The comparative effectiveness of combined hydrodilatation/corticosteroid procedure with two different quantities for adhesive capsulitis.

OBJECTIVE: To assess the efficacy of injecting various amounts of fluid into the shoulder joints for capsule distension in patients with adhesive capsulitis. DESIGN: A randomized controlled trial. SETTING: Outpatient clinic of a tertiary care centre. PARTICIPANTS: Eighty-four patients with adhesive capsulitis underwent a baseline (time0), 6 weeks (time1), and 12 weeks (time2) follow-up after hydrodilitation. INTERVENTION: Group 1 (n = 42) received 20 ml of lidocaine, steroid, and saline hydrodilatation via posterior glenohumeral recess, while Group 2 (n = 42) received 10 ml of lidocaine, steroid, and saline hydrodilitation. MAIN MEASURES: The primary outcome was the visual analogue scale for pain. The secondary outcomes were shoulder pain and disability index (SPADI) and ROM of the shoulder. RESULTS: There was a significant reduce in VAS scores for pain, SPADI scores, and increased shoulder ROM in both groups over time; however, the group-by-time interactions for any of the outcomes between groups were not significant except VAS pain in motion. Post-hoc pairwise analysis of the marginal effect of time and group showed that the significant difference of VAS in motion is due to time effect: time1 vs time0 (95% CI -4.09 to -2.68), time2 vs time0 (-4.21 to -2.77), and time2 vs time1 (-0.83 to 0.63), without between-group difference: group 1 vs group 2 (-0.38 to 0.59). CONCLUSION: Our study suggests hydrodilatation achieved an optimal effect at time1 for patients with adhesive capsulitis in both groups, and adding more saline offers additional benefits in flexion and external roatation until time2.

[The Effect of Using a Real-Time Feedback Device on the Quality of Cardio Pulmonary Resuscitation (CPR)].

BACKGROUND: Cardiopulmonary resuscitation (CPR) is a standard procedure delivered to patients experiencing cardiac arrest. CPR quality is associated with the rate of survival of patients with cardiac arrest. PURPOSE: To determine the efficacy of a real-time feedback device in terms of improving CPR performance quality and CPR self-efficacy in nursing staffs. METHODS: A total of 72 nursing staffs were enrolled in this randomized trial (intervention n = 38, control n = 34). A real-time feedback device was used to monitor CPR quality and provide real-time feedback. The participants performed CPR on a manikin with (intervention) or without (control) feedback for 5 cycles (about 2 minutes). Data on participant demographic characteristics and CPR self-efficacy scores were also collected. RESULTS: The intervention group performed better in terms of the compression adequate rate ratio (76.3 vs. 52.3, p < .001), mean depth (52.8 mm vs. 50.6 mm, p = .003), adequate depth ratio (65.6 vs. 55.1, p = .014), quality of CPR performance score (44.1 vs. 26.1, p < .001), proportion of excellent CPR (60.5 vs. 26.5, p < .001), and CPR self-efficacy score (40.22 vs. 36.71, p < .001). However, no significant differences between the two groups were found in terms of proportion of complete chest decompression and chest compression fracture (p >.05). CONCLUSIONS: Using a real-time feedback device may not only significantly improve the quality of CPR performed on a manikin but also improve self-confidence to implement CPR correctly in practice.

High-frequency versus theta burst transcranial magnetic stimulation for the treatment of poststroke cognitive impairment in humans

Background: Because the reliability of repetitive transcranial magnetic stimulation (rTMS) in treating poststroke cognitive impairment has not been convincingly demonstrated, we systematically examined the effectiveness of this regimen with 2 protocols. Methods: We randomly allocated 41 patients with poststroke cognitive impairment to receive 5 Hz rTMS (n = 11), intermittent theta burst stimulation (iTBS; n = 15) or sham stimulation (n = 15). Each group received 10 stimulation sessions over the left dorsolateral prefrontal cortex. We performed the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) and the Beck Depression Inventory at baseline and after the intervention. Results: The 5 Hz rTMS group showed significantly greater improvement than the sham group in RBANS total score (p = 0.006), attention (p = 0.001) and delayed memory (p < 0.001). The iTBS group showed significantly greater improvement than the sham group in RBANS total score (p = 0.005) and delayed memory (p = 0.007). The 5 Hz rTMS group exhibited a superior modulating effect in attention compared to the iTBS group (p = 0.016). Patients without comorbid hypertension (p = 0.008) were predisposed to favourable therapeutic outcomes. Limitations: Although we included only patients with left hemispheric stroke, heterogeneity associated with cortical and subcortical implications existed. We did not investigate the remote effects of rTMS. Conclusion: Our results demonstrated that both 5 Hz rTMS and iTBS were effective for poststroke cognitive impairment in terms of global cognition, attention and memory function; the domain of attention was susceptible to 5 Hz modulation. Treatment with 5 Hz rTMS may slow cognitive decline, representing both a pivotal process in poststroke cognitive impairment and an aspect of neuroplasticity that contributes to disease-modifying strategies. Clinical trial registration: NCT02006615; clinicaltrials.gov/ct2/show/NCT02006615.

Effects of individualized Tai-Chi on balance and lower-limb strength in older adults.

BACKGROUND: To investigate whether a simplified and personalized Tai-Chi program could be beneficial for practitioners. A prospective quasi-experimental observer-blinded controlled trial was done in Beitou District of Taipei City. METHODS: Community-dwelling adults aged 65 and older without debilitating disease (N = 50) participated the study. Those who were willing to participate in exercise program were assigned to individualized Tai-Chi (iTC) group (n = 20), receiving iTC training for 8 weeks, and traditional Tai-Chi (tTC) group (n = 15), receiving tTC training for 8 weeks. Those who were not willing to participate in exercise training were included in the control group (n = 15). Functional balance tests, the Berg Balance Scale (BBS), timed up-and-go (TUG) test, functional-reach test, and measurement of lower-extremity muscle strength were conducted before and 8 weeks after the intervention. RESULTS: Significant improvements were noted in all functional balance tests and strength assessments of 16 major lower-limb muscle groups in participants of the iTC group compared to the control group, whereas only BBS and muscle strength of hips and ankles were improved in the tTC group. Practitioners of iTC outperformed tTC in BBS and strength of two major muscles. CONCLUSIONS: Personalized Tai-Chi training designed based on an objective measurement and conducted according to graded intensity and complexity benefitted practitioners after a short period. TRIAL REGISTRATION: Trial registration number: ClinicalTrials.gov ID: NCT03659396 , Unique Protocol ID: 1000087 Date of registration: 03/28/2017 The trial was registered retrospectively.

Detection of free flap pedicle thrombosis by infrared surface temperature imaging.

BACKGROUND: Reliable detection of any circulatory issue threatening flap viability after free flap surgery is essential for prompt flap salvage. Currently, the gold standard of flap monitoring is clinical monitoring. However, this method presents logistical challenges to insufficient trained personnel. Auxiliary methods are becoming increasingly vital. MATERIALS AND METHODS: Twelve swine pedicle myocutaneous flaps were harvested and monitored using infrared cameras to investigate the developed monitoring parameters and vascular thrombosis in the free flap model. RESULTS: The mean flap surface temperature after vein or artery occlusion decreased significantly, but the differences were relatively small. As a result, the difference between recorded (flap surface temperature [Ts]) and predicted (estimated surface temperature [Tes]) flap surface temperature (ΔT = Ts- Tes) was used as the parameter for pedicle thrombosis. A ΔT of <0.86°C was used as a vascular occlusion criterion; the sensitivity and specificity of this parameter were 90% and 81%, respectively. The standard deviation of the surface temperature (SDT) was another indicator of vascular occlusion; the estimated sensitivity and specificity for vessel occlusion of SDT < 0.48°C were 84% and 73%, respectively. CONCLUSIONS: Infrared thermal imaging has the advantages of being noninvasive, contact-free, continuous, and able to detect the whole flap surface area. Two indicators, ΔT and SDT, can be used with high sensitivity and specificity for early prediction of flap pedicle thrombosis. Further human studies are necessary to validate clinical application of infrared thermal imaging.

Why teaching innovation matters: Evidence from a pre- versus peri-COVID-19 pandemic comparison of student evaluation data.

The COVID-19 pandemic has robustly affected global education environments, so higher education institutions need to emphasize innovation and creativity in educational methods for teachers to improve their teaching performance as well as enhance the engagement and motivation of students in this changing environment. Accordingly, it is essential to discuss the role of teaching innovation in the setting of the COVID-19 pandemic compared to the pre-COVID-19 period. The aim of this study is to empirically validate the importance of teaching innovation in student evaluation of teaching before and during the COVID-19 pandemic. Data were collected from the medical college of a comprehensive university in Taiwan and were subjected to t-tests and multiple linear regression analysis. Findings from a quantitative study with 44 teachers revealed that teaching innovation was positively correlated to student evaluation of teaching. We also found that teachers who implemented teaching innovation strategies performed better than those teachers who used conventional teaching strategies on student evaluation of teaching. In particular, teaching innovative teachers had improvement in student evaluation of teaching during the time of the COVID-19 pandemic, but not non-teaching innovative teachers. The evidence from this study suggests that teaching innovation can not only enhance teachers' teaching development and performance but also boost students' motivation for learning, especially in the time of the COVID-19 pandemic. Our findings have important implications for future research on teaching innovation and for higher education institutions and faculty wishing to provide high-quality learning environments to their students.

Comparing the Effects of Stroke-Appearing and Stroke-Disappearing on Learning the Order of Strokes in Chinese Characters.

Different approaches to stimulating perceptions in learning can be easily designed with technology-enhanced learning systems. This study aimed to explore how different approaches can influence learners' perceptions that may negatively or positively affect their learning performance of writing Chinese characters using the correct Chinese order of strokes (COS). We therefore designed an e-learning system which was subdivided into two modes: stroke-appearing (i.e., using red to mark incorrect strokes) and stroke-disappearing (i.e., using blanks to mark incorrect strokes) to indicate strokes written in the incorrect order. We then investigated the modes that would facilitate a higher level of attention and better learning outcomes. A total of 10 third-grade elementary school students participated in the experiment, divided into two test groups. Their EEG data were collected, and time series analysis and t-tests were utilized to analyze the differences. The results indicated that: (1) there was a significant difference in the attention levels of the students practicing with the stroke-appearing and stroke-disappearing modes when learning COS, and (2) there was a significant difference in the learning outcomes of the students practicing with the stroke-appearing and stroke-disappearing modes when learning COS. These findings support the specific role of stroke order knowledge in learning Chinese characters and the need for the design of an effective method for teaching children to learn Chinese characters.

Speed and temporal adaptations during nonmotorized treadmill walking in Parkinson disease and nondisabled individuals.

Few studies have explored the potential of gait analysis and training in nonmotorized treadmill (NMT) in Parkinson's disease (PD) patients. We investigated (a) the walking strategy adopted by patients with PD on NMT and (b) how balance may influence spatiotemporal gait parameters. We enrolled 12 patients with PD of modified Hoehn and Yahr stage 2-3 and 13 nondisabled individuals as controls. All participants were evaluated using Tinetti's performance oriented mobility assessment scale, freezing of gait questionnaire, modified falls efficacy scale, and the timed up and go test. They were asked to ambulate with comfortable and maximal speeds on the NMT. The gait parameters acquired on the NMT included walking speed, cadence (CAD), step length, and vertical ground reaction force, which were calculated for intragroup and intergroup comparisons. The PD group took on with higher contribution of CAD and less contribution of step length to increase walking speed as compared with control group. The postural stability is correlated significantly positively to the CAD at the setting of maximal speed in the PD group. Moreover, a significantly lower ratio of vertical ground reaction force/body weight was noted in the PD group during both comfortable and maximal walking speeds compared with the nondisabled controls. Our study outcomes clearly support the perceived benefits of NMT to differentiate spatiotemporal gait parameters between PD and controls. NMT may potentially be useful to evaluate the recovery of physical activities in PD receiving medications and/or rehabilitation.

Secondary metabolites of petri-dish cultured Antrodia camphorata and their hepatoprotective activities against alcohol-induced liver injury in mice.

Antrodia camphorata, a well-known and highly valued edible medicinal mushroom with intriguing activities like liver protection, has been traditionally used for the treatment of alcoholic liver disease. A. camphorata shows highly medicinal and commercial values with the demand far exceeds the available supply. Thus, the petri-dish cultured A. camphorata (PDCA) is expected to develope as a substitute. In this paper, nineteen triterpenes were isolated from PDCA, and thirteen of them were the unique anthroic acids in A. camphorata, including the main content antcin K, which suggested that PDCA produced a large array of the same anthroic acids as the wild one. Furthermore, no obvious acute toxicity was found suggesting the edible safety of PDCA. In mice alcohol-induced liver injury model, triglyceride (TG), aspartate aminotransferase (AST), alanine aminotransferase (ALT), and malondialdehyde (MDA) had been reduced by the PDCA powder as well as the main content antcin K, which indicated that the PDCA could protect alcoholic liver injury in mice model and antcin K could be the effective component responsible for the hepatoprotective activities of PDCA against alcoholic liver diseases.

Sonographic findings of painful hemiplegic shoulder after stroke.

BACKGROUND: Hemiplegic shoulder pain is common in stroke patients and can influence rehabilitation outcome. The underlying pathology can be various: in addition to impaired motor control and altered peripheral and central nervous activity, soft tissue lesions may also play an important role. It remains unclear how these pathologies may interact or correlate with each other. METHODS: This retrospective study collected data from 26 stroke patients who received sonography examination due to shoulder pain. Severity of soft tissue lesion over the shoulder joint was graded on the basis of the sonographic findings. The information regarding cognition, sensory function, spasticity (measured by the Modified Ashworth Scale) and the Brunnstrom stage of motor recovery was collected though medical chart review. This study examined the association between sonographic findings and the clinical findings. RESULT: This study showed that sonographic grading of painful hemiplegic shoulder is not statistically associated with impaired cognition and sensory function. (p value = 0.0587 and 0.9776, respectively) In addition, there is no correlation between sonographic grading and motor recovery in patients with hemiplegic shoulder pain. (Spearman's correlation coefficient = -0.0053, p value = 0.9796) Neither is there any statistically significant correlation between sonographic grading and the degree of spasticity. (Spearman's correlation coefficient = -0.0311, p value = 0.8801). CONCLUSION: The results of this study suggests that the mechanism through which soft tissue lesions causes hemiplegic shoulder pain may be independent of the mechanisms through which changes of muscle tone and nervous activity causes shoulder pain.

Printing a 3-dimensional, Patient-specific Splint for Wound Immobilization: A Case Demonstration.

Three-dimensional (3D) printing technology can generate objects in almost any shape and geometry. This technique also has clinical applications, such as the fabrication of specific devices based on a patient's anatomy. A demonstration study is presented of a 54-year-old man who needed a thermoplastic splint to limit arm movement while a dehisced left shoulder wound healed. The patient's upper extremity was scanned using the appropriate noncontact scanner and 3D technology software, and the polylactic acid splint was printed over the course of 66 hours. This patient-specific splint was worn during the day, and after 2 weeks the wound was healed sufficiently to permit hospital discharge. Creation of an individualized splint is one of many potential medical uses of 3D technology. Although the lengthy printing time imposes limitations, the implications for practice are positive.

Spinal cord implantation with acidic fibroblast growth factor as a treatment for root avulsion in obstetric brachial plexus palsy.

Nerve root avulsion carries the worst prognosis among brachial plexus injuries and remains a great challenge for surgeons to repair. In this case, a boy with complete avulsion of the left-side C6 root presented with flaccid paralysis of the left arm after birth. As there was no significant spontaneous recovery, the patient underwent operation when he was 6 months old. One end of the nerve graft from the sural nerve was anastomosed with the avulsed C6 root, and the other end was implanted into the ventrolateral aspect of the spinal cord with fibrin glue containing acidic fibroblast growth factor. After 2 years of follow-up, there has been significant improvement in motor function and in electrophysiologic studies over the left upper limb.

Injuries during a massive tug-of-war game.

"Tug-of-war" may cause a variety of sports injuries, which has rarely been reported previously. This report described an uncommon case of a previously fit 64-year-old male who presented with abrupt onset of loss of consciousness after falling down in a game of massive tug of war including 1,500 participants as the rope snapped apart. Computed tomography (CT) scan of his abdomen revealed liver and spleen rupture. Spinal cord injury due to traumatic herniation of intervertebral disc at C5-6 level and bilateral brachial plexus injury were also noted after exploratory laparotomy with primary repair of liver and spleen. He then received diskectomy over C5-6 and C6-7 and neurolysis for the right brachial plexus. Multiple neurological complications including paraplegia, severe neuralgia over bilateral C5 dermatome and spasticity over bilateral lower extremities developed. After two-year comprehensive rehabilitation programs, the patient recovered to ambulate with assistive device, and resumed partially dependent daily living activities.

eFurniture for home-based frailty detection using artificial neural networks and wireless sensors.

The purpose of this study is to integrate wireless sensor technologies and artificial neural networks to develop a system to manage personal frailty information automatically. The system consists of five parts: (1) an eScale to measure the subject's reaction time; (2) an eChair to detect slowness in movement, weakness and weight loss; (3) an ePad to measure the subject's balancing ability; (4) an eReach to measure body extension; and (5) a Home-based Information Gateway, which collects all the data and predicts the subject's frailty. Using a furniture-based measuring device to provide home-based measurement means that health checks are not confined to health institutions. We designed two experiments to obtain optimum frailty prediction model and test overall system performance: (1) We developed a three-step process to adjust different parameters to obtain an optimized neural identification network whose parameters include initialization, L.R. dec and L.R. inc. The post-process identification rate increased from 77.85% to 83.22%. (2) We used 149 cases to evaluate the sensitivity and specificity of our frailty prediction algorithm. The sensitivity and specificity of this system are 79.71% and 86.25% respectively. These results show that our system is a high specificity prediction tool that can be used to assess frailty.

Prevalence, characteristics, and work-related risk factors of low back pain among hospital nurses in Taiwan: a cross-sectional survey.

BACKGROUND: Low back pain is a common health problem among hospital nurses. However, the prevalence, characteristics, and work-related risk factors of low back pain have not been widely investigated in Taiwan. MATERIALS AND METHODS: This study used a cross-sectional survey of 217 hospital nurses to gather self-reported information on the prevalence of back pain, demographic and pain characteristics, and work-related risk factors from 178 respondents who indicated a past history of back pain. The association between the characteristics of back pain and work-related risk factors was also examined. RESULTS: The lifetime prevalence of back pain was 82.03%, and the point prevalence of back pain was 43.78%. The mean pain score is 41.67. The number of years at work was significantly associated with the pain score for an individual's most recent episode of back pain, the extent of bothersomeness of back pain and leg pain, and the extent to which back pain interfered with normal work. CONCLUSION: Back pain is common among hospital nurses in Taiwan. Years at work are significantly associated with pain severity and disability caused by back pain.

Characteristics and treatment of headache after traumatic brain injury: a focused review.

Headache is one of the most common complaints in patients with traumatic brain injury. By definition, headache that develops within 1 wk after head trauma (or within 1 wk after regaining consciousness) is referred to as posttraumatic headache (PTH). Although most PTH resolves within 6-12 mos after injury, approximately 18-33% of PTH persists beyond 1 yr. We performed a systematic literature review on this topic and found that many patients with PTH had clinical presentations very similar to tension-type headache (37% of all PTH) and migraine (29% of all PTH). Although there is no universally accepted protocol for treating PTH, many clinicians treat PTH as if they were managing primary headache. As a result of the heterogeneity in the terminology and paucity in prospective, well-controlled studies in this field, there is a definite need for conducting double-blind, placebo-controlled treatment trials in patients with PTH.

Effect of selective posterior rhizotomy on transverse myelitis in a patient with systemic lupus erythematosus.

This report describes the case of a 26-yr-old man experiencing transverse myelitis, a rare but serious complication of systemic lupus erythematosus occurring in less than 1% of patients with systemic lupus erythematosus, 4 yr after the onset of systemic lupus erythematosus. Significant neurologic deficits, including spastic paraplegia, dysthetic pain, and impaired bladder control, which made him completely bedridden and dependent in activities of daily living, continued, despite his immediate diagnosis and treatment. The patient received bilateral L1 to S1 selective posterior rhizotomy 1 yr after the onset of transverse myelitis, and 10 mo after selective posterior rhizotomy, he was completely independent in ambulation and self-care, demonstrating that selective posterior rhizotomy can be safely performed and its goals achieved under different medical conditions, as long as thorough preoperative evaluation and every possible precaution have been taken.

Electrophysiologic findings and muscle strength grading in brachioplexopathies.

The electrophysiological evaluations and the British Medical Research Council (MRC) scale (0-5) findings of target muscles in brachioplexopathies before surgery and 1 year postsurgery were conducted. Each component of the brachial plexus was analyzed in 15 patients with injuries, among them, to 5 roots, 19 trunks, 7 cords, and 13 terminal nerves. In each of these cases, neurolysis and/or nerve transfer and/or neurotization were performed, within 3 weeks to 6 months after the injury was incurred, to ameliorate the resulting severe disabilities. The degrees of impairment were graded using a modified version of Dumitru's and Wilbourn's scale (mild: normal to slight decrease of SNAP amplitude and CMAP amplitude, and occasional denervation; moderate: profound decrease of SNAP amplitude and CMAP amplitude, constant denervation, and normal to slight decrease in motor unit recruitment; severe: absent SNAP amplitude, absent CMAP amplitude, marked denervation, and profound decrease or no volitional motor unit recruitment. mild = 1; moderate = 2; severe = 3). The motor power of the target muscles was graded through MRC scores. The presurgical versus postsurgical differences in the severity of the injury to each brachial plexus component, and differences in the grading of target muscle power, were calculated through the Wilcoxon signed-rank test. The presurgical degrees of the severity of injury, as measured by the electromyography (EMG) were 3.00 +/- 0.00 (mean +/- SD) in root, 2.84 +/- 0.50 in trunk, 3.00 +/- 0.00 in cord, and 2.85 +/- 0.38 in terminal nerves. The postsurgical results were 2.60 +/- 0.55 in root, 2.53 +/- 0.70 in trunk, 2.43 +/- 0.53 in cord, and 1.77 +/- 0.73 in terminal nerves. There was significant improvement at the trunk, cord, and terminal nerve levels after repair, but not at the root levels. Moreover, although the MRC grading showed significant motor recovery in the infraspinatus, deltoid, biceps, and triceps muscles, there was little apparent improvement in the pectoralis major, EDC, APB, and ADM muscles. Nerve repair was notably successful in all plexuses except at the root level. However, our cases demonstrated only poor motor power gains in the forearm and the hand muscles. Consequently, future surgical techniques for brachioplexopathy repairs need further improvement.

Neurourological changes before and after radical hysterectomy in patients with cervical cancer.

BACKGROUND: The severity of bladder dysfunction in patients receiving radical hysterectomy for cervical cancer has been related to the delicacy and the degree of radicality of the hysterectomy. Our goal was to evaluate the effect of modified radical hysterectomy on the storage and evacuation of the lower urinary tract. METHODS: In this prospective study, 18 patients underwent radical hysterectomy for cervical cancer with FIGO stages Ia, Ib and IIa. These patients participated in a pudendal motor nerve conduction study and a urodynamic study, including urethral pressure profile (UPP), cystometry (CMG) and uroflowmetry (UFR). These were carried out at preoperative baseline and at 2 weeks, 6 weeks, 3 months and 6 months following surgery. We used generalized linear models to evaluate, over time, the relationship between the different parameters marked in these profiles. RESULTS: The average pudendal nerve motor latency was prolonged at 2 and 6 weeks after surgery but recovered to baseline at 3 months postsurgery. Maximal urethral closing pressure revealed a tendency to decrease, and the CMG showed a significant increase in maximum intravesical filling pressure and a marked decrease in compliance throughout the investigative course. Increased residual urine volume and decreased uroflow rates were detected in a series of UFR. However, these values headed for baseline at 6 months after surgery. CONCLUSION: Transient neurological changes in the majority of our patients suggested that both somatic and autonomic demyelination with or without denervation might be responsible for the temporal changes in vesicourethral function after radical hysterectomy and recovery to baseline condition within 6 months.