Acoustic assessment in mandarin-speaking Parkinson's disease patients and disease progression monitoring and brain impairment within the speech subsystem.

Approximately 90% of Parkinson's patients (PD) suffer from dysarthria. However, there is currently a lack of research on acoustic measurements and speech impairment patterns among Mandarin-speaking individuals with PD. This study aims to assess the diagnosis and disease monitoring possibility in Mandarin-speaking PD patients through the recommended speech paradigm for non-tonal languages, and to explore the anatomical and functional substrates. We examined total of 160 native Mandarin-speaking Chinese participants consisting of 80 PD patients, 40 healthy controls (HC), and 40 MRI controls. We screened the optimal acoustic metric combination for PD diagnosis. Finally, we used the objective metrics to predict the patient's motor status using the Naïve Bayes model and analyzed the correlations between cortical thickness, subcortical volumes, functional connectivity, and network properties. Comprehensive acoustic screening based on prosodic, articulation, and phonation abnormalities allows differentiation between HC and PD with an area under the curve of 0.931. Patients with slowed reading exhibited atrophy of the fusiform gyrus (FDR p = 0.010, R = 0.391), reduced functional connectivity between the fusiform gyrus and motor cortex, and increased nodal local efficiency (NLE) and nodal efficiency (NE) in bilateral pallidum. Patients with prolonged pauses demonstrated atrophy in the left hippocampus, along with decreased NLE and NE. The acoustic assessment in Mandarin proves effective in diagnosis and disease monitoring for Mandarin-speaking PD patients, generalizing standardized acoustic guidelines beyond non-tonal languages. The speech impairment in Mandarin-speaking PD patients not only involves motor aspects of speech but also encompasses the cognitive processes underlying language generation.

Development, Evaluation, and impLemenTation for guideline adaptation: a quality improvement protocol for the DELTA study in global health practice.

BACKGROUND: Guideline adaptation is an emerging field to provide more appropriate recommendations for local clinical practice quality and to promote global health equity. However, its utilization status, adaptation procedures, and related materials remain to be studied. METHODS: This study developed a quality improvement protocol for a study as the Development, Evaluation, and impLemenTation for guideline Adaptation (DELTA) study. Current adapted clinical practice guidelines (CPGs) will be systematically searched. Their characteristics, utilization status, and adaptation procedures will be extracted, compared, and analyzed. Whether these adapted CPGs rigorously followed the instruments and steps of adaptation frameworks will also be appraised. In addition, the advantages and limitations of current adaptation methods and their suitable application situations will be analyzed. In addition, future perspectives as DELTA series and DELTA system, aiming for comprehensively evaluating current needs for guideline adaptation and developing a unified framework and related materials were proposed to improve the acceptability, applicability, and implementation of guideline adaptation in clinical practice. The DELTA series are divided into four phases: phase I in analyzing status, characteristics, and procedures and completeness of adapted CPGs; phase II in analyzing differences, heterogeneity, and implementation between adapted and original CPGs; and phase III in collecting, analyzing, and comparing all available adaptation materials. With these research bases, an international working group will be established in phase IV and will develop unified guideline adaptation materials after Delphi consensus, including adaptation frameworks, appraisal tools and checklists, registries, and databases. DISCUSSION: Guideline adaptation has been advanced as an efficient way to guide local clinical practice. However, it still faces several major challenges. The proposed DELTA study, series, and system will further contribute to this emerging topic. TRIAL REGISTRATION:  This study has been registered by the PROSPERO international database. https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=400170 .

Clinical application and accuracy assessment of imaging-based surgical navigation guided 125I interstitial brachytherapy in deep head and neck regions.

Brachytherapy has the advantages of being minimally invasive and highly conformal, and it achieves good results in head and neck tumors. To precisely implant the radioactive seeds according to the preplan in deep head and neck regions, the surgical navigation is applied. This study aims to explore the clinical application and accuracy of imaging-based surgical navigation-guided 125I interstitial brachytherapy in terms of seed position. We included 41 patients with tumors in deep head and neck regions. The brachytherapy treatment plan was designed, and the preplanned data were transferred to the navigation system. Needle implantation and seed delivery were performed under surgical navigation system guidance with or without the combination of individual template. The treatment accuracy was evaluated by comparing seed cluster locations between the preoperative treatment plan and the postoperative treatment outcome. A total of 2879 seeds were delivered. The range, mean and median distances between the geometric centers of the preoperative seed point clusters and the postoperative seed point clusters were 0.8-10.5 mm, 4.5 ± 2.3 mm and 4.1 mm, respectively. The differences between preoperative and postoperative volumes of the minimum bounding box of seed point clusters were nonsignificant. In conclusion, the imaging-based surgical navigation system is a promising clinical tool to provide the preplanned data for interstitial brachytherapy intraoperatively, and it is feasible and accurate for the real-time guidance of needle implantation and seed delivery in deep head and neck regions.

Correlation and Prognostic Assessment of Low T3 Syndrome and Norepinephrine Dosage for Patients with Sepsis: A Retrospective Single-Center (Cohort) Study.

Purpose: To investigate the correlation and prognostic significance of low triiodothyronine (T3) syndrome and norepinephrine dosage in patients with sepsis and septic shock. Methods: This single-center, retrospective, cohort study enrolled 169 patients with sepsis and septic shock that were admitted to the intensive care unit of First Hospital of Nanchang, Nanchang, China from June 2017 to July 2019. All included patients were followed up for 28 days or died, whichever was earlier. Patients with free T3 (FT3) of <3.1 pmol/L were considered with low T3 syndrome. The correlation and prognostic significance of the FT3 and maximum dosage of norepinephrine (MDN) within 72 h, as well as other clinical indicators, were analyzed by using correlation analysis, principal component analysis, receiver operating characteristic curve, Youden index, and logistic regression. Results: A total of 138 patients were allocated to the low T3 group. FT3 inversely correlated with the Sequential Organ Failure Assessment (SOFA) score within 24 h, fluid resuscitation volume within 24 h, and lactic acid levels, and positively correlated with the mean arterial pressure. The critical values of age, SOFA, and MDN for predicting the 28-day mortality were 79.5 years, 8.5 points, and 0.61 µg/kg/min, respectively. The mortality of the low T3 and normal T3 groups was similar. Considering the MDN of 0.61 µg/kg/min as the cutoff value, the mortality between the two groups was significantly different. Conclusion: Among patients with sepsis and septic shock, FT3 was inversely correlated with the disease severity. An MDN ≥ 0.61 µg/kg/min within 72 h may be an important prognostic indicator.

Factors controlling soil organic carbon content in wetlands at multiple scales and assessment of the universality of estimation equations: A mega-data study.

The factors controlling soil organic carbon (SOC) content in wetlands need to be identified to estimate the global stores of SOC. Although there have been a large number of small-scale studies of the local patterns of SOC content, global studies are still required. We used a random forest algorithm and other statistical approaches to determine the controls on the SOC content in wetlands at global, continental, and national scales based on the Harmonized World Soil Database and field data. The results showed that, at the three scales explored, the soil cation exchange capacity and bulk density were the main controls on the SOC content in wetlands. Moreover, equations for estimating global SOC content were established. To assess the universality of SOC content estimation equations, the soil properties were considered as a "community" and the normalized stochasticity ratio (NST) was used to assess the stochasticity in the assembly of soil "communities". The results showed that, globally, the interaction of these factors was stochastic in the "community" composed of the controllers and SOC. The reason for this result might be that microbes were not considered in the equation. Therefore, the weighted abundance of related microbes (WARM) was therefore recommended in the estimation of SOC. With NST and WARM factors, we found that microbes play a key role in increasing the determinacy of SOC estimation equations in wetlands with less anthropogenic contamination. Our findings show that when microbial impacts are taken into account, the patterns of SOC content in pristine wetlands are more universal. Our newly established equations for estimating global SOC content are crucial in projecting changes in wetland SOC, and the two factors indicated in this study favor the universality for SOC content estimation.

Older fusion-surgery age in congenital scoliosis patients is a risk factor for extended length of stay, more estimated blood loss, longer fused segments and higher medical costs: a retrospective study.

BACKGROUND: Contradictory opinions about whether early correction and fusion surgeries should be performed for congenital scoliosis (CS) patients at a young age exist. The objectives of this study were to analyze the association between patient characteristics and fusion-surgery outcomes in CS patients treated with spinal correction and fusion surgeries and to report risk factors for extended length of stay (LOS), more estimated blood loss (EBL), longer fused segments and higher medical costs. METHODS: We analyzed data of 1,207 CS inpatients treated with fusion surgeries in our institute from January 2010 - December 2019. All patients underwent spinal X-ray, CT, MRI, echocardiogram and urogenital ultrasound. We analyzed demographic and clinical information and outcome measures, including LOS, EBL, fused segments and medical costs. RESULTS: Age at fusion (OR = 1.053; p < 0.001), musculoskeletal defects (OR = 1.670; p = 0.004) and thoracic deformity (OR = 1.519; p = 0.03) were risk factors for extended LOS. Age at fusion (OR = 1.117; p < 0.001), male sex (OR = 1.813; p < 0.001), mixed defects (OR = 1.662; p = 0.027) and failure of formation (OR = 1.718; p = 0.021) were risk factors for more EBL. Age at fusion (OR = 1.213; p < 0.001) was a risk factor for longer fused segments. Age at fusion (OR = 1.091; p < 0.001) and thoracic deformity (OR = 1.853; p = 0.004) were risk factors for higher medical costs. CONCLUSIONS: We found that older age at fusion in CS patients is a risk factor for extended LOS, more EBL, longer fused segments and higher medical costs with the risk increasing by 5-21 % for each year of age. Other identified risk factors include thoracic deformity for extended LOS; longer fused segments, higher medical costs, and musculoskeletal defects for extended LOS; and CS type (FF and MD) and sex (male) for more EBL.

Quantitative assessment of structural and functional changes in temporal lobe epilepsy with hippocampal sclerosis.

BACKGROUND: Magnetic resonance imaging (MRI) changes in hippocampal sclerosis (HS) could be subtle in a significant proportion of mesial temporal lobe epilepsy (mTLE) patients. In this study, we aimed to document the structural and functional changes in the hippocampus and amygdala seen in HS patients. METHODS: Quantitative features of the hippocampus and amygdala were extracted from structural MRI data in 66 mTLE patients and 28 controls. Structural covariance analysis was undertaken using volumetric data from the amygdala and hippocampus. Functional connectivity (FC) measured using resting intracranial electroencephalography (EEG) was analyzed in 22 HS patients and 16 non-HS disease controls. RESULTS: Hippocampal atrophy was present in both MRI-positive and MRI-negative HS groups (Mann-Whitney U: 7.61, P<0.01; Mann-Whitney U: 6.51, P<0.01). Amygdala volumes were decreased in the patient group (Mann-Whitney U: 2.92, P<0.05), especially in MRI-negative HS patients (Mann-Whitney U: 2.75, P<0.05). The structural covariance analysis showed the normalized volumes of the amygdala and hippocampus were tightly coupled in both controls and HS patients (ρSpearman =0.72, P<0.01). FC analysis indicated that HS patients had significantly increased connectivity (Student's t: 2.58, P=0.03) within the hippocampus but decreased connectivity between the hippocampus and amygdala (Student's t: 3.33, P=0.01), particularly for MRI-negative HS patients. CONCLUSIONS: Quantitative structural changes, including hippocampal atrophy and temporal pole blurring, are present in both MRI-positive and MRI-negative HS patients, suggesting the potential usefulness of incorporating quantitative analyses into clinical practice. HS is characterized by increased intra-hippocampal EEG synchronization and decreased coupling between the hippocampus and amygdala.

Assessment of CPS + EG, Neo-Bioscore and Modified Neo-Bioscore in Breast Cancer Patients Treated With Preoperative Systemic Therapy: A Multicenter Cohort Study.

This study was to assess the prognosis stratification of the clinical-pathologic staging system incorporating estrogen receptor (ER)-negative disease, the nuclear grade 3 tumor pathology (CPS + EG), Neo-Bioscore, and a modified Neo-Bioscore system in breast cancer patients after preoperative systemic therapy (PST). A retrospective multicenter cohort study was conducted from 12 participating hospitals' databases from 2006 to 2015. Five-year disease free survival (DFS), disease specific survival (DSS), and overall survival (OS) were calculated using Kaplan-Meier Method. Area under the curve (AUC) of the three staging systems was compared. Wald test and maximum likelihood estimates in Cox proportional hazards model were used for multivariate analysis. A total of 1,077 patients were enrolled. The CPS + EG, Neo-Bioscore, and modified Neo-Bioscore could all stratify the DFS, DSS, and OS (all P < 0.001). While in the same stratum of Neo-Bioscore scores 2 and 3, the HER2-positive patients without trastuzumab therapy had much poorer DSS (P = 0.013 and P values < 0.01, respectively) as compared to HER2-positive patients with trastuzumab therapy and HER2-negative patients. Only the modified Neo-Bioscore had a significantly higher stratification of 5-year DSS than PS (AUC 0.79 vs. 0.65, P = 0.03). So, the modified Neo-Bioscore could circumvent the limitation of CPS + EG or Neo-Bioscore. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov, identifier NCT03437837.

Neuroimaging Phenotyping and Assessment of Structural-Metabolic-Electrophysiological Alterations in the Temporal Neocortex of Focal Cortical Dysplasia IIIa.

BACKGROUND: Focal cortical dysplasia IIIa (FCD IIIa) is a common histopathological finding in temporal lobe epilepsy. However, subtle alterations in the temporal neocortex of FCD IIIa renders presurgical diagnosis and definition of the resective range challenging. PURPOSE: To explore neuroimaging phenotyping and structural-metabolic-electrophysiological alterations in FCD IIIa. STUDY TYPE: Retrospective. SUBJECTS: One hundred and sixty-seven subjects aged 4-39 years, including 64 FCD IIIa patients, 89 healthy controls and 14 FCD I patients as disease controls. FIELD STRENGTH/SEQUENCE: 3 T, fast-spin-echo T2 -weighted fluid-attenuated inversion recovery (FLAIR), synthetic T1 -weighted magnetization prepared rapid acquisition gradient echo (MPRAGE). ASSESSMENT: Surface-based linear model was applied to reveal neuroimaging phenotyping in FCD IIIa and assess its relationship with clinical variables. Logistic regression was implemented to identify FCD IIIa patients. Epileptogenicity mapping (EM) was conducted to explore the structural-metabolic-electrophysiological alterations in temporal neocortex of FCD IIIa. STATISTICAL TESTS: Student's t-test was applied to determine the significance of paired differences. Calibration curves were plotted to assess the goodness-of-fit (GOF) of the models, combined with the Hosmer-Lemeshow test. RESULTS: FCD IIIa exhibited widespread hyperintensities in temporal neocortex, and these alterations correlated with disease duration (Puncorrected < 0.01). Machine learning model accurately identified 84.4% of FCD IIIa patients, 92.1% of healthy controls and 92.9% of FCD I patients. Cross-modality analysis showed a significant negative correlation between FLAIR hyperintensity and positron emission tomography hypometabolism P < 0.01). Furthermore, epileptogenic cortices were located predominantly in brain regions with FLAIR hyperintensity and hypometabolism. DATA CONCLUSION: FCD IIIa exhibited widespread temporal neocortex FLAIR hyperintensity. Automated machine learning of neuroimaging patterns is conducive for accurate identification of FCD IIIa. The degree and distribution of morphological alterations related to the extent of metabolic and epileptogenic abnormalities, lending support to its potential value for reduction of the radiative and invasive approaches during presurgical workup. LEVEL OF EVIDENCE: 3 TECHNICAL EFFICACY STAGE: 2.

Treatment of coronavirus disease 2019 in Shandong, China: a cost and affordability analysis.

BACKGROUND: Coronavirus disease 2019 (COVID-19) is now a global public threat. Given the pandemic of COVID-19, the economic impact of COVID-19 is essential to add value to the policy-making process. We retrospectively conducted a cost and affordability analysis to determine the medical costs of COVID-19 patients in China, and also assess the factors affecting their costs. METHODS: This analysis was retrospectively conducted in Shandong Provincial Chest Hospital between 24 January and 16 March 2020. The total direct medical expenditures were analyzed by cost factors. We also assessed affordability by comparing the simulated out-of-pocket expenditure of COVID-19 cases relative to the per capita disposable income. Differences between groups were tested by student t test and Mann-Whitney test when appropriate. A multiple logistic regression model was built to determine the risk factors associated with high cost. RESULTS: A total of 70 COVID-19 patients were included in the analysis. The overall mean cost was USD 6827 per treated episode. The highest mean cost was observed in drug acquisition, accounting for 45.1% of the overall cost. Total mean cost was significantly higher in patients with pre-existing diseases compared to those without pre-existing diseases. Pre-existing diseases and the advanced disease severity were strongly associated with higher cost. Around USD 0.49 billion were expected for clinical manage of COVID-19 in China. Among rural households, the proportions of health insurance coverage should be increased to 70% for severe cases, and 80% for critically ill cases to avoid catastrophic health expenditure. CONCLUSIONS: Our data demonstrate that clinical management of COVID-19 patients incurs a great financial burden to national health insurance. The cost for drug acquisition is the major contributor to the medical cost, whereas the risk factors for higher cost are pre-existing diseases and severity of COVID-19. Improvement of insurance coverage will need to address the barriers of rural patients to avoid the occurrence of catastrophic health expenditure.

Association between change in physician remuneration and use of peritoneal dialysis: a population-based cohort analysis.

BACKGROUND: Health care payers are interested in policy-level interventions to increase peritoneal dialysis use in end-stage renal disease. We examined whether increases in physician remuneration for peritoneal dialysis were associated with greater peritoneal dialysis use. METHODS: We studied a cohort of patients in Alberta who started long-term dialysis with at least 90 days of preceding nephrologist care between Jan. 1, 2001, and Dec. 31, 2014. We compared peritoneal dialysis use 90 days after dialysis initiation in patients cared for by fee-for-service nephrologists and those cared for by salaried nephrologists before and after weekly peritoneal dialysis remuneration increased from $0 to $32 (fee change 1, Apr. 1, 2002), $49 to $71 (fee change 2, Apr. 1, 2007), and $71 to $135 (fee change 3, Apr. 1, 2009). Remuneration for peritoneal dialysis remained less than hemodialysis until fee change 3. We performed a patient-level differences-in-differences logistic regression, adjusted for demographic characteristics and comorbidities, as well as an unadjusted interrupted time-series analysis of monthly outcome data. RESULTS: Our cohort included 4262 patients. There was no statistical evidence of a difference in the adjusted differences-indifferences estimator following fee change 1 (0.89, 95% confidence interval [CI] 0.44-1.81), 2 (1.15, 95% CI 0.73-1.83), or 3 (1.52, 95% CI 0.96-2.40). There was no significant difference in the immediate change or the trend over time in peritoneal dialysis use between fee-for-service and salaried groups following any of the fee changes in the interrupted time-series analysis. INTERPRETATION: We identified no statistical evidence of an increase in peritoneal dialysis use following increased fee-for-service remuneration for peritoneal dialysis. It remains unclear what role, if any, physician payment plays in selection of dialysis modality.

Limited One-time Sampling Irregularity Map (LOTS-IM) for Automatic Unsupervised Assessment of White Matter Hyperintensities and Multiple Sclerosis Lesions in Structural Brain Magnetic Resonance Images.

We present the application of limited one-time sampling irregularity map (LOTS-IM): a fully automatic unsupervised approach to extract brain tissue irregularities in magnetic resonance images (MRI), for quantitatively assessing white matter hyperintensities (WMH) of presumed vascular origin, and multiple sclerosis (MS) lesions and their progression. LOTS-IM generates an irregularity map (IM) that represents all voxels as irregularity values with respect to the ones considered "normal". Unlike probability values, IM represents both regular and irregular regions in the brain based on the original MRI's texture information. We evaluated and compared the use of IM for WMH and MS lesions segmentation on T2-FLAIR MRI with the state-of-the-art unsupervised lesions' segmentation method, Lesion Growth Algorithm from the public toolbox Lesion Segmentation Toolbox (LST-LGA), with several well established conventional supervised machine learning schemes and with state-of-the-art supervised deep learning methods for WMH segmentation. In our experiments, LOTS-IM outperformed unsupervised method LST-LGA on WMH segmentation, both in performance and processing speed, thanks to the limited one-time sampling scheme and its implementation on GPU. Our method also outperformed supervised conventional machine learning algorithms (i.e., support vector machine (SVM) and random forest (RF)) and deep learning algorithms (i.e., deep Boltzmann machine (DBM) and convolutional encoder network (CEN)), while yielding comparable results to the convolutional neural network schemes that rank top of the algorithms developed up to date for this purpose (i.e., UResNet and UNet). LOTS-IM also performed well on MS lesions segmentation, performing similar to LST-LGA. On the other hand, the high sensitivity of IM on depicting signal change deems suitable for assessing MS progression, although care must be taken with signal changes not reflective of a true pathology.

Status Analysis of Nursing Assessment Terminology of Neurological Conditions and Its Cross-Mapping with the International Classification of Functioning, Disability, and Health (ICF).

Patients with nervous system disorders with an accurate nursing assessment can experience an improved prognosis and promotion of health. The lack of uniform terminology limits the accuracy of nursing in China. ICF constitutes a unified and standard language can help standardize nursing assessment terms. This study show that ICF is suitable for Chinese nursing practice by using ICF Clinical Checklist and ICF-linking-rules to map the nursing assessment terminology of neurological conditions with ICF.

Standardized Assessment of Automatic Segmentation of White Matter Hyperintensities and Results of the WMH Segmentation Challenge.

Quantification of cerebral white matter hyperintensities (WMH) of presumed vascular origin is of key importance in many neurological research studies. Currently, measurements are often still obtained from manual segmentations on brain MR images, which is a laborious procedure. The automatic WMH segmentation methods exist, but a standardized comparison of the performance of such methods is lacking. We organized a scientific challenge, in which developers could evaluate their methods on a standardized multi-center/-scanner image dataset, giving an objective comparison: the WMH Segmentation Challenge. Sixty T1 + FLAIR images from three MR scanners were released with the manual WMH segmentations for training. A test set of 110 images from five MR scanners was used for evaluation. The segmentation methods had to be containerized and submitted to the challenge organizers. Five evaluation metrics were used to rank the methods: 1) Dice similarity coefficient; 2) modified Hausdorff distance (95th percentile); 3) absolute log-transformed volume difference; 4) sensitivity for detecting individual lesions; and 5) F1-score for individual lesions. In addition, the methods were ranked on their inter-scanner robustness; 20 participants submitted their methods for evaluation. This paper provides a detailed analysis of the results. In brief, there is a cluster of four methods that rank significantly better than the other methods, with one clear winner. The inter-scanner robustness ranking shows that not all the methods generalize to unseen scanners. The challenge remains open for future submissions and provides a public platform for method evaluation.

Chronic vagus nerve stimulation reverses heart rhythm complexity in patients with drug-resistant epilepsy: An assessment with multiscale entropy analysis.

OBJECTIVE: Vagus nerve stimulation (VNS) is an adjunctive treatment in drug-resistant epilepsy. The alterations in heart rate dynamics through VNS are not well understood. This study aimed to determine changes in heart rhythm complexity in association with VNS and to relate the findings to the outcome of VNS treatment in patients with drug-resistant epilepsy. METHODS: We prospectively analyzed 32 patients with drug-resistant epilepsy, who underwent VNS implantation, and 32 age- and sex-matched healthy control subjects. The interictal heartbeat intervals were analyzed using the heart rhythm complexity with multiscale entropy (MSE) and traditional heart rate variability (HRV) analyses based on ambulatory 24-hour electrocardiograms (ECGs). RESULTS: Patients had significantly decreased complexity indices (Slope 5, Area 1-5, Area 6-15, Area 6-20) on MSE analysis and decreased HRV measurements (standard deviation of the heartbeat interval (SDNN), square root of the mean of sum of squares of the differences between adjacent RR intervals (RMSSD), pNN50, very low frequency (VLF), low frequency (LF), high frequency (HF), total power (TP)) in time and frequency domain analyses. After one year of VNS treatment in patients with drug-resistant epilepsy, there was a trend in an elevated MSE profile with significant higher values between the scales 1 and 9. Vagus nerve stimulation induces a more significant increase of MSE in VNS responders than those in the nonresponders. The conventional HRV measurements did not change. CONCLUSION: Our results suggest that heart rhythm complexity is impaired in patients with drug-resistant epilepsy, and this is at least partially reversed by VNS treatment. Furthermore, VNS-induced effects on heart rate complexity may be associated with the therapeutic response to VNS in patients with drug-resistant epilepsy.

Impairment of heart rhythm complexity in patients with drug-resistant epilepsy: An assessment with multiscale entropy analysis.

OBJECTIVE: Epilepsy and seizures can have dramatic effects on the cardiac function. The aim of this study was to investigate the heart rhythm complexity in patients with drug-resistant epilepsy (DRE). METHODS: Ambulatory 24-h electrocardiograms (ECG) from 70 DRE patients and 50 healthy control subjects were analyzed using conventional heart rate variability (HRV) and multiscale entropy (MSE) methods The variation of complexity indices (CI), which was calculated from MSE profile, was determined. RESULTS: DRE patients had significantly lower time domain (Mean RR, SDNN, RMSSD, pNN50) and frequency domain (VLF, LF, HF, TP) HRV measurements than healthy controls. Of the MSE analysis, MSE profile, CI including Slope 5, Area 1-5, Area 6-15 and Area 6-20 were significantly lower than those in the healthy control group. In receiver operating characteristic (ROC) curve analysis, VLF had the greatest discriminatory power for the two groups. In both net reclassification improvement (NRI) model and integrated discrimination improvement (IDI) models, CI derived from MSE profiles significantly improved the discriminatory power of Mean RR, SDNN, RMSSD, pNN50, VLF, LF, HF and TP. SIGNIFICANCE: The heart rate complexity is impaired for DRE patients. CI are useful to discriminate DRE patients from subjects with normal cardiac complexity. These findings indicate that MSE method may serve as a complementary approach for characterizing and understanding abnormal heart rate dynamics in epilepsy. Furthermore, the CI may potentially be used as a biomarker in monitoring epilepsy.

Dosimetric characterization of GMS BT-125-1 125 I radioactive seed with Monte Carlo simulations and experimental measurement.

PURPOSE: To investigate the dosimetric characteristics of the new GMS BT-125-1 125 I radioactive seed, including dose rate constant, radial dose functions, and anisotropy functions. METHODS: Dosimetric parameters of GMS BT-125-1 125 I seed including dose rate constant, radial dose functions, and anisotropy functions were calculated using the Monte Carlo code of MCNP5, and measured with thermoluminescent dosimeters (TLDs). The results were compared with those of PharmaSeed BT-125-1, PharmaSeed BT-125-2 125 I, and model 6711 125 I seeds. RESULTS: The dose rate constant of GMS BT-125-1 125 I seed was 0.959 cGy·h-1·U-1, with the difference of 0.94%, 0.83%, and 0.73% compared with the PharmaSeed BT-125-1 125 I seed, PharmaSeed BT-125-2 125 I seed, and Model 6711 125 I seed, respectively. For radial dose function, the differences between the Monte Carlo and the experimental g(r) results were mostly within 10%. Monte Carlo results of g(r) for GMS BT-125-1 125 I seed were found in agreement (within 3.3%) with corresponding results for the PharmaSeed BT-125-2 125 I seed. The largest differences were 8.1% and 6.2% compared with PharmaSeed BT-125-1 125 I seed and model 6711 125 I seed, respectively. For anisotropy function, the difference between GMS BT-125-1 125 I seed and PharmaSeed BT-125-2 125 I seed was typically <10%. CONCLUSIONS: The measured dose rate constant, radial dose functions, and two-dimensional anisotropy functions for the GMS BT-125-1 125 I seed showed good agreement with the Monte Carlo results. The dose rate constant of the GMS BT-125-1 125 I seed is similar to that of the PharmaSeed BT-125-1 125 I seed, the PharmaSeed BT-125-2 125 I seed, and the model 6711 125 I seed. For radial dose functions and two-dimensional anisotropy functions, the GMS BT-125-1 125 I seed is similar to the PharmaSeed BT-125-2 125 I seed but different from the PharmaSeed BT-125-1 125 I seed and the model 6711 125 I seed.

Assessment of anti-cancerous potential of 6-gingerol (Tongling White Ginger) and its synergy with drugs on human cervical adenocarcinoma cells.

The anti-cancerous activity of 6-gingerol extracted from Tongling White Ginger was investigated. 6-Gingerol inhibited the growth of HeLa cells with IC50 (96.32 µM) and IC80 (133.01 µM) and led to morphological changes, induced the cell cycle arrest in G0/G1-phase and ultimately resulted into apoptosis. Among cell cycle-related genes and proteins, the expression of cyclin (A, D1, E1) reduced, while of CDK-1, p21 and p27 showed slight decrease, except cyclin B1 and E1 (protein). Western blotting reported the induction of apoptosis with an increased Bax/Bcl-2 ratio, release of cytochrome c, cleavage of caspase-3, -8, -9 and PRPP in treated cells. 6-Gingerol activated AMPK, but inhibited PI3K/AKT phosphorylation with reduced P70S6K expression and also suppressed the mTOR phosphorylation. 6-Gingerol with 5-FU and Ptx resulted in 83.2% and 52% inhibition respectively, this synergy have stimulated apoptosis proteins more efficiently as compared to 6-Gingerol alone (10.75%) under in vitro conditions.

Health risk assessment of exposure to organic matter from the use of reclaimed water in toilets.

To estimate the carcinogenic and non-carcinogenic risks of six volatile organic compounds (VOCs) found in reclaimed water used for flushing toilets, a probabilistic health risk assessment based on Monte Carlo simulations was used. Before Monte Carlo simulations, the contaminant volatilization model was applied to estimate the concentration of the pollutants in air. Moreover, a questionnaire was used to acquire daily exposure time and the Batch Fit tool of Crystal Ball software was applied to find the best-fitting distribution of a part of the input parameters. The risk analysis indicated that the health risks from six VOCs were lower than the negligible risk level (1 × 10(-8)) in all cases, and the health risk for females was slightly higher than that for males. Overall, exposure to organic pollutants in reclaimed water during toilet flushing does not currently pose a significant carcinogenic risk to humans. In this study, we want to provide some information on the health risk from reclaimed water used for toilet flushing in China and hope that it will be useful to promote the application of reclaimed water in water-deficient areas.

X-Ray assessment of the effect of pedicle screw on vertebra and spinal canal growth in children before the age of 7 years.

PURPOSE: To determine the reliability of pedicle screws placed in children younger than 7 years of age, and to evaluate the effect of pedicle screw insertion on further growth of the vertebra and spinal canal. METHODS: A retrospective study of 35 consecutive patients through Jan 2003-Dec 2010 for congenital scoliosis in <7 years children was performed at one spine center. Patients undergoing pedicle screw instrumentation of at least two levels, which had been followed-up for at least 24 months were included. Measurements were performed in instrumented and adjacent non-instrumented levels. The effect of pedicle screw insertion on further growth was evaluated. RESULTS: The average age at surgery was 4.4 year (53 months, range, 23-84 months). 190 segments in 35 patients met the inclusion criteria. 77 segments had no screws and 113 had at least one screw. There was a significant difference between the pre-operative and final follow-up values of the measurement of spinal canal and vertebral body parameters (P < 0.001). No significant difference existed between growth rates of vertebral bodies and the sagittal diameters of spinal canal with or without screws. The growth rates of vertebral bodies in lumbar spine were higher than in thoracic spine in both instrumented and adjacent groups. CONCLUSION: Pedicle screw instrumentation does not cause a retardation effect on the development of vertebral bodies and the spinal canal in children at an early age. It is a safe and reliable procedure to achieve a stable fixation.