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1.
Clin Lab ; 66(7)2020 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-32658428

RESUMO

BACKGROUND: There is currently no clinical biomarker for the early diagnosis of giant cell tumor of bone. Long-chain non-coding RNAs (lncRNAs) have a wide range of important gene regulatory functions and play an important role in the occurrence and development of various malignant tumors. This study mainly screened the differential expression of lncRNAs in patients with giant cell tumor of bone by gene chip technology, verified the biological function. We tried to establish a reference basis for early diagnosis of tumor and prediction of tumor recurrence. METHODS: From September 2018 to September 2019, we randomly selected 20 cases of primary giant cell tumor of bone and 20 cases of recurrent giant cell tumor of bone, and 20 cases of bone trauma tissue. First, the differential expression of incRNAs in the bone tissue of the patients was evaluated via utilizing gene chip technology. The gene chip was Human LncRNA Array v 3.0 (8 x 60 K) was completed by Shanghai Kangcheng Biotechnology Co., Ltd. The DAVID online analysis platform was used to analyze the differentially expressed genes by GO and KEGG pathways. The target lncRNAs were screened; real-time quantitative PCR (qRT-PCR) was used to verify the relative expression levels of target lncRNAs in bone tissue and serum of three groups of patients. RESULTS: Using gene chip technology screening, fold-change (FC) value > 2.0 was used as standard. A total of 1,254 differentially expressed lncRNAs were detected of which 896 were up-regulated and 358 were down-regulated. Additionally, a total of 106 differentially expressed lncRNAs were detected with FC values > 10.0. Among these, 72 lncRNAs were upregulated and 34 lncRNAs were downregulated. We then selected two lncRNAs with up-regulation and down-regulation with the largest fold difference. qRT-PCR analytical results showcased that the expression of AK124776 in bone tissue and serum of patients in the recurrent group was significantly higher than that of the initial group and the normal group. Conversely, for RP11-160A10.2, the expression level in the recurrent group was significantly lower than that in the initial group, and the normal group was the highest; the difference was statistically significant (p < 0.05). Finally, we used the expression levels of AK124776 and RP11-160A10.2 in each group as the diagnostic indicators. According to the receiver operating curve (ROC), the accuracy of AK¬124776 and RP11-160A10.2 in the diagnosis of giant cell tumor of bone (area under the curve), the AUC was 0.865 and 0.877, respectively; the accuracy of predicting recurrence of giant cell tumor of bone was 0.832 and 0.841, respectively. CONCLUSIONS: The early detection of differential expression of lncRNAs in the serum of patients with giant cell tumor of bone is important for the diagnosis of disease and prediction of recurrence. The establishment of stable expression of lncRNAs and simple and easy detection methods are of great value for guiding clinical application.

2.
JMIR Mhealth Uhealth ; 8(3): e16650, 2020 03 20.
Artigo em Inglês | MEDLINE | ID: mdl-32196458

RESUMO

BACKGROUND: Gait impairments including shuffling gait and hesitation are common in people with Parkinson's disease (PD), and have been linked to increased fall risk and freezing of gait. Nowadays the gait metrics mostly focus on the spatiotemporal characteristics of gait, but less is known of the angular characteristics of the gait, which may provide helpful information pertaining to the functional status and effects of the treatment in PD. OBJECTIVE: This study aimed to quantify the angles of steps during walking, and explore if this novel step angle metric is associated with the severity of PD and the effects of the treatment including the acute levodopa challenge test (ALCT) and deep brain stimulation (DBS). METHODS: A total of 18 participants with PD completed the walking test before and after the ALCT, and 25 participants with PD completed the test with the DBS on and off. The walking test was implemented under two conditions: walking normally at a preferred speed (single task) and walking while performing a cognitive serial subtraction task (dual task). A total of 17 age-matched participants without PD also completed this walking test. The angular velocity was measured using wearable sensors on each ankle, and three gait angular metrics were obtained, that is mean step angle, initial step angle, and last step angle. The conventional gait metrics (ie, step time and step number) were also calculated. RESULTS: The results showed that compared to the control, the following three step angle metrics were significantly smaller in those with PD: mean step angle (F1,48=69.75, P<.001, partial eta-square=0.59), initial step angle (F1,48=15.56, P<.001, partial eta-square=0.25), and last step angle (F1,48=61.99, P<.001, partial eta-square=0.56). Within the PD cohort, both the ALCT and DBS induced greater mean step angles (ACLT: F1,38=5.77, P=.02, partial eta-square=0.13; DBS: F1,52=8.53, P=.005, partial eta-square=0.14) and last step angles (ACLT: F1,38=10, P=.003, partial eta-square=0.21; DBS: F1,52=4.96, P=.003, partial eta-square=0.09), but no significant changes were observed in step time and number after the treatments. Additionally, these step angles were correlated with the Unified Parkinson's Disease Rating Scale, Part III score: mean step angle (single task: r=-0.60, P<.001; dual task: r=-0.52, P<.001), initial step angle (single task: r=-0.35, P=.006; dual task: r=-0.35, P=.01), and last step angle (single task: r=-0.43, P=.001; dual task: r=-0.41, P=.002). CONCLUSIONS: This pilot study demonstrated that the gait angular characteristics, as quantified by the step angles, were sensitive to the disease severity of PD and, more importantly, can capture the effects of treatments on the gait, while the traditional metrics cannot. This indicates that these metrics may serve as novel markers to help the assessment of gait in those with PD as well as the rehabilitation of this vulnerable cohort.

3.
Food Chem ; 317: 126410, 2020 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-32070844

RESUMO

A heterocyclic hypercrosslinked polymer (Py-DMB HCP) was prepared by Friedel-Crafts alkylation reaction using pyrrole as monomer and p-dimethoxybenzene as crosslinker. The Py-DMB HCP was employed as an adsorbent for solid-phase extraction (SPE) of phenylurea herbicides (PUHs) and showed superior extraction performance. Thus, a sensitive analytical method for the determination of PUHs from soybean milk and tomato samples was established by combining Py-DMB HCP based SPE with high performance liquid chromatography. Under the optimal conditions, good sensitivity was achieved with the detection limits of 0.10-0.20 ng mL-1 and 0.06-0.15 ng g-1 for soybean milk and tomato samples, respectively. The linearity range of PUHs was 0.3-150.0 ng mL-1 and 0.2-150.0 ng g-1, respectively. The recoveries were 87.4% to 116% with relative standard deviations lower than 6.5%. Density functional theory calculation was performed to study the intermolecular interaction mechanism, demonstrating the coexistence of both the H-bonding and π-π interactions in the adsorption process.


Assuntos
Contaminação de Alimentos/análise , Herbicidas/análise , Lycopersicon esculentum/química , Compostos de Fenilureia/análise , Leite de Soja/química , Cromatografia Líquida de Alta Pressão/métodos , Análise de Alimentos/métodos , Concentração de Íons de Hidrogênio , Limite de Detecção , Polímeros/química , Sensibilidade e Especificidade , Extração em Fase Sólida/métodos
4.
ACS Nano ; 14(2): 2126-2136, 2020 02 25.
Artigo em Inglês | MEDLINE | ID: mdl-32027121

RESUMO

Similar to translated thermal ablative techniques in clinic, the occurrence of cellular necrosis during tumor photothermal therapy (PTT) would induce inflammatory responses that are detrimental to therapeutic outcomes. Inspired by the well-known colorimetric Folin-Ciocalteu assay, monodispersed and renal-clearable tungsten (W)-based polyoxometalate nanoclusters (W-POM NCs, average diameter of around 2.0 nm) were successfully obtained here through a facile redox reaction with natural gallic acid in alkaline aqueous solution. Apart from excellent stability in the form of freeze-dried powder, the as-prepared W-POM NCs occupied considerable biocompatibility toward normal cells/tissues both in vitro and in vivo, since no obvious toxicities were observed by treating female Balb/c mice with concentrated W-POM NCs during the 30 day post-treatment period. More importantly, W-POM NCs exhibited not only considerable near-infrared (NIR) light absorption (coloration effect originated from the existence of electron-trapped W5+) for efficient PTT but also impressive anti-inflammatory ability (eliminating inflammation-related reactive oxygen species by the oxidation of W5+ into W6+ state) to achieve better therapeutic outcomes. Thus, our study pioneers the application of POMs for non-inflammatory PTT with expected safety and efficiency.

5.
Neurosci Lett ; 720: 134775, 2020 02 16.
Artigo em Inglês | MEDLINE | ID: mdl-31972253

RESUMO

The dynamics of the resting-state activity in brain functional networks are complex, containing meaningful patterns over multiple temporal scales. Such physiologic complexity is often diminished in older adults. Here we aim to examine if the resting-state complexity within functional brain networks is sensitive to functional status in older adults and if repeated exposure to transcranial direct current stimulation (tDCS) would modulate such complexity. Twelve older adults with slow gait and mild-to-moderate executive dysfunction and 12 age- and sex-matched controls completed a baseline resting-state fMRI (rs-fMRI). Ten participants in the functionally-limited group then completed ten 20-minute sessions of real (n = 6) or sham (n = 4) tDCS targeting the left prefrontal cortex over a two-week period as well as a follow-up rs-fMRI. The resting-state complexity associated with seven functional networks was quantified by averaging the multiscale entropy (MSE) of the blood oxygen level-dependent (BOLD) time-series for all voxels within each network. Compared to controls, functionally-limited group exhibited lower complexity in the motor, ventral attention, limbic, executive and default mode networks (F > 6.3, p < 0.02). Within this group, those who received tDCS exhibited greater complexity within the ventral, executive and limbic networks (p < 0.04) post intervention as compared to baseline, while no significant changes in sham group was observed. This study provides preliminary evidence that older adults with functional limitations had diminished complexity of resting-state brain network activity and repeated exposure to tDCS may increase that resting-state complexity, warranting future studies to establish such complexity as a marker of brain health in older adults.

6.
Ann Neurol ; 87(1): 75-83, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31693765

RESUMO

OBJECTIVE: Symptomatic head trauma associated with American-style football (ASF) has been linked to brain pathology, along with physical and mental distress in later life. However, the longer-term effects of such trauma on objective metrics of cognitive-motor function remain poorly understood. We hypothesized that ASF-related symptomatic head trauma would predict worse gait performance, particularly during dual task conditions (ie, walking while performing an additional cognitive task), in later life. METHODS: Sixty-six retired professional ASF players aged 29 to 75 years completed a health and wellness questionnaire. They also completed a validated smartphone-based assessment in their own homes, during which gait was monitored while they walked normally and while they performed a verbalized serial-subtraction cognitive task. RESULTS: Participants who reported more symptomatic head trauma, defined as the total number of impacts to the head or neck followed by concussion-related symptoms, exhibited greater dual task cost (ie, percentage increase) to stride time variability (ie, the coefficient of variation of mean stride time). Those who reported ≥1 hit followed by loss of consciousness, compared to those who did not, also exhibited greater dual task costs to this metric. Relationships between reported trauma and dual task costs were independent of age, body mass index, National Football League career duration, and history of musculoskeletal surgery. Symptomatic head trauma was not correlated with average stride times in either walking condition. INTERPRETATION: Remote, smartphone-based assessments of dual task walking may be utilized to capture meaningful data sensitive to the long-term impact of symptomatic head trauma in former professional ASF players and other contact sport athletes. ANN NEUROL 2020;87:75-83.


Assuntos
Cognição/fisiologia , Traumatismos Craniocerebrais/fisiopatologia , Futebol Americano/lesões , Marcha/fisiologia , Adulto , Idoso , Concussão Encefálica/complicações , Concussão Encefálica/fisiopatologia , Traumatismos Craniocerebrais/complicações , Humanos , Masculino , Pessoa de Meia-Idade , Tecnologia de Sensoriamento Remoto/métodos , Aposentadoria , Autorrelato , Smartphone/estatística & dados numéricos , Inquéritos e Questionários
7.
Food Chem ; 309: 125618, 2020 Mar 30.
Artigo em Inglês | MEDLINE | ID: mdl-31767479

RESUMO

In this study, a porous organic polymer (denoted as Car-DMB) was fabricated by a simple one-step crosslinking polymerization of carbazole and p-dimethoxybenzene for the first time. Then the Car-DMB was served as adsorbent of solid phase extraction to enrich triazine herbicides from white gourd, tomato and soybean milk samples prior to their determination by high performance liquid chromatography. Under the optimal conditions, the response linearity was in the range of 0.3-100.0 ng g-1 for white gourds and tomato samples, and 0.5-100.0 ng mL-1 for soybean milk, with the coefficient of determination higher than 0.996. The detection limits were 0.1-0.2 ng g-1 for white gourd and tomato samples, and 0.15-0.3 ng mL-1 for soybean milk. The adsorption mechanism of the Car-DMB for the triazines was attributed to the strong H-bonding and weak π-π interactions. The efficient extraction for several other compounds demonstrated that Car-DMB holds great potential for diverse analysis applications.


Assuntos
Herbicidas/isolamento & purificação , Polímeros/química , Extração em Fase Sólida/métodos , Triazinas/isolamento & purificação , Verduras/química , Adsorção , Anisóis/química , Carbazóis/química , Cromatografia Líquida de Alta Pressão , Reagentes para Ligações Cruzadas/química , Teoria da Densidade Funcional , Análise de Alimentos/métodos , Herbicidas/análise , Limite de Detecção , Nanotubos de Carbono/química , Polímeros/síntese química , Poliestirenos/química , Porosidade , Extração em Fase Sólida/instrumentação , Triazinas/análise
8.
Front Neurosci ; 13: 1075, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31680815

RESUMO

Foot-sole somatosensory impairment is a main contributor to balance decline and falls in aging and disease. The cortical networks involved in walking-related foot sole somatosensation, however, remain poorly understood. We thus created and tested a novel MRI-compatible device to enable study of the cortical response to pressure stimuli applied to the foot sole that mimic those stimuli experienced when walking. The device consists of a dual-drive stimulator equipped with two pneumatic cylinders, which are separately programed to apply pressure waveforms to the entire foot sole. In a sample of nine healthy younger adults, the pressure curve applied to the foot sole closely correlated with that experienced during over ground walking (r = 0.811 ± 0.043, P < 0.01). MRI compatibility testing indicated that the device has no or negligible impact on MR image quality. Gradient-recalled echo-planar images of nine healthy young adults using a block-designed 3.5-min walking-related stimulation revealed significant activation within the supplementary motor area, supramarginal gyrus, paracingulate gyri, insula, precentral gyrus, middle temporal gyrus, and hippocampus (uncorrected P < 0.001, k ≥ 10). Together, these results indicate that this stimulation system is MRI-compatible and capable of mimicking walking-related pressure waveforms on foot sole. It may thus be used as a research tool to identify cortical targets for interventions (e.g., non-invasive brain stimulation) aimed at enhancing this important source of input to the locomotor control system.

9.
Artigo em Inglês | MEDLINE | ID: mdl-31585008

RESUMO

BACKGROUND: In older adults, compromised white matter tract integrity within the brain has been linked to impairments in mobility. We contend that poorer integrity disrupts mobility by altering the processing of sensorimotor, cognitive and attentional resources in neural networks. The richness of information processing in a given network can be quantified by calculating the complexity of resting-state fMRI time-series. We hypothesized that: 1) older adults with lower brain complexity, specifically within sensorimotor, executive and attention networks, would exhibit slower walking speed and greater dual-task costs (i.e., DTC); and 2) such complexity would mediate the effect of white matter integrity on these metrics of mobility. METHOD: Fifty-three older adults completed a walking assessment and a neuroimaging protocol. Brain complexity was quantified by calculating the multiscale entropy of the resting-state fMRI signal within seven previously defined functional networks. The white matter integrity across structures of the corpus callosum was quantified using fractional anisotropy (FA). RESULTS: Participants with lower resting-state complexity within the sensorimotor, executive and attention networks walked more slowly under single- and dual-task (i.e., walking while performing a serial-subtraction task) conditions (ß>0.28, p≤0.01) and had a greater DTC (ß<-0.28, p<0.04). Complexity in these networks mediated the influence of the corpus callosum genu on both single- (indirect effects>0.15, 95% CIs=0.02~0.32) and dual-task walking speeds (indirect effects>0.13, 95% CIs=0.02~0.33). CONCLUSION: These results suggest that the multi-scale dynamics of resting-state brain activity correlate with mobility and mediate the effect of the microstructural integrity in the corpus callosum genu on walking speed in older adults.

10.
Glob Adv Health Med ; 8: 2164956119870984, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31489259

RESUMO

Background: The objective was to assess the feasibility of a prenatal yoga randomized controlled trial (RCT) for gestational low back pain (LBP), mobility, and maternal well-being. Methods: In this pilot, women aged 18 to 39 years with uncomplicated pregnancies at 12 to 26 weeks were randomized, stratified by presence of LBP, to attend a weekly yoga class or a time-matched educational support group for 12 weeks. Sample size was based on anticipated enrollment of 2 subjects per month. Primary outcomes were measures of feasibility and acceptability. Secondary outcomes included LBP disability, pregnancy symptom burden, childbirth self-efficacy, instrumented gait, balance, and falls at baseline, every 4 weeks, and 6 weeks postpartum. Results: From April 2015 to December 2015, 168 women were contacted and 115 (68%) were eligible. Twenty women enrolled (N = 11 yoga; N = 9 control; mean gestational age 20.2 weeks). Retention at 12 weeks was 81% in yoga and 77% in control. There were no yoga-related adverse events. Exploratory analyses show no differences in back pain disability between groups. Significant groups effects were found on biomechanical assessments, including percentage change in gait speed (F = 4.4, P = .04), double support time (F = 23.6, P < .01), instrumented timed-up-and-go (F = 8.6, P < .01), and turn time (F = 5.7, P = .02) suggesting clinically relevant improvements with yoga. Pregnancy Symptom Inventory (PSI) scores improved (13.1 point difference, 95% confidence interval, 5.1-21.1) at 12 weeks in yoga compared to control, adjusted for baseline gestational age. Conclusion: Conducting an RCT of prenatal yoga to improve gestational LBP and maternal well-being is feasible and safe. While no differences in back pain were observed, biomechanical measures were sensitive assessments for evaluating gestational LBP-related mobility impairment and showed group differences. Additionally, the PSI showed significant differences in symptom burden over 12 weeks, supporting the ongoing claims that yoga improves a pregnant woman's overall well-being.

11.
J Sports Sci ; 37(22): 2625-2630, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31379263

RESUMO

The dynamics of tremulous motion in the upper limb is complex. We aimed to explore the relationship between the complexity of upper limb tremor when aiming and aiming performance and the influences of physical load on the two outcomes. Fifteen modern pentathlon athletes were recruited and completed two 1000-m treadmill running and three 60-s standard aiming task trials: one at baseline and each of the other two immediately after each running. The time series of light spot trace on the target was measured using a high-speed camera. The complexity of this time series was quantified using multiscale entropy. The effective aiming rate was used to assess the aiming performance. We observed that participants with lower tremor complexity had lower effective aiming rate across three physical load conditions (r2 > 0.38, p < 0.01). Physical load decreased both tremor complexity (F = 4.8, p = 0.01) and effective aiming rate (F = 13.5, p < 0.0001), but no difference was observed after 1000-m running compared to that after 2000-m running. The per cent change of tremor complexity associated with the change of effective aiming rate (r2 = 0.55, p < 0.0001). This pilot study demonstrates that multiscale complexity of tremulous motion in the upper limb when aiming may serve as a novel marker to assess the physiologic system functionality when aiming.


Assuntos
Desempenho Atlético/fisiologia , Movimento/fisiologia , Esportes/fisiologia , Extremidade Superior/fisiologia , Adulto , Feminino , Armas de Fogo , Humanos , Masculino , Projetos Piloto , Corrida/fisiologia , Análise e Desempenho de Tarefas , Tremor/fisiopatologia , Suporte de Carga , Adulto Jovem
12.
Front Neurol ; 10: 654, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31293499

RESUMO

The fatigue in aerobic exercise affects the task performance. In addition to the fatigue in the muscular system, the diminished performance may arise from the altered cerebral blood supply and oxygen extraction. However, the effects of the fatiguing aerobic exercise on the ability of brain to regulate the cerebral blood flow (CBF) and to extract the oxygen are not fully understood. In this pilot study, we aim to quantify such effects via advanced functional MRI techniques. Twenty healthy younger elite athletes were recruited. In the screening visit, one circle ergometer test was used to screen the maximal relative oxygen consumption (VO2max). Eleven eligible participants then completed the next MRI visit after 7 days. These participants completed a 2-min pulsed arterial spin labeling (ASL) using the PICORE/QUIPSS II and 5-min asymmetric spin echo (ASE) scan at baseline and immediately after the aerobic circle ergometer test. The CBF was then measured using the ASL images and the oxygen consumption of the brain was quantified using oxygen extraction fractions (OEF) derived from the ASE images. The test time, VO2max, and anaerobic threshold were also recorded. As compared to baseline, participants had significant reduction of global CBF (p = 0.003). Specifically, the CBF in bilateral striatum, left middle temporal gyrus (MTG) and right inferior frontal gyrus (IFG) decreased significantly (p < 0.005, K > 20). No significant changes of the OEFs were observed. Participants with greater OEF within the right striatum at baseline had longer test time, greater anaerobic threshold and relative VO2max (r 2 > 0.51, p < 0.007). Those with longer test time had less reduction of CBF within the right IFG (r 2 = 0.55, p = 0.006) and of OEF within the left striatum (r 2 = 0.52, p = 0.008). Additionally, greater anaerobic threshold was associated with less reduction of OEF within the left MTG (r 2 = 0.49, p = 0.009). This pilot study provided first-of-its-kind evidence suggesting that the fatiguing aerobic exercise alters the cerebral blood supply in the brain, but has no significant effects on the ability of brain to extract oxygenation. Future studies are warranted to further establish the CBF and OEF as novel markers for physical and physiological function to help the assessment in the sports science and clinics.

13.
Mikrochim Acta ; 186(3): 145, 2019 02 01.
Artigo em Inglês | MEDLINE | ID: mdl-30707320

RESUMO

A new covalent organic framework (COF) was synthesized by the amide coupling between 1,3,5-tris(4-aminophenyl)benzene and trimesoyl chloride at room temperature. The COF was applied as a steel fiber coating for the solid phase microextraction of polycyclic aromatic hydrocarbons (PAHs) from water samples. The effect of extraction time, salt concentration, and extraction temperature on the efficiency of SPME was optimized by a Box-Behnken design. The PAHs were quantified by gas chromatography with mass spectrometric detection. Figures of merit include (a) a wide linear range (typically from 0.2 ng L-1 to 2 µg L-1), (b) low limits of detection (0.29 to 0.94 ng L-1 at S/N = 3), and (c) high enrichment factors (EFs; 819-2420). Density functional theory was employed to study the interaction between the COF cluster and the PAHs. The results demonstrated that the EFs increase with the enhancement of π stacking interaction. The repeatability (one fiber; n = 5) and reproducibility (fiber to fiber; n = 5), expressed as the relative standard deviations were in the range of 4.3%-8.4% and 8.5-11.0%, respectively. The recoveries of the PAHs from water samples spiked at levels of 20.0 and 100 ng L-1 ranged from 79.0% to 105.0%. Graphical abstract A covalent organic framework prepared from 1,3,5-tris(4-aminophenyl)benzene and trimesoyl chloride (TAPB-TMC-COF) was synthesized and employed as solid phase microextraction (SPME) fiber coating for the extraction of polycyclic aromatic hydrocarbons from water samples prior to gas chromatography (GC) - mass spectrometric (MS) detection.

14.
Front Neurol ; 10: 73, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30809184

RESUMO

Spinocerebellar ataxia (SCA) is a neurodegenerative disorder caused by dysfunction of the cerebellum and its connected neural networks. There is currently no cure for SCA and symptomatic treatment remains limited. We aimed here to examine the effects of a repetitive transcranial magnetic stimulation (rTMS) targeting the cerebellum on clinical impression, postural control and gait in patients with SCA. In this randomized, double-blinded and sham-controlled study, 20 individuals aged 18-75 years with SCA confirmed by genetic testing completed rTMS or sham intervention comprising 20 sessions of MRI-guided stimulation over the cerebellum. Baseline assessments included the Standard Ataxia Rating Assessment (SARA), the 9-hole peg test of manual dexterity, the Timed Up-and-Go (TUG) test, standing postural control with eyes-open and eyes-closed, and gait. Immediate (within 1-week) and 1-month follow-ups were completed. Intervention compliance was high (19 ± 2 of 20 sessions) and no rTMS-related adverse events were reported. rTMS, compared to sham, was associated with greater percent improvement in SARA total score from baseline to the 1-month follow-up (p = 0.008). Secondary analyses of individual SARA items revealed that rTMS improved performance within the "stance" sub-score only (p = 0.002). This functional change was accompanied by improvement to several objective metrics of postural sway during eyes-open and eyes-closed standing (p < 0.008). rTMS did not influence the 9-hole peg test, TUG, or gait kinematics. A 20-session rTMS intervention is safe and feasible for those with SCA. Additional research is warranted to confirm the observed longer-term benefits of this intervention on standing postural control. Clinical Trial Registration: www.ClinicalTrials.gov, identifier: NCT01975909.

15.
J Am Geriatr Soc ; 67(4): 794-798, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30674067

RESUMO

BACKGROUND/OBJECTIVES: Every year, up to 40% of the more than 16 million older Americans who undergo anesthesia/surgery develop postoperative cognitive dysfunction (POCD) or delirium. Each of these distinct syndromes is associated with decreased quality of life, increased mortality, and a possible increased risk of Alzheimer's disease. One pathologic process hypothesized to underlie both delirium and POCD is neuroinflammation. The INTUIT study described here will determine the extent to which postoperative increases in cerebrospinal fluid (CSF) monocyte chemoattractant protein 1 (MCP-1) levels and monocyte numbers are associated with delirium and/or POCD and their underlying brain connectivity changes. DESIGN: Observational prospective cohort. SETTING: Duke University Medical Center, Duke Regional Hospital, and Duke Raleigh Hospital. PARTICIPANTS: Patients 60 years of age or older (N = 200) undergoing noncardiac/nonneurologic surgery. MEASUREMENTS: Participants will undergo cognitive testing before, 6 weeks, and 1 year after surgery. Delirium screening will be performed on postoperative days 1 to 5. Blood and CSF samples are obtained before surgery, and 24 hours, 6 weeks, and 1 year after surgery. CSF MCP-1 levels are measured by enzyme-linked immunosorbent assay, and CSF monocytes are assessed by flow cytometry. Half the patients will also undergo pre- and postoperative functional magnetic resonance imaging scans. 32-channel intraoperative electroencephalogram (EEG) recordings will be performed to identify intraoperative EEG correlates of neuroinflammation and/or postoperative cognitive resilience. Eighty patients will also undergo home sleep apnea testing to determine the relationships between sleep apnea severity, neuroinflammation, and impaired postoperative cognition. Additional assessments will help evaluate relationships between delirium, POCD, and other geriatric syndromes. CONCLUSION: INTUIT will use a transdisciplinary approach to study the role of neuroinflammation in postoperative delirium and cognitive dysfunction and their associated functional brain connectivity changes, and it may identify novel targets for treating and/or preventing delirium and POCD and their sequelae. J Am Geriatr Soc 67:794-798, 2019.

17.
BMC Geriatr ; 18(1): 274, 2018 11 12.
Artigo em Inglês | MEDLINE | ID: mdl-30419857

RESUMO

BACKGROUND: Peripheral sensory loss is considered one of many risk factors for gait impairments and falls in older adults, yet no prospective studies have examined changes in touch sensation in the foot over time and their relationship to mobility and falls. Therefore, we aimed to determine the prevalence and progression of peripheral sensory deficits in the feet of older adults, and whether sensory changes are associated with the slowing of gait and development of falls over 5 years. METHODS: Using baseline, and 18 and 60 month followup data from the Maintenance Of Balance, Independent Living, Intellect, and Zest in the Elderly (MOBILIZE) Study in Boston, MA, we determined changes in the ability to detect stimulation of the great toe with Semmes Weinstein monofilaments in 351 older adults. We used covariate-adjusted repeated measures analysis of variance to determine relationships between sensory changes and gait speed or fall rates. RESULTS: Subjects whose sensory function was consistently impaired over 5 years had a significantly steeper decline in gait speed (- 0.23 m/s; 95% CI: -0.28 to - 0.18) compared to those with consistently intact sensory function (- 0.12 m/s; 95% CI: -0.15 to - 0.08) and those progressing from intact to impaired sensory function (- 0.13 m/s; - 0.16 to - 0.10). Compared to subjects with consistently intact sensation, those whose sensory function progressed to impairment during followup had the greatest risk of falls (adjusted risk ratio = 1.57 (95% confidence interval = 1.12 to 2.22). CONCLUSIONS: Our longitudinal results indicate that a progressive decline in peripheral touch sensation is a risk factor for mobility impairment and falls in older adults.


Assuntos
Acidentes por Quedas/estatística & dados numéricos , Transtornos Neurológicos da Marcha/diagnóstico , Equilíbrio Postural/fisiologia , Velocidade de Caminhada/fisiologia , Idoso , Idoso de 80 Anos ou mais , Feminino , Seguimentos , Transtornos Neurológicos da Marcha/fisiopatologia , Humanos , Estudos Longitudinais , Masculino , Prevalência , Prognóstico , Estudos Prospectivos , Teste de Caminhada
18.
J Endourol ; 32(12): 1154-1159, 2018 12.
Artigo em Inglês | MEDLINE | ID: mdl-30398381

RESUMO

INTRODUCTION: A novel semirigid ureterorenoscope, named the Sotn ureterorenoscope, was designed with a vacuum suction system. The present study aimed to evaluate the feasibility and safety of using the Sotn ureterorenoscope to manage single proximal ureteral or renal pelvic stones. PATIENTS AND METHODS: Data were retrospectively collected from consecutive patients treated with a Sotn ureterorenoscope between February 2010 and August 2015 at Sun Yat-sen Memorial Hospital of Sun Yat-sen University and Jiangmen Wuyi Traditional Chinese Medicine Hospital in China. The primary outcome was the primary stone-free rate (SFR) in 1 month. The secondary outcomes were the final SFR and the perioperative complication rate. RESULTS: A total of 386 patients were evaluated, including 240 males and 146 females. The median (interquartile range [IR]) age was 50 (40-59) years. There were 96 and 290 stones located in the renal pelvis and proximal ureter, respectively. The median (IR) operative time and console time for all patients were 40 (30-70) and 20 (12-38) minutes, respectively. The primary overall SFR was 86.5%, whereas the SFRs for stones with a diameter of ≤1, 1 to 2, and 2 to 3 cm were 95.7%, 86.9%, and 69.0%, respectively. Complications occurred in 90 patients (23.3%); these complications were classified as Clavien-Dindo grades 1 to 2 (minor) in 79 (20.5%) patients, and grades 3 to 4 (major) in 11 (2.8%). CONCLUSIONS: The novel semirigid Sotn ureterorenoscope featuring a vacuum suction system is effective and safe for managing proximal ureteral and renal pelvic stones.


Assuntos
Cálculos Renais/diagnóstico por imagem , Cálculos Ureterais/diagnóstico por imagem , Ureteroscópios , Ureteroscopia/instrumentação , Adulto , Idoso , China , Feminino , Humanos , Cálculos Renais/cirurgia , Pelve Renal/diagnóstico por imagem , Pelve Renal/cirurgia , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Estudos Retrospectivos , Sucção , Resultado do Tratamento , Ureter , Cálculos Ureterais/cirurgia , Vácuo
19.
Sci Rep ; 8(1): 14456, 2018 09 27.
Artigo em Inglês | MEDLINE | ID: mdl-30262859

RESUMO

This study aims to investigate how the frequency settings of deep brain stimulation (DBS) targeting the subthalamic nucleus (STN) influence the motor symptoms of Parkinson's disease (PD). Stimulation with frequencies less than 100 Hz (mostly 60 or 80 Hz) is considered low-frequency stimulation (LFS) and with frequencies greater than 100 Hz (mostly 130 or 150 Hz) is considered high-frequency stimulation (HFS). We conducted a comprehensive literature review and meta-analysis with a random-effect model. Ten studies with 132 patients were included in our analysis. The pooled results showed no significant difference in the total Unified Parkinson Disease Rating Scale part III (UPDRS-III) scores (mean effect, -1.50; p = 0.19) or the rigidity subscore between HFS and LFS. Compared to LFS, HFS induced greater reduction in the tremor subscore within the medication-off condition (mean effect, 1.01; p = 0.002), while no significance was shown within the medication-on condition (mean effect, 0.01; p = 0.92). LFS induced greater reduction in akinesia subscore (mean effect, -1.68, p = 0.003), the time to complete the stand-walk-sit (SWS) test (mean effect, -4.84; p < 0.00001), and the number of freezing of gait (FOG) (mean effect, -1.71; p = 0.03). These results suggest that two types of frequency settings may have different effects, that is, HFS induces better responses for tremor and LFS induces greater response for akinesia, gait, and FOG, respectively, which are worthwhile to be confirmed in future study, and will ultimately inform the clinical practice in the management of PD using STN-DBS.


Assuntos
Estimulação Encefálica Profunda/métodos , Marcha , Doença de Parkinson , Núcleo Subtalâmico/fisiopatologia , Tremor , Caminhada , Ensaios Clínicos como Assunto , Estimulação Encefálica Profunda/instrumentação , Feminino , Humanos , Masculino , Doença de Parkinson/fisiopatologia , Doença de Parkinson/terapia , Tremor/fisiopatologia , Tremor/terapia
20.
Neurorehabil Neural Repair ; 32(9): 788-798, 2018 09.
Artigo em Inglês | MEDLINE | ID: mdl-30132389

RESUMO

OBJECTIVE: To determine the effects of a transcranial direct current stimulation (tDCS) intervention with the anode placed over the left dorsolateral prefrontal cortex (dlPFC) and cathode over the right supraorbital region, on cognition, mobility, and "dual-task" standing and walking in older adults with mild-to-moderate motor and cognitive impairments. METHODS: A double-blinded, block-randomized, sham-controlled trial was conducted in 18 nondemented, ambulatory adults aged ⩾65 years with slow walking speed (⩽1.0 m/s) and "executive" dysfunction (Trail Making Test B score ⩽25th percentile of age- and education-matched norms). Interventions included ten 20-minute sessions of tDCS or sham stimulation. Cognition, mobility, and dual-task standing and walking were assessed at baseline, postintervention, and 2 weeks thereafter. Dual tasking was also assessed immediately before and after the first tDCS session. RESULTS: Intervention compliance was high (mean ± SD = 9.5 ± 1.1 sessions) and no unexpected or serious side effects were reported. tDCS, compared with sham, induced improvements in the Montreal Cognitive Assessment total score ( P = .03) and specifically within the executive function subscore of this test ( P = .002), and in several metrics of dual-task standing and walking ( P < .05). Each of these effects persisted for 2 weeks. tDCS had no effect on the Timed Up-and-Go test of mobility or the Geriatric Depression Scale. Those participants who exhibited larger improvements in dual-task standing posture following the first tDCS session exhibited larger cognitive-motor improvements following 2 weeks of tDCS ( P < .04). INTERPRETATION: tDCS intervention designed to stimulate the left dorsolateral prefrontal cortex may improve executive function and dual tasking in older adults with functional limitations.


Assuntos
Cognição/fisiologia , Destreza Motora/fisiologia , Caminhada/fisiologia , Idoso , Método Duplo-Cego , Função Executiva/fisiologia , Feminino , Humanos , Masculino , Testes Neuropsicológicos , Estimulação Transcraniana por Corrente Contínua , Resultado do Tratamento
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