Two-dimensional correlation infrared spectroscopy elucidated the volatilization process of the microemulsion composed of peppermint essential oil and composite herbal extract.

Microemulsion is usually a transparent and isotropic liquid mixture composed of oil phase, water phase, surfactant and cosurfactant. The surfactant-framed nanoscale droplets in the microemulsion can penetrate into the skin surface to reduce its barrier function. This makes microemulsion an ideal preparation for the transdermal drug delivery. The permeability of microemulsion may be further enhanced when botanical essential oils that can dissolve the stratum corneum are used as the oil phase. However, the volatility of essential oils is possible to shorten the retention time of the microemulsion on the skin surface. Therefore, analytical methods are required to understand the volatilization process of the microemulsion composed of essential oils to develop the reasonable topical drug carrier system. In this research, Fourier transform infrared (FTIR) spectroscopy with an attenuated total reflection (ATR) accessory cooperated with two-dimensional correlation spectroscopy (2DCOS) to elucidate the volatilization processes of some microemulsions composed of peppermint essential oil. Principal component analysis (PCA) and moving-window two-dimensional correlation spectroscopy (MW2DCOS) revealed the multiple stages of the volatilization processes of the microemulsions. Synchronous 2D correlation infrared spectra indicated the compositional changes during each stage. It was found that the successive volatilizations of ethanol, water and menthone were the major events during the volatilization process of the microemulsion composed of peppermint essential oil. Ethanol can accelerate the volatilization of water, while the composite herbal extract seemed to not influence the volatilization of the other ingredients. After a 20-min-long volatilization process, the remaining microemulsion still contained considerable peppermint essential oil to affect the skin. The above results showed the feasibility of developing the microemulsion composed of peppermint essential oil for the transdermal drug delivery of composite herbal extract. This research also proved that the combination of ATR-FTIR spectroscopy and 2DCOS was valuable to study the volatilization process of the microemulsion.

Seconds Timescale Synthesis of Highly Stretchable Antibacterial Hydrogel for Skin Wound Closure and Epidermal Strain Sensor.

Effective wound healing is critical for patient care, and the development of novel wound dressing materials that promote healing, prevent infection, and are user-friendly is of great importance, particularly in the context of point-of-care testing (POCT). This study reports the synthesis of a hydrogel material that can be produced in less than 10 s and possesses antibacterial activity against both gram-negative and gram-positive microorganisms, as well as the ability to inhibit the growth of eukaryotic cells, such as yeast. The hydrogel is formed wholly based on covalent-like hydrogen bonding interactions and exhibits excellent mechanical properties, with the ability to stretch up to more than 600% of its initial length. Furthermore, the hydrogel demonstrates ultra-fast self-healing properties, with fractures capable of being repaired within 10 s. This hydrogel can promote skin wound healing, with the added advantage of functioning as a strain sensor that generates an electrical signal in response to physical deformation. The strain sensor composed of a rubber shell realizes fast and responsive strain sensing. The findings suggest that this hydrogel has promising applications in the field of POCT for wound care, providing a new avenue for improved patient outcomes.

Self-Reported Neurological Symptoms Two Years After Hospital Discharge Among COVID-19 Survivors.

Background: The acute stage of COVID-19 often presents with neurological manifestations. Objective: This study aims to investigate the long-term neurological effects on survivors. Methods: This study recruited 1,546 COVID-19 survivors from Wuhan, including 1,119 nonsevere cases and 427 severe survivors. Participants were interviewed two years after discharge to report their neurological symptoms. The neurological symptoms of COVID-19 were compared between survivors of severe and nonsevere COVID-19. Results: Among the 1,546 COVID-19 survivors, 44.24% discovered at least one neurological symptom. The most prevalent self-reported symptom was fatigue (28.33%), memory deficit (13.26%), attention deficit (9.96%), myalgia (8.34%), dizziness (3.82%), and headache (2.52%). Severe cases had higher incidences of fatigue, myalgia, memory deficit, attention deficit than nonsevere cases. Older age, severe COVID-19, and comorbidity burden were associated with long-term neurological symptoms. Conclusion: Neurological symptoms are common among COVID-19 survivors, especially in severe cases.

Study on the dynamic metabolic characteristic of main active ingredients in Danggui Buxue Decoction by liquid chromatography-tandem mass spectrometry based on in situ sequential metabolism strategy.

Danggui Buxue Decoction is a classic formula for replenishing qi and nourishing blood. Despite its widespread use, its dynamic metabolism involved remains unclear. Based on the sequential metabolism strategy, blood samples from different metabolic sites were obtained via in situ closed intestine ring integrated with a jugular venous continuous blood supply technique. An ultra-high-performance liquid chromatography-linear triple quadruple-Orbitrap-tandem mass spectrometry method was developed for the identification of prototypes and metabolites in rat plasma. The dynamic absorption and metabolic landscape of flavonoids, saponins, and phthalides were characterized. Flavonoids could be deglycosylated, deacetylated, demethylated, dehydroxylated, and glucuronicated in the gut and then absorbed for further metabolism. Jejunum is an important metabolic site for saponins biotransformation. Saponins that are substituted by Acetyl groups tend to lose their acetyl groups and convert to Astragaloside IV in the jejunum. Phthalides could be hydroxylated and glucuronidated in the gut and then absorbed for further metabolism. Seven components serve as crucial joints in the metabolic network and are potential candidates for the quality control of Danggui Buxue Decoction. The sequential metabolism strategy described in this study could be useful for characterizing the metabolic pathways of Chinese medicine and natural products in the digestive system.

Field specific capture of Pb(II) in aqueous samples with three channels in-tip microextraction apparatus based on ion-imprinted polymer.

On-site specific capture is a critical step in accurate analysis of trace Pb(II) in environmental waters. In this connection, a new Pb(II)-imprinted polymer-based adsorbent (LIPA) was in-situ prepared in pipette tip and used as the extraction medium of laboratory-made portable three channels in-tip microextraction apparatus (TIMA). Density function theory was employed to verify the selection of functional monomers for the preparation of LIPA. The physical and chemical properties of the prepared LIPA were inspected with various characterization techniques. Under the beneficial preparation parameters, the LIPA presented satisfactory specific recognition performance towards Pb(II). Selectivity coefficients of LIPA towards Pb(II)/Cu(II) and Pb(II)/Cd(II) were 6.82 and 3.27 times higher than that of non-imprinted polymer-based adsorbent, respectively, and the adsorption capacity towards Pb(II) was as high as 36.8 mg/g. Freundlich isotherm model fitted well with the adsorption data, revealing that the adsorption of Pb(II) on LIPA was a multilayer process. After optimizing the extraction conditions, the developed LIPA/TIMA was employed to field selectively separate and enrich trace Pb(II) in various environmental waters followed by quantification with atomic absorption spectrometry. The enhancement factor, linear range, limit of detection and RSDs for precision were 183, 0.50-10000 ng/L, 0.14 ng/L and 3.2-8.4%, respectively. Accuracy of the developed approach was inspected by means of spiked recovery and confirmation experiments. Achieved results reveal that the developed LIPA/TIMA technique is good for field selective separation and preconcentration of Pb(II) and the introduced approach can be used to measure ultra-trace Pb(II) in a variety of waters.

Universal Fully Integrated Wearable Sensor Arrays for the Multiple Electrolyte and Metabolite Monitoring in Raw Sweat, Saliva, or Urine.

Fully integrated wearable sensors are capable of dynamically, directly, and independently tracking biomarkers in raw noninvasive biofluids without any other equipment or accessories by integrating the unique on-body monitoring feature with the special complete functional implementation attribute. Sweat, saliva, and urine are three important noninvasive biofluids, and changes in their biomarkers hold great potential for revealing physiological conditions. However, it is still a challenge to design single fully integrated wearable sensor arrays (FIWSAs) that are universally able to concurrently measure electrolytes and metabolites in three of the most common noninvasive biofluids including sweat, saliva, and urine. Here, we propose the first single universal FIWSAs for wirelessly, noninvasively, and simultaneously measuring various metabolites (i.e., uric acid) and electrolytes (i.e., Na+ and H+) in raw sweat, saliva, or urine under subjects' exercise by integrating the specifically designed microfluidic, sensing, and electronic modules in a seamless manner. We evaluate its utility for noninvasive gout management in healthy subjects and in gout patients through a purine-rich meal challenge and with a medicine-treatment control, respectively. Noninvasive monitoring of multiple electrolytes and metabolites in a variety of raw noninvasive biofluids via such single universal FIWSAs may enrich the understanding of the biomarkers' levels in the body and would also facilitate self-health management.

Danggui Buxue Decoction: Comparative pharmacokinetic research on six bio-active components in different states by ultra-performance liquid chromatography-tandem mass spectrometry after oral administration.

Danggui Buxue Decoction is a classic formula containing Astragali Radix and Angelicae Sinensis Radix in a 5:1 ratio and has been extensively used to treat blood deficiency for thousands of years. The aim of the study was to investigate the differences in plasma protein binding, pharmacokinetics, and tissue distribution of Danggui Buxue Decoction in normal and blood-deficient rats by ultra-performance liquid chromatography-tandem mass spectrometry. The effects on peripheral blood routine were verified. The compounds exhibited higher plasma protein binding and absorption in the model group compared to the control group, except formononetin. The six ingredients were distributed widely, and the highest concentrations were detected in the heart and uterus. As has been demonstrated in the previous study of the effect of Danggui Buxue Decoction, its potential is to serve as an effective traditional Chinese medicine formula for treating cardiovascular diseases and impacting estrogenic properties, which reveals the potential target organs of Danggui Buxue Decoction the heart and uterus. Our findings suggested that the absorption and distribution of different components in Danggui Buxue Decoction varies depending on the pathological state, molecular weight, lipid solubility, transporter-mediated efflux, and other factors.

Interventional effect of processing temperature on anti-angiogenesis of Coptis chinensis and screening of active components by UPLC-MS/MS on quail chick chorioallantoic membrane model.

ETHNOPHARMACOLOGICAL RELEVANCE: Coptis chinensis Franch. (CC), as a commonly used heat-clearing and toxin-resolving traditional Chinese herbal medicine, has gained increased attention for its anti-tumor activity. However, little is known about the anti-tumor angiogenesis effect of CC and its possible bioactive components. Also, it has been shown that temperature affects the quality of CC, albeit whether and how it affects the anti-angiogenic activity of CC is currently unknown. AIM OF THE STUDY: To determine the processing temperatures (40, 60, 80, 120, 140, 150, 160 and 200 °C) at which CC has the strongest anti-angiogenic effect and speculate the possible bioactive components. MATERIALS AND METHODS: The q-CAM model was constructed to explore the anti-angiogenesis agents of CC. The angiogenesis inhibition effects of CC samples at different processing temperatures and its seven alkaloids were determined based on morphological observation and vascular area proportion analysis. UPLC-MS/MS was employed to screen the potent active components of CC on anti-angiogenesis. RESULTS: All the intervention by CC at different processing temperatures and its seven alkaloids could inhibit angiogenesis on q-CAM vessels, as evidenced by a poor vasular development in morphological observation and a low vascular area proportion in vascular quantitative analysis, most evident in CC processed at 40 °C and palmatine. LC-MS revealed that palmatine displayed strongest inhibitory effect on q-CAM vessels with a high absorption due to its stable structure. And the maternal nucleus transformation phenomenon of CC alkaloids was found in the quail embryo metabolism. CONCLUSIONS: The q-CAM models in conjunction with the UPLC-MS/MS technique could be a useful tool for assessing tumor angiogenesis and screening tumor-targeted medicines. Processing temperature can affect the anti-angiogenesis effect of CC because of its function on the content of alkaloids, and palmatine can be considered as a prospective anti-angiogenic drug.

Involvement of striatal motoric subregions in familial frontotemporal dementia with parkinsonism harboring the C9orf72 repeat expansions.

The chromosome 9 open reading frame 72 (C9ORF72) has been proposed as the causative gene of frontotemporal dementia with parkinsonism (FTDP), but its pathophysiological mechanism of parkinsonism is poorly understood. To explore the roles of striatal motor subdivisions in the pathogenesis of parkinsonism resulting from C9ORF72 repeat expansions in the FTDP, two patients with FTDP from one pedigree and seventeen healthy controls were enrolled. The participants received clinical interviews, physical examinations, genetic testing, [18F]-fluorodeoxyglucose PET/MRI, and [18F]-dihydrotetrabenazine PET/CT. Voxel-wise and region of interest analysis were conducted with respect to gray matter volume, metabolism, and dopamine transport function between patients and controls, focusing on the motor part of the striatum according to the Oxford-GSK-Imanova Striatal Connectivity Atlas. Patient 1 presented with parkinsonism as the initial symptom, while patient 2 exhibited behavior disturbance as the first symptom, followed by parkinsonism within one year. Both patients had the hexanucleotide expansion detected in C9ORF72(>52 repeats). Gray matter volume atrophy, hypometabolism and dopamine dysfunction were observed in the motor areas of the striatum. Of the two patients, marked glucose hypometabolism within the striatal motor subregion was observed in patient 1, with corresponding gray matter atrophy. In addition, presynaptic dopaminergic integrity of patient 2 was deteriorated in the motor subregions which was consistent with gray matter atrophy. These findings imply that parkinsonism in FTDP may be associated with the degeneration and dopaminergic dysfunction of the striatal motor subregion, which might be attributed to C9orf72 repeat expansions.

Superlow Power Consumption Artificial Synapses Based on WSe2 Quantum Dots Memristor for Neuromorphic Computing.

As the emerging member of zero-dimension transition metal dichalcogenide, WSe2 quantum dots (QDs) have been applied to memristors and exhibited better resistance switching characteristics and miniaturization size. However, low power consumption and high reliability are still challenges for WSe2 QDs-based memristors as synaptic devices. Here, we demonstrate a high-performance, superlow power consumption memristor device with the structure of Ag/WSe2 QDs/La0.3Sr0.7MnO3/SrTiO3. The device displays excellent resistive switching memory behavior with a R OFF/R ON ratio of ~5 × 103, power consumption per switching as low as 0.16 nW, very low set, and reset voltage of ~0.52 V and~ -0.19 V with excellent cycling stability, good reproducibility, and decent data retention capability. The superlow power consumption characteristic of the device is further proved by the method of density functional theory calculation. In addition, the influence of pulse amplitude, duration, and interval was studied to gradually modulating the conductance of the device. The memristor has also been demonstrated to simulate different functions of artificial synapses, such as excitatory postsynaptic current, spike timing-dependent plasticity, long-term potentiation, long-term depression, and paired-pulse facilitation. Importantly, digit recognition ability based on the WSe2 QDs device is evaluated through a three-layer artificial neural network, and the digit recognition accuracy after 40 times of training can reach up to 94.05%. This study paves a new way for the development of memristor devices with advanced significance for future low power neuromorphic computing.

Correction: A self-activated cascade nanoreactor based on Pd-Ru/GOx for bacterial infection treatment.

Correction for 'A self-activated cascade nanoreactor based on Pd-Ru/GOx for bacterial infection treatment' by Tianbao Zhu et al., J. Mater. Chem. B, 2022, https://doi.org/10.1039/d2tb01416e.

A Bifunctional Fully Integrated Wearable Tracker for Epidermal Sweat and Wound Exudate Multiple Biomarkers Monitoring.

Fully integrated wearable electronics that combine the extraordinary feature of incessant and on-body operation with the distinctive external equipment-free trait are the ultimate goal of modern wearables. Epidermal sweat and wound exudate, as two noninvasively accessible biofluids on/surrounding the skin, reflect underlying health conditions. However, the design of universal wearable sensors with the bifunctional capability to monitor both epidermal secretions is still a challenge. Here, a single bifunctional fully integrated wearable tracker for wirelessly, simultaneously, and dynamically in situ measuring multiple epidermal sweat or wound exudate biomarkers is propos. Considering the electrolytes (e.g., Na+ , K+ , and H+ ) and metabolites (e.g., uric acid (UA)) levels in sweat or wound exudate may correlate with health or wound conditions, the dynamic and skin-on tracking of the biomarkers of Na+ , K+ , pH, and UA levels in sweat under subjects' exercise and in wound exudate during subjects' wound healing are performed through the seamless integration of microfluidic, sensing, and electronic modules. Its applicability is evaluated for noninvasive hyperuricemia management in hyperuricemia/healthy subjects through a purine-rich intake test and for wound management in subjects' infected wounds through a control medical treatment.

A self-activated cascade nanoreactor based on Pd-Ru/GOx for bacterial infection treatment.

Enzyme cascade reactions that integrate natural enzymes and nanozymes have attracted intensive attention in biomedical studies. Nevertheless, it is still an important challenge to design simple, high-performance and safe cascade reaction systems. Herein, we constructed a cascade reactor Pd-Ru/GOx, in which two-dimensional Pd-Ru nanosheets (NSs) with excellent peroxidase (POD)-like activity were employed as a carrier for the covalent grafting of glucose oxidase (GOx) by glutaraldehyde coupling chemistry. The designed Pd-Ru/GOx cascade reactor possesses both GOx and POD-like activities and can not only transform non-toxic glucose into toxic hydroxyl radicals (˙OH) but also decrease the pH value of the reaction system to improve catalytic activity, achieving dual effects of cascade synergy and promotion. The in vitro and vivo experimental results manifested that Pd-Ru/GOx presented good antibacterial effects via the generation of reactive oxygen species (ROS). This work offers a simple strategy to construct a highly efficient and safe enzymatic cascade nanoreactor and holds tremendous promise for clinical bacterial infection control.

Atomic overlayer of permeable microporous cuprous oxide on palladium promotes hydrogenation catalysis.

The interfacial sites of metal-support interface have been considered to be limited to the atomic region of metal/support perimeter, despite their high importance in catalysis. By using single-crystal surface and nanocrystal as model catalysts, we now demonstrate that the overgrowth of atomic-thick Cu2O on metal readily creates a two-dimensional (2D) microporous interface with Pd to enhance the hydrogenation catalysis. With the hydrogenation confined within the 2D Cu2O/Pd interface, the catalyst exhibits outstanding activity and selectivity in the semi-hydrogenation of alkynes. Alloying Cu(0) with Pd under the overlayer is the major contributor to the enhanced activity due to the electronic modulation to weaken the H adsorption. Moreover, the boundary or defective sites on the Cu2O overlayer can be passivated by terminal alkynes, reinforcing the chemical stability of Cu2O and thus the catalytic stability toward hydrogenation. The deep understanding allows us to extend the interfacial sites far beyond the metal/support perimeter and provide new vectors for catalyst optimization through 2D interface interaction.

Effects of MRI protocols on brain FDG uptake in simultaneous PET/MR imaging.

PURPOSE: To investigate the potential effects of MRI protocols on brain FDG uptake in simultaneous PET/MR imaging. METHODS: Seventy healthy subjects and ten patients with temporal lobe epilepsy were enrolled. Healthy subjects were divided to three groups to undergo different PET/MR scan protocols: "continuous MRI" with MRI stimulation presented during the whole scan, "late MRI" with MRI stimulation started after 40 min glucose uptake, and "no MRI" without MRI stimulation at all. Region-wise and voxel-wise differences in FDG uptake among the three protocols were compared. All epilepsy patients were scanned with the "continuous MRI" scan protocol. The effects of MRI protocol stimulation on pathological interpretation were evaluated. RESULTS: Highest global averaged metabolism was found in the normal dataset with continuous MRI scan protocol (P < 0.05). Specifically, we observed higher FDG uptake in the primary auditory cortex, putamen, and lower FDG uptake in the occipital lobe and cerebellum during the "continuous MRI" scan protocol. However, MRI protocol stimulation after 40 min glucose uptake did not cause any significant differences in FDG uptake. Respectively compared to the normal dataset, patients with epilepsy showed consistent hypometabolism in the temporal lobe. Besides, significant metabolism changes in the primary auditory cortex, vermis, and occipital lobe were found in the "late MRI" protocol. CONCLUSION: The effects of MRI protocol on brain FDG uptake were varied. The effects, including from other practical setting, were conspicuous for scans where MRI protocol started immediately after glucose uptake, but would dramatically decrease to negligible 40 min later. Hence, it would be necessary for pathology studies to collect data from a normal control group using the same scan protocol for unbiased evaluation.

Alloy electrode engineering in memristors for emulating the biological synapse.

The development of conductive bridging random access memory (CBRAM) as an artificial synaptic device is an important step in the realization of an efficient biomimetic neural morphology computing system. In fact, CBRAM devices with simple substance electrodes often form unstable and discrete conductive filaments, thereby resulting in poor device performance. In this work, the effects of different alloy electrode ratios on the performance of HfOx devices with dielectric layers were systematically investigated via electrode composition engineering. The devices (a kind of memristor) with an Ag-Cu ratio of 63 : 37 exhibited a lower formation voltage and set voltage, better set voltage distribution uniformity, faster response speed, and lower power consumption than other devices. Moreover, the device is capable of emulating the biosynapse functions, including paired-pulse facilitation (PPF), post-tetanic potentiation (PTP), spike-rate-dependent plasticity (SRDP), and spike-timing-dependent plasticity (STDP). Interestingly, the associative learning process of Pavlov's dog experiment and aversion therapy were also realized without the use of complex external circuits. The use of electrode component engineering provides a new path for boosting the memristor properties via CBRAM devices, thereby laying the foundation for further development of neural morphology computing systems.

Individual [18F]FDG PET and functional MRI based on simultaneous PET/MRI may predict seizure recurrence after temporal lobe epilepsy surgery.

OBJECTIVES: To investigate the individual measures of brain glucose metabolism, neural activity obtained from simultaneous 18[F]FDG PET/MRI, and their association with surgical outcomes in medial temporal lobe epilepsy due to hippocampal sclerosis (mTLE-HS). METHODS: Thirty-nine unilateral mTLE-HS patients who underwent anterior temporal lobectomy were classified as having completely seizure-free (Engel class IA; n = 22) or non-seizure-free (Engel class IB-IV; n = 17) outcomes at 1 year after surgery. Preoperative [18F]FDG PET and functional MRI (fMRI) were obtained from a simultaneous PET/MRI scanner, and individual glucose metabolism and fractional amplitude of low-frequency fluctuation (fALFF) were evaluated by standardizing these with respect to healthy controls. These abnormality measures and clinical data from each patient were incorporated into a machine learning framework (gradient boosting decision tree and logistic regression analysis) to estimate seizure recurrence. The predictive values of features were evaluated by the receiver operating characteristic (ROC) curve in the training and test cohorts. RESULTS: The machine learning classification model showed [18F]FDG PET and fMRI variations in contralateral hippocampal network and age of onset identify unfavorable surgical outcomes effectively. In the validation dataset, the logistic regression model with [18F]FDG PET and fALFF obtained from simultaneous [18F]FDG PET/MRI gained the maximum area under the ROC curve of 0.905 for seizure recurrence, higher than 0.762 with 18[F]-FDG PET, and 0.810 with fALFF alone. CONCLUSION: Machine learning model suggests individual [18F]FDG PET and fMRI variations in contralateral hippocampal network based on 18[F]-FDG PET/MRI could serve as a potential biomarker of unfavorable surgical outcomes. KEY POINTS: • Individual [18F]FDG PET and fMRI obtained from preoperative [18F]FDG PET/MR were investigated. • Individual differences were further assessed based on a seizure propagation network. • Machine learning can classify surgical outcomes with 90.5% accuracy.

Repair of rotator cuff tears in patients aged 75 years and older: Does it make sense? A systematic review.

Background: Rotator cuff injuries are common, and morbidity increases with age. The asymptomatic full-thickness tear rate is 40% in the over 75-year-old population. Purpose: This study aimed to systematically review the literature on the outcomes of rotator cuff repair among >75 years old patients. Study design: Systematic review. Methods: A systematic review of the literature was performed following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. A literature search was performed in the electronic databases of PubMed, Medline, Embase, and The Cochrane Library. Studies in English evaluating repair of full-thickness rotator cuff tears in patients aged >75 years were included. Results: Six studies were reviewed, including 311 patients (313 shoulders) treated with arthroscopic and/or open rotator cuff repair. Sixty-one patients were lost to follow-up, leaving 252 shoulders with outcome data. Patients in this age group demonstrated a significant improvement in the clinical and functional scores after rotator cuff repair, with a high satisfaction rate. The mean American Shoulder and Elbow Surgeons scores improved from 43.8 (range, 42.0-45.5) preoperatively to 85.3 (range, 84.0 to 86.5) postoperatively, and the mean Constant scores improved from 45.4 (range, 34.7-55.5) to 78.6 (range, 67.0-91.6). Pain, evaluated in all studies by the visual analog scale for pain, showed a significant improvement at the last follow-up compared with the mean preoperative score. Furthermore, range of motion and return to daily activities and sports gained marked improvements. Conclusion: Rotator cuff repair in patients aged >75 years could achieve high clinical success rates with good outcomes and pain relief. Although patients in this age group are at a high risk of retear, rotator cuff repair may offer a good option with significant functional and clinical improvement.

Morphometric analysis program and quantitative positron emission tomography in presurgical localization in MRI-negative epilepsies: a simultaneous PET/MRI study.

PURPOSE: To evaluate morphometric analysis program (MAP) and quantitative positron emission tomography (QPET) in epileptogenic zone (EZ) identification using a simultaneous positron emission tomography/magnetic resonance imaging (PET/MRI) system in MRI-negative epilepsies. METHODS: Seventy-one localization-related MRI-negative epilepsies who underwent preoperative simultaneous PET/MRI examination and surgical resection were enrolled retrospectively. MAP was performed on a T1-weighted volumetric sequence, and QPET was analyzed using statistical parametric mapping (SPM) with comparison to age- and gender-matched normal controls. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of MAP, QPET, MAP + QPET, and MAP/QPET in EZ localization were assessed. The correlations between surgical outcome and modalities concordant with cortical resection were analyzed. RESULTS: Forty-five (63.4%) patients had Engel I seizure outcomes. The sensitivity, specificity, PPV, and NPV of MAP were 64.4%, 69.2%, 78.3%, and 52.9%, respectively. The sensitivity, specificity, PPV, NPV of QPET were 73.3%, 65.4%, 78.6%, and 58.6%, respectively. MAP + QPET, defined as two tests concordant with cortical resection, had reduced sensitivity (53.3%) but increased specificity (88.5%) relative to individual tests. MAP/QPET, defined as one or both tests concordant with cortical resection, had increased sensitivity (86.7%) but reduced specificity (46.2%) relative to individual tests. The regions determined by MAP, QPET, MAP + QPET, or MAP/QPET concordant with cortical resection were significantly associated with the seizure-free outcome. CONCLUSION: QPET has a superior sensitivity than MAP, while the combined MAP + QPET obtained from a simultaneous PET/MRI scanner may improve the specificity of the diagnostic tests in EZ localization coupled with the preferable surgical outcome in MRI-negative epilepsies.