Association Between Frequency of Rehabilitation Therapy and Long-Term Mortality After Stroke: A Nationwide Cohort Study.

BACKGROUND: Previous studies have demonstrated conflicting results regarding the effects of rehabilitation therapy on poststroke mortality. We aimed to investigate the association between rehabilitation therapy, including both inpatient and outpatient treatment, within the first 6 months after stroke and long-term all-cause mortality in patients with stroke using the Korean National Health Insurance System data. METHODS: A total of 10 974 patients newly diagnosed with stroke using the International Classification of Diseases, Tenth Revision, codes (I60-I64) between 2003 and 2019 were enrolled and followed up for all-cause mortality until 2019. Follow-up for mortality began 6 months after the index event. Poststroke patients were categorized into 3 groups according to the frequency of rehabilitation therapy: no rehabilitation therapy, ≤40 sessions and >40 sessions. Cox proportional hazards models were used to assess the mortality risk according to rehabilitation therapy stratified by disability severity measured based on activities of daily living 6 months after stroke onset. RESULTS: Within 6 months after stroke, 6738 patients (61.4%) did not receive rehabilitation therapy, whereas 2122 (19.3%) received ≤40 sessions and 2114 (19.3%) received >40 sessions of rehabilitation therapy. Higher frequency of rehabilitation therapy was associated with significantly lower poststroke mortality in comparison to no rehabilitation therapy (hazard ratio [HR], 0.88 [95% CI, 0.79-0.99]), especially among individuals with severe disability after stroke (mild to moderate: HR, 1.02 [95% CI, 0.77-1.35]; severe: HR, 0.74 [95% CI, 0.62-0.87]). In the context of stroke type, higher frequency of rehabilitation therapy was associated with reduced mortality rates compared with no rehabilitation therapy only in patients with hemorrhagic stroke (ischemic: HR, 1.04 [95% CI, 0.91-1.18]; hemorrhagic: HR, 0.60 [95% CI, 0.49-0.74]). CONCLUSIONS: We found a positive association between rehabilitation therapy within 6 months after stroke onset and long-term mortality in patients with stroke. A higher frequency of rehabilitation therapy would be recommended for poststroke patients, especially those with hemorrhagic stroke and severe disability.

Depressive Symptoms and the Subsequent Risk of Parkinson's Disease: A Nationwide Cohort Study.

OBJECTIVE: Only a few studies have focused on depressive symptoms and Parkinson's disease (PD) risk. As a time lag exists from the onset of depressive symptoms to the diagnosis of depression, elucidating the association between depressive symptoms and PD development might be helpful for the early prediction of PD. We investigate the association between depressive symptoms and subsequent PD risk using nationwide population-based cohort database. DESIGN AND SETTING: Cohort study using the Korean National Health Insurance Service data between 2007 and 2017, with longitudinal follow-up until 2019. PARTICIPANTS: A total of 98,296 elderly people responded to a self-reported questionnaire from the National Health Screening Program on depressive symptoms. MEASUREMENTS: The association between depressive symptoms such as 1) decreased activity or motivation, 2) worthlessness, and 3) hopelessness and PD risk was analyzed. RESULTS: During median 5.06-year follow-up, 839 PD cases occurred: 230 in individuals with depressive symptoms and 609 in those without symptoms. Results showed an increased risk of PD development in those with depressive symptoms (HR = 1.47, 95% CI, 1.26-1.71), with dose-response association between the number of depressive symptoms and PD risk. Even in those already diagnosed with depression, combined depressive symptoms were linked to a higher risk compared to those without symptoms (with symptoms, HR = 2.71, 95% CI, 2.00-3.68; without symptoms, HR = 1.84, 95% CI, 1.43-2.36). CONCLUSION: Individuals with depressive symptoms were at an increased risk of developing PD, and there was a dose-response association between the number of depressive symptoms and PD risk.

Comparison of Particulate Steroid Injection vs Nonparticulate Steroid Injection for Lumbar Radicular Pain: A Systematic Review and Meta-analysis.

OBJECTIVE: The objective of this study was to identify the difference on pain intensity and disability between particulate and nonparticulate steroid injections in patients with lumbar radicular pain. Subgroup analysis by study design, type of particulate steroid, and follow-up duration were performed. DATA SOURCES: We performed the literature search in the PubMed, Embase, and Cochrane Library up March, 2023. STUDY SELECTION: Studies, including randomized controlled trials (RCTs) and nonrandomized studies, that compared particulate steroid injection and nonparticulate steroid injection in patients with lumbar radicular pain were independently reviewed by 2 reviewers for eligibility for inclusion. DATA EXTRACTION: Outcomes of interest were pain intensity and disability. Two reviewers independently assessed the quality of included studies using the revised Cochrane Risk of Bias (RoB2.0) tool for RCTs and the Risk of Bias in Nonrandomized Studies of Interventions Tool (ROBINS-I) for nonrandomized studies. Effect sizes were estimated using mean difference (MD) and standardized mean difference (SMD). DATA SYNTHESIS: A total of 10 studies were included in this meta-analysis. The results showed no significant difference in visual analog scale, disability score and the numbers of patients with 50% pain reduction between particulate and nonparticulate steroid injection groups (P>.05). Particulate steroid injections showed significant better effect in pain scale in RCTs (MD=0.62; 95% CI 0.08-1.16, P=.02). In subgroup analysis with steroid types, methylprednisolone showed better effect compared with dexamethasone, while dexamethasone showed better effect compared with betamethasone. CONCLUSIONS: This meta-analysis suggested no significant differences between the particulate and nonparticulate steroid groups in pain or disability score. Therefore, considering the safety profile of nonparticulate steroids, nonparticulate steroid injection may be helpful in patients with lumbar radicular pain.

New-onset neurodegenerative diseases as long-term sequelae of SARS-CoV-2 infection: A systematic review and meta-analysis.

The association between SARS-CoV-2 infection with increased risk for new-onset neurodegenerative diseases remains unclear. Therefore, this meta-analysis aims to elucidate whether new-onset neurodegenerative diseases are long-term sequelae of SARS-CoV-2 infection. PubMed/MEDLINE, CENTRAL, and EMBASE were systematically searched for articles published up to January 10, 2023. A systematic review and meta-analysis were performed to calculate the pooled effect size, expressed as hazard ratios (HR) with corresponding 95% confidence interval (CI) of each outcome. Twelve studies involving 33 146 809 individuals (2 688 417 post-COVID-19 cases and 30 458 392 controls) were included in the present meta-analysis. The pooled analyses compared with control groups showed a significant association between SARS-CoV-2 infection and increased risk for new-onset Alzheimer's disease (HR = 1.50, 95% CI 1.22-1.85, I2 = 97%), dementia (HR = 1.66, 95% CI 1.42-1.94, I2 = 91%), and Parkinson's disease (HR = 1.44, 95% CI 1.06-1.95, I2 = 86%) among COVID-19 survivors. SARS-CoV-2 infection may be associated with a higher risk for new-onset neurodegenerative diseases in recovered COVID-19 patients. Future studies are warranted to determine the biological mechanisms underlying the neurodegenerative consequences of COVID-19 as long-term sequelae of SARS-CoV-2 infection.

Network Effects of Brain Lesions Causing Central Poststroke Pain.

OBJECTIVE: This study was undertaken to test whether lesions causing central poststroke pain (CPSP) are associated with a specific connectivity profile, whether these connections are associated with metabolic changes, and whether this network aligns with neuromodulation targets for pain. METHODS: Two independent lesion datasets were utilized: (1) subcortical lesions from published case reports and (2) thalamic lesions with metabolic imaging using 18F- fluorodeoxyglucose positron emission tomography-computed tomography. Functional connectivity between each lesion location and the rest of the brain was assessed using a normative connectome (n = 1,000), and connections specific to CPSP were identified. Metabolic changes specific to CPSP were also identified and related to differences in lesion connectivity. Therapeutic relevance of the network was explored by testing for alignment with existing brain stimulation data and by prospectively targeting the network with repetitive transcranial magnetic stimulation (rTMS) in 7 patients with CPSP. RESULTS: Lesion locations causing CPSP showed a specific pattern of brain connectivity that was consistent across two independent lesion datasets (spatial r = 0.82, p < 0.0001). Connectivity differences were correlated with postlesion metabolism (r = -0.48, p < 0.001). The topography of this lesion-based pain network aligned with variability in pain improvement across 12 prior neuromodulation targets and across 32 patients who received rTMS to primary motor cortex (p < 0.05). Prospectively targeting this network with rTMS improved CPSP in 6 of 7 patients. INTERPRETATION: Lesions causing pain are connected to a specific brain network that shows metabolic abnormalities and promise as a neuromodulation target. ANN NEUROL 2022;92:834-845.

Prevalence and Mortality Risk of Neurological Disorders during the COVID-19 Pandemic: An Umbrella Review of the Current Evidence.

INTRODUCTION: Coronavirus disease 2019 (COVID-19), a global pandemic, has infected approximately 10% of the world's population. This comprehensive review aimed to determine the prevalence of various neurological disorders in COVID-19 without overlapping meta-analysis errors. METHODS: We searched for meta-analyses on neurological disorders following COVID-19 published up to March 14, 2023. We obtained 1,184 studies, of which 44 meta-analyses involving 9,228,588 COVID-19 patients were finally included. After confirming the forest plot of each study and removing overlapping individual studies, a re-meta-analysis was performed using the random-effects model. RESULTS: The summarized combined prevalence of each neurological disorder is as follows: stroke 3.39% (95% confidence interval, 1.50-5.27), dementia 6.41% (1.36-11.46), multiple sclerosis 4.00% (2.50-5.00), epilepsy 5.36% (-0.60-11.32), Parkinson's disease 0.67% (-1.11-2.45), encephalitis 0.66% (-0.44-1.77), and Guillain-Barré syndrome 3.83% (-0.13-7.80). In addition, the mortality risk of patients with comorbidities of COVID-19 is as follows: stroke OR 1.63 (1.23-2.03), epilepsy OR 1.71 (1.00-2.42), dementia OR 1.90 (1.31-2.48), Parkinson's disease OR 3.94 (-2.12-10.01). CONCLUSION: Our results show that the prevalence and mortality risk may increase in some neurological diseases during the COVID-19 pandemic. Future studies should elucidate the precise mechanisms for the link between COVID-19 and neurological diseases, determine which patient characteristics predispose them to neurological diseases, and consider potential global patient management.

Association between Low Blood Pressure and Subsequent Risk of Parkinson's Disease in Older Adults Aged ≥75 Years.

INTRODUCTION: The association between blood pressure (BP) and incidence of Parkinson's disease (PD) in older adults remains uncertain. Therefore, this study aimed to investigate the association between BP (high or low) and PD incidence in adults aged ≥75 years. METHODS: In this nationwide population-based cohort study, we enrolled participants aged ≥75 years without a prior PD diagnosis who had undergone health examination provided by the Korean National Health Insurance Service at least once from January 1, 2009, to December 31, 2012. The participants were followed up until December 31, 2019, or the date of their death. The Cox proportional hazards model was used to assess the risk of PD depending on systolic BP (SBP), diastolic BP (DBP), and pulse pressure. RESULTS: Overall, 963,525 participants were enrolled in the analysis and followed up until December 31, 2019, or the date of death (40.7% male, mean age 78.5 ± 3.6 years). The mean SBP and DBP were 131.4 ± 16.7 and 77.9 ± 10.3 mm Hg, respectively. During the 10-year follow-up period, 16,414 (1.7%) newly diagnosed cases of PD were reported. A significant inverse dose-response association was found between SBP and PD incidence. In the subgroup analysis, this association was maintained for most variables, including sex, use of antihypertensive medication, comorbidities, alcohol consumption, physical activity, and body mass index, except for smoking status. CONCLUSION: Lower SBP and DBP were associated with a higher PD incidence in older adults. These results may have substantial implications for determining the optimal BP control target in adults aged ≥75 years.

Design and synthesis of a DNA-encoded combinatorial library of bicyclic peptoids.

Here we describe the design and synthesis of a DNA-encoded library of bicyclic peptoids. We show that our solid-phase strategy is facile and DNA-compatible, yielding a structurally diverse combinatorial library of bicyclic peptoids of various ring sizes. We also demonstrate that affinity-based screening of a DNA-encoded library of bicyclic peptoids enables to efficiently identify high-affinity ligands for a target protein. Given their highly constraint structures, as well as increased cell permeability and proteolytic stability relative to native peptides, bicyclic peptoids could be an excellent source of protein capture agents. As such, our DNA-encoded library of bicyclic peptoids will serve as versatile tools that facilitate the generation of potent ligands against many challenging targets, such as intracellular protein-protein interactions.

The mortality rate of Parkinson's disease and related comorbidities: a nationwide population-based matched cohort study in Korea.

BACKGROUND: previous studies on mortality of Parkinson's disease (PD) enrolled a relatively small number of participants and were conducted in western countries. The objective of this study was to evaluate mortality rate of PD using a large nationwide cohort in Korea and to evaluate effects comorbidities have on mortality in PD. METHODS: the nationwide population-based cohort study was conducted using the Korean National Health Insurance Service-National Sample Cohort data. Patients with a primary diagnosis of PD were selected from the database. A matched cohort without PD was enrolled through randomly matching patients by sex, age, year of diagnosis, residential area and income level to the PD group with a ratio of 1:9. The Cox proportional hazard model was used to assess mortality risk between the two cohorts. A logistic regression analysis was used to identify mortality risk factors in PD cohort. RESULTS: in total, 25,620 patients were enrolled. The Cox proportional regression model had an adjusted hazard ratio of 2.479 [95% confidence interval (CI), 2.272-2.704] for mortality in PD cohort. Comorbidities, such as ischaemic stroke [odds ratios (OR) = 2.314, 95% CI, 1.895-2.824], haemorrhagic stroke (OR = 2.281, 95% CI, 1.466-3.550) and chronic obstructive pulmonary disease (OR = 1.307, 95% CI, 1.048-1.630) were associated with increased mortality, whereas dyslipidemia (OR = 0.285, 95% CI, 0.227-0.358) was negatively correlated with mortality. CONCLUSION: over the 10 year follow-up period, the PD cohort's mortality rate was 2.5 times higher than the comparison cohort. Understanding the effects that comorbidities have on morality in PD would be useful for predicting mortality in patients with PD.

Hip Fracture in Patients with Parkinson's Disease and Related Mortality: A Population-Based Study in Korea.

INTRODUCTION: Patients with Parkinson's disease (PD) are prone to falls, thereby increasing the risk of fractures and mortality. This population-based study investigated the risk of hip fractures and their effect on mortality in patients with PD in Korea. METHODS: National Health Insurance Service-National Sample Cohort data were used. Patients newly diagnosed with PD between 2006 and 2015 and age- and sex-matched individuals were classified into the PD group and the comparison group, respectively, with a 1:9 ratio. The Cox proportional hazards model was used to calculate hazard ratios (HRs), and the Kaplan-Meier method to identify survivorship. RESULTS: In total, 26,570 individuals were enrolled in the study: 2,657 in the PD cohort and 23,913 in the matched comparison cohort. The PD group had about a 2 times higher risk of hip fracture than the comparison group (3.95 vs. 1.94%, p < 0.001). According to sex, the difference between the PD and comparison groups for the risk of hip fracture was greater in males than in females. The highest difference in HR for hip fracture between the PD and comparison groups was found in individuals aged between 60 and 69 years. Regarding post-fracture mortality in patients with PD, the mortality risk was twice as high in the patients with hip fracture than in those without. The effect of hip fracture on mortality between these 2 groups was also the highest in individuals aged between 60 and 69 years. CONCLUSION: The PD group showed an approximately 2 times higher risk of hip fracture compared with the comparison group, and the post-fracture mortality rate was 2 times higher in the patients with PD with hip fracture than in those without. Those aged 60-69 years were associated with the highest risk of hip fracture and post-hip fracture mortality among patients with PD.

Diabetic polyneuropathy and the risk of developing carpal tunnel syndrome: A nationwide, population-based study.

BACKGROUND: We investigated the risk of carpal tunnel syndrome (CTS) in diabetic polyneuropathy (DPN). METHODS: This study was conducted using records from the National Health Insurance System (NHIS). We divided patients diagnosed with diabetes mellitus (DM) into those with and without DPN. We assessed the effect of DPN on the risk of CTS using Cox proportional hazards regression analyses. RESULTS: DPN was associated with an increased risk of CTS (hazard ratio [HR], 1.33; 95% confidence interval [CI], 1.12-1.58). In sub-analyses, female gender (HR, 1.45; 95% CI, 1.20-1.76), presence of type 2 DM (HR, 1.36; 95% CI, 1.11-1.64), and age 35 to 64 years (HR 1.35; 95% CI, 1.11-1.64) were significantly associated with an increased risk of CTS. CONCLUSIONS: Patients with DPN had an increased risk of CTS compared with the non-DPN group, particularly females, those with type 2 DM, and those aged 35 to 64 years.

Clinical Implication of Altered Inhibitory Response in Patients with Post-traumatic Stress Disorder: Electrophysiological Evidence from a Go/Nogo Task.

Inhibitory dysfunction is closely associated to post-traumatic stress disorder (PTSD). The present study investigated the neurophysiological evidence for and the brain regions related to inhibitory dysfunction in PTSD. Fifty patients with PTSD and 63 healthy controls (HCs) participated in a Go/Nogo task combined with electroencephalographic recordings. The N2-P3 complexes of event-related potentials (ERPs) elicited during the Nogo condition were compared between groups. Participants underwent structural magnetic resonance imaging to examine cortical volumes and completed questionnaires. Correlations between altered ERPs and cortical volumes of regions of interest as well as psychological symptoms were analysed. Nogo-N2 latencies at five electrode sites (Fz, FCz, Cz, CPz, and Pz) were significantly delayed in patients with PTSD compared to HCs. Nogo-N2 latency had a significant negative correlation with the volume of gyrus in the inferior frontal cortex, orbitofrontal cortex, amygdala, and medial prefrontal cortex. Nogo-N2 latency was significantly and positively correlated with catastrophizing, anxiety, and perceived threat. These findings show inhibitory dysfunction in patients with PTSD, reflected by the delay in Nogo-N2 latencies. They also indicate that Nogo-N2 latencies are associated with smaller cortical volumes responsible for inhibition as well as with major symptoms of PTSD.

Does the Type of Extracorporeal Shock Therapy Influence Treatment Effectiveness in Lateral Epicondylitis? A Systematic Review and Meta-analysis.

BACKGROUND: Extracorporeal shock wave therapy (ESWT) has been used in various musculoskeletal disorders, including lateral epicondylitis. However, in 2005, a meta-analysis of randomized controlled trials showed that ESWT provides minimal or no benefit in terms of pain and function in patients with lateral epicondylitis. Since the review, several randomized controlled trials including different types of ESWT such as radial type for lateral epicondylitis have been published. Investigations of the effect modifiers such as symptom and follow-up duration on the effects of ESWT on lateral epicondylitis have not been performed. QUESTIONS/PURPOSES: (1) Does ESWT reduce pain and improve grip strength in patients with lateral epicondylitis? (2) Which type of ESWT, radial or focused, is more effective? (3) Is the duration of symptoms associated with the efficacy of ESWT for lateral epicondylitis? (4) Do improvements in pain scores remain in patients with longer follow-up? METHODS: The PubMed, Embase, and Cochrane Central Register of Controlled Trials databases were searched up to July 2019 for articles published in English or Korean. Studies were included if patient allocation was randomized, the sample was composed of patients with lateral epicondylitis, interventions were ESWT (focused or radial), comparison group only received sham stimulation or no additional treatment, and the study outcome was pain intensity or grip strength. The quality of the evidence was assessed using the Cochrane risk of bias tool. Twelve studies including 1104 participants fulfilled the inclusion criteria and were included in the meta-analysis. The mean difference for pain reduction and improvement in grip strength was calculated. RESULTS: The meta-analysis showed no clinically important difference in the VAS score (2.48 ± 7.55 versus 3.17 ± 9.78, mean difference -0.68 [95% confidence interval -1.17 to -0.19]; p = 0.006) and grip strength (38.02 ± 70.56 versus 34.85 ± 108.26, mean difference 3.33 [95% CI 0.93 to 5.73]; p = 0.007) after ESWT relative to the comparison group's score. Even though radial ESWT showed more improvement than focused, the mean difference for VAS did not exceed the minimal clinically important differences threshold. There were no clinically important effects on the VAS scores of patients with lateral epicondylitis (2.78 ± 5.57 versus 3.92 ± 6.29, mean difference -1.13 [95% CI -1.84 to -0.42]; p = 0.002) and focused ESWT did not improve pain in patients with lateral epicondylitis. In the subgroup analysis, ESWT was effective in patients with a symptom duration of more than 6 months (2.28 ± 8.48 versus 3.31 ± 11.81, mean difference -0.95 [95% CI -1.75 to -0.15]; p = 0.02) but not for those with shorter symptom duration. The effects did not last beyond 24 weeks (2.52 ± 9.19 versus 3.34 ± 5.93, mean difference -0.82 [95% CI -2.57 to 0.93]; p = 0.36). CONCLUSIONS: ESWT did not show clinically important improvement in pain reduction and grip strength. Radial ESWT, symptom duration of longer than 6 months, and short follow-up duration (less than 24 weeks) were related to better effects. Further studies are needed to determine the appropriate protocol and elucidate the effects according to the intervention type and specific disease condition. LEVEL OF EVIDENCE: Level I, therapeutic study.

Latent awareness: Early conscious access to motor preparation processes is linked to the readiness potential.

An experience of intention to move accompanies execution of some voluntary actions. The Readiness Potential (RP) is an increasing negativity over motor brain areas prior to voluntary movement. Classical studies suggested that the RP starts before intention is consciously accessed as measured by offline recall-based reports, yet the interpretation of the RP and its temporal relation to awareness of intention remain controversial. We designed a task in which self-paced actions could be interrupted at random times by a visual cue that probed online awareness of intention. Participants were instructed to respond by pressing a key if they felt they were actively preparing a self-paced movement at the time of the cue (awareness report), but to ignore the cue otherwise. We show that an RP-like activity was more strongly present before the cue for probes eliciting awareness reports than otherwise. We further show that recall-based reports of the time of conscious intention are linked to visual attention processes, whereas online reports elicited by a probe are not. Our results suggest that awareness of intention is accessible at relatively early stages of motor preparation and that the RP is specifically associated with this conscious experience.

The relationship between rotator cuff tear and four acromion types: cross-sectional study based on shoulder magnetic resonance imaging in 227 patients.

BACKGROUND: Rotator cuff tear (RCT) has been believed to be related to specific types of the acromion. However, most of the studies were performed on a small number of patients with surgical findings not considering the severity of RCT. PURPOSE: To analyze the relationship between age, gender, the side of the shoulder, the acromion type, and the severity of RCT using shoulder magnetic resonance arthrography (MRA). MATERIAL AND METHODS: A total of 277 shoulder MRA findings were analyzed by a radiologist specializing in the musculoskeletal system. The relationship between variables (age, gender, side of the shoulder, and acromion type) and the injury of the supraspinatus (no rupture, partial rupture, full rupture, complete rupture) was confirmed. The partial tear of the supraspinatus tendon was divided into bursal and articular side tear in order to investigate the damage caused by the anatomical difference of the acromion. We also confirmed the differences between single supraspinatus injury and multiple RCTs. RESULTS: The severity of supraspinatus tear and multiple RCTs were statistically significant with the old age and the right side of the shoulder, but not with a specific acromion type. In supraspinatus partial tear, there was no statistical difference between bursal and articular side tears. CONCLUSION: Our study revealed that the age at which degeneration could occur also was associated with multiple RCTs and is considered to be the most important factor in RCT, not anatomical structures such as acromion type.

Electroencephalography-based endogenous brain-computer interface for online communication with a completely locked-in patient.

BACKGROUND: Brain-computer interfaces (BCIs) have demonstrated the potential to provide paralyzed individuals with new means of communication, but an electroencephalography (EEG)-based endogenous BCI has never been successfully used for communication with a patient in a completely locked-in state (CLIS). METHODS: In this study, we investigated the possibility of using an EEG-based endogenous BCI paradigm for online binary communication by a patient in CLIS. A female patient in CLIS participated in this study. She had not communicated even with her family for more than one year with complete loss of motor function. Offline and online experiments were conducted to validate the feasibility of the proposed BCI system. In the offline experiment, we determined the best combination of mental tasks and the optimal classification strategy leading to the best performance. In the online experiment, we investigated whether our BCI system could be potentially used for real-time communication with the patient. RESULTS: An online classification accuracy of 87.5% was achieved when Riemannian geometry-based classification was applied to real-time EEG data recorded while the patient was performing one of two mental-imagery tasks for 5 s. CONCLUSIONS: Our results suggest that an EEG-based endogenous BCI has the potential to be used for online communication with a patient in CLIS.

New Method for Pure-Tone Audiometry Using Electrooculogram: A Proof-of-Concept Study.

Precise and timely evaluation of an individual's hearing loss plays an important role in determining appropriate treatment strategies, including medication and aural rehabilitation. However, currently available hearing assessment systems do not satisfy the need for an objective assessment tool with a simple and non-invasive procedure. In this paper, we propose a new method for pure-tone audiometry, which may potentially be used to assess an individual's hearing ability objectively and quantitatively, without need for the user's active response. The proposed method is based on the auditory oculogyric reflex, where the eyes involuntary rotate towards the source of a sound, in response to spatially moving pure-tone audio stimuli modulated at specific frequencies and intensities. We quantitatively analyzed horizontal electrooculograms (EOG) recorded with a pair of electrodes under two conditions-when pure-tone stimuli were (1) "inaudible" or (2) "audible" to a participant. Preliminary experimental results showed significantly increased EOG amplitude in the audible condition compared to the inaudible condition for all ten healthy participants. This demonstrates potential use of the proposed method as a new non-invasive hearing assessment tool.

Association between cervical lordotic curvature and cervical muscle cross-sectional area in patients with loss of cervical lordosis.

Disruption of the cervical lordotic curve can cause undesirable symptoms such as neck pain, and cord compression. The purpose of this study was to investigate the biomechanics of loss of cervical lordosis by measuring the cross-sectional area (CSA) of the cervical muscles using magnetic resonance imaging (MRI), and to determine the relationship between cervical lordosis angle and cervical muscle status. The cervical lordosis angle was measured on standing lateral plain radiography using the posterior tangent technique in patients who complained of neck pain. The CSAs of the cervical flexor muscles including the longus cervicis and longus capitis, the cervical extensor muscles including the splenius capitis and semispinalis capitis, and the sternocleidomastoid muscle, were measured at the maximum levels by axial T1-weighted MRI. We compared neck muscle CSAs between the two groups, the correlation with cervical lordosis angle, and muscle status including CSA and imbalance. The CSA of the semispinalis capitis was significantly lower in the loss of cervical lordosis group, and the ratio of cervical flexor to extensor was significantly different between the two groups (P < 0.05). Partial correlation analysis revealed that the cervical lordotic angle was significantly positively correlated with the ratio of flexor to extensor muscle CSAs (P < 0.05). There is a significant relationship between cervical muscle imbalance, including extensor muscle weakness, and loss of cervical lordosis. An exercise program focusing on cervical extensor muscle strengthening and restoring the balance of flexor and extensor muscles is recommended for patients with loss of cervical lordosis. Clin. Anat. 31:710-715, 2018. © 2018 Wiley Periodicals, Inc.

Comparison of the Therapeutic Effects of a Sling Exercise and a Traditional Stabilizing Exercise for Clinical Lumbar Spinal Instability.

CONTEXT: Specific muscle-stabilization training can be relevant to patients with clinical spinal instability symptoms. The authors hypothesized that performing sling exercise using an elastic band in patients with clinical spinal instability would lead to pain reduction and improved lumbar spine stability. OBJECTIVE: To compare supervised sling exercise with an elastic band with traditional stabilizing exercise in chronic lower back pain (LBP) patients with clinical spinal instability. DESIGN: Randomized assessor-blind controlled trial. SETTING: University rehabilitation hospital. MAIN OUTCOME MEASURES: The participants were evaluated thrice at baseline, immediately after, and 3 mo after the last treatment session with the Numeric Pain Rating Scale (NPRS) and by the Oswestry Disability Index (ODI). INTERVENTIONS: Participants were randomly assigned to 1 of 2 treatment groups: a traditional trunk-muscle-stabilizing exercise group or a sling-exercise with elastic bands group. The participants in all treatment groups attended treatment twice a week for 12 wk. RESULTS: The NPRS at immediately and 3 mo after treatments showed significantly higher improvement in the sling-exercise with elastic bands group than in the traditional trunk-muscle-stabilizing exercise group, respectively (P < .05). The ODI at immediately and 3 mo after treatment showed a significantly higher improvement in the sling-exercise with elastic bands group than in the traditional trunk-muscle-stabilizing exercise group, respectively (P < .05). CONCLUSION: A sling exercise with elastic bands leads to a reduction in pain and disability compared with a traditional stabilizing exercise, although traditional stabilizing exercise also shows good results in chronic LBP patients with clinical spinal instability. A sling exercise with an elastic band could be a useful treatment for chronic LBP with clinical spinal instability.

Diagnostic Value of Time-Constrained Naming Test in Mild Cognitive Impairment.

BACKGROUND: Naming difficulties have recently garnered more interest in elderly individuals with mild cognitive impairment (MCI). We anticipate that naming tests with the consideration of response time can provide more informative and distinct neuropsychological profiles of individuals with MCI. METHODS: Naming tests were administered to 76 elderly individuals with MCI and 149 healthy elderly (HE). We analyzed the impact of MCI on naming performance and occurrence of "delayed" response. We also validated the predictive power of naming tests with a time-constrained scoring system. RESULTS: MCI participants performed poorer on the noun naming test than HE participants (p = 0.014). MCI was significantly associated with the occurrence of "delayed" response on the noun (odds ratio [OR] = 3.57; 95% confidence interval [CI] = 1.78-7.17) and verb naming tests (OR = 4.66; 95% CI = 2.07-10.46). The time-constrained naming scores were significantly better able to distinguish the MCI from the HE group than the conventional spontaneous naming score on both the noun (p < 0.001) and verb (p = 0.002) naming tests. CONCLUSIONS: Our findings broaden the knowledge related to the naming ability in individuals with MCI, with respect to the response time. We also confirmed the validity of the naming tests by applying the "delayed" responses as supplementary assessments in the diagnosis of MCI.