Reference Genome Choice and Filtering Thresholds Jointly Influence Phylogenomic Analyses

Molecular phylogenies are a cornerstone of modern comparative biology and are commonly employed to investigate a range of biological phenomena, such as diversification rates, patterns in trait evolution, biogeography, and community assembly. Recent work has demonstrated that significant biases may be introduced into downstream phylogenetic analyses from processing genomic data; however, it remains unclear whether there are interactions among bioinformatic parameters or biases introduced through the choice of reference genome for sequence alignment and variant calling. We address these knowledge gaps by employing a combination of simulated and empirical data sets to investigate the extent to which the choice of reference genome in upstream bioinformatic processing of genomic data influences phylogenetic inference, as well as the way that reference genome choice interacts with bioinformatic filtering choices and phylogenetic inference method. We demonstrate that more stringent minor allele filters bias inferred trees away from the true species tree topology, and that these biased trees tend to be more imbalanced and have a higher center of gravity than the true trees. We find the greatest topological accuracy when filtering sites for minor allele count (MAC) >3-4 in our 51-taxa data sets, while tree center of gravity was closest to the true value when filtering for sites with MAC >1-2. In contrast, filtering for missing data increased accuracy in the inferred topologies; however, this effect was small in comparison to the effect of minor allele filters and may be undesirable due to a subsequent mutation spectrum distortion. The bias introduced by these filters differs based on the reference genome used in short read alignment, providing further support that choosing a reference genome for alignment is an important bioinformatic decision with implications for downstream analyses. These results demonstrate that attributes of the study system and dataset (and their interaction) add important nuance for how best to assemble and filter short-read genomic data for phylogenetic inference.

Effect of Annoying Sounds on Postural Control

Objectives: This study aimed to explore the impact of irritating sounds on the postural control of healthy adults, considering both linear and nonlinear parameters, subjective assessments, and gender differences. Methods: Thirty-four young participants (17 females, 17 males) completed three 30 s bipedal standing stability tests on a balance platform: one with visual control (EO), another without visual control (EC), and a third without visual control but accompanied by irritating sounds (ECS). Additionally, participants filled out a questionnaire evaluating their sound sensitivity. Linear and nonlinear parameters from each balance test were considered for statistical analysis. Results: The findings reveal significant gender-based variations in sensitivity to sound, with women exhibiting higher sensitivity. No statistically significant differences in postural control were observed between males and females, except for a notable increase in irregularity (SampEn values) in the anterior-posterior direction for females in the ECS trial. Correlation analyses revealed a moderate and statistically significant correlation between SampEn values in the AP direction and SE scores. Conclusions: This study highlights the intricate relationship between sensory stimuli, attention, and the body's ability to maintain balance. The presence of irritating sounds led to increased irregularity in postural control, particularly in the absence of visual control.

Efficacy of Laurus nobilis L. for Tight Junction Protein Imbalance in Leaky Gut Syndrome

Laurus nobilis L. (LNL) belongs to the evergreen Lauraceae family. It is native to the Mediterranean and widely distributed in the southern United States, Europe, and the Middle East. LNL is rich in active ingredients of the sesquiterpene lactone series and has been reported to have antioxidant, anti-inflammatory, and anticancer effects. And parthenolide, known as a sesquiterpene lactone-based compound, inhibits the activation of lipopolysaccharide-binding protein (LBP), which is a major trigger for leaky gut syndrome. However, the effectiveness of LNL in improving the state of increased intestinal permeability has not yet been reported. Therefore, we demonstrated the efficacy of LNL, which is known to be rich in parthenolide, in improving intestinal permeability induced by IL-13. We investigated the improvement in permeability and analyzed major tight junction proteins (TJs), permeability-related mechanisms, weight and disease activity indices, and corresponding cytokine mechanisms. LNL maintained TJs homeostasis and clinical improvement by reducing increased claudin-2 through the inhibition of IL-13/STAT6 activation in TJ-damaged conditions. These results are expected to be effective in preventing leaky gut syndrome through the TJ balance and to further improve intestinal-related diseases, such as inflammatory bowel disease.

Can Dynamic Spinal Stabilization Be an Alternative to Fusion Surgery in Adult Spinal Deformity Cases?

BACKGROUND

Rigid stabilization and fusion surgery are widely used for the correction of spinal sagittal and coronal imbalance (SCI). However, instrument failure, pseudoarthrosis, and adjacent segment disease are frequent complications of rigid stabilization and fusion surgery in elderly patients. In this study, we present the results of dynamic stabilization and 2-stage dynamic stabilization surgery for the treatment of spinal SCI. The advantages and disadvantages are discussed, especially as an alternative to fusion surgery.

METHODS

In our study, spinal, sagittal, and coronal deformities were corrected with dynamic stabilization performed in a single session in patients with good bone quality (without osteopenia and osteoporosis), while 2-stage surgery was performed in patients with poor bone quality (first stage: percutaneous placement of screws; second stage: placement of dynamic rods and correction of spinal SCI 4-6 months after the first stage). One-stage dynamic spinal instrumentation was applied to 20 of 25 patients with spinal SCI, and 2-stage dynamic spinal instrumentation was applied to the remaining 5 patients.

RESULTS

Spinal SCI was corrected with these stabilization systems. At 2-year follow-up, no significant loss was observed in the instrumentation system, while no significant loss of correction was observed in sagittal and coronal deformities.

CONCLUSION

In adult patients with spinal SCI, single or 2-stage dynamic stabilization is a viable alternative to fusion surgery due to the very low rate of instrument failure.

CLINICAL RELEVANCE

This study questions the use of dynamic stabilization systems for the treatment of adult degenerative deformities.

LEVEL OF EVIDENCE: 4

Wrist extensor pathomechanics: implications for tendon and nerve transfer

Central and peripheral nervous system lesions may disrupt the intricate balance of the prime movers of the wrist. In spasticity, hyperactive wrist flexors create a flexion moment and, if untreated, can lead to flexion contractures. In patients with C6 spinal cord injury and tetraplegia, the posterior interosseus nerve is typically affected by a complex pattern of upper and/or lower motoneuron lesions causing radial deviation of the wrist due to loss of ulnar deviation actuators. In this report, we illustrate severe pathomechanics that may occur even with relatively modest changes in wrist balance. These results illustrate how thorough understanding of muscle-tendon-joint interaction aids in designing tendon and nerve reconstructive surgeries to normalize wrist positions and balance in neuromuscular conditions.

Improving imbalance classification via ensemble learning based on two-stage learning

The excellent performance of deep neural networks on image classification tasks depends on a large-scale high-quality dataset. However, the datasets collected from the real world are typically biased in their distribution, which will lead to a sharp decline in model performance, mainly because an imbalanced distribution results in the prior shift and covariate shift. Recent studies have typically used a two-stage learning method consisting of two rebalancing strategies to solve these problems, but the combination of partial rebalancing strategies will damage the representational ability of the networks. In addition, the two-stage learning method is of little help in addressing the problem of covariate shift. To solve the above two issues, we first propose a sample logit-aware reweighting method called (SLA), which can not only repair the weights of majority class hard samples and minority class samples but will also integrate with logit adjustment to form a stable two-stage learning strategy. Second, to solve the covariate shift problem, inspired by ensemble learning, we propose a multi-domain expert specialization model, which can achieve a more comprehensive decision by averaging expert classification results from multiple different domains. Finally, we combine SLA and logit adjustment into a two-stage learning method and apply our model to the CIFAR-LT and ImageNet-LT datasets. Compared with the most advanced methods, our experimental results show excellent performance.

Alleviate oxidative stress in diabetic retinopathy: antioxidant therapeutic strategies

OBJECTIVES

This review outlines the function of oxidative stress in DR and discusses therapeutic strategies to treat DR with antioxidants.

METHODS

Published papers on oxidative stress in DR and therapeutic strategies to treat DR with antioxidants were collected and reviewed via database searching on PubMed.

RESULTS

The abnormal development of DR is a complicated process. The pathogenesis of DR has been reported to involve oxidative stress, despite the fact that the mechanisms underlying this are still not fully understood. Excessive reactive oxygen species (ROS) accumulation can damage retina, eventually leading to DR. Increasing evidence have demonstrated that antioxidant therapy can alleviate the degeneration of retinal capillaries in DR.

CONCLUSION

Oxidative stress can play an important contributor in the pathogenesis of DR. Furthermore, animal experiments have shown that antioxidants are a beneficial therapy for treating DR, but more clinical trial data is needed.

Episodic Vertigo: A Narrative Review Based on a Single-Center Clinical Experience

(1) Background: Usually, the majority of patients suffering from vertigo and dizziness can be identified in four major categories: acute spontaneous vertigo, episodic (recurrent) vertigo, recurrent positional vertigo, and chronic imbalance. Our purpose is to retrospectively evaluate the main causes of episodic vertigo and to find indications for a reliable clinical suspicion useful for a definitive diagnosis, comparing patients affected by different presenting symptomatology (acute vertigo, recurrent episodic vertigo, and imbalance). (2) Methods: we retrospectively evaluated the clinical records in a population of 249 consecutive patients observed for vertigo in our tertiary referral center in the period 1 January 2019-31 January 2020. On the basis of the reported clinical history, patients were divided into three groups: patients with their first ever attack of vertigo, patients with recurrent vertigo and dizziness, and patients with chronic imbalance. (3) Results: On the basis of the results of the instrumental examination, we arbitrarily divided (for each type of symptoms) the patients in a group with a normal vestibular instrumental examination and a group of patients in which the clinical-instrumental evaluation showed some pathological results; a highly significant difference (p: 0.157) was found between recurrent and acute vertigo and between recurrent vertigo and imbalance. (4) Conclusions: Patients with recurrent vertigo more frequently exhibit a negative otoneurological examination since they are often examined in the intercritical phase. A precise and in-depth research of the patient's clinical history is the key to suspect or make a diagnosis together with the search for some instrumental or clinical hallmark, especially in cases where the clinical picture does not fully meet the international diagnostic criteria.

Optimal Design of Galvanic Vestibular Stimulation for Patients with Vestibulopathy and Cerebellar Disorders

OBJECTIVES

Galvanic vestibular stimulation (GVS) has shown positive outcomes in various neurological and psychiatric disorders, such as enhancing postural balance and cognitive functions. In order to expedite the practical application of GVS in clinical settings, our objective was to determine the best GVS parameters for patients with vestibulopathy and cerebellar disorders using optimal design calculation.

METHODS

A total of 31 patients (26 males, mean age 57.03 ± 14.75 years, age range 22-82 years) with either unilateral or bilateral vestibulopathy (n = 18) or cerebellar ataxia (n = 13) were enrolled in the study. The GVS intervention included three parameters, waveform (sinusoidal, direct current [DC], and noisy), amplitude (0.4, 0.8, and 1.2 mA), and duration of stimulation (5 and 30 min), resulting in a total of 18 GVS intervention modes as input variables. To evaluate the effectiveness of GVS, clinical vertigo and gait assessments were conducted using the Dizziness Visual Analogue Scale (D-VAS), Activities-specific Balance Confidence Scale (ABC), and Scale for Assessment and Rating of Ataxia (SARA) as output variables. Optimal design and local sensitivity analysis were employed to determine the most optimal GVS modes.

RESULTS

Patients with unilateral vestibulopathy experienced the most favorable results with either noisy or sinusoidal GVS at 0.4 mA amplitude for 30 min, followed by DC GVS at 0.8 mA amplitude for 5 min. Noisy GVS at 0.8 or 0.4 mA amplitude for 30 min demonstrated the most beneficial effects in patients with bilateral vestibulopathy. For patients with cerebellar ataxia, the optimal choices were noisy GVS with 0.8 or 0.4 mA amplitude for 5 or 30 min.

CONCLUSIONS

This study is the first to utilize design optimization methods to identify the GVS stimulation parameters that are tailored to individual-specific characteristics of dizziness and imbalance. A sensitivity analysis was carried out along with the optimal design to offset the constraints of a limited sample size, resulting in the identification of the most efficient GVS modes for patients suffering from vestibular and cerebellar disorders.

Chronic symptoms in patients with unilateral vestibular hypofunction: systematic review and meta-analysis

Objective

To systematically evaluate the full spectrum of self-reported chronic symptoms in patients with unilateral vestibular hypofunction (UVH) and to investigate the effect of interventions on these symptoms.

Methods

A systematic review was conducted following the guidelines of the Preferred Reporting Items for Systematic Review and Meta-Analysis Statement (PRISMA). A literature search was performed in Pubmed, Web of Science, Embase, and Scopus to investigate self-reported symptoms and self-report questionnaires in patients with UVH. All original studies ranging from full-text clinical trials to case reports, written in English, German, and French, were included. The frequency of self-reported symptoms was presented. For self-report questionnaires, a meta-analysis was carried out to synthesize scale means by the pre- and post-intervention means and mean changes for studies that investigated interventions.

Results

A total of 2,110 studies were retrieved. Forty-seven studies were included after title-abstract selection and full-text selection by two independent reviewers. The symptoms of UVH patients included chronic dizziness (98%), imbalance (81%), symptoms worsened by head movements (75%), visually induced dizziness (61%), symptoms worsened in darkness (51%), and oscillopsia (22%). Additionally, UVH could be accompanied by recurrent vertigo (77%), tiredness (68%), cognitive symptoms (58%), and autonomic symptoms (46%). Regarding self-report questionnaires, UVH resulted on average in a moderate handicap, with an estimated mean total score on the Dizziness Handicap Inventory (DHI) and the Vertigo Symptom Scale (VSS) of 46.31 (95% CI: 41.17-51.44) and 15.50 (95% CI: 12.59-18.41), respectively. In studies that investigated the effect of vestibular intervention, a significant decrease in the estimated mean total DHI scores from 51.79 (95% CI: 46.61-56.97) (pre-intervention) to 27.39 (95% CI: 23.16-31.62) (post intervention) was found (p < 0.0001). In three studies, the estimated mean total Visual Analog Scale (VAS) scores were 7.05 (95% CI, 5.64-8.46) (pre-intervention) and 2.56 (95% CI, 1.15-3.97) (post-intervention). Finally, a subgroup of patients (≥32%) persists with at least a moderate handicap, despite vestibular rehabilitation.

Conclusion

A spectrum of symptoms is associated with UVH, of which chronic dizziness and imbalance are most frequently reported. However, semi-structured interviews should be conducted to define the whole spectrum of UVH symptoms more precisely, in order to establish a validated patient-reported outcome measure (PROM) for UVH patients. Furthermore, vestibular interventions can significantly decrease self-reported handicap, although this is insufficient for a subgroup of patients. It could therefore be considered for this subgroup of patients to explore new intervention strategies like vibrotactile feedback or the vestibular implant.

Systematic review registration

[https://www.crd.york.ac.uk/prospero/], identifier [CRD42023389185].

Prevalence and Types of Otological Symptoms Presenting in COVID-19 Patients in Jeddah, Saudi Arabia: A Questionnaire-Based Study

Background The clinical manifestations of coronavirus disease 2019 (COVID-19) can cause sensory dysfunction of taste, smell, and hearing. Otological symptoms may exceed hearing loss to ear pressure, tinnitus, and hyperacusis. Objective The objective of this study was to identify the prevalence and types of otological symptoms among patients diagnosed with COVID-19 in Jeddah, Saudi Arabia. Methods This is a cross-sectional study that was conducted among COVID-19 patients who have been diagnosed at Dr. Soliman Fakeeh Hospital (DSFH), Jeddah KSA, aged 18 years or older. The data collection was done through phone-call interviews utilizing an online form of a pre-structured questionnaire. The form included six otological symptoms; each symptom was further detailed with regard to duration, intensity, clinical course (continuous vs intermittent), and recovery. Results A total of 406 responses from patients diagnosed with COVID-19 were analyzed. Females represented 53.7% of the sample. The highest proportion of patients (30%) was in the age group of 31-40, followed by 22.9% in the age group of 25-30. The otological symptoms' prevalence rates were as follows: dizziness, vertigo, or imbalance 34.5%, ear pain 13.1%, tinnitus 12.1%, ear pressure 10%, hearing loss 6.4%, and hyperacusis 5.4%. Males had a higher prevalence of tinnitus, while females had higher reported symptoms of ear pain, hearing loss, and hyperacusis. Conclusion The most common otological symptoms were dizziness, vertigo, and imbalance among one-third of COVID-19 patients. Females reported higher rates of symptoms with ear pressure having significantly higher odds among females. Age groups were also significantly associated with ear pain, tinnitus, and ear pressure.

Sex differences in change of direction deficit and asymmetries in footballers with cerebral palsy

The aims of this study were (1) to describe and examine differences in change of direction (COD) performance and the magnitude of asymmetries in para-footballers with cerebral palsy (CP) and controls and (2) to evaluate the association between COD outcomes and linear sprint performance. Twenty-eight international para-footballers with CP and thirty-nine non-impaired football players (control group) participated in this study. All participants completed a 10-m sprint and two attempts of the 505 COD test with the dominant and non-dominant leg. The COD deficit was calculated using the difference between the 505 test and the 10-m sprint time, while the asymmetry index was determined by comparing each leg's completion time and COD deficit. Players across groups showed interlimb asymmetries between the dominant and non-dominant legs in COD outcomes and deficit (p < 0.05, d_g  = -0.40 to -1.46), although these asymmetries imbalance were not significantly different between the sexes with and without impairment. Males with CP exhibited a faster directional COD speed and a shorter COD deficit than their female counterparts (p < 0.01, d_g  = -1.68 to -2.53). Similarly, the control group had faster scores than the CP groups of the same sex (p < 0.05, d_g  = 0.53 to 3.78). Lastly, the female CP group and male control groups showed a significant association between sprint and the COD deficit in the dominant leg (p < 0.05, r = -0.58 to 0.65). Therefore, the use of directional dominance, the COD deficit, and asymmetry outcomes could be helpful for classification purposes to assess the impact of the impairment on sport-specific activity testing according to sex.

Predicting postoperative coronal alignment for adult spinal deformity: do lower-extremity factors matter?

OBJECTIVE

The objective was to describe an intraoperative method that accurately predicts postoperative coronal alignment for up to 2 years of follow-up. The authors hypothesized that the intraoperative coronal target for adult spinal deformity (ASD) surgery should account for lower-extremity parameters, including pelvic obliquity (PO), leg length discrepancy (LLD), lower-extremity mechanical axis difference (MAD), and asymmetrical knee bending.

METHODS

Two lines were drawn on intraoperative prone radiographs: the central sacral pelvic line (CSPL) (the line bisecting the sacrum and perpendicular to the line touching the acetabular sourcil of both hips) and the intraoperative central sacral vertical line (iCSVL) (which is drawn relative to CSPL based on the preoperative erect PO). The distance from the C7 spinous process to CSPL (C7-CSPL) and the distance from the C7 spinous process to iCSVL (iCVA) were compared with immediate and 2-year postoperative CVA. To account for LLD and preoperative lower-extremity compensation, patients were categorized into four preoperative groups: type 1, no LLD (< 1 cm) and no lower-extremity compensation; type 2, no LLD with lower-extremity compensation (PO > 1°, asymmetrical knee bending, and MAD > 2°); type 3, LLD and no lower-extremity compensation; and type 4, LLD with lower-extremity compensation (asymmetrical knee bending and MAD > 4°). A retrospective review of a consecutively collected cohort with ASD who underwent minimum 6-level fusion with pelvic fixation was performed for validation.

RESULTS

In total, 108 patients (mean ± SD age 57.7 ± 13.7 years, 14.0 ± 3.9 levels fused) were reviewed. Mean preoperative/2-year postoperative CVA was 5.0 ± 2.0/2.2 ± 1.8 cm. For patients with type 1, both C7-CSPL and iCVA had similar error margins for immediate postoperative CVA (0.5 ± 0.6 vs 0.5 ± 0.6 cm, p = 0.900) and 2-year postoperative CVA (0.3 ± 0.4 vs 0.4 ± 0.5 cm, p = 0.185). For patients with type 2, C7-CSPL was more accurate for immediate postoperative CVA (0.8 ± 1.2 vs 1.7 ± 1.8 cm, p = 0.006) and 2-year postoperative CVA (0.7 ± 1.1 vs 2.1 ± 2.2 cm, p < 0.001). For patients with type 3, iCVA was more accurate for immediate postoperative CVA (0.3 ± 0.4 vs 1.7 ± 0.8 cm, p < 0.001) and 2-year postoperative CVA (0.3 ± 0.2 vs 1.9 ± 0.8 cm, p < 0.001). For patients with type 4, iCVA was more accurate for immediate postoperative CVA (0.6 ± 0.7 vs 3.0 ± 1.3 cm, p < 0.001) and 2-year postoperative CVA (0.5 ± 0.6 vs 3.0 ± 1.6 cm, p < 0.001).

CONCLUSIONS

This system, which accounted for lower-extremity factors, provided an intraoperative guide to determine both immediate and 2-year postoperative CVA with high accuracy. For patients with type 1 and 2 (no LLD, with or without lower-extremity compensation), C7-intraoperative CSPL accurately predicted postoperative CVA up to 2-year follow-up (mean error 0.5 cm). For patients with type 3 and 4 (LLD, with or without lower-extremity compensation), iCVA accurately predicted postoperative CVA up to 2-year follow-up (mean error 0.4 cm).

Minimisation for the design of parallel cluster-randomised trials: An evaluation of balance in cluster-level covariates and numbers of clusters allocated to each arm

BACKGROUND

Cluster-randomised trials often use some form of restricted randomisation, such as stratified- or covariate-constrained randomisation. Minimisation has the potential to balance on more covariates than blocked stratification and can be implemented sequentially unlike covariate-constrained randomisation. Yet, unlike stratification, minimisation has no inbuilt guard to maintain close to a 1:1 allocation. A departure from a 1:1 allocation can be unappealing in a setting with a small number of allocation units such as cluster randomisation which typically include about 30 clusters.

METHODS

Using simulation (10,000 per scenario), we evaluate the performance of a range of minimisation procedures on the likelihood of a 1:1 allocation of clusters (10-80 clusters) to treatment arms, along with its performance on covariate imbalance. The range of minimisation procedures includes varying: the proportion of clusters allocated to the least imbalanced arm (known as the stochastic element) - between 0.7 and 1, percentage of first clusters allocated completely at random (known as the bed-in period) - between 0% and 20% and adding 'number of clusters allocated to each arm' as a covariate in the minimisation algorithm. We additionally include a comparison of stratifying and then minimising within key strata (such as country within a multi country cluster trial) as a potential aid to increasing balance.

RESULTS

Minimisation is unlikely to result in an exact 1:1 allocation unless the stochastic element is set higher than 0.9. For example, with 20 clusters, 2 binary covariates and setting the stochastic element to 0.7: only 41% of the possible randomisations over the 10,000 simulations achieved a 1:1 allocation. While typical sizes of imbalance were small (a difference of two clusters per arm), allocations as extreme as of 10:10 were observed. Adding the 'number of clusters' into the minimisation algorithm reduces this risk slightly, but covariate imbalance increases slightly. Stratifying and then minimising within key strata improve balance within strata but increase imbalance across all clusters, both on the number of clusters and covariate imbalance.

CONCLUSION

In cluster trials, where there are typically about 30 allocation units, when using minimisation, unless the stochastic element is set very high, there is a high risk of not achieving a 1:1 allocation, and a small but nonetheless real risk of an extreme departure from a 1:1 allocation. Stratification with minimisation within key strata (such as country) improves the balance within strata although compromises overall balance.

Can We Predict Imbalance in Patients? Analysis of the CDC National Health and Nutrition Examination Survey

Understanding global body balance can optimize the postoperative course for patients undergoing spinal or lower limb surgical realignment. This observational cohort study aimed to characterize patients with reported imbalance and identify predictors. The CDC establishes a representative sample annually via the NHANES. All participants who said "yes" (Imbalanced) or "no" (Balanced) to the following question were identified from 1999-2004: "During the past 12 months, have you had dizziness, difficulty with balance or difficulty with falling?" Univariate analyses compared Imbalanced versus Balanced subjects and binary logistic regression modeling predicted for Imbalance. Of 9964 patients, imbalanced (26.5%) were older (65.4 vs. 60.6 years), with more females (60% vs. 48%). Imbalanced subjects reported higher rates of comorbidities, including osteoporosis (14.4% vs. 6.6%), arthritis (51.6% vs. 31.9%), and low back pain (54.4% vs 32.7%). Imbalanced patients had more difficulty with activities, including climbing 10 steps (43.8% vs. 21%) and stooping/crouching/kneeling (74.3% vs. 44.7%), and they needed greater time to walk 20 feet (9.5 vs. 7.1 s). Imbalanced subjects had significantly lower caloric and dietary intake. Regression revealed that difficulties using fingers to grasp small objects (OR: 1.73), female gender (OR: 1.43), difficulties with prolonged standing (OR: 1.29), difficulties stooping/crouching/kneeling (OR: 1.28), and increased time to walk 20 feet (OR: 1.06) were independent predictors of Imbalance (all p < 0.05). Imbalanced patients were found to have identifiable comorbidities and were detectable using simple functional assessments. Structured tests that assess dynamic functional status may be useful for preoperative optimization and risk-stratification for patients undergoing spinal or lower limb surgical realignment.

Electrolyte Imbalance Among Bangladeshi Patients With COVID-19

Introduction Infection with SARS-CoV-2 begins in the lower respiratory tract, but COVID-19 often involves the renal system, resulting in serum electrolyte imbalance. Monitoring serum electrolyte levels and parameters of liver and kidney function is essential to understand disease prognosis. Objectives This study aimed to determine the effect of imbalances in serum electrolytes and other parameters on COVID-19 severity. Material and method This retrospective study comprised 241 patients, ages 14 years and older, including 186 patients who were moderately affected and 55 who were categorized as severely affected by COVID-19. Serum electrolytes (sodium (Na⁺), potassium (K⁺), and chloride (Cl^-)) and biomarkers of kidney and liver function (creatinine and alanine aminotransferase (ALT)) were measured and correlated with disease severity. This research was conducted among admitted patients of Holy Family Red Crescent Medical College Hospital designated into two groups based on retrospective hospital records. Individuals with moderate illness had evidence of lower respiratory tract infection (cough, cold, breathless, etc.) during clinical assessment or imaging (chest X-ray and computed tomography (CT) scan of the lungs) and have an oxygen saturation by pulse oximetry (SpO₂) ≥ 94% on room air at sea level. The severely ill group involved individuals with SpO₂ ≤94% on room air at sea level and respiratory rate ≥ 30 breaths/minute, and critically ill patients are those who needed mechanical ventilation or required intensive care unit (ICU) care. This categorization was based on the Coronavirus Disease 2019 (COVID-19) Treatment Guidelines (https://www.covid19treatmentguidelines.nih.gov/about-the-guidelines/whats-new/). Results Average Na⁺ and creatinine increased by 2.30 parts (95% confidence interval (CI) = 0.20, 4.81, P = 0.041) and 0.35 units (95% CI = 0.03, 0.68, P = 0.043) in severe cases compared with moderate cases. Older participants had relatively Na⁺ lowered to -0.06 parts (95% CI = -0.12, -0.001, P = 0.045), significant Cl^- reduction by 0.09 units (95% CI = -0.14, -0.04, P = 0.001), and ALT by 0.47 units (95% CI = -0.88, -0.06, P = 0.024), whereas serum creatinine was increased by 0.01 parts (95% CI = 0.001, 0.02, P = 0.024). The creatinine and ALT of COVID-19 participants were significantly higher in males by 0.34 units and 23.2 units, respectively, compared with females. In severe COVID-19 cases compared with moderate cases, the risks of hypernatremia, elevated chloride levels, and elevated serum creatinine levels were increased by 2.83-fold (95% CI = 1.26, 6.36, P = 0.012), 5.37-fold (95% CI = 1.90, 15.3, P = 0.002), and 2.00-fold (95% CI = 1.08, 4.31, P = 0.039), respectively. Conclusion Serum electrolyte and biomarker levels can serve as good indicators of the condition and disease prognosis of patients with COVID-19. Our purpose in this study was to determine the association between serum electrolyte imbalance and disease severity. We collected data from ex post facto hospital records and did not intend to assess the mortality rate. Consequently, this study expects that the prompt diagnosis of electrolyte disparity or disturbance possibly minimizes COVID-19-related morbidity and mortality.

Environment Intensifies Imbalance and Fear of Falling: Comparing Urban and Rural Aging Communities

BACKGROUND

The relationship between environmental diversity and the health status of older adults has been less considered in studies. This study seeks to investigate the causal relationship among the environment, falling, fear of falling, and the imbalance of older adults in southern Iran in 2021.

OBJECTIVE

The investigation into the relationship between environmental pollution to the imbalance and fear of falling, especially in comparing urban and rural aging societies is the aim of current study.

METHODS

In a cross-sectional study, 489 older samples from rural and urban areas were chosen randomly and their experience of falling, fear of falling, imbalance, and IADL were examined. The ordinal and nominal logistic regression and ANOVA were performed using IBM-SPSS.

RESULTS

With a mean age of 71.8 (SD = 8.3), older participants have long time chronic disease (69.6%) and falling experience twice a year (42.7%). The values of effect size indicated the high effectiveness of settlement in explaining IADL, health situation, experience and fear of falling, and imbalance (Eta squared > 30). The odds ratio for being in the urban settlement was 5.51, indicating the imbalance score increased by approximately 5.52 times.

CONCLUSION

Imbalance in older people leads to the fear and experience of falling. This imbalance is strongly influenced by the environment. Urban pollution can contribute to this problem. Future studies on aging need to focus on environmental pollution and diversity in the experience of falling and imbalance.

[The study of elemental picture in reliance on age and intensity of physical activity in male inhabitants of Magadan city.]

The study aimed at analyzing the mineral picture of young, middle-aged and elderly men of the city of Magadan having physical activity of a different intensity. The survey involved 235 men aged 18-44, 130 men at the age of 45-59, and 100 men 60-74 years old whose lifestyle varied with the intensity of physical activity. Hair samples were used to assess the content of 25 macro- and microelements (ME) with spectrometric methods on «Optima 2000 DV» and «NexION 300D units» («Perkin Elmer», USA). The analysis showed the so called northern type of ME imbalance experienced by all the examinees regardless of the age and intensity of physical activity with pronounced deficit in essential elements - Ca, Mg, Co, and Se. In case of men 60-74 years old age, we also observed lowered concentrations of Cr, V, and Si. At a younger age, physically active men exhibited significantly higher concentrations of Co, K, and P with lower variables of Cr, Li, V, I, Cd and Pb. The middle-aged subjects were high in P and low in Co, Fe, Mn, Al, Pb, and Sn. As for the elderly males, they tended to show reduced concentrations of As, Be, and Si. The total frequency of elemental deficiency was characteristic of all the age groups with low physical activity, and it was greatest at a younger age regardless of the intensity of physical activity. In addition to preventive measures on maintaining tone, metabolism, training of the heart muscle and blood vessels, the recommended physical activity should be of at least a moderate intensity as a natural physiological corrector to achieve the body bio elemental balance.

Relationship between serum Th1/Th2 imbalance and depression in elderly patients with COPD and its clinical implications

BACKGROUND

Chronic obstructive pulmonary disease (COPD) causes organic damage as well as anxiety, depression, fear, and other psychological disorders, which seriously affect the quality of life and prognosis of patients and cause a huge economic burden to the family and society.

OBJECTIVE

The aim of this study was to investigate the correlation between an imbalance of serum Th1/Th2 indicators and psychiatric depression in elderly patients with COPD and analyze its implications for clinical management.

METHODS

From January 2018 to May 2022, 120 elderly patients with COPD treated at our hospital were categorized into two groups based on the self-rating depression scale (SDS): COPD with depression (SDS score ⩾ 50) and COPD alone (SDS score < 50). Blood gas analysis, pulmonary function, and serum Th1/Th2 index were determined. Receiver operating characteristic (ROC) curves were analyzed to explore the diagnostic value of serum Th1/Th2 ratios for COPD complicated by depression.

RESULTS

Compared with the group without depression, the partial pressure of carbon dioxide and COPD assessment test scores were significantly higher, and the oxygenation index, forced expiratory volume in one second (FEV1), and percent predicted FEV1 were significantly lower in the COPD with depression group (P< 0.05). Interleukin (IL)-1β, IL-2, IL-6, IL-8, IL-10, and tumor necrosis factor-α (TNF-α) were significantly higher in the COPD with depression group than in the group without depression (P< 0.05). Logistic regression analysis indicated that the imbalance of serum IL-1β, IL-2, IL-6, IL-8, IL-10, and TNF-α was a risk factor for mental depression in elderly patients with COPD. When comparing prognostic indices, the interval before the first onset of clinically noticeable deterioration (CID-C) in the COPD with depression group was noticeably shorter than that in the COPD without depression group; the incidence of CID-C within 6 months was noticeably higher in the COPD with depression group than in the group without depression.

CONCLUSION

Elderly patients with COPD and depression had reduced pulmonary function and higher serum Th1/Th2 levels, and an imbalance in serum Th1/Th2 indicators was a potential risk factor for depression. Moreover, elderly patients with COPD and depression were at a higher risk of disease progression and had a worse prognosis. Thus, an imbalance in serum Th1/Th2 indicators is a potential prognostic factor for evaluating depression in patients with COPD.

One-year prevalence and clinical characteristics in chronic dizziness: The 2019-2020 Korean National Health and Nutrition Examination Survey

INTRODUCTION

In this cross-sectional study, we investigated the 1-year prevalence and related factors in the general population with an experience of chronic dizziness.

METHODS

This study analyzed persons (n = 5,163) who respond to dizziness and nutrition questionnaire from participant of Korean National Health and Nutrition Examination Survey (KNHANES, 2019-2020).

RESULTS

Of individuals over 40 years, 25.3% of the general population (61.6% females) reported either dizziness or imbalance for the past year. Moreover, 4.8% of the patients reported they suffered from chronic dizziness or imbalance for more than 3 months. In multiple regression analysis, patients with chronic dizziness were older, females, had lower body mass index (BMI), had stress awareness, and had a history of tinnitus within 1 year (>5 min per episode). Relative to normal body weight, both overweight and mild obesity (obesity stages 1 and 2) were associated with a significantly lower risk of chronic dizziness. Overweight, obesity stage 1, and obesity stage 2 had odds ratios of 0.549 [95% confidence interval (CI), 0.332-0.910], 0.445 (95% CI, 0.273-0.727), and 0.234 (95% CI, 0.070-0.779), respectively.

CONCLUSIONS

In this study, the prevalence of chronic dizziness in the general population was 4.8%. Our study demonstrated that overweight and mild obesity were independently associated with a lower risk of chronic dizziness in adults for the past year. Therefore, the optimal BMI for patients with dizziness should be defined and managed according to an integrated care pathway.

Vertigo in Acute Stroke Is a Predictor of Brain Location but Is Not Related to Early Outcome: The Experience of Sagrat Cor Hospital of Barcelona Stroke Registry

BACKGROUND

Vertigo is an uncommon symptom among acute stroke victims. Knowledge about the clinical profile, the brain location, and the early outcome in stroke patients with cerebrovascular diseases and vertigo remains limited.

OBJECTIVES

In this study, the effects of vertigo on cerebral topography and early prognosis in cerebrovascular diseases were investigated.

METHODS

A comparative analysis in terms of demographics, risk factors, clinical characteristics, stroke subtypes, cerebral and vascular topography, and early outcome was performed between patients with presence or absence of vertigo on a sample of 3743 consecutive acute stroke patients available from a 24-year ongoing single-center hospital-based stroke registry.

RESULTS

Vertigo was present in 147 patients (3.9%). Multiple logistic regression analysis showed that variables independently associated with vertigo were: location in the cerebellum (OR 5.59, CI 95% 3.24-9.64), nausea or vomiting (OR 4.48, CI 95% 2.95-6.82), medulla (OR 2.87, CI 95% 1.31-6.30), pons (OR 2.39, CI 95% 1.26-4.51), basilar artery (OR 2.36, CI 95% 1.33-4.17), ataxia (OR 2.33, CI 95% 1.41-3.85), and headache (OR 2.31, CI 95% 1.53-3.49).

CONCLUSION

The study confirmed that the presence of vertigo was not related with increased in-hospital mortality or poor prognosis at hospital discharge. Vertigo is mainly related to non-lacunar vertebrobasilar stroke with topographic localization in the cerebellum and/or brainstem.

Early Revision Surgery for Distal Adding-On Correction in Lenke 1 and 2 Adolescent Idiopathic Scoliosis

Objective To evaluate the outcome of an early revision strategy for postoperative distal adding-on (DAO) after Lenke 1 and 2 adolescent idiopathic scoliosis (AIS) surgery. Summary of background data Improper choice of the lowest instrumented vertebra (LIV) is a major cause of postoperative imbalance and unsatisfactory results in AIS surgery. The long-term consequences of such imbalance remain unclear. Early corrective surgery has not been described. Methods We retrieved the records of operated AIS patients at the former institution of the senior author. There were 18 cases of early revision by one-level distal extension of instrumentation and fusion. Patients were reoperated based on progressive distal local imbalance and clinical lumbar asymmetry. Several local and global balance parameters were compared on serial long-standing radiographs before and after the index surgery, before and after the revision surgery, and at the last follow-up. The Kruskal-Wallis test was used for the comparison of the results. A value of p<0.05 was considered significant. Results All patients were female with a mean age of 13.9 years. The mean delay between the two surgeries was 8.4 months and the last follow-up was at 32.5 months after the revision surgery. Unsatisfactory results after the index surgery were reflected by a progressive increase in disc angulation below the lowest instrumented vertebra (LIV) and an increased tilt and rotation of the LIV+1. The clinical lumbar shift was also accentuated from 19 mm to 25 mm. Revision surgery significantly reduced local and global balance parameters. There was a decrease in the LIV translation (from 26 mm to 19 mm) and of the wedging below it (from 7.9° to 1.3°) and a better positioning of the LIV+1 with less tilt (from 14.6° to 3.6°), translation (from 22.2 mm to 13.8 mm) and rotation (from 20° to 15°). The clinical lumbar shift was reduced from 25 mm to 3.6 mm. Global coronal and sagittal balance were also ameliorated. All results were maintained at a mean follow-up of 32.5 months from the revision surgery. No complications were noted and there was no need for a blood transfusion. Conclusion The revision surgery proposed in this paper is simple with low morbidity and may be considered as a fine-tuning of the failed index surgery. Further studies are needed to evaluate the long-term consequences of treated and untreated postoperative distal adding-on in AIS surgery.

Skin Lesion Classification on Imbalanced Data Using Deep Learning with Soft Attention

Today, the rapid development of industrial zones leads to an increased incidence of skin diseases because of polluted air. According to a report by the American Cancer Society, it is estimated that in 2022 there will be about 100,000 people suffering from skin cancer and more than 7600 of these people will not survive. In the context that doctors at provincial hospitals and health facilities are overloaded, doctors at lower levels lack experience, and having a tool to support doctors in the process of diagnosing skin diseases quickly and accurately is essential. Along with the strong development of artificial intelligence technologies, many solutions to support the diagnosis of skin diseases have been researched and developed. In this paper, a combination of one Deep Learning model (DenseNet, InceptionNet, ResNet, etc) with Soft-Attention, which unsupervisedly extract a heat map of main skin lesions. Furthermore, personal information including age and gender are also used. It is worth noting that a new loss function that takes into account the data imbalance is also proposed. Experimental results on data set HAM10000 show that using InceptionResNetV2 with Soft-Attention and the new loss function gives 90 percent accuracy, mean of precision, F1-score, recall, and AUC of 0.81, 0.81, 0.82, and 0.99, respectively. Besides, using MobileNetV3Large combined with Soft-Attention and the new loss function, even though the number of parameters is 11 times less and the number of hidden layers is 4 times less, it achieves an accuracy of 0.86 and 30 times faster diagnosis than InceptionResNetV2.

[The effectiveness of vestibular rehabilitation in Ménière's disease patients with chronic imbalance]

Objective:To observe the effectiveness of vestibular rehabilitation in Ménière's disease patients with chronic imbalance. Methods:Forty-five Ménière's disease patients with chronic imbalance treated in vertigo specialist clinic of Eye and ENT Hospital of Fudan University from December 2020 to December 2021 were enrolled. Patients were divided randomly into two groups, 23 patients in experimental group and 22 patients in control group. Both groups received routine outpatient treatment, and the experimental group received an additional vestibular rehabilitation for 8 weeks. All patients were evaluated with dizziness handicap inventory （DHI） at baseline and 8-week follow-up, and the incidence of fall was calculated. The occurrence of adverse events during the study was also recorded. Results:There was no significant difference in baseline data between the two groups （P>0.05）. During the study, 1 patient were lost to follow-up and 2 patients dropped out. A total of 42 patients completed the study. Intentionality analysis was performed on lost follow-up patients. After 8 weeks of the treatment, there were significant statistically differences in difference values of DHI and DHI-F scores（d₁=-30.22±3.78, d₂=-13.09±4.85, t=-2.799, P<0.05; d₁=-12.43±1.46, d₂=-4.55±2.17, t=-3.043, P<0.05）, while no significant difference was showed in the difference values of DHI-P and DHI-E scores（P>0.05）. There was no significant difference in incidence of fall between two groups（P>0.05）, but the incidence of experimental group decreased significantly compared with that before treatment（4.35% vs 34.78%, χ²=4.973, P<0.05）. No serious adverse event was reported in the two groups. Conclusion:Vestibular rehabilitation can improve the balance function and reduce risk of fall in Ménière's disease patients with chronic imbalance. Therefore, it is worthy of clinical application.

Effects of imbalance of mineral elements on peripheral neutrophil metabolism in sheep

The imbalance of mineral element homeostasis in animals is common, causing animal immune dysfunction. Ten female sheep were randomly selected and injected with 4% (w/v) Na2EDTA through a central venous catheter to establish the mineral element imbalance model, then divided into control group (before injection) and Ethylene Diamine Tetraacetic Acid (EDTA) group (after injection). Isolation of peripheral blood neutrophils for mineral elements content determination was done using Inductively coupled plasma-mass spectrometry (ICP-MS) and nontargeted metabolomics analysis using liquid chromatography-tandem mass spectrometry (LC-MS/MS). The ICP-MS results showed that Hg and Cs levels in neutrophils were significantly lower after injection than before (P < 0.05), but had no significant effects on other elements. Our previous study showed that serum Zn, P, K, and other 11 elements were significantly lower after the injection of Na2EDTA than before. LC-MS/MS results showed that differential metabolites are mainly involved in amino acid metabolism, lipid metabolism, and nucleotide metabolism; monoamine metabolism was weakened; and polyamine metabolism was enhanced. Under positive and negative ion modes, the mineral elements P, K, Ca, Mn, Cu, and Zn had the highest correlation with the differential metabolites of neutrophils, followed by Se, and the correlation between each mineral element and different differential metabolites was also different. The results indicated that the imbalance in mineral elements affected the metabolism of sheep neutrophils, these may affect neutrophil function, and Na2EDTA could help to reduce the level of heavy metals in the body of sheep. Our data may provide a theoretical basis for the precise regulation of animal immune metabolism by modern animal husbandry nutrition.

Deep Learning-Based Non-Intrusive Commercial Load Monitoring

Commercial load is an essential demand-side resource. Monitoring commercial loads helps not only commercial customers understand their energy usage to improve energy efficiency but also helps electric utilities develop demand-side management strategies to ensure stable operation of the power system. However, existing non-intrusive methods cannot monitor multiple commercial loads simultaneously and do not consider the high correlation and severe imbalance among commercial loads. Therefore, this paper proposes a deep learning-based non-intrusive commercial load monitoring method to solve these problems. The method takes the total power signal of the commercial building as input and directly determines the state and power consumption of several specific appliances. The key elements of the method are a new neural network structure called TTRNet and a new loss function called MLFL. TTRNet is a multi-label classification model that can autonomously learn correlation information through its unique network structure. MLFL is a loss function specifically designed for multi-label classification tasks, which solves the imbalance problem and improves the monitoring accuracy for challenging loads. To validate the proposed method, experiments are performed separately in seen and unseen scenarios using a public dataset. In the seen scenario, the method achieves an average F1 score of 0.957, which is 7.77% better than existing multi-label classification methods. In the unseen scenario, the average F1 score is 0.904, which is 1.92% better than existing methods. The experimental results show that the method proposed in this paper is both effective and practical.

Vascular vertigo and dizziness: Diagnostic criteria

This paper presents diagnostic criteria for vascular vertigo and dizziness as formulated by the Committee for the Classification of Vestibular Disorders of the Bárány Society. The classification includes vertigo/dizziness due to stroke or transient ischemic attack as well as isolated labyrinthine infarction/hemorrhage, and vertebral artery compression syndrome. Vertigo and dizziness are among the most common symptoms of posterior circulation strokes. Vascular vertigo/dizziness may be acute and prolonged (≥24 hours) or transient (minutes to  < 24 hours). Vascular vertigo/dizziness should be considered in patients who present with acute vestibular symptoms and additional central neurological symptoms and signs, including central HINTS signs (normal head-impulse test, direction-changing gaze-evoked nystagmus, or pronounced skew deviation), particularly in the presence of vascular risk factors. Isolated labyrinthine infarction does not have a confirmatory test, but should be considered in individuals at increased risk of stroke and can be presumed in cases of acute unilateral vestibular loss if accompanied or followed within 30 days by an ischemic stroke in the anterior inferior cerebellar artery territory. For diagnosis of vertebral artery compression syndrome, typical symptoms and signs in combination with imaging or sonographic documentation of vascular compromise are required.

Nutritional and Metabolic Imbalance in Keratoconus

Keratoconus (KC) is a progressive corneal degeneration characterized by structural changes consisting of progressive thinning and steepening of the cornea. These alterations result in biomechanical weakening and, clinically, in vision loss. While the etiology of KC has been the object of study for over a century, no single agent has been found. Recent reviews suggest that KC is a multifactorial disease that is associated with a wide variety of genetic and environmental factors. While KC is typically considered a disease of the cornea, associations with systemic conditions have been well described over the years. In particular, nutritional and metabolic imbalance, such as the redox status, hormones, metabolites, and micronutrients (vitamins and metal ions), can deeply influence KC initiation and progression. In this paper, we comprehensively review the different nutritional (vitamins and minerals) and metabolic (hormones and metabolites) factors that are altered in KC, discussing their possible implication in the pathophysiology of the disease.

Trunk balance, head posture and plantar pressure in adolescent idiopathic scoliosis

BACKGROUND

The relationship of trunk balance with head posture and plantar pressure is unknown in patients with adolescent idiopathic scoliosis (AIS).

OBJECTIVE

To investigate the relationship of trunk balance with head posture and plantar pressure by analyzing the imaging data of patients with AIS.

MATERIALS AND METHODS

This retrospective study was performed on 80 AIS patients who had whole spine frontal and lateral radiographs, and the imaging parameters were measured and analyzed.

RESULTS

The coronal trunk imbalance rate was 67.5%, the trunk offset direction was towards left in 65 cases and right in 15 cases, and the head offset direction was towards left in 66 cases and right in 14 cases. The sagittal trunk imbalance rate was 57.25%. The distance of apical vertebrae and head offset in the coronal trunk balance group was significantly (P < 0.05) smaller than that in the imbalance group. The apical vertebrae offset distance and head offset distance were positively correlated with the tilt angle of trunk (r = 0.484 and 0.642, respectively, P < 0.05). The difference in the percentage of pressure load on the left and right foot was significantly (P < 0.05) greater in the coronal imbalance group than that in the balance group.The center of pressure (COP) sway area was significantly (P < 0.05) larger in the overall trunk imbalance group (both coronal and sagittal imbalance) than in the balanced group.

CONCLUSION

Most AIS patients have trunk imbalance which is severer on the coronal than on the sagittal plane. AIS patients with trunk imbalance show more significant local deformities, greater head offset, greater COP sway area, and decreased head and standing stability.

Machine Learning Based Metagenomic Prediction of Inflammatory Bowel Disease

In this study, we investigate faecal microbiota composition, in an attempt to evaluate performance of classification algorithms in identifying Inflammatory Bowel Disease (IBD) and its two types: Crohn's disease (CD) and ulcerative colitis (UC). From many investigated algorithms, a random forest (RF) classifier was selected for detailed evaluation in three-class (CD versus UC versus nonIBD) classification task and two binary (nonIBD versus IBD and CD versus UC) classification tasks. We dealt with class imbalance, performed extensive parameter search, dimensionality reduction and two-level classification. In three-class classification, our best model reaches F1 score of 91% in average, which confirms the strong connection of IBD and gastrointestinal microbiome. Among most important features in three-class classification are species Staphylococcus hominis, Porphyromonas endodontalis, Slackia piriformis and genus Bacteroidetes.

[The assessment of the efficacy of Ethoxidol treatment in patients with chronic cerebral ischemia]

OBJECTIVE

To evaluate the clinical effects of ethylmethylhydroxypyridine malate (Ethoxidol) in patients with chronic cerebral ischemia in an outpatient practice.

MATERIAL AND METHODS

60 patients were examined, 58 patients with a diagnosis of cerebrovascular disease (chronic cerebral ischemia) completed the participation in the program. The average age of the patients is 61.2±8.2 years. Neurological complaints typical of patients with chronic cerebral ischemia were recorded. To assess the dynamics of neurological disorders during therapy were used: The Montreal Cognitive Assessment (MoCA), Multidimensional fatigue inventory (MFI-20), Berg Balance Scale (BBS), Tinnitus Handicap Inventory (THI), Clinical Global Impression of Improvement Scale (CGI). The doctors and the patients satisfaction with therapy was assessed using the Visual Analogue Scale (VAS); quality of life - by the VAS of the European Quality of Life Group (EQ-VAS). The course of therapy lasted 60 days. All patients received daily Ethoxidol chewable tablets 400 mg/day (2 tablets (200 mg) in the morning and 2 tablets (200 mg) in the evening).

RESULTS

The results of the observational program showed high efficacy and good tolerability of Ethoxidol in patients with chronic cerebral ischemia. A statistically significant decrease in the severity of the clinical manifestations of chronic cerebral ischemia was noted as early as the 30th day of therapy, followed by maintaining a positive trend until the end of the course of treatment with the drug (60th day). On the therapy, the severity of asthenia, cognitive impairment, dizziness, balance disorders, and tinnitus decreased. There was a decrease in the severity of the condition and the presence of clinical improvement on the CGI scale; there was an increase in the quality of life of patients on the EQ-VAS scale. The majority of the patients and the doctors rated the therapy as effective and safe and were satisfied with it. No serious adverse events were reported.

CONCLUSION

The data obtained allow us to consider Ethoxidol as an effective drug in the treatment of patients with chronic cerebral ischemia in an outpatient practice.

Receiving Long-Term Disability or Pursuing a Legal Claim May Prevent Recovery From Chronic Dizziness

OBJECTIVES/HYPOTHESIS

Chronic dizziness (CD) and imbalance have multiple etiologies. CD is strongly linked with psychiatric and psychological comorbidities, thus an interdisciplinary approach, including psychopharmacological interventions, is recommended. Despite the use of this comprehensive treatment approach, the recovery of individuals with CD that pursue long-term disability (LTD) insurance or legal claims (LC) appears hampered. As such, we aimed to compare symptom recovery from CD in an interdisciplinary setting between patients receiving LTD/LC versus those who were not, and to explore the factors that may contribute to changes in symptom severity.

STUDY DESIGN

Retrospective cohort study.

METHODS

Dizziness-related diagnoses were extracted from the charts of 195 adults in an outpatient interdisciplinary neurotology clinic in Toronto, Canada. Patients with baseline Dizziness Handicap Inventory (DHI) and Dizziness Catastrophizing Scale (DCS) assessments between August 2012 and July 2018 and a mean follow-up visit within approximately 10 months were included. The study participants were categorized as "LTD/LC+" (n = 92) or "LTD/LC-" (n = 103), referring to either receiving or pursuing LTD/LC or not, respectively.

RESULTS

There were differences in the mean percentage changes in DHI (t[187] = 3.02, P = .003) and DCS (t[179] = 2.63, P = .009) scores between LTD/LC+ and LTD/LC- patients. LTD/LC+ patients showed 8.0% and 7.6% mean increases in DHI and DCS scores, respectively, whereas LTD/LC- patients showed 21.5% and 25.9% reductions in DHI and DCS scores, respectively, controlling for age, sex, and baseline illness severity.

CONCLUSIONS

Patients receiving or pursuing LTD insurance or a legal claim did not improve from CD and dizziness catastrophizing compared to those who were not. Future studies are required to test these findings prospectively and to determine the factors that may contribute to symptom recovery, including the anxiety-aggravating effects of the LTD/LC process and the deleterious consequences of developing a sick-role while afflicted with a chronic illness.

LEVEL OF EVIDENCE

3 Laryngoscope, 2021.

Assessing the Magnitude and Direction of Asymmetry in Unilateral Jump and Change of Direction Speed Tasks in Youth Female Team-Sport Athletes

The direction of inter-limb asymmetries and the change of direction (COD) deficit are two aspects that have increased in recent years. The main objective of the present study was to assess the magnitude of neuromuscular asymmetries in an elite youth female team-sports sample and determine its directionality. Secondary objectives were to evaluate the relationship between COD deficit, linear speed and COD time performance. Elite female youth basketball and handball players (n = 33, age = 16 ± 1.17 y) performed the Single Leg Countermovement Jump in vertical (SLCJ-V), horizontal (SLCJ-H), and lateral (SLCJ-L) directions, the COD and the 10-m sprint. Results showed statistical differences between limbs in all the neuromuscular tests (p < 0.001). The Kappa coefficient showed poor to fair levels of agreement between tasks (K range = -0.087 to 0.233), indicating that asymmetries rarely favoured the same limb between skills. Additionally, small and non-significant correlations were found between the linear sprint capacity and the COD ability. The findings of the present study highlight the independent directionality of asymmetries across tests. The COD deficit does not appear to be much more advantageous than COD total time to measure asymmetry. Practitioners are encouraged to use a fitness testing battery to detect existing side differences and each ability should be specifically trained with functional tasks.

Predicting Successes and Failures of Clinical Trials With Outer Product-Based Convolutional Neural Network

Despite several improvements in the drug development pipeline over the past decade, drug failures due to unexpected adverse effects have rapidly increased at all stages of clinical trials. To improve the success rate of clinical trials, it is necessary to identify potential loser drug candidates that may fail at clinical trials. Therefore, we need to develop reliable models for predicting the outcomes of clinical trials of drug candidates, which have the potential to guide the drug discovery process. In this study, we propose an outer product–based convolutional neural network (OPCNN) model which integrates effectively chemical features of drugs and target-based features. The validation results via 10-fold cross-validations on the dataset used for a data-driven approach PrOCTOR proved that our OPCNN model performs quite well in terms of accuracy, F1-score, Matthews correlation coefficient (MCC), precision, recall, area under the curve (AUC) of the receiver operating characteristic, and area under the precision–recall curve (AUPRC). In particular, the proposed OPCNN model showed the best performance in terms of MCC, which is widely used in biomedicine as a performance metric and is a more reliable statistical measure. Through 10-fold cross-validation experiments, the accuracy of the OPCNN model is as high as 0.9758, F1 score is as high as 0.9868, the MCC reaches 0.8451, the precision is as high as 0.9889, the recall is as high as 0.9893, the AUC is as high as 0.9824, and the AUPRC is as high as 0.9979. The results proved that our OPCNN model shows significantly good prediction performance on outcomes of clinical trials and it can be quite helpful in early drug discovery.

Determining Gut Microbial Dysbiosis: a Review of Applied Indexes for Assessment of Intestinal Microbiota Imbalances

Assessing “dysbiosis” in intestinal microbial communities is increasingly considered a routine analysis in microbiota studies, and it has added relevant information to the prediction and characterization of diseases and other adverse conditions. However, dysbiosis is not a well-defined condition.

Assessing “dysbiosis” in intestinal microbial communities is increasingly considered a routine analysis in microbiota studies, and it has added relevant information to the prediction and characterization of diseases and other adverse conditions. However, dysbiosis is not a well-defined condition. A variety of different dysbiosis indexes have been suggested and applied, but their underlying methodologies, as well as the cohorts and conditions for which they have been developed, differ considerably. To date, no comprehensive overview and comparison of all the different methodologies and applications of such indexes is available. Here, we list all types of dysbiosis indexes identified in the literature, introduce their methodology, group them into categories, and discuss their potential descriptive and clinical applications as well as their limitations. Thus, our focus is not on the implications of dysbiosis for disease but on the methodological approaches available to determine and quantify this condition.

Does a Loaded Warm-Up Influence Jump Asymmetry and Badminton-Specific Change of Direction Performance?

PURPOSE

Previously, it has been shown that loaded warm-up (LWU) can improve change-of-direction speed (CODS) in professional badminton players. However, the effect of asymmetry on CODS in badminton players and the influence of LWU on asymmetry has not been examined.

METHODS

A total of 21 amateur badminton players (age 29.5 [8.4] y, playing experience 8.4 [4.2] y) completed 2 trials. In the first, they performed a control warm-up. In the second, they performed the same warm-up but with 3 exercises loaded with a weight vest (LWU). Following both warm-ups, players completed single-leg countermovement jump and badminton-specific CODS tests.

RESULTS

No significant differences between control warm-up and LWU were observed for CODS, single-leg countermovement jump, or single-leg countermovement jump asymmetry. However, small effect sizes suggested faster CODS (mean difference: -5%; d = -0.32) and lower asymmetries (mean difference: -3%; d = -0.39) following LWU. Five players (24%) experienced CODS improvements greater than the minimum detectable change while 2 (10%) responded negatively. Asymmetry was not correlated with CODS following control warm-up (ρ = .079; P = .733) but was negatively associated with CODS after LWU (ρ = -.491; P = .035).

CONCLUSION

LWU may prove a strategy to trial on an individual basis, but generic recommendations should not be applied.

Photomorphogenesis in the Picocyanobacterium Cyanobium gracile Includes Increased Phycobilisome Abundance Under Blue Light, Phycobilisome Decoupling Under Near Far-Red Light, and Wavelength-Specific Photoprotective Strategies

Photomorphogenesis is a process by which photosynthetic organisms perceive external light parameters, including light quality (color), and adjust cellular metabolism, growth rates and other parameters, in order to survive in a changing light environment. In this study we comprehensively explored the light color acclimation of Cyanobium gracile, a common cyanobacterium in turbid freshwater shallow lakes, using nine different monochromatic growth lights covering the whole visible spectrum from 435 to 687 nm. According to incident light wavelength, C. gracile cells performed great plasticity in terms of pigment composition, antenna size, and photosystem stoichiometry, to optimize their photosynthetic performance and to redox poise their intersystem electron transport chain. In spite of such compensatory strategies, C. gracile, like other cyanobacteria, uses blue and near far-red light less efficiently than orange or red light, which involves moderate growth rates, reduced cell volumes and lower electron transport rates. Unfavorable light conditions, where neither chlorophyll nor phycobilisomes absorb light sufficiently, are compensated by an enhanced antenna size. Increasing the wavelength of the growth light is accompanied by increasing photosystem II to photosystem I ratios, which involve better light utilization in the red spectral region. This is surprisingly accompanied by a partial excitonic antenna decoupling, which was the highest in the cells grown under 687 nm light. So far, a similar phenomenon is known to be induced only by strong light; here we demonstrate that under certain physiological conditions such decoupling is also possible to be induced by weak light. This suggests that suboptimal photosynthetic performance of the near far-red light grown C. gracile cells is due to a solid redox- and/or signal-imbalance, which leads to the activation of this short-term light acclimation process. Using a variety of photo-biophysical methods, we also demonstrate that under blue wavelengths, excessive light is quenched through orange carotenoid protein mediated non-photochemical quenching, whereas under orange/red wavelengths state transitions are involved in photoprotection.

Medio-Lateral and Flexion-Extension Gap Imbalances in Mechanically Aligned Total Knee Arthroplasty Using Measured Resection Technique in Korean Patients: 3D Simulation

Background: It is well known that the measured resection (MR) technique in mechanically aligned (MA) total knee arthroplasty (TKA) generates significant gap imbalances, but little is known about whether this applies to the knees of Asian patients. The aim of this study was to evaluate the medio-lateral and flexion-extension gap imbalances and to find the most optimal posterior femoral condyle resection method for operating on the knees of Asian patients. Methods: In total, 738 magnetic resonance imaging (MRI) scans of consecutive patients who underwent TKA were obtained. Four posterior femoral condylar resection methods were used: alignment by the surgical transepicondylar axis (TEA), Whiteside’s line (WSL), 3° external rotation to the posterior condylar axis (PCA), and flexion-extension axis (FEA). Results: For the medial compartments, there were significant differences between the flexion and extension gaps in the varus knee group in all four methods, but there were no differences between the flexion and extension gaps in the valgus knee group. For the lateral compartment, all the methods showed significant differences except for WSL of the valgus knee group and FEA of the varus knee group. Conclusions: In Asian patients, the use of the MA MR technique inevitably leads to medio-lateral or flexion-extension imbalances. Therefore, surgeons should consider which methods can minimize imbalances and choose the best method within the technically possible range.

Pivotal Role of the Interaction Between Herbal Medicines and Gut Microbiota on Disease Treatment

With the recognition of the important role of gut microbiota in both health and disease progression, attempts to modulate its composition, as well as its co-metabolism with the organism, have attracted special attention. Abundant studies have demonstrated that dysfunction or imbalance of gut microbiota is closely related to disease progression, including endocrine diseases, neurodegenerative diseases, tumors, cardiovascular diseases, etc. Herbal medicines have been applied to prevent and treat diseases worldwide for hundreds of years. Although the underlying mechanism seems to be complex, one of the important ones is through modulating gut microbiota. In this review, co-metabolism between herbal medicines and microbiota, as well as the potential pathways are summarized from most recent published papers.

Vestibular Migraine of Childhood and Recurrent Vertigo of Childhood: Diagnostic criteria Consensus document of the Committee for the Classification of Vestibular Disorders of the Bárány Society and the International Headache Society

This paper describes the diagnostic criteria for “Vestibular Migraine of Childhood”, “probable Vestibular Migraine of Childhood” and “Recurrent Vertigo of Childhood” as put forth by the Committee for the Classification of Vestibular Disorders of the Bárány Society (ICVD) and the Migraine Classification subgroup of the International Headache Society. Migraine plays an important role in some subgroups of children with recurrent vertigo. In this classification paper a spectrum of three disorders is described in which the migraine component varies from definite to possibly absent. These three disorders are: Vestibular Migraine of Childhood, probable Vestibular Migraine of Childhood and Recurrent Vertigo of Childhood. The criteria for Vestibular Migraine of Childhood (VMC) include (A) at least five episodes with vestibular symptoms of moderate or severe intensity, lasting between five minutes and 72 hours, (B) a current or past history of migraine with or without aura, and (C) at least half of episodes are associated with at least one migraine feature. Probable Vestibular Migraine of Childhood (probable VMC) is considered when at least three episodes with vestibular symptoms of moderate or severe intensity, lasting between five minutes and 72 hours, are accompanied by at least criterion B or C from the VMC criteria. Recurrent Vertigo of Childhood (RVC) is diagnosed in case of at least three episodes with vestibular symptoms of moderate or severe intensity, lasting between 1 minute and 72 hours, and none of the criteria B and C for VMC are applicable. For all disorders, the age of the individual needs to be below 18 years old. It is recommended that future research should particularly focus on RVC, in order to investigate and identify possible subtypes and its links or its absence thereof with migraine.

Do Mothers Have Worse Sleep Than Fathers? Sleep Imbalance, Parental Stress, and Relationship Satisfaction in Working Parents

PURPOSE

Previous research indicates that mothers take a larger responsibility for child care during the night and that they have more disturbed sleep than fathers. The purpose of this study was to determine whether such a sleep imbalance exists in working parents of young children, and the extent to which it depends on the way sleep is measured. The study also examined whether imbalanced sleep between parents predicts parental stress and relationship satisfaction.

METHODS

Sleep was measured for seven consecutive days in 60 parenting couples (average age of the youngest child: 3.3 years ± SD 2.5 years). Actigraphs were worn across the week, and ratings of sleep, parental stress, and relationship satisfaction were made daily.

RESULTS

Mothers perceived their sleep quality as worse (b= -0.38 scale units, p<0.001), with more wake periods (b= +0.96 awakenings, p<0.001) but with longer sleep duration (b= +32.4 min, p<0.01) than fathers. Actigraphy data confirmed that mothers slept longer than fathers (b= +28.03 min, p<0.001), but no significant differences were found for wake time, number of awakenings or who woke up first during shared awakenings. Furthermore, there was no difference in whether mothers and fathers slept sufficiently. The level of sleep imbalance between parents did not predict parental stress. A larger imbalance in subjective sleep sufficiency predicted decreased relationship satisfaction for fathers (b= -0.13 scale units, p<0.01) but increased relationship satisfaction for mothers (b= 0.14 scale units, p<0.05). No other sleep imbalance measures predicted relationship satisfaction.

CONCLUSION

Our findings are in line with previous research on sleep in men and women in general, with longer sleep and subjective reports of sleep disturbances in women, rather than previous research on sleep in parents of young children. Thus, we found no evidence of a sleep imbalance when both parents have similar working responsibilities.

Usefulness of Mobile Devices in the Diagnosis and Rehabilitation of Patients with Dizziness and Balance Disorders: A State of the Art Review

Objective

The gold standard for objective body posture examination is posturography. Body movements are detected through the use of force platforms that assess static and dynamic balance (conventional posturography). In recent years, new technologies like wearable sensors (mobile posturography) have been applied during complex dynamic activities to diagnose and rehabilitate balance disorders. They are used in healthy people, especially in the aging population, for detecting falls in the older adults, in the rehabilitation of different neurological, osteoarticular, and muscular system diseases, and in vestibular disorders. Mobile devices are portable, lightweight, and less expensive than conventional posturography. The vibrotactile system can consist of an accelerometer (linear acceleration measurement), gyroscopes (angular acceleration measurement), and magnetometers (heading measurement, relative to the Earth’s magnetic field). The sensors may be mounted to the trunk (most often in the lumbar region of the spine, and the pelvis), wrists, arms, sternum, feet, or shins. Some static and dynamic clinical tests have been performed with the use of wearable sensors. Smartphones are widely used as a mobile computing platform and to evaluate the results or monitor the patient during the movement and rehabilitation. There are various mobile applications for smartphone-based balance systems. Future research should focus on validating the sensitivity and reliability of mobile device measurements compared to conventional posturography.

Conclusion

Smartphone based mobile devices are limited to one sensor lumbar level posturography and offer basic clinical evaluation. Single or multi sensor mobile posturography is available from different manufacturers and offers single to multi-level measurements, providing more data and in some instances even performing sophisticated clinical balance tests.

Monitoring Muscle-Tendon Adaptation Over Several Years of Athletic Training and Competition in Elite Track and Field Jumpers

Differences in muscle and tendon responsiveness to mechanical stimuli and time courses of adaptive changes may disrupt the interaction of the musculotendinous unit (MTU), increasing the risk for overuse injuries. We monitored training-induced alterations in muscle and tendon biomechanical properties in elite jumpers over 4 years of athletic training to detect potential non-synchronized adaptations within the triceps surae MTU. A combined cross-sectional and longitudinal investigation over 4 years was conducted by analyzing triceps surae MTU mechanical properties in both legs via dynamometry and ultrasonography in 67 elite track and field jumpers and 24 age-matched controls. Fluctuations in muscle and tendon adaptive changes over time were quantified by calculating individual residuals. The cosine similarity of the relative changes of muscle strength and tendon stiffness between sessions served as a measure of uniformity of adaptive changes. Our cross-sectional study was unable to detect clear non-concurrent differences in muscle strength and tendon stiffness in elite jumpers. However, when considering the longitudinal data over several years of training most of the jumpers demonstrated greater fluctuations in muscle strength and tendon stiffness and hence tendon strain compared to controls, irrespective of training period (preparation vs. competition). Moreover, two monitored athletes with chronic Achilles tendinopathy showed in their affected limb lower uniformity in MTU adaptation as well as higher fluctuations in tendon strain over time. Habitual mechanical loading can affect the MTU uniformity in elite jumpers, leading to increased mechanical demand on the tendon over an athletic season and potentially increased risk for overuse injuries.

Effects of Myeloid Hif-1β Deletion on the Intestinal Microbiota in Mice under Environmental Hypoxia

External environmental factors can cause an imbalance in intestinal flora. For people living in the extremes of a plateau climate, lack of oxygen is a primary health challenge that leads to a series of reactions. We wondered how intestinal microorganisms might change in a simulated plateau environment and what changes might occur in the host organism and intestinal microorganisms in the absence of hypoxia-related factors. In this study, mice carrying a knockout of hypoxia-inducible factor 1β (Hif-1β) in myeloid cells and wild-type mice were raised in a composite hypoxic chamber to simulate a plateau environment at 5,000 m of elevation for 14 days. The mice carrying the myeloid Hif-1β deletion displayed aggravated hypoxic phenotypes in comparison to and significantly greater weight loss and significantly higher cardiac index values than the wild-type group. The levels of some cytokines increased in the hypoxic environment. Analysis of 16S rRNA sequencing results showed that hypoxia had a significant effect on the gut microbiota in both wild-type and Hif-1β-deficient mice, especially on the first day. The levels of members of the Bacteroidaceae family increased continuously from day 1 to day 14 in Hif-1β deletion mice, and they represented an obviously different group of bacteria at day 14 compared with the wild-type mice. Butyrate-producing bacteria, such as Butyricicoccus, were found in wild-type mice only after 14 days in the hypoxic environment. In conclusion, hypoxia caused heart enlargement, greater weight loss, and obvious microbial imbalance in myeloid Hif-1β-deficient mice. This study revealed genetic and microecological pathways for research on mechanisms of hypoxia.

[Clinical analysis of idiopathic bilateral vestibulopathy]

Objective:To improve the level of clinical diagnosis and treatment of idiopathic bilateral vestibulopathy（IBV） by investigating the clinical characteristics of this disease. Method:Retrospective analysis was performed on patients with IBV diagnosed, excluding patients with clear primary factors, and including IBV patients with unknown causes, to analyze their clinical symptoms and vestibular function examination results. Result:In this group of cases, three cases were in line with the diagnosis of IBV. The clinical manifestations included imbalance, oscillopsia, and normal hearing level, which cannot be explained by other diseases. The vestibular function testing of the patients with IBV showed bilateral reduced response in caloric tests, positive response in video head impulse test, and decreased score in sensory organization test. Vestibular rehabilitation therapy were carried for these patients, and could improve the patients' symptoms. Conclusion:IBV has typical clinical manifestations. Vestibular function testing indicates bilateral vestibular dysfunction. Other diseases with bilateral vestibulopathy should be excluded for diagnoses, and vestibular rehabilitation therapy is one of the appropriate treatments.

Predicting Clinical Outcome in Acute Ischemic Stroke Using Parallel Multi-parametric Feature Embedded Siamese Network

Stroke is the second leading cause of death and disability worldwide, with ischemic stroke as the most common type. The preferred diagnostic procedure at the acute stage is the acquisition of multi-parametric magnetic resonance imaging (MRI). This type of imaging not only detects and locates the stroke lesion, but also provides the blood flow dynamics that helps clinicians in assessing the risks and benefits of reperfusion therapies. However, evaluating the outcome of these risky therapies beforehand is a complicated task due to the variability of lesion location, size, shape, and cerebral hemodynamics involved. Though the fully automated model for predicting treatment outcomes using multi-parametric imaging would be highly valuable in clinical settings, MRI datasets acquired at the acute stage are mostly scarce and suffer high class imbalance. In this paper, parallel multi-parametric feature embedded siamese network (PMFE-SN) is proposed that can learn with few samples and can handle skewness in multi-parametric MRI data. Moreover, five suitable evaluation metrics that are insensitive to imbalance are defined for this problem. The results show that PMFE-SN not only outperforms other state-of-the-art techniques in all these metrics but also can predict the class with a small number of samples, as well as the class with high number of samples. An accuracy of 0.67 on leave one cross out testing has been achieved with only two samples (minority class) for training and accuracy of 0.61 with the highest number of samples (majority class). In comparison, state-of-the-art using hand crafted features has 0 accuracy for minority class and 0.33 accuracy for majority class.

Inter-limb strength asymmetry in adolescent distance runners: Test-retest reliability and relationships with performance and running economy

The purpose of this investigation was, firstly, to quantify the test-retest reliability of strength measures in adolescent distance runners; and secondly, to explore the relationships between inter-limb strength asymmetry and performance and running economy (RE) in a similar cohort of young runners. For the reliability study, twelve (n = 6 female) post-pubertal adolescent distance runners performed an isometric quarter-squat on a dual force plate and unilateral isometric hip extension and hip abduction tests on two occasions. For the correlation study, participants (n = 31) performed the strength tests plus a submaximal incremental running assessment and a maximal running test. Running economy was expressed as the average energy cost of running for all speeds below lactate turnpoint and was scaled for body mass using a previously calculated power exponent. Allometrically scaled peak force during the quarter-squat and peak torque in the hip strength tasks showed acceptable levels of reproducibility (typical error ≤6.3%). Relationships between strength asymmetry and performance and RE were low or negligible (r < 0.47, p > 0.05), except for hip abduction strength asymmetry and RE in the female participants (r = 0.85, p < 0.001, n = 16). Practitioners should consider inter-limb hip abduction strength asymmetry on an individual level, and attempting to reduce this asymmetry in females may positively impact RE.

An analysis of preoperative shoulder and neck balance and surgical outcome in 111 adolescent idiopathic scoliosis patients with two subtypes of Lenke 1 curves

OBJECTIVE

The incidence of postoperative shoulder imbalance following posterior spinal fusion (PSF) is still high in Lenke 1 curves despite following current treatment recommendations for upper instrumented vertebra (UIV) selection. The objective of this retrospective study was to identify differences in preoperative shoulder balance and to report the surgical outcome of two subtypes of Lenke 1 curves (flexible vs stiff) in patients with adolescent idiopathic scoliosis (AIS).

METHODS

The authors grouped patients' curves as Lenke 1-ve (flexible) when their preoperative proximal thoracic side bending (PTSB) Cobb angle was < 15° and as Lenke 1+ve (stiff) when the PTSB Cobb angle was 15°-24.9°. The authors hypothesized that these two subtypes had distinct preoperative and postoperative shoulder and neck balance following PSF using pedicle screw constructs.

RESULTS

Fifty patients had Lenke 1 (flexible) curves and 61 had Lenke 1 (stiff) curves. The mean preoperative T1 tilt for patients with Lenke 1 (flexible) was -4.9° ± 5.3°, and for those with Lenke 1 (stiff) curves it was -1.0° ± 5.3° (p < 0.001). Mean cervical axis (CA) was -0.1° ± 3.2° for Lenke 1 (flexible) curves and 2.3° ± 3.5° for Lenke 1 (stiff) curves (p < 0.001). Preoperative radiographic shoulder height (RSH) and clavicle angle (Cla-A) were similar between the two curve subtypes. Following surgery, there were significant differences between the subtypes in terms of T1 tilt (p < 0.001), RSH (p = 0.014), and Cla-A (p = 0.031). Interestingly, 41.0% of patients with a Lenke 1 (stiff) curve had +ve T1 tilt compared to 2.0% in Lenke 1 (flexible) group. Moreover, 26.2% of patients with the Lenke 1 (stiff) curve had +ve RSH compared to 12.0% of those with Lenke 1 (flexible) curves. And, 24.6% of patients with Lenke 1 (stiff) had +ve Cla-A compared to 10.0% of those with Lenke 1 (flexible) curves.

CONCLUSIONS

Lenke 1 (flexible) and Lenke 1 (stiff) curves had distinct preoperative T1 tilt and CA measurements. Following PSF, the authors noted +ve T1 tilt in 41% of patients with Lenke 1 (stiff) curves versus 2.0% in those with Lenke 1 (flexible) curves. The authors also noted a significant difference in postoperative RSH and Cla-A measurements.

Muscle and Tendon Morphology in Early-Adolescent Athletes and Untrained Peers

Adolescent athletes can feature significantly greater muscle strength and tendon stiffness compared to untrained peers. However, to date, it is widely unclear if radial muscle and tendon hypertrophy may contribute to loading-induced adaptation at this stage of maturation. The present study compares the morphology of the vastus lateralis (VL) and the patellar tendon between early-adolescent athletes and untrained peers. In 14 male elite athletes (A) and 10 untrained controls (UC; 12–14 years of age), the VL was reconstructed from full muscle segmentations of magnetic resonance imaging (MRI) sequences and ultrasound imaging was used to measure VL fascicle length and pennation angle. The physiological cross-sectional area (PCSA) of the VL was calculated by dividing muscle volume by fascicle length. The cross-sectional area (CSA) of the patellar tendon was measured over its length based on MRI segmentations as well. Considering body mass as covariate in the analysis, there were no significant differences between groups considering the VL anatomical cross-sectional area (ACSA) over its length or maximum ACSA (UC: 24.0 ± 8.3 cm², A: 28.1 ± 5.3 cm², p > 0.05), yet athletes had significantly greater VL volume (UC: 440 ± 147 cm³, A: 589 ± 121 cm³), PCSA (UC: 31 ± 9 cm², A: 46 ± 9 cm²), pennation angle (UC: 8.2 ± 1.4°, A: 10.1 ± 1.3°), and average patellar tendon CSA (UC: 1.01 ± 0.18 cm², A: 1.21 ± 0.18 cm²) compared to the untrained peers (p < 0.05). However, the ratio of average tendon CSA to VL PCSA was significantly lower in athletes (UC: 3.4 ± 0.1%, A: 2.7 ± 0.5%; p < 0.05). When inferring effects of athletic training based on the observed differences between groups, these results suggest that both muscle and tendon of the knee extensors respond to athletic training with radial growth. However, the effect seems to be stronger in the muscle compared to the tendon, with an increase of pennation angle contributing to the marked increase of muscle PCSA. A disproportionate response to athletic training might be associated with imbalances of muscle strength and tendon stiffness and could have implications for the disposition towards tendon overuse injury.

Organ of hearing and balance in peri- and postmenopausal women. Effects of hormone replacement therapy on hearing and balance in peri- and post-menopausal women: The current state of knowledge

Sensory-neural hearing loss in people over 50 - senile deafness - is currently an increasing problem due to the growing proportion of the elderly people in the population. We can find a number of worldwide publications on hearing loss and dizziness in peri-menopausal women, but the data is inconsistent. Reports describing the influence of sex hormones on the ear and its aging are similarly controversial. This review attempts to summarize the current state of knowledge regarding hearing and balance in women during menopause, based on recent studies in this field. It describes the possible causes of hearing and balance impairment in post-menopausal women other than the mere physiological aging of the ear. The review concludes that impairment of hearing and balance is significantly related to osteoporosis, which results from estrogen deficiency during menopause. It also presents the results of studies on the impact of hormone replacement therapy (HRT) and of particular hormonal components of HRT on hearing and balance. The European population is aging, so accurate knowledge about the effects of HRT on hearing and balance is crucial in the context of improving the quality of life of elderly women through appropriate qualification for hormone substitution therapy. Further detailed and extensive study is necessary to verify the impact of sex hormones on hearing in post-menopausal women, taking into account the type of HRT used, serum hormone levels and the presence or absence of osteoporosis.