Surface-functionalized SERS platform for deep learning-assisted diagnosis of Alzheimer's disease

Early diagnosis of Alzheimer's disease is crucial to stall the deterioration of brain function, but conventional diagnostic methods require complicated analytical procedures or inflict acute pain on the patient. Then, label-free Surface-enhanced Raman spectroscopy (SERS) analysis of blood-based biomarkers is a convenient alternative to rapidly obtain spectral information from biofluids. However, despite the rapid acquisition of spectral information from biofluids, it is challenging to distinguish spectral features of biomarkers due to interference from biofluidic components. Here, we introduce a deep learning-assisted, SERS-based platform for separate analysis of blood-based amyloid β (1-42) and metabolites, enabling the diagnosis of Alzheimer's disease. SERS substrates consisting of Au nanowire arrays are fabricated and functionalized in two characteristic ways to compare the validity of different Alzheimer's disease biomarkers measured on our SERS system. The 6E10 antibody is immobilized for the capture of amyloid β (1-42) and analysis of its oligomerization process, while various self-assembled monolayers are attached for different dipole interactions with blood-based metabolites. Ultimately, SERS spectra of blood plasma of Alzheimer's disease patients and human controls are measured on the substrates and classified via advanced deep learning techniques that automatically extract informative features to learn generalizable representations. Accuracies up to 99.5% are achieved for metabolite-based analyses, which are verified with an explainable artificial intelligence technique that identifies key spectral features used for classification and for deducing significant biomarkers.

Improved diagnostic performance of susceptibility-weighted imaging with compressed sensing-sensitivity encoding and neuromelanin-sensitive MRI for Parkinson's disease and atypical Parkinsonism

AIM

To verify the diagnostic performance of the loss of nigrosome-1 on susceptibility-weighted imaging (SWI) with compressed sensing-sensitivity encoding (CS-SENSE) and neuromelanin on neuromelanin-sensitive (NM) magnetic resonance imaging (MRI) for the diagnosis of Parkinson's disease (PD) and atypical Parkinsonism.

MATERIALS AND METHODS

A total of 195 patients who underwent MRI between October 2019 and February 2020, including SWI, with or without CS-SENSE, and NM-MRI, were reviewed retrospectively. Two neuroradiologists assessed the loss of nigrosome-1 on SWI and neuromelanin on the NM-MRI. The result of N-3-fluoropropyl-2-beta-carbomethoxy-3-beta-(4-iodophenyl) nortropane positron-emission tomography (PET) was set as the reference standard.

RESULTS

When CS-SENSE was applied for nigrosome-1 imaging on SWI, the non-diagnostic scan rate was lowered significantly from 19.3% (17/88) to 5.6% (6/107; p=0.004). Diagnosis of PD and atypical Parkinsonism based on the loss of nigrosome-1 on SWI and based on NM-MRI showed good diagnostic value (area under the curve [AUC] 0.821, 95% confidence interval [CI] = 0.755-0.875: AUC 0.832, 95% CI = 0.771-0.882, respectively) with a substantial inter-reader agreement (κ = 0.791 and 0.681, respectively). Combined SWI and neuromelanin had a similar discriminatory ability (AUC 0.830, 95% CI = 0.770-0.880). Similarly, the diagnosis of PD was excellent.

CONCLUSIONS

CS-SENSE may add value to the diagnostic capability of nigrosome-1 on SWI to reduce the nondiagnostic scan rates. Furthermore, loss of nigrosome-1 on SWI or volume loss of neuromelanin on NM-MRI may be helpful for diagnosing PD.

The future of wearable EEG: a review of ear-EEG technology and its applications

Objective.This review paper provides a comprehensive overview of ear-electroencephalogram (EEG) technology, which involves recording EEG signals from electrodes placed in or around the ear, and its applications in the field of neural engineering.Approach.We conducted a thorough literature search using multiple databases to identify relevant studies related to ear-EEG technology and its various applications. We selected 123 publications and synthesized the information to highlight the main findings and trends in this field.Main results.Our review highlights the potential of ear-EEG technology as the future of wearable EEG technology. We discuss the advantages and limitations of ear-EEG compared to traditional scalp-based EEG and methods to overcome those limitations. Through our review, we found that ear-EEG is a promising method that produces comparable results to conventional scalp-based methods. We review the development of ear-EEG sensing devices, including the design, types of sensors, and materials. We also review the current state of research on ear-EEG in different application areas such as brain-computer interfaces, and clinical monitoring.Significance.This review paper is the first to focus solely on reviewing ear-EEG research articles. As such, it serves as a valuable resource for researchers, clinicians, and engineers working in the field of neural engineering. Our review sheds light on the exciting future prospects of ear-EEG, and its potential to advance neural engineering research and become the future of wearable EEG technology.

Decoding auditory-evoked response in affective states using wearable around-ear EEG system

Objective.In this paper, an around-ear EEG system is investigated as an alternative methodology to conventional scalp-EEG-based systems in classifying human affective states in the arousal-valence domain evoked in response to auditory stimuli.Approach.EEG recorded from around the ears is compared to EEG collected according to the international 10-20 system in terms of efficacy in an affective state classification task. A wearable device with eight dry EEG channels is designed for ear-EEG acquisition in this study. Twenty-one subjects participated in an experiment consisting of six sessions over three days using both ear and scalp-EEG acquisition methods. Experimental tasks consisted of listening to an auditory stimulus and self-reporting the elicited emotion in response to the said stimulus. Various features were used in tandem with asymmetry methods to evaluate binary classification performances of arousal and valence states using ear-EEG signals in comparison to scalp-EEG.Main results.We achieve an average accuracy of 67.09% ± 6.14 for arousal and 66.61% ± 6.14 for valence after training a multi-layer extreme learning machine with ear-EEG signals in a subject-dependent context in comparison to scalp-EEG approach which achieves an average accuracy of 68.59% ± 6.26 for arousal and 67.10% ± 4.99 for valence. In a subject-independent context, the ear-EEG approach achieves 63.74% ± 3.84 for arousal and 64.32% ± 6.38 for valence while the scalp-EEG approach achieves 64.67% ± 6.91 for arousal and 64.86% ± 5.95 for valence. The best results show no significant differences between ear-EEG and scalp-EEG signals for classifications of affective states.Significance.To the best of our knowledge, this paper is the first work to explore the use of around-ear EEG signals in emotion monitoring. Our results demonstrate the potential use of around-ear EEG systems for the development of emotional monitoring setups that are more suitable for use in daily affective life log systems compared to conventional scalp-EEG setups.

Eosinophil-derived TGFβ1 controls the new bone formation in chronic rhinosinusitis with nasal polyps

BACKGROUND

Chronic rhinosinusitis with nasal polyps (CRSwNP) is characterized by chronic eosinophilic inflammation and new bone formation (NBF). These processes may be associated with each other in the pathogenesis and influence the severity and prognosis of the disease. However, it is still unclear how eosinophilic inflammation is involved in the NBF.

METHODOLOGY

Sinus bone cells were isolated from ethmoid bone tissues of patients with CRSwNP and controls. Transforming growth factor beta 1 (TGFβ1) and alkaline phosphatase (ALP) expression in sinus bone cells was determined using quantitative RT-PCR, immunoblotting, and immunohistochemistry. The co-localization of TGFβ1 with eosinophils was assessed by immunofluorescence staining. Sinus bone cells were co-cultured with eosinophils (Eol-1 cell line), which were differentiated with butyrate, to measure the osteoblast differentiation activity of sinus bone cells.

RESULTS

TGFβ1 expression was increased in sinus bone tissues and correlated with CT scores in CRSwNP. TGFβ1 was also increased in the submucosa of CRSwNP and co-localized predominantly with eosinophils compared with neutrophils Differentiated Eol-1 cells-derived TGFβ1 increased ALP expression in sinus bone cells. Treatment with a TGFβ inhibitor attenuated TGFβ1-induced ALP expression and staining in sinus bone cells of CRSwNP, leading to loss of bone formation.

CONCLUSIONS

Eosinophil-derived TGFβ1 was enriched in the submucosa of CRSwNP, which induced ALP expression in sinus bone cells and NBF. Therefore, eosinophil-derived TGFβ1 may mediate aberrant bone remodeling in CRSwNP.

Adapting Artifact Subspace Reconstruction Method for SingleChannel EEG using Signal Decomposition Techniques. Annu Int Conf IEEE Eng Med Biol Soc 2023;2023:1-4. [PMID: 38083141 DOI: 10.1109/embc40787.2023.10340077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0]

Artifact removal from electroencephalography (EEG) data is a crucial step in the analysis of neural signals. One method that has been gaining popularity in recent years is Artifact Subspace Reconstruction (ASR), which is highly effective in eliminating large amplitude and transient artifacts in EEG data. However, traditional ASR is not possible to use with single-channel EEG data. In this study, we propose incorporating signal decomposition techniques such as ensemble empirical mode decomposition (EEMD), wavelet transform (WT), and singular spectrum analysis (SSA) into ASR, to decompose single-channel data into multiple components. This allows the ASR process to be applied effectively to the data. Our results show that the proposed single-channel version of ASR outperforms its counterpart Independent Component Analysis (ICA) methods when tested on two open datasets. Our findings indicate that ASR has significant potential as a powerful tool for removing artifacts from EEG data analysis.Clinical Relevance- This provided artifact removal technique for single-channel EEG.

Neural Applications Using Immersive Virtual Reality: A Review on EEG Studies

Recent advancements in immersive virtual reality head-mounted displays allowed users to better engage with simulated graphical environments. Having the screen egocentrically stabilized in a way such that the users may freely rotate their heads to observe virtual surroundings, head-mounted displays present virtual scenarios with rich immersion. With such an enhanced degree of freedom, immersive virtual reality displays have also been integrated with electroencephalograms, which make it possible to study and utilize brain signals non-invasively, to analyze and apply their capabilities. In this review, we introduce recent progress that utilized immersive head-mounted displays along with electroencephalograms across various fields, focusing on the purposes and experimental designs of their studies. The paper also highlights the effects of using immersive virtual reality discovered through the electroencephalogram analysis and discusses existing limitations, current trends as well as future research opportunities that may hopefully act as a useful source of information for further improvement of electroencephalogram-based immersive virtual reality applications.

ALIS: Learning Affective Causality Behind Daily Activities From a Wearable Life-Log System

Human emotions and behaviors are reciprocal components that shape each other in everyday life. While the past research on each element has made use of various physiological sensors in many ways, their interactive relationship in the context of daily life has not yet been explored. In this work, we present a wearable affective life-log system (ALIS) that is robust as well as easy to use in daily life to accurately detect emotional changes and determine the cause-and-effect relationship between emotions and emotional situations in users' lives. The proposed system records how a user feels in certain situations during long-term activities using physiological sensors. Based on the long-term monitoring, the system analyzes how the contexts of the user's life affect his/her emotional changes and builds causal structures between emotions and observable behaviors in daily situations. Furthermore, we demonstrate that the proposed system enables us to build causal structures to find individual sources of mental relief suited to negative situations in school life.

Detection rate of MR myelography without intrathecal gadolinium in patients with newly diagnosed spontaneous intracranial hypotension

AIM

To evaluate the detection rate of magnetic resonance (MR) myelography without intrathecal gadolinium for cerebrospinal fluid (CSF) leakage in patients with newly diagnosed spontaneous intracranial hypotension (SIH) and to validate a published scoring system for predicting CSF leakage.

MATERIALS AND METHODS

This retrospective, observational, single-institution study included patients with newly diagnosed SIH between March 2015 and April 2021. Patients were included if they (a) had newly diagnosed SIH and (b) underwent initial brain MR imaging and preprocedural MR myelography with two- and three-dimensional turbo spin-echo sequences. Patients who underwent spine surgery or procedures including epidural injection and acupuncture were excluded. The detection rate was defined as the proportion of patients with a true-positive MR myelography result among all patients with confirmed CSF leakage. The interobserver agreement for the MR myelography results between two radiologists was analysed using weighted kappa statistics.

RESULTS

A total of 136 patients (mean age, 48 years; 70 women) with suspected SIH were included. Of these patients, 120 (88%, 120/136) were confirmed to have CSF leakage. Of the patients with confirmed CSF leakage, 90 (75%, 90/120) had epidural fluid collection. The detection rate of MR myelography for CSF leakage was 88% (105/120). The interobserver agreement between the two readers for detecting CSF leakage (κ = 0.76) or epidural fluid collection (κ = 0.76) on MR myelography was high. Among 24 patients with normal brain MR imaging results, 16 had CSF leakage (67%, 16/24).

CONCLUSIONS

Non-invasive MR myelography without intrathecal gadolinium should be considered to detect CSF leakage in patients with suspected SIH.

A novel online BCI system using speech imagery and ear-EEG for home appliances control

BACKGROUND AND OBJECTIVE

This paper investigates a novel way to interact with home appliances via a brain-computer interface (BCI), using electroencephalograph (EEG) signals acquired from around the user's ears with a custom-made wearable BCI headphone.

METHODS

The users engage in speech imagery (SI), a type of mental task where they imagine speaking out a specific word without producing any sound, to control an interactive simulated home appliance. In this work, multiple models are employed to improve the performance of the system. Temporally-stacked multi-band covariance matrix (TSMBC) method is used to represent the neural activities during SI tasks with spatial, temporal, and spectral information included. To further increase the usability of our proposed system in daily life, a calibration session, where the pre-trained models are fine-tuned, is added to maintain performance over time with minimal training. Eleven participants were recruited to evaluate our method over three different sessions: a training session, a calibration session, and an online session where users were given the freedom to achieve a given goal on their own.

RESULTS

In the offline experiment, all participants were able to achieve a classification accuracy significantly higher than the chance level. In the online experiments, a few participants were able to use the proposed system to freely control the home appliance with high accuracy and relatively fast command delivery speed. The best participant achieved an average true positive rate and command delivery time of 0.85 and 3.79 s/command, respectively.

CONCLUSION

Based on the positive experimental results and user surveys, the novel ear-EEG-SI-based BCI paradigm is a promising approach for the wearable BCI system for daily life.

POS0030 CLINICAL AND GENETIC FACTORS ASSOCIATED WITH RADIOGRAPHIC PROGRESSION IN PATIENTS WITH ANKYLOSING SPONDYLITIS

Background

Ankylosing spondylitis (AS) is a heritable inflammatory disease eventually leading to spinal fusion 1. Severity of structural damage is highly variable, some patients develop almost no change in spinal structure for long disease duration, whereas others have total ankylosis even in the early stage of disease.

Objectives

To identify clinical and genetic factors associated with severe radiographic damage in patients with AS.

Methods

We newly generated genome-wide variant data (833K, KoreanChip) of 444 AS patients. The severity of radiographic damage was assessed using the modified Stoke Ankylosing Spondylitis Spinal Score (mSASSS). To identify clinical and genetic factors associated with severe radiographic damage, multiple linear regression analyses were performed. Human AS osteoprogenitor cells were used for functional validation. Pathway analysis was also conducted.

Results

A total 444 AS patients (male 90.3%) were enrolled. The median mSASSS at baseline was 7.7 (5.5-16.8). The patients were observed for 9.6 (7.9-11.3) years. Within this period, the median mSASSS score increased to 14.0 (7.0-36.8). The most influential clinical factor of final mSASSS was baseline mSASSS (β = 0.818, p < 0.001). Peripheral joint involvement was associated with decreased possibility of severe radiographic damage (β = -0.221, p < 0.001). Eye involvement, longer follow up duration, and increased age at enrollment were associated with increased final mSASSS (β = 0.165, p < 0.001; β = 0.039, p < 0.001; β = 0.010, p = 0.002, respectively). Ryanodine receptor 3 (RYR3) gene was associated with severe radiographic damage (β = 1.105, p = 1.97x10-06). Treatment with Rhodamine B, a ligand of RYR3, induced extracellular matrix mineralization of AS osteoprogenitors in vitro. For the pathway analysis, PI3K-Akt signaling pathway and focal adhesion pathway were associated with severe radiographic damage in AS.

Conclusion

This study identified clinical and genetic factors that contributed to better understanding of the pathogenesis and biology associated with radiographic damage in AS.

References

[1]Li Z, Brown MA. Progress of genome-wide association studies of ankylosing spondylitis. Clinical & Translational Immunology. 2017;6(12):e163.

Disclosure of Interests

None declared

SOX9+ enthesis cells are associated with spinal ankylosis in ankylosing spondylitis

OBJECTIVE

Although cartilage degeneration and invasion of the subchondral bone plate in entheseal lesion has been considered to consequently lead bony ankylosis in ankylosing spondylitis (AS), no evident mechanisms are known.

DESIGN

To identify histopathological and physiological changes in enthesitis-related ankylosis in AS, we performed molecular characterization of transcription factors and surface markers, and transcriptome analysis with human tissues. Entheseal tissue containing subchondral bone was obtained from the facet joints of 9 patients with AS and 10 disease controls, and assessed by using differential staining techniques. Enthesis cells were isolated, characterized, stimulated with TNF and/or IL-17A, and analysed by cell-based experimental tools.

RESULTS

We found diffusely distributed granular tissue and cartilage in the subchondral bone in AS. Co-expression of SOX9, a specific transcription factor in cartilage, and matrix metalloproteinase 13 (MMP13) was found in the granular tissues within the subchondral bone from AS patients. Intriguingly, SOX9 expression was significantly higher in AS enthesis cells than controls and correlated with TNFR1 and IL-17RA expressions, which is important for high reactivity to TNF and IL-17A cytokines. Co-stimulation by TNF and IL-17A resulted in accelerated mineralization/calcification features, and increased OCN expression in AS enthesis cells. Furthermore, SOX9 overexpression in enthesis leads to promoting mineralization feature by TNF and IL-17A stimuli. Finally, OCN expression is elevated in the destructive enthesis of advanced AS.

CONCLUSION

These findings provide insight into the links between inflammation and the mineralization of entheseal tissue as the initiation of spinal ankylosis, emphasizing the importance of SOX9⁺ enthesis cells.

Impact of prognostic nutritional index on the recurrence of hepatocellular carcinoma after a curative resection

Backgrounds/Aims

The purpose of this retrospective study was to determine the association between prognostic nutritional index (PNI) and recurrence of hepatocellular carcinoma after a curative resection.

Methods

Between 2007 to 2019, 130 patients who underwent curative hepatectomy for hepatocellular carcinoma were enrolled. PNI was calculated. Its cutoff value was identified through receiver operating characteristic curve analysis. According to PNI, patients were divided into two groups. Univariate and multivariate analyses were performed to identify independent risk factors for recurrence.

Results

The cutoff value of PNI was 52. In univariate analysis, alcoholic liver cirrhosis (p = 0.041), protein induced by vitamin K antagonist- II &ge; 200 (p = 0.012), indocyanine green retention test (ICG R15) >10% (p = 0.001), estimated blood loss &ge; 800 mL (p = 0.037), tumor size (p = 0.001), microvascular invasion (p = 0.023), T-stage (p = 0.001), and PNI < 52 (p = 0.001) were significant factors affecting the recurrence. In multivariate analysis, alcoholic liver cirrhosis (p = 0.046), ICG R15 >10% (p = 0.025), T-stage (p = 0.003), and PNI < 52 (p = 0.046) were independent prognostic factors for disease-free survival.

Conclusions

PNI, a nutritional and immunologic factor, is an independent prognostic factor that can predict the recurrence of hepatocellular carcinoma in patients undergoing a curative resection.

Isolated mass-forming IgG4-related sclerosing cholangitis masquerading as extrahepatic cholangiocarcinoma: A case report

BACKGROUND

IgG4-related sclerosing cholangitis (IgG4-RSC) is an uncommon benign disease, and its rarer, isolated and mass-forming subtype poses a significant challenge to differential diagnosis from cholangiocarcinoma of the extrahepatic bile duct. We herein report a case of isolated IgG4-RSC with an obstructing bile duct mass, for which extrahepatic bile duct resection was performed under the impression of proximal common bile duct (CBD) cancer.

CASE SUMMARY

A 79-year-old male was admitted for jaundice that had developed 1 mo prior. There was no family history for autoimmune diseases or biliary cancer. Computed tomography (CT) and magnetic resonance cholangiopancreaticography revealed a short segmental concentric wall thickening of the proximal CBD with diffuse dilatation of the bile duct to the periphery. The endoscopic biopsy specimen showed no malignant cells. Positron emission tomography-CT showed a focal hypermetabolic lesion (SUVmax 4.2) in and around the proximal CBD area. With the impression of proximal CBD cancer, we performed segmental resection of the extrahepatic bile duct. Histopathology demonstrated marked sclerosis with diffuse lymphoplasmacytic infiltration and some eosinophils. Immunohistochemical staining for IgG4 showed increased positivity in some areas (up to 30/high-power field) and IgG4+/IgG+ cell ratio as 30%-50%. Pathologists’ impression was IgG4-related sclerosing disease. Follow-up serum IgG4 levels were continuously elevated; however, no evidence of relapse or other organ involvement related to IgG4-RSC presented.

CONCLUSION

Isolated and mass-forming IgG4-RSC displays striking similarity with cholangiocarcinoma. To avoid unnecessary major surgery, high index of suspicion is needed.

Speech-imagery-based brain-computer interface system using ear-EEG

OBJECTIVE

This study investigates the efficacy of electroencephalography (EEG) centered around the user's ears (ear-EEG) for a speech-imagery-based brain-computer interface (BCI) system.

APPROACH

A wearable ear-EEG acquisition tool was developed and its performance was directly compared to that of a conventional 32-channel scalp-EEG setup in a multi-class speech imagery classification task. Riemannian tangent space projections of EEG covariance matrices were used as input features to a multi-layer extreme learning machine classifier. Ten subjects participated in an experiment consisting of six sessions spanning three days. The experiment involves imagining four speech commands ('Left,' 'Right,' 'Forward,' and 'Go back') and staying in a rest condition.

MAIN RESULTS

The classification accuracy of our system is significantly above the chance level (20%). The classification result averaged across all ten subjects is 38.2% and 43.1% with a maximum (max) of 43.8% and 55.0% for ear-EEG and scalp-EEG, respectively. According to an analysis of variance, seven out of ten subjects show no significant difference between the performance of ear-EEG and scalp-EEG.

SIGNIFICANCE

To our knowledge, this is the first study that investigates the performance of ear-EEG in a speech-imagery-based BCI. The results indicate that ear-EEG has great potential as an alternative to the scalp-EEG acquisition method for speech-imagery monitoring. We believe that the merits and feasibility of both speech imagery and ear-EEG acquisition in the proposed system will accelerate the development of the BCI system for daily-life use.

Review of machine learning methods in soft robotics

Soft robots have been extensively researched due to their flexible, deformable, and adaptive characteristics. However, compared to rigid robots, soft robots have issues in modeling, calibration, and control in that the innate characteristics of the soft materials can cause complex behaviors due to non-linearity and hysteresis. To overcome these limitations, recent studies have applied various approaches based on machine learning. This paper presents existing machine learning techniques in the soft robotic fields and categorizes the implementation of machine learning approaches in different soft robotic applications, which include soft sensors, soft actuators, and applications such as soft wearable robots. An analysis of the trends of different machine learning approaches with respect to different types of soft robot applications is presented; in addition to the current limitations in the research field, followed by a summary of the existing machine learning methods for soft robots.

Eyes are faster than hands: A soft wearable robot learns user intention from the egocentric view

To perceive user intentions for wearable robots, we present a learning-based intention detection methodology using a first-person-view camera.

A-Situ: a computational framework for affective labeling from psychological behaviors in real-life situations

This paper presents a computational framework for providing affective labels to real-life situations, called A-Situ. We first define an affective situation, as a specific arrangement of affective entities relevant to emotion elicitation in a situation. Then, the affective situation is represented as a set of labels in the valence-arousal emotion space. Based on psychological behaviors in response to a situation, the proposed framework quantifies the expected emotion evoked by the interaction with a stimulus event. The accumulated result in a spatiotemporal situation is represented as a polynomial curve called the affective curve, which bridges the semantic gap between cognitive and affective perception in real-world situations. We show the efficacy of the curve for reliable emotion labeling in real-world experiments, respectively concerning (1) a comparison between the results from our system and existing explicit assessments for measuring emotion, (2) physiological distinctiveness in emotional states, and (3) physiological characteristics correlated to continuous labels. The efficiency of affective curves to discriminate emotional states is evaluated through subject-dependent classification performance using bicoherence features to represent discrete affective states in the valence-arousal space. Furthermore, electroencephalography-based statistical analysis revealed the physiological correlates of the affective curves.

Interactive virtual objects attract attention and induce exploratory behaviours in rats

Animals use visual information to recognize the value of objects and respond with different behaviours, such as evasion or approach. While rodents show defensive behaviour toward an artificial looming stimulus that mimics an approaching avian predator, the visual feature that attracts them to targets with positive value, such as prey, remains unclear. Here, we reveal that rats show curiosity-related behaviours towards a virtual object on screen when it moves interactively with their movements, whereas they show less response to a static object, a regularly moving object, or interactive dislocation of the background. To mimic evading prey, we programmed the object to shrink when touched. Rats preferentially responded to interactive shrinking over interactive enlargement. These results suggest that rats exhibit a selective response to interactive objects. This would seem to be an efficient strategy for finding optimal prey using the evolutionarily conserved prey-predator relationship.

Clinicopathologic analysis of intraductal papillary neoplasm of bile duct: Korean multicenter cohort study

BACKGROUND

IPNB is very rare disease and most previous studies on IPNB were case series with a small number due to low incidence. The aim of this study is to validate previously known clinicopathologic features of intraductal papillary neoplasm of bile duct (IPNB) based on the first largest multicenter cohort.

METHODS

Among 587 patients previously diagnosed with IPNB and similar diseases from each center in Korea, 387 were included in this study after central pathologic review. We also reviewed all preoperative image data.

RESULTS

Of 387 patients, 176 (45.5%) had invasive carcinoma and 21 (6.0%) lymph node metastasis. The 5-year overall survival was 80.9% for all patients, 88.8% for IPNB with mucosal dysplasia, and 70.5% for IPNB with invasive carcinoma. According to the "Jang & Kim's modified anatomical classification," 265 (68.5%) were intrahepatic, 103 (26.6%) extrahepatic, and 16 (4.1%) diffuse type. Multivariate analysis revealed that tumor invasiveness was a unique predictor for survival analysis. (p = 0.047 [hazard ratio = 2.116, 95% confidence interval 1.010-4.433]).

CONCLUSIONS

This is the first Korean multicenter study on IPNB through central pathologic and radiologic review process. Although IPNB showed good long-term prognosis, relatively aggressive features were also found in invasive carcinoma and extrahepatic/diffuse type.

SAT0353 STAT3 PHOSPHORYLATION IS INVOLVED IN THE DEVELOPMENTS OF INFLAMMATORY ARTHRITIS, ENTHESITIS, AND NEW BONE FORMATION IN ANKYLOSING SPONDYLITIS

Background:

Ankylosing Spondylitis (AS) is a chronic inflammatory rheumatic disease, which is characterized by the enthesitis, peripheral arthritis, and chronic inflammation of the spine, leading to bony ankylosis. Signal transducer and activator of transcription (STAT) family proteins are latent cytoplasmic transcription factors that convey signals to the nucleus. It is activated by IL-6, IL-23, and IL-22 through JAK-mediated phosphorylation. Moreover, genetic studies implicate interleukin-23 (IL-23) receptor signal, including STAT3 in the development of AS. IL-17A has recently emerged as a potential target that regulates the extensive inflammation and abnormal bone formation observed in AS. It was reported that STAT3 is a regulatory factor that induces Th17 cell development from naive CD4 T cells.

Objectives:

The aim of this study is to investigate whether the STAT3 phosphorylation (stat3-p) inhibitor has a therapeutic effect on inflammation and new bone formation in AS.

Methods:

Eight weeks after curdlan injection, SKG mice were treated with stat3-p inhibitor or mock as a control. Clinical and histologic scores for arthritis and enthesitis were evaluated. Synovial fluid mononuclear cells (SFMC) samples were obtained from AS patients. Inflammatory cytokine producing cells were analyzed using flow cytometry. Bone tissue samples were obtained from the facet joints of patients with AS at surgery. Primary bone-derived cells (BdCs) were isolated and cultured. The osteogenic differentiation was assessed in vitro for 3 weeks using ALP activity, Alizarin red S (ARS), Type I collagen, von kossa,and hydroxyapatitestains. Statistical analysis was performed using Prism 5.0 Software. A p < 0.05 was considered statistically significant.

Results:

The stat3-p inhibitor significantly suppressed peripheral arthritis and enthesitis in SKG mice (figure 1). Inflammatory infiltration around the tendon–bone insertion site and along the tendon, as well as bony involvement were all reduced in stat3-p inhibitor-treated mice compared to control mice. We found that the levels of IFN-±, IL-17, TNF-± were higher in AS Synovial fluid. A significantly decreased frequencies of IFN-±, IL-17, TNF-± producing cells in AS SFMC were shown after stat3-p inhibitor treatment (P < 0.01).

In vitro experiment of bone formation, the stat3-p inhibitor suppressed ALP activity. In addition, there were significant decrease in Alizarin red S (ARS), Type I collagen, von kossa staining scores due to stat3-p inhibitor at a concentration of 5 μM.Light intensity of hydroxyapatitestaining was also decreased by stat3-p inhibitor in a dose dependent manner (figure 2). Intriguingly, the stat3-p inhibitor suppressed osteogenesis in both early phase and late phase in AS-BdCs, down-regulating osteoblast-involved genes.

Conclusion:

The stat3-p inhibitor had beneficial effects on reducing inflammation and new bone formation in AS animal model. In addition, stat3-p inhibitor suppressed bone formation in vitro experiment. These findings suggest that the stat3-p inhibitor could be a potential therapeutic agent for AS.

References:

[1]Arthritis Res Ther 2018;20:115.

[2]Nat Med 2012;18:1069-76.

[3]Rheumatology (Oxford) 2017;56:488-493.

[4]Nat Rev Immunol. 2011;11:239–50.

[5]J Exp Med 2005;201:949–60.

Acknowledgments:

None

Disclosure of Interests:

None declared

AB0116 DECREASED SERUM LEVEL OF IRISIN IN PATIENTS WITH ANKYLOSING SPONDYLITIS

Background:

Irisin, exercise-mediated myokine, is one of the most recently discovered hormones. Irisin has been shown to play multifunctional roles including anti-inflammation by suppressing secretion of NF kß, TNF-α, IL-6, and other pro-inflammatory cytokines from macrophages and adipocytes [1]. Thus, several attempts have been made to investigate irisin in chronic inflammatory rheumatic diseases. And recent evidences show that serum irisin concentration is lower in patients with osteoarthritis, rheumatoid arthritis, and behcet disease than health individuals [2-4]. Furthermore, one study showed that serum irisin level was negatively correlated with radiographic severity of knee osteoarhtiritis [2]. However, no previous study has investigated irisin in patients with ankylosing spondylitis (AS).

Objectives:

To assess the serum level of irisin, and evaluate the possible relationship of irisin with disease activity in patients with AS.

Methods:

Male patients with AS fulfilled the modified New York criteria (n=119), and healthy male controls (n=30) were enrolled. Serum irisin level was measured by ELISA (Cusabio, CSB-EQ027943HU). Disease activity was assessed by acute phase reactants, Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Bath Ankylosing Spondylitis Functional Index (BASFI), and modified Stoke Ankylosing Spondylitis Spinal Score (mSASSS). Clinical characteristics and serum irisin level of the AS group were compared with those of the control group using Student t-test for normally distributed continuous measures and Mann-Whitney U test for non-normally distributed continuous measures. To evaluate the correlations of serum Irisin level and AS disease activity, Spearman’s correlation test was used. AS patients were grouped into the high BASDAI group (BASDAI ≥ 4, n=45) and the Low BASDAI group (BASDAI < 4, n=74). And serum irisin level was also compared between two groups.

Results:

AS group had lower serum irisin concentration compared with healthy control group (60.50 [23.68-131.15] vs. 124.69 [79.58-192.90], p=0.013), while age and body mass index were not significantly different between groups. There was no significant correlation between irisin level and disease activities. However, High BASDAI group showed significantly lower irisin level than low BASDAI group (44.64 [18.13-85.89] vs. 65.68 [31.81-165.31], p=0.011).

Conclusion:

AS patients have lower serum irisin concentrations than healthy controls. AS patients with severe symptoms tend to have lower serum level of irisin than those with less severe symptoms.

References:

[1]H. Askari, et al. A glance at the therapeutic potential of irisin against diseases involving inflammation, oxidative stress, and apoptosis: an introductory review. Pharmacol Res. 2018

[2]Mao Y, et al. Association of Irisin and CRP Levels with the Radiographic Severity of Knee Osteoarthritis. Genet Test Mol Biomarkers. 2016

[3]Rania M. Gamal, et al. Preliminary study of the association of serum irisin levels with poor sleep quality in rheumatoid arthritis patients. Sleep Med. 2020

[4]A. Icli, et al. Novel myokine: irisin may be an independent predictor for subclinic atherosclerosis in Behcet’s disease. J. Investig. Med. 2016

Disclosure of Interests:

None declared

Pancreatitis, panniculitis, and polyarthritis syndrome caused by pancreatic pseudocyst: A case report

BACKGROUND

Panniculitis, polyarthritis, and pancreatitis (PPP) syndrome is a triad comprising an extremely rare extra-pancreatic complication of pancreatic disease. Herein, we describe a patient with PPP syndrome caused by fistula formation between the inferior vena cava (IVC) and pancreatic pseudocyst.

CASE SUMMARY

A 64-year-old man visited the hospital with bilateral leg pain that began one week prior. He had no specific diseases, except hypertension. His vital signs were normal. Blood test revealed the following findings: White blood cell count, 28690/µL; amylase level, 9055 U/L; lipase level, 2089 U/L; and C-reactive protein level, 12.94 mg/dL. Computed tomography of the pancreas revealed recent acute pancreatitis. Nonsteroidal anti-inflammatory drugs were administered with no improvement. After steroid administration, pain slightly improved. Skin lesions were diagnosed as panniculitis. Bone scan and knee magnetic resonance imaging revealed osteoarthritis and bone marrow infarctions. Surgical treatment was considered; total pancreatectomy with splenectomy was performed. A pseudocyst was present posterior to the head of the pancreas, forming a fistula with the suprarenal IVC. After surgery, amylase and lipase levels decreased. However, the patient died of an uncontrolled infection on the 13th postoperative day.

CONCLUSION

PPP syndrome should be suspected when accompanied by skin and joint lesions. Delays in diagnosis could have catastrophic consequences.

Bayesian Weight Decay on Bounded Approximation for Deep Convolutional Neural Networks

This paper determines the weight decay parameter value of a deep convolutional neural network (CNN) that yields a good generalization. To obtain such a CNN in practice, numerical trials with different weight decay values are needed. However, the larger the CNN architecture is, the higher is the computational cost of the trials. To address this problem, this paper formulates an analytical solution for the decay parameter through a proposed objective function in conjunction with Bayesian probability distributions. For computational efficiency, a novel method to approximate this solution is suggested. This method uses a small amount of information in the Hessian matrix. Theoretically, the approximate solution is guaranteed by a provable bound and is obtained by a proposed algorithm, where its time complexity is linear in terms of both the depth and width of the CNN. The bound provides a consistent result for the proposed learning scheme. By reducing the computational cost of determining the decay value, the approximation allows for the fast investigation of a deep CNN (DCNN) which yields a small generalization error. Experimental results show that our assumption verified with different DCNNs is suitable for real-world image data sets. In addition, the proposed method significantly reduces the time cost of learning with setting the weight decay parameter while achieving good classification performances.

Surgery for metastatic renal cell carcinoma in the pancreatic head: A case report and literature review

Malignant tumors that metastasize to the pancreas are rare. Among them, renal cell carcinoma is the most common. Surgical resection is more effective in treatment for patients with pancreatic metastasis from renal cell carcinoma, although targeted therapy is applied, to advanced renal cell carcinoma. It is essential to know exact medical history of the patient, because metastasis can occur late after nephrectomy. Surgical procedure may vary, depending on location and number of tumors. We report a case of resection of a pancreatic head tumor, 20 years after nephrectomy due to renal cell carcinoma.

Influencing factors on preventive health behaviours for Zika virus in pregnant women and their partners

AIMS AND OBJECTIVES

To identify Zika virus-related knowledge, attitudes to Zika virus and health motivations of pregnant women, women preparing for pregnancy and their partners, and to identify factors that influence preventive health behaviours for Zika virus infection.

BACKGROUND

Prevention of Zika virus infection is becoming a major worldwide public health effort. The high-risk group for Zika virus infection comprises women who are pregnant or preparing for pregnancy. Few studies have addressed preventive health behaviours for Zika virus infection by gender.

DESIGN

This study was a descriptive cross-sectional survey.

METHODS

Participants (112 males and 147 females) were selected by convenience sampling from three obstetric clinics located in South Korea. Women and their partners who visited obstetric clinics during pregnancy or preparing for pregnancy were included as subjects.

RESULTS

Factors associated with preventive health behaviours for Zika virus were checking infection status of Zika virus on destinations when planning a trip and attitudes to Zika virus in males and age, educational level, intention to travel to Zika virus endemic countries, attitudes to Zika virus and health motivation in females.

CONCLUSIONS

Factors that influence preventive health behaviours for Zika virus were different by gender. However, attitudes to Zika virus were influential to both genders. Gender differences should be considered in development of health policies to improve preventive health behaviours for Zika virus. Younger and less educated women are to be targeted, and health management programmes should be developed to promote health motivation.

RELEVANCE TO CLINICAL PRACTICE

Pregnant women, women preparing for pregnancy and their partners need education and public health promotion to improve self-management during travel to places where Zika virus is endemic. Health policies and health management programmes considering age and educational background should be developed to promote health motivation in women of childbearing age.

Peritonitis from injury of an aberrant subvesical bile duct during laparoscopic cholecystectomy: A rare case report

Aberrant subvesical bile ducts are rare anatomical structures. Damage to these ducts leads to bile leakage and can result in life-threatening complications. Surgeons should be cautious that such a structure may be present, and surgery should be performed with the correct surgical field to prevent damage to these structures.

Long-term outcomes of cemented versus cementless humeral components in arthroplasty of the shoulder

Aims

In the initial development of total shoulder arthroplasty (TSA), the humeral component was usually fixed with cement. Cementless components were subsequently introduced. The aim of this study was to compare the long-term outcome of cemented and cementless humeral components in arthroplasty of the shoulder.

Patients and Methods

All patients who underwent primary arthroplasty of the shoulder at our institution between 1970 and 2012 were included in the study. There were 4636 patients with 1167 cemented humeral components and 3469 cementless components. Patients with the two types of fixation were matched for nine different covariates using a propensity score analysis. A total of 551 well-balanced pairs of patients with cemented and cementless components were available after matching for comparison of the outcomes. The clinical outcomes which were analysed included loosening of the humeral component determined at revision surgery, periprosthetic fractures, post-operative infection and operating time.

Results

The overall five-, ten-, 15- and 20-year rates of survival were 98.9%, 97.2%, 95.5%, and 94.4%, respectively. Survival without loosening at 20 years was 98% for cemented components and 92.4% for cementless components. After propensity score matching including fixation as determined by the design of the component, humeral loosening was also found to be significantly higher in the cementless group. Survival without humeral loosening at 20 years was 98.7% for cemented components and 91.0% for cementless components. There was no significant difference in the risk of intra- or post-operative fracture. The rate of survival without deep infection and the mean operating time were significantly higher in the cemented group.

Conclusion

Both types of fixation give rates of long-term survival of > 90%. Cemented components have better rates of survival without loosening but this should be weighed against increased operating time and the risk of bony destruction of the proximal humerus at the time of revision of a cemented humeral component. Cite this article: Bone Joint J 2017;99-B:666–73.