Edge-wise analysis reveals white matter connectivity associated with focal to bilateral tonic-clonic seizures.

OBJECTIVE: Focal to bilateral tonic-clonic seizures (FBTCS) represent a challenging subtype of focal temporal lobe epilepsy (TLE) in terms of both severity and treatment response. Most studies have focused on regional brain analysis that is agnostic to the distribution of white matter (WM) pathways associated with a node. We implemented a more selective, edge-wise approach that allowed for identification of the individual connections unique to FBTCS. METHODS: T1-weighted and diffusion-weighted images were obtained from 22 patients with solely focal seizures (FS), 43 FBTCS patients, and 65 age/sex-matched healthy participants (HPs), yielding streamline (STR) connectome matrices. We used diffusion tensor-derived STRs in an edge-wise approach to determine specific structural connectivity changes associated with seizure generalization in FBTCS compared to matched FS and HPs. Graph theory metrics were computed on both node- and edge-based connectivity matrices. RESULTS: Edge-wise analyses demonstrated that all significantly abnormal cross-hemispheric connections belonged to the FBTCS group. Abnormal connections associated with FBTCS were mostly housed in the contralateral hemisphere, with graph metric values generally decreased compared to HPs. In FBTCS, the contralateral amygdala showed selective decreases in the structural connection pathways to the contralateral frontal lobe. Abnormal connections in TLE involved the amygdala, with the ipsilateral side showing increases and the contralateral decreases. All the FS findings indicated higher graph metrics for connections involving the ipsilateral amygdala. Data also showed that some FBTCS connectivity effects are moderated by aging, recent seizure frequency, and longer illness duration. SIGNIFICANCE: Data showed that not all STR pathways are equally affected by the seizure propagation of FBTCS. We demonstrated two key biases, one indicating a large role for the amygdala in the propagation of seizures, the other pointing to the prominent role of cross-hemispheric and contralateral hemisphere connections in FBTCS. We demonstrated topographic reorganization in FBTCS, pointing to the specific WM tracts involved.

HgCl2 exposure mediates pyroptosis of HD11 cells and promotes M1 polarization and the release of inflammatory factors through ROS/Nrf2/NLRP3.

Mercury (Hg) is a serious metal environmental pollutant. HgCl2 exposure causes pyroptosis. When macrophages are severely stimulated, they often undergo M1 polarization and release inflammatory factors. However, the mechanisms by which mercuric chloride exposure induces macrophage apoptosis, M1 polarization, and inflammatory factors remain unclear. HD11 cells were exposed to different concentrations of Hg chloride (180, 210 and 240 nM HgCl2). The results showed that mercury chloride exposure up-regulated ROS, C-Nrf2 and its downstream factors (NQO1 and HO-1), and down-regulated N-Nrf2. In addition, the expressions of focal death-related indicators (Caspase-1, NLRP3, GSDMD, etc.), M1 polarization marker CD86 and inflammatory factors (TNF-α, IL-1ß) increased, and the above changes were related to mercury. Oxidative stress inhibitor (NAC) can block ROS/ NrF2-mediated oxidative stress, inhibit mercury-induced pyroptosis and M1 polarization, and effectively reduce the release of inflammatory factors. The addition of Vx-765 to inhibit pyroptosis can effectively alleviate M1 polarization of HD11 cells and reduce the expression of inflammatory factors. HgCl2 mediates pyroptosis of HD11 cells by regulating ROS/Nrf2/NLRP3, promoting M1 polarization and the release of inflammatory factors.

Cognitive Control Architecture for the Practical Realization of UAV Collision Avoidance.

A highly intelligent system often draws lessons from the unique abilities of humans. Current humanlike models, however, mainly focus on biological behavior, and the brain functions of humans are often overlooked. By drawing inspiration from brain science, this article shows how aspects of brain processing such as sensing, preprocessing, cognition, obstacle learning, behavior, strategy learning, pre-action, and action can be melded together in a coherent manner with cognitive control architecture. This work is based on the notion that the anti-collision response is activated in sequence, which starts from obstacle sensing to action. In the process of collision avoidance, cognition and learning modules continuously control the UAV's repertoire. Furthermore, simulated and experimental results show that the proposed architecture is effective and feasible.

Immunoproteasome function maintains oncogenic gene expression in KMT2A-complex driven leukemia.

Pharmacologic targeting of chromatin-associated protein complexes has shown significant responses in KMT2A-rearranged (KMT2A-r) acute myeloid leukemia (AML) but resistance frequently develops to single agents. This points to a need for therapeutic combinations that target multiple mechanisms. To enhance our understanding of functional dependencies in KMT2A-r AML, we have used a proteomic approach to identify the catalytic immunoproteasome subunit PSMB8 as a specific vulnerability. Genetic and pharmacologic inactivation of PSMB8 results in impaired proliferation of murine and human leukemic cells while normal hematopoietic cells remain unaffected. Disruption of immunoproteasome function drives an increase in transcription factor BASP1 which in turn represses KMT2A-fusion protein target genes. Pharmacologic targeting of PSMB8 improves efficacy of Menin-inhibitors, synergistically reduces leukemia in human xenografts and shows preserved activity against Menin-inhibitor resistance mutations. This identifies and validates a cell-intrinsic mechanism whereby selective disruption of proteostasis results in altered transcription factor abundance and repression of oncogene-specific transcriptional networks. These data demonstrate that the immunoproteasome is a relevant therapeutic target in AML and that targeting the immunoproteasome in combination with Menin-inhibition could be a novel approach for treatment of KMT2A-r AML.

Cortical morphometric vulnerability to generalised epilepsy reflects chromosome- and cell type-specific transcriptomic signatures.

AIMS: Generalised epilepsy is thought to involve distributed brain networks. However, the molecular and cellular factors that render different brain regions more vulnerable to epileptogenesis remain largely unknown. We aimed to investigate epilepsy-related morphometric similarity network (MSN) abnormalities at the macroscale level and their relationships with microscale gene expressions at the microscale level. METHODS: We compared the MSN of genetic generalised epilepsy with generalised tonic-clonic seizure patients (GGE-GTCS, n = 101) to demographically matched healthy controls (HC, n = 150). Cortical MSNs were estimated by combining seven morphometric features derived from structural magnetic resonance imaging for each individual. Regional gene expression profiles were derived from brain-wide microarray measurements provided by the Allen Human Brain Atlas. RESULTS: GGE-GTCS patients exhibited decreased regional MSNs in primary motor, prefrontal and temporal regions and increases in occipital, insular and posterior cingulate cortices, when compared with the HC. These case-control neuroimaging differences were validated using split-half analyses and were not affected by medication or drug response effects. When assessing associations with gene expression, genes associated with GGE-GTCS-related MSN differences were enriched in several biological processes, including 'synapse organisation', 'neurotransmitter transport' pathways and excitatory/inhibitory neuronal cell types. Collectively, the GGE-GTCS-related cortical vulnerabilities were associated with chromosomes 4, 5, 11 and 16 and were dispersed bottom-up at the cellular, pathway and disease levels, which contributed to epileptogenesis, suggesting diverse neurobiologically relevant enrichments in GGE-GTCS. CONCLUSIONS: By bridging the gaps between transcriptional signatures and in vivo neuroimaging, we highlighted the importance of using MSN abnormalities of the human brain in GGE-GTCS patients to investigate disease-relevant genes and biological processes.

Lower-extremity fatigue fracture detection and grading based on deep learning models of radiographs.

OBJECTIVES: To identify the feasibility of deep learning-based diagnostic models for detecting and assessing lower-extremity fatigue fracture severity on plain radiographs. METHODS: This retrospective study enrolled 1151 X-ray images (tibiofibula/foot: 682/469) of fatigue fractures and 2842 X-ray images (tibiofibula/foot: 2000/842) without abnormal presentations from two clinical centers. After labeling the lesions, images in a center (tibiofibula/foot: 2539/1180) were allocated at 7:1:2 for model construction, and the remaining images from another center (tibiofibula/foot: 143/131) for external validation. A ResNet-50 and a triplet branch network were adopted to construct diagnostic models for detecting and grading. The performances of detection models were evaluated with sensitivity, specificity, and area under the receiver operating characteristic curve (AUC), while grading models were evaluated with accuracy by confusion matrix. Visual estimations by radiologists were performed for comparisons with models. RESULTS: For the detection model on tibiofibula, a sensitivity of 95.4%/85.5%, a specificity of 80.1%/77.0%, and an AUC of 0.965/0.877 were achieved in the internal testing/external validation set. The detection model on foot reached a sensitivity of 96.4%/90.8%, a specificity of 76.0%/66.7%, and an AUC of 0.947/0.911. The detection models showed superior performance to the junior radiologist, comparable to the intermediate or senior radiologist. The overall accuracy of the diagnostic model was 78.5%/62.9% for tibiofibula and 74.7%/61.1% for foot in the internal testing/external validation set. CONCLUSIONS: The deep learning-based models could be applied to the radiological diagnosis of plain radiographs for assisting in the detection and grading of fatigue fractures on tibiofibula and foot. KEY POINTS: • Fatigue fractures on radiographs are relatively difficult to detect, and apt to be misdiagnosed. • Detection and grading models based on deep learning were constructed on a large cohort of radiographs with lower-extremity fatigue fractures. • The detection model with high sensitivity would help to reduce the misdiagnosis of lower-extremity fatigue fractures.

Coordinatized lesion location analysis empowering ROI-based radiomics diagnosis on brain gliomas.

OBJECTIVES: To assess the value of coordinatized lesion location analysis (CLLA), in empowering ROI-based imaging diagnosis of gliomas by improving accuracy and generalization performances. METHODS: In this retrospective study, pre-operative contrasted T1-weighted and T2-weighted MR images were obtained from patients with gliomas from three centers: Jinling Hospital, Tiantan Hospital, and the Cancer Genome Atlas Program. Based on CLLA and ROI-based radiomic analyses, a fusion location-radiomics model was constructed to predict tumor grades, isocitrate dehydrogenase (IDH) status, and overall survival (OS). An inter-site cross-validation strategy was used for assessing the performances of the fusion model on accuracy and generalization with the value of area under the curve (AUC) and delta accuracy (ACC) (ACCtesting-ACCtraining). Comparisons of diagnostic performances were performed between the fusion model and the other two models constructed with location and radiomics analysis using DeLong's test and Wilcoxon signed ranks test. RESULTS: A total of 679 patients (mean age, 50 years ± 14 [standard deviation]; 388 men) were enrolled. Based on tumor location probabilistic maps, fusion location-radiomics models (averaged AUC values of grade/IDH/OS: 0.756/0.748/0.768) showed the highest accuracy in contrast to radiomics models (0.731/0.686/0.716) and location models (0.706/0.712/0.740). Notably, fusion models ([median Delta ACC: - 0.125, interquartile range: 0.130]) demonstrated improved generalization than that of radiomics model ([- 0.200, 0.195], p = 0.018). CONCLUSIONS: CLLA could empower ROI-based radiomics diagnosis of gliomas by improving the accuracy and generalization of the models. CLINICAL RELEVANCE STATEMENT: This study proposed a coordinatized lesion location analysis for glioma diagnosis, which could improve the performances of the conventional ROI-based radiomics model in accuracy and generalization. KEY POINTS: • Using coordinatized lesion location analysis, we mapped anatomic distribution patterns of gliomas with specific pathological and clinical features and constructed glioma prediction models. • We integrated coordinatized lesion location analysis into ROI-based analysis of radiomics to propose new fusion location-radiomics models. • Fusion location-radiomics models, with the advantages of being less influenced by variabilities, improved accuracy, and generalization performances of ROI-based radiomics models on predicting the diagnosis of gliomas.

Polystyrene microplastics induce myocardial inflammation and cell death via the TLR4/NF-κB pathway in carp.

Microplastics (MPs) have attracted widespread attention as an emerging environmental pollutant. Especially in aquatic ecosystems, the harm of MPs to aquatic animals has increasingly become a severe environmental problem. In this study, we constructed a carp polystyrene microplastics (PS-MPs) exposure model to explore the damage and mechanism of PS-MPs exposure to carp myocardial tissue. The results of H&E, TUNEL, and AO/EB staining showed that PS-MPs exposure could induce inflammation, apoptosis, and necrosis in carp myocardial tissue and cardiomyocytes. In addition, our study explored the targeting relationship between PS-MPs and TLR4 and found that PS-MPs exposure could significantly increase the expression of TLR4 pathway-related factors. As the concentration of PS-MPs increased, the NF-κB pathway and inflammation-related factors increased dose-dependent. In addition, myocardial injury induced by exposure to PS-MPs was predominantly apoptotic, accompanied by necrosis. In short, our data suggest that PS-MPs cause damage to myocardial tissue via the TLR4\NF-κB pathway. The above findings enrich the theory of toxicological studies on PS-MPs and provide an essential reference for aquaculture.

Polystyrene microplastics induced inflammation with activating the TLR2 signal by excessive accumulation of ROS in hepatopancreas of carp (Cyprinus carpio).

Polystyrene microplastics (PS-MPs) affect the immune defense function on carp (Cyprinus carpio). The PS-MPs model of carp was established by feeding with PS-MPs particle size of 8 µm and concentration of 1000 ng/L water. Hepatopancreas function test revealed the activities of AKP, ALT, AST and LDH abnormal increase. PS-MPs induced tissue damage and lead to abnormal hepatopancreas function. The PS-MPs also induced a oxidative stress with the antioxidant enzymes SOD, CAT, GSH-PX, and T-AOC activities decreasing and reactive oxygen species (ROS) excessive accumulation. PS-MPs activated the Toll like receptor-2 (TLR2) signaling pathway. The mRNA and protein expressions of TLR2, Myeloid differentiation primary response 88 (MyD88), tumor necrosis factor receptor-associated factor 6 (TRAF6), NF-κB p65, Tumor necrosis factor (TNF-α), Interleukin-1ß (IL-1ß), Inducible Nitric Oxide Synthase (iNOS), and cycooxygenase 2(COX2) was revealed increased in both hepatopancreas and hepatocytes with the qPCR and Western blotting analysis mode. ELISA showed the expressions of TNF-α, IL-1ß, iNOS, and COX2 inflammatory molecule were increased in both hepatopancreas and hepatocytes. The results showed that PS-MPs caused a serious injure in the hepatopancreas and brought serious effects on the inflammatory response of carp. The present study displayed the harm caused by PS-MPs in freshwater fish, and provided some suggestions and references for toxicological studies of microplastics in freshwater environment.

Systematically disrupted functional gradient of the cortical connectome in generalized epilepsy: Initial discovery and independent sample replication.

Genetic generalized epilepsy is a network disorder typically involving distributed areas identified by classical neuroanatomy. However, the finer topological relationships in terms of continuous spatial arrangement between these systems are still ambiguous. Connectome gradients provide the topological representations of human macroscale hierarchy in an abstract low-dimensional space by embedding the functional connectome into a set of axes. Leveraging connectome gradients, we systematically scrutinized abnormalities of functional connectome gradient in patients with genetic generalized epilepsy with tonic-clonic seizure (GGE-GTCS, n = 78) compared to healthy controls (HC, n = 85), and further examined the reproducibility across multiple processing configurations and in an independent validation sample (patients with GGE-GTCS, n = 28; HC, n = 31). Our findings demonstrated an extended principal gradient at different spatial scales, network-level and vertex-level, in patients with GGE-GTCS. We found consistent results across processing parameters and in validation sample. The extended principal gradient revealed the excessive functional segregation between unimodal and transmodal systems associated with duration of epilepsy and age at seizure onset in patients. Furthermore, the connectivity profile of regions with abnormal principal gradients verified the disrupted functional hierarchy revealed by gradients. Together, our findings provided a novel view of functional system hierarchy alterations, which facilitated a continuous spatial arrangement of macroscale networks, to increase our understanding of the functional connectome hierarchy in generalized epilepsy.

Recycling diagnostic MRI for empowering brain morphometric research - Critical & practical assessment on learning-based image super-resolution.

Preliminary studies have shown the feasibility of deep learning (DL)-based super-resolution (SR) technique for reconstructing thick-slice/gap diagnostic MR images into high-resolution isotropic data, which would be of great significance for brain research field if the vast amount of diagnostic MRI data could be successively put into brain morphometric study. However, less evidence has addressed the practicability of the strategy, because lack of a large-sample available real data for constructing DL model. In this work, we employed a large cohort (n = 2052) of peculiar data with both low through-plane resolution diagnostic and high-resolution isotropic brain MR images from identical subjects. By leveraging a series of SR approaches, including a proposed novel DL algorithm of Structure Constrained Super Resolution Network (SCSRN), the diagnostic images were transformed to high-resolution isotropic data to meet the criteria of brain research in voxel-based and surface-based morphometric analyses. We comprehensively assessed image quality and the practicability of the reconstructed data in a variety of morphometric analysis scenarios. We further compared the performance of SR approaches to the ground truth high-resolution isotropic data. The results showed (i) DL-based SR algorithms generally improve the quality of diagnostic images and render morphometric analysis more accurate, especially, with the most superior performance of the novel approach of SCSRN. (ii) Accuracies vary across brain structures and methods, and (iii) performance increases were higher for voxel than for surface based approaches. This study supports that DL-based image super-resolution potentially recycle huge amount of routine diagnostic brain MRI deposited in sleeping state, and turning them into useful data for neurometric research.

Cortico-striato-thalamo-cerebellar networks of structural covariance underlying different epilepsy syndromes associated with generalized tonic-clonic seizures.

Generalized tonic-clonic seizures (GTCS) are the severest and most remarkable clinical expressions of human epilepsy. Cortical, subcortical, and cerebellar structures, organized with different network patterns, underlying the pathophysiological substrates of genetic associated epilepsy with GTCS (GE-GTCS) and focal epilepsy associated with focal to bilateral tonic-clonic seizure (FE-FBTS). Structural covariance analysis can delineate the features of epilepsy network related with long-term effects from seizure. Morphometric MRI data of 111 patients with GE-GTCS, 111 patients with FE-FBTS and 111 healthy controls were studied. Cortico-striato-thalao-cerebellar networks of structural covariance within the gray matter were constructed using a Winner-take-all strategy with five cortical parcellations. Comparisons of structural covariance networks were conducted using permutation tests, and module effects of disease duration on networks were conducted using GLM model. Both patient groups showed increased connectivity of structural covariance relative to controls, mainly within the striatum and thalamus, and mostly correlated with the frontal, motor, and somatosensory cortices. Connectivity changes increased as a function of epilepsy durations. FE-FBTS showed more intensive and extensive gray matter changes with volumetric loss and connectivity increment than GE-GTCS. Our findings implicated cortico-striato-thalamo-cerebellar network changes at a large temporal scale in GTCS, with FE-FBTS showing more severe network disruption. The study contributed novel imaging evidence for understanding the different epilepsy syndromes associated with generalized seizures.

Temporal variability profiling of the default mode across epilepsy subtypes.

OBJECTIVE: Epilepsies are a group of neurological disorders sharing certain core features, but also demonstrate remarkable pathogenic and symptomatic heterogeneities. Various subtypes of epilepsy have been identified with abnormal shift in the brain default mode network (DMN). This study aims to evaluate the fine details of shared and distinct alterations in the DMN among epileptic subtypes. METHODS: We collected resting-state functional magnetic resonance imaging (MRI) data from a large epilepsy sample (n = 371) at a single center, including temporal lobe epilepsy (TLE), frontal lobe epilepsy (FLE), and genetic generalized epilepsy with generalized tonic-clonic seizures (GGE-GTCS), as well as healthy controls (HC, n = 150). We analyzed temporal dynamics profiling of the DMN, including edge-wise and node-wise temporal variabilities, and recurrent dynamic states of functional connectivity, to identify abnormalities common to epilepsies as well as those specific to each subtype. RESULTS: The analyses revealed that hypervariable edges within the specific DMN subsystem were shared by all subtypes (all PNBS  < .005), and deficits in node-wise temporal variability were prominent in TLE (all t(243) ≤ 2.51, PFDR  < .05) and FLE (all t(302) ≤ -2.65, PFDR  < .05) but relatively weak in GGE-GTCS. Moreover, dynamic states were generally less stable in patients than controls (all P's < .001). SIGNIFICANCE: Collectively, these findings demonstrated general DMN abnormalities common to different epilepsies as well as distinct dysfunctions to subtypes, and provided insights into understanding the relationship of pathophysiological mechanisms and brain connectivity.

Delayed brain development of Rolandic epilepsy profiled by deep learning-based neuroanatomic imaging.

OBJECTIVES: Although Rolandic epilepsy (RE) has been regarded as a brain developmental disorder, neuroimaging studies have not yet ascertained whether RE has brain developmental delay. This study employed deep learning-based neuroanatomic biomarker to measure the changed feature of "brain age" in RE. METHODS: The study constructed a 3D-CNN brain age prediction model through 1155 cases of typically developing children's morphometric brain MRI from open-source datasets and further applied to a local dataset of 167 RE patients and 107 typically developing children. The brain-predicted age difference was measured to quantitatively estimate brain age changes in RE and further investigated the relevancies with cognitive and clinical variables. RESULTS: The brain age estimation network model presented a good performance for brain age prediction in typically developing children. The children with RE showed a 0.45-year delay of brain age by contrast with typically developing children. Delayed brain age was associated with neuroanatomic changes in the Rolandic regions and also associated with cognitive dysfunction of attention. CONCLUSION: This study provided neuroimaging evidence to support the notion that RE has delayed brain development. KEY POINTS: • The children with Rolandic epilepsy showed imaging phenotypes of delayed brain development with increased GM volume and decreased WM volume in the Rolandic regions. • The children with Rolandic epilepsy had a 0.45-year delay of brain-predicted age by comparing with typically developing children, using 3D-CNN-based brain age prediction model. • The delayed brain age was associated with morphometric changes in the Rolandic regions and attentional deficit in Rolandic epilepsy.

Discrimination between transient and persistent subsolid pulmonary nodules on baseline CT using deep transfer learning.

OBJECTIVES: To develop and validate a deep learning model to discriminate transient from persistent subsolid nodules (SSNs) on baseline CT. METHODS: A cohort of 1414 SSNs, consisting of 319 transient SSNs in 168 individuals and 1095 persistent SSNs in 816 individuals, were identified on chest CT. The cohort was assigned by examination date into a development set of 996 SSNs, a tuning set of 212 SSNs, and a validation set of 206 SSNs. Our model was built by transfer learning, which was transferred from a well-performed deep learning model for pulmonary nodule classification. The performance of the model was compared with that of two experienced radiologists. Each nodule was categorized by Lung CT Screening Reporting and Data System (Lung-RADS) to further evaluate the performance and the potential clinical benefit of the model. Two methods were employed to visualize the learned features. RESULTS: Our model achieved an AUC of 0.926 on the validation set with an accuracy of 0.859, a sensitivity of 0.863, and a specificity of 0.858, and outperformed the radiologists. The model performed the best among Lung-RADS 2 nodules and maintained well performance among Lung-RADS 4 nodules. Feature visualization demonstrated the model's effectiveness in extracting features from images. CONCLUSIONS: The transfer learning model presented good performance on the discrimination between transient and persistent SSNs. A reliable diagnosis on nodule persistence can be achieved at baseline CT; thus, an early diagnosis as well as better patient care is available. KEY POINTS: • Deep learning can be used for the discrimination between transient and persistent subsolid nodules. • A transfer learning model can achieve good performance when it is transferred from a model with a similar task. • With the assistance of deep learning model, a reliable diagnosis on nodule persistence can be achieved at baseline CT, which can bring a better patient care strategy.

Pb exposure triggers MAPK-dependent inflammation by activating oxidative stress and miRNA-155 expression in carp head kidney.

Lead (Pb) is a toxic heavy metal and an aquatic pollutant. Various amounts of heavy metals are released into the environment through industrial discharge, causing excessive contamination of aquatic ecosystems. The head kidney is a unique immune organ of the bony fish and plays an important role in the metabolism of heavy metals. Studies of toxic Pb exposure that have investigated the head kidney of carp are limited. This study was carried out to explore the potential immunotoxicity effects of Pb and the specific related mechanisms in the carp head kidney. Pb poisoning was shown to induce the production of reactive oxygen species (ROS) and increase the expression levels of phosphorylated proteins related to the MAPK pathway, including p38, extracellular signal-regulated protein kinase (ERK), and c-Jun N-terminal kinase (JNK). We also found that microRNA-155 played a key role in regulating the production of inflammatory factors TNF-α, IL-1ß, and IL-6, and the pre-miRNA-155 inhibitor reversed the Pb-induced inflammation. In conclusion, these in vitro and in vivo findings suggest that oxidative stress and the MAPKs are involved in the Pb-induced inflammasome response, and the production of microRNA-155 aggravated the occurrence of inflammation in carp head kidney.

Application of Three-Dimensional Printing Technology in the Orbital Blowout Fracture Reconstruction.

The aim of this study was to investigate the clinical outcomes of orbital blowout fracture repair by using the three-dimensional (3D) printing-assisted fabrication of individual titanium mesh. Clinical and radiologic data were analyzed for 12 patients with orbital floor and/or medial wall fractures. Lower eyelid incision was used to expose the fractures. Preoperative computed tomographic data were input into an imaging software to rebuild a 3D orbit and mirror the unaffected side into the affected side to replace the demolished orbit. A resin model of the reshaped orbit was generated and used to develop an individual titanium mesh for repairing the fractured orbital. The surgical results were assessed by value of enophthalmos and a comparison of preoperative and postoperative orbital volume difference. All patients had a successful treatment outcome without any complications. Clinical significant enophthalmos were not observed after treatment, and diplopia were solved within 2 weeks postoperative. No extraocular muscle limitation was observed. Postoperative computed tomography scans demonstrated appropriate positioning of titanium mesh and there was no implant displacement. The postoperative orbital volume and enophthalmos difference between the 2 eyes decreased significantly than preoperative (P < 0.001). Three-dimensional printing-assisted fabrication of individual titanium mesh is appropriate for use in orbital blowout fracture.

Removal of Motion Artifacts in Photoplethysmograph Sensors during Intensive Exercise for Accurate Heart Rate Calculation Based on Frequency Estimation and Notch Filtering.

With photoplethysmograph (PPG) sensors showing increasing potential in wearable health monitoring, the challenging problem of motion artifact (MA) removal during intensive exercise has become a popular research topic. In this study, a novel method that combines heart rate frequency (HRF) estimation and notch filtering is proposed. The proposed method applies a cascaded adaptive noise cancellation (ANC) based on the least mean squares (LMS)-Newton algorithm for preliminary motion artifacts reduction, and further adopts special heart rate frequency tracking and correction schemes for accurate HRF estimation. Finally, notch filters are employed to restore the PPG signal with estimated HRF based on its quasi-periodicity. On an open source data set that features intensive running exercise, the proposed method achieves a competitive mean average absolute error (AAE) result of 0.92 bpm for HR estimation. The practical experiments are carried out with the PPG evaluation platform developed by ourselves. Under three different intensive motion patterns, a 0.89 bpm average AAE result is achieved with the average correlation coefficient between recovered PPG signal and reference PPG signal reaching 0.86. The experimental results demonstrate the effectiveness of the proposed method for accurate HR estimation and robust MA removal in PPG during intensive exercise.

Aberrances of Cortex Excitability and Connectivity Underlying Motor Deficit in Acute Stroke.

Purpose: This study was aimed at evaluating the motor cortical excitability and connectivity underlying the neural mechanism of motor deficit in acute stroke by the combination of functional magnetic resonance imaging (fMRI) and electrophysiological measures. Methods: Twenty-five patients with motor deficit after acute ischemic stroke were involved. General linear model and dynamic causal model analyses were applied to fMRI data for detecting motor-related activation and effective connectivity of the motor cortices. Motor cortical excitability was determined as a resting motor threshold (RMT) of motor evoked potential detected by transcranial magnetic stimulation (TMS). fMRI results were correlated with cortical excitability and upper extremity Fugl-Meyer assessment scores, respectively. Results: Greater fMRI activation likelihood and motor cortical excitability in the ipsilesional primary motor area (M1) region were associated with better motor performance. During hand movements, the inhibitory connectivity from the contralesional to the ipsilesional M1 was correlated with the degree of motor impairment. Furthermore, ipsilesional motor cortex excitability was correlated with an enhancement of promoting connectivity in ipsilesional M1 or a reduction of interhemispheric inhibition in contralesional M1. Conclusions: The study suggested that a dysfunction of the ipsilesional M1 and abnormal interhemispheric interactions might underlie the motor disability in acute ischemic stroke. Modifying the excitability of the motor cortex and correcting the abnormal motor network connectivity associated with the motor deficit might be the therapeutic target in early neurorehabilitation for stroke patients.

Resting-state fMRI revealed different brain activities responding to valproic acid and levetiracetam in benign epilepsy with central-temporal spikes.

OBJECTIVES: Our aim was to investigate regional difference in brain activities in response to antiepileptic drug (AED) medications in benign epilepsy with central-temporal spikes (BECTS) using resting-state functional magnetic resonance imaging (fMRI). METHODS: Fifty-seven patients with BECTS underwent resting-state fMRI scans after receiving either valproic acid (VPA) (n = 15), levetiracetam (LEV) (n = 21), or no medication (n = 21). fMRI regional homogeneity (ReHo) parameter among the three groups of patients were compared and were correlated with total doses of AED in the two medicated groups. RESULTS: Compared with patients on no-medication, patients receiving either VPA or LEV showed decreased ReHo in the central-temporal region, frontal cortex, and thalamus. In particular, the VPA group showed greater ReHo decrease in the thalamus and milder in cortices and caudate heads compared with the LEV group. In addition, the VPA group demonstrated a negative correlation between ReHo values in the central-temporal region and medication dose. CONCLUSION: Both VPA and LEV inhibit resting-state neural activity in the central-temporal region, which is the main epileptogenic focus of BECTS. VPA reduced brain activity in the cortical epileptogenic regions and thalamus evenly, whereas LEV reduced brain activity predominantly in the cortices. Interestingly, VPA showed a cumulative effect on inhibiting brain activity in the epileptogenic regions in BECTS. KEY POINTS: • Regional differences in brain activity in response to different AEDs in BECTS. • AEDs inhibit resting-state neural activity in epileptogenic and subcortical regions in BECTS. • Valproic acid effect on the cortical epileptogenic regions and thalamus evenly. • Levetiracetam effect seen predominantly in cortices. • Valproic acid has a cumulative effect on inhibiting brain activity in epileptogenic regions.