A Systematic Review of Machine Learning Based Gait Characteristics in Parkinson's Disease.

OBJECTIVE: Parkinson's disease is a pervasive neuro disorder that affects people's quality of life throughout the world. The unsatisfactory results of clinical rating scales open the door for more research. PD treatment using current biomarkers seems a difficult task. So automatic evaluation at an early stage may enhance the quality and time period of life. METHODS: Grading of Recommendations Assessment, Development, and Evaluation (GRADE) and population, Intervention, Comparison, and Outcome (PICO) search methodology schemes are followed to search the data and eligible studies for this survey. Approximate 1500 articles were extracted using related search strings. After the stepwise mapping and elimination of studies, 94 papers are found suitable for the present review. RESULTS: After the quality assessment of extracted studies, nine inhibitors are identified to analyze people's gait with Parkinson's disease, where four are critical. This review also differentiates the various machine learning classification techniques with their PD analysis characteristics in previous studies. The extracted research gaps are described as future perspectives. Results can help practitioners understand the PD gait as a valuable biomarker for detection, quantification, and classification. CONCLUSION: Due to less cost and easy recording of gait, gait-based techniques are becoming popular in PD detection. By encapsulating the gait-based studies, it gives an in-depth knowledge of PD, different measures that affect gait detection and classification.

Significance of MRI Guided Focused Ultrasound Thalamotomy for Parkinson's Disease: A Review.

BACKGROUND: Magnetic-Resonance guided Focused Ultrasound (FUS) thalamotomy is a new and less invasive surgical technique for treating Parkinson's disease (PD). During therapy, the required part of the cerebral (as STN, Internal Globus Pallidus, and Ventral Intermediate Nucleus) is ablated with less possibility of infection and brain hemorrhage as it normally happens in invasive procedures. INTRODUCTION: New advancement in the technique enables it for transcranial transportation of US. Nowadays, US coupling with MRI confirms the accurate energy transferring and monitoring. So, MRI guided FUS lesioning is discovered for various psychiatric and brain disorders. METHODS: A technical overview of non-invasive MRI-FUS thalamotomy to treat various tremors is described here. Research, review articles, and book chapters are extracted from online resources using related search strings from the year 1994-2020. RESULTS: MRgFUS is concluded a non-invasive, satisfactory, and safe technique to reduce the tremor. Conlusion: MRgFUS is comparatively a new method that is being explored as a non-invasive cerebral ablation to solve the problems of movement disorder.

TB infection and BCG vaccination: are we protected from COVID-19?

OBJECTIVES: The incidence of emerging coronavirus disease 2019 (COVID-19) disease is variable across the different parts of the world. Apart from travel patterns, other factors determining this difference may include host immune response. The aim of this study was to assess the effect of tuberculosis (TB) endemicity and Bacille Calmette-Guerin (BCG) coverage on COVID-19. STUDY DESIGN: This was a cross-sectional study. METHODS: We reviewed available data regarding TB incidence, BCG coverage (as per the World Health Organization), and COVID-19 incidence of 174 countries. We divided the countries into four cohorts depending on annual TB incidence and BCG coverage. RESULTS: Countries with high TB incidence had lower COVID-19 than countries with low TB incidence. Similarly, countries with high BCG coverage had lower incidence of COVID-19, suggesting some protective mechanisms in TB-endemic areas. However, the ecological differences and different testing strategies between countries could not be accounted for in this analysis. CONCLUSION: Higher TB incidence and BCG coverage were found to be associated with lesser incidence of COVID-19. This outcome paves the way for further research into pathogenesis and immune response in COVID-19.

Neuroglial cyst: a rare occurence in abdomen and pelvis.

We hereby report a case of a child who presented with abdominal distension and urinary retention. Radiological investigations and exploratory laparotomy revealed a cystic mass in the sacral region pushing the urinary bladder anteriorly and upwards. Histopathological examination revealed neuroglial elements. Neuroglial cysts are uncommon outside the central nervous system and this is the first report of its occurrence in abdomen and pelvis.

Origin of estradiol fatty acid esters in human ovarian follicular fluid.

The estradiol fatty acid esters are the most potent of the naturally occurring steroidal estrogens. These esters are present predominantly in fat, where they are sequestered until they are hydrolyzed by esterases. Thus they act as a preformed reservoir of estradiol. We have previously shown that ovarian follicular fluid from patients undergoing gonadotropin stimulation contains very high amounts of estradiol fatty acid esters (approximately 10(-7) M). The source of these esters is unknown. They can be formed by esterification of estradiol in the follicular fluid by lecithin:cholesterol acyltransferase (LCAT), or in the ovary by an acyl coenzyme A:acyltransferase. In order to determine which of these enzymatic processes is the source of the estradiol esters in the follicular fluid, we incubated [3H]estradiol with follicular fluid and cells isolated from human ovarian follicular fluid and characterized the fatty acid composition of the [3H]estradiol esters biosynthesized in each. In addition, we characterized the endogenous estradiol fatty acid esters in the follicular fluid and compared them to the biosynthetic esters. The fatty acid composition of the endogenous esters was different than those synthesized by the cellular acyl coenzyme A:acyltransferase, and the same as the esters synthesized by LCAT, demonstrating that the esters are produced in situ in the follicular fluid. Although the role of these estradiol esters in the ovary is not known, given their remarkable estrogenic potency it is highly probable that they have an important physiological role.

Long-lived testosterone esters in the rat.

Over the past decade it has become increasingly clear that steroid hormones are enzymatically esterified with fatty acids. These steroidal esters are the natural analogs of synthetic esters that are used therapeutically. One such family of pharmacological steroids is the synthetic alkyl esters of testosterone, androgens with great hormonal potency. We have investigated whether testosterone esters exist naturally by using the rat as a model. Most tissues of male rats, including blood, have very little if any ester (quantified by immunoassay as a nonpolar saponifiable metabolite), but fat and testes have sizable quantities, approximately 3 ng of testosterone equivalents per g of tissue. Testosterone in fat averages 9 ng/g. The fat from female rats and long-term (> 2 weeks) castrated males has no detectable testosterone ester. The presence of testosterone esters was confirmed by GC/MS, which clearly showed the presence of testosterone in the hydrolyzed ester fraction of fat from intact males but not long-term castrates. Upon castration, testosterone levels in the fat completely disappear within 6 hr. To the contrary, it is not until 48 hr after castration that a measurable fall in the testosterone ester fraction was observed; even after 10 days a small amount of ester is still present in the fat. These experiments demonstrate the existence of a previously unknown androgen with a potentially important physiological impact; testosterone esters, natural analogs of potent therapeutic agents, occur in the fat where they can serve as a reservoir of preformed androgen to stimulate neighboring target tissues.

A comparison of the esterification of steroids by rat lecithin:cholesterol acyltransferase and acyl coenzyme A:cholesterol acyltransferase.

Although fatty acid esters of several steroids have been found in both blood and tissues, their biosynthetic origins are uncertain. For example, the fatty acid esters of delta 5-3 beta-hydroxysteroids pregnenolone and dehydroepiandrosterone (DHEA) are synthesized in tissues by an acyl coenzyme A:acyltransferase. These esters are not secreted, and the circulating esters are formed in blood by lecithin:cholesterol acyltransferase (LCAT). Fatty acid esters of corticosterone (B) and estradiol (E2) are also present in both blood and tissues, but unlike the delta 5-3 beta-hydroxysteroids, their structures are so different from cholesterol that it would not necessarily follow that they are esterified by the same enzyme. We have examined the esterification of the steroids DHEA, B, and E2 in blood and tissue, in comparison to the esterification of cholesterol, using as a model plasma and hepatic microsomes from the rat. All of the steroids were esterified in plasma, but at very different rates: cholesterol > DHEA >> E2 = B. The LCAT inhibitor, 5.5'-dithiobis-(2-nitrobenzoic acid), inhibited the esterification of all of the substrates. DHEA inhibited the esterification of cholesterol, albeit only at high concentration. The fatty acid compositions of the cholesterol and DHEA esters were analyzed, and they were found to be identical, with arachidonate the predominant ester, greater than 60%. In hepatic microsomes, the rate of esterification was different than plasma: cholesterol > E2 > or = DHEA >> B. Although B was esterified in both plasma and hepatic microsomes, the rate was exceedingly slow in both. The acyl coenzyme A:cholesterol acyltransferase inhibitor, N'-(2,4-difluorophenyl)-N-[[4-(2,2-dimethylpropyl)phenyl]- methyl]-N-heptylurea, blocked the esterification of cholesterol almost completely, but surprisingly, it had no effect on the esterification of the other steroids. The fatty acid esters of cholesterol, E2, and DHEA synthesized in the hepatic microsomes were analyzed. The composition of the cholesterol esters from the microsomes was very different than the esters of DHEA and E2. These results show that all of the steroids tested are esterified by LCAT, and consequently that blood LCAT is the probable source of the circulating steroidal esters. Most interesting are the studies of microsomal esterification. It has been presumed that similar to blood, the esterification of steroids in tissues is carried out by the same enzyme that esterifies cholesterol.(ABSTRACT TRUNCATED AT 400 WORDS)

The isolation and characterization of estradiol-fatty acid esters in human ovarian follicular fluid. Identification of an endogenous long-lived and potent family of estrogens.

The estradiol-fatty acid esters are highly potent and long-lived estrogens that were first isolated and identified from in vitro biosynthetic experiments (Mellon-Nussbaum S., Ponticorvo, L., Schatz, F., and Hochberg, R. B. (1982) J. Biol. Chem. 257, 5678-5684). Other studies have indicated that these esters exist endogenously, but the evidence is indirect, resting solely on the presence of a nonpolar saponifiable metabolite. Although there are similar reports of other naturally occurring fatty acid esters of biologically active steroid hormones, likewise, none has been isolated and characterized. In this study we have found that follicular fluid from the ovaries of women stimulated with gonadotrophins contains relatively large amounts of a nonpolar saponifiable derivative of estradiol (approximately 10(-7)M), which we presumed to be fatty acid esters. Using a combination of chromatographic techniques we isolated these estradiol metabolites and identified them by mass spectral analysis. They are a mixture of five different estradiol-17 fatty acid esters. The amount of each present was determined by separating the esters by reversed phase high performance liquid chromatography and then quantifying each peak by radioimmunoassay and UV absorption. The esters of estradiol are predominantly unsaturated, with linoleate the most abundant comprising 43% of the total. The other esters are: palmitate (20%), arachidonate (19%), oleate (14%), and stearate (4%). Thus these studies conclusively demonstrate the existence of these unusually powerful estrogens.

Aromatase and testosterone fatty acid esters: the search for a cryptic biosynthetic pathway to estradiol esters.

The estradiol fatty acid esters (lipoidal derivatives, LE2) are extremely potent estrogens that accumulate in fat, including fat of menopausal women. These steroidal esters are protected from metabolism and are converted to the free, biologically active steroid through the action of esterases. Previous studies have shown that biosynthetic pathways in the adrenal gland exist in which steroid fatty acid esters are substrates. This led us to determine whether a cryptic aromatase pathway exists in which testosterone esters could be converted directly into LE2. We tested a representative fatty acid ester, testosterone stearate, both as an inhibitor and as a substrate for the aromatase enzyme from human placental microsomes. This ester had neither activity. In addition, we tested [1 beta-3H]testosterone acetate as a substrate for this enzyme complex, measuring the production of 3H2O as evidence of aromatization. Although the rate of reaction was considerably slower than that of testosterone, 3H2O was produced. However, when [2, 4, 6, 7-3H]testosterone acetate was incubated and the steroidal products isolated, we found that hydrolysis of the substrate had occurred. Both [3H]-labeled testosterone and estradiol were found, and very little if any [3H]estradiol acetate was formed. Thus, we conclude that an aromatase pathway involving testosterone esters does not exist and that the sole source of LE2 is through direct esterification of estradiol.

The biosynthesis of D-ring fatty acid esters of estriol.

Biological esterification with fatty acids is a feature that is now known to be common to most steroids. The esterification of estradiol in the D-ring at the 17 beta-hydroxyl leads to a family of extremely active estrogens. Similarly, esterification of the weaker estrogen, estriol (E3), has an even greater impact on its hormonal potency. We have recently shown that synthetic long chain esters of E3 at either 16 alpha- or 17 beta- are highly potent estrogens. The estrogenic activity of the synthetic E3 esters led us to determine whether E3 is biologically esterified, and if so, to characterize the resulting esters. Incubation of E3 with rat lung, a tissue which is highly active in esterifying estradiol, produces a nonpolar metabolite which upon saponification is converted back into E3. There was no evidence for the formation of a diester. Purification by high performance liquid chromatography separates the non-polar metabolite into two peaks, one the C-16 alpha- (approximately 60%) and the other the C-17 beta-ester (approximately 40%). The two fractions were further purified and characterized; each is a mixture of fatty acid esters of E3. The composition of the C-16 alpha- and the C-17 beta-fatty acid esters of E3 is identical. The predominant fatty acids are arachidonate, 34%, palmitate, 26%, followed by oleate 14%, linoleate 13%, stearate 8%, and palmitoleate 5%. The similarity of the esters at C-16 and C-17 may indicate that the fatty acid precursor for the acyltransferase is the same for both hydroxyl groups. It may also suggest that the same enzyme esterifies both positions in the D-ring. Since synthetic estriol fatty acid esters are extremely potent and long-lived estrogens, the enzymatic esterification of estriol produces powerful estrogens with considerable physiological potential.

Estrogenic action of estriol fatty acid esters.

Recent studies suggest that, estriol, like estradiol, is biosynthetically esterified with fatty acids. We have synthesized the stearate estriol, at C-16 alpha, C-17 beta and the diester, C-16 alpha,17 beta and tested these D-ring esters for their estrogenic action both in vivo and in vitro, comparing them to estradiol, estriol and estradiol-17-stearate. None of the estriol esters bind to the estrogen receptor. They are only weakly estrogenic in a microtiter plate estrogen bioassay: stimulation of alkaline phosphatase in the Ishikawa endometrial cells. However, both estriol monoesters are extremely potent estrogens when injected subcutaneously (in aqueous alcohol) into ovariectomized mice. Compared to the free steroids, they produced a dramatically increased uterine weight with a greatly prolonged duration of stimulation. The 16 alpha,17 beta-diester also induced a protracted uterotrophic response, but the stimulation of uterine weight was comparatively low. Since the esters of estradiol and estriol do not bind to the estrogen receptor, their estrogenic signal must be generated through the action of esterase enzymes. These naturally occurring esters have the potential of being extremely useful pharmacological agents for long-lived estrogenic stimulation.

Steroidal fatty acid esters.

Several years ago we discovered an unexpected family of steroidal metabolites, steroidal fatty acid esters. We found that fatty acid esters of 5-ene-3 beta-hydroxysteroids, pregnenolone and dehydroisoandrosterone are present in the adrenal. Subsequently, others have shown the existence of these non-polar 5-ene-3 beta-hydroxysteroidal esters in blood, brain and ovaries. Currently, almost every family of steroid hormone is known to occur in esterified form. We have studied the esters of the estrogens and glucocorticoids in some detail, and have found that these two steroidal families are esterified by separate enzymes. In a biosynthetic experiment performed simultaneously with estradiol and corticosterone, we established that the fatty acid composition of the steroidal esters is quite different. The corticoid is composed predominantly of one fatty acid, oleate, while the estradiol esters are extremely heterogeneous. Our studies have demonstrated that the estrogens are extremely long-lived hormones, that they are protected by the fatty acid from metabolism. They are extremely potent estrogens, with prolonged activity. Esterification appears to be the only form of metabolism that does not deactivate the biological effects of estradiol. We have demonstrated the biosynthesis of fatty acid esters of estriol, monoesters at both C-16 alpha and C-17 beta. They too are very potent estrogens. These fatty acid esters of the estrogens are the endogenous analogs of estrogen esters, like benzoate, cypionate, etc., which have been used for decades, pharmacologically because of their prolonged therapeutic potency. We have found that the estradiol esters are located predominantly in hydrophobic tissues, such as fat. Sequestered in these tissues, they are an obvious reservoir of estrogenic reserve, requiring only an esterase for activation. To the contrary the biological activity of the fatty acid esters of the glucocorticoid, corticosterone, is not different from that of its free parent steroid. We have shown that the rapid kinetics of its induction of gluconeogenic responses is caused by its labile C-21 ester which is rapidly hydrolyzed by esterase enzymes. While it appears that the physiological role of the estrogen esters may be related to their long-lived hormonal activity, the role of the other families of steroidal esters is not yet apparent. They, and perhaps the estrogen esters as well, must serve other purposes. Indeed they may serve important biological functions beyond those which we ordinarily associate with steroid hormones.

Biological activity of the fatty acid ester metabolites of corticoids.

Fatty acid esters of all families of steroid hormones are known to exist naturally. While their physiological roles are not clear, the C-17-fatty acid esters of estradiol are extremely potent and unusually long-lived estrogens. Thus, it appeared that increased potency would be a logical consequence of the esterification of all of the active steroid hormones. To test this hypothesis we measured the effect of an ester of corticosterone, corticosterone-21-stearate, on the induction of tyrosine aminotransferase in adrenalectomized rats. Surprisingly, while the ester is active compared to the unesterified corticoid corticosterone, there was no difference in either the magnitude or the duration of the induction of this enzyme. To determine whether the C-21-steroidal ester could itself induce this gluconeogenic response, we tested corticosterone-21-oleate and corticosterone-21-stearate as competitors for the binding of [3H] dexamethasone to the glucocorticoid receptor in rat liver cytosol. Both were poor ligands, with binding affinities of about 4% and more than 1%, respectively, compared to corticosterone. From these results, it is doubtful that the esters could act directly in vivo without prior cleavage of the fatty acid. We measured the rate of hydrolysis of corticosterone-21-stearate and estradiol-17-stearate by rat liver esterases. Corticosterone-21-stearate is hydrolyzed at a much greater rate (10- to 25-fold) than estradiol-17-stearate. Consequently, the difference in both potency and duration of response between the ester of the corticoid and that of the estrogen can be explained by the very rapid rate of conversion of the former into the unesterified form. Since the esterification of the corticoids appears not to be related to an increased biological half-life, as it is in the estrogens, the question remains as to the physiological role that they might play.

A comparison of the fatty acid esters of estradiol and corticosterone synthesized by tissues of the rat.

The biosynthesis of the fatty acid esters of the corticoid (corticosterone) and estrogen (estradiol) was compared in parallel incubations of corticosterone and estradiol with several tissues of the rat. The fatty acid composition of the esters of the two steroids was characterized in mammary and uterine tissue. In both of these tissues, the esters of estradiol were extremely heterogeneous. To the contrary, in the same tissues only one predominant ester of corticosterone, corticosterone-21-oleate, was formed. It comprised 70-80% of the total. The oleate ester of estradiol accounted for only 20% of the esters of this estrogen. In addition, fatty acid esters of an A-ring reduced metabolite of corticosterone, 5 beta-dihydrocorticosterone, was also identified. Its fatty acid composition is identical to that of corticosterone. In other experiments the fatty acid esters of both steroids were isolated from several tissues and quantified. When the amount of steroidal ester formed was compared, there was over a 100-fold difference among the various tissues in the ratio of estradiol to corticosterone ester synthesized. Thus, the rate of synthesis of the fatty acid esters of each class of steroid varies dramatically from tissue to tissue, and their fatty acid composition differs markedly as well. If the same enzyme synthesized both the estrogen and corticoid esters, then it would be expected that the relative amount of both esters synthesized in various tissues should be constant and likewise that their composition should be the same. Since neither occurred, these results suggest that the enzyme which produces the C-17 fatty acid esters of the estrogens may be different from the one which synthesizes the C-21 esters of the corticoids. The existence of separate enzyme systems for the synthesis of the fatty acid esters of these steroid hormones opens the possibility of specific physiological controls of each of these unusual steroidal metabolites.

Estradiol metabolism in Ishikawa endometrial cancer cells.

Estrogen-responsive human cells derived from a specimen of well differentiated endometrial adenocarcinoma (Ishikawa line) were incubated with [3H]estradiol (E2) at various concentrations and the medium was sampled at 3, 6 and 24 h to evaluate the kinetics of removal of the hormone and the formation of unconjugated or sulfated metabolites. The detectable products of metabolism were estrone and the conjugate estradiol-3-sulfate. The latter was identified by high pressure chromatography, before and after acetylation, oxidation, and hydrolysis. The disappearance of [3H]E2 from the medium was found to follow first order kinetics between 3 and 24 h, with half-lives increasing from 4.7 to 53 h as the initial concentrations of the hormone were raised from 10(-8) to 10(-6)M. At the lowest concentration, practically all of the [3H]E2 added to the cultures was converted to estradiol-3-sulfate in 24 h, whereas at 10(-6)M oxidation to estrone was quantitatively more important than sulfation. These results indicate the presence in Ishikawa cells of an estrogen sulfotransferase of low Michaelis constant for E2, and 17 beta-oxidoreductase activity that significantly contributes to the metabolism of E2 only at higher concentrations of substrate.

16 Alpha-[125I]iodo-11 beta-methoxy-17 beta-estradiol: a radiochemical probe for estrogen-sensitive tissues.

We have synthesized an analog of 16 alpha-iodoestradiol, 11 beta-methoxy-16 alpha-iodo-estra-1,3,5-(10)triene-3,17 beta-diol (16 alpha-iodo-11 beta-methoxyestradiol), as a potential radiopharmaceutical for the in vivo imaging of estrogen-sensitive tissues. This steroid was synthesized labeled with 125I by halogen exchange of the stable intermediate 11 beta-methoxy-16 beta-bromo-17 beta-estradiol with Na125I. The halogen exchange reaction produces the radioiodinated steroid with a 65-80% yield in 3 h. This rapid synthesis and purification of the 125I-labeled estrogen permits a similar synthesis with 123I, a radioisotope with excellent properties for imaging. The 11-methoxy analog is a highly potent estrogen that binds to the estrogen receptor with an affinity equal to that of estradiol. In vivo, 11 beta-methoxy-16 alpha-[125I]iodoestradiol concentrates in an estrogen receptor-dependent manner in the uterus, producing remarkably sustained and much higher uterus to blood ratios than 16 alpha-[125I]iodoestradiol. Thus, this radiosteroid shows great promise, both as a research probe of the estrogen receptor and as a clinical tool for the imaging of estrogen-responsive tumors.

Bovine retinal glutamine synthetase 1. Purification, characterization and immunological properties.

Glutamine synthetase (GS) from bovine retina was purified to apparent homogeneity by ammonium sulfate fractionation followed by Sephacryl S-200, hydroxylapatite, and Sephadex G-150 chromatography. The purified enzyme showed a single band on polyacrylamide gel electrophoresis. Based on the purification data, retinal GS was shown to be approximately 2% of the total soluble retinal protein. By gel filtration, sedimentation velocity centrifugation, and gel electrophoresis, it was shown that the enzyme has a subunit molecular weight of 45 000 daltons and a native molecular weight of 360 000 daltons, which is consistent with an octameric structure. Throughout the various stages of purification, it was found that GS and glutamyl transferase (GT) activities were maintained at a constant ratio. Thus, the GS and GT reactions are catalyzed by the same enzyme. Immunodiffusion of antiretinal GS antibodies gave a single line of precipitation with both crude retinal and brain enzymes as well as purified enzyme preparations. Precipitation lines of retinal and brain enzymes completely fused with each other without any spur formation. The immunochemical titration of brain enzyme activity with antiretinal GS antibodies also revealed an immunological homology between retinal and brain enzymes.

Bovine retinal glutamine synthetase 2. Regulation and properties on the basis of glutamine synthetase and glutamyl transferase reactions.

Glutamine, the end product formed by the glutamine synthetase (GS) reaction, inhibits retinal GS activity in the presence of Mn2+, but not in the presence of Mg2+. In the presence of Mg2+, Mn2+ itself inhibits retinal GS activity. Other compounds which inhibit retinal GS activity significantly are methionine sulfoximine, D-alanine and carbamyl phosphate. Amino acids, such as L-alanine, L-serine and glycine, do not affect the enzyme activity. These amino acids, however, significantly inhibit the enzyme activity when measured on the basis of the glutamyl transferase (GT) reaction. GS isolated from neuronal tissues is regulated differently from that previously reported by others for non-neuronal tissues. The enzyme activity, as measured by GS activity, shows three-fold higher activity with Mg2+ over Mn2+ or Co2+ and on the basis of GT activity, shows about three-fold higher activity with Mn2+ over Mg2+ or Co2+. The optimum pH for the GS reaction lies in the range of 7.2-7.8 and for the GT reaction is 6.4-7.0. Both the GS and GT activities of the enzyme show similar heat stabilities.