Unobtrusive, Continuous LIDAR-Based Measurement of Gait Characteristics at Home.

This paper describes a novel approach to the unobtrusive assessment of a subset of gait characteristics using a light detection and ranging (LIDAR) device. The developed device is poised to enable unobtrusive, nearly continuous monitoring and inference of patients' gait characteristics to assess physical and cognitive states. The device provides a rapidly sampled signal representing the distance of a participant's body from the LIDAR device. The densely sampled distance estimation is processed by custom algorithms that can potentially be used to estimate various gait characteristics such as step size, cadence, double support, and even step-size symmetry.Clinical Relevance- Since gait is a complex behavior that requires seamless cooperation of multiple systems, including sensation, perception, muscular synergies, and even cognition. Subtle changes in gait may, therefore, indicate issues with physical and mental functionality. In addition to the walking speed, the gait monitoring results can provide inferences about the physical and cognitive states of the unobtrusively monitored individuals using their own data as a baseline.

A neglected etiology of bronchiectasis: External compression due to hiatal hernia.

AIM: To investigate the incidence of bronchiectasis supposed to be made by the external compression of hiatal hernia (HH) to bronchi. MATERIALS AND METHODS: The thorax computed tomography (CT) scans of patients which were carried out in Duzce University Hospital between February 2014 and August 2015 were retrospectively evaluated. The repeated scans in the same patient were excluded. RESULTS: A total of 4388 patients were included in the study. A total of 98 HH cases were detected of which 58 (59.2%) were female. The mean age was 73.30 ± 9.14 (45-90). The rate of HH according to small, moderate and large size was 45 (45.9%), 9 (9.2%), 44 (44.9%), respectively. The rate of hiatal hernia accompanied by bronchiectasis were similar in both males and females (P = 0.078). The prevalence of bronchiectasis was significantly high in large hernias with 81.4% rate (P = 0.009). Bronchiectasis rate was 12.343 times (OR: 12.343, 95% CI: 1.479-103.027, P = 0.009) higher in the large HH group compared to small and moderate HH groups. Hiatal hernia accompanied by bronchiectasis was 88.1% anatomically near to HH. CONCLUSIONS: Thus, hiatal hernia may cause bronchiectasis due to external compression rather than lymphadenopathy or the tumor as an etiology of bronchiectasis and should be considered in the differential diagnosis.

The predictive effect of initial complete blood count of intensive care unit patients on mortality, length of hospitalization, and nosocomial infections.

OBJECTIVE: The mean platelet volume (MPV) can be used as an indicator of platelet activation. However, it has been shown that the platelet/lymphocyte ratio (PLR) can provide useful predictive information about inflammation and aggregation pathways. The neutrophil/lymphocyte ratio (NLR) may also be helpful as a marker of systemic or local inflammation. The main objective of this study evaluated to unselected critically ill patients the relationship of initial MPV, NLR, and PLR with mortality, length of hospitalization, and the risk of developing nosocomial infections in ICU patients. PATIENTS AND METHODS: In this retrospective study, we evaluated consecutive patients at our tertiary nine-bed ICU. One hundred seventy-three patients who were followed up during a 1-year period were included. RESULTS: MPV levels were found to be higher in patients who died in the hospital (p = 0.05). In addition, there was a significant positive correlation between expected mortality rate and MPV among non-survivors (p = 0.009). NLR levels were higher among non-survivors, but this difference was not statistically significant (p = 0.435). PLR levels were similar between non-survivors and survivors (p = 0.173). The initial NLR and PLR were significantly higher in patients with nosocomial infections. NLR and PLR had a significant positive correlation with length of hospitalization (p = 0.006 and p = 0.027, respectively). CONCLUSIONS: In our study, we found that high PLR and NLR may be indicators for the development of nosocomial infections. Moreover, the length of hospitalization may be prolonged in patients with high PLR and NLR.

[PRESSURE ULCER AS THE PRINCIPAL INDICATOR OF HEALTH CARE QUALITY AT NEUROLOGY DEPARTMENT].

According to the European Pressure Ulcer Advisory Panel (EPUAP) definition, pressure ulcer is a local skin or subcutaneous tissue damage due to the force of pressure or friction or their combination. Pressure ulcers have accompanied humans since the beginning and respective descriptions are found in the 19th century literature. Pressure ulcer is a major medical, social and health-economic problem because it is associated with a number of complications that require multidisciplinary approach in care and treatment. In affected patients, pressure ulcer causes quality of life reduction, discomforts, pain, emotional problems and social isolation. If the process of tissue decay is not halted, tissue damage will spread involving deep and wider structures, thus seriously compromising the patient general condition. Pressure ulcer usually develops at the sites of protrusions formed by lumbar spine, ischium, hip, ankle, knee or elbow, as well as in the areas with less developed adipose tissue. Any temporary or permanent immobility should be perceived as a milieu favoring the onset of pressure ulcer. Advances in medicine and standards of living in general have prolonged life expectancy, thus also increasing the population at risk of chronic diseases including pressure ulcer. The aim of the study was to determine the relationship between the length of bed-ridden condition and the occurrence of pressure ulcers in patients treated at Department of Cerebrovascular Diseases and Intensive Neurology from January 1, 2012 until December 31, 2015. The study included patients with pressure ulcer verified on admission and those having developed pressure ulcer during hospital stay. Clinical picture of severe stroke predominated in the majority of study patients. Patients were divided into groups according to health care requirements as classified by the Croatian Chamber of Nurses. Preliminary results indicated the length of bed-ridden condition to be associated with the occurrence of chronic wounds, and thus with increased cost and length of hospital treatment. Therefore, health care methods and procedures should be focused on reduction of pressure ulcer development, quality health care, implementation of preventive measures, and continuous education of health care professionals.

[Multidisciplinary Management and Neurorehabilitation of Patients with Amyotrophic Lateral Sclerosis].

Patients with amyotrophic lateral sclerosis require comprehensive care with a multidisciplinary approach, which is individually adjusted to each patient. The goals of neurorehabilitation should be adjusted to the stage of disease. In early stages, physical therapy is focused on preserving and optimizing motor and respiratory function. At this stage, family should be involved to partake in desired activities and be informed regarding the natural course of the disease. In late stages, physical therapy is focused on preventing respiratory complications and contractures, and orthotics may also be recommended. The onset of dysarthria should trigger swallowing and pulmonary function testing. Swallowing maneuvers should be tried at the onset of symptoms, later feeding tubes or percutaneous gastrostomy tube is necessary. Noninvasive mechanical ventilation may delay the need of tracheostomy and invasive mechanical ventilation. The key objectives of multidisciplinary teams are to optimize medical care, facilitate communication, and thus to improve the quality of care and quality of life.

Prevalence and dynamics of cytomegalovirus infection among patients undergoing chronic hemodialysis.

Cytomegalovirus (CMV) is an important pathogen in immunocompromised individuals. The aim of this study was to analyze prevalence and dynamics of CMV infection among patients undergoing chronic hemodialysis. From 2010 to 2012, a total of 162 patients and 160 control subjects were tested for the presence of CMV IgM and IgG antibodies using enzyme-linked immunosorbent assay. IgM/IgG reactive samples were further evaluated for IgG avidity to confirm or rule out recent primary CMV infection. The overall IgG seropositivity was higher in hemodialysis patients compared to controls (90.7% vs. 81.9%; crude odds ratio [OR] =2.02, 95% confidence interval [CI] =1.05-3.89; OR adjusted for age and gender = 2.18, 95% CI = 1.05-4.55). CMV IgG antibody titers were similar in both groups. There was no difference in CMV prevalence between males (87.9%) and females (96.3%). According to age, a progressive increase in seropositivity was observed in both hemodialysis patients and the control group. Three hemodialysis patients (1.9%) developed recurrent CMV infection (positive IgM with high avidity IgG antibodies). In one patient (2.9%), seroconversion was documented during the second year of the follow-up period indicating primary infection. In contrast, in the control group, recent primary CMV infection (positive IgM with low/borderline IgG avidity) was demonstrated in three subjects (1.9%), whereas one (0.6%) developed recurrent infection. On multivariate logistic regression, hemodialysis and older age were significant predictors for CMV seropositivity.

Common biological networks underlie genetic risk for alcoholism in African- and European-American populations.

Alcohol dependence (AD) is a heritable substance addiction with adverse physical and psychological consequences, representing a major health and economic burden on societies worldwide. Genes thus far implicated via linkage, candidate gene and genome-wide association studies (GWAS) account for only a small fraction of its overall risk, with effects varying across ethnic groups. Here we investigate the genetic architecture of alcoholism and report on the extent to which common, genome-wide SNPs collectively account for risk of AD in two US populations, African-Americans (AAs) and European-Americans (EAs). Analyzing GWAS data for two independent case-control sample sets, we compute polymarker scores that are significantly associated with alcoholism (P = 1.64 × 10(-3) and 2.08 × 10(-4) for EAs and AAs, respectively), reflecting the small individual effects of thousands of variants derived from patterns of allelic architecture that are population specific. Simulations show that disease models based on rare and uncommon causal variants (MAF < 0.05) best fit the observed distribution of polymarker signals. When scoring bins were annotated for gene location and examined for constituent biological networks, gene enrichment is observed for several cellular processes and functions in both EA and AA populations, transcending their underlying allelic differences. Our results reveal key insights into the complex etiology of AD, raising the possibility of an important role for rare and uncommon variants, and identify polygenic mechanisms that encompass a spectrum of disease liability, with some, such as chloride transporters and glycine metabolism genes, displaying subtle, modifying effects that are likely to escape detection in most GWAS designs.

Silicon detector dark matter results from the final exposure of CDMS II.

We report results of a search for weakly interacting massive particles (WIMPS) with the silicon detectors of the CDMS II experiment. This blind analysis of 140.2 kg day of data taken between July 2007 and September 2008 revealed three WIMP-candidate events with a surface-event background estimate of 0.41(-0.08)(+0.20)(stat)(-0.24)(+0.28)(syst). Other known backgrounds from neutrons and 206Pb are limited to <0.13 and <0.08 events at the 90% confidence level, respectively. The exposure of this analysis is equivalent to 23.4 kg day for a recoil energy range of 7-100 keV for a WIMP of mass 10 GeV/c2. The probability that the known backgrounds would produce three or more events in the signal region is 5.4%. A profile likelihood ratio test of the three events that includes the measured recoil energies gives a 0.19% probability for the known-background-only hypothesis when tested against the alternative WIMP+background hypothesis. The highest likelihood occurs for a WIMP mass of 8.6 GeV/c2 and WIMP-nucleon cross section of 1.9×10(-41) cm2.

Anterograde-retrograde rendezvous approach for radiation-induced complete upper oesophageal sphincter stenosis: case report and literature review.

BACKGROUND: Strictures of the hypopharynx and oesophagus are frequently observed following (chemo)radiation. Anterograde dilatation of a complete stenosis carries a high risk of perforation. An alternative is described: a combined anterograde-retrograde approach. CASE REPORT: A 75-year-old man developed complete stenosis of the oesophageal inlet after primary radiotherapy for laryngeal carcinoma and full percutaneous endoscopic gastrostomy feeding. To prevent creation of a false route into the mediastinum, a dilatation wire was introduced in a retrograde fashion into the oesophagus, through the gastrostomy opening. The wire was endoscopically identified from the proximal side and then passed through a perforation created by CO2 laser. Anterograde dilatation was safely performed, and the patient returned to a normal diet. There is consensus in the literature that blind anterograde dilatation carries a high risk of perforation; therefore, an anterograde-retrograde rendezvous technique is advisable. CONCLUSION: In cases of complete obstruction of the oesophageal inlet, anterograde-retrograde dilatation represents a safe technique with which to restore enteric continuity.

Results from a low-energy analysis of the CDMS II germanium data.

We report results from a reanalysis of data from the Cryogenic Dark Matter Search (CDMS II) experiment at the Soudan Underground Laboratory. Data taken between October 2006 and September 2008 using eight germanium detectors are reanalyzed with a lowered, 2 keV recoil-energy threshold, to give increased sensitivity to interactions from weakly interacting massive particles (WIMPs) with masses below ∼10 GeV/c(2). This analysis provides stronger constraints than previous CDMS II results for WIMP masses below 9 GeV/c(2) and excludes parameter space associated with possible low-mass WIMP signals from the DAMA/LIBRA and CoGeNT experiments.

Pulse wave velocity predicts mortality in renal transplant patients.

BACKGROUND: measuring arterial stiffness using pulse wave velocity (PWV) has become an important tool to assess vascular function and cardiovascular mortality. For subject with hypertension, end-stage renal disease and diabetes, PWV has been shown to predict cardiovascular and all-cause mortality. We hypothesize that PWV would also predict mortality in subjects who have undergone kidney transplantation. METHODS: a cohort of 330 patients with renal transplantation was studied with a mean age at entry 51.4 ± 0.75 years. Mean follow-up was 3.8 years (± 0.7 years); 16 deaths occurred during follow-up. At entry, together with standard clinical and biochemical parameters, PWV was determined from pressure tracing over carotid and femoral arteries. RESULTS: with increasing PWV, there was a significant increase in age, systolic blood pressure and pulse pressure. In addition, subjects with higher PWV also exhibited more frequently the presence of coronary heart disease. On the basis of Cox analyses, PWV and systolic blood pressure emerged as predictors of all-cause mortality. CONCLUSION: these results provide evidence that PWV is a strong predictor of all-cause mortality in the population of renal transplant recipients.

[Have we made progress in the development of a vestibular implant?]. / Queues avancées cette année dans le développement d'un implant vestibulaire?

The concept of a vestibular implant to restore balance in patients suffering from bilateral loss of function is similar to that of a cochlear implant. Motion sensors will capture head movements and this information will be transmitted to the central nervous system via electrodes implanted in the vestibular system. However, several key questions must be answered before such prosthesis could be used in humans. One is to restore a baseline neural activity in the system that can be then adequately modulated by the prosthesis, without causing unbearable symptoms. We showed that this is possible in human. This is an important prerequisite for the feasibility of a vestibular implant.

Clinical comparison of patients with osteonecrosis of the jaws, with and without a history of bisphosphonates administration.

This retrospective study aimed to evaluate the role of bisphosphonates in jaw osteomyelitis. 29 patients were included: 18 had been treated with bisphosphonates (12 with multiple myelomas, 3 with breast carcinomas, 2 with prostate carcinomas, and 1 with osteoporosis). Of 11 control patients, 2 had breast carcinomas, 2 had bronchial carcinomas, and 7 had no cancer. Descriptive and statistical evaluations were conducted to investigate the influence of chemotherapy, corticosteroids, stem cell transplantation, and bisphosphonates on the development and clinical picture of osteomyelitis. Both groups had similar disease histories, clinical pictures, treatment methods, and outcome. Wound dehiscence frequencies were also similar (Mann-Whitney rank sum test 1.66±1.5 vs. 1.45±2.0 p=0.393). Chemotherapy, steroid therapy, stem cell transplantation, or bisphosphonate administration did not correlate with the clinical picture. Neither the duration of therapy nor the type of bisphosphonate influenced the clinical picture (negative Fisher's tests). The bisphosphonate group showed a characteristic settlement of Actinomyces in the exposed bone (positive Fisher's test, p=0.021). These results suggested that osteomyelitis developed as a consequence of the simultaneous, cumulative action of many factors. Bisphosphonates played a role comparable to other predisposing features. Coating the jaws with bisphosphonates could promote the settlement of Actinomyces.

Mucoadhesion on urinary bladder mucosa: the influence of sodium, calcium, and magnesium ions.

The aim of the present work was to establish if different cations present in the lumen of the urinary bladder at the time of application affect the mucoadhesion strength of cationic chitosan, anionic sodium carboxymethyl cellulose (NaCMC), and nonionic hydroxypropyl cellulose (HPC). The mucoadhesion strength of polymeric films was determined on pig urinary bladder mucosa. Sodium, calcium, and magnesium ions decreased the mucoadhesion strength of all three polymers except NaCMC, whose detachment forces were not influenced by the presence of sodium. Lower mucoadhesion strength in the presence of cations should be considered when drug delivery systems, for example microspheres, containing the tested mucoadhesive polymers are applied intravesically. In the majority of the experiments, cations decreased the mucoadhesion strength of the polymers already in concentrations normally present in urine. For stronger mucoadhesion, application of microspheres into the empty urinary bladder would be recommended. Additionally, the mucoadhesion properties of the tested polymers could be controlled by the selection of a proper medium for the suspension of microspheres. Namely, for all three polymers bivalent calcium and magnesium had stronger influence on mucoadhesion compared to univalent sodium, and with increasing concentrations of cations mucoadhesion strength of the polymers decreased.

Atypical presentations of malignant otitis externa.

INTRODUCTION: Malignant otitis externa is a life-threatening infection of the skull base. Its presentation is not always typical. CASE REPORTS: We report three cases of malignant otitis externa which illustrate the diversity of its clinical manifestations and the difficulties in its diagnosis. DISCUSSION: The perception of malignant otitis externa as an infection caused by Pseudomonas aeruginosa in diabetic patients is not always correct. The adoption of diagnostic criteria could be helpful in identifying atypical cases.

Dark matter search results from the CDMS II experiment.

Astrophysical observations indicate that dark matter constitutes most of the mass in our universe, but its nature remains unknown. Over the past decade, the Cryogenic Dark Matter Search (CDMS II) experiment has provided world-leading sensitivity for the direct detection of weakly interacting massive particle (WIMP) dark matter. The final exposure of our low-temperature germanium particle detectors at the Soudan Underground Laboratory yielded two candidate events, with an expected background of 0.9 +/- 0.2 events. This is not statistically significant evidence for a WIMP signal. The combined CDMS II data place the strongest constraints on the WIMP-nucleon spin-independent scattering cross section for a wide range of WIMP masses and exclude new parameter space in inelastic dark matter models.

Search for axions with the CDMS experiment.

We report on the first axion search results from the Cryogenic Dark Matter Search (CDMS) experiment at the Soudan Underground Laboratory. An energy threshold of 2 keV for electron-recoil events allows a search for possible solar axion conversion into photons or local galactic axion conversion into electrons in the germanium crystal detectors. The solar axion search sets an upper limit on the Primakov coupling g(agammagamma) of 2.4x10(-9) GeV-1 at the 95% confidence level for an axion mass less than 0.1 keV/c2. This limit benefits from the first precise measurement of the absolute crystal plane orientations in this type of experiment. The galactic axion search analysis sets a world-leading experimental upper limit on the axioelectric coupling g(aee) of 1.4x10(-12) at the 90% confidence level for an axion mass of 2.5 keV/c2.