Feasibility Analysis of Teleophthalmology Diagnosis and Referral in Remote Areas of Taiwan.

Background: Remote areas of Taiwan lack routine and specialized ophthalmology services. This study aimed to analyze feasibility of teleophthalmology service for diseases diagnosis and referral in remote areas of Taiwan. Methods: A retrospective study of medical records from 11 remote teleophthalmology clinics in the Taitung area of Taiwan was conducted from May 2020 to December 2021. Vision and intraocular pressure were checked. Ophthalmic imaging was performed by local trained nurses using a hand-held ophthalmoscope and slit lamp biomicroscope. The images were transmitted by telemedicine system to a medical center. Consultation was conducted via face-to-face real-time video calls. Ophthalmologists in the medical center provided diagnosis and treatment advice based on the real-time images and interactive history taking via the telemedicine system. All the images and data were collected and well-reviewed by ophthalmologists in the medical center, and disease prevalence and referral were analyzed for the program. A small-scale satisfaction questionnaire survey was conducted for efficacy evaluation of the program. Results: A total of 1,401 medical records from 1,094 patients were collected and screened. Patients' ages ranged from 9 months to 94 years, with a mean age of 57.27 (standard deviation ±20.47) years. The most frequent ophthalmologic diagnosis was dry eye disease (20.2%), followed by conjunctivitis (12.4%). Among 322 patients with underlying diseases of diabetes mellitus, 59 patients (18.3%) were diagnosed with diabetic retinopathy. Major diagnosis was made in 102 patients (7.3%) and referral to hospital for further management was suggested. This program had high overall satisfaction score of 89% (mean 4.43 ± 0.52 points) in satisfaction questionnaire survey. Conclusion: Teleophthalmology provides an alternative tool for ocular disease diagnosis and screening for patients in remote areas, especially during the COVID-19 pandemic. This service helps to detect major but undiagnosed diseases and promotes health care accessibility and availability in remote areas that lack specialists.

PREDICTED PROTEIN STRUCTURE VARIATIONS INDICATE THE CLINICAL PRESENTATION OF CYP4V2-RELATED BIETTI CRYSTALLINE DYSTROPHY.

PURPOSE: To investigate the relationship between different CYP4V2 disease-causing variants and disease severity in Bietti crystalline dystrophy (BCD). METHODS: Twenty-one subjects from 19 unrelated families with a clinical diagnosis of BCD were enrolled. A novel severity prediction score for BCD based on the predicted molecular impact of CYP4V2 variants was applied for grouping and subsequent analyses. The more severe variants led to less CYP4V2 protein function preservation and a higher severity prediction score. RESULTS: All subjects harbored two alleles of CYP4V2 disease-causing variants, of which c.802-8_810del17insGC was the most prevalent (14/21, 66.67%) and c.1507G>C was novel. According to the severity score, the subjects were categorized into severe, moderate, and mild groups with different preservation of central vision (mean logMAR visual acuity 0.95 ± 0.82, 0.89 ± 1.22, and 0.56 ± 0.64, respectively). The patients with a lower severity score had slower disease progression. CONCLUSION: This is the first cohort study of BCD in Taiwan, and we established a novel BCD severity index based on the molecular impact of different CYP4V2 variants. More severe impairment of CYP4V2 protein led to a more severe disease course with earlier progression. Our results could be helpful in identifying a therapeutic window for patients with BCD.

A Preliminary Study of Pre-Season Taekwondo Preparation Strategy: Personal Isolation Training Effect for Elite Athletes.

BACKGROUND: The global coronavirus disease pandemic (COVID-19) has had a considerable impact on athletic competition and team sports training. Athletes have been forced to train alone at home. However, the isolation training model effects are still unknown. PURPOSE: This study compared the effects of personal isolation training (PIT) and detraining (DT) on specific sport performances (flexibility, power, reaction time, acceleration, and aerobic capacity) and body composition in elite taekwondo athletes. METHODS: Eleven elite taekwondo athletes were recruited as voluntary subjects. Athletes were randomly paired by weight into the personal isolation training group (PIT group: N = 5, age: 21.2 ± 0.4 years, BMI: 22.2 ± 0.8 kg/m2) or detraining group (DT group: N = 6, age: 19.8 ± 0.3 years, BMI: 23.1 ± 1.0 kg/m2). All subjects performed the same training content prior to the pre-test (T1). When the pre-test was completed, all subjects underwent 12 weeks of PIT or DT. Athletes were then administrated the post-test (T2). The athlete's sport performances and body composition were measured to compare the differences between the two groups (PIT and DT) and two phases (T1 and T2). RESULTS: There were no significant differences in kicking reaction time and flexibility in both groups (p > 0.05). The PIT showed significant improvements in 10 m (10M) sprint performance (p < 0.05), and displayed a progress trend in Abalakov jump performance. In addition, the PIT resulted in a better change response in 10M sprint performance (PIT: -4.2%, DT: +2.1%), aerobic endurance performance (PIT: -10.2%, DT: -18.4%), right arm muscle mass (PIT: +2.9%, DT: -3.8%), and trunk muscle mass (PIT: +2.2%, DT: -1.9%) than DT (p < 0.05). The fat mass percentage showed a negative change from T1 to T2 in both groups (p < 0.05). CONCLUSIONS: PIT showed a trend toward better body composition (arm and trunk muscle) and sport performances (10M sprint and aerobic capacity) compared to DT. This finding may provide information on the effectiveness of a personal isolation training model for optimal preparation for taekwondo athletes and coaches. It may also serve as a useful and safe guideline for training recommendations during the coronavirus disease (COVID-19).

Acute Effects of Handheld Loading on Standing Broad Jump in Youth Athletes.

The study aimed to investigate the acute effects of handheld loading on standing broad jump (SBJ) performance and biomechanics. Fifteen youth male athletes (mean age: 14.7 ± 0.9 years; body mass: 59.3 ± 8.0 kg; height: 1.73 ± 0.07 m) volunteered to participate in the study. Participants were assigned to perform SBJ with and without 4 kg dumbbells in a random order. Kinematic and kinetic data were collected using 10 infrared high-speed motion-capture cameras at a 250 Hz sampling rate and two force platforms at a 1000 Hz sampling rate. A paired t-test was applied to all variables to determine the significance between loading and unloading SBJs. Horizontal distance (p < 0.001), take-off distance (p = 0.001), landing distance (p < 0.001), horizontal velocity of center of mass (CoM; p < 0.001), push time (p < 0.001), vertical impulse (p = 0.003), and peak horizontal and vertical ground reaction force (GRF; p < 0.001, p = 0.017) were significantly greater in loading SBJ than in unloading SBJ. The take-off vertical velocity of CoM (p = 0.001), take-off angle (p < 0.001), peak knee and hip velocity (p < 0.001, p = 0.007), peak ankle and hip moment (p = 0.006, p = 0.011), and peak hip power (p = 0.014) were significantly greater in unloading SBJ than in loading SBJ. Conclusions: Acute enhancement in SBJ performance was observed with handheld loading. The present findings contribute to the understanding of biomechanical differences in SBJ performance with handheld loading and are highly applicable to strength and conditioning training for athletes.

Genotypes Predispose Phenotypes-Clinical Features and Genetic Spectrum of ABCA4-Associated Retinal Dystrophies.

The ABCA4 gene is one of the most common disease-causing genes of inherited retinal degeneration. In this study, we report different phenotypes of ABCA4-associated retinal dystrophies in the Taiwanese population, its clinical progression, and its relationship with genetic characteristics. Thirty-seven subjects were recruited and all patients underwent serial ophthalmic examinations at a single medical center. Fundus autofluorescence (FAF) images were quantified for clinical evaluation, and panel-based next-generation sequencing testing was performed for genetic diagnosis. Visual preservation, disease progression, and genotype-phenotype correlation were analyzed. In this cohort, ABCA4-associated retinal degeneration presented as Stargardt disease 1 (STGD1, 62.16%), retinitis pigmentosa (32.43%), and cone-rod dystrophy (5.41%). STGD1 could be further divided into central and dispersed types. In each phenotype, the lesion areas quantified by FAF increased with age (p < 0.01) and correlated with poorer visual acuity. However, three patients had the foveal sparing phenotype and had relatively preserved visual acuity. Forty-two ABCA4 variants were identified as disease-causing, with c.1804C>T (p.Arg602Trp) the most frequent (37.84%). Patients with a combination of severe/null variants could have more extensive phenotypes, such as arRP and dispersed STGD1. This is the first cohort study of ABCA4-associated retinal degeneration in Taiwan with wide spectrums of both genotypic and phenotypic characteristics. An extremely high prevalence of c.1804C>T, which has not been reported in East Asia before, was noted. The extensiveness of retinal involvement might be regarded as a spectrum of ABCA4-associated retinal dystrophies. Different types of genetic variations could lead to distinctive phenotypes, according to the coding impact of variants.

Can Match-Mimicking Intermittent Practice Be Used as a Simulatory Training Mode of Competition Using Olympic Time Frame in Elite Taekwondo Athletes?

Aim: The physiological realities between Taekwondo (TKD) simulation kicking training and TKD competition according to the Olympic time frame remain unclear. The purpose of this study is to establish an Olympic match-simulated kicking model and compare its effects with real TKD competition on physiological challenges and hormonal responses during serial matches in elite athletes. Method: Sixteen elite TKD athletes randomly were assigned into either a TKD match-simulated kicking group (TMSK; N = 8, age: 21.3 ± 0.2 years) or a simulated TKD competition group (STC; N = 8, age: 21.6 ± 0.5 years). Both groups performed either simulated kicking or TKD competitions in the same time-course order, and all physiological parameters and blood sampling time-points were identical between groups. The heart rate (HR) and rating of perceived exertion (RPE) were recorded during each match-simulated kicking and TKD competition session. Blood samples were obtained before competition (Pre-Comp.), after competition-in ths case meaning four consecutive matches (End-Comp.), and 24 h after the first match (Next day) for determination of biomarkers of muscle damage (myoglobin and CK), hematological profiles, and hormonal profiles (testosterone and cortisol). Results: The responses of HR, RPE, and blood lactate levels during the consecutive testing sessions showed no differences between TMSK and STC. The changes in CK and myoglobin were greater in STC (p < 0.05), and a greater decrease in red blood cell (RBC) loss was observed in the STC group (p < 0.05). Compared with TMSK, the inflammatory state, reflected by the ratios of neutrophils-to-lymphocyte (NLR) and platelets-to-lymphocyte (PLR), was higher in STC (p < 0.05). Moreover, the catabolic state (cortisol/testosterone) was greater in STC than in TMSK (p < 0.05). Conclusion: We demonstrated that, compared with TMSK, the STC produced greater muscle damage, inflammatory responses, and catabolic stress in the Olympic competition time frame in elite male TKD athletes. Although TMSK is capable of eliciting similar physiological challenges as TKD competition, the muscle damage and hormonal profiles provoked by TMSK were not comparable to TKD competition. Our findings provide science-based data and better understanding for coaches, athletes, and sports scientists to develop TKD-specific training programs for Olympic preparation.

Short-Term High-Dose Vitamin C and E Supplementation Attenuates Muscle Damage and Inflammatory Responses to Repeated Taekwondo Competitions: A Randomized Placebo-Controlled Trial.

Background: Exercise-induced muscle damage during intensive sport events is a very common issue in sport medicine. Therefore, the purpose is to investigate the effects of short-term high-dose vitamin C and E supplementation on muscle damage, hemolysis, and inflammatory responses to simulated competitive Olympic Taekwondo (TKD) matches in elite athletes. Methods: Using a randomized placebo-controlled and double-blind study design, eighteen elite male TKD athletes were weight-matched and randomly assigned into either a vitamin C and E group (Vit C+E; N = 9) or placebo group (PLA; N = 9). Vit C+E or PLA supplements were taken daily (Vit C+E: 2000 mg/d vitamin C; 1400 U/d vitamin E) for 4 days (3 days before and on competition day) before taking part in 4 consecutive TKD matches on a single day. Plasma samples were obtained before each match and 24-hours after the first match for determination of markers of muscle damage, hemolysis, and systemic inflammatory state. Results: Myoglobin was lower in the Vit C+E group, compared to PLA, during the match day (area under curve, AUC -47.0% vs. PLA, p = 0.021). Plasma creatine kinase was lower in the Vit C+E group (AUC -57.5% vs. PLA, p = 0.017) and hemolysis was lower in the Vit C+E group (AUC -40.5% vs. PLA, p = 0.034). Conclusions: We demonstrated that short-term (4-days) vitamin C and E supplementation effectively attenuated exercise-induced tissue damage and inflammatory response during and after successive TKD matches.

Interference with PSMB4 Expression Exerts an Anti-Tumor Effect by Decreasing the Invasion and Proliferation of Human Glioblastoma Cells.

BACKGROUND/AIMS: Glioblastoma (GBM) is a malignant brain tumor with a poor prognosis. Proteasome subunit beta type-4 (PSMB4) is an essential subunit that contributes to the assembly of the 20S proteasome complex. However, the role of PSMB4 in glioblastomas remains to be clarified. The aim of this study was to investigate the role of PSMB4 in GBM tumor progression. METHODS: We first analyzed the PSMB4 protein and mRNA expression in 80 clinical brain specimens and 77 datasets from the National Center for Biotechnology Information (NCBI) Gene Expression Omnibus (GEO) database. Next, we inhibited the PSMB4 expression by siRNA in cellular and animal models to explore PSMB4's underlying mechanisms. The cell survival after siPSMB4 transfection was assayed by MTT assay. Annexin V and propidium iodide staining was used to monitor the apoptosis by flow cytometric analysis. Moreover, the migration and invasion were evaluated by wound healing and Transwell assays. The expression of migration-related and invasion-related proteins after PSMB4 inhibition was detected by Western blotting. In addition, an orthotropic xenograft mouse model was used to assay the effect of PSMB4 knockdown in the in vivo study. RESULTS: Basis on the results of bioinformatics study, glioma patients with higher PSMB4 expression had a shorter survival time than those with lower PSMB4 expression. The staining of clinical brain tissues showed elevated PSMB4 expression in GBM tissues compared with normal brain tissues. The PSMB4 inhibition decreased proliferation, migration and invasion abilities in human GBM cells. Downregulated PSMB4 resulted in cell cycle arrest and apoptosis in vitro. In an orthotropic xenograft mouse model, the glioma tumors progression was reduced when PSMB4 was down-regulated. The decreased PSMB4 enhanced the anti-tumor effect of temozolomide (TMZ) on tumor growth. In addition, the absence of PSMB4 decreased the expression of phosphorylated focal adhesion kinase and matrix metallopeptidase 9 in vivo. CONCLUSION: PSMB4 inhibition in combination with TMZ may exert an anti-tumor effect by decreasing cell proliferation and invasion as well as by promoting apoptosis in human glioblastoma cells. This research may improve the therapeutic efficacy of glioblastoma treatment.

Acute changes in blood lipid profiles and metabolic risk factors in collegiate elite taekwondo athletes after short-term de-training: a prospective insight for athletic health management.

BACKGROUND: This study used a short-term de-training model to mimic the physiological weight changes during the early retirement stage in Taekwondo (TKD) athletes. This study investigates whether the negative changes in body composition, blood lipid profiles, and metabolic biomarkers occur in elite collegiate TKD athletes when experiencing a two-months de-training period. METHODS: Fourteen collegiate Division Ι elite TKD athletes (age: 21.1 ± 0.2 years, BMI: 22.3 ± 1.1 kg/m2; 10 males and 4 females) participated in this study. The body composition, blood lipid profiles, atherogenic dyslipidemia indexes, metabolic biomarkers and baseline systemic inflammation states were measured before and after two-months de-training. RESULTS: The body weight and BMI did not change after de-training in these elite TKD athletes. The total muscle mass displayed a significant decline after de-training (-2.0%, p = 0.019), with an increase in fat mass (+24.3%, p < 0.01). The blood triglyceride did not change, but the total cholesterol was higher after de-training (+8.3%, p = 0.047). The CHOL-to-HDL and LDL-to-HDL ratios increased by 12.4% (p < 0.001) and 13.2% (p = 0.002) after de-training, respectively. The blood platelet number, plateletcrit, and platelet-to-lymphocyte ratio increased significantly by 5.0% (p = 0.013), 7.3% (p = 0.009), and 20.6% (p = 0.018) after de-training, respectively. The McAuley's Index decreased (-6.9%, p = 0.025) after de-training. CONCLUSION: We demonstrated that a two-months de-training period resulted in adverse effects on early atherogenic dyslipidemia development, progressing insulin resistance, low-grade inflammation, and visceral adiposity in young elite TKD athletes. Our findings provide clear insights into the possible deleterious impacts at early stage retirement in former combative sports athletes.

Initial systemic inflammatory state perturbs exercise training adaptations in elite Taekwondo athletes.

PURPOSE: This study examined ten-week TKD-specific training effects on aerobic capacity, body composition, hormone responses and hematological parameters in elite TKD athletes with varied initial inflammatory states. METHODS: Twenty-two elite college TKD athletes were divided into two groups according to their initial neutrophils-to-lymphocytes ratio (NLR) values: Low NLR (N = 11, 9M/2F, age: 21.6 ± 1.0 yrs; NLR: 1.3 ± 0.2) and High NLR (N = 11, 8M/3F, age: 22.0 ± 0.7 yrs, NLR: 2.5 ± 1.3), and participated in a 10-week TKD-specific training program. Aerobic capacity, body composition, hormonal responses and hematological parameters were measured at baseline and 10-weeks after TKD training. RESULTS: VO2max and shuttle run distance were significantly increased in both groups after training. However, the degree of improvement was greater in the Low NLR group than in the High NLR group. After 10-weeks of exercise training, the High NLR group presented markedly higher fat mass percentage and visceral fat area and significantly lowers DHEA-S to cortisol ratio (D/C ratio) than the Low NRL group. The post-training NLR was negatively correlated with the D/C ratio. Neutrophil counts and NLR were still significantly higher in the High NLR group after training. CONCLUSIONS: This study provides new evidence that young elite TKD athletes with slightly high baseline systemic inflammatory state appear to perturb adaptations to exercise training.

Eight-Week Training Cessation Suppresses Physiological Stress but Rapidly Impairs Health Metabolic Profiles and Aerobic Capacity in Elite Taekwondo Athletes.

Changes in an athlete's physiological and health metabolic profiles after detraining have not been studied in elite Taekwondo (TKD) athletes. To enable a better understanding of these physiological changes to training cessation, this study examined the effects of 8-weeks detraining on the aerobic capacity, body composition, inflammatory status and health metabolic profile in elite TKD athletes. Sixteen elite TKD athletes (age: 21.0 ± 0.8 yrs, BMI: 22.4 ± 3.9 kg/m2; Mean ± SD; 11 males and 5 females) participated in this study. Physical activity level assessment using computerized physical activity logs was performed during the competitive preparation season (i.e. one-week before national competition) and at two week intervals throughout the detraining period. Participant aerobic capacity, body fat, and blood biomarkers were measured before and after detraining, and the blood biomarker analyses included leukocyte subpopulations, blood glucose, insulin, dehydroepiandrosterone-sulfate (DHEA-S), and cortisol. Eight-week detraining increased DHEA-S/cortisol ratio (+57.3%, p = 0.004), increased insulin/cortisol ratio (+59.9%, p = 0.004), reduced aerobic power (-2.43%, p = 0.043), increased body fat accumulation (body fat%: +21.3%, p < 0.001), decreased muscle mass (muscle mass%: -4.04%, p < 0.001), and elevated HOMA-IR (the biomarker of systemic insulin resistance; +34.2%, p = 0.006). The neutrophil-to-lymphocyte ratio (NLR), a systemic inflammatory index, increased by 48.2% (p = 0.005). The change in aerobic capacity was correlated with the increased fat mass (r = -0.429, p = 0.049) but not with muscle loss. An increase in the NLR was correlated to the changes in HOMA-IR (r = 0.44, p = 0.044) and aerobic capacity (r = -0.439, p = 0.045). We demonstrate that 8-week detraining suppresses physiological stress but rapidly results in declines in athletic performance and health metabolic profiles, including reduced aerobic capacity, increased body fat, muscle loss, insulin resistance development and elevated systemic inflammatory status in these young elite TKD athletes. The inflammation state was positively associated with insulin resistance development, fat mass, WHR (the index for central fat accumulation), and the decline in VO2max.