Gait and/or balance disturbances associated with Alzheimer's dementia among older adults with amnestic mild cognitive impairment: A longitudinal observational study.

AIMS: To explore whether gait and/or balance disturbances are associated with the onset of Alzheimer's dementia (AD) among older adults with amnestic mild cognitive impairment (MCI). DESIGN: This study employed a longitudinal retrospective cohort design. METHODS: We obtained data from the National Alzheimer's Coordinating Center's Uniform Data Set collected from 35 National Institute on Aging Alzheimer's Disease Research Centers between September 2005 and December 2021. The mean age of participants (n = 2692) was 74.5 years with women making up 47.2% of the sample. Risk of incident AD according to baseline gait and/or balance disturbances as measured using the Postural Instability and Gait Disturbance Score, a subscale of the Unified Parkinson's Disease Rating Scale Motor Score, was examined by the Cox proportional hazards regression models adjusting for baseline demographics, medical conditions and study sites. The mean follow-up duration was 4.0 years. RESULTS: Among all the participants, the presence or the severity of gait and/or balance disturbances was associated with an increased risk of AD. The presence or the severity of gait and/or balance disturbances was associated with a higher risk of Alzheimer's dementia among the subgroups of female and male participants. CONCLUSION: Gait and/or balance disturbances may increase the risk of developing AD, regardless of sex. IMPACT: Gait and/or balance disturbances among community-dwelling older adults with amnestic MCI may need to be frequently assessed by nurses to identify potential risk factors for cognitive decline. NO PATIENT OR PUBLIC CONTRIBUTION: Given the secondary analysis, patients, service users, caregivers or members of the public were not directly involved in this study.

Comparison between polynomial regression and weighted least squares regression analysis for verification of analytical measurement range.

OBJECTIVES: Recently, the linearity evaluation protocol by the Clinical & Laboratory Standards Institute (CLSI) has been revised from EP6-A to EP6-ED2, with the statistical method of interpreting linearity evaluation data being changed from polynomial regression to weighted least squares linear regression (WLS). We analyzed and compared the analytical measurement range (AMR) verification results according to the present and prior linearity evaluation guidelines. METHODS: The verification of AMR of clinical chemistry tests was performed using five samples with two replicates in three different laboratories. After analyzing the same evaluation data in each laboratory by the polynomial regression analysis and WLS methods, results were compared to determine whether linearity was verified across the five sample concentrations. In addition, whether the 90% confidence interval of deviation from linearity by WLS was included in the allowable deviation from linearity (ADL) was compared. RESULTS: A linearity of 42.3-56.8% of the chemistry items was verified by polynomial regression analysis in three laboratories. For analysis of the same data by WLS, a linearity of 63.5-78.3% of the test items was verified where the deviation from linearity of all five samples was within the ADL criteria, and the cases where the 90% confidence interval of all deviation from linearity overlapped the ADL was 78.8-91.3%. CONCLUSIONS: Interpreting AMR verification data by the WLS method according to the newly revised CLSI document EP6-ED2 could reduce laboratory workload, enabling efficient laboratory practice.

Nationwide Survey for Current Status of Laboratory Diagnosis of Clostridioides difficile Infection in Korea.

BACKGROUND: The interest in Clostridioides difficile infection (CDI) has increased, and the choice of assays became wider since the first national survey in Korea on CDI diagnosis in 2015. We conducted a survey of the domestic CDI assays with more varied questions to understand the current situation in Korea. METHODS: In April 2018, about 50 questions on the current status of CDI assays and details on implementation and perceptions were written, and a survey questionnaire was administered to laboratory medicine specialists in 200 institutions. RESULTS: One-hundred and fifty institutions responded to the questionnaire, of which 90 (60.0%) including one commercial laboratory, performed CDI assays. The toxin AB enzyme immunoassay (toxin AB EIA), nucleic acid amplification test (NAAT), and C. difficile culture, glutamate dehydrogenase assay, alone or in combination with other assays, were used in 75 (84.3%), 52 (58.4%), 35 (36.0%), and 23 (25.8%), respectively, and 65 (73.0%) institutions performed a combination of two or more assays. The sensitivity of toxin AB EIA was more negatively perceived, and that on specificity was more positively perceived. The perception of sensitivity and specificity of NAAT was mostly positive. Perception on the algorithm test projected it as useful but in need of countermeasures. Sixty-three (73.3%) institutions responded that they performed surveillance on CDI. CONCLUSION: This study provides useful evidence on the current status of CDI laboratory diagnosis in Korea as well as on items that require improvement and is thought to aid in standardizing and improving the CDI laboratory diagnosis in Korea.

Automation of Harboe method for the measurement of plasma free hemoglobin.

BACKGROUND: Although plasma free hemoglobin (fHb) test is important for assessing intravascular hemolysis, it is still dependent on the gold standard Harboe method using manual and labor-intensive spectrometric measurements at the wavelength of 380-415-450 nm. We established an automated fHb assay using a routine chemistry autoanalyzer that can be tuned to a wavelength of 380-416-450 nm. METHODS: The linearity, precision, accuracy, correlation, and sample carryover of fHb measurement using TBA200FRneo method and manual Harboe method were evaluated, respectively. fHb values measured by manual Harboe method were compared with those measured by our new automated TBA200FRneo method. RESULTS: fHb measurements were linear in the range of 0.05~38.75 µmol/L by TBA200FRneo and 0.05~9.69 µmol/L by manual Harboe method. Imprecision analysis (%CV) revealed 0.9~2.8% for TBA200FRneo method and 5.3~13.6% for the manual Harboe method. Comparison analysis showed 0.9986 of correlation coefficient (TBA200FRneo = 0.970 × Harboe + 0.12). In analytical accuracy analysis, the manual Harboe method revealed about 4 times higher average total error % (12.2%) than the TBA200FRneo automated method (2.8%). The sample carryover was -0.0016% in TBA200FRneo method and 0.0038% in Harboe method. CONCLUSIONS: In the measurement of fHb, the automated TBA200FRneo method showed better performance than the conventional Harboe method. It is expected that the automated fHb assay using the routine chemistry analyzer can replace the gold standard Harboe method which is labor-intensive and need an independent spectrophotometry equipment.

Cortical dynamics within and between parietal and motor cortex in essential tremor.

BACKGROUND: Evidence from functional imaging in essential tremor suggests that activity within parietal and motor cortices may be associated with worsening of tremor at increased visual feedback. OBJECTIVES: Examine how cortical oscillations within these regions and the connectivity between these regions is associated with worsening of tremor in essential tremor in response to high visual feedback. METHOD: The study included 24 essential tremor participants and 17 controls. We measured cortical activity and tremor magnitude at low and high feedback conditions. Cortical activity was measured using high-density electroencephalogram and isolated using source localization. RESULTS: Changes in power across feedback in the 4-12 Hz and 12-30 Hz bands were reduced within the contralateral motor cortex of essential tremor patients compared to controls. The 12-30 Hz bidirectional connectivity between the parietal and contralateral motor cortex was decreased in essential tremor patients. Worsening of tremor from low to high visual feedback was associated with 4-12 Hz activity in contralateral motor cortex. The greatest separation between groups was found when using the difference of the contralateral motor cortex activity at high and low feedback, rather than either feedback condition alone. CONCLUSION: Our findings provide new evidence that tremor in essential tremor is associated with reduced power across feedback in the motor cortex and reduced connectivity between the parietal and motor cortices. Combined with previous work on the cerebellar-thalamo-cortical motor circuit, our findings suggest that the network level disturbances associated with essential tremor extend to the cortico-cortical pathway between the parietal cortex and motor cortex. © 2018 International Parkinson and Movement Disorder Society.

A widespread visually-sensitive functional network relates to symptoms in essential tremor.

Essential tremor is a neurological syndrome of heterogeneous pathology and aetiology that is characterized by tremor primarily in the upper extremities. This tremor is commonly hypothesized to be driven by a single or multiple neural oscillator(s) within the cerebello-thalamo-cortical pathway. Several studies have found an association of blood-oxygen level-dependent (BOLD) signal in the cerebello-thalamo-cortical pathway with essential tremor, but there is behavioural evidence that also points to the possibility that the severity of tremor could be influenced by visual feedback. Here, we directly manipulated visual feedback during a functional MRI grip force task in patients with essential tremor and control participants, and hypothesized that an increase in visual feedback would exacerbate tremor in the 4-12 Hz range in essential tremor patients. Further, we hypothesized that this exacerbation of tremor would be associated with dysfunctional changes in BOLD signal and entropy within, and beyond, the cerebello-thalamo-cortical pathway. We found that increases in visual feedback increased tremor in the 4-12 Hz range in essential tremor patients, and this increase in tremor was associated with abnormal changes in BOLD amplitude and entropy in regions within the cerebello-thalamo-motor cortical pathway, and extended to visual and parietal areas. To determine if the tremor severity was associated with single or multiple brain region(s), we conducted a birectional stepwise multiple regression analysis, and found that a widespread functional network extending beyond the cerebello-thalamo-motor cortical pathway was associated with changes in tremor severity measured during the imaging protocol. Further, this same network was associated with clinical tremor severity measured with the Fahn, Tolosa, Marin Tremor Rating Scale, suggesting this network is clinically relevant. Since increased visual feedback also reduced force error, this network was evaluated in relation to force error but the model was not significant, indicating it is associated with force tremor but not force error. This study therefore provides new evidence that a widespread functional network is associated with the severity of tremor in patients with essential tremor measured simultaneously at the hand during functional imaging, and is also associated with the clinical severity of tremor. These findings support the idea that the severity of tremor is exacerbated by increased visual feedback, suggesting that designers of new computing technologies should consider using lower visual feedback levels to reduce tremor in essential tremor.

Comparison of the lead and copper adsorption capacities of plant source materials and their biochars.

Lead (Pb) and Cu are the most common pollutants found in industrial effluents which affect ecosystem and human health. To remove Pb and Cu from aquatic system, cost-effective and environmentally friendly adsorbents are required. Therefore, the study evaluated the adsorption of Pb and Cu by waste plant materials and their biochars. The adsorption kinetics and isotherms were applied to compare the Pb and Cu adsorption capacities using the gingko (Spiraea blumei) leaf (GL), peanut shell (PS), and Metasequoia leaf (ML), and their derived biochars (GB, PB, and MB, respectively). The GB showed a significantly higher Pb adsorption capacity than the other adsorbents. Maximum Pb adsorption by GB was 138.9 mg/g followed by GL (117.6 mg/g). The highest Cu adsorption (59.9 mg/g) was also achieved by GB followed by GL (57.8 mg/g). The carbonates and the phosphate functional groups in the GB and higher affinity of Pb to the functional groups contributed to higher Pb adsorption. The Pb adsorption kinetics on the plant source materials and their biochars followed a pseudo-second order model. The Pb and Cu adsorption capacities, with the exception of the GL, ML, and GB, are better explained by Langmuir-isotherm models. The carbonization did not always lead to better heavy metal adsorption. The Pb and Cu adsorption significantly reduced with carbonization of ML because of disappearance of oxygen containing functional groups. Therefore, appropriate method to prepare metal adsorbent should be selected depending on feedstocks and metal removal mechanisms. The GL is the most-abundant fallen leaf in the streets of the Republic of Korea; therefore, the use of the GL biochar for heavy-metal adsorption will also reduce the cost for waste disposal.

Pain-Related Suppression of Beta Oscillations Facilitates Voluntary Movement.

Increased beta oscillations over sensorimotor cortex are antikinetic. Motor- and pain-related processes separately suppress beta oscillations over sensorimotor cortex leading to the prediction that ongoing pain should facilitate movement. In the current study, we used a paradigm in which voluntary movements were executed during an ongoing pain-eliciting stimulus to test the hypothesis that a pain-related suppression of beta oscillations would facilitate the initiation of a subsequent voluntary movement. Using kinematic measures, electromyography, and high-density electroencephalography, we demonstrate that ongoing pain leads to shorter reaction times without affecting the kinematics or accuracy of movement. Reaction time was positively correlated with beta power prior to movement in contralateral premotor areas. Our findings corroborate the view that beta-band oscillations are antikinetic and provide new evidence that pain primes the motor system for action. Our observations provide the first evidence that a pain-related suppression of beta oscillations over contralateral premotor areas leads to shorter reaction times for voluntary movement.

Recovery of sulfuric acid aqueous solution from copper-refining sulfuric acid wastewater using nanofiltration membrane process.

We used a nanofiltration (NF) membrane process to produce purified aqueous sulfuric acid from copper-refining sulfuric acid wastewater. Wastewater generated from a copper-refining process was used to explore the membrane performances and acid stabilities of six commercial NF membranes. A combination of permeate flux, sulfate permeation, and metal ion rejection clearly showed that two polyamide membranes and a polyacrylonitrile-based membrane achieved recovery of a purified sulfuric acid solution. Acid-stability and long-term performance tests showed that the polyamide membranes were unsuitable for copper-refining wastewater treatment because of their low acid stabilities. In contrast, the polyacrylonitrile-based composite membrane showed excellent acid stability, and gave greater than 90% metal ion rejection, with the exception of calcium ions, for 430 d. We also evaluated the recovery performance in 1 ton/d pilot-scale process using wastewater from copper-refining process; 90% metal ion rejection was achieved, with the exception of calcium ions, even at 95% recovery rate.

Hydrophilic and positively charged polyethylenimine-functionalized mesoporous magnetic clusters for highly efficient removal of Pb(II) and Cr(VI) from wastewater.

We develop mesoporous magnetic clusters (MMCs) functionalized with hydrophilic branched polyethylenimine (b-PEI), later called b-MG, and MMCs functionalized with positively charged b-PEI (p-MG). These materials efficiently remove Pb(II) and Cr(VI) from wastewater. Fourier-transform infrared spectroscopy, X-ray photoelectron spectroscopy, thermogravimetric analysis, and nitrogen adsorption-desorption analysis results clearly indicate that hydrophilic b-PEI and positively charged b-PEI are successfully attached to the MMC surfaces. Wide-angle X-ray diffraction, high-resolution transmission electron microscopy, and field-emission scanning electron microscopy analyses confirm that the crystal structures and morphologies of the MMCs are maintained well even when wet chemical modification processes are used to introduce hydrophilic b-PEI and positively charged b-PEI to the MMC surfaces. Langmuir and Sips isotherm models are applied to describe Pb(II) adsorption behavior of the b-MG and Cr(VI) adsorption behavior of the p-MG. The isotherm models indicate that the maximum adsorption capacities of b-MG and p-MG, respectively, are 216.3 and 334.1 mg g-1, respectively. These are higher than have previously been found for other adsorbents. In reusability tests, using magnetic separation and controlling the pH, the Pb(II) recovery efficiency of the b-MG is 95.6% and the Cr(VI) recovery efficiency of the p-MG is 68.0% even after the third cycle.

Functional activity of the sensorimotor cortex and cerebellum relates to cervical dystonia symptoms.

Cervical dystonia (CD) is the most common type of focal dystonia, causing abnormal movements of the neck and head. In this study, we used noninvasive imaging to investigate the motor system of patients with CD and uncover the neural correlates of dystonic symptoms. Furthermore, we examined whether a commonly prescribed anticholinergic medication in CD has an effect on the dystonia-related brain abnormalities. Participants included 16 patients with CD and 16 healthy age-matched controls. We collected functional MRI scans during a force task previously shown to extensively engage the motor system, and diffusion and T1-weighted MRI scans from which we calculated free-water and brain tissue densities. The dystonia group was also scanned ca. 2 h after a 2-mg dose of trihexyphenidyl. Severity of dystonia was assessed pre- and post-drug using the Burke-Fahn-Marsden Dystonia Rating Scale. Motor-related activity in CD was altered relative to controls in the primary somatosensory cortex, cerebellum, dorsal premotor and posterior parietal cortices, and occipital cortex. Most importantly, a regression model showed that increased severity of symptoms was associated with decreased functional activity of the somatosensory cortex and increased activity of the cerebellum. Structural imaging measures did not differ between CD and controls. The single dose of trihexyphenidyl altered the fMRI signal in the somatosensory cortex but not in the cerebellum. Symptom severity was not significantly reduced post-treatment. Findings show widespread changes in functional brain activity in CD and most importantly that dystonic symptoms relate to disrupted activity in the somatosensory cortex and cerebellum. Hum Brain Mapp 38:4563-4573, 2017. © 2017 Wiley Periodicals, Inc.

Free-water and BOLD imaging changes in Parkinson's disease patients chronically treated with a MAO-B inhibitor.

Rasagiline is a monoamine oxidase type B inhibitor that possesses no amphetamine-like properties, and provides symptomatic relief in early and late stages of Parkinson's disease (PD). Data in animal models of PD suggest that chronic administration of rasagiline is associated with structural changes in the substantia nigra, and raise the question whether the structure and function of the basal ganglia could be different in PD patients treated chronically with rasagiline as compared with PD patients not treated with rasagiline. Here, we performed a retrospective cross-sectional magnetic resonance imaging (MRI) study at 3 T that investigated nigrostriatal function and structure in PD patients who had taken rasagiline before testing (∼8 months), PD who had not taken rasagiline before testing, and age-matched controls. The two PD groups were selected a priori to not differ significantly in age, sex, disease duration, severity of symptoms, cognitive status, and total levodopa equivalent daily dose of medication. We evaluated percent signal change in the posterior putamen during force production using functional MRI, free-water in the posterior substantia nigra using diffusion MRI, and performance on a bimanual coordination task using a pegboard test. All patients were tested after overnight withdrawal from antiparkinsonian medication. The rasagiline group had greater percent signal change in the posterior putamen, less free-water in the posterior substantia nigra, and better performance on the coordination task than the group not taking rasagiline. These findings point to a possible chronic effect of rasagiline on the structure and function of the basal ganglia in PD. Hum Brain Mapp 37:2894-2903, 2016. © 2016 Wiley Periodicals, Inc.

Structurally Enhanced Self-Plasticization of Poly(vinyl chloride) via Click Grafting of Hyperbranched Polyglycerol.

A highly self-plasticized poly(vinyl chloride) (PVC) is demonstrated for the first time via click grafting of hyperbranched polyglycerol (HPG). The plasticizing effect of the grafted HPG on PVC is systematically investigated by various analytical methods. The amorphous and bulky dendritic structure of HPG efficiently increases the free volume of the grafted PVC, which leads to a remarkably lower glass transition temperature comparable to that of the conventional plasticized PVC. Viscoelastic analysis reveals that HPG considerably improves the softness of the grafted PVC at room temperature and promotes the segmental motion in the system. The HPG-grafted PVC films exhibit an exceptional stretchability unlike the mixture of PVC and HPG because the covalent attachment of HPG to PVC allows it to maintain its homogeneous and well-organized architecture under tensile stretching. The work provides valuable insights into the design of highly flexible and stretchable polymeric materials by means of introducing hyperbranched side chains.

Probing the Role of Side-Chain Interconnecting Groups in the Structural Hydrophobicity of Comblike Fluorinated Polystyrene by Solid-State NMR Spectroscopy.

In order to probe the role of side-chain interconnecting groups (-O-, -S-, and -SO2- linkages between the polystyrene (PST) main chain and fluorooctyl side chain) in the hydrophobicity of the comblike fluorinated polystyrenes, the molecular motion and structure of polymers are explored using the spin-lattice relaxation times (T1 and T1ρ) by solid-state (1)H and (19)F nuclear magnetic resonance spectroscopy. The chain-end motions of the polystyrene main chain and the fluorooctyl side chain are homogeneous, regardless of the interconnecting groups, which means that the chain-end motions of the main chain and the side chain maintain consistency, and these are irrelevant to each other. However, the local dynamic of the main chain shows the structural heterogeneity composed of the mobile and rigid regions, attributed to the rigidity of the side chain. The mobile dynamic portions of the main chain for PST-O and PST-S increase, and their rigid dynamic portions decrease as the temperature increases, whereas the ratio of structural heterogeneity for PST-SO2 is maintained despite increasing temperature. The activation energies (Ea) corresponding to the local motion of fluorooctyl side chains for PST-O and PST-S are drastically increased on the fast motion side compared to the slow motion side, suggesting the motional transformation of side chains for PST-O and PST-S from the small local motion into the large-scale movements related to a cooperative segmental motion when heated. Also, the local motion of the fluorooctyl side chain for PST-SO2 has similar Ea values on both sides, indicating that the relaxation time of PST-SO2 does not change with temperature. Therefore, PST-SO2 is structurally more stable than PST-O or PST-S, which can be attributed to the densely packed fluorooctyl side chain structure caused by the large dipole moment of the sulfone interconnecting group.

Adsorption-assisted photocatalytic activity of nitrogen and sulfur codoped TiO2 under visible light irradiation.

Applying post thermal treatment on the doped TiO2 at high temperature is mostly regarded as an indispensable process, although it has negative effects on the photocatalytic activity of doped TiO2. Herein, we synthesized the N- and S-codoped TiO2 (NSTs) with an anatase phase using a simple solvothermal treatment and investigated their visible light photocatalytic activity associated with the thermal behavior of dopants in NSTs. We found that the as-synthesized NST (NST-As) has better visible light photocatalytic activity and adsorptivity than the commercially available P25 and the thermally treated NSTs. The S dopants effectively assist the surface reaction by adsorbing cations of organic dyes on the NST-As surface. The N dopants increase the absorbance at visible light region of NST-As by forming a delocalized state at the band gap of NST-As. However, the photocatalytic activity of NSTs gradually weakens with the post thermal treatment, because S dopants on the NST-As surface are transformed from sulfide to sulfate during the thermal treatment and N dopants move out during the crystallization of TiO2. The adsorption-assisted photocatalytic activity of NST-As under visible light irradiation is an attractive feature for environmental and photonic technologies.

Delta check limits for thyroid function tests adjusted for clinical settings.

BACKGROUND: This study aimed to determine practical delta check limits (DCLs) for thyroid function tests (TFTs) to detect sample misidentifications across various clinical settings. METHODS: Between 2020 and 2022, 610,437 paired TFT results were collected from six university hospitals. The absolute DCL (absDCL) was determined using the 95th percentile for each clinical setting from a random 60 % of the total data. These absDCLs were then tested within and across different settings using the remaining 40 % of the data, alongside mix-up datasets for result and sample comparisons. The sensitivities of absDCL were calculated within and across groups in the mix-up datasets. RESULTS: Health screening absDCLs were notably lower than in other settings (2.58 vs. 5.93-7.08 for thyroid-stimulating hormone; 4.12 vs. 8.24-10.04 for free thyroxine; 0.49 vs. 0.82-0.91 for total triiodothyronine). The proportion of results exceeding absDCL of health screening differed from those of other clinical settings. Furthermore, sensitivity between health screening and other clinical settings was significantly different in both the result mix-up and sample mix-up datasets. CONCLUSIONS: This study determined practical DCLs for TFTs and highlighted differences in absDCLs between health screening and other settings. These findings emphasize the importance of tailored DCLs in improving the accurate reporting of TFTs.

Acute hypernatremia increases functional connectivity of NaCl sensing regions in the human brain: An fMRI pilot study.

Rodent studies demonstrated specialized sodium chloride (NaCl) sensing neurons in the circumventricular organs, which mediate changes in sympathetic nerve activity, arginine vasopressin, thirst, and blood pressure. However, the neural pathways involved in NaCl sensing in the human brain are incompletely understood. The purpose of this pilot study was to determine if acute hypernatremia alters the functional connectivity of NaCl-sensing regions of the brain in healthy young adults. Resting-state fMRI scans were acquired in 13 participants at baseline and during a 30 min hypertonic saline infusion (HSI). We used a seed-based approach to analyze the data, focusing on the subfornical organ (SFO) and the organum vasculosum of the lamina terminalis (OVLT) as regions of interest (ROIs). Blood chemistry and perceived thirst were assessed pre- and post-infusion. As expected, serum sodium increased from pre- to post-infusion in the HSI group. The primary finding of this pilot study was that the functional connectivity between the SFO and a cluster within the OVLT increased from baseline to the late-phase of the HSI. Bidirectional connectivity changes were found with cortical regions, with some regions showing increased connectivity with sodium-sensing regions while others showed decreased connectivity. Furthermore, the functional connectivity between the SFO and the posterior cingulate cortex (a control ROI) did not change from baseline to the late-phase of the HSI. This finding indicates a distinct response within the NaCl sensing network in the human brain specifically related to acute hypernatremia that will need to be replicated in large-scale studies.

Quantitative Evaluation of the Real-World Harmonization Status of Laboratory Test Items Using External Quality Assessment Data.

Background: In recent decades, the analytical quality of clinical laboratory results has substantially increased because of collaborative efforts. To effectively utilize laboratory results in applications, such as machine learning through big data, understanding the level of harmonization for each test would be beneficial. We aimed to develop a quantitative harmonization index that reflects the harmonization status of real-world laboratory tests. Methods: We collected 2021-2022 external quality assessment (EQA) results for eight tests (HbA1c, creatinine, total cholesterol, HDL-cholesterol, triglyceride, alpha-fetoprotein [AFP], carcinoembryonic antigen [CEA], and prostate-specific antigen [PSA]). This EQA was conducted by the Korean Association of External Quality Assessment Service, using commutable materials. The total analytical error of each test was determined according to the bias% and CV% within peer groups. The values were divided by the total allowable error from biological variation (minimum, desirable, and optimal) to establish a real-world harmonization index (RWHI) at each level (minimum, desirable, and optimal). Good harmonization was arbitrarily defined as an RWHI value ≤ 1 for the three levels. Results: Total cholesterol, triglyceride, and CEA had an optimal RWHI of ≤ 1, indicating an optimal harmonization level. Tests with a desirable harmonization level included HDL-cholesterol, AFP, and PSA. Creatinine had a minimum harmonization level, and HbA1c did not reach the minimum harmonization level. Conclusions: We developed a quantitative RWHI using regional EQA data. This index may help reflect the actual harmonization level of laboratory tests in the field.

Ultrastable nanostructured polymer glasses.

Owing to the kinetic nature of the glass transition, the ability to significantly alter the properties of amorphous solids by the typical routes to the vitreous state is restricted. For instance, an order of magnitude change in the cooling rate merely modifies the value of the glass transition temperature (T(g)) by a few degrees. Here we show that matrix-assisted pulsed laser evaporation (MAPLE) can be used to form ultrastable and nanostructured glassy polymer films which, relative to the standard poly(methyl methacrylate) glass formed on cooling at standard rates, are 40% less dense, have a 40 K higher T(g), and exhibit a two orders of magnitude enhancement in kinetic stability at high temperatures. The unique set of properties of MAPLE-deposited glasses may make them attractive in technologies where weight and stability are central design issues.

Free water imaging unravels unique patterns of longitudinal structural brain changes in Parkinson's disease subtypes.

Background: Research shows that individuals with Parkinson's disease (PD) who have a postural instability and gait difficulties (PIGD) subtype have a faster disease progression compared to those with a tremor dominant (TD) subtype. Nevertheless, our understanding of the structural brain changes contributing to these clinical differences remains limited, primarily because many brain imaging techniques are only capable of detecting changes in the later stages of the disease. Objective: Free water (FW) has emerged as a robust progression marker in several studies, showing increased values in the posterior substantia nigra that predict symptom worsening. Here, we examined longitudinal FW changes in TD and PIGD across multiple brain regions. Methods: Participants were TD and PIGD enrolled in the Parkinson's Progression Marker Initiative (PPMI) study who underwent diffusion MRI at baseline and 2 years later. FW changes were quantified for regions of interest (ROI) within the basal ganglia, thalamus, brainstem, and cerebellum. Results: Baseline FW in all ROIs did not differ between groups. Over 2 years, PIGD had a greater percentage increase in FW in the putamen, globus pallidus, and cerebellar lobule V. A logistic regression model incorporating percent change in motor scores and FW in these brain regions achieved 91.4% accuracy in discriminating TD and PIGD, surpassing models based solely on clinical measures (74.3%) or imaging (76.1%). Conclusion: The results further suggest the use of FW to study disease progression in PD and provide insight into the differential course of brain changes in early-stage PD subtypes.