Risk factors for bone cement dislodgement following balloon kyphoplasty for osteoporotic vertebral compression fracture.

OBJECTIVE: The study aimed to determine the incidence and risk factors associated with bone cement dislodgement in patients with osteoporotic vertebral compression fracture following balloon kyphoplasty treatment. METHODS: A retrospective study was conducted on 203 patients who underwent kyphoplasty in 255 vertebral bodies between January 2017 and December 2021. The patients were categorized into two groups: the bone cement dislodgment group (n = 16) and the non-bone cement dislodgement group (n = 239). Various patient characteristics and radiologic parameters were evaluated. Statistical analysis involved the assessment of the background homogeneity of the group by using independent sample t tests, chi-square tests, and Fisher's exact. Univariate and multivariate logistic regression analyses were performed to explore the impact of background variables on cement dislodgement. RESULTS: The results revealed that split-type fracture (χ2 = 31.706, p < 0.001), DISH (χ2 = 18.827, p = 0.011), pedicle fracture (χ2 = 22.246, p < 0.001), endplate deficit (χ2 = 14.023, p < 0.001), posterior wall injury (χ2 = 29.124, p < 0.001), and intervertebral vacuum cleft (χ2 = 21.469, p < 0.001) were the factors that significantly differed between the two groups. The multivariate logistic regression analysis revealed posterior wall injury (OR = 12.983, p = 0.025) and intervertebral vacuum cleft (OR = 5.062, p = 0.024) to be independent risk factors. CONCLUSION: The incidence of bone cement dislodgement in our study was 6.3%. This study underscores the importance of using preoperative radiologic parameters to predict the risk of bone cement dislodgement following balloon kyphoplasty.

Dissecting the risk factors for hyperuricemia in vegetarians in Taiwan.

BACKGROUND: Vegetarian diets have been shown to lower the risks of hyperuricemia and gout. Little is known about the risk factors of hyperuricemia in vegetarians. METHODS: This community-based retrospective case-control study was conducted to establish prediction models for hyperuricemia. From September 5, 2005, to December 31, 2016, 7331 adult vegetarians were recruited at Taipei Tzu Chi Hospital. Hyperuricemia was defined as a serum uric acid concentration greater than 7 mg/dL. RESULTS: There were 593 (8.1%) vegetarians with hyperuricemia and 6738 (91.9%) without hyperuricemia. We stepwise built up three models for predicting hyperuricemia in vegetarians. The full model (model 3) has the highest area under the receiver operating characteristic curve (AUROC, 85.52%). Additionally, the AUROC of model 3 is 77.97% and 84.85% in vegetarians with or without prior gout history, respectively. Moreover, male gender, hyperlipidemia, body mass index, and serum albumin are independent risk factors for hyperuricemia in vegetarians. In contrast, estimated glomerular filtration rate and proteinuria are independently associated with lower risks of hyperuricemia in vegetarians. CONCLUSION: Our study revealed that risk factors for hyperuricemia, which includes clinical characteristics, account for more than 85% of discriminatory performance in Taiwanese vegetarians. This model may be helpful for monitoring and preventing hyperuricemia in the population.

The role of the tongue in post-stroke dysphagia and obstructive sleep apnea: Correlation with sonography measurement.

OBJECTIVE: Obstructive sleep apnea (OSA) is a common risk factor for stroke, and dysphagia and pneumonia are both well-known complications of stroke. The development of these conditions is related to the oropharyngeal structures. We investigated whether specific structural features of the tongue may lead to the development of these complications. METHODS: Patients with ischemic stroke who required admission and community-dwelling elderly controls were enrolled. The participants underwent tongue measurements by received hand-held ultrasound, and received questionnaires to evaluate sleep quality and daytime sleepiness. The patient group also underwent objective sleep measurement by actigraphy and the 3-Step Swallowing Test (3-SSS). Sleep parameters and outcomes were analyzed. RESULTS: Patient with ischemic stroke had significantly thicker tongue than controls (6.53 cm v. 6.05 cm, p = 0.002). Multiple logistic regression analysis revealed that the anatomical parameters of the tongue in patients with stroke were significantly correlated with parameters of OSA, and the thickness of the tongue was positively correlated with the development of OSA (p = 0.024) and pneumonia (p = 0.048). CONCLUSIONS: A thicker-than average tongue may be a risk factor for OSA and pneumonia in patient with stroke. Hand-held ultrasound can be used to identify these anatomical features. Further studies are warranted to clarify the role of the tongue in these post-stroke complications.

Fall risk classification with posturographic parameters in community-dwelling older adults: a machine learning and explainable artificial intelligence approach.

BACKGROUND: Computerized posturography obtained in standing conditions has been applied to classify fall risk for older adults or disease groups. Combining machine learning (ML) approaches is superior to traditional regression analysis for its ability to handle complex data regarding its characteristics of being high-dimensional, non-linear, and highly correlated. The study goal was to use ML algorithms to classify fall risks in community-dwelling older adults with the aid of an explainable artificial intelligence (XAI) approach to increase interpretability. METHODS: A total of 215 participants were included for analysis. The input information included personal metrics and posturographic parameters obtained from a tracker-based posturography of four standing postures. Two classification criteria were used: with a previous history of falls and the timed-up-and-go (TUG) test. We used three meta-heuristic methods for feature selection to handle the large numbers of parameters and improve efficacy, and the SHapley Additive exPlanations (SHAP) method was used to display the weights of the selected features on the model. RESULTS: The results showed that posturographic parameters could classify the participants with TUG scores higher or lower than 10 s but were less effective in classifying fall risk according to previous fall history. Feature selections improved the accuracy with the TUG as the classification label, and the Slime Mould Algorithm had the best performance (accuracy: 0.72 to 0.77, area under the curve: 0.80 to 0.90). In contrast, feature selection did not improve the model performance significantly with the previous fall history as a classification label. The SHAP values also helped to display the importance of different features in the model. CONCLUSION: Posturographic parameters in standing can be used to classify fall risks with high accuracy based on the TUG scores in community-dwelling older adults. Using feature selection improves the model's performance. The results highlight the potential utility of ML algorithms and XAI to provide guidance for developing more robust and accurate fall classification models. Trial registration Not applicable.

Anticonvulsant effect of equilibrative nucleoside transporters 1 inhibitor in a mouse model of Dravet syndrome.

There are limited therapeutic options for patients with Dravet syndrome (DS). The equilibrative nucleoside transporters 1 (ENT1) mediate both the influx and efflux of adenosine across the cell membrane exerted beneficial effects in the treatment of epilepsy. This study aimed to evaluate the anticonvulsant effect of the ENT1 inhibitor in an animal model of DS (Scn1aE1099X/+ mice). J7 (5 mg/kg) treatment was efficacious in elevating seizure threshold in Scn1aE1099X/+ mice after hyperthermia exposure. Moreover, the J7 treatment significantly reduced the frequency of spontaneous excitatory post-synaptic currents (sEPSCs, ~35% reduction) without affecting the amplitude in dentate gyrus (DG) granule cells. Pretreatment with the adenosine A1 receptor (A1R) antagonist, DPCPX, abolished the J7 effects on sEPSCs. These observations suggest that the J7 shows an anticonvulsant effect in hyperthermia-induced seizures in Scn1aE1099X/+ mice. This effect possibly acts on presynaptic A1R-mediated signaling modulation in granule cells.

Can peripheral biomarkers reflect the psychological condition in geriatric populations? The influence of cardiovascular comorbidities.

BACKGROUND: Although previous studies indicated the association between peripheral biomarkers and psychological conditions, a higher prevalence of cardiovascular diseases (CVD) among geriatric populations may hinder the applicability of the biomarkers. The objective of this study was to assess the adequacy of the application of biomarkers to evaluate psychological conditions among geriatric populations. METHOD: We collected information on the demographics and history of CVD in all participants. All participants completed the Brief Symptom Rating Scale (BSRS-5) and the Chinese Happiness Inventory (CHI), which are the measurement of negative and positive psychological conditions, respectively. Four indicators of the peripheral biomarkers, including the standard deviation of normal to normal RR intervals (SDNN), finger temperature, skin conductance, and electromyogram were collected for each participant during a 5-min resting state. Multiple linear regression models were conducted to evaluate the association between the biomarkers and the psychological measurements (BSRS-5, CHI) with and without the inclusion of the participants with CVD. RESULTS: A total of 233 participants without CVD (non-CVD group) and 283 participants with CVD (CVD group) were included. The CVD group was older and with higher body mass index compared to the non-CVD group. In the multiple linear regression model with all participants, only BSRS-5 scores had a positive association with electromyogram. After the exclusion of the CVD group, the association between the BSRS-5 scores and electromyogram was more relevant, while CHI scores became positively associated with SDNN. CONCLUSIONS: A single measurement of the peripheral biomarker may be insufficient to depict psychological conditions among geriatric populations.

Evaluation of the optimal cutoff number of types of social participation activities in older people.

INTRODUCTION: Social participation activities have a close association with health aging. However, the clinical significance of numbers of social participation activities and its cutoff value has not been defined. METHODS: We recruited 516 people aged ≥55 years. Twelve social participation behaviors modified according to Taiwanese culture were investigated, and the adequacy of cutoff number was determined by the area under the receiver operating characteristic curve (AUC) according to the results of cluster analysis of individual activities and scores of the Brief Symptom Rating Scale-5 (BSRS-5) and the Chinese Happiness Inventory (CHI). Demographic, BSRS-5 and CHI data were then compared according to the candidate cutoff numbers. RESULTS: The distribution of the numbers of social activities suggested that the highest partition of numbers of social activities was 3 in women and 4 in men. The AUC regarding the cluster of activity types was 0.917, with the highest Youden's J value located between 3 and 4. The AUC regarding the cluster of activity types and scores of the BSRS-5 and the CHI was 0.929, with similar cutoffs. If 3 and 4 were used as cutoffs, the between-group differences of both the CHI and the BSRS-5 were significant. More types of social activities had a different engaging frequency with the 3 and 4 cutoffs. CONCLUSION: Our findings found an adequate cutoff with better differential power in the psychopathology and happiness of older people that provided a basis for application in intervention and policy formation.

Cross-cultural adaptation of the Taiwan Chinese version of the Falls Efficacy Scale-International for community-dwelling elderly individuals.

BACKGROUND: The Falls Efficacy Scale-International (FES-I) is a commonly used questionnaire to evaluate concerns about falling. We adapted a Taiwan Chinese version (FES-ITC) and evaluated its reliability and validity in community-dwelling elderly individuals. The discriminative validity was tested in relation to several known risk factors for fear of falling (FOF). METHODS: The questionnaire was adapted through translation, back-translation, and expert review processes. A convenience sample of 135 community-dwelling elderly individuals (at least 60 years old) completed the adapted questionnaire, and 31 of them had a retest within 7-10 days. Cronbach's α and an intraclass correlation coefficient (ICC) were used to evaluate the internal consistency and test-retest reliability. Principal component factor analysis was performed to assess the factor-construct validity. The discriminative validity was tested in relation to demographic features, fall-related history and performances on three functional tests: timed up and go, four-stage balance and 30-s chair stand tests. Effect sizes were computed. Correlation coefficients between physical functional performance and FES-ITC scores were computed. Receiver operating characteristic curves were used to determine the cutoff point for the score to differentiate high and low concern of falling. RESULTS: The FES-ITC questionnaire had high internal consistency (Cronbach's α = 0.94) and excellent test-retest reliability (ICC = 0.94). Principal component factor analysis yielded a two-factor model, with several items requiring high demand on postural control loading on factor 2. FES-ITC scores discriminated individuals with different ages, reporting FOF, reporting falls in the past year and using walking aids. However, FES-ITC scores did not differ between the participants who were at risk of falling and those who were not at risk based on functional test performance and there was no correlation found between them. CONCLUSION: The FES-ITC was highly reliable and had adequate construct and discriminative validity. The lack of correlation between FES-ITC scores and functional test performance implied the presence of FOF even in individuals with good functional performance. Further follow up studies are warranted to verify the predictive validity of the FES-ITC.

Supratentorial hemangioblastoma: A rare case report and literature review.

Hemangioblastomas are rare and benign tumors of the central nervous system. They account for 1.5%-2.5% of all intracranial tumors and have an incidence of 3.2%. The resemblance of hemangioblastomas to other tumors renders preoperative diagnosis and management challenging. Herein, we report a case of a supratentorial hemangioblastoma accompanied by extensive reactive gliosis and diagnosed through magnetic resonance imaging. In addition, we review the relevant literature.

Cardiomyopathy correlates to nerve damage in p.A117S late-onset transthyretin amyloid polyneuropathy.

OBJECTIVE: Late-onset hereditary transthyretin amyloidosis with polyneuropathy (ATTRv-PN) is often associated with heart involvement. Recent advances in cardiac imaging allow the detection of cardiac amyloidosis. This study aimed to explore cardiomyopathy by cardiac imaging and its clinical correlates with polyneuropathy in late-onset ATTRv-PN. METHODS: Polyneuropathy was assessed by intraepidermal nerve fiber (IENF) density, nerve conduction study (NCS), autonomic function tests, quantitative sensory testing, and clinical questionnaires. Cardiomyopathy was evaluated by echocardiography, 99m Tc-pyrophosphate (PYP) single-photon emission computed tomography (SPECT) imaging, cardiac magnetic resonance imaging (CMR), and serum Pro-B-type natriuretic peptide. Healthy controls and patients with Brugada syndrome were enrolled for comparison of CMR. RESULTS: Fifty late-onset ATTRv-PN patients (38 men, 46 with p. A117S mutation), aged 63.7 ± 5.5 years, of polyneuropathy disability stage 1-4 were enrolled. All patients presented polyneuropathy in NCS, and 74.5% of patients had reduced IENF density in distal legs. All patients showed significant radiotracer uptake in the heart on 99m Tc-PYP SPECT imaging, and 87.8% of patients had abnormally increased left ventricular (LV) septum thickness on echocardiography. CMR showed longer myocardial native T1, larger extracellular volume, greater LV mass index, and higher LV mass to end-diastolic volume ratio in ATTRv-PN patients than healthy controls and patients with Brugada syndrome. These CMR parameters were associated with skin denervation, absent sympathetic skin responses, elevated thermal thresholds, worsened NCS profiles, and functional deficits of polyneuropathy. INTERPRETATION: Late-onset ATTRv-PN coexisted with cardiomyopathy regardless of the clinical severity of polyneuropathy. The cardiac amyloid burden revealed by CMR was correlated with pathophysiology and clinical disability of nerve degeneration.

A Novel Two-Stage Heat Treatment with Medium-Temperature Aging Influence on Microstructure, Al3(Sc, Zr) Nanoprecipitation, and Application Properties, Enhancing Selective Laser Melting of Al-Mg-Sc-Zr Alloy.

Al-Mg-Sc-Zr alloy fabricated through selective laser melting (SLM) is an additive manufacturing alloy with promising industrial potential. In this study, as-printed specimens were subjected to either single-stage or two-stage heat treatment processes to investigate the effect of temperature from room temperature to high temperature on the specimens' tensile and fatigue properties to establish a reliable reference for aerospace applications. The tensile test results indicated that the heat treatment contributed to determine the properties of the nanoprecipitate Al3(Sc, Zr) with a strengthening phase, improving tensile strength. Moreover, the dynamics strain aging (DSA) effect vanished as temperature increased. It is noteworthy that the nanoprecipitation was distributed at the boundary of the melting pool after single-stage heat treatment with the highest tensile properties in all tests. In addition, the microstructure observed after the two-stage heat treatment indicated a melting pool interface decomposition, and the nanoprecipitation was homogeneously scattered over the Al matrix, increasing strength and further delaying fatigue crack transmission. Those features build a high-fatigue-resistance foundation. TEM analysis also confirmed the promotion of Sc thermal diffusion and an Al3(Sc, Zr) precipitation transformation mechanism under two-stage heat treatment, corresponding to aforementioned inferences. The SLM Al-Mg-Sc-Zr alloy with two-stage heat treatment brings about balance between tensile properties and fatigue resistance, providing new insight into additive manufacturing with Al alloys.

The psychopathology and happiness of the older adults in Yunlin, Taiwan: What do we need for long-term care service?

BACKGROUND: The purpose of this study was to investigate the psychopathology and level of happiness and their association with the demographic data of the older population in long-term care situations in Taiwan. METHODS: The study enrolled 500 participants who were the elderly in long-term care situations and used the Brief Symptom Rating Scale (BSRS-5) and Chinese Happiness Inventory (CHI) to determine the psychopathology and level of happiness. Multiple linear regression analysis (using a stepwise method) and a two-step cluster analysis were performed to examine the data. RESULTS: The results revealed mean scores for total CHI and total BSRS-5 of 16.08 and 2.34, respectively. Regular exercise habits, higher living expense and having a job were positively associated with happiness. Being older and living in an apartment/condominium were factors negatively associated with happiness. Living in an apartment/condominium was positively associated with a higher BSRS-5 score. Four clusters were grouped according to the variables that contributed the most: housing, exercise habits, living expense and working status. The cluster with no work, no exercise habits and lower living expense had the highest BSRS-5 score and the lowest CHI score. CONCLUSION: We concluded that the association between demographic data and happiness is stronger than the association between demographic data and psychopathology in a community sample in Taiwan. Those who have steady work, higher living expense and regular exercise habits have better happiness and less psychopathology.

The Medial Prefrontal Cortex, Nucleus Accumbens, Basolateral Amygdala, and Hippocampus Regulate the Amelioration of Environmental Enrichment and Cue in Fear Behavior in the Animal Model of PTSD.

A growing body of evidence showed that environmental enrichment (EE) ameliorated footshock-induced fear behavior of posttraumatic stress disorder (PTSD). However, no research comprehensively tested the effect of EE, cue, and the combination of EE and cue in footshock-induced fear behavior of PTSD symptoms. The present study addressed this issue and examined whether the medial prefrontal cortex (mPFC, including the cingulate cortex 1 (Cg1), prelimbic cortex (PrL), and infralimbic cortex (IL)), the nucleus accumbens (NAc), the basolateral amygdala (BLA), and the hippocampus (e.g., CA1, CA3, and dentate gyrus (DG)) regulated the amelioration of the EE, cue, or the combination of EE and cue. The results showed that EE or cue could reduce fear behavior. The combination of EE and cue revealed a stronger decrease in fear behavior. The cue stimulus may play an occasion setting or a conditioned stimulus to modulate the reduction in fear behavior induced by footshock. Regarding the reduction of the EE in fear behavior, the Cg1 and IL of the mPFC and the NAc upregulated the c-Fos expression; however, the BLA downregulated the c-Fos expression. The mPFC (i.e., the Cg1, PrL, and IL) and the hippocampus (i.e., the CA1, CA3, and DG) downregulated the c-Fos expression in the suppression of the cue in fear behavior. The interaction of EE and cue in reduction of fear behavior occurred in the Cg1 and NAc for the c-Fos expression. The data of c-Fos mRNA were similar to the findings of the c-Fos protein expression. These findings related to the EE and cue modulations in fear behavior may develop a novel nonpharmacological treatment in PTSD.

Maladaptive motor cortical excitability and connectivity in polyneuropathy with neuropathic pain.

BACKGROUND AND PURPOSE: Sensory symptoms, especially neuropathic pain, are common in polyneuropathy. Conventional diagnostic tools can evaluate structural or functional impairment of nerves but cannot reveal mechanisms of neuropathic pain. Changes in the brain after polyneuropathy may play roles in the genesis of neuropathic pain. METHODS: This cross-sectional study investigated changes of cortical excitability within left primary motor cortex (M1) by measuring resting motor thresholds, short-interval intracortical inhibition (SICI), intracortical facilitation (ICF), and afferent inhibition between polyneuropathy patients and controls, and investigated the correlates of these parameters with neuropathic pain and M1 structural and functional connectivity assessed by diffusion tractography imaging and functional magnetic resonance imaging. RESULTS: Thirty-three painful and 15 nonpainful neuropathic patients and 21 controls were enrolled. There were no differences in intraepidermal nerve fiber density, nerve conduction studies, thermal thresholds, or autonomic functional tests between patients with and without neuropathic pain. Compared to controls, neuropathic patients exhibited similar resting motor thresholds or afferent inhibition, but attenuated SICI and augmented ICF, especially in painful patients. Changes of intracortical excitability in neuropathic patients were correlated with intensities of neuropathic pain, and different presentations of SICI and ICF were noted between patients with and without thermal paresthesia. Additionally, short-latency afferent inhibition at an interstimulus interval of 20 ms was associated with structural connectivity of left M1 with brain areas associated with pain perception. CONCLUSIONS: Maladaptive cortical excitability with altered structural connectivity in left M1 developed after peripheral nerve degeneration and was associated with neuropathic pain and sensory symptoms in polyneuropathy.

Transcriptome analysis reveals the mechanisms for mycorrhiza-enhanced salt tolerance in rice.

More than half of the global population relies on rice as a staple food, but salinization of soil presents a great threat to rice cultivation. Although previous studies have addressed the possible benefits of arbuscular mycorrhizal (AM) symbiosis for rice under salinity stress, the underlying molecular mechanisms are still unclear. In this study, we found that mycorrhizal rice had better shoot and reproductive growth and a significantly higher K+/Na+ ratio in the shoot. The reactive oxygen species (ROS) scavenging capacity in rice shoots was also improved by AM symbiosis. To elucidate the molecular mechanisms required for AM-improved salt tolerance, transcriptome analysis revealing the differentially expressed genes (DEGs) based on the response to AM symbiosis, salinity or specific tissue was performed. Thirteen percent of DEGs showed tissue-preferred responses to both AM symbiosis and salt stress and might be the key genes contributing to AM-enhanced salt tolerance. Gene Ontology (GO) enrichment analysis identified GO terms specifically appearing in this category, including cell wall, oxidoreductase activity, reproduction and ester-related terms. Interestingly, GO terms related to phosphate (Pi) homeostasis were also found, suggesting the possible role of the Pi-related signaling pathway involved in AM-enhanced salt tolerance. Intriguingly, under nonsaline conditions, AM symbiosis influenced the expression of these genes in a similar way as salinity, especially in the shoots. Overall, our results indicate that AM symbiosis may possibly use a multipronged approach to influence gene expression in a way similar to salinity, and this modification could help plants be prepared for salt stress.

Condyloma acuminatum mimicking cervical cancer in a pregnant woman and treatment with cryotherapy: A case report.

RATIONALE: Condyloma acuminata and anogenital warts are protruding papillomatous lesions caused by human papillomavirus. In pregnant women, condyloma acuminata over the cervical region may grow rapidly, mimicking cervical cancer. PATIENT CONCERNS: A pregnant woman at 14 weeks of gestation with condyloma acuminatum mimicking cervical cancer was referred to our hospital for further management. DIAGNOSIS: Condyloma acuminata. INTERVENTIONS: Tumor biopsy was performed twice, and the pathology confirmed condyloma acuminatum. Immunohistochemistry revealed focal positivity for p16 and Ki-67. Cryotherapy was performed and regular follow-up was performed at 2-week intervals. A small residual condyloma acuminata was found and treated with cryotherapy. OUTCOME: During the follow-up period, no recurrence of condyloma acuminata was noted. She delivered a baby at 37 weeks of gestation via cesarean section, without complications. LESSONS: Condyloma acuminata of the cervix may grow faster during pregnancy, mimicking cervical cancer. Multiple factors must be considered when treating condyloma acuminata during pregnancy. Cryotherapy is proposed as a 1st-line treatment in all trimesters because of its safety, convenience, and cost-effectiveness. Serial follow-up at 2-week intervals to observe post-cryotherapy conditions is recommended.

Comparison of FAST and Stroke-112: A randomized study in Taiwan.

BACKGROUND/PURPOSE: FAST and Stroke-112 are two campaigns to reduce the emergency room arrival time of stroke patients. No study has compared the effectiveness of these campaigns. This study aimed to compare recalling capacity of people in these two campaigns. METHODS: A prospective, open-label randomized study was conducted in 2019. Recall ability for the items of the two campaigns on the 5th and 30th days post-education was compared using non-parametric methods. Subject characteristics including age, education level, presence of stroke in co-residents, and habitual language were evaluated using multiple ordered logistic regression. RESULTS: There were 202 participants in FAST group and 193 participants in Stroke-112 group who completed the study. No differences were observed between the two groups in recall ability, either on day 5 or day 30 after receiving education. For both campaigns, recall ability was better for signs in the face (FAST: 87.1%, Stroke-112: 86.5%) and the arm (FAST: 87.1%, Stroke-112: 88.1%) than for abnormality in speech (FAST: 78.7%, Stroke-112: 76.7%) on day 5. Recall ability on day 30 remained the same only for the arm item (FAST: 86.1%, Stroke-112: 88.6%). The recall ability was correlated to education level equal or more than 7 years in FAST group, and was inversely correlated to age and being a stroke patient in Stroke-112 group. CONCLUSION: We found no difference in recall ability between the 2 campaigns. Education level was associated with recallability of FAST, and age and stroke history were associated with recallability of Stroke-112.

Bilateral widespread segmental swelling on nerve sonography in multifocal acquired demyelinating sensory and motor neuropathy: Two case reports.

INTRODUCTION: Multifocal acquired demyelinating sensory and motor neuropathy (MADSAM) is an asymmetric immune-related neuropathy with conduction block. We report 2 MADSAM cases with detailed clinical, electrophysiological, and sonography profiles. PATIENT CONCERNS AND DIAGNOSIS: Two cases presented with patchy sensorimotor impairment in both clinical and electrophysiological findings. Notably, nerve ultrasound demonstrated multifocal nerve enlargement not only at sites of conduction blockade but also at the unaffected contralateral sites. Interestingly, in our first case, focal radial nerve enlargement was observed prior to the clinical manifestations, suggesting nerve dynamic pathogenesis with variable clinical significance. INTERVENTIONS AND OUTCOMES: The first patient was initially treated with prednisolone, however, 3 months after steroid therapy, her symptoms progressed. After treatment with intravenous immunoglobulin for 3 months, the symptoms stabilized. The second patient showed improvement after 2 months of prednisolone treatment. CONCLUSION: These observations suggest a more widespread pathomechanism underlying MADSAM, and ultrasound may detect nerve lesions earlier than clinical electrophysiology studies, and is warranted for early detection and thorough documentation of nerve pathology.

Association of Hematuria with Renal Progression and Survival in Patients Who Underwent Living Donor Liver Transplant.

BACKGROUND: This study aimed to determine the association between episodic or persistent hematuria after liver transplantation and long-term renal outcomes. METHODS: Patients who underwent living donor liver transplantation between July 2005 and June 2019 were recruited and divided into two groups based on the finding of microscopic or gross hematuria after transplantation. All patients were followed up from the index date until the end date in May 2020. The risks of chronic kidney disease, death, and 30% and 50% declines in estimated glomerular filtration rate (eGFR) were compared between groups. RESULTS: A total of 295 patients underwent urinalysis for various reasons after undergoing transplantation. Hematuria was detected in 100 patients (group A) but was not present in 195 patients (group B). Compared with group B, group A had a higher risk of renal progression, including eGFR decline >50% [aHR = 3.447 (95%CI: 2.24~5.30), p < 0.001] and worse survival. In addition, patients who took non-steroidal anti-inflammatory drugs (NSAIDs) continuously for over seven days within six months before transplant surgery had high risks of rapid renal progression, including a >30% decline in eGFR [aHR = 1.572 (95%CI: 1.12~2.21), p = 0.009)]. CONCLUSION: Development of hematuria after surgery in patients who underwent living donor liver transplant and were exposed to NSAIDs before surgery were associated with worse long-term renal dysfunction and survival.