Advancing Intraoperative Neurophysiological Monitoring With Human Reflexes.

Human reflexes are simple motor responses that are automatically elicited by various sensory inputs. These reflexes can provide valuable insights into the functioning of the nervous system, particularly the brainstem and spinal cord. Reflexes involving the brainstem, such as the blink reflex, laryngeal adductor reflex, trigeminal hypoglossal reflex, and masseter H reflex, offer immediate information about the cranial-nerve functionality and the overall state of the brainstem. Similarly, spinal reflexes such as the H reflex of the soleus muscle, posterior root muscle reflexes, and sacral reflexes provide crucial information about the functionality of the spinal cord and peripheral nerves. One of the critical benefits of reflex monitoring is that it can provide continuous feedback without disrupting the surgical process due to no movement being induced in the surgical field. These reflexes can be monitored in real time during surgical procedures to assess the integrity of the nervous system and detect potential neurological damage. It is particularly noteworthy that the reflexes provide motor and sensory information on the functional integrity of nerve fibers and nuclei. This article describes the current techniques used for monitoring various human reflexes and their clinical significance in surgery. We also address important methodological considerations and their impact on surgical safety and patient outcomes. Utilizing these methodologies has the potential to advance or even revolutionize the field of intraoperative continuous monitoring, ultimately leading to improved surgical outcomes and enhanced patient care.

The effect of topic familiarity and volatility of auditory scene on selective auditory attention.

Selective auditory attention has been shown to modulate the cortical representation of speech. This effect has been well documented in acoustically more challenging environments. However, the influence of top-down factors, in particular topic familiarity, on this process remains unclear, despite evidence that semantic information can promote speech-in-noise perception. Apart from individual features forming a static listening condition, dynamic and irregular changes of auditory scenes-volatile listening environments-have been less studied. To address these gaps, we explored the influence of topic familiarity and volatile listening on the selective auditory attention process during dichotic listening using electroencephalography. When stories with unfamiliar topics were presented, participants' comprehension was severely degraded. However, their cortical activity selectively tracked the speech of the target story well. This implies that topic familiarity hardly influences the speech tracking neural index, possibly when the bottom-up information is sufficient. However, when the listening environment was volatile and the listeners had to re-engage in new speech whenever auditory scenes altered, the neural correlates of the attended speech were degraded. In particular, the cortical response to the attended speech and the spatial asymmetry of the response to the left and right attention were significantly attenuated around 100-200 ms after the speech onset. These findings suggest that volatile listening environments could adversely affect the modulation effect of selective attention, possibly by hampering proper attention due to increased perceptual load.

Invasive sphenoid sinus aspergillosis with normal findings on initial diagnostic tests that mimics Tolosa-Hunt syndrome-a diagnostic dilemma: a case report.

Invasive sphenoid sinus aspergillosis can mimic Tolosa-Hunt syndrome (THS), leading to frequent misdiagnoses and potentially fatal consequences. We report a case of invasive sphenoid sinus aspergillosis initially misdiagnosed as THS. A 79-year-old man presented with right periorbital pain, ophthalmoplegia, and loss of vision. Initial evaluations including magnetic resonance imaging (MRI), were normal. He was first diagnosed with THS based on clinical features. The disease progressed despite high-dose intravenous steroid treatment, and an enhancing mass-like lesion was found in the right orbital apex, cavernous sinus, and sphenoid sinus on follow-up MRI. Aspergillosis was eventually confirmed by sphenoid sinus biopsy. The patient developed cerebral infarction and finally died despite being treated with amphotericin B. Given that invasive sphenoid sinus aspergillosis may initially resemble THS, high suspicion and rapid histological examination are important for diagnosis.

Intraoperative bulbocavernosus reflex monitoring in posterior lumbar fusion surgery.

OBJECTIVE: To assess the utility of intraoperative bulbocavernosus reflex (BCR) monitoring in posterior lumbar fusion surgery. METHODS: We retrospectively evaluated 153 patients undergoing posterior lumbar fusion with intraoperative BCR monitoring. Voiding function was assessed at discharge and two follow-ups. RESULTS: BCR was preserved in 151 patients and completely disappeared in two patients at the end of surgery. For patients in whom BCR was preserved, voiding difficulties at discharge and 1-month and 6-month follow-ups were noted in 16 (10.6%), 9 (6.0%), and 0 (0.0%) patients, respectively. However, patients with BCR loss experienced voiding difficulties at all three time-points. Statistical analysis showed a significant difference in voiding between those with preserved and disappeared BCRs at 6 months postoperatively. BCR disappeared during surgery but recovered before the end of surgery in six patients. Among these patients, one experienced transient voiding difficulties postoperatively but with good recovery. However, the other five patients did not experience postoperative voiding difficulties. CONCLUSIONS: BCR had low sensitivity for voiding dysfunction at discharge, but had high accuracy at 6-month follow-up examinations. BCR loss was associated with new voiding dysfunction. SIGNIFICANCE: Intraoperative BCR monitoring is a potentially useful tool for enhancing safety during posterior lumbar fusion by predicting postoperative voiding dysfunction.

Efficacy of intraoperative bulbocavernosus reflex monitoring for the prediction of postoperative voiding function in adult patients with lumbosacral spinal tumor.

Lumbosacral spinal tumor surgery is associated with a relatively high risk of postoperative voiding dysfunction. This study aimed to investigate the correlation between intraoperative bulbocavernosus reflex (BCR) changes and postoperative voiding function in adult patients with lumbosacral spinal tumors. We retrospectively reviewed 63 patients who underwent intradural conus and cauda equina tumor surgeries with intraoperative BCR monitoring. We evaluated patients' voiding functions for 6 months postoperatively. BCR was maintained in 60 patients and disappeared in 3 patients at the end of the surgery. Among the patients in whom BCR was maintained, examinations conducted at discharge and at 1- and 6-month follow-ups revealed that 7 (11.7%), 4 (6.7%), and zero (0.0%) patients experienced voiding difficulty, respectively. However, all 3 (100%) patients without BCR experienced voiding difficulty at the three corresponding follow-ups. Data analysis indicated no significant difference in voiding between the maintained and disappeared BCR groups 6-months postoperatively. The sensitivity, specificity, positive predictive, and negative predictive values of intraoperative BCR monitoring for detecting new and worsening difficulty in voiding were all 100% 6 months postoperatively. Our results shows that intraoperative BCR monitoring is a reliable predictor of voiding function following surgery in adult patients undergoing lumbosacral spinal tumor surgery. Intraoperative BCR monitoring can be useful for assessing and monitoring the integrity of the voiding function during lumbosacral spinal tumor surgery.

Standard for the Quantification of a Sterilization Effect Using an Artificial Intelligence Disinfection Robot.

Recent outbreaks and the worldwide spread of COVID-19 have challenged mankind with unprecedented difficulties. The introduction of autonomous disinfection robots appears to be indispensable as consistent sterilization is in desperate demand under limited manpower. In this study, we developed an autonomous navigation robot capable of recognizing objects and locations with a high probability of contamination and capable of providing quantified sterilization effects. In order to quantify the 99.9% sterilization effect of various bacterial strains, as representative contaminants with robots operated under different modules, the operating parameters of the moving speed, distance between the sample and the robot, and the radiation angle were determined. We anticipate that the sterilization effect data we obtained with our disinfection robot, to the best of our knowledge, for the first time, will serve as a type of stepping stone, leading to practical applications at various sites requiring disinfection.

Neurophysiological monitoring during anterior cervical discectomy and fusion for ossification of the posterior longitudinal ligament.

OBJECTIVE: This study aimed to investigate the value of intraoperative neurophysiological monitoring (IONM) in anterior cervical spine discectomy with fusion (ACDF) for ossification of the posterior longitudinal ligament (OPLL). METHODS: Patients who underwent multimodal IONM (transcranial electrical motor-evoked potentials [tcMEP], somatosensory-evoked potentials, and continuous electromyography) for ACDF from 2009 to 2019 were compared to historical controls from 2003 to 2009. The rates of postoperative neurological deficits, neurophysiological warnings, and their characteristics were analyzed. RESULTS: Among 196 patients, postoperative neurological deficit rates were 3.79% and 14.06% in the IONM and historical control (non-IONM) groups, respectively (p < 0.05). The use of IONM (OR: 0.139, p = 0.003) and presence of myelopathy (OR: 8.240, p = 0.013) were associated with postoperative neurological complications on multivariate regression. In total, 23 warnings were observed during IONM (17 tcMEP and/or electromyography; six electromyography). Sensitivity and specificity of IONM warnings for detecting neurological complications were 84.2% and 93.7%, respectively. CONCLUSIONS: IONM, especially multimodal IONM, may be a useful tool to detect neurological damage in ACDF for high-risk conditions such as OPLL with pre-existing myelopathy. SIGNIFICANCE: The utility of IONM in ACDF for OPLL has not been evaluated due to its rarity. This study supports the use of IONM in cervical OPLL with myelopathy.

Predictive value of intraoperative blink reflex monitoring for surgical outcome during microvascular decompression for hemifacial spasm.

OBJECTIVE: To investigate the prognostic and predictive value of intraoperative blink reflex (BR) monitoring during microvascular decompression (MVD) for hemifacial spasm (HFS). METHODS: We retrospectively reviewed 41 patients with HFS undergoing MVD with intraoperative BR and lateral spread response (LSR) monitoring. Facial spasm was evaluated for six months postoperatively. RESULTS: The BR resolved in 38 patients and persisted in three after MVD. For patients who exhibited BR resolution, 1-day, 1-month, and 6-month follow-ups revealed that 35 (92.1%), 35 (92.1%), and 38 (100%) patients had spasm resolution, respectively. However, of the three patients with persistent BR, one (33.3%), one (33.3%), and zero (0%) patients exhibited spasm resolution at the three corresponding follow-ups. We found a statistically significant difference in spasm resolution between the persistent and resolved BR groups at six months postoperatively. A comparison between intraoperative BR and LSR monitoring revealed that BR was a better predictor of clinical outcomes. CONCLUSIONS: Intraoperative BR monitoring is a potentially useful tool to help facilitate an adequate decompression and is a reliable prognostic predictor of surgical outcome. SIGNIFICANCE: This study is the first to document the relationship between intraoperative BR monitoring and surgical outcome in patients with HFS.

Characteristics of forearm mixed nerve conduction study in carpal tunnel syndrome: Comparison with ultrasound assessments.

This study aimed to characterize forearm mixed nerve conduction study (NCS) findings in carpal tunnel syndrome (CTS). Eighty-two patients with CTS and 48 healthy controls were enrolled. We directly compared the forearm mixed NCS and ultrasonography results from CTS patients with those from the controls. Correlation analyses were performed to identify the relationship between forearm mixed NCS parameters and ultrasound measurements in CTS. We observed reduced forearm mixed nerve amplitude and increased cross-sectional area (CSA) of the median nerve at the proximal carpal tunnel (CT) inlet in CTS. The forearm mixed nerve amplitude negatively correlated with the CSA at the proximal CT inlet. We found a negative correlation between Bland's neurophysiological grade and the forearm mixed nerve amplitude as well as a positive correlation between the CSA of the median nerve at the proximal CT inlet and Bland's neurophysiological grade. We confirmed that the reduced median mixed nerve amplitude is the distinguishing feature of forearm mixed NCS in CTS. Our findings suggest that the forearm mixed NCS is potentially useful in evaluating its severity.

Intraoperative neuromonitoring during microsurgical clipping for unruptured anterior choroidal artery aneurysm.

OBJECTIVE: To investigate the safety and unexpected finding of the intraoperative neuromonitoring (IONM) including somatosensory evoked potentials (SSEPs) and motor evoked potentials (MEPs) during microsurgical clipping of an unruptured anterior choroidal artery (AChA) aneurysm. PATIENTS AND METHODS: From January 2011 to March 2018, the neurophysiological, clinical, and radiological data of 115 patients who underwent microsurgical clipping for an unruptured AChA aneurysm under IONM were retrospectively analyzed. The incidence of ischemic complications after microsurgical clipping of unruptured AChA aneurysms as well as the false-negative rate, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of IONM during surgery were calculated. RESULTS: Ischemic complications after the microsurgical clipping of an AChA aneurysm under IONM occurred in 7 of 115 patients (6.08%). Among them, 3 were symptomatic (2.6%). The false-negative rate of IONM for ischemic complications was 6.08% (7 patients). High specificity; 100% (95% confidence interval [95% CI] = 0.972-1.000), PPVs; 100% (95% CI = 0.055-1.000), and NPVs; 93% (95% CI = 0.945-0.973) with low sensitivity; 11.1% (95% CI = 0.006-0.111) were calculated. CONCLUSIONS: IONM including transcranial MEP during microsurgical clipping of unruptured AChA aneurysm might have limited usefulness. Therefore, other MEP monitoring using direct cortical stimulation or modified transcranial methodology should be considered to compensate for it.

Ontology-based Dementia Care Support System.

In this paper, we have designed an ontology-based knowledge system for caring person with dementia at home or care facility. Proposed system contains an ontology that describes the knowledge of dementia patient, dementia symptoms, indoor environment, qualitative things and various patient's situation happening during daily life. We first describe the overall system architecture of the proposed system targeting at supporting caregivers or family members that can provide appropriate care guides for distinct symptoms of a dementia patient. We have tested the feasibility of the proposed system with two different prototypal application systems: robot platform and knowledge sharing system.

Abnormalities of Otoacoustic Emissions in Myasthenia Gravis: Association With Serological and Electrophysiological Features.

Objective: To investigate whether otoacoustic emissions (OAEs) are impaired in patients with myasthenia gravis (MG) and whether such dysfunction is associated with serological and electrophysiological features of MG. Methods: We tested 15 patients with MG (30 ears) and 10 healthy age- and sex-matched subjects (20 ears) for transiently evoked OAE (TEOAE) and distortion product OAE (DPOAE). Results: Compared with controls, MG patients revealed a significant reduction in the amplitude of TEOAEs (p < 0.05) and DPOAEs at higher frequencies between 2,026 and 4,053 Hz (p < 0.05). In the subgroup analysis, TEOAE and DPOAE amplitudes were significantly lower in the acetylcholine receptor (AChR) antibody-positive group (p < 0.05) as well as in the repetitive nerve stimulation (RNS)-positive (p < 0.05) group. In particular, the OAE alteration significantly correlated with anti-AChR antibody titers. No significant difference of the OAEs was found between thymomatous and non-thymomatous MG or between purely ocular and generalized MG. Conclusions: Our study confirms that OAEs reveal subclinical dysfunction of the cholinergic neurotransmission of cochlear outer hair cells and correlate well with electrophysiological and serological characteristics of MG patients. Our findings imply that the measurement of OAEs might increase the diagnostic accuracy and help to monitor the severity of MG.

Social skills training for children with autism spectrum disorder using a robotic behavioral intervention system.

We designed a robot system that assisted in behavioral intervention programs of children with autism spectrum disorder (ASD). The eight-session intervention program was based on the discrete trial teaching protocol and focused on two basic social skills: eye contact and facial emotion recognition. The robotic interactions occurred in four modules: training element query, recognition of human activity, coping-mode selection, and follow-up action. Children with ASD who were between 4 and 7 years old and who had verbal IQ ≥ 60 were recruited and randomly assigned to the treatment group (TG, n = 8, 5.75 ± 0.89 years) or control group (CG, n = 7; 6.32 ± 1.23 years). The therapeutic robot facilitated the treatment intervention in the TG, and the human assistant facilitated the treatment intervention in the CG. The intervention procedures were identical in both groups. The primary outcome measures included parent-completed questionnaires, the Autism Diagnostic Observation Schedule (ADOS), and frequency of eye contact, which was measured with the partial interval recording method. After completing treatment, the eye contact percentages were significantly increased in both groups. For facial emotion recognition, the percentages of correct answers were increased in similar patterns in both groups compared to baseline (P > 0.05), with no difference between the TG and CG (P > 0.05). The subjects' ability to play, general behavioral and emotional symptoms were significantly diminished after treatment (p < 0.05). These results showed that the robot-facilitated and human-facilitated behavioral interventions had similar positive effects on eye contact and facial emotion recognition, which suggested that robots are useful mediators of social skills training for children with ASD. Autism Res 2017,. © 2017 International Society for Autism Research, Wiley Periodicals, Inc. Autism Res 2017, 10: 1306-1323. © 2017 International Society for Autism Research, Wiley Periodicals, Inc.

Evaluation of Fear Using Nonintrusive Measurement of Multimodal Sensors.

Most previous research into emotion recognition used either a single modality or multiple modalities of physiological signal. However, the former method allows for limited enhancement of accuracy, and the latter has the disadvantages that its performance can be affected by head or body movements. Further, the latter causes inconvenience to the user due to the sensors attached to the body. Among various emotions, the accurate evaluation of fear is crucial in many applications, such as criminal psychology, intelligent surveillance systems and the objective evaluation of horror movies. Therefore, we propose a new method for evaluating fear based on nonintrusive measurements obtained using multiple sensors. Experimental results based on the t-test, the effect size and the sum of all of the correlation values with other modalities showed that facial temperature and subjective evaluation are more reliable than electroencephalogram (EEG) and eye blinking rate for the evaluation of fear.

A Fuzzy-Based Fusion Method of Multimodal Sensor-Based Measurements for the Quantitative Evaluation of Eye Fatigue on 3D Displays.

With the rapid increase of 3-dimensional (3D) content, considerable research related to the 3D human factor has been undertaken for quantitatively evaluating visual discomfort, including eye fatigue and dizziness, caused by viewing 3D content. Various modalities such as electroencephalograms (EEGs), biomedical signals, and eye responses have been investigated. However, the majority of the previous research has analyzed each modality separately to measure user eye fatigue. This cannot guarantee the credibility of the resulting eye fatigue evaluations. Therefore, we propose a new method for quantitatively evaluating eye fatigue related to 3D content by combining multimodal measurements. This research is novel for the following four reasons: first, for the evaluation of eye fatigue with high credibility on 3D displays, a fuzzy-based fusion method (FBFM) is proposed based on the multimodalities of EEG signals, eye blinking rate (BR), facial temperature (FT), and subjective evaluation (SE); second, to measure a more accurate variation of eye fatigue (before and after watching a 3D display), we obtain the quality scores of EEG signals, eye BR, FT and SE; third, for combining the values of the four modalities we obtain the optimal weights of the EEG signals BR, FT and SE using a fuzzy system based on quality scores; fourth, the quantitative level of the variation of eye fatigue is finally obtained using the weighted sum of the values measured by the four modalities. Experimental results confirm that the effectiveness of the proposed FBFM is greater than other conventional multimodal measurements. Moreover, the credibility of the variations of the eye fatigue using the FBFM before and after watching the 3D display is proven using a t-test and descriptive statistical analysis using effect size.

Robust pedestrian detection by combining visible and thermal infrared cameras.

With the development of intelligent surveillance systems, the need for accurate detection of pedestrians by cameras has increased. However, most of the previous studies use a single camera system, either a visible light or thermal camera, and their performances are affected by various factors such as shadow, illumination change, occlusion, and higher background temperatures. To overcome these problems, we propose a new method of detecting pedestrians using a dual camera system that combines visible light and thermal cameras, which are robust in various outdoor environments such as mornings, afternoons, night and rainy days. Our research is novel, compared to previous works, in the following four ways: First, we implement the dual camera system where the axes of visible light and thermal cameras are parallel in the horizontal direction. We obtain a geometric transform matrix that represents the relationship between these two camera axes. Second, two background images for visible light and thermal cameras are adaptively updated based on the pixel difference between an input thermal and pre-stored thermal background images. Third, by background subtraction of thermal image considering the temperature characteristics of background and size filtering with morphological operation, the candidates from whole image (CWI) in the thermal image is obtained. The positions of CWI (obtained by background subtraction and the procedures of shadow removal, morphological operation, size filtering, and filtering of the ratio of height to width) in the visible light image are projected on those in the thermal image by using the geometric transform matrix, and the searching regions for pedestrians are defined in the thermal image. Fourth, within these searching regions, the candidates from the searching image region (CSI) of pedestrians in the thermal image are detected. The final areas of pedestrians are located by combining the detected positions of the CWI and CSI of the thermal image based on OR operation. Experimental results showed that the average precision and recall of detecting pedestrians are 98.13% and 88.98%, respectively.