Urinary Fetuin-A Fragments Predict Progressive Estimated Glomerular Filtration Rate Decline in Two Independent Type 2 Diabetes Cohorts of Different Ethnicities.

INTRODUCTION: There is a great clinical need for novel markers to predict kidney function decline in patients with type 2 diabetes. We explored the potential of posttranslationally modified fetuin-A fragments in urine (uPTM-FetA) as such a marker. METHODS: We included patients with type 2 diabetes from two independent, nonoverlapping prospective cohort studies. A cut-off for uPTM-FetA, measured via ELISA method, was determined using the Youden index in the primary cohort of patients with type 2 diabetes from Taiwan. Kidney endpoint was defined as an estimated glomerular filtration rate (eGFR) decline ≥30% from baseline, reaching of an eGFR <15 mL/min/1.73 m2, or a need of renal replacement therapy. Prospective associations were assessed in Cox regression models. All analyses were replicated in a cohort of patients with type 2 diabetes from the Netherlands. RESULTS: In total, 294 patients with type 2 diabetes (age 61 ± 10 years, 55% male, eGFR 88 ± 16 mL/min/1.73 m2) were included in the primary cohort. During a follow-up of median 4.6 years, 42 participants (14%) experienced the kidney endpoint. Using the defined cut-off, a high uPTM-FetA was associated with a higher risk of renal function decline (Plog-rank < 0.0001). This association was similar in subgroups depending on albuminuria. This association remained, independent of age, sex, baseline eGFR, albuminuria, HbA1c, and other potential confounders (HR: 9.94; 95% CI: 2.96-33.40; p < 0.001 in the final model). Analyses in the validation cohort (376 patients with type 2 diabetes, age 64 ± 11 years, 66% male, eGFR 76 ± 24 mL/min/1.73 m2) using the same cut-off yielded similar results. CONCLUSION: uPTM-FetA was independently associated with kidney function decline in patients with type 2 diabetes validated in a 2-cohort study. The significant additive predictive power of this biomarker from conventional risk factors suggests its clinical use for renal function progression in patients with type 2 diabetes.

Egocentric-View Fingertip Detection for Air Writing Based on Convolutional Neural Networks.

This research investigated real-time fingertip detection in frames captured from the increasingly popular wearable device, smart glasses. The egocentric-view fingertip detection and character recognition can be used to create a novel way of inputting texts. We first employed Unity3D to build a synthetic dataset with pointing gestures from the first-person perspective. The obvious benefits of using synthetic data are that they eliminate the need for time-consuming and error-prone manual labeling and they provide a large and high-quality dataset for a wide range of purposes. Following that, a modified Mask Regional Convolutional Neural Network (Mask R-CNN) is proposed, consisting of a region-based CNN for finger detection and a three-layer CNN for fingertip location. The process can be completed in 25 ms per frame for 640×480 RGB images, with an average error of 8.3 pixels. The speed is high enough to enable real-time "air-writing", where users are able to write characters in the air to input texts or commands while wearing smart glasses. The characters can be recognized by a ResNet-based CNN from the fingertip trajectories. Experimental results demonstrate the feasibility of this novel methodology.

Selective Criteria and Markers in Adipose-Derived Stromal Cells Collection Quality and Expansion Potency.

BACKGROUND: Adipose tissue-derived stromal cells (ADSCs) have been extensively used in clinical trials for various therapeutic applications. However, there is a paucity of selective criteria regarding collection and expansion procedures. The purpose of this study was to investigate the effect of liposuction and donor age on ADSCs and to assess the criteria and markers for ADSC long-term expansion potential. METHODS: Adipose tissues were collected using syringe liposuction, water-jet, or ultrasonic techniques. Tissue/cell viability was evaluated using the XTT assay. CD34 and SSEA-4 expression were examined using flow cytometry. SOX2 gene expression was estimated using quantitative polymerase chain reaction, and Nile-red staining was performed to evaluate the adipogenesis potency during ADSC expansion. RESULTS: The lipoaspirates obtained from syringe and ultrasonic liposuction methods were superior to those of the water-jet method in stromal vascular fraction yield and durability during temporary storage. SSEA-4, SOX2 expression, and adipogenesis potency of early-passage ADSCs were significantly correlated with the P15 cumulative population doublings data. CD34 expression was strongly correlated with P0 ADSC yield and doubling time. Tissue viability, P0 ADSC CD34⁺ percentage, and P15 cumulative population doublings were decreased along with donor age. CONCLUSIONS: This study established criteria and markers to determine whether lipoaspirate tissue and cultured ADSCs are suitable for further large-scale expansion and allogenic universal cell banking.

Bilateral Meniere's disease assessed by an inner ear test battery.

CONCLUSION: An inner ear test battery may suggest bilateral involvement and aid in 'grading' of potential disease in a patient with actively symptomatic Meniere's disease (MD). OBJECTIVES: This study applied an inner ear test battery in patients with bilateral MD to map the inner ear deficits in each ear. METHODS: From 2009 to 2012, 100 (20%) of 498 MD patients were diagnosed with bilateral involvement, which was defined as established MD in one ear, and the opposite ear had inner ear symptoms combined with documented hearing loss. Each patient underwent audiometry, and ocular vestibular-evoked myogenic potential (oVEMP), cervical VEMP (cVEMP), and caloric tests. RESULTS: Grading of inner ear deficits was based on the number of abnormal results in the inner ear test battery. Of 100 patients with bilateral MD, 54% had the same grade and 46% had different grades in their 2 ears. On the other hand, based on four-tone average, 79% had the same Meniere stage and 21% had different stages in their two ears. The difference between ears with asymmetric grades (46%) and ears with asymmetric stages (21%) accounts for 25% of bilateral MD patients, which may be caused by the saccular hydrops in the opposite ear.

Ocular and cervical vestibular-evoked myogenic potentials in Tumarkin falls.

OBJECTIVE: This study applied ocular vestibular-evoked myogenic potential (oVEMP) and cervical VEMP (cVEMP) tests in Ménière's patients with Tumarkin falls to investigate the etiologic role of the saccule/utricle in the event of Tumarkin falls. STUDY DESIGN: Retrospective study. SETTING: University hospital. SUBJECTS: Twenty unilateral definite Ménière's patients were divided into 2 age- and sex-matched groups. Ten patients had a history of drop attacks, and 10 had no history of drop attacks. MAIN OUTCOME MEASURES: All patients underwent audiometry and caloric, oVEMP, and cVEMP tests. RESULTS: No significant differences were observed between the fall and nonfall groups in terms of Ménière staging, and caloric and cVEMP test results. In the fall group, oVEMP test via Fz tapping showed augmented, reduced, and absent responses in 1, 1, and 8 patients, respectively. In 3 of the latter 8 patients, however, oVEMPs could be obtained by lateral mastoid tapping. Thus, 100% of patients in the fall group had abnormal oVEMPs, which significantly differed from 50% oVEMP abnormalities in the nonfall group. Comparison of the abnormal results for the caloric, oVEMP, and cVEMP tests revealed that poorer residual vestibular function in the fall group than the nonfall group. CONCLUSION: Absence of oVEMP by Fz tapping and presence of oVEMPs via lateral tapping indicates a residual utricular function. With residual canal function (canal paresis) and absent cVEMPs, subsequently residual utricular function may trigger the Tumarkin falls in Ménière's patients.

Correlation between caloric and ocular vestibular evoked myogenic potential test results.

CONCLUSION: The ocular vestibular evoked myogenic potential (o-VEMP) test results correlate significantly with caloric test results for patients with acoustic neuroma (AN), but not for patients with Meniere's disease (MD), indicating that the o-VEMP test may replace the caloric test for evaluating the vestibular nerve from which the AN arises. Conversely, the caloric, o-VEMP, and cervical VEMP (c-VEMP) tests should be performed to map lesion sites in the vestibular labyrinth. OBJECTIVE: This study performed caloric, o-VEMP, and c-VEMP tests on patients with central and peripheral vestibular disorders to investigate their relationships. METHODS: In all, 66 patients comprising 16 with unilateral AN and 50 with unilateral definite MD were enrolled. All patients underwent caloric, o-VEMP, and c-VEMP tests. RESULTS: In the AN group, the caloric test identified canal paresis and caloric areflexia in 10 ears, while the o-VEMP and c-VEMP tests identified abnormal (absent or delayed) responses in 12 and 11 ears, respectively. A significant correlation existed between caloric and o-VEMP test results, but not between caloric and c-VEMP test results, or between o-VEMP and c-VEMP test results. For the MD group, abnormal caloric, o-VEMP, and c-VEMP test results were obtained for 24%, 44%, and 38% of hydropic ears, respectively. No correlation existed between any two test results.

Localization and prevalence of hydrops formation in Ménière's disease using a test battery.

This study investigated the localization and prevalence of hydrops formation in 20 patients with unilateral Ménière's disease using a battery of tests, including audiometry, caloric, ocular vestibular evoked myogenic potential (oVEMP) and cervical VEMP (cVEMP) tests. The latter two tests used air-conducted sound (ACS) and bone-conducted vibration (BCV) as stimuli. Thirteen patients (65%) had abnormal hearing with a 4-tone average >26 dBHL. In the caloric test, 4 patients (20%) had abnormal responses, including canal paresis in 3 and caloric areflexia in 1 patient. The percentages of patients with abnormal ACS-oVEMP, BCV-oVEMP, ACS-cVEMP, and BCV-cVEMP tests were 65, 25, 45, and 25% in affected ears, and 40, 0, 15, and 0% in unaffected ears, respectively. Although ACS- and BCV-oVEMP results differed significantly, ACS- and BCV-cVEMP results did not, regardless of the affected or unaffected ears. Thus, the abnormal rates for hearing, ACS-cVEMP, BCV-oVEMP, and caloric tests in affected ears were 65, 45, 25, and 20%, respectively. This decreasing order of abnormal percentages in function of the cochlea, saccule, utricle, and semicircular canals mimics the declining sequence of hydrops formation in temporal bone studies. In conclusion, an inner ear test battery comprising audiometry, caloric, oVEMP, and cVEMP tests may provide further insight into the localization and prevalence of hydrops formation in Ménière's disease.