Automatic Assessment of Expanded Disability Status Scale (EDSS) in Multiple Sclerosis Using a Decision Tree

The expanded disability status scale (EDSS) is frequently used to classify the patients with multiple sclerosis (MS). We presented in this paper a novel method to automatically assess the EDSS score from posturologic data (center of pres-sure signals) using a decision tree. Two groups of participants (one for learning and the other for test) with EDSS rang-ing from 0 to 4.5 performed our balance experiment with eyes closed. Two linear measures (the length and the surface) and twelve non-linear measures (the recurrence rate, the Shannon entropy, the averaged diagonal line length and the trapping time for the position, the instantaneous velocity and the instantaneous acceleration of the center of pressure respectively) were calculated for all the participants. Several decision trees were constructed with learning data and tested with test data. By comparing clinical and estimated EDSS scores in the test group, we selected one decision tree with five measures which revealed a 75% of agreement. The results have signified that our tree model is able to auto-matically assess the EDSS scores and that it is possible to distinguish the EDSS scores by using linear and non-linear postural sway measures.

Correlation between cerebral cortex changes and clinical features in patients with neuromyelitis optica spectrum disorder with normal-appearing brain tissue:a case-control study

Neuro myelitis optica spectrum disorder(NMOSD) is an inflammatory demyelinating disease of the central nervous system.However,whether and how cortical changes occur in NMOSD with normal-appearing brain tissue,or whether any cortical changes correlate with clinical chara cteristics,is not completely clear.The current study recruited 43 patients with NMOSD who had normal-appearing brain tissue and 45 healthy controls matched for age,sex,and educational background from December 2020 to February 2022.A surface-based morphological analysis of high-resolution T1-weighted structural magnetic resonance images was used to calculate the cortical thickness,sulcal depth,and gyrification index.Analysis showed that cortical thickness in the bilate ral rostral middle frontal gyrus and left superior frontal gyrus was lower in the patients with NMOSD than in the control participants.Subgroup analysis of the patients with NMOSD indicated that compared with those who did not have any optic neuritis episodes,those who did have such episodes exhibited noticeably thinner cortex in the bilateral cuneus,superior parietal co rtex,and pericalcarine co rtex.Correlation analysis indicated that co rtical thickness in the bilateral rostral middle frontal gyrus was positively correlated with scores on the Digit Symbol Substitution Test and negatively correlated with scores on the Trail Making Test and the Expanded Disability Status Scale.These results are evidence that cortical thinning of the bilateral regional frontal cortex occurs in patients with NMOSD who have normal-appearing brain tissue,and that the degree of thinning is correlated with clinical disability and cognitive function.These findings will help im prove our understanding of the imaging chara cteristics in NMOSD and their potential clinical significance.

Combinatorial model of solute transport in porous media

Modeling of solute transport is a key issue in the area of soil physics and hydrogeology. The most common approach (the convection-dispersion equation) considers an average convection flow rate and Fickian-like dispersion. Here,we propose a solute transport model in porous media of continuously expanding scale, according to the combinatorics principle. The model supposed actual porous media as a combinative body of many basic segments. First, we studied the solute transport process in each basic segment body, and then deduced the distribution of pore velocity in each basic segment body by difference approximation, finally assembled the solute transport process of each basic segment body into one of the combinative body. The simulation result coincided with the solute transport process observed in test. The model provides useful insight into the solute transport process of the non-Fickian dispersion in continuously expanding scale.

Nusinersen for spinal muscular atrophy types Ⅱ and Ⅲ:a retrospective single-center study in South Korea

Background This study investigated the efficacy and safety of nusinersen,an antisense oligonucleotide,in patients with spinal muscular atrophy(SMA)types II(OMIM:253,550)or III(OMIM:253,400),including those with severe scoliosis or requiring respiratory support via mechanical ventilation.Methods Data from 40 patients with genetically confirmed SMA who were treated with nusinersen at our institute from March 2019 to April 2022 were retrospectively analyzed.Of these,30 patients with an age of onset<3 years and not on permanent ventilation were selected.Clinical and genetic characteristics were investigated,and motor function was evaluated based on the Hammersmith Functional Motor Scale-Expanded(HFMSE)score.Results The mean age of symptom onset was 1.2 years.Most patients were diagnosed with SMA type II(27/30,90%).Nusinersen was administered via computed tomography-guided or direct intrathecal injection in 87%(26/30)and 13%(4/30)of the patients,respectively.At the 6-,14-,22-,and 26-month follow-ups,72%,71%,88%,and 86%of patients showed motor improvement,respectively,with mean changes in HFMSE scores of 2.10,2.88,4.21,and 5.29,respectively.Multivariable analysis showed that the use of noninvasive ventilation was associated with poorer outcomes of motor function.Conclusions Patients with SMA type II or III who received nusinersen treatment showed significant improvement in motor function.A longer treatment duration led to a higher number of patients with improved motor function.No significant side effects of nusinersen were observed.Patients with SMA,even those with severe scoliosis or on respiratory support,can be safely treated using nusinersen.