A multimodal screening system for elderly neurological diseases based on deep learning.

In this paper, we propose a deep-learning-based algorithm for screening neurological diseases. We proposed various examination protocols for screening neurological diseases and collected data by video-recording persons performing these protocols. We converted video data into human landmarks that capture action information with a much smaller data dimension. We also used voice data which are also effective indicators of neurological disorders. We designed a subnetwork for each protocol to extract features from landmarks or voice and a feature aggregator that combines all the information extracted from the protocols to make a final decision. Multitask learning was applied to screen two neurological diseases. To capture meaningful information about these human landmarks and voices, we applied various pre-trained models to extract preliminary features. The spatiotemporal characteristics of landmarks are extracted using a pre-trained graph neural network, and voice features are extracted using a pre-trained time-delay neural network. These extracted high-level features are then passed onto the subnetworks and an additional feature aggregator that are simultaneously trained. We also used various data augmentation techniques to overcome the shortage of data. Using a frame-length staticizer that considers the characteristics of the data, we can capture momentary tremors without wasting information. Finally, we examine the effectiveness of different protocols and different modalities (different body parts and voice) through extensive experiments. The proposed method achieves AUC scores of 0.802 for stroke and 0.780 for Parkinson's disease, which is effective for a screening system.

Effects of Blood Transfusion on Hepatic Ischemia-Reperfusion Injury-Induced Renal Tubular Injury.

OBJECTIVES: Hepatic ischemia-reperfusion injury and transfusion of red blood cells in liver surgery are wellknown risk factors to induce acute tubular injury. Transfusion of stored red blood cells may affect hepatic ischemia-reperfusion injury-induced acute tubular injury. Here, we hypothesized whether preischemic (due to increased severity of hepatic injury) and postischemic (due to renal uptake of free heme and iron) transfusion of stored red blood cells may potentiate acute tubular injury in rats subjected to hepatic ischemia-reperfusion injury. MATERIALS AND METHODS: Sprague Dawley rats (n = 24) were divided into 4 groups: sham operation (sham group), hepatic ischemia-reperfusion injury only (injury-only group), red blood cell transfusion before hepatic ischemia-reperfusion injury (preinjury transfusion group), and red blood celltransfusion after hepatic ischemia-reperfusion injury (postinjury transfusion group). Partial hepatic ischemia was induced for 90 minutes, with reperfusion allowed for 12 hours. Hepatic and renal tubular injury markers, renal mRNA levels of oxidant stress markers, and inflammatory markers were assessed. Renal cortex samples were examined under hematoxylin and eosin staining for tubular histopathologic score and immunohistochemical staining forinflammatory cells. RESULTS: With regard to hepatic and renal tubular injury markers, serum alanine aminotransferase, serum urea nitrogen, and histopathologic scores were increased in the preinjury and postinjury transfusion groups versus injury-only group, with moderate to strong correlation between alanine aminotransferase and tubular injury markers. Renal oxidative stress markers (heme oxygenase-1 and neutrophil gelatinaseassociated lipocalin) were correlated with increased alanine aminotransferase, with upregulation of oxidant stress markers in the preinjury transfusion group versus sham group (all markers), as well as in the injury-only and postinjury transfusion groups (heme oxygenase-1 only). We observed no changes in renal inflammatory responses among the groups. CONCLUSIONS: Preischemic transfusion potentiated acute tubular injury without triggering renal inflammatory responses. Exacerbation of hepatic injury may induce acute tubular injury via renal oxidant stress.

Massive Duodenal Bleeding after the Migration of Endovascular Coils into the Small Bowel.

Among gastrointestinal emergencies, acute upper gastrointestinal bleeding remains a challenging clinical problem owing to significant patient morbidity and costs involved in management. Endoscopic hemostatic therapy is the mainstay of treatment and decreases the incidence of re-bleeding, the need for surgery, morbidity, and mortality. However, in 8%-15% of patients with upper gastrointestinal bleeding, endoscopic hemostatic therapy does not successfully control bleeding. Trans-arterial coil embolization is an effective alternative treatment for endoscopic hemostatic failure; however, this procedure can induce adverse outcomes, such as non-target vessel occlusion, vessel dissection and perforation, and coil migration. Coil migration is rare but causes severe complications, such as re-bleeding and bowel ischemia. However, in most cases, coil migration is local and involves spontaneous healing without serious complications. Here, we report the case of a patient who underwent trans-arterial coil embolization of the gastroduodenal artery with the purpose of controlling massive duodenal bleeding, resulting in a fatal outcome caused by coil migration.

Algal Bloom Prediction Using Extreme Learning Machine Models at Artificial Weirs in the Nakdong River, Korea.

In this study, we design an intelligent model to predict chlorophyll-a concentration, which is the primary indicator of algal blooms, using extreme learning machine (ELM) models. Modeling algal blooms is important for environmental management and ecological risk assessment. For this purpose, the performance of the designed models was evaluated for four artificial weirs in the Nakdong River, Korea. The Nakdong River has harmful annual algal blooms that can affect health due to exposure to toxins. In contrast to conventional neural network (NN) that use backpropagation (BP) learning methods, ELMs are fast learning, feedforward neural networks that use least square estimates (LSE) for regression. The weights connecting the input layer to the hidden nodes are randomly assigned and are never updated. The dataset used in this study includes air temperature, rainfall, solar radiation, total nitrogen, total phosphorus, N/P ratio, and chlorophyll-a concentration, which were collected on a weekly basis from January 2013 to December 2016. Here, upstream chlorophyll-a concentration data was used in our ELM2 model to improve algal bloom prediction performance. In contrast, the ELM1 model only uses downstream chlorophyll-a concentration data. The experimental results revealed that the ELM2 model showed better performance in comparison to the ELM1 model. Furthermore, the ELM2 model showed good prediction and generalization performance compared to multiple linear regression (LR), conventional neural network with backpropagation (NN-BP), and adaptive neuro-fuzzy inference system (ANFIS).

Preischemic transfusion of old packed RBCs exacerbates early-phase warm hepatic ischemia reperfusion injury in rats.

BACKGROUND: Hepatic innate immune cells are considered to play a central role in the early phase of hepatic ischemia reperfusion (IR) injury. Transfusion of old red blood cells (RBCs) is known to prime immune cells, and transfusion before IR may exacerbate liver injury because of the expected hyperresponsiveness of immune cells. MATERIALS AND METHODS: Twenty-four Sprague-Dawley rats were divided into four groups: sham operation (Sham); hepatic IR only (IR Control); and two transfusion groups, preischemic (Pre-T) and postischemic (Post-T), in which allogeneic RBCs stored for 2 weeks were transfused before hepatic IR or after reperfusion, respectively. Partial hepatic ischemia was induced for 90 min, and reperfusion was allowed for 120 min. Serum alanine transaminase levels, area of necrosis, and apoptotic cells were then assessed. Inflammatory (tumor necrosis factor alpha, interleukin 1 beta [IL-1ß], IL-6, IL-10, and cyclooxygenase 2) and oxidative mediators (heme oxygenase 1, superoxide dismutase, and glutathione peroxidase 1) were assessed for elucidating the relevant mechanisms underlying the hepatic injury. RESULTS: Pre-T, but not Post-T, showed increased serum alanine transaminase levels than IR Control (P < 0.05). Area of necrosis was more severe in Pre-T than in IR Control or Post-T (P < 0.01), and apoptotic cells were also more abundant in Pre-T than in IR Control (P < 0.01). tumor necrosis factor alpha and IL-6 levels were higher in Pre-T than in IR Control or Post-T (P < 0.05), with no significant difference in cytoprotective protein levels. CONCLUSIONS: Preischemic transfusion of old RBCs aggravated hepatic injury. Inflammatory cytokines seemed to play a crucial role in liver injury exacerbation. Our results indicate that transfusion before hepatic ischemia may be detrimental.

Interrater reliability and intrarater reliability of lateral scapular slide tests of females in their 20s.

[Purpose] The purpose of the present study was to examine the intrarater reliability and intrarater reliability of lateral scapular slide tests among young females. [Subjects and Methods] A total of 60 female students in U University in Gyeongsangbuk-do, South Korea participated in this study. Lateral scapular slide tests (LSST) were conducted to identify interrater & intrarater reliability. In the LSSTs, the distance from the inferior angle of the scapula to thoracic vertebral spinous process T8 was measured in three positions (shoulder joint 0°, 45°, and 90° abduction) using tape measures. [Results] Intrarater reliability is shown to be moderate with scores not lower than 0.7 in left positions 1 and 3 and is shown to be excellent with scores not lower than 0.9 in the remaining positions. Interrater reliability is shown to be excellent with scores not lower than 0.9 in all three left and right positions. [Conclusion] LSST is sufficiently high to be accepted as an objective tool in the results of general previous studies. In addition, it can be considered useful at clinics because the measuring tool and method are simple.

Correlation among scapular asymmetry, neck pain, and neck disability index (NDI) in young women with slight neck pain.

[Purpose] This study aimed to investigate the correlations among scapular asymmetry, neck pain, and neck disability index in women in their 20s with slight neck pain. [Subjects and Methods] A total of 60 female students at U university in Gyeongsangbuk-do, South Korea, participated in this study. The lateral scapular slide test, which measures the distance between the thorax and scapula, was used to analyze the scapular asymmetry. The lateral scapular slide test was performed in three positions. The visual analogue scale and neck disability index were used to measure neck pain. [Results] In the lateral scapular slide test in position 3 (shoulder abduction at 90 degrees), the scapular left-right asymmetry and VAS showed a moderate positive linear relationship, with r=0.344. The VAS and NDI showed a moderate positive linear relationship, with r = 0.632. [Conclusion] Scapular asymmetry indicates imbalance of surrounding muscles of the scapula and is related to neck pain based on the results of measuring the distance from the thorax to the scapula.

Abnormal sitting pressures of hemiplegic cerebral palsy children on a school chair.

[Purpose] The purpose of this study was to investigate the differences in symmetry of sitting posture between typical developmental (TD) children and hemi-cerebral palsy (CP) children. [Subjects and Methods] A school chair mounted on a force platform was used to assess the quiet-sitting pressure distribution of 10 TD and 10 CP children. [Results] The symmetry index of the TD children was significantly closer to zero than that of the CP children irrespective of the latter group's hemiparetic side. [Conclusions] Sitting posture on school chairs of CP children was more asymmetrical than that of TD children.

Effects on training and detraining on physical function, control of diabetes and anthropometrics in type 2 diabetes; a randomized controlled trial.

The purpose of this study was to investigate the effect of circuit exercise training and detraining, which is defined by termination of training without additional physical activities, in type 2 diabetic patients. Elderly with type 2 diabetes were divided into a group that exercised for 1 h three times a week for 12 weeks, followed by detraining for 8 weeks, or into a control group. Muscular strength, endurance, flexibility, agility, balance, body mass index (BMI), glycosylated hemoglobin (HbA1c), and blood lipid profile were measured. Of the 98 diabetic participants who joined this study, 37 patients completed the program (exercise group = 24, control group = 13). After training, muscular strength, flexibility, balance, agility, and endurance in the training group were significantly higher than at baseline and compared to the control group. HbA1c levels decreased in the training group. There was no significant improvement in BMI and blood lipid profile in either group. Flexibility and agility in the training group declined significantly after detraining. In spite of this decline, flexibility and agility were significantly higher compared to the baseline and to the control group. In type 2 diabetic patients, circuit training had a beneficial effect on the indices of physical function and glucose metabolism. Training resulted in good improvement; and during detraining, the effect of exercise training was maintained except in some parameters.

Impairment of balance in elderly subjects with type 2 diabetes.

[Purpose] The purpose of this study was to investigate balance among elderly subjects with type 2 diabetes. [Subjects and Methods] Twelve subjects with type 2 diabetes and 15 age-matched controls were examined. Balance was assessed by a computerized device while the subjects were standing. [Results] Subjects with diabetes exhibited significantly more sway than control subjects while standing on a balance platform. [Conclusion] Our findings suggest that diabetes impairs balance when compared with that in normal elderly subjects.

A comparison of gait characteristics in the elderly people, people with knee pain, and people who are walker dependent people.

[Purpose] The purpose of this study was to compare the gait parameters of age-matched people with a normal gait (≥ 65 years), age-matched people with knee pain, and age-matched people with walker dependent gait at a self-selected gait speed. [Methods] Subjects walked on even ground in bare feet and were allowed a natural arm swing on a 6-m walkway. Walker-dependent participants walked on a walkway without a walker. [Results] The kinematic and spatiotemporal gait characteristics were used to investigate the difference among the each group. Hip flexion, knee flexion, and stride width parameters were not different. The gait speed, stride length and time, hip and knee extension, and ankle flexion and extension parameters were significantly different. [Conclusion] A comparision of kinematic and spatiotemporal gait characteristics during gait may provide an insight into the gait pattern of normal elderly people, those with knee pain, and the walker-dependent elderly.

Balance improvement by strength training for the elderly.

[Purpose] Aging is associated with a progressive decline in overall muscle strength. Loss of lower limb strength leads to an increased risk of falls and a sedentary lifestyle. The purpose of this study was to investigate whether lower limb strengthening exercise leads to improved lower limb strength and balance function for the elderly. [Subjects] From a total of 74 respondents, 50 subjects were randomly assigned to either a training group (n = 30) or a control group (n = 20). The subjects ranged in age from 65 to 82 years. A randomized controlled trial compared the effects of strengthening exercise and balance function. [Methods] Leg extension and lower curl exercises were performed during the 12-week study. [Results] After training, the lower limb strength and balance of the individuals in the training group had significantly improved compared to the baseline. [Conclusion] Improvement in lower limb strength may lead to balance enhancement in neurologically intact older persons.

Assessment of hydraulic fish habitat condition using integrated toolkit: a case study of the Geum river basin, Republic of Korea.

Artificial changes of rivers, including construction and operation of dams, inevitably lead to physical and ecological changes throughout waterways and their floodplains. In this study, a conceptual model coupled with integrated numerical modeling is presented for hydraulic fish habitat assessment of the Geum River basin, Republic of Korea. Based on the major events which might have affected the ecological system, a conceptual model was formulated to guide desktop and field studies, modeling and scenario evaluations. The result of hydraulic fish habitat assessment indicated that the construction of the Daecheong Multipurpose Dam (DMD) in the Geum River basin has altered flow magnitudes and reduced the river's flow variability. Changes are evident in the magnitude of medium and small flows and the river experiences increased low flows during the dry season. Black shiner, an endangered fish species in Korea, was selected and analyzed to explore relationships between flow regime change by dams and changes to its preferred habitats. As a result, fewer sensitive riffle-benthic species were observed in the reaches downstream of DMD due to the reduction of suitable habitat conditions such as riffle-pool sequences. The proposed conceptual model and integrated toolkit would allow river managers to isolate the physical and biological effects associated with dam operation and could be useful for developing river management strategies.

Alteration of mitochondrial DNA sequence and copy number in nasal polyp tissue.

This study was designed to investigate the possibility that mtDNA mutations might arise in inflammatory or chronically damaged nasal polyp tissue from 23 patients. Thirteen patients (57%) displayed nasal polyp tissue-specific mtDNA mutations in the hypervariable segment of the control region and cytochrome b gene, which were not found in the corresponding blood cells and/or adjacent normal tissue. Nasal polyp tissue-specific length heteroplasmic mutations were also detected in nucleotide position (np) 303-315 homopolymeric poly C track (39%), np 514-523 CA repeats (17%) and np 16184-16193 poly C track (30%). The average mtDNA copy number was about three times higher in nasal polyp tissue than in the corresponding peripheral blood cells and adjacent non-polyp tissues. The level of reactive oxygen species (ROS) was significantly higher in the nasal polyp tissues compared to those from the corresponding samples. High level of ROS in nasal polyp tissue may contribute to development of mtDNA mutations, which may play a crucial role in the vicious cycle of pathophysiology of nasal polyps.