Changes in postural stability after cerebrospinal fluid tap test in patients with idiopathic normal pressure hydrocephalus.

Introduction: In patients with idiopathic normal pressure hydrocephalus (iNPH), the characteristics of balance disturbance are not as well understood as those related to gait. This study examined changes in postural stability in quiet standing after the cerebrospinal fluid tap test (CSFTT) in these patients. Furthermore, the study explored the relationship between the amount of spontaneous body sway and both gait and executive function. Materials and methods: All patients diagnosed with iNPH underwent CSFTT. We evaluated their center of pressure (COP) measurements on a force plate during quiet standing, both pre- and post-CSFTT. Following the COP measurements, we calculated COP parameters using time and frequency domain analysis and assessed changes in these parameters after CSFTT. At pre-CSFTT, we assessed the Timed Up and Go (TUG) and the Frontal Assessment Battery (FAB). We investigated the relationship between COP parameters and the TUG and FAB scores at pre-CSFTT. Results: A total of 72 patients with iNPH were initially enrolled, and 56 patients who responded positively to CSFTT were finally included. Post-CSFTT, significant improvements were observed in COP parameters through time domain analysis. These included the velocity of COP (vCOP), root-mean-square of COP (rmsCOP), turn index, torque, and base of support (BOS), compared to the pre-CSFTT values (p < 0.05). In the frequency domain analysis of COP parameters post-CSFTT, there was a decrease in both the peak and average of power spectral density (PSD) values in both the anteroposterior (AP) and mediolateral (ML) directions below 0.5 Hz (p < 0.05). In addition, the TUG scores showed a positive correlation with vCOP, rmsCOP, turn index, torque, BOS, and both the peak and average PSD values in the AP and ML directions below 0.5 Hz (p < 0.05). The FAB scores demonstrated a negative correlation with vCOP, rmsCOP, turns index, BOS, and both peak and average PSD values in the AP direction below 0.5 Hz (p < 0.05). Conclusion: In patients with iNPH who responded to CSFTT, there was an improvement in spontaneous body sway during quiet standing after CSFTT. Increased spontaneous sway is associated with impaired gait and frontal lobe function. This may be linked to impaired cortico-cortical and cortico-subcortical circuits in patients with iNPH.

Machine Learning-Based Classification of Dependence in Ambulation in Stroke Patients Using Smartphone Video Data.

The goal of this study was to develop a framework to classify dependence in ambulation by employing a deep model in a 3D convolutional neural network (3D-CNN) using video data recorded by a smartphone during inpatient rehabilitation therapy in stroke patients. Among 2311 video clips, 1218 walk action cases were collected from 206 stroke patients receiving inpatient rehabilitation therapy (63.24 ± 14.36 years old). As ground truth, the dependence in ambulation was assessed and labeled using the functional ambulatory categories (FACs) and Berg balance scale (BBS). The dependent ambulation was defined as a FAC score less than 4 or a BBS score less than 45. We extracted patient-centered video and patient-centered pose of the target from the tracked target's posture keypoint location information. Then, the extracted patient-centered video was input in the 3D-CNN, and the extracted patient-centered pose was used to measure swing time asymmetry. Finally, we evaluated the classification of dependence in ambulation using video data via fivefold cross-validation. When training the 3D-CNN based on FACs and BBS, the model performed with 86.3% accuracy, 87.4% precision, 94.0% recall, and 90.5% F1 score. When the 3D-CNN based on FACs and BBS was combined with swing time asymmetry, the model exhibited improved performance (88.7% accuracy, 89.1% precision, 95.7% recall, and 92.2% F1 score). The proposed framework for dependence in ambulation can be useful, as it alerts clinicians or caregivers when stroke patients with dependent ambulatory move alone without assistance. In addition, monitoring dependence in ambulation can facilitate the design of individualized rehabilitation strategies for stroke patients with impaired mobility and balance function.

Machine learning analysis to automatically measure response time of pharyngeal swallowing reflex in videofluoroscopic swallowing study.

To evaluate clinical features and determine rehabilitation strategies of dysphagia, it is crucial to measure the exact response time of the pharyngeal swallowing reflex in a videofluoroscopic swallowing study (VFSS). However, measuring the response time of the pharyngeal swallowing reflex is labor-intensive and particularly for inexperienced clinicians, it can be difficult to measure the brief instance of the pharyngeal swallowing reflex by VFSS. To accurately measure the response time of the swallowing reflex, we present a novel framework, able to detect quick events. In this study, we evaluated the usefulness of machine learning analysis of a VFSS video for automatic measurement of the response time of a swallowing reflex in a pharyngeal phase. In total, 207 pharyngeal swallowing event clips, extracted from raw VFSS videos, were annotated at the starting point and end point of the pharyngeal swallowing reflex by expert clinicians as ground-truth. To evaluate the performance and generalization ability of our model, fivefold cross-validation was performed. The average success rates of detection of the class "during the swallowing reflex" for the training and validation datasets were 98.2% and 97.5%, respectively. The average difference between the predicted detection and the ground-truth at the starting point and end point of the swallowing reflex was 0.210 and 0.056 s, respectively. Therefore, the response times during pharyngeal swallowing reflex are automatically detected by our novel framework. This framework can be a clinically useful tool for estimating the absence or delayed response time of the swallowing reflex in patients with dysphagia and improving poor inter-rater reliability of evaluation of response time of pharyngeal swallowing reflex between expert and unskilled clinicians.

Automatic Detection of the Pharyngeal Phase in Raw Videos for the Videofluoroscopic Swallowing Study Using Efficient Data Collection and 3D Convolutional Networks †.

Videofluoroscopic swallowing study (VFSS) is a standard diagnostic tool for dysphagia. To detect the presence of aspiration during a swallow, a manual search is commonly used to mark the time intervals of the pharyngeal phase on the corresponding VFSS image. In this study, we present a novel approach that uses 3D convolutional networks to detect the pharyngeal phase in raw VFSS videos without manual annotations. For efficient collection of training data, we propose a cascade framework which no longer requires time intervals of the swallowing process nor the manual marking of anatomical positions for detection. For video classification, we applied the inflated 3D convolutional network (I3D), one of the state-of-the-art network for action classification, as a baseline architecture. We also present a modified 3D convolutional network architecture that is derived from the baseline I3D architecture. The classification and detection performance of these two architectures were evaluated for comparison. The experimental results show that the proposed model outperformed the baseline I3D model in the condition where both models are trained with random weights. We conclude that the proposed method greatly reduces the examination time of the VFSS images with a low miss rate.

[Studies on the metacercariae from fresh water fishes in the Kum-Ho River]

The distribution and the infestation rates of metacercariae in fishes from the Kum-Ho river were observed from June 1965 to August l967. The results obtained are as follows: 1)The Fourteen kinds of metacercariae; Exorchis oviformis, Metorchis orientalis, Cyathocotyle species, Metacercaria hasegawai, Clonorchis sinensis, Metagonimus species, Pseudexorchis major, Echinochasmus species, Centrocestus species, Prosorhpynchus species, and four kinds of unidentified species, A, B, C and D were detected from 12 kinds of fishes. 2)Clonorchis sinensis, Metagonimus species, Echinochasmus species, and Centrocestus species of the detected 14 kinds of flukes were noted to be parasited in man; Metorchis orientalis and Cyathocotyle species in avian species; and Exorchis ovifomis and Pseudexorchis major in wels, but the definite host of the other 6 kinds of flukes were not identified. 3)Exorchis oviformis was found in 64.5 percent, of all kinds of fishes, Cyathocotyle species in 36.8 percent of 7 kinds of fishes, Metacercaria hasegawai in 36.3 percent of 8 kinds, Clonorchis sinensis in 95.0 percent of 6 kinds and Metagonimus species in 47.9 percent of 10 kinds. 4)Concerning the infested rates of metacercaria and the length of fishes, Exorchis oviformis and Clonorchis sinensis showed increased rate by the length of fishes but the rest of fishes showed no relationship between them. 5)The infested degree of metacercaria of Clonorchis sinensis was highest in Pseudorasbora parva with 34.3 parasites per cubic cm of flesh, of Exorchis oviformis in Carassius carassius with 7.3, of Cyathocotyle species in Acheilognathus with 6.0, and of Metacercaria hasegawai in Pseudogobio esocinus with 5.7 but Prosorhpynchus etc. were very few in all kinds of fishes. 6)The infested rates of metacercaria in the four kinds of fishes, Pseudorasbora parva, Pungtungia herzi, Pseudogobio esocinus and Gnathopogon coreanus seemed not to be influenced by season, Spring and Autumn. 7)In the infested rates of metacercariae by parts of fishes, Exorchis oviformis was chiefly infested in scales and fins; Metorchis orientalis, Cyathocotyle species, Clonorchis sinensis, Pseudexorchis major, Centrocestus species and Prosorhpynchus ecinatus were chiefly infested in muscle; Metacercaria hasegawai in muscle and fins; Metagonimus species chiefly in scales; and Echinochasmus chiefly in gills.

[Studies On The Larval Trematodes From Brackish Water Fishes: 2. Observation On Pseudexorchis Major (Hasegawa, 1935) Yamaguti, 1938]

The Parasitological investigation on the encysted metacercariae in brackish water fish, Tribolodon taczanowskii, in the downstream of Hyungsan river which is located in Kyungpook Province of Korea, were carried out serially and the following results were obtained. 1)Metacercariae of Pseudexorchis major were found in six fishes(15.8 %) out of 38 examined. 2)Parasitic frequencies of the encysted metacercaria of Psedexorchis major in Tribolodon taczanowskii were 15.8 %(6 out of 38) in the scale, 10.5 %(4 out of 38) in the fin, 13.2 %(5 out of 38) in the gill, 10.5 %(4 out of 38) in the oral cavity and 7.9 %(3 out of 38) in the flesh. 3)The worms were identified as Pseudexorchis major (Hasegawa, 1935) Yamaguti, 1938 by morphological studies on the metacercariae, excysted metacercariae, adults and eggs, and compared with prereported Pseudexorchis species.

[Studies Of The Larval Trematodes From Brackish Water Fishes: 2. Observation On Metagonimus Yokogawai Katsurada, 1912]

The Parasitological investigation on the encysted metacercariae in brackish water fish, Tribolodon taczanowskii Steindachner, in the downstream of Hyungsan river which is located in Kyungpook province of Korea, were carried out, and the following results were obtained. 1)Metacercariae of Metagonimus species were found in seventy five fishes (40.5 percent) out of 185 examined. 2)Parasitic frequencies of the encysted matacercaria of Metagonimus species in Tribolodon taczanowskii were 23.2 percent (43 out of 185) in the scale, 7.0 percent (13 out of 185) in the gill, and 10.3 percent (19 out of 185) in the flesh. 3)The number of the metacercaria in the scale, gill and flesh were fewer than that of the others. 4)The worms were identified as Metagonimus yokogawai Katsurada, 1912 by morphological studies on the adults and eggs, and compared with prereported Metagonimus species.