Novel Approach Combining Shallow Learning and Ensemble Learning for the Automated Detection of Swallowing Sounds in a Clinical Database.

Cervical auscultation is a simple, noninvasive method for diagnosing dysphagia, although the reliability of the method largely depends on the subjectivity and experience of the evaluator. Recently developed methods for the automatic detection of swallowing sounds facilitate a rough automatic diagnosis of dysphagia, although a reliable method of detection specialized in the peculiar feature patterns of swallowing sounds in actual clinical conditions has not been established. We investigated a novel approach for automatically detecting swallowing sounds by a method wherein basic statistics and dynamic features were extracted based on acoustic features: Mel Frequency Cepstral Coefficients and Mel Frequency Magnitude Coefficients, and an ensemble learning model combining Support Vector Machine and Multi-Layer Perceptron were applied. The evaluation of the effectiveness of the proposed method, based on a swallowing-sounds database synchronized to a video fluorographic swallowing study compiled from 74 advanced-age patients with dysphagia, demonstrated an outstanding performance. It achieved an F1-micro average of approximately 0.92 and an accuracy of 95.20%. The method, proven effective in the current clinical recording database, suggests a significant advancement in the objectivity of cervical auscultation. However, validating its efficacy in other databases is crucial for confirming its broad applicability and potential impact.

Physical Load While Using a Tablet at Different Tilt Angles during Sitting and Standing.

Few standards and guidelines to prevent health problems have been associated with tablet use. We estimated the effects of posture and tablet tilt angle on muscle activity and posture in healthy young adults. Seventeen healthy young adults (age: 20.5 ± 3 years) performed a cognitive task using a tablet in two posture (sitting and standing) and tablet tilt angle (0 degrees and 45 deg) conditions. Segment and joint kinematics were evaluated using 16 inertial measurement unit sensors. Neck, trunk, and upper limb electromyography (EMG) activities were monitored using 12 EMG sensors. Perceived discomfort, kinematics, and EMG activities were compared between conditions using the Friedman test. The perceived discomfort in the standing-0 deg condition was significantly higher than in the remaining three conditions. Standing posture and tablet inclination significantly reduced the sagittal segment and joint angles of the spine, compared with sitting and flat tablet conditions. Similarly, standing posture and tablet inclination significantly reduced EMG activities of the dorsal neck, upper, and lower trunk muscles, while increasing EMG activity of shoulder flexors. Standing posture and tablet inclination reduced the sagittal flexion angle, and dorsal neck, upper, and lower trunk muscle activities, while potentially increasing the muscle activity of arm flexors.

Effects of sitting posture and jaw clenching on neck and trunk muscle activities during typing.

Neck pain is one of the most common musculoskeletal complaints. Evidence suggests that increased activities of neck and trunk muscles are one of the mechanisms related to neck pain. Jaw clenching and sitting posture may modulate the muscle activity in neck and trunk muscles during typing. The present study aimed to assess the effects of different postural positions and clenching conditions on neck and trunk muscle activities. Thirteen healthy adults (39.8 ± 5.0 years) performed computer typing tasks in four conditions (two postural positions [upright vs slouched] and two jaw clenching conditions [clenching vs non-clenching]). Integrated surface electromyography (iEMG) was measured in sternocleidomastoid (SCM), upper trapezius (uTP) and middle trapezius (mTP) muscles and compared between conditions. The Friedman and Wilcoxon signed-rank tests with Bonferroni's corrections were used to estimate the condition-specific differences in the iEMG data. The statistical significance level was set at 5%. In both postural positions, iEMGSCM was significantly greater under the jaw clenching than under the non-clenching condition (χ2  = 21.700, P < .01). Under both jaw clenching conditions, iEMGuTP was significantly greater in the slouched than in the upright postural position (χ2  = 23.182, P < .01). No significant differences in iEMGmTP were seen across conditions (χ2  = 5.018, P = .10). Sitting posture and jaw clenching appear to influence activities of different muscles.

Chronic Neuroleptic-Induced Parkinsonism Examined With Positron Emission Tomography.

BACKGROUND: Neuroleptic drug-induced parkinsonism (NIP) is a leading cause of parkinsonism, particularly in aging. Based on abnormal dopamine transporter scan results, individuals displaying chronic NIP are often diagnosed with Lewy-body Parkinson's disease (PD), but this assumption needs further substantiation. OBJECTIVE: To quantitate the profile of striatal dopaminergic nerve terminal density in NIP relative to PD. METHODS: We used the positron emission tomography ligand [11 C](+)-dihydrotetrabenazine targeting vesicular monoamine transporter type 2 (VMAT2) binding sites and collected various clinical parameters (motor ratings, olfaction, polysomnography to document rapid eye movement sleep muscle activity, quantitative sensory testing for pain thresholds) possibly predicting binding results in patients older than age 50 living with schizophrenia spectrum disorders under long-term stable antipsychotic drug treatment, with (N = 11) or without (N = 11) chart documention of chronic NIP, and compared them to healthy volunteers (N = 11) and others medicated for PD (N = 12). RESULTS: Striatal VMAT2 binding was dichotomous in the NIP group between those with spared (N = 5) or low (N = 6) PD-like values. Striatal binding reduction in the low VMAT2-NIP group was asymmetric without the gradient of maximal involvement in the posterior putamen typical of PD. Anosmia was the only nonmotor parameter measured matching the abnormal striatal VMAT2 binding status. CONCLUSION: These preliminary observations suggest that striatal VMAT2 binding is abnormal in a fraction of chronic NIP cases and differs in spatial distribution from PD. The possibility of a drug-induced axonopathy and resultant synaptopathy, as well as the evolution of the binding deficit, warrant further longitudinal studies in a large cohort. © 2020 International Parkinson and Movement Disorder Society.

Incidence and risk factors for osteonecrosis of the hip in renal transplant patients: a prospective single-centre study.

BACKGROUND: There is a lack of evidence about the risk factors associated with osteonecrosis of the femoral head (ONFH). PURPOSES: To determine the incidence and risk factors for ONFH following renal transplantation (RT). METHODS: In total, data of 681 RT patients (mean age at surgery, 49.5 ± 13.6 years; 249 women and 432 men) were evaluated to determine the incidence of ONFH. Hip magnetic resonance imaging (MRI) was performed six months after RT. The following potential predictors of ONFH were evaluated: (1) patient's condition at RT; laboratory test results including calcium (Ca), phosphorus (P), calcium-phosphorus product (Ca × P), and intact parathyroid hormone before RT; blood relationship between the patient and donor; and mismatching number of human leukocyte antigens (HLAs), especially HLA class I and class II and (2) dosages of steroids after RT, immunosuppressive regimen, and incidence of acute rejection. RESULTS: ONFH was observed in 30 hips (21 cases, 3.1%). We successfully matched 63 patients without ONFH. Multivariate logistic regression analysis, adjusted for cumulative dosages of steroids, revealed that mismatching number of HLA (hazard ratio [HR], 1.61; 95% confidence interval [CI], 1.10-2.36; p = 0.014), HLA class II (HR, 3.73; 95% CI, 1.46-9.56; p = 0.001), P before RT (HR, 1.62; 95% CI, 1.02-2.58; p = 0.041), and Ca × P  before RT (HR, 1.06; 95% CI, 1.01-1.11; p = 0.024) were risk factors for ONFH. CONCLUSION: A greater number of HLA mismatches, HLA class II, serum P, and serum Ca × P were risk factors for ONFH after RT. Therefore, these factors should be evaluated in order to predict ONFH after RT.

Association of masticatory muscle activity with sleep arousal and other concomitant movements during sleep.

OBJECTIVE: This study aims to verify the associations among sleep bruxism (SB), sleep arousal (SA) and concurrent body movements. MATERIAL AND METHODS: Subjects underwent a standard overnight polysomnography test and audio-video recordings. Sleep quality was evaluated according to the Rechtschaffen and Kales criteria, while SA was determined as per the American Sleep Disorders Association criteria. Analyses were performed by an external institution after masking of the subjects' information. SB was assessed based on the presence/absence of rhythmic masticatory muscle activity (RMMA) episodes, which were identified by using electromyography of the masseter muscle. The observed simultaneous movements included lower leg movement (LLM), swallowing, face scratching, head movement, body movement, eye blinking, coughing, licking, sighing, body scratching, lip sucking, somniloquy and yawning. The LLM was determined visually, as well as through an increase in the tibialis electromyogram signal. Other movements were visually assessed using audio-video recordings. The incidences of all the simultaneous movements were compared between RMMA with intercurrent SA (SAwRMMA; RMMA episode derived from a masseter electromyogram showing more than 10% of maximum voluntary contraction) and SA without RMMA (SAw/oRMMA). RESULTS: Fourteen subjects were included in this study (females/males: 4/10, mean age: 31.5 ± 5.7 years). Among these, LLM, swallowing, body movement, licking, body scratching and lip sucking were frequently observed in SAwRMMA episodes than in SAw/oRMMA episodes, significantly. However, the non-specific simultaneous movements were higher observed in SAw/oRMMA episodes than that in SAwRMMA. CONCLUSION: Our results suggest that SB is concurrently activated with LLM in relation to arousal.

Emergence of nontrivial magnetic excitations in a spin-liquid state of kagomé volborthite.

When quantum fluctuations destroy underlying long-range ordered states, novel quantum states emerge. Spin-liquid (SL) states of frustrated quantum antiferromagnets, in which highly correlated spins fluctuate down to very low temperatures, are prominent examples of such quantum states. SL states often exhibit exotic physical properties, but the precise nature of the elementary excitations behind such phenomena remains entirely elusive. Here, we use thermal Hall measurements that can capture the unexplored property of the elementary excitations in SL states, and report the observation of anomalous excitations that may unveil the unique features of the SL state. Our principal finding is a negative thermal Hall conductivity [Formula: see text] which the charge-neutral spin excitations in a gapless SL state of the 2D kagomé insulator volborthite Cu3V2O7(OH)2[Formula: see text]2H2O exhibit, in much the same way in which charged electrons show the conventional electric Hall effect. We find that [Formula: see text] is absent in the high-temperature paramagnetic state and develops upon entering the SL state in accordance with the growth of the short-range spin correlations, demonstrating that [Formula: see text] is a key signature of the elementary excitation formed in the SL state. These results suggest the emergence of nontrivial elementary excitations in the gapless SL state which feel the presence of fictitious magnetic flux, whose effective Lorentz force is found to be less than 1/100 of the force experienced by free electrons.

Template-Free Fabrication of Mesoporous Alumina Nanospheres Using Post-Synthesis Water-Ethanol Treatment of Monodispersed Aluminium Glycerate Nanospheres for Molybdenum Adsorption.

This work reports the template-free fabrication of mesoporous Al2 O3 nanospheres with greatly enhanced textural characteristics through a newly developed post-synthesis "water-ethanol" treatment of aluminium glycerate nanospheres followed by high temperature calcination. The proposed "water-ethanol" treatment is highly advantageous as the resulting mesoporous Al2 O3 nanospheres exhibit 2-4 times higher surface area (up to 251 m2 g-1 ), narrower pore size distribution, and significantly lower crystallization temperature than those obtained without any post-synthesis treatment. To demonstrate the generality of the proposed strategy, a nearly identical post-synthesis "water treatment" method is successfully used to prepare mesoporous monometallic (e.g., manganese oxide (MnO2 )) and bimetallic oxide (e.g., CuCo2 O4 and MnCo2 O4 ) nanospheres assembled of nanosheets or nanoplates with highly enhanced textural characteristics from the corresponding monometallic and bimetallic glycerate nanospheres, respectively. When evaluated as molybdenum (Mo) adsorbents for potential use in molybdenum-99/technetium-99m (99 Mo/99m Tc) generators, the treated mesoporous Al2 O3 nanospheres display higher molybdenum adsorption performance than non-treated Al2 O3 nanospheres and commercial Al2 O3 , thereby suggesting the effectiveness of the proposed strategy for improving the functional performance of oxide materials. It is expected that the proposed method can be utilized to prepare other mesoporous metal oxides with enhanced textural characteristics and functional performance.

Evaluation of thoracic factors after scoliosis surgery in patients with both scoliosis and pectus excavatum.

PURPOSE: Pectus excavatum can negatively impact cardiac function during scoliosis surgery. Several authors reported severe hypotension associated with the prone position during scoliosis surgery in children that had both scoliosis and pectus excavatum. However, we could find no studies that evaluated the change in the thoracic factors, such as sternal tilt angle and Haller index after scoliosis surgery in patients with both scoliosis and pectus excavatum. The purpose of this study is to evaluate the change in thoracic factors after surgical treatment for scoliosis associated with pectus excavatum. METHODS: We performed a retrospective review on 20 patients (10 males and 10 females) who underwent surgical treatment for scoliosis associated with pectus excavatum from August 2004 to April 2014 in our hospital. We investigated the scoliosis diagnosis, preoperative and postoperative Cobb and thoracic kyphosis (TK) angles, the change in TK after surgery and thoracic factors, including the AP and transverse diameters of the chest, the sternal tilt angle, and Haller index. RESULTS: Patient mean age was 13.2 years old (4-27 years old) at surgery. Types of scoliosis were idiopathic in 8 patients, syndromic in 10, and neuromuscular in 2. The mean Cobb angles were 72.1° preoperatively and 19.0° postoperatively. Curve locations were thoracic in 13 patients, thoracolumbar in 4, and lumbar in 3. Surgical treatment of pectus excavatum was performed in 9 patients (45 %) before scoliosis treatment. Mean sternal tilt angles were 11.5° preoperatively and 11.1° postoperatively. Mean Haller indices were 4.8 preoperatively and 5.3 postoperatively. This was especially true for syndromic or neuromuscular scoliosis and thoracolumbar/lumbar curve type patients in which scoliosis surgery tended to worsen the Haller index. CONCLUSION: The Haller index increased postoperatively in 11 of 20 patients, which means sternal depression deteriorated after scoliosis surgery in about 50 % of patients. We suggest that surgeons fully assess the thoracic factors in patients with scoliosis and pectus excavatum prior to performing scoliosis surgery and carefully monitor their patient's general condition during surgery.

Three-Dimensional Analysis of Hemimetameric Segmental Shift in Congenital Scoliosis.

STUDY DESIGN: This is a retrospective cohort study. BACKGROUND: Hemimetameric segmental shift (HMMS) is defined as a hemivertebral deformation in which 2 or more hemivertebrae exist on both sides of the spine and are separated by at least 1 normal vertebra. Reports of HMMS are rare and based on simple anterior x-ray images. No reports have used 3-dimensional computed tomography (3D-CT) to analyze both the anterior and posterior elements. The objective of this study was to analyze the morphology and clinical features of HMMS 3 dimensionally. METHODS: HMMS was confirmed in 32 (6.6%, 16 males and 16 females) of 483 patients diagnosed with congenital scoliosis at the study institution between 1998 and 2013. The average age at the first visit was 6 years and 3 months. 3D-CT imaging was performed for 30 patients older than 2 years (average age: 9 y and 8 mo) and used to classify cases according to posterior elements. RESULTS: With regard to the number of hemivertebrae present, 21 patients had 2 hemivertebrae, 7 patients had 3 hemivertebrae, and 2 patients had 4 hemivertebrae. Patients with 2 hemivertebrae predominantly had hemivertebrae in the thoracolumbar spine. Patients were classified into 2 categories: malformation existing at an equal level in anterior and posterior sides (unison HMMS) and malformation existing at nonequal levels (discordant HMMS). Nine patients had unison HMMS and all of them had 2 hemivertebrae (average: 4.6 vertebrae). Twenty-one patients had discordant HMMS, with 12 having 2 hemivertebrae, 7 having 3 hemivertebrae, and 2 having 4 hemivertebrae. CONCLUSIONS: Through 3D-CT analysis, HMMS was categorized as unison or discordant. Discordant HMMS was observed in 21 of 30 (70%) patients and in all patients with >3 hemivertebrae. Diagnosing HMMS, whether unison or discordant, is clinically important and should be done with careful analysis of bone models and/or radiologic images to determine the correct spinal levels. LEVEL OF EVIDENCE: Level IV-diagnostic study.