Changes in Navigation Controls and Field-of-View Modes Affect Cybersickness Severity and Spatiotemporal Gait Patterns After Exposure to Virtual Environments.

OBJECTIVE: To examine the effects of navigation controls and field-of-view modes on cybersickness severity and gait dynamics after cessation of exposure to a virtual environment (VE). BACKGROUND: The applications of virtual reality are increasing in various fields; however, whether changes in interaction techniques and visual contents could mitigate the potential gait disturbance following VE exposure remains unclear. METHOD: Thirty healthy adults wore a head-mounted display to complete six sessions of 12-min run-and-gun tasks using different navigation controls (gamepad, head, natural) and field-of-view modes (full, restricted). Forward and backward walking tasks were performed before and after VE exposure. The degrees of cybersickness and presence were evaluated using questionnaires, along with the in-session task performance. Spatiotemporal gait measures and their variabilities were calculated for each walking task. RESULTS: The participants experienced less cybersickness with the head and natural controls than with the gamepad. Natural control, based on matching body movements, was associated with the highest degree of presence and best performance. VE navigation using the gamepad showed reduced cadences and increased stride times during postexposure forward-walking tasks. When the VE was presented via the restricted field-of-view mode, increased gait variabilities were observed from backward-walking tasks after VE exposure. CONCLUSION: Body movement-based navigation controls may alleviate cybersickness. We observed gait adaptation during both ambulation tasks, which was influenced by the navigation control method and field-of-view mode. APPLICATION: This study provides the first evidence for gait adaptation during balance-demanding tasks after VE exposure, which is valuable for designing guidelines for virtual reality interactions.

Clinical Manifestations of Pediatric Food Allergy: a Contemporary Review.

Food allergies (FAs) are an emerging health care issue, and a "second wave of the allergy epidemic" was named. There are extensive data that documented the prevalence rate as high as approximately 10%. FAs are immunological adverse reactions, including IgE-mediated mechanisms, cell-mediated mechanisms, or mixed IgE- and cell-mediated mechanisms. A diagnosis of FA is made by specific symptoms encounter with food, detailed past history, sensitization tests, and oral food challenges (OFCs) if necessary. The component-resolved diagnostics (CRD) test can distinguish true or cross-reaction. "Minimal elimination" from the results of CRD and OFC could avoid unnecessary food restriction. Strict food limitation is harsh and stressful on patients and their families. Children with FAs experience a higher rate of post-traumatic stress symptoms (PTSS) and bullying than others. In the last 20 years, oral immunotherapy (OIT), sublingual immunotherapy (SLIT), and epicutaneous immunotherapy (EPIT) are treatment strategies. OIT and EPIT are the most two encouraging treatments for FA. This review aims to introduce FAs in diverse clinical disorders, new perspectives, and their practical implications in diagnosing and treating FA.

Use of an inflatable mat to reduce body discomfort development when performing computer work at a standing desk.

This study aimed to determine the effects of inflatable mat design on body discomfort, task performance, and musculoskeletal exposures during standing computer work. Twenty-seven healthy adults completed three 2-hour standing trials on different mediums (concrete floor, foam mat, and inflatable mat) on different days in an experimental laboratory. Both mats were associated with reduced discomfort in all lower-body regions and increased typing performance compared to the concrete floor. Perceived discomfort in lower extremities (except thighs) was further alleviated while standing on the inflatable mat than on the foam mat. Use of the inflatable mat led to increased lower-body muscle activity, a flexed lower back, and a wide range of sagittal knee movements. As standing time increased, body discomfort increased, typing accuracy decreased, and there were increased variations in muscle activity and postural movements in the lower body. The inflatable mat shows potential to improve the ergonomic experience during prolonged standing. Practitioner summary: Incorporating standing postures in office-based workplaces can reduce sitting time and may mitigate the health hazards associated with sedentary behaviour. With adequate weight-shifting movements, using an inflatable mat for standing could be an effective way to lessen discomfort and accumulated musculoskeletal strain due to constrained standing, without jeopardising task productivity. Abbreviations: APDF: amplitude probability distribution function. AVR: average rectified value. CI: confidence interval. CMRR: common mode rejection ratio. COP: center of pressure. CV: coefficient of variation. EA: electrical activity. EMG: electromyography. FL: fibularis longus. GM: gluteus medius. LBP: lower back pain. LES: lumbar erector spinae. MVC: maximum voluntary contraction. PD: pain developer. rANOVA: repeated-measures analysis of variance. SOL: soleus. VAS: visual analog scale. WPM: words per minute.

Cumulative incidence of urinary incontinence and associated factors during pregnancy and after childbirth: a cohort study.

INTRODUCTION AND HYPOTHESIS: This study examined the associated factors (i.e., obstetric and maternal-newborn factors) related to cumulative incidence of urinary incontinence and changes in urinary incontinence during pregnancy and the first year postpartum. METHODS: This prospective, longitudinal, within-subject study included 501 women who completed the Incontinence Questionnaire-Urinary Incontinence Short Form during pre-pregnancy, early pregnancy, mid-pregnancy, and late pregnancy and at five time points during the first year postpartum. Data were analyzed by multivariate logistic regression, McNemar's and analysis of variance (ANOVA) tests. RESULTS: According to the multivariate analysis, the gestational week and number of previous vaginal deliveries increased the risk of cumulative incidence of urinary incontinence (CIUI) during pregnancy (both p < 0.05). Full-time employment, higher body mass index, vaginal delivery and UI during early pregnancy and mid-pregnancy increased the risk of CIUI during the first year postpartum (all p < 0.05). CIUI tended to increase throughout the entire pregnancy (p < 0.001) and decrease from 3 to 5 days to 6 months postpartum (p = 0.028). The prevalence rates of UI at all postpartum visits were lower than those during late pregnancy (p < 0.001-0.009) but higher than those during pre-pregnancy (p < 0.001). CONCLUSIONS: The results identified the change patterns in UI and the risk factors associated with CIUI during the entire pregnancy (i.e., gestational age and number of previous vaginal deliveries) and the first year postpartum (i.e., full-time work, higher body mass index, vaginal delivery and UI during early and mid-pregnancy). Appropriate counseling should be provided to women preparing for pregnancy and during the prenatal and postpartum periods.

The combined effects of nucleotide-binding domain-like receptor protein 3 polymorphisms and levels of blood lead on developmental delays in preschool children.

Nucleotide-binding domain-like receptors protein 3 (NLRP3) inflammasomes are associated with neuroinflammation and multiple NLRP3 genes regulate NLRP3 expression. Our study aimed to investigate the association of NLRP3 polymorphisms with developmental delay in preschool children. We also explored whether NLRP3 polymorphisms modified the effects of total urinary arsenic and blood cadmium and lead to developmental delays. A total of 178 children with developmental delays and 88 healthy children were analyzed for urinary arsenic concentrations and red blood cell lead and cadmium concentrations. We examined the genotypes of fifteen common single-nucleotide polymorphisms in NLRP3. We observed that levels of total urinary arsenic and blood lead were significantly associated with developmental delay. The NLRP3rs10754555 CG versus CC/GG, NLRP3rs12048215 AG versus AA/GG, and NLRP3rs12137901 TC/TT versus CC genotype showed a lower odds of developmental delay, with the odds ratio (OR) and 95% confidence interval (CI) = 0.38 (0.19-0.75), 0.52 (0.27-0.99), and 0.33 (0.12-0.90), respectively. Children with the NLRP3rs10754555 CC/GG genotype and high blood lead levels had a significant multiplicative interaction with developmental delay [OR (95% CI) = 9.74 (3.59-26.45)]. This study found evidence that suggested the joint effects of NLRP3rs10754555 CC/GG genotype and high blood lead levels on developmental delays.

Risk factors for stress and urge urinary incontinence during pregnancy and the first year postpartum: a prospective longitudinal study.

INTRODUCTION AND HYPOTHESIS: We examined obstetric and maternal-newborn factors and UI history for stress urinary incontinence (UI) and urge UI during pregnancy and the first year postpartum. METHODS: This prospective cohort study included 1447 pregnant women who underwent prenatal examinations and completed an Incontinence Questionnaire-Urinary Incontinence Short Form before pregnancy, during early, mid- and late pregnancy, and at five visits during the first year postpartum. Data were analyzed using univariate/multivariate generalized estimating equation (GEE) logistic regression analyses. RESULTS: The prevalence rates of stress UI during late pregnancy (42.5%) and urge UI at 3-5 days postpartum (10.4%) were the highest throughout pregnancy and the first year postpartum. After adjusting for covariates, gestational age increased the risks of stress UI (p < 0.001) and urge UI (p = 0.003); stress UI during pre-pregnancy, number of previous vaginal deliveries and concurrent high body mass index (BMI) increased stress UI (all p < 0.05); urge UI during pre-pregnancy and full-time work increased urge UI (both p < 0.05) during pregnancy. During the postpartum period, vaginal delivery increased stress UI (p < 0.001) and urge UI (p = 0.041); stress UI during pre-pregnancy and pregnancy, women aged ≥ 30 years and vacuum extraction/forceps delivery increased stress UI (all p < 0.05). Urge UI during early, mid- and late pregnancy increased stress UI (all p < 0.05). CONCLUSIONS: Gestational age increased stress and urge UI, while previous vaginal deliveries and high BMI increased stress UI; full-time work increased urge UI during pregnancy. Vaginal delivery increased both UIs, and vacuum/forceps delivery and maternal age increased stress UI during postpartum.

Influence of virtual keyboard design and usage posture on typing performance and muscle activity during tablet interaction.

This study aimed to determine the effects of virtual keyboard designs and postures on task performance and muscle activity during tablet use. Eighteen healthy adults were randomly assigned to one of three postures (DESK, LAP, BED) to complete six sessions of 60-minute typing on a tablet with three virtual keyboards (STD, WIDE, SPLIT) twice in an experimental laboratory. Keystroke dynamics and muscle activity of the forearm and neck-shoulder regions were measured by electromyography. The split virtual keyboard was found to be associated with faster typing speed (SPLIT vs STD, p = .015; SPLIT vs WIDE, p < .001) and decreased muscle activity of extensor digitorum communis (SPLIT vs STD, p = .021). Lap posture was associated with faster typing speed (p = .018) and higher forearm muscle activity (p < .05). Typing performance decreased (p < .001) with elevated neck extensor muscle activity (p = .042) when the task duration prolonged. The split virtual keyboard showed potential to improve tablet ergonomics under various postures. Practitioner Summary: Tablets have become widely used for a variety of tasks and have gradually expanded into the realm of mobile productivity and education. Adequate designs of virtual keyboards for tablets show the potential for increased task performance and decreased muscle activity pertinent to typing activity and posture constraints imposed by non-traditional work positions. Abbreviations: WPM: words per minute; IKI: inter-key press interval; EMG: electromyography; EDC: extensor digitorum communis; FDS: flexor digitorum superficialis; CES: cervical erector spinae; UT: upper trapezius; EA: electrical activity; MVC: maximum voluntary contraction; APDF: amplitude probability distribution function.

Combined effect of polymorphisms of MTHFR and MTR and arsenic methylation capacity on developmental delay in preschool children in Taiwan.

Polymorphisms of methylenetetrahydrofolate reductase (MTHFR) and methionine synthase (MTR) are related to cognitive dysfunction and mental disability. These genes, along with folate and vitamin B12 levels, are regulators of one-carbon metabolism, which synthesizes S-adenosylmethionine (SAM) as a methyl donor for arsenic methylation. The aim of this study was to explore whether polymorphisms of MTHFR and MTR influence arsenic methylation capacity and plasma folate and vitamin B12 levels and if these influences cause developmental delay in preschool children. A total of 178 children with developmental delay and 88 without developmental delay were recruited from August 2010 to March 2014. A high-performance liquid chromatography-hydride generator and atomic absorption spectrometer were used to determine urinary arsenic species. Plasma folate and vitamin B12 concentrations were measured by SimulTRAC-SNB radioassay. Polymorphisms of MTHFR C677T, MTHFR A1298C, and MTR A2756G were examined by polymerase chain reaction and restriction fragment length variation. The results show that MTHFR C677T C/T and T/T genotypes had a lower risk of developmental delay than the C/C genotype (odds ratio [OR] = 0.47; 95% confidence interval, 0.26-0.85). Subjects with the MTHFR C677T C/C genotype had significantly lower plasma folate and vitamin B12 levels than those with the MTHFR C677T C/T and T/T genotype. The MTHFR C677T C/C genotype combined with high total urinary arsenic and poor arsenic methylation capacity indices significantly increased the OR of developmental delay in a dose-response manner. This is the first study to show the combined effect of MTHFR C677T genotype and poor arsenic methylation capacity on developmental delay.

Neuropsychiatric Disorders Due to Limbic Encephalitis: Immunologic Aspect.

Limbic encephalitis (LE) is a rare cause of encephalitis presenting as an acute and subacute onset of neuropsychiatric manifestations, particularly with memory deficits and confusion as core features, along with seizure occurrence, movement disorders, or autonomic dysfunctions. LE is caused by neuronal antibodies targeting the cellular surface, synaptic, and intracellular antigens, which alter the synaptic transmission, especially in the limbic area. Immunologic mechanisms involve antibodies, complements, or T-cell-mediated immune responses in different degree according to different autoantibodies. Sensitive cerebrospinal fluid markers of LE are unavailable, and radiographic findings may not reveal a typical mesiotemporal involvement at neurologic presentations; therefore, a high clinical index of suspicions is pivotal, and a neuronal antibody testing is necessary to make early diagnosis. Some patients have concomitant tumors, causing paraneoplastic LE; therefore, tumor survey and treatment are required in addition to immunotherapy. In this study, a review on the molecular and immunologic aspects of LE was conducted to gain awareness of its peculiarity, which we found quite different from our knowledge on traditional psychiatric illness.

Association of plasma folate, vitamin B12 levels, and arsenic methylation capacity with developmental delay in preschool children in Taiwan.

Developmental delay has been associated with inefficient arsenic methylation capacity in preschool children. Folate and vitamin B12 are important nutrients that produce s-adenosylmethionine during single-carbon metabolism and provide methyl groups for arsenic methylation. The aim of the present study was to explore whether plasma folate and vitamin B12 levels influence arsenic methylation capacity and in turn are related to developmental delay in preschool children. A case-control study was conducted in 178 children with developmental delay and 88 normal children, who were recruited from Shin Kong Wu Ho-Su Memorial Teaching Hospital from August 2010 to March 2014. Arsenite (AsIII), arsenate (AsV), monomethylarsonic acid (MMAV), and dimethylarsinic acid (DMAV) in the urine was determined by high-performance liquid chromatography-linked hydride generator and atomic absorption spectrometry. Plasma folate and vitamin B12 levels were measured using a SimulTRAC-SNB radioassay. The results show that the combination of high plasma folate and high vitamin B12 levels were correlated with efficient arsenic methylation capacity (low MMAV %, low InAs %, and high DMAV %). High MMAV % significantly increased and high DMAV % and secondary methylation index decreased the odds ratio (OR) of developmental delay in a dose-dependent manner in both low plasma folate and low vitamin B12 (low/low) groups; the multivariate OR and 95% confidence interval were 5.01 (0.83-30.06), 0.21 (0.04-1.23), and 0.20 (0.03-1.20), respectively. This is the first study to show that the combination of high plasma folate and high vitamin B12 levels increases arsenic methylation capacity and indirectly decreases the OR of developmental delay in preschool children.

Plasma selenium influences arsenic methylation capacity and developmental delays in preschool children in Taiwan.

Inefficient arsenic methylation capacity has been associated with developmental delay in preschool children. Selenium has antioxidant and anti-inflammatory properties that protect experimental animals from chemically induced neurotoxicity. The present study was designed to explore whether plasma selenium levels affects arsenic methylation capacity related to developmental delay in preschool children. A case-control study was conducted from August 2010 to March 2014. All participants were recruited from the Shin Kong Wu Ho-Su Memorial Teaching Hospital. In total, 178 children with a developmental delay and 88 children without a delay were recruited. High-performance liquid chromatography-linked hydride generator and atomic absorption spectrometry were used to determine urinary arsenic species, including arsenite (AsIII), arsenate (AsV), monomethylarsonic acid (MMAV), and dimethylarsinic acid (DMAV). Plasma selenium levels were measured by inductively coupled plasma mass spectrometry. As results, plasma selenium concentration was significantly inversely associated with the odds ratio (OR) of developmental delay. Plasma selenium concentration was positively associated with arsenic methylation capacity [percentage of inorganic arsenic and percentage of MMAV (MMAV%) decreased, and percentage of DMAV (DMAV%) increased]. High plasma selenium concentration and high DMA% significantly and additively interacted to decrease the OR of developmental delay; the OR and 95% confidence interval were 0.40 (0.18-0.90). This is the first study to show a combined dose-response effect of plasma selenium concentration and that efficient arsenic methylation capacity decreased the OR of developmental delay in preschool children.

Sexual dysfunction predicts depressive symptoms during the first 2 years postpartum.

BACKGROUND: The association between sexual function and depression has yet to be examined in a prospective cohort study with prolonged postpartum follow-up. AIM: We investigated whether sexual dysfunction predicted depressive symptoms during the 24-month postpartum period and examined the influence of obstetric factors. METHODS: This prospective 2-year cohort study with repeated measures included 196 participants who were recruited in a medical center in Taipei, Taiwan (2010-2011). Data on participants' personal characteristics, sexual function, and depression symptoms at 4-6 weeks and at 3, 6, 12, and 24 months postpartum were collected and then assessed using the Female Sexual Function Index and the Center for Epidemiologic Studies Depression Scale. RESULTS: After adjusting for time and covariates, women with sexual dysfunction had a 1.62-fold (95% confidence interval [CI]: 1.05-2.50-fold) higher estimated odds ratio (OR) for depressive symptoms during the entire 24 months after childbirth than did women without sexual dysfunction. Risk factors for depressive symptoms were a higher pain score (OR: 1.33, 95% CI: 1.13-1.57), a medical condition (OR: 1.65, 95% CI: 1.00-2.73), and severe perineal laceration (OR: 4.67, 95% CI: 1.37-15.92). Sexual satisfaction during the entire 24 months after childbirth (OR: 0.81, 95% CI: 0.70-0.95) and the highest personal income level (OR: 0.33, 95% CI: 0.11-0.99) were factors protecting against higher-scoring depressive symptoms. CONCLUSIONS: Our study provides robust evidence that sexual dysfunction and poor satisfaction, together with severe perineal laceration, greater pain, and a medical condition, predict depressive symptoms during the 24-month postpartum period.

Association of blood heavy metals with developmental delays and health status in children.

The aim of this study was to evaluate the association of blood lead, mercury, and cadmium concentrations with developmental delays and to explore the association of these concentrations with the health status of children. This study recruited 89 children with developmental delays and 89 age- and sex-matched children with typical development. Their health status was evaluated using the Pediatric Quality of Life (PedsQL) Inventory for health-related quality of life (HRQOL) and the Pediatric Outcomes Data Collection Instrument for function. Family function was also evaluated. Blood lead, mercury, and cadmium concentrations were measured using inductively coupled mass spectrometry. The children with developmental delays had a considerably poorer HRQOL, lower functional performance and family function, and a higher blood lead concentration than those with typical development. The blood lead concentration had a significantly positive association with developmental delays [odds ratio (OR) = 1.54, p < 0.01] in a dose-response manner, and it negatively correlated with PedsQL scores (regression coefficient: -0. 47 to -0.53, p < 0.05) in all the children studied. The higher blood cadmium concentration showed a significantly positive association with developmental delays (OR = 2.24, for >1.0 µg/L vs. <0.6 µg/L, p < 0.05). The blood mercury concentration was not associated with developmental delays and health status.

The impact of walking while using a smartphone on pedestrians' awareness of roadside events.

Previous studies have shown that using a cell phone to talk or text while walking changes gait kinematics and encourages risky street-crossing behaviors. However, less is known about how the motor-cognitive interference imposed by smartphone tasks affects pedestrians' situational awareness to environmental targets relevant to pedestrian safety. This study systematically investigated the influence of smartphone use on detection of and responses to a variety of roadside events in a semi-virtual walking environment. Twenty-four healthy participants completed six treadmill walking sessions while engaged in a concurrent picture-dragging, texting, or news-reading task. During distracted walking, they were required to simultaneously monitor the occurrence of road events for two different levels of event frequency. Performance measures for smartphone tasks and event responses, eye movements, and perceived workload and situational awareness were compared across different dual-task conditions. The results revealed that during dual-task walking, the reading app was associated with a significantly higher level of perceived workload, and impaired awareness of the surrounding environment to a greater extent compared with the texting or picture-dragging apps. Pedestrians took longer to visually detect the roadside events in the reading and texting conditions than in the dragging condition. Differences in event response performances were mainly dependent on their salient features but were also affected by the type of smartphone task. Texting was found to make participants more reliant on their central vision to detect road events. Moreover, different gaze-scanning patterns were adopted by participants to better protect dual-task performance in response to the changes in road-event frequency. The findings of relationships between workload, dual-task performances, and allocation strategies for visual attention further our understanding of pedestrian behavior and safety. By knowing how attentional and motor demands involved in different smartphone tasks affect pedestrians' awareness to critical roadside events, effective awareness campaigns might be devised to discourage smartphone use while walking.

Relation of polymorphism of arsenic metabolism genes to arsenic methylation capacity and developmental delay in preschool children in Taiwan.

Inefficient arsenic methylation capacity has been associated with developmental delay in children. The present study was designed to explore whether polymorphisms and haplotypes of arsenic methyltransferase (AS3MT), glutathione-S-transferase omegas (GSTOs), and purine nucleoside phosphorylase (PNP) affect arsenic methylation capacity and developmental delay. A case-control study was conducted from August 2010 to March 2014. All participants were recruited from the Shin Kong Wu Ho-Su Memorial Teaching Hospital. In total, 179 children with developmental delay and 88 children without delay were recruited. Urinary arsenic species, including arsenite (AsIII), arsenate (AsV), monomethylarsonic acid (MMAV), and dimethylarsinic acid (DMAV) were measured using a high-performance liquid chromatography-linked hydride generator and atomic absorption spectrometry. The polymorphisms of AS3MT, GSTO, and PNP were performed using the Sequenom MassARRAY platform with iPLEX Gold chemistry. Polymorphisms of AS3MT genes were found to affect susceptibility to developmental delay in children, but GSTO and PNP polymorphisms were not. Participants with AS3MT rs3740392 A/G+G/G genotype, compared with AS3MT rs3740392 A/A genotype, had a significantly lower secondary methylation index. This may result in an increased OR for developmental delay. Participants with the AS3MT high-risk haplotype had a significantly higher OR than those with AS3MT low-risk haplotypes [OR and 95% CI, 1.59 (1.08-2.34)]. This is the first study to show a joint dose-response effect of this AS3MT high-risk haplotype and inefficient arsenic methylation capacity on developmental delay. Our data provide evidence that AS3MT genes are related to developmental delay and may partially influence arsenic methylation capacity.

Association of Arsenic Methylation Capacity with Developmental Delays and Health Status in Children: A Prospective Case-Control Trial.

This case-control study identified the association between the arsenic methylation capacity and developmental delays and explored the association of this capacity with the health status of children. We recruited 120 children with developmental delays and 120 age- and sex-matched children without developmental delays. The health status of the children was assessed using the Pediatric Quality of Life Inventory (PedsQL) and Pediatric Outcomes Data Collection Instrument (PODCI). The arsenic methylation capacity was determined by the percentages of inorganic arsenic (InAs%), monomethylarsonic acid (MMAV%), and dimethylarsinic acid (DMAV%) through liquid chromatography and hydride generation atomic absorption spectrometry. Developmental delays were significantly positively associated with the total urinary arsenic concentration, InAs%, and MMAV%, and was significantly negatively associated with DMAV% in a dose-dependent manner. MMAV% was negatively associated with the health-related quality of life (HRQOL; -1.19 to -1.46, P < 0.01) and functional performance (-0.82 to -1.14, P < 0.01), whereas DMAV% was positively associated with HRQOL (0.33-0.35, P < 0.05) and functional performance (0.21-0.39, P < 0.01-0.05) in all children and in those with developmental delays. The arsenic methylation capacity is dose-dependently associated with developmental delays and with the health status of children, particularly those with developmental delays.

Variations of movement disorders in anti-N-methyl-D-aspartate receptor encephalitis: A nationwide study in Taiwan.

Anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis is one of the most common autoimmune encephalitis that presents with a wide variety of movement disorders. The purpose of our study is to review the manifestations and duration of movement disorders in different ages with NMDAR encephalitis.A retrospective cohort of 28 patients (20 females and 8 males) with positive cerebrospinal fluid (CSF) anti-NMDAR antibody in a 5-year period from major hospitals in Taiwan was enrolled. They were categorized into 3 age groups: 7 patients were ≤10 years, 14 patients were 10 to 18 years, and 7 patients were >18 years.Total 28 patients (20 females and 8 males) with age ranging from 8 months to 38 years were enrolled. Nearly all patients (n = 27/28, 96%) presented with at least 2 types of disorders, including orofacial-lingual dyskinesia (OFLD; n = 20), catatonia (n = 19), tremor (n = 11), bradykinesia (n = 11), dystonia (n = 11), choreoathethosis (n = 9), and ballism (n = 3). Only 1 patient below 10 years presented with isolated periodic choreoathethosis without other movement disorders. OFLD was common in all age groups. Choreoathetosis was most common in patients aged ≤10 years, while catatonia was most common in patients aged >10 years (P = 0.001 and 0.020, respectively). Bradykinesia was also more common in patients aged >10 years (P = 0.020). The clinical presentations of movement disorders were not significantly different in the age of 10 to 18 years and those >18 years. Neither patient ≤10 years old nor male patients had associated tumors. All patients' movement disorders were improved after treatment, while female patients with tumors had worse short-term outcome (P = 0.014). Compared with other disorders, choreoathetosis persisted significantly longer in patients ≤10 years (P = 0.038), while OFLD and catatonia last longer in patients >10 years (P = 0.047 and 0.002, respectively).Our study shows that hyperkinetic movements such as choreoathetosis are more common and last longer in younger age groups, whereas hypokinetic movements such as catatonia and bradykinesia are more common and last longer in older age groups. Female patients with ovarian tumors had worse short-term outcome.

Walking while Performing Working Memory Tasks Changes the Prefrontal Cortex Hemodynamic Activations and Gait Kinematics.

BACKGROUND: Increasing evidence suggests that walking while performing a concurrent task negatively influences gait performance. However, it remains unclear how higher-level cognitive processes and coordination of limb movements are altered in challenging walking environments. This study investigated the influence of cognitive task complexity and walking road condition on the neutral correlates of executive function and postural control in dual-task walking. METHODS: Twenty-four healthy young adults completed a series of overground walks with three walking road conditions (wide, narrow, with obstacles) with and without the concurrent n-back working memory tasks of two complexity levels (1-back and 3-back). Prefrontal brain activation was assessed by functional near-infrared spectroscopy. A three-dimensional motion analysis system was used simultaneously to measure gait performance and lower-extremity kinematics. Repeated measures analysis of variance were performed to examine the differences between the conditions. RESULTS: In comparison with standing still, participants showed lower n-back task accuracy while walking, with the worst performance from the road with obstacles. Spatiotemporal gait parameters, lower-extremity joint movements, and the relative changes in oxygenated hemoglobin (HbO) concentration levels were all significantly different across the task complexity and walking path conditions. While dual-tasking participants were found to flex their hips and knees less, leading to a slower gait speed, longer stride time, shorter step length, and greater gait variability than during normal walking. For narrow-road walking, smaller ankle dorsiflexion and larger hip flexion were observed, along with a reduced gait speed. Obstacle negotiation was mainly characterized by increased gait variability than other conditions. HbO levels appeared to be lower during dual-task walking than normal walking. Compared to wide and obstacle conditions, walking on the narrow road was found to elicit a smaller decrement in HbO levels. CONCLUSION: The current study provided direct evidence that, in young adults, neural correlates of executive function and dynamic postural control tend to be altered in response to the cognitive load imposed by the walking environment and the concurrent task during ambulation. A shift of brain activation patterns between functionally connected networks may occur when facing challenging cognitive-motor interaction.

Relationships between perineal pain and postpartum depressive symptoms: A prospective cohort study.

BACKGROUND: The relationship between concurrent or previous postnatal pain and depressive symptoms remains controversial. To the best of our knowledge, no previous study has used validated measures and multiple scales to evaluate perineal pain, or examined its relationship with depressive symptoms during the postpartum period. OBJECTIVES: We investigated the association between pain and previous postnatal pain with depression during the 6-month postpartum period, and the influence of previous postnatal depressive symptoms. DESIGN: A prospective cohort study design was used. SETTING: Maternity unit of a medical center. PARTICIPANTS: This study included 432 participants; data regarding demographic characteristics, perineal pain, and any pain and depression during the 6-month postpartum period were collected. METHODS: Pain and depressive symptoms were measured using the Short Form-McGill Pain Questionnaire and Center for Epidemiologic Studies Depression Scale, respectively. A generalized estimating equation was used to examine factors associated with postpartum depression. RESULTS: After adjusting for covariates, women who had perineal pain at 4-6 weeks postpartum showed an increased risk for depression at 4-6 weeks (risk ratio [RR]: 1.9, 95% confidence limits [CL]: 1.2, 3.2) and 6 months (RR: 1.9, 95% CL: 1.1, 3.3) compared to those with no perineal pain. Perineal pain severity, 4-6 weeks postpartum, also predicted depressive symptoms at 6 months postpartum (ß=0.63, p=0.02). Any pain intensity score at 3-5 days postpartum predicted depression at 3 months (ß=0.01, p=0.04). Women with high depression scores at 3-5 days had a two- or three-fold higher risk for depression at 4-6 weeks and 3 and 6 months, respectively, compared to those with low depression scores (RR: 3.5, 95% CL: 2.2, 5.4; RR: 2.2, 95% CL: 1.3, 3.4; and RR: 2.8, 95% CL: 1.7, 4.8, respectively). CONCLUSIONS: Our study provides robust evidence that perineal pain 4-6 weeks postpartum is associated with depressive symptoms 4-6 weeks and 6 months postpartum; pain at 3-5 days postpartum predicts depressive symptoms at 3 months postpartum; and previous postnatal depressive symptoms, particularly depressive symptoms 3-5 days postpartum, predict depressive symptoms during the 6-month postpartum period.

Usage Position and Virtual Keyboard Design Affect Upper-Body Kinematics, Discomfort, and Usability during Prolonged Tablet Typing.

PURPOSE: The increase in tablet usage allows people to perform computer work in non-traditional office environments. The aim of this study was to assess the effects of changes in tablet keyboard design on postures of the upper extremities and neck, discomfort, and usability under different usage positions during prolonged touch-typing. METHODS: Eighteen healthy participants familiar with touch-screen devices were randomized into three usage positions (desk, lap, and bed) and completed six, 60-minute typing sessions using three virtual keyboard designs (standard, wide, split). Electrogoniometers continuously measured the postures of the wrists, elbow, and neck. Body discomfort and system usability were evaluated by questionnaires before and immediately after each typing session. RESULTS: Separate linear mixed effects models on various postural measures and subjective ratings are conducted with usage position as the between-subject factors, keyboard design and typing duration as the with-in subject factors were conducted. Using the tablet in bed led to more extended wrists but a more natural elbow flexion than the desk position. The angled split virtual keyboard significantly reduced the extent of wrist ulnar deviation than the keyboard with either standard or wide design. However, little difference was observed across the usage position and keyboard design. When the postural data were compared between the middle and end of typing sessions, the wrists, elbow, and neck all exhibited a substantially increased range of joint movements (13% to 38%). The discomfort rating also increased significantly over time in every upper body region investigated. Additionally, the split keyboard design received a higher usability rating in the bed position, whereas participants had more satisfactory experience while using the wide keyboard in the traditional desk setting. CONCLUSIONS: Prolonged use of tablets in non-traditional office environments may result in awkward postures in the upper body that may expose users to greater risks of developing musculoskeletal symptoms. Adequate virtual keyboard designs show the potential to alleviate some postural effects and improve the user experience without changing the tablet form factors.