Reduction In Frequency Research Articles

The impact of exercise training on muscle sympathetic nerve activity: a systematic review and meta-analysis.

The purpose of this systematic review and meta-analysis was to examine the effects of exercise training on muscle sympathetic nerve activity (MSNA) in humans. Studies included exercise interventions [randomized controlled trials (RCTs), nonrandomized controlled trials (non-RCTs), or pre-to-post intervention] that reported on adults (≥18 yr) where MSNA was directly assessed using microneurography, and relevant outcomes were assessed [MSNA (total activity, burst frequency, burst incidence, amplitude), heart rate, blood pressure (systolic blood pressure, diastolic blood pressure, or mean blood pressure), and aerobic capacity (maximal or peak oxygen consumption)]. Forty intervention studies (n = 1,253 individuals) were included. RCTs of exercise compared with no exercise illustrated that those randomized to the exercise intervention had a significant reduction in MSNA burst frequency and incidence compared with controls. This reduction in burst frequency was not different between individuals with cardiovascular disease compared with those without. However, the reduction in burst incidence was greater in those with cardiovascular disease [9 RCTs studies, n = 234, mean difference (MD) -21.08 bursts/100 hbs; 95% confidence interval (CI) -16.51, -25.66; I2 = 63%] compared with those without (6 RCTs, n = 192, MD -10.92 bursts/100 hbs; 95% CI -4.12, -17.73; I2 = 76%). Meta-regression analyses demonstrated a dose-response relationship where individuals with higher burst frequency and incidence preintervention had a greater reduction in values post-intervention. These findings suggest that exercise training reduces muscle sympathetic nerve activity, which may be valuable for improving cardiovascular health.NEW & NOTEWORTHY This systematic review and meta-analysis suggests exercise training reduces muscle sympathetic nerve activity (MSNA), which may be valuable for improving cardiovascular health. The reduction in burst incidence was greater among individuals with cardiovascular disease when compared with those without; exercise training may be particularly beneficial for individuals with cardiovascular disease. Meta-regression analyses demonstrated a dose-response relationship, where individuals with higher sympathetic activity preintervention had greater reductions in sympathetic activity post-intervention.

Cenobamate add-on therapy for drug-resistant focal epilepsy.

Although most people with epilepsy achieve complete seizure cessation, approximately one-third of those with the condition continue experiencing seizures despite the use of antiseizure medications (ASMs) given as monotherapy or polytherapy. In this review, we summarised the evidence from randomised controlled trials (RCTs) about cenobamate as an add-on treatment for focal epilepsy uncontrolled by one or more concomitant ASMs. To assess the efficacy and tolerability of add-on oral cenobamate for the treatment of drug-resistant focal-onset seizures, defined as seizures persisting despite treatment with one or more ASMs. We searched the Cochrane Register of Studies (CRS Web) and MEDLINE Ovid (September 2022). In addition, we contacted the manufacturer of cenobamate and experts in the field to enquire after any ongoing or unpublished studies. RCTs comparing add-on cenobamate to placebo or another ASM in people with focal epilepsy uncontrolled by one or more concomitant ASMs. Two review authors independently selected trials for inclusion, extracted data, performed risk of bias assessment, and assessed the certainty of the evidence using the GRADE approach. Our primary outcomes were at least a 50% reduction in total seizure frequency, seizure freedom, and the occurrence of adverse events. We used an intention-to-treat approach for our primary analyses. For each outcome we estimated summary risk ratios (RRs) with their 95% confidence intervals (CIs). We summarised the estimates of effects and certainty of the evidence for each outcome in a summary of findings table. We included two studies (659 adult participants, 442 allocated to cenobamate and 217 to placebo). The overall RR for at least a 50% reduction in seizure frequency for add-on cenobamate at any dose compared to placebo was 2.17 (52% versus 24%, 95% CI 1.66 to 2.84; 2 studies, 605 participants; moderate-certainty evidence). The RR for seizure freedom for add-on cenobamate at any dose compared to placebo was 4.45 (16% versus 5%, 95% CI 2.25 to 8.78; 2 studies, 605 participants; moderate-certainty evidence). The RR for the occurrence of adverse events for add-on cenobamate at any dose compared to placebo was 1.14 (77% versus 67%, 95% CI 1.02 to 1.27; 2 studies, 659 participants; moderate-certainty evidence). We judged the two included RCTs as at low or unclear risk of bias. Both studies were sponsored by the drug company that produces cenobamate. Add-on cenobamate is probably better than placebo in reducing the frequency of seizures by at least 50% and in achieving seizure freedom in adults with focal epilepsy uncontrolled by one or more concomitant ASMs (moderate level of certainty). Its use is probably associated with an increased risk of adverse events (moderate level of certainty). Further prospective, controlled trials are required to evaluate the efficacy and tolerability of add-on cenobamate compared to other ASMs. The efficacy and tolerability of cenobamate as adjunctive treatment for focal epilepsy in children should be further investigated. Finally, the long-term efficacy and tolerability of add-on cenobamate treatment in people with other epilepsy types (e.g. generalised epilepsy) or specific epilepsy syndromes, as well as its use as monotherapy, require additional study.

Open label experience of repeated OnabotulinumtoxinA injections towards the sphenopalatine ganglion in patients with chronic cluster headache and chronic migraine.

A novel technique for injection of OnabotulinumtoxinA (BTA) towards the sphenopalatine ganglion (SPG) has shown promise in refractory chronic migraine (CM) and chronic cluster headache (CCH). Open label safety and efficacy data are presented here. Patients with refractory CM or CCH who had received at least one injection and completed headache diaries were included. Efficacy was defined as ≥50% reduction in moderate-to-severe headache days for CM, or ≥50% reduction in attack frequency for CCH, at weeks five to eight. Over 261 injections, there were 123 adverse events (AE), of which one was serious. Most (93%) AEs were mild and all were transient. The 50% response to one injection was 81% for CM and 69% for CCH. The response gradually reduced over subsequent months for CM but stayed between 55% and 67% for CCH. Repeated injections were beneficial. Injections resulted in improvement for both groups and was maintained with repeated injections. Repeat injection after three months may be beneficial in CM. Adverse events were not uncommon, but universally transient, presumably as a result of the mechanism of action of BTA. Repeated BTA injection towards the SPG could be an effective treatment for refractory CM and CCH. Larger, randomised, placebo-controlled trials are required.

Bilateral centromedian nucleus of thalamus responsive neurostimulation for pediatric-onset drug-resistant epilepsy.

Neuromodulation therapies offer an efficacious treatment alternative for patients with drug-resistant epilepsy (DRE), particularly those unlikely to benefit from surgical resection. Here we present our retrospective single-center case series of patients with pediatric-onset DRE who underwent responsive neurostimulation (RNS) depth electrode implantation targeting the bilateral centromedian nucleus (CM) of the thalamus between October 2020 and October 2022. Sixteen patients were identified; seizure outcomes, programming parameters, and complications at follow-up were reviewed. The median age at implantation was 13 years (range 3.6-22). Six patients (38%) were younger than 12 years of age at the time of implantation. Ictal electroencephalography (EEG) patterns during patients' most disabling seizures were reliably detected. Ten patients (62%) achieved 50% or greater reduction in seizure frequency at a median 1.3 years (range 0.6-2.6) of follow-up. Eight patients (50%) experienced sensorimotor side effects, and three patients (19%) had superficial pocket infection, prompting the removal of the RNS device. Side effects of stimulation were experienced mostly in monopolar-cathodal configuration and alleviated with programming change to bipolar configuration or low-frequency stimulation. Closed-loop neurostimulation using RNS targeting bilateral CM is a feasible and useful therapy for patients with pediatric-onset DRE.

Fiber endoscopic evaluation of swallowing (FEES) - an important tool for diagnosing myasthenia gravis

A 76-year old man was admitted with a globus sensation and weight loss for further investigations to our geriatric ward. A gastroscopic evaluation executed before had been unremarkable. Physical examination was unremarkable, including a neurological examination. All radiological findings (computer tomography of chest, abdomen and neck) were unremarkable. In a FEES investigation we found retentions and a reduction of frequency of swallowing after a while. During the investigation the patient complained about a muscular weakness in his neck. The assumed diagnosis of a myasthenia gravis was confirmed by antibodies against acetylcholine receptors and a decrement in repetitive irritation of the orbicularis and trapezius muscle. FEES can be a valid diagnosis tool for a pharyngeal type of a myasthenia gravis.

SEEG-RFTC in patients with refractory focal epilepsy: real-world outcomes from 121 cases.

Radiofrequency thermocoagulation (RFTC) has emerged as an effective and safe treatment method for patients with refractory focal epilepsy, when stereo-electroencephalography (SEEG) is implanted. Although real-world research results are still limited, a considerable number of patients have shown favorable outcomes with this less invasive method. This study aims to describe the outcomes and predictive factors of SEEG-RFTC in real-world research. A retrospective observational study was conducted on patients in the authors' epilepsy center. In total, 121 patients who underwent RFTC were included in the study. Post-RFTC outcomes were evaluated using the seizure-free rate and response rate (seizure frequency reduction more than 50%). Predictive factors influencing post-RFTC outcome were considered by comparing different variables. The mean follow-up period was 18.3 months. Eighty-two patients (67.8%) were responders and 54 (44.6%) were seizure free. In 36 patients with malformation of cortical development, the seizure-free rate and the response rate were 69.44% and 83.33%, respectively. In 20 patients with hippocampal sclerosis, 19 patients were responders and 14 (70%) patients were seizure free at the last follow-up. The MRI feature and etiology of epilepsy are correlated with the outcome. MR-positive is a predictive factor for seizure freedom (p < 0.01) and responders (p < 0.01). Other factors have no predictive value for post-RFTC outcome. SEEG-RFTC is a safe procedure and yields favorable outcomes in numerous cases of focal DRE. The MRI feature and etiology of epilepsy are correlated with the seizure-free rate and response rate. And MRI positivity is the predictor for good RFTC outcome.

Treatment simplification to optimize cenobamate effectiveness and tolerability: A real-world retrospective study in Spain.

This study aimed to explore the impact of co-antiseizure medication (co-ASM) optimization on the effectiveness and tolerability of adjunctive cenobamate (CNB) in patients with drug-resistant epilepsy in a real-world setting. This unicentric, retrospective, observational study included adults with focal-onset seizures who had received ≥2 previous ASMs. The main effectiveness endpoints included responder rates and seizure frequency reduction at 3, 6, and 12-month visits. The number of co-ASMs and defined daily dose (DDD) were analyzed at every visit. Safety endpoints included adverse drug reactions (ADRs). Thirty-four patients with a median epilepsy duration of 22 years and a median of 15.5 seizures/month were analyzed. The median number of prior ASMs was 12, and the mean number of co-ASMs was 2.9 (SD 1). There was a reduction in seizure frequency/month from baseline to the last visit (p < 0.0001). Between baseline and the end of the study, the mean number of co-ASMs in the per-protocol (PP) population was reduced from 2.9 to 1.6 (p < 0.0001), and DDD was reduced from 3.6 to 1.4 (p < 0.0001). Sodium channel blockers (carbamazepine and lacosamide) and GABAergic drugs (clobazam) were the agents with the most significant reductions in DDD after 12 months. The percentage of patients in the PP population with ≥3 co-ASMs was reduced from 61.8% at baseline to 14.3% at 12 months; 1 patient was receiving CNB as monotherapy at the last visit. At the last visit, 85.7% of the PP population were ≥50% responders, and 33.3% were seizure-free. The percentage of patients with ADRs in the PP population was 71.9% at 3 months and 52.3% at 12 months. Following rational polytherapy, optimization of co-ASM management during CNB treatment allowed high seizure freedom rates despite meaningful reductions in co-medication, while also achieving both good tolerability and patient satisfaction scores in a highly drug-resistant population. Many patients with epilepsy still have seizures, even after being treated with several different epilepsy drugs. In this study of 34 patients from a Spanish clinic, we show that the epilepsy drug cenobamate can reduce the number of seizures in these patients, even after many other epilepsy drugs have failed. We also show that patients treated with cenobamate can reduce the dose or even stop taking certain other epilepsy drugs. This allows them to simplify their treatment and reduce adverse effects while still keeping control of their epilepsy.

CNTFET-Based Single-Ended Fractional Order Colpitts Oscillator: Design, Simulation and Comparative Analysis

In this paper, we design and simulate a Single-Ended Colpitts Oscillator (CO) in integer and fractional order domains. The oscillators are realized in 32[Formula: see text]nm node conventional MOSFET and carbon nanotube field effect transistor (CNTFET) technologies. Therefore, four COs have been designed, simulated and rigorously compared. These include integer order conventional MOSFET-based CO, fractional order MOSFET-based CO, CNTFET-based integer order CO and CNTFET-based fractional order CO, all based on 32-nm technology nodes. The fractional order approach has been used as it results in better control over the phase and frequency of the oscillator. Herein, fractional order capacitors of various orders, used in realizing the fractional order COs, are realized and their frequency responses are studied. This is being done to ensure whether the designed pseudo-capacitances have fractional behavior or not in the desired frequency and phase spectrum. It has been observed that the variation of fractional order [Formula: see text] from 0.4 to 0.81 has resulted in a slight reduction of oscillation frequency from 1.68[Formula: see text]GHz ([Formula: see text]) to 1.351[Formula: see text]GHz ([Formula: see text]) keeping the pseudo-capacitance same at 0.3[Formula: see text]nF in MOS-based topology. Since the fractional order realization increases the circuit complexity and power consumption, therefore, CNTFET-based integer order as well as fractional order COs have been designed. The CNTFET-based fractional order CO retains the advantages of the fractional order domain as well as the power efficiency of CNTFETs. Further, it has been observed that integrating fractional-order capacitor (FOC) with the CNTFET CO results in a much larger constant phase zone (CPZ), an important performance measuring parameter. A rigorous comparative analysis of the four COs designed in this work has been performed.

Deciphering split ring resonators: understanding theoretical validation and simulation implications

This study presents a comparative analysis of analytical calculations and simulation results of a single-ring split ring resonator (SRR). A simulated SRR made of aluminum, designed in high frequency structure simulator (HFSS), with the resonant frequency of 3.97 GHz with transmission loss of −47.7 dB. The initial gap, width, and thickness of the ring are set at 1 mm, 1 mm, and 3 mm, respectively. These geometrical parameters are subsequently varied in simulations, and theoretical calculations are conducted for each variation using Python 3.10 code to facilitate comparative analysis. The analytical calculations reveal certain limitations in accurately modeling the impact of fringing and radiation, particularly when dealing with smaller dimensions. Although there exist slight disparities between the simulated and calculated outcomes, it is evident that the theoretically derived results exhibit a close correspondence with simulated responses, particularly for dimensions that are not excessively small. This observation underscores the confirmation that an augmentation in the gap of the Split Ring Resonator (SRR) leads to an elevation in the resonant frequency. Furthermore, by maintaining a constant inner radius and adjusting the outer radius to modulate the width of the SRR, a decrease in the resonant frequency is noted with an increase in the width of the metallic ring. Similarly, an increase in the thickness of the ring contributes to a reduction in the resonant frequency This comprehensive investigation provides a valuable methodology for corroborating theoretically derived results with simulation data. Additionally, the research underscores the diverse resonances that can be achieved by fine-tuning the gap, width, and thickness of the split ring resonator, highlighting the significance of selecting these dimensions carefully to attain specific resonant frequencies.

Categorizing Monogenic Epilepsies by Genetic Mechanisms May Predict Efficacy of the Ketogenic Diet

BackgroundThe ketogenic diet (KD) is an effective treatment for epilepsy. In recent years, studies have shown favorable efficacy of KD in epilepsy from genetic disorders. In this study, we propose an approach to KD in monogenic epilepsy: we evaluate the utility of categorizing genetic variants based on rational associations with the known mechanisms of KD. MethodsPatients with monogenic epilepsy treated with KD were reviewed. The genetic etiologies were categorized into five groups: (1) conditions causing cellular energy impairment, (2) GABA-pathies, (3) mToR-pathies, (4) ion channelopathies, and (5) no known mechanisms associated with KD mechanisms. Treatment response was defined as a median reduction in seizure frequency of greater than 50%. ResultsOf 35 patients, 24 (69%) were responders at three months. Based on categories, Group 1 had the highest response rate with seven of seven (100%), followed by Group 2, six of seven (86%), and Group 3, two of three (67%). Patients in Groups 4 and 5 had poorer responses with three of seven (43%) and four of 11 (36%) response rates, respectively (P < 0.01). Median percentage of seizure reduction showed Group 1 with the highest reduction of 97.5%, Group 2 at 94%, and Groups 3, 4, and 5 at 62.5%, 30%, and 40%, respectively (P = 0.036). ConclusionOur findings show a favorable response to KD in patients with monogenic epilepsy (69% at three months) with the highest response in patients with conditions involving cellular energy impairment and GABA-pathies. The KD, therefore, should be considered early in patients with monogenic epilepsy, especially those involving genes associated with cellular energy impairment or GABA-pathies.

Saccadic "inhibition" unveils the late influence of image content on oculomotor programming.

Image content is prioritized in the visual system. Faces are a paradigmatic example, receiving preferential processing along the visual pathway compared to other visual stimuli. Moreover, face prioritization manifests also in behavior. People tend to look at faces more frequently and for longer periods, and saccadic reaction times can be faster when targeting a face as opposed to a phase-scrambled control. However, it is currently not clear at which stage image content affects oculomotor planning and execution. It can be hypothesized that image content directly influences oculomotor signal generation. Alternatively, the image content could exert its influence on oculomotor planning and execution at a later stage, after the image has been processed. Here we aim to disentangle these two alternative hypotheses by measuring the frequency of saccades toward a visual target when the latter is followed by a visual transient in the central visual field. Behaviorally, this paradigm leads to a reduction in saccade frequency that happens about 90 ms after any visual transient event, also known as saccadic "inhibition". In two experiments, we measured occurrence of saccades in visually guided saccades as well as microsaccades during fixation, using face and noise-matched visual stimuli. We observed that while the reduction in saccade occurrence was similar for both stimulus types, face stimuli lead to a prolonged reduction in eye movements. Moreover, saccade kinematics were altered by both stimulus types, showing an amplitude reduction without change in peak velocity for the earliest saccades. Taken together, our experiments imply that face stimuli primarily affect the later stages of the behavioral phenomenon of saccadic "inhibition". We propose that while some stimulus features are processed at an early stage and can quickly influence eye movements, a delayed signal conveying image content information is necessary to further inhibit/delay activity in the oculomotor system to trigger eye movements.

Nonlinear Dynamic Analysis of High-Strength Concrete Bridges under Post-Fire Earthquakes Considering Hydrodynamic Effects

This study employed the linear interpolation method to ascertain the curve relationship between the elastic modulus and stress of high-strength concrete C60 with temperature, and the nonlinear dynamic analysis of high-strength concrete bridge structures subjected to post-fire earthquake action at varying water levels was subsequently evaluated. It was established that both the hydrodynamic effects and the temperature effects have a considerable impact on the structural dynamic response of bridges. The presence of water has been observed to increase the dynamic response of pier structures. At water levels of 0 m and 10 m, the temperature effect results in a reduction in the fundamental frequencies of acceleration and displacement responses by 73.68% and a decrease in the fundamental frequency of stress responses by 83.33%. At a water level of 20 m, the fundamental frequencies of the acceleration, displacement, and stress responses decrease by 53.49%. In consideration of the acceleration and displacement at the pier top and stress at the pier base at a water depth of 10 m, the superposition of temperature effects and hydrodynamic effects results in an increase of 59.06% in acceleration, 25.93% in displacement, and 49.53% in stress than combination effects, respectively. At a water depth of 20 m, the superposition of temperature and hydrodynamic effects results in an increase of 92.82%, 100%, and 127.85% in acceleration, displacement, and stress, respectively. The combined effects of hydrodynamic and temperature effects cannot be described merely as a linear superposition of the two single actions. The research findings provide a significant theoretical basis for understanding the impact of multiple disasters, such as fires and earthquakes, on bridge structures.

Successful treatment with traditional Japanese medicine (kampo medicine) Yokukansan as a migraine prophylactic drug: A case report.

The use of anti-CGRP antibody drugs as migraine preventive drugs is increasing worldwide, but there are still a certain number of cases where antibody drugs are ineffective or cannot be used due to high prices. Conventional prophylactic drugs or traditional Japanese medicine (kampo medicine) are still often used in such cases. However, to date, only limited evidence supports the efficacy of kampo medicine for headaches because these treatments have been used primarily empirically and traditionally. However, in recent years studies have begun to be published that describe the efficacy of kampo medicine for various types of headache. Here, we report the case of a patient who achieved a marked reduction in migraine frequency and severity by prophylactic therapy with the kampo drug yokukansan (TSUMURA Yokukansan Extract Granules). The patient was a 50-year-old woman. She began to experience headaches around high school age and was diagnosed with migraine without aura at 42 years of age. She started prophylactic therapy with amitriptyline and topiramate and this treatment reduced the frequency of migraines for several years. However, the frequency began to increase again around 47 years, which is when she presented at our hospital. We achieved a temporary reduction in migraine frequency by adjusting the dose of drugs in her prophylactic therapy regimen, but the frequency increased again around age 49. We then tried monotherapy with the kampo medicine yokukansan, and this markedly reduced migraine frequency and severity over the following year. This therapy has remained effective to date. We speculate that, in this case, migraine without aura was improved by prophylactic therapy with yokukansan due to its action on the glutamatergic system or serotonin system through suppression of orexin-A secretion or its anti-inflammatory effects as reported in previous animal studies. Yokukansan could be a usable kampo medicine for migraine prophylaxis in countries all over the world and should be investigated in a large clinical trial as soon as possible.

Responsive neurostimulation in pediatric epilepsy: a systematic review and individual patient meta-analysis supplemented by a single institution case series in 105 aggregated patients.

To assess responsive neurostimulation (RNS) efficacy in pediatric patients with drug-resistant epilepsy, comparing response (≥ 50% reduction in seizure frequency) rates between patients with two or fewer seizure foci and those with multifocal or generalized epilepsy. This study seeks to address the gap in knowledge regarding RNS effectiveness in pediatric populations. A systematic review and meta-analysis included data from PubMed, Embase, and Web of Science through November 2023, including 17 retrospective studies and a case series of 24 patients from our practice for a total of 105 aggregated patients. The inclusion criteria of patients were age 18 and diagnosis of DRE. Exclusion criteria were nonhuman subjects and cases where RNS was not utilized to treat DRE. Study inclusion criteria were detailing the use of RNS and comparing patients with 2 foci with other focalities. Study exclusion criteria were failure to specify RNS lead placement or type of epilepsy. The risk of bias was assessed using the ROBINS-I tool for all non-randomized studies. Effect sizes and variances were aggregated to provide a comprehensive measure of RNS efficacy, and heterogeneity among the studies was assessed using I2 statistics and Cochran's Q test to evaluate the consistency of the findings. Statistical analyses were conducted using IBM SPSS. We analyzed demographics, epilepsy history, treatment outcomes, and RNS details using descriptive and inferential statistics, including Wilcoxon-Mann-Whitney, Fisher's exact, and chi-squared tests. This systematic review was not registered. Seventeen retrospective studies and a single-institution case series, encompassing 105 pediatric patients, were analyzed. Effect sizes and confidence intervals were calculated to quantify treatment effects. Analyses revealed that RNS reduces seizure frequency across a spectrum of pediatric epilepsy syndromes, irrespective of the seizures' focal, multifocal, or generalized origins. The effectiveness of RNS was not influenced by the patient's sex, age at epilepsy onset, or presence of neurological and psychiatric comorbidities. Prior vagus nerve stimulation surgery and the presence of an epileptic syndrome were factors associated with a lower likelihood of near-complete seizure remission with RNS, underscoring the complexities of treating patients with generalized epilepsies or previous interventional failures. The necessity of further research into individualized surgical strategies for patients was underscored by the mixed results of comparisons of electrode characteristics with responder rates. Limitations of our study include its reliance on retrospective studies, which introduces potential bias and limits the ability to infer causality. RNS is a safe and effective treatment in pediatric patients with DRE across demographic, comorbidity, and focality variability. FDA age and focality restrictions, along with patient and physician hesitancy, may be limiting the potential for effective treatment of pediatric DRE with RNS. Prospective randomized trials are recommended to validate these findings.

Long term safety, continuation rates and subjective and objective success of Posterior Tibial Nerve Stimulation for Overactive Bladder

Introduction:Posterior tibial nerve stimulation (PTNS) is currently offered to patients with refractory overactive bladder (OAB). We aim to evaluate the efficacy, safety and long-term continuation of PTNS over 11 years. Methods:We conducted a retrospective cohort study on all patients who underwent PTNS from 2012 to 2023. The primary outcomes were change in urinary frequency over 24 hours, maximum voided volume (MVV), number of episodes of urgency urinary incontinence (UUI) and patient perception of intensity of urgency scale (PPIUS). Results:We identified 81 patients. 83% of patients completed 12 treatments of PTNS, and 54% of those that did not complete their full course of treatment stated that this was due to inefficacy. 33% of patients underwent PTNS ‘top ups’ as needed. Only 1 patient reported an adverse effect of musculoskeletal leg pain.28% of patients reported a subjective improvement of their symptoms by 50% or more. There was an average reduction in daytime frequency by 0.6 episodes (p = 0.033), an increase in MVV by 13mls (p = 0.927), a reduction in UUI episodes each day by 0.7 (p = 0.008) and a reduction in average PPIUS by 0.4 (p = 0.024). Conclusion:PTNS remains a safe treatment option for patients with refractory OAB with evidence of both subjective and objective improvement to most symptoms. The majority of our patients completed a 12-week cycle but only 1 in 3 chose to have further PTNS ‘top ups’ and only 1 in 5 are continuing with PTNS for long term management of their OAB.

Viability of high-frequency environmental DNA (eDNA) sampling as a fish enumeration tool

Despite growing interest in environmental DNA (eDNA) monitoring as a low-cost, non-invasive tool for monitoring fish presence and relative abundance, quantitative comparisons between fish abundance and eDNA are still rare, especially for anadromous species of conservation concern. To examine the relationship between eDNA data and management-relevant abundance data, we assessed eDNA abundance of river herring, an ecologically relevant anadromous sister-species pair, alongside sonar-generated fish counts at a well-characterized site in the Choptank River, Chesapeake Bay, MD. Over the 2021 spawning season, there was a strong correlation between daily eDNA concentration and daily counts of fish swimming upstream (Spearman’s rho = 0.86). A generalized additive model for location scale and shape (GAMLSS) was used to estimate fish count as a function of flow-corrected eDNA concentration and relevant covariates. Model- and sonar-generated run counts were 729,385 and 733,208 fish respectively, differing by just 0.5 %. A sub-sampling analysis showed that a model built on at least five weeks of data could utilize eDNA abundance to produce accurate estimates for the remainder of the season, while a reduction in eDNA sampling frequency substantially reduced run count accuracy. This work emphasizes the utility of quantitative eDNA monitoring for river herring populations and shows the necessity of high-frequency eDNA sampling to estimate run count.

Experimental study of pool boiling heat transfer on mini-pillar surfaces with different hydrophobic dot arrays

In this study, we conducted experimental research on the pool boiling performance of mini-pillar surfaces with different hydrophobic dot arrays. The experimental results show that the distribution and total area of hydrophobic dot arrays on pillar tops significantly influence the boiling performance of mini-pillar surfaces. In comparison with the mini-pillar surface without wettability modification, introducing hydrophobic dot arrays on the pillar tops can improve the bubble nucleation density and diminish the wall superheat at boiling onset. Therefore, the boiling performance of mini-pillar surfaces can be gradually improved by increasing the total area of hydrophobic dot arrays at low heat fluxes. However, a further increase in the total area of hydrophobic dot arrays may lead to the reduction of the bubble departure frequency at high heat fluxes, which is not conducive to the segregation of the liquid and vapor pathways. The experimental results indicated that when the total area of hydrophobic pillar tops accounts for 10.24 % of the projected area of the mini-pillar surfaces, an optimal enhancement is achieved, and the optimal enhancement of boiling performance on the mini-pillar surfaces with hydrophobic dot arrays results from a suitable balance between promoting the bubble nucleation and maintaining higher bubble departure frequency.

Nonlinear dynamics of diamagnetically levitating resonators

The ultimate isolation offered by levitation provides new opportunities for studying fundamental science and realizing ultra-sensitive floating sensors. Among different levitation schemes, diamagnetic levitation is attractive because it allows stable levitation at room temperature without a continuous power supply. While the dynamics of diamagnetically levitating objects in the linear regime are well studied, their nonlinear dynamics have received little attention. Here, we experimentally and theoretically study the nonlinear dynamic response of graphite resonators that levitate in permanent magnetic traps. By large amplitude actuation, we drive the resonators into nonlinear regime and measure their motion using laser Doppler interferometry. Unlike other magnetic levitation systems, here we observe a resonance frequency reduction with amplitude in a diamagnetic levitation system that we attribute to the softening effect of the magnetic force. We then analyze the asymmetric magnetic potential and construct a model that captures the experimental nonlinear dynamic behavior over a wide range of excitation forces. We also investigate the linearity of the damping forces on the levitating resonator, and show that although eddy current damping remains linear over a large range, gas damping opens a route for tuning nonlinear damping forces via the squeeze-film effect.

Evaluating the Efficacy of Vagus Nerve Stimulation across 'Minor' and 'Major' Seizure Types: A Retrospective Analysis of Clinical Outcomes in Pharmacoresistant Epilepsy.

Background: Evaluating the differential impact of vagus nerve stimulation (VNS) therapy across various seizure types, our study explores its efficacy specifically in patients with categorized minor and major seizures. Methods: We conducted a retrospective cohort study involving 76 patients with pharmacoresistant epilepsy treated at the University Emergency Hospital of Bucharest between 2021 and 2024. Seizures were classified as 'minor' (including focal-aware and non-motor/absence seizures) and 'major' (including focal to bilateral tonic-clonic and generalized motor seizures), based on modified International League Against Epilepsy (ILAE) criteria. This classification allowed us to assess the response to VNS therapy, defined by a 50% or greater reduction in seizure frequency at the 12-month follow-up. Results: Our findings reveal that major seizures respond more favorably to VNS therapy, significantly reducing both frequency and intensity. In contrast, minor seizures showed a less pronounced response in frequency reduction but noted improvements in neurocognitive functions, suggesting a nuanced benefit of VNS in these cases. Conclusion: The study underscores the importance of seizure type in determining the efficacy of VNS therapy, advocating for personalized treatment approaches based on seizure classification. This approach could potentially enhance clinical outcomes by tailoring VNS settings to specific seizure types, improving overall management strategies in pharmacoresistant epilepsy.

Effectiveness of smoking cessation interventions among adults: an overview of systematic reviews

BackgroundThis overview of reviews aims to identify evidence on the benefits (i.e. tobacco use abstinence and reduction in smoking frequency) and harms (i.e. possible adverse events/outcomes) of smoking cessation interventions among adults aged 18 years and older.MethodsWe searched Medline, Embase, PsycINFO, Cochrane Database of Systematic Reviews, Database of s of Reviews of Effects, the CADTH Health Technology Assessment Database and several other websites for grey literature. Searches were conducted on November 12, 2018, updated on September 24, 2020, with publication years 2008 to 2020. Two reviewers independently performed title-abstract and full-text screening considering pre-determined inclusion criteria. Data extraction and quality assessments were initially completed by two reviewers independently (i.e. 73% of included studies (n = 22)) using A Measurement Tool to Assess Systematic Reviews-2 (AMSTAR 2), and the remainder done by one reviewer and verified by another due to resources and feasibility. The application of Grading of Recommendations Assessment, Development and Evaluation (GRADE) was performed by one independent reviewer and verified by another.ResultsA total of 22 Cochrane systematic reviews evaluating the impact of smoking cessation interventions on outcomes such as tobacco use abstinence, reduction in smoking frequency, quality of life and possible adverse events were included. Pharmaceutical (i.e. varenicline, cytisine, nicotine replacement therapy (NRT), bupropion) and behavioural interventions (i.e. physician advice, non-tailored print-based self-help materials, stage-based individual counselling, etc.) showed to have increased smoking cessation; whereas, data for mobile phone-based interventions including text messaging, hypnotherapy, acupuncture, continuous auricular stimulation, laser therapy, electrostimulation, acupressure, St John’s wort, S-adenosyl-L-methionine (SAMe), interactive voice response systems and other combination treatments were unclear. Considering harms related to smoking cessation interventions, small/mild harms (i.e. increased palpitations, chest pain, nausea, insomnia, headache) were observed following NRT, varenicline and cytisine use. There were no data on harms related to behavioural therapies (i.e. individual or group counselling self-help materials, internet interventions), combination therapies or other therapies (i.e. laser therapy, electrostimulation, acupressure, St John’s wort, SAMe).ConclusionResults suggest that pharmacological and behavioural interventions may help the general smoking population quit smoking with observed small/mild harms following NRT or varenicline. Consequently, evidence regarding ideal intervention strategies and the long-term impact of these interventions for preventing smoking was unclear.Systematic review registrationPROSPERO CRD42018099691