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Background/Purpose This study measured the acceleration magnitude using a dummy model filled with various air-material ratios to elucidate the mechanism of resonance effect on ocular vestibular-evoked myogenic potential (oVEMP). Methods With the percentages of air volume altered by filling various materials (water, glycerol, or ethanol) in an acrylic-made hollow spherical model, a minishaker was utilized to deliver vibration stimuli to the model. Then, acceleration magnitude of each model was measured. Results Since the air was most occupied at the upper part of the model (z-axis), acceleration magnitude along the z-axis was selected for comparison. An increasing trend of the z-axis acceleration magnitude ranging 0.110–0.759 g was identified in air–water model with air volume percentage ranged 40–100%. On the other hand, a significant increasing trend of acceleration magnitude along the z-axis (0.157–0.759 g) was noted in air-glycerol model with 80–100% of air volume. While in air-ethanol model, a significant increasing trend in acceleration magnitude along the z-axis ranged 0.121–0.759 g correlating with 40–100% of air volume. Conclusion The mechanism for eliciting oVEMP is via the first-order bone vibration coupled with the second-order resonance effect. Both percentage of air volume (i.e. frontal sinus) and density of filling media (i.e. skull property) may contribute to the resonance effect, which then increases the acceleration magnitude so as to enhance the elicitation of oVEMP.

Purpose: In advanced or high-grade prostate cancer (PCa), prostate-specific antigen (PSA) is usually elevated, however, some patients may present with low initial PSA (iPSA) levels. The objective of this study was to evaluate whether different iPSA levels were associated with dissimilar clinical outcomes among men with high-grade PCa and advanced disease after robot-assisted laparoscopic radical prostatectomy (RaLRP). Methods: This study enrolled 69 PCa patients with initial Gleason score ≥8 and pathologic T-stage ≥3a from April 2012 to December 2018. Patients were stratified into 3 groups based on iPSA levels at diagnosis

The ankylosed spine is prone to fracture even as a result of minor trauma due to its changed biomechanical properties. Fractures in ankylosing spondylitis (AS) patients are highly unstable and surgical intervention for fixation is warranted. Implant failure rates are high and combined anterior and posterior fixation is required to enhance the fixation outcome. For fusion, anterior interbody fusion or posterior bone graft fusion is often adopted. Here, we introduce a new method which combines vertebroplasty with anterior and posterior approaches to improve pain control, facilitate the long-term fixation outcome and mechanics, and decrease perioperative risks with prompt stabilization, especially in patients with spine curve deformity. Here, we present two AS cases with cervical spine fracture treated with this new method.

Urothelial carcinomas (UCs) are highly prevalent in patients with end-stage renal disease. Chronic kidney disease (CKD) is the predecessor of end-stage renal disease, and it is also associated with UC. However, the interplay between CKD and UC lacks solid evidence. Acrolein is produced by polyamines and has been suggested to be the uremic "toxin." The level of acrolein correlates well with chronic renal failure. We recently found that acrolein-induced DNA damage and inhibited DNA repair in urothelial cells, which contribute to bladder cancer. Therefore, we hypothesize that acrolein is involved in the formation of UC in patients with CKD.A total of 62 UC patients and 43 healthy control subjects were recruited. Acrolein-DNA (Acr-dG) adducts and p53 gene mutations in UC tissues, plasma acrolein-protein conjugates (Acr-PC) and S-(3-hydroxypropyl)-N-acetylcysteine levels, and urinary Acr metabolites were analyzed in these patients.Acr-dG levels were statistically correlated with CKD stages in UC patients (P0.01). Most p53 mutations were G to A and G to T mutations in these patients, and 50% of mutations at G:C pairs occurred in CpG sites, which is similar to the mutational spectra induced by Acr-dG adducts. Acr-PC levels in the plasma of UC patients with CKD were significantly higher than those of control subjects (P0.001). Altered urinary S-(3-hydroxypropyl)-N-acetylcysteine was also found in UC patients with CKD compared to control subjects (P0.005).These results indicate that acrolein acts as an endogenous uremic toxin and contributes to UC formation in patients with CKD.

Convalescence after hernia repair is one of the main focuses for hernia surgeons. We analyzed our prospectively collected data to identify possible predictive factors for post-operative acute and chronic pain. We prospectively collected the demographic data and peri-operative findings. Post-operative acute pain was evaluated with Visual Analog Pain Scale. The chronic pain (pain persists for > 6 months since operation) was also recorded. From June 2008 to August 2018, there were 807 patients with 1029 sites of inguinal hernia enrolled in our analysis. Pain before operation was associated with the severity of acute pain on OP (operation) day, POD 1 (post-operative day 1), and POD 7 (post-operative day 7). Younger patients had significantly higher post-operative acute pain on OP day, POD 1, and POD 7. The staple mesh fixation method resulted in a higher pain score at OP day and POD 1. The predictive factors for chronic pain were sex (female), young age (

Objective: Heart rate variability (HRV) reflects autonomous nervous system disturbance and is used for seizure prediction. The aim of this study was to develop a real-time, continuous physiological medical signal data acquisition system in seizure detection for intensive care unit (ICU). Methods: This prospective study was conducted in National Taiwan University Hospital from August 2018 to October 2019. This study included 20 patients who (a) had a sustained return of spontaneous circulation following out-of-hospital cardiac arrest, (b) were over 18 years old, (c) and were admitted to the emergency ICU for post-cardiac-arrest care. One-lead electrocardiography and bilateral two-channel electroencephalography recorders were synchronically used to conduct measurements for a maximum of 72 hours. The recorded data were wirelessly real-time transmitted by a proxy transmitting module through an access point and a local gateway. A system with a novel algorithm processed the signals and conducted feature extraction and supervised learning for seizure detection. Results: A total of 89 nonseizure and 83 seizure events were detected by the system. Seizure occurred in two-thirds of the patients assessed by intensivists and neurologists. Four HRV parameters, namely standard deviation of normal-to-normal R-wave intervals, high frequency, low frequency-high frequency ratio, and sample entropy, were determined as potential features for identifying seizures. The sensitivity and specificity of the developed system were 0.74 and 0.81, respectively, and the positive predictive value was 0.82. Conclusion: The developed system can be used to identify seizure events through HRV features. Significance: The current study achieved real-time seizure detection and overcame previous limitations on continuity and accessibility.

Objective This study performed ocular vestibular-evoked myogenic potential (oVEMP) test via Fpz bone vibration (termed Fpz-oVEMP) and Fz bone vibration (termed Fz-oVEMP) using a minishaker. The aim of this study was to evaluate the resonance effect of the frontal sinus on the oVEMP recordings, so as to establish an optimal clinical protocol for eliciting oVEMPs by bone vibration. Design Thirty healthy volunteers (15 children and 15 adults) and 15 adults with frontal sinusitis were enrolled in this study. All subjects underwent oVEMP test via Fpz and Fz bone vibration stimuli, and volume of the frontal sinus was measured by CT scan. Results Because healthy adults (3.20 ± 1.08 mL) had significantly larger frontal sinus volume than healthy children (2.04±1.87 mL), the former (100%) showed higher response rates of Fpz-oVEMP than the latter (30%), but not Fz-oVEMP. When the frontal sinus volume is >1.91 mL (approximately at the age of 14 years), Fpz-oVEMP displayed larger reflex amplitude than Fz-oVEMP did. In contrast, Fpz-oVEMP (30%) displayed lower response rate than Fz-oVEMP (73%) in patients with frontal sinusitis. Conclusions Both developmental (frontal sinus volume) and pathological (frontal sinus inflammation) factors may affect the oVEMP responses via altering resonance function. For the developmental factor, frontal sinus volume >1.91 mL may initiate the resonance effect on oVEMPs, as evidenced by higher response rate with larger reflex amplitude of Fpz-oVEMP than Fz-oVEMP. For the pathological factor, frontal sinusitis may hamper the resonance effect on oVEMPs, as shown by the lower response rate of Fpz-oVEMP than Fz-oVEMP. Hence, oVEMP test may be performed via Fpz bone vibration first in healthy adults, while via Fz bone vibration first in children aged under 14 years or subjects with frontal sinusitis.

Background We designed a novel ankle foot orthosis (AFO), namely, ideal training AFO (IT-AFO), with motion feedback on the hemiparetic lower limb to improve ambulation in individuals with stroke-related hemiplegia. We, therefore sought to compare the kinematic parameters of gait between IT-AFO with and without dynamic control and conventional anterior-type AFO or no AFO. Methods Gait parameters were measured using the RehaWatch® system in seven individuals with hemiplegia (mean 51.14 years). The parameters were compared across four conditions: no AFO, conventional anterior AFO, IT-AFO without dynamic control, and IT-AFO with dynamic control, with three trials of a 10-m walk test for each. Results The dorsiflexion angle increased during the swing phase when the IT-AFO was worn, and it was larger with dynamic control. These data can confirm drop foot improvement; however, the difference between the parameters with- and without-AFO control conditions was not significant in the swing phase. The IT-AFO with or without dynamic control enhanced the loading response to a greater extent between the hemiparetic and unaffected lower limbs than conventional AFO or no AFO. The duration of the stance phase on the hemiparetic lower limb was also longer when using IT-AFO with and without dynamic control than that when using conventional AFO, which improved asymmetry. User comfort and satisfaction was greater with IT-AFO than with the other conditions. Conclusions The IT-AFO with dynamic control improved gait pattern and weight shifting to the hemiparetic lower limb, reducing gait asymmetry. The difference with and without dynamic control of IT-AFO is not statistically significant, and it is limited by sample size. However, this study shows the potential of IT-AFO in applying positive motion feedback with gait training. Trial registration Taipei Medical University-Joint Institutional Review Board. N201510010. Registered 12 February 2015. http://ohr.tmu.edu.tw/main.php.

Cardiopulmonary resuscitation (CPR) resuscitates patients suffering from cardiac arrest. Mechanical chest compression CPR highlights the need for high CPR quality to facilitate survival and neurological recovery. However, current CPR devices cannot be used on pregnant women or infants. These devices’ long re-setup times interrupt CPR and can cause cerebral ischemia. This study designed a novel device with a crank-sliding mechanism. The polar coordinate system (r, θ, z) shortened the setup time and enabled adjustment without moving the patient. We compared our device with commercial products (e.g., LUCAS-2) by quantifying the compression pressure. Control groups for manual CPR of trained physicians and untrained citizens were recruited. We used Resusci Anne products as models. Our results indicated that our design exhibited performance similar to that of LUCAS-2 in adults (557.8 vs. 623.6 mmHg, p = 0.217) and met the current CPR standard guidelines. Notably, our device is applicable to pregnant women [565 vs. 564.5 (adults) mmHg, p = 0.987] and infants [570.8 vs. 564.5 (adults) mmHg, p = 0.801] without lowering the compression quality. The overall compression quality and stability of mechanical chest compression CPR were favorable to those of manual CPR. Our device provides an innovative prototype for the next generation of CPR facilities.

The American Urological Association guidelines for the management of non-neurogenic overactive bladder (OAB) recommend the use of OnabotulinumtoxinA, sacral neuromodulation (SNM), and peripheral tibial nerve stimulation (PTNS) as third line treatment options with no treatment hierarchy. The current study used network meta-analysis to compare the efficacy of these three modalities for managing adult OAB syndrome. We performed systematic literature searches of several databases from January 1995 to September 2019 with language restricted to English. All randomized control trials that compared any dose of OnabotulinumtoxinA, SNM, and PTNS with each other or a placebo for the management of adult OAB were included in the study. Overall, 17 randomized control trials, with a follow up of 3&ndash, 6 months in the predominance of trials (range 1.5&ndash, 24 months), were included for analysis. For each trial outcome, the results were reported as an average number of episodes of the outcome at baseline. Compared with the placebo, all three treatments were more efficacious for the selected outcome parameters. OnabotulinumtoxinA resulted in a higher number of complications, including urinary tract infection and urine retention. Compared with OnabotulinumtoxinA and PTNS, SNM resulted in the greatest reduction in urinary incontinence episodes and voiding frequency. However, comparison of their long-term efficacy was lacking. Further studies on the long-term effectiveness of the three treatment options, with standardized questionnaires and parameters are warranted.

In the daily life of the elderly, falling is a common accident and results in severe consequences. Hence, considerable research has been conducted on fall detection for the elderly. Smartphones, which have motion sensors and transmitting modules, have been applied as fall detectors. However, the performance of human activity recognition using various smartphones is usually lower than those using a dedicated smartphone due to different specification values of built-in smartphone accelerometers. This presents a challenge in the development of technology for using smartphones as fall detectors. In this study, we compared the specifications of built-in accelerometers which are essential for fall detection in four smartphones from different manufacturers. To test fall detection performance on various smartphones, 10 young healthy volunteers were included to wear the four smartphones and perform daily activities and fall event trials. Then the accuracies of a fall detection algorithm performed on four d...

Purpose To evaluate the response in patients undergoing SBRT using dynamic contrast-enhanced (DCE) integrated magnetic resonance positron emission tomography (MR-PET). Stereotactic body radiation therapy (SBRT) is efficacious as a front-line local treatment for non-small cell lung cancer (NSCLC). Materials and Methods We prospectively enrolled 19 lung tumors in 17 nonmetastatic NSCLC patients who were receiving SBRT as a primary treatment. They underwent DCE-integrated 3T MR-PET before and 6 weeks after SBRT. The following image parameters were analyzed: tumor size, standardized uptake value (SUV), apparent diffusion coefficient, Ktrans, kep, ve, vp, and iAUC60. Chest computed tomography (CT) was performed at 3 months after SBRT. Results SBRT treatment led to tumor changes including significant decreases in the SUVmax (–61%, P 10 (P = 0.083). Conclusion In patients with NSCLC who are receiving SBRT, DCE-integrated MR-PET can be used to evaluate the response after SBRT and to predict the local treatment outcome. Level of Evidence: 2 Technical Efficacy: Stage 1 J. Magn. Reson. Imaging 2017.

Falling is a common accident that can lead to serious injury among the elderly. To reduce injuries resulting from falls, automatic detection allows immediate medical assistance. Hence, various fall detectors, including body sensors and smartphones, have been developed in recent decades. In our previous study, an accelerometer-based fall detector was designed with high accuracy for simulated falls performed by young volunteers. However, there are significant differences between the acceleration signals generated by simulated and real falls. Simulated devices do not accurately assess the sensitivity and specificity of falls. Hence, the goal of this study is to access the accuracy of our designed accelerometer-based fall detection algorithm using a real-world repository. The results showed that the algorithm accurately characterizes real falls. Differences between our approach and previously published algorithms are discussed. This study is expected to assist in the design of more effective practical...

Introduction Although testosterone deficiency has a well-known association with increased risk of cardiovascular disease (CVD), the threshold remains to be determined. Aim To investigate whether there is a discriminatory testosterone level below which the CVD risk increases. Methods The study included 876 men 45 to 74 years old who underwent a general health checkup. The Framingham Risk Score was used to estimate the 10-year CVD risk; a high-sensitivity C-reactive protein (hsCRP) level of at least 1 mg/L was considered an indicator of increased CVD risk. Aging symptoms and sexual function were evaluated with the Aging Males’ Symptom Scale. Main Outcome Measures Locally weighted regression was performed to determine the testosterone threshold for Framingham CVD risk and increased hsCRP. Results The mean age was 56.6 ± 7.0 years. The mean total testosterone level was 394.3 ± 115.7 ng/dL. The mean 10-year Framingham CVD risk was 16.6 ± 10.7%, and 169 (19.3%) had increased hsCRP. The locally weighted regression showed that total testosterone levels of 440 and 480 ng/dL were associated with increased Framingham CVD risk and an increased probability of increased hsCRP, respectively. Men with sexual dysfunction (poor sexual performance, decreased morning erection, and loss of libido) had significantly greater CVD risk. Their risk appeared to increase at a relatively higher testosterone level, and it reached a plateau at a testosterone level of 300 to 350 ng/dL. In contrast, the risk in those with no or less sexual dysfunction remained low at a higher testosterone level, and a threshold level of 425 to 475 ng/dL was associated with increased CVD risk. A similar pattern and threshold were identified in the analyses of the relation between testosterone and hsCRP. Conclusion These data showed that a testosterone threshold of 440 ng/dL was associated with increased Framingham 10-year CVD risk in middle-aged and elderly men. Poor sexual performance, decreased morning erection, and loss of libido had an impact on the testosterone threshold for CVD risk. The threshold level was higher in men with sexual dysfunction. Further study is required to evaluate the validity of these testosterone thresholds for CVD risk.

This study aimed to investigate the risks of thromboembolic vascular disease following androgen deprivation therapy (ADT) administered to prostate cancer (PCa) patients. A total of 24,464 men with newly diagnosed PCa during 2000–2008 were recruited through a longitudinal health insurance database in Taiwan. All PCa patients were stratified into two: ADT and non-ADT groups. Patients with ADT treatment were grouped into three: surgical castration, chemical castration, and anti-androgen alone. The risks of pulmonary embolism (PE), peripheral arterial occlusion disease (PAOD), and deep vein thrombosis (DVT) were assessed in multiple Cox proportional-hazards regression with time-dependent covariates. During the 12-year follow-up period, incidence rates per 1000 person-years in ADT and non-ADT groups were 2.87 and 1.62 for DVT, 1.00 and 0.52 for PE, and 1.03 and 0.70 for PAOD, respectively. The DVT and PE risks were significantly increased in patients receiving combined androgen blockade (CAB) compared with the counterpart ADT non-recipients. After adjusting for potential risk factors, PCa patients receiving CAB had the highest PE risk (HR = 3.11), followed by DVT risk (HR = 2.53). The DVT risk remained elevated throughout the entire duration of chemical castration. However, high PE risk was observed in patients with ≤720-day treatment duration. No association was found between ADT and PAOD risks. Overall, the risks of PE and DVT were considerably heightened in Asian men subjected to CAB for PCa, whereas PAOD risk was unrelated to such treatments.

Background/Purpose: The inflammatory milieu has been firmly established to affect cancer progression. However, the connection between natural killer (NK) cells and prostate cancer (PCa) has not been elucidated. Methods: Prospective data on NK cell activity (NKA) and NK cell subset distribution patterns were evaluated from 51 patients treated with robot-assisted laparoscopic radical prostatectomy. Whole-blood samples were collected from patients preoperatively and 4–6 weeks postoperatively. The samples were subjected to NKA tests, NK cell number counts, determination of the NKG2D (activating receptor of NK cells), NKG2A (inhibiting receptor), and other surface markers. All the analyses were compared to the clinicopathological characteristics of patients. NKA was estimated by measuring interferon-γ (IFN-γ) levels after stimulation of the peripheral blood with PROMOCA™, which specifically stimulates the release of IFN-γ from NK cells. Results: NKA was lower in patients with PCa than in healthy participants (484.66 vs. 1550 pg/mL). A paired comparison revealed significantly higher NKA postoperatively than preoperatively (1054 vs. 484.66 pg/mL; p = 0.011). Patients with negative surgical margins exhibited significantly higher postoperative NKA and NKA ratio (postoperative NKA/preoperative NKA) than those with positive margins (557 vs. 1921 pg/mL, p

Objectives/Hypothesis Unilateral vocal fold paralysis with no preceding causes is diagnosed as idiopathic unilateral vocal fold paralysis. However, comprehensive guidelines for evaluating the defining characteristics of idiopathic unilateral vocal fold paralysis are still lacking. In the present study, we hypothesized that idiopathic unilateral vocal fold paralysis may have different clinical and neurologic characteristics from unilateral vocal fold paralysis caused by surgical trauma. Study Design Retrospective, case series study. Methods Patients with unilateral vocal fold paralysis were evaluated using quantitative laryngeal electromyography, videolaryngostroboscopy, voice acoustic analysis, the Voice Outcome Survey, and the Short Form-36 Health Survey quality-of-life questionnaire. Patients with idiopathic and iatrogenic vocal fold paralysis were compared. Results A total of 124 patients were recruited. Of those, 17 with no definite identified causes after evaluation and follow-up were assigned to the idiopathic group. The remaining 107 patients with surgery-induced vocal fold paralysis were assigned to the iatrogenic group. Patients in the idiopathic group had higher recruitment of the thyroarytenoid–lateral cricoarytenoid muscle complex and better quality of life compared with the iatrogenic group. Conclusion Idiopathic unilateral vocal fold paralysis has a distinct clinical presentation, with relatively minor denervation changes in the involved laryngeal muscles, and less impact on quality of life compared with iatrogenic vocal fold paralysis. Level of Evidence 4. Laryngoscope, 2016

This study examined the efficacy of polo-like kinase 1 (PLK1) inhibition on radiosensitivity in vitro and in vivo by a pharmacologic approach using the highly potent PLK1 inhibitor volasertib. Human esophageal squamous cell carcinoma (ESCC) cell lines KYSE 70 and KYSE 150 were used to evaluate the synergistic effect of volasertib and irradiation in vitro using cell viability assay, colony formation assay, cell cycle phase analysis, and western blot, and in vivo using ectopic tumor models. Volasertib decreased ESCC cell proliferation in a dose- and time-dependent manner. Combination of volasertib and radiation caused G2/M cell cycle arrest, increased cyclin B levels, and induced apoptosis. Volasertib significantly enhanced radiation-induced death in ESCC cells by a mechanism involving the enhancement of histone H3 phosphorylation and significant cell cycle interruption. The combination of volasertib plus irradiation delayed the growth of ESCC tumor xenografts markedly compared with either treatment modality alone. The in vitro results suggested that targeting PLK1 might be a viable approach to improve the effects of radiation in ESCC. In vivo studies showed that PLK1 inhibition with volasertib during irradiation significantly improved local tumor control when compared to irradiation or drug treatment alone.

Background: This study presents the first report in the same patients on the time efficiency of surface registration as well as the navigational accuracy using optic and electromagnetic tracking systems. Methods: Thirty patients with bilateral chronic paranasal pansinusitis underwent endoscopic sinus surgery. After surface registration, the surgeries were performed on one side using optic navigation guidance and on the other side using electromagnetic navigation guidance. The intraoperative measurements performed included the time taken for the surface registration and surgical procedure on each side, as well as the navigation errors at the different locations. Results: The time for surface registration was significantly longer in the optic navigation group than the electromagnetic group. A comparison of the navigation errors along the 3 axes showed that the deviation in the medial-lateral direction was significantly less than that in the anterior-posterior and cranial-caudal directions in the optic navigation group as well as the electromagnetic group. Conclusions: The procedure for surface registration in both optic and electromagnetic guidance is efficient and convenient. The accuracy of both navigation systems is comparable and within acceptable ranges for clinical use. In addition, the best accuracy was measured in the medial-lateral direction compared with the other two axes.

Background/Purpose Pediatric cardiac computed tomography (CT) is a noninvasive imaging modality used to clearly demonstrate the anatomical detail of congenital heart diseases. We investigated the impact of cardiac CT on the utilization of cardiac catheterization among children with congenital heart disease. Methods The study sample consisted of 2648 cardiac CT and 3814 cardiac catheterization from 1999 to 2009 for congenital heart diseases. Diagnoses were categorized into 11 disease groups. The numbers of examination, according to the different modalities, were compared using temporal trend analyses. The estimated effective radiation doses (mSv) of CT and catheterization were calculated and compared. Results The number of CT scans and interventional catheterizations had a slight annual increase of 1.2% and 2.7%, respectively, whereas that of diagnostic catheterization decreased by 6.2% per year. Disease groups fell into two categories according to utilization trend differences between CT and diagnostic catheterization. The increased use of CT reduces the need for diagnostic catheterization in patients with atrioventricular connection disorder, coronary arterial disorder, great vessel disorder, septal disorder, tetralogy of Fallot, and ventriculoarterial connection disorder. Clinicians choose either catheterization or CT, or both examinations, depending on clinical conditions, in patients with semilunar valvular disorder, heterotaxy, myocardial disorder, pericardial disorder, and pulmonary vein disorder. The radiation dose of CT was lower than that of diagnostic cardiac catheterization in all age groups. Conclusion The use of noninvasive CT in children with selected heart conditions might reduce the use of diagnostic cardiac catheterization. This may release time and facilities within the catheterization laboratory to meet the increasing demand for cardiac interventions.

Background Androgen deprivation therapy (ADT) remains the mainstay treatment for locally advanced or metastatic prostate cancer (PC). However, potential effects of ADT treatment on neurocognitive dysfunction remain unclear. The present study was conducted to assess the relation between ADT treatment and risk of cognitive decline in Asian men with PC. Methods A population-based cohort of 24,464 men with PC, each newly diagnosed between 2000 and 2008, was selected from the Taiwan National Health Insurance Database. Subjects were further grouped by treatment as non-ADT (n = 4685) or ADT (n = 12,740), members of the latter subjected to bilateral orchiectomy or medical treatment (ie, luteinizing hormone-releasing hormone agonists, antiandrogens, or combination therapy). A multivariable Cox proportional hazard model with ADT as time-dependent covariate was used to generate adjusted hazard ratios (HRs) of subsequent cognitive decline, including dementia, Alzheimer's disease (AD), and Parkinson’s disease (PD). Results ADT showed a significant association with overall risk of cognitive decline (HR = 1.51, 95 % CI: 1.31–1.74), especially for PD, dementia, and non-Alzheimer dementia (non-AZD). When stratified by various ADT regimens, antiandrogen-only recipients displayed significantly heightened risks of subsequent AD, non-AZD, and PD. However, combined androgen blockade also imposed an increased risk of PD. There was no apparent correlation between duration of ADT exposure and cognitive dysfunction. Conclusions Various ADT therapies may have disparate impacts on cognitive function. Prospective studies exploring pertinent clinical characteristics more fully are needed to confirm these findings.

Introduction Awake craniotomy pursues a balance between extensive tumor resection and preservation of postoperative language function. A dilemma exists in patients whose tumor resection is restricted due to signs of language impairment observed during awake craniotomy. In order to determine the degree to which recovery of language function caused by tumor resection can be achieved by spontaneous neuroplasticity, the change in postoperative language function was compared to quantified intraoperative linguistic performance. Methods The modified, short-form Boston Diagnostic Aphasia Examination (sfBDAE) was used to assess pre- and postoperative language functions; visual object naming (DO 80) and semantic-association (Pyramid and Palm Tree Test, PPTT) tests assessed intraoperative linguistic performance. DO 80 and PPTT were performed alternatively during subcortical functional monitoring while performing tumor resection and sfBDAE was assessed 1-week postoperatively. Results Most patients with observed language impairment during awake surgery showed improved language function postoperatively. Both intraoperative DO 80 and PPTT showed significant correlation to postoperative sfBDAE domain scores (p

Postischemic angiogenesis is an important recovery mechanism. Both arteries and veins are upregulated during angiogenesis, but eventually there are more angiogenic veins than arteries in terms of number and length. It is critical to understand how the veins are modulated after ischemia and then transitioned into angiogenic vessels during the proangiogenic stage to finally serve as a restorative strength to the injured area. Using a rat model of transient focal cerebral ischemia, the hypercapnic blood oxygen level-dependent (BOLD) response was used to evaluate vascular reactivity, while the hyperoxic BOLD and tissue oxygen level-dependent (TOLD) responses were used to evaluate the vascular functionality at 1, 3, and 7 days after ischemia. Vessel-like venous signals appeared on R2* maps on days 3 and 7, but not on day 1. The large hypercapnic BOLD responses on days 3 and 7 indicated that these areas have high vascular reactivity. The temporal correlation between vascular reactivity and the immunoreactivity to desmin and VEGF further indicates that the integrity of vascular reactivity is associated with the pericyte coverage as regulated by the VEGF level. Vascular functionality remained low on days 1, 3, and 7, as reflected by the small hyperoxic BOLD and large hyperoxic TOLD responses, indicating the low oxygen consumption of the ischemic tissues. These functional changes in proangiogenic veins may be critical for angiogenesis.

Background/Purpose The technical and ergonomic details of laparoendoscopic single site (LESS) reconstruction have not been reported. In this study, we explored the feasibility and safety of performing advanced LESS upper urinary tract reconstruction with conventional laparoscopic instruments. Methods Between September 2010 and March 2011, we retrospectively reviewed prospectively collected data from five patients who underwent LESS urinary tract reconstruction. The LESS reconstruction included pyeloureterostomy ( N = 1), dismembered pyeloplasty ( N = 2), ureteroneocystostomy ( N = 1), and ureteroplasty for bifid blind ending ureter ( N = 1). The perioperative and postoperative parameters were collected for analysis. The ergonomic principles and techniques are detailed. Results All reconstructive LESS procedures were completed successfully without open conversion or laparoscopic conversion. Ancillary ports or ancillary instruments were not applied in any of the patients. The mean patient age was 40.4 years. The mean operative time was 213 ± 69 minutes, the estimated blood loss ranged from minimal to 50 mL, and the mean hospital stay was 4.4 ± 4 days. No operation-related complication occurred. Conclusion Based on our ergonomic principles and suturing/knotting techniques, conventional laparoscopic instruments are feasible and safe for LESS urinary reconstructive procedures.

Introduction While the epidemiology of testosterone deficiency has been well described in men with previously known type 2 diabetes mellitus (T2DM), it was less reported in those with untreated, newly diagnosed T2DM. Aim The aim of this study was to investigate the prevalence and the risk factors of testosterone deficiency of men with newly diagnosed T2DM. Methods The cross-sectional study included 105 men (mean age: 61.2 ± 6.8 years) with previously known T2DM and another 81 (57.8 ± 8.8 years) with newly diagnosed T2DM. All received health checkup and sex hormone measurement at our institute in 2009. Main Outcome Measures We calculated the prevalence and explored the risk factors of low total ( Results Men with previously known T2DM were older and had higher diastolic pressure and greater fasting glucose. There was no significant difference in total (358.0 [155.0] ng/dL vs. 363.0 [154.0] ng/dL, P = 0.68) and free (7.2 [2.5] ng/dL vs. 7.4 [2.4] ng/dL, P = 0.84) testosterone and sex-hormone binding globulin (SHBG) (27.3 [22.3] nmol/L vs. 28.7 [14.9] nmol/L, P = 0.46). The prevalence of low total and free testosterone was 28.4% and 21.0%, respectively, in men with newly diagnosed T2DM, and was 26.7% and 19.0% in those with previously known T2DM. In men with previously known T2DM, better glycemic control (HbA1c Conclusions The prevalence and the risk factors of testosterone deficiency are similar between newly diagnosed and previously known type 2 diabetic men.

To assess the safety, efficacy, clinical outcomes, and prognostic factors associated with transcatheter arterial embolization (TAE) with N-butyl cyanoacrylate (NBCA) for nonvariceal upper gastrointestinal (GI) hemorrhage in hemodynamically unstable patients.Between January 2008 and December 2012, 49 hemodynamically unstable patients (systolic blood pressure90 mm Hg and ongoing transfusion requirement) underwent emergency TAE with NBCA for nonvariceal upper GI bleeding and were included in the study. The technical (cessation of extravasation) and clinical (no residual bleeding within 7 d) success rates, incidence of ischemic complications, and clinical and technical predictors of recurrent bleeding within 30 days were analyzed.The technical and clinical success rates were 98% and 71%, respectively. There were no ischemic bowel complications; one patient experienced hepatic infarction with elevated liver enzymes. The incidence of major complications was 2%. The incidence of rebleeding within 30 days was 39%. Hematologic malignancies (P = .017), coagulopathy (P = .003), steroid pulse therapy (P = .025), and the absence of NBCA in the target lesions (P = .003) were associated with recurrent bleeding.NBCA embolization can be safely performed in hemodynamically unstable patients with active nonvariceal upper GI bleeding. The clinical factors associated with rebleeding might influence the clinical outcome.

Objective: This study strived to evaluate the relationship between degree of pulmonary emphysema and cardiac ventricular function in chronic obstructive pulmonary disease (COPD) patients with pulmonary hypertension (PH) using electrocardiographic-gated multidetector computed tomography (CT). Materials and Methods: Lung transplantation candidates with the diagnosis of COPD and PH were chosen for the study population, and a total of 15 patients were included. The extent of emphysema is defined as the percentage of voxels below -910 Hounsfield units in the lung windows in whole lung CT without intravenous contrast. Heart function parameters were measured by electrocardiographic-gated CT angiography. Linear regression analysis was conducted to examine the associations between percent emphysema and heart function indicators. Results: Significant correlations were found between percent emphysema and right ventricular (RV) measurements, including RV end-diastolic volume (R 2 = 0.340, p = 0.023), RV stroke volume (R 2 = 0.406, p = 0.011), and RV cardiac output (R 2 = 0.382, p = 0.014); the correlations between percent emphysema and left ventricular function indicators were not observed. Conclusion: The study revealed that percent emphysema is correlated with RV dysfunction among COPD patients with PH. Based on our findings, percent emphysema can be considered for use as an indicator to predict the severity of right ventricular dysfunction among COPD patients. Index terms: Pulmonary hypertension; Chronic obstructive pulmonary disease; Emphysema; Right ventricular function

This study investigated ocular vestibular-evoked myogenic potential (oVEMP) tests via Fpz and Fz taps to assess the role of the frontal sinus in mediating oVEMP elicitation. Forty healthy subjects and 80 patients with Ménière disease (MD) underwent a series of oVEMP tests via a minishaker tapping at the Fpz and Fz sites in a randomized order. Response rates of oVEMP test via various tapping sites were compared. Dimensions of the frontal sinus were measured via CT scan. A significantly negative correlation between the age and height of the frontal sinus was noted, and the cutoff age for discriminating present and absent Fpz oVEMPs in MD patients was 52 years. Additionally, oVEMPs by Fpz tapping were more efficiently presented in males than females, likely because of the greater resonance by the larger height of the frontal sinus in males (3.88 ± 0.68 cm) than females (3.42 ± 0.67 cm). In conclusion, the height of the frontal sinus plays a role in mediating the elicitation of oVEMPs. The oVEMPs could be easily elicited by the first-order bone vibration (Fpz/Fz tapping) coupled with the second-order resonance effect (with a high extent of the frontal sinus). Thus, initial tapping at the Fpz site is suggested. If it fails, try the Fz site for screening the oVEMPs.

Objective: Tele-assessment techniques can provide healthcare professionals with easily accessible information regarding patients' clinical progress. Recently, kinematic analysis systems have been used to assess rehabilitative outcomes in stroke patients. Kinematic systems, however, are not compatible with tele-assessment. The objective of our study was to develop a tele-assessment system for acquiring kinematic data of forward reaching movements in stroke patients, with an emphasis on cost-effectiveness, portability, and ease of use. Materials and Methods: We selected four healthy control participants and eight hemiplegic stroke patients for our study. The stroke patients were classified as Brunnstrom stage III, stage IV, or stage V. Our tele-assessment system used two three-axes accelerometers, a potentiometer, a multifunctional data acquisition card, and two computers. A standardized kinematic system was applied simultaneously to validate the measurements recorded by our tele-assessment system during five repetitions of forward reaching movements. Results: The correlation coefficients of the reaching displacement, velocity, and acceleration measurements obtained using our tele-assessment system and the standardized kinematic system were 0.956, 0.896, and 0.727, respectively. Differences in the maximum reaching distance and the maximum reaching velocity of forward reaching movements were observed among the study groups. There were no significant differences in the time required to complete the testing session among the study groups. Conclusions: Our tele-assessment system is valid for the evaluation of upper-extremity reaching ability in stroke patients. Further research is needed to investigate the feasibility of the use of the tele-assessment system in patients' homes.

The objective of this article is to present an innovative treatment for peripheral neuropathy using ultrasound-guided perineural vitamin B 12 injection. A 37-year-old patient presented with a progressive dropped foot for 2 months. Preceding trauma was denied. On examination, severe weakness of ankle dorsiflexion was revealed. Ultrasound showed peroneal nerve swelling. Nerve conduction velocity and electromyography study showed results compatible with peroneal neuropathy. Under the diagnosis of peroneal neuropathy, the patient was given 500 μg of methylcobalamin around the peroneal nerve under ultrasound guidance two times, with an interval of 2 weeks. The patient showed improvement of muscle power within 2 weeks. Full muscle power was regained after 3 months. There was no adverse symptom after ultrasound-guided perineural vitamin B 12 injection. Ultrasound-guided perineural vitamin B 12 has the advantage of precise delivery of high-dose vitamin B 12 directly around the defective nerve.

This study uses a simulation model as a tool for strategic capacity planning for an outpatient physical therapy clinic in Taipei, Taiwan. The clinic provides a wide range of physical treatments, with 6 full-time therapists in each session. We constructed a discrete-event simulation model to study the dynamics of patient mixes with realistic treatment plans, and to estimate the practical capacity of the physical therapy room. The changes in time-related and space-related performance measurements were used to evaluate the impact of various strategies on the capacity of the clinic. The simulation results confirmed that the clinic is extremely patient-oriented, with a bottleneck occurring at the traction units for Intermittent Pelvic Traction (IPT), with usage at 58.9 %. Sensitivity analysis showed that attending to more patients would significantly increase the number of patients staying for overtime sessions. We found that pooling the therapists produced beneficial results. The average waiting time per patient could be reduced by 45 % when we pooled 2 therapists. We found that treating up to 12 new patients per session had no significantly negative impact on returning patients. Moreover, we found that the average waiting time for new patients decreased if they were given priority over returning patients when called by the therapists.

Objectives Adequately addressing the scope of disability in patients with chronic neck pain is crucial in a clinical setting. The aim of this study was to determine the disease profile of patients with chronic neck pain and to analyze the factors related to the level of disability. Methods We studied 121 patients with chronic neck pain. The following data were obtained from the participants: Chinese Health Questionnaire-12, the Pittsburgh Sleep Quality Index, the visual analog scale to pain, pressure pain threshold, the Neck Disability Index, and heart rate variability analysis. Cluster analysis was performed to divide patients into separate groups according to their presentations. A Pearson correlation was computed to analyze factors correlated with disability (Neck Disability Index). The significance level was set at P Results Cluster analysis yielded 3 groups of patients with distinct features. Group I had a sex composition similar to the original population, was younger, and displayed the lowest overall deficits. Group II included middle-to-older-aged women, and presented with a higher level of pain, psychological distress, sleep disorder, and disability. Group III, comprising middle-to-older-aged men, showed moderate symptom severity. Correlation revealed that the factors significantly associated with a high degree of disability were low heart rate variability, high pain intensity, older age, poor sleep quality, and high psychological distress. Discussion We suggest that 3 distinct subgroups of patients with chronic neck pain exhibit particular features. Furthermore, reduced heart rate variability was associated with subjective disability in these patients. Further study is advised to establish the pathologic mechanism and clinical applications of our findings.

The danger of falling among the elderly is a public concern and is becoming an important issue that needs further attention. Sensors embedded in smartphones provide information about user activity, such as the accelerometer which is widely used in fall detection. In this paper, we propose a fall detection algorithm which is formed by feature extraction processing and recognition processing. A total of six features were calculated in feature extraction processing. Four of them are related to the gravity vector which is extracted from accelerometer data by using low-pass filtering. As falling mostly occurs in a vertical direction, the gravity-related features are useful. In recognition processing, a set of six features was clustered by support vector machine. The main feature - acceleration in the gravity vector direction - contains the vertical directional information and provides a distinct pattern of fall-related activity. This feature acts as a trigger-key in recognition processing to avoid false alarms which lead to excessive computation. The results show that our algorithm could achieve a sensitivity of 96.67% and specificity of 95%.

Objective The staging system of Meniere’s disease utilizes audiograms to probe cochlear dysfunction. We explored the addition of galvanic vestibular-evoked myogenic potentials (VEMP) to further explore vestibular function. Methods Seventy patients with unilateral Meniere’s disease were enrolled in this study. Within 2 weeks of diagnosis, all subjects underwent pure tone audiometry, cervical and ocular VEMP, and caloric test. The prevalence of abnormal tests and the VEMP characteristic parameters such as latencies and amplitudes were analyzed. Results In affected ears, the abnormal rate of acoustic cVEMPs, galvanic cVEMPs, vibratory oVEMPs and galvanic oVEMPs was 37%, 17%, 20%, and 9%, respectively. No significant differences existed in VEMP latencies and amplitudes between affected ears and unaffected ears. Conclusions The impairment of otolithic organs was found to be more than that of vestibular afferents. The deterioration of the saccule was more than that of the utricle, whereas retrolabyrinthine degeneration of sacculo-collic reflex and vestibulo-ocular reflex was similar. Significance This study is the first to use an electrophysiological test to evaluate the retrolabyrinthine function of patients with unilateral Meniere’s disease.

Testosterone deficiency increases the cardiovascular disease (CVD) risk.To evaluate the effect of erectile dysfunction (ED), sexual frequency and hypogonadal symptoms on CVD risk.A total of 395 hypogonadal men aged 45-74 years were surveyed using the Androgen Deficiency in the Aging Male and the International Index of Erectile Function.The 10-year CVD risk was measured with the Framingham Risk Score. Logistic regression was performed to obtain the odds ratios of sexual function and hypogonadal symptoms for a 10-year CVD risk ≥20% (high risk).The mean age was 56.1 ± 6.7 years. The mean 10-year CVD risk of the whole cohort was 18.1% ± 11.4%, while 131 subjects (33.2%) were classified as high risk. Logistic regression revealed that ED severity was associated with CVD risk [OR = 2.37 (CI 1.24-4.51) for mild-to-moderate ED, OR = 4.39 (1.78-8.43) for moderate ED and OR = 12.81 (4.65-26.11) for severe ED]. Compared to sexual frequency1 per month, sexual frequency ≥4 decreased the risk of high CVD risk [OR = 0.35 (0.23-0.780)]. Loss of libido [OR = 2.95 (1.91-4.12)] and less strong erection [OR = 3.87 (CI 2.11-4.95)] increased the risk of high CVD risk. All remained significant after adjustment for age and testosterone.ED, decreased sexual frequency and loss of libido predict a high 10-year CVD risk in hypogonadal men.

The aim of this study was to explore the feasibility and safety of performing laparoendoscopic single-site surgery (LESS) with conventional laparoscopic instruments. We retrospectively reviewed our data from 175 patients who underwent various urological LESS procedures via the same ergonomic and geometric principles between 2008 and 2011. LESS procedures performed included adrenalectomy (N = 23), radical nephrectomy (N = 5), radical nephroureterectomy with bladder cuff resection (N = 5), varicocelectomy (N = 12), nephropexy (N = 4), lumbar sympathectomy (N = 4), orchiectomy for intra-abdominal testis (N = 1), pyeloureterostomy (N = 1), dismembered pyeloplasty (N = 1), and adult inguinal hernia mesh repair (N = 119). All procedures were completed successfully without the use of ancillary ports or articulating instruments except two cases that required laparoscopic conversion. The mean patient age was 48.9 years. Mean operative time was 99.7 min, mean estimated blood loss was 17.3 ml, and mean hospital stay was 2.1 days. There were no intraoperative complications. According to our ergonomic and geometric principles, use of conventional laparoscopic instruments is feasible and safe in LESS procedures.

The purpose of this study was to improve the accuracy of tissue segmentation on brain magnetic resonance (MR) images preprocessed by multiscale retinex (MSR), segmented with a combined boosted decision tree (BDT) and MSR algorithm (hereinafter referred to as the MSRBDT algorithm). Simulated brain MR (SBMR) T1-weighted images of different noise levels and RF inhomogeneities were adopted to evaluate the outcome of the proposed method; the MSRBDT algorithm was used to identify the gray matter (GM), white matter (WM), and cerebral-spinal fluid (CSF) in the brain tissues. The accuracy rates of GM, WM, and CSF segmentation, with spatial features (G, x, y, r, θ), were respectively greater than 0.9805, 0.9817, and 0.9871. In addition, images segmented with the MSRBDT algorithm were better than those obtained with the expectation maximization (EM) algorithm; brain tissue segmentation in MR images was significantly more precise. The proposed MSRBDT algorithm could be beneficial in clinical image segmentation.

Parkinson's Disease (PD) is a common neurodegenerative disorder with progressive loss of dopaminergic and other sub-cortical neurons. Among various approaches, gait analysis is commonly used to help identify the biometric features of PD. There have been some studies to date on both the classification of PD and estimation of gait parameters. However, it is also important to construct a regression system that can evaluate the degree of abnormality in PD patients. In this paper, we intended to develop a PD gait regression model that is capable of predicting the severity of motor dysfunction from given gait image sequences. We used a model-free strategy and thus avoided the critical demands of segmentation and parameter estimation. Furthermore, we used linear discriminant analysis (LDA) to increase the feature efficiency by maximizing and minimizing the between- and within-group variations. Regression was also achieved by assessing the spatial and temporal information through classification and finally by using these two new indices for linear regression. According to the experiments, the outcomes significantly correlated with the sum of sub-scores from the Unified Parkinson's Disease Rating Scale (UPDRS): motor examination section with r=0.92 and 0.85 for training and testing, respectively, with p

To compare a multiple breath-hold, multiecho, multiplanar spin-echo (BHMEMPSE) magnetic resonance (MR) sequence with a TR of 300ms with a traditional multiecho, multiplanar spin-echo (MEMPSE) MR sequence for assessing liver iron content.This study was approved by the institutional review board; informed consent was waived. Liver R2 measurement was derived from the mono-exponential model by BHMEMPSE and MEMPSE MR sequences of a 1.5T MR machine in 30 thalassemia patients (9men, 21women, aged 27.7±6.8years). Hepatic iron contents were estimated using Ferriscan in all patients. The inter- and intra-observer agreement of the 2 MR sequences was also evaluated.MEMPSE R2 values significantly correlated with Ferriscan iron content values (r=0.895, p0.001) and serum ferritin concentration (r=0.661, p0.001). BHMEMPSE R2 values significantly correlated with Ferriscan values (r=0.914, p0.001) and serum ferritin concentration (r=0.608, p0.001). The distribution of MEMPSE R2 values against BHMEMPSE R2 values revealed an excellent linear relationship (r=0.978, p0.001). The inter- and intra-observer agreement of the 2 MR sequences was excellent, with an interclass correlation coefficient exceeding 0.9. The distribution of Ferriscan against BHMEMPSE R2 values revealed a curvilinear relationship (r=0.935, p0.001).The BHMEMPSE sequence exhibited comparable estimation for assessing liver iron content, comparable repeatability and a shorter acquisition time compared with the MEMPSE sequence. The BHMEMPSE sequence can serve as an adjunctive sequence to assess liver iron content.

The micro-fluidic systems based on the dielectrophoresis (DEP) phenomenon have become one of the hottest topics recently. By combining sensor and actuator into a system, a miniature traveling wave dielectrophoretic (TWDEP) pump can be widely used in biomedical applications. As often powered by lower voltage, the actuator of such a system must be minimized yet with adequate capability to drive the DEP pump to the required speed. The driving circuit for the actuator described in this study is designed and tested to attain the purpose of driving a TWDEP pump for whole blood samples. For improving the driving capability, four-phase AC fields were designed and the output levels were increased to double the supply voltage. Quantitative comparison between the driving circuit and function generator by velocity measurement was made. The driving circuit works properly for the steady state operation of the pump.

Introduction At least 40% of survivors of biliary atresia have progressive cirrhosis even after undergoing Kasai operation. The values of hepatic apparent diffusion coefficient and apparent-diffusion-coefficient-related indices were applied to biliary atresia patients and correlated with cirrhotic severity scores of model for end-stage liver disease or pediatric end-stage liver disease model, Child-Turcotte, and Child-Pugh systems. Materials and methods Thirty-three biliary atresia patents (mean = 1140, 61–4314 days of age) received magnetic resonance image examinations due to complications of biliary atresia from April 2008 to August 2009. Two non-breath-hold diffusion weighted imaging sequences were performed with motion-probing gradients in three directions with two b values: 0/100 and 0/500 s/mm 2 ; 1000 ms/61.1 ms, time to repeat/time to echo; number of excitation, 1.0; 8 mm section thickness; 40 cm × 40 cm field of view; 128 × 256 matrix in all biliary atresia patients and 18 control subjects. We used the Spearman rank correlation test to analyze the relationship among the scores of model for end-stage liver disease or pediatric end-stage liver disease model, Child-Turcotte and Child-Pugh scores and right hepatic apparent diffusion coefficients, apparent diffusion coefficient using b factor of 500-albumin product and alanine transaminase/apparent diffusion coefficient with b factor of 500 ratio. Results The right hepatic apparent diffusion coefficient using b factor of 100, apparent diffusion coefficient with b factor of 500 and product of apparent diffusion coefficient with b factor of 500-albumin level were significantly negatively correlated ( p ≤ 0.0125) with model for end-stage liver disease or pediatric end-stage liver disease model, Child-Turcotte, and Child-Pugh scores of biliary atresia patients. The ratio of alanine transaminase level/right hepatic apparent diffusion coefficient with b factor of 500 was also significantly ( p ≤ 0.0251), moderately correlated with Child-Turcotte and Child-Pugh scores (rho = 0.5256 and 0.7518, respectively). Conclusion Right hepatic apparent diffusion coefficient with b factor of 500 and alanine transaminase/right hepatic apparent diffusion coefficient with b factor of 500 can be useful for long-term follow-up of cirrhotic severity in biliary atresia patients.

Distraction osteogenesis is a procedure in orthopedics for skeletal lengthening. This operation sometimes causes clinical complications such as paralysis and pain related to the rate and extent of distraction. Therefore, a tension-force monitoring system is mandatory to control optimal lengthening. We developed a portable, low-power consumption system to continuously monitor the distracted tensions during the distraction osteogenesis period on the tibias of four male New Zealand white rabbits. The lengthening rate was 1mm per day at frequencies of once a day in one rabbit, and of three successive steps in the others. The system indicates the distraction measured by force, which is considered to be more physiological in nature rather than by distance. Radiographs were also taken for comparison. The results showed that the system was stable and approximate to being ideal. The measured distract-tension recovered to a steady state faster at the frequency of 1mm a day in three steps, rather than once per day. ...

Objective: The purpose of this study is to determine the effects of propranolol on the left ventricular (LV) volume during CT coronary angiography. Materials and Methods: The LV volume of 252 normal Chinese subjects (126 subjects with propranolol medication and 126 age- and gender-matched Chinese subjects without medication) was estimated using 64 slices multi-detector CT (MDCT). The heart rate difference was analyzed by the logistic linear regression model with variables that included gender, age, body height, body weight, systolic blood pressure (SBP), diastolic blood pressure (DBP) and the dosage of propranolol. The following global LV functional parameters were calculated: the real-end diastolic volume (EDV), the real-end systolic volume (ESV) and the real-ejection fraction (EF). Results: The female subjects had a greater decrease of heart rate after taking propranolol. The difference of heart rate was negatively correlated with the dosage of propranolol. The real-EDV, the real-ESV and the real-EF ranged from 48.1 to 109 mL/m 2 , 6.1 to 57.1 mL/m 2 and 41% to 88%, respectively. There was no significant difference in the SBP and DBP between the groups without and with propranolol medication (123 ± 17 and 80 ± 10 mmHg; 120 ± 14 and 80 ± 11 mmHg, respectively). The real-EDV showed no significant difference between these two groups, but the real-ESV and realEF showed significant differences between these two groups (69.4 ± 9.3 and 70.6 ± 8.9 mL/m 2 ; 23.5 ± 5.7 and 25.6 ± 3.7 mL/m 2 , 66.5 ± 5.1% and 63.5 ± 4.6%, respectively). Conclusion: The difference of heart rate is significantly influenced by gender and the dosage of propranolol. Propranolol will also increase the ESV, which contributes to a decreased EF, while the SBP, DBP and EDV are not statistically changed. Index terms: Left ventricular volume; Ejection fraction; Heart rate; Beta-blocker; Propranolol, 64-slice MDCT; CT coronary angiography

Background and Purpose— Stroke is a documented risk factor for hip fracture. However, no documented studies are available on the risk of stroke among patients with hip fracture. This study investigated the frequency and risk of stroke after hip fracture using a nationwide population-based study. Methods— The study cohort included 2101 patients hospitalized with a principal diagnosis of hip fracture from 2001 to 2004. The comparison cohort consisted of 6303 randomly selected subjects matched on sex, age, and year of index healthcare use as controls. We tracked patients for a 1-year period from their index healthcare encounter to identify those who had a stroke. Stratified Cox proportional hazard regression was performed to evaluate the association of hip fracture with subsequent stroke during 1-year follow-up. Results— Of a total of 8404 patients, 86 (4.1%) from the study group and 170 (2.7%) from the comparison group had strokes during the follow-up period ( P P =0.001) that of the comparison group. Furthermore, after adjusting for the major cardiovascular risk factors, the increased stroke risk of patients with hip fracture persisted at about the same level as in the unadjusted analysis (hazard ratio, 1.53; 95% CI, 1.17 to 2.01; P =0.002). Conclusion— Hip fracture is associated with increased risk of stroke in the next year.

A portable biomedical signal recorder is valuable for the detection of acute symptoms. By the use of an ambulatory recorder, investigators and clinicians have more opportunity to analyze paroxysmal or sudden symptoms from the long-duration recorded signals. We propose a modular recorder that contains a motherboard, modules, and an isolated RS-232 interface. The modules have been modified to measure electrogastrogram (EGG), electrocardiogram (ECG), and electroencephalogram (EEG) signals. The compact motherboard includes a microcontroller with a built-in A/D converter, secure digital (SD) memory card, and the driven-right-leg (DRL) circuit. The power consumption of the proposed recorder is less than 2 mA (6 mW). It can continuously record a lead-II ECG signal with a 10-bit resolution for 3.9 days. As a result, the design is suitable for the purpose of long-term portable recording.

This article introduces a wireless 12-lead electrocardiogram (ECG) recording system to monitor high-risk cardiovascular diseases. The design overcomes the limitation of wireless transmission by analog multiplexing. The proposed technique provides three leads of ECG at a time and requires less than 15 sec to display the total 12 leads ECG signals on a remote computer. This increases the chances to discover certain acute symptoms earlier. In addition, the synchronous display of three-lead ECG allows the clinician to survey the ECG from the same plane of the heart. The system is designed with low power consumption and is capable of long-term monitoring.

Magnetic resonance (MR) imaging plays an important role in the preoperative evaluation of the living-related liver donors to reduce postoperative morbidity and complications. Though invasive, intraoperative cholangiography is still the golden standard in demonstrating anatomical variation of bile ducts. We design this study to compare the validity and reliability between these two imaging modalities and retrospectively searched the database of living-related liver transplantation (LRLT) center during the period from April 2005 to September 2008. The clinical information and images of total 58 donors (female : male = 35 : 23) were reviewed. Five types of branching patterns of the bile ducts were encountered. The rate of disagreement in the classification of branching pattern between MR and intraoperative cholangiography was 5% (3/58). Intraoperative cholangiography could detect significantly more division degree of right hepatic ducts (mean degree: 7) than MR cholangiography (mean degree: 4) (using paired t-test, p < 0.05). No significant difference existed in the detection of division degree of left hepatic ducts. However, MR cholangiography was significantly better than intraoperative cholangiography in demonstrating major branches of the left hepatic ducts including tributaries of segment 2 and 3 (58/58 versus 35/58) (using McNemar's chi-square test, p < 0.05). We conclude that MR cholangiography is nearly as good as intraoperative cholangiography in identifying the branching pattern of bile ducts, and demonstrates the major left hepatic ducts better.

The purpose of this study was to investigate the effectiveness of the combined use of intravenous morphine and intramuscular glucagon in improving magnetic resonance cholangiopancreatography (MRCP) image quality in donors for living-related liver transplantation. Sixteen healthy donor candidates underwent an MRCP study. Coronal, single-shot, fast spin-echo, heavily T2-weighted dynamic MRCP images were obtained before and 3 minutes after the intravenous administration of morphine HCl with a dose of 0.04 mg/kg. Thirty minutes after the injection of morphine, intramuscular glucagon was used. Another MRCP image of the same pulse sequence was generated 15 minutes after the injection of glucagon with a dose of 1 mg. The diameter, signal intensity, and number of branches of bile ducts in MRCP images taken immediately before and after the injection of morphine and after the injection of glucagon (plus delayed morphine effects) were compared and analyzed. In all 16 donor candidates, the diameters of the right and left hepatic ducts, common bile duct, and main pancreatic duct were significantly increased (P < 0.05) in the MRCP images taken 3 minutes after the injection of morphine and 15 minutes after the injection of glucagon (plus delayed morphine effects) in comparison with MRCP images taken before any drug administration. The qualitative grading scores of the signal intensity and order of branches of bile ducts revealed improvements in the MRCP images after the injection of glucagon (plus delayed morphine effects; P < 0.05). In conclusion, combining the intravenous administration of low-dose morphine and the intramuscular use of glucagon before MRCP examination improves the visualization of the nondilated biliary ductal anatomy, which is important for the preoperative biliary evaluation of donor candidates for living-related liver transplantation.