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1.
Crit Care ; 23(1): 293, 2019 Sep 02.
Artigo em Inglês | MEDLINE | ID: mdl-31477181

RESUMO

BACKGROUND: It remains unclear whether sepsis-related cardiovascular complications have an adverse impact on survival independent of pre-existing comorbidities. To investigate the survival impact of post-sepsis cardiovascular complications among sepsis survivors, we conducted a population-based study using the National Health Insurance Database of Taiwan. METHODS: We identified sepsis patients from the National Health Insurance Research Database of Taiwan using ICD-9-CM codes involving infection and organ dysfunction between 2000 and 2011. Post-sepsis incident myocardial infarction (MI) and stroke were ascertained by ICD-9-CM codes and antiplatelet treatment. We constructed a non-sepsis comparison cohort using propensity score matching to ascertain the association between sepsis and cardiovascular complications. Furthermore, we compared the 180-day mortality and 365-day mortality between patients surviving sepsis with or without post-sepsis MI or stroke within 70 days of hospital discharge. We constructed Cox regression models adjusting for pre-existing comorbidities to evaluate the independent survival impact of post-sepsis MI or stroke among sepsis survivors. RESULTS: We identified 42,316 patients hospitalized for sepsis, from which we matched 42,151 patients 1:1 with 42,151 patients hospitalized without sepsis. Compared to patients hospitalized without sepsis, patients hospitalized with sepsis had an increased risk of MI or stroke (adjusted odds ratio 1.72, 95% CI 1.60-1.85). Among 42,316 patients hospitalized for sepsis, 486 (1.15%) patients developed incident stroke and 108 (0.26%) developed incident MI within 70 days of hospital discharge. Compared to sepsis survivors without cardiovascular complications, sepsis survivors with incident MI or stroke had a higher mortality rate at 180 days (11.68% vs. 4.44%, P = 0.003) and at 365 days (16.75% vs. 7.11%, P = 0.005). Adjusting for age, sex, and comorbidities, post-sepsis MI or stroke was independently associated with increased 180-day (adjusted hazard ratio [HR] 2.16, 95% CI 1.69-2.76) and 365-day (adjusted HR 1.90, 95% CI 1.54-2.32) mortality. CONCLUSIONS: Compared to sepsis patients without incident MI or stroke, sepsis patients with incident MI or stroke following hospital discharge had an increased risk of mortality for up to 365 days of follow-up. This increased risk cannot be explained by pre-sepsis comorbidities.

2.
Neurosci Lett ; 712: 134515, 2019 Nov 01.
Artigo em Inglês | MEDLINE | ID: mdl-31560996

RESUMO

Shoulder pain is a common condition associated with slow recovery and high recurrence rates. Persistent pain may lead to structural brain changes that may further promote pain chronification. The present study addressed whether abnormal changes in cortical surface structure exist in patients with chronic shoulder pain of myofascial origin and whether such changes would be related to pain measures. Brain structural MRIs were obtained in 22 patients with chronic pain in the bilateral upper trapezius muscles and in 22 healthy controls. Cortical thickness, gyrification index and sulcal depth were assessed together with pain measures. Shallower sulcal depth was found in patients in the right central sulcus, posterior insula, inferior frontal and dorsomedial prefrontal cortices, precuneus, and the middle temporal cortex, and in the left medial orbitofrontal cortex. Negative correlations were found between the right central sulcus and pain intensity and between the left medial orbitofrontal cortex and pain affect. Cortical thickness or gyrification index did not differ significantly between the two groups. The afflicted cortical regions constitute interacting networks responsible for sensory, affective and cognitive dimensions of the pain experience.

3.
BMC Musculoskelet Disord ; 20(1): 264, 2019 May 31.
Artigo em Inglês | MEDLINE | ID: mdl-31151391

RESUMO

BACKGROUND: Foot orthoses are widely used to manage plantar heel pain (PHP). However, the evidence concerning the effect of foot orthoses on PHP is not conclusive. The study aims to identify the characteristics of patients with PHP likely to achieve a positive outcome after customized foot orthoses and to verify the concept that patients who respond positively to anti-pronation taping would achieve a positive prognosis after wearing foot orthoses for six months. METHODS: This is a prospective observational cohort study. Seventy-four patients with PHP underwent a baseline examination and received anti-pronation taping to their painful feet. The taping effects on pain and function were assessed at the 7-day follow-up visit. Then, all patients received an intervention for their PHP with customized foot orthoses for six months. Outcome was assessed with a numeric pain rating scale, the patient-specific functional scale, the foot function index, and the global rating of perceived change. Significant reduction of pain, increase of function, and perception of a meaningful improvement were considered a positive response. RESULTS: Of 74 patients, 49 had a positive response to the customized foot orthosis treatment. Five predictors were identified: (1) the average pain intensity decreased by over 1.5 points with taping, (2) the range of ankle plantarflexion > 54 degrees, (3) the strength of ankle plantarflexors on the symptomatic side was equal to or stronger than that on the other side, (4) the range of hip internal rotation < 39 degrees, and (5) the range of hip external rotation > 45 degrees. The presence of three or more predictors increased the rate of achieving positive outcome from 66 to 89%. CONCLUSIONS: The predictors of customized foot orthosis outcome in patients with PHP are related to several physical measures of a lower extremity. Findings of the study can be used to screen and select patients with PHP for foot orthosis intervention. Moreover, patients who respond positively to anti-pronation taping would also benefit from the customized foot orthoses. However, since there was no control group in the current study, it is inappropriate to draw conclusions about the effectiveness of the foot orthoses treatment. TRIAL REGISTRATION: The trial was retrospectively registered with the Australian and New Zealand Clinical Trials Registry (ACTRN 12617000119392 ).


Assuntos
Articulação do Tornozelo/fisiopatologia , Fita Atlética , Órtoses do Pé , Manejo da Dor/instrumentação , Dor/diagnóstico , Adulto , Feminino , Calcanhar , Humanos , Masculino , Pessoa de Meia-Idade , Dor/fisiopatologia , Medição da Dor , Prognóstico , Pronação/fisiologia , Estudos Prospectivos , Resultado do Tratamento
4.
J Healthc Eng ; 2019: 7681237, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31093320

RESUMO

Frozen shoulder is a common clinical shoulder condition. Measuring the degree of shoulder joint movement is crucial to the rehabilitation process. Such measurements can be used to evaluate the severity of patients' condition, establish rehabilitation goals and appropriate activity difficulty levels, and understand the effects of rehabilitation. Currently, measurements of the shoulder joint movement degree are typically conducted by therapists using a protractor. However, along with the growth of telerehabilitation, measuring the shoulder joint mobility on patients' own at home will be needed. In this study, wireless inertial sensors were combined with the virtual reality interactive technology to provide an innovative shoulder joint mobility self-measurement system that can enable patients to measure their performance of four shoulder joint movements on their own at home. Pilot clinical trials were conducted with 25 patients to confirm the feasibility of the system. In addition, the results of correlation and differential analyses compared with the results of traditional measurement methods exhibited a high correlation, verifying the accuracy of the proposed system. Moreover, according to interviews with patients, they are confident in their ability to measure shoulder joint mobility themselves.

5.
J Am Coll Cardiol ; 72(12): 1369-1378, 2018 09 18.
Artigo em Inglês | MEDLINE | ID: mdl-30213330

RESUMO

BACKGROUND: Previous studies raised safety concerns on the association between fluoroquinolone treatment and serious collagen disorders, aortic aneurysm and dissection (AA/AD). OBJECTIVES: This study sought to evaluate this association via a case-crossover analysis in a large national administrative database. METHODS: A case-crossover design was used to compare the distributions of fluoroquinolone exposure for the same patient across a 60-day period before the AA/AD event (hazard period) and 1 randomly selected 60-day period (referent period) between 60 to 180 days before the AA/AD events. In the sensitivity analysis, the authors repeated the main analysis using a 1:5 ratio of hazard period to referent period, to adjust for the effect of time-variant confounders. A disease-risk score-matched time control analysis was performed to investigate the potential time-trend bias. The risks were calculated by a conditional logistic regression model. RESULTS: A total of 1,213 hospitalized AA/AD patients were identified between 2001 and 2011. In the main case-crossover analysis, exposure to fluoroquinolone was more frequent during the hazard periods than during the referent periods (1.6% vs. 0.6%; odds ratio [OR]: 2.71; 95% confidence interval [CI]: 1.14 to 6.46). In the sensitivity analysis, after adjustment for infections and co-medications, the risk remains significant (OR: 2.05; 95% CI: 1.13 to 3.71). An increased risk of AA/AD was observed for prolonged exposure to fluoroquinolones (OR: 2.41 for 3- to 14-day exposure; OR: 2.83 for >14-day exposure). Susceptible period analysis revealed that the use of fluoroquinolone within 60 days was associated with the highest risk of AA/AD. In the case-time-control analysis, there was no evidence that the observed association is due to temporal changes in fluoroquinolone exposure. CONCLUSIONS: Exposure to fluoroquinolone was substantially associated with AA/AD. This risk was modified by the duration of fluoroquinolone use and the length of the hazard period.


Assuntos
Aneurisma Dissecante/epidemiologia , Antibacterianos/efeitos adversos , Aneurisma Aórtico/epidemiologia , Fluoroquinolonas/efeitos adversos , Administração Oral , Idoso , Estudos Cross-Over , Bases de Dados Factuais , Feminino , Humanos , Modelos Logísticos , Masculino , Taiwan/epidemiologia , Fatores de Tempo
6.
CMAJ ; 190(36): E1062-E1069, 2018 09 10.
Artigo em Inglês | MEDLINE | ID: mdl-30201613

RESUMO

BACKGROUND: Patients are at increased risk of cardiovascular complications while recovering from sepsis. We aimed to study the temporal change and susceptible periods for cardiovascular complications in patients recovering from sepsis by using a national database. METHODS: In this retrospective population-based cohort study, patients with sepsis were identified from the National Health Insurance Research Database in Taiwan. We estimated the risk of myocardial infarction (MI) and stroke following sepsis by comparing a sepsis cohort to a matched population and hospital control cohort. The primary outcome was first occurrence of MI or stroke requiring admission to hospital during the 180-day period following discharge from hospital after sepsis. To delineate the risk profile over time, we plotted the weekly risk of MI and stroke against time using the Cox proportional hazards model. We determined the susceptible period by fitting the 2 phases of time-dependent risk curves with free-knot splines, which highlights the turning point of the risk of MI and stroke after discharge from the hospital. RESULTS: We included 42 316 patients with sepsis; stroke developed in 831 of these patients and MI developed in 184 within 180 days of discharge from hospital. Compared with population controls, patients recovering from sepsis had the highest risk for MI or stroke in the first week after discharge (hazard ratio [HR] 4.78, 95% confidence interval [CI] 3.19 to 7.17; risk difference 0.0028, 95% CI 0.0021 to 0.0034), with the risk decreasing rapidly until the 28th day (HR 2.38, 95% CI 1.94 to 2.92; risk difference 0.0045, 95% CI 0.0035 to 0.0056) when the risk stabilized. In a repeated analysis comparing the sepsis cohort with the nonsepsis hospital control cohort, we found an attenuated but still marked elevated risk before day 36 after discharge (HR 1.32, 95% CI 1.15 to 1.52; risk difference 0.0026, 95% CI 0.0013 to 0.0039). The risk of MI or stroke was found to interact with age, with younger patients being associated with a higher risk than older patients (interaction p = 0.0004). INTERPRETATION: Compared with the general population with similar characteristics, patients recovering from sepsis had a markedly elevated risk of MI or stroke in the first 4 weeks after discharge from hospital. More close monitoring and pharmacologic prevention may be required for these patients at the specified time.


Assuntos
Infarto do Miocárdio/mortalidade , Alta do Paciente/estatística & dados numéricos , Sepse/reabilitação , Acidente Vascular Cerebral/mortalidade , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/etiologia , Infarto do Miocárdio/fisiopatologia , Pontuação de Propensão , Modelos de Riscos Proporcionais , Estudos Retrospectivos , Medição de Risco , Sepse/complicações , Sepse/mortalidade , Sepse/fisiopatologia , Acidente Vascular Cerebral/etiologia , Acidente Vascular Cerebral/fisiopatologia , Taxa de Sobrevida , Taiwan/epidemiologia , Fatores de Tempo
7.
Phys Ther Sport ; 31: 58-67, 2018 May.
Artigo em Inglês | MEDLINE | ID: mdl-29655069

RESUMO

OBJECTIVES: To develop a clinical prediction rule (CPR) to identify patients with plantar heel pain (PHP) likely to benefit from biomechanical anti-pronation taping (BAPT). DESIGN: A prospective cohort study. SETTING: An outpatient rehabilitation department in a general hospital. PARTICIPANTS: Seventy-five patients with PHP. MAIN OUTCOME MEASURES: After completing a series of physical examinations, all patients received BAPT and were evaluated with a numeric rating scale for pain intensity, the patient-specific functional scale and foot function index (FFI) for function, and the global rating of change for perceived improvement. RESULTS: Twenty-eight patients achieved a successful outcome. A CPR with 6 significant variables was identified by a multivariate logistic regression: FFI score less than 33.3, hip adduction angle of the most affected side was greater than the contralateral side, ankle plantarflexors and hip abductors on the most affected side were not weaker than those on the contralateral side, ankle invertors on the most affected side were weaker than the contralateral side, and having more than 2 painful sites in the low back and lower extremity regions. If 5 or more of the 6 predictors were presented, the probability of success increased from 37% to 80%. CONCLUSIONS: A CPR has been developed to identify patients with PHP likely to benefit from BAPT.


Assuntos
Fita Atlética , Fasciíte Plantar/terapia , Calcanhar/fisiopatologia , Manejo da Dor , Pronação , Adulto , Fenômenos Biomecânicos , Técnicas de Apoio para a Decisão , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Dor/fisiopatologia , Estudos Prospectivos
8.
Crit Care Med ; 46(6): 926-934, 2018 06.
Artigo em Inglês | MEDLINE | ID: mdl-29533311

RESUMO

OBJECTIVE: We aimed to compare the sepsis incidence, mortality rates, and primary sites of infection among adult, elderly, and octogenarian patients with sepsis. DESIGN: Population-based cohort study. SETTING: The entire health insurance claims data of Taiwan, which enrolled 99.8% of the 23 million Taiwanese population. PATIENTS: Sepsis patients were identified by International Classification of Diseases, 9th Edition, Clinical Modification codes for both infection and organ dysfunction from January 1, 2002, to December 31, 2012. Patients were categorized into three age groups: 1) adults (18-64 yr); 2) elderly (65-84 yr); and 3) oldest old (≥ 85 yr). The 30-day all-cause mortality was verified by a linked national death certificate database. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: From 2002 to 2012, we identified 1,259,578 patients with sepsis, of which 417,328 (33.1%) were adults, 652,618 (51.8%) were elderly, and 189,632 (15.1%) were oldest old. We determined that the incidence of sepsis in the oldest old was 9,414 cases per 100,000 population on 2012, which was 31-fold greater than the adult incidence (303 cases per 100,000 population) and three-fold greater than the elderly incidence (2,908 cases per 100,000 population). Despite the increasing trend in incidence, the mortality decreased by 34% for adults, 24% for elderly, and 22% for oldest old. However, systemic fungal infection was disproportionately increased in oldest old patients (1.76% annual increase) and the elderly patients (1.00% annual increase). CONCLUSION: The incidence of sepsis is disproportionately increased in elderly and oldest old patients. Despite the increasing trend in incidence, the mortality rate in geriatric patients with sepsis has decreased. However, the increased incidence of fungal infections in the geriatric population warrants further attention.


Assuntos
Sepse/epidemiologia , Adolescente , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Sepse/microbiologia , Sepse/mortalidade , Choque Séptico/epidemiologia , Choque Séptico/microbiologia , Choque Séptico/mortalidade , Taiwan/epidemiologia , Adulto Jovem
9.
J Chin Med Assoc ; 81(1): 81-86, 2018 01.
Artigo em Inglês | MEDLINE | ID: mdl-28974355

RESUMO

BACKGROUND: More and more elderly problems come to our life and the elderly health care become more important. Elderly people with lower extremities weakness usually use walkers to assist in walking. Although the commercial standard walkers (N-type) can improve elderly people's walking ability, users sometimes take risk of falling when using the standard walkers to perform sit-to-stand (STS). The purpose of this study is to design an additional armrest which can be attached to a standard walker for users performing STS more easily and evaluate it with clinical assessments and a body worn sensor. METHODS: The combination of the walker and the new armrest design are referred to as a better type (B-type). Clinical assessments and a motion analysis were performed on 34 elderly people (age, 83 ± 6 y/o) with a Five Times Sit-to-Stand Test (FTSST), a satisfaction survey and an inertial measurement unit (IMU) attached to the trunk to measure the acceleration data when using B-type and N-type during STS. RESULTS: The FTSST result shows that the B-type can reduce about 5 s spending time of elderly people during STS and 63.7% of subjects were more satisfied on the B-type than the N-type. According to the IMU, the result reveals that the B-type can provide subjects higher peak-peak anterio-posterior acceleration, peak flexion acceleration and peak extension acceleration during STS. CONCLUSION: There is a better assistance during STS when using our new armrests design combined with the commercial product which could provide larger acceleration to perform sit-to-stand.


Assuntos
Força Muscular/fisiologia , Equilíbrio Postural , Andadores , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino
10.
J Healthc Eng ; 2017: 9840273, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-29230275

RESUMO

Stroke is a leading cause of long-term disability, and virtual reality- (VR-) based stroke rehabilitation is effective in increasing motivation and the functional performance. Although much of the functional reach and grasp capabilities of the upper extremities were regained, the pinch movement remains impaired following stroke. In this study, we developed a haptic-enhanced VR system to simulate haptic pinch tasks to assist the recovery of upper-extremity fine motor function. We recruited 16 adults with stroke to verify the efficacy of this new VR system. Each patient received 30 min VR training sessions 3 times per week for 8 weeks. Outcome measures, Fugl-Meyer assessment (FMA), Test Evaluant les Membres superieurs des Personnes Agees (TEMPA), Wolf motor function test (WMFT), Box and Block test (BBT), and Jamar grip dynamometer, showed statistically significant progress from pretest to posttest and follow-up, indicating that the proposed system effectively promoted fine motor recovery of function. Additionally, our evidence suggests that this system was also effective under certain challenging conditions such as being in the chronic stroke phase or a coside of lesion and dominant hand (nondominant hand impaired). System usability assessment indicated that the participants strongly intended to continue using this VR-based system in rehabilitation.


Assuntos
Força da Mão , Reabilitação do Acidente Vascular Cerebral/instrumentação , Reabilitação do Acidente Vascular Cerebral/métodos , Realidade Virtual , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Recuperação de Função Fisiológica , Interface Usuário-Computador
11.
PLoS One ; 12(9): e0183813, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28873440

RESUMO

BACKGROUND: Fluoroquinolone is a commonly prescribed antimicrobial agent, and up to 20% of its users registers adverse gastroenterological symptoms. We aimed to evaluate the association between use of fluoroquinolone and gastrointestinal tract perforation. METHODS: We conducted a nested case-control study on a national health insurance claims database between 1998 and 2011. The use of fluoroquinolones was classified into current (< 60 days), past (61-365 days prior to the index date) and any prior year use of fluoroquinolones. We used the conditional logistic regression model to estimate rate ratios (RRs), adjusting or matching by a disease risk score (DRS). RESULTS: We identified a cohort of 17,510 individuals diagnosed with gastrointestinal perforation and matched them to 1,751,000 controls. Current use of fluoroquinolone was associated with the greatest increase in risk of gastrointestinal perforations after DRS score adjustment (RR, 1.90; 95% CI, 1.62-2.22). The risk of gastrointestinal perforation was attenuated for past (RR, 1.33; 95% CI, 1.20-1.47) and any prior year use (RR, 1.46; 95% CI, 1.34-1.59). To gain insights into whether the observed association can be explained by unmeasured confounder, we compared the risk of gastrointestinal perforation between fluoroquinolone and macrolide. Use of macrolide, an active comparator, was not associated with a significant increased risk of gastrointestinal perforation (RR, 1.11, 95%CI, 0.15-7.99). Sensitivity analysis focusing on perforation requiring in-hospital procedures also demonstrated an increased risk associated with current use. To mitigate selection bias, we have also excluded people who have never used fluoroquinolone before or people with infectious colitis, enteritis or gastroenteritis. In both of the analysis, a higher risk of gastrointestinal perforation was still associated with the use of fluoroquinolone. CONCLUSIONS: We found that use of fluoroquinolones was associated with a non-negligible increased risk of gastrointestinal perforation, and physicians should be aware of this possible association.


Assuntos
Antibacterianos/efeitos adversos , Fluoroquinolonas/efeitos adversos , Gastroenteropatias/induzido quimicamente , Perfuração Intestinal/induzido quimicamente , Intestinos/efeitos dos fármacos , Administração Oral , Idoso , Estudos de Casos e Controles , Estudos de Coortes , Feminino , Humanos , Intestinos/patologia , Masculino , Pessoa de Meia-Idade , Análise de Regressão , Medição de Risco , Fatores de Risco , Sensibilidade e Especificidade , Taiwan , Resultado do Tratamento
12.
PLoS One ; 12(6): e0178822, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28614395

RESUMO

Rehabilitation is the main therapeutic approach for reducing poststroke functional deficits in the affected upper limb; however, significant between-patient variability in rehabilitation efficacy indicates the need to target patients who are likely to have clinically significant improvement after treatment. Many studies have determined robust predictors of recovery and treatment gains and yielded many great results using linear approachs. Evidence has emerged that the nonlinearity is a crucial aspect to study the inter-areal communication in human brains and abnormality of oscillatory activities in the motor system is linked to the pathological states. In this study, we hypothesized that combinations of linear and nonlinear (cross-frequency) network connectivity parameters are favourable biomarkers for stratifying patients for upper limb rehabilitation with increased accuracy. We identified the biomarkers by using 37 prerehabilitation electroencephalogram (EEG) datasets during a movement task through effective connectivity and logistic regression analyses. The predictive power of these biomarkers was then tested by using 16 independent datasets (i.e. construct validation). In addition, 14 right handed healthy subjects were also enrolled for comparisons. The result shows that the beta plus gamma or theta network features provided the best classification accuracy of 92%. The predictive value and the sensitivity of these biomarkers were 81.3% and 90.9%, respectively. Subcortical lesion, the time poststroke and initial Wolf Motor Function Test (WMFT) score were identified as the most significant clinical variables affecting the classification accuracy of this predictive model. Moreover, 12 of 14 normal controls were classified as having favourable recovery. In conclusion, EEG-based linear and nonlinear motor network biomarkers are robust and can help clinical decision making.


Assuntos
Eletroencefalografia/métodos , Neurônios Motores/fisiologia , Reabilitação do Acidente Vascular Cerebral/métodos , Acidente Vascular Cerebral/fisiopatologia , Extremidade Superior/fisiopatologia , Atividades Cotidianas , Adulto , Idoso , Feminino , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Modalidades de Fisioterapia , Recuperação de Função Fisiológica
13.
Mod Rheumatol ; 27(6): 973-980, 2017 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-28058962

RESUMO

To determine whether hyaluronic acid (HA) injection into rheumatoid arthritis ankles and feet can achieve improvement in foot function and reduce synovial hyper-vascularization. Forty-four patients with RA having unilateral or bilateral painful ankle and foot involvement (N = 75) were studied. All the patients were randomized to receive HA (N = 40) or lidocaine (LI) (N = 35) injection at 2-week intervals; Clinical assessments were performed using a visual analog scale (VAS) and foot function index (FFItotal) including subscales of pain (FFIpain) before injection at baseline, 4 weeks (first evaluation) and 12 weeks (secondary evaluation). Imaging evaluation based on color Doppler ultrasound (CDUS) and synovitis scores was performed simultaneously. HA injection improved the VAS score (p = .009), FFIpain (p = .041), and FFItotal (p = .032) considerably more than LI injections did at the first evaluation. The CDUS values at first evaluation (p = .005) and secondary evaluation (p < .001) decreased significantly compared with the base line values. HA injections reduced the CDUS values of more than half of the joints (54%, p = .042) while the control group exhibited no change (20%, p = .56). However, HA injection did not reduce the CDUS values more than LI injection did. Regarding the evaluation of synovial hypertrophy, no significant difference was observed between or within the groups in the synovitis scores. HA injection improved short-term foot function and pain reduction. HA injection may have a modest effect in reducing synovial hyper-vascularization. Further large-scale study is warranted to confirm this result.


Assuntos
Antirreumáticos/uso terapêutico , Artrite Reumatoide/tratamento farmacológico , Ácido Hialurônico/uso terapêutico , Injeções Intra-Articulares/métodos , Idoso , Articulação do Tornozelo/diagnóstico por imagem , Articulação do Tornozelo/patologia , Antirreumáticos/administração & dosagem , Antirreumáticos/efeitos adversos , Artrite Reumatoide/diagnóstico por imagem , Feminino , Articulações do Pé/diagnóstico por imagem , Articulações do Pé/patologia , Humanos , Ácido Hialurônico/administração & dosagem , Ácido Hialurônico/efeitos adversos , Injeções Intra-Articulares/efeitos adversos , Masculino , Pessoa de Meia-Idade , Projetos Piloto , Ultrassonografia
14.
Biomed Res Int ; 2016: 7075464, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-27642600

RESUMO

Objective. This study aims to extract motor ingredients through data mining from wearable sensors in a virtual reality goal-directed shoulder rehabilitation (GDSR) system and to examine their effects toward clinical assessment. Design. A single-group before/after comparison. Setting. Outpatient research hospital. Subjects. 16 patients with frozen shoulder. Interventions. The rehabilitation treatment involved GDSR exercises, hot pack, and interferential therapy. All patients first received hot pack and interferential therapy on the shoulder joints before engaging in the exercises. The GDSR exercise sessions were 40 minutes twice a week for 4 weeks. Main Measures. Clinical assessments included Constant and Murley score, range of motion of the shoulder, and muscle strength of upper arm as main measures. Motor indices from sensor data and task performance were measured as secondary measures. Results. The pre- and posttest results for task performance, motor indices, and the clinical assessments indicated significant improvement for the majority of the assessed items. Correlation analysis between the task performance and clinical assessments revealed significant correlations among a number of items. Stepwise regression analysis showed that task performance effectively predicted the results of several clinical assessment items. Conclusions. The motor ingredients derived from the wearable sensor and task performance are applicable and adequate to examine and predict clinical improvement after GDSR training.


Assuntos
Bursite/fisiopatologia , Bursite/reabilitação , Atividade Motora , Reabilitação/instrumentação , Interface Usuário-Computador , Braço/fisiopatologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Força Muscular , Amplitude de Movimento Articular , Análise e Desempenho de Tarefas
15.
Medicine (Baltimore) ; 95(19): e3579, 2016 May.
Artigo em Inglês | MEDLINE | ID: mdl-27175655

RESUMO

Numerous epidemiological data suggest that the use of angiotensin-converting enzyme inhibitors (ACEis) can improve the clinical outcomes of pneumonia. Tuberculosis (TB) is an airborne bacteria like pneumonia, and we aimed to find out whether the use of ACEis can decrease the risk of active TB.We conducted a nested case-control analysis by using a 1 million longitudinally followed cohort, from Taiwan national health insurance research database. The rate ratios (RRs) for TB were estimated by conditional logistic regression, and adjusted using a TB-specific disease risk score (DRS) with 71 TB-related covariates.From January, 1997 to December, 2011, a total of 75,536 users of ACEis, and 7720 cases of new active TB were identified. Current use (DRS adjusted RR, 0.87 [95% CI, 0.78-0.97]), but not recent and past use of ACEis, was associated with a decrease in risk of active TB. Interestingly, it was found that chronic use (>90 days) of ACEis was associated with a further decrease in the risk of TB (aRR, 0.74, [95% CI, 0.66-0.83]). There was also a duration response effect, correlating decrease in TB risk with longer duration of ACEis use. The decrease in TB risk was also consistent across all patient subgroups (age, sex, heart failure, cerebrovascular diseases, myocardial infraction, renal diseases, and diabetes) and patients receiving other cardiovascular medicine.In this large population-based study, we found that subjects with recent and chronic use of ACEis were associated with decrease in TB risk.


Assuntos
Inibidores da Enzima Conversora de Angiotensina/administração & dosagem , Profilaxia Pós-Exposição/métodos , Tuberculose Pulmonar/prevenção & controle , Estudos de Casos e Controles , Bases de Dados Factuais , Feminino , Humanos , Modelos Logísticos , Estudos Longitudinais , Masculino , Medição de Risco , Fatores de Risco , Taiwan , Fatores de Tempo , Tuberculose Pulmonar/etiologia
16.
Biomark Med ; 10(3): 329-42, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-26860036

RESUMO

AIM: Galectin-3 (Gal-3) is a new biomarker for assessing prognosis of heart failure (HF) patients. This systemic review and meta-analysis aims to examine Gal-3's ability in assessing prognosis of HF patients. METHOD: We searched MEDLINE and Embase up to November 2014. Test performance characteristics were summarized using forest plots and hierarchical summary receiver operating characteristic curves. RESULTS: The diagnostic odds ratio of Gal-3 in predicting mortality in chronic HF patients was 2.36 (95% CI: 1.71-3.26) and 2.30 (95% CI: 1.76-3.01) in acute HF patients. CONCLUSION: Elevated levels of Gal-3 are associated with mortality in both acute and chronic HF patients. However, current evidence does not support sole use of Gal-3 for prognosis evaluation of HF patients.


Assuntos
Galectina 3/metabolismo , Insuficiência Cardíaca/mortalidade , Doença Aguda , Doença Crônica , Humanos , Infarto do Miocárdio/mortalidade
17.
Medicine (Baltimore) ; 93(28): e304, 2014 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-25526477

RESUMO

There are very limited data on the postmarketing outcome comparison of different guideline antibiotic regimens for patients with urinary tract infections (UTIs). We carried out a population-based comparative effectiveness study from year 2000 through 2009, using the administrative data of 2 million patients from the National Health Informatics Project of Taiwan. Treatment failure was defined as either hospitalization or emergency department visits for UTI. Odd ratios were computed using conditional logistic regression models matched on propensity score. We identified 73,675 individuals with UTI, of whom 54,796 (74.4%) received trimethoprim-sulfamethoxazole (TMP-SMX), 4184 (5.7%) received ciprofloxacin, 3142 (4.3%) received levofloxacin, 5984 (8.1%) received ofloxacin, and 5569 (7.6%) received norfloxacin. Compared with TMP-SMX, the composite treatment failure was significantly lowered for norfloxacin in propensity score (PS) matching analyses (OR, 0.73; 95% CI, 0.54-0.99). Both norfloxacin (PS-matched OR, 0.68; 95% CI, 0.47-0.98) and ofloxacin (PS-matched OR, 0.70; 95% CI, 0.49-0.99) had significantly lowered composite treatment failure rate when compared with ciprofloxacin. Subgroup analysis suggested that both norfloxacin and ofloxacin were more effective in female patients without complications (W/O indwelling catheters, W/O bedridden status and W/O spinal cord injury), when compared with either TMP-SMX or ciprofloxacin. Among outpatients receiving oral fluoroquinolone therapy for UTIs, there was evidence of superiority of norfloxacin or ofloxacin over ciprofloxacin or TMP-SMX in terms of treatment failure. Given the observational nature of this study and regional difference in antibiotic resistance patterns, more studies are required to validate our results.


Assuntos
Antibacterianos/administração & dosagem , Revisão da Utilização de Seguros/estatística & dados numéricos , Pacientes Ambulatoriais , Infecções Urinárias/tratamento farmacológico , Administração Oral , Adulto , Idoso , Quimioterapia Combinada , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Morbidade/tendências , Pontuação de Propensão , Estudos Retrospectivos , Taxa de Sobrevida/tendências , Taiwan , Fatores de Tempo , Falha de Tratamento , Resultado do Tratamento , Infecções Urinárias/epidemiologia
18.
Complement Ther Clin Pract ; 20(4): 243-50, 2014 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-25454967

RESUMO

PURPOSE: This study compared the therapeutic effects of collateral meridian therapy (CMT) with traditional acupoint pressure therapy (APT) in patients with unilateral upper back pain. MATERIAL AND METHODS: Forty-nine patients with active myofascial trigger points in upper trapezius muscle were randomly allocated to the control (CTL), APT, or CMT group. Each subject in the CMT and APT groups received 2 sessions of treatment per week over 1 month. RESULTS: Patients in the APT and CMT groups showed significant improvements 1 month after treatment in visual analogue scale, range of motion, pain pressure threshold, regional superficial blood flow, and physical health, as compared to the CTL group. No significant differences in outcome measures were found between APT and CMT groups 1 month after treatment. CONCLUSION: Both APT and CMT have comparable therapeutic efficacy in the treatment of unilateral upper back pain with active myofascial trigger points in the upper trapezius muscle.


Assuntos
Pontos de Acupuntura , Meridianos , Síndromes da Dor Miofascial/terapia , Adulto , Feminino , Frequência Cardíaca/fisiologia , Humanos , Masculino , Pessoa de Meia-Idade , Síndromes da Dor Miofascial/epidemiologia , Qualidade de Vida/psicologia , Amplitude de Movimento Articular/fisiologia , Fluxo Sanguíneo Regional/fisiologia , Pontos-Gatilho/fisiopatologia , Escala Visual Analógica , Adulto Jovem
19.
NeuroRehabilitation ; 35(3): 435-49, 2014.
Artigo em Inglês | MEDLINE | ID: mdl-25227546

RESUMO

BACKGROUND: Among numerous studies on virtual reality (VR) technology for motor rehabilitation, the majorities have only used it as a motor training system and did not use the kinematic or kinetic information obtained as the basis for therapeutic effect assessment. OBJECTIVE: Incorporating the kinematic and kinetic information acquired through a robot-assisted VR system on pinch-grip training, this study intends to propose novel motor ingredients represented as indices for the interpretation of motor behaviors and verify the efficacy of them for the assessment in chronic stroke. METHODS: Clinical trials were conducted on eight stroke patients and clinical assessments were made as the objective standard. Non-parametric test and correlation analysis were performed on results of motor indices and clinical assessments. RESULTS: Non-parametric test indicated that 50% of the motor indices significantly improved while the others showed a trend of improvement, consisting with the findings in clinical assessments. Correlation analysis showed that the three clinical assessment items were correlated to items in the motor ingredients. CONCLUSIONS: The proposed motor ingredients gathered from the robot-assisted VR training system were able to contribute to the assessment of therapeutic effect in chronic stroke and were capable for the interpretation of behavior phases.


Assuntos
Gráficos por Computador , Força da Mão , Destreza Motora , Robótica , Reabilitação do Acidente Vascular Cerebral , Acidente Vascular Cerebral/fisiopatologia , Interface Usuário-Computador , Adulto , Idoso , Idoso de 80 Anos ou mais , Fenômenos Biomecânicos , Doença Crônica , Simulação por Computador , Desenho de Equipamento , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Desempenho Psicomotor , Resultado do Tratamento , Adulto Jovem
20.
J Chin Med Assoc ; 77(9): 482-6, 2014 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-25107497

RESUMO

BACKGROUND: A delayed decrease in heart rate recovery (HRR) following a maximal exercise test is a predictor of mortality in healthy adults and in those referred for diagnostic testing evaluation. Cardiac rehabilitation (CR) has been proven to be beneficial in the treatment of numerous diseases. The purpose of this retrospective study was to explore the relationship between CR and improvement of HRR and to determine which factors can be predictive for the improvement of abnormal HRR after Phase II CR. METHODS: We reviewed the medical histories of patients referred for symptom-limited cardiopulmonary treadmill testing with abnormal HRR. Each patient underwent exercise testing before and after Phase II CR, and parameters including functional aerobic impairment, metabolic equivalent, anaerobic threshold (AT), and %AT were recorded and compared. RESULTS: Of the 25 patients recruited, 13 patients showed no abnormal HRR after Phase II CR. The functional capacity of these patients was improved after Phase II CR, to a statistically significant extent; the aerobic capacity (as expressed with AT and %AT) showed improvement, but without statistical significance. CONCLUSION: There are multiple factors of cardiopulmonary exercise tests that cannot be used to predict the effect of Phase II CR on the improvement of abnormal HRR. Forty-one percent of patients with abnormal HRR could improve after Phase II CR, but all of the patients could have improved exercise capacity regardless of whether or not HRR improved. We can conclude that HRR and exercise capacity change independently. However, it is important to closely follow-up during Phase III CR for patients with persistently abnormal HRR after Phase II CR has been completed.


Assuntos
Cardiopatias/reabilitação , Frequência Cardíaca/fisiologia , Idoso , Teste de Esforço , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
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