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1.
ERJ Open Res ; 7(3)2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-34589540

RESUMO

Endobronchial ultrasound (EBUS)-guided transbronchial biopsy (TBB) is a common procedure used to diagnose peripheral pulmonary lesions (PPLs). However, existing literature did not conclusively show a difference in the ability of EBUS-TBB with and without a guide sheath (GS) to diagnose PPLs. This multicenter cohort study enrolled patients presenting for EBUS-TBB of PPLs that finally proved to be malignant. The diagnostic yield and complication rate were compared between patients undergoing EBUS-TBB with and without a GS (EBUS-TBB+GS versus EBUS-TBB-GS). A propensity score matching method was used to balance differences of pertinent clinical features between the two groups. The original cohort consisted of 975 patients (556 in EBUS-TBB-GS; 419 in EBUS-TBB+GS). GS guidance was more likely to be used with smaller (40 mm versus 44 mm) and middle or lower lobe (60% versus 35%) lesions. After propensity score matching, 720 (360 in each group) patients were included; the diagnostic yields for PPLs were 79% and 78% for EBUS-TBB-GS and EBUS-TBB+GS groups, respectively (p=0.649). The complication rates (5.8% versus 7.2% for bleeding; 0.6% versus 1.9% for pneumothorax) appeared to be lower in the EBUS-TBB+GS group, but the differences did not reach statistical significance. The procedure time was significantly longer in the EBUS-TBB+GS group than in the EBUS-TBB-GS group (29 min versus 24 min; p<0.001). In conclusion, adding a GS to EBUS-TBB did not improve the diagnostic yield for malignant PPLs. GS guidance was seemingly associated with a lower number of complications after TBB but contributed significantly to a longer procedure time.

2.
Int J Mol Sci ; 22(15)2021 Jul 30.
Artigo em Inglês | MEDLINE | ID: mdl-34361003

RESUMO

Atopic dermatitis (AD) is a chronic and persistent inflammatory skin disease characterized by eczematous lesions and itching, and it has become a serious health problem. However, the common clinical treatments provide limited relief and are accompanied by adverse effects. Therefore, there is a need to develop novel and effective therapies to treat AD. Neferine is a small molecule compound isolated from the green embryo of the mature seeds of lotus (Nelumbo nucifera). It has a bisbenzylisoquinoline alkaloid structure. Relevant studies have shown that neferine has many pharmacological and biological activities, including anti-inflammatory, anti-thrombotic, and anti-diabetic activities. However, there are very few studies on neferine in the skin, especially the related effects on inflammatory skin diseases. In this study, we proved that it has the potential to be used in the treatment of atopic dermatitis. Through in vitro studies, we found that neferine inhibited the expression of cytokines and chemokines in TNF-α/IFN-γ-stimulated human keratinocyte (HaCaT) cells, and it reduced the phosphorylation of MAPK and the NF-κB signaling pathway. Through in vivo experiments, we used 2,4-dinitrochlorobenzene (DNCB) to induce atopic dermatitis-like skin inflammation in a mouse model. Our results show that neferine significantly decreased the skin barrier damage, scratching responses, and epidermal hyperplasia induced by DNCB. It significantly decreased transepidermal water loss (TEWL), erythema, blood flow, and ear thickness and increased surface skin hydration. Moreover, it also inhibited the expression of cytokines and the activation of signaling pathways. These results indicate that neferine has good potential as an alternative medicine for the treatment of atopic dermatitis or other skin-related inflammatory diseases.


Assuntos
Anti-Inflamatórios/farmacologia , Benzilisoquinolinas/farmacologia , Dermatite Atópica/tratamento farmacológico , Animais , Anti-Inflamatórios/uso terapêutico , Benzilisoquinolinas/uso terapêutico , Dermatite Atópica/etiologia , Dermatite Atópica/metabolismo , Dinitroclorobenzeno/toxicidade , Células HaCaT/efeitos dos fármacos , Células HaCaT/metabolismo , Humanos , Interferon gama/metabolismo , Sistema de Sinalização das MAP Quinases , Camundongos , Camundongos Endogâmicos BALB C , NF-kappa B/metabolismo , Fator de Necrose Tumoral alfa/metabolismo
3.
Artigo em Inglês | MEDLINE | ID: mdl-34069579

RESUMO

Prolonged sitting combined with an awkward posture might contribute to the increased risks of developing spinal pain. Maintaining an upright sitting posture is thus often suggested, especially nowadays when people spend longer periods in the sitting posture for occupational or leisure activities. Many types of assistive devices are commercially available to help computer users maintain an upright sitting posture. As the technology advances, wearable sensors that use microelectromechanical technology are designed to provide real-time biofeedback and promote adjusting posture actively. However, whether such wearable biofeedback sensors could assist adjusting sitting posture in computer users during prolonged typing remains unknown. This study aimed to investigate the effects of a wearable biofeedback sensor on maintaining an upright sitting posture. Twenty-one healthy young adults were recruited and performed a 1-h computer typing task twice, with and without using the active biofeedback device. The sagittal spinal posture during computer typing was measured using a three-dimensional motion analysis system. Using the wearable biofeedback sensor significantly decreased the neck flexion (p < 0.001), thoracic kyphotic (p = 0.033), and pelvic plane (p = 0.021) angles compared with not using the sensor. Computer users and sedentary workers may benefit from using wearable biofeedback sensors to actively maintain an upright sitting posture during prolonged deskwork.


Assuntos
Postura Sentada , Dispositivos Eletrônicos Vestíveis , Biorretroalimentação Psicológica , Computadores , Humanos , Postura , Adulto Jovem
4.
Artigo em Inglês | MEDLINE | ID: mdl-33922598

RESUMO

The abdominal expansion (AE) strategy, involving eccentric contraction of the abdominal muscles, has been increasingly used in clinical practices; however, its effects have not been rigorously investigated. This study aimed to investigate the immediate effects of the AE versus abdominal drawing-in (AD) strategy on lumbar stabilization muscles in people with nonspecific low back pain (LBP). Thirty adults with nonspecific LBP performed the AE, AD, and natural breathing (NB) strategies in three different body positions. Ultrasonography and surface electromyography (EMG) were, respectively, used to measure the thickness and activity of the lumbar multifidus and lateral abdominal wall muscles. The AE and AD strategies showed similar effects, producing higher EMG activity in the lumbar multifidus and lateral abdominal wall muscles when compared with the NB strategy. All muscles showed higher EMG activity in the quiet and single leg standing positions than in the lying position. Although the AE and AD strategies had similar effects on the thickness change of the lumbar multifidus muscle, the results of thickness changes of the lateral abdominal muscles were relatively inconsistent. The AE strategy may be used as an alternative method to facilitate co-contraction of lumbar stabilization muscles and improve spinal stability in people with nonspecific LBP.


Assuntos
Dor Lombar , Músculos Abdominais/diagnóstico por imagem , Adulto , Estudos Transversais , Eletromiografia , Humanos , Região Lombossacral/diagnóstico por imagem , Ultrassonografia
5.
Phys Ther ; 101(8)2021 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-33929540

RESUMO

OBJECTIVE: The purpose of this review was to evaluate the effects of sling exercise on pain intensity, disability, and health-related quality of life in adults with neck pain. METHODS: The Cochrane Central Register of Controlled Trials, EMBASE, Physiotherapy Evidence Database (PEDro), and 6 other databases were searched from inception to July 2020. The reference lists of relevant articles to identify additional trials were also screened. Randomized controlled trials were included if they investigated the effects of sling suspension therapy in patients with neck pain, including mechanical neck disorders, cervicogenic headache, and neck disorders with radicular findings. Studies were required to be published in English or Chinese. The methodological quality and levels of evidence of studies were assessed using the PEDro scale and the Grading of Recommendations Assessment, Development and Evaluation approach, respectively. The random-effects model was used to perform meta-analyses. RESULTS: Eleven randomized controlled trials were included (n = 595). The mean total PEDro score was 4.64 (SD = 1.21) of 10, which indicated a fair methodological quality. The intervention groups showed significant improvements in pain intensity (SMD = -1.23; 95% CI = -1.88 to -0.58) immediately postintervention compared with the control groups. No significant effects were found for disability, cervical range of motion, and health-related quality of life. However, sensitivity analyses revealed significant short-term improvements in pain intensity, disability, and cervical range of motion and sustained effects on disability at intermediate-term follow-up. CONCLUSION: Sling exercise appears to be beneficial for improvements in pain intensity (moderate- to low-level evidence) among patients with neck pain. However, no definitive conclusion could be made regarding the effect of sling exercise for neck pain due to methodological limitations and high heterogeneity in the included studies. IMPACT: This review provides overall moderate- to very low-level evidence for health care professionals who may consider including sling exercise in the intervention program for patients with neck pain.

6.
Sci Rep ; 10(1): 21025, 2020 12 03.
Artigo em Inglês | MEDLINE | ID: mdl-33273701

RESUMO

Comorbidities adversely affect the quality of life and survival of patients with chronic obstructive pulmonary disease (COPD), and timely identification and management of comorbidities are important in caring for COPD patients. This study aimed to investigate the impact of COPD on long-term developmental trajectories of its comorbidities. From 2010 to 2013, all spirometry-confirmed COPD patients with a 5-year follow-up period were identified as the cases. The prevalence of comorbidities and their trajectories in COPD cases were obtained and compared with those in non-COPD controls matched for age, sex, smoking status and Charlson comorbidity index (CCI). Over the study period, a total of 682 patients, 341 each in COPD and control groups were included, with a mean age of 69.1 years and 89% male. The baseline mean CCI was 1.9 for both groups of patients and significantly increased to 3.4 and 2.7 in COPD and control groups after 5 years, respectively (both P < 0.001). Through the 5-year follow-up, a significant increase in the prevalence of all comorbidities of interest was observed in the COPD cohort and the incidence was remarkably higher for hypertension [incidence rate ratio (IRR) 1.495; 95% confidence interval (CI) 1.017-2.198], malignancy (IRR 2.397; 95% CI 1.408-4.081), diabetes mellitus (IRR 2.927; 95% CI 1.612-5.318), heart failure (IRR 2.531; 95% CI 1.502-4.265) and peptic ulcer disease (IRR 2.073; 95% CI 1.176-3.654) as compared to the non-COPD matched controls. In conclusion, our findings suggest that the presence of COPD may be considered a pathogenic factor involved in the development of certain comorbidities.


Assuntos
Diabetes Mellitus Tipo 2/epidemiologia , Hipertensão/epidemiologia , Neoplasias/epidemiologia , Úlcera Péptica/epidemiologia , Doença Pulmonar Obstrutiva Crônica/epidemiologia , Fumar/epidemiologia , Idoso , Comorbidade , Feminino , Humanos , Masculino , Taiwan
7.
BMC Gastroenterol ; 20(1): 383, 2020 Nov 16.
Artigo em Inglês | MEDLINE | ID: mdl-33198635

RESUMO

BACKGROUND: Development of gastrointestinal (GI) complications is adversely associated with prognosis in the critically ill. However, little is known about their impact on the outcome of non-critically ill patients. In this study, we aimed to investigate the incidence of GI complications and their influence on prognosis of hospitalized pneumonia patients. METHODS: Adult patients admitted with a diagnosis of pneumonia from 2012 to 2014 were included. Medical records were reviewed to obtain patients' demographics, physical signs, comorbidities, laboratory results, clinical events, and the Confusion, Urea, Respiratory rate, Blood pressure and age ≥ 65 (CURB-65) score was calculated to assess the severity of pneumonia. GI complications, including bowel distension, diarrhea, GI bleeding and ileus, were evaluated during the first 3 days of hospitalization and their association with patient outcomes, such as hospital mortality and length of stay, was analyzed. RESULTS: A total of 1001 patients were enrolled, with a mean age of 73.7 years and 598 (59%) male. Among them, 114 (11%) patients experienced at least one GI complication and diarrhea (5.2%) was the most common. The hospital mortality was 14% and was independently associated with an increase in the CURB-65 score (odds ratio [OR] 1.952 per point increase; 95% confidence interval [CI] 1.516-2.514), comorbid malignancy (OR 1.943; 95% CI 1.209-3.123), development of septic shock (OR 25.896; 95% CI 8.970-74.765), and the presence of any GI complication (OR 1.753; 95% CI 1.003-3.065). CONCLUSIONS: Compared to a critical care setting, GI complications are not commonly observed in a non-critical care setting; however, they still have a negative impact on prognosis of pneumonia patients, including higher mortality and prolonged length of hospital stay.


Assuntos
Estado Terminal , Pneumonia , Adulto , Idoso , Cuidados Críticos , Mortalidade Hospitalar , Humanos , Unidades de Terapia Intensiva , Tempo de Internação , Masculino , Pneumonia/epidemiologia , Índice de Gravidade de Doença
8.
Front Neurosci ; 14: 573509, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33041765

RESUMO

Moderate exercise and mild hypothermia have protective effects against brain injury and neurodegeneration. Running in a cold environment alters exercise-induced hyperthermia and outcomes; however, evaluations of post-exercise cold exposure related to exercise benefits for the brain are relatively rare. We investigated the effects of 4°C cold exposure after exercise on exercise-induced thermal responses and neuroprotection in an MPTP (1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine)-induced Parkinsonian mouse model. Male C57BL/6J mice were pretreated with MPTP for five consecutive days and follow-up treadmill exercise for 4 weeks. After 1-h running at a 22°C temperature, the mice were exposed to a 4°C environment for 2 h. An MPTP injection induced a transient drop in body and brain temperatures, while mild brain hypothermia was found to last for 4 weeks after MPTP treatment. Preventing brain hypothermia by exercise or 4°C exposure was associated with an improvement in MPTP-induced striatal uncoupling protein 4 (UCP4) downregulation and nigrostriatal dopaminergic neurodegeneration. However, 4°C exposure after exercise abrogated the exercise-induced beneficial effects and thermal responses in MPTP-treated mice, including a low amplitude of exercise-induced brain hyperthermia and body temperature while at rest after exercise. Our findings elucidate that post-exercise thermoregulation and UCP4 expression are important in the neuroprotective effects of exercise against MPTP toxicity.

9.
Sensors (Basel) ; 20(21)2020 Oct 23.
Artigo em Inglês | MEDLINE | ID: mdl-33114105

RESUMO

Footwork is the most fundamental skill in badminton, involving the ability of acceleration or deceleration and changing directions on the court, which is related to accurate shots and better game performance. The footwork performance in-field is commonly assessed using the total finished time, but does not provide any information in each direction. With the higher usage of the smartphones, utilizing their built-in inertial sensors to assess footwork performance in-field might be possible by providing information about body acceleration in each direction. Therefore, the purpose of this study was to evaluate the feasibility of a smartphone-based measurement system on badminton six-point footwork. The body acceleration during the six-point footwork was recorded using a smartphone fixed at the belly button and a self-developed application in thirty badminton players. The mean and maximum of the acceleration resultant for each direction of the footwork were calculated. The participants were classified into either the faster or slower group based on the finished duration of footwork. Badminton players who finished the footwork faster demonstrated a greater mean and maximum acceleration compared to those who finished slower in most directions except for the frontcourt directions. The current study found that using a smartphone's built-in accelerometer to evaluate badminton footwork is feasible.

10.
J Vestib Res ; 30(4): 267-274, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32925126

RESUMO

BACKGROUND: Patients with Benign Paroxysmal Positional Vertigo (BPPV) often report a sensation of disequilibrium before treatment with the canalith repositioning maneuvers. Apart from vestibular information, visual input also contributes to balance control. How visual stimuli influence balance control in BPPV patients is unclear. OBJECTIVE: To investigate the influence of visual stimuli on balance performance in BPPV patients. METHODS: Three groups of participants, patients with BPPV, and healthy young and older adults, were instructed to stand under three conditions: 1) eyes open (EO); 2) while watching a static picture via a video display; and 3) while watching a rotating visual scene. Antero-posterior (AP), lateral (ML), and total sway path during standing were analyzed. RESULTS: In all conditions, patients with BPPV showed significantly larger AP, ML and total sway path than young, whereas older adults only showed significantly larger AP and total sway path than young adults. During the visual stimuli, all participants exhibited significantly increased AP and total sway while watching a static image and a moving scene as compared with the EO condition. CONCLUSIONS: Patients with BPPV have similar balance control to older adults, but poorer balance control than young adults. The reduced lack of standing balance control in the coronal plane of patients with BPPV, might affect balance strategy after external perturbations.

11.
Neurochem Int ; 140: 104827, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-32853748

RESUMO

In this study, we investigated whether melatonin treatment prevents development of neuropathic pain via suppression of glial mitogen-activated protein kinases (MAPKs) activation in the cuneate nucleus (CN) in a lysophosphatidylcholine (LPC)-induced median nerve demyelination neuropathy model. Rats were fed orally with melatonin once a day at a dose of 37.5, 75, or 150 mg/kg 30 min before until 3 days after LPC treatment. Subsequently, behavioral tests were conducted on these animals, and immunohistochemistry and immunoblotting were used for qualitative and quantitative analysis of glia and MAPKs, including ERK, JNK, and p38, activation. Enzyme-linked immunosorbent assays were applied to measure pro-inflammatory cytokine responses. Furthermore, intra-CN microinjection of S26131 (MT1 receptor antagonist), 4P-PDOT (MT2 receptor antagonist), or prazosin (MT3 receptor antagonist) were performed to investigate the association between melatonin receptor subtypes and effects of melatonin on demyelination neuropathy. LPC treatment of the median nerve induced a significant increase in glial fibrillary acidic protein (GFAP; an astrocyte marker) and ED1 (an activated microglia marker) immunoreactivity in the ipsilateral CN and led to development of neuropathic pain behavior. Inspection of GFAP-immunoreactive astrocytes revealed that astrocytic hypertrophy, but not proliferation, contributed to increased GFAP immunoreactivity. Double immunofluorescence showed that both GFAP-immunoreactive astrocytes and ED1-immunoreactive microglia co-expressed p-ERK, p-JNK, and p-p38 immunoreactivity. Melatonin administration dose-dependently reduced neuropathic pain behavior, decreased glial and MAPKs activation, and diminished the release of pro-inflammatory cytokines in the ipsilateral CN after LPC treatment. Furthermore, 4P-PDOT, but not S26131 or prazosin, antagonized the therapeutic effects of melatonin. In conclusion, administration of melatonin, via its cognate MT2 receptor, inhibited activation of glial MAPKs, production of pro-inflammatory cytokines, and development of demyelination-induced neuropathic pain behavior.

12.
Artigo em Inglês | MEDLINE | ID: mdl-32731521

RESUMO

Cervical stabilization exercises are frequently used to reduce pain, maximize function, and improve physical impairments for people with nonspecific neck pain. We conducted a single arm study to evaluate the effects of a home-based cervical stabilization exercise program for university violin players with nonspecific neck pain who frequently assume an asymmetrical neck posture and activate their superficial cervical flexors to stabilize the violin. Twenty violin players with nonspecific neck pain from university symphony orchestras participated in this study. All participants received assessments twice before the intervention and once immediately after a 6-week cervical stabilization exercise program. No significant differences were found between the two pretests before the intervention. After the intervention, the Numeric Rating Scale, the Neck Disability Index, the craniocervical flexion test, muscle endurance tests, cervical range of motion (all directions except flexion) tests, and cervicocephalic relocation tests (flexion and left rotation) showed improvements. The forward head posture indicated by the craniovertebral angle also slightly improved. The results of this single arm study suggest that cervical stabilization exercise is feasible and has the potential to improve physical health for collegiate violin players with nonspecific neck pain.


Assuntos
Música , Cervicalgia/terapia , Avaliação da Deficiência , Terapia por Exercício , Humanos , Pescoço , Doenças Profissionais/terapia , Amplitude de Movimento Articular , Universidades
13.
J Pain Res ; 13: 1497-1503, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32606915

RESUMO

Purpose: This pilot study aimed to determine the feasibility of hip corrective taping to improve self-reported knee pain and lower extremity joint kinematics in basketball players with patellofemoral pain. Patients and Methods: A single group pre-test and post-test design. Collegiate basketball players with patellofemoral pain were recruited. Three-dimensional hip and knee joint kinematics were measured during two tasks, single-leg squat (SLS) and lay-up jump (LUJ), and each task was conducted under no-taping and taping conditions. Subjective report of pain was compared between no-taping and taping conditions only during SLS. Results: Twelve collegiate basketball players with patellofemoral pain (median age, 22.7 [2.5] years; mean height, 173.8 ± 7.4 cm; mean weight, 72.5 ± 12.8 kg) participated in this study. Compared with no-taping, the use of hip corrective taping significantly increased the hip abduction angle at the instant of the maximal vertical ground reaction force during LUJ (no-taping vs taping: 0.6° ± 6.3° vs 3.3° ± 5.1°, p = 0.029), and also caused a trend of decreased maximal hip internal rotation angle during SLS (no-taping vs taping: 8.0° ± 6.6° vs 4.7° ± 6.9°, p = 0.050). Hip corrective taping also improved self-reported knee pain during SLS (no-taping vs taping: 3.4 ± 1.7 vs 2.6 ± 1.0, p = 0.046). Conclusion: Hip corrective taping may be used as an effective intervention for athletes with patellofemoral pain during basketball-related tasks.

14.
Brain Res ; 1738: 146822, 2020 07 01.
Artigo em Inglês | MEDLINE | ID: mdl-32272096

RESUMO

Sepsis-associated encephalopathy (SAE) is frequently encountered in critically ill patients. Hyperglycemia is a common phenomenon among patients with sepsis, and glycemic control improves patient outcomes. Therefore, here, we aimed to explore whether glycemic control using insulin inhibits the pro-inflammatory cytokine response and glial activation in the cerebrum and is concomitantly associated with the relief of SAE. Using cecal ligation and puncture (CLP), sepsis was induced in male Sprague-Dawley rats. The CLP rats were administered intravenous glucose or subjected to subcutaneous insulin implant within the first hour after CLP. The survival rate, blood glucose (BG) values, and behavioral expression were assessed daily for 5 days after CLP. At day 5 after CLP, electroencephalography (EEG) recordings and blood-brain barrier (BBB) permeability testing were performed. Immunohistochemistry, immunoblotting, and enzyme-linked immunosorbent assays were used to evaluate glial activation and the pro-inflammatory cytokine response qualitatively and quantitatively, respectively. The glucose-treated CLP rats (BG > 390 mg/dL) exhibited a decline in survival rate; insensitivity to mechanical and thermal stimuli; slowed EEG activity; and an increase in BBB permeability, pro-inflammatory cytokine (TNF-α, IL-1ß, and IL-6) levels, and glial activation (astrocytes and microglia) in the cerebral tissues compared with CLP rats (BG ~ 270 mg/dL). Double-immunofluorescence showed that activated astrocytes and microglia co-expressed phosphorylated nuclear factor kappa B and mitogen-activated protein kinases, respectively. Furthermore, glycemic control using insulin therapy maintained the BG at 120-160 mg/dL and inhibited the production of pro-inflammatory cytokines and glial activation in the cerebrum of septic rats. In addition, the survival rate, sensory threshold, EEG activity, and BBB permeability recovered to near-normal levels in septic rats after insulin therapy. Taken together, the results of this study elucidated the pathophysiological alterations in brains subjected to sepsis, especially regarding glycemic control. These findings improve our understanding of SAE and support the importance of glycemic control in sepsis.

15.
J Sport Rehabil ; 29(1): 65-72, 2020 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-30526235

RESUMO

CONTEXT: Core control and strength are important for reducing the risk of lower-extremity injury. Current evidence on the effect of core training in male adolescent athletes is limited, and other investigations into the effects of core training often emphasized core strength only. OBJECTIVE: To examine whether core training emphasizing both control and strength of the trunk and hip would improve joint kinematics during landing, sports performance, and lower-extremity muscle strength in adolescent male volleyball athletes. DESIGN: Single group pretest and posttest design. SETTING: University laboratory. PARTICIPANTS: Sixteen male participants (age: 13.4 [1] y, height: 167.8 [8.6] cm, mass: 58.6 [13.9] kg, and volleyball experience: 3.8 [1.5] y) from a Division I volleyball team at a junior high school. MAIN OUTCOME MEASUREMENTS: Kinematics of the trunk and lower-extremity during box landing and spike jump landing tasks, volleyball-related sports performance, and isokinetic strength of hip and knee muscles were assessed before and after a 6-week core training program. RESULTS: After training, the participants demonstrated decreased trunk flexion angle (P = .01, Cohen's d = 0.78) during the box landing task and reduced the maximum knee internal rotation angle (P = .04, Cohen's d = 0.56) during the spike jump landing task. The average isokinetic strength of hip flexors and external rotators, and knee flexors and extensors also significantly increased (P = .001, Cohen's d = 0.98; P = .04, Cohen's d = 0.57; P = .02, Cohen's d = 0.66; P = .003, Cohen's d = 0.87, respectively); however, sports performance did not show significant changes. CONCLUSIONS: A more erect landing posture following training suggests that the core training program may be beneficial for improving core stability. The long-term effect of core training for knee injury prevention needs further investigation.


Assuntos
Desempenho Atlético/fisiologia , Terapia por Exercício/métodos , Extremidade Inferior/fisiologia , Força Muscular/fisiologia , Voleibol/fisiologia , Suporte de Carga/fisiologia , Adolescente , Fenômenos Biomecânicos , Criança , Humanos , Masculino
16.
BMC Pulm Med ; 19(1): 193, 2019 Oct 31.
Artigo em Inglês | MEDLINE | ID: mdl-31672128

RESUMO

BACKGROUND: Radial endobronchial ultrasound (R-EBUS)-guided transbronchial biopsy (TBB) is a common diagnostic modality for peripheral pulmonary lesions; however, there is uncertainty about the optimal sequence of TBB and bronchial brushing during the procedure. Thus, we aimed to investigate whether a biopsy-first or brushing-first strategy confers a better diagnostic yield and safety signal for R-EBUS-guided procedures for peripheral pulmonary malignancy. METHODS: From January 2017 to June 2018, consecutive patients referred for R-EBUS-guided TBB and bronchial brushing of peripheral pulmonary lesions and with a final malignant diagnosis were included. Patients were placed in a biopsy-first (biopsy followed by brushing) or a brushing-first (brushing followed by biopsy) group. The outcomes of interest were the diagnostic yield and complication profile of the procedures. Multivariate logistic regression and subgroup analysis were used to assess the impact of the procedure strategy. RESULTS: A total of 438 patients were included and the diagnostic yield of R-EBUS-guided TBB plus brushing for peripheral pulmonary malignancy was 73%. The diagnostic yield was associated with the solid lesion appearance (odds ratio [OR] 2.01; 95% confidence interval [CI] 1.08-3.75) and R-EBUS probe position within the lesion (OR 1.92; 95% CI 1.08-3.42), and the yield rates were comparable between the biopsy-first and brushing-first strategies. Moreover, the safety signal did not differ between the two groups. CONCLUSIONS: The two procedure strategies were indistinguishable in terms of diagnostic efficacy and adverse events for patients with peripheral pulmonary malignancy. Current evidence indicates that in patients with peripheral pulmonary lesions suspected of being malignant, either biopsy-first or brushing-first is a viable and acceptable diagnostic strategy during R-EBUS-guided procedures.


Assuntos
Brônquios/patologia , Broncoscopia/métodos , Neoplasias Pulmonares/diagnóstico , Ultrassonografia de Intervenção/métodos , Idoso , Brônquios/cirurgia , Feminino , Humanos , Biópsia Guiada por Imagem/efeitos adversos , Biópsia Guiada por Imagem/métodos , Modelos Logísticos , Neoplasias Pulmonares/cirurgia , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Estudos Retrospectivos , Tomografia Computadorizada por Raios X
17.
Respir Med ; 158: 49-54, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31605921

RESUMO

BACKGROUND: _The mitogen response in interferon-γ(IFN-γ) release assays(IGRAs) measures IFN-γ after binding to CD2, a surface adhesion marker found on T-cells and NK cells. A lower mitogen response implies either peripheral blood mononuclear cells have fewer adhesion molecules either in absolute numbers or per T-cells, or the pathway from adhesion molecules to IFN-γ production is not functioning well. To date, it remains poorly understood whether the mitogen response is associated with outcomes in tuberculosis patients. METHODS: _From 2012 to 2017, patients with culture-confirmed tuberculosis were tested for QuantiFERON-TB Gold In-Tube(QFT-GIT). The associations between patient outcomes and QFT-GIT as well as IFN-γ responses to the mitogen were investigated. Outcomes of interest included 1-year mortality after tuberculosis diagnosis and 2-month culture conversion. RESULTS: _In total, 466 culture-confirmed tuberculosis patients were enrolled and QFT-GIT was positive in 309(66%). Within 1 year of diagnosis, 20(4%) died and notably, 15(11%) out of 137 patients with a lower mitogen response did so. The multivariate Cox model showed that a lower mitogen response (hazard ratio, 8.789; 95% confidence interval, 3.074-25.129) was independently associated with 1-year mortality. Moreover, among 160 patients with smear-positive culture-confirmed pulmonary tuberculosis, multivariate logistic analysis indicated that a lower mitogen response (odds ratio, 3.966; 95% confidence interval, 1.182-13.303) was significantly associated with 2-month culture persistence. CONCLUSIONS: _This study found that a lower mitogen response was associated with worse 1-year survival in tuberculosis patients and correlated with 2-month culture persistence in patients with sputum smear-positive culture-confirmed tuberculosis. These findings suggest another application of QFT-GIT for prognostication of tuberculosis patients.


Assuntos
Substâncias de Crescimento/imunologia , Interferon gama/metabolismo , Tuberculose/imunologia , Tuberculose/metabolismo , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Taxa de Sobrevida , Tuberculose/mortalidade , Adulto Jovem
18.
J Clin Med ; 8(7)2019 Jul 20.
Artigo em Inglês | MEDLINE | ID: mdl-31330785

RESUMO

Clinical course and mortality in septic patients with low disease severity remain poorly understood and is worth further investigation. We enrolled septic patients admitted to intensive care units (ICUs) between 2010 and 2014 with Acute Physiology and Chronic Health Evaluation II (APACHE II) scores of ≤15. We sought to determine their clinical trajectories and causes of death, and to analyze risk factors associated with in-hospital mortality. A total of 352 patients were included, of whom 89 (25%) did not survive to hospital discharge, at a rate higher than predicted (<21%) by the APACHE II score. Approximately one third (31/89) of non-survivors succumbed to index sepsis; however, more patients (34/89) died of subsequent sepsis. New-onset ICU sepsis developed in 99 (28%) patients and was an independent risk factor for mortality. In addition, septic patients with comorbid malignancy or index infection acquired in the hospital settings were more likely to have in-hospital mortality than those without. In conclusion, septic patients with low APACHE II scores were at a higher mortality risk than expected, and subsequent sepsis rather than index sepsis was the primary cause of death. This study provides insight into unexpected clinical trajectories and outcomes of septic patients with low disease severity at ICU admission and highlights the need for more research and clinical attention in this patient population.

19.
Respir Res ; 20(1): 69, 2019 Apr 05.
Artigo em Inglês | MEDLINE | ID: mdl-30953517

RESUMO

BACKGROUND AND OBJECTIVE: Among patients with chronic obstructive pulmonary disease (COPD), diabetes mellitus (DM) is a common comorbidity and is probably associated with increased systemic inflammation and worse prognosis. Metformin, with its pleiotropic anti-inflammatory and antioxidant actions, may offer theoretical benefits in COPD patients with DM. Thus, this study aimed to investigate the effects of DM and metformin use on mortality in the clinical trajectory of COPD. METHODS: This was a retrospective cohort study comprising patients with spirometry-confirmed COPD and an age of ≥40 years from 2008 to 2014. The primary outcome of interest was all-cause mortality. We evaluated the effects of DM on mortality through the clinical course of COPD and we also assessed the impact of metformin use on survival of the COPD population. RESULTS: Among 4231 COPD patients, 556 (13%) had DM, and these patients had 1.62 times higher hazards of 2-year mortality than those without DM (95% confidence interval [CI], 1.15-2.28) after adjusting for age, gender, COPD stage, comorbidities and prior COPD hospitalization. Over a 2-year period, metformin users had a significantly lower risk of death (hazard ratio, 0.46; 95% CI, 0.23-0.92) compared with non-metformin users in patients with coexistent COPD and DM. Moreover, metformin users had similar survival to COPD patients without DM. CONCLUSIONS: This study shows that DM is associated with an increased risk of death in COPD patients and metformin use seems to mitigate the hazard. Our findings suggest a potential role of metformin in the management of DM in COPD.


Assuntos
Diabetes Mellitus/diagnóstico , Diabetes Mellitus/tratamento farmacológico , Hipoglicemiantes/uso terapêutico , Metformina/uso terapêutico , Doença Pulmonar Obstrutiva Crônica/diagnóstico , Doença Pulmonar Obstrutiva Crônica/tratamento farmacológico , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Comorbidade , Diabetes Mellitus/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Doença Pulmonar Obstrutiva Crônica/epidemiologia , Estudos Retrospectivos
20.
Phys Ther Sport ; 37: 27-33, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30818085

RESUMO

OBJECTIVE: Morphological changes of the abductor hallucis muscle (AbH) in flexible flatfoot (FF) individuals influence regulations of the medial longitudinal arch (MLA). Prolonged and repeated stretching of AbH in flexible flatfoot may cause changes in muscle reflex properties and further influence postural performance. However, AbH muscle reflex under different postural conditions have never been examined. The purpose of this study was to investigate differences in AbH H-reflex and postural performance between individuals with normal foot (NF) alignment and FF under prone, double-leg stance (DLS), and single-leg stance (SLS) conditions. DESIGN: Cross-sectional study. SETTING: University laboratory. PARTICIPANTS: Individuals with FF (n = 12) and NF (n = 12). MAIN OUTCOME MEASURES: AbH H-reflex, AbH EMG and center of pressure (CoP) displacement. RESULTS: Under all postural conditions, AbH H-reflex was significantly lower in the FF group (P < .05). Under the SLS condition, AbH EMG was significantly higher in the FF group (P < .05), and CoP displacement for the medial-lateral and anterior-posterior directions were significantly higher in the FF group (P < .05). CONCLUSIONS: With increased postural demand, FF individuals maintained their postural stability by recruiting greater AbH activities than through automatic stretch reflex, but FF individuals still showed inferior posture stability.


Assuntos
Pé Chato/fisiopatologia , Reflexo H/fisiologia , Músculo Esquelético/fisiopatologia , Equilíbrio Postural/fisiologia , Adulto , Estudos de Casos e Controles , Estudos Transversais , Eletromiografia , Feminino , Humanos , Masculino
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