Effectiveness of Repetitive Transcranial Magnetic Stimulation Combined With Transspinal Electrical Stimulation on Corticospinal Excitability for Individuals With Incomplete Spinal Cord Injury: A Pilot Study.

Repetitive Transcranial Magnetic Stimulation (rTMS) and transspinal electrical stimulation (tsES) have been proposed as a novel neurostimulation modality for individuals with incomplete spinal cord injury (iSCI). In this study, we integrated magnetic and electrical stimulators to provide neuromodulation therapy to individuals with incomplete spinal cord injury (iSCI). We designed a clinical trial comprising an 8-week treatment period and a 4-week treatment-free observation period. Cortical excitability, clinical features, inertial measurement unit and surface electromyography were assessed every 4 weeks. Twelve individuals with iSCI were recruited and randomly divided into a combined therapy group, a magnetic stimulation group, an electrical stimulation group, or a sham stimulation group. The magnetic and electric stimulations provided in this study were intermittent theta-burst stimulation (iTBS) and 2.5-mA direct current (DC) stimulation, respectively. Combined therapy, which involves iTBS and transspinal DC stimulation (tsDCS), was more effective than was iTBS alone or tsDCS alone in terms of increasing corticospinal excitability. In conclusion, the effectiveness of 8-week combined therapy in increasing corticospinal excitability faded 4 weeks after the cessation of treatment. According to the results, combination of iTBS rTMS and tsDCS treatment was more effective than was iTBS rTMS alone or tsDCS alone in enhancing corticospinal excitability. Although promising, the results of this study must be validated by studies with longer interventions and larger sample sizes.

Gouty sacroiliitis: A case report of an often-overlooked cause of inflammatory back pain.

Gout is a chronic disease caused by monosodium urate crystal deposition, typically affecting the big toe, midfoot, and ankle. As it rarely involves the sacroiliac joints, it could be easily misdiagnosed as spondylarthritis. Here, we report the case of a patient with a long history of gout with recurrent low back pain. Computed tomography of the sacroiliac joint suggested sacroiliac arthritis, puncture biopsy indicated gout granuloma, and polarized light microscopy confirmed monosodium urate crystal deposits.

Surfactant Tween 20 Controlled Perovskite Film Fabricated by Thermal Blade Coating for Efficient Perovskite Solar Cells.

In recent years, additive engineering has received considerable attention for the fabrication of high-performance perovskite solar cells (PSCs). In this study, a non-ionic surfactant, polyoxyethylene (20) sorbitan monolaurate (Tween 20), was added as an additive into the MAPbI3 perovskite layer, and the thermal-assisted blade-coating method was used to fabricate a high-quality perovskite film. The Tween 20 effectively passivated defects and traps in the MAPbI3 perovskite films. Such a film fabricated with an appropriate amount of Tween 20 on the substrate showed a higher photoluminescence (PL) intensity and longer carrier lifetime. At the optimal concentration of 1.0 mM Tween 20, the performance of the PSC was apparently enhanced, and the champion PSC demonstrated a PCE of 18.80%. Finally, this study further explored and compared the effect on the device performance and ambient stability of the MAPbI3 perovskite film prepared by the spin-coating method and the thermal-assisted blade coating.

Ambient Air Pollution and Risk for Stroke Hospitalization: Impact on Susceptible Groups.

Stroke is a leading cause of death, and air pollution is associated with stroke hospitalization. However, the susceptibility factors are unclear. Retrospective studies from 2014 to 2018 in Kaohsiung, Taiwan, were analyzed. Adult patients (>17 years) admitted to a medical center with stroke diagnosis were enrolled and patient characteristics and comorbidities were recorded. Air pollutant measurements, including those of particulate matter (PM) with aerodynamic diameters < 10 µm (PM10) and < 2.5 µm (PM2.5), nitrogen dioxide (NO2), and ozone (O3), were collected from air quality monitoring stations. During the study period, interquartile range (IQR) increments in PM2.5 on lag3 and lag4 were 12.3% (95% CI, 1.1−24.7%) and 11.5% (95% CI, 0.3−23.9%) concerning the risk of stroke hospitalization, respectively. Subgroup analysis revealed that the risk of stroke hospitalization after exposure to PM2.5 was greater for those with advanced age (≥80 years, interaction p = 0.045) and hypertension (interaction p = 0.034), after adjusting for temperature and humidity. A dose-dependent effect of PM2.5 on stroke hospitalization was evident. This is one of few studies focusing on the health effects of PM2.5 for patients with risk factors of stroke. We found that patients with risk factors, such as advanced age and hypertension, are more susceptible to PM2.5 impacts on stroke hospitalization.

Synthesis and Excimer Formation Properties of Electroactive Polyamides Incorporated with 4,5-Diphenoxypyrene Units.

A new dietherpyrene-cored diamine monomer, namely, 4,5-bis(4-aminophenoxy)pyrene, was successful synthesized and formed a series of electroactive polyamides with an aryloxy linkage in a polymer main chain and bearing pyrene chromophore as a pendent group using conventional one-pot polycondensation reactions with commercial aromatic/aliphatic dicarboxylic acids. The resulting polyamides exhibited good solubility in polar organic solvents and, further, can be made into transparent films. They had appropriate levels of thermal stability with moderately high glass-transition values. The dilute NMP solutions of these polyamides exhibited pyrene characteristic fluorescence and also showed a remarkable additional excimer emission peak centered at 475 nm. Electrochemical studies of these polymer films showed that these polyamides have both p- and n-dopable states as a result of the formation of radical cations and anions of the electroactive pyrene moieties.

Antisolvent Engineering to Enhance Photovoltaic Performance of Methylammonium Bismuth Iodide Solar Cells.

High absorption ability and direct bandgap makes lead-based perovskite to acquire high photovoltaic performance. However, lead content in perovskite becomes a double-blade for counterbalancing photovoltaic performance and sustainability. Herein, we develop a methylammonium bismuth iodide (MBI), a perovskite-derivative, to serve as a lead-free light absorber layer. Owing to the short carrier diffusion length of MBI, its film quality is a predominant factor to photovoltaic performance. Several candidates of non-polar solvent are discussed in aspect of their dipole moment and boiling point to reveal the effects of anti-solvent assisted crystallization. Through anti-solvent engineering of toluene, the morphology, crystallinity, and element distribution of MBI films are improved compared with those without toluene treatment. The improved morphology and crystallinity of MBI films promote photovoltaic performance over 3.2 times compared with the one without toluene treatment. The photovoltaic device can achieve 0.26% with minor hysteresis effect, whose hysteresis index reduces from 0.374 to 0.169. This study guides a feasible path for developing MBI photovoltaics.

Oxidative Stress Biomarkers and Mitochondrial DNA Copy Number Associated with APOE4 Allele and Cholinesterase Inhibitor Therapy in Patients with Alzheimer's Disease.

Studies of the oxidative/anti-oxidative status in patients with Alzheimer's disease (AD) carrying different alleles of the apolipoprotein E (APOE) gene are currently inconclusive; meanwhile, data regarding mitochondrial DNA copy number (mtCN) remain limited. We herein determined the thiobarbituric acid reactive substances (TBARS), thiols, and mtCN in blood samples of 600 AD patients and 601 controls. A significantly higher oxidative TBARS (1.64 µmol/L), lower antioxidative thiols (1.60 µmol/L), and lower mtCN (2.34 log Delta Ct) were found in the AD cohort as compared to the non-AD cohort (1.54 µmol/L, 1.71 µmol/L, 2.46 log Delta Ct). We further identified the ε4 alleles (APOE4) and separated subjects into three groups according to the number of APOE4. A significant trend was noted in the TBARS levels of both AD and non-AD cohorts, highest in the homozygous two alleles (1.86 and 1.80 µmol/L), followed by heterozygous one allele (1.70 and 1.74 µmol/L), and lowest in the no APOE4 allele (1.56 and 1.48 µmol/L). Similar trends of lower thiols and mtCN were also found in the AD cohort. In our study of the influence of cholinesterase inhibitor therapy, we found significantly reduced TBARS levels, and elevated mtCN in AD patients receiving rivastigmine and galantamine therapy. Our study demonstrates associations between the APOE4 allele and oxidative stress biomarkers and mtCN. Using cholinesterase inhibitor therapy may benefit AD patients through attenuation of oxidative stress and manipulation of the mtCN.

Combined drought and bark beetle attacks deplete non-structural carbohydrates and promote death of mature pine trees.

How carbohydrate reserves in conifers respond to drought and bark beetle attacks are poorly understood. We investigated changes in carbohydrate reserves and carbon-dependent diterpene defences in ponderosa pine trees that were experimentally subjected to two levels of drought stress (via root trenching) and two types of biotic challenge treatments (pheromone-induced bark beetle attacks or inoculations with crushed beetles that include beetle-associated fungi) for two consecutive years. Our results showed that trenching did not influence carbohydrates, whereas both biotic challenges reduced amounts of starch and sugars of trees. However, only the combined trenched-bark beetle attacked trees depleted carbohydrates and died during the first year of attacks. While live trees contained higher carbohydrates than dying trees, amounts of constitutive and induced diterpenes produced did not vary between live and beetle-attacked dying trees, respectively. Based on these results we propose that reallocation of carbohydrates to diterpenes during the early stages of beetle attacks is limited in drought-stricken trees, and that the combination of biotic and abiotic stress leads to tree death. The process of tree death is subsequently aggravated by beetle girdling of phloem, occlusion of vascular tissue by bark beetle-vectored fungi, and potential exploitation of host carbohydrates by bark beetle symbionts as nutrients.

Impact of estimated-weight-base dose of alteplase in acute stroke treatment on clinical outcome.

Dosing of recombinant tissue plasminogen activator (rt-PA) for acute ischemic stroke treatment is often based on estimated body weight (BW) worldwide in routine clinical practice due to infeasible of accurate BW measurement. The aim of our study is to explore the impact of estimated BW when dosing rt-PA in acute ischemic stroke treatment on clinical outcome. Between January 2013 to May 2018, 126 acute ischemic stroke patients received intravenous rt-PA treatment based on estimated BW dosage were recruited. All patients had actual BW measured in ward after treatment. Based on the dosage of rt-PA given, patients were categorized into three groups, standard dose (0.8-1.0 mg/kg), overdose (>1.0 mg/kg), and underdose (<0.8 mg/kg). Among all 126 patients, 101 (80.2%) patients were treated with standard dose, 12 (9.5%) patients with overdose, and 13 (10.3%) patients with underdose of rt-PA respectively. There was no significant difference between demographic characteristics, pre-morbid risk factors, National Institutes of Health Stroke Scale (NIHSS) score at 24 h, NIHSS score at discharge, modified Rankin scale (mRS) within 0 to 2 in discharge or in 3 months after the event within the three groups. There was also no significant difference in hemorrhagic transformation and symptomatic intracranial hemorrhage (SICH). In conclusion, calculation of the dose of rt-PA based upon the estimated BW to treat acute ischemic stroke patients had no negative impact on the clinical outcome in our study.

Using a Multiclass Machine Learning Model to Predict the Outcome of Acute Ischemic Stroke Requiring Reperfusion Therapy.

Prediction of functional outcome in ischemic stroke patients is useful for clinical decisions. Previous studies mostly elaborate on the prediction of favorable outcomes. Miserable outcomes, which are usually defined as modified Rankin Scale (mRS) 5-6, should be considered as well before further invasive intervention. By using a machine learning algorithm, we aimed to develop a multiclass classification model for outcome prediction in acute ischemic stroke patients requiring reperfusion therapy. This was a retrospective study performed at a stroke medical center in Taiwan. Patients with acute ischemic stroke who visited between January 2016 and December 2019 and who were candidates for reperfusion therapy were included. Clinical outcomes were classified as favorable outcome, intermediate outcome, and miserable outcome. We developed four different multiclass machine learning models (Logistic Regression, Supportive Vector Machine, Random Forest, and Extreme Gradient Boosting) to predict clinical outcomes and compared their performance to the DRAGON score. A sample of 590 patients was included in this study. Of them, 180 (30.5%) had favorable outcomes and 152 (25.8%) had miserable outcomes. All selected machine learning models outperformed the DRAGON score on accuracy of outcome prediction (Logistic Regression: 0.70, Supportive Vector Machine: 0.67, Random Forest: 0.69, and Extreme Gradient Boosting: 0.67, vs. DRAGON: 0.51, p < 0.001). Among all selected models, Logistic Regression also had a better performance than the DRAGON score on positive predictive value, sensitivity, and specificity. Compared with the DRAGON score, the multiclass machine learning approach showed better performance on the prediction of the 3-month functional outcome of acute ischemic stroke patients requiring reperfusion therapy.

Catechin Photolysis Suppression by Aluminum Chloride under Alkaline Conditions and Assessment with Liquid Chromatography-Mass Spectrometry.

Tea is rich in catechins and aluminum. In this study, the process of catechin photolysis was applied as a model for examining the effects of aluminum chloride (AlCl3) on the structural changes of catechin and the alteration of aluminum complexes under blue light irradiation (BLI) at pH 8 using liquid chromatography and mass spectrometry techniques. Additionally, the effects of anions on catechin upon the addition of AlCl3 and treatment with BLI were also studied. In this study, when 1 mM catechin was treated with BLI, a superoxide anion radical (O2•-) was generated in an air-saturated aqueous solution, in addition to forming a dimeric catechin (proanthocyanidin) via a photon-induced redox reaction. The relative percentage of catechin was found to be 59.0 and 95.7 for catechin treated with BLI and catechin upon the addition of 1 mM AlCl3 treated with BLI, respectively. It suggested that catechin treated with BLI could be suppressed by AlCl3, while AlCl3 did not form a complex with catechin in the photolytic system. However, under the same conditions, it was also found that the addition of AlCl3 inhibited the photolytic formation of O2•-, and reduced the generation of proanthocyanidin, suggesting that the disconnection of proanthocyanidin was achieved by AlCl3 acting as a catalyst under treatment with BLI. The influence of 1 mM fluoride (F-) and 1 mM oxalate (C2O42-) ions on the photolysis of 1 mM catechin upon the addition of 1 mM AlCl3 and treatment with BLI was found to be insignificant, implying that, during the photolysis of catechin, the Al species were either neutral or negatively charged and the aluminum species did not form a complex with anions in the photolytic system. Therefore, aluminum, which is an amphoteric species, has an inherent potential to stabilize the photolysis of catechin in an alkaline conditions, while suppressing the O2•- and proanthocyanidin generation via aluminum ion catalysis in the catechin/Al system under treatment with BLI.

Dopamine Therapy and the Regulation of Oxidative Stress and Mitochondrial DNA Copy Number in Patients with Parkinson's Disease.

Few studies have reported on changes to oxidative stress and mitochondrial DNA copy numbers in patients with Parkinson's disease (PD), particularly those undergoing long-term dopamine therapy. This study measured mitochondrial copy numbers, thiobarbituric acid reactive substances (TBARS), and thiols in 725 PD patients and 744 controls. The total prescribed dopamine dose was calculated for each PD patient. A decreased mitochondrial copy number and antioxidant thiols level, but an elevated oxidative TBARS level presented in PD patients. Stratification into age subgroups revealed a consistently lower mitochondrial copy number and thiols in all PD subgroups, but increased TBARS levels compared with those of the controls. Further study found an association between lower serum TBARS and dopamine administration. There appears to be an indirect relationship with the mitochondrial copy number, where a decrease in TBARS was found to diminish the effect of pathogenetic and age-related decrease in mitochondrial copy number in PD patients. Follow-up evaluations noted more significant decreases of mitochondrial copy numbers in PD patients over time; meanwhile, dopamine administration was associated with an initial decrease of the TBARS level which attenuated with high-dose and long-term therapy. Our study provides evidence that moderate dopamine dose therapy benefits PD patients through attenuation of oxidative stress and manipulation of the mitochondrial copy number.

Achieving High-Performance Perovskite Photovoltaic by Morphology Engineering of Low-Temperature Processed Zn-Doped TiO2 Electron Transport Layer.

Perovskite solar cells (PSCs) have become one of the most promising renewable energy converting devices. However, in order to reach a sufficiently high power conversion efficiency (PCE), the PSCs typically require a high-temperature sintering process to prepare mesostructured TiO2 as an efficient electron transport layer (ETL), which prohibits the PSCs from commercialization in the future. This work investigates a low-temperature synthesis of TiO2 nanocrystals and introduces a two-fluid spray coating process to produce a nanostructured ETL for the following deposition of perovskite layer. The temperature during the whole deposition process can be maintained under 150 °C. Compared to the typical planar TiO2 layer, the perovskite layer fabricated on a nanostructured TiO2 layer shows uniform compactness, preferred orientation, and high crystallinity, leading to reproducible and promising device performance. The detail mechanisms are revealed by the contact angle test, morphology characterization, grazing incident wide angle X-Ray scattering measurement, and space charge limited currents analysis. Finally, optimized device performance can be achieved through adequate Zn doping in the TiO2 layer, demonstrating an average PCE of 19.87% with champion PCE of 21.36%. The efficiency can maintain over 80% of its original value after 3000 h storage in ambient atmosphere. This study suggests a promising approach to offer high-efficiency PSCs using the low-temperature process.

Non-vitamin K Oral Anticoagulants and Anti-seizure Medications: A Retrospective Cohort Study.

Purpose: Concerns of drug-drug interactions (DDIs) between anti-seizure medications (ASMs) and non-vitamin K oral anticoagulants (NOACs) have emerged in recent case reports and guidelines. Theoretically, the induction of hepatic cytochrome P450 3A4 (CYP3A4) enzyme and permeability glycoprotein (P-GP) efflux transporter protein systems may reduce the effect of NOACs. We aimed to investigate whether such DDIs are clinically relevant in a real-world situation. Methods: We retrospectively reviewed 320 ischemic stroke patients with atrial fibrillation (Af) and grouped them according to different potential interactions with CYP3A4 and P-GP. Ischemic stroke events, transient ischemic attack (TIA) events, follow-up duration, baseline characteristics, concomitant ASMs, and stroke risk factors were collected. Statistical analysis included Kaplan-Meier survival curves and the log-rank test. Results: Overall, 320 ischemic stroke with Af patients received NOACs. Among the NOAC users, 75 also took ASMs, including 56 that have potential DDIs: 43 (13.4%) were categorized as potential CYP and P-GP DDIs and 13 (4.1%) as P-GP-only DDIs. The remaining 264 (82.5%) patients were used as controls including 19 exposed to nonsignificant DDI ASMs and 245 patients without ASM exposure. The incidence rates of recurrent stroke/TIA events in both CYP3A4 and P-GP DDIs, P-GP DDIs only, and no DDIs were 7.5, 2.1, and 8.4/100 person-years, respectively. Kaplan-Meier survival curves and the log-rank test did not show significant differences among the groups. Conclusions: The recurrent stroke rate of NOAC users with potential DDIs was not higher than in those without potential DDIs in this single-institute study. Our results suggest that theoretical interactions between ASMs and NOACs may not be as severe as previously thought in a real-world situation.

Low Persistence of Antithrombotic Agents is Associated with Poor Outcomes after First-ever Acute Ischemic Stroke.

OBJECTIVE: This study investigated the time-trend persistence with antithrombotic agents (AT) and assessed the impact of AT persistence on outcome events and adverse events (AE) within two years after first-ever acute ischemic stroke (IS). METHODS: Using Taiwan's National Health Insurance claims dataset, 7,341 IS subjects hospitalized between 2001 and 2005 with AT prescribed at discharge and survived at least 3 months were followed up for 2 years. Time-trends of AT usage were analyzed. Medication persistence was assessed as the proportion of days covered (PDC) for filled prescription, and categorized into low, intermediate and high persistence. Multivariate logistic regression analysis and multivariate Cox proportional hazard regression models were performed to identify factors associated with AT persistence and its impact on vascular outcomes. RESULTS: AT persistence rates declined sharply from 81% to 52% during the first 6 months. In addition to patient and facility-level characteristics, occurrence of AE (e.g., GI bleeding/ulceration, fractures/ major trauma, and iatrogenic/unspecific illness) was inversely related to AT persistence. Compared with patients with low persistence, the composite risk of recurrent stroke, cardiovascular disease, or death from any cause was significantly lower in patients with intermediate (Hazard Ratio [HR] 0.64, 0.57-0.71) or high AT persistence (0.74, 0.66-0.83).

Quantum process capability.

Physical processes in the quantum regime possess non-classical properties of quantum mechanics. However, methods for quantitatively identifying such processes are still lacking. Accordingly, in this study, we develop a framework for characterizing and quantifying the ability of processes to cause quantum-mechanical effects on physical systems. We start by introducing a new concept, referred to as quantum process capability, to evaluate the effects of an experimental process upon a prescribed quantum specification. Various methods are then introduced for measuring such a capability. It is shown that the methods are adapted to quantum process tomography for implementation of process capability measure and applicable to all physical processes that can be described using the general theory of quantum operations. The utility of the proposed framework is demonstrated through several examples, including processes of entanglement, coherence, and superposition. The formalism proposed in this study provides a generic approach for the identification of dynamical processes in quantum mechanics and facilitates the general classification of quantum-information processing.

Dual functional photo-response for p-Si/SiO2/n-InGaZnO graphene nanocomposites photodiodes.

This study demonstrates dual functional hybrid heterojunction photodiodes (PDs) that comprise an amorphous indium gallium zinc oxide (a-IGZO) thin film blended with graphene nanoflakes and a SiO2 (5 nm)/Si substrate. The PDs exhibit a photo-responsivity of approximately 0.15-0.27 A W-1 under 633 nm illumination, which is much higher than that for a-IGZO based phototransistor in the visible region. The device also gives a long-lasting persistent photocurrent (PPC) when the UV light is extinguished. This results show that the hybrid heterojunction acts as a high performance photodetector for the detection of visible light and provides a universal scenario for development of PPC.

Quantifying Quantum-Mechanical Processes.

The act of describing how a physical process changes a system is the basis for understanding observed phenomena. For quantum-mechanical processes in particular, the affect of processes on quantum states profoundly advances our knowledge of the natural world, from understanding counter-intuitive concepts to the development of wholly quantum-mechanical technology. Here, we show that quantum-mechanical processes can be quantified using a generic classical-process model through which any classical strategies of mimicry can be ruled out. We demonstrate the success of this formalism using fundamental processes postulated in quantum mechanics, the dynamics of open quantum systems, quantum-information processing, the fusion of entangled photon pairs, and the energy transfer in a photosynthetic pigment-protein complex. Since our framework does not depend on any specifics of the states being processed, it reveals a new class of correlations in the hierarchy between entanglement and Einstein-Podolsky-Rosen steering and paves the way for the elaboration of a generic method for quantifying physical processes.

Size distribution of airborne fungi in vehicles under various driving conditions.

Circulation or air conditioning (AC) system was proven to improve the air quality inside the vehicles; however, the quantified study was limited. In this study, fungal concentration under various driving mode inside the vehicle was proposed. The driving conditions were classified into 4 states: (1) window closed without AC and circulation, (2) window open without AC and circulation, (3) window closed with only circulation on, and (4) window closed with only AC on. Results show that at state 4, the mean respirable fraction was 83.3%, with a number median diameter of the fungi being 1.73 µm. More attention should be paid for these smaller fungi easily penetrating into the alveoli and probably lead to allergic alveolitis. Turning on AC for reducing the normalized concentration for each size range of fungi was suggested; however, the respirable fraction increased. Those who are prone to allergies or asthma are suggested to switch between AC and the circulation mode while driving a long time.