The Text-Picture Integration Scale for Perspectives on Mental Illness: Development and Validation.

IMPORTANCE: Understanding the root cause of mental illness stigma is necessary to adopt effective management strategies. OBJECTIVE: To establish a stable and effective text-picture integration rating scale to predict public perspectives on mental illness and to examine its reliability and validity. DESIGN: Descriptive cross-sectional study using internet survey data. SETTING: Online. PARTICIPANTS: Two hundred volunteers. RESULTS: The 10-item the Text-Picture Integration Scale for Perspectives on Mental Illness was developed. The authors conducted data analysis using SPSS to evaluate the reliability and criterion-related validity of the Mental Health Literacy Scale (MHLS). The Text-Picture Integration Scale's item-level content validity index ranged from 0.83 to 1.00, and the scale-level content validity index was 0.97. The scale demonstrated acceptable reliability (Cronbach's α = .80). The mean value of individual items ranged from 3.18 to 4.48, and the mean total score was 39.44 (SD = 8.47). The Text-Picture Integration Scale exhibited satisfactory criterion-related validity with the MHLS (r = .76, p < .001). CONCLUSIONS AND RELEVANCE: Preliminary analyses support that the Text-Picture Integration Scale is a stable and effective rating scale to determine public perspectives on mental illness and is appropriate for evaluating destigmatization efforts. Plain-Language Summary: The study findings support the use of the Text-Picture Integration Scale as a stable and effective rating scale to determine public perspectives on mental illness. The scale is also appropriate for evaluating ways to address the stigmas that people associate with mental illness, which pose challenges for people in recovery. Occupational therapists can leverage their understanding of public perspectives on mental illness when choosing interventions to support the overall well-being of their clients with mental illness.

Consistency between two subjective assessments of activities of daily living: Patient- and occupational therapist-reported judgments.

Purpose: To examine the consistency between patient- and occupational therapist-reported judgments of patients' ability and change in ADL abilities. Materials: Patient- and therapist-reported ADL abilities were assessed using a Visual Analogue Scale, whilst the changes in patients' ADL abilities were reported by patients and therapists using a 15-point Likert-type scale. Methods: Repeated assessments at a 3-week interval were used. 88 inpatients with stroke and 16 occupational therapists were recruited from rehabilitation wards in a medical center. Results: Moderate correlations (rs = .53-.56) were found between the patient- and therapist-reported ADL abilities. The patient-reported scores were significantly lower (ds = .45; ps < .001 at follow-up) than the therapist-reported scores. Only low correlation (r = .33) was found for the change scores. Conclusions: Our findings indicated that there was only a moderate to low correlation between the patients' reports and the therapists' judgments regarding the patients' ADL ability and its change. Because both patients' reports and therapists' judgments affect decisions on rehabilitation, frequent communication may be beneficial for reaching consensus and helpful in managing the interventions.

Effects of virtual reality-based motor control training on inflammation, oxidative stress, neuroplasticity and upper limb motor function in patients with chronic stroke: a randomized controlled trial.

BACKGROUND: Immersive virtual reality (VR)-based motor control training (VRT) is an innovative approach to improve motor function in patients with stroke. Currently, outcome measures for immersive VRT mainly focus on motor function. However, serum biomarkers help detect precise and subtle physiological changes. Therefore, this study aimed to identify the effects of immersive VRT on inflammation, oxidative stress, neuroplasticity and upper limb motor function in stroke patients. METHODS: Thirty patients with chronic stroke were randomized to the VRT or conventional occupational therapy (COT) groups. Serum biomarkers including interleukin 6 (IL-6), intracellular adhesion molecule 1 (ICAM-1), heme oxygenase 1 (HO-1), 8-hydroxy-2-deoxyguanosine (8-OHdG), and brain-derived neurotrophic factor (BDNF) were assessed to reflect inflammation, oxidative stress and neuroplasticity. Clinical assessments including active range of motion of the upper limb and the Fugl-Meyer Assessment for upper extremity (FMA-UE) were also used. Two-way mixed analyses of variance (ANOVAs) were used to examine the effects of the intervention (VRT and COT) and time on serum biomarkers and upper limb motor function. RESULTS: We found significant time effects in serum IL-6 (p = 0.010), HO-1 (p = 0.002), 8-OHdG (p = 0.045), and all items/subscales of the clinical assessments (ps < 0.05), except FMA-UE-Coordination/Speed (p = 0.055). However, significant group effects existed only in items of the AROM-Elbow Extension (p = 0.007) and AROM-Forearm Pronation (p = 0.048). Moreover, significant interactions between time and group existed in item/subscales of FMA-UE-Shoulder/Elbow/Forearm (p = 0.004), FMA-UE-Total score (p = 0.008), and AROM-Shoulder Flexion (p = 0.001). CONCLUSION: This was the first study to combine the effectiveness of immersive VRT using serum biomarkers as outcome measures. Our study demonstrated promising results that support the further application of commercial and immersive VR technologies in patients with chronic stroke.

The impact of multi-person virtual reality competitive learning on anatomy education: a randomized controlled study.

BACKGROUND: Anatomy is one of the core subjects in medical education. Students spend considerable time and effort on learning the requisite anatomy knowledge. This study explored the effect of a multiple-player virtual reality (VR) gaming system on anatomy learning. METHODS: 18 participants were randomly assigned into 3 learning conditions: (1) a textbook reading control group (CG), (2) a single-player VR (SP) group; and (3) a multiple-player VR (MP) group. The participants studied anatomy for 5 days, and completed a multiple-choice test on Days 1, 5, and 12. In the VR environment, the participants used handheld controllers to move the simulated tissues. The mission of the game was to complete puzzles of a human body. The SP and MP groups filled out a motivation inventory on Day 5. The scores on the multiple-choice test, the correct assembly rates, and the motivation inventory scores were analyzed using the 2-way ANOVA or independent t-test to compare group differences. RESULTS: There was a significant interaction effect of group and timepoint (p = 0.003) in the multiple-choice test. In the CG, the scores on Day 1, Day 5, and Day 12 were significantly different (p < 0.001). The scores on Day 5 were significantly higher than those on Day 1 (p < 0.001). Although the scores declined slightly on Day 12, they were still significantly higher than those on Day 1 (p < 0.001). The SP and MP groups had similar results (p < 0.001, p < 0.001). The differences between the groups were only significant on Day 12 (p = 0.003), not Day 5 (p = 0.06). On Day 12, the scores of the MP group were higher than those of the CG (p = 0.002). The SP group and MP group had high scores on the interest, competence, and importance subscales of the motivation inventory. Both VR groups considered the system to be fun and beneficial to their learning. However, the MP group reported higher stress levels than the SP group. CONCLUSION: The results indicated that the proposed VR learning system had a positive impact on the anatomy learning. Although the between-player competition caused higher stress levels for the VR groups, the stress could have been a mediator of their learning outcomes. TRIAL REGISTRATION: ETRD, ETRD-D-19-00573. Registered 20 December 2018, http://www.edah.org.tw/irb/index.htm.

Optimal Grasp Distance and Muscle Loads for People With Rheumatoid Arthritis Using Carpometacarpal and Metacarpophalangeal Immobilization Orthoses.

OBJECTIVES: The objectives of this study were to investigate whether people with rheumatoid arthritis (RA) require greater muscle loads to equal the grip strength of healthy adults and to find the optimal grip distance for people with RA using carpometacarpal and metacarpophalangeal immobilization orthoses as measured by electromyography of the forearm muscles. METHOD: A 2 × 2 (Group × Orthosis) experiment and a 2 × 3 (Orthosis × Grasp Distance) factorial were conducted. Grip strength and muscle load were measured. RESULTS: Grip strength was significantly lower, and muscle load was greater, in 18 participants with RA than in 18 healthy adults. No effect of orthosis use on grip strength and muscle load was found. Muscle load was lower for the 42.25-mm diameter dynamometer handle than for handles with larger diameters. CONCLUSION: People with RA require more muscle load than healthy adults to produce the same exertion, and 42.25 mm is recommended for people with RA as the optimal grasp distance.

Cyclic Stretch Facilitates Myogenesis in C2C12 Myoblasts and Rescues Thiazolidinedione-Inhibited Myotube Formation.

Thiazolidinedione (TZD), a specific peroxisome proliferator-activated receptor γ (PPARγ) agonist, was developed to control blood glucose in diabetes patients. However, several side effects were reported that increased the risk of heart failure. We used C2C12 myoblasts to investigate the role of PPARs and their transcriptional activity during myotube formation. The role of mechanical stretch during myogenesis was also explored by applying cyclic stretch to the differentiating C2C12 myoblasts with 10% strain deformation at 1 Hz. The myogenesis medium (MM), composed of Dulbecco's modified Eagle's medium with 2% horse serum, facilitated myotube formation with increased myosin heavy chain and α-smooth muscle actin (α-SMA) protein expression. The PPARγ protein and PPAR response element (PPRE) promoter activity decreased during MM induction. Cyclic stretch further facilitated the myogenesis in MM with increased α-SMA and decreased PPARγ protein expression and inhibited PPRE promoter activity. Adding a PPARγ agonist (TZD) to the MM stopped the myogenesis and restored the PPRE promoter activity, whereas a PPARγ antagonist (GW9662) significantly increased the myotube number and length. During the myogenesis induction, application of cyclic stretch rescued the inhibitory effects of TZD. These results provide novel perspectives for mechanical stretch to interplay and rescue the dysfunction of myogenesis with the involvement of PPARγ and its target drugs.

Cross-Sectional Nakagami Images in Passive Stretches Reveal Damage of Injured Muscles.

Muscle strain is still awanting a noninvasive quantitatively diagnosis tool. High frequency ultrasound (HFU) improves image resolution for monitoring changes of tissue structures, but the biomechanical factors may influence ultrasonography during injury detection. We aim to illustrate the ultrasonic parameters to present the histological damage of overstretched muscle with the consideration of biomechanical factors. Gastrocnemius muscles from mice were assembled and ex vivo passive stretching was performed before or after injury. After injury, the muscle significantly decreased mechanical strength. Ultrasonic images were obtained by HFU at different deformations to scan in cross and longitudinal orientations of muscle. The ultrasonography was quantified by echogenicity and Nakagami parameters (NP) for structural evaluation and correlated with histological results. The injured muscle at its original length exhibited decreased echogenicity and NP from HFU images. Cross-sectional ultrasonography revealed a loss of correlation between NP and passive muscle stretching that suggested a special scatterer pattern in the cross section of injured muscle. The independence of NP during passive stretching of injured muscle was confirmed by histological findings in ruptured collagen fibers, decreased muscle density, and increased intermuscular fiber space. Thus, HFU analysis of NP in cross section represents muscle injury that may benefit the clinical diagnosis.

Shear Stress Induces Differentiation of Endothelial Lineage Cells to Protect Neonatal Brain from Hypoxic-Ischemic Injury through NRP1 and VEGFR2 Signaling.

Neonatal hypoxic-ischemic (HI) brain injuries disrupt the integrity of neurovascular structure and lead to lifelong neurological deficit. The devastating damage can be ameliorated by preserving the endothelial network, but the source for therapeutic cells is limited. We aim to evaluate the beneficial effect of mechanical shear stress in the differentiation of endothelial lineage cells (ELCs) from adipose-derived stem cells (ASCs) and the possible intracellular signals to protect HI injury using cell-based therapy in the neonatal rats. The ASCs expressed early endothelial markers after biochemical stimulation of endothelial growth medium. The ELCs with full endothelial characteristics were accomplished after a subsequential shear stress application for 24 hours. When comparing the therapeutic potential of ASCs and ELCs, the ELCs treatment significantly reduced the infarction area and preserved neurovascular architecture in HI injured brain. The transplanted ELCs can migrate and engraft into the brain tissue, especially in vessels, where they promoted the angiogenesis. The activation of Akt by neuropilin 1 (NRP1) and vascular endothelial growth factor receptor 2 (VEGFR2) was important for ELC migration and following in vivo therapeutic outcomes. Therefore, the current study demonstrated importance of mechanical factor in stem cell differentiation and showed promising protection of brain from HI injury using ELCs treatment.

Synergy of endothelial and neural progenitor cells from adipose-derived stem cells to preserve neurovascular structures in rat hypoxic-ischemic brain injury.

Perinatal cerebral hypoxic-ischemic (HI) injury damages the architecture of neurovascular units (NVUs) and results in neurological disorders. Here, we differentiated adipose-derived stem cells (ASCs) toward the progenitor of endothelial progenitor cells (EPCs) and neural precursor cells (NPCs) via microenvironmental induction and investigated the protective effect by transplanting ASCs, EPCs, NPCs, or a combination of EPCs and NPCs (E+N) into neonatal HI injured rat pups. The E+N combination produced significant reduction in brain damage and cell apoptosis and the most comprehensive restoration in NVUs regarding neuron number, normal astrocytes, and vessel density. Improvements in cognitive and motor functions were also achieved in injured rats with E+N therapy. Synergistic interactions to facilitate transmigration under in vitro hypoxic microenvironment were discovered with involvement of the neuropilin-1 (NRP1) signal in EPCs and the C-X-C chemokine receptor 4 (CXCR4) and fibroblast growth factor receptor 1 (FGFR1) signals in NPCs. Therefore, ASCs exhibit great potential for cell sources in endothelial and neural lineages to prevent brain from HI damage.

Delayed mirror visual feedback presented using a novel mirror therapy system enhances cortical activation in healthy adults.

BACKGROUND: Mirror visual feedback (MVF) generated in mirror therapy (MT) with a physical mirror promotes the recovery of hemiparetic limbs in patients with stroke, but is limited in that it cannot provide an asymmetric mode for bimanual coordination training. Here, we developed a novel MT system that can manipulate the MVF to resolve this issue. The aims of this pilot study were to examine the feasibility of delayed MVF on MT and to establish its effects on cortical activation in order to understand how it can be used for clinical applications in the future. METHODS: Three conditions (no MVF, MVF, and 2-s delayed MVF) presented via our digital MT system were evaluated for their time-course effects on cortical activity by event-related desynchronization (ERD) of mu rhythm electroencephalography (EEG) during button presses in 18 healthy adults. Phasic ERD areas, defined as the areas of the relative ERD curve that were below the reference level and within -2-0 s (P0), 0-2 s (P1), and 2-4 s (P2) of the button press, were used. RESULTS: The overall (P0 to P2) and phasic ERD areas were higher when MVF was provided compared to when MVF was not provided for all EEG channels (C3, Cz, and C4). Phasic ERD areas in the P2 phase only increased during the delayed-MVF condition. Significant enhancement of cortical activation in the mirror neuron system and an increase in attention to the unseen limb may play major roles in the response to MVF during MT. In comparison to the no MVF condition, the higher phasic ERD areas that were observed during the P1 phase in the delayed-MVF condition indicate that the image of the still hand may have enhanced the cortical activation that occurred in response to the button press. CONCLUSIONS: This study is the first to achieve delayed MVF for upper-limb MT. Our approach confirms previous findings regarding the effects of MVF on cortical activation and contributes additional evidence supporting the use of this method in the future for upper-limb motor training in patients with stroke.

Glucagon-like peptide-1 receptor agonist activation ameliorates venous thrombosis-induced arteriovenous fistula failure in chronic kidney disease.

High shear stress that develops in the arteriovenous fistula of chronic kidney diseases (CKD) may increase H2O2 and thromboxane A2 (TXA2) release, thereby exacerbating endothelial dysfunction, thrombosis, and neointimal hyperplasia. We investigated whether glucagon-like peptide-1 receptor agonist/exendin-4, a potentially cardiovascular protective agent, could improve TXA2-induced arteriovenous fistula injury in CKD. TXA2 administration to H2O2-exposed human umbilical vein endothelial cells increased apoptosis, senescence, and detachment; these phenotypes were associated with the downregulation of phosphorylated endothelial nitric oxide synthase/heme oxygenase-1 (eNOS/HO-1) signalling. Exendin-4 reduced H2O2/TXA2-induced endothelial injury via inhibition of apoptosis-related mechanisms and restoration of phosphorylated eNOS/HO-1 signalling. Male Wistar rats subjected to right common carotid artery-external jugular vein anastomosis were treated with exendin-4 via cervical implant osmotic pumps for 16-42 days. High shear stress induced by the arteriovenous fistula significantly increased venous haemodynamics, blood and tissue H2O2 and TXB2 levels, macrophage/monocyte infiltration, fibrosis, proliferation, and adhesion molecule-1 expression. Apoptosis was also increased due to NADPH oxidase gp91 activation and mitochondrial Bax translocation in the proximal end of the jugular vein of CKD rats. Exendin-4-treatment of rats with CKD led to the restoration of normal endothelial morphology and correction of arteriovenous fistula function. Exendin-4 treatment or thromboxane synthase gene deletion in CKD mice markedly reduced ADP-stimulated platelet adhesion to venous endothelium, and prevented venous occlusion in FeCl3-injured vessels by upregulation of HO-1. Together, these data reveal that the use of glucagon-like peptide-1 receptor agonists is an effective strategy for treatment of CKD-induced arteriovenous fistula failure.

Ergonomic design of a computer mouse for clients with wrist splints.

OBJECTIVE: We explored effects of cutaneous feedback and hump position on efficiency and comfort in mouse use with a splint. We also analyzed the relationship between anthropometric measurements (width of hand and length of hand, palm, and index) and the task performance. METHOD: Thirty participants performed a computer task with two forms of mice (front hump and rear hump) and two kinds of wrist splints (dorsal and volar). Movement time and satisfaction scores were recorded. RESULTS: No interaction effect (Hump Position × Splint Type) was found on movement time. Movement time was shorter for rear-hump mouse users than for front-hump mouse users. Movement time was also shorter for wearers of dorsal wrist splints than for wearers of volar wrist splints. Limited differences existed in the satisfaction scores. Participants with a longer index finger had shorter movement time. CONCLUSION: Both dorsal wrist splints and rear-hump mice are recommended. Length of index finger positively correlated with task performance.

Functional recoveries of sciatic nerve regeneration by combining chitosan-coated conduit and neurosphere cells induced from adipose-derived stem cells.

Suboptimal repair occurs in a peripheral nerve gap, which can be partially restored by bridging the gap with various biosynthetic conduits or cell-based therapy. In this study, we developed a combination of chitosan coating approach to induce neurosphere cells from human adipose-derived stem cells (ASCs) on chitosan-coated plate and then applied these cells to the interior of a chitosan-coated silicone tube to bridge a 10-mm gap in a rat sciatic nerve. Myelin sheath degeneration and glial scar formation were discovered in the nerve bridged by the silicone conduit. By using a single treatment of chitosan-coated conduit or neurosphere cell therapy, the nerve gap was partially recovered after 6 weeks of surgery. Substantial improvements in nerve regeneration were achieved by combining neurosphere cells and chitosan-coated conduit based on the increase of myelinated axons density and myelin thickness, gastrocnemius muscle weight and muscle fiber diameter, and step and stride lengths from gait analysis. High expressions of interleukin-1ß and leukotriene B4 receptor 1 in the intra-neural scarring caused by using silicone conduits revealed that the inflammatory mechanism can be inhibited when the conduit is coated with chitosan. This study demonstrated that the chitosan-coated surface performs multiple functions that can be used to induce neurosphere cells from ASCs and to facilitate nerve regeneration in combination with a cells-assisted coated conduit.

Facilitation of human osteoblast apoptosis by sulindac and indomethacin under hypoxic injury.

Hypoxic-ischemia injury occurs after trauma causes consequential bone necrosis. Non-steroid anti-inflammatory drugs (NSAIDs) are frequently used in orthopedic clinics for pain relief. However, the underlying mechanism and outcome for usage of NSAIDs is poorly understood. To investigate the damage and loss of osteoblast function in hypoxia, two hypoxia mimetics, cobalt chloride (CoCl(2)) and desferrioxamine (DFO), were used to create an in vitro hypoxic microenvironment. The cell damage was observed by decreases of cell viability and increases in cyclooxygenase-2 and cleaved poly(ADP-ribose) polymerase (PARP). Cell apoptosis was confirmed by WST-1 cytotoxic assays and flow cytometry. The functional expression of osteoblast in alkaline phosphatase (ALP) activity was significantly decreased by CoCl(2) and inhibited when treated with DFO. To simulate the use of NSAID after hypoxic injury, four types of anti-inflammatory drugs, sulindac sulfide (SUL), indomethacin (IND), aspirin (Asp), and sodium salicylate (NaS), were applied to osteoblasts after 1 h of hypoxia mimetic treatment. SUL and IND further enhanced cell death after hypoxia. ALP activity was totally abolished in hypoxic osteoblasts under IND treatment. Facilitation of osteoblast apoptosis occurred regardless of IND dosage under hypoxic conditions. To investigate osteoblast in vivo, local hypoxia was created by fracture of tibia and then treated the injured mice with IND by oral feeding. IND-induced osteoblast apoptosis was confirmed by positive staining of TUNEL assay in fractured mice. Significant delay of fracture healing in bone tissue was also observed with the treatment of IND. These results provide information pertaining to choosing appropriate anti-inflammatory drugs for orthopedic patients.