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To evaluate the role of hyaluronic acid (HA) filler injection in the management of upper eyelid retraction (UER) in thyroid eye disease (TED).Retrospective interventional series of all patients with TED who had undergone HA injection, from February 2011 to April 2013 by a single surgeon (Y-DK) in a tertiary medical institution. Outcome measures: Mean margin reflex distance 1 (MRD1) pre- and post-filler.There was a total of 13 patients and 17 eyes included in the study. The injection dosage for 15 eyes was 0.5 ml, one patient had 0.35cc on the right eye and 0.65cc on the left eye. Mean MRD1 at presentation was 6.21 mm. There was a mean decrease in MRD1 of 2.01 mm (Transconjunctival HA injection is an effective treatment option for TED-related UER in both active and inactive TED patients in an East Asian population, with a potentially long-lasting effect.

Deep brain stimulation (DBS) of the subthalamic nucleus (STN) represents an effective treatment for severe Parkinson's disease (PD), but little is known about the long-term benefit.To investigate the survival rate and long-term outcome of DBS.We investigated all 81 patients including 37 males and 44 females who underwent bilateral STN DBS from March 2005 to March 2008 at a single institution. The current survival status of the patients was investigated. Preoperative and postoperative follow-up assessments were analyzed.The mean age at the time of surgery was 62 (range 27-82) years, and the median clinical follow-up duration was 145 months. Thirty-five patients (43%) died during the follow-up period. The mean duration from DBS surgery to death was 110.46 ± 40.8 (range 0-155) months. The cumulative survival rate is as follows: 98.8 ± 1.2% (1 year), 95.1 ± 2.4% (5 years), and 79.0 ± 4.5% (10 years). Of the 81 patients, 33 (40%) were ambulatory up to more than 11 years. The Unified Parkinson's Disease Rating Scale (UPDRS) score was significantly improved until 5 years after surgery although it showed a tendency to increase again after 10 years. The patient group with both electrodes located within the STN showed a higher rate of survival and maintained ambulation.STN DBS is a safe and effective treatment for patients with advanced PD. This study based on the long-term follow-up of large patient populations can be used to elucidate the long-term fate of patients who underwent bilateral STN DBS for PD.

The objective biomarker for prediction of gait and balance in the long-term follow-up of Parkinson's disease(PD) patients with subthalamic nucleus deep brain stimulation(STN-DBS) has not yet been elucidated. We investigated the value of pre-operative quantitative gait parameters for the prediction of long-term prognosis of gait in PD patients with DBS.We retrospectively collected gait videos(both medication ON/OFF states) of PD patients recorded as preoperative evaluation before STN DBS. We enrolled patients who were followed-up for more than 5 years after the surgery from 2006 to 2014. We derived objective gait parameters from video-based gait analysis algorithm. We defined the clinical milestones of frequent falling, impaired walking, and loss of autonomy based on the Unified Parkinson's disease rating scale and Hoehn and Yahr stage, which were regularly followed up to 156 months after surgery. We calculated hazard ratios(HRs) of baseline gait parameters for predicting the clinical milestones.A total of 96 gait videos from 63 PD patients were analyzed. The mean follow-up duration(standard deviation) was 88.0(34.2) months after surgery. Relatively high (mean + 1 standard deviation) variability for step length, step time and stride time (HR = 2.92[1.02-8.33], 3.91[1.38-11.11] and 7.16[2.09-24.52],respectively) in medication-ON state significantly predicted reaching any of the three clinical milestones of frequent falling, impaired walking and loss of autonomy. Gait parameters from the medication-OFF state did not predict any clinical milestone.High preoperative gait variability from the medication-ON state predicts long-term outcomes for gait and balance in PD patients with STN DBS.

Objective This study aims to develop an automated and objective tool to evaluate postural abnormalities in Parkinson’s disease (PD) patients.Methods We applied a deep learning-based pose-estimation algorithm to lateral photos of prospectively enrolled PD patients (n = 28). We automatically measured the anterior flexion angle (AFA) and dropped head angle (DHA), which were validated with conventional manual labeling methods.Results The automatically measured DHA and AFA were in excellent agreement with manual labeling methods (intraclass correlation coefficient > 0.95) with mean bias equal to or less than 3 degrees.Conclusion The deep learning-based pose-estimation algorithm objectively measured postural abnormalities in PD patients.

Purpose: This study was conducted to determine the factors affecting a hypothetical model of testing for general hospital nurses’ job embeddedness.Methods: Data were collected from August 20 to September 19, 2021, by a self-administered questionnaire answered by 428 general hospital nurses. The data were analyzed by SPSS and AMOS.Results: Nine of the hypothetical model’s 12 hypotheses were supported by the data collected from all participants. The test results indicate that ego resilience, subjective career success, and recovery experience from job stress directly affect participants’ job embeddedness. Nurses’ work environments were reported to affect ego resilience and subjective career success, while at the same time ego resilience and subjective career success affected the participants’ job embeddedness. Work-life balance was found to affect ego resilience and ego resilience affected subjective career success, and at the same time subjective career success directly affected participants’ recovery experiences from job stress and job embeddedness. Of these variables, subjective career success had the strongest direct effect on participants’ job embeddedness. Work-life balance affected the participants’ recovery experiences from job stress, and their recovery experiences from job stress were found to directly affect job embeddedness.Conclusion: These results suggest that different management strategies to enhance hospital nurses’ job embeddedness should address nurses’ ego resilience, subjective career success, and recovery experiences from job stress.

Residual functional ankle instability regardless of the restoration of mechanical stability after the lateral ligament repair or reconstruction can cause recurrent sprain. The purpose of this study was to identify the sequential changes of joint-position sense, peroneal strength, postural control, and functional performance ability after the modified Broström procedure (MBP) for chronic ankle instability. A total of 46 patients (46 ankles) underwent the MBP for chronic ankle instability were eligible for this study and were followed for 1 year postoperatively. The changes of joint-position sense and peroneal strength were periodically evaluated with an isokinetic dynamometer. Postural control ability was evaluated using a one-leg stance test with eyes closed. The functional performance ability examination comprised a one-leg hop test, a 6-meter hop test, and a cross 3-meter hop test. The error in joint-position sense significantly improved from a mean 4.3º to 2.8º (p.001). Peak torque for eversion significantly improved from a mean 18.2 Nm to 21.2 Nm (p = .024). Balance retention time significantly improved from a mean 4.7 seconds to 6.4 seconds (p.001). Among the functional performance tests, only the one-leg hop test showed a significant improvement postoperatively (p = .031). At 1 year postoperatively, the recovery ratios compared to the unaffected ankle were 67.9% in joint-position sense (p.001), 86.9% in peroneal strength (p = .012), and 74.4% in postural control (p.001) with significant side-to-side differences. Although joint-position sense, peroneal strength, postural control, and functional performance ability were significantly improved after the MBP, recovery ratios compared to the unaffected ankle were insufficient up to 1 year postoperatively.

OBJECTIVE The petrous apex (PA) is one of the most challenging areas in skull base surgery because it is surrounded by numerous critical neurovascular structures. The authors analyzed the clinical outcomes of patients who underwent endoscopic endonasal approach (EEA) and transorbital approach (TOA) procedures for lesions involving PA to determine the perspectives and proper applications of these two approaches. METHODS The authors included patients younger than 80 years with lesions involving PA who were treated between May 2015 and December 2019 and had regular follow-up MR images available for analysis. Patients with meningioma involving petroclival regions were excluded. The authors classified PA into three regions: superior to the petrous segment of the internal carotid artery (p-ICA) (zone 1); posterior to p-ICA (zone 2); and inferior to p-ICA (zone 3). Demographic data, preoperative clinical and radiological findings, surgical outcomes, and morbidities were reviewed. RESULTS A total of 19 patients with lesions involving PA were included. Ten patients had malignant tumor (chondrosarcoma, chordoma, and osteosarcoma), and 6 had benign tumor (schwannoma, Cushing’s disease, teratoma, etc.). Three patients had PA cephalocele (PAC). Thirteen patients underwent EEA, and 5 underwent TOA. Simultaneous combined EEA and TOA was performed on 1 patient. Thirteen of 16 patients (81.3%) had gross- or near-total resection. Tumors within PA were completely resected from 13 of 16 patients using a view limited to only the PA. Complete obliteration of PAC was achieved in all patients. Postoperative complications included 2 cases of CSF leak, 1 case of injury to ICA, 1 fatality due to sudden herniation of the brainstem, and 1 case of postoperative diplopia. CONCLUSIONS EEA is a versatile surgical approach for lesions involving all three zones of PA. Clival tumor spreading to PA in a medial-to-lateral direction is a good indication for EEA. TOA provided a direct surgical corridor to the superior portion of PA (zone 1). Patients with disease with cystic nature are good candidates for TOA. TOA may be a reasonable alternative surgical treatment for select pathologies involving PA.

Objectives: To describe the features, management approaches, and outcomes of orbito-cranial schwannomas. Methods: Retrospective review of ten patients with orbito-cranial schwannomas managed in six orbital services over 22 years. Data collected included demographics, presenting features, neuroimaging characteristics, histology, management approach, complications, and outcomes. Results: Mean age of the patients was 41.4 ± 19.9 years, and 6 (60%) were females. The majority presented with proptosis (90%), limited extraocular motility (80%), eyelid swelling (60%), and optic neuropathy (60%). Most lesions (80%) involved the entire anterior-posterior span of the orbit, with both intra- and extraconal involvement. All tumours involved the orbital apex, the superior orbital fissure, and extended at least to the cavernous sinus. Surgical resection was performed for all. Seven (70%) of the tumours were completely or subtotally resected combining an intracapsular approach by an orbital-neurosurgical collaboration, with no recurrence on postoperative follow-up (6–186 months). Three underwent tumour debulking. Of these, two remained stable on follow-up (6–34 months) and one showed progression of the residual tumour over 9 years (cellular schwannoma on histology) necessitating stereotactic radiotherapy (SRT) for local control. Adjuncts to the orbito-cranial resection included perioperative frozen section (n = 5), endoscopic transorbital approach (n = 2), and image-guided navigation (n = 1). Post-surgical adjuvant SRT was used in three subjects. Conclusions: These results highlight the possibility of successful surgical control in complex orbito-cranial schwannomas. A combined neurosurgical/orbital approach with consideration of an intracapsular resection is recommended. Recurrence may not occur with subtotal excision and observation may be reasonable. Adjunctive SRT for progression or residual tumour can be considered.

Deep water freshening beneath pan-Arctic ice shelves has recently been proposed based on the absence of excess thorium in glacial Arctic sediments. This profound proposal requires scrutiny of Arctic paleohydrology during past glacial periods. Here, we present structural and geochemical results of inorganic authigenic carbonates in deep-sea glacimarine sediments from the Mendeleev Ridge, western Arctic Ocean over the last 76 kyr. Our results suggest that Polar Deep Water in the western Arctic became brackish and anoxic during stadial periods. We argue that sediment-laden hyperpycnal meltwater discharged from paleo-ice sheets filled much of the water column depending upon the density, substantially reducing the salinity and oxygen content of the Polar Deep Water. Our findings suggest that this phenomenon was more extreme in the western Arctic Ocean and may point to the potential role of the western Arctic Ocean as an additional carbon reservoir in the global carbon cycle across glacial-interglacial cycles.

ObjectiveThis study aimed to investigate the effect of small molecules incorporated into the engineered nanofibrous scaffold to enhance the osteoblast differentiationMaterials and methodsPoly-ε-caprolactone (PCL) nanofiber matrices with lithium chloride (LiCl) were fabricated using the electrospinning technique. Scaffolds were characterized using scanning electron microscopy (SEM) and energy-dispersive X-ray (EDX). Scaffolds were seeded with MC3T3-E1 cells and assessed using Western blots (β-catenin), alamarBlue assay (proliferation), qPCR (osteoblast differentiation), and mineralization (Alizarin Red staining).ResultsWe observed LiCl nanofiber scaffolds induced concentration-dependent cell proliferation that correlated with an increased β-catenin expression indicating sustained Wnt signaling. Next, we examined osteoblast differentiation markers such as osteocalcin (OCN) and Runt-related transcription factor 2 (Runx2) and noted increased expression in LiCl nanofiber scaffolds. We also noted increased bone morphogenetic protein (BMP-2, 4, and 7) expressions suggesting activated Wnt can promote cures to further osteogenic differentiation. Finally, Alizarin Red staining demonstrated increased mineral deposition in LiCl-incorporated nanofiber scaffolds.ConclusionsTogether, these results indicated that LiCl-incorporated nanofiber scaffolds enhance osteoblast differentiation.Clinical relevanceSmall molecule-incorporated nanofibrous scaffolds are an innovative clinical tool for bone tissue engineering.

To evaluate the effect of continuous positive airway pressure (CPAP) on the quality of life (QoL) in patients with multiple system atrophy (MSA) and their caregivers.We reviewed the electronic medical records of patients with MSA treated with CPAP (n = 15). After CPAP treatment, we checked the patient global impression of change (PGI-C) scale for sleep complaints and QoL for six patients who continued to use CPAP. QoL was also assessed for five caregivers of these patients.A total of 15 patients (6 women) were included. The mean age was 63.6 ± 8.1 years old and the mean disease duration was 4.9 years. The mean duration of CPAP treatment was 22.1 ± 10.6 months and the average compliance was 90%. Three patients died during CPAP treatment, and two patients discontinued CPAP after tracheostomy. For six patients who continued to use CPAP, sleep complaints minimally improved. Five patients reported an improved QoL, and all five caregivers reported improved caregivers' QoL.This study showed that the use of CPAP has a beneficial effect on sleep complaints and QoL of patients with MSA and their caregivers.

To elucidate the biomarkers related to survival in multiple system atrophy(MSA), we analyzed the predictability of retrospectively collected blood markers for survival in 650 probable MSA. High absolute neutrophil count, red-cell distribution width, C-reactive protein, erythrocyte sedimentation rate, and low hemoglobin, protein, albumin, and creatinine were correlated with higher mortality in MSA. Systemic alteration in inflammation and nutritional status in the early stage are associated with higher mortality in MSA.

Objective To assess nocturnal hypokinesia using the Korean version of the Nocturnal Hypokinesia Questionnaire (NHQ-K) in Parkinson’s disease (PD) patients across disease stages.Methods We developed the NHQ-K and performed questionnaire-based interviews with 108 PD patients from three referral hospitals. Clinical associations of nocturnal hypokinesia and its impact on health-related quality of life (HRQoL) were also analyzed.Results The NHQ-K showed acceptable internal consistency (0.83) and interrater reliability (0.95). Nocturnal hypokinesia significantly affected HRQoL in PD patients at both the early and advanced stages (adjusted p < 0.001). Increased severity of nocturnal hypokinesia was associated with dyskinesias, off-period disability, apathy, and anxious mood in PD patients (adjusted p < 0.01) after controlling for disease severity and medication dose.Conclusion The NHQ-K is useful for screening nocturnal hypokinesia in PD patients. Given the high impact of nocturnal hypokinesia on HRQoL, comprehensive management of nocturnal disability is needed for PD patients.

Recent advances in physical reservoir computing, which is a type of temporal kernel, have made it possible to perform complicated timing-related tasks using a linear classifier. However, the fixed reservoir dynamics in previous studies have limited application fields. In this study, temporal kernel computing was implemented with a physical kernel that consisted of a W/HfO2/TiN memristor, a capacitor, and a resistor, in which the kernel dynamics could be arbitrarily controlled by changing the circuit parameters. After the capability of the temporal kernel to identify the static MNIST data was proven, the system was adopted to recognize the sequential data, ultrasound (malignancy of lesions) and electrocardiogram (arrhythmia), that had a significantly different time constant (10−7 vs. 1 s). The suggested system feasibly performed the tasks by simply varying the capacitance and resistance. These functionalities demonstrate the high adaptability of the present temporal kernel compared to the previous ones., Recently there has been an interest in utilising memristors as physical temporal kernels. Here, Jang et al demonstrate a physical temporal kernel using a memristor combined with a capacitor and resistor, where the additional circuit elements can be varied to allow the system to tackle a diverse range of tasks.