1992年台北榮總研究 Incidence of Stroke in Taiwan

35歲以上成人, 每年中風發生率, 男性十萬分之 378, 女性十萬分之 280, 平均十萬分之 330

The crude average annual incidence rate of first-ever stroke in inhabitants in Taiwan above age 35 years was 330 per 100,000 (378 per 100,000 for men and 280 per 100,000 for women). The age-adjusted incidence rate was 329 per 100,000 (348 per 100,000 for men and 301 per 100,000 for women) (Table 1).

高血壓與高鹽飲食會增加中風機率

高血壓增加 1.9 倍中風機率

高鹽飲食增加 1.3 倍中風機率

In the present study, age-adjusted risk ratio for hypertension was 3.75. Other significant risk factors of stroke in the current study were consumption of alcohol and salty food (Table 4). After multivariate adjustment for age, sex, and all factors in Table 4, age, hypertension, and salty food remained significant and independent risk factors for stroke, with a risk ratio of 1.9 for hypertension and 1.3 for salty food (/?<0.05).

https://www.ahajournals.org/doi/pdf/10.1161/01.STR.23.9.1237

阻力訓練 Resistance exercise training (RET)

阻力訓練可以增加肌肉量.
*High total energy expenditure leads to increased longevity (JAMA 2006;296:171) *Resistant exercise can increase muscle mass. (J Gerontol: Med Sci 2006; 61A: 78. J Appl Physiol 2001;90:2341)

Trunk Flexion extension.
Hip abduction/adduction

另, 老人的預防失能可以參考韓德生醫師的PPT
https://www.tma.tw/TakeCare2018/files/0819_4.pdf

靜態阻力訓練. 肌肉長度不改變 isometric exercise.

Resistance Tubing: The Answer to Weight Training Tools

還可以利用家中的環境作阻力訓練, 下面是露天拍賣的商品. 

https://goods.ruten.com.tw/item/show?30184833782490

也可以利用橡皮帶作訓練

或

老人的肌衰弱測試

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運動處方 EIM 運動可治療的疾病

1. 關節炎 arthritis
Prevention: possibly through weight control
• Treatment: yes
• Effective modality: AET, RET, aquatic ex
– Low impact
– Adequate volume to achieve healthy weight

Cancer

• Prevention: yes 

• Treatment: yes, for QOL, wasting, lymph edema, psychological function, breast ca survival 

• Effective modality: AET, RET

COPD

• Prevention: no 

• Treatment: yes, for extrapulmonary benefit 

• Effective modality: AET, RET 

– RET is more tolerable in severe dis, complementary effects in combined modality 

– Ex with bronchodilator use 

– Use O2 during ex if needed

Cognitive impairment

• Prevention: yes 

• Treatment: yes 

• Effective modality: AET, RET 

– Mechanism unknown 

–Need supervision in dementia

Hypertension

• Prevention: yes 

• Treatment: yes 

• Effective modality: AET, RET 

– Large change in those reduce weight 

– Small reduction in both SBP & DBP

Osteoporosis

• Prevention: yes 

• Treatment: yes 

• Effective modality: AET, RET, balance training, high-impact ex 

– Weight bearing, high-impact, high-velocity (jump) 

– RET effect is local around contracted muscles 

– Balance training to prevent fall

Peripheral vascular disease 

• Prevention: yes

• Treatment: yes 

• Effective modality: AET, RET 

– Systemic vascular effect 

– Ex volume to the limits of pain tolerance to improve claudication 

– RET is less robust

Benefits of AET in older adult

• Aerobic ex capacity (A): sufficient AE intensity (>60% of pretraining VO2max), freq, and length (>3 d/wk for >16 wk) increase VO2max in healthy middle & old aged adults 

• CV effects (A): >3 mo of mod-intensity AE elicits CV adaptations in healthy middle & old aged adults, at rest & acute dynamic ex 

• Body composition (A/B): mod-intensity AET reduce body fat in obese middle & old aged adults, no effect on FFM 

• Metabolic effect (B): AET can enhance glycemic control, augment postprandial lipids clearance, and utilize fat during submax ex 

• Bone health (B): AET can counteract agerelated decline in BMD in post-menopausal ˖

• Muscle strength can be increased after RET(A)

• Muscle quality is increased after RET(B). similar between older and younger, male and female

• Muscle endurance can be improved by mod- or high-intensity RET, not low-intensity (C). 

• Body composition (B/C): FFM increased. FM decreased with mod- or high-intensity RET

• High-intensity RET improved BMD relative to sedentary control(B)

• Metabolic and endocrine effects (B/C): the evidence is mixed. 

Benefits of balance training in older adult 

• (C): Multimodal ex, including stength and balance ex, and Tai-chi 太極拳 have been shown to be effective in reducing the risk of non-injurious and sometimes injurious falls in populations who are at elevated risk of falling. 

Benefits of stretching and flexibility training in older adult

(D) there is some evidence that flexibility can be increased in the major joints by ROM ex; however, how much and what types of ROM ex are most effective have not been established. 

運動處方

FOTT-Pro

= frequency, intensity, time, type, proression. 

種類

- AET aerobic exercise training: jog, stair climb, brisk walk, bicycle, swim

- Resistance exercise training RET: weight lift, theraband, weight training. 

- Flexibility exercise: stretch

- balance impact exercise: sprinting, single-leg stance

特異性

有氧運動

- 中等強度 for 30-60 min on 5d/wk, 或vigorous-intensity 激烈強度 20-30 min on 3d/wk (1A). 

- 10 point scale (sitting 0, all-out 10)

~ mod: 5/6 , noticeable increase in HR and Breath. 

~ vig: 7/8 , large increase in HR and breath

- Routine light-intensiry ADL or mod-intensity activity < 10 min are not included. 

- Walking, stationary bike, aquatics (NWB no weight bearing). 

- define aerobic intensity by fitness, instead of absolute term (eg, MET). 

~~ 50-85% of O2 uptake reserve

~~5-8/10 of perceived effort 自覺運動強度

~~~ correlated but not linearly

~~A period of supervised exercise may help them learn the desired level of effort 

肌力訓練

Muscle-strengthening activity

• Maintain or increase muscular strength and endurance >2d/wk (IIaA) 

• At least 1 set of 8-10 ex using major m. on 2 or more nonconsecutive days per wk 

• 8-12rep, 1-3set, mod to high intensity 

• 10-point scale (no move:0, max effort:10) – Mod-int: 5/6, High-int: 7/8 – 40-50% 1RM -> 60-80% 1RM 

• Mode: progressive wt training, wt bearing calisthenics, stairs climbing, similar resistance ex

 

Greater amount of activity 

• Additional health benefits & physical fitness in higher levels of AE/RE(IA) 

– If no condition preclude higher amounts of PA 

      • Improve fitness 

      • Improve management of existing dz 

      • Reduce risk of premature chronic condition 

• Higher impact weight bearing activity for skeletal health (IIaB) 

• Higher PA for preventing weight gain (IIaB)

Flexibility activity

• 2 d/wk for >10 min/d to maintain flexibility necessary for regular PA and daily life (IIbB) 

• Major muscle and tendon with 30-60s for a static stretch 

• Stretch to the point of feeling tightness or slight discomfort; static, not ballistic 

• Perform on the day that AE or RE is performed 

• Specific health benefit is unclear 

   – Reduce risk of ex-related inj

Balance exercise

• Balance exercise to reduce risk of falls in community-dwelling older adults (IIaA) 

• Multi-component interventions prevent fall in community elderly 

• Ex, not activity (eg.dancing) is recommended, though PA itself could reduce falls 35-45% 

• 3 times/wk? Preferred types, frequency, and duration are unclear 

• No evidence for LTC and hospital setting

整合預防性及治療性活動

• 對許多疾病而言是相同的

• 骨質酥鬆為例, 預防性運動: 有氧,阻力, 平衡, 柔軟度,

  • 強調負重急高衝力活動, 例如跳躍 

   –Osteoporosis as example: preventive for aerobic, resistance, balance, flexibility. Emphasize wt bearing and high impact activity, like jumping

• At least avoid sedentary behavior, when chronic conditions preclude minimum recommended activity. – Activity limitation: assess the nature of the activity limitation, the capability and preferences of the person. Usually determine the target activity level and details of activity plan mostly in CR/PR centers, or ex classes.

老人照護的一般原則

- 不要給太辛, 太複雜活動, 最好是老人們以前熟悉有興趣的

- 從低強度開始, 隨時保持警覺性, 適時加以調整老人們活動內容及強度

- 提供老人安全舒適的活動空間, 例如照明, 地板防滑, 行進動線, 洗手間設備等. 

- 注意老人服用多種藥物的情況. 

 

野外與登山醫學---高海拔腦水腫 High Altitude Cerebral Edema 2019-12-17 by Jacob D. Jensen; Andrew L. Vincent.

High Altitude Cerebral Edema (HACE)
Jacob D. Jensen; Andrew L. Vincent.
Last Update: December 17, 2019.

Introduction 簡介

高海拔腦水腫 HACE 是高海拔疾病的嚴重潛在致死表現, 特徵是運動失調, 疲憊, 神智改變

HACE 被視為是 AMS 末期表現, 雖然 HACE 在高海拔疾病的發生率不高, 但可能在 24 小時內致死

(並非一定能活 24 小時, 而是 24 小時內若沒有適當診斷治療可能死亡)
(HACE沒有黃金時間, 一但診斷需立即處置)
High Altitude Cerebral Edema (HACE) is a severe and potentially fatal manifestation of high altitude illness and is often characterized by ataxia, fatigue, and altered mental status. HACE is often thought of as an extreme form/end-stage of Acute Mountain Sickness (AMS). Although HACE represents the least common form of altitude illness, it may progress rapidly to coma and death as a result of brain herniation within 24 hours, if not promptly diagnosed and treated.

Etiology 病因

HACE通常在上升到海拔 4000m 以上兩天後發生, 但也可能在較低海拔 2500m 快速發生. 

有一些患者會出現AMS症狀, 但並非全部. 也有些人會同時罹患 HAPE.

單獨發生HACE較罕見, 但即使沒有先出現 HAPE或 AMS, 也不能直接排除 HACE.
HACE generally occurs after 2 days above 4000m but can occur at lower elevations (2500m) and with faster onset. Some, but not all, individuals will suffer from symptoms of AMS such as headache, insomnia, anorexia, nausea prior to transitioning to HACE. Some may also have concomitant High Altitude Pulmonary Edema (HAPE). HACE in isolation is rare, but the absence of concomitant HAPE or symptoms of AMS prior to deterioration does not rule-out the presence of HACE. 

Epidemiology 

HACE在海拔 4000-5000 公尺的盛行率約 0.5-1%, HACE 會影響各年齡層與性別, 但年輕患者的機率較高 (年輕人較高的原因, 例如帶著症狀上升, 或爬升速率較快)

HACE危險因子包括

1. prior history of high altitude illness 先前曾經罹患高海拔疾病

2. lack of acclimatization 缺乏高度適應

3. heavy physical exertion 大量體力活動

4. rapid rate of ascent 快速上升

5. abrupt ascent from lower altitudes. 突然從低海拔爬升至高海拔

Incidence of HACE is 0.5-1% at altitudes of 4000-5000 m. HACE affects those of all ages and genders, though younger males may be at higher risk due to continuation of ascent despite symptoms of AMS and faster rate of ascent. Risk factors include prior history of high altitude illness, lack of acclimatization, heavy physical exertion, rapid rate of ascent, and abrupt ascent from lower altitudes.

Benzbromarone 促尿酸排泄 Gouless Euricon

促尿酸排泄藥物 (benzbromarone, sulfinpyrazone) 

對尿酸之製造無影響，而僅是增加其排除

會增加尿路結石及尿酸腎病變機率

因此不適用於下列病患：

(1) 製造過多引起的高尿酸血症

(2) 腎功能降低時，此類藥物會失去效用，尤其是 sulfinpyrazone 在肌酸酐廓清率 (creatinine clearance, CCr) <30 mL/min 時無效，宜避免使用

(3) 有尿酸成分尿路結石者為禁忌，因易增加尿路結石及尿酸腎病變危險。

促尿酸排泄藥物通常要從小劑量開始，且喝水要充足，以預防尿路尿酸結石的副作用。

Benzbromarone
初始劑量 50 mg qd. 需多喝水
Peak: 服藥之後 2-3 小時到達最大血中濃度
Duration: 半衰期 half life 12-13 小時
Max 100 mg qd. (但euricon原廠仿單說 150 mg qd)

警示, 六個月內應定期檢查肝功能.
1. 猛爆性肝炎, 服藥六個月內可能發生
2. 肝功能異常需停藥. 

禁忌
1. 腎結石病患, 嚴重腎功能不良
2. 懷孕或可能懷孕的婦女
3. 肝功能異常.

注意事項:
1. 急性痛風發作不要吃
2. 服藥初期有誘發痛風的可能
3. 尿液在酸性環境容易產生尿酸結石, 應增加喝水

Bell's palsy and Ramsay hunt syndrome 顏面神經麻痺 耳朵皰疹

下面這篇是黃醫師找到的, 來不及翻譯. 另外貼這裡 

Antiviral treatment for Bell's palsy (idiopathic facial paralysis).

Abstract

BACKGROUND:

Corticosteroids are widely used in the treatment of idiopathic facial paralysis (Bell's palsy), but the effectiveness of additional treatment with an antiviral agent is uncertain. This review was first published in 2001 and most recently updated in 2015. Since a significant benefit of corticosteroids for the early management of Bell's palsy has been demonstrated, the main focus of this update, as in the previous version, was to determine the effect of adding antivirals to corticosteroid treatment. We undertook this update to integrate additional evidence and to better assess the robustness of findings, taking risk of bias fully into account.

AUTHORS' CONCLUSIONS:

The combination of antivirals and corticosteroids may have little or no effect on rates of incomplete recovery in comparison to corticosteroids alone in Bell's palsy of various degrees of severity, or in people with severe Bell's palsy, but the results were very imprecise. Corticosteroids alone were probably more effective than antivirals alone and antivirals plus corticosteroids were more effective than placebo or no treatment. There was no clear benefit from antivirals alone over placebo.The combination of antivirals and corticosteroids probably reduced the late sequelae of Bell's palsy compared with corticosteroids alone. Studies also showed fewer episodes of long-term sequelae in corticosteroid-treated participants than antiviral-treated participants.We found no clear difference in adverse events from the use of antivirals compared with either placebo or corticosteroids, but the evidence is too uncertain for us to draw conclusions.An adequately powered RCT in people with Bell's palsy that compares different antiviral agents may be indicated.下面這篇是黃醫師找到的, 來不及翻譯. 另外貼這裡 

Antiviral treatment for Bell's palsy (idiopathic facial paralysis).

Abstract

BACKGROUND:

Corticosteroids are widely used in the treatment of idiopathic facial paralysis (Bell's palsy), but the effectiveness of additional treatment with an antiviral agent is uncertain. This review was first published in 2001 and most recently updated in 2015. Since a significant benefit of corticosteroids for the early management of Bell's palsy has been demonstrated, the main focus of this update, as in the previous version, was to determine the effect of adding antivirals to corticosteroid treatment. We undertook this update to integrate additional evidence and to better assess the robustness of findings, taking risk of bias fully into account.

AUTHORS' CONCLUSIONS:

The combination of antivirals and corticosteroids may have little or no effect on rates of incomplete recovery in comparison to corticosteroids alone in Bell's palsy of various degrees of severity, or in people with severe Bell's palsy, but the results were very imprecise. Corticosteroids alone were probably more effective than antivirals alone and antivirals plus corticosteroids were more effective than placebo or no treatment. There was no clear benefit from antivirals alone over placebo.The combination of antivirals and corticosteroids probably reduced the late sequelae of Bell's palsy compared with corticosteroids alone. Studies also showed fewer episodes of long-term sequelae in corticosteroid-treated participants than antiviral-treated participants.We found no clear difference in adverse events from the use of antivirals compared with either placebo or corticosteroids, but the evidence is too uncertain for us to draw conclusions.An adequately powered RCT in people with Bell's palsy that compares different antiviral agents may be indicated.