Feasibility of artificial intelligence assisted quantitative muscle ultrasound in carpal tunnel syndrome.

BACKGROUND: In case of focal neuropathy, the muscle fibers innervated by the corresponding nerves are replaced with fat or fibrous tissue due to denervation, which results in increased echo intensity (EI) on ultrasonography. EI analysis can be conducted quantitatively using gray scale analysis. Mean value of pixel brightness of muscle image defined as EI. However, the accuracy achieved by using this parameter alone to differentiate between normal and abnormal muscles is limited. Recently, attempts have been made to increase the accuracy using artificial intelligence (AI) in the analysis of muscle ultrasound images. CTS is the most common disease among focal neuropathy. In this study, we aimed to verify the utility of AI assisted quantitative analysis of muscle ultrasound in CTS. METHODS: This is retrospective study that used data from adult who underwent ultrasonographic examination of hand muscles. The patient with CTS confirmed by electromyography and subjects without CTS were included. Ultrasound images of the unaffected hands of patients or subjects without CTS were used as controls. Ultrasonography was performed by one physician in same sonographic settings. Both conventional quantitative grayscale analysis and machine learning (ML) analysis were performed for comparison. RESULTS: A total of 47 hands with CTS and 27 control hands were analyzed. On conventional quantitative analysis, mean EI ratio (i.e. mean thenar EI/mean hypothenar EI ratio) were significantly higher in the patient group than in the control group, and the AUC was 0.76 in ROC analysis. In the analysis using machine learning, the AUC was the highest for the linear support vector classifier (AUC = 0.86). When recursive feature elimination was applied to the classifier, the AUC value improved to 0.89. CONCLUSION: This study showed a significant increase in diagnostic accuracy when AI was used for quantitative analysis of muscle ultrasonography. If an analysis protocol using machine learning can be established and mounted on an ultrasound machine, a noninvasive and non-time-consuming muscle ultrasound examination can be conducted as an ancillary tool for diagnosis.

Nanoencapsulation enhances the bioavailability of fucoxanthin in microalga Phaeodactylum tricornutum extract.

The marine carotenoid fucoxanthin (FX) has various health benefits but suffers from poor bioavailability. We hypothesize that the bioavailability of FX in microalga Phaeodactylum tricornutum extract (PE) could be improved through nanoencapsulation. Here, we developed two types of nanoparticles: one consisting of alginate and casein (A-C-PE, 246 nm diameter, 79.6% encapsulation efficiency) and the other A-C-PE coated with chitosan (CS-A-C-PE, 258 nm, 78.1%). Both types of nanoparticles incorporating PE showed controlled FX release during simulated gastrointestinal digestion, as well as 1.8-fold improvement of membrane permeability in Caco-2/TC7 cells compared to non-encapsulated PE. Pharmacokinetic behavior of two FX metabolites (fucoxanthinol and amarouciaxanthin A) in mouse plasma was monitored after oral administration. The results showed that 31.8-332.1% more FX metabolites from the nanoparticles were absorbed into plasma than those from PE. In conclusion, encapsulation of PE in both types of nanoparticles significantly promoted the bioavailability of FX.

Association between Elevated Plasma Homocysteine and Low Skeletal Muscle Mass in Asymptomatic Adults.

BACKGROUND: Homocysteine has been drawing attention with a closed linkage with skeletal muscle. However, the association of hyperhomocysteinemia with decreased skeletal muscle mass remains unclear. We aimed to investigate the association of hyperhomocysteinemia with low skeletal muscle mass (LMM) in asymptomatic adults. METHODS: This was a cross-sectional study of 114,583 community-dwelling adults without cancer, stroke, or cardiovascular diseases who underwent measurements of plasma homocysteine and body composition analysis from 2012 to 2018. Hyperhomocysteinemia was defined as >15 µmol/L. Skeletal muscle mass index (SMI) was calculated based on appendicular muscle mass (kg)/height (m)2. Participants were classified into three groups based on SMI: "normal," "mildly low," and "severely low." RESULTS: The prevalence of hyperhomocysteinemia was the highest in subjects with severely LMM (12.9%), followed by those with mildly LMM (9.8%), and those with normal muscle mass (8.5%) (P for trend <0.001). In a multivariable logistic regression model, hyperhomocysteinemia was significantly associated with having a mildly LMM (odds ratio [OR], 1.305; 95% confidence interval [CI], 1.224 to 1.392) and severely LMM (OR, 1.958; 95% CI, 1.667 to 2.286), respectively. One unit increment of log-transformed homocysteine was associated with 1.360 and 2.169 times higher risk of having mildly LMM and severely LMM, respectively. CONCLUSION: We demonstrated that elevated homocysteine has an independent association with LMM in asymptomatic adults, supporting that hyperhomocysteinemia itself can be a risk for decline in skeletal musculature.

Prevalence and Related Factors for Poststroke Complex Regional Pain Syndrome: A Retrospective Cross-Sectional Cohort Study.

OBJECTIVE: The objective of this study was to evaluate the prevalence of poststroke complex regional pain syndrome (CRPS) to estimate related factors for poststroke CRPS in patients with first-ever stroke. DESIGN: This was a retrospective cross-sectional cohort study of adult patients (age >18y) with stroke who were admitted to rehabilitation unit from December 2014 to May 2018 in Korea. SETTING: Single acute rehabilitation unit of university hospital. PARTICIPANTS: Participants (N=313) diagnosed with first-ever stroke were identified from the stroke rehabilitation registry of our institute. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Prevalence of poststroke CRPS based on clinical features and 3-phase bone scintigraphy and the related factors of poststroke CRPS. RESULTS: A total of 313 records were analyzed, including demographic, clinical characteristics, and functional variables. Poststroke CRPS was found in 8.94% (28 of 313) patients with first-ever stroke. Logistic regression analysis showed that Fugl Meyer Assessment of Upper Extremity (FMA-UE) score was a significant associated factor for the presence of CRPS (odds ratio, 0.96; 95% confidence interval, 0.94-0.98; P=.003). The cutoff value of 76 points for FMA-UE score yielded moderate accuracy in identifying of poststroke CRPS (92.6% sensitivity, 65.8% specificity, and 0.85 area under the curve). CONCLUSIONS: The prevalence of poststroke CRPS was 8.94% in patients with first-ever stroke. The FMA-UE score was associated with the poststroke CRPS. Therefore, in patients with low FMA-UE score, prevention and high suspicion of post-stroke CRPS is necessary.

The Diagnostic Significance of Ultrasonographic Measurement of the Achilles Tendon Thickness for the Insertional Achilles Tendinopathy in Patients with Heel Pain.

No consensus exists concerning the diagnostic role or cutoff value of the Achilles tendon thickness on ultrasonography (US) for the diagnosis of insertional Achilles tendinopathy. This study sought to assess the diagnostic utility of US measurement of the thickness and echogenicity of the Achilles tendon for the insertional Achilles tendinopathy in patients with heel pain, and to compare the results with those of the plantar fascia for the plantar fasciitis. We conducted US examinations in consecutive patients who presented with unilateral or bilateral heel pain at the foot clinic of a single tertiary hospital from February 2016 to December 2020. Each US evaluation assessed the thickness and echogenicity of the insertion area of the Achilles tendon and plantar fascia. We retrospectively compared these parameters between patients with insertional Achilles tendinopathy or plantar fasciitis and normal controls and analyzed the diagnostic utility of these parameters. Based on clinical diagnosis, 44 feet were diagnosed with insertional Achilles tendinopathy, 109 feet were diagnosed with plantar fasciitis, and 32 feet were classified as normal. There was a significant difference in the thickness of the plantar fascia between the plantar fasciitis and normal control groups (p = 0.032). There was also a significant difference in the echogenicity of the plantar fascia between the plantar fasciitis and normal groups (p < 0.001). However, there was no significant difference in the thickness of the insertional area of the Achilles tendon between the insertional Achilles tendinopathy and normal groups (p = 0.132). There was a significant difference in the echogenicity of the insertional area of the Achilles tendon between the insertional Achilles tendinopathy and normal groups (p < 0.001). US measurement of the thickness of the insertional area of the Achilles tendon might not reflect the clinical status of insertional Achilles tendinopathy, unlike that of plantar fasciitis.

Effects of the Addition Levels of White Kimchi Powder and Acerola Juice Powder on the Qualities of Indirectly Cured Meat Products.

This study investigated the effects of the addition levels of white kimchi powder and acerola juice powder, as natural sources of sodium nitrite and sodium ascorbate, on the quality of cooked ground pork products. Freeze-dried white kimchi powder was prepared and used after fermentation for 2 wk. Six treatments were included: control (100 ppm sodium nitrite and 500 ppm sodium ascorbate), treatment 1 (0.2% white kimchi powder, 0.02 % starter culture, and 0.1% acerola juice powder), treatment 2 (0.2% white kimchi powder, 0.02% starter culture, and 0.2% acerola juice powder), treatment 3 (0.4% white kimchi powder, 0.04% starter culture, and 0.1% acerola juice powder), treatment 4 (0.4% white kimchi powder, 0.04% starter culture, and 0.2% acerola juice powder), and treatment 5 (0.4% celery powder, 0.04% starter culture, and 0.2% acerola juice powder). The pH values were decreased (p<0.05) because of lower pH of acerola juice powder, resulting in lower cooking yields (p<0.05) in these treatments. CIE L* and CIE a* values of indirectly cured meat products were not different (p>0.05) from the sodium nitrite-added control. However, indirectly cured meat products showed lower (p<0.05) residual nitrite contents, but higher (p<0.05) nitrosyl hemochrome contents and cure efficiency than the control. Treatments 2 and 4 had higher (p<0.05) total pigment contents and lipid oxidation than the control. This study indicates that white kimchi powder coupled with acerola juice powder has substantial potential to substitute synthetic nitrite to naturally cured meat products, which could be favored by consumers seeking clean label products.

Effects of radish powder concentration and incubation time on the physicochemical characteristics of alternatively cured pork products.

Previous research has indicated that radish powder could be a suitable replacement for chemical nitrite sources in alternatively cured meat products. However, the effects of radish powder level on the physicochemical properties of cured meat have not been systematically studied. In this study, we aimed to investigate the effects of varying concentrations of radish powder and incubation time on the physicochemical properties and cured meat pigments of alternatively cured meat products. We divided our experimental setup into seven groups with different radish powder concentrations and incubation times: control (0.01% sodium nitrite), treatment 1 (0.15% radish powder and 2 h incubation), treatment 2 (0.15% radish powder and 4 h incubation), treatment 3 (0.30% radish powder and 2 h incubation), treatment 4 (0.30% radish powder and 4 h incubation), treatment 5 (0.30% celery powder and 2 h incubation), and treatment 6 (0.30% celery powder and 4 h incubation). The cooking yield, CIE a* values (redness), and total pigment levels were not significantly different (p > 0.05) between any of the alternatively cured treatments and the control. However, when 0.30% radish powder or celery powder was added to the products, the CIE b* values increased significantly (p < 0.05) with incubation time. At the same vegetable concentration, the nitrite content, nitrosyl hemochrome, and curing efficiency also increased significantly (p < 0.05) as the incubation time increased from 2 to 4 h, regardless of the types of vegetable powder. Among the meat products cured with radish powder, treatment 4 showed the highest increase in residual nitrite content, nitrosyl hemochrome content, and curing efficiency, but showed decreased lipid oxidation. Our results suggest that increased concentrations of radish powder and longer incubation times would be more suitable for producing alternatively cured meat products comparable to traditionally cured products treated with synthetic nitrite.

Association between the severity of cerebral small vessel disease, pulsatility of cerebral arteries, and brachial ankle pulse wave velocity in patients with lacunar infarction.

BACKGROUND/AIMS: Stiff arteries cause high pulse pressure and flow to be transmitted to distal organs during systole, damaging the cerebral microvasculatures. We investigated the association between the severity of cerebral small vessel disease (CSVD), the pulsatility of cerebral arteries, and the stiffness of large arteries in patients with lacunar infarction (LI). METHODS: Subjects included 120 patients with LIs, who underwent MRI, transcranial Doppler ultrasonography, and brachial ankle pulse wave velocity (BaPWV). We compared the severity of CSVD, the pulsatile index (PI) of both middle cerebral arteries (MCAs), and BaPWV. RESULTS: Patients with higher BaPWV were more likely to have multiple LIs and more severe white matter lesions, and tended to have higher age, systolic blood pressure, pulse pressure, heart rate, and the PI of MCAs. The PI of MCAs significantly correlated with BaPWV (with PI: r = 0.441, p < 0.001) and age (with PI: r = 0.538, p < 0.001). Multiple linear regression analysis indicated that aging (ß = 0.008, p < 0.001) and BaPWV (ß = 0.001, p = 0.007) were independent determinants of the PI of MCAs after adjustment for sex, pulse pressure, hypertension, and diabetes. CONCLUSION: These findings suggest that systemic arterial stiffness may be associated with the severity of CSVD and pulsatility of cerebral arteries.