Prediction of posttraumatic functional recovery in middle-aged and older patients through dynamic ensemble selection modeling

IntroductionAge-specific risk factors may delay posttraumatic functional recovery; complex interactions exist between these factors. In this study, we investigated the prediction ability of machine learning models for posttraumatic (6 months) functional recovery in middle-aged and older patients on the basis of their preexisting health conditions.MethodsData obtained from injured patients aged ≥45 years were divided into training–validation (n = 368) and test (n = 159) data sets. The input features were the sociodemographic characteristics and baseline health conditions of the patients. The output feature was functional status 6 months after injury; this was assessed using the Barthel Index (BI). On the basis of their BI scores, the patients were categorized into functionally independent (BI >60) and functionally dependent (BI ≤60) groups. The permutation feature importance method was used for feature selection. Six algorithms were validated through cross-validation with hyperparameter optimization. The algorithms exhibiting satisfactory performance were subjected to bagging to construct stacking, voting, and dynamic ensemble selection models. The best model was evaluated on the test data set. Partial dependence (PD) and individual conditional expectation (ICE) plots were created.ResultsIn total, nineteen of twenty-seven features were selected. Logistic regression, linear discrimination analysis, and Gaussian Naive Bayes algorithms exhibited satisfactory performances and were, therefore, used to construct ensemble models. The k-Nearest Oracle Elimination model outperformed the other models when evaluated on the training–validation data set (sensitivity: 0.732, 95% CI: 0.702–0.761; specificity: 0.813, 95% CI: 0.805–0.822); it exhibited compatible performance on the test data set (sensitivity: 0.779, 95% CI: 0.559–0.950; specificity: 0.859, 95% CI: 0.799–0.912). The PD and ICE plots showed consistent patterns with practical tendencies.ConclusionPreexisting health conditions can predict long-term functional outcomes in injured middle-aged and older patients, thus predicting prognosis and facilitating clinical decision-making

Correlations between subjective treatment responses and plantar pressure parameters of metatarsal pad treatment in metatarsalgia patients: a prospective study

BACKGROUND: Metatarsalgia is related to repetitive high-pressure loading under the metatarsal head (MH) that causes pain. The high pressure under the MH can be reduced by adequately applying metatarsal pads (MPs). Plantar pressure measurements may provide a method to objectively evaluate pressure loading under the MH. However, it is still unclear if the decrease in plantar pressure under the MH after MP treatment is associated with subjective improvement. This study aims to explore the correlations between subjective pain improvement and outcome rating, and the plantar pressure parameters in metatarsalgia patients treated using MPs. METHODS: Thirteen patients (a total of 18 feet) with secondary metatarsalgia were included in this study. Teardrop-shaped MPs made of polyurethane foam were applied just proximal to the second MH by an experienced physiatrist. Insole plantar pressure was measured under the second MH before and after MP application. Visual analog scale (VAS) scores of pain were obtained from all subjects before and after 2 weeks of MP treatment. The subjects rated using four-point subjective outcome scales. The Wilcoxon signed-rank test was used to analyze the difference between the plantar pressure parameters and VAS scores before and after treatment. The Kruskal-Wallis test was applied to compare the plantar pressure parameters in each outcome group. Pearson's correlation was applied to analyze the correlation between the changes in plantar pressure parameters and VAS scores. Statistical significance was set as p < 0.05. RESULTS: MP application decreased the maximal peak pressure (MPP) and pressure-time integral (PTI) under the second MH and also statistically improved subjective pain scores. However, neither the pre-treatment values of the MPP and PTI shift in the position of the MPP after treatment, nor the age, gender and body mass index (BMI) of the subjects were statistically correlated with subjective improvement. Declines in the PTI and MPP values after MP application were statistically correlated with the improvement in VAS scores (r = 0.77, R(2 )= 0.59, p < 0.001; r = 0.60, R(2 )= 0.36, p = 0.009). CONCLUSION: We found that the successful decline in the PTI and MPP under the second MH after MP application was correlated to subjective pain improvement. This study provides a strategy for the further design and application of MPs for metatarsalgia treatment

Effects of an irregular bedtime schedule on sleep quality, daytime sleepiness, and fatigue among university students in Taiwan

<p>Abstract</p> <p>Background</p> <p>An irregular bedtime schedule is a prevalent problem in young adults, and could be a factor detrimentally affecting sleep quality. The goal of the present study was to explore the association between an irregular bedtime schedule and sleep quality, daytime sleepiness, and fatigue among undergraduate students in Taiwan.</p> <p>Methods</p> <p>A total of 160 students underwent a semi-structured interview and completed a survey comprising 4 parts: Pittsburgh Sleep Quality Index (PSQI), Epworth Sleepiness Scale (ESS), Fatigue Severity Scale (FSS), and a rating of irregular bedtime frequency. Participants were grouped into 3 groups in terms of irregular bedtime frequency: low, intermediate, or high according to their 2-week sleep log. To screen for psychological disorders or distress that may have affected responses on the sleep assessment measures, the Chinese health questionnaire-12 (CHQ-12) was also administered.</p> <p>Results</p> <p>We found an increase in bedtime schedule irregularity to be significantly associated with a decrease in average sleep time per day (Spearman r = -0.22, p = 0.05). Multivariate regression analysis revealed that irregular bedtime frequency and average sleep time per day were correlated with PSQI scores, but not with ESS or FSS scores. A significant positive correlation between irregular bedtime frequency and PSQI scores was evident in the intermediate (partial r = 0.18, p = 0.02) and high (partial r = 0.15, p = 0.05) frequency groups as compared to low frequency group.</p> <p>Conclusion</p> <p>The results of our study suggest a high prevalence of both an irregular bedtime schedule and insufficient sleep among university students in Taiwan. Students with an irregular bedtime schedule may experience poor sleep quality. We suggest further research that explores the mechanisms involved in an irregular bedtime schedule and the effectiveness of interventions for improving this condition.</p

Increased Risk of Stroke in the Year after a Hip Fracture a Population- Based Follow-up Study

Background and Purpose-Stroke is a documented risk factor for hip fracture. However, no documented studies are available on the risk of stroke among patients with hip fracture. This study investigated the frequency and risk of stroke after hip fracture using a nationwide population- based study. Methods-The study cohort included 2101 patients hospitalized with a principal diagnosis of hip fracture from 2001 to 2004. The comparison cohort consisted of 6303 randomly selected subjects matched on sex, age, and year of index healthcare use as controls. We tracked patients for a 1-year period from their index healthcare encounter to identify those who had a stroke. Stratified Cox proportional hazard regression was performed to evaluate the association of hip fracture with subsequent stroke during 1-year follow -up. Results-Of a total of 8404 patients, 86 (4.1%) from the study group and 170 (2.7%) from the comparison group had strokes during the follow-up period (P<0.001). The stratified Cox proportional analysis shows that the 1-year crude hazard of stroke among patients with hip fracture was 1.55 times (95% CI, 1.19 to 2 .03; P=0.001) that of the comparison group. Furthermore, after adjusting for the major cardiovascular risk factors, the increased stroke risk of patients with hip fracture persisted at about the same level as in the unadjusted analysis (hazard ratio, 1.53; 95% CI, 1.17 to 2.01; P=0.002). Conclusion-Hip fracture is associated with increased risk of stroke in the next year

The characteristics of surface electromyography of trapezius muscle during sleep

研究背景及目的方肌是人類穩定肩頸部的一塊重要的姿勢肌。斜方肌肌痛症則是臨床上十分常見，也是職業醫學中重要的慢性問題之一。目前對於產生斜方肌肌肉痛的機轉仍不十分清楚。之前的假說認為斜方肌的表皮肌電訊號可能與疼痛的發生有關。有研究發現斜方肌在一般休息狀態會出現低強度自發性的收縮，而在上肢工作或是有心智壓力時會改變運動神經元活性使得收縮模式改變，同時，斜方肌肌痛症患者在處於心智壓力的狀態下，肌電活性會上升，而且需較長時間才會恢復。因此有學者認為此種不正常的活性會因為長時間低強度的肌肉收縮而所造成的肌肉疲勞及微創傷。另一方面亦有研究發現在有疼痛的受試者中，夜間的斜方肌肌電訊號也會出現較高的活性，而指出這類患者可能在夜間的斜方肌不正常肌電訊號和疾病發生有相關。要回答此一問題則需先針對一般人睡眠中斜方肌的肌電活性做一深入探討。最近的研究發現在健康人睡眠時，斜方肌表皮肌電圖活性會出現極低頻率震盪 (&lt;0.3 Hz)的現象，並指出這個發現可用以觀察運動路徑的活性。由於目前仍無文獻探討對於斜方肌肌電圖活性特色及與睡眠中腦波之關係。本研究之目的在於針對一般人在睡眠中斜方肌的肌電訊號做一定量及定性分析，同時分析肌電訊號與腦波訊號的相關性。本研究的結果可以建立正常人睡眠斜方肌表皮肌電圖變化的常模，同時也可以應用於進一步比較斜方肌肌痛患者的睡眠肌電圖，以作為臨床上的應用。究方法有25名健康女性接受研究測試。受試者在最近一個月內無肩頸疼痛及睡眠相關問題的症狀。本研究監測採用美國睡眠醫學會建議標準睡眠多項生理檢查之頻道，同時合併雙側斜方肌之表皮肌電圖監測。每一個健康受測者，皆須完成一週睡眠日誌及PSQI，ESS，CHQ-12之量表。在進行夜間多項生理檢查之前三晚，禁止熬夜或是服用任何藥物。為避免第一夜效應，若受試者之監測睡眠效率小於85%，則須監測第二晚。我們將所記錄的斜方肌肌電圖及腦波訊號原始訊號，先經過合適濾波處理以減少干擾，再計算其每16秒間距的快速傅立葉之頻譜分布。並觀察其與同時的腦波不同頻帶頻譜強度變化的相關性。最後，我們計算出斜方肌肌電訊號及腦波訊號的耦合頻譜訊號，並分析該頻譜在不同睡眠時期下極低頻訊號強度的變化。研究採用paired t-test比較雙側斜方肌表皮肌電訊號的差異。利用Pearson correlation test分析斜方肌肌電訊號極低頻譜強度與不同的腦波頻譜帶強度的相關性。One-way ANOVA分析不同時期，極低頻耦合訊號頻譜強度的差異。究結果們發現在一般女性睡眠中，斜方肌肌電訊號會呈現低強度的訊號，其均方根約為峰值均方根強度的1.3 ± 0.4%。分析斜方肌肌電訊號頻譜發現確實會有間斷性出現極低頻震盪之情形。其極低頻震盪維持的時間約為數十秒至一小時左右，總長度平均約占整體睡眠時間的42.6 ± 19.2 %。進一步分析極低頻震盪的肌電訊號的頻譜強度，發現會與腦波相同頻帶的頻譜的強度成有意義的正相關 (平均相關係數：右r = 0.47,左 r = 0.39)，然而對於相對高頻(delta、theta、alpha、beta)頻帶的腦波頻譜，其相關性則較不一定。進一步研究顯示在極低頻頻譜上肌電訊號及腦波會有間歇耦合的現象，此種情形在淺睡期最為明顯。論們的研究證實睡眠時斜方肌肌電訊號會有極低頻率震盪的情形，且為第一個敘述睡眠腦波與肌電訊號相關性之研究。本研究結果可供進一步運用於慢性斜方肌痛與其他睡眠相關運動障礙患者的研究。Backgroundrapezius muscle is a posture muscle to maintain human shoulder-neck stability. Trapezius myalgia (TM) is a common problem in the general clinic. Previous studies indicated TM may be related to mal-posture or biomechanical loading which result in microtrauma of muscle microstructure. However, the correlation of pain and surface electromyographic (sEMG) findings of TM patients is low or insignificant in many studies. However, elevated of sEMG activities of trapezius during sleep was showed in TM patients and the mechanism was unknown. There were still scanty studies to explore the sEMG characteristics of trapezius muscle during sleep. A recent study showed a very low frequency (VLF) oscillation of trapezius sEMG occurred during sleep. This phenomenon may be related to oscillation activities of motor cortex during sleep. Analysis the trapezius sEMG data with other electrophysiological data during sleep in healthy subjects is a necessary to understand the trapezius. Our study’s goal is to analyze the sEMG pattern of trapezius muscles and their association with EEG during sleep. aterials and Methods5 healthy female subjects were recruited for complete polysomnographic studies with additional sEMG recording of bilateral trapezius muscles. The raw data of EEG and sEMG of trapezius were extracted and processed. Root mean square (RMS) of sEMG of bilateral trapezius muscle was calculated. Fast Fournier Transform (FFT) of 16-s window of two signals was analyzed. Coupling spectrum of EEG and contralateral sEMG signal was computed by calculated the product of the power of two signals in every frequency. Paired-t test and Pearson’s correlation were applied to analyze the difference between bilateral sides and correlation of power spectrum between EEG and sEMG of trapezius muscles. One way ANOVA was applied to compare the VLF power of coupling spectrum among the sleep stages.esults and Conclusionhe trapezius sEMG had low-level activities during sleep and the mean of RMS was 1.3 % of RMS of maximal contraction. We confirmed that the VLF oscillation of trapezius sEMG signals occurred intermittently during sleep. The mean duration of occurrence of VLF of trapezius sEMG was 96 seconds. The mean of longest duration of VLF was about 27 minutes. The power of VLF of trapezius sEMG spectrum was positively correlated with the power of VLF of EEG spectrum significantly (mean right r = 0.47, left r = 0.39). The power of coupling spectrum of VLF of two signals was highest during stage 1/2 during sleep (p = 0.03). To our knowledge, this is the first study to describe the relationship between trapezius sEMG and EEG during sleep. These results of our study will help us to establish the norm data of trapezius sEMG change of healthy human during sleep. Further studies to compare the normal and TM subjects will be conducted for clinical application.壹、中文摘要--------------------------------------------------------4、緒論------------------------------------------------------------6、斜方肌的神經支配及解剖構造------------------------------------6、斜方肌肌痛症及肌肉筋膜痛症狀群--------------------------------7、斜方肌的表皮肌電訊號研究--------------------------------------8、睡眠與運動系統的關係------------------------------------------9、睡眠相關的疼痛疾患-------------------------------------------10、研究的假說與目的---------------------------------------------12、研究方法與材料-------------------------------------------------13、結果-----------------------------------------------------------16、討論-----------------------------------------------------------17、展望-----------------------------------------------------------21、英文簡述-------------------------------------------------------22、參考文獻-------------------------------------------------------24、圖表-----------------------------------------------------------30一、研究個案招募流程-------------------------------------------30二、腦波及表皮肌電訊號資料處理及分析流程-----------------------31三、表皮肌電訊號經快速傅立葉轉換後的整夜頻譜圖範例-------------32四、十六秒間距之腦波頻譜範例-----------------------------------33五、極低頻斜方肌肌電訊號頻譜強度與腦波頻譜強度之相關性---------34六、腦波與表皮肌電訊號的耦合頻譜圖與睡眠時期相關圖之範例-------35七、極慢速耦合頻譜的強度於不同睡眠時期的變化-------------------36一、睡眠相關參數-----------------------------------------------37二、斜方肌表皮肌電訊號-----------------------------------------38三、斜方肌表皮肌電訊號極低頻頻譜與腦波各頻譜訊號強度之相關性---3

放射治療後脊髓病變臨床病程與核磁共振影像之相關：病例報告

We described a case of radiation myelopathy (RM). The correlations of evolutional changes in magnetic resonance image (MRI) findings in three years with clinical symptoms and treatment responses in different stages of the disease were discussed. We also describe some special rehabilitative consideration for RM patients. Cord enlargement with contrast-enhancement showed in MRI findings corresponding to rapid neurological deterioration. Some neurological improvement after anti- coagulation and steroid therapy was observed in this stage. Cord atrophy without contrast- enhancement was showed in following MRI. The neurological deficits still progressed slowly in this stage and almost did not response to the treatment. We conclude that MRI is a powerful diagnostic tool for RM and may predict the treatment responses

Particulate air pollution and neurological diseases: The role of tauopathies

Neurodegenerative diseases, such as dementia, Parkinson's disease, and parkinsonism, are due to the gradual and progressive loss of neural cells, leading to nervous system dysfunction. Increasing epidemiological and toxicological evidence has demonstrated the possible association between neurological diseases and particulate air pollution. Chronic exposure to particulate matter (PM) of < 2.5 μm in aerodynamic size (PM2.5) is related to reductions in white matter and gray matter in brains of older women. Alterations of the structural integrity of the brain were reported for particulate air pollution-induced neurological disorders. Clinically, intraneuronal accumulation of tau proteins is considered to be an important hallmark of the development of neurodegenerative diseases. In Alzheimer's disease brains, for example, hyperphosphorylated levels of tau are around 3–4 times higher than levels in normal adult brains. Tau overexpression in neuroblastoma cells can lead to tau aggregations and the appearance of smaller proteolytic fragments. Degradative mechanisms, such as autophagy that remove tau from cells are considered essential functions for maintaining the brain's health. Notably, increasing numbers of reports have indicated that autophagy dysfunction occurs due to particulate air pollution in vitro and in vivo. Dysfunction of autophagy can lead to tau accumulation in the brain. We reviewed the effects of particulate air pollution on neurological diseases and the underlying mechanisms (i.e., tau and autophagy). Further toxicological evidence is required to fill in the gaps between epidemiological and clinical observations