Characteristics of spinal and bulbar muscular atrophy in South Korea: a cross-sectional study of 157 patients.

Spinal and bulbar muscular atrophy, namely Kennedy disease, is a rare progressive neurodegenerative disorder caused by the expansion of a CAG repeat in the first exon of the androgen receptor gene on the X chromosome. We assessed the clinical history, laboratory findings, functional scales and electrophysiological data, as well as the levels of luteinizing hormone, follicle-stimulating hormone and testosterone, in 157 Korean patients with genetically confirmed spinal and bulbar muscular atrophy (mean age at data collection = 56.9 years; range = 33-83 years). Hand tremor was the first symptom noticed by patients at a median age of 35 years, followed by gynaecomastia, orofacial fasciculation, cramps and fatigability in ascending order. Clinical symptoms such as paraesthesia and dysphagia appeared during the later stages of the disease. Cane use during ambulation began at a median age of 62 years. There were statistically significant differences between patients and controls in the results of sensory nerve studies, motor conduction velocity, and distal latencies. Furthermore, among the hormone markers analysed, the level of luteinizing hormone exhibited a negative correlation with the spinal and bulbar muscular atrophy functional rating scale, Korean version. However, among the patients with a disease duration of ≤5 years, the levels of luteinizing hormone showed a significant correlation with assessments using the amyotrophic lateral sclerosis functional rating scale-revised, spinal and bulbar muscular atrophy functional rating scale, Korean version and the 6-minute walk test. In conclusion, our findings provide clinical information from a substantial number of patients with spinal and bulbar muscular atrophy in Korea that accorded with that of patients with this disease worldwide but with updated clinical features.

Association between Cognitive Abilities before the Age of 3 and Those at Least 1 Year Later in Children with Developmental Delay.

AIM: This study investigated whether early cognitive assessment in children with developmental delay (DD) predicts cognitive development. We investigated the correlation between cognitive and language development in children with DD, cerebral palsy (CP), and autism spectrum disorder (ASD). METHODS: Data were collected from children diagnosed with DD who visited the hospital between 2015 and 2023. The assessments included the Korean Bayley Scales of Infant and Toddler Development Second Edition (K-BSID-II) and the Korean Wechsler Preschool Primary Scale of Intelligence Fourth Edition (K-WPPSI-IV). Language development was evaluated using the Sequenced Language Scale for Infants (SELSI) and Preschool Receptive-Expressive Language Scale (PRES). Correlation and multivariate regression analyses were performed. RESULTS: Among 95 children in the study, a significant correlation was discovered between early cognitive assessments (the Mental Developmental Index from the K-BSID-II) and later cognitive development (the Full-Scale Intelligence Quotient from the K-WPPSI-IV) in the DD and CP groups, but not in the ASD group. The DD and CP groups exhibited significant correlations in language development between the SELSI and PRES, whereas the ASD group did not. INTERPRETATION: Early cognitive assessments can predict later cognitive development in children with DD and CP, but not in those with ASD, according to this study. There was a strong correlation between language and cognitive development in the DD and CP groups, highlighting the importance of early intervention and assessment for these children. Further investigation is necessary to address these limitations and refine demographic data.

Relationship between sleep disturbance and developmental status in preschool-aged children with developmental disorder.

BACKGROUND: Sleep has been known to affect childhood development. Sleep disturbance is likely more common in children with developmental delay (DD) than in typical development. There are few studies on the correlation between sleep disturbance and developmental features in children with DD. Therefore, this study aimed to evaluate the associations between the two in children with DD. METHODS: A total of 45 children (age range 27.0 ± 11.1) with DD were recruited and evaluated using the Sleep Disturbance Scale for Children (SDSC) and Bayley Scales of Infant and Toddler Development (BSID-III). The outcomes are expressed as means and standard deviations. The correlation between SDSC and BSID-III was assessed using Spearman's rank correlation test. Multiple regression analysis was performed to investigate the relationship between BSID-III domains and SDSC questionnaire subscales. Statistical significance was set at p < 0.05. RESULTS: Based on the correlation analysis and subsequent hierarchical regression analysis, cognition and socio-emotional domains of BSID-III were significantly associated with the DOES subscale of the SDSC questionnaire. In addition, the expressive language domain of the BSID-III was found to be associated with the DA subscale of the SDSC questionnaire. It seems that excessive daytime sleepiness might negatively affect emotional and behavioral problems and cognitive function. Also, arousal disorders seem to be related to memory consolidation process, which is thought to affect language expression. CONCLUSION: This study demonstrated that DA and DOES subscales of the SDSC questionnaire were correlated with developmental aspects in preschool-aged children with DD. Sleep problems in children with DD can negatively affect their development, thereby interfering with the effectiveness of rehabilitation. Identifying and properly managing the modifiable factors of sleep problems is also crucial as a part of comprehensive rehabilitation treatment. Therefore, we should pay more attention to sleep problems, even in preschool-aged children with DD.

Deep learning algorithm for automatically measuring Cobb angle in patients with idiopathic scoliosis.

PURPOSE: The Cobb angle is a standard measurement to qualify and track the progression of scoliosis. However, the Cobb angle has high inter- and intra-observer variability. Consequently, its measurement varies with vertebrae and may even differ when the same vertebra is measured. Therefore, it is not constant and differs with measurements. This study aimed to develop a deep learning model that automatically measures the Cobb angle. The deep learning model for identifying vertebrae on spine radiographs was developed. METHODS: The dataset consisted of 297 images that were divided into two subsets for training and validation. Two hundred and twenty-seven images (76.4%) were used to train the model, while 70 images (23.6%) were used as the validation dataset. Absolut error between the measurements by the observer and developed deep learning model and intraclass correlation coefficient (ICC). RESULTS: The average absolute error between the measurements was 1.97° with a standard deviation of 1.57°. In addition, 95.9% of the angles had an absolute error of less than 5°. The ICC was calculated to assess the model's reliability further. The ICC was 0.981, indicating excellent reliability. CONCLUSIONS: The authors believe the model will be useful in clinical practice by relieving clinicians of the burden of having to manually compute the Cobb angle. Further studies are needed to enhance the accuracy and versatility of this deep learning model.

The association between cognition and gait disturbance in central nervous system demyelinating disorder with mild disability.

INTRODUCTION: Gait disturbance in central nervous system (CNS) demyelinating disorders, including multiple sclerosis (MS) and neuromyelitis optica (NMO) is one of the most troublesome problems that has a direct impact on the quality of life. However, the associations between gait disturbance and other clinical variables of these two diseases have not been fully elucidated. OBJECTIVE: This study aimed to evaluate gait disturbance using a computerized gait analysis system and its association with various clinical variables in patients with MS and NMO. METHODS: A total of 33 patients (14 with MS and 19 with NMO) with minor disabilities, who were able to walk independently and had passed their acute phase, were enrolled in the study. Gait analysis were performed using a computer-based instrumented walkway system. (Walk-way MG-1000, Anima, Japan) Clinical variables, such as disease duration, medication, body mass index (BMI), hand grip power, and muscle mass were recorded. The Montreal Cognitive Assessment (MOCA), Beck Depression Inventory score-II (BDI), and fatigue scale were measured using the Functional Assessment of Chronic Illness Therapy-fatigue scale (FACIT-fatigue) scale. A trained neurologist scored the Expanded Disability Status Scale (EDSS). RESULTS: Gait speed was the single parameter that showed a significant positive correlation with MOCA (p < 0.001). The stance phase time was the single parameter that showed a significant negative correlation with EDSS (p < 0.001). Hand grip strength showed a significant positive correlation with skeletal muscle mass as assessed by bioimpedance analysis (p < 0.05). The FACIT-fatigue scale score showed a significant negative correlation with the BDI (p < 0.001). CONCLUSION: In our patients with MS/NMO with mild disability, cognitive impairment was significantly correlated with gait speed, and the degree of disability was significantly correlated with stance phase time. Our findings may imply that early detection of a decrease in gait speed and an increase in stance phase time can predict the progression of cognitive impairment in patients with MS/NMO with mild disability.

The effect of intensive rehabilitation treatment on sleep disorder in children with motor delays.

BACKGROUND: Although the importance of sleep problems has been increasingly emphasized due to the effects on children's development and children's and families' daytime behaviors, physical health, and quality of life, they have been overlooked in clinical practice. However, there have been few studies on the effects of rehabilitation on sleep problems. Therefore, in this study, we investigated the effects of an intensive rehabilitation program on sleep problems in children with developmental delays (DD). METHODS: We included 36 children with DD (30 outpatients, 6 inpatients) and their caregivers who completed all items on the Sleep Disturbance Scale for Children. Of the children with DD, 19 (59.3%) had cerebral palsy (CP) and 13 (40.7%) had DD of non-CP origins, of which 6 (18.8%) had prematurity, 4 (12.5%) had genetic causes, and 3 (9.4%) had an unknown origin. Changes in sleep problems after the intensive rehabilitation program were evaluated using a paired or unpaired t-test, depending on the distribution of the continuous variables. RESULTS: After the intensive rehabilitation program, in 36 children with DD, there was a significant improvement in the difficulty in initiating and maintaining sleep (DIMS) sub-score (p < 0.05). However, there was no significant improvement in the total score or other sub-scores, such as those for sleep breathing disorders (SBD), disorders of arousal (DA), sleep-wake transition disorders (SWTD), disorders of excessive somnolence (DOES), and sleep hyperhidrosis (SH). In the subgroup analysis according to the cause of DD, children with CP had a significant improvement in DIMS and DOES sub-scores (p < 0.05). CONCLUSION: The intensive rehabilitation program, consisting of more than two sessions per day, effectively alleviated sleep problems in children with DD, especially in those with CP. Among the sleep problems, the intensive rehabilitative program was most effective at improving the DIMS. However, further prospective studies with a larger number of patients with DD and a more standardized protocol are necessary to generalize this effect.

Prediction of motor outcome based on brain perfusion single photon emission computed tomography in corona radiata infarct.

BACKGROUND: There is limited information on brain perfusion single-photon emission computed tomography (SPECT) findings related to motor outcomes in patients with stroke. We aimed to investigate whether brain SPECT can be used to determine motor outcomes after corona radiata infarction. METHODS: Eighty-nine patients were recruited in this study. Brain SPECT and diffusion tensor tractography (DTT) were conducted to evaluate the state of the corticospinal tract (CST) within 7-30 days of corona radiata infarct. Motor outcome was measured 6 months after infarct onset and was evaluated using the modified Brunnstrom classification (MBC) and functional ambulation category (FAC) for motor function of the upper and lower extremities, respectively. The presence of hypoperfusion on brain SPECT was evaluated in the frontal lobe, temporal lobe, parietal lobe, basal ganglia, thalamus, and cerebellum on both the ipsilesional and contralesional sides. Statistical analysis was performed using multivariate logistic regression, comparing patients in which CST was spared versus interrupted. RESULTS: Hypoperfusion in the contralesional cerebellum was indicative of poor recovery in both the upper and lower extremities after corona radiata infarction when the CST was interrupted. Additionally, when the CST was preserved, hypoperfusion in the ipsilesional thalamus was indicative of poor recovery of the lower extremities. CONCLUSION: Brain SPECT evaluation was shown to be a useful tool for predicting motor outcomes in patients with corona radiata infarcts.

Long-term outcomes of edaravone in amyotrophic lateral sclerosis in South Korea: 72-week observational study.

BACKGROUND: Amyotrophic lateral sclerosis (ALS) is a lethal neurodegenerative disease characterized by the gradual loss of upper and lower motor neurons that leads to progressive muscle atrophy and weakness. Edaravone, a free-radical scavenger, was approved as an ALS treatment in 2015 in South Korea. METHODS: This study investigated the long-term effects and safety of edaravone by reviewing the medical records of 16 Korean patients with ALS who received extended edaravone between 2015 and 2021 in a single tertiary ALS center. RESULTS: Among sixteen patients, eleven patients underwent extended edaravone therapy for more than 18 cycles (72 weeks). The mean monthly changes in the revised ALS Functional Rating Scale (ALSFRS-R) were - 0.96 ± 0.83 (0-24 weeks), - 0.70 ± 0.76 (24-48 weeks), - 1.18 ± 1.67 (48-72 weeks), and - 0.81 ± 0.60 (0-72 weeks). The mean decline in forced vital capacity (FVC) was 17.4 ± 24.1. The changes were significant in both ALSFRS-R (p < 0.001) and FVC (p = 0.048); however, the mean change in compound muscle action potential of phrenic nerves was not. Patients experienced only minor adverse events, which were well tolerated. CONCLUSIONS: This study verifies previous reported outcomes of edaravone in 16 Korean ALS patients, indicating a modest effect with a favorable safety profile.

Continuous administration of mirabegron has advantages in inhibition of central sensitization compared with short-term treatment cessation in a mouse model of overactive bladder.

AIMS: There is no clear pathophysiologic evidence determining how long overactive bladder (OAB) medication should be continued. We, therefore, investigated the effect of mirabegron using cessation (CES) or continuation (CON) treatment in an OAB animal model. METHODS: Female C57BL/6 mice were divided into four groups (N = 8 each): Sham, OAB, CES, and CON groups. The OAB-like condition was induced by three times weekly intravesical instillations of KCl mixture with hyaluronidase. After the last intravesical instillation for inducing OAB, mirabegron (2 mg/kg/day) was administered in CES and CON groups for 10 and 20 days, respectively. Final experiments were carried out on 20 days from the last intravesical instillation in all groups. After cystometry, mRNA levels of bladder muscarinic, ß-adrenergic, and P2X purinergic receptors were measured to investigate bladder efferent and afferent activity. In addition, mRNA levels of CCL2 and CCR2 in L6-S1 dorsal root ganglia (DRG) were measured to assess afferent sensitization. Immunofluorescent staining of CX3CR1, GFAP, and CCR2 in the L6 spinal cord was also conducted to investigate glial activation and central sensitization. RESULTS: OAB mice showed bladder overactivity evidenced by decreased intercontraction interval (3.56 ± 0.51 vs. 5.76 ± 0.95 min in sham mice), increased non-voiding contractions (0.39 ± 0.11 vs. 0.13 ± 0.07/min in sham mice), and inefficient voiding (72.1 ± 8.6% vs. 87.1 ± 9.5% in sham mice). Increased M2, M3, ß2, ß3, P2X2 , P2X3 , P2X4 , and P2X7 levels in the bladder and increased CCL2 and CCR2 in DRG indicate bladder efferent and afferent hyperexcitability. In addition, CX3CR1, GFAP, and CCR2 in the L6 spinal cord were upregulated in OAB mice. However, the CON group exhibited reduced ß2, ß3, P2X2 , P2X3 , P2X4 , and P2X7 levels in the bladder, reduced CCL2 and CCR2 in DRG, which are markers of afferent hyperexcitability, and reduced immunoreactivities of CX3CR1, GFAP, and CCR2 in the L6 spinal cord, which are markers of the central sensitization. Moreover, the CON group showed better improvements in nonvoiding contractions (0.16 ± 0.09 vs. 0.44 ± 0.17/min) and voiding efficiency (93.9 ± 7.4% vs. 76.5 ± 13.1%) and reductions in bladder ß3 receptors and CCL2 of L6-S1 DRG, and immunoreactivities of CX3CR1 and GFAP in the L6 spinal cord compared to the CES group. CONCLUSIONS: Continuous mirabegron treatment seems to prevent central sensitization and, thus, might be desirable for long-term disease control of OAB.

Practical Machine Learning Model to Predict the Recovery of Motor Function in Patients with Stroke.

BACKGROUND: Machine learning (ML) is an artificial intelligence technique in which a system learns patterns and rules from a given data. OBJECTIVES: The objective of the study was to investigate the potential of ML for predicting motor recovery in stroke patients. METHODS: We analyzed data from 833 consecutive stroke patients using 3 ML algorithms: deep neural network (DNN), random forest, and logistic regression. We created a practical ML model using the most common data measured in almost all rehabilitation hospitals as input data. Demographic and clinical data, including modified Brunnstrom classification (MBC) and functional ambulation classification (FAC), were collected when patients were transferred to the rehabilitation unit (8-30 days) and 6 months after stroke onset and were used as input data. Motor outcomes at 6 months after stroke onset of the affected upper and lower extremities were classified according to MBC and FAC, respectively. Patients with an MBC of <5 and an FAC of <4 at 6 months after stroke onset were considered to have a "poor" outcome, whereas those with MBC ≥5 and FAC ≥4 were considered to have a "good" outcome. RESULTS: The area under the curve (AUC) for the DNN model for predicting motor function was 0.836 for the upper and lower limb motor functions. For the random forest and logistic regression models, the AUCs were 0.736 and 0.790 for the upper and lower limb motor functions, respectively. The AUCs for the random forest and logistic regression models were 0.741 and 0.795 for the upper and lower limb motor functions, respectively. CONCLUSION: Although we used simple and common data that can be obtained in clinical practice as variables, our DNN algorithm was useful for predicting motor recovery of the upper and lower extremities in stroke patients during the recovery phase.

Stronger correlation of peak oxygen uptake with distance of incremental shuttle walk test than 6-min walk test in patients with COPD: a systematic review and meta-analysis.

BACKGROUND: The 6-min walk test (6MWT) and incremental shuttle walk test (ISWT) are valid and reliable measures to assess exercise capacity of patients with chronic obstructive pulmonary disease (COPD). However, the comparison of correlation between peak oxygen uptake (peak VO2) and 6MWT or ISWT distance has not been investigated. We aimed to investigate the correlation between peak VO2 and 6MWT and ISWT distances in COPD patients through a meta-analysis. METHODS: We systematically searched MEDLINE, Scopus, Embase, and the Cochrane Library up to June, 2020 for studies comparing the correlation of peak VO2 with either 6MWT or ISWT in COPD patients. Meta-analysis was performed with R software using a fixed-effect model. We compared the correlation coefficient and measured the heterogeneity using I2 statistics. RESULTS: We identified 12 studies involving 746 patients. Meta-analysis showed a significant correlation between peak VO2 and 6MWT and ISWT distances (6MWT: r = 0.65, 95% CI 0.61-0.70; ISWT: r = 0.81, 95% CI 0.74-0.85; p < 0.0001). The heterogeneity was lower in ISWT than in 6MWT (6MWT: I2 = 56%, p = 0.02; ISWT: I2 = 0%, p = 0.71). Subgroup analysis showed a higher correlation coefficient in the low exercise capacity group than in the high exercise capacity group in both field tests. CONCLUSIONS: 6MWT and ISWT significantly correlated with peak VO2. Our findings suggest that ISWT has a stronger correlation with peak VO2 than 6MWT. The exercise capacity in COPD patients may affect the strength of the relationship between peak VO2 and walking distance in both field tests, suggesting the importance of using various exercise tests. Trial registration CRD 42020200139 at crd.york.ac.uk/prospero/.

Deep Learning Analysis to Automatically Detect the Presence of Penetration or Aspiration in Videofluoroscopic Swallowing Study.

BACKGROUND: Videofluoroscopic swallowing study (VFSS) is currently considered the gold standard to precisely diagnose and quantitatively investigate dysphagia. However, VFSS interpretation is complex and requires consideration of several factors. Therefore, considering the expected impact on dysphagia management, this study aimed to apply deep learning to detect the presence of penetration or aspiration in VFSS of patients with dysphagia automatically. METHODS: The VFSS data of 190 participants with dysphagia were collected. A total of 10 frame images from one swallowing process were selected (five high-peak images and five low-peak images) for the application of deep learning in a VFSS video of a patient with dysphagia. We applied a convolutional neural network (CNN) for deep learning using the Python programming language. For the classification of VFSS findings (normal swallowing, penetration, and aspiration), the classification was determined in both high-peak and low-peak images. Thereafter, the two classifications determined through high-peak and low-peak images were integrated into a final classification. RESULTS: The area under the curve (AUC) for the validation dataset of the VFSS image for the CNN model was 0.942 for normal findings, 0.878 for penetration, and 1.000 for aspiration. The macro average AUC was 0.940 and micro average AUC was 0.961. CONCLUSION: This study demonstrated that deep learning algorithms, particularly the CNN, could be applied for detecting the presence of penetration and aspiration in VFSS of patients with dysphagia.

The parameters of gait analysis related to ambulatory and balance functions in hemiplegic stroke patients: a gait analysis study.

BACKGROUND: Ambulatory and balance functions are important for maintaining general health in humans. Gait analysis allows clinicians and researchers to identify the parameters to be focused on when assessing balance and ambulatory functions. In this study, we performed gait analysis with pressure sensors to identify the gait-analysis parameters related to balance and ambulatory functions in hemiplegic stroke patients. METHODS: We retrospectively reviewed the medical records of 102 patients with hemiplegic stroke who underwent gait analysis. Correlations between various temporospatial parameters in the gait analysis and the motor and balance functions assessed using functional ambulation category, modified Barthel index, and Berg balance scale were analyzed. RESULTS: Gait speed/height and the lower-limb stance-phase time/height were the only temporal and spatial parameters, respectively, that showed a statistical correlation with motor and balance functions. CONCLUSIONS: Measurements of walking speed and stance-phase time of the unaffected lower limb can allow clinicians to easily assess the ambulatory and balance functions of hemiplegic stroke patients. Rehabilitative treatment focusing on increasing gait speed and shortening the stance-phase time of the unaffected side may improve the ambulatory and balance functions in these patients.

Antifibrosis treatment by inhibition of VEGF, FGF, and PDGF receptors improves bladder wall remodeling and detrusor overactivity in association with modulation of C-fiber afferent activity in mice with spinal cord injury.

AIMS: Spinal cord injury (SCI) above the sacral level causes bladder dysfunction and remodeling with fibrosis. This study examined the antifibrotic effects using nintedanib, an inhibitor of vascular endothelial growth factor, fibroblast growth factor, and platelet-derived growth factor receptors, on detrusor overactivity (DO) and bladder fibrosis, as well as the modulation mechanisms of C-fiber afferent pathways. METHODS: Thirty female C57BL/6 mice were divided into group A (spinal intact), group B (SCI with vehicle), and group C (SCI with nintedanib). At 2 weeks after SCI, vehicle or 50 mg/kg nintedanib was administered subcutaneously for 2 weeks. Then, cystometry was conducted, followed by RT-PCR measurements of fibrosis-related molecules, muscarinic, ß-adrenergic, TRP and purinergic receptors in the bladder or L6-S1 dorsal root ganglia (DRG). Trichrome stain and Western blot analysis of transforming growth factor-beta and fibronectin were performed in the bladder. TRPV1 expression in L6 DRG was measured by immunohistochemistry. RESULTS: In cystometry, intercontraction intervals, nonvoiding contractions, voided volume, and voiding efficiency were significantly improved in group C versus group B. RT-PCR, Western blotting, and trichrome staining revealed the fibrotic changes in the bladder of group B, which was improved in group C. Increased messenger RNA levels of TRPV1, TRPA1, P2X2 , and P2X3 in DRG of group B were significantly decreased in group C. TRPV1 immunoreactivity in DRG was increased in group B, but decreased in group C. CONCLUSIONS: Nintedanib improves storage and voiding dysfunctions and bladder fibrosis in SCI mice. Also, nintedanib-induced improvement of DO is associated with reduced expression of C-fiber afferent markers, suggesting the modulation of bladder C-fiber afferent activity.

Effectiveness of pharmacologic treatment for dysphagia in Parkinson's disease: a narrative review.

BACKGROUND: The effectiveness of pharmacological treatment on dysphagia in Parkinson's disease (PD) is debatable. We reviewed the literature for analyzing the effect of pharmacological treatment on the improvement of dysphagia in PD patients. METHODS: We searched the PubMed database for papers published before June 21, 2020, that evaluated the effect of pharmacologic treatments for improving dysphagia in patients with PD. The following inclusion criteria were applied for the selection of articles: 1) studies performed on patients with dysphagia due to PD, 2) studies where pharmacologic treatment was applied for improvement of dysphagia, and 3) those where follow-up evaluation was performed after the treatment. RESULTS: The primary literature search yielded 415 relevant papers. After reading their titles and abstracts and assessing their eligibility based on the full-text articles, we finally included nine studies in this review. In five previous studies, the positive effects of dopaminergic drugs on dysphagia were reported, whereas two showed no significant positive results. The remaining two studies showed equivocal results. CONCLUSION: We found that dopaminergic drugs have some potential to improve dysphagia in patients with PD. However, studies with high-quality evidence are lacking. For the clear elucidation of the effect of dopaminergic drugs on dysphagia in patients with PD, randomized controlled trials with large cohorts and detailed analyses should be conducted in the future.

Prediction of the motor prognosis with diffusion tensor imaging in hemorrhagic stroke: a meta-analysis.

This paper investigates whether diffusion tensor imaging performed within 2 weeks of intracerebral hemorrhage onset could predict the motor outcome by categorizing previous diffusion tensor imaging studies based on the time-point of performing diffusion tensor imaging (<2 weeks and ≥2 weeks after intracerebral hemorrhage onset). A comprehensive database search on PubMed, Embase, Cochrane Library, and SCOPUS was conducted. The pooled estimate was acquired using correlation analysis between the diffusion tensor imaging parameters of fractional anisotropy and motor recovery based on the period of stroke onset. In the results, out of 511 retrieved articles, eight were finally included in the meta-analysis. In patients who underwent diffusion tensor imaging within 2 weeks of intracerebral hemorrhage onset, a random-effects model revealed that the ratio of fractional anisotropy is a significant predictor of motor recovery of the hemi-side extremity after intracerebral hemorrhage (p = 0.0015). In patients who underwent diffusion tensor imaging after 2 weeks of intracerebral hemorrhage onset, a fixed-effects model revealed that the ratio of fractional anisotropy was also a significant predictor of motor recovery of the hemi-side extremity after intracerebral hemorrhage (p < 0.0001). Our meta-analysis revealed that ratio of fractional anisotropy (rFa) calculated from diffusion tensor imaging (DTI) performed ≥2 weeks of intracerebral hemorrhage onset had a positive correlation with the motor outcomes after intracerebral hemorrhage (ICH). Also, although diffusion tensor imaging was performed <2 weeks after intracerebral hemorrhage onset, the ratio of fractional anisotropy calculated from diffusion tensor imaging helped predict the motor outcome. Further analyses, including a more significant number of studies focused on this topic, are warranted.

The Effect of Deep Brain Stimulation on Swallowing Function in Parkinson's Disease: A Narrative Review.

Unlike appendicular motor symptoms, such as bradykinesia and rigidity, in Parkinson's disease (PD), which have already been reported to respond well to deep brain stimulation (DBS), there is limited literature on the effects of DBS on swallowing function in patients with PD. The field lacks consensus as there are conflicting reports among existing studies regarding whether swallowing function improves or declines following DBS implantation. This narrative review aims to summarize and analyze the studies published on the effect of DBS on swallowing function in patients with PD. We collated studies published up to February 2020 using a comprehensive electronic database search of PubMed, SCOPUS, EMBASE, and the Cochrane Library. Two reviewers independently assessed the studies using strict inclusion and exclusion criteria. The primary literature search yielded 529 relevant papers. After reading their titles and abstracts and assessing their eligibility based on the full-text, we finally included and reviewed 14 publications. Nine of these studies reported positive effects of DBS on swallowing function and four studies showed no significant positive results. The remaining study showed decreased swallowing function after unilateral subthalamic nucleus-DBS surgery. In conclusion, we found that DBS has the potential to improve swallowing function in patients with PD. However, high-quality evidence is lacking. To clearly elucidate the effect of DBS on swallowing function in patients with PD, high-quality randomized controlled trials should be conducted in the future.

Clinical effectiveness of the sequential 4-channel NMES compared with that of the conventional 2-channel NMES for the treatment of dysphagia in a prospective double-blind randomized controlled study.

BACKGROUND: To date, conventional swallowing therapies and 2-channel neuromuscular electrical stimulation (NMES) are standard treatments for dysphagia. The precise mechanism of 2-channel NMES treatment has not been determined, and there are controversies regarding the efficacy of this therapy. The sequential 4-channel NMES was recently developed and its action is based on the normal contractile sequence of swallowing-related muscles. OBJECTIVE: To evaluate and compare the rehabilitative effectiveness of the sequential 4-channel NMES with that of conventional 2-channel NMES. METHODS: In this prospective randomized case-control study, 26 subjects with dysphagia were enrolled. All participants received 2- or 4-channel NMES for 2-3 weeks (minimal session: 7 times, treatment duration: 300-800 min). Twelve subjects in the 4-channel NMES group and eleven subjects in the 2-channel NMES group completed the intervention. Initial and follow-up evaluations were performed using the videofluoroscopic dysphagia scale (VDS), the penetration-aspiration scale (PAS), the MD Anderson dysphagia inventory (MDADI), the functional oral intake scale (FOIS), and the Likert scale. RESULTS: The sequential 4-channel NMES group experienced significant improvement in their VDS (oral, pharyngeal, and total), PAS, FOIS, and MDADI (emotional, functional, and physical subsets) scores, based on their pretreatment data. VDS (oral, pharyngeal, and total) and MDADI (emotional and physical subsets) scores, but not PAS and FOIS scores, significantly improved in the 2-channel NMES group posttreatment. When the two groups were directly compared, the 4-channel NMES group showed significant improvement in oral and total VDS scores. CONCLUSIONS: The sequential 4-channel NMES, through its activation of the suprahyoid and thyrohyoid muscles, and other infrahyoid muscles mimicking physiological activation, may be a new effective treatment for dysphagia. TRIAL REGISTRATION: clinicaltrial.gov, registration number: NCT03670498, registered 13 September 2018, https://clinicaltrials.gov/ct2/show/NCT03670498?term=NCT03670498&draw=2&rank=1 .

Risk factors for disease progression in COVID-19 patients.

BACKGROUND: Coronavirus disease (COVID-19) is rapidly spreading worldwide. Although 10-20% of patients with COVID-19 have severe symptoms, little is known about the risk factors related to the aggravation of COVID-19 symptoms from asymptomatic or mild to severe disease states. METHODS: This retrospective study included 211 patients who were asymptomatic or with mild presentations of COVID-19. We evaluated the differences in demographic and clinical data between the cured (discharged to home) and transferred (aggravated to severe-stage COVID-19) groups. RESULTS: A multivariate logistic analysis showed that body temperature, chills, initial chest X-ray findings, and the presence of diabetes were significantly associated with predicting the progression to severe stage of COVID-19 (p < 0.05). The odds ratio of transfer in patients with COVID-19 increased by 12.7-fold for abnormal findings such as haziness or consolidation in initial chest X-ray, 6.32-fold for initial symptom of chills, and 64.1-fold for diabetes. CONCLUSIONS: Even if patients are asymptomatic or have mild symptoms, clinicians should closely observe patients with COVID-19 presenting with chills, body temperature > 37.5 °C, findings of pneumonia in chest X-ray, or diabetes.

Ultrasonographic Findings of the Ulnar Nerve Following Elbow Flexion in Patients with Cubital Tunnel Syndrome.

OBJECTIVE: To evaluate the ultrasonographic findings obtained following various degrees of elbow flexion in patients with cubital tunnel syndrome (CuTS). DESIGN: Retrospective, cross-sectional study. SETTING: General teaching hospital, rehabilitation unit. SUBJECTS: Electrophysiological and ultrasonographic assessments were performed on 11 elbows of healthy controls and 21 elbows of 17 patients with CuTS. METHODS: Dynamic movement of the ulnar nerve during elbow motion was measured. To measure ulnar nerve dynamic movement during elbow motion, the distance from the medial epicondyle (ME) to the nearest surface of the ulnar nerve toward the ME was measured at the cubital tunnel inlet at elbow extension (0°), elbow flexion to 60°, and elbow flexion to 90°. RESULTS: The distance between the ME and ulnar nerve was lower in CuTS patients than in healthy patients at all elbow flexion angles. This difference was statistically significant at 0° and 60° elbow flexion (P < 0.05). When calculating the cutoff value, the distance between the ME and ulnar nerve at full elbow extension for CuTS diagnosis was 0.53 cm (sensitivity = 71.4%, specificity = 90.7%). The distance ratio between the ME and ulnar nerve for diagnosis of ulnar neuropathy at the elbow was 24.4% (sensitivity = 76.2%, specificity = 100%). CONCLUSION: Measurement of the distance between the ME and ulnar nerve in full elbow extension may facilitate the diagnosis of patients with CuTS. These findings may be important for CuTS diagnosis, as they were also observed in patients with mild-stage CuTS.