Baseline characteristics and predictors for early implantation of vagus nerve stimulation therapy in people with drug-resistant epilepsy: Observations from an international prospective outcomes registry (CORE-VNS).

OBJECTIVE: Vagus nerve stimulation (VNS) Therapy is routinely indicated for people with drug-resistant epilepsy (DRE). We analyzed the baseline characteristics of individuals receiving the recently released VNS models and identified factors associated with early or late implantation. METHODS: The Comprehensive Outcomes Registry of subjects with Epilepsy (CORE-VNS), a prospective observational study evaluating the clinical and psychosocial outcomes of VNS Therapy®, is following participants for up to 60 months after VNS implantation. In this analysis, we used Cox proportional hazards model to identify baseline characteristics associated with the time from diagnosis to first implantation. RESULTS: Of the 819 enrolled, 792 (96.7%) participants implanted with a VNS device were evaluated. 529 (64.6%) underwent the first implantation and 263 (32.1%) a re-implantation. Participants' median age at first implant was 24 years; 492 (62.1%) were ≥18 years old and 166 (20.3%) were < 12 years old. The average number of failed ASMs prior to VNS implantation was 7.1, and 145 (17.7%) had undergone previous epilepsy-related surgery. Epilepsy was classified as focal in 47.7% of participants, generalized in 16.1% and combined focal and generalized in 34.2%. Many of the participants (40.9%) had epilepsy of unknown etiology. The median time from diagnosis to first implantation was 10.33 years and was significantly shorter in participants with combined focal and generalized epilepsy compared to those with focal epilepsy alone, and in participants with genetic and immune epilepsy compared to those with unknown etiologies. SIGNIFICANCE: In people with DRE, VNS Therapy is provided after multiple failures of ASMs and after failure of epilepsy surgery in one in six individuals. Time from diagnosis to first implantation is associated with epilepsy type and etiology, likely reflecting variable treatment pathways. Clearer guidelines on when and how non-drug therapies should be deployed in people with DRE related to different epilepsy factors are needed. PLAIN LANGUAGE SUMMARY: Neuromodulation can be a very helpful treatment in people who have seizures that do not respond to medications. The most widely utilized neuromodulation therapy is vagus nerve stimulation (VNS). We present data from a large, global study to show that people use an average of seven anti-seizure medications before attempting VNS Therapy and that it takes about 10 years for people to get their first VNS implant. We advocate for clearer treatment guidelines on how and when to consider VNS Therapy in people with seizures that are resistant to medication.

Clinical characteristics and treatment exposure of patients with marked treatment-resistant unipolar major depressive disorder: A RECOVER trial report.

BACKGROUND: RECOVER is a randomized sham-controlled trial of vagus nerve stimulation and the largest such trial conducted with a psychiatric neuromodulation intervention. OBJECTIVE: To describe pre-implantation baseline clinical characteristics and treatment history of patients with unipolar, major depressive disorder (MDD), overall and as a function of exposure to interventional psychiatric treatments (INTs), including electroconvulsive therapy, transcranial magnetic stimulation, and esketamine. METHODS: Medical, psychiatric, and treatment records were reviewed by study investigators and an independent Study Eligibility Committee prior to study qualification. Clinical characteristics and treatment history (using Antidepressant Treatment History [Short] Form) were compared in those qualified (N = 493) versus not qualified (N = 228) for RECOVER, and among the qualified group as a function of exposure to INTs during the current major depressive episode (MDE). RESULTS: Unipolar MDD patients who qualified for RECOVER had marked TRD (median of 11.0 lifetime failed antidepressant treatments), severe disability (median WHODAS score of 50.0), and high rate of baseline suicidality (77% suicidal ideation, 40% previous suicide attempts). Overall, 71% had received at least one INT. Compared to the no INT group, INT recipients were younger and more severely depressed (QIDS-C, QIDS-SR), had greater suicidal ideation, earlier diagnosis of MDD, and failed more antidepressant medication trials. CONCLUSIONS: RECOVER-qualified unipolar patients had marked TRD and marked treatment resistance with most failing one or more prior INTs. Treatment with ≥1 INTs in the current MDE was associated with earlier age of MDD onset, more severe clinical presentation, and greater treatment resistance relative to patients without a history of INT. TRIAL REGISTRATION: ClinicalTrials.gov Identifier NCT03887715.

Understanding ADC variation by fat content effect using a dual-function MRI phantom.

BACKGROUND: A dual-function phantom designed to quantify the apparent diffusion coefficient (ADC) in different fat contents (FCs) and glass bead densities (GBDs) to simulate the human tissues has not been documented yet. We propose a dual-function phantom to quantify the FC and to measure the ADC at different FCs and different GBDs. METHODS: A fat-containing diffusion phantom comprised by 30 glass-bead-containing fat-water emulsions consisting of six different FCs (0, 10, 20, 30, 40, and 50%) multiplied by five different GBDs (0, 0.1, 0.25, 0.5, and 1.0 g/50 mL). The FC and ADC were measured by the "iterative decomposition of water and fat with echo asymmetry and least squares estimation-IQ," IDEAL-IQ, and single-shot echo-planar diffusion-weighted imaging, SS-EP-DWI, sequences, respectively. Linear regression analysis was used to evaluate the relationship among the fat fraction (FF) measured by IDEAL-IQ, GBD, and ADC. RESULTS: The ADC was significantly, negatively, and linearly associated with the FF (the linear slope ranged from -0.005 to -0.017, R2 = 0.925 to 0.986, all p < 0.001). The slope of the linear relationship between the ADC and the FF, however, varied among different GBDs (the higher the GBD, the lower the slope). ADCs among emulsions across different GBDs and FFs were overlapped. Emulsions with low GBDs plus high FFs shared a same lower ADC range with those with median or high GBDs plus median or lower FFs. CONCLUSIONS: A novel dual-function phantom simulating the human tissues allowed to quantify the influence of FC and GBD on ADC. RELEVANCE STATEMENT: The study developed an innovative dual-function MRI phantom to explore the impact of FC on ADC variation that can affect clinical results. The results revealed the superimposed effect on FF and GBD density on ADC measurements. KEY POINTS: • A dual-function phantom made of glass bead density (GBD) and fat fraction (FF) emulsion has been developed. • Apparent diffusion coefficient (ADC) values are determined by GBD and FF. • The dual-function phantom showed the mutual ADC addition between FF and GBD.

Do personal values and motivation affect women's solo travel intentions in Taiwan?

Female solo travel is experiencing a global increase and specifically, gaining popularity in Asia. This study explores how personal values and female solo travel motivation affect travel behavior. Using a sample comprising 381 single females in Taiwan, partial least squares structural equation modeling was utilized to investigate the hypotheses. The results revealed Hypothesis 1 and Hypothesis 3 are supported, which verifies personal internal values significantly affect female solo travel motivation, and are identified as significant factors influencing female solo travel intention. Additionally, Hypothesis 5 is partially support, indicating the female solo travel motivations of escape/relaxation, relationship, and self-actualization contribute to the formation of positive female solo travel intention. As Hypothesis 2 and Hypothesis 4 are unsupported, external values have no impact on female solo travel motivation or any significant effect on female solo travel intention. This research adds to the vast gap in tourism literature by identifying the personal values and motivations of female solo travel, and benefits the development of the female solo travel market.

Assessing the synergies and trade-offs of development projects in response to climate change in an urban region.

A synthesis of the complex relationships, including synergies and trade-offs, between urban development projects and climate change mitigation and adaptation objectives can ensure that all these relationships are taken into consideration. We used a systems approach and applied an impact matrix and chain effect analysis methods to projects in the highly urbanized Taipei metropolitan region to identify the influences and effects between urban development projects and climate change objectives. Three types of urban plans and projects were analyzed: flood control, transportation, and urban planning. The magnitudes of the influences and effects between these projects and plans were derived through interviews with experts familiar with Taipei's urban development. This pilot study found no synergy in the response to climate change mitigation and adaptation for the urban development projects analyzed. The current standalone policies and plans related to urbanization in Taipei have resulted in trade-offs for flood control and public transit projects because they contribute positively toward one climate objective but negatively impact another. A high-level policymaking mechanism that ensures coordination and collaboration between different sectors is needed to supervise sectoral policies. Prior to the approval and implementation of a plan, policymakers should request the assessment of synergies and trade-offs between plans and projects to ensure a synergistic effect to climate change issues. This study confirms that the strategy from individual sector in a metropolitan region will result in trade-off between climate change issues is a global problem. This paper also strengthens the concept that the assessment of synergy/trade-offs between policy and plans should be conducted using systemic approach.

Insight on Photocatalytic and Photoinduced Antimicrobial Properties of ZnO Thin Films Deposited by HiPIMS through Thermal Oxidation.

Zinc oxide thin films have been developed through thermal oxidation of Zinc thin films grown by high impulse power magnetron sputtering (HiPIMS). The influence of various sputtering power on thin film structural, morphological, photocatalytic, and antimicrobial properties was investigated. X-ray diffraction (XRD) analysis confirmed that the crystalline phase of ZnO thin films consists of a hexagonal wurtzite structure. Increasing the sputtering power will lead to intrinsic stress on thin films that promote whisker formation. In this study, whiskers were successfully developed on the thin films without precursors/catalysts and not thermally treated over the Zn melting point. This finding showed that the film phase structure and morphology are significantly affected by sputtering power. It was found that ZnO thin films exhibit high photocatalytic performance under UV irradiation (89.91%) of methylene blue after 300 min of irradiation. The antimicrobial activity on ZnO thin films showed significant inhibition activity (p < 0.05) against E. coli, S. aureus, and C. albicans. However, the whisker formation on ZnO thin films is not accessible to enhance photocatalytic and antimicrobial activity. This study demonstrates that the HiPIMS method through the thermal oxidation process can promote a good performance of ZnO thin films as photocatalyst and antimicrobial agents.

Fried egg sign: A typical ultrasonography feature of neurolymphomatosis.

Neurolymphomatosis (NL) is a rare condition caused by non-Hodgkin's lymphoma or leukemia. We present a case of NL and describe ultrasound features, including the "fried egg sign" in which there is a clear demarcation between an avascular echogenic core and a hypoechoic vascularized peripheral zone that may help to distinguish NL from primary nerve sheath tumors.

Analysis of changes in farm pond network connectivity in the peri-urban landscape of the Taoyuan area, Taiwan.

The farm pond system for irrigation is the most prominent feature in the Taoyuan area, Taiwan, giving the region a unique landscape and hydrological character. Although this area had more than 3,290 ponds in the 1970s, fewer than 1,800 now remain. This study analyzes changes in irrigation farm ponds and the canal network landscape in the Taoyuan area. The spatial and temporal changes to ponds and the canal network on the Taoyuan plain were examined graphically for each spatial unit (2,765 m × 2,525 m) using aerial photographs for 1979 and 2005. Landscape metrics were calculated to analyze landscape change associated with increased urbanization. Landscape indices of connectivity and circuitry were utilized to describe changes in the configuration of ponds and canal networks. The total length of canals and total number of ponds in the study area decreased significantly during 1979-2005. The average values of connectivity indices (γ- and α-index) also decreased during 1979-2005, reflecting degradation of canal networks due to urban sprawl. A multivariate technique was applied to portion the study area into three zones according to changes to land cover, ponds, and canal networks. The effects of urban sprawl on the spatial pattern of ponds and canal networks are discussed.