Subthalamic nucleus deep brain stimulation (STN DBS) is effective against freezing of gait (FOG) in Parkinson's disease (PD); however, whether this effect persists over the long term is debated. The ...aim of the current study was to investigate the long-term effect of STN DBS on FOG in patients with PD.
Data on 52 cases in which PD patients received bilateral STN DBS were obtained from a prospective registry. The authors blindly analyzed FOG incidence and its severity from the videotapes of a 5-m walking task at the baseline and at the 1-, 2-, and 5- or 7-year follow-up visits. They also compared the axial score from the Unified Parkinson's Disease Rating Scale (UPDRS) part III, UPDRS part II (UPDRS-II) item 14, and the FOG questionnaire (FOG-Q). Postoperatively, video-based FOG analysis and the axial score were evaluated under 4 conditions (off-medication/off-stimulation, off-medication/on-stimulation, on-medication/off-stimulation, and on-medication/on-stimulation), and UPDRS-II item 14 and the FOG-Q score were evaluated under 2 conditions (off-medication/on-stimulation and on-medication/on-stimulation).
During the off-medication state, the on-stimulation condition improved FOG outcomes, except for video-based FOG severity, up to the last follow-up compared with the baseline. Video-based FOG outcomes and the axial score during the off-medication state were improved with the on-stimulation condition up to the last follow-up compared with the off-stimulation condition. During the on-medication state, the on-stimulation condition did not improve any FOG outcome compared with the baseline; however, it improved video-based FOG outcomes up to the 2-year follow-up and the axial score up to the last follow-up compared with the off-stimulation condition.
Our findings suggest that STN DBS has a long-term effect on FOG in the off-medication state. However, STN DBS did not show a long-term effect on FOG in the on-medication state, although it had a short-term effect until the 2-year follow-up.
Minimally-invasive and biocompatible implantable bioelectronic circuits are used for long-term monitoring of physiological processes in the body. However, there is a lack of methods that can cheaply ...and conveniently image the device within the body while simultaneously extracting sensor information. Magnetic Particle Imaging (MPI) with zero background signal, high contrast, and high sensitivity with quantitative images is ideal for this challenge because the magnetic signal is not absorbed with increasing tissue depth and incurs no radiation dose. We show how to easily modify common implantable devices to be imaged by MPI by encapsulating and magnetically-coupling magnetic nanoparticles (SPIOs) to the device circuit. These modified implantable devices not only provide spatial information via MPI, but also couple to our handheld MPI reader to transmit sensor information by modulating harmonic signals from magnetic nanoparticles via switching or frequency-shifting with resistive or capacitive sensors. This paper provides proof-of-concept of an optimized MPI imaging technique for implantable devices to extract spatial information as well as other information transmitted by the implanted circuit (such as biosensing) via encoding in the magnetic particle spectrum. The 4D images present 3D position and a changing color tone in response to a variable biometric. Biophysical sensing via bioelectronic circuits that take advantage of the unique imaging properties of MPI may enable a wide range of minimally invasive applications in biomedicine and diagnosis.
Probabilistic computing can solve complex combinatorial optimization problems more efficiently than conventional deterministic computing. A probabilistic bit (p‐bit) with an n‐p‐n bistable resistor ...(biristor) is demonstrated for probabilistic computing. It is fabricated on an 8‐inch wafer with complementary metal–oxide–semiconductor (CMOS) compatible technologies. Its stochastic behavior of threshold switching, which is based on the phenomenon of a single transistor latch, provides output with a Boltzmann distribution. The p‐bit is composed of a biristor, a serial resistor, and a comparator. The output probability of the biristor‐based p‐bits shows a sigmoidal relationship with the input voltage, showing typical p‐bit characteristics. Invertible Boolean logic operations with p‐bits are demonstrated, and weighted maximum Boolean satisfiability problems are solved with high energy efficiency and accuracy. The biristor‐based p‐bits with perfect CMOS compatibility show sufficient device stability, demonstrating the possibility of large‐scale integration with a p‐bit array for complex optimization solvers.
A probabilistic bit (p‐bit) with an n‐p‐n bistable resistor is demonstrated for probabilistic computing. It is fabricated on an 8‐inch wafer with complementary metal–oxide–semiconductor compatible technologies. Based on the stochastic behavior of a single transistor latch, invertible Boolean logic operations are demonstrated, and weighted maximum Boolean satisfiability problems are solved with high energy efficiency and accuracy.
Deep brain stimulation (DBS) of the subthalamic nucleus (STN) has been reported to have a positive effect on sleep-wake disturbance in Parkinson's disease (PD). We aimed to investigate the long-term ...effects of STN DBS on sleep in patients with PD.
Sixty-one patients with PD who had undergone bilateral STN DBS were followed for 3 years with assessments including the Parkinson's disease sleep scale (PDSS), Epworth sleepiness scale (ESS), total sleep hours per day, Unified PD Rating Scale part I-III, Hoehn & Yahr stage, levodopa equivalent dose, quality of life measure, and depression scale measured preoperatively and at 6 months after postoperatively, and annually thereafter.
Among the 61 patients at baseline, 46 patients completed the last follow-up assessment. The total PDSS score significantly improved after STN DBS from baseline up to 3 years after STN DBS (79.0±30, 100.0±23.3, 98.8±23.0, 97.1±29.6, and 93.3±28.0 at baseline, 6, 12, 24, and 36 months, respectively, p = 0.006 for the change over time). Among the eight PDSS domains, the domains for overall quality of a night's sleep, sleep onset and maintenance insomnia, and nocturnal motor symptoms showed significant improvement after STN DBS (p = 0.036, 0.029, and < 0.001, respectively, for the change over time). The total sleep hours per day were increased, but the total ESS score did not show significant change after STN DBS (p = 0.001 and 0.055, respectively, for the change over time). Changes in the total PDSS were associated with changes in the depression and motivation items in the Unified PD Rating Scale part I, depression scale, and quality of life measure, but those variables at baseline were not predictive of changes in the total PDSS after STN DBS.
In the largest systematic long-term follow-up study, the improvement in subjective sleep quality after bilateral STN DBS was sustained in PD patients. Improved nocturnal sleep and nocturnal motor symptoms were correlated with an improved mood and quality of life. However, STN DBS did not reduce excessive daytime sleepiness despite reductions in antiparkinsonian medications.
To investigate the longitudinal change of non-motor symptoms according to the age at onset in Parkinson's disease (PD).
This cohort study using the Parkinson's Progression Markers Initiative data ...included 405 patients with early PD. They were classified into late-onset (age at onset ≥ 70 years, n = 63), middle-onset (50 to 69 years, n = 268), and young-onset (<50 years, n = 74) groups. Non-motor symptoms were assessed with well-validated instruments covering neuropsychiatric, sleep-related, and autonomic symptoms yearly over 5 years of follow-up. Dopamine transporter imaging was also performed at baseline and the 1-, 2-, and 4-year follow-up visits.
The late-onset group had a mean decrease of 0.35 more points per year in the Montreal Cognitive Assessment (MoCA) scores (p = 0.008) and increases of 0.32 more points in the 15-item Geriatric Depression Scale scores (p = 0.002) and 0.72 more points in the State-Trait Anxiety Inventory-state scores (p = 0.022) compared to the middle-onset group. The young-onset group had a mean decrease of 0.22 fewer points per year in the MoCA scores (p = 0.002) than the middle-onset group. The other non-motor progression did not differ among the groups. No significant differences were found between the late-onset, middle-onset, and young-onset groups in the changes of striatal DAT binding ratios.
Compared to middle-onset PD, late-onset PD showed a faster progression of cognitive impairment along with depression and anxiety, and young-onset PD showed a slower progression of cognitive impairment in the early phases of the disease. These differences do not appear to be associated with the longitudinal changes in striatal dopaminergic activities.
•Late-onset PD showed faster decline in cognitive impairment, depression, and anxiety compared to middle-onset PD.•Young-onset PD showed a slower progression of cognitive impairment compared to middle-onset PD.•These differences do not appear to be related to the longitudinal changes in striatal dopaminergic activities.
Abstract
Study Objectives
We investigated electroencephalographic (EEG) slow oscillations (SOs), sleep spindles (SSs), and their temporal coordination during nonrapid eye movement (NREM) sleep in ...patients with idiopathic rapid eye movement (REM) sleep behavior disorder (iRBD).
Methods
We analyzed 16 patients with video-polysomnography-confirmed iRBD (age, 65.4 ± 6.6 years; male, 87.5%) and 10 controls (age, 62.3 ± 7.5 years; male, 70%). SSs and SOs were automatically detected during stage N2 and N3. We analyzed their characteristics, including density, frequency, duration, and amplitude. We additionally identified SO-locked spindles and examined their phase distribution and phase locking with the corresponding SO. For inter-group comparisons, we used the independent samples t-test or Wilcoxon rank-sum test, as appropriate.
Results
The SOs of iRBD patients had significantly lower amplitude, longer duration (p = 0.005 for both), and shallower slope (p < 0.001) than those of controls. The SS power of iRBD patients was significantly lower than that of controls (p = 0.002), although spindle density did not differ significantly. Furthermore, SO-locked spindles of iRBD patients prematurely occurred during the down-to-up-state transition of SOs, whereas those of controls occurred at the up-state peak of SOs (p = 0.009). The phase of SO-locked spindles showed a positive correlation with delayed recall subscores (p = 0.005) but not with tonic or phasic electromyography activity during REM sleep.
Conclusions
In this study, we found abnormal EEG oscillations during NREM sleep in patients with iRBD. The impaired temporal coupling between SOs and SSs may reflect early neurodegenerative changes in iRBD.
Fraud detection is becoming an integral part of business intelligence, as detecting fraud in the work processes of a company is of great value. Fraud is an inhibitory factor to accurate appraisal in ...the evaluation of an enterprise, and it is economically a loss factor to business. Previous studies for fraud detection have limited the performance enhancement because they have learned the fraud pattern of the whole data. This paper proposes a novel method using hierarchical clusters based on deep neural networks in order to detect more detailed frauds, as well as frauds of whole data in the work processes of job placement. The proposed method, Hierarchical Clusters-based Deep Neural Networks (
HC-DNN
) utilizes anomaly characteristics of hierarchical clusters pre-trained through an autoencoder as the initial weights of deep neural networks to detect various frauds.
HC-DNN
has the advantage of improving the performance and providing the explanation about the relationship of fraud types. As a result of evaluating the performance of fraud detection by cross validation, the results of the proposed method show higher performance than those of conventional methods. And from the viewpoint of explainable deep learning the hierarchical cluster structure constructed through
HC-DNN
can represent the relationship of fraud types.
Although medical treatment including botulinum toxic injection is the first-line treatment for dystonia, response is insufficient in many patients. In these patients, deep brain stimulation (DBS) can ...provide significant clinical improvement. Mounting evidence indicates that DBS is an effective and safe treatment for dystonia, especially for idiopathic and inherited isolated generalized/segmental dystonia, including DYT-
TOR1A
. Other inherited dystonia and acquired dystonia also respond to DBS to varying degrees. For Meige syndrome (craniofacial dystonia), other focal dystonia, and some rare inherited dystonia, further evidences are still needed to evaluate the role of DBS. Because short disease duration at DBS surgery and absence of fixed musculoskeletal deformity are associated with better outcome, DBS should be considered as early as possible when indicated after careful evaluation including genetic work-up. This review will focus on the factors to be considered in DBS for patients with dystonia and the outcome of DBS in the different types of dystonia.
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