In gait stability analysis, patients suffering from dysfunction problems are impacted by shifts in their dynamic balance. Monitoring the patients' progress is important for allowing physicians and patients to observe the rehabilitation process accurately. In this study, we designed a new methodology for classifying gait disorders to quantify patients' progress. The dataset in this study includes 84 measurements of 37 patients based on a physician's opinion. In this study, the system, which includes a Kinect camera to observe and store the frames of patients walking down a hallway, a key-point detector to detect the skeletal key points, and an encoder transformer classifier network integrated with generator-discriminator networks (ET-GD), is designed to evaluate the classification of gait dysfunction. The detector extracts the skeletal key points of patients. After feature engineering, the selected high-level features are fed into the proposed neural network to analyse patient movement and perform the final evaluation of gait dysfunction. The proposed network is inspired by the 1D encoder transformer, which is integrated with two main networks: a network for classification and a network to generate fake output data similar to the input data. Furthermore, we used a discriminator structure to distinguish between the actual data (input) and fake data (generated data). Due to the multi-structural networks in the proposed method, multi-loss functions need to be optimised; this increases the accuracy of the encoder transformer classifier.
- MeSH
- analýza chůze MeSH
- chůze (způsob) * MeSH
- chůze MeSH
- lidé MeSH
- neuronové sítě MeSH
- pohybové poruchy * MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
PURPOSE: We aimed to assess the ability of a head-shaking test (HST) to reflect vestibular compensation in patients after unilateral peripheral vestibular loss and to provide missing evidence and new insights into the features of head-shaking-induced nystagmus (HSN) over a 2-year follow-up. BACKGROUND: HSN may occur after a prolonged sinusoidal oscillation of the head. HSN is frequently observed in subjects with vestibular function asymmetry; it usually beats toward the functionally intact or "stronger" ear and can be followed by a reversal of its direction. STUDY DESIGN: A prospective observational case-control study. SETTINGS: A tertiary academic referral center. METHODS: A total of 38 patients after acute unilateral vestibular loss (22 patients with vestibular neuronitis and 16 patients after vestibular neurectomy) and 28 healthy controls were followed for four consecutive visits over a 2-year period. A complex vestibular assessment was performed on all participants, which included spontaneous nystagmus (SPN), the caloric test, the head-shaking test (HST), the video head impulse test (vHIT), the Timed Up and Go (TUG) test, and the Dizziness Handicap Inventory (DHI) questionnaire. We established the criteria for the poorly compensated group to assess different compensatory behaviors and results. RESULTS: We found a time-related decrease in HSN (ρ < -0.84, p < 0.001) after unilateral vestibular loss. After 2 years of follow-up, HSN intensity in compensated patients reached the level of the control group; TUG and DHI also improved to normal; however, the caloric and vHIT tests remained abnormal throughout all follow-ups, indicating a chronic vestibular deficit. Besides, poorly compensated patients had a well-detectable HSN throughout all follow-ups; TUG remained abnormal, and DHI showed at least a moderate deficit. CONCLUSIONS: Our study showed that, after a unilateral peripheral vestibular loss, the intensity of HSN decreased exponentially over time, reflecting an improvement in dynamic ability and self-perceived deficit. HSN tended to decline to the value of the control group once vestibular compensation was satisfactory and sufficient for a patient's everyday life. In contrast, well-detectable HSN in poorly compensated patients with insufficient clinical recovery confirmed the potential of HSN to reflect and distinguish between adequate and insufficient dynamic compensation. HSN could serve as an objective indicator of stable unilateral vestibular loss.
- Publikační typ
- časopisecké články MeSH
1. vydání 10 stran : ilustrace ; 21 cm
Příručka, která se zaměřuje na diagnostiku akutní závrati. Určeno odborníkům v praxi.
- MeSH
- akutní nemoc MeSH
- fyzikální vyšetření MeSH
- závrať diagnóza MeSH
- Publikační typ
- příručky MeSH
- Konspekt
- Patologie. Klinická medicína
- NLK Obory
- neurologie
- otorinolaryngologie
- NLK Publikační typ
- brožury
Background: The availability and development of methods testing the vestibuloocular reflex (VOR) brought a broader view into the lateral semicircular canal (L-SCC) function. However, the higher number of evaluated parameters makes more difficult the specialist's diagnose-making process. Purpose: To provide medical specialists, a new diagnostic-graphic tool, Estimated Vestibulogram- EVEST, enabling a quick and easy-to-read visualization and comparison of the VOR test results within the L-SCC. Methods: The development of EVEST involved 148 participants, including 49 healthy volunteers (28 female and 21 male) and 99 (58 female and 41 male) patients affected by different degrees of peripheral vestibular deficit. The corresponding L-SCC VOR test results, from patients meeting the diagnostic criteria, were used to create the EVEST. Results: Based on the test results, we depicted and calculated the EVEST vestibular function asymmetry (VFA) in all the groups. To assess a feasibility of EVEST to describe a vestibular function deficit, we calculated sensitivity and specificity of VFA using a receiver operating characteristic curve (ROC) and compared it to single tests. In all the tests, we determined the cutoff value as the point with the highest sensitivity and specificity. For discrimination of any vestibular deficit, the VFA with cutoff 6.5% was more sensitive (91%) and specific (98%) than single tests. Results showed that EVEST is a beneficial graphic tool for quick multifrequency comparison and diagnosis of different types of the peripheral vestibular loss. Conclusions: EVEST can help to easily evaluate various types of peripheral vestibular lesion.
- MeSH
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- senioři MeSH
- vestibulární funkční testy * MeSH
- vestibulární nemoci * diagnóza patofyziologie MeSH
- vestibulookulární reflex * MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- MeSH
- benigní paroxysmální polohové vertigo terapie MeSH
- chybná diagnóza psychologie MeSH
- dospělí MeSH
- lidé MeSH
- nemoci vnitřního ucha * diagnóza chirurgie psychologie MeSH
- otologické chirurgické výkony metody MeSH
- počítačová rentgenová tomografie metody MeSH
- pooperační komplikace MeSH
- semicirkulární kanálky diagnostické zobrazování chirurgie MeSH
- výsledek terapie MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- mužské pohlaví MeSH
- Publikační typ
- kazuistiky MeSH
Cíle práce: Tracheotomie je jedním z nejčastěji prováděných výkonů u kriticky nemocných pacientů. Tracheostomie v terénu popáleninového traumatu představuje specifické téma. Cílem práce je zhodnocení této problematiky. Metodika: Byla provedena retrospektivní studie pacientů hospitalizovaných na JIP Kliniky popáleninové medicíny 3. LF UK a FNKV v období 1. 1. 2012 - 31. 12. 2017, u kterých byla založena tracheostomie lékařem Otorinolaryngologické kliniky 3. LF UK a FNKV. Do studie bylo zařazeno 47 pacientů. Hodnotili jsme především výskyt komplikací ve vztahu k lokalizaci popáleniny, načasování tracheotomie a také zkušenosti operatéra. Výsledky: Z hlediska lokalizace popáleniny (skupina s popáleninovým traumatem v oblasti krku, vs. skupina s popáleninou mimo oblast krku) nebyl prokázán významný rozdíl ve výskytu chirurgických komplikací, infektů stomatu, pneumonií, kolonizace dýchacích cest multirezistentními kmeny ani mortality. Při zhodnocení výskytu komplikací tracheostomie v závislosti na době provedení jsme zjistili vyšší výskyt multirezistentních nemocničních kmenů v dolních dýchacích cestách u pozdně indikovaných tracheostomií (p=0,07). Ačkoliv bylo zastoupení komplikací u tracheostomií provedených méně zkušeným chirurgem vyšší, nebyly mezi atestovanými a neatestovanými operatéry zjištěny významné rozdíly. Závěr: Tracheostomie u popáleninového traumatu je specifické téma vzhledem k základnímu onemocnění pacienta. Postupy se všeobecně řídí doporučeními odborných společností. U pacientů s popáleninou přímo v oblasti krku je rozhodování o managementu dýchacích cest nejkontroverznější. Podle výsledků naší studie však nebyl u této skupiny pacientů zaznamenán vyšší výskyt komplikací. Načasování tracheotomie může hrát roli v kolonizaci dýchacích cest multirezistentními patogeny. Je ke zvážení, zda by tracheotomii v terénu popáleniny neměli provádět především zkušenější chirurgové.
Introduction: Tracheostomy is one of the most frequent surgical procedures in critical care patients. Tracheostomy in burn injury patients is, however, very specific topic. The purpose of our research is the evaluation of such topic. Methods: We conducted a retrospective study of patients hospitalized at ICU of Department of Burn Injuries at University Hospital Královské Vinohrady and Third Faculty of Medicine, Charles University in Prague between 1. 1. 2012 - 31. 12. 2017, who underwent tracheostomy performed by an otorhinolaryngologist. 47 patients were enrolled to the study. We evaluated the complications of tracheostomy and its correlation to the factors of the site of the burn injury, timing of tracheostomy and experience of the surgeon. Results: There was no significant difference between the group with burn injury in the neck region versus burn injury outside the neck in terms of surgical complications, stoma infections, postoperative pneumonia, colonization of the respiratory tract mucosa by multi-resistant bacteria nor mortality. Regarding the timing of tracheostomy, we found higher occurrence of multi resistant nosocomial bacteria in lower respiratory tract in the late tracheostomy group (p=0.07). Although the overall complications rate was higher in tracheostomies performer by resident otorhinolaryngologists, the difference was not statistically significant. Conclusion: Tracheostomy in burn injury is a specific topic given the patient's primary illness. The management usually follows the international societies' guidelines. The most controversial long-term airway management is in the presence of burn trauma directly in the neck region. According to our study results, there was no higher incidence of complications in such patients though. Timing of tracheostomy may play role in multi-resistant bacteria colonization of the lower respiratory tract. The choice of a level of experience of a surgeon to be performing tracheostomy in burn injury should be carefully considered.
This pilot study deals with the possibilities of a Continuous Glucose Monitoring System (CGMS, Minimed- Medtronic) to optimize insulin substitution. Ten persons with type 1 diabetes mellitus treated by means of an insulin pump entered the study and eight of them completed the protocol. CGMS was introduced for a period of 5 days. The standard dinner (60 g of carbohydrates) and overnight fasting were designed to ensure standard night conditions in all persons in the study while maintaining their usual daily eating routine, physical exercise and assessment of prandial insulin boluses. The only adaptation of basal rates of insulin pump was performed on day 3. Comparison of the mean plasma glucose concentration (0:00-24:00 hrs) between day 2 (before adaptation) and day 4 (following adaptation) was made. An independent comparison of the mean plasma glucose concentration between the night from day 2 till day 3 (22:00-6:00 hrs) and the night from day 4 till day 5 (22:00-6:00 hrs) was performed. The mean plasma glucose investigated by means of CGMS improved in the 24-hour period in 5 out of 8 persons and in the night fasting period (22:00 to 6 hrs) in 6 out of 8 persons. The CGMS is a useful means for assessment of the effectiveness of basal rate and prandial insulin doses in persons with type 1 diabetes treated by means of an insulin pump. However, further studies are necessary to improve the algorithm for insulin substitution.
- MeSH
- ambulantní monitorování MeSH
- diabetes mellitus 1. typu krev farmakoterapie MeSH
- dospělí MeSH
- hypoglykemika aplikace a dávkování MeSH
- inzulin aplikace a dávkování MeSH
- inzulinové infuzní systémy MeSH
- krevní glukóza analýza MeSH
- lidé středního věku MeSH
- lidé MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
