Effects of physical training on depression and related quality of life in pre-frail and frail older adults: a systematic review and meta-analysis

OBJECTIVES

To investigate the effects of physical training on depression and related quality of life in pre-frail and frail individuals.

DESIGN

A systematic review and meta-analysis.

PARTICIPANTS

Pre-frail and frail older adults.

METHODS

Five electronic databases, including PubMed, Cochrane, Medline, CINAHL, and Wiley were searched through December 2023. Randomized controlled trials (RCT) comparing physical training with usual care, health education, or light-intensity exercise were included. Outcomes included depression and depression-related quality of life. The quality of the included studies was assessed using Physiotherapy Evidence Database (PEDro) score, and the Cochrane Risk of Bias Tool was used to assess the risk of bias. Meta-analysis was performed using the RevMan5.4. The certainty of the evidence was evaluated by The Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach.

RESULTS

Ten articles with 589 participants met the inclusion criteria and were included. The pooled analysis indicated that depression (SMD = -0.55, 95%CI = -0.92, -0.17, p = 0.004) and mental health status in life (SMD = 1.05, 95%CI = 0.59, 1.50, p < 0.00001) improved significantly in the experimental group. The results of subgroup analysis revealed that the beneficial effects of physical training were significant only in frail older adults but not in pre-frail older adults.

CONCLUSION

This meta-analysis showed that the positive effects of physical training on depression and related quality of life were evident for people with frailty. However, no positive results were observed in pre-frail older adults, indicating the need for further investigation in this subgroup.

Cardiopulmonary Protection for Bilateral Breast Irradiation: A Dosimetric Comparison between Proton and Photon Plans

PURPOSE/OBJECTIVE(S)

Recent advances in cancer treatment improve cancer survivorship. Cardiovascular disease has become the leading cause of non-cancer death in breast cancer survivors. Therefore, risk of cardiopulmonary toxicities during multimodality treatment should be assessed carefully. It remains to be defined the best scenario for proton therapy to confer meaningful cardiovascular protection in the setting of breast irradiation. We hypothesized proton therapy plan provides optimal cardiopulmonary protection during bilateral breast irradiation. The study aimed to compare cardiopulmonary dosimetric parameters of proton and photon radiotherapy plans.

MATERIALS/METHODS

We conducted a retrospective study and patients with bilateral breast cancer indicated for radiotherapy between January 01, 2010 and December 31, 2020 were included. All patients received whole breast or chest wall irradiation with or without regional nodal irradiation. The dose scheme was 50-50.4 Gy in 25-28 fractions. Boost was allowed if patients receiving breast conserving surgery or known risk factors. The dosimetric parameters included planning target volume, mean dose to the heart, the volume of whole lung receiving 5 Gy, 10 Gy, and 20 Gy. For photon therapy, volumetric modulated arc therapy using double partial arc plans was generated with Pinnacle 9.8, Elekta Synergy and tomotherapy helical plan was generated with Tomo Hi-Art planning system. For proton therapy, treatment planning was generated with Ray station 9A. All data was managed using SAS v.9.4 software. Analysis of variance (α = 0.05) was used to compute the dosimetry of different treatment modalities. The statistical significance was considered with a p-value <0.05.

RESULTS

Thirty-one patients with bilateral breast cancer were included, including 12 bilateral breast irradiation patients and 6 bilateral chest wall irradiation patients. The mean dose of heart was 53.0±43.3 cGy in proton therapy while 736.6±225.1 cGy and 869.67±241.0 cGy in Tomotherapy and volumetric modulated arc therapy respectively. The volume of whole lung receiving 5 Gy was 15.4±7.91% in proton therapy while 46.1±10.8% and 46.3±2.5% in Tomotherapy and volumetric modulated arc therapy respectively. The volume of whole lung receiving 20 Gy was 7.7±4.3% in proton therapy while 15.4±5.6% and 19±3.5% in Tomotherapy and volumetric modulated arc therapy respectively. The effects of cardiopulmonary protection were more significant for chest wall irradiation over breast irradiation.

CONCLUSION

Proton radiotherapy provided significant dose reduction for bilateral breast irradiation. The benefit is more significant is patients receiving bilateral chest wall irradiation. Further clinical validations will be warranted to confirm the clinical relevance of the finding.

Gait performance and prefrontal cortex activation during single and dual task walking in older adults with different cognitive levels

Background

Growing evidence shows the cognitive function influences the motor performance. The prefrontal cortex (PFC) as a part of the executive locomotor pathway is also important for cognitive function. This study investigated the differences in motor function and brain activity among older adults with different cognitive levels, and examined the significance of cognition on motor functions.

Methods

Normal control (NC), individuals with mild cognitive impairment (MCI) or mild dementia (MD) were enrolled in this study. All participants received a comprehensive assessment including cognitive function, motor function, PFC activity during walking, and fear of fall. The assessment of cognitive function included general cognition, attention, executive function, memory, and visuo-spatial. The assessment of motor function included timed up and go (TUG) test, single walking (SW), and cognitive dual task walking (CDW).

Results

Individuals with MD had worse SW, CDW and TUG performance as compared to individuals with MCI and NC. These gait and balance performance did not differ significantly between MCI and NC. Motor functions all correlated with general cognition, attention, executive function, memory, and visuo-spatial ability. Attention ability measured by trail making test A (TMT-A) was the best predictor for TUG and gait velocity. There were no significant differences in PFC activity among three groups. Nevertheless, the PFC activated more during CDW as compared with SW in individuals with MCI (p = 0.000), which was not demonstrated in the other two groups.

Conclusion

MD demonstrated worse motor function as compared to NC and MCI. The greater PFC activity during CDW in MCI may be considered as a compensatory strategy for maintaining the gait performance. Motor function was related to the cognitive function, and the TMT A was the best predictor for the gait related performance in present study among older adults.

Effects of Transcranial Direct Current Stimulation Followed by Treadmill Training on Dual-Task Walking and Cortical Activity in Chronic Stroke: A Double-Blinded Randomized Controlled Trial

OBJECTIVE

To explore the effects of transcranial direct current stimulation followed by treadmill training on dual-task gait performance and contralesional cortical activity in chronic stroke patients.

METHODS

Forty-five chronic stroke participants were randomized into 3 groups: a bilateral transcranial direct current stimulation and treadmill training group; a cathodal transcranial direct current stimulation and treadmill training group; and a sham transcranial direct current stimulation and treadmill training group for 50 min per session (20 min transcranial direct current stimulation followed by 30 min treadmill training), 3 sessions per week for 4 weeks. Outcome measures included cognitive dual-task walking, motor dual-task walking, walking performance, contralesional cortical activity, and lower-extremity motor control.

RESULTS

The cathodal transcranial direct current stimulation + treadmill training group showed significantly greater improvements in cognitive dual-task walking speed than the other groups (p cathodal vs sham = 0.006, p cathodal vs bilateral = 0.016). In the cathodal transcranial direct current stimulation + treadmill training group the silent period duration increased significantly more than in the other groups (p < 0.05). Changes in motor evoked potentials in the cathodal transcranial direct current stimulation + treadmill training group were greater than those in the sham transcranial direct current stimulation + treadmill training group (p < 0.05). No significant changes were observed in the bilateral transcranial direct current stimulation + treadmill training group.

CONCLUSION

Cathodal transcranial direct current stimulation followed by treadmill training is an effective intervention for improving cognitive dual-task walking and modulating contralesional cortical activity in chronic stroke. No beneficial effects were observed after bilateral transcranial direct current stimulation and treadmill training.

[Bacterial community diversity in Dermatophagoides farinae using high-throughput sequencing]

OBJECTIVE

To investigate the bacterial community diversity in Dermatophagoides farinae.

METHODS

Laboratory-cultured D. farinae was collected, and the composition of microbial communities was determined by sequence analyses of the V4 region in the bacterial 16S ribosomal RNA (16S rRNA) gene on an Illumina PE250 high-throughput sequencing platform. Following quality control and filtering of the raw sequence files, valid reads were obtained and subjected to operational taxonomic units (OTU) clustering and analysis of the composition of microbial communities and alpha diversity index using the Usearch software, Silva database, and Mothur software.

RESULTS

A total of 187 616 valid reads were obtained, and 469 OTUs were clustered based on a sequence similarity of more than 97%. OTU annotation showed that the bacteria in D. farinae belonged to 26 phyla, 43 classes, 100 orders, 167 families and 284 genera. The bacteria in D. farinae were mainly annotated to five phyla of Proteobacteria, Firmicutes, Bacteroidota, Actinobacteriota, and Acidobacteriota, with Proteobacteria as the dominant phylum, and mainly annotated to five dominant genera of Ralstonia, norank-f-Mitochondria, Staphylococcus and Sphingomonas, with Wolbachia identified in the non-dominant genus.

CONCLUSIONS

A high diversity is identified in the composition of the bacterial community in D. farinae, and there are differences in bacterial community diversity and abundance among D. farinae.

Multiarea Brain Activation and Gait Deterioration During a Cognitive and Motor Dual Task in Individuals With Parkinson Disease

BACKGROUND AND PURPOSE

In people with Parkinson disease (PD), gait performance deteriorating during dual-task walking has been noted in previous studies. However, the effects of different types of dual tasks on gait performance and brain activation are still unknown. The purpose of this study was to investigate cognitive and motor dual-task walking performance on multiarea brain activity in individuals with PD.

METHODS

Twenty-eight participants with PD were recruited and performed single walking (SW), walking while performing a cognitive task (WCT), and walking while performing a motor task (WMT) at their self-selected speed. Gait performance including walking speed, stride length, stride time, swing cycle, temporal and spatial variability, and dual-task cost (DTC) was recorded. Brain activation of the prefrontal cortex (PFC), premotor cortex (PMC), and supplementary motor areas (SMA) were measured using functional near-infrared spectroscopy during walking.

RESULTS

Walking performance deteriorated upon performing a secondary task, especially the cognitive task. Also, a higher and more sustained activation in the PMC and SMA during WCT, as compared with the WMT and SW, in the late phase of walking was found. During WMT, however, the SMA and PMC did not show increased activation compared with during SW. Moreover, gait performance was negatively correlated with PMC and SMA activity during different walking tasks.

DISCUSSION AND CONCLUSIONS

Individuals with mild to moderate PD demonstrated gait deterioration during dual-task walking, especially during WCT. The SMA and PMC were further activated in individuals with PD when performing cognitive dual-task walking.Supplemental Digital Content is Available in the Text.Video Abstract available for more insights from the authors (see the Video, Supplemental Digital Content 1, available at: http://links.lww.com/JNPT/A383 ).

Balance Training Modulates Cortical Inhibition in Individuals with Parkinson's Disease: A Randomized Controlled Trial

BACKGROUND

Most individuals with Parkinson's disease (PD) develop balance dysfunction. Previous studies showed that individuals with PD have abnormal corticomotor changes related to severity of motor symptoms and disease progression. Cortical disinhibition was observed in PD and this alteration can be an early sign of PD. Balance training seems to be an effective intervention to improve balance in individuals with PD. However, it is not much known about the effect of balance training on cortical neuroplasticity in PD population.

OBJECTIVE

To investigate the effects of balance training on corticomotor excitability in individuals with PD.

METHODS

Twenty-eight PD participants were recruited and randomly assigned to either the balance training (BT) or the control (CON) group. Both groups underwent 16 training sessions over 8 weeks. Outcome measures for corticomotor inhibition included the cortical silent period (CSP) and short-interval intracortical inhibition (SICI) on transcranial magnetic stimulation. Balance performance was measured using the Mini-Balance Evaluation Systems Test (Mini-BEST) and the Timed Up and Go (TUG) test.

RESULTS

Participants in the BT group showed a significant increase in corticomotor inhibition (CSP: P = .028, SICI: P = .04) and a significant improvement in balance performance (Mini-BEST: P = .001, TUG: P = .04) after training. Compared to the CON group, the BT group showed a greater increase in corticomotor inhibition (CSP: P = .017, SICI: P = .046) and better improvement in balance (Mini-BEST: P = .046).

CONCLUSION

Balance training could modulate corticomotor inhibition in the primary motor cortex and improve balance performance in individuals with PD.

Effects of inclined treadmill training on inadequate ankle control during walking in individuals after stroke: A pilot randomized controlled trial

BACKGROUND: Inadequate ankle control influences walking ability in people after stroke. Walking on inclined surface activates ankle muscles and movements. However, the effect of inclined treadmill training on ankle control is not clear. OBJECTIVE: To investigate the effects of inclined treadmill training on ankle control in individuals with inadequate ankle control after chronic stroke. METHODS: This was a randomized single-blinded study. Eighteen participants were randomly assigned to receive 12 sessions of 30 min inclined (n = 9) or regular (n = 9) treadmill training and 5 min over-ground walking training. The outcomes included ankle control during walking, muscle strength of affected leg, walking performance, and stair climbing performance. RESULTS: Inclined treadmill training significantly improved ankle dorsiflexion at initial contact (p = 0.002), increased tibialis anterior activities (p = 0.003 at initial contact, p = 0.006 in swing phase), and decreased dynamic plantarflexors spasticity (p = 0.027) as compared with regular treadmill training. Greater improvements were also shown in stair climbing with affected leg leading (p = 0.006) and affected knee extensors strength (p = 0.002) after inclined treadmill training. CONCLUSIONS: Inclined treadmill training was proposed to improve inadequate ankle control after chronic stroke. Inclined treadmill training also improved the stair climbing ability accompanied with increased muscle strength of the affected lower extremity.

Effects of different dual task training on dual task walking and responding brain activation in older adults with mild cognitive impairment

The concurrent additional tasking impacts the walking performance, and such impact is even greater in individuals with mild cognitive impairment (MCI) than in healthy elders. However, effective training program to improve dual task walking ability for the people with MCI is not immediately provided. Therefore, this study aimed to determine the effects of cognitive and motor dual task walking training on dual task walking performance and the responding brain changes in older people with MCI. Thirty older adults with MCI were randomly allocated to receive 24 sessions of 45-min cognitive dual task training (CDTT, n = 9), motor dual task training (MDTT, n = 11), or conventional physical therapy (CPT, n = 10). Gait performance and brain activation during single and dual task walking, and cognitive function assessed by trail-making test (TMT-A, B) and digit span test were measured at pre-, post-test, and 1-month follow-up. Both CDTT and MDTT improved dual task walking with responding activation changes in specific brain areas. The improvements in motor dual task walking performance after both dual task trainings were significantly better than after CPT in the older adults with MCI. Both cognitive and motor dual task training were feasible and beneficial to improve dual task walking ability in older adults with MCI.

Trial Registration: The trial was registered to Thai Clinical Trial Registry and the registration number is TCTR20180510002 (first registration date: 10/05/2018).

Comparing different montages of transcranial direct current stimulation on dual-task walking and cortical activity in chronic stroke: double-blinded randomized controlled trial

BACKGROUND

Transcranial direct current stimulation (tDCS) is a noninvasive brain stimulation to modulate cortical activity for improving motor function. However, the different tDCS applications for modulating cortical activity and dual task gait performance in chronic stroke have not yet been investigated. This study investigated the effects of different tDCS applications on dual task gait performance and contralesional M1 activation in chronic stroke.

METHODS

Forty-eight participants were randomized to anodal, bilateral, cathodal, and sham tDCS groups. Each group received 20 min of tDCS stimulation, except the sham group. Gait performance was measured by GaitRite system during cognitive dual task (CDT) walking, motor dual task (MDT) walking, and single walking (SW). Contralesional M1 activity of unaffected tibialis anterior (TA) was measured using transcranial magnetic stimulation (TMS). Intragroup difference was analyzed by Wilconxon sign ranks test with Bonferroni correction, and Kruskal-Wallis one-way analysis of variance by ranks was used for intergroup comparisons, followed by post-hoc Mann-Whitney U tests with Bonferroni correction.

RESULTS

The bilateral tDCS (p = 0.017) and cathodal tDCS (p = 0.010) improved the CDT walking speed more than sham group. The bilateral tDCS (p = 0.048) and cathodal tDCS (p = 0.048) also improved the MDT walking speed more than sham group. Furthermore, bilateral tDCS (p = 0.012) and cathodal tDCS (p = 0.040) increased the silent period (SP) more than the anodal and sham group. Thus, one-session of bilateral and cathodal tDCS improved dual task walking performance paralleled with increasing contralesional corticomotor inhibition in chronic stroke.

CONCLUSIONS

Our results indicate that one-session of bilateral and cathodal tDCS increased contralesional corticomotor inhibition and improved dual task gait performance in chronic stroke.

TRIAL REGISTRATION

Thai Clinical Trials Registry (TCTR20180116001). Registered prospectively on 16th Jan, 2018 at http://www.thaiclinicaltrials.org .

[The expression and clinical significance of Bmi-1 gene in oral leukoplakia with different prognosis]

Objective: To detect the expression of Bmi-1 in oral leukoplakia (OL) cells and tissues, and analyze its role and clinical significance in the malignant transformation of OL. Methods: Immunohistochemistry was used to evaluate Bmi-1 expression in OL samples from 109 patients (51 males, 58 females, age range: 18-74 years) who were treated in the Department of Stomatology, the Affiliated Wuxi People's Hospital of Nanjing Medical University and the Center of Stomatology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, between 1996 and 2018. The correlation between Bmi-1 expression level and clinicopathological parameters and prognosis in patients with OL was analyzed. The mRNA and protein expression levels of Bmi-1 gene in normal oral mucosal epithelial cells, OL cells, oral squamous cell carcinoma (OSCC) cells, OL tissues and paired adjacent normal tissues were detected by real-time PCR and Western blotting. The effects of Bmi-1 on the proliferation, colony formation and apoptosis were investigated by silencing expression of Bmi-1 in OL cell lines Leuk-1. Results: The protein level of Bmi-1 in OL tissue with severe and mild dysplasia was statistically different (6 819±994 vs 4 713±372, P=0.017). The OSCC-free survival rate of OL patients with high Bmi-1 expression was 65.5% (36/55), which was lower than that of OL patients with low Bmi-1 expression (88.9%, 48/54, P=0.003). Multivariate Cox proportional analysis indicated that Bmi-1 expression was the independent predictor for malignant transformation of OL (HR=2.522, 95%CI: 1.128-5.640, P=0.024). The mRNA level of Bmi-1 in OL specimens was 0.455±0.120, which was higher than that in paired adjacent normal tissues (0.063±0.009, P=0.014). The Bmi-1 mRNA level in malignant transformed OL specimens was (1.405±0.397), which was higher than that in untransformed OL specimens (0.145±0.017, P<0.001). After transfection of Bmi-1-shNC and Bmi-1-shRNA2 adenovirus into OL cell line Leuk-1, there were significant differences in the number of clone formation (824±40 vs 414±38, P=0.002) and apoptosis rate (17.7%±2.3% vs 36.0%±2.0%, P=0.004). Conclusions: The up-regulation of Bmi-1 expression promotes the malignant biological behavior of OL cells. Bmi-1 expression can be used as a predictor for malignant transformation of OL.

Transcranial Direct Current Stimulation on Different Targets to Modulate Cortical Activity and Dual-Task Walking in Individuals With Parkinson’s Disease: A Double Blinded Randomized Controlled Trial

Background

Transcranial direct current stimulation (tDCS) is a non-invasive brain stimulation to modulate cortical activity for improving motor function. However, the information of tDCS stimulation on different brain regions for dual-task walking and cortical modulation in Parkinson’s disease (PD) has not yet been compared.

Objective

The objective of this study was to investigate the effects of different tDCS targets on dual-task gait performance and cortical activity in patients with PD.

Methods

A total of 36 participants were randomly assigned to primary motor cortex (M1) tDCS, dorsal lateral prefrontal cortex (DLPFC) tDCS, cerebellum tDCS, or Sham tDCS group. Each group received 20 min of tDCS stimulation, except for the Sham group. Gait performance was measured by the GAITRite system during dual-task walking and single walking. Corticomotor activity of the tibialis anterior (TA) was measured using transcranial magnetic stimulation (TMS). The functional mobility was assessed using the timed up and go (TUG) test.

Results

All participants showed no significant differences in baseline data. Following the one session of tDCS intervention, M1 (p = 0.048), DLPFC (p < 0.001), and cerebellum (p = 0.001) tDCS groups demonstrated significant improvements in dual-task gait speed compared with a pretest. The time × group interaction [F(3, 32) = 5.125, p = 0.005] was detected in dual-task walking speed. The post hoc Tukey’s test showed that the differences in gait speed were between the Sham tDCS group and the DLPFC tDCS group (p = 0.03). Moreover, DLPFC tDCS also increased the silent period (SP) more than M1 tDCS (p = 0.006) and Sham tDCS (p = 0.002).

Conclusion

The results indicate that DLPFC tDCS exerted the most beneficial effects on dual-task walking and cortical modulation in participants with PD.

Clinical trial registration

[http://www.thaiclinicaltrials.org/show/TCTR20200909005], Thai Clinical Trials Registry [TCTR20200909005].

The SDF1-CXCR4 Axis Is Involved in the Hyperbaric Oxygen Therapy-Mediated Neuronal Cells Migration in Transient Brain Ischemic Rats

Neurogenesis is a physiological response after cerebral ischemic injury to possibly repair the damaged neural network. Therefore, promoting neurogenesis is very important for functional recovery after cerebral ischemic injury. Our previous research indicated that hyperbaric oxygen therapy (HBOT) exerted neuroprotective effects, such as reducing cerebral infarction volume. The purposes of this study were to further explore the effects of HBOT on the neurogenesis and the expressions of cell migration factors, including the stromal cell-derived factor 1 (SDF1) and its target receptor, the CXC chemokine receptor 4 (CXCR4). Thirty-two Sprague–Dawley rats were divided into the control or HBO group after receiving transient middle cerebral artery occlusion (MCAO). HBOT began to intervene 24 h after MCAO under the pressure of 3 atmospheres for one hour per day for 21 days. Rats in the control group were placed in the same acrylic box without HBOT during the experiment. After the final intervention, half of the rats in each group were cardio-perfused with ice-cold saline followed by 4% paraformaldehyde under anesthesia. The brains were removed, dehydrated and cut into serial 20μm coronal sections for immunofluorescence staining to detect the markers of newborn cell (BrdU⁺), mature neuron cell (NeuN⁺), SDF1, and CXCR4. The affected motor cortex of the other half rats in each group was separated under anesthesia and used to detect the expressions of brain-derived neurotrophic factor (BDNF), SDF1, and CXCR4. Motor function was tested by a ladder-climbing test before and after the experiment. HBOT significantly enhanced neurogenesis in the penumbra area and promoted the expressions of SDF1 and CXCR4. The numbers of BrdU⁺/SDF1⁺, BrdU⁺/CXCR4⁺, and BrdU⁺/NeuN⁺ cells and BDNF concentrations in the penumbra were all significantly increased in the HBO group when compared with the control group. The motor functions were improved in both groups, but there was a significant difference between groups in the post-test. Our results indicated that HBOT for 21 days enhanced neurogenesis and promoted cell migration toward the penumbra area in transient brain ischemic rats. HBOT also increased BDNF expression, which might further promote the reconstructions of the impaired neural networks and restore motor function.

Effects of square-stepping exercise on motor and cognitive function in older adults - A systematic review and meta-analysis

OBJECTIVES

To document the effects of square-stepping exercise (SSE) on motor and cognitive function in older adults.

METHODS

Five online databases were searched in May 2021. Controlled studies published from 2006 to May 2021 were included. The experimental group received SSE alone or SSE combined with other exercise(s), whereas the control group received no training or other exercise(s). Motor and cognitive outcomes included balance, fall risk, agility, endurance, gait speed, flexibility, muscle strength, reaction time, global cognitive function, memory, and executive function.

RESULTS

Ten articles with a total of 920 participants were included. Static balance (p=0.0009), dynamic balance (p=0.0008), fall risk (p<0.00001), and agility (p=0.02) improved more in the intervention group than in the control group. However, SSE did not seem to exert beneficial effects on cognitive function.

CONCLUSION

In older adults, SSE provided beneficial effects on motor function, including static and dynamic balance, risk of falls, and agility. However, positive effects on cognitive function were not observed and require further investigation.

Effects of Exergame-Based Dual-Task Training on Executive Function and Dual-Task Performance in Community-Dwelling Older People: A Randomized-Controlled Trial

Objective: Aging is associated with decline in executive function that may lead to reduced dual-task performance. Regular exercise has been recommended for promoting or maintaining mental and physical health in older adults, yet only a fraction of older adults exercise regularly. Exergame training may have the potential to enhance exercise adherence. Therefore, the aim of this study was to examine the effects of exergame-based dual-task training on executive function and dual-task performance in community-dwelling older adults. Materials and Methods: This was a single-blinded, randomized-controlled trial. Twenty community-dwelling older adults were recruited and randomly assigned to one of two groups. All participants completed 36 trainings, including three 60-minute sessions/week over 12 weeks. Participants in the experimental group received exergame-based dual-task training, while those in the control group received home-based multicomponent exercise training. Measures of executive function, dual-task performance, and community walking ability were assessed before and after the intervention. Results: Significant group × time interactions (P = 0.000-0.027) with large effects were found in all selected outcome measures. Compared with the control group, the experimental group improved significantly in measures of general executive function (P = 0.014), inhibitory control (P = 0.037), cognitive dual-task performance (P < 0.001), and community walking ability (P = 0.002). Enhanced general executive function was highly correlated with either improved motor dual-task performance (r = 0.674) or improved cognitive dual-task performance (r = -0.701). Conclusion: These results suggested that exergame-based dual-task training improved both executive function and dual-task performance in older people. These positive effects could be transferred to enhance community walking ability. Clinical Trial Registration number: ACTRN 12617000095369.

Effect of exergaming versus combined exercise on cognitive function and brain activation in frail older adults: A randomised controlled trial

BACKGROUND

Cognitive impairment is prevalent among frail older adults. Traditional exercise and exergaming positively affect cognition in healthy older people. However, few studies have investigated the effects of exergaming on cognition and brain activation in frail older adults.

OBJECTIVE

This study compared the effect of Kinect based exergaming (EXER) and combined physical exercise (CPE) training on cognitive function and brain activation in frail older adults in Taiwan. We hypothesised that EXER would be superior to CPE in this population.

METHODS

We randomised 46 community-dwelling frail older adults to the EXER or CPE group for 36 sessions (three 60-min training sessions per week) over 12 weeks. Outcome measures for cognitive function included global cognition measured by the Montreal Cognitive Assessment, executive function measured by the Executive Interview 25, verbal memory measured by the Chinese version of the California Verbal Learning Test, attention measured by the Stroop Colour and Word Test and Trail Making Test (part B), and working memory measured by spatial n-back tests. Prefrontal cortex activation during the global cognition test was documented with functional near-infrared spectroscopy (fNIRS).

RESULTS

Both groups improved significantly in global cognition (P<0.05), executive function (P<0.05), and attention (P<0.05) after the 12-week intervention. The group×time interaction indicated that EXER training significantly enhanced global cognition more than CPE training (F(1,44)=5.277, P=0.026). Moreover, only the EXER group showed significant improvements in verbal (P<0.05) and working (P<0.05) memory after the intervention. The fNIRS hemodynamics data revealed decreased activation in prefrontal cortices of both groups (P<0.05) during the post-training cognitive assessment, thereby suggesting greater neural efficiency; however, we found no significant group difference.

CONCLUSION

In frail older adults, exergaming and CPE could improve cognitive function, most likely by increasing neural efficiency. Moreover, exergaming may be superior to CPE, particularly in improving global cognition.

Feasibility and effectiveness of interactive stepping exercise on community-dwelling older adults: A pilot randomized controlled trial

Recently, the interactive stepping exercise (ISE) was developed on the basis of square stepping exercise. The aim of this study was to examine the feasibility and effectiveness of ISE on executive function and gait variability among community-dwelling older adults. Fourteen participants were recruited and randomly assigned to the experimental group (n=7) or control group (n=7) and received ISE or home exercise program, respectively, three times a week for 12 weeks. The outcomes included retention rate, attendance rate, Trail Making Test, and dual-task walking. The results showed that participants had high retention and attendance rate for the ISE intervention. Moreover, significant improvement in the part A of Trail Making Test and stride length variability during cognitive dual-task walking after 12-week ISE intervention. The current results suggested that ISE is a feasible and effective intervention on executive function and gait variability in community-dwelling older adults.

Effects of transcranial direct current stimulation followed by exercise on neuropathic pain in chronic spinal cord injury: a double-blinded randomized controlled pilot trial

STUDY DESIGN

Double-blinded randomized controlled pilot trial.

OBJECTIVES

The present study aimed to investigate the effects of multiple sessions of tDCS followed by exercise on neuropathic pain and brain activity in individuals with chronic SCI.

SETTING

Rehabilitation center in Taipei, Taiwan.

METHODS

Twelve individuals with neuropathic pain after SCI were randomized into the experimental (real) or control (sham) tDCS group. All participants received 12 sessions of real or sham tDCS, and moderate upper body exercises over 4-6 weeks. Pain intensity, characters of pain, self-rating change of pain, brain activity, and quality of life were assessed at pre, posttest, and 4-week follow-up.

RESULTS

The between-group differences (95% CI) of pain intensity at posttest and at 4-week follow-up were -2.2/10 points (-3.0 to 1.0, p = 0.060) and -2.0/10 points (-5.0 to -0.4, p = 0.035), respectively. The between-group differences of paresthesia/dysesthesia pain character were -2.0/10 points (-3.2 to 1.0, p = 0.053) at posttest and -2.3/10 points (-5.0 to 2.5, p = 0.054) at follow-up. No significant changes in brain activity and quality of life were noted at post-intervention and follow-up in both groups.

CONCLUSIONS

The multiple sessions of anodal tDCS combined with moderate upper body exercise were feasible for individuals with neuropathic pain after spinal cord injury. However, the analgesic effect was not superior to exercise alone after 12 sessions of intervention, and the beneficial effect was observed at 4-week follow-up.

Effects of repetitive hyperbaric oxygen therapy on neuroprotection in middle cerebral artery occlusion rats

Hyperbaric oxygen (HBO) has been suggested as a possible therapy for brain injury. However, the effects of HBO after transient brain ischemia are inconsistent and the underlying mechanisms are not fully known. The present study aimed to investigate the effects of repetitive HBO intervention in a transient middle cerebral artery occlusion (MCAO) animal model. Seventy-two Sprague-Dawley rats received MCAO and were randomly assigned to normal air control or HBO intervention groups. Each group was divided into 3 subgroups according to the intervention time period (7, 14, and 21 days). HBO was started 24 h post-MCAO for 1 h/day at 3.0 ATA with no-air breaks. After the final intervention, half of the rats in each subgroup were sacrificed and the right motor cortex was removed to examine levels of Akt phosphorylation and glutathione (GSH), as well as glutathione peroxidase (GPx) and reductase (GR) activity. The other half of the rats were used to examine infarct volume. At 24 h post-MCAO and the end of the final intervention, rats underwent tests to examine motor performance. We noted that 14- and 21-day HBO interventions significantly reduced infarct volume and increased Akt phosphorylation and GSH levels and GPx and GR activity. Motor performance was also significantly improved after 14- and 21-day interventions. No significant differences were observed between the controls and 7-day intervention groups. Repetitive HBO intervention starting 24 h post-MCAO and applied for at least 14 days, provided neuroprotective effects through modulating the cell survival pathway and antioxidative defense system.

Muscle activation and intermuscular coherence during forward and backward pedaling

The purpose of this study was to investigate muscle activity and intermuscular coherence of the rectus femoris (RF) and biceps femoris (BF) during forward (FW) and backward (BW) pedaling. Sixteen healthy volunteers performed FW and BW pedaling in 30, 45, and 60 revolutions per minute (RPM), while electromyographic (EMG) signals of the RF and BF were recorded bilaterally to determine integral EMG and intermuscular coherence. BW pedaling showed a statistically significant larger EMG activity on the left BF (P = 0.023) in 30 RPM; on the left BF (P = 0.01), right BF (P = 0.05), and right RF (P = 0.006) in 45 RPM, and on the left BF (P = 0.014) and right RF (P = 0.011) in 60 RPM than FW pedaling. In 45 RPM, higher coherence was demonstrated on the left leg (P = 0.011) during the left flexor and right extensor phases and on the right leg (P = 0.043) during the right flexor and left extensor phases in BW compared with FW pedaling. In 60 RPM, higher coherence was observed on both legs (left, P = 0.037; right, P < 0.001) during the left flexor and right extensor phases in BW compared with FW pedaling. Our results suggest that BW pedaling increased the muscle activity of both biarticular muscles and intermuscular coherence.

The effects of Ai Chi for balance in individuals with chronic stroke: a randomized controlled trial

This study investigated the effectiveness of Ai Chi compared to conventional water-based exercise on balance performance in individuals with chronic stroke. A total of 20 individuals with chronic stroke were randomly allocated to receive either Ai Chi or conventional water-based exercise for 60 min/time, 3 times/week, and a total of 6 weeks. Balance performance assessed by limit of stability (LOS) test and Berg balance scale (BBS). Fugl-Meyer assessment (FMA) and gait performance were documented for lower extremity movement control and walking ability, respectively. Excursion and movement velocity in LOS test was significantly increased in anteroposterior axis after receiving Ai Chi (p = 0.005 for excursion, p = 0.013 for velocity) but not conventional water-based exercise. In particular, the improvement of endpoint excursion in the Ai Chi group has significant inter-group difference (p = 0.001). Both groups showed significant improvement in BBS and FMA yet the Ai Chi group demonstrated significantly better results than control group (p = 0.025). Ai Chi is feasible for balance training in stroke, and is able to improve weight shifting in anteroposterior axis, functional balance, and lower extremity control as compared to conventional water-based exercise.

Role of sonoelastography in assessment of axillary lymph nodes in breast cancer: a systematic review and meta-analysis

AIM

To evaluate the effectiveness of shear-wave elastography (SWE) and strain elastography (SE) for axillary lymph nodes (ALNs).

MATERIALS AND METHODS

PubMed, Embase, and Cochrane Library databases were searched until September 2018. Weighted mean difference was calculated for continuous variables. The accuracy of sonoelastography was assessed by calculating pooled sensitivity, specificity, area under the curve (AUC), positive likelihood ratio (PLR), negative likelihood ratio (NLR), and diagnostic odds ratio (DOR). All data were analysed using Stata 12.0.

RESULTS

Ten studies with 1,038 ALNs were included in the meta-analysis. Five studies evaluated the use of SE, and the other five evaluated the SWE. The SWE stiffness values of malignant ALNs were significantly higher than those of benign nodes. Both SE and SWE have relatively high specificity and sensitivity. The max stiffness in SWE showed the highest specificity (0.94; 95% confidence interval [CI], 0.81-0.98), PLR (12.1; 95% CI, 4-36.5), NLR (0.29; 95% CI, 0.12-0.69), AUC (0.94; 95% CI, 0.91-0.96), and DOR (42; 95% CI, 12-154); in contrast, the mean stiffness showed the highest sensitivity (0.80; 95% CI, 0.61-0.91).

CONCLUSION

Sonoelastography demonstrated high sensitivity and specificity for differentiating between malignant and benign ALNs. The max and mean stiffness on SWE appeared to exhibit the highest accuracy. Thus, SWE is an effective accompaniment to sentinel node biopsy, and is appropriate for preoperative assessment of ALNs in the post-Z0011 era.

[Effect of artesunate on airway responsiveness and airway inflammation in asthmatic mice]

Objective: To observe the effects of artesunate on airway responsiveness and airway inflammation in asthmatic mice. Methods: Thirty female BALB/c mice aged 6-8 weeks were randomly divided into control group, asthma group and artesunate group. In the asthma group and the artesunate group, the mice were sensitized by intraperitoneal injection of 20 μg of ovalbumin (OVA) and 0.2 ml of aluminum hydroxide suspension (2 mg) on day 0 and 14, respectively, and 1% OVA 10 ml dissolved in sterile phosphate (PBS) buffer was aerosolized for 30 min from the 21st to 28th day. The control group was sensitized with 0.2 ml of 2 mg suspension of aluminum hydroxide on day 0 and 14, and aerosolized by 10 ml of sterile PBS from the 21st to 28th day. Before the challenge, the artesunate group was intraperitoneally injected with 0.2 ml of artesunate. Artesunate was replaced with the same amount of normal saline in the control group and the asthma group. The mice were treated after 24 hours of last stimulation. The airway responsiveness of mice was measured by airway intubation and the changes of airway resistance and compliance were observed. Bronchoalveolar lavage fluid (BALF) was classified by cytology, and pathological changes of left lung tissue were observed and scored. Results: The airway resistance of the three groups increased and the lung compliance decreased with the increase of methacholine (Ach) concentration. The airway resistance and lung compliance of the three groups were different under the same concentration (P<0.05). The airway resistance of the artesunate group at Ach 6.25, 12.5, 25, 50, 100 mg/ml was lower than that of the asthma group at the same concentration [(1.01±0.48) vs (1.30±0.22), (1.06±0.44) vs (1.70±0.31), (1.30±0.64) vs (2.66±0.79), (1.82±0.55) vs (3.38±1.35), (2.49±0.85) vs (4.07±1.34) cmH(2)O·s(-1)·ml(-1)(1 cmH(2)O=0.098 kPa); t=3.862, 7.376, 9.113, 7.051, 6.685, all P<0.05]; the degree of lung compliance decrease at the concentration of Ach 3.125, 6.25, 12.5, 25, 50, 100 mg/ml was lower than that of the asthma group at the same concentration [(3.89±0.55)×10(-2) vs (3.07±0.63)×10(-2), (3.61±0.52)×10(-2) vs (3.04±0.58)×10(-2), (3.48±0.38)×10(-2) vs (2.78±0.57)×10(-2), (3.09±0.52)×10(-2) vs (1.73±0.62)×10(-2), (2.32±0.60)×10(-2) vs (1.29±0.54)×10(-2), (1.87±0.59)×10(-2) vs (1.15±0.44)×10(-2) ml/cmH(2)O; t=-6.295, -4.921, -6.533, -11.135, -8.48, -6.319, all P<0.05]. The proportion of eosinophils in artesunate group in BALF was significantly lower than that in asthma group [(16.63±8.58)% vs (40.44±12.94)%; t=4.336, P<0.05]. In the asthma group, the inflammatory cells infiltration of the bronchi and the perivascular area, the bronchial epithelial edema and degeneration can be observed, and the artesunate could reduce the infiltration of inflammatory cells around the bronchus and blood vessels, and the mucus secretion was also reduced in the artesunate group. Conclusion: Artesunate can improve airway hyperresponsiveness and airway inflammation in asthmatic mice and has a certain therapeutic effect on asthma.

Cognitive and motor dual task gait training exerted specific training effects on dual task gait performance in individuals with Parkinson's disease: A randomized controlled pilot study

Gait impairments in Parkinson’s disease (PD) are aggravated under dual task conditions. Providing effective training to enhance different dual task gait performance is important for PD rehabilitation. This pilot study aimed to investigate the effects of cognitive and motor dual task gait training on dual task gait performance in PD. Eighteen PD participants (n = 6 per training group) were assigned to cognitive dual task gait training (CDTT), motor dual task gait training (MDTT), or general gait training (control) group randomly. The training was 30 min each session, 3 sessions per week for 4 weeks. Primary outcomes including gait performance during cognitive dual task, motor dual task, and single walking were assessed at pre- and post-training. The results showed decreased double support time during cognitive dual task walking after CDTT (-17.1±10.3%) was significantly more than MDTT (6.3±25.6%, p = .006) and control training (-5.6±7.8%, p = .041). Stride time variability during motor dual task walking decreased more after MDTT (-16.3±32.3%) than CDTT (38.6±24.0%, p = .015) and control training (36.8±36.4%, p = .041). CDTT also improved motor dual task walking performance especially on gait speed (13.8±10.71%, p = .046) stride length (10.5±6.6%, p = .046), and double support time (-8.0±2.0%, p = .028). CDTT improved single walking performance as well on gait speed (11.4±5.5%, p = .046), stride length (9.2±4.6%, p = .028), and double support time (-8.1±3.0%, p = .028). In summary, our preliminary data showed 12-session of CDTT decreased double support time during cognitive dual task walking, and MDTT reduced gait variability during motor dual task walking. Different training strategy can be adopted for possibly different training effects in people with PD.

Novel gait training alters functional brain connectivity during walking in chronic stroke patients: a randomized controlled pilot trial

Background

A recent study has demonstrated that a turning-based treadmill program yields greater improvements in gait speed and temporal symmetry than regular treadmill training in chronic stroke patients. However, it remains unknown how this novel and challenging gait training shapes the cortico-cortical network and cortico-spinal network during walking in chronic stroke patients. The purpose of this study was to examine how a novel type of gait training, which is an unfamiliar but effective task for people with chronic stroke, enhances brain reorganization.

Methods

Subjects in the experimental and control groups received 30 min of turning-based treadmill training and regular treadmill training, respectively. Cortico-cortical connectivity and cortico-muscular connectivity during walking and gait performance were assessed before and after completing the 12-session training.

Results

Eighteen subjects (n = 9 per group) with a mean age of 52.5 ± 9.7 years and an overground walking speed of 0.61 ± 0.26 m/s consented and participated in this study. There were significant group by time interactions for gait speed, temporal gait symmetry, and cortico-cortical connectivity as well as cortico-muscular connectivity in walk-related frequency (24–40 Hz) over the frontal-central-parietal areas. Compared with the regular treadmill training, the turning-based treadmill training resulted in greater improvements in these measures. Moreover, the increases in cortico-cortical connectivity and cortico-muscular connectivity while walking were associated with improvements in temporal gait symmetry.

Conclusions

Our findings suggest this novel turning-based treadmill training is effective for enhancing brain functional reorganization underlying cortico-cortical and corticomuscular mechanisms and thus may result in gait improvement in people with chronic stroke.

Trial registration

ACTRN12617000190303. Registered 3 February 2017, retrospectively registered.

High-frequency repetitive transcranial magnetic stimulation enhanced treadmill training effects on gait performance in individuals with chronic stroke: A double-blinded randomized controlled pilot trial

BACKGROUND

Repetitive transcranial magnetic stimulation (rTMS) combined with treadmill training has been suggested to modulate corticomotor activity and improve gait performance in people with Parkinson's disease.

RESEARCH QUESTION

It is unclear whether this combination therapy has a similar effect in people with stroke. The current study aimed to investigate whether high-frequency rTMS enhances the effects of subsequent treadmill training in individuals with chronic stroke.

METHODS

Fourteen participants meeting the selection criteria were randomly assigned to either the experimental (n = 8) or control (n = 6) group. The experimental group received 5 Hz rTMS prior to treadmill training three times per week for 3 weeks. The control group received sham rTMS before treadmill training. Walking speed, gait symmetry, corticomotor excitability, motor function of the lower extremities, and muscle activity during walking were measured before intervention, after intervention, and at 1-month follow-up.

RESULTS

The walking speed, spatial asymmetry of gait, and motor function of the lower extremities improved significantly in the experimental group, and these improvements exhibited significant differences in between-group comparisons. However, there was no significant difference in corticomotor excitability or brain asymmetry ratio after the intervention in each group.

SIGNIFICANCE

The current results revealed that applying 5 Hz high-frequency rTMS over the leg motor cortex in the affected hemisphere enhanced the effects of subsequent treadmill training on gait speed and spatial asymmetry in individuals with chronic stroke. Improvement in gait speed persisted for at least 1 month in individuals with chronic stroke.

Effects of neuromuscular electrical stimulation on gait performance in chronic stroke with inadequate ankle control - A randomized controlled trial

Neuromuscular electrical stimulation (NMES) has been used to improve muscle strength and decrease spasticity of the ankle joint in stroke patients. However, it is unclear how NMES could influence dynamic spasticity of ankle plantarflexors and gait asymmetry during walking. The study aimed to evaluate the effects of applying NMES over ankle dorsiflexors or plantarflexors on ankle control during walking and gait performance in chronic stroke patients. Twenty-five stroke participants with inadequate ankle control were recruited and randomly assigned to an experimental or a control group. The experimental group received 20 minutes of NMES on either the tibialis anterior muscle (NMES-TA) or the medial gastrocnemius muscle (NMES-MG). The control group received 20 minutes of range of motion and stretching exercises. After the 20 minutes of NMES or exercises, all participants received ambulation training for 15 minutes. Training sessions occurred 3 times per week for 7 weeks. The pre- and post-training assessments included spatio-temporal parameters, ankle range of motion, and dynamic spasticity of ankle plantarflexors during walking. Muscle strength of ankle dorsiflexors and plantarflexors as well as static spasticity of ankle plantarflexors were also examined. The results showed that the static and dynamic spasticity of ankle plantarflexors of the NMES-TA group were significantly decreased after training. Reduction in dynamic spasticity of ankle plantarflexors of the NMES-TA group was significantly greater than that of the NMES-MG group. When compared to the control group, the NMES-TA group had greater improvements in spatial asymmetry, ankle plantarflexion during push off, and muscle strength of ankle dorsiflexors, and the NMES-MG group showed a significant decrease in temporal asymmetry. In summary, NMES on ankle dorsiflexors could be an effective management to enhance gait performance and ankle control during walking in chronic stroke patients. NMES on ankle plantarflexors may improve gait symmetry.

Immediate effect of hip taping on balance and walking ability in cane-dependent ambulators with chronic stroke: a randomized controlled trial

BACKGROUND

Previous studies showed that cane-dependent post-stroke ambulators have poor balance and gait performance. Adhesive taping on the hip may be used as a therapeutic modality for improving range of motion and muscle activity in individuals with stroke.

AIM

The objective of this study was to investigate the immediate effect of the hip extensor and abductor taping on balance and walking ability in cane-dependent ambulators with chronic stroke.

DESIGN

This study was a single-blinded, randomized controlled trial.

SETTING

Outpatients from a hospital rehabilitation department.

POPULATION

Twenty-eight cane-dependent ambulators with chronic stroke were recruited.

METHODS

Participants were randomized into either the control group with sham tape (N.=14) or experimental group with non-elastic tape (N.=14). The Berg Balance Scale, gait speed, 6-minute walk test, and Fall Efficacy Scale were measured with and without taping.

RESULTS

After taping, participants in the experimental group showed significant improvement in the Berg Balance Scale, gait speed, and 6-minute walk test. Furthermore, experimental group showed significant improvement in the Berg Balance Scale and 6-minute walk test compared with sham taping control group.

CONCLUSIONS

Non-elastic tape could immediately improve balance, gait speed, and endurance in cane-dependent ambulators with chronic stroke.

CLINICAL REHABILITATION IMPACT

Non-elastic tape may be a useful adjunct to current rehabilitation strategies for individuals with chronic stroke.

Beta event-related desynchronization can be enhanced by different training programs and is correlated with improved postural control in individuals with Parkinson's disease

BACKGROUND AND OBJECTIVE

The purpose of this study was to investigate the effects of a specific exercise (SE) training program focusing on balance and muscle strengthening and a turning-based treadmill (TT) training program on cortical desynchronization and postural control in Parkinson's disease (PD).

METHODS

Eighteen patients with PD were recruited and randomly assigned to the SE group, TT training group or control exercise (CE) group and participated in 12 30-min training sessions focusing on balance and strengthening, turning-based treadmill training, or general exercise training, respectively, followed by 10 minutes of over-ground walking in each session for 4 to 6 weeks. The outcomes included alpha event-related desynchronization (ERD), beta ERD, postural control ability indicated by postural instability and gait disorder (PIGD), the step/quick turn test (SQT), and the sensory organization test (SOT). All measurements were assessed at baseline and after training.

RESULTS

The results (n=6 for each group) showed that both the SE and TT groups had improved beta ERD, but not alpha ERD, in the Cz area, PIGD score, and turn sway/time in the SQT compared with the CE group. Furthermore, postural control ability was positively correlated with beta ERD in the Cz area. However, there was no significant correlation between SOT total score and alpha ERD in the Cz area.

CONCLUSIONS

This study showed that beta ERD in the central area and postural control can be improved with balance training, along with lower extremity muscle strengthening exercise and turning-based treadmill training, in patients with PD. Furthermore, improvement in beta ERD in the central area correlated with improvements in postural control ability. This trial was registered at http://www.anzctr.org.au/ (ACTRN12616000198426).

Measurement of acetabular inclination and anteversion via CT generated 3D pelvic model

Background

Inclination and anteversion were the main factors that determined the reliability of the acetabulum. Inclination and anteversion measurements included anatomical, operational and radiographic methods. The aim of our present study was to exhibit divergence of inclination and anteversion via the three measurements.

Methods

Inclination and anteversion were defined according to the definitions put forward by Murray. Three-dimensional models of pelvis of CT data were brought forth. Acetabular axis was determined by the rim of acetabula. Reference planes were established by bone landmarks including anterior superior iliac spine, pubic tubercles and sacral crests. Inclinations and anteversions were calculated according to the definitions.

Results

Forty-nine cases were involved in the research. Data of inclination form anatomical, operational and radiographic showed 37.48 ± 11.07, 45.12 ± 14.76 and 48.76 ± 14.36, and anteversion were 18.12 ± 7.59, 24.97 ± 9.68, 14.30 ± 5.64. A substantial deviation was noted in the inclinations (P < 0.01) and anteversions (P < 0.01).

Conclusion

Our findings suggested that the inclinations and anteversions of the three measurements varied, which might in turn interfere the decision of orthopedists.

[Petrous bone cholesteatoma: surgery approach and outcomes]

Objective: To investigate the choice of surgical approach of petrous bone cholesteatoma (PBC)and surgical outcomes. Methods: A retrospective study was performed on 90 patients diagnosed and treated for PBC from January 2000 to December 2014 by the Chinese People's Liberation Army General Hospital otolaryngologists. According to Sanna's classification, 40 out of the 90 cases were supralabyrinthine, five infralabyrinthine, four infralabyrinthine-apical, 25 massive and 16 apical. Five cases underwent transmastoid and retrolabyrinthine approach, translabyrinthine approach was performed on six patients, 19 cases underwent subtotal petrosectomy, seven cases underwent transotic approach, 41 cases underwent middle fossa approach, combined transmastoid/middle fossa approach was performed on 11 cases, translabyrinthine and sphenoid sinus approach were performed on one case. Supralabyrinthine cases mainly applied middle fossa approach (77.5%, 31/40) and combined transmastoid and middle-fossa approach(20.0%, 8/40). Combined transmastoid-retrolabyrinthine approach were applied for all the infralabyrinthine cases (100.0%, 5/5). Infralabyrinthine-apical cases mainly applied subtotal petrosectomy (75.0%, 3/4). Massive cases mainly applied subtotal petrosectomy (60.0%, 15/25), transcochlear approach (20.0%, 5/25), and translabyrinthine approach (16.0%, 4/25). Apical cases mainly applied middle fossa approach (62.5%, 10/16). Results: Ninty percent (18/20) of the patients who had preoperative grade Ⅰ facial nerve function maintained in the postoperative period. Out of 90 cases, only 11 cases received open cavity, and the rest cases received cavityobliteration. There were three cases of recurrence, four cases of cavity infection, three cases of cerebrospinal fluid leakage, and one case of epidural hematoma, who all received surgeries. Conclusions: Sanna's classification should be used to classify different kinds of PBC cases, choose the best surgical approach for different cases, and preserve or repair facial function during removal of PBC, and thus reduce recurrence and complications.

Risk of failure of adenotonsillectomy for obstructive sleep apnea in obese pediatric patients

INTRODUCTION

Pediatric obesity is a leading risk factor for obstructive sleep apnea (OSA), a condition commonly treated with adenotonsillectomy (T&A). It has been hypothesized that obesity increases a child's risk of failing T&A for OSA, however this relationship has not yet been quantified. The primary objective of this study was to investigate the relationship between obesity as measured by perioperative Body Mass Index (BMI) and persistent OSA following T&A as measured by polysomnography (PSG).

STUDY DESIGN

Retrospective chart review.

METHODS

Pediatric patients who underwent T&A between Jan. 2004 and Jan. 2016 were included. We recruited both obese and non-obese patients to compare caregiver/self reported improvement. Obese patients were recruited from a weight management clinic and included if they had a BMI z-score >1.65 and had pre- and post-operative polysomnograms (PSGs). Control patients included those undergoing T&A for OSA at our institution with BMI <1.65. These patients were age matched to the obese patient population. Age, gender, perioperative BMI z-score, caregiver/self reported improvement, total Apnea-Hypopnea Index (AHI), and O₂ saturation nadir were collected where available. Univariate linear regressions were calculated between perioperative BMI z-score and PSG data.

RESULTS

26 obese study and 47 control subjects were identified for analysis. T&A resulted in statistically significant improvements in total AHI (p = 0.030) and nadir O₂ saturation (p = 0.013) in obese subjects. There was no significant difference between the rate of caregiver/self reported improvement in the two groups. There was a statistically significant correlation between perioperative BMI z-score and the change in total AHI (p = 0.049). Within our population, for every increase by 0.1 in perioperative BMI z-score, the improvement in total AHI post-operatively decreased by 1.63 events/hr. Further, patients with BMI more than 3 standard deviations away from the age-derived normative mean received essentially no benefit from T&A alone.

CONCLUSIONS

Our study established an inverse linear relationship between perioperative BMI z-score and improvement in total AHI with essentially no improvement in patients with BMI z-scores >3. Further studies are required to further elucidate this relationship and investigate the role of additional procedures in the initial management of OSA in obese children.

Balance Ability in Patients with Benign Paroxysmal Positional Vertigo

OBJECTIVE: The purpose of the study was to investigate the balance ability of the patients with benign paroxysmal positional vertigo (BPPV).

STUDY DESIGN AND SETTING: Twenty-three patients (63.3 ± 9.2 years of age) with a diagnosis of unilateral posterior semicircular canal BPPV were recruited. Static balance was measured in 4 conditions with eyes open and eyes closed: stance on firm surface, stance on foam surface, left leg stance, and right leg stance. Dynamic balance was measured in tandem walk test. Data of the patients with BPPV were compared to age-matched norm values of the healthy adults.

RESULTS: The patients with BPPV demonstrated greater sway velocity in stance on foam surface with eyes closed ( P < 0.05), in single leg stance with eyes closed ( P < 0.001), and in tandem walk test ( P < 0.05) compared to the healthy adults.

CONCLUSIONS: Patients with BPPV demonstrated impaired static and dynamic balance ability particularly when depriving visual and changing proprioceptive inputs.

SIGNIFICANCE: Clinically, in addition to canalith repositioning maneuver, balance retraining on different conditions may be a useful adjunct to treatment for patients with BPPV.

[The expression and significance of heparanase in oral squamous cell carcinoma with different metastatic potentials]

Objective: To detect the expression of heparanase (HPSE) in oral squamous cell carcinoma (OSCC) with different metastatic potentials and investigate its clinical significance. Methods: Transcriptional and translational status of HPSE in OSCC cell lines with different metastatic capacities, primary OSCC samples and their paired metastatic cancer tissues were determined using real-time polymerase chain reaction (PCR) and Western blotting analysis. Immunohistochemistry was used to evaluate HPSE expression in 131 OSCC samples. The correlation between HPSE expression pattern and clinicopathological parameters and clinical outcome in patients with OSCC were analyzed. HPSE level was reduced using HPSE-siRNAs in OSCC cell lines and its impact on cell migration and invasion was measured by scratch assay and matrigel invasion assay. Results: The mRNA and protein levels of HPSE were remarkably up-regulated in OSCC cell lines with highly metastatic capacity (P<0.000 1) and metastatic OSCC tissues (P<0.000 1). The protein levels of HPSE were strongly associated with lymph node metastasis (P<0.000 1) and tumor node metastasis stage (P=0.012). Survival analyses revealed that high HPSE expression was associated with worse overall survival (P=0.000 3). Multivariate Cox proportional analyses indicated that HPSE expression was strongly associated with clinical outcome in patients with OSCC (HR=2.203, 95% CI: 1.203-3.988, P=0.009). The siRNA-mediated silencing of HPSE could suppress the migration and invasion (P=0.008) of HN12 cells in vitro. Conclusions: The up-regulation of HPSE contributes to invasion and metastasis of OSCC. HPSE may serve as a useful biomarker for patients with OSCC.

Positive Effects of Specific Exercise and Novel Turning-based Treadmill Training on Turning Performance in Individuals with Parkinson's disease: A Randomized Controlled Trial

Two different training strategies to improve turning performance in individuals with Parkinson’s disease (PD) were designed and investigated in this study. Subjects were randomly assigned to a specific exercise group, turning-based training group, or control group to receive training that emphasized balance and strengthening, turning-based treadmill training, and general exercise training, respectively. A total of 12 30-min training sessions followed by 10 min of turning training on a level surface were administered over 4 to 6 weeks. The results (n = 12 for each group) showed that both the specific exercise and turning-based training group experienced improved turning performance, the primary outcome, compared with the control group (specific exercise, 33% change, p = 0.016; turning-based training, 35% change, p = 0.021). For the secondary outcomes, the specific exercise group performed better than the control group on the Tinetti balance scale, limit of stability test and lower extremity extensor and abductor strength. The turning-based training groups performed better than the control group in sensory organization and ankle plantar flexor strength. In summary, specific exercise training and turning-based treadmill training were both effective in improving turning performance in participants with PD. However, the improvements in turning performance of these two groups resulted from improving different aspects of impairment in individuals with PD.

Effects of a balance-based exergaming intervention using the Kinect sensor on posture stability in individuals with Parkinson's disease: a single-blinded randomized controlled trial

Background

The present study examined the effects of a balance-based exergaming intervention using the Kinect sensor on postural stability and balance in people with Parkinson’s disease (PD).

Methods

We conducted a subject-blinded, randomized controlled study. Twenty people with PD (Hoehn and Yahr stages I through III) were recruited and randomly assigned to either a balance-based exergaming group (N = 10) or a balance training group (N = 10) for an 8-week balance training period. Postural stability was assessed using the limits of stability (LOS) and one-leg stance (OLS) tests. Balance was assessed using the Berg Balance Scale (BBS) and the timed up and go (TUG) test. Participants were assessed pre- and post-training.

Results

After training, participants in the balance-based exergaming group showed significant improvements in LOS performance, and in the eyes-closed condition of the OLS test. Both training programs led to improvements in BBS and TUG performance. Furthermore, balance-based exergaming training resulted in significantly better performance in directional control in the LOS test (78.9 ± 7.65 %) compared with conventional balance training (70.6 ± 9.37 %).

Conclusions

Balance-based exergaming training resulted in a greater improvement in postural stability compared with conventional balance training. Our results support the therapeutic use of exergaming aided by the Kinect sensor in people with PD.

Trial registration

ClinicalTrials.gov.NCT02671396

Electronic supplementary material

The online version of this article (doi:10.1186/s12984-016-0185-y) contains supplementary material, which is available to authorized users.

Efficacy of Bobath versus orthopaedic approach on impairment and function at different motor recovery stages after stroke: a randomized controlled study

Objective: To investigate the effectiveness of Bobath on stroke patients at different motor stages by comparing their treatment with orthopaedic treatment.

Design: A single-blind study, with random assignment to Bobath or orthopaedic group.

Setting: Physical therapy department of a medical centre.

Subjects: Twenty-one patients with stroke with spasticity and 23 patients with stroke at relative recovery stages participated.

Interventions: Twenty sessions of Bobath programme or orthopaedic treatment programme given in four weeks.

Main outcome measures: Stroke Impairment Assessment Set (SIAS), Motor Assessment Scale (MAS), Berg Balance Scale (BBS) and Stroke Impact Scale (SIS) for impairment and functional limitation level.

Results: Participants with spasticity showed greater improvement in tone control (change score: 1.209±1.03 versus 0.089±0.67, p =0.006), MAS (change score: 7.64±4.03 versus 4.009±1.95, p =0.011), and SIS (change score: 7.309±6.24 versus 1.259±5.33, p=0.023) after 20 sessions of Bobath treatment than with orthopaedic treatment. Participants with relative recovery receiving Bobath treatment showed greater improvement in MAS (change score: 6.149±5.55 versus 2.779±9.89, p=0.007), BBS (change score: 19.189±15.94 versus 6.859±5.23, p=0.015), and SIS scores (change score: 8.509±3.41 versus 3.629±4.07, p =0.006) than those with orthopaedic treatment.

Conclusion: Bobath or orthopaedic treatment paired with spontaneous recovery resulted in improvements in impairment and functional levels for patient with stroke. Patients benefit more from the Bobath treatment in MAS and SIS scores than from the orthopaedic treatment programme regardless of their motor recovery stages.

Gait outcomes after additional backward walking training in patients with stroke: a randomized controlled trial

Objective: To examine the effectiveness of additional backward walking training on gait outcome of patients post stroke.

Design: Randomized controlled trial.

Setting: Medical centre.

Subjects: Twenty-five subjects with stroke, who were lower extremity Brunnstrom motor recovery stage at 3 or 4 and were able to walk 11 m with or without a walking aid or orthosis, randomly allocated to two groups, control (n = 12) and experimental (n = 13).

Interventions: Subjects in both groups participated in 40 min of conventional training programme three times a week for three weeks. Subjects in experimental group received additional 30 min of backward walking training for three weeks at a frequency of three times per week.

Main measures: Gait was measured using the Stride Analyzer. Gait parameters of interest were walking speed, cadence, stride length, gait cycle and symmetry index. Measures were made at baseline before commencement of training (pre-training) and at the end of the three-week training period (post-training).

Results: After a three-week training period, subjects in experimental group showed more improvement than those in control group for walking speed (change score: 8.609 ± 6.95 versus 3.659 ± 2.92, p-value = 0.032), stride length (change score: 0.0909 ± 0.076 versus 0.00649 ± 0.078, p-value = 0.006), and symmetry index (change score: 44.079 ± 53.29 versus 5.309 ± 13.91, p-value = 0.018).

Conclusions: This study demonstrated that asymmetric gait pattern in patients post stroke could be improved from receiving additional backward walking therapy.

Task-oriented progressive resistance strength training improves muscle strength and functional performance in individuals with stroke

Objective: To examine the effectiveness of task-oriented progressive resistance strength training on lower extremity strength and functional performance in chronic stroke subjects.

Design: Single-blind, randomized controlled trial.

Setting: Medical centre and district hospital.

Subjects: Forty-eight subjects at least one year post stroke.

Interventions: Participants randomly allocated to two groups, control (n-/24) and experimental (n-/24). Subjects in the control group did not receive any rehabilitation training. Subjects in the experimental group were put on a four-week task-oriented progressive resistance strength training.

Main measures: Lower extremity muscle strength, gait velocity, cadence, stride length, six-minute walk test, step test, and timed up and go test.

Results: Muscle strength significantly improved in the experimental group for strong side muscle groups (ranged from 23.9% to 36.5%) and paretic side muscle groups (ranged from 10.1% to 77.9%). In the control group muscle strength changes ranged from 6.7% gain to 11.2% decline. The experimental group showed significant improvement in all selected measures of functional performance except for the step test. In the control group, the number of repetitions of the step test significantly decreased (-20.3%) with no change in other functional tests. There was a significant difference between groups for muscle strength and all functional measures. The strength gain was significantly associated with gain in the functional tests.

Conclusions: The task-oriented progressive resistance strength training programme could improve lower extremity muscle strength in individuals with chronic stroke and could carry over into improvement in functional abilities.

Far-reaching geometrical artefacts due to thermal decomposition of polymeric coatings around focused ion beam milled pigment particles

Focused ion beam and scanning electron microscope (FIB-SEM) instruments are extensively used to characterize nanoscale composition of composite materials, however, their application to analysis of organic corrosion barrier coatings has been limited. The primary concern that arises with use of FIB to mill organic materials is the possibility of severe thermal damage that occurs in close proximity to the ion beam impact. Recent research has shown that such localized artefacts can be mitigated for a number of polymers through cryogenic cooling of the sample as well as low current milling and intelligent ion beam control. Here we report unexpected nonlocalized artefacts that occur during FIB milling of composite organic coatings with pigment particles. Specifically, we show that FIB milling of pigmented polysiloxane coating can lead to formation of multiple microscopic voids within the substrate as far as 5 μm away from the ion beam impact. We use further experimentation and modelling to show that void formation occurs via ion beam heating of the pigment particles that leads to decomposition and vaporization of the surrounding polysiloxane. We also identify FIB milling conditions that mitigate this issue.

Electromyography of symmetrical trunk movements and trunk position sense in chronic stroke patients

[Purpose] To explore the differences in bilateral trunk muscle activation between chronic stroke patients and healthy controls, this study investigated the symmetry index and cross-correlation of trunk muscles during trunk flexion and extension movements. This study also assessed the differences in trunk reposition error between groups and the association between trunk reposition error and bilateral trunk muscle activation. [Subjects and Methods] Fifteen stroke patients and 15 age- and gender-matched healthy subjects participated. Bilateral trunk muscle activations were collected by electromyography during trunk flexion and extension. Trunk reposition errors in trunk flexion and extension directions were recorded by a Qualisys motion capture system. [Results] Compared with the healthy controls, the stroke patients presented lower symmetrical muscle activation of the bilateral internal oblique and lower cross-correlation of abdominal muscles during trunk flexion, and lower symmetry index and cross-correlation of erector spinae in trunk extension. They also showed a larger trunk extension reposition error. A smaller trunk reposition error was associated with higher cross-correlation of bilateral trunk muscles during trunk movements in all subjects. [Conclusion] Trunk muscle function during symmetrical trunk movements and trunk reposition sense were impaired in the chronic stroke patients, and trunk position sense was associated with trunk muscle functions. Future studies should pay attention to symmetrical trunk movements as well as trunk extension position sense for patients with chronic stroke.

Relationship between trunk stability during voluntary limb and trunk movements and clinical measurements of patients with chronic stroke

[Purpose] The purposes of this study were to investigate differences between patients with chronic stroke and age matched healthy controls in trunk stability, by assessing the kinematics of the center of mass and moving body segments during voluntary limb and trunk movement, and the relationship between trunk stability and clinical measurements. [Subjects and Methods] Fifteen stroke patients and 15 age- and gender-matched healthy subjects participated. Each subject performed flexion of the hip and shoulder of the non-paretic or matched side as fast as possible, as well as trunk flexion and extension at a self-selected speed. A Qualisys motion system was employed to track the kinematics of the trunk and limbs. [Results] Patients presented larger mediolateral displacement of the center of mass during all limb and trunk movements, and larger velocity of center of mass during hip flexion movement. Healthy subjects showed greater movement velocity during shoulder flexion, trunk flexion and extension. Patients’ clinical measurements only correlated with movement characteristics during voluntary trunk motions. [Conclusion] Trunk stability in patients with chronic stroke was compromised during voluntary trunk as well as non-paretic limb movements, and the voluntary trunk movements reflected the trunk deficits measured using clinical measurements. Rehabilitation of patients with chronic stroke should include programs to improve trunk stability.

Maintaining Gait Performance by Cortical Activation during Dual-Task Interference: A Functional Near-Infrared Spectroscopy Study

In daily life, mobility requires walking while performing a cognitive or upper-extremity motor task. Although previous studies have evaluated the effects of dual tasks on gait performance, few studies have evaluated cortical activation and its association with gait disturbance during dual tasks. In this study, we simultaneously assessed gait performance and cerebral oxygenation in the bilateral prefrontal cortices (PFC), premotor cortices (PMC), and supplemental motor areas (SMA), using functional near-infrared spectroscopy, in 17 young adults performing dual tasks. Each participant was evaluated while performing normal-pace walking (NW), walking while performing a cognitive task (WCT), and walking while performing a motor task (WMT). Our results indicated that the left PFC exhibited the strongest and most sustained activation during WCT, and that NW and WMT were associated with minor increases in oxygenation levels during their initial phases. We observed increased activation in channels in the SMA and PMC during WCT and WMT. Gait data indicated that WCT and WMT both caused reductions in walking speed, but these reductions resulted from differing alterations in gait properties. WCT was associated with significant changes in cadence, stride time, and stride length, whereas WMT was associated with reductions in stride length only. During dual-task activities, increased activation of the PMC and SMA correlated with declines in gait performance, indicating a control mechanism for maintaining gait performance during dual tasks. Thus, the regulatory effects of cortical activation on gait behavior enable a second task to be performed while walking.

Effects of combined exercise on gait variability in community-dwelling older adults

Training that focuses on strength, balance, and endurance, the so-called combined exercise, can enhance physical function, including gait, according to a literature review. However, the effects of combined exercise on improving gait variability are limited. The objective of this study is to investigate the effects of 12 weeks of combined exercise comprised of resistance, endurance, and balance training on gait performance in older adults. Twenty-nine community-dwelling older adults were recruited and assigned to either the experimental group (n = 17) or the control group (n = 12). The 12-week intervention was a combined exercise program at 1 h per day and 3 days per week. The participants received an assessment for both a 6-min walk and gait during both habitual walking and fast walking conditions at pre-intervention and after 8 and 12 weeks of exercise. The 6-min walk was used to assess gait endurance. GAITRite was used to evaluate gait. An analysis of covariance with the pretest score as the covariate was used to determine the difference in each dependent variable between groups. The level of significance was set as p less than 0.05. Our results showed significant between-group effects in the 6-min walk and velocity, stride time, and stride length in both conditions after 8 weeks of exercise and significant between-group effects in the 6-min walk test and all selected gait parameters in both conditions after 12 weeks of exercise. Our findings demonstrate that a 12-week combined exercise program may positively affect gait endurance and gait performance including gait variability in habitual walking and fast walking conditions among older adults. The current study provides important evidence of short-term combined exercise effects on improvements in gait performance.

Effects of interactive visual feedback training on post-stroke pusher syndrome: a pilot randomized controlled study

Objective:

We investigated the effects of a computer-generated interactive visual feedback training program on the recovery from pusher syndrome in stroke patients.

Design:

Assessor-blinded, pilot randomized controlled study.

Participants:

A total of 12 stroke patients with pusher syndrome were randomly assigned to either the experimental group ( N = 7, computer-generated interactive visual feedback training) or control group ( N = 5, mirror visual feedback training).

Main outcome measures:

The scale for contraversive pushing for severity of pusher syndrome, the Berg Balance Scale for balance performance, and the Fugl-Meyer assessment scale for motor control were the outcome measures. Patients were assessed pre- and posttraining.

Results:

A comparison of pre- and posttraining assessment results revealed that both training programs led to the following significant changes: decreased severity of pusher syndrome scores (decreases of 4.0 ±1.1 and 1.4 ±1.0 in the experimental and control groups, respectively); improved balance scores (increases of 14.7 ±4.3 and 7.2 ±1.6 in the experimental and control groups, respectively); and higher scores for lower extremity motor control (increases of 8.4 ±2.2 and 5.6 ±3.3 in the experimental and control groups, respectively). Furthermore, the computer-generated interactive visual feedback training program produced significantly better outcomes in the improvement of pusher syndrome ( p < 0.01) and balance ( p < 0.05) compared with the mirror visual feedback training program.

Conclusions:

Although both training programs were beneficial, the computer-generated interactive visual feedback training program more effectively aided recovery from pusher syndrome compared with mirror visual feedback training.

Virtual Reality-Based Training to Improve Obstacle-Crossing Performance and Dynamic Balance in Patients With Parkinson's Disease

BACKGROUND

Obstacle crossing is a balance-challenging task and can cause falls in people with Parkinson's disease (PD). However, programs for people with PD that effectively target obstacle crossing and dynamic balance have not been established.

OBJECTIVE

To examine the effects of virtual reality-based exercise on obstacle crossing performance and dynamic balance in participants with PD.

METHODS

Thirty-six participants with a diagnosis of PD (Hoehn and Yahr score ranging 1 to 3) were randomly assigned to one of three groups. In the exercise groups, participants received virtual reality-based Wii Fit exercise (VRWii group) or traditional exercise (TE group) for 45 minutes, followed by 15 minutes of treadmill training in each session for a total of 12 sessions over 6 weeks. Participants in the control group received no structured exercise program. Primary outcomes included obstacle crossing performance (crossing velocity, stride length, and vertical toe obstacle clearance) and dynamic balance (maximal excursion, movement velocity, and directional control measured by the limits-of-stability test). Secondary outcomes included sensory organization test (SOT), Parkinson's Disease Questionnaire (PDQ39), fall efficacy scale (FES-I), and timed up and go test (TUG). All outcomes were assessed at baseline, after training, and at 1-month follow-up.

RESULTS

The VRWii group showed greater improvement in obstacle crossing velocity, crossing stride length, dynamic balance, SOT, TUG, FES-I, and PDQ39 than the control group. VRWii training also resulted in greater improvement in movement velocity of limits-of-stability test than TE training.

CONCLUSIONS

VRWii training significantly improved obstacle crossing performance and dynamic balance, supporting implementation of VRWii training in participants with PD.

Decreased eccentric exercise-induced macrophage infiltration in skeletal muscle after supplementation with a class of ginseng-derived steroids

Dammarane steroids (DS) are a class of chemical compounds present in Panax ginseng. Here, we evaluated the effect of 10 weeks of DS supplementation on inflammatory modulation in the soleus muscle following eccentric exercise (EE)-induced muscle damage (downhill running). Eighty rats were randomized into 4 groups of DS supplementation (saline, 20, 60, 120 mg/kg body weight). Inflammatory markers were measured at rest and again 1 h after EE. At rest, NFκB signaling, TNF-alpha and IL-6 mRNAs, 3-nitrotyrosine, glutathione peroxidase, and GCS (glutamylcysteine synthetase) levels were significantly elevated in the skeletal muscle of DS-treated rats in a dose-dependent manner. Additionally, there were no detectable increases in the number of necrotic muscle fibers or CD68+ M1 macrophages. However, muscle strength, centronucleation, IL-10 mRNA expression, and the number of CD163+ M2 macrophages increased significantly over controls with DS treatment in rat soleus muscle. Under EE-challenged conditions, significant increases in muscle fiber necrosis, CD68+ M1 macrophage distribution, and 3-nitrotyrosine were absent in rats that received low and medium doses (20 and 60 mg/kg) of DS treatment, suggesting that DS possess anti-inflammatory action protecting against a muscle-damaging challenge. However, this protective activity was diminished when a high dose of DS (120 mg/kg) was administered, suggesting that DS possess hormetic properties. In conclusion, our study provides new evidence suggesting that DS is an ergogenic component of ginseng that potentiate inflammation at baseline but that produce anti-inflammatory effects on skeletal muscle following muscle-damaging exercise. Furthermore, high doses should be avoided in formulating ginseng-based products.