Minimal important difference of Berg Balance Scale, performance-oriented mobility assessment and dynamic gait index in chronic stroke survivors.

OBJECTIVE: The Berg Balance Scale (BBS), Performance-Oriented Mobility Assessment (POMA), and Dynamic Gait Index (DGI) are crucial standard tools used to evaluate functional balance. However, their minimal important difference (MID) threshold is yet to be established. The objective of this research was to explore the MID for BBS, POMA, and DGI in people suffering from chronic stroke. METHODS: A total of 130 chronic stroke patients were assessed using BBS, POMA and DGI before and after undergoing interventions. The treatment procedures included a series of task-oriented exercises focusing on motor re-learning. In anchor-based approach, the Clinical Global Impression of Improvement scale served as the anchor. The Receiver Operating Characteristic (ROC) curve was employed to identify the best MID cut-off point for BBS, POMA, and DGI. In the distribution-based approach, one-third standard deviation (SD), half SD, one standard error of measurement (SEM), and the total score of BBS, POMA and DGI were used to determine the MID. RESULTS: The MID from the ROC curve was greater than 2 points for BBS, greater than 1 point for POMA and DGI. For the distribution-based approach, the MIDs corresponding to one-third of the SD, half of the SD, and one SEM for BBS were 1.92, 3.20, and 0.90; for POMA were 1.47, 2.45, and 1.96; for DGI were 1.48, 2.47, and 1.16 points, respectively. CONCLUSION: BBS, POMA and DGI are suitable instruments for assessing functional balance in individuals with chronic stroke, with demonstrable MID. Additionally, the results indicated that DGI has higher sensitivity and specificity than the other examined scales for distinguishing between groups without change and those with minimal balance improvement after receiving interventions.

Psychometric features of Neuropathic Pain Symptom Inventory in Iranian people with Parkinson's disease.

OBJECTIVE: Neuropathic pain is a type of pain reported in people with Parkinson's disease. There are various scales to evaluate the characteristics of this kind of pain. The purpose of this study was to investigate the psychometric properties of the Neuropathic Pain Symptom Inventory (NPSI), a specific scale that measures neuropathic pain in Iranian people with Parkinson's disease. METHOD: Four hundred forty-seven individuals with Parkinson's disease were recruited in the study. Acceptability, internal consistency (Cronbach's alpha), and test-retest reliability (intraclass correlation coefficient, ICC) of NPSI were calculated. Dimensionality was examined through exploratory factor analysis. For convergent validity, correlations of NPSI with Douleur Neuropathic 4, Brief Pain Inventory, King's Pain Parkinson disease Scale, and Visual Analog Scale-Pain were used. Discriminative validity and sensitivity to change between On- and Off- medication states were analyzed. RESULTS: A marked floor effect was observed for this scale (64.2%). Cronbach's alpha and ICC were 0.90 and 0.87, respectively. Items of NPSI were placed in 4 factors. A moderate to the strong association (rs = 0.55 to 0.85) between NPSI and other scales was obtained. The results of discriminative validity and sensitivity to change indicate the ability of NPSI to show differences between medication states. CONCLUSION: The results of this study suggest that NPSI has acceptable reliability, validity, and sensitivity to change, indicating that this scale is suitable for measuring neuropathic pain in Iranian people with Parkinson's disease.

Teledentistry as a novel pathway to improve dental health in school children: a research protocol for a randomised controlled trial.

BACKGROUND: Despite great improvement in child oral health, some children subgroups still suffer from higher levels of dental caries. Geographic and socioeconomic barriers and the lack of access to dental care services are among common reasons for poor oral health in children. Historically in Australia, oral health therapists or dental therapists have been responsible for providing dental care for school children through the School Dental Services (SDS). The current SDS has been unable to provide sustainable dental care to all school children due to a reduction in workforce participation and limited resources. We propose a paradigm shift in the current service through the introduction of user-friendly technology to provide a foundation for sustainable dental care for school children. METHODS/DESIGN: We describe an ongoing parallel, two-armed, non-inferiority randomised controlled trial that compares routine and teledental pathway of dental care in children aged 4-15 years (n = 250). Participating schools in Western Australia will be randomly assigned to the control or teledental group, approximately three schools in each group with a maximum of 45 children in each school. All participants will first receive a standard dental examination to identify those who require urgent referrals and then their teeth will be photographed using a smartphone camera. At the baseline, children in the control group will receive screening results and advice on the pathway of dental care based on the visual dental screening while children in the teledental group will receive screening results based on the assessment of dental images. At 9 months follow-up, all participants will undergo a final visual dental screening. The primary outcomes include decay experience and proportion of children become caries active. The secondary outcomes include the diagnostic performance of photographic dental assessment and costs comparison of two pathways of dental care. DISCUSSION: The current project seeks to take advantage of mobile technology to acquire dental images from a child's mouth at school settings and forwarding images electronically to an offsite dental practitioner to assess and prepare dental recommendations remotely. Such an approach will help to prioritise high-risk children and provide them with a quick treatment pathway and avoid unnecessary referrals or travel. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry, ACTRN12619001233112. Registered 06 September 2019.

Psychometric properties of the Berg balance scale in idiopathic Parkinson' disease in the drug off-phase.

BACKGROUND: Having an appropriate tool for assessment of the balance status during the drug off-phase in idiopathic Parkinson's disease (PD) is relevant for clinical and research settings. Our objective was to assess the clinimetric properties of the Berg balance scale (BBS) during drug off-phase in PD. METHOD: Balance of 98 PD patients (mean age ± SD, 59.19 ± 10.88 years) was evaluated with the BBS. Other assessments in the study included the Fall Efficacy Scale-International (FES-I), Functional Reach Test (FRT), Section II of the Unified Parkinson's Disease Rating Scale-3.0, Parkinson's Disease Questionnaire-39 (PDQ-39), and Schwab and England Activities of Daily Living Scale. All evaluations took place during the drug off-phase. Internal consistency and inter- and intra-rater reliability were evaluated by Cronbach's alpha coefficient and intraclass correlation coefficient, respectively. Dimensionality was explored by factor analysis. Discriminative validity was tested by comparing BBS score between PD patients with and without a history of falling. RESULTS: Internal consistency was high (α = 0.98), as were intra- and inter-rater reliability (ICC = 0.98 and 0.95, respectively). Factor analysis identified only one dimension for the BBS, whose convergent validity with FES-I, FRT, and domain mobility of the PDQ-39 were moderate or high (rS = |0.60-0.74|). Correlation of BBS with functional scales and PDQ-39 Summary Index was moderate (rS = |0.45-0.62|). Finally, the BBS showed a moderate strength to discriminate between PD patients with and without a history of falling. CONCLUSION: Our study suggests that BBS has satisfactory internal consistency, reliability, and construct validity for measuring functional balance in people with PD during the drug off-phase.

The association between fear of falling and quality of life for balance impairments based on hip and ankle strategies in the drug On- and Off-phase of patients with idiopathic Parkinson' disease.

Background: Despite the negative effect of fear of falling during functioning and social participation of patients with Parkinson' disease, so far, only few studies have investigated its effect on the quality of life in these patients. We aimed to investigate the association between fear of falling and quality of life controlling for balance impairments based on hip and ankle strategy in drug On- and Off-phase of patients with idiopathic Parkinson' disease. Methods: In this non-experimental cross-sectional study, 139 patients with idiopathic Parkinson' disease (100 male, 39 female) by mean± SD age of 60.2±12.27 years, mean±SD time since diagnosis of 6.7±5.53 years and mean±SD Hoehn and Yahr stage of 2.8±1.49 were selected by a simple non-probability method. Balance function was measured by a functional reach test with hip and ankle strategy. The Persian version of the selfcompleted Fall Efficacy Scale-International and Parkinson's disease quality of life questionnaire was used to evaluate fear of falling and quality of life, respectively. Results: The results showed that the score of all dimensions of quality of life (i.e., mobility, activities of daily living, emotional wellbeing, stigma, social support, cognition, communication and bodily discomfort) were significantly affected by the intensity of fear of falling. Multiple regression analysis indicated a significant association between fear of falling and quality of life in a way that fear of falling explained 11% to 47% and 12% to 43% of variance in drug On-phase, as well as 8% to 45% and 9% to 48% of variance in the drug Off-phase in dimensions of quality of life after controlling for balance function based on hip and ankle strategy, respectively. In the drug On-phase, the strongest association (R=0.85, p<0.001) was found between fear of falling and mobility dimension of quality of life. In the drug Off-phase, the strongest relation was observed between fear of falling and mobility (R=0.82, p<0.001) as well as activities of daily living (R=0.78-0.79, p<0.001) dimensions. Conclusion: This study found that fear of falling affects the quality of life of patients with Parkinson' disease beyond its relationship with balance impairments based on the hip and ankle strategy in both drug On- and Off-phase.

Employing texture loss to denoise OCT images using generative adversarial networks.

OCT is a widely used clinical ophthalmic imaging technique, but the presence of speckle noise can obscure important pathological features and hinder accurate segmentation. This paper presents a novel method for denoising optical coherence tomography (OCT) images using a combination of texture loss and generative adversarial networks (GANs). Previous approaches have integrated deep learning techniques, starting with denoising Convolutional Neural Networks (CNNs) that employed pixel-wise losses. While effective in reducing noise, these methods often introduced a blurring effect in the denoised OCT images. To address this, perceptual losses were introduced, improving denoising performance and overall image quality. Building on these advancements, our research focuses on designing an image reconstruction GAN that generates OCT images with textural similarity to the gold standard, the averaged OCT image. We utilize the PatchGAN discriminator approach as a texture loss to enhance the quality of the reconstructed OCT images. We also compare the performance of UNet and ResNet as generators in the conditional GAN (cGAN) setting, as well as compare PatchGAN with the Wasserstein GAN. Using real clinical foveal-centered OCT retinal scans of children with normal vision, our experiments demonstrate that the combination of PatchGAN and UNet achieves superior performance (PSNR = 32.50) compared to recently proposed methods such as SiameseGAN (PSNR = 31.02). Qualitative experiments involving six masked clinical ophthalmologists also favor the reconstructed OCT images with PatchGAN texture loss. In summary, this paper introduces a novel method for denoising OCT images by incorporating texture loss within a GAN framework. The proposed approach outperforms existing methods and is well-received by clinical experts, offering promising advancements in OCT image reconstruction and facilitating accurate clinical interpretation.

A Deep Learning-Based System for the Assessment of Dental Caries Using Colour Dental Photographs.

D1ental caries remains the most common chronic disease in childhood, affecting almost half of all children globally. Dental care and examination of children living in remote and rural areas is an ongoing challenge that has been compounded by COVID. The development of a validated system with the capacity to screen large numbers of children with some degree of automation has the potential to facilitate remote dental screening at low costs. In this study, we aim to develop and validate a deep learning system for the assessment of dental caries using color dental photos. Three state-of-the-art deep learning networks namely VGG16, ResNet-50 and Inception-v3 were adopted in the context. A total of 1020 child dental photos were used to train and validate the system. We achieved an accuracy of 79% with precision and recall respectively 95% and 75% in classifying 'caries' versus 'sound' with inception-v3.

Minimal clinically important difference of the King's Parkinson's disease Pain Scale.

OBJECTIVE: Pain is a common and debilitating symptom of Parkinson's disease (PD) and has no specific treatment. King's Parkinson's disease Pain Scale (KPPS) is the only specific scale for pain measurement in PD with established psychometric properties. The minimal clinically important difference (MCID) of KPPS, an important parameter for the design and interpretation of therapeutic interventions, has not yet been measured. The aim of our study was to assess the MCID of KPPS. METHODS: Two hundred and seven PD patients were evaluated by KPPS before and after receiving the intervention. The Clinical Global Impression of Improvement Scale was used as an anchor, and a Receiver Operating Characteristic (ROC) curve was used to determine the optimal MCID cut-off point for KPPS. The distribution-based approach applied one-third standard deviation (SD), 0.5 SD, and one standard error of measurement (SEM) of the total score of KPPS to determine the MCID. RESULTS: The MCID achieved from the ROC curve was 3 points (sensitivity: 74.4%; specificity: 81.9%). For the distribution-based method, the MCIDs corresponding to 0.3 SD, 0.5 SD, and one SEM were 5.65, 9.41, and 2.54 points, respectively. CONCLUSION: KPPS is a valid scale for measuring pain in PD with demonstrable MCID. IMPLICATIONS FOR REHABILITATIONThe King's Parkinson's disease Pain Scale (KPPS) is a valid scale for measuring pain in patients with Parkinson's disease (PD) with demonstrable minimal clinically important difference (MCID).The MCID obtained in the current study will assist clinicians and researchers when interpreting KPPS change score to determine clinically meaningful changes of pain in both PD progression and response to interventions.

The Effect of Physical Exercise Pretreatment on Spatial Memory and Learning and Function of Mitochondria in the Brain in Type 2 Diabetic Rats.

Background: The prevalence of type 2 diabetes mellitus (T2DM) is increasing worldwide, and this issue is one of the major concerns in the pending years. T2DM causes numerous complications, including cognition, learning, and memory impairments. The positive effect of physical exercise as a popular approach has been shown in many chronic diseases. Further, the improvement effects of exercise on cognition and memory impairment have been noticed. Objectives: This study examines the possible preventative effects of physical exercise on spatial memory attenuation and brain mitochondrial dysfunction caused by T2DM. Methods: Male Wistar rats received treadmill exercise (30 min per day, five days per week for two or four weeks). Then, T2DM was induced by a high-fat diet and an injection of streptozotocin (30 mg/kg). Spatial learning and memory were assessed by the Morris water maze test. Further, brain mitochondrial function, including reactive oxygen species (ROS) generation, mitochondrial membrane potential (MMP), mitochondrial swelling, outer membrane damage, cytochrome c release, and ADP/ATP ratio, were measured. Results: Impaired spatial memory in T2DM rats was observed. Furthermore, brain mitochondrial dysfunction was demonstrated proved by increased ROS generation, MMP collapse, mitochondrial swelling, outer membrane damage, cytochrome c release, and ADP/ATP ratio. Conversely, physical exercise, before diabetes onset, significantly ameliorated spatial memory impairment and brain mitochondrial dysfunction. Conclusions: This study reveals that physical exercise could prevent diabetes-induced spatial memory impairment. Moreover, it could ameliorate brain mitochondrial dysfunction as one of the possible underlying mechanisms of spatial memory impairment in T2DM.

Evaluation of a deep learning system for automatic detection of proximal surface dental caries on bitewing radiographs.

OBJECTIVE: This study aimed to evaluate a deep learning (DL) system using convolutional neural networks (CNNs) for automatic detection of caries on bitewing radiographs. STUDY DESIGN: In total, 2468 bitewings were labeled by 3 dentists to create the reference standard. Of these images, 1257 had caries and 1211 were sound. The Faster region-based CNN was applied to detect the regions of interest (ROIs) with potential lesions. A total of 13,246 ROIs were generated from all 'sound' images, and 50% of 'caries' images (selected randomly) were used to train the ROI detection module. The remaining 50% of 'caries' images were used to validate the ROI detection module. Caries detection was then performed using Inception-ResNet-v2. A set of 3297 'caries' and 5321 'sound' ROIs cropped from the 2468 images was used to train and validate the caries detection module. Data sets were randomly divided into training (90%) and validation (10%) data sets. Recall, precision, specificity, accuracy, and F1 score were used as metrics to assess performance. RESULTS: The caries detection module achieved recall, precision, specificity, accuracy, and F1 scores of 0.89, 0.86, 0.86, 0.87, and 0.87, respectively. CONCLUSIONS: The proposed DL system demonstrated promising performance for detecting proximal surface caries on bitewings.

Deep learning for automated detection and numbering of permanent teeth on panoramic images.

OBJECTIVE: This study aimed to evaluate an automated detection system to detect and classify permanent teeth on orthopantomogram (OPG) images using convolutional neural networks (CNNs). METHODS: In total, 591 digital OPGs were collected from patients older than 18 years. Three qualified dentists performed individual teeth labelling on images to generate the ground truth annotations. A three-step procedure, relying upon CNNs, was proposed for automated detection and classification of teeth. Firstly, U-Net, a type of CNN, performed preliminary segmentation of tooth regions or detecting regions of interest (ROIs) on panoramic images. Secondly, the Faster R-CNN, an advanced object detection architecture, identified each tooth within the ROI determined by the U-Net. Thirdly, VGG-16 architecture classified each tooth into 32 categories, and a tooth number was assigned. A total of 17,135 teeth cropped from 591 radiographs were used to train and validate the tooth detection and tooth numbering modules. 90% of OPG images were used for training, and the remaining 10% were used for validation. 10-folds cross-validation was performed for measuring the performance. The intersection over union (IoU), F1 score, precision, and recall (i.e. sensitivity) were used as metrics to evaluate the performance of resultant CNNs. RESULTS: The ROI detection module had an IoU of 0.70. The tooth detection module achieved a recall of 0.99 and a precision of 0.99. The tooth numbering module had a recall, precision and F1 score of 0.98. CONCLUSION: The resultant automated method achieved high performance for automated tooth detection and numbering from OPG images. Deep learning can be helpful in the automatic filing of dental charts in general dentistry and forensic medicine.

Psychometric properties of dexterity questionnaire-24 in Iranian chronic stroke survivors.

INTRODUCTION: Dexterity is one of the most critical upper extremity functions that may be impaired in chronic stroke survivors. This study aimed to investigate the psychometric properties of DextQ-24 in Iranian chronic stroke survivors. METHOD: A total of 123 people with chronic stroke were included in the study. Internal consistency and test-retest reliability were assessed through Cronbach's alpha and Interclass Correlation (ICC), respectively. Dimensionality was performed by Exploratory Factor Analysis. In addition, to assess the convergent validity of DextQ-24, Box and Block Test, Motor Activity Log Questionnaire, ABILHAND Questionnaire, and Purdue Pegboard Test were used. Discriminant validity of DextQ-24 was measured between different stages of recovery (Brunnstrom stage). Acceptability was calculated by ceiling and floor effect. RESULTS: Cronbach's alpha and ICC were 0.92 and 0.91, respectively. The 24 items of this questionnaire were classified into six components. Further, a moderate to strong correlation between the total score of DextQ-24 with other tools | r = 0.41-0.84 | was obtained. The results of discriminant validity approved the ability of the total score of DextQ-24 to separate different stages of recovery. The results also reported that this questionnaire did not have a significant ceiling and floor effect. CONCLUSION: The results of our study showed that the Persian DextQ-24 has high reliability and a good convergent and discriminant validity in people with chronic stroke for dexterity measurement as a PROM questionnaire.

Reliability, validity, and diagnostic accuracy of Parkinson's Disease-Cognitive Rating Scale in Iranian patients with idiopathic Parkinson's disease.

PURPOSE: To investigate the reliability and validity of Parkinson's Disease-Cognitive Rating Scale (PD-CRS) in Iranian patients with idiopathic PD. METHODS: One hundred and eighty patients with PD and 60 age-, gender-, and educational level-matched healthy individuals participated in this study. Inter-rater and test-retest reliability of the Persian version of PD-CRS was investigated in 80 patients with PD. To evaluate the construct validity of the PD-CRS, its correlation with the Scales for Outcomes in Parkinson's disease-Cognition (SCOPA-Cog), Mini-Mental State Examination, Montreal Cognitive Assessment, Clock Drawing Test, Unified Parkinson's Disease Rating Scale-Section I, and Quick Dementia Rating System was assessed. To assess the diagnostic accuracy of the PD-CRS, patients with PD were classified as groups with normal cognitive function, mild cognitive impairment (MCI), and dementia using the Clinical Dementia Rating. RESULTS: Test-retest and inter-rater reliability (ICC > 0.90), as well as internal consistency (α = 0.94) of the Persian version of PD-CRS, were excellent. A high positive correlation was found between the PD-CRS and SCOPA-Cog. A cut-off point of ≤79 (sensitivity 98.15% and specificity 98.04%) and ≤62 (sensitivity 100%, and specificity 100%) on the PD-CRS total score was obtained for detecting MCI and dementia in PD patients, respectively. CONCLUSIONS: The results of this study showed that the Persian version of PD-CRS is a reliable and valid measure with high sensitivity and specificity to identify MCI and dementia in patients with PD.Implications for rehabilitationThe PD-CRS has an excellent test-retest and inter-rater reliability and validity in Iranian patients with PD.The PD-CRS has high sensitivity and specificity for discriminating between different levels of cognitive impairment (i.e. no cognitive impairment, mild cognitive impairment, and dementia) in Iranian patients with PD.

Staging of cognitive impairment in Parkinson's disease: validity of Quick Dementia Rating System.

PURPOSE: This study aimed to investigate the ability of the Quick Dementia Rating System (QDRS) to discriminate patients with PD who have mild cognitive impairment from those without cognitive impairment and those with dementia. METHOD: A total of 105 patients with PD were classified as without cognitive impairment (N = 32), with mild cognitive impairment (N = 23), and PDD (N = 50), according to their score on clinical dementia rating. Multivariate regression analysis was performed considering age, education, and disease severity as covariates and mild cognitive impairment or dementia as outcome variables. Receiver operating characteristic curve analysis was carried out to derive the optimal cut-off points. RESULTS: The cut-off point >2.5 (sensitivity = 86.96%, area under curve (AUC) = 0.88) was obtained for discriminating patients with mild cognitive impairment from those without cognitive impairment based on the total score of QDRS. The cut-off point >5 (sensitivity = 84%, AUC = 0.84) was derived for discriminating mild cognitive impairment from dementia based on the total score of QDRS. CONCLUSIONS: The results of this study showed a good discriminative validity of the QDRS for discriminating mild cognitive impairment from no cognitive impairment and dementia in patients with PD.IMPLICATIONS FOR REHABILITATIONThe Quick Dementia Rating System has a good discriminative validity for diagnosing mild cognitive impairment from normal cognitive function in Parkinson's disease.The Quick Dementia Rating System has a good discriminative validity for diagnosing mild cognitive impairment from dementia in Parkinson's disease.The Quick Dementia Rating System could be suggested as a routine rapid cognitive screening tool for patients with Parkinson's disease.

Mobile photographic screening for dental caries in children: Diagnostic performance compared to unaided visual dental examination.

OBJECTIVES: This study was conducted to compare the use of intraoral photographs with the unaided visual dental examination as a means of dental caries detection in children. METHODS: Children aged 4- to 14-year-olds were visually examined at their schools. Following dental examinations, children had five photographs of their teeth taken using a smartphone camera. Four dental reviewers, who are different from those who visually examined the children, assessed intraoral photographs for dental caries. Sensitivity, specificity, and inter-rater reliability agreement were estimated to assess the diagnostic performance of the photographic method relative to the benchmark visual dental assessments. Caries prevalence was measured using dft/DFT (decayed and filled teeth) index. RESULTS: One hundred thirty-eight children (67 male and 71 female) were enrolled and had a mean age of 7.8 ± 2.1 years. The caries prevalence (dft/DFT > 0) using photographic dental assessments ranged from 30 percent to 39 percent but was not significantly different from the prevalence (42 percent) estimated with the visual dental examination (P ≥ 0.07). The sensitivity and specificity of the photographic method for detection of dental caries compared to visual dental assessments were 58-80 percent and 99.7-99.9 percent, respectively. The sensitivity for the photographic assessments was high in the primary dentition (63-82 percent) and children ≤7-year-olds (67-78 percent). The inter-rater reliability for the photographic assessment versus the benchmark ranged from substantial to almost perfect agreement (Kappa = 0.72-0.87). CONCLUSIONS: The photographic approach to dental screening, used within the framework of its limitations, yielded an acceptable diagnostic level of caries detection, particularly in younger children with primary dentition.

Psychometric features of brief pain inventory for Parkinson's disease during medication states.

PURPOSE: Patients with idiopathic Parkinson's disease (PD) suffer from different non-motor symptoms, including pain. The present study aimed to measure the psychometric properties of the Brief Pain Inventory (BPI) in patients with PD during ON- and OFF-states. METHODS: We recruited 460 patients with PD and 100 non-PD controls. The pain was assessed by the BPI, King's Parkinson's disease Pain Scale (KPPS), Neuropathic Pain Symptom Inventory (NPSI), Visual Analogue Scale-Pain (VAS-pain), and short-form McGill Pain Questionnaire-2 (SF-MPQ-2) in both medication states. Internal consistency and test-retest reliability was examined using Cronbach's alpha coefficient and intra-class correlation coefficient (ICC). Dimensionality and convergent validity of BPI were also investigated. Diagnostic accuracy and discriminative validity were determined by Receiver Operating Characteristics (ROC) curve analysis and Area Under the Curve (AUC). RESULTS: Cronbach's alpha was satisfactory (α = 0.91-0.97) in both states. The ICC values were 0.85-0.96 in ON- and OFF-state. Factor analysis revealed two factors. A high correlation was obtained between BPI subscales and other scales. AUC >0.91, sensitivity, and specificity> 0.77 were observed for discriminating different pain levels. Furthermore, appropriate diagnostic accuracy was found (AUC, sensitivity, and specificity >0.67) between non-PD control and PD patients. CONCLUSION: The BPI has acceptable psychometric features as well as diagnostic accuracy for patients with PD.Implications for rehabilitationPain as a non-motor symptom in PD can affect daily and social activities.The BPI is used to assess pain severity and interference in activities.For better treatment, pain should be assessed in off-state like to on-state.BPI has satisfactory reliability and validity in different medication states in PD.

An in Vitro Study of Molecular Effects of a Combination Treatment with Antibiotics and Nanofluid Containing Carbon Nano-tubes on Klebsiella pneumoniae.

BACKGROUND: We aimed to prepare a nanofluid, containing f-MWCNTs, and investigate the antibacterial efficacy of f-MWCNTs+ ciprofloxacin (cip) on Klebsiella pneumoniae by evaluating the virulence gene expression. METHODS: This study was carried out from 2019 to 2020, in the Department of Mycobacteriology and Pulmonary Research, Pasteur Institute of Iran. The nanofluid containing antibiotic and f-MWCNTs were prepared by the ultrasonic method. The minimum inhibitory concentrations (MICs) of ciprofloxacin and f-MWCNTs were determined using the broth micro dilution MIC tests. For examining the antibacterial effects, the expression level of virulence genes, under the influence of f-MWCNTs, was evaluated by a real-time PCR. RESULTS: The effect of 8 µg/ml ciprofloxacin + 400 µg/ml f-MWCNTs, completely inhibited the growth of the resistant isolate of K. pneumoniae, while, in the ATCC 700,603 isolate, 2 µg/ml ciprofloxacin with 100 µg/ml f-MWCNT could inhibit a bacterial growth. In the resistant K. pneumoniae clinical isolate, after f-MWCNT+cip treatment, the expression of fimA, fimD, wza, and wzi genes was significantly downregulated, compared to the ciprofloxacin treatment, and upregulated, compared to the negative control. For the ATCC 700,603 isolate treated with f-MWCNT+cip, the expression of fimA, fimD and wza virulence genes showed upregulation, compared to the negative control and downregulated in comparison with the ciprofloxacin treatment. CONCLUSION: Simultaneous treatment of resistant isolate of K. pneumoniae with f-MWCNTs +antibiotic could improve the effectiveness of antibiotic at lower doses, due to the reduced expression of virulence genes in comparison with antibiotic treatment, besides the increased cell wall permeability to antibiotics.

King's Parkinson's disease pain scale cut-off points for detection of pain severity levels: A reliability and validity study.

BACKGROUND: Pain is one of the most common non-motor symptoms in Parkinson's disease (PD). Using an appropriate and specific measuring tool would be helpful in managing the pain. King's Parkinson's disease Pain Scale (KPPS) is an instrument designed to specifically measure pain in people with PD. PURPOSE: This study aimed to examine the psychometric properties of the Persian version of KPPS (KPPS-P) and its cut-off points for pain severity levels. METHODS: A total of 480 people with PD (with a mean (SD) age of 60.89 (10.98)) were recruited. The acceptability of KPPS-P was calculated. The structural validity and discriminant validity for different levels of pain was explored via the factor analysis, and Receiver Operating Characteristics (ROC) curves, respectively. Internal consistency, test-retest, and inter-rater reliability were estimated by Cronbach's alpha and Interclass Correlation coefficient (ICC). Convergent validity was established between KPPS-P and other scales including Visual Analog Scale-Pain, Douleur Neuropathic 4, Brief Pain Inventory, Short-form McGill Pain Questionnaire-2, and Parkinson's Disease-8. RESULTS: A significant floor effect was observed. The exploratory factor analysis revealed 4 factors. Cronbach's alpha and ICC values were higher than 0.80. The correlation range between KPPS-P and other scales was 0.35-0.76. Cut-off points of 0, 17, and 68 were obtained to discriminate pain severity levels between no pain, mild, moderate, and severe pain, respectively, with sensitivity and specificity above 0.80. CONCLUSION: Our results indicate that the Persian version of KPPS not only has acceptable psychometric properties to assess pain in PD but also has the ability to distinguish between different levels of pain severity.

Deep feature loss to denoise OCT images using deep neural networks.

SIGNIFICANCE: Speckle noise is an inherent limitation of optical coherence tomography (OCT) images that makes clinical interpretation challenging. The recent emergence of deep learning could offer a reliable method to reduce noise in OCT images. AIM: We sought to investigate the use of deep features (VGG) to limit the effect of blurriness and increase perceptual sharpness and to evaluate its impact on the performance of OCT image denoising (DnCNN). APPROACH: Fifty-one macula-centered OCT pairs were used in training of the network. Another set of 20 OCT pair was used for testing. The DnCNN model was cascaded with a VGG network that acted as a perceptual loss function instead of the traditional losses of L1 and L2. The VGG network remains fixed during the training process. We focused on the individual layers of the VGG-16 network to decipher the contribution of each distinctive layer as a loss function to produce denoised OCT images that were perceptually sharp and that preserved the faint features (retinal layer boundaries) essential for interpretation. The peak signal-to-noise ratio (PSNR), edge-preserving index, and no-reference image sharpness/blurriness [perceptual sharpness index (PSI), just noticeable blur (JNB), and spectral and spatial sharpness measure (S3)] metrics were used to compare deep feature losses with the traditional losses. RESULTS: The deep feature loss produced images with high perceptual sharpness measures at the cost of less smoothness (PSNR) in OCT images. The deep feature loss outperformed the traditional losses (L1 and L2) for all of the evaluation metrics except for PSNR. The PSI, S3, and JNB estimates of deep feature loss performance were 0.31, 0.30, and 16.53, respectively. For L1 and L2 losses performance, the PSI, S3, and JNB were 0.21 and 0.21, 0.17 and 0.16, and 14.46 and 14.34, respectively. CONCLUSIONS: We demonstrate the potential of deep feature loss in denoising OCT images. Our preliminary findings suggest research directions for further investigation.