Performance of ChatGPT in Answering Clinical Questions on the Practical Guideline of Blepharoptosis.

BACKGROUND: ChatGPT is a free artificial intelligence (AI) language model developed and released by OpenAI in late 2022. This study aimed to evaluate the performance of ChatGPT to accurately answer clinical questions (CQs) on the Guideline for the Management of Blepharoptosis published by the American Society of Plastic Surgeons (ASPS) in 2022. METHODS: CQs in the guideline were used as question sources in both English and Japanese. For each question, ChatGPT provided answers for CQs, evidence quality, recommendation strength, reference match, and answered word counts. We compared the performance of ChatGPT in each component between English and Japanese queries. RESULTS: A total of 11 questions were included in the final analysis, and ChatGPT answered 61.3% of these correctly. ChatGPT demonstrated a higher accuracy rate in English answers for CQs compared to Japanese answers for CQs (76.4% versus 46.4%; p = 0.004) and word counts (123 words versus 35.9 words; p = 0.004). No statistical differences were noted for evidence quality, recommendation strength, and reference match. A total of 697 references were proposed, but only 216 of them (31.0%) existed. CONCLUSIONS: ChatGPT demonstrates potential as an adjunctive tool in the management of blepharoptosis. However, it is crucial to recognize that the existing AI model has distinct limitations, and its primary role should be to complement the expertise of medical professionals. LEVEL OF EVIDENCE V: Observational study under respected authorities. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Association between Severity of Freezing of Gait and Turning Characteristics in People with Parkinson's Disease.

For people with Parkinson's disease (PD) with freezing of gait (FOG) (freezers), symptoms mainly exhibit as unilateral motor impairments that may cause difficulty during postural transitions such as turning during daily activities. We investigated the turning characteristics that distinguished freezers among people with PD and analyzed the association between the New Freezing of Gait Questionnaire (NFOGQ) scores and the gait characteristics according to the turning direction for the affected limbs of freezers. The study recruited 57 people with PD (27 freezers, 30 non-freezers). All experiments measured the maximum 180° turning task with the "Off" medication state. Results revealed that the outer ankle range of motion in the direction of the inner step of the more affected limb (IMA) was identified to distinguish freezers and non-freezers (RN2 = 0.735). In addition, higher NFOGQ scores were associated with a more significant anteroposterior root mean square distance of the center of mass in the IMA direction and a greater inner stance phase in the outer step of the more affected limb (OMA) direction; explanatory power was 50.1%. Assessing the maximum speed and turning direction is useful for evaluating the differences in turning characteristics between freezers and non-freezers, which can help define freezers more accurately.

Association of Muscle Mass, Muscle Strength, and Muscle Function with Gait Ability Assessed Using Inertial Measurement Unit Sensors in Older Women.

Aging-related muscle atrophy is associated with decreased muscle mass (MM), muscle strength (MS), and muscle function (MF) and may cause motor control, balance, and gait pattern impairments. This study determined associations of three speed-based gait variables with loss of MM, MS, and MF in older women. Overall, 432 older women aged ≥65 performed appendicular skeletal muscle, handgrip strength, and five times sit-to-stand test to evaluate MM, MS, and MF. A gait test was performed at three speeds by modifying the preferred walking speed (PWS; slower walking speed (SWS); faster-walking speed (FWS)) on a straight 19 m walkway. Stride length (SL) at PWS was significantly associated with MM. FWS and coefficient of variance (CV) of double support phase (DSP) and DSP at PWS showed significant associations with MS. CV of step time and stride time at SWS, FWS, and single support phase (SSP) at PWS showed significant associations with MF. SL at PWS, DSP at FWS, CV of DSP at PWS, stride time at SWS, and CV of SSP at PWS showed significant associations with composite MM, MS, and MF variables. Our study indicated that gait tasks under continuous and various speed conditions are useful for evaluating MM, MS, and MF.

Classification of Parkinson's disease with freezing of gait based on 360° turning analysis using 36 kinematic features.

BACKGROUND: Freezing of gait (FOG) is a sensitive problem, which is caused by motor control deficits and requires greater attention during postural transitions such as turning in people with Parkinson's disease (PD). However, the turning characteristics have not yet been extensively investigated to distinguish between people with PD with and without FOG (freezers and non-freezers) based on full-body kinematic analysis during the turning task. The objectives of this study were to identify the machine learning model that best classifies people with PD and freezers and reveal the associations between clinical characteristics and turning features based on feature selection through stepwise regression. METHODS: The study recruited 77 people with PD (31 freezers and 46 non-freezers) and 34 age-matched older adults. The 360° turning task was performed at the preferred speed for the inner step of the more affected limb. All experiments on the people with PD were performed in the "Off" state of medication. The full-body kinematic features during the turning task were extracted using the three-dimensional motion capture system. These features were selected via stepwise regression. RESULTS: In feature selection through stepwise regression, five and six features were identified to distinguish between people with PD and controls and between freezers and non-freezers (PD and FOG classification problem), respectively. The machine learning model accuracies revealed that the random forest (RF) model had 98.1% accuracy when using all turning features and 98.0% accuracy when using the five features selected for PD classification. In addition, RF and logistic regression showed accuracies of 79.4% when using all turning features and 72.9% when using the six selected features for FOG classification. CONCLUSION: We suggest that our study leads to understanding of the turning characteristics of people with PD and freezers during the 360° turning task for the inner step of the more affected limb and may help improve the objective classification and clinical assessment by disease progression using turning features.

Prediction of Decline in Global Cognitive Function Using Machine Learning with Feature Ranking of Gait and Physical Fitness Outcomes in Older Adults.

Gait and physical fitness are related to cognitive function. A decrease in motor function and physical fitness can serve as an indicator of declining global cognitive function in older adults. This study aims to use machine learning (ML) to identify important features of gait and physical fitness to predict a decline in global cognitive function in older adults. A total of three hundred and six participants aged seventy-five years or older were included in the study, and their gait performance at various speeds and physical fitness were evaluated. Eight ML models were applied to data ranked by the p-value (LP) of linear regression and the importance gain (XI) of XGboost. Five optimal features were selected using elastic net on the LP data for men, and twenty optimal features were selected using support vector machine on the XI data for women. Thus, the important features for predicting a potential decline in global cognitive function in older adults were successfully identified herein. The proposed ML approach could inspire future studies on the early detection and prevention of cognitive function decline in older adults.

Estimating Health-Related Quality of Life Based on Demographic Characteristics, Questionnaires, Gait Ability, and Physical Fitness in Korean Elderly Adults.

The elderly population in South Korea accounted for 15.5% of the total population in 2019. Thus, it is important to study the various elements governing the process of healthy aging. Therefore, this study investigated multiple prediction models to determine the health-related quality of life (HRQoL) in elderly adults based on the demographics, questionnaires, gait ability, and physical fitness. We performed eight physical fitness tests on 775 participants wearing shoe-type inertial measurement units and completing walking tasks at slower, preferred, and faster speeds. The HRQoL for physical and mental components was evaluated using a 36-item, short-form health survey. The prediction models based on multiple linear regression with feature importance were analyzed considering the best physical and mental components. We used 11 variables and 5 variables to form the best subset of features underlying the physical and mental components, respectively. We laid particular emphasis on evaluating the functional endurance, muscle strength, stress level, and falling risk. Furthermore, stress, insomnia severity, number of diseases, lower body strength, and fear of falling were taken into consideration in addition to mental-health-related variables. Thus, the study findings provide reliable and objective results to improve the understanding of HRQoL in elderly adults.

XGBoost based machine learning approach to predict the risk of fall in older adults using gait outcomes.

This study aimed to identify the optimal features of gait parameters to predict the fall risk level in older adults. The study included 746 older adults (age: 63-89 years). Gait tests (20 m walkway) included speed modification (slower, preferred, and faster-walking) while wearing the inertial measurement unit sensors embedded in the shoe-type data loggers on both outsoles. A metric was defined to classify the fall risks, determined based on a set of questions determining the history of falls and fear of falls. The extreme gradient boosting (XGBoost) model was built from gait features to predict the factor affecting the risk of falls. Moreover, the definition of the fall levels was classified into high- and low-risk groups. At all speeds, three gait features were identified with the XGBoost (stride length, walking speed, and stance phase) that accurately classified the fall risk levels. The model accuracy in classifying fall risk levels ranged between 67-70% with 43-53% sensitivity and 77-84% specificity. Thus, we identified the optimal gait features for accurate fall risk level classification in older adults. The XGBoost model could inspire future works on fall prevention and the fall-risk assessment potential through the gait analysis of older adults.

Low composite functional movement screen score associated with decline of gait stability in young adults.

BACKGROUND: The functional movement screen (FMS)TM is a screening tool used to evaluate fundamental motor function. A score of 14 for the composite total FMS score (TFMS) is generally used as the cut-off point (≤14/21). In addition, gait analysis is used to evaluate fundamental motor function in humans. Thus, evaluating the fundamental motor function using the FMSTM test and gait analysis at various speeds can provide further understanding of any decline in gait stability. In this study, we aimed to investigate the association between gait ability and fundamental movement patterns in young adults according to the cut-off point. METHODS: A total of 439 participants (male: 203, female: 236) successfully completed the FMS test and a 1 min treadmill test; the participants were classified into two groups: low TFMS (≤14) and high TFMS (>14). RESULTS: The low TFMS group exhibited slower and shortened walking patterns and worsen gait variability than the high TFMS group. The coefficient of variance (CV) for the double support phase at a faster speed (male) and the stride length at a slower speed (female) were classifiers between the two groups. In addition, the low TFMS group demonstrated insufficient gait adaptation at the preferred and faster speeds based on the CV of the double support phase and gait asymmetry. Lower TFMS is associated with a decline in gait ability. Therefore, participants with a lower TFMS and poor gait ability may require intervention programs to prevent risk of future injury and to enhance motor function.

Characteristics of Gait Variability in the Elderly While Walking on a Treadmill with Gait Speed Variation.

Gait variability (GV), which is a variable for predicting mobility issues and risk of falling in elderly people, is defined as the fluctuation in spatiotemporal characteristics from one step to the next in walking. The goal of this study was to analyze the age- and sex-related spatiotemporal variability characteristics of elderly individuals using the measurements taken while walking on a treadmill for one minute based on gait speed variation. Gait testing was conducted on 225 healthy male and female individuals aged 60-79 years who were able to walk and move on their own and, specifically, walk on a treadmill for one minute. The test was performed at three speed conditions-the preferred speed of the participant, 20% higher than the preferred speed, and 20% lower than the preferred speed-and data were recorded using shoe-type data loggers. The different age groups and sex could be distinguished using the coefficient of variance (CV) of the double support phase and gait asymmetry (GA) at the preferred speed, and CVs of stride length and stance phase at faster speed. The results indicated that the values of GV obtained from the test were used to determine the variation in gait characteristics of elderly individuals.

Association between Gait Variability and Gait-Ability Decline in Elderly Women with Subthreshold Insomnia Stage.

This study investigates the gait characteristics of elderly women, aged more than 65 years, with subthreshold insomnia stage at various walking speeds. A total of 392 participants (insomnia: 202 and controls: 190) wearing shoe-type inertial measurement units completed walking tests on a treadmill for a duration of 1 min at slower, preferred, and faster speeds. The insomnia group indicated lower pace parameters (range of Cohen's d: 0.283-0.499) and the single support phase (Cohen's d: 0.237), greater gait variability (range of Cohen's d: 0.217-0.506), and bilateral coordination (range of Cohen's d: 0.254-0.319), compared with their age-matched controls; the coefficient of variance (CV) of the stance phase at the faster speed condition was a crucial variable for distinguishing between insomnia and control groups. In addition, the insomnia group demonstrated insufficient gait adaptation at the slower and preferred speeds, as indicated by the CVs of the stride length, stride time, and step time. In particular, participants with worsened insomnia symptoms or sleep problems showed that these worse gait patterns may increase the potential risk of falling in elderly women. Thus, elderly women with subthreshold insomnia stage need to improve their sleep quality to enhance their physical functions.

Associating Gait Phase and Physical Fitness with Global Cognitive Function in the Aged.

This study aimed to identify classifier variables by considering both gait and physical fitness for identifying adults aged over 75 years and global cognitive function declines in older adults. The participants included 735 adults aged 65-89 years who were asked to walk at three different speeds (slower, preferred, and faster) while wearing inertial measurement units embedded in shoe-type data loggers and to perform nine physical fitness tests. The variability in the stance phase as well as the strength, balance, and functional endurance showed a strong dependence on the age being over 75 years. The cognitive function was evaluated by the Mini-Mental State Examination; a longer stance phase at a slower walking speed and decreased grip strength and five times sit-to-stand were associated with cognitive function. These findings may be useful for determining the decline in physical performance of older adults. A longer stance phase and decreased grip strength and five times sit-to-stand may be factors that help distinguish declines in cognitive function from normal age-related declines.

Turning Characteristics of the More-Affected Side in Parkinson's Disease Patients with Freezing of Gait.

This study investigated the turning characteristics of the more-affected limbs in Parkinson's disease (PD) patients in comparison with that of a control group, and in PD patients with freezing of gait (FOG; freezers) in comparison with those without FOG (non-freezers) for 360° and 540° turning tasks at the maximum speed. A total of 12 freezers, 12 non-freezers, and 12 controls participated in this study. The PD patients showed significantly longer total durations, shorter inner and outer step lengths, and greater anterior-posterior (AP) root mean square (RMS) center of mass (COM) distances compared to those for the controls. The freezers showed significantly greater AP and medial-lateral (ML) RMS COM distances compared to those of non-freezers. The turning task toward the inner step of the more-affected side (IMA) in PD patients showed significantly greater step width, total steps, and AP and ML RMS COM distances than that toward the outer step of the more-affected side (OMA). The corresponding results for freezers revealed significantly higher total steps and shorter inner step length during the 540° turn toward the IMA than that toward the OMA. Therefore, PD patients and freezers exhibited greater turning difficulty in performing challenging turning tasks such as turning with an increased angle and speed and toward the more-affected side.

Gait Characteristics under Imposed Challenge Speed Conditions in Patients with Parkinson's Disease During Overground Walking.

Evaluating gait stability at slower or faster speeds and self-preferred speeds based on continuous steps may assist in determining the severity of motor symptoms in Parkinson's disease (PD) patients. This study aimed to investigate the gait ability at imposed speed conditions in PD patients during overground walking. Overall, 74 PD patients and 52 age-matched healthy controls were recruited. Levodopa was administered to patients in the PD group, and all participants completed imposed slower, preferred, and faster speed walking tests along a straight 15-m walkway wearing shoe-type inertial measurement units. Reliability of the slower and faster conditions between the estimated and measured speeds indicated excellent agreement for PD patients and controls. PD patients demonstrated higher gait asymmetry (GA) and coefficient of variance (CV) for stride length and stance phase than the controls at slower speeds and higher CVs for phases for single support, double support, and stance. CV of the double support phase could distinguish between PD patients and controls at faster speeds. The GA and CVs of stride length and phase-related variables were associated with motor symptoms in PD patients. Speed conditions should be considered during gait analysis. Gait variability could evaluate the severity of motor symptoms in PD patients.

Gait Characteristics Based on Shoe-Type Inertial Measurement Units in Healthy Young Adults during Treadmill Walking.

This study investigated the gait characteristics of healthy young adults using shoe-type inertial measurement units (IMU) during treadmill walking. A total of 1478 participants were tested. Principal component analyses (PCA) were conducted to determine which principal components (PCs) best defined the characteristics of healthy young adults. A non-hierarchical cluster analysis was conducted to evaluate the essential gait ability, according to the results of the PC1 score. One-way repeated analysis of variance with the Bonferroni correction was used to compare gait performances in the cluster groups. PCA outcomes indicated 76.9% variance for PC1-PC6, where PC1 (gait variability (GV): 18.5%), PC2 (pace: 17.8%), PC3 (rhythm and phase: 13.9%), and PC4 (bilateral coordination: 11.2%) were the gait-related factors. All of the pace, rhythm, GV, and variables for bilateral coordination classified the gait ability in the cluster groups. We suggest that the treadmill walking task may be reliable to evaluate the gait performances, which may provide insight into understanding the decline of gait ability. The presented results are considered meaningful for understanding the gait patterns of healthy adults and may prove useful as reference outcomes for future gait analyses.

Age-specific differences in gait domains and global cognitive function in older women: gait characteristics based on gait speed modification.

BACKGROUND: Several studies have reported the association between gait and global cognitive function; however, there is no study explaining the age-specific gait characteristics of older women and association between those characteristics and global cognitive function by age-specific differences and gait speed modification. The aim of this study was to examine age-specific differences in gait characteristics and global cognitive function in older women as well as identify gait domains strongly associated with global cognitive function in older women based on gait speed modification. METHODS: One hundred sixty-four female participants aged 65-85 years were examined. Participants were assessed for global cognitive function through the mini-mental state examination. They also performed three trials of the overground walking test along a straight 20 m walkway. Inertial measurement unit sensors with shoe-type data loggers on both the left and right outsoles were used to measure gait characteristics. RESULTS: The pace at all speeds and the variability and phase at faster speeds were altered in women aged >75 years (all pace domain parameters, p < 0.05); variability and phase highly depended on age (all p < 0.05). Variability at slower speeds (ß = -0.568 and p = 0.006) and the phase at the preferred (ß = -0.471 and p = 0.005) and faster speeds (ß = -0.494 and p = 0.005) were associated with global cognitive function in women aged >75 years. DISCUSSION: The variability and phase domains at faster speeds were considered to identify gait changes that accompany aging. In addition, the decreases in global cognitive function are associated with increased variability and phase domains caused by changes in gait speed in older women. CONCLUSION: Our results are considered useful for understanding age-related gait characteristics with global cognitive function in old women.

Effect of knee extensor fatigue level and sex on bilateral jump-landing.

OBJECTIVE: The purpose of this study was to determine the effect of fatigue level and sex on the range of motions of the lower extremities and impulses during the jump-landing phase after performing bilateral fatiguing tasks. METHODS: In total, 41 healthy young adults volunteered for this study. Participants' jump-landing trajectories were monitored using nine cameras, and ground reaction forces were measured using a force plate. Participants performed five maximal bilateral countermovement jumps as prefatiguing tasks. The fatiguing tasks consisted of maximal effort contractions of the knee extensor at 60°/s on a dynamometer until task failure, defined as the inability to reach 50% of the peak knee extension torque for three consecutive times. The post-task maximal bilateral jumps were immediately captured after the participants failed the fatiguing task. Participants were asked to perform this cycle again, performing the fatiguing contraction task until failure to reach 30% of the peak knee extension torque. RESULTS AND CONCLUSION: It was found that the knee joint was more extended in the post-30% fatiguing task, which was due to the reduction of the flexion angle of the hip and knee joints in response to fatigue level. The impulses for both sexes were reduced at the severe fatigue level. Fatigability altered jump-landing kinematics, jump heights and impulses in response to fatigue level. The post-30% fatiguing task elicited more fatigue than the post-50% fatiguing task.

Validity of shoe-type inertial measurement units for Parkinson's disease patients during treadmill walking.

BACKGROUND: When examining participants with pathologies, a shoe-type inertial measurement unit (IMU) system with sensors mounted on both the left and right outsoles may be more useful for analysis and provide better stability for the sensor positions than previous methods using a single IMU sensor or attached to the lower back and a foot. However, there have been few validity analyses of shoe-type IMU systems versus reference systems for patients with Parkinson's disease (PD) walking continuously with a steady-state gait in a single direction. Therefore, the purpose of this study is to assess the validity of the shoe-type IMU system versus a 3D motion capture system for patients with PD during 1 min of continuous walking on a treadmill. METHODS: Seventeen participants with PD successfully walked on a treadmill for 1 min. The shoe-type IMU system and a motion capture system comprising nine infrared cameras were used to collect the treadmill walking data with participants moving at their own preferred speeds. All participants took anti-parkinsonian medication at least 3 h before the treadmill walk. An intraclass correlation coefficient analysis and the associated 95% confidence intervals were used to evaluate the validity of the resultant linear acceleration and spatiotemporal parameters for the IMU and motion capture systems. RESULTS: The resultant linear accelerations, cadence, left step length, right step length, left step time, and right step time showed excellent agreement between the shoe-type IMU and motion capture systems. CONCLUSIONS: The shoe-type IMU system provides reliable data and can be an alternative measurement tool for objective gait analysis of patients with PD in a clinical environment.

Impaired permeability and antimicrobial barriers in type 2 diabetes skin are linked to increased serum levels of advanced glycation end-product.

The incidence of type 2 diabetes mellitus (DM) has been increasing rapidly, and the disease has become a serious sociomedical problem. Many skin problems, such as xerosis, pruritus, skin infections and delayed wound healing, that might be related to chronic impairment of skin barrier function decrease the quality of life in patients with DM. However, the status of the permeability and antimicrobial barrier of the skin in DM remains unknown. This study aimed to elucidate skin barrier impairment in patients with type 2 DM and its pathomechanisms using classic animal models of type 2 DM. Functional studies of the skin barrier and an analysis of stratum corneum (SC) lipids were compared between patients with type 2 DM and age- and sex-matched non-diabetes controls. Also, functional studies on the skin barrier, epidermal lipid analyses, and electron microscopy and biomolecular studies were performed using type 2 DM animal models, db/db and ob/ob mice. Patients with type 2 DM presented with epidermal barrier impairments, including SC hydration, which was influenced by blood glucose control (HbA1c level). In the lipid analysis of SC, ceramides, fatty acids and cholesterol were significantly decreased in patients with type 2 DM compared with controls. Type 2 DM murine models presented with severe hyperglycaemia, impairment of skin barrier homeostasis, decreases in epidermal proliferation and epidermal lipid synthesis, decreases in lamellar body (LB) and epidermal antimicrobial peptides (AMPs), an increase in receptors for advanced glycation end-product (AGE) in the epidermis and an increase in serum AGE. Impairment of the skin barrier was observed in type 2 DM, which results in part from a decrease in epidermal proliferation. Serum AGE and its epidermal receptors were increased in type 2 diabetic mice which display impaired skin barrier parameters such as epidermal lipid synthesis, LB production, epidermal AMP and SC lipids.

Periadnexal mucin as an additional histopathologic feature of chronic eczematous dermatitis.

BACKGROUND: Cutaneous mucinoses are a heterogeneous group of disorders characterized by an abnormal amount of mucin in the skin. However, the pathomechanism of an excessive mucin deposition in the skin is still unknown. Eczematous dermatitis is sub-classified histologically into acute, subacute, and chronic variants. The characteristic histopathologic findings for chronic eczema are variable. However, periadnexal mucin deposition is not known as a feature of chronic eczema. OBJECTIVE: To evaluate the presence of periadnexal mucin deposition in chronic eczematous dermatitis. METHODS: We analyzed the skin biopsy specimens from 36 patients who were pathologically diagnosed with chronic eczematous dermatitis. Alcian blue, colloidal iron, and periodic acid-Schiff stains were used to evaluate the mucin deposition in histologic sections. Two dermatologists and two dermatopathologists evaluated the degree of mucin deposition using a 4-point scale. RESULTS: Various amounts of mucin deposition were observed in the periadnexal area of patients who were diagnosed with chronic eczema. Mucin deposition was more visible after staining with mucin-specific stains. Evaluation of the staining analysis scores revealed that the staining intensities were significantly higher in patients with chronic eczema than age- and site-matched controls (normal, acute to subacute eczema, and psoriasis vulgaris). CONCLUSION: Periadnexal mucin (secondary mucinoses) may be an additional finding of chronic eczematous dermatitis.