidopamina/farmacologia , Células PC12/efeitos dos fármacos , Doença de Parkinson/sangue , Proteínas Proto-Oncogênicas c-bcl-2/metabolismo , Ratos , Espécies Reativas de Oxigênio/metabolismo , Sirtuína 1/genética , Superóxido Dismutase/sangue , Substâncias Reativas com Ácido Tiobarbitúrico/metabolismo , Fatores de Transcrição/genética , Fatores de Transcrição/metabolismo , Proteína X Associada a bcl-2/metabolismo
18.
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
19.
J Stroke Cerebrovasc Dis ; 24(6): 1317-23, 2015 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-25891753

RESUMO

BACKGROUND: The goal of the study was to compare the effects of isokinetic and isotonic strengthening program on the changes of muscle strength, functional capacity, life quality, and inflammatory cytokines in hemiparetic patients within 6 months of stroke attack. METHODS: Thirty-one participants were randomly assigned into either isotonic training group or isokinetic training group. Both training programs were carried out 5 days a week for a total of 4 weeks. Outcome measures included the peak isometric torque of knees at 90° flexion, the peak torque of knees extension and flexion at angular velocities 60°/s and 120°/s, Short Form 36 (SF-36) Health Survey Questionnaire, Timed Up and Go test, and inflammatory cytokines including high sensitivity C-reactive protein, interleukin-6, and tumor necrosis factor-α. RESULTS: Seven patients were not able to complete the training program and were excluded from our study. The results from the remaining 24 patients showed that there were more peak torque, and SF-36 items significantly improved in the isokinetic training group compared with the isotonic group. The Timed Up and Go test and interleukin-6 were improved in both groups, but tumor necrosis factor-α was improved in only the isokinetic group. There were no significant differences between the improvements of the 2 groups except the isokinetic flexion torque at 60°/s and 120°/s. CONCLUSIONS: Early strengthening exercise is important for subacute stroke patients, and isokinetic program, if accessible, can bring more significant benefits for them.


Assuntos
Força Muscular/fisiologia , Treinamento de Força/métodos , Reabilitação do Acidente Vascular Cerebral , Idoso , Proteína C-Reativa/metabolismo , Feminino , Humanos , Interleucina-6/sangue , Masculino , Pessoa de Meia-Idade , Índice de Gravidade de Doença , Acidente Vascular Cerebral/sangue , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/fisiopatologia , Resultado do Tratamento , Fator de Necrose Tumoral alfa/sangue
20.
J Clin Neurosci ; 22(2): 363-7, 2015 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-25497706

RESUMO

Although past studies have confirmed that chronic dust exposure is a risk factor for cardiovascular disease, the relationship between it and cerebrovascular disease is still unclear. We aimed to determine whether pneumoconiosis is related to increased incidence of ischemic stroke in the following 5 to 11 years. We selected 1238 patients with pneumoconiosis from Taiwan's National Health Insurance database as our study cohort. After matching for age, sex and the date of ambulatory care visit, another 4952 patients without pneumoconiosis were selected as the comparison cohort. Each patient was individually followed up until the end of 2010 to track the incidence of stroke, and Cox proportional hazard regression analysis was performed to compute the relative hazard ratio of stroke. Our results showed 19.6% of pneumoconiosis patients and 15.8% of non-pneumoconiosis patients developed stroke. After statistically adjusting for age, sex, and medical comorbidities, the hazard of developing stroke was 1.36 times greater for those with pneumoconiosis compared to those without. Even in those with pneumoconiosis excluding chronic obstructive pulmonary disease, the hazard of developing stroke was still 1.31 times greater than those without pneumoconiosis. Our study revealed that pneumoconiosis patients are at a higher risk of ischemic stroke, and primary prevention of stroke is particularly important in this group of patients.


Assuntos
Isquemia Encefálica/etiologia , Pneumoconiose/complicações , Acidente Vascular Cerebral/etiologia , Adulto , Fatores Etários , Idoso , Isquemia Encefálica/epidemiologia , Estudos de Coortes , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Prevenção Primária , Modelos de Riscos Proporcionais , Doença Pulmonar Obstrutiva Crônica/complicações , Doença Pulmonar Obstrutiva Crônica/epidemiologia , Estudos Retrospectivos , Medição de Risco , Fatores Sexuais , Acidente Vascular Cerebral/epidemiologia , Taiwan/epidemiologia
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