Search

Wang Chun Kwok,1 Chi Hung Chau,2 Terence Chi Chun Tam,1 Fai Man Lam,1 James Chung Man Ho1 1Department of Medicine, Queen Mary Hospital, University of Hong Kong, Hong Kong Special Administrative Region, People’s Republic of China; 2Tuberculosis and Chest Unit, Grantham Hospital, Hong Kong Special Administrative Region, People’s Republic of ChinaCorrespondence: James Chung Man Ho, Department of Medicine, Queen Mary Hospital, 4/F, Professorial Block, 102 Pokfulam Road, Hong Kong Special Administrative Region, People’s Republic of China, Tel +852 2255 4542, Fax +852 2816-2863, Email jhocm@hku.hkBackground: Chronic obstructive pulmonary disease (COPD) phenotyping using stable-state blood eosinophil level was shown to have prognostic implication in terms of exacerbation risk. However, using a single cut-off of blood eosinophil level to predict clinical outcome has been challenged. There have been suggestions that variability of blood eosinophil count at stable-state could provide additional information on exacerbation risk.Methods: A retrospective cohort study was conducted in a major regional hospital and a tertiary respiratory referral centre in Hong Kong, including 275 Chinese patients with COPD, to investigate the possible role of variability of blood eosinophil count at stable-state to predict COPD exacerbation risk in one year.Results: Higher variability of baseline eosinophil count, which is defined as the difference of the minimal and maximal eosinophil count at stable-state, was associated with increased risk of COPD exacerbation in the follow-up period with adjusted OR (aOR) of 1.001 (95% CI = 1.000– 1.003, p-value = 0.050) for 1 unit (cells/μL) increase in variability of baseline eosinophil count, aOR of 1.72 (95% CI = 1.00– 3.58, p-value = 0.050) for 1 SD increase in variability of baseline eosinophil count and aOR of 1.06 (95% CI = 1.00– 1.13) for 50 cells/μL increase in variability of baseline eosinophil count. The AUC by ROC analysis was 0.862 (95% CI = 0.817– 0.907, p-value < 0.001). The cut-off for variability of baseline eosinophil count identified was 50 cells/μL, with sensitivity of 82.9% and specificity of 79.3%. Similar findings were also shown in the subgroup with stable-state baseline eosinophil count below 300 cells/μL.Conclusion: Variability of baseline eosinophil count at stable-state might predict the exacerbation risk of COPD, exclusively among patients with baseline eosinophil count below 300 cells/μL. The cut-off value for variability was 50 cells/μValidation of the study findings in large scale prospective study would be meaningful.Keywords: COPD, eosinophil, phenotype, COPD exacerbation

Background: Pseudomonas aeruginosa is an important pathogen in patients with chronic respiratory diseases. It can colonize the airway and could have prognostic value in bronchiectasis and cystic fibrosis. Its role in chronic obstructive pulmonary disease (COPD) is less well defined., Methods: A prospective study was conducted in Hong Kong to investigate the possible association between Pseudomonas aeruginosa colonization and acute exacerbation of COPD (AECOPD) risks., Results: Among 327 Chinese patients with COPD included, 33 (10.1%) of the patients had Pseudomonas aeruginosa colonization. Patients with or without Pseudomonas aeruginosa colonization had similar background characteristics. Patients with Pseudomonas aeruginosa colonization had increased risks of moderate to severe AECOPD, severe AECOPD and pneumonia with adjusted odds ratio (aOR) of 3.15 (95% CI 1.05 - 9.48, p = 0.042), 2.59 (95% CI 1.01 - 6.64, p = 0.048) and 4.19 (95% CI 1.40 - 12.54, p = 0.011) respectively. Patients with Pseudomonas aeruginosa colonization also had increased annual frequency of moderate to severe AECOPD, median 0 [0 - 0.93] in the non- Pseudomonas aeruginosa colonization group and 1.35 [0 - 3.39] in the Pseudomonas aeruginosa colonization group, with a p-value of 0.005 in multi-variate linear regression., Conclusion: Pseudomonas aeruginosa colonization is a potential independent risk factor for moderate to severe AECOPD and pneumonia among patients with COPD without co-existing bronchiectasis., (JCOPDF © 2024.)

CT coronary angiography is the most reliable non-invasive imaging technique for ruling out coronary artery disease. However, its specificity is not high. Thus, when coronary stenosis of uncertain functional significance is detected, the recommendation is to perform complementary imaging tests to assess myocardial ischemia. CT myocardial perfusion imaging and CT fractional flow reserve provide added diagnostic accuracy and prognostic value to CT coronary angiography, by increasing its predictive value and facilitating therapeutic decision-making., Competing Interests: Declaration of competing interest The authors declare that they have no conflicts of interest., (Copyright © 2024 SERAM. Published by Elsevier España, S.L.U. All rights reserved.)

Objectives: This study aimed to systematically review the additional value of providing real-time postural feedback during balance and mobility training in older people., Methods: PubMed, Embase, CINAHL, and Web-of-Science were searched from inception to August 2023. Studies comparing the effectiveness of feedback-based versus non-feedback-based postural balance or mobility training on balance or mobility outcomes were selected. Similar outcomes were pooled in meta-analyses using a random-effect model. The quality of evidence for available outcomes was rated by Grading of Recommendations Assessment, Development and Evaluation (GRADE)., Results: Eight studies were identified with 203 subjects. Two studies showed that providing postural feedback immediately improved stability in static balance and gait. For the post-training effect, however, no significant change was found in trunk movement during single-leg standing (i.e., pitch angle, MD=0.65, 95 %CI=-0.77 to 2.07, low-quality; roll angle, MD=0.96, 95 %CI=-0.87 to 2.80, moderate-quality), in the Mini-BESTest (MD=1.88, 95 %CI=-0.05 to 3.80, moderate-quality), and in balance confidence (MD=0.29, 95 %CI=-3.43 to 4.2, moderate-quality). A worsened functional reach distance was associated with providing feedback during balance training (MD=-3.26, 95 %CI=-6.31 to -0.21, high-quality). Meta-analyses on mobility outcomes were mostly insignificant, except for the trunk-roll angle of walking (MD=0.87, 95 %CI=0.05 to 1.70, low-quality) and trunk-pitch angle of walking with head-turning (MD=1.87, 95 %CI=0.95 to 2.79, moderate-quality)., Conclusion: Adding real-time postural feedback to balance and mobility training might immediately improve stability in balance and mobility in older people. However, mixed results were reported for its post-training effect., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024. Published by Elsevier B.V.)

While studies have suggested increased risks of severe COVID-19 infection in chronic obstructive pulmonary disease (COPD), the persistent and delayed consequences of COVID-19 infection on patients with COPD upon recovery remain unknown. A prospective clinical study was conducted in Hong Kong to investigate the persistent and delayed outcomes of patients with COPD who had COVID-19 infection of different severity (mild-moderate COVID-19 and severe COVID-19), compared with those who did not. Chinese patients with COPD ≥ 40 years old were recruited from March to September 2021. They were prospectively followed up for 24.9 ± 5.0 months until 31st August 2023. The primary outcome was the deterioration in COPD control defined as the change in mMRC dyspnea scale. The secondary outcomes included the change in exacerbation frequency and non-COVID-19 respiratory mortality (including death from COPD exacerbation or bacterial pneumonia). 328 patients were included in the analysis. Patients with mild-moderate and severe COVID-19 infection had statistically significant increased risks of worsening of mMRC dyspnoea scale by increase in 1 score from baseline to follow-up with adjusted odds ratios of 4.44 (95% CI = 1.95-10.15, p < 0.001) and 6.77 (95% CI = 2.08-22.00, p = 0.001) respectively. Patients with severe COVID-19 infection had significantly increased risks of increase in severe COPD exacerbation frequency with adjusted odds ratios of 4.73 (95% CI = 1.55-14.41, p = 0.006) non-COVID-19 respiratory mortality from COPD exacerbation or pneumonia with adjusted hazard ratio of 11.25 (95% CI = 2.98-42.45, p < 0.001). After recovery from COVID-19, worsening of COPD control from worsening of dyspnea, increase in severe exacerbation frequency to non-COVID-19 respiratory mortality (COPD exacerbation and pneumonia) was observed among patients with severe COVID-19. Mild to moderate COVID-19 was also associated with symptomatic deterioration., (© 2024. The Author(s).)

An AI-empowered indoor digital contact-tracing system was developed using a centralized architecture and advanced low-energy Bluetooth technologies for indoor positioning, with careful preservation of privacy and data security. We analyzed the contact pattern data from two RCHs and investigated a COVID-19 outbreak in one study site. To evaluate the effectiveness of the system in containing outbreaks with minimal contacts under quarantine, a simulation study was conducted to compare the impact of different quarantine strategies on outbreak containment within RCHs. The significant difference in contact hours between weekdays and weekends was observed for some pairs of RCH residents and staff during the two-week data collection period. No significant difference between secondary cases and uninfected contacts was observed in a COVID-19 outbreak in terms of their demographics and contact patterns. Simulation results based on the collected contact data indicated that a threshold of accumulative contact hours one or two days prior to diagnosis of the index case could dramatically increase the efficiency of outbreak containment within RCHs by targeted isolation of the close contacts. This study demonstrated the feasibility and efficiency of employing an AI-empowered system in indoor digital contact tracing of outbreaks in RCHs in the post-pandemic era., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2024 The Authors.)

Falls are a prevalent cause of injury among older people. While some wearable inertial measurement unit (IMU) sensor-based systems have been widely investigated for fall risk assessment, their reliability, validity, and identification ability in community-dwelling older people remain unclear. Therefore, this study evaluated the performance of a commercially available IMU sensor-based fall risk assessment system among 20 community-dwelling older recurrent fallers (with a history of ≥2 falls in the past 12 months) and 20 community-dwelling older non-fallers (no history of falls in the past 12 months), together with applying the clinical scale of the Mini-Balance Evaluation Systems Test (Mini-BESTest). The results show that the IMU sensor-based system exhibited a significant moderate to excellent test-retest reliability (ICC = 0.838, p < 0.001), an acceptable level of internal consistency reliability (Spearman's rho = 0.471, p = 0.002), an acceptable convergent validity (Cronbach's α = 0.712), and an area under the curve (AUC) value of 0.590 for the IMU sensor-based receiver-operating characteristic (ROC) curve. The findings suggest that while the evaluated IMU sensor-based system exhibited good reliability and acceptable validity, it might not be able to fully identify the recurrent fallers and non-fallers in a community-dwelling older population. Further system optimization is still needed.

Background: The main sequences used to assess degree of endolymphatic hydrops (EH) are the 3D- inversion-recovery (IR) with real reconstruction and the 3D- fluid-attenuated inversion recovery (FLAIR)., Objectives: The purpose of this study is to describe and compare both sequences., Material and Methods: Forty-two consecutive patients diagnosed with probable or definite Ménièr´s disease were referred for hydrops MR examination. Vestibular and cochlear EH in both sequences were read by two independent radiologists, unaware of the patient's clinical status. The primary study endpoint was the concordance in the hydrops detection and severity with both imaging sequences. This was assessed using the Cohen's kappa Κ statistic for disease grading and Pearson Χ 2 test to test the difference in detection rates of hydrops. Statistical significance was defined as two-sided p  < .05., Results: We obtained an excellent overall concordance, with a kappa of 0.821, ( p  < .001) when comparing hydrops detection. The degree of concordance is higher in vestibular hydrops than in cochlear hydrops. The 3D-IR sequence detected more hydrops than the 3D FLAIR, (62 vs. 39.5%, p  < .03)., Conclusion: The 3D-IR sequence seems to be superior to the 3D-FLAIR for the assessment of EH. Significance: The 3D-IR sequence should be considered as a standalone parameter for a shorter and optimized EH magnetic resonance imaging protocol.

Questions: What is the effect of physical exercise on cognitive decline and behavioural problems in people with mild cognitive impairment (MCI) or dementia? What is the effect of physical exercise on particular domains of cognitive function? How do training protocols and patients' characteristics influence the outcomes?, Design: Systematic review and meta-analysis of randomised trials., Participants: People with MCI or dementia as their primary diagnosis., Intervention: Physical exercise., Outcome Measures: Cognitive function including global cognition, memory, executive function, reasoning, attention, language, and behavioural problems., Results: Forty-six trials involving 5099 participants were included in this review. Meta-analysis of the data estimated that aerobic exercise reduced the decline in global cognition, with a standardised mean difference (SMD) of 0.44, 95% CI 0.27 to 0.61, I 2  = 69%. For individual cognitive functions, meta-analysis estimated that exercise lessened working memory decline (SMD 0.28, 95% CI 0.04 to 0.52, I 2  = 40%). The estimated mean effect on reducing the decline in language function was favourable (SMD 0.17), but this estimate had substantial uncertainty (95% CI -0.03 to 0.36, I 2  = 67%). The effects of exercise on other cognitive functions were unclear. Exercise also reduced behavioural problems (SMD 0.36, 95% CI 0.07 to 0.64, I 2  = 81%)., Conclusion: Physical exercise can reduce global cognitive decline and lessen behavioural problems in people with MCI or dementia. Its benefits on cognitive function can be primarily attributed to its effects on working memory. Aerobic exercise at moderate intensity or above and a total training duration of > 24 hours can lead to a more pronounced effect on global cognition., (Copyright © 2019 Australian Physiotherapy Association. Published by Elsevier B.V. All rights reserved.)

Background: Dual-task mobility performance is compromised after stroke., Aim: This study evaluated how the difficulty level of mobility and cognitive tasks influenced the cognitive-motor interference pattern among individuals with chronic stroke and whether it differed from age-matched control participants., Design: A cross-sectional study., Setting: University laboratory., Population: Individuals with chronic stroke and age-matched controls., Methods: Sixty-one individuals with chronic stroke (mean age: 62.9±7.8 years) and 32 controls (mean age: 61.0±7.3 years) performed three mobility tasks (forward walking, obstacle-crossing, backward walking) and two cognitive tasks (serial-3-subtractions, serial-7-subtractions) in single-task and dual-task conditions. time to complete the mobility tasks and correct response rates were recorded., Results: Serial subtractions significantly increased the walking time compared to single-task walking (P<0.001) without decreasing the correct response rate (P>0.05) in both groups, indicating cognitive-related motor interference. As the difficulty of the walking task was increased (i.e., obstacle crossing), the dual-task effect on the walking time was similar to that observed during forward walking, but the correct response rate significantly decreased (P<0.05), indicating that more attentional resources were allocated to the mobility task. When the walking task difficulty level increased further (i.e., backward walking), an exaggerated increase in the walking time (P<0.001) was observed in both groups, but the stroke group also had a decreased correct response rate (P<0.001), indicative of a mutual interference pattern. The control group, however, maintained the correct response rate (P>0.05) despite the slowed walking speed in this condition (P<0.001)., Conclusions: The degree of dual-task interference and task prioritization strategies are highly specific to the combinations of the walking and cognitive tasks used and are affected by the presence of stroke., Clinical Rehabilitation Impact: The study results may provide the basis for establishing assessment tools and creating intervention programs that address dual-task mobility function post-stroke.

Objective: To investigate whether a comprehensive exercise program was effective in improving physical function among institutionalized older adults and whether adding whole-body vibration to the program conferred additional therapeutic benefits., Design: A single-blinded randomized controlled trial was conducted., Setting: This study was carried out in residential care units., Participants: In total, 73 older adults (40 women, mean age: 82.3 ± 7.3 years) were enrolled into this study., Interventions: Participants were randomly allocated to one of the three groups: strength and balance program combined with whole-body vibration, strength and balance program without whole-body vibration, and social and recreational activities consisting of upper limb exercises only. All participants completed three training sessions per week for eight weeks., Outcome Measures: Assessment of mobility, balance, lower limb strength, walking endurance, and self-perceived balance confidence were conducted at baseline and immediately after the eight-week intervention. Incidences of falls requiring medical attention were recorded for one year after the end of the training period., Results: A significant time × group interaction was found for lower limb strength (five-times-sit-to-stand test; P = 0.048), with the exercise-only group showing improvement (pretest: 35.8 ± 16.1 seconds; posttest: 29.0 ± 9.8 seconds), compared with a decline in strength among controls (pretest: 27.1 ± 10.4 seconds; posttest: 28.7 ± 12.3 seconds; P = 0.030). The exercise with whole-body vibration group had a significantly better outcome in balance confidence (pretest: 39.2 ± 29.0; posttest: 48.4 ± 30.6) than the exercise-only group (pretest: 35.9 ± 24.8; posttest: 38.2 ± 26.5; P = 0.033)., Conclusion: The exercise program was effective in improving lower limb strength among institutionalized older adults but adding whole-body vibration did not enhance its effect. Whole-body vibration may improve balance confidence without enhancing actual balance performance.

Question: Does physical exercise training improve physical function and quality of life in people with cognitive impairment and dementia? Which training protocols improve physical function and quality of life? How do cognitive impairment and other patient characteristics influence the outcomes of exercise training?, Design: Systematic review with meta-analysis of randomised trials., Participants: People with mild cognitive impairment or dementia as the primary diagnosis., Intervention: Physical exercise., Outcome Measures: Strength, flexibility, gait, balance, mobility, walking endurance, dual-task ability, activities of daily living, quality of life, and falls., Results: Forty-three clinical trials (n=3988) were included. According to the Grades of Recommendation, Assessment, Development and Evaluation (GRADE) system, the meta-analyses revealed strong evidence in support of using supervised exercise training to improve the results of 30-second sit-to-stand test (MD 2.1 repetitions, 95% CI 0.3 to 3.9), step length (MD 5cm, 95% CI 2 to 8), Berg Balance Scale (MD 3.6 points, 95% CI 0.3 to 7.0), functional reach (3.9cm, 95% CI 2.2 to 5.5), Timed Up and Go test (-1second, 95% CI -2 to 0), walking speed (0.13m/s, 95% CI 0.03 to 0.24), and 6-minute walk test (50m, 95% CI 18 to 81) in individuals with mild cognitive impairment or dementia. Weak evidence supported the use of exercise in improving flexibility and Barthel Index performance. Weak evidence suggested that non-specific exercise did not improve dual-tasking ability or activity level. Strong evidence indicated that exercise did not improve quality of life in this population. The effect of exercise on falls remained inconclusive. Poorer physical function was a determinant of better response to exercise training, but cognitive performance did not have an impact., Conclusion: People with various levels of cognitive impairment can benefit from supervised multi-modal exercise for about 60minutes a day, 2 to 3days a week to improve physical function. [Lam FMH , Huang MZ, Liao LR, Chung RCK, Kwok TCY, Pang MYC (2018) Physical exercise improves strength, balance, mobility, and endurance in people with cognitive impairment and dementia: a systematic review. Journal of Physiotherapy 64: 4-15]., (Copyright © 2017 Australian Physiotherapy Association. Published by Elsevier B.V. All rights reserved.)

Objective: This study aimed to investigate how whole-body vibration (WBV) and exercise and their interactions influenced leg muscle activity in elderly adults., Study Design: An experimental study with repeated measures design that involved a group of ambulatory, community-dwelling elderly adults (n=30; 23 women; mean age=61.4±5.3years)., Main Outcome Measures: Muscle activity of the vastus lateralis (VL), biceps femoris (BF), tibialis anterior (TA), and gastrocnemius (GS) was measured by surface electromyography (EMG), while participants were performing seven different exercises during 4 WBV conditions (condition 1: frequency=30Hz, amplitude=0.6mm, intensity=2.25 units of Earth's gravity (g); condition 2: 30Hz, 0.9mm, 3.40g; condition 3: 40Hz, 0.6mm, 3.65g; condition 4: 40Hz, 0.9mm, 5.50g) and a no-WBV condition in a single experimental session., Results: Significantly greater muscle activity was recorded in VL (3%-148%), BF (16%-202%), and GS (19% -164%) when WBV was added to the exercises, compared with the same exercises without WBV (p≤0.015). The effect of vibration intensity on EMG amplitude was exercise-dependent in VL (p=0.002), and this effect was marginally significant in GS (p=0.052). The EMG activity induced by the four WBV intensities was largely similar, and was the most pronounced during static erect standing and static single-leg standing., Conclusions: The EMG amplitude of majority of leg muscles tested was significantly greater during WBV exposure compared with the no-WBV condition. Low-intensity WBV can induce muscle activity as effectively as higher-intensity protocols, and may be the preferred choice for frail elderly adults., (Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.)

Unlabelled: The study aimed to quantify the long-term effects of stroke on tibial bone morphology and hip bone density. Only the trabecular bone mineral density and bone strength index in the hemiparetic tibial distal epiphysis showed a significant decline among individuals who had sustained a stroke 12-24 months ago., Introduction: This study aims to determine the changes in bone density and morphology in lower limb long bones during a 1-year follow-up period and their relationship to muscle function in chronic stroke patients., Methods: Twenty-eight chronic stroke patients (12-166 months after the acute stroke event at initial assessment) and 27 controls underwent bilateral scanning of the hip and tibia using dual-energy X-ray absorptiometry and peripheral quantitative computed tomography, respectively. Each subject was re-assessed 1 year after the initial assessment., Results: Twenty stroke cases and 23 controls completed all assessments. At the end of the follow-up, the paretic tibial distal epiphysis suffered significant decline in trabecular bone density (-1.8 ± 0.6 %, p = 0.006) and bone strength index (-2.7 ± 0.6 %, p < 0.001). More severe decline in the former was associated with poorer leg muscle strength (ρ = 0.447, p = 0.048) and motor recovery (ρ = 0.489, p = 0.029) measured at initial assessment. The loss in trabecular bone density remained significant among those whose stroke onset was 12-24 months ago (p < 0.001), but not among those whose stroke onset was beyond 24 months ago (p > 0.05) at the time of initial assessment. The changes of outcomes in the tibial diaphysis, except for cortical bone mineral content on the non-paretic side (-1.3 ± 0.3 %, p = 0.003), and hip bone density were well within the margin of error for precision., Conclusions: There is evidence of continuous trabecular bone loss in the paretic tibial distal epiphysis among chronic stroke patients, but it tends to plateau after 2 years of stroke onset. The steady state may have been reached earlier in the hip and tibial diaphysis.

Objective: Peripheral quantitative computed tomography (pQCT) has been increasingly used in stroke research. The correlations between tibial bone measurements by pQCT and hip areal bone mineral density (aBMD) measurements by dual-energy x-ray absorptiometry (DXA) (gold standard for diagnosing osteoporosis) in chronic stroke patients were examined in this study. If the correlations were strong, there may be potential for further pursuit of clinical use of pQCT., Methods: Seventy-four chronic stroke patients who are household ambulators (22 women, 52 men; ≥ 6 months after onset) underwent pQCT scanning of the tibial distal epiphysis (4% site) and diaphysis (66% site) and DXA hip scans on both sides. Pearson's correlation coefficients were used to investigate the correlations between the pQCT-derived variables and the DXA-derived total hip and femoral neck aBMD., Results: All pQCT tibial variables, except the total area, were significantly associated with total hip and femoral neck aBMD. Cortical bone mineral content (66% site) was the only variable that yielded good-to-excellent correlations with total hip and femoral neck aBMD on both sides (r = 0.750-0.833)., Conclusions: Based on the good correlations between tibial pQCT variables and hip aBMD, the clinical use of pQCT in assessing bone health in this population should be further pursued.

Background: The ability to maintain balance while simultaneously performing a cognitive task is essential for daily living and has been implicated as a risk factor of falls in older adults., Aims: To evaluate the evidence related to the psychometric properties of dual-task balance assessments in older adults., Methods: An extensive literature search of electronic databases was conducted. Articles were included if they evaluated the psychometric properties of dual-task balance assessment tools in older adults. The data were extracted by two independent researchers and confirmed with the principal investigator. The methodology quality of each study was rated by using the Consensus-based Standards for the Selection of Health Measurement Instruments (COSMIN) checklist., Results: Twenty-six articles were included in this systematic review. For dual-task static standing balance assessments, the center of pressure-related parameters (displacement, velocity) and reaction time measurements were reliable but not useful for prediction of falls. For walking balance assessments, the gait outcomes derived generally demonstrated good to excellent reliability (intraclass correlation coefficient >0.75), but their ability to predict falls varied. Outcomes derived from the cognitive tasks and the dual-task cost (dual-task performance minus single-task performance) mostly demonstrated low to fair reliability. The methodological quality of majority of studies was poor to fair, mainly due to small sample size., Conclusions: Among the dual-task balance assessments examined, the reliability and validity varied. The findings of this review should be useful in guiding the selection of dual-task balance measures in future research., (Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.)

Background: Whole-body vibration (WBV) has gained increasing popularity in rehabilitation. Recent studies have investigated the application of WBV in individuals with chronic illnesses, including stroke., Purpose: The purpose of this study was to compare WBV exercise with the same exercise condition without WBV and with other types of physical exercise in enhancing body functions and structures, activity, and participation in individuals with stroke and examine its safety., Data Source: Electronic searches were conducted on MEDLINE, CINAHL, PEDro, PubMed, PsycINFO, and Science Citation Index., Study Selection: Randomized controlled trials (RCTs) that investigated the effects of WBV among individuals with stroke were identified by 2 independent researchers. Ten articles (9 studies, totaling 333 study participants) satisfied the selection criteria and were included in this review., Data Extraction: The methodological quality was rated using the PEDro scale. The results were extracted by 2 independent researchers and confirmed with the principal investigator., Data Synthesis: Only 2 RCTs were considered as demonstrating level 1 evidence (PEDro score ≥6 and sample size >50). Two RCTs examined the effects of a single WBV session, and 7 RCTs examined the effects of WBV programs spanning 3 to 12 weeks. No consistent benefits on bone turnover, leg motor function, balance, mobility, sensation, fall rate, activities of daily living, or societal participation were found, regardless of the nature of the comparison group. Adverse events were minor., Limitations: A broad approach was used, with stroke as an inclusion criterion for review. No solid evidence was found concerning the effects of WBV on subgroups of people with specific stroke-related deficits due to the heterogeneity of patient groups., Conclusions: Based on the review, there is insufficient evidence to support clinical use of WBV in enhancing body functions and structures, activity, and participation after stroke., (© 2014 American Physical Therapy Association.)

Purpose: It has been previously shown that whole-body vibration (WBV) can augment muscle activity in young healthy adults. However, the EMG response of leg muscles during WBV in individuals with stroke is unknown. The objective of this study was to determine the influence of WBV on the activity of the vastus lateralis (VL) and gastrocnemius (GS) muscles during the performance of different exercises in chronic stroke patients., Methods: Forty-five chronic stroke patients were studied. Each subject was exposed to three WBV conditions of 1) no WBV, 2) low-intensity WBV protocol (peak acceleration: 0.96 unit of gravitational constant [g]), and 3) high-intensity WBV protocol (peak acceleration: 1.61g) while performing eight different static exercises involving upright standing, semisquat, deep squat, weight shifted forward, weight shifted backward, weight shifted to the side, forward lunge, and single-leg standing. Bilateral VL and GS muscle activity was recorded with surface EMG and expressed as a percentage of the EMG amplitude recorded during a maximal voluntary contraction of the respective muscles., Results: Two-way repeated-measures ANOVA revealed that exposure to WBV (low- and high-intensity protocols) significantly increased VL and GS EMG amplitude (large effect size, partial η = 0.135-0.643, P < 0.001) on both the paretic and nonparetic sides in different exercise conditions compared with no WBV. No significant difference in EMG magnitude was found between the high- and the low-intensity WBV protocols (P > 0.05). With a few exceptions, WBV enhanced EMG activity in the paretic and nonparetic leg muscles to a similar extent in different exercise conditions., Conclusions: Leg muscle activity was increased significantly with the addition of WBV. Further clinical trials are needed to determine the effectiveness of different WBV protocols for strengthening leg muscles in chronic stroke patients.

Background: The ability of the Sensory Organization Test (SOT) to detect subtle balance problems has been challenged. The Head-Shake Sensory Organization Test (HS-SOT) has been developed to improve the delineation of balance performance., Objective: The purposes of this study were: (1) to examine age-related differences in balance measured with the HS-SOT and (2) to establish the test-retest reliability of the HS-SOT in younger adults who were healthy and older adults who were healthy., Design: A test-retest design was used in this observational measurement study., Methods: Ninety-two younger adults who were healthy (mean age=28.3 years) and 73 older adults who were healthy (mean age=60.3 years) underwent the SOT and the HS-SOT. Seventy-seven of them (56 younger adults, 21 older adults) underwent the same assessments 1 to 2 weeks later., Results: The equilibrium scores in HS-SOT conditions 2 (head movements with eyes closed while standing on a firm surface) and 5 (head movements with eyes closed while standing on a sway-referenced surface) were significantly lower than those in tests without dynamic head movements added (SOT conditions 2 and 5). Older adults attained significantly lower scores in both HS-SOT conditions than their younger peers. The test-retest reliability values, reported as intraclass correlation coefficients (ICC [3,2]), of the HS-SOT scores in conditions 2 and 5 for the younger adults were .85 and .78, respectively; those for the older adults were .64 and .55, respectively. The corresponding minimal detectable change values for the former were 2.7 and 16.2, and those for the latter were 3.6 and 22.7., Limitations: Only head rotation movements on the horizontal plane were tested., Conclusions: Adding head movements to the SOT increased the separation of younger adults who were healthy and older adults who were healthy. The HS-SOT has good reliability, and the reported minimal detectable change values may facilitate the interpretation of clinical studies in which the HS-SOT is used to assess changes in balance performance in younger and older adults.

Setting: Systematic studies of fluoroquinolones (FQs) and Clostridium difficile-associated diarrhoea (CDAD) are scarce among tuberculosis (TB) patients, in whom fluoroquinolones (FQs) are increasingly used., Objective: To evaluate the relationship between FQs and CDAD among TB patients., Design: Retrospective cohort and nested case-control analyses were conducted among 3319 hospital patients on anti-tuberculosis treatment from 1999 to 2005. Each case of CDAD was matched by three sex- and age-matched controls randomly selected from the rest of the cohort. Not every case was confirmed by C. difficile cytotoxins., Results: Among 38 cases studied, the incidence of CDAD, which was 28.2 (95%CI 20.3-38.3) per 100 000 patient-days overall, increased from 12.9 (95%CI 5.8-25.3) for patients aged <60 years to 26.6 (95%CI 15.5-42.8) for those aged between 60 and 79 years, and 66.9 (95%CI 39.8-106.1) for those aged >79 years. Univariate analysis showed a significant association between CDAD and age, FQs, non-FQ antibiotics, serum albumin level, duration of hospital stay and nasogastric feeding. Only duration of hospital stay and nasogastric feeding remained significant on multivariable analysis., Conclusion: The risk of CDAD due to FQs among TB patients is probably modest after controlling for sex, age, non-FQ antibiotics, serum albumin level, duration of hospital stay and nasogastric feeding.

The aim of this study was to evaluate the role of autofluorescence bronchoscopy (AFB) in the routine work-up of lung cancer. Consecutive patients with atypical or suspicious cells in sputum or bronchial aspirate, no localising abnormality on chest radiography and nondiagnostic white-light bronchoscopic (WLB) results were recruited. WLB and AFB were performed sequentially during the same session. All abnormal areas detected by WLB, AFB or both were sampled and the biopsy specimens sent for histological examination. Sixty-two patients were recruited within the 32-month study period. Seventeen had no endobronchial lesion detected. Among the 45 patients with endobronchial lesions, 37 had lesions with a histopathological grade of mild dysplasia or less; of the eight patients who had a lesion with a histological grade of moderate dysplasia or worse, five were found to have lung cancer, two invasive lung cancer and three an intra-epithelial neoplasm (severe dysplasia). Lesions showing moderate dysplasia or worse were more commonly found in patients with suspicious cells than in those with atypical cells on sputum examination. AFB was more sensitive than WLB (91 versus 58%) at detecting these lesions, but less specific (26 versus 50%). A combination of white-light and autofluorescence bronchoscopy can increase the diagnostic yield of this invasive procedure in patients exhibiting abnormal sputum cytology.

A total of 562 patients with lung cancer was evaluated by fibreoptic bronchoscopy (FOB) by three bronchoscopic diagnostic procedures: biopsy, bronchial brushing and bronchial washing. Endoscopically visible tumours (EV) were detected in 264, while 257 had endoscopically nonvisible tumours > or = 2 cm in diameter and FOB was done without fluoroscopy because of limited availability (ENV). Forty-one had small (< 2 cm), endoscopically nonvisible tumours with FOB performed under uniplanar fluoroscopy (ENV + F). The overall diagnostic yield rates of FOB were 98.1%, 61.5% and 58.5% for the EV, ENV and ENV + F cases, respectively. Reviewing the differential yield rates of the three diagnostic techniques and comparing them with the results of previous studies led to the following conclusions. (1) Combinations of biopsy with brushing and biopsy with washing can diagnose more than 95% of all fibreoptic bronchoscopy positive cases with endoscopically visible tumours. Performing either of these combinations may be more cost-effective than doing all three techniques routinely. (2) For cases with endoscopically nonvisible tumours, performance of all three diagnostic techniques is recommended, especially when fibreoptic bronchoscopy is performed without fluoroscopic guidance, as washing and brushing seem to compensate for a lower yield of the biopsy. (3) For tumours < 2 cm in diameter, knowledge on the diagnostic efficacy of fibreoptic bronchoscopy was limited owing to the small size of previous studies. The yield of 58.5% for fibreoptic bronchoscopy in these patients with performance of all three diagnostic procedures was comparatively high. It could be further increased to 75.6% if supplemented by percutaneous needle biopsy when fibreoptic bronchoscopy turned out to be nondiagnostic. If available, the use of transbronchial needle aspiration may also increase the overall diagnostic yield of fibreoptic bronchoscopy in these cases.