Search

PURPOSE We undertook a study to investigate the relationship between duration of medication use and prevalence of impaired awareness of hypoglycemia (IAH) among patients with insulin-treated or sulfonylurea-treated type 2 diabetes in Taiwan. METHODS A total of 898 patients (41.0% insulin users, 65.1% sulfonylurea users; mean [SD] age = 59.9 [12.3] years, 50.7% female) were enrolled in pharmacies, clinics, and health bureaus of Tainan City, Taiwan. Presence of IAH was determined with Chinese versions of the Gold questionnaire (Gold-TW) and Clarke questionnaire (Clarke-TW). Sociodemographics, disease and treatment histories, diabetes-related medical care, and health status were collected. We used multiple logistic regression models to assess the relationship between duration of medication use and IAH. RESULTS Overall IAH prevalence was 41.0% (Gold-TW) and 28.2% (Clarke-TW) among insulin users, and 65.3% (Gold-TW) and 51.3% (Clarke-TW) among sulfonylurea users. Prevalence increased with the duration of sulfonylurea use, whereas it decreased with the duration of insulin use. After controlling for potential confounders, 5 or more years of sulfonylurea use was significantly associated with 3.50-fold (95% CI, 2.39-5.13) and 3.06-fold (95% CI, 2.11-4.44) increases in the odds of IAH based on the Gold-TW and Clarke-TW criteria, respectively. On the other hand, regular blood glucose testing and retinal examinations were associated with reduced odds in both insulin users and sulfonylurea users. CONCLUSIONS The prevalence of IAH was high among patients using sulfonylureas long term, but the odds of this complication were attenuated for those who received regular diabetes-related medical care. Our study suggests that long-term sulfonylurea use and irregular follow-up increase risk for IAH. Further prospective studies are needed to confirm the observed associations. Key words: hypoglycemia; type 2 diabetes; sulfonylurea; insulin; hypoglycemic agents; glycemic control; risk factors; diabetes complications; primary care https://doi.org/10.1370/afm.3129 Annals Early Access article, INTRODUCTION Hypoglycemia is a noteworthy problem in the glycemic control of type 2 diabetes. The annual prevalence of mild hypoglycemia is approximately 30% to 40% among patients with insulin-treated type [...]

Objective To investigate the rehabilitation effects of vestibular rehabilitation in acute brainstem infarction patients with subjective visual vertical (SVV) tilting, and the correlation between the SVV, balance confidence, dizziness/vertigo and walking function. Methods All 45 acute brainstem infarction patients with SVV tilting who were hospitalized in Tianjin Huanhu Hospital from July 2022 to July 2023 were collected. Patients were divided into vestibular rehabilitation group (n = 25) and general rehabilitation group (n = 20), Bucket Test was used to test SVV tilting angle, Activities-Specific Balance Confidence Scale (ABC) was used to evaluate balance confidence, Visual Analog Scales (VAS) was used to evaluate dizziness/vertigo and Functional Ambulation Category Scale (FAC) was used to evaluate walking function before and after 2 weeks of treatment. Results The SVV tilting angle (F = 4.356, P = 0.043), ABC score (F = 4.389, P = 0.042), dizziness/vertigo VAS score (F = 4.138, P = 0.048) were significantly different between vestibular rehabilitation group and general rehabilitation group. After treatment, the SVV tilting angle (t = - 2.139, P = 0.038) and the dizziness/vertigo VAS score (t = - 2.952, P = 0.005) in vestibular rehabilitation group were lower than those in general rehabilitation group, and the ABC score was higher than that in general rehabilitation group (t = 2.920, P = 0.006). SVV tilting angle (F = 196.923, P = 0.000), ABC score (F = 89.050, P = 0.000), dizziness/vertigo VAS score (F = 81.803, P = 0.000), FAC grade (F = 72.866, P = 0.000) were statistically significant. The SVV tilting angle (t = 0.763, P = 0.000; t = 0.972, P = 0.000) and dizziness/vertigo VAS score (t = 8.815, P = 0.000; t = 5.107, P = 0.000) after treatment were lower than those before treatment of 2 groups, and the ABC score (t = 0.689, P = 0.001; t = 0.703, P = 0.001) and FAC grade (t = - 6.721, P = 0.000; t = - 5.772, P = 0.000) were higher than those before treatment of 2 groups. Correlation analysis showed a positive correlation between SVV tilting angle and dizziness/vertigo VAS score in acute brainstem infarction patients with SVV tilting (r = 0.627, P = 0.000). Conclusions Vestibular rehabilitation can effectively improve the SVV tilting, balance confidence and dizziness/vertigo symptoms of acute brainstem infarction patients with SVV tilting, and the SVV tilting angle is closely related to the degree of dizziness/vertigo.

Objective To explore the gait characteristics prior to the step initiation in patients with early Parkinson's disease (PD). Methods A total of 20 patients diagnosed with early PD admitted to Tianjin Huanhu Hospital from July 2020 to June 2021, and 22 normal controls with normal cognitive and motor function matched by gender, age, body mass index (BMI) and education were included. The gait characters in the initial step stage [anticipatory postural adjustments (APAs) duration, fowward APAs peak, lateral APAs peak] and the first step period (first step duration, first step swing angle), as well as the gait characters in the walking stage (step speed and stride length) during the 7 m Stand and Walk Test (7MSAW) were recorded by gait analyzer. Receiver operating characteristic (ROC) curve was plotted to evaluate the value of gait characteristics in diagnosis of early PD. Results The APAs duration in early PD group was longer than that in control group (Z = ⁃ 4.853, P = 0.000), and the forward APAs peak was lower than that in control group (Z = ⁃ 5.253, P = 0.000). The cut⁃off value of APAs duration was 0.440 s, the area under the curve (AUC) was 0.947 (95%CI: 0.885-1.000, P = 0.000), the sensitivity was 95%, the specificity was 77.30%, and the Youden index was 0.723. The cut⁃off value of forward APAs peak was 0.445 m/s2, the AUC was 0.974 (95%CI: 0.936-1.000, P = 0.000), the sensitivity was 85%, the specificity was 95.50%, and the Youden index was 0.805. The cut⁃off value of the combination was 0.540, the AUC was 0.974 (95%CI: 0.936-1.000, P = 0.000), the sensitivity was 90%, the specificity was 90.10%, and the Youden index was 0.801. Conclusions The APAs in the initial step stage is abnormal in patients with early PD, the related parameters have high sensitivity and specificity, which can assist clinicians in early screening of diseases.

Medical artificial intelligence (AI) applies AI technology to the medical field to meet clinical needs, combines with the experience of doctors, and relies on the computing, analysis and decision⁃making ability of AI to provide accurate intelligent assistance for clinical diagnosis and treatment. At present, medical AI is based on knowledge guided and data driven approaches, but each has its own advantages and disadvantages. Combining knowledge⁃guided AI with data⁃driven AI and utilizing their respective advantages is expected to break through the application bottle neck of medical AI and promote the development and innovation of medical AI. This paper summarizes the application of medical AI driven by knowledge guidance and data mining and looks forward to the future development direction, in order to promote the innovation and application of AI technology in the medical field.

With the development of the combination of medicine and engineering and the improvement of clinical rehabilitation demand, intelligent upper limb rehabilitation robots can provide stroke patients with high intensity and repetition of active rehabilitation training to restore the upper limb motor function and achieve the remodeling of damaged brain nerves. However, many upper limb rehabilitation robot systems are still in the stage of laboratory development or clinical verification. This paper summarizes the latest research results of upper limb rehabilitation robots at home and abroad, compares the advantages and disadvantages of different types of robots, looks forward to the development trend of upper limb rehabilitation robots, and provides ideas for further promoting clinical transformation.

The combination of medicine and engineering is gradually becoming a new model for clinical diagnosis and treatment of Parkinson's disease (PD). Intelligent assisted diagnosis and treatment is attracting more and more attention from clinicians, among which video technology is favored for its advantages of simple operation and no need to wear. Video technology combined with artificial intelligence (AI) can discover the early symptom characteristics of PD, quantify the symptoms of PD, and realize the remote medical treatment of PD. This article reviews the latest progress in the diagnosis and treatment of PD through intelligent video technology and looks forward to its future application in order to promote its clinical application.

Objective To investigate the difference between walking and static standing characteristics in stroke patients with and without vestibular symptoms. Methods A total of 82 stroke patients who received rehabilitation treatment in Tianjin Huanhu Hospital, Tianjin University from May 2020 to December 2021, and 49 controls with the matched gender, age and education level were included. The stroke patients were divided into vestibular symptom group (n=51) and vestibular symptomless group (n=31) according to the condition of vestibular symptoms. The walking stability was evaluated by 7⁃Meter Walking Test, and the stability of static standing balance was evaluated by the Clinical Test of Sensory Interaction and Balance (CTSIB). Results The results of the 7⁃Meter Walking Test showed that there were statistically significant differences in the spatial and temporal parameters of gait, the coronal plane swing angle of trunk, swing area and the root mean square of coronal plane posture swing among 3 groups (P=0.000, for all). The stride length, stride speed and stride frequency of the vestibular symptoms group and the vestibular symptomless group were lower than those of the control group (P=0.000, for all), and the time parameters of the double brace phase time and the terminal double brace phase time were higher than those of the control group (P=0.000, for all). The stride length, stride speed and stride frequency of the vestibular symptoms group were lower than those of vestibular symptomless group (P＜0.05, for all), and the time of dual brace phase and terminal dual brace phase were higher than those of vestibular symptomless group (P=0.000, for all). The trunk coronal plane swing angle (P＜0.01, for all), swing area (P=0.000, for all) and root mean square of coronal plane posture swing (P=0.000, for all) in vestibular symptoms group and vestibular symptomless group were greater than those in control group. The coronal plane swing angle of trunk and the root mean square of coronal plane posture swing of vestibular symptoms group were also greater than those of vestibular symptomless group (P=0.000, for all). The results of CTSIB showed there were statistically significant differences in trunk swing area, root mean square of coronal and sagittal plane postural swing among 3 groups (P=0.000, for all). In vestibular symptom group and vestibular symptomless group, the root mean square of coronal and sagittal plane postural swing were greater than those of the control group under the 4 test conditions of eyes open on firm, eyes closed of firm, eyes open on foam, eyes closed on foam (P＜0.01, for all). In vestibular symptom group and vestibular symptomless group, the trunk swing area was greater than that in control group under 3 test conditions of eyes open on firm, eyes closed on firm and eyes closed on foam (P=0.000, for all). The trunk swing area in vestibular symptom group was greater than that in control group (P=0.000), but less than that in vestibular symptomless group (P=0.000). There was no statistical significance between vestibular symptoms group and vestibular symptomless group under 4 test conditions (P＞0.05, for all). Conclusions The walking parameters of stroke patients with vestibular symptoms were significantly changed than those of vestibular symptomless, which can provide important clinical value for the implementation of precise rehabilitation treatment.

Neuromodulation technique not only provides a new idea for the treatment of many diseases, but also has a profound influence on the innovation and development of rehabilitation medicine. Nowadays, the neuromodulation technique in China is in the stage of rapid development, facing great opportunities and challenges, and has broad application prospects. This review intends to describe the mechanism of different types of neuromodulation technologies, and its application status and future development in the field of rehabilitation medicine, in order to promote the application and development of neuromodulation technique in the field of neurorehabilitation in China.

Objective To investigate the effect of cognitive⁃motor dual⁃task on gait automaticity in patients with Parkinson's disease (PD). Methods A total of 45 patients with primary PD in Tianjin Huanhu Hospital were selected from June 2020 to December 2021. Cognitive single task, motor single task and cognitive⁃motor dual⁃task in the "off" and "on" states of dopaminergic medication were performed. The correct number of subtractions was recorded to measure cognitive performance. A three⁃dimensional gait analyzer was used to extract the parameters of stride length and gait velocity, and the dual⁃task cost (DTC) was calculated to measure gait automaticity. Results Compared with single task, patients with PD showed slower gait velocity (t=11.909, P=0.000; t=11.621, P=0.000), shortened stride length (t=9.027, P=0.000; t=9.991, P=0.000), while there was no significant difference in the correct number of subtraction (t=0.651, P=0.519; t=1.205, P=0.234) during both "off" and "on" states. In patients with PD, the DTC of gait velocity (Z=⁃4.148, P=0.000) and stride length (Z=⁃4.114, P=0.000) in the "off" state was higher than that in the "on" state, while the DTC for subtraction had no significant difference (Z=⁃1.005, P=0.315). The DTC of gait velocity in the "off" and "on" states of patients with PD was negatively correlated with the Mini⁃Mental State Examination (MMSE) score (rs=⁃0.474, P=0.000; rs=⁃0.461, P=0.000), but positively correlated with Unified Parkinson's Disease Rating Scale Ⅲ (UPDRS Ⅲ) score (rs=0.446, P=0.002; rs=0.428, P=0.003). Conclusions Patients with PD have a significant decrease in stride length and gait velocity, and higher risk of falling when performing dual⁃task. Dopaminergic medication can improve the gait automaticity of patients, and cognitive decline may lead to gait automaticity disorder in patients with PD.

Objective To explore the risk factors related to higher fall risk in patients with cerebral small vessel disease (CSVD) who can walk independently. Methods A total of 226 patients with CSVD treated in Department of Neurorehabilitation, Tianjin Huanhu Hospital from December 2017 to December 2020 were included. Clinical data (including sex, age, height, weight, past medical history, resting blood pressure, fasting blood glucose and glycosylated hemoglobin) were collected. Lacunar infarct (LACI) and white matter hyperintense [deep white matter hyperintense (DWMH) and periventricular white matter hyperintense (PWMH)] were observed by MRI, carotid intima⁃media thickness (IMT) was measured by color Doppler ultrasound. Postural instability was assessed based on One⁃Leg Standing Test (OLST). Univariate and multivariate forward Logistic regression analysis were used to screen the risk factors of higher fall risk in patients with CSVD who can walk independently. Results According to OLST time, the patients were divided into high fall risk group (≤10 s, 104 cases) and low fall risk group (＞10 s, 122 cases). Univariate and multivariate forward Logistic regression analysis suggested that age (OR=1.053, 95%CI: 1.006-1.101; P=0.026), diabetes history (OR=2.910, 95%CI: 1.288-6.577; P=0.010), DWMH Fazekas score 1 (OR=7.329, 95%CI: 1.775-30.272; P=0.006), Fazekas score 2 (OR=8.004, 95%CI: 1.905-33.627; P=0.005) and Fazekas score 3 (OR=23.884, 95%CI: 4.205-135.657; P=0.000) were the risk factors of higher fall risk patients with CSVD who can walk independently. Conclusions For patients with CSVD, especially those who appear to have a normal gait and can walk independently, there is still a high risk of falling, which may be independently related to the age, diabetes history and DWMH.

Brain ⁃ computer interface (BCI) is a cutting ⁃ edge technology of interdisciplinary integration, which has been widely used in many fields. This article introduces the four key parts of BCI technology, including signal acquisition, feature extraction, feature classification and external devices manipulation. This review introduces the application status of BCI in the medical field, we focus on the application of network science and deep learning in BCI, including extracting deeper electroencephalography (EEG) signal representations and achieving high ⁃ precision classification. Lastly, we explore the application prospects and challenges of BCI in the medical field.

As a new science and technology, artificial intelligence (AI) has been applied to the prevention, diagnosis, treatment and rehabilitation of stroke, and shows great potential. The combination of artificial intelligence and big data can accurately identify high ⁃ risk subjects, classify stroke subtype, and assist in the formulate of therapeutic strategies in acute period and prevention strategy of stroke. Sequentially, it can improve the effect of rehabilitation. This paper reviews the research progress of artificial intelligence in the prevention, diagnosis, treatment and rehabilitation of stroke.

Intravenous thrombolysis with recombinant tissue plasminogen activator (rtPA) is the primary treatment for ischemic stroke. However, rtPA treatment can substantially increase blood‐brain barrier (BBB) permeability and susceptibility to hemorrhagic transformation. Herein, the mechanism underlying the side effects of rtPA treatment is investigated and demonstrated that ferroptosis plays an important role. The ferroptosis inhibitor, liproxstatin‐1 (Lip) is proposed to alleviate the side effects. A well‐designed macrocyclic carrier, glucose‐modified azocalix[4]arene (GluAC4A), is prepared to deliver Lip to the ischemic site. GluAC4A bound tightly to Lip and markedly improved its solubility. Glucose, modified at the upper rim of GluAC4A, imparts BBB targeting to the drug delivery system owing to the presence of glucose transporter 1 on the BBB surface. The responsiveness of GluAC4A to hypoxia due to the presence of azo groups enabled the targeted release of Lip at the ischemic site. GluAC4A successfully improved drug accumulation in the brain, and Lip@GluAC4A significantly reduced ferroptosis, BBB leakage, and neurological deficits induced by rtPA in vivo. These findings deepen the understanding of the side effects of rtPA treatment and provide a novel strategy for their effective mitigation, which is of great significance for the treatment and prognosis of patients with ischemic stroke. [ABSTRACT FROM AUTHOR]

Objective: To assess the trend in prevalence and socioeconomic correlates of diabetes in pregnancy (DIP) in Taiwan from 2007 to 2014. Methods: In all, 1 606 344 pregnancies, including 199 383 DIP (1693 with pre‐pregnancy type 1 diabetes [T1DM], 17 171 with pre‐pregnancy type 2 diabetes [T2DM], and 180 519 with gestational diabetes mellitus [GDM]) were investigated. Logistic regression models were performed to identify the covariates significantly associating with DIP. Results: Over the study period, the prevalence of pre‐pregnancy T2DM increased by 568.44%; the prevalence of T1DM and GDM also increased but with a smaller magnitude. However, only the prevalence of pre‐pregnancy T2DM showed an increase after socioeconomic variables were considered. Compared with immigrant mothers, native‐born mothers had a significantly higher adjusted odds ratio of DIP, particularly pre‐pregnancy T1DM (3.33, 95% confidence interval 1.57–7.05). Additionally, indigenous mothers and those from rural areas had a higher prevalence of pre‐pregnancy T2DM but lower prevalence of GDM. Lower maternal education and income were associated with higher prevalence of pre‐pregnancy T1DM but lower prevalence of pre‐pregnancy T2DM and GDM. Conclusion: Socioeconomic variables largely accounted for the increased secular trend in pre‐pregnancy T1DM and GDM, but the prevalence of pre‐pregnancy T2DM still doubled, which was independent of socioeconomic covariates. Synopsis: Diabetes in pregnancy, particularly pre‐pregnancy type 2 diabetes, has been increasing in Taiwan, and it shows obvious socioeconomic inequality and urban–rural disparity. [ABSTRACT FROM AUTHOR]

The severity of autism spectrum disorder was strongly related to the education and service outcome. Without a clear profile of autistic population and its change, efforts to understand its nature and improve the quality of service or education will be impossible. The present study aims to describe the over time reported rate of autism severity based on a nationwide population-based 10 years register data in Taiwan. We obtained the national register data--"the Disabled Population by Aged and Grade" and "the Taiwan General Population by Age" to examine the overtime trend change of autism severity from 2000 to 2009. Results showed that the reported prevalence of autistic cases significantly increased from 0.93 to 3.96 per 10,000 population in 2000-2009. The group of mild disability grade was significant increasing from 33.4% to 56.2% in percentage of four disability levels in the year of 2000 and 2009, the other groups were decreasing percentage significantly at the same period (p less than 0.001 in linear trend tests). However, the gender difference in the number of autism in all disability severity needed to be measured in the future study. The study highlights that it is needed to measure the effect of autism severity on the healthcare and education needs in the near future, to improve the quality service for people with autism spectrum disorder. (Contains 1 table and 4 figures.)

Dependency ratios are useful as general indicators of future economic and social health. The present paper focuses on the description of dependency ratios and over time change in different kind of disability which include autism, intellectual disability, vision, hearing, and limb impairments. We analyzed data mainly from the public web-access information which collected by the Taiwan MOI. We analyzed the national register data in two ways for 2000-2009: the Disabled Population by Aged and Grade and the Taiwan General Population by Age, to examine the dependent ratios in disabilities. The dependency ratio measures the percentage of dependent people (not of working age)/number of people of working age (economically active), and it is decomposed into the child dependency ratio, the aged dependency ratio and index of aging. The results found the aged dependency ratios in general or disabled population were significantly increased in 2000-2009. Vision, hearing and limb disabilities had the higher aging index in all disabilities. Intellectual disability and autistic cases were relatively younger age population than other disabilities. However, the trend test revealed that child dependency ratio in autism decrease significantly as the identified case number increase during the past 10 years. Many reasons were discussed in the context of the trend changes. Finally, the results highlights that the increasing dependency ratio trends revealed that we are facing an aging population, the social security system need to provide for a significantly older and non-working population. The future study should consider the indicators such as the number of people receiving disability benefits or the use of disability-adjusted life years, they would provide more accurate for tracking dependency in the society. (Contains 5 tables.)