Exploring the role of anticipatory postural adjustment duration within APA2 subphase as a potential mediator between clinical disease severity and fall risk in Parkinson's disease.

Introduction: People with Parkinson's Disease (PD) often show reduced anticipatory postural adjustments (APAs) before voluntary steps, impacting their stability. The specific subphase within the APA stage contributing significantly to fall risk remains unclear. Methods: We analyzed center of pressure (CoP) trajectory parameters, including duration, length, and velocity, throughout gait initiation. This examination encompassed both the postural phase, referred to as anticipatory postural adjustment (APA) (APA1, APA2a, APA2b), and the subsequent locomotor phases (LOC). Participants were instructed to initiate a step and then stop (initiating a single step). Furthermore, we conducted assessments of clinical disease severity using the Unified Parkinson's Disease Rating Scale (UPDRS) and evaluated fall risk using Tinetti gait and balance scores during off-medication periods. Results: Freezing of gait (FOG) was observed in 18 out of 110 participants during the measurement of CoP trajectories. The Ramer-Douglas-Peucker algorithm successfully identified CoP displacement trajectories in 105 participants (95.5%), while the remaining 5 cases could not be identified due to FOG. Tinetti balance and gait score showed significant associations with levodopa equivalent daily dose, UPDRS total score, disease duration, duration (s) in APA2a (s) and LOC (s), length in APA1 (cm) and APA2b (cm), mediolateral velocity in APA1 (X) (cm/s), APA2a (X) (cm/s), APA2b (X) (cm/s) and LOC (X) (cm/s), and anterior-posterior velocity in APA2a (Z) (cm/s) and APA2b (Z) (cm/s). Multiple linear regression revealed that only duration (s) in APA2a and UPDRS total score was independently associated with Tinetti gait and balance score. Further mediation analysis showed that the duration (s) in APA2a served as a mediator between UPDRS total score and Tinetti balance and gait score (Sobel test, p = 0.047). Conclusion: APA2 subphase duration mediates the link between disease severity and fall risk in PD, suggesting that longer APA2a duration may indicate reduced control during gait initiation, thereby increasing fall risk.

Multiscale brain age prediction reveals region-specific accelerated brain aging in Parkinson's disease.

Brain biological age, which measures the aging process in the brain using neuroimaging data, has been used to assess advanced brain aging in neurodegenerative diseases, including Parkinson disease (PD). However, assuming that whole brain degeneration is uniform may not be sufficient for assessing the complex neurodegenerative processes in PD. In this study we constructed a multiscale brain age prediction models based on structural MRI of 1240 healthy participants. To assess the brain aging patterns using the brain age prediction model, 93 PD patients and 91 healthy controls matching for sex and age were included. We found increased global and regional brain age in PD patients. The advanced aging regions were predominantly noted in the frontal and temporal cortices, limbic system, basal ganglia, thalamus, and cerebellum. Furthermore, region-level rather than global brain age in PD patients was associated with disease severity. Our multiscale brain age prediction model could aid in the development of objective image-based biomarkers to detect advanced brain aging in neurodegenerative diseases.

Rosmarinic acid Ameliorates neuronal regeneration in the bridging silicone rubber conduits of the sciatic nerve in taxol-treated rats.

Background and aim: Taxol modulates local inflammatory conditions in peripheral nerves, which may impair their regeneration and recovery when injured. This study aimed to determine the effects of rosmarinic acid (RA, a polyphenol constituent of many culinary herbs) on the regeneration of the sciatic nerves in the bridging conduits. Experimental procedure: In the cell study, RA decreased nuclear factor (NF)-κB activity induced by taxol in a dose dependency. In the animal model, taxol-treated rats were divided into 3 groups (n = 10/group): taxol (2 mg/kg body weight for 4 times) and taxol + RA (3 times/week for 4 weeks at 20 and 40 mg/kg body weight) groups. Macrophage infiltration, calcitonin gene-related peptide (CGRP) expression levels, neuronal connectivity, animal behavior, and neuronal electrophysiology were evaluated. Results and conclusion: At the end of 4 weeks, macrophage density, CGRP expression level, and axon number significantly increased in the RA group compared with the taxol group. The RA administration unaffected heat, cold plate licking latencies, and motor coordination. Moreover, the 40 mg/kg RA group had significantly larger nerve conduction velocity and less latency compared to the taxol group. This study suggested that RA could ameliorate local inflammatory conditions to augment the recovery of regenerating nerves by accelerating their regrowth and improving electrophysiological function in taxol-treated peripheral nerve injury repaired with the silicone rubber conduit.

Electroencephalogram-Driven Machine-Learning Scenario for Assessing Impulse Control Disorder Comorbidity in Parkinson's Disease Using a Low-Cost, Custom LEGO-Like Headset.

Patients with Parkinson's disease (PD) may develop cognitive symptoms of impulse control disorders (ICDs) when chronically treated with dopamine agonist (DA) therapy for motor deficits. Motor and cognitive comorbidities critically increase the disability and mortality of the affected patients. This study proposes an electroencephalogram (EEG)-driven machine-learning scenario to automatically assess ICD comorbidity in PD. We employed a classic Go/NoGo task to appraise the capacity of cognitive and motoric inhibition with a low-cost, custom LEGO-like headset to record task-relevant EEG activity. Further, we optimized a support vector machine (SVM) and support vector regression (SVR) pipeline to learn discriminative EEG spectral signatures for the detection of ICD comorbidity and the estimation of ICD severity, respectively. With a dataset of 21 subjects with typical PD, 9 subjects with PD and ICD comorbidity (ICD), and 25 healthy controls (HC), the study results showed that the SVM pipeline differentiated subjects with ICD from subjects with PD with an accuracy of 66.3% and returned an around-chance accuracy of 53.3% for the classification of PD versus HC subjects without the comorbidity concern. Furthermore, the SVR pipeline yielded significantly higher severity scores for the ICD group than for the PD group and resembled the ICD vs. PD distinction according to the clinical questionnaire scores, which was barely replicated by random guessing. Without a commercial, high-precision EEG product, our demonstration may facilitate deploying a wearable computer-aided diagnosis system to assess the risk of DA-triggered cognitive comorbidity in patients with PD in their daily environment.

Long-Lasting Electret Melt-Blown Nonwoven Functional Filters Made of Organic/Inorganixc Macromolecular Micron Materials: Manufacturing Techniques and Property Evaluations.

Melt-blown nonwoven fabrics for filtration are usually manufactured using polypropylene, but after a certain time period the middle layer of the mask may have a reduced effect on adsorbing particles and may not be easily stored. Adding electret materials not only increases storage time, but also shows in this study that the addition of electret can improve filtration efficiency. Therefore, this experiment uses a melt-blown method to prepare a nonwoven layer, and adds MMT, CNT, and TiO2 electret materials to it for experiments. Polypropylene (PP) chip, montmorillonite (MMT) and titanium dioxide (TiO2) powders, and carbon nanotube (CNT) are blended and made into compound masterbatch pellets using a single-screw extruder. The resulting compound pellets thus contain different combinations of PP, MMT, TiO2, and CNT. Next, a hot pressor is used to make the compound chips into a high-poly film, which is then measured with differential scanning calorimetry (DSC) and Fourier transform infrared spectroscopy (FTIR). The optimal parameters are yielded and employed to form the PP/MMT/TiO2 nonwoven fabrics and PP/MMT/CNT nonwoven fabrics. The basis weight, thickness, diameter, pore size, fiber covering ratio, air permeability, and tensile property of different nonwoven fabrics are evaluated in order to have the optimal group of PP-based melt-blown nonwoven fabrics. According to the results of DSC and FTIR measurements, PP and MMT, CNT, and TiO2 are completely mixed, and the melting temperature (Tm), crystallization temperature (Tc) and endotherm area are changed accordingly. The difference in enthalpy of melting changes the crystallization of PP pellets, which in turn changes the fibers. Moreover, the Fourier transform infrared (FTIR) spectroscopy results substantiate that PP pellets are well blended with CNT and MMT, according to the comparisons of characteristic peaks. Finally, the scanning electron microscopy (SEM) observation suggests that with a spinning die temperature of 240 °C and a spinning die pressure lower than 0.01 MPa, the compound pellets can be successfully formed into melt-blown nonwoven fabrics with a 10-micrometer diameter. The proposed melt-blown nonwoven fabrics can be processed with electret to form long-lasting electret melt-blown nonwoven filters.

Effectiveness of Center of Pressure Trajectory as Anticipatory Postural Adjustment Measurement in Parkinson's Disease With Freezing of Gait History.

BACKGROUND: Evidence showed that patients with Parkinson's disease (PD) who have a history of freezing of gait (FOG) have hypometric anticipatory postural adjustment (APA) during gait initiation (GI) compared to PD without FOG. OBJECTIVES: This study aimed to test the feasibility of center of pressure (COP) displacement during GI as the measure of APA in PD with and without a history of FOG. METHODS: Patients with PD underwent COP trajectory measurements, including duration, length, velocity, and acceleration in different phases of APA (APA1, APA2a, APA2, and LOC), as well as evaluation of New Freezing of Gait Questionnaire (NFOG-Q), Tinetti balance and gait score, and Postural Instability and Gait Difficulty (PIGD) score in the on and off medication states. RESULTS: The duration (seconds) of APA2a, APA2b, and LOC were highest while velocity in mediolateral direction (X) (m/s), including APA1, APA2a, APA2b, and LOC showed lowest in PD with FOG. Velocity in the mediolateral direction in different phases of APA increased in patients with FOG after dopaminergic therapy. APA2a (seconds) and APA2b (X) (m/s) were significantly associated with NFOG-Q part II, APA2b (X) (m/s) was significantly associated with NFOG-Q part III, and APA2a (seconds) was significantly associated with Tinetti balance and gait and PIGD score. CONCLUSIONS: PD with FOG history showed a favorable response of APAs to dopaminergic replacement. The APA parameters by COP trajectory, especially lateral COP shift toward the stance foot (APA2b (X) (m/s) and APA2a (seconds)) are surrogate markers to assess PD with FOG history.

Improving detection of impacted animal bones on lateral neck radiograph using a deep learning artificial intelligence algorithm.

OBJECTIVE: We aimed to develop a deep learning artificial intelligence (AI) algorithm to detect impacted animal bones on lateral neck radiographs and to assess its effectiveness for improving the interpretation of lateral neck radiographs. METHODS: Lateral neck radiographs were retrospectively collected for patients with animal bone impaction between January 2010 and March 2020. Radiographs were then separated into training, validation, and testing sets. A total of 1733 lateral neck radiographs were used to develop the deep learning algorithm. The testing set was assessed for the stand-alone deep learning AI algorithm and for human readers (radiologists, radiology residents, emergency physicians, ENT physicians) with and without the aid of the AI algorithm. Another radiograph cohort, collected from April 1, 2020, to June 30, 2020, was analyzed to simulate clinical application by comparing the deep learning AI algorithm with radiologists' reports. RESULTS: In the testing set, the sensitivity, specificity, and accuracy of the AI model were 96%, 90%, and 93% respectively. Among the human readers, all physicians of different subspecialties achieved a higher accuracy with AI-assisted reading than without. In the simulation set, among the 20 cases positive for animal bones, the AI model accurately identified 3 more cases than the radiologists' reports. CONCLUSION: Our deep learning AI model demonstrated a higher sensitivity for detection of animal bone impaction on lateral neck radiographs without an increased false positive rate. The application of this model in a clinical setting may effectively reduce time to diagnosis, accelerate workflow, and decrease the use of CT.

Clinical Utility of Plantar Pressure Measurements as Screening in Patients With Parkinson Disease With and Without Freezing of Gait History.

OBJECTIVE: To test the feasibility of objective assessments using the TekScan MatScan pressure mat plantar pressure measurement as a time-effective screening service for Parkinson disease (PD) with and without freezing of gait (FOG) history. DESIGN: Prospective cross-sectional study. SETTING: Largest medical center in southern Taiwan. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Plantar pressure measurements including average peak pressure (PP), contact area (CA), and pressure-time integral (PTI) in static and dynamic conditions as well as clinical scores during off-medication states. PARTICIPANTS: A total of 103 patients with PD and 22 age- and sex-matched volunteers without PD (N=125). RESULTS: Plantar pressure assessment including PP, CA, and PTI on the total foot areas between participants with PD and controls without PD in the static conditions are similar. Patients with PD presented higher PTI on total foot areas as well as hallux, midfoot area, and medial and lateral heels during dynamic conditions than controls without PD. The PP, CA, and PTI during the static condition and CA during the dynamic condition on the hallux showed statistical significance between PD with and without FOG history. Stepwise logistic regression after controlling with age and body mass index showed only PTI on hallux (static conditions) was significantly associated with the presence of FOG. The receiver operating characteristic curve analysis in diagnostic accuracy for FOG in PTI was statistically significant (P=.002; area under the curve, 0.71). CONCLUSIONS: FOG screening using the TekScan MatScan pressure mat plantar pressure measurement could serve as a time-effective screening service at the outpatient clinic. Based on our study, PTI may be valuable in auxiliary diagnosis.

Construction Sheets Made of High-Performance Flame-Retardant Nonwoven Fabrics and Combustion-Resistant Polyurethane Foam: Preparation Process and Property Evaluations.

In this study, nonwoven fabrics, rigid polyurethane foam (RPUF), Basalt woven fabrics, and an aluminum foil film mold are used to produce multi-functional composite sheets with flame-retardant, sound-absorbing, and electromagnetic-shielding functions. The nonwoven layer is composed of Nomex fibers, flame-retardant PET fibers, and low-melting-point (LMPET) fibers via the needle rolling process. The optimal Nomex fiber/flame-retardant PET fiber/LMPET fiber (N/F/L) nonwoven fabrics are then combined with rigid polyurethane (PU) foam, Basalt woven fabric, and an aluminum foil film mold, thereby producing nonwoven/rigid polyurethane foam/Basalt woven fabric composite sheets that are wrapped in the aluminized foil film. The test results indicate that formed with a foaming density of 60 kg/m3 and 10 wt% of a flame retardant, the composite sheets exhibit electromagnetic interference shielding efficacy (EMI SE) that exceeds 40 dB and limiting oxygen index (LOI) that is greater than 26. The efficient and highly reproducible experimental design proposed in this study can produce multifunctional composite sheets that feature excellent combustion resistance, sound absorption, and EMI SE and are suitable for use in the transportation, industrial factories, and building wall fields.

Thermoplastic Laminated Composites Applied to Impact Resistant Protective Gear: Structural Design and Development.

Laminated composites have been commonly applied to all fields. When made into laminated composites, Kevlar woven fabrics are able to provide the required functions. In this study, two types of TPU are incorporated to improve the intralayer features of Kevlar/TPU laminated composites. Hence, the Kevlar/TPU laminated composites consist of firmly bonded laminates while retaining flexibility of the fabrics. Being the interlayer of the laminated composites, the TPU layer provides adhesion while strengthening the tensile property, dynamic puncture resistance, and buffer strength of Kevlar/TPU laminated composites. The test results indicate that with a blending ratio of two types of TRU being 85/15 wt%, the Kevlar/TPU laminated composites exhibit a tensile strength of 18.08 MPa. When the stacking thickness is 1 mm, the tensile strength is improved to 357.73 N with the buffering strength reaching 4224.40 N. Notably, with a thickness being 1.2 mm, the laminated composites demonstrate a dynamic resistance being 672.15 N. In the meanwhile, functional Kevlar fabrics are allowed to keep the fiber morphology owing to the protection of TPU composite films. Considering the composition of protective gear, Kevlar/TPU laminated composites possess a powerful potential and are worthwhile exploring.

Combing High-Modulus Fibers with a Novel Foaming Structure Applied to Protective Sandwich-Structured Composites: Manufacturing Techniques and Property Evaluations.

This study proposes the composites with a sandwich structure that is primarily made by the multi-step foaming process. The staple material is polyurethane (PU) foam that is combined with carbon fibers, followed by a Kevlar woven fabric. The composites are evaluated in terms of puncture resistance, buffer absorption, and electromagnetic wave shielding effectiveness (EMSE). The manufacturing process provides the composites with a stabilized structure efficiently. Serving the interlayer, a Kevlar woven fabric are sealed between a top and a bottom layer consisting of both PU foam and an aluminum film in order, thereby forming five-layered composites. Namely, the upper and lower surfaces of the five-layered sandwiches are aluminum films which is laminated on a purpose for the EMSE reinforcement. The test results indicate that the PU foam composites are well bonded and thus acquire multiple functions from the constituent materials, including buffer absorption, puncture resistance, and EMSE. There is much prospect that the PU foam composites can be used as a protective material in diverse fields owing to a flexible range of functions.

Additive manufacturing of Schwann cell-laden collagen/alginate nerve guidance conduits by freeform reversible embedding regulate neurogenesis via exosomes secretion towards peripheral nerve regeneration.

Peripheral nerve injury is a common clinical problem that could be debilitating to one's quality of life. The complex nerve guidance conduits (NGCs) with cells in order to improve nerve regeneration. Therefore, we used freeform reversible embedding of suspended hydrogels to fabricate Schwann cells (SCs)-laden collagen/alginate (Col/Alg) NGCs. First, we evaluated Col influence on the characteristics of NGCs. After which, Wharton's jelly mesenchymal stem cells (WJMSC) are seeded onto the inner channel of NGCs and evaluated neural regeneration behaviors. Results indicated the SCs-laden NGCs with 2.5 % Col found the highest proliferation and secretion of neurotrophic protein. Furthermore, co-culture of SCs promoted differentiation of WJMSC as seen from the increased neurogenic-related protein in NGCs. To determine the molecular mechanism between SCs and WJMSC, we demonstrated the neurotrophic factors secreted by SCs act on tropomyosin receptor kinase A (TrkA) receptors of WJMSC to promote nerve regeneration. In addition, our study demonstrated SCs-derived exosomes had a critical role in regulating neural differentiation of WJMSC. Taken together, this study demonstrates the fabrication of SCs-laden Col/Alg NGCs for nerve regeneration and understanding regarding the synergistic regenerative mechanisms of different cells could bring us a step closer for clinical treatment of large nerve defects.

Reinforcement Effects of Shear Thickening Fluid over Mechanical Properties of Nonwoven Fabrics.

Conventional personal protective equipment is usually made in multilayer stacks, and appears clumsy and uncomfortable, offering limited protection. In recent years, a newly-developed nanosuspension, shear thickening fluids (STFs), has been commonly applied to buffer and shock absorption. In this study, nonwoven fabrics are impregnated with 30 wt%, 35 wt%, or 40 wt% STF in order to strengthen the interaction among fibers. The resultant STF composite nonwoven fabrics are observed for their morphology, and tested for their tensile strength, tearing strength, bursting strength, and dynamic impact resistance, thereby examining the damage resistance of the materials. The SEM images indicate that the fibers are adhered with a tremendous amount of silicon dioxide (SiO2) particulates with a rise in the STF concentration, due to which the smooth fibers become rough. Moreover, the mechanical test results indicate that a rise in the STF concentration improves the frictional force during the relative motion of fibers, which subsequently mechanically strengthens the STF composite nonwoven fabrics. The dynamic impact test results show that when the STF concentration increases from 30 wt% to 35 wt%, the materials exhibit dynamic impact strength that is significantly improved to 51.9%. Nonetheless, significant improvement in dynamic impact strength is absent when the STF concentration increases to 40 wt%. To sum up, a critical value of STF concentration has a positive influence over the mechanical strengths of STF composite nonwoven fabrics.

Residual, regrowth, and new growth of radiofrequency ablation for benign thyroid nodules of different volumes: two-year follow-up results.

INTRODUCTION: Radiofrequency ablation (RFA) is recognized as an effective technique for the treatment of benign thyroid nodules (BTNs), although the long-term results are limited. This study aimed to evaluate the residual vital volume increase, regrowth, and new growth over a 2-year period after RFA among different nodule volume groups. SUBJECTS AND METHODS: This retrospective study evaluated 135 patients with 153 BTNs who underwent ultrasound guided RFA. The BTNs were categorized into small (<10 mL), medium (10-30 mL), and large (>30 mL) according to the initial volume of BTNs prior to ablation. The volume changes of each nodule were analyzed at 1, 3, 6, 12 and 24 months after RFA. New growth was defined as the growth in volume not found in the early follow-up on ultrasonography. RESULTS: The initial ablation ratio of all BTNs was 99.67%. The mean volume reduction ratio (VRR) of BTNs was 85.53% after 2-year follow-up. The small nodule group showed a lower VRR compared to the other two groups at the 1-month follow-up, and there was no difference of VRR at the subsequent follow-ups. The incidence of residual vital volume increase was 4.58%. The overall incidence of regrowth was 3.92% and the mean timing of regrowth was 16.71 months. New growth occurred in 18.95% of patients. No further treatment was required in the majority of cases. CONCLUSION: RFA achieved a clinically relevant volume reduction in different sizes of single BTNs which persisted for at least 2 years, thereby preventing the need for retreatment.

Deep Learning-Based Automatic Detection of ASPECTS in Acute Ischemic Stroke: Improving Stroke Assessment on CT Scans.

(1) Background: The Alberta Stroke Program Early CT Score (ASPECTS) is a standardized scoring tool used to evaluate the severity of acute ischemic stroke (AIS) on non-contrast CT (NCCT). Our aim in this study was to automate ASPECTS. (2) Methods: We utilized a total of 258 patient images with suspected AIS symptoms. Expert ASPECTS readings on NCCT were used as ground truths. A deep learning-based automatic detection (DLAD) algorithm was developed for automated ASPECTS scoring based on 168 training patient images using a convolutional neural network (CNN) architecture. An additional 90 testing patient images were used to evaluate the performance of the DLAD algorithm, which was then compared with ASPECTS readings on NCCT as performed by physicians. (3) Results: The sensitivity, specificity, and accuracy of DLAD for the prediction of ASPECTS were 65%, 82%, and 80%, respectively. These results demonstrate that the DLAD algorithm was not inferior to radiologist-read ASPECTS on NCCT. With the assistance of DLAD, the individual sensitivity of the ER physician, neurologist, and radiologist improved. (4) Conclusion: The proposed DLAD algorithm exhibits a reasonable ability for ASPECTS scoring on NCCT images in patients presenting with AIS symptoms. The DLAD algorithm could be a valuable tool to improve and accelerate the decision-making process of front-line physicians.

Increased Levels of Plasma Alzheimer's Disease Biomarkers and Their Associations with Brain Structural Changes and Carotid Intima-Media Thickness in Cognitively Normal Obstructive Sleep Apnea Patients.

Obstructive sleep apnea (OSA) has been linked to Alzheimer's disease (AD) and amyloid deposition in the brain. OSA is further linked to the development of cardiovascular and cerebrovascular diseases. In this study, we analyzed the plasma levels of AD neuropathology biomarkers and their relationships with structural changes of the brain and atherosclerosis. Thirty OSA patients with normal cognition and 34 normal controls were enrolled. Cognitive functions were assessed by the Wechsler Adult Intelligence Scale third edition and Cognitive Ability Screening Instrument. Plasma Aß-40, Aß-42, and T-tau levels were assayed using immunomagnetic reduction. The carotid intima-media thickness was measured to assess the severity of atherosclerosis. Structural MR images of brain were acquired with voxel-based morphometric analysis of T1 structural images. The OSA patients exhibited significantly elevated plasma levels of Aß-42 and T-tau, as well as increased gray matter volume in the right precuneus. Plasma T-tau level is associated with carotid intima-media thickness and gray matter volume of the precuneus. These findings may indicate early changes that precede clinically apparent cognitive impairment. The measurement of these biomarkers may aid in the early detection of OSA-associated morbidity and possible treatment planning for the prevention of irreversible neuronal damage and cognitive dysfunction.

Efficacy and safety of radiofrequency ablation for primary and secondary hyperparathyroidism with or without previous parathyroidectomy: a retrospective study.

INTRODUCTION: This study aimed to investigate and compare the therapeutic efficacy and safety of ultrasound-guided radiofrequency ablation (RFA), between primary hyperparathyroidism (PHPT) and secondary hyperparathyroidism (SHPT) patients, with or without previous parathyroidectomy (PTX). SUBJECTS AND METHODS: A total of 21 patients (7 PHPT, 14 SHPT) underwent RFA for hyperparathyroidism (HPT) at Kaohsiung Chang Gung Memorial Hospital, Taiwan. Five of the 14 SHPT patients had previously received PTX. The laboratory data, volume change of each parathyroid nodule, symptomatic scores, and complications were analyzed and compared between all groups at 1 and 7 days, and at 1, 3, 6, and 12 months after RFA. RESULTS: After RFA, the volume reduction ratio (VRR) for all patients at the last follow-up was 93.76%, and clinical symptoms significantly improved. At 12 months, all PHPT patients achieved successful treatment of intact PTH (iPTH). In SHPT patients, the mean iPTH value significantly decreased 1-day post-RFA, subsequently exhibiting a transient rebound which proceeded to decrease, with 57.1% reaching successful treatment standards. SHPT patients with PTX showed a lower complication score, shorter ablation time, higher iPTH baseline and outcomes, and lower VRR, compared to patients without PTX. The serum calcium level significantly decreased to normal range in 85.7% of all patients at 12 months. Severe hypocalcemia occurred in 23.8% at 1 week, and all were corrected with calcium supplements. CONCLUSIONS: RFA demonstrates a therapeutic efficacy similar to PTX. It can thus be considered an effective alternative treatment for PHPT, SHPT, or post-PTX patients who are unsuitable for another PTX.

Clinical Disease Severity Mediates the Relationship between Stride Length and Speed and the Risk of Falling in Parkinson's Disease.

The shuffling gait with slowed speed and reduced stride length has been considered classic clinical features in idiopathic Parkinson's disease (PD), and the risk of falling increases as the disease progresses. This raises the possibility that clinical disease severity might mediate the relationship between stride length and speed and the risk of falling in patients with PD. Sixty-one patients with PD patients underwent the clinical scores as well as quantitative biomechanical measures during walking cycles before and after dopamine replacement therapy. Mediation analysis tests whether the direct effect of an independent variable (stride length and speed) on a dependent variable (three-step fall prediction model score) can be explained by the indirect influence of the mediating variable (Unified Parkinson's Disease Rating Scale (UPDRS) total scores). The results demonstrate that decreased stride length, straight walking speed, and turning speed is associated with increased three-step fall prediction model score (r = -0.583, p < 0.0001, r = -0.519, p < 0.0001, and r = -0.462, p < 0.0001, respectively). We further discovered that UPDRS total scores value is negatively correlated with stride length, straight walking, and turning speed (r = -0.651, p < 0.0001, r = -0.555, p < 0.0001, and r = -0.372, p = 0.005, respectively) but positively correlated with the fall prediction model score value (r = 0.527, p < 0.0001). Further mediation analysis shows that the UPDRS total score values serve as mediators between lower stride length, straight walking, and turning speed and higher fall prediction model score values. Our results highlighted the relationship among stride length and speed, clinical disease severity, and risk of falling. As decreased stride length and speed are hallmarks of falls, monitoring the changes of quantitative biomechanical measures along with the use of wearable technology in a longitudinal study can provide a scientific basis for pharmacology, rehabilitation programs, and selecting high-risk candidates for surgical treatment to reduce future fall risk.

Novel Composite Planks Made of Shape Memory Polyurethane Foaming Material with Two-Step Foaming Process.

In this study, shape memory polyurethane (SMP) foaming material is used as the main material that is incorporated with carbon fiber woven fabrics via two-step foaming method, forming sandwich-structured composite planks. The process is simple and efficient and facilitates any composition as required. The emphasis of this study is protection performances, involving puncture resistance, buffer absorption, and electromagnetic wave shielding effectiveness. The proposed soft PU foam composite planks consist of the top and bottom PU foam layers and an interlayer of carbon fiber woven fabric. Meanwhile, PU foam is incorporated with carbon staple fibers and an aluminized PET film for reinforcement requirements and electromagnetic wave shielding effectiveness, respectively. Based on the test results, the two-step foaming process can provide the PU foam composite planks with excellent buffer absorption, puncture resistance, and electromagnetic wave shielding effectiveness; therefore, the proposed composite planks contribute a novel structure composition to SMP, enabling it to be used as a protective composite. In addition, the composites contain conductive material and thus exhibit a greater diversity of functions.

Clinical Impact of Gadoxetic Acid-Enhanced Magnetic Resonance Imaging on Living Donor Liver Transplant.

BACKGROUND: Gadolinium-ethoxybenzyl-diethylene triamine pentaacetic acid (Gd-EOB-DTPA) is a newer magnetic resonance contrast that has the combined effect of conventional and liver-specific contrast. The use of Gd-EOB-DTPA may aid in management of patients with hepatocellular carcinoma (HCC) undergoing living donor liver transplant (LDLT). MATERIALS AND METHODS: We retrospectively reviewed all HCC patients who received LDLT with Gd-EOB-DTPA-enhanced magnetic resonance imaging (MRI) as part of a pretransplant evaluation between October 2012 and October 2016. The detection rate and impact on decision making were assessed between multidetector-row computed tomography (MDCT) and Gd-EOB-DTPA-enhanced MRI with pathology of the explanted liver being the reference standard. RESULTS: We analyzed 25 patients with 80 nodules. Gd-EOB-DTPA-enhanced MRI showed superior detection rate for HCCs than MDCT (76.1% vs 35.8%). Among the 25 patients, 16 had additional HCCs detected by Gd-EOB-DTPA-enhanced MRI, which led to changes in therapeutic decisions in 11 patients. The recurrence rate and mortality rate were 4% (1 of 25). In the same period in our institution, the mortality rate was 13.9% (25 of 180) for those who did not receive Gd-EOB-DTPA-enhanced MRI as part of the pretransplant evaluation. CONCLUSIONS: The use of Gd-EOB-DTPA-enhanced MRI can aid in characterization of indeterminate nodules and detect more HCCs and thus more adequate downstaging and pretransplant neoadjuvant treatment ensue, which may lower the recurrence rate after LDLT.