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Background: An external cue can markedly improve gait initiation in people with Parkinson’s disease (PD) and is often used to overcome freezing of gait (FOG). It is unknown if the effects of external cueing are comparable if the imperative stimulus is triggered by the person receiving the cue (self-triggered) or an external source. Objective: Two experiments were conducted to compare the effects of self- versus externally triggered cueing on anticipatory postural adjustments (APAs) during gait initiation in people with PD. Methods: In experiment 1, 10 individuals with PD and FOG initiated gait without a cue or in response to a stimulus triggered by the experimenter or by the participant. Experiment 2 compared self- versus externally triggered cueing across three groups: healthy young adults (n = 16), healthy older adults (n = 11), and a group with PD (n = 10). Results: Experiment 1: Externally triggered cues significantly increased APA magnitudes compared to uncued stepping, but not when the same cue was self-triggered. Experiment 2: APAs were not significantly improved with a self-triggered cue compared to un-cued stepping in both the PD and healthy older adult groups, but the young adults showed a significant facilitation of APA magnitude. Conclusion: The effectiveness of an external cue on gait initiation in people with PD and older adults is critically dependent upon whether the source of the trigger is endogenous (self-produced) or exogenous (externally-generated). These results may explain why cueing interventions that rely upon self-triggering of the stimulus are often ineffective in people with PD.

Increasing the toughness of poly(lactic acid) (PLA), i.e., simultaneously increasing both the tensile strength and ductility, remains a major challenge. In this study, fully bio-based PLA blends with polydecalactone (PDL)-grafted cellulose copolymer (CgPD) were prepared and comprehensively analyzed to enhance the toughness of the PLA matrix. The blends were found by FT-IR and solid-state 1H NMR to be physically intact and miscible at the sub-twenty-nanometer scale. The WXRD and DSC analyses indicated that the addition of the alkyl-branched CgPD imparts a more structurally disordered PLA mesophase state to the prepared PLA_CgPD bio-blends. UTM analysis was used to characterize the macroscopic mechanical properties of the PLA_CgPD bio-blends. Both the tensile strength and elongation properties were simultaneously improved with the addition of 1 wt% CgPD loading amount to PLA (PLA_CgPD1). This study experimentally demonstrates that the enhanced mechanical properties of PLA_CgPD1 are closely related to the existence of more ordered PLA mesophases induced by the introduction of an optimal amount of CgPD into the PLA matrix.

Recently, there has been increasing interest in reducing hazardous and CO2 emissions from vehicles. For emission reduction, it is necessary to analyze operating conditions of vehicles by using real on-road data and to improve their effective performance. In particular, for heavy-duty vehicles, technical improvements and operational management are critical in terms of air quality management, for although the number of vehicles is small, the duration and level of emissions are relatively high. However, research data obtained from analyses of driving characteristics of heavy-duty domestic delivery vehicles are relatively insufficient. Technically, there are many difficulties in setting driving conditions for such analysis, such as measuring driving resistance and determining variations in the vehicle mass with the amount of freight. In this study, on the basis of the speed and engine output data of a heavy-duty gas delivery tractor obtained during real road driving, the driving characteristics of the vehicle was analyzed, its weight was estimated, and the effect of the vehicle’s weight on the driving energy and vehicle output was investigated.

Endovascular treatment (EVT) is less effective for intracranial atherosclerosis-induced emergent large vessel occlusion. Extracranial-intracranial (EC-IC) bypass surgery is a possible treatment option to augment cerebral blood flow in the perfusion defect area. We compared the efficacy and safety of EC-IC bypass surgery with those of EVT and maximal medical treatment for acute ischemic stroke.The data from 39 patients, for whom vessel revascularization had failed despite mechanical thrombectomy, were retrospectively analyzed. Of the 39 patients, 22 had undergone percutaneous transluminal angioplasty or intracranial stenting (PTA/S), 10 had undergone emergency EC-IC bypass surgery within 24 hours of symptom onset, and 7 had received maximal medical treatment (MMT) only. The patency, perfusion status, and postoperative infarct volume were evaluated. The clinical outcomes were assessed at 6 months postoperatively using the modified Rankin scale.The mean reperfusion time was significantly longer for the EC-IC bypass group (14.9 hours) compared with that in the PTA/S group (4.1 hours) and MMT group (7.5 hours; P0.05). The postoperative infarct volume on diffusion-weighted magnetic resonance imaging was significantly lower in the emergency EC-IC bypass group (11.3 cmEmergency EC-IC bypass surgery is an effective and safe treatment option for intracranial atherosclerosis-induced acute ischemic stroke for which EVT is inadequate.

INTRODUCTION A Sysmex XN-series hematology analyzer (Sysmex), the next generation up from the Sysmex XE-series, can provide information regarding malaria infection in the form of a parasitic red blood cell (pRBC) flag. This study aimed to determine the usefulness of the pRBC flag for early detection and follow-up in patients infected with Plasmodium vivax. METHODS A total of 221 patients with fever for whom CBC and malaria microscopy had been requested were analyzed. Sixty-seven individuals were diagnosed with P vivax infection, and 154 were diagnosed with other febrile diseases. The sensitivity and specificity of the pRBC flag for malaria parasite detection and the relationship between parasite density and presence of the pRBC flag were determined. The concordance rate between malaria microscopy and pRBC flag in 147 follow-up cases was calculated. RESULTS The pRBC flag was detected in 56 of 67 malaria patients (sensitivity, 83.6%; specificity, 100%). The patients with the pRBC flag at initial diagnosis revealed significantly higher parasite density than the patients without the pRBC flag (P

This review aimed to evaluate the effects of multi-domain interventions on cognition among individuals without dementia. Multi-domain interventions refer to those combining any single preventive measure such as physical activity, cognitive training, and/or nutrition to prevent dementia. Seventeen studies were included (n = 10,056 total participants; mean age = 73 years), eight of which were rated as strong in quality while the other nine showed moderate quality. The standardized mean difference (SMD; d) was used to calculate the effect size for each included study. Multi-domain interventions consisting of physical activity, cognitive training, cardioprotective nutrition, and/or cardiovascular health education exerted beneficial effects on global cognition, episodic memory, and/or executive function with very small to moderate effect sizes (0.16–0.77). Nurses may consider combining these components to potentially stave off dementia. Future research is warranted to identify the optimal multi-domain intervention components that can induce clinically significant beneficial effects on cognition.

Background: Subtle gait deficits can be seen in people with idiopathic rapid eye movement (REM) sleep behavior disorder (RBD), a prodromal stage of Parkinson’s disease (PD) and related alpha-synucleinopathies. It is unknown if the presence and level of REM sleep without atonia (RSWA, the electromyographic hallmark of RBD) is related to the severity of gait disturbances in people with PD. Objective: We hypothesized that gait disturbances in people with mild-to-moderate PD would be greater in participants with RSWA compared to those without RSWA and matched controls, and that gait impairment would correlate with measures of RSWA. Methods: Spatiotemporal characteristics of gait were obtained from 41 people with PD and 21 age-matched controls. Overnight sleep studies were used to quantify muscle activity during REM sleep and group participants with PD into those with RSWA (PD-RSWA+, n = 22) and normal REM sleep muscle tone (PD-RSWA-, n = 19). Gait characteristics were compared between groups and correlated to RSWA. Results: The PD-RSWA+ group demonstrated significantly reduced gait speed and step lengths and increased stance and double support times compared to controls, and decreased speed and cadence and increased stride velocity variability compared to PD-RSWA- group. Larger RSWA scores were correlated with worse gait impairment in the PD group. Conclusion: The presence and level of muscle tone during REM sleep is associated with the severity of gait disturbances in PD. Pathophysiological processes contributing to disordered gait may occur earlier and/or progress more rapidly in people with PD and RBD.

Background Much of our understanding of the deficits in force control in Parkinson’s disease (PD) relies on findings in the upper extremity. Currently, there is a paucity of data pertaining to the effect of PD on lower limb force control. Objective The purpose of this study was to concurrently evaluate upper- and lower-limb force control in early-stage PD and a group of age- and gender-matched healthy controls. Methods Twenty individuals with PD and twenty-one healthy older adults participated in this study. Participants performed two visually guided, submaximal (15% of maximum voluntary contractions) isometric force tasks: a pinch grip task and an ankle dorsiflexion task. PD were tested on their more affected side and after overnight withdrawal from antiparkinsonian medication. The tested side in controls was randomized. Differences in force control capacity were assessed by manipulating speed-based and variability-based task parameters. Results Compared with controls, PD demonstrated slower rates of force development and force relaxation during the foot task, and a slower rate of relaxation during the hand task. Force variability was similar across groups but greater in the foot than in the hand in both PD and controls. Lower limb rate control deficits were greater in PD with more severe symptoms based on the Hoehn and Yahr stage. Conclusions Together, these results provide quantitative evidence of an impaired capacity in PD to produce submaximal and rapid force across multiple effectors. Moreover, results suggest that force control deficits in the lower limb may become more severe with disease progression.

The purpose of this review is to understand why in individuals with Parkinson’s disease (PD) present with bradykinesia (i.e., slowness of movement). Bradykinesia reflects difficulties in motor plan, initiation and execution of movement. Clinically, bradykinesia is used to as a marker of disease severity, and is used to understand underlying mechanisms of motor disabilities in people with PD. In this review, we focus on the neurophysiology of bradykinesia by discussing the role of basal ganglia-cortical motor pathway. Moreover, we will discuss the neuromuscular characterization of bradykinesia in clinical and experimental studies in PD. Upon completing this review, human movement science scholars and practitioners should have a more comprehension understanding of the connections between the mechanisms of human movements and understanding neurophysiology of bradykinesia in PD.

Objectives Recently, the linearity evaluation protocol by the Clinical & Laboratory Standards Institute (CLSI) has been revised from EP6-A to EP6-ED2, with the statistical method of interpreting linearity evaluation data being changed from polynomial regression to weighted least squares linear regression (WLS). We analyzed and compared the analytical measurement range (AMR) verification results according to the present and prior linearity evaluation guidelines. Methods The verification of AMR of clinical chemistry tests was performed using five samples with two replicates in three different laboratories. After analyzing the same evaluation data in each laboratory by the polynomial regression analysis and WLS methods, results were compared to determine whether linearity was verified across the five sample concentrations. In addition, whether the 90% confidence interval of deviation from linearity by WLS was included in the allowable deviation from linearity (ADL) was compared. Results A linearity of 42.3–56.8% of the chemistry items was verified by polynomial regression analysis in three laboratories. For analysis of the same data by WLS, a linearity of 63.5–78.3% of the test items was verified where the deviation from linearity of all five samples was within the ADL criteria, and the cases where the 90% confidence interval of all deviation from linearity overlapped the ADL was 78.8–91.3%. Conclusions Interpreting AMR verification data by the WLS method according to the newly revised CLSI document EP6-ED2 could reduce laboratory workload, enabling efficient laboratory practice.

The mechanisms contributing to increased expression of motor and cognitive impairment in people with Parkinson9s disease who lack muscle atonia during rapid eye movement (REM) sleep compared to those with muscle atonia are poorly understood. This study used tract-based spatial statistics to compare diffusion measures of white matter microstructure between people with Parkinson9s disease with and without REM sleep without atonia as well as the relationships of these measures to motor and cognitive function. Thirty-eight individuals with mild-to-moderate Parkinson9s disease and twenty-one matched control subjects underwent ultra-high-field MRI (7Tesla), quantitative motor assessments of gait and bradykinesia, and neuropsychological testing. The Parkinson9s disease cohort was separated post-hoc into those with and without elevated chin or leg muscle activity during REM sleep based on polysomnography findings. Fractional anisotropy was significantly higher, and radial and mean diffusivity significantly lower, in diffuse regions of the corpus callosum, projection, and association white matter pathways in the Parkinson9s group with normal REM sleep compared to controls. In contrast, there was no significant difference in fractional anisotropy between the Parkinson9s group with elevated muscle tone and controls. Fractional anisotropy was also significantly higher in a subset of pathways in the Parkinson9s disease group with normal REM sleep muscle tone compared to those with elevated REM sleep muscle tone. The group with elevated REM sleep muscle tone had significant impairments in gait and upper arm speed compared to controls and significantly worse scores in specific cognitive domains (executive function, visuospatial memory) compared to the Parkinson9s disease group with normal REM sleep muscle tone. Regression analyses showed that gait speed and step length in the Parkinson9s disease cohort were predicted by measures of mean fractional anisotropy of the anterior corona radiata, whereas elbow flexion velocity was predicted by fractional anisotropy of the superior corona radiata. Visuospatial memory task performance was predicted by the radial diffusivity of the posterior corona radiata. These findings demonstrate that people with mild-to-moderate severity of Parkinson9s disease who have normal muscle tone during REM sleep show alterations in white matter microstructure that are associated with preserved motor and cognitive function, but these adaptations are reduced or absent in those with increased REM sleep motor tone.

Anaerobic digestion (AD) can produce renewable energy and reduce carbon emissions, but the energy conversion efficiency is still limited in some waste streams. This study tested the effect of applied voltage removal for microbial electrolysis cells (MECs) treating primary sewage sludge. Two MECs were operated in parallel: a MEC-0.3 V with an applied voltage of 0.3 V and a MEC-OCV with open circuit voltage. Both reactors were inoculated with seed sludge originating from a MEC at 0.3 V applied voltage, and three batch cycles were operated for 36 d. The methane production of the MEC-OCV was 3759 mL/L in the first cycle and 2759 mL/L in the second cycle, which was similar (105% and 103%, respectively) to that of the MEC-0.3 V. However, in the third cycle, the methane production of the MEC-OCV (1762 mL/L) was 38.8% lower than that of the MEC-0.3 V (4545 mL/L). The methane contents in the biogas were 68.6–74.2% from the MEC-OCV, comparable to those from the MEC-0.3 V (66.6–71.1%). These results indicate that not only the MEC-0.3V but also the MEC-OCV outperformed AD in terms of methane yield and productivity, and the promotion using MEC-derived inoculum persisted equally with the MEC-OCV for two batch cycles after removing the applied voltage. Therefore, a MEC operation with cycled power supply may be beneficial in reducing the electric energy usage and improving the biogas production performance, compared to conventional AD.

People with Parkinson’s disease who have elevated muscle activity during rapid eye movement sleep (REM sleep without atonia) typically have a worse motor and cognitive impairment compared with those with normal muscle atonia during rapid eye movement sleep. This study used tract-based spatial statistics to compare diffusion MRI measures of fractional anisotropy, radial, mean and axial diffusivity (measures of axonal microstructure based on the directionality of water diffusion) in white matter tracts between people with Parkinson’s disease with and without rapid eye movement sleep without atonia and controls and their relationship to measures of motor and cognitive function. Thirty-eight individuals with mild-to-moderate Parkinson’s disease and 21 matched control subjects underwent ultra-high field MRI (7 T), quantitative motor assessments of gait and bradykinesia and neuropsychological testing. The Parkinson’s disease cohort was separated post hoc into those with and without elevated chin or leg muscle activity during rapid eye movement sleep based on polysomnography findings. Fractional anisotropy was significantly higher, and diffusivity significantly lower, in regions of the corpus callosum, projection and association white matter pathways in the Parkinson’s group with normal rapid eye movement sleep muscle tone compared with controls, and in a subset of pathways relative to the Parkinson’s disease group with rapid eye movement sleep without atonia. The Parkinson’s disease group with elevated rapid eye movement sleep muscle tone showed significant impairments in the gait and upper arm speed compared with controls and significantly worse scores in specific cognitive domains (executive function, visuospatial memory) compared with the Parkinson’s disease group with normal rapid eye movement sleep muscle tone. Regression analyses showed that gait speed and step length in the Parkinson’s disease cohort were predicted by measures of fractional anisotropy of the anterior corona radiata, whereas elbow flexion velocity was predicted by fractional anisotropy of the superior corona radiata. Visuospatial memory task performance was predicted by the radial diffusivity of the posterior corona radiata. These findings show that people with mild-to-moderate severity of Parkinson’s disease who have normal muscle tone during rapid eye movement sleep demonstrate compensatory-like adaptations in axonal microstructure that are associated with preserved motor and cognitive function, but these adaptations are reduced or absent in those with increased rapid eye movement sleep motor tone.

The interest inIn April 2018, about 50 questions on the current status of CDI assays and details on implementation and perceptions were written, and a survey questionnaire was administered to laboratory medicine specialists in 200 institutions.One-hundred and fifty institutions responded to the questionnaire, of which 90 (60.0%) including one commercial laboratory, performed CDI assays. The toxin AB enzyme immunoassay (toxin AB EIA), nucleic acid amplification test (NAAT), andThis study provides useful evidence on the current status of CDI laboratory diagnosis in Korea as well as on items that require improvement and is thought to aid in standardizing and improving the CDI laboratory diagnosis in Korea.

Background Several factors contribute to differences in Streptococcus pneumoniae serotype distribution. We investigated the serotype distribution and antimicrobial resistance of S. pneumoniae isolated between 2014 and 2016 in Korea. Methods We collected a total of 1,855 S. pneumoniae isolates from 44 hospitals between May 2014 and May 2016, and analyzed the serotypes by sequential multiplex PCR. We investigated the distribution of each serotype by patient age, source of the clinical specimen, and antimicrobial resistance pattern. Results The most common serotypes were 11A (10.1%), followed by 19A (8.8%), 3 (8.5%), 34 (8.1%), 23A (7.3%), and 35B (6.2%). The major invasive serotypes were 3 (12.6%), 19A (7.8%), 34 (7.8%), 10A (6.8%), and 11A (6.8%). Serotypes 10A, 15B, 19A, and 12F were more common in patients ≤5 years old, while serotype 3 was more common in patients ≥65 years old compared with the other age groups. The coverage rates of pneumococcal conjugate vaccine (PCV)7, PCV10, PCV13, and pneumococcal polysaccharide vaccine 23 were 11.8%, 12.12%, 33.3%, and 53.6%, respectively. Of the 1,855 isolates, 857 (46.2%) were multi-drug resistant (MDR), with serotypes 11A and 19A predominant among the MDR strains. The resistance rates against penicillin, cefotaxime, and levofloxacin were 22.8%, 12.5%, and 9.4%, respectively. Conclusions There were significant changes in the major S. pneumoniae serotypes in the community. Non-PCV13 serotypes increased in patients ≤5 years old following the introduction of national immunization programs with the 10- and 13-polyvalent vaccines.

Background In Korea, the Korean Laboratory Accreditation Program (KLAP) has set minimum standards for verification of clinical test performance. This verification process is time-consuming and labor-intensive when performed manually. We developed a free, statistical software program for KLAP, using the R language (R Foundation for Statistical Computing, Vienna, Austria). Methods We used CLSI guidelines for the algorithm. We built graphic user interfaces, including data input, with Embarcadero Delphi EX4 (Embarcadero Technologies, Inc., Texas, USA). The R Base Package and MCR Package for Method Comparison Regression were used to implement statistical and graphical procedures. Results Our program LaboStats has six modules: parallel test, linearity, method comparison, precision, reference interval, and cutoff. Data can be entered into the field either manually or by copying and pasting from an MS Excel worksheet. Users can print out precise reports. Conclusions LaboStats can be useful for evaluating clinical test performance characteristics and preparing documents requested by KLAP.

The self-healing polyurethane films have received significant attention due to their unique shape memory behaviors and the hydrogen bonding arising from the urethane linkages. However, it is still a challenge to develop self-healing polyurethane with transparent, high impact resistance, and excellent shape recovery and mechanical properties. In particular, polycarbonate-based polyurethane shows transparency, weatherability and excellent mechanical properties. In this work, transparent self-healing polyurethane film with robust mechanical properties (breaking stress of 26 MPa and elongation at break of 630%) was synthesized by controlling the different molecular weight of the polycarbonate diol and incorporating dynamic disulfide bonds for reversibility. As a result, the self-healing polyurethane film showed an excellent self-healing ability with 98% healing efficiency and excellent shape memory ability with a recovery efficiency of ˃92%. In addition, we have identified a potential application for the self-healing flexible substrate in flexible electronics because of their stable electrical resistance even upon mechanical deformation.

Mechanically enhanced supramolecular carbon nanotube (CNT) films were prepared in water by employing the π-electron-rich phenyl, naphthalenyl, and pyrenyl end-functionalized polyethylene oxides (PEOs) as supramolecular linkers, followed by vacuum filtration. Among them, the supramolecular CNT film produced by the pyrenyl end-functionalized PEO (PEO-Py) exhibited the highest mechanical strength, which was ~ 1.5–2 times higher than that of the CNT films produced using the typical dispersant, Triton X-100, although the functionality of PEO-Py was lower than that prepared using other linkers, and the content of PEO-Py in the CNT films was lower than that obtained using Triton X-100. Fluorescence and UV–Vis spectroscopy demonstrated that the improved mechanical properties of the supramolecular CNT film result from the formation of π–π interactions between the CNT and the pyrene moieties of the PEO-Py linker. Finally, the supramolecular CNT film exhibited a 40–50 dB electromagnetic shielding efficiency through hybridization with silver nanowires.

To optimize a dynamic network structure is a key feature for a supramolecular self-healing material capable of perfectly and repeatedly restoring its morphology and performance following a mechanically damaging event. Despite significant progress in self-healing supramolecular networks over the past few decades, many questions surrounding the dynamic responses of these networks during healing still remain. Herein, we present the self-healing behavior of a dual dynamic supramolecular network (DDN) consisting of a weak clustery supramolecular network and a strong dendritic supramolecular network simultaneously. The DDN is easily prepared by the complexation of linear and non-linear poly(e-caprolactone)s end functionalized with 2-ureido-4[1H]-pyrimidinone, which exhibits 100%-optical and 95%-mechanical healing efficiencies within 2 and 5 min, respectively, at 90 °C. In addition, the DDN film is shown to repeatedly self-heal ten times, even when damaged at the same position. DDN healing depends significantly on the density of the supramolecular network, and is specifically accomplished by the reassociation of hydrogen bonds between UPy moieties at the thermally swollen status of the dendritic network following the thermal disassembly of the clustery network. The DDN-coated nylon fabric exhibits excellent self-healing characteristics, which opens opportunities for creating scratch-protective materials.

To use implantable biomedical devices such as electrocardiograms and neurostimulators in the human body, it is necessary to package them with biocompatible materials that protect the internal electronic circuits from the body’s internal electrolytes and moisture without causing foreign body reactions. Herein, we describe a hydrogel surface-modified polyurethane copolymer film with concurrent water permeation resistance and biocompatibility properties for application to an implantable biomedical device. To achieve this, hydrophobic polyurethane copolymers comprising hydrogenated poly(ethylene-co-butylene) (HPEB) and aliphatic poly(carbonate) (PC) were synthesized and their hydrophobicity degree and mechanical properties were adjusted by controlling the copolymer composition ratio. When 10 wt% PC was introduced, the polyurethane copolymer exhibited hydrophobicity and water permeation resistance similar to those of HPEB, however, with improved mechanical properties. Subsequently, a hydrophilic poly(vinyl pyrrolidone) (PVP) hydrogel layer was formed on the surface of the polyurethane copolymer film by Fenton reaction using an initiator and crosslinking agent and the effect of the initiator and crosslinking agent immobilization time, PVP concentration and crosslinking agent concentration on the hydrogel properties were investigated. Finally, MTT assay showed that the hydrogel surface-modified polyurethane copolymer film displays excellent biocompatibility.