A Combined sEMG and Accelerometer System for Monitoring Functional Activity in Stroke

Remote monitoring of physical activity using bodyworn sensors provides an alternative to assessment of functional independence by subjective, paper-based questionnaires. This study investigated the classification accuracy of a combined surface electromyographic (sEMG) and accelerometer (ACC) sensor system for monitoring activities of daily living in patients with stroke. sEMG and ACC data were recorded from 10 hemi paretic patients while they carried out a sequence of 11 activities of daily living (Identification tasks), and 10 activities used to evaluate misclassification errors (non-Identification tasks). The sEMG and ACC sensor data were analyzed using a multilayered neural network and an adaptive neuro-fuzzy inference system to identify the minimal sensor configuration needed to accurately classify the identification tasks, with a minimal number of misclassifications from the non-Identification tasks. The results demonstrated that the highest sensitivity and specificity for the identification tasks was achieved using a subset of 4 ACC sensors and adjacent sEMG sensors located on both upper arms, one forearm, and one thigh, respectively. This configuration resulted in a mean sensitivity of 95.0 %, and a mean specificity of 99.7 % for the identification tasks, and a mean misclassification error of < 10% for the non-Identification tasks. The findings support the feasibility of a hybrid sEMG and ACC wearable sensor system for automatic recognition of motor tasks used to assess functional independence in patients with stroke.

Molecular biomarker testing for non-small cell lung cancer: consensus statement of the Korean Cardiopulmonary Pathology Study Group

Molecular biomarker testing is the standard of care for non–small cell lung cancer (NSCLC) patients. In 2017, the Korean Cardiopulmonary Pathology Study Group and the Korean Molecular Pathology Study Group co-published a molecular testing guideline which contained almost all known genetic changes that aid in treatment decisions or predict prognosis in patients with NSCLC. Since then there have been significant changes in targeted therapies as well as molecular testing including newly approved targeted drugs and liquid biopsy. In order to reflect these changes, the Korean Cardiopulmonary Pathology Study Group developed a consensus statement on molecular biomarker testing. This consensus statement was crafted to provide guidance on what genes should be tested, as well as methodology, samples, patient selection, reporting and quality control.

Evaluation of an accelerated 3D modulated flip-angle technique in refocused imaging with an extended echo-train sequence with compressed sensing for imaging of the knee: comparison with routine 2D MRI sequences

AIM

To accelerate the acquisition of high-resolution magnetic resonance imaging (MRI) by using the three-dimensional (3D) matrix sequence with compressed sensing and to compare it with conventional two-dimensional (2D) proton-density (PD) and fast spin-echo (FSE) sequences.

MATERIALS AND METHODS

3D matrix, 2D FSE, and PD sequences were acquired from 68 participants using 3 T magnetic resonance imaging (MRI). Two radiologists scored image quality independently on a four-point scale. The structural similarity index (SSIM), and signal- (SNRs) and contrast-to-noise ratios (CNRs) of different anatomical structures of the knee were assessed and compared between sequences using Wilcoxon signed-rank tests and Cohen's kappa.

RESULTS

The median acquisition time reduction was 44.5%. There was a substantial to perfect agreement for the rating between the 3D matrix FSE and 2D FSE or PD sequences when evaluating cartilage, subchondral bone, and ligaments (κ=0.783-872, p>0.05). The mean SSIM values between the 3D matrix FSE and 2D FSE, and between the 3D matrix PD and 2D PD sequences was 0.994 and 0.971, respectively, which are acceptable. No significant differences were found in SNR between the 3D matrix FSE and 2D FSE, and between the 3D matrix PD and 2D PD sequences, even though the SNR appeared to be higher on routine 2D sequences. The CNR of subchondral bone-meniscus, subchondral bone-joint fluid, and meniscus-joint fluid did not differentiate significantly between the 3D matrix sequence and routine 2D sequences.

CONCLUSIONS

3D matrix reduced the acquisition time in routine clinical knee MRI without the loss in image quality, SNR, and CNR.

Differences in the clinical characteristics and long-term outcome of peripartum tako-tsubo cardiomyopathy and peripartum cardiomyopathy

Background

Some peripartum-associated cardiomyopathy patients present similarly to those of tako-tsubo cardiomyopathy (TCM), little is known about the clinical course of peripartum TCM.

Purpose

To know clinicial characteristics and outcomes of peripartum TCM, in comparison with peripartum cardiomyopathy (PPCM)

Methods and results

Of 31 pregnancy-associated cardiomyopathy patients in a tertiary hospital, 10 cases of peripartum TCM and 21 cases of PPCM were found. Maternal near-missed death was significantly more common in the peripartum TCM group than in the PPCM group (100.0% vs. 76.2%, p=0.030). Complete recovery was observed with all peripartum TCM cases, while 23.8% of the PPCM cases had residual left ventricle (LV) dysfunction. LV ejection fraction greater than 30% on the initial echocardiogram independently predicted early echocardiographic recovery of left ventricular systolic function (odds ratio 331.33, 95% confidence interval 3.87–28402.60, p=0.011). There was no difference between the two groups in terms of the rate of adverse clinical events at 3 years of follow-up (PPCM group: 26.3% [5/19] vs. TCM group: 33.3% [3/9], p=0.750).

Conclusions

One-third of pregnancy-associated cardiomyopathy patients had peripartum TCM. With contemporary supportive care, both PPCM and peripartum TCM patients had a low mortality rate and excellent long-term outcomes.

Kaplan-Meier survival curves for death,

Funding Acknowledgement

Type of funding source: None

Detection and quantification of Aflatoxin B1 in corn and corn-grown soils in the district of Anuradhapura, Sri Lanka

Aflatoxin B1 contamination adversely affects human health by impairing long-term physical and cognitive development. Several crops have been associated with aflatoxin B1 contamination and corn is one of them. In the Anuradhapura district of the North Central Province of Sri Lanka, corn is one of the main agricultural produce. Due to poor farming practices in this area, it is possible that aflatoxin B1 is somehow transported from soil to the corn ears. This study was carried out to detect and quantify aflatoxin B1 in corn and corn-grown soils in Anuradhapura. Corn (n = 60) and corn-grown soil (n = 60) samples were randomly collected from 20 minor-scale corn-grown fields with three random replicates. Each sample was prepared for the measurement of aflatoxin B1 levels using the Enzyme-Linked Immunosorbent Assay (ELISA). Though 20 ppb is considered as the poisonous or deleterious level for corn consumption, there were toxin contaminations of up to 60–70 ppb in the corn kernel, while majority of soil had 350–400 ppb of aflatoxin B1 levels. Fifteen corn samples had exceeded the acceptable level while 22 samples were free of aflatoxin B1 and 23 samples were within the acceptable level. The results showed that the presence of aflatoxin B1 in corn is not habitually distributed throughout Anuradhapura district and it increased with the soil aflatoxin B1 concentration. It appears that there is a relationship between corn kernel and corn-grown soil aflatoxin B1 levels.

0995 Nightcap For School-nights: Association Between Milk Intake And Sleep Duration In First-graders

Introduction

Insufficient sleep has been identified as an obesity risk factor due to mechanistic pathways contributing to higher carbohydrate intake, including in children. Dietary intake of macronutrients, such as fats and protein found in milk, may serve as a modifiable risk factor for adequate sleep. We hypothesize that milk intake among a sample of urban first-graders may be associated with sleep duration.

Methods

Cross-sectional analysis of parent reports of an adapted version of the Child Sleep Health Questionnaire (CSHQ) and Block Dietary Data Systems Food Frequency Questionnaire (FFQ) were analyzed among a sample of 837 Black children in Brooklyn, New York. Summary scores were created for milk type. Milk intake was classified by fat content: whole milk and 2% categorized as high-fat, and 1% and skim as low-fat. Independent t-test, correlations and regression analysis to identify associations between parent reports of child’s sleep duration and milk intake were conducted.

Results

On average, children were 7.3 + 0.6 years old and 52% female. Nearly 57% of parents were immigrants. Children’s mean BMI was 17.27, approximately at the 85th BMI percentile according to CDC index-for-age percentiles. On average, FFQ data reported children consumed high-fat milk 6 days a week. Linear variable regression analysis between high-fat milk intake and sufficient sleep were significant (β =, 0.090, p &lt; 0.05). BMI was significantly associated with high-fat milk intake (β= 0.17, p&lt;0.05). However, high-fat milk intake was not significantly associated with (in)sufficient sleep, after controlling for BMI, sex and age. No difference was reported between immigrant parents and U.S. born parents.

Conclusion

Plausibly, high-fat milk is contributing to satiety and longer sleep duration. Future studies should include more comprehensive measurement of milk consumption (i.e. time of day and volume) to consider possible effects on children’s sleep. Actigraphy measures and sleep diaries should also be considered.

Support

Bezos Grant and Community Service Plan grant.

0580 Habitual Sleep Pattern, Anxiety and Depression are Predictive of Excessive Daytime Sleepiness in a Large-Scale Clinical Samples of Obstructive Sleep Apnea

Introduction

Excessive daytime sleepiness (EDS) is a common symptom that patients with obstructive sleep apnea (OSA) seek medical attention for. Prevalence ranged from 20% to 60%. Previous studies reported factors associated with EDS included age, body mass index (BMI), depression, and OSA severity. In most studies, the sample size was small, participants having specific co-morbidities, and the definitions of EDS was heterogeneous. Moreover, the association between anxiety, depression, habitual sleep pattern, and EDS has not been widely studied. Therefore, the present study aims to investigate the prevalence of EDS and associated factors, especially anxiety, depression, and habitual sleep pattern, in a large-scale clinical sample.

Methods

Data was prospectively collected from 8,081 adult patients who underwent initial overnight polysomnography (PSG) for the first time were referred from 2009 to 2016. Patients with total recording time less than 240 minutes and missing data were excluded. Data collected include demographics, anthropometrics, co-morbidities, and self-reported habitual sleep patterns. Subjective sleepiness was assessed by the Epworth Sleepiness Scale (ESS) with EDS defined as ESS ≥10. Anxiety and depression were assessed by the Hospital Anxiety and Depression Scale (HADS). The stepwise forward Logistic regression was used to identified predictors for EDS.

Results

In 5,780 (82.6%) patients with OSA (apnea-hypopnea index, AHI≥5/h), mean age was 63.9±0.2 yr, BMI was 27.7±0.1, and ESS was 10.4±0.1 and 80.5% were male. Prevalence of EDS in all OSA patients was 55.1% where the patients with severe OSA had higher prevalence (59.8%) than that in mild (49.5%) and moderate OSA (51.8%). Anxiety (OR: 2.036, 95% CI:1.153-1.502), depression (OR: 1.159, 95% CI:1.01-1.33), and short sleep (&lt;6hr/night) (OR:1.316, 95% CI:1.32,1.70) were top three risk factors for EDS. Other risk factors for EDS included AHI, arousal index, % total sleep time with SpO2&lt;90%, %REM, smoking while hypnotic use and long sleep (≥ 8hr/night) were associated with lower risk.

Conclusion

Anxiety, depression, short sleep are predictive and OSA severity are predictive of EDS while long sleep was associated with lower risk.

Support

National Taiwan University (NTU-EPR-104R8951-1; 105R8951-1; 106R880301), Center of electronics technology integration (NTU-107L900502, 108L900502) by the Ministry of Education in Taiwan and MediaTek Inc (201802034RIND).

Prophylactic low-molecular-weight heparin administration protected against severe acute pancreatitis partially by VEGF/Flt-1 signaling in a rat model

BACKGROUND

The present study was aimed to explore the effects and the underlying mechanism of prophylactic low-molecular-weight heparin (LMWH) treatment on taurocholate-induced severe acute pancreatitis (SAP) in a rat model.

METHODS

Rat SAP model was induced by injection of 4% sodium taurocholate into the pancreatic duct. LMWH was applied half an hour before the induction of pancreatitis at the dose of 200 IU/kg subcutaneous injection. The rats were euthanized at 1 h, 6 h, and 12 h after taurocholate-induced SAP. The inflammatory and oxidative response markers were assessed. And the vascular endothelial growth factor (VEGF) and Fms-related tyrosine kinase 1 (Flt-1) expression were evaluated by immunohistochemistry (IHC) and western blot methods.

RESULTS

The expression of inflammatory and oxidative response markers increased after induction of SAP. IHC and western blot results showed the VEGF and Flt-1 expression were increased in SAP group. Prophylactic LMWH administration reduced the inflammatory and oxidative response markers expression and decreased the expression of VEGF and Flt-1.

CONCLUSIONS

This study suggested that prophylactic LMWH treatment mitigated the severity of pancreatitis in rat SAP model by anti-inflammation and oxidative response. The underlying mechanism may result from downregulating VEGF/Flt-1 signaling of LMWH in SAP rat model.