Human motion detection using an earphone type wearable device and its application to health care （イヤホン型ウェアラブルデバイスを用いた身体動作検出とヘルスケアへの応用）

信州大学(Shinshu university)博士（工学）Thesis黒澤　真美. Human motion detection using an earphone type wearable device and its application to health care　（イヤホン型ウェアラブルデバイスを用いた身体動作検出とヘルスケアへの応用）. 信州大学, 2020, 博士論文. 博士（工学）, 甲第720号, 令和02年03月20日授与.doctoral thesi

Psychometric and Oral Function Assessment of Patients Treated by the Use of Implant-Retained Prostheses

The loss of natural teeth followed by alveolar bone resorption results in the deterioration of the alveolar ridges. These atrophic changes, particularly in the mandible, contribute significantly to a reduction in the stability, retention and load bearing capacity of complete dentures. In addition to a compromised functional capacity, there is a loss of facial support and a reduction in face height. In recent years the use of osseointegrated dental implants for the rehabilitation of edentulous and partially dentate subjects has gained considerable clinical acceptance owing to the high clinical success rates reported. In addition to improvements in dental function there are reported psychological benefits for patients treated with implants, particularly in the case of patients who previously have suffered long-standing problems with conventional complete dentures. It IS useful for the dentist to have an insight into the psychological make-up of patients, particularly when considering the edentulous patient's expectations of what will be achieved from the provision of dentures. Clinical success requires not only the use of appropriate techniques and materials, but depends also upon patients' adaptation potential and upon influences such as motivation and behavioural patterns. The most common complaints arising following the provision of conventional complete dentures are lack of denture stability/retention, pain/discomfort, reduction of masticatory function, difficulty with speech and aesthetic problems, all of which may cause varying degrees of psychological dissatisfaction. In this study, there are two sections. Chapters One and Two comprise the first section. In Chapter One there is a description for the history of implant dentistry and a brief review of the main dental implant systems currently in use. Chapter Two consists of a prospective psychometric analysis of two groups of edentulous patients to investigate their psychological profiles before and after implant treatment. The first group consisted of twenty edentulous subjects who were followed-up over a three year period, using the Cattell's 16-PF psychological test. A second group of ten edentulous subjects were assessed over a shorter period of time using the SCL-90-R psychological test. The second section of this work consists of three chapters developing the work started in Chapter Two dealing with the group of ten edentulous subjects, who had been selected from the waiting list at Glasgow Dental Hospital. All had been referred to the Department of Prosthodontics with long-standing problems centred on their mandibular complete dentures; problems such as denture instability and discomfort, often associated with psycho-social difficulties. The main aims of the present study were: (1) To provide all ten patients with new complete dentures of optimised design and to evaluate the outcome of this treatment by measuring of patients' speech and bite force. Patient self-evaluation of masticatory function, denture stability, comfort, appearance, self-confidence, social interaction, patients' perception of their prostheses, and overall satisfaction was also measured, by the use of self-administered questionnaires designed specifically for this purpose. In addition, the psychological status of patients was evaluated with the use of professionally analysed psychological tests. These assessments were carried out three months after the patients started wearing optimised conventional dentures. (2) To provide all ten patients with mandibular implant-retained overdentures anchored by two implant fixtures with ball attachments, to evaluate this treatment outcome and to compare it to the earlier conventional denture treatment. Two months after the use of the implant-retained overdentures all the above assessments were repeated, in order to allow comparison with respect to the evaluated variables. (3) To assess any correlation between maximum occlusal force as measured by the use of a bite force transducer, speech performance as measured by means of perceptual analysis and the subjective measure of patients' perception of treatment outcome as assessed by self-administered questionnaires, before and after implant treatment

Tinnitus, biomarkers and quality of life in an older population

Tinnitus is a symptom involving the perception of sound in the ears or head, without a corresponding external acoustic stimulus. It is related to many different conditions and has a major impact on quality of life of the affected person. Currently, its diagnosis and monitoring are based on subjective audiometric and psychometric measures. There are no objective methods for tinnitus identification. In addition, the pathophysiological mechanisms underlying tinnitus remains unknown. The purpose of this thesis was to study the mechanisms underlying tinnitus and their relationship to hearing loss, being that hearing loss is the comorbidity most frequently associated with tinnitus. It also aimed to evaluate the contribution of genetic, audiological and immunological factors to the etiology of tinnitus. For this purpose, systematic reviews (SR) were performed, in order to account the state of art, the perspectives of the patient and their relatives, and previous clinical trials of tinnitus treatments. SRs contributed to the identification of a pool of tinnitus-related complaint domains used by COMIT’ID (Core outcome measures in tinnitus international Delphi) in a 3-round internet-based Delphi survey to identifying core outcome sets (COS), i.e., which complaints related to tinnitus are essential for evaluation in clinical trials. These recommendations are specific to the three main therapeutic modalities: sound, psychological, and pharmacological. In order to contribute to the standardization of tinnitus clinical evaluation and treatment, TINNET, a European network for scientific tinnitus research, was created. Among the different activities carried out in were a systematic review of existing national clinical practice guidelines for the diagnosis and treatment of tinnitus. This review contributed to the development of a multidisciplinary European guideline for tinnitus: diagnosis, evaluation and treatment. This guideline was presented at TINNET final meeting and it is being disseminated widely. Another aim of the present thesis was to review work on somatosensory tinnitus (pathophysiology, diagnosis, treatment and the participation in an international Delphi consensus group on the diagnosis of this subtype of tinnitus), to contribute to a better understanding of this subtype of tinnitus. In order to achieve the objectives of this PhD study, 114 participants aged 55 to 75 years were recruited from the Portuguese population. Participants were divided into four groups according to the presence/absence of tinnitus and hearing loss. The completion of the study protocol gave rise to four original research articles, including a demographic characterization, relevant psychological and quality of life aspects comparing the studied population and the published literature, audiologic markers of tinnitus, and immunological profile of population and biomarkers of presbycusis and tinnitus. The results point to hearing loss as a risk factor for the development of tinnitus and psychological complaints as a risk factor for more severe tinnitus and consequently less quality of life in patients with this symptom. In characterizing audiological markers, the presence of previous noise exposure and the hearing loss increased the probability of developing tinnitus. Also, participants with an abrupt onset of tinnitus and who had a negative effect or rebound on residual inhibition were more likely to develop severe or catastrophic tinnitus. For the population with tinnitus, a reduction in amplitude of auditory evoked potentials wave I and a higher values in the 'Ratio of Waves V/I for both ears' were associated with a greater probability of developing severe or catastrophic tinnitus. The inflammatory profile of the study population showed significant differences in IL10 levels between the group with and without tinnitus. IL1α was significantly higher in patients with tonal tinnitus, while IL2 was higher in participants who reported negative or rebound effect on residual inhibition of tinnitus. A negative correlation was also found between IL10 and tinnitus duration, and between HSP70 and tinnitus intensity. Biomarkers were explored in this thesis. A systematic review was performed to synthesize evidence for the existence and clinical usefulness of biomarkers. GRM7 and NAT2 were evaluated in the thesis population. The results indicate a higher prevalence of the T allele in the GRM7 gene (60.3% T/T and 33.3% A/T). Participants with a T/T genotype appeared to be at a higher risk for ARHL development, and 33% have a lower risk of developing tinnitus compared to participants with A/A and A/T genotype. Regarding the NAT2 phenotype, the slow acetylator (53%) was most common, followed by the intermediate acetylator (35.9%). These results suggest that the AT allele of GRM7 and the slow acetylating phenotype of Nat2 are potential biomarkers of tinnitus severity. The results in this thesis are very interesting and original, showing us the need for future research in larger samples, and employing rigorous methodological design in order to control for confounding variables. On the other hand, translational studies may be the key to clarifying the pathophysiologic dilemmas of tinnitus.O acufeno é um sintoma referente à perceção de um som nos ouvidos ou na cabeça, sem que exista um estímulo acústico externo correspondente. Está presente em diferentes patologias (otológicas ou não) e tem um impacto importante na qualidade de vida da pessoa afetada. Atualmente, o seu diagnóstico e monitorização são baseados em medidas subjetivas audiométricas e psicométricas, sendo que não existem métodos objetivos para a identificação do acufeno. Além disso, os mecanismos fisiopatológicos subjacentes ao acufeno subjectivo permanecem desconhecidos. O objetivo da presente tese é estudar os mecanismos subjacentes ao acufeno subjectivo e a sua relação com a surdez, visto que a surdez é a co-morbilidade mais frequentemente associada ao acufeno. Pretende-se também avaliar a contribuição dos fatores genéticos, audiológicos e imunológicos na etiologia do acufeno. Para isso, foram realizadas revisões sistemáticas (RS) sobre esta temática de forma a conhecer o estado de arte, primeiramente em relação à forma como os pacientes e os familiares percecionam o acufeno e também sobre os ensaios clínicos existentes acerca da eficácia do tratamento do acufeno. Ambas as RS contribuíram para a identificação de um conjunto de domínios relacionados com o acufeno, usado pelo COMIT’ID (Core outcome measures in tinnitus international Delphi), num método de consensos Delphi, baseado na Internet, com o objetivo de identificar um ‘Core Outcome Set’ (ou seja definir quais as queixas relacionadas com o acufeno que são imprescindíveis para a sua avaliação) recomendado para ensaios clínicos de eficácia terapêutica para o acufeno assim como para o seu diagnóstico. Estas recomendações são específicas para as três modalidades terapêuticas principais: sonora, psicológica e farmacológica uma vez que cada modalidade tem fundamentos específicos e por isso visam avaliar diferentes aspetos do acufeno. Com o objetivo de contribuir para a padronização da avaliação e do tratamento clínico do acufeno, foi constituída a TINNET, uma rede europeia para a investigação científica do acufeno. Considerando o objetivo do presente estudo e a hipótese de integrar esta rede europeia, foram desenvolvidas um conjunto de atividades que em muito contribuíram para o conhecimento sobre o acufenos. Entre as diferentes atividades realizadas com o apoio da TINNET destaca-se a realização de uma revisão sistemática sobre as ‘guidelines’ clínicas existentes para o diagnóstico e tratamento do acufeno. Esta revisão foi uma das bases que conduziu ao desenvolvimento das ‘guidelines’ europeias multidisciplinares para o acufeno: diagnóstico, avaliação e tratamento. Estas ‘guidelines’ foram apresentadas na conferência final do TINNET e estão atualmente em fase de disseminação. Outro foco de interesse da presente tese foi a realização de trabalhos de revisão sobre o acufeno somatosensorial (nomeadamente sobre a fisiopatologia, diagnóstico e tratamento), bem como a participação num grupo de consenso internacional sobre o diagnóstico deste subtipo do acufeno, de forma a contribuir para uma melhor compreensão deste subtipo do acufeno. Também estas atividades contribuíram para o desenvolvimento de competências cientificas essenciais ao desenvolvimento do presente estudo, dado que permitiram uma melhor compreensão deste subtipo do acufeno, demonstrando-se a heterogeneidade e diversidade do acufeno. De forma a alcançar os objetivos deste estudo de doutoramento, recrutaram-se 114 voluntários da população portuguesa com idade dos 55 aos 75 anos. Os indivíduos desta amostra permitiam a realização de diferentes estudos nomeadamente os laboratoriais, tendo a analise dos resultados envolvido a amostra dividida em quatro grupos consoante a presença/ausência do acufeno e de surdez. Dos resultados desta tese fazem parte quatro artigos originais que e incluem uma caracterização demográfica, aspetos relevantes a nível psicológico e de qualidade de vida, marcadores audiológicos do acufeno, perfil imunológico da população e biomarcadores da presbiacusia e do acufeno. Os resultados obtidos sugerem a perda auditiva como fator de risco para o desenvolvimento do acufeno e as queixas a nível psicológico como fator de risco para o acufeno mais grave e consequentemente associado a menor qualidade de vida nos pacientes com este sintoma. A nível da caracterização dos marcadores audiológicos, verificou-se que a presença de antecedentes de exposição ao ruído e a perda auditiva aumentam a probabilidade de desenvolver acufeno. Também, os participantes com um início abrupto do acufeno e que apresentam um efeito negativo ou ‘rebound’ na inibição residual têm maior probabilidade de desenvolver acufeno grave ou catastrófico. Encontrou-se nos Potenciais Evocados Auditivos, uma redução da amplitude na onda I em pacientes com acufeno, bem como valores maiores no ‘Ratio de amplitude das ondas V e I de ambos ouvidos’ estando associados a maiores probabilidades de desenvolver acufeno severo ou catastrófico. O perfil inflamatório da nossa população mostra diferenças significativas entre o grupo com e sem acufeno quando comparados para a IL10. Quanto à relação entre os parâmetros imunológicos e a acufenometria, verificou-se uma correlação entre o aumento da IL1α e acufeno tonal, bem como entre o aumento da IL2 e a inibição residual do acufeno. Foi também encontrada uma correlação negativa para a IL10 e a duração do acufeno e para o HSP70 e a intensidade do acufeno. Estes resultados são muito originais e suscitam a necessidade de estudos futuros que permitam esclarecer os mecanismos subjacentes às correlações encontradas. Em relação aos biomarcadores, foi efetuada uma revisão sistemática com a finalidade de sintetizar evidências para a existência e utilidade clínica dos biomarcadores para o desenvolvimento ou gravidade do acufeno. Foi também realizado um estudo acerca do papel do GRM7 e do NAT2 na nossa amostra. Os resultados apontam para uma maior prevalência do alelo T no gene GRM7 (60,3% T/T e 33,3% A/T). Os participantes com um genótipo T/T parecem ter um maior risco para o desenvolvimento de ARHL e 33% apresentam menor risco para o desenvolvimento do acufeno, em comparação com indivíduos com A/A e genótipo A/T. Em relação ao fenótipo NAT2, o acetilador lento (53%) foi o mais comum seguido pelo intermediário acetilador (35,9%). Os nossos resultados sugerem que o genótipo A/T de GRM7 e o fenótipo acetilador lento de NAT2 como potenciais biomarcadores da severidade do acufeno. Os resultados obtidos são originais e no seu conjunto são muito interessantes, apontando para a necessidade de estudos futuros em larga escala de forma a aprofundar as conclusões aqui obtidas. Por outro lado, os estudos translacionais poderão ser a chave para esclarecer os dilemas da fisiopatologia do acufeno

Osteoarthritis

Osteoarthritis is one of the most debilitating diseases affecting millions of people worldwide. However, there is no FDA approved disease modifying drug specifically for OA. Surgery remains an effective last resort to restore the function of the joints. As the aging populations increase worldwide, the number of OA patients increases dramatically in recent years and is expected to increase in many years to come. This is a book that summarizes recent advance in OA diagnosis, treatment, and surgery. It includes wide ranging topics from the cutting edge gene therapy to alternative medicine. Such multifaceted approaches are necessary to develop novel and effective therapy to cure OA in the future. In this book, different surgical methods are described to restore the function of the joints. In addition, various treatment options are presented, mainly to reduce the pain and enhance the life quality of the OA patients

Investigation and Quantification of FES Exercise – Isometric Electromechanics and Perceptions of Its Usage as an Exercise Modality for Various Populations

Functional Electrical Stimulation (FES) is the triggering of muscle contraction by use of an electrical current. It can be used to give paralyzed individuals several health benefits, through allowing artificial movement and exercise. Although many FES devices exist, many aspects require innovation to increase usability and home translation. In addition, the effect of changing electrical parameters on limb biomechanics is not entirely understood; in particular with regards to stimulation duty cycle. This thesis has two distinct components. In the first (public health component), interview studies were conducted to understand several issues related to FES technology enhancement, implementation and home translation. In the second (computational biomechanics component), novel signal processing algorithms were designed that can be used to measure mechanical responses of muscles subjected to electrical stimulation. These experiments were performed by changing duty cycle and measuring its effect on quadriceps-generated knee torque. The studies of this thesis have presented several ideas, toolkits and results which have the potential to guide future FES biomechanics studies and the translatability of systems into regular usage for patients. The public health studies have provided conceptual frameworks upon which FES may be used in the home by patients. In addition, they have elucidated a range of issues that need to be addressed should FES technology reach its true potential as a therapy. The computational biomechanics studies have put forward novel data analysis techniques which may be used for understanding how muscle responds to electrical stimulation, as measured via torque. Furthermore, the effect of changing the electrical stimulation duty cycle on torque was successfully described, adding to an understanding of how electrical stimulation parameter modulation can influence joint biomechanics