Quadriceps muscle activity during walking with a knee ankle foot orthosis is associated with improved gait ability in acute hemiplegic stroke patients with severe gait disturbance.

Introduction: A knee-ankle-foot orthosis (KAFO) prevents knee buckling during walking and enables gait training for acute hemiplegic stroke patients with severe gait disturbances. Although the goal of gait training with a KAFO is to improve gait ability, that is, to acquire walking with an ankle-foot orthosis (AFO), it is not clear how gait training with a KAFO contributes to improving gait ability. Therefore, this study aimed to investigate the relationship between muscle activities during walking with a KAFO and the improvement of gait ability in hemiplegic stroke patients with severe gait disturbance. Methods: A prospective cohort study was conducted. Fifty acute hemiplegic stroke patients who could not walk with an AFO participated. Muscle activities of the paretic rectus femoris, biceps femoris, tibialis anterior, and soleus were assessed with surface electromyogram during walking with a KAFO. Electromyograms were assessed at the beginning of gait training and at the time the Ambulation Independence Measure score improved by 3 or higher, or discharge. Results: Even in patients with complete hemiplegia, paretic rectus femoris, biceps femoris, and soleus showed periodic muscle activity during walking with a KAFO. Twenty-three patients improved to an Ambulation Independence Measure score of 3 or higher and were able to walk with an AFO (good recovery group). At the beginning of gait training, paretic rectus femoris muscle activity during the first double-limb support phase was significantly higher in the good recovery group than in the poor recovery group. The rectus femoris muscle activity significantly increased from before to after acute rehabilitation, which consisted mainly of gait training with a KAFO. Discussion: For acute hemiplegic stroke patients with severe disturbance, the induction and enhancement of paretic quadriceps muscle activity during walking with a KAFO play an important role in acquiring walking with an AFO.

Insight into Scattering Mechanisms and Transport Properties of AgCuS for Flexible Thermoelectric Applications.

The development of flexible thermoelectric devices requires materials possessing ductility and high thermoelectric performance at room temperature. However, only a few existing materials meet both criteria. In this study, the ductile properties, electronic structure, and transport properties of the low-temperature phase α-AgCuS were elucidated using first-principles calculations combined with Boltzmann transport theory. With a layered zigzag structure similar to the well-known ductile semiconductor Ag2S, AgCuS is determined to have good metal-like ductility. Through consideration of various intrinsic scattering mechanisms, we found that electron-polar optical phonon interactions have the most significant impact on the transport behavior of AgCuS. The predominance of this type of interaction is also disclosed by the covalent-ionic bonding nature of the Ag-S and Cu-S bonds. Therefore, weakening this interaction via doping or alloying could optimize the thermoelectric performance of the system. At room temperature, a maximum dimensionless figure of merit ZT of up to 0.592 could be achieved under a tuning of hole concentration to 2 × 1019 cm-3, suggesting that α-AgCuS could be a promising p-type candidate for flexible thermoelectric applications.

A Case of Tardive Dystonia with Task Specificity Confined to the Lower Extremities only during Walking.

Background: Task-specific dystonia (TSD) confined to the lower extremities (LE) is relatively rare. This report describes dystonia confined to the LE only during forward walking. This case required careful neurological and diagnostic assessment because the patient was taking several neuropsychiatric drugs that cause symptomatic dystonia, such as aripiprazole (ARP). Case: A 53-year-old man visited our university hospital with a complaint of abnormalities in the LE that appeared only during walking. Neurological examinations other than walking were normal. Brain magnetic resonance imaging revealed meningioma in the right sphenoid ridge. The patient had been treated for depression with neuropsychiatric medications for a long time, and his abnormal gait appeared about 2 years after additional administration of ARP. After the meningioma was removed, his symptoms remained. Surface electromyography showed dystonia in both LE during forward walking, although his abnormal gait appeared to be accompanied by spasticity. The patient was tentatively diagnosed with tardive dystonia (TD). Although dystonia did not disappear clinically, it was alleviated after discontinuing ARP. Administration of trihexyphenidyl hydrochloride and concomitant rehabilitation improved his dystonia until return to work, but some residual gait abnormalities remained. Discussion: We report an unusual case of TD with task specificity confined to the LE. The TD was induced by the administration of ARP in combination with multiple psychotropic medications. Careful consideration was required for clinical diagnosis, rehabilitation, and assessment of its relevance to TSD.

Factor analysis for construct validity of a trunk impairment scale in Parkinson's disease: a cross-sectional study.

Objectives: To investigate the construct validity of the Trunk Impairment Scale (TIS), which was developed to assess trunk impairment in patients with stroke, in patients with Parkinson's disease (PD). Design: This retrospective, cross-sectional study enrolled consecutive PD inpatients. Correlation analysis was performed to clarify whether the TIS assessment was related to other balance functions, lower extremity muscle strength, or walking ability. Factor analysis was performed to see how the background factors of TIS differ from balance function, lower limb muscle strength, and walking ability. Results: Examining the data of 471 patients with PD, there were relationships between TIS and the Mini-Balance Evaluation Systems Test (r = 0.67), Barthel Index (r = 0.57), general lower limb extension torque (r = 0.51), two-minute walk test (r = 0.54), Hoehn and Yahr stage (r = -0.61), and Movement Disorder Society Unified Parkinson's Disease Rating Scale part III total points (r = -0.59). Factor analysis showed that TIS items were divided into three factors (an abdominal muscles and righting reflex component; a perception and verticality component; and a rotational component), differing from other scales that included clinical assessment items. Conclusion: The TIS can be useful for assessing the underlying trunk impairment as a basis for activities of daily living, gait function, and balance ability in patients with PD.

Short-Term Motor Outcomes in Parkinson's Disease after Subthalamic Nucleus Deep Brain Stimulation Combined with Post-Operative Rehabilitation: A Pre-Post Comparison Study.

Background: The effects of subthalamic nuclear deep brain stimulation therapy (STN-DBS) and combined postoperative rehabilitation for patients with Parkinson's disease with postural instability have yet to be well reported. This study investigated the effects of short-term postoperative rehabilitation with STN-DBS on physical function in patients with Parkinson's disease. Methods: Patients diagnosed with Parkinson's disease who were admitted to our hospital for STN-DBS surgery were included in this study. Data were prospectively collected and retrospectively analyzed. Postoperative rehabilitation consisted of muscle-strengthening exercises, stretching, and balance exercises for 40-60 minutes per day for approximately 14 days. The Mini-Balance Evaluation Systems Test (Mini-BESTest), Timed Up and Go test (TUG) seconds and steps, Trunk Impairment Scale (TIS), seconds for 10 times toe-tapping, lower limb extension torque using StrengthErgo240, and center of pressure sway in the quiet standing posture were evaluated preoperatively, postoperatively, and at discharge. Mini-BESTest changes were also evaluated in the two groups classified by the presence or absence of postural instability. One-way and two-way repeated measures analyses of variance were performed for each of the three periods of change, and paired t-tests with the Bonferroni method were performed as multiple comparison tests. A stepwise multiple regression model was used to identify factors associated with balance improvement. Results: A total of 60 patients with Parkinson's disease were included, and there were significant increases in Mini-BESTest, TIS, StrengthErgo240, and postural sway during closed-eye standing compared to pre- and postoperative conditions at discharge (p < 0.05), and they decreased significantly compared to the postoperative period (p < 0.05). On stepwise multiple regression analysis, decreased steps of TUG and improvement of TIS scores were related to improvement of the Mini-BESTest (p < 0.05). In addition, Mini-BESTest scores in both groups with and without postural instability were significantly increased at discharge compared to preoperative and postoperative conditions (p < 0.01). Conclusion: Postoperative rehabilitation combined with STN-DBS may provide short-term improvements in physical function compared with the preoperative medicated status. The improvements in gait step length and trunk function may be important factors for obtaining improvement of postoperative postural stability.

Widespread mesenteric phlebosclerosis presenting as intestinal obstruction due to stenosis of the right-sided colon.

Mesenteric phlebosclerosis is a rare form of intestinal ischemia characterized by thickening of the right-sided colon and calcification of the mesenteric vein. We describe the case of a 58-year-old woman admitted to our hospital because of abdominal pain and distension. An abdominal computed tomography study revealed remarkable dilatation and fluid collection of the small intestine compatible with intestinal obstruction, which was considered to be the result of stenosis of the ascending colon. The thickened wall of the cecum and ascending colon was associated with calcification of the colonic wall and mesenteric veins. Colonoscopy showed dark purple discoloration of the edematous mucosa from the splenic flexure through the hepatic flexure, at which point the colonoscope could not be advanced further because of stenosis of the ascending colon. Over 10 years previously, the patient had taken an herbal medicine containing gardenia fruit, which can cause mesenteric phlebosclerosis. An extensive colonic resection was performed after intestinal decompression. This case highlights extensive mesenteric phlebosclerosis causing intestinal obstruction from the cecum through the proximal portion of the sigmoid colon, which was treated with extensive colonic resection.

Serious role of non-quarantined COVID-19 patients for random walk simulations.

The infectious disease (COVID-19) causes serious damages and outbreaks. A large number of infected people have been reported in the world. However, such a number only represents those who have been tested; e.g. PCR test. We focus on the infected individuals who are not checked by inspections. The susceptible-infected-recovered (SIR) model is modified: infected people are divided into quarantined (Q) and non-quarantined (N) agents. Since N-agents behave like uninfected people, they can move around in a stochastic simulation. Both theory of well-mixed population and simulation of random-walk reveal that the total population size of Q-agents decrease in spite of increasing the number of tests. Such a paradox appears, when the ratio of Q exceeds a critical value. Random-walk simulations indicate that the infection hardly spreads, if the movement of all people is prohibited ("lockdown"). In this case the infected people are clustered and locally distributed within narrow spots. The similar result can be obtained, even when only non-infected people move around. However, when both N-agents and uninfected people move around, the infection spreads everywhere. Hence, it may be important to promote the inspections even for asymptomatic people, because most of N-agents are mild or asymptomatic.

Using the larynx as a last resort for oral intake in a hypopharyngeal cancer patient.

We present a new oral intake route in a hypopharyngeal cancer patient with severe complications. A 64-year-old man was diagnosed as having T2N0M0 squamous cell carcinoma of the posterior wall of the hypopharynx. He had previously undergone radiotherapy for laryngeal cancer and tricuspid valve replacement surgery, and also had atrial flutter and renal dysfunction. We performed surgery with curative intent. The hypopharynx was primarily closed after tumor resection. Laryngotracheal separation and tracheoesophageal diversion with end-to-end anastomosis of the trachea to the esophagus was performed. After surgery, complete oral feeding was achieved using the new pathway created. The larynx, contradictory to its typical role, can be used as a pathway to the esophagus using our revolutionary technique.

Correction: Intrinsic defect formation and the effect of transition metal doping on transport properties in a ductile thermoelectric material α-Ag2S: a first-principles study.

Correction for 'Intrinsic defect formation and the effect of transition metal doping on transport properties in a ductile thermoelectric material α-Ag2S: a first-principles study' by Ho Ngoc Nam et al., Phys. Chem. Chem. Phys., 2021, DOI: .

Intrinsic defect formation and the effect of transition metal doping on transport properties in a ductile thermoelectric material α-Ag2S: a first-principles study.

In this paper, the electronic structure and transport properties of a ductile thermoelectric material α-Ag2S are examined using first-principles calculations combined with the Boltzmann transport equation within a constant relaxation-time approximation. The use of the exchange-correlation functional SCAN + rVV10 successfully describes the geometric and electronic structure of α-Ag2S with a direct bandgap value of 0.99 eV, which is consistent with the previous experimental observations. Based on the calculations of the formation energy of typical intrinsic defects, it is found that intrinsic defect formation greatly affects the conductivity of the system where silver vacancy and interstitial silver act as p-type and n-type defects, respectively. Large Seebeck coefficients at room-temperature, of around -760 µV K-1 for n-type and 1400 µV K-1 for p-type, are realized. It is also suggested that the doping of fully filled d-block elements such as Cu and Au not only maintained the Seebeck coefficients at high values but also improved electrical conductivity by more than 1.4 times, leading to the improvement of the power factor by up to 40% compared to the non-doped sample at low carrier concentration.

Meta-iodobenzylguanidine myocardial scintigraphy in Perry disease.

INTRODUCTION: Perry disease (Perry syndrome), a hereditary TAR DNA-binding protein 43 (TDP-43) proteinopathy, is caused by dynactin subunit 1 (DCNT1) mutations and is characterized by rapidly progressive parkinsonism accompanied by depression, apathy, unexpected weight loss, and respiratory symptoms including central hypoventilation and central sleep apnea. Meta-iodobenzylguanidine (MIBG) myocardial scintigraphy is considered a diagnostic biomarker for Lewy body disease (LBD), as denervation of cardiac sympathetic nerves is a pathological feature in LBD. However, our previous studies have reported a decreased cardiac uptake of MIBG in patients with Perry disease. In this study, we aimed to correlate the MIBG myocardial scintigraphy findings with clinical features in Perry disease. METHODS: We evaluated data obtained from a multicenter survey of patients of Japanese origin with suspected Perry disease, who visited neurology departments in Japan from January 2010 to December 2018. We screened each patient's DNA for the DCTN1 mutation using Sanger sequencing and obtained the clinical details of all patients including findings from their MIBG myocardial scintigraphy. RESULTS: We identified two novel mutations, p.G71V and p.K68E, in DCTN1 in patients from two different families. The majority of patients (7/8, 87.5%) showed a decrease in cardiac uptake (heart to mediastinum ratio) in MIBG myocardial scintigraphy. These patients commonly presented with symptoms related to autonomic dysfunction: constipation, fecal incontinence, urinary disturbance, and orthostatic hypotension. CONCLUSIONS: MIBG myocardial scintigraphy may be a useful biomarker of autonomic dysfunction in Perry disease.

Hole-mediated ferromagnetism in a high-magnetic moment material, Gd-doped GaN.

As an exotic material in spintronics, Gd-doped GaN is known as a room- temperature ferromagnetic material that possesses a large magnetic moment (4000 µBper Gd ion). This paper theoretically proposes that the large magnetic moment and room-temperature ferromagnetism observed in Gd-doped GaN is caused by N 2p holes based on the assumption that Ga-vacancies (VGa) result from the introduction of Gd ions via the volume compensation effect. This causes that the too large magnetic moment is estimated for Gd ions if only Gd ions contributed the magnetic moment.

Basic reproduction number of SEIRS model on regular lattice.

In this paper we give a basic reproduction number $\mathscr{R}_0$ of an SEIRS model on regular lattice using next-generation matrix approach. Our result is straightforward but differs from the basic reproduction numbers for various fundamental epidemic models on the regular lattice which have been shown so far. Sometimes it is caused by the difference of derivation methods for $\mathscr{R}_0$ although their threshold of infectious rates for epidemic outbreak remain the same. Then we compare our $\mathscr{R}_0$ to the ones by these previous studies from several epidemic points of view.

Two-dimensional NaxSiS as a promising anode material for rechargeable sodium-based batteries: ab initio material design.

The rapidly rising demand for energy storage systems presents an imperative need to develop sodium-ion batteries with high energy density, high conductivity, and low barrier energy. In this work, we present a Density Functional study on the properties of two-dimensional NaxSiS as a promising anode material for rechargeable sodium-ion batteries. Energetically stable structures of Na-adsorbed silicene sulfide NaxSiS with various Na contents were explored. It is found that the adsorption energy of a Na atom is higher than -0.4 eV and it decreases with increasing Na content. The electronic structure of pristine silicene sulfide shows semiconductor behaviour with a bandgap of 0.99 eV, while the Na-adsorbed SiS exhibits metallic characteristics. The highest theoretical capacity of 187.2 mA h g-1, which is higher than that of well-known two dimensional materials, is found in the fully intercalated phase of SiS Na0.5SiS which corresponds to per side layer. Furthermore, Na ions can diffuse along two typical pathways on the surface of SiS with a small barrier of 183 meV which is much smaller than that of the two dimensional LixSiS, NaxTiS2, and NaxMoS2. All these characteristics suggest that silicene sulfide SiS can be expected to be a promising anode material for sodium ion batteries.

Balance and Gait Improvements of Postoperative Rehabilitation in Patients with Parkinson's Disease Treated with Subthalamic Nucleus Deep Brain Stimulation (STN-DBS).

BACKGROUND: Deep brain stimulation of the subthalamic nucleus (STN-DBS) is a surgical treatment to reduce the "off" state motor symptoms of Parkinson's disease (PD). Postural instability is one of the major impairments, which induces disabilities of activities of daily living (ADLs). The effectiveness of STN-DBS for postural instability is unclear, and the effect of rehabilitation following STN-DBS has remained uncertain. OBJECTIVE: The purpose of this study was to examine changes in balance ability, gait function, motor performance, and ADLs following 2 weeks of postoperative rehabilitation in PD patients treated with STN-DBS. METHODS: Sixteen patients were reviewed retrospectively from February 2016 to March 2017. All patients were tested in their "on" medication state for balance and gait performance using the Mini-Balance Evaluation Systems Test (Mini-BESTest) and the Timed "Up and Go" (TUG) test before the operation, after the operation, and during the discharge period. The UPDRS motor score (UPDRS-III) and Barthel Index (BI) were assessed before the operation and during the discharge period. Rehabilitation focused on muscle strengthening with stretching and proactive balance training. Friedman's test and the post hoc Wilcoxon's signed-rank test were used to analyze the balance assessments, and ANOVA and the post hoc Tukey's test were used to analyze gait performance. The significance level was p < 0.05. RESULTS: During the discharge period, the Mini-BESTest and TUG were significantly improved compared with the preoperative and postoperative periods (p < 0.05). There were no differences between preoperative and postoperative periods in the Mini-BESTest (p=0.12) and TUG (p=0.91). The BI and motor sections of the UPDRS did not differ significantly between the preoperative and postoperative periods (p=0.45, p=0.22). CONCLUSION: The results of this study suggest that postoperative rehabilitation improves balance and gait ability in patients with PD treated with STN-DBS.

Metapopulation model for a prey-predator system: Nonlinear migration due to the finite capacities of patches.

Many species live in spatially separated patches, and individuals can migrate between patches through paths. In real ecosystems, the capacities of patches are finite. If a patch is already occupied by the individuals of some species, then the migration into the patch is impossible. In the present paper, we deal with prey-predator system composed of two patches. Each patch contains a limited number of cells, where the cell is either empty or occupied by an individual of prey or predator. We introduce "swapping migration" defined by the exchange between occupied and empty cells. An individual can migrate, only when there are empty cells in the destination patch. Reaction-migration equations in prey-predator system are presented, where the migration term forms nonlinear function of densities. We numerically solve equilibrium densities, and find that the population dynamics are largely affected by nonlinear migration. Not only extinction points but also the responses to the environmental changes crucially depend on the patch capacities.

Effects of cyclic allele dominance rules and spatial structure on the dynamics of cyclic competition models.

Barreto et al. (2017) showed that the genotypic cyclic competition model with three phenotypes appearing as three morphs of male lizards' throats had the same equilibrium but a wider stability region as the corresponding phenotypic model. In this paper we re-examine stability conditions under the symmetric choice of parameters for the phenotypic model so we can set the same internal equilibrium densities for all three phenotypes. In this setting we compare the stability regions of cyclic allele dominance rule. Next we consider the dynamics on a two-dimensional square lattice space and then show the effect of this spatial structure on the stability of phenotypic model. We obtain the following results: (i) Cyclic allele dominance rule in a genotypic model gives a wider stable region of internal equilibrium than the allele dominance rule observed in lizards; and (ii) spatial structure drastically changes dynamical behavior, especially when all three phenotypes coexist in almost all the parameter spaces when both competition and dispersal occur locally.

Performance Evaluation of Age Estimation from T1-Weighted Images Using Brain Local Features and CNN.

The age of a subject can be estimated from the brain MR image by evaluating morphological changes in healthy aging. We consider using two-types of local features to estimate the age from T1-weighted images: handcrafted and automatically extracted features in this paper. The handcrafted brain local features are defined by volumes of brain tissues parcellated into 90 or 1,024 local regions defined by the automated anatomical labeling atlas. The automatically extracted features are obtained by using the convolutional neural network (CNN). This paper explores the difference between the handcrafted features and the automatically extracted features. Through a set of experiments using 1,099 T1-weighted images from a Japanese MR image database, we demonstrate the effectiveness of the proposed methods, analyze the effectiveness of each local region for age estimation and discuss its medical implication.

Disease Exacerbation after the Cessation of Fingolimod Treatment in Japanese Patients with Multiple Sclerosis.

Objective In Japan, following the launch of dimethyl fumarate (DMF) after fingolimod as a disease-modifying drug in multiple sclerosis (MS), some patients switched from fingolimod to DMF. The aim of this study was to determine the follow-up status of MS patients who switched to DMF after fingolimod cessation. Methods Clinical and magnetic resonance imaging (MRI) data in 19 patients with MS who switched to DMF were collected for at least for 6 months after fingolimod cessation. Results Ten patients (52.6%) experienced clinical or MRI exacerbation after fingolimod cessation. The peripheral blood lymphocyte counts at the time of fingolimod cessation in those with disease exacerbation were significantly lower than in those without exacerbation. The patients with disease exacerbation were further classified into three groups based on MRI findings: those with some new T2-weighted lesions with or without gadolinium (Gd) enhancement (group I), those with more new and/or enlarged T2-weighted lesions with Gd enhancement compared to pre-fingolimod induction (group II), and those with multifocal tumefactive demyelinating lesions. In group II, the clinical disease activity, which was similar to that at fingolimod initiation in group I, was higher than the clinical disease activity observed before fingolimod initiation. Conversely, group III exhibited unexpected new MRI findings that were not evident before fingolimod initiation. Conclusion Cessation of fingolimod might precipitate rebound or reactivation of clinical disease in patients with MS, and careful follow-up is necessary for patients who discontinue fingolimod.

Probing the Entropic Effect in Molecular Noncovalent Interactions between Resin-Bound Polybrominated Arenes and Small Substrates.

The associative interaction between resin-bound polybrominated arenes and small molecules was analyzed by using various spectroscopic techniques as well as a synthetic molecular model to establish the thermodynamics. The binding in acetonitrile was three orders of magnitude stronger than that in methanol, partly owing to the tertiary conformational gating of the resin that controls the entropic terms. By using the entropic superiority, the associative binding of up to 3×104 m-1 is achieved with the non-biological system. A modified Hill plot for the quantitative analysis of bindings was also devised, which enabled the interactions at the molecular level to be elucidated.