Effects of early warm water sitz bath on urinary retention and pain after haemorrhoidectomy: A randomized controlled trial.

BACKGROUND: Haemorrhoids are a common chronic anorectal disease, and haemorrhoidectomy is the standard treatment for advanced (grade III and IV) haemorrhoids. Warm water sitz has commonly been used to stimulate urination, cleanse wounds, and decrease pain. Although urinary retention and pain usually occur within the first 24 h after surgery, the warm water sitz bath is provided 24 h after haemorrhoidectomy, which might be a missed opportunity to optimize the quality and efficiency of the care provided. OBJECTIVE: To investigate the effect of early warm water sitz bath on the day of haemorrhoidectomy surgery on preventing urinary retention and reducing wound pain. DESIGN: This was a longitudinal double-blind study with a permuted block randomization design. SETTING(S): This study was conducted in a surgical ward of a medical center. An average of 18 patients receiving hemorrhoid surgery in that ward every month. PARTICIPANTS: A total of 64 participants (32 each in the experimental and control groups) were enrolled. (The first recruitment date is January 16, 2020.) METHODS: Patients who received haemorrhoidectomy for grade III or IV haemorrhoids from January to December 2020 were enrolled. The experimental and control groups received the same conventional treatment and care before the haemorrhoidectomy. The experimental group started warm-water sitz bath 6 h after the surgery, and the control group started warm water sitz bath on post-haemorrhoidectomy day 1 as usual. Urinary retention was defined as use of Foley catheter during the hospital stay or remaining urine volume ≧ 300 ml using the bladder scan. A numerical rating scale was used to rate the pain level. Each participant was evaluated 6 times in total until hospital discharge. The data were analysed by descriptive statistics, chi-square test, and independent samples t test. Generalized estimating equations and intention to treat were used to identify changes in urinary retention and pain over time and missing data, respectively. RESULTS: There was no significant difference in the degree of change in the number of people with urinary retention between groups. A change in the wound pain index was noted; the study group had a statistically significant lower pain score than the control group (B = -0.81, 95 % CI: -1.44 to -0.18). CONCLUSIONS: Early warm water sitz bath was a safe and effective strategy to decrease post-haemorrhoidectomy pain, but not urinary retention. Nurses could provide early warm water sitz bath for post-haemorrhoidectomy patients' comfort. REGISTRATION: ClinicalTrials.gov ID: NCT04535765.

Risk of Malnutrition in Adults Who Have Undergone Sleeve Gastrectomy: A Retrospective Study.

Sleeve gastrectomy achieves long-term weight control by reducing gastric volume. However, postoperative gastrointestinal symptoms and insufficient nutritional intake are likely to occur, which are not conducive to physical health. A retrospective study aimed to investigate changes in nutritional status and associated factors in patients after sleeve gastrectomy. Data were collected from the medical records of patients who underwent sleeve gastrectomy at a teaching hospital in Taiwan. Data from 120 patients who met the eligibility criteria were included in the analysis. The results show that sleeve gastrectomy has a strong weight loss effect. Within 12 months, the average body mass index of the patients decreased by 13.47 kg/m2. The number of morbidly obese patients decreased from 62 (51.7%) to 3 (2.5%). However, surgery is also associated with gastrointestinal symptoms and the threat of malnutrition. The number of patients with moderate to severe nutritional risk increased from 4 (3.3%) before surgery to 24 (20%) at 12-month follow-up. Likewise, the number of patients with anemia increased from 11 (9.2%) to 29 (24.17%). Gender, constipation, and diarrhea affected postoperative nutritional status. These findings suggest that patients after sleeve gastrectomy are at risk of malnutrition and require regular monitoring. Special attention should be given to women and patients with constipation or diarrhea, as they are at a particularly high risk of malnutrition.

Differential Impact of Exercises on Quality-of-Life Improvement in Breast Cancer Survivors: A Network Meta-Analysis of Randomized Controlled Trials.

This study aimed to assess the effectiveness of various exercise interventions in enhancing the quality of life for breast cancer survivors. To achieve this, randomized controlled trials were identified from major electronic databases, focusing on the relationship between exercise and quality of life in breast cancer survivors. The primary outcome was the impact of exercise on quality of life 12 weeks after the intervention, with a secondary outcome comparing dropout rates between intervention groups and a regular care control group. The study protocol was registered with INPLASY (INPLASY202340007). A network meta-analysis of nine randomized controlled trials involving 725 participants was conducted, examining aerobic and strength training, aerobic activity, yoga, and strength exercise. Results showed that aerobic and strength training was the most effective intervention, significantly improving the quality of life of breast cancer survivors (1.31; 95% confidence interval: 0.49 to 2.12). Aerobic activity had a borderline effect (0.83; 0.03 to 1.63), while no exercise interventions were associated with an increased dropout risk compared to the control group (regular care). The study concluded that concurrent aerobic and strength training can improve breast cancer survivors' quality of life after 12 weeks of intervention without increasing dropout risk compared to regular care.

Post-Acute Care for Traumatic Brain Injury Patients in Taiwan.

Background: Traumatic brain injury (TBI) can result in functional impairments. Many patients with TBI require post-acute care to improve their functional skills and allow for greater self-independence and a better quality of life. Taiwan's National Health Insurance proposed a nationwide post-acute care program in 2017 for patients with traumatic brain injury. The program's goal was to maximize patients' functional recovery and make it possible for them to return to their homes and communities. This study aimed to explore the effectiveness of such programs in Taiwan. Methods: This pilot study retrospectively evaluated a de-identified database that contained the scores of various assessments evaluated at admission and discharge. It used the data to determine the functional improvement of patients with traumatic brain injury after participating in post-acute care programs. Results: This study collected complete data from 27 patients. After an average of 45.11 days in the program, the patients showed significant improvement in the Barthel Activity Daily Living Index, the Lawton-Brody Instrumental Activity Daily Living Scale, the Mini Nutrition Assessment, the EuroQol Five Dimensions Questionnaire, the Berg Balance Scale, the Galveston Orientation and Amnesia Test, the Rancho Los Amigos Scale, the Concise Chinese Aphasia Test, and the Mini Mental State Examination. After discharge, 96% of the patients could return to their community. Conclusion: This pilot study concluded that the program significantly promoted functional recovery for patients and could help patients with traumatic brain injury return to their communities and reduce the risk of institutionalization. Thus, patients with the potential for functional recovery could receive post-acute care in regional or community hospitals immediately after being discharged from acute wards. In the future randomized controlled trials are needed to further confirm the clinical impact of this program.

Detection of biotin with zeptomole sensitivity using recombinant spores and a competition assay.

Detection of protein-binding analytes is important for many applications. Currently, various instrument-based techniques are used for detecting protein-binding analytes. However, such techniques have several limitations including high cost and time-consuming sample processing. In order to overcome these limitations, we developed a sensitive competition assay for the detection of protein-binding analytes using recombinant endospores as a sensing element. The method is based on the competition between the biotin, the model analyte, and a biotin-magnetic bead complex to bind the recombinant spores containing the biotin binding region of streptavidin. After magnetic attraction, the residual spores in the suspension are spread on plates to form colonies which are used to count the amount of the residual spores; the higher the residual ratio of spores, the more biotin in the samples. The linear range was from 150 zmol to 1.5 fmol and the limit of detection of the assay was 150 zmol. The assay proposed herein is sensitive and does not require any expensive equipment. It is suitable for qualitative or semi-quantitative analysis such as screening tests for the detection of toxic chemicals.

Different weight shift trainings can improve the balance performance of patients with a chronic stroke: A randomized controlled trial.

BACKGROUND: Improving balance ability, increasing walking ability, and reducing the occurrence of falls are important objectives in the rehabilitation of stroke patients. Do the posture balance training and the intervention of lateral wedge insoles to improve of balance function and increase walking ability in patients with a chronic stroke? METHODS: A randomized, controlled trial with concealed allocation, intention-to-treat analysis, and blinded assessors. Participants who had a chronic stroke (onset >6 months) were recruited from the rehabilitation and neurology departments of a hospital in central Taiwan. Subjects were divided into 3 groups: a visual biofeedback balance training group, a lateral wedge group, and a control group; apart from their usual rehabilitation program, and both experimental groups received a 6-week training session program. The primary outcome was the balance computerized adaptive test (balance CAT), and secondary outcome was timed up and go (TUG) test. All subjects were evaluated at the baseline, posttraining (6-week), 1st follow-up (10-week), and 2nd follow-up (18-week). RESULTS: A total of 56 subjects were participated in this study, including 38 males and 18 females. The mean age of the subjects was 59.1 years old, and the mean time was 43.7 months after the onset of the stroke. This study found the interaction in groups and measurement time points reached statistical significance of the balance CAT and TUG test (F = 5.740, P < .001; F = 2.926, P = .011; respectively). In addition, the performance of both the visual biofeedback training and lateral wedge group was superior to that of the control group. CONCLUSION: Six-week visual biofeedback training and intervention of 5° lateral wedge insoles can improve the balance ability of patients with a chronic stroke. TRIAL REGISTRY: http://www.chictr.org.cn, ChiCTR-IPR-15007092.

Post-acute care for stroke - a retrospective cohort study in Taiwan.

BACKGROUND: Stroke often causes functional decline in patients. Therefore, after the acute phase, many patients require post-acute care (PAC) to maximize their functional progress, reduce disability, and make it possible for them to return to their home and community. PAC can be provided in different settings. Taiwan's National Health Insurance (NHI) proposed a PAC pilot program, effective since 2014, for stroke patients that allowed patients with the potential for functional improvement to receive PAC rehabilitation in regional or community hospitals. The purpose of this study was to explore the initial achievements and clinical impact of this program in Taiwan. METHODS: This was a retrospective cohort study that mainly analyzed basic hospitalization data and scores for function and quality of life, as recorded immediately after admission and before discharge, for stroke patients in the PAC program in a hospital in Taiwan. RESULTS: This study collected complete data from a total of 168 patients. After an average of 43.57 days in the program, patients showed significant improvement in the Modified Rankin Scale (MRS), the Barthel Activity Daily Living Index (B-ADL), the Lawton-Brody Instrumental Activity Daily Living Scale (LB-IADL), the Functional Oral Intake Scale (FOIS), and the Mini Nutrition Assessment (MNA), in mobility, self-care, and usual activity, as well as on anxiety/depression in the EuroQol Five Dimensions Questionnaire (EQ-5D) and in the Mini Mental State Examination (MMSE). After discharge, 76.8% of the patients could return to their home and community. CONCLUSION: This study showed that the pilot PAC program significantly promoted recovery of function in stroke patients and helped them to return to their home and community. Patients with the potential for functional recovery should consider receiving PAC service in a hospital after discharge from acute stroke care.

Effect of Two Frequencies of Whole-Body Vibration Training on Balance and Flexibility of the Elderly: A Randomized Controlled Trial.

OBJECTIVE: The aim of this study was to investigate the effects of whole-body vibration training with different frequencies on the balance and flexibility of the healthy elderly. DESIGN: The participants were recruited from hospital volunteers and the community; all of them were healthy subjects, all over 65 years of age. The study involved three randomized groups in a parallel and single-blind design. The main outcome variables included the limits of stability test and the sit and reach test, which were measured at pre-training, Month 1 (Mid-training), Month 3 (Post-training), and Month 6 (Follow-up). RESULTS: A total of 45 subjects, with a mean age of 69.6 ± 3.9 years, were randomly divided into three groups. There was significant interaction in the performance of the limits of stability and sit and reach tests in the different groups at the four different time points (F = 25.218, P < 0.001, F = 12.235, P < 0.001, respectively). There was a significant difference in balance performance between the vibration groups at the frequencies of 20 Hz and 40 Hz and the control group at Month 1, Month 3, and Month 6 (P < 0.001). CONCLUSION: Whole-body vibration training at 20 Hz has significant benefit to the balance and flexibility of the elderly who do not engage in habitual exercise.

Effect of whole-body vibration for 3 months on arterial stiffness in the middle-aged and elderly.

BACKGROUND: Cardiovascular disease (CVD) is a common problem of middle-aged and older adults. Increased arterial stiffness is a CVD risk factor. Whole-body vibration (WBV) is a simple and convenient exercise for middle-aged and older adults; however, there have been few studies investigating the effect of WBV on arterial stiffness. This study mainly investigated the effect of WBV on arterial stiffness in middle-aged and older adults. METHODS: A total of 38 (21 women and 17 men) middle-aged and elderly subjects (average age, 61.9 years) were randomly divided into the WBV group and the control group for a 3-month trial. The WBV group received an intervention of 30 Hz and 3.2 g WBV in a natural full standing posture at a sports center. The brachial-ankle pulse wave velocity (baPWV), a marker of systemic arterial stiffness, and blood pressure and heart rate were measured before and after the intervention. RESULTS: After 3 months, there were no significant changes in blood pressure or heart rate in both groups. However, the bilateral baPWV was significantly reduced in the WBV group (decreased by 0.65 m/second [P=0.014]; 0.63 m/second [P=0.041] in either side), but not in the control group. The comparison between the two groups was not statistically significant. CONCLUSION: This study found that 3 months of WBV had a positive effect on arterial stiffness in middle-aged and older adults and could therefore be regarded as a supplementary exercise. Larger-scale studies are needed to confirm the effects of WBV in the future.

Grip strength measurement in older adults in Taiwan: a comparison of three testing positions.

AIM: The purpose of this study was to explore the effects of three commonly used positions on grip strength measurement in older people. METHOD: A total of 249 (113 women, 136 men) older participants, 72.8 ± 6.5 years old, participated in this study. Grip strength (kg) was measured in three positions: (i) the standard posture (sitting, elbow flexed 90°) suggested by the American Society of Hand Therapists; (ii) standing, elbow flexed 90°; and (3) standing, elbow fully extended. RESULTS: One-way repeated measures analysis of variance showed that grip strength was significantly greater in the standing position with the elbow fully extended than in the other two positions. CONCLUSIONS: The grip strengths obtained from the three positions were not all comparable in our community-dwelling older adults. Clinicians and researchers need to be cautious when choosing testing position for assessing and interpreting grip strength results obtained from these positions.

Effect of 6 months of whole body vibration on lumbar spine bone density in postmenopausal women: a randomized controlled trial.

BACKGROUND: The issue of osteoporosis-induced fractures has attracted the world's attention. Postmenopausal women are particularly at risk for this type of fracture. The nonmedicinal intervention for postmenopausal women is mainly exercise. Whole body vibration (WBV) is a simple and convenient exercise. There have been some studies investigating the effect of WBV on osteoporosis; however, the intervention models and results are different. This study mainly investigated the effect of high-frequency and high-magnitude WBV on the bone mineral density (BMD) of the lumbar spine in postmenopausal women. METHODS: This study randomized 28 postmenopausal women into either the WBV group or the control group for a 6-month trial. The WBV group received an intervention of high-frequency (30 Hz) and high-magnitude (3.2 g) WBV in a natural full-standing posture for 5 minutes, three times per week, at a sports center. Dual-energy X-ray absorptiometry was used to measure the lumbar BMD of the two groups before and after the intervention. RESULTS: Six months later, the BMD of the WBV group had significantly increased by 2.032% (P=0.047), while that of the control group had decreased by 0.046% (P=0.188). The comparison between the two groups showed that the BMD of the WBV group had increased significantly (P=0.016). CONCLUSION: This study found that 6 months of high-frequency and high-magnitude WBV yielded significant benefits to the BMD of the lumbar spine in postmenopausal women, and could therefore be provided as an alternative exercise.

In vitro and in vivo anticancer effects of destruxin B on human colorectal cancer.

AIM: The study of the anticancer effects of destruxin B (DB) is rare and its anticancer mechanism remains unknown. The aim of this study was to test the in vitro and in vivo anticancer effects of DB, on human HT-29 colorectal cancer (CRC). MATERIALS AND METHODS: DB was isolated and characterized by high pressure liquid chromatography, electrospray ionization mass spectrometry and (1)H-nuclear magnetic resonance spectroscopy. (3-(4,5-Dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) assay was used to assess the effects of DB on HT-29 cells in vitro. The anticancer effects of DB were investigated in a murine xenograft model of human colon cancer. RESULTS: A significant inhibition of cell viability was observed with DB treatment in time- and dose-dependent manners. DB administered subcutaneously daily at 0.6-15 mg/kg was proven to be safe and effective in inhibiting the growth of CRC cells. Expression of Bax, cleaved poly (ADP-ribose) polymerase and active caspase-3 were observed with DB treatment and the increase in tumor volumes of treated groups were significantly (p<0.05) lower than those of the mock-treated group. CONCLUSION: DB has potential as a new therapeutic agent against human CRC.

Comprehensive MDCT evaluation of patients with pulmonary hypertension: diagnosing underlying causes with the updated Dana Point 2008 classification.

OBJECTIVE: Pulmonary hypertension is a challenge for imagers and clinicians, with a variety of possible underlying causes, each with its own specific treatment. Although the diagnosis is based on physiologic measurements, ECG-gated MDCT can play a vital role in elucidating underlying cardiac, vascular, and pulmonary causes. CONCLUSION: A revised system for pulmonary hypertension, the Dana Point classification, can provide a template for review of the myriad causes of this complex condition.

Comprehensive evaluation of patients with suspected prosthetic heart valve disorders using MDCT.

OBJECTIVE: Early diagnosis of prosthetic valve disorders is very important in reducing morbidity and mortality of patients with a replaced heart valve. Recently, MDCT has become an important noninvasive problem-solving tool in clinical practice. This article will introduce the scanning technique, interpretation algorithm, and image findings of many valvular and extravalvular diagnoses. CONCLUSION: With proper scanning technique and interpretation, MDCT can be a powerful technique for prosthetic heart valve evaluation.

Global and regional wall motion abnormalities of pacing-induced heart failure assessed by multi-detector row CT: a patient and canine model study.

This study used multi-detector row CT (MDCT) to evaluate the regional geometric parameters of left ventricle (LV) in patients and dogs after right ventricular apical (RVA) pacing. First, we measured and compared the global and regional wall motion parameters derived from MDCT images between three patients post RVA pacing and seven age-matched healthy subjects. The LV ejection fraction (LVEF), LV end-diastolic volume and LV end-systolic volume were measured. We also measured the regional wall thickness, wall thickening and regional wall motion in 12 different segments of the LV. Second, we performed MDCT scan on five dogs as the study group (pacing wire + RVA pacing, 2 months) and four dogs as the sham control group (pacing wire, 2 months). The global and regional geometric parameters were compared within both human and canine groups. Compared with normal subjects, patients post RVA pacing had low LVEF (60.4 ± 10.5 vs. 33.2 ± 17.6, P = 0.014), impaired regional wall thickening and regional wall motion, particularly in segments near the pacing lead. Some segments near the pacing lead were showing dyskinesia after pacing. These findings were successfully reproduced in the canine model. We found that RVA pacing can result in impaired regional wall thickening and regional wall motion, particularly in segments near the pacing lead.

Arteriovenous fistula and graft evaluation in hemodialysis patients using MDCT: a primer.

OBJECTIVE: Patent arteriovenous fistula (AVF) is related to better prognosis and quality of life for patients on long-term dialysis. When AVF dysfunction is suspected, MDCT is a good noninvasive tool for evaluating the entire AVF structure and determining reversible conditions for treatment. The aim of this article is to introduce the scanning and interpretation techniques and to illustrate the conditions related to early and late fistula failures. CONCLUSION: MDCT is a fast, noninvasive, and accurate technique for diagnosing AVF complications. Radiologists familiar with these techniques can help to improve the prognosis and quality of life for hemodialysis patients.

Probing inhibitory effects of destruxins from Metarhizium anisopliae using insect cell based impedance spectroscopy: inhibition vs chemical structure.

A noninvasive technique based on electric cell-substrate impedance sensing (ECIS) was demonstrated for on-line probing inhibitory effects of five destruxins on Spodoptera frugiperda Sf9 insect cells. Such chemically structurally similar cyclic hexadepsipeptides, were isolated and purified from the fungus Metarhizium anisopliae. Based on a response function, the inhibitory effect of the destruxins was established from determining the half-inhibition concentration (ECIS50), i.e., the level at which 50% inhibition of the cell response was obtained. Probing by cell based impedance spectroscopy indicated that only a slight change in their chemical structures provoked a significant effect on inhibition. Destruxin B was most inhibitory but replacement of a single methyl group with hydrogen (destruxin B2) or addition of a hydroxyl group (destruxin C) significantly reduced the inhibition. The removal of one methyl group and one hydrogen (destruxin A) lowered the inhibitory effect even more whereas the formation of an epoxy ring (destruxin E) in the structure nullified the inhibitory effect.

Comprehensive evaluation of patients with suspected renal hypertension using MDCT: from protocol to interpretation.

OBJECTIVE: The objectives of this article are to, first, describe the reasons for and details of the MDCT protocol for patients with suspected renal hypertension; second, explain the importance of comprehensive evaluation by MDCT in patients with suspected renal hypertension; third, review the image appearances of important conditions that may be encountered in the reader's clinical practice; and, fourth, explain what information should be included in a comprehensive MDCT report for patients with suspected renal hypertension. CONCLUSION: MDCT is widely used for renal artery evaluation in patients with resistant hypertension. Because the regions outside the renal arteries might also have diseases that contribute to the symptoms, a comprehensive interpretation including the renal arteries, renal parenchyma, adrenal glands, and scanned abdomen is very important. The scanning parameters should be adjusted according to the patient's body habitus because some patients with suspected renal hypertension are children or young women. In this article, cases with illustrations showing the process from protocol to interpretation are provided.

Left ventricular myocardial volumes measured during arterial and delayed phases of multidetector row computed tomography: a study on intra- and interobserver variability.

To compare and correlate left ventricular (LV) myocardial volumes obtained using arterial and delayed phases of multidetector row computed tomography (CT) and evaluate their intra- and interobserver variation. Two observers evaluated the arterial- and delayed-phase serial short-axis images of 45 healthy volunteers. Intra- and interobserver variations in LV myocardial volumes were correlated with four factors-myocardial volume, contrast-volume-to-body-weight ratio, and contrast-to-noise ratios in the arterial and delayed phases. Variations in the apex, mid-ventricle, and base were compared. Intra- and interobserver analyzes revealed no statistical difference and good correlation. Intra- and interobserver variations were within 5 and 10%, respectively, and were independent of the four factors. Variations were the highest at the apex. LV myocardial volumes measured using arterial- and delayed-phase cardiac CT exhibit no significant difference and good correlation. Intra- and interobserver variations are both clinically acceptable, and the apex contributes most to these variations.

Comprehensive evaluation of ischemic heart disease using MDCT.

OBJECTIVE: Recently MDCT has become widely used for the evaluation of ischemic heart disease, but clinically the evaluation is primarily focused on the coronary artery only. We describe why and how to comprehensively evaluate the cardiac CT scan, including myocardium, motion, viability, valve, and perfusion aspects related to ischemic heart disease. CONCLUSION: Radiologists should be familiar with the protocol design and comprehensive interpretation of cardiac MDCT to provide comprehensive treatment suggestions for the patients.