Objective Parameters Research Articles

Heparan sulfate in cerebrospinal fluid as a biomarker to assess disease severity and for treatment monitoring in patients with Mucopolysaccharidosis Type II: a position statement.

Patients with mucopolysaccharidosis type II (MPS II) can present with a severe neuronopathic phenotype or an attenuated non-neuronopathic phenotype. In the light of the recent development of drugs that cross the blood-brain barrier for treatment of neurologic MPS II symptoms, it is critical to define biomarkers that objectively differentiate phenotypes and monitor therapeutic outcomes of advanced treatments. In December 2023, a panel of Brazilian experts discussed the potential of quantifying heparan sulfate (HS) in the cerebrospinal fluid (CSF) as a biomarker for assessing neurological impairment in patients with MPS II, as well as the potential of the molecule as an objective parameter for therapeutic monitoring. Based on scientific evidence, the experts concluded that HS in CSF is predominantly derived from the brain and reflects neurological impairment in patients with MPS II. CSF HS levels may help differentiate between neuronopathic and non-neuronopathic forms of MPS II, with preliminary observations suggesting a potential threshold around 4,000 ng/mL when HS quantification is performed using the same method described in clinical studies of pabinafusp alfa. According to the authors, monitoring HS levels in CSF can serve as an objective parameter for assessing the effectiveness of treatment with drugs that cross the blood-brain barrier. The recommended timing of HS evaluations in CSF of patients with the severe phenotype is: (i) before treatment; (ii) six months after starting treatment; and (iii) two years after starting treatment. The same monitoring scheme is recommended for patients with the attenuated MPS II phenotype, however, after two years of treatment, the physician may elect to perform regular neurocognitive evaluations instead of measuring HS in CSF. Lastly, the authors reinforced the importance of evaluating adherence to treatment, including interruptions, to provide a more meaningful assessment of the treatment's real-world impact and to determine the ideal timing of CSF collection for therapeutic monitoring.

Magnetic manipulation of unknown and complex conductive nonmagnetic objects with application in the remediation of space debris

This article extends recent work in magnetic manipulation of conductive, nonmagnetic objects using rotating magnetic dipole fields. Eddy-current-based manipulation provides a contact-free way to manipulate metallic objects. We are particularly motivated by the large amount of aluminum in space debris. We previously demonstrated dexterous manipulation of solid spheres with all object parameters known a priori. This work expands the previous model, which contained three discrete modes, to a continuous model that covers all possible relative positions of the manipulated spherical object with respect to the magnetic field source. We further leverage this new model to examine manipulation of spherical objects with unknown physical parameters by applying techniques from the online-optimization and adaptive-control literature. Our experimental results validate our new dynamics model, showing that we get improved performance compared to the previously proposed model, while also solving a simpler optimization problem for control. We further demonstrate the first physical magnetic manipulation of aluminum spheres, as previous controllers were only physically validated on copper spheres. We show that our adaptive control framework can quickly acquire useful object parameters when weakly initialized. Finally, we demonstrate that the spherical-object model can be used as an approximate model for adaptive control of nonspherical objects by performing magnetic manipulation of a variety of objects for which a spherical model is not an obvious approximation.

Spleen stiffness measurements during recompensation in patients with acutely decompensated liver cirrhosis: preliminary findings of a pilot study

BackgroundAcute decompensation (AD) in patients with liver cirrhosis is associated with a dramatic deterioration in prognosis. Immediate initiation of appropriate recompensation measures is essential to improve patient’s outcome, although objective parameters for evaluating the success of recompensation are still lacking. Spleen stiffness measurements (SSM) have emerged as promising non-invasive tool to assess clinically significant portal hypertension (CSPH), which is the main driver of acute decompensation. However, while SSM accurately predicts CSPH and its complication, currently no data are available on its diagnostic performance during recompensation. This pilot-study aimed at evaluating changes in spleen stiffness following the initiation of recompensation measures in cirrhotic patients hospitalized due to AD.MethodsIn this prospective pilot-study, 60 patients with cirrhosis showing AD were included. Liver stiffness measurements (LSM) and SSM were performed on admission and repetitive SSM on day 3 and 5, respectivele, during recompensation measures. A cohort of patients (n = 10) with compensated cirrhosis served as control.ResultsA total of 36 data sets from the originally enrolled 60 patients were eligible for final analysis. On admission, patients with AD revealed a significantly increased spleen stiffness compared to the control group (70.51 vs. 29.06 kPa, p < 0.0001). Following the initiation of recompensation measures SSM revealed a significant reduction in spleen stiffness compared to the baseline assessment on day 3 (−18.5 kPa, −21.53%; p = 0.0002) with no further decrease on day 5 (−17.63 kPa, −21.23%; p = 0.0326).ConclusionRepetitive SSM seems to be a useful non-invasive clinical marker to assess the effectiveness of recompensation measures in cirrhotic patients with AD.

Duchenne Muscular Dystrophy (DMD) and Becker Muscular Dystrophy (BMD): A Review on Assessing Measures

Mutations in the encoding Dystrophin gene lead to lethal, genetic muscular dystrophies such as Duchenne Muscular Dystrophy (DMD), and Becker Muscular Dystrophy (BMD) which have a slower progression than DMD and an intermediate form. Dystrophin gene mutations abolish the production of Dystrophin in body muscles such as skeletal, cardiac, and smooth muscles. The progressive degeneration of muscle tissues and functions will occur. Most often respiratory, orthopaedic, and cardiac-related complications have led to death. These neuromuscular disorders occur at a frequency of about 1 in 5000 newborn males. The objective of this review was to identify and understand the available measures used for assessing muscular dystrophies in DMD and BMD. Review of studies identified from searching medical bibliographic sources relevant to assessing methods and techniques of DMD and BMD between the years of 2002 and 2022. The studies showed measures used to assess the muscles in DMD patients apart from clinical assessments to quantify the pathological changes involved in the muscles as objective parameters. The measures can be categorized into invasive and non- invasive methods. This study has resulted in manual muscle testing methods and methods of assessing the functional ability of the muscles such as muscle biopsies, Ultrasound scans (USS), and Magnetic Resonance Images (MRI) etc. It concludes that the most widely used effective and reliable investigation method has been identified as MRI scans due to various purposes and methods of assessing muscular dystrophies.

Leveraging ChatGPT for Enhanced Aesthetic Evaluations in Minimally Invasive Facial Procedures.

In recent years, the application of AI technologies like ChatGPT has gained traction in the field of plastic surgery. AI models can analyze pre- and post-treatment images to offer insights into the effectiveness of cosmetic procedures. This technological advancement enables rapid, objective evaluations that can complement traditional assessment methods, providing a more comprehensive understanding of treatment outcomes. The study aimed to comprehensively assess the effectiveness of custom ChatGPT model, "Face Rating and Review AI," in facial feature evaluation in minimally invasive aesthetic procedures, particularly before and after Botox treatments. An analysis was conducted on the Web of Science (WoS) database, identifying 79 articles published between 2023 and 2024 on ChatGPT in the field of plastic surgery from various countries. A dataset of 23 patients from Kaggle, including pre- and post-Botox images, was used. The custom ChatGPT model, "Face Rating & Review AI," was used to assess facial features based on objective parameters such as the golden ratio, symmetry, proportion, side angles, skin condition, and overall harmony, as well as subjective parameters like personality, temperament, and social attraction. The WoS search found 79 articles on ChatGPT in plastic surgery from 27 countries, with most publications originating from the USA, Australia, and Italy. The objective and subjective parameters were analyzed using a paired t-test, and all facial features showed low p-values (<0.05). Higher mean scores on features such as the golden ratio (mean = 5.86, SD = 0.69), skin condition (mean = 3.78, SD = 0.73), and personality (mean = 5.0, SD = 0.79) indicate positive shifts after the treatment. The custom ChatGPT model "Face Rating and Review AI" is a valuable tool for assessing facial features in Botox treatments. It effectively evaluates objective and subjective attributes, aiding clinical decision-making. However, ethical considerations highlight the need for diverse datasets in future research to improve accuracy and inclusivity. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Prospective study of the application of a 3D exoscope system (VITOM 3D) in ear surgery compared to conventional surgical microscopes: part I - analysis of objective parameters.

This prospective study compared the application of a 3D exoscope (VITOM 3D) with surgical microscopes (SM) in ear surgery. 62 patients were included (exoscope group (E+) n = 31; SM group (E-) n = 31). Procedures included cochlea implantation (nE + = 10, nE- = 10), reconstructive middle ear surgery due to chronic otitis media with (COMwC; nE + = 11, nE- = 11) and without cholesteatoma (COMsC; nE + = 10, nE- = 10). Objective (e.g. set-up time and wrap-up time, corrected cut-suture-time, pure operating time, adjustment time, time per adjustment procedure, learning curves) and subjective perioperative parameters were evaluated. This paper only addressed the analysis of the objective parameters. The pooled data showed that the mean time delay in the E + group was significantly higher compared to the E- group with regard to set-up time and wrap-up time, corrected cut-suture time, adjustment time and time per adjustment procedure. Time delay tended to be higher for pure operating time. In all subgroups of the E + group, the objective time parameters also showed at least a tendency to be prolonged on average compared to the corresponding subgroups in the E- group. The learning curve analysis showed that the E + group (corrected cut suture time for CI surgery, mean time per adjustment procedure across all subgroups) approached the times of the E- group during the course of the study. Based on the pooled data from the study arms, the exoscope tends to be inferior to the microscope for the objective time parameters evaluated when used in ear surgery. However, due to the small group sizes, no solid conclusions could be drawn regarding the individual surgical procedures. In addition, further studies with a longer observation period are needed to minimize the influence of the learning curve on the results.

Quantification of normal bone and osseous metastases in castration-resistant prostate cancer using SPECT/CT with xSPECT Quant: prospective imaging sub-study of a phase 2 clinical trial investigating the combination of pembrolizumab plus radium-223 compared to radium-223 alone.

The purpose of this study is to demonstrate the consistency and reproducibility of quantitative SPECT/CT by evaluating the maximum SUV (SUVmax) in normal bone, to provide the reference value of metastatic lesions, and to evaluate the clinical implication of SUVmax changes of osseous metastasis during treatment. This prospective imaging sub-study was performed as part of a phase 2 clinical trial of patients with metastatic castration-resistant prostate cancer (mCRPC) randomized to the combination of pembrolizumab plus radium-223 or to radium-223 alone (NCT03093428). The maximum standardized uptake value (SUVmax) and mean Hounsfield Unit (HUmean) of normal bone as well as metastases were measured using a 1.5cm region of interest (ROI) on CT and xSPECT Quant reconstruction on the baseline study (S0) and restaging scans. The most tracer-avid metastatic lesion in each patient on S0 was selected as a target lesion, and changes of SUVmax and HUmean of the target lesion were compared on the first restaging scan (S1). Correlations between the percentage changes of SUVmax of the target lesion with alkaline phosphatase (ALP) and prostate-specific antigen (PSA) were assessed. Twenty-one patients were enrolled on the imaging sub-study of which 15 had paired baseline S0 and S1 data. On S0, the median SUVmax and HUmean of normal bone was 5.85g/mL (0.42-14.98) and 133.03 (range, 28.47-461.91), respectively. The median SUVmax and HUmean of metastasis were 42.2g/mL (range, 17.96-143.36) and 549.58 (177.87-1107.64), respectively. There was significant reduction in SUVmax (- 40.1%, range - 86.2 to + 23.5%), p < 0.001) and increase in HUmean (+ 8.3%, range - 11.3 to + 61.7%, p = 0.0479, Wilcoxon signed-rank test) of target lesions between S0 and S1. Spearman correlation between the percentage changes of SUVmax of a target lesion and both serum PSA (r = 0.33, p = 0.226) and ALP (r = 0.45, p = 0.094) were not statistically significant. Quantitative SPECT/CT provides consistent and objective imaging parameters, which can help monitor tumor burden. The median SUVmax of metastasis at baseline was roughly 7.2-fold higher than normal bone. Quantitative SPECT/CT may help visualize the early osteoblastic treatment response in prostate cancer patients treated with radium-223 alone or combined with pembrolizumab.

Changes in clinical condition and quality of life of patients with involutional changes of facial skin and metabolic syndrome after the course of treatment with therapeutic physical factors

BACKGROUND: The presence of concomitant chronic non-infectious diseases, which significantly increase in probability and severity with age, contributes to the intensity of external manifestations of involutional processes. This is absolutely true for the metabolic syndrome, which is confirmed to be associated with involutional changes in the skin and soft tissues of the face through systemic mechanisms of comorbidity, determining mutual additive influences. AIM: The aim of the study was to evaluate the clinical efficacy of the combined use of transcranial magnetic field therapy, oxygen bar therapy, and laser phoresis of hyaluronic acid for the treatment of involutional skin changes in patients with metabolic syndrome. MATERIALS AND METHODS: Using a simple randomization technique, patients with involutional skin changes associated with metabolic syndrome (n=120) were divided into 4 groups of 30 subjects each. Subjects in group 1 (control group) received only laser phoresis of hyaluronic acid; subjects in group 2 (comparator group 1) received one course of transcranial magnetic therapy; subjects in group 3 (comparator group 2) received one course of oxygen bar therapy; subjects in group 4 (experimental group) received one course of combined treatment (laser phoresis of hyaluronic acid + transcranial magnetic therapy + oxygen bar therapy). Results were evaluated based on changes in the severity of key clinical and functional signs of age-related skin changes. In addition, the quality of life of the patients was evaluated using the Dermatologic Index, and the overall aesthetic improvement was evaluated using the Global Aesthetic Improvement Scale (GAIS). RESULTS: The comorbidity of chronoaging with metabolic syndrome is associated with subjectively more severe major clinical manifestations of facial skin aging and indicative changes in its morphological and functional parameters. A comparative analysis of the effectiveness of using different monotherapy regimens showed the most significant regression of clinical manifestations with the laser phoresis of hyaluronic acid. The total subjective score of major clinical manifestations of age-related skin changes decreased by 39.8% on a visual analog scale (VAS), and the quality of life increased by 61.7%. The GAIS score was 2.48. Visual analog scale scores were largely consistent with changes in objective skin parameters. In the transcranial magnetic therapy and oxygen bar therapy groups, the effect was weaker and almost equal. The highest efficacy was reported in the experimental group: regression of clinical manifestations of skin chronoaging and restoration of objective dermal parameters were reliable and exceeded the level of the control group after the treatment. CONCLUSION: The combined treatment shows a significant increase in clinical efficacy due to the pathogenetic effect on the metabolic syndrome. Sinergy of therapeutic physical factors is achieved by different modalities, sites of treatment, and mechanisms of biological potential.

Comparison of 3-month clinical outcomes between two enhanced monofocal intraocular lenses: A single-center prospective study.

This study aims to compare the 3-month clinical outcomes between two enhanced monofocal intraocular lenses (IOLs) following cataract surgery.Setting: Eye Clinic of Careggi University Hospital, Florence, Italy. Single-center prospective study. We included patients with cataract and corneal astigmatism less than 0.75 D, with no ocular comorbidities, who underwent unilateral cataract surgery with implantation of either the Tecnis Eyhance ICB00 (N = 25) or Evolux (N = 25) IOLs. Standard cataract procedures were performed without complications. The main outcome measures included uncorrected and corrected visual acuity at distance (4 m), intermediate (60 cm) and near (40 cm) at 3-month follow-up. Additionally, monocular defocus curves, aberrometric profiles, and perceptions of halo and glare were evaluated. The study involved 50 patients (26 male, 24 female) with a mean age of 68 ± 8 years. Preoperative characteristics were similar between the groups, and no intraoperative or postoperative complications were reported. Statistically significant differences were observed between the groups, with the Evolux IOL showing superior results (p < 0.05) in terms of uncorrected and corrected visual acuity at near, intermediate, and distance, as well as in aberrometric profiles (lower-order aberration root-mean-square [RMS], higher-order aberration RMS, spherical equivalent RMS, and point spread function) and defocus curves. Based on our experience, while both IOLs offer substantial visual performance for intermediate and distance vision, the Evolux IOL demonstrated superior mean visual outcomes and objective parameters at the 3-month follow-up compared to the Tecnis Eyhance IOL. This indicates a potential advantage of the Evolux IOL in providing better visual performance.

A Comparative Analysis of Bhumija-Style Gondeshwar Temple’s Acoustic Characteristics with Hemadpanti-Style Temples

ABSTRACT The study of the Hindu temple’s acoustics, acoustic characteristics, sound quality for clarity of music and speech intelligibility, and other applicable acoustic parameters must be addressed more in the literature. This study has conducted field measurements in Bhumija-style Gondeshwar temples in Nashik district, India. The temple has a distinctive tiered domed concave ceiling design in the pavilion and sanctum space and unique acoustic properties shaped by its architectural features. The research aims to report and investigate the acoustic characteristics through the well-known Impulse Response (IR) method to investigate empty temple conditions. A 3D model was imported and calibrated in ODEON 12.10 to compare scenarios when the worshippers were 100% present in the temple for various musical and chanting activities. Objective room-acoustic parameters such as Early Decay Time (EDT), Reverberation Time (T30), Clarity of Music (C80), Definition (D50), and Speech Transmission Index (STI) were measured and analyzed. The field measurements were also compared with previously studied Hemadpanti-style Hindu temples, such as the Markanda and Mrikunda temples. The results indicated that the tiered ceiling in Hemadpanti temples indicates a balance and moderate T30 values for all frequency ranges, as compared to the tiered concave domed ceiling in Bhumija-style Gondeshwar temple with higher T30 values observed at the lower frequency.

Comparison of Occupational Performance in Immersive Virtual and Real Environments Among Patients With Stroke: Observational Randomized Crossover Pilot Study.

Conventional rehabilitation approaches involve therapists simulating various occupational tasks in health care settings or recreating real-life situations to assess and train patients in instrumental activities of daily living (IADLs). As an alternative, immersive virtual reality (IVR) has been widely used in stroke rehabilitation for years, but research comparing occupational performance between virtual and real environments is limited. This study aims to introduce a novel IVR shopping system designed for patients with stroke and to investigate the correlation of occupational performance in virtual and real environments among patients with stroke. Ten patients with stroke were recruited from the Department of Rehabilitation Medicine, Shenzhen Hospital, Southern Medical University, who met the inclusion and exclusion criteria for this observational, randomized crossover study; the patients were predominantly male (n=7), had experienced ischemic stroke (n=9), were aged 14 to 73 years, and had a time since stroke of 1 to 42 months. All patients attempted shopping tasks in virtual and real environments. The Mini-Mental State Examination (MMSE), Timed Up and Go Test (TUGT), modified Barthel index (MBI), and Lawton index (LI) were used to assess cognition, ambulation, and activities of daily living. Memory capacity and duration in the virtual and real environments were recorded as the primary parameters of occupational performance. The Wilcoxon test and Spearman correlation coefficients were used to analyze the differences and correlations between the 2 environments. The Wilcoxon test showed no significant differences between the virtual and real environments in memory capacity and duration of task completion (P>.99 and P=.99), and memory capacity in both environments correlated with the LI (ρ=0.81; P=.005). Memory duration had a relationship with the TUGT in the virtual environment (ρ=0.68; P=.03) and a borderline negative correlation with MMSE in the real environment (ρ=-0.58; P=.08). Considering the small sample size used in this study and the study's limitations, despite the significant correlation between shopping performance in IVR and the real world, it is still too early to conclude that IVR is a noninferior approach, but it presents the potential to be an alternative for assessment and training in IADLs when resources are limited. However, further research is needed to investigate the psychometric properties, clinical effects, and impact of virtual training on real-world performance. The implications for practice might include the following: (1) occupational performance in virtual shopping might be the same as real-world shopping, and more virtual IADLs could thus be developed; (2) virtual IADL assessment and training systems could be used in remote locations or locations with limited resources; and (3) more objective parameters of IADLs could be extracted from virtual environments.

The effectiveness of cryostimulation exposure on sleep and recovery in male athletes: Timing considerations.

The objectives of the study were (i) to evaluate the effects of whole-body cryostimulation (WBC) after training as an effective tool to improve sleep and recovery and (ii) to determine which exposure schedule for WBC (immediately after training vs. 1h before bedtime) is the most appropriate to improve sleep and recovery. Twenty-two well-trained male athletes or triathletes (23.1±3.5-years) were recruited in this controlled crossover protocol. Each participant completed the three experimental sessions, each composed of a running training session and one night of sleep analysis. Depending on the experimental condition, subjects were exposed-or not (CONT)-to WBC immediately after training (CRYO 7 p.m.) or 1h before going to bed (CRYO 10 p.m.). All participants were randomly assigned to each condition, spaced seven days apart. Sleep was monitored via actimetry, cerebral activity recordings, heart rate variability, body core temperature, and perceptual measurements. WBC after training did not modify subjective or objective sleep parameters compared to the control condition. However, WBC significantly improved cardiac parasympathetic activity. More specifically, it was more activated during the night following the CRYO 10 p.m. condition than in the other experimental conditions. Core body temperature (CBT) 1h after bedtime was the lowest in the CRYO 10 p.m. condition. This study confirmed the effectiveness of WBC as a recovery technique after intense evening training. We suggest that WBC may exhibit the most significant benefit on recovery if the session is performed 1h before bedtime, acting on subsequent parasympathetic activation and CBT drop.

Three Parameters Impact the Perception of Smile Asymmetry in Patients with Facial Paralysis.

Background: The ability to smile is impaired in patients with facial palsy, and objective parameters assessing smile symmetry to guide treatment are not well elucidated. Objective: This study seeks to identify objective facial measurements that relate smile recognition, perception of smile asymmetry, and perceived emotions from photographs of individuals with asymmetrical smiles compared with control photographs of individuals without smile asymmetry as measured by a photograph analysis application. Methods: Fifty-six photographs of smiles were categorized using objective perioral morphometric measurements (Emotrics). A photographic survey of these smiles was disseminated with queries regarding smile symmetry, smile recognition, and emotion perception. Generalized linear mixed modeling (GLMM) was performed to assess the effect of facial measurements on survey responses. Results: From 756 survey responses, smile symmetry predicted for smile recognition (F = 1084, p < 0.001) and emotion perception (F = 422, p < 0.001). Correlation analysis and GLMM identified three parameters (lower lip height, commissure position, and commissure height) that predicted smile recognition (F = 1040, p < 0.001), emotion perception (F = 976, p < 0.001), and symmetry (F = 1248, p < 0.001). Lower lip height (β = -57.84, p < 0.001) and commissure position (β = -29.41, p < 0.001) were the most significant drivers. Conclusions: Correcting lower lip height and commissure position represents efficacious clinical benchmarks for improving smile recognition by reducing smile asymmetry and conveying negative emotions.

The effect of restricted and free-living conditions on light exposure and sleep in older adults

ABSTRACT During the COVID-19 pandemic, studies reported that restricted living conditions were associated with worse subjective sleep quality. This effect might have been caused by reduced light exposure during lockdowns. We investigated light exposure levels, subjective and objective sleep and physical activity levels in older adults during restricted and free-living conditions after the pandemic. Ninety-one participants (62.7 ± 8.4 years) recruited from the community using social media with 44 participants (63.4 ± 8.9 years) completed follow-up during free-living conditions. Participants wore an actigraphy device and completed sleep diaries for 7 days during each condition. Light values were extracted in hourly bins across the 24-h period and objective and subjective sleep were compared between the conditions. There was an increase in mean 24-h light exposure during restricted-living (1103.7 ± 1024.8 lux) compared to free-living (803.0 ± 803.6 lux; p < 0.001). This was partially related to participants spending 18 min more in bright light conditions (>1,000 lux) during wakefulness in restricted living (2.6 ± 1.9 h) compared to free-living (2.3 ± 2.0 h; p = 0.036). Despite differences in light exposure, there were no significant differences in objective and subjective sleep parameters between the two conditions. More research is required to better understand behaviours related to light exposure and how this may impact on sleep.

Differences in internal carotid artery tortuosity in ruptured and unruptured anterior circulation aneurysms. A matched case-control study

ObjectiveTortuosity of the internal carotid artery is believed to contribute to the formation of intracranial aneurysms, although there is scant literature on its role as a risk factor for rupture specifically. Therefore, this study investigated the influence of cervical internal carotid artery (cICA) tortuosity on rupture of aneurysms of the anterior cerebral circulation. MethodsAngiographic imaging studies from patients who underwent endovascular embolisation for anterior circulation aneurysms at a tertiary centre were identified. 83 patients with a history of aneurysmal rupture and subarachnoid haemorrhage (SAH group) were matched for age, aneurysm location and size, history of subarachnoid haemorrhage and hypertension to 83 subjects with unruptured aneurysms (control group). cICA tortuosity was assessed utilising subjective (kinks, loops or coils) and objective (tortuosity index) parameters. ResultsSubjective cICA tortuosity was identified in 33.7% and 56.6% of patients in the SAH and control groups respectively (OR 0.39 [95% CI 0.21–0.75]). Objective cICA tortuosity was present in 35.7% and 46.8% of SAH and control patients (OR 0.63 [95% CI 0.32–1.27]). OR values are suggestive of cICA tortuosity as a negative predictor of aneurysmal rupture, with more predictive power attributed to the subjective assessment, despite the limited statistical significance of the objective results. ConclusionsThis study demonstrated an increased presence of cICA tortuosity in unruptured aneurysms compared to ruptured aneurysms, suggesting it is unlikely to represent a risk factor for rupture. Further research in the form of longitudinal observational studies of untreated aneurysms would aid in investigating cICA tortuosity as a protective factor.

Facial aging, cognitive impairment, and dementia risk

BackgroundFacial aging, cognitive impairment, and dementia are all age-related conditions. However, the temporal relation between facial age and future risk of dementia was not systematically examined.ObjectivesTo investigate the relationship between facial age (both subjective/perceived and objective) and cognitive impairment and/or dementia risk.MethodsThe study included 195,329 participants (age ≥ 60 y) from the UK Biobank (UKB) with self-perceived facial age and 612 participants from the Nutrition and Health of Aging Population in China Project (NHAPC) study (age ≥ 56 y) with objective assessment of facial age. Cox proportional hazards model was used to prospectively examine the hazard ratios (HRs) and their 95% confidence intervals (CIs) of self-perceived facial age and dementia risk in the UKB, adjusting for age, sex, education, APOE ε4 allele, and other potential confounders. Linear and logistic regressions were performed to examine the cross-sectional association between facial age (perceived and objective) and cognitive impairment in the UKB and NHAPC, with potential confounders adjusted.ResultsDuring a median follow-up of 12.3 years, 5659 dementia cases were identified in the UKB. The fully-adjusted HRs comparing high vs. low perceived facial age were 1.61 (95% CI, 1.33 ~ 1.96) for dementia (P-trend ≤ 0.001). Subjective facial age and cognitive impairment was also observed in the UKB. In the NHAPC, facial age, as assessed by three objective wrinkle parameters, was associated with higher odds of cognitive impairment (P-trend < 0.05). Specifically, the fully-adjusted OR for cognitive impairment comparing the highest versus the lowest quartiles of crow’s feet wrinkles number was 2.48 (95% CI, 1.06 ~ 5.78).ConclusionsHigh facial age was associated with cognitive impairment, dementia and its subtypes after adjusting for conventional risk factors for dementia. Facial aging may be an indicator of cognitive decline and dementia risk in older adults, which can aid in the early diagnosis and management of age-related conditions.

Analysis of the quality of life in patients with multiple sclerosis within 3 years after high-dose immunosuppressive therapy with autologous hematopoietic stem cell transplantation

Introduction. To date, data have been accumulated indicating the high effectiveness of the HDIT-AHSCT and the possibility of preserving and improving the quality of life of patients after its application.The objective was to analyze the dynamics of quality of life using standardized assessment tools in patients with MS for 3 years after the use of HDIT-AHSCT, who participated in the program of clinical approbation of the method.Methods and materials. The single-center observational study included 21 patients (10 women, 11 men) with a reliable diagnosis of MS, who underwent HDIT-AHSCT at the Pavlov First Saint Petersburg State Medical Universityin accordance with the protocol of clinical approbation. Distribution by type of MS course: remitting (RMS) 16 (76.2 %), secondary progressive (SPMS) 4 (19 %), primary progressive (PPMS) 1 patient (4.8 %). The assessment of quality of life (SF-36, FAMS, CSP-MS42, HADS) and severity of disability (EDSS) in all patients was performed before, 12 and 36 months after HDIT-AHSCT.Results. Three years after the HDIT-AHSCT, a significant decrease in weakness, feelings of constant fatigue and rapid fatigue during exertion was recorded. The level of anxiety decreased in more than 50 % of patients. A direct relationship between the dynamics of clinical characteristics and the data of the scales of the SF-36 questionnaire was revealed; at the same time, after 36 months, an improvement in all parameters of the scale was noted.Conclusion. The assessment of the indicators of the quality of life questionnaires allows us to confirm the effectiveness and significance of therapy not only from the point of view of objective clinical and radiation parameters necessary for the evidence base of the treatment method, but also from the patient’s position, which in conditions of a chronic progressive process is an integral factor for the appointment of therapeutic intervention.

A Design and Safety Analysis of the “Electricity-Hydrogen-Ammonia” Energy Storage System: A Case Study of Haiyang Nuclear Power Plant

With the development of modernization, traditional fossil energy reserves are decreasing, and the power industry, as one of the main energy consumption forces, has begun to pay attention to increasing the proportion of clean energy generation. With the deepening of electrification, the peak-valley difference of residential electricity consumption increases, but photovoltaic and wind power generation have fluctuations and are manifested as reverse peak regulation. Thermal power plants as the main force of peak regulation gradually reduce the market share, making nuclear power plants bear the heavy responsibility of participating in peak regulation. The traditional method of adjusting operating power by inserting and removing control rods has great safety risks and wastes resources. Therefore, this paper proposes a new energy storage system that can keep the nuclear power plant running at full power and produce hydrogen to synthesize ammonia from excess power. A comprehensive evaluation model of energy storage based on z-score data standardization and objective parameter assignment AHP (analytic hierarchy process) analysis method was established to evaluate energy storage systems according to a multi-index system. With an AP1000 daily load tracking curve as the input model, the simulation model built by Aspen Plus V14 was used to calculate the operating conditions of the system. In order to provide a construction basis for practical engineering use, Haiyang Nuclear Power Plant in Shandong Province is taken as an example. The system layout scheme is proposed according to the local environmental conditions. The accident tree analysis method is combined with ALOHA 5.4.1.2 (Areal Locations of Hazardous Atmospheres) hazardous chemical analysis software and MARPLOT 5.1.1 geographic information technology. A qualitative and quantitative assessment of risk factors and the consequences of leakage, fire, and explosion accidents caused by hydrogen and ammonia storage processes is carried out to provide guidance for accident prevention and emergency rescue. The design of an “Electric-Hydrogen-Ammonia” energy storage system proposed in this paper provides a new idea for zero-carbon energy storage for the peak shaving of nuclear power plants and has a certain role in promoting the development of clean energy.

Effects of Voice Therapy on Maximum Phonation Time and S:Z Ratio in Patients With Primary Muscle Tension Dysphonia

ObjectiveThis study aimed to evaluate the influence of voice therapy on maximum phonation time (MPT) and S:Z ratio in patients diagnosed with primary muscle tension dysphonia (pMTD). The goal was to investigate whether pMTD is associated with reduced S:Z ratio and prolonged MPT. Study DesignProspective cohort study. MethodsA comparative analysis was conducted on a cohort of patients diagnosed with pMTD. Prevoice and postvoice therapy assessments of MPT and S:Z ratio were performed. Data from these measurements were analyzed to determine the impact of voice therapy on the studied parameters. A paired t test was used to evaluate MPT and S:Z ratio pretherapy and post therapy. ResultsFifty-two patients met the inclusion criteria for the study, having completed a laryngology evaluation with diagnosis of pMTD and agreeing to voice therapy between July 22, 2021, and April 4, 2023. Sixteen of these patients completed a full course of voice therapy. The Voice Handicap Index-10 (VHI-10), MPT, and S:Z ratio were measured during initial evaluation as part of a complete laryngeal function study. A statistically significant reduction in VHI-10 scores was observed, with values decreasing from 17.81 (±2.81) pretherapy to 8.81 (±1.8) post therapy (P < 0.001). However, no significant differences were detected in MPT or the S:Z ratio following the intervention. ConclusionsThere is a lack of correlation between subjective evaluations of voice (VHI-10) and objective assessments (MPT and S:Z ratio), indicating that these objective parameters may not accurately reflect changes in voice quality following therapy in the pMTD population. Lay SummaryMPT and S:Z ratio do not appear to be uniformly impacted in patients with pMTD. Moreover, these measures do not consistently improve following voice therapy for pMTD.

CLINICAL STUDY OF EFFICACY OF SHASHANKHLEKHADI CHOORNA IN KUSHTHA (CHAKRADATTA)

Present study deals with evaluation of efficacy of ShashanklekhadiChoorna in the management of DadruKushtha. Study was done in 30 patients who were suffering from DadruKushtha. Drug ShashankhlekhadiChoorna was given to patients in dose of 3 gms twice a day inPragbhakta with Tiltail as Anupana. Study period was of 28 days. The patients were assessed on the basis of subjective parameters i.e.Kandu (Itching), Daha (Burning sensation), Raga (Colour changes), Pidaka (Eruptions) and objective parameters i.e. Size of Lesions and No. of Lesions. Medicine proved to be effective for Dadru.