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To evaluate the effectiveness of a mobile health (mHealth) application, based on self-regulation theory, on patients' knowledge of wound care, skills in changing dressings and anxiety.A prospective randomized controlled trial.Seventy patients (or family members) at a 1,500-bed university hospital in Taiwan were randomized into an experimental (N = 35) or control group (N = 35) from March to December 2016. The experimental group used a mHealth application for wound care; the control group received verbal instructions and a booklet. Instruments to collect data were a wound care knowledge scale, wound care skills scale, State-Trait Anxiety Inventory, and a digital heart variability device. Data were collected at baseline, after three additional demonstrations and before discharge. The generalized estimating equation was used for statistical analysis.The experimental group showed significantly higher levels of wound care knowledge, improved wound care skills, lower levels of state anxiety, and lower heart rate variability than the control group after baseline data collection.Results support hat a mHealth application may be effective in health education. Clinicians can use the results to promote patients' wound care knowledge, enhance their wound care skills, and reduce anxiety related to dressing changes.Lack of wound care knowledge and skills can affect the willingness and ability to perform effective wound dressing changes, producing anxiety and having an impact on a patient's self-care after hospital discharge. mHealth applications (apps) have the potential to deliver health information in targeted and tailored ways that strengthen the self-management of diseases. mHealth app can increase wound care knowledge, improve care skills, and reduce anxiety related to wound care. mHealth app effectively supports self-monitoring of the wound healing process, self-judgement of the wound condition, and self-reaction of wound care accuracy. mHealth app provides step-by-step visual tutorials on wound care that allow patients and family caregivers to take pictures of the wounds and monitor the wound healing process. mHealth app for wound care knowledge is an effective and individualized method for learning.This study was registered by U.S. National Library of Medicine, ClinicalTrials.gov (ID: NCT03683303).目的: 基于自我调节理论,评估移动医疗(mHealth)应用程序对患者伤口护理知识、换药技能和焦虑程度的作用。 设计: 一项前瞻性随机对照试验 方法: 2016年3月至2016年12月,台湾一所拥有1,500张床位的大学附属医院的70名患者(或家属)被随机分为实验组(N = 35)或对照组(N = 35)。实验组使用移动医疗(mHealth)应用程序申请进行伤口护理;对照组收到口头指示和小册子。数据采集工具包括伤口护理知识量表、伤口护理技能量表、状态特质焦虑问卷和数字式心率变异装置。数据收集时间点是治疗前的基础值、三次额外演示后和出院前。采用广义估计方程进行统计分析。 结果: 在进行基础数据收集之后,实验组的伤口护理知识水平、伤口护理技能改善情况、状态特质焦虑水平和心率变异性均显著高于对照组。 结论: 研究结果支持移动医疗(mHealth)应用程序在健康教育中的有效性。临床医生可利用这些结果来加强患者的伤口护理知识,提高他们的伤口护理技能,降低与换药相关的焦虑。 影响: 缺乏伤口护理知识和技能会影响患者进行有效伤口换药的意愿和能力,使患者产生焦虑,并影响患者出院后的自我护理。移动医疗(mHealth)应用程序(apps)有可能提供具有针对性的定制化健康信息,从而加强患者对疾病的自我管理。移动医疗(mHealth)应用程序可以增加患者的伤口护理知识,提高护理技能,降低与伤口护理相关的焦虑。移动医疗(mHealth)应用程序可有效支持伤口愈合过程的自我监控、伤口状况的自我判断以及伤口护理准确性的自我反应。移动医疗(mHealth)应用程序可提供有关伤口护理的分步式可视化教程,允许患者和家庭护理提供者拍摄伤口照片并监控伤口愈合过程。移动医疗(mHealth)伤口护理知识应用程序是一种有效的个性化学习方法。 临床试验: 该研究在美国国立医学图书馆ClinicalTrials.gov注册(编号:NCT03683303)。.

Alteration of elbow range of motion (ROM) has been observed in baseball pitchers. This study aims to compare dominant elbow ROM between early-puberty, late-puberty, and young-adult pitchers.We recruited 62 pitchers, consisting of 17 early-puberty (mean age 13.1 years old), 22 late-puberty (mean age 17.7 years old), and 23 young-adult players (mean age 19.4 years old). Dominant elbow ROMs was measured. One-way ANOVA was used to compare the differences in elbow ROM variables between 3 groups.Late-puberty pitchers exhibited a significantly lower elbow hyperextension and flexion than early-puberty or young-adult pitchers (P .05). Valgus angle was significantly lower in young-adult (7.7°±5.5°) versus early-puberty (12.1°±2.3°) and late-puberty pitchers (13.0°±4.1°; P .05). Young-adult pitchers had the largest forearm supination range (101.2°±18.1°), followed by early-puberty (82.5°±6.5°; P .05) and late-puberty pitchers (70.6°±15.8°). Elbow flexion-hyperextension total range was smallest in late-puberty pitchers (130.3°±7.4°), followed by young-adult (142.6°±9.3°) and early-puberty pitchers (144.6°±8.3°; P .05). Forearm pronation-supination total range was also smallest in late-puberty pitchers (142.0°±20.3°), followed by early-puberty (159.8°±9.5°) and young-adult pitchers (177.2°±20.8°; P .05).These results indicate that careful monitoring of the elbow and forearm range of motion should be undertaken in adolescent baseball pitchers to prevent and or minimize injury risk.

This study used the mitochondrial DNA cytochrome b and control region sequences to examine the population genetic structure of Microphysogobio brevirostris, an endemic cyprinid species in northern Taiwan. In total, 90 specimens were collected from six populations belonging to four major rivers. All haplotypes were identified as two major clades (Clades N and S), exhibiting a southern and a northern distribution. The results of statistical dispersal-vicariance analysis (S-DIVA) revealed that two vicariance events and one dispersal event shaped the phylogeographic pattern of M. brevirostris. These results suggest that the ancestral populations of M. brevirostris are widely distributed throughout northern Taiwan, north of the Miaoli Plateau. The ancestral populations then diverged into two clades (N and S) by the raising of the Taoyuan Plateau. Finally, two major rivers of the S clade diverged and dispersed into adjacent rivers. Besides, our results revealed that Microphysogobio alticorpus and M. brevirostris colonized Taiwan during the same ice age through different colonization routes.

Supplementing chicken feed with antibiotics can improve survival and prevent disease outbreaks. However, overuse of antibiotics may promote the development of antibiotic-resistant bacteria. Recently, antimicrobial peptides have been proposed as alternatives to antibiotics in animal husbandry. Here, we evaluate the effects of antimicrobial peptide, Epinephelus lanceolatus piscidin (EP), in Gallus gallus domesticus. The gene encoding EP was isolated, sequenced, codon-optimized and cloned into a Pichia pastoris recombinant protein expression system. The expressed recombinant EP (rEP) was then used as a dietary supplement for G. g. domesticus; overall health, growth performance and immunity were assessed. Supernatant from rEP-expressing yeast showed in vitro antimicrobial activity against Gram-positive and Gram-negative bacteria, according to an inhibition-zone diameter (mm) assay. Moreover, the antimicrobial peptide function of rEP was temperature independent. The fermentation broth yielded a spray-dried powder formulation containing 262.9 μg EP/g powder, and LC-MS/MS (tandem MS) analysis confirmed that rEP had a molecular weight of 4279 Da, as expected for the 34-amino acid peptide; the DNA sequence of the expression vector was also validated. We then evaluated rEP as a feed additive for G. g. domesticus. Treatment groups included control, basal diet and rEP at different doses (0.75, 1.5, 3.0, 6.0 and 12%). Compared to control, rEP supplementation increased G. g. domesticus weight gain, feed efficiency, IL-10 and IFN-γ production. Our results suggest that crude rEP could provide an alternative to traditional antibiotic feed additives for G. g. domesticus, serving to enhance growth and health of the animals.

Previous study has showed superior sensory organisation ability in rhythmic gymnasts, but mostly in longitudinal data. With a cross-sectional design, this study used a dual-task paradigm to examine the above phenomenon. Fifteen female rhythmic gymnasts (15.0 ± 1.8 yr.) and matched peers (15.1 ± 2.1 yr.) were recruited. The Sensory Organization Test (SOT) was administered with a concurrent lower-demand (serial subtraction of three, serving as the baseline) or higher-demand (serial subtraction of seven, serving as the dual-task) arithmetic task. The results showed no main effect of group, but a group by level of arithmetic task (P = 0.001) interaction effect on SOT equilibrium score. The higher-demand task facilitated balance performance in the gymnasts, but it impeded performance in the controls, with the differences more pronounced in challenging SOT conditions. With the higher-demand task, the gymnasts adopted a sensory strategy with a higher visual ratio but a smaller somatosensory ratio compared to the controls. Better visual utilisation of sensory organisation ability was apparent in gymnasts, but only when the SOT test was performed with a higher-demand secondary task. We have demonstrated the efficacy of using the dual-task paradigm to identify the superior sensory organisation ability of adolescent rhythmic gymnasts.

Apart from drug control, diabetes management should pay more attention to how lifestyle and daily routine affect blood sugar. This study aimed to explore the impact of m-health programme using a minimal psychological intervention on diabetes patients' knowledge, behavioural, and psychological health. A pretest-posttest single-group pre-experimental study was undertaken with 30 individuals to recruit patients with diabetes. A total of 22 participants completed the 10-week online programme. The pretest-posttest results demonstrated the differences in health behaviour, including foot care, diet control, and exercise. The adoption of m-health that changed and improved patient's self-care; however, the acceptance of using m-health remains a challenge for public dissemination.

BACKGROUND This study was to investigate the effects of prophylactic Kinesio taping and athletic taping on the functional performance of the lower extremities in healthy collegiate players with tapes applied to the dominant leg. METHODS The study design was a prospective, randomized, clinical trial with comparison of groups. The 32 healthy collegiate players who participated in this study were randomly assigned to 2 groups, an athletic taping group and a Kinesio taping group. Active range of motion of ankle joint, ankle plantar-flexor strength, endurance, vertical jump performance, and dynamic balance were used to measure the player's functional performance of the lower extremities. These tests were conducted 2 times at 4-hour intervals before and after different tapes were applied. The repeated measures analysis of variance was used to examine the interaction in functional performance between the groups before and after the tapes applied. RESULTS The results found less limitation of range of motion in active ankle dorsiflexion and significant improvement in dynamic balance in the Kinesio taping group (F=5.150, P=0.031, F=18.766, P

The reproductive biology of the black marlin, Istiompax indica, was assessed by examining 4762 fish (458 ovary samples) caught by offshore longliners off southwestern and eastern Taiwan during 2004–2007. The overall sex ratio (0.67 off southwestern and 0.86 off eastern Taiwan) was significantly different from 0.5 (p

Aims and objectives This study reviewed existing literature to investigate how frequently nurses include complementary and alternative forms of medicine in their clinical practice. In so doing, we investigated nurses' knowledge of and attitudes towards complementary and alternative medicine as well as their ability to communicate the risks and benefits of these therapies with patients. Background Little information is available concerning nurses' knowledge and attitudes towards complementary and alternative medicine or how they incorporate these therapies into their practice. In addition, little is known about the ability of nurses to communicate the risks and benefits of complementary and alternative medicine to their patients. Study design This study used a scoping review method to map and synthesise existing literature. Data sources Both electronic and manual searches were used to identify relevant studies published between January 2007 and January 2014. Review methods The review was conducted in five stages: (1) identification of research question(s), (2) locate studies, (3) selection of studies, (4) charting of data, and (5) collating, summarising, and reporting of results. Results Fifteen papers met the inclusion criteria for this review, among which 53·7% referenced how frequently nurses include complementary and alternative medicine in their practice. We found that 66·4% of nurses had positive attitudes towards complementary and alternative medicine; however, 77·4% did not possess a comprehensive understanding of the associated risks and benefits. In addition, nearly half of the respondents (47·3–67·7%) reported feeling uncomfortable discussing complementary and alternative medicine therapies with their patients. Conclusion The lack of knowledge about complementary and alternative medicine among nurses is a cause for concern, particularly in light of its widespread application. Relevance to clinical practice Findings from this study suggest that health care professionals need to promote evidence informed decision-making in complementary and alternative medicine practice and be knowledgeable enough to discuss complementary and alternative medicine therapies. Without involvement of complementary and alternative medicine communication on the part of our profession, we may put our patients at risk of uninformed and without medical guidance.

Plasma isolation and protein detection from whole blood are necessary processes for diagnosing various diseases and evaluating treatment effectiveness in patients. A microfluidics device has the potential to achieve the miniaturization and integration of blood detection assays. In this study, we have developed a simple microfluidics system for separating plasma and detecting human chorionic gonadotrophin (hCG) from whole blood using a sheath flow and polydimethylsiloxane as a material. We investigated the effects of various sheath flows on plasma separation and hCG detection. Our results showed that when the sheath flow increased, the number of blood cells in the plasma-recovered microchannels decreased. At a sheath flow ≥13.6 × 10−5 m/s, the blood cells sedimented on the bottom of the main-flow microchannels. When the sheath flow was increased, the number of fluorescence spots indicating the detection of hCG decreased. Our results indicate that a prepared amount of protein A of 1 × 10−2 mg/mL and a sheat...

Interactions between transcriptional inducers of cytochrome P450 (CYP450) and pharmacological agents might decrease drug efficacy and induce side effects. Such interactions could be prevented using an antagonist of the pregnane X receptor (PXR) and constitutive androstane receptor (CAR). Here, we aimed to determine the antagonistic effect of oleanolic acid (OA) on PXR and CAR. OA attenuated the promoter activities, expressions, and enzyme catalytic activities of CYP3A4 and CYP2B6 mediated by rifampin (RIF) and CITCO. Moreover, OA displayed species specificity for rodent PXR. Interaction of coregulators with PXR and transcriptional complexes on the CYP3A4 promoter was disrupted by OA. Additionally, OA reversed the cytotoxic effects of isoniazid induced by RIF. These data demonstrate that OA inhibited the transactivation of PXR and CAR, reduced the expression and function of CYP3A4 and CYP2B6, and may therefore serve as an effective agent for reducing probability adverse interactions between transcriptional inducers of CYP450 and therapeutic drugs.

Aims To investigate the effects of threshold inspiratory muscle training (IMT) in patients with stages II through IV chronic obstructive pulmonary disease (COPD) using maximum inspiratory pressure (PImax), baseline dyspnoea index (BDI), 6-minute walk test (6MWT), and quality of life (QoL). Background A threshold inspiratory muscle training device provides pressure for inspiratory muscle strength, but there is limited information on the effects of threshold inspiratory muscle training starting at low pressure training. Design Randomized experimental design Methods A total of 55 patients completed this study between September 2013 and April 2014. The experimental group (n=27) was provided medical treatment and routine care, along with five sessions of threshold IMT per week (21-30 minutes per session), accompanied by a progressive increase in the pressure threshold over a period of eight weeks. The control group (n=28) was provided medical treatment and routine care only, without intervention. In the inferential analysis, p values

Objective: To illustrate the experiences and perceived benefits of healing yoga as described by patients with breast cancer participating in a healing yoga program. Methods: The qualitative research with naturalistic design was conducted after the completion of an 8 weeks healing yoga program. A total of 11 breast cancer women with adjuvant chemotherapy were interviewed using the semi-structured interview guidelines. Findings: Participants expressed their experiences of healing yoga, including transforming concern to confidence, regaining a sense of belonging, gaining experience and satisfaction, and leading the way for life, were critical in developing these benefits. The perceived benefits of participating in this program was described as positive mental support, promoted a mind-body interaction and provided benefits ascribed to social activities, leading to a reported increase in active participation in life. Conclusion: This study gives support for the positive experiences of healing yoga among patients with a breast cancer. The objective effect of the healing yoga must be examined further to guide nurses in implementing suitable health promotional strategies for breast cancer patients.

Phellinus linteus and its constituent hispolon induce potent anti-inflammatory activity in macrophages. Efficient production of the effective constituent and the biological function of P. linteus in the regulation of innate sensing have rarely been investigated. The aim of this study was to efficiently manufacture P. linteus -fermented broth containing the effective constituent, hispolon, and evaluate its immunoregulatory functions in macrophages. Four distinct fermented broths (PL1–4) and the medium dialyzate (MD) were prepared to screen suitable culture conditions for the mycelial growth of P. linteus . The P. linteus -fermented broth exhibited a dose-responsive inhibition of lipopolysaccharide (LPS)-induced nitric oxide (NO) production by murine macrophages. In addition, the P. linteus -fermented broths suppressed macrophage LPS-mediated nuclear factor (NF)-κB activity and tumor necrosis factor (TNF)-α. Among the tested samples from P. linteus , PL4 contained vast amounts of hispolon and showed the greatest anti-inflammatory activity in both the RAW264.7 cells and murine primary peritoneal exudate macrophages (PEMs). This study demonstrates that the purification of the effective constituent from P. linteus -fermented broth may enable the production of a potent therapeutic agent for anti-inflammation in macrophages.

Compared with regulation-weight baseballs, lightweight baseballs generate lower torque on the shoulder and elbow joints without altering the pitching movement and timing. This study investigates the throwing accuracy, throwing velocity, arm swing velocity, and maximum shoulder external rotation (MSER) of adolescent players after 10 weeks of pitching training with appropriate lightweight baseballs. We assigned 24 adolescent players to a lightweight baseball group (group L) and a regulation-weight baseball group (group R) based on their pretraining throwing velocity. Both groups received pitching training 3 times per week for 10 weeks with 4.4- and 5-oz baseballs. The players' throwing accuracy, throwing velocity, arm swing velocity, and MSER were measured from 10 maximum efforts throws using a regulation-weight baseball before and after undergoing the pitching training. The results showed that the players in group L significantly increased their throwing velocity and arm swing velocity (p0.05) after 10 weeks of pitching training with the 4.4-oz baseball, whereas group R did not (p0.05). Furthermore, the percentage change in the throwing velocity and arm swing velocity of group L was significantly superior to that of group R (p0.05). Thus, we concluded that the 10 weeks of pitching training with an appropriate lightweight baseball substantially enhanced the arm swing velocity and throwing velocity of the adolescent baseball players. These findings suggest that using a lightweight baseball, which can reduce the risk of injury without altering pitching patterns, has positive training effects on players in the rapid physical growth and technique development stage.

The reproductive biology of female bigeye tuna Thunnus obesus was assessed by examining 888 fish (ranging from 84·9 to 174·4 cm fork length, LF ) caught by Taiwanese offshore longliners in the western Pacific Ocean from November 1997 to November 1998 and November to December 1999 and 258 gonad samples from these fish. The overall sex ratio of the catch during the sampling differed significantly from 0·5, but males were predominant in sizes >140 cm LF . Reproductive activity (assessed by histology), a gonado-somatic index, and the size-frequency distributions of whole oocytes indicated that spawning occurred throughout the year and the major spawning season appeared to be from February to September. The estimated sizes at 50% maturity (LF50 ) of females was 102·85 cm (95% c.i.: 90·79-110·21 cm) and the smallest mature female was 99·7 cm LF . They are multiple spawners and oocytes develop asynchronously. The proportion of mature (0·63) and reproductively active (0·70) females with ovaries containing postovulatory follicles indicated that they spawn almost daily. Batch fecundity for 15 females with the most advanced oocytes (>730 µm) ranged from 0·84 to 8·56 million eggs (mean ± s.d. = 3·06 ± 2·09). The relationships between batch fecundity (FB , in millions of eggs) and LF (cm) and round mass (MR , kg) were FB=9·91×10-14LF6·38 (r(2) = 0·84) and FB=8·89×10-4MR2·05 (r(2) = 0·80), respectively. The parameters estimated in this study are key information for stock assessments of T. obesus in the western Pacific Ocean and will contribute to the conservation and sustainable yield of this species.

Blue marlin are sexually dimorphic in size-at-age and other biological characteristics. However, few studies have examined the possible impact of sexual dimorphism on the population parameters and the ratios of fishing to total mortality (the exploitation ratios) for this species. We analyzed sex-specific catch-at-length data for blue marlin collected from the Taiwanese tuna longline fishery in the northwest Pacific Ocean, ranging between 100–311 cm in eye to fork length (EFL) for females and 100–236 cm EFL for males, and show that the proportion of females in the catch (the sex ratio) increases with length, with females reaching larger body sizes than males. Minor differences in fishery sex ratios among months were observed. Growth parameters, length structures, and natural mortality rates were estimated to differ between males and females, while fishing mortality rates were found to be similar. Nevertheless, the exploitation ratio for females was higher than that for males. We suggest that growth parameters and natural mortality rates should be sex-specific when assessments for sexually-dimorphic species such as blue marlin are conducted, and that management of blue marlin fisheries could be developed based on size limit regulations for large individuals.

Background Adolescent tennis players require sufficient hip and shoulder flexibility to achieve the kinetic chain of a tennis stroke or serve. Hence, the objective of this study is to measure the glenohumeral joint internal and external rotation (IR and ER, respectively) and hip ER range of motion (ROM) and to compare these parameters between experienced and beginner-level adolescent tennis players. Methods Twenty-three adolescent tennis players were divided into experienced (N.=12) and beginner groups (N.=11) on the basis of the adolescent national ranking of the Taiwan Tennis Association. For all participants, the shoulder IR and ER at 90° of abduction were measured, and hip ER which used Partick's Test was also evaluated on the dominant and nondominant sides. The total rotation ROM of the shoulder and the difference in shoulder ER, IR, and total rotation and hip ER between the dominant and nondominant sides were also calculated after measurements. An independent-samples t-test was applied to test the homogeneity of the participants' demographic data and the difference in shoulder IR, ER, and total rotation and hip ER values between the dominant and nondominant sides. Subsequently, a repeated-measured two-way analysis of variance (2 × 2) was used to compare the dominant and nondominant shoulder and hip ROM of the participants between the experienced and beginner groups. Results The experienced group exhibited a significantly less total rotation ROM than the beginner group. In addition, both groups showed less dominant shoulder IR ROM and more dominant shoulder ER ROM compared with the nondominant side. Compared with the experienced group, the beginner group showed an obvious difference in total shoulder rotation between dominant and nondominant sides. More tightness for the hip ER was observed in the experienced group than in the beginner group, but no difference was observed between the dominant and nondominant sides in both groups. Conclusions Beginner adolescent tennis players differ more in the degree of total shoulder ROM between the dominant and nondominant sides than experienced players. Beginner and experienced adolescent tennis players also have more shoulder ER and less IR on the dominant side. The results suggest that beginner-level adolescent tennis players should undergo a stretching and strengthening program to reduce the potential risk of injury and possibly enhance performance.

Rhythmic gymnasts specialise in dynamic balance under sensory conditions of numerous somatosensory, visual, and vestibular stimulations. This study investigated whether adolescent rhythmic gymnasts are superior to peers in Sensory Organisation test (SOT) performance, which quantifies the ability to maintain standing balance in six sensory conditions, and explored whether they plateaued faster during familiarisation with the SOT. Three and six sessions of SOTs were administered to 15 female rhythmic gymnasts (15.0 ± 1.8 years) and matched peers (15.1 ± 2.1 years), respectively. The gymnasts were superior to their peers in terms of fitness measures, and their performance was better in the SOT equilibrium score when visual information was unreliable. The SOT learning effects were shown in more challenging sensory conditions between Sessions 1 and 2 and were equivalent in both groups; however, over time, the gymnasts gained marginally significant better visual ability and relied less on visual sense when unreliable. In conclusion, adolescent rhythmic gymnasts have generally the same sensory organisation ability and learning rates as their peers. However, when visual information is unreliable, they have superior sensory organisation ability and learn faster to rely less on visual sense.

Background/Purpose This study compares heart rate variability (HRV) and systolic blood pressure (SBP) changes of spinal cord injury (SCI) patients during urodynamic study (UDS) with able-bodied controls. Methods Twenty four complete suprasacral SCI patients (12 tetraplegia and 12 paraplegia) and 12 age-matched able-bodied volunteers received BP and HRV evaluation throughout urodynamic examination. We chose seven time points during the examinations: resting, Foley catheter insertion, start of infusion, and infused volume reaching 1/4, 2/4, 3/4 and 4/4 of maximal capacity. At each time point, electrocardiogram with a duration of 5 min was used for power spectral density analysis of HRV. Results Only control subjects displayed significant elevation of SBP during Foley catheter insertion compared to resting values. Both control and tetraplegic groups experienced significant elevation of SBP at maximal bladder capacity compared to resting values. Tetraplegic values were also significantly greater than the other two groups. Control subjects displayed significant elevation of low frequency/high frequency (LF/HF) ratios during Foley catheter insertion and when approaching maximum bladder capacity. These findings were not seen in the paraplegic and tetraplegic groups. However, subgroup analysis of tetraplegic subjects with SBP elevation >50 mmHg demonstrated a similar LF/HF response to the able-bodied controls. Conclusion Tetraplegic patients experienced BP elevation but did not experience significant changes in HRV during bladder distension. This finding may imply that different neurological pathways contribute to AD reaction and HRV changes during bladder distension. However, profound AD during UDS in tetraplegic patients was associated with corresponding changes in HRV. Whether HRV monitoring would be beneficial in SCI patients presenting with significant AD, it needs further studies to elucidate.

It was previously reported that the oral administration of lactoferrin (LF) provides antimicrobial activity in animals against bacterial and viral infections and is involved in immunomodulatory properties. In this report, a hybrid strain of Oreochromis nilotica (male) × O. mossambicus (female) was fed homemade diets with or without supplementation with 10, 50, 100, and 150 mg bovine LF g−1 feed for 60 days. After dietary treatment, the experimental fish were infected with Streptococcus agalactiae. LF supplementation resulted in a significantly higher survival rate and suppression of bacterial growth at 24–96 h in the liver, spleen, kidneys, eyes, and gills. A reduction in peroxidase activity was followed by a similar reduction in the peroxidase content of leukocytes at 24 h as analyzed by spectrophotometry. Respiratory burst (RB) activity was detected regardless of the time at which LF was administered to fish in relation to the bacterial infection. A beneficial effect of LF on RBs was also detected before bacterial challenge (with 100 mg LF/g) and 24 h after bacterial challenge with 150 mg/g. The results obtained validate LF’s beneficial effects on RBs by phagocytes in tilapia, which was only shown at 48 h after supplementation with 100 mg bovine LF g−1 feed after the bacterial infection. Moreover, after oral administration of LF, it was detected in the mucosa of the small intestines of tilapia. In conclusion, we demonstrate a reduction in fish mortality after the oral administration of LF, and we examined its immunomodulatory properties in tilapia.

Objectives To determine the immediate effects of applied forearm Kinesio taping on maximal grip strength and force sense of healthy collegiate athletes. Design Single group, repeated measures study. Setting Clinical sports medicine laboratory at a university hospital. Participants Twenty-one healthy collegiate athletes voluntarily participated in this study. All subjects were male (average height: 181.24 ± 7.60 cm; average body weight: 72.86 ± 7.03 kg; average age: 20.86 ± 2.59 years). Main Outcome Measures First, maximal grip strength of the dominant hand was assessed by hand-held dynamometer. Then, 50% of maximal grip strength was established as the reference value of force sense. Absolute and related force sense errors and maximal grip strength were measured under three conditions: (1) without taping; (2) with placebo taping; and (3) with Kinesio taping. Results Results revealed no significant differences in maximal grip strength between the three conditions ( p = 0.936). Both related and absolute force sense errors in grip strength measurements significantly increased the accuracy of the results under the three conditions (related force sense errors: p p Conclusion Forearm Kinesio taping may enhance either related or absolute force sense in healthy collegiate athletes. However, Kinesio taping did not result in changes in maximal grip strength in healthy subjects.

Tilapia piscidin 3 (TP3) and tilapia piscidin 4 (TP4) are antimicrobial peptides recently isolated from Oreochromis niloticus. We previously showed that synthetic TP3 and TP4 possessed antimicrobial activities. Here, we analyzed the bactericidal abilities and immunomodulatory properties of these AMPs following the electroporation of pCMV-GFP-TP3 or pCMV-GFP-TP4 plasmid into tilapia (O. niloticus) muscle and subsequent infection with Vibrio vulnificus or Streptococcus agalactiae. Prior overexpression of TP3 or TP4 in tilapia muscle tissues efficiently reduced bacterial numbers at 24 and 48 h after V. vulnificus infection and reduced bacterial numbers at 24 h after S. agalactiae infection compared to numbers in controls expressing pCMV-GFP (EGFP). Electroporation of pCMV-EGFP-TP3 (TP3) or pCMV-EGFP-TP4 (TP4) significantly increased expression of several immune-related genes in muscle (IL-1β (12 h, TP3), IL-8 (12 h, TP3), TGFβ (3 h, TP4), and IκB (48 h, TP3, TP4)) and decreased the expression of TLR5 (12 h and 24 h, TP3) after V. vulnificus infection. Following S. agalactiae infection, expression of the following genes was significantly decreased in muscle: IL-1β (12 h, TP3), IL-8 (12 h, TP3, TP4), TLR5 (3 h-24 h, TP3, TP4), TGFβ (3 h, TP4; 24 h, TP3, TP4), and IκB (3 h, TP3). These data suggest that TP3 and TP4 exert antimicrobial effects after overexpression in the O. niloticus muscle, and also play important roles in the regulation of immune-related gene expression.

Phellinus linteus, a species of mushroom, has been shown to contribute to health benefits, such as anti-inflammatory activity and immunomodulatory efficacy. The aim of this study was to analyze the most effective constituents of P. linteus fermented broths, polysaccharides, and to evaluate their immunoregulatory effects on T cells. Four fermented broths (PL1–4) and the dialyzate medium (MD) were prepared from P. linteus mycelia, and the polysaccharide contents of each were analyzed. The P. linteus samples were tested for biological activity in the regulation of T cell activation. In T cells, the production of mitogen-induced interleukin (IL)-2 and cell cycle progression were dose-responsively inhibited by PL3 and MD, primarily through cell-cycle arrest in S phase. PL3 broth, which contained large quantities of polysaccharides, significantly decreased the ratio of interferon-gamma (IFN-γ) to interleukin 4 (IL-4) in T cells. Thus, P. linteus fermented broths produced additive effects on the regulation of the Th1/Th2 balance and show promise for the development of immunomodulatory therapeutics.

Context:Fatigue of the shoulder rotator muscles may negatively affect joint position sense (JPS) and ultimately lead to injury.Objective:Recovery of shoulder JPS after muscle fatigue.Design:A repeated-measures study.Setting:Musculoskeletal research laboratory.Patients:Thirteen subjects participated in joint position error tests and isokinetic concentric strength assessment in shoulder rotation, before and after rotator muscle fatigue.Interventions:Local muscle fatigue was induced using isokinetic concentric contractions of the shoulder rotator muscles.Main Outcome Measurements:Shoulder rotator strength and JPS error signals were measured before fatigue, immediately after fatigue, and every ten minutes thereafter for one hour.Results:Before shoulder rotation muscle fatigue, the accuracy of shoulder JPS was 2.79 ± 1.67 degrees. After muscle fatigue, the accuracy decreased to 6.39 ± 2.90 degrees. Shoulder JPS was influenced up to 40 minutes after muscle fatigue, but shoulder strength was only affected for 10 minutes after muscle fatigue.Conclusions:Proprioceptive recovery was slower than strength following fatigue of the shoulder rotators.

OBJECTIVE To test the hypothesis that recreational tennis players transmit more shock impact from the racket to the elbow joint than experienced tennis players during the backhand stroke. Also, to test whether recreational tennis players used higher electromyographic (EMG) activities in common wrist extensor and flexor around epicondylar region at follow-through phase. DESIGN A repeated-measure, cross-sectional study. SETTING National College of Physical Education and Sports at Taipei, Taiwan. PARTICIPANTS Twenty-four male tennis players with no abnormal forearm musculoskeletal injury participated in the study. According to performance level, subjects were categorized into 2 groups: experienced and recreational. MAIN OUTCOME MEASUREMENTS Impact transmission and wrist extensor-flexor EMG for backhand acceleration, impact, and follow-through phases were recorded for each player. An independent t test with a significance level of 0.05 was used to examine mean differences of shock impact and EMG between the 2 test groups. One-way ANOVA associated with Tukey multiple comparisons was used to identify differences among different impact locations and EMG phases. RESULTS Experienced athletes reduced the racket impact to the elbow joint by 89.2%, but recreational players reduced it by only 61.8%. The largest EMG differences were found in the follow-through phase (P

This study compared the strength and endurance of shoulder internal rotators (IR) and external rotators (ER) among baseball pitchers of four age levels. Eighty baseball pitchers aged 10-23 years participated this study. Strength was assessed by the average peak torque of the middle 3 out of 5 repetitions. Endurance was assessed by thirty concentric internal and external contractions. Percentage of strength loss, initial and final torque ratio were used to assess endurance ability. The results showed that IR strength was greater than the ERs for all groups. The ER/IR ratio ranged 0.71-0.77. In endurance assessment, the players were found to have 70% strength loss in the IRs. Adolescent and pre-pubescent players had larger ( p< 0.05) strength loss in the ERs. Compared with adult pitchers, adolescent and pre-pubescent baseball pitchers had relatively weaker shoulder ERs especially after high repetition muscle contraction. In order to prevent shoulder injury in adolescent and pre-adolescent baseball throwers, muscle endurance in ER should be emphasized.

Tai chi has been increasingly applied in osteoporosis patients. However, systematic reviews of the efficacy of this practice have been few and of limited scope.This study reviews previous experimental research work using tai chi as an intervention in postmenopausal women with osteoporosis and to appraise the reported research designs used, tai chi methods used, and outcomes.A systematic review method was used to search 14 databases for articles published between January 1980 and July 2013. Searched keywords included: "tai chi," "osteoporosis," and "postmenopausal women". The 2,458 articles initially identified were reduced to 4 valid articles based on considerations of criteria and repeatability. The 4 valid articles used either a randomized clinical trial (RCT) or a controlled clinical trial (CCT). They were further analyzed and synthesized in terms of common variables such as balance, muscle strength, and quality of life.Three of the 4 studies identified significant pretest / posttest differences in physiological aspects of quality of life in participants but did not obtain consistent results in terms of the psychological aspects. While reports identified a significant and positive tai chi effect on balance, they all used different measurements to do so. Only one of the four studies identified significant improvement in muscle strength. Therefore, this review could not identify clear support for the effectiveness of tai chi on balance or muscle strength.This review did not definitively support the positive effects of tai chi on balance, muscle strength, and quality of life in postmenopausal women with osteoporosis. The designs used in the tai chi interventions may be referenced for future studies. We suggest that future studies use data triangulation rather than a single-item tool to validate the research in order to cross-verify the same information. This may strengthen the research and increase the credibility and the validity of related findings.運用太極拳於停經後骨質疏鬆婦女之成效探討—系統性文獻回顧太極拳是近年來常用於骨質疏鬆症患者的運動介入方案，但目前仍缺乏以停經後骨質疏鬆婦女為族群之系統性文獻探討。本文是回顧以太極拳為介入措施於停經後骨質疏鬆婦女之臨床實驗性研究，對於研究方法、太極拳法及其成效品質做評價，期以利太極拳運動訓練的推廣。以系統文獻回顧法搜尋1980年1月～2013年7月年間發表於14個電子資料庫，關鍵字含太極拳、骨質疏鬆、停經後婦女等字彙群組，搜尋共2,458篇文獻，排除重複性及未符合篩選標準文獻，最後剩下4篇等級較高的隨機控制實驗性研究，並針對文中相同的變項（平衡感、肌力、生活品質）進行整理與分析。4篇研究中，有3篇太極拳對於停經後骨質疏鬆婦女生活品質之生理層面項目較有顯著性成效，但心理成效研究結果較不一致，在平衡感評估，雖使用不同測量工具但都有其成效。肌力只有一篇有顯著性成效，故較難整體評價太極拳對於平衡感與肌力之影響。太極拳對停經後骨質疏鬆婦女於生活品質、平衡感與肌力之影響仍待商確，但其研究操作手法仍可提供未來介入之參考。另建議使用多元化工具測量同一項量以提供更完善的成效評價，增加研究的信效度。

Aging and age-related health problems are major issues of concern for community health services. Yoga is an exercise with both physiological and psychological effects on aging. Although many studies have assessed the effectiveness of yoga in the elderly, little information is available in the literature to support empirical conclusions.This review synthesizes and characterizes findings related to the effects of yoga on depression and quality of sleep in the elderly.Researchers used keywords including yoga, elderly, aged / older adult, depression, sleep, and quality to search 6 electronic databases for relevant studies published prior to March 2013. Inclusion and exclusion criteria were used to screen identified study abstracts. The Jadad scale appraised the quality of identified studies.Seven studies met the inclusion criteria. Five studies found significant changes in participant depression symptoms after doing yoga. Three studies found significant effects on the quality of sleep of participants after 6 months of doing yoga.Yoga significantly reduced the depressive symptoms of elderly participants and improved their quality of sleep after 6 months. Findings were similar for elderly living in institutions and in the community. However, the majority of participants in the assessed studies were women characterized by a high level of social participation and proactive participation in health promotion activities. Future studies should broaden the scope of research to address different aging populations and use long-term cohort observations in order to better elicit the effectiveness of yoga and to develop strategies to introduce yoga into daily activities.瑜珈於老年人憂鬱及睡眠品質之系統性文獻回顧老年健康議題，隨人口老化逐年上升而倍備受重視。瑜珈對促進老年健康之身心運動，雖有多位學者曾探討老年人執行瑜珈的成效，但文獻中鮮少提供具體實證性結論。本文經由系統性文獻回顧，整合及探討瑜珈運用於老年人憂鬱及睡眠品質之成效。搜尋六個中英文資料庫，使用關鍵字瑜珈（yoga）、老年人（elderly, aged, or older adult）、憂鬱（depression）、睡眠品質（sleep and quality）進行搜尋，時間至2013年3月前，於摘要為根據篩選納入及排除條件，並以modified Jadad score評定文獻品質。最後納入七篇文獻，其中有五篇文獻顯示在執行瑜珈後老年人的憂鬱症狀有顯著改善；三篇測量睡眠品質文獻，顯示瑜珈課程六個月後睡眠品質達到顯著改善。不論居住於機構或社區的老人，其憂鬱症狀及睡眠品質在執行六個月瑜珈後皆有顯著性改善。但由於受試者大多為女性、社會參與度高及具有健康促進的觀念者，建議未來可針對不同族群老年人進行探討，此外，亦建議進行世代研究，長期觀察瑜珈者的身心狀態，藉以了解瑜珈應用於老年人之效益，使老年人能將運動與日常生活結合。

The aim of this study was to apply the International Classification of Functioning, Disability and Health - Child and Youth (ICF-CY) framework to identify the factors related to the participation of children with autism.A convenience sample included 162 preschool children with autism ages 36 to 72 months. The raters collected data using the ICF-CY-based questionnaire as an instrument to construct the structural equation modeling of factors associated with participation.The internal structure of the model was acceptable, indicating that the observed variables would suffice in accounting for latent variables. The structural model showed that the performance of participation in children with autism was influenced by body functions and personal factors. All the variables accounted for 77% of the explained variance for activities and for participation by 71% of the children with autism.These findings may provide critical information pertaining to predictive factors of participation for parents, educators, and professionals who work with children with autism.

A nosocomial outbreak of multi-drug-resistant Acinetobacter calcoaceticus-A. baumannii (MDR-ACB) complex infection occurred in a newly constructed building at a 2,500-bed tertiary medical center in Taiwan.An investigation was carried out by molecular approaches to trace the bacteria. Antimicrobial susceptibilities, risk factors, and the occurrence of nosocomial MDR-ACB infections were investigated. From January to December 2009, 53 patients were infected with MDR-ACB, and 23 environmental surveys were performed in two surgical intensive care units (ICUs) within the new building. Forty-two clinical isolates were obtained from patients and 22 samples from nine environmental surveys.Forty clinical isolates (95.2%) and 18 environmental samples (81.8%) were positive for MDR-ACB of type A, the predominant outbreak strain. This strain was identical to that isolated in an outbreak in the old hospital in 2006, as proved by repetitive extragenic palindromic-based polymerase chain reaction and pulsed-field gel electrophoresis. Although the outbreak isolates contained blaOXA-23-like and blaOXA-51-like genes, analysis of the antimicrobial susceptibilities demonstrated increases in resistance to cefepime and imipenem-cilastatin in MDR-ACB isolated in the later outbreak.Not only patients or healthcare workers, but also medical equipment, might have carried the predominant outbreak strain from the old district to the new building. Therefore, even in a new environment, infection control programs must be enforced continually, and healthcare providers must be educated repeatedly to prevent recurrent outbreaks of MDR-ACB infection in the hospital setting.

The study was to investigate relation between tennis serving techniques and shoulder joint muscles in various skilled players in Taiwan. The study used Micro FET3 (Digital Manual Muscle Dynamometer and Goniometer) which appraised the isometric capacity of the shoulder joint and perimeter muscle. The research consists of 13 collegiate male tennis players; 6 players were in elite groups and the other 7 players were in general groups. The tennis players performed 30 servers testing the range to appraise serve technique reflect. The application of t-test and Linear Regression analyzed the serve technique reflect interrelated with the shoulder joint muscle. The muscle strength and the serve accuracy predominate interrelated place where middle trapezius, shoulder internal rotator, and shoulder external rotator of favor hands were obvious. The muscle strength and the serve speed predominated interrelated place where shoulder internal rotator and shoulder external rotator of favor hands were obvious. This study also discovered triceps of favor hands, shoulder extensor, shoulder abductor, triceps, and middle trapezius of non- favor hands muscle strength didn't have any outstanding reference with tennis league table. The research confirmed that the shoulder joint muscle discipline increased shoulder internal rotator, shoulder external rotator, and middle trapezius that help the serve technique reflect.

Ethnopharmacological relevance Helicobacter pylori is associated with the majority of gastric disorders and the antibiotic resistant rates have increased annually worldwide. Anisomeles indica and its constituent, ovatodiolide (OVT), were shown to have bactericide activity against Helicobacter pylori. The aim of this study was to manufacture extracts containing the effective constituent, OVT, and evaluate their bactericidal function and the inhibition of inflammatory responses to Helicobacter pylori infection. Materials and methods Various concentrations of ethanol for extraction of Anisomeles indica were performed and the content of OVT was analyzed by high-performance liquid chromatography (HPLC). The anti-bacterial activity of Anisomeles indica ethanol extracts and the constituent OVT were determined. Additional experiments were performed to investigate the Anisomeles indica ethanol extracts and OVT to inhibit the Helicobacter pylori-induced inflammation of both gastric epithelial cells and macrophages. Results Amongst the extracts tested, 50% and 95% ethanol extracts contained large amount of OVT and showed potent anti-Helicobacter pylori activity. An in vitro Helicobacter pylori-infection model revealed that 95% ethanol extract attenuated Helicobacter pylori-induced nuclear factor kappa B (NF-κB) activity and interleukin (IL)-8 secretion of gastric epithelial cells. In addition, 95% ethanol extract significantly inhibited lipopolysaccharide (LPS)-induced expression of inducible nitric oxide synthase (iNOS), as well as production of nitric oxide (NO) and tumor necrosis factor α (TNF-α) by macrophages. Conclusions This study reveals that Anisomeles indica ethanol extracts containing OVT may be a potent and economic therapeutic agent for Helicobacter pylori infection and attenuation of Helicobacter pylori-mediated inflammation.

A Gram-negative, heterotrophic, aerobic, marine bacterium, designated AIT1T, was isolated from a seawater sample collected in the shallow coastal region of Bitou Harbour, New Taipei City, Taiwan. Cells grown in broth cultures were straight or slightly curved rods that were motile by means of a single polar flagellum. Strain AIT1T required NaCl for growth, grew optimally at 30–40 °C and with 1.5–5.0 % NaCl, and was incapable of anaerobic growth by fermentation of glucose or other carbohydrates. The isoprenoid quinones consisted of Q-8 (95.2 %) and Q-9 (4.8 %). The major polar lipids comprised diphosphatidylglycerol, phosphatidylglycerol and phosphatidylethanolamine. The cellular fatty acids were predominantly iso-branched and included iso-C17 : 0 (26.5 %), summed feature 9 (comprising iso-C17 : 1ω9c and/or 10-methyl C16 : 0; 25.9 %) and iso-C15 : 0 (20.5 %). The DNA G+C content was 51.5 mol%. Phylogenetic analysis based on 16S rRNA gene sequences showed that strain AIT1T formed a distinct lineage within the class Gammaproteobacteria and was most closely related to members of the genus Idiomarina in the family Idiomarinaceae (91.5–93.9 % 16S rRNA gene sequence similarity). The phylogenetic data, together with chemotaxonomic, physiological and morphological data, revealed that the isolate should be classified as a representative of a novel species in a new genus in the family Idiomarinaceae, for which the name Aliidiomarina taiwanensis gen. nov., sp. nov. is proposed. The type strain is AIT1T ( = JCM 16052T = BCRC 80035T = NCCB 100321T).

In this study, we sequenced the complete mitochondrial genome of Parazacco spilurus (Cypriniformes, Cyprinidae). This mitochondrial genome, consisting of 16,612 base pairs (bp), encoded 13 protein-coding genes, 2 ribosomal RNAs, 22 transfer RNAs, and a noncoding control region as those found in other vertebrates, with the gene synteny identical to that of typical vertebrates. Control region (D-Loop), of 926 bp in length, is located between tRNA(Pro) and tRNA(Phe). The overall base composition of the heavy strand shows T 26.91%, C 26.01%, A 30.45% and G 16.63%, with an AT bias of 57.36%.

In this study, we sequenced the complete mitochondrial genome of Metzia mesembrinum (Cypriniformes, Cyprinidae), an Endangered pelagic primary freshwater fish distributed in South China. This mitochondrial genome, consisting of 16,611 base pairs (bp), encoded 13 protein-coding genes, 2 ribosomal RNAs, 22 transfer RNAs, and a noncoding control region as those found in other vertebrates, with the gene synteny identical to that of typical vertebrates. Control region (D-Loop), of 936 bp long, was located between tRNAPro and tRNAPhe. The overall base composition of the heavy strand shows T 26.83%, C 25.48%, A 32.01% and G 15.68%, with a slight AT bias of 58.84%.

Shoulder injury was common seen in racquet sports and baseball players. One of the injury factors was weakness of muscles that around the scapulae. Therefore, the purpose of this study was compared the scapular muscle strength between collegiate pitchers and tennis players. Seventeen collegiate pitchers and fourteen male tennis players were recruited to participate this study. All subjects have no any history with upper extremities injuries. The isometric muscle strength of dominated arm was measured by using MicroFet 2 manual muscle tester. The measured scapular muscles included middle trapezium, lower trapezium, serratus anterior, and shoulder internal and external rotators. The values of scapular muscle strength had normalized by subjects’ body weight. The independent T test was used to compare the scapular muscle strength of dominated arm between collegiate pitchers (P) and tennis players (T). The results had showed significantly difference between pitchers and tennis players in middle trapezium (P: 0.19 ±0.03 vs T: 0.22±0.03, p

Background There is little understanding of the reasons for the limited communication between patients and conventional healthcare professionals regarding patients’ use of complementary and alternative medicine (CAM). The purpose of this study is to explore the predictors of outpatients’ decision to disclose their use of natural products to conventional healthcare professionals. Methods A mixed method design was used. Quantitative data were obtained through a survey and qualitative data were obtained from semi-structured interviews. A total of 257 outpatients who fulfilled the criteria of having used natural products prior to the interview were recruited for this study. Subsequently, 39 patients of those who completed the survey were further selected to take part in an in-depth qualitative interview. Results Predictors of the decision to disclose the use of natural products to conventional healthcare professionals included age, frequency of clinic visits, knowledge of the natural products and the attitude towards the benefits of CAM use. The themes that emerged from the qualitative data included safeness of the natural products, consulting alternative sources of information, apprehension regarding the development of negative relationships with healthcare professionals and reactions from the healthcare professionals. Conclusions Understanding the factors and reasons affecting patients’ decision as to whether to disclose their use of natural products provides an opportunity for conventional healthcare professionals to communicate better with patients. It is important to encourage patients to disclose their use of natural products in order to provide responsible health care as well as increasing patient safety regarding medication usage.

Chun-Ming Chang,1,* Yen-Ching Chang,2,3 Hsiao-Yun Chang,4 Li-Wei Chou5,6,* 1Department of Applied Informatics and Multimedia, Asia University, Taichung, Taiwan; 2Department of Medical Informatics, Chung Shan Medical University, Taichung, Taiwan; 3Department of Medical Imaging, Chung Shan Medical University Hospital, Taichung, Taiwan; 4Department of Biotechnology, Asia University, Taichung, Taiwan; 5Department of Physical Medicine and Rehabilitation, China Medical University Hospital, Taichung, Taiwan; 6School of Chinese Medicine, College of Chinese Medicine, China Medical University, Taichung, Taiwan*These authors contributed equally to this workBackground: Increases in the aging population and in the number of accidents have resulted in more people suffering from physical impairments or disabilities. Rehabilitation therapy thus attracts greater attention as a means of helping patients recover and return to a normal life. With the extremely long and tedious nature of traditional rehabilitation, patients are reluctant to continue the entire process, thus the expected effects of the therapy cannot be obtained. Games are well known to help patients improve their concentration and shift their attention away from the discomfort of their injuries during rehabilitation. Thus, incorporating game technology into a rehabilitation program may be a promising approach.Methods: In this study, a gaming system used for shoulder rehabilitation was developed. The mechanical parts and electric circuits were integrated to mimic the functionalities of a shoulder wheel. Several games were also designed to suit the rehabilitation needs of the patients based on the age and gender differences among the individual users, enabling individuals to undergo the rehabilitation process by playing games. Two surveys were conducted to evaluate the satisfaction of the participants regarding the gaming system.Results: The results of the online survey among a larger population coincide with the responses of the hands-on participants through a paper-and-pencil survey. Statistical results suggest that the participants are willing to accept this novel approach.Conclusion: This gaming system can distract a patient from the sensation of pain or anxiety, and increase their motivation to participate in the therapeutic program. Advantages in terms of low-cost and easy setup increase the attractiveness of this new equipment for various potential users.Keywords: virtual reality, virtual rehabilitation, shoulder wheel, game design