Search results for: radiation therapy oncology group (RTOG)

Authors: Aya Al Masri, Stefaan Carpentier, Fabrice Leroy, Thibault Julien, Safoin Aktaou, Malorie Martin, Fouad Maaloul

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Introduction: During an 'Interventional Radiology (IR)' procedure, the patient's skin-dose may become very high for a burn, necrosis and ulceration to appear. In order to prevent these deterministic effects, an accurate calculation of the patient skin-dose mapping is essential. For most machines, the 'Dose Area Product (DAP)' and fluoroscopy time are the only information available for the operator. These two parameters are a very poor indicator of the peak skin dose. We developed a mathematical model that reconstructs the magnitude (delivered dose), shape, and localization of each irradiation field on the patient skin. In case of critical dose exceeding, the system generates warning alerts. We present the results of its comparison with clinical studies. Materials and methods: Two series of comparison of the skin-dose mapping of our mathematical model with clinical studies were performed: 1. At a first time, clinical tests were performed on patient phantoms. Gafchromic films were placed on the table of the IR machine under of PMMA plates (thickness = 20 cm) that simulate the patient. After irradiation, the film darkening is proportional to the radiation dose received by the patient's back and reflects the shape of the X-ray field. After film scanning and analysis, the exact dose value can be obtained at each point of the mapping. Four experimentation were performed, constituting a total of 34 acquisition incidences including all possible exposure configurations. 2. At a second time, clinical trials were launched on real patients during real 'Chronic Total Occlusion (CTO)' procedures for a total of 80 cases. Gafchromic films were placed at the back of patients. We performed comparisons on the dose values, as well as the distribution, and the shape of irradiation fields between the skin dose mapping of our mathematical model and Gafchromic films. Results: The comparison between the dose values shows a difference less than 15%. Moreover, our model shows a very good geometric accuracy: all fields have the same shape, size and location (uncertainty < 5%). Conclusion: This study shows that our model is a reliable tool to warn physicians when a high radiation dose is reached. Thus, deterministic effects can be avoided.

Keywords: clinical experimentation, interventional radiology, mathematical model, patient's skin-dose mapping.

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Authors: Majid Manawer Alenezi, Gavin Lawrence, Hans-Peter Kubis

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Imagery training could be an important treatment for muscle function improvements in patients who are facing limitations in exercise training by pain or other adverse symptoms. However, recent studies are mostly limited to small muscle groups and are often contradictory. Moreover, a possible bilateral transfer effect of imagery training has not been examined. We, therefore, investigated the effectiveness of unilateral imagery training in comparison with exercise training on hip abductor muscle strength and EMG. Additionally, both limbs were assessed to investigate bilateral transfer effects. Healthy individuals took part in an imagery or exercise training intervention for two weeks and were assesses pre and post training. Participants (n=30), after randomization into an imagery and an exercise group, trained 5 times a week under supervision with additional self-performed training on the weekends. The training consisted of performing, or to imagine, 5 maximal isometric hip abductor contractions (= one set), repeating the set 7 times. All measurements and trainings were performed laying on the side on a dynamometer table. The imagery script combined kinesthetic and visual imagery with internal perspective for producing imagined maximal hip abduction contractions. The exercise group performed the same number of tasks but performing the maximal hip abductor contractions. Maximal hip abduction strength and EMG amplitudes were measured of right and left limbs pre- and post-training period. Additionally, handgrip strength and right shoulder abduction (Strength and EMG) were measured. Using mixed model ANOVA (strength measures) and Wilcoxen-tests (EMGs), data revealed a significant increase in hip abductor strength production in the imagery group on the trained right limb (~6%). However, this was not reported for the exercise group. Additionally, the left hip abduction strength (not used for training) did not show a main effect in strength, however, there was a significant interaction of group and time revealing that the strength increased in the imagery group while it remained constant in the exercise group. EMG recordings supported the strength findings showing significant elevation of EMG amplitudes after imagery training on right and left side, while the exercise training group did not show any changes. Moreover, measures of handgrip strength and shoulder abduction showed no effects over time and no interactions in both groups. Experiments showed that imagery training is a suitable method for effectively increasing functional parameters of larger limb muscles (strength and EMG) which were enhanced on both sides (trained and untrained) confirming a bilateral transfer effect. Indeed, exercise training did not reveal any increases in the parameters above omitting functional improvements. The healthy individuals tested might not easily achieve benefits from exercise training within the time tested. However, it is evident that imagery training is effective in increasing the central motor command towards the muscles and that the effect seems to be segmental (no increase in handgrip strength and shoulder abduction parameters) and affects both sides (trained and untrained). In conclusion, imagery training was effective in functional improvements in limb muscles and produced a bilateral transfer on strength and EMG measures.

Keywords: imagery, exercise, physiotherapy, motor imagery

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Authors: Ashok K. Gupta

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Over the past few decades, since the bio-engineering revolution, autologous cell therapy (ACT) has become a rapidly evolving field. Currently, this form of therapy has broad applications in modern medicine and plastic surgery, ranging from the treatment/improvement of wound healing to life-saving operations. A study was conducted on 50 patients having to disfigure, and deform post burn scars and was treated by injection of extracted, refined adipose tissue grafts with their unique stem cell properties. To compare the outcome, a control of 20 such patients was treated with conventional skin or soft-tissue flaps or skin grafting, and a control of 10 was treated with more advanced microsurgical techniques such as Pre-fabricated flaps/pre laminated flaps / free flaps. Assessment of fat volume and survival post- follow up period was done by radiological aid, using MRI and clinically (Survival of the autograft and objective parameters for scar elasticity were evaluated skin elasticity parameters 3 to 9 months postoperatively). Recently, an enzyme that is involved in collagen crosslinking in fibrotic tissue, lysyl hydroxylase (LH2), was identified. This enzyme is normally active in bone and cartilage but hardly in the skin. It has been found that this enzyme is highly expressed in scar tissue and subcutaneous fat; this is in contrast to the dermis, where the enzyme is hardly expressed. Adipose tissue-derived stem cell injections are an effective method in the treatment of various extensive post-burn scar deformities that makes it possible to re-create the lost sub-dermal tissue for improvement in the function of involved joint movements.

Keywords: adipose tissue-derived stem cell injections, treatment of various extensive post-burn scar deformities, re-create the lost sub-dermal tissue, improvement in function of involved joint movements

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Authors: J. Van der Walt, N. A. Plastow, M. Unger

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Gross and fine motor skill difficulties among children affect their ability to learn and progress in school. Research indicates that children in low socio-economic areas are at a higher risk of motor skill difficulties, while therapy resources are limited. The Hopscotch motor skill programme is a well-researched accessible in-school intervention developed by occupational and physiotherapists through complex intervention development. The development stage of the complex intervention development model firstly included a prevalence study in a low-resourced area in the West Coast of South Africa, indicating a high prevalence with significant motor skill difficulties among pre-school children at 14.5% with fine motor skill difficulties at 24.6%. A scoping review identifies motor skill interventions for pre-school children and a proposed a framework of fundamental concepts to consider when developing a motor skill intervention. a Delphi-study considered the framework and encouraged collaboration between therapists and educators to make the programme accessible, resource and cost effective, specifically geared towards a rural, low resourced area. The results from the Delphi study, together with the proposed framework from the scoping review was used to develop the Hopscotch programme, adopting a task-shifting approach. The eight-week small-group programme is facilitated by teachers with the support of therapists. The programme aims to improve the motor skills of pre-school aged children with motor skill difficulties to promote academic readiness through obstacle courses, ball skill games and fine motor games and crafts. A randomised controlled trial is planned as a next stage to determine the preliminary effect of the programme on the motor and early academic skills of pre-school children.

Keywords: accesible learning, motor skill intervention, school readiness, task shifting

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Authors: Shreya Srivastava, Sagnik Dey

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Aerosol direct radiative forcing (ADRF) refers to the alteration of the Earth's energy balance from the scattering and absorption of solar radiation by aerosol particles. India experiences substantial ADRF due to high aerosol loading from various sources. These aerosols' radiative impact depends on their physical characteristics (such as size, shape, and composition) and atmospheric distribution. Quantifying ADRF is crucial for understanding aerosols’ impact on the regional climate and the Earth's radiative budget. In this study, we have taken radiation data from Clouds and the Earth’s Radiant Energy System (CERES, spatial resolution=1ox1o) for 22 years (2000-2021) over the Indian subcontinent. Except for a few locations, the short-wave DARF exhibits aerosol cooling at the TOA (values ranging from +2.5 W/m2 to -22.5W/m2). Cooling due to aerosols is more pronounced in the absence of clouds. Being an aerosol hotspot, higher negative ADRF is observed over the Indo-Gangetic Plain (IGP). Aerosol Forcing Efficiency (AFE) shows a decreasing seasonal trend in winter (DJF) over the entire study region while an increasing trend over IGP and western south India during the post-monsoon season (SON) in clear-sky conditions. Analysing atmospheric heating and AOD trends, we found that only the aerosol loading is not governing the change in atmospheric heating but also the aerosol composition and/or their vertical profile. We used a Multi-angle Imaging Spectro-Radiometer (MISR) Level-2 Version 23 aerosol products to look into aerosol composition. MISR incorporates 74 aerosol mixtures in its retrieval algorithm based on size, shape, and absorbing properties. This aerosol mixture information was used for analysing long-term changes in aerosol composition and dominating aerosol species corresponding to the aerosol forcing value. Further, ADRF derived from this method is compared with around 35 studies across India, where a plane parallel Radiative transfer model was used, and the model inputs were taken from the OPAC (Optical Properties of Aerosols and Clouds) utilizing only limited aerosol parameter measurements. The result shows a large overestimation of TOA warming by the latter (i.e., Model-based method).

Keywords: aerosol radiative forcing (ARF), aerosol composition, MISR, CERES, SBDART

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Authors: H. Mazouz, A. Belghachi, F. Hadjaj

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Solar cells used in orbit are exposed to radiation environment mainly protons and high energy electrons. These particles degrade the output parameters of the solar cell. The aim of this work is to characterize the effects of electron irradiation fluence on the J (V) characteristic and output parameters of gaAs solar cell by numerical simulation. The results obtained demonstrate that the electron irradiation-induced degradation of performances of the cells concerns mainly the short circuit current.

Keywords: gaAs solar cell, MeV electron irradiation, irradiation fluence, short circuit

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Authors: Naqoosh Haidry

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Objective & Goal: Enucleation of the maxillomandibular cysts will lead to the creation of post-surgical bone defects which may take more than a year for complete bone healing. The use of bone grafts is common to aid bone regeneration in large defects. The study aimed to evaluate the healing and bone formation capabilities of polymer of injectable platelet fibrin (i-PRF) and hydroxyapatite (HA) as bone graft substitute in maxilla-mandibular postsurgical defects compared to hydroxyapatite alone. The primary objective was to find out the clinical and radiological assessment of healing postoperatively and compare the outcome of both groups. Material and Methods: After surgical enucleation of 19 maxillomandibular cysts/tumors, either HA or HA+ i-PRF graft was adapted to the defect. Clinical outcome variables such as pain (VAS score), edema, and mucosal color were evaluated on postoperative days 01, 03, and 07 while radiological outcome variables such as volume of defect (cc), density of new bone (HU) on computed tomography were evaluated at 2nd and 4th month. The results obtained were tabulated and compared with the inferential analysis. Results: Clinical parameters seem to be better in the HA + i-PRF group, but the result was non-significant. Radiologically, the mean healing ratios were significantly greater in the HA + i-PRF group (63.5 ± 2.34 at 2nd month, 90.3 ± 7.32 at 4th month) compared to the HA group (57.2 ± 5.21at 2nd month, 80.8 ± 5.33 at 4th month). When comparing the mean density of new bone, there was a statistically significant difference with a mean difference of 95.2 HU more in the HA + i-PRF (623 HU ± 42.9) compared to the HA group (528 HU ± 96.5) in 2nd month. Conclusion: The polymer of i-PRF and HA prepared as the sticky bone yields faster and better bone healing in post-enucleation maxillomandibular bony defects as compared to hydroxyapatite alone based on radiological findings till four months.

Keywords: bone defect, density of new bone, hydroxyapatite, injectable platelet rich fibrin, maxillomandibular cysts, surgical defect

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Authors: Chinh Phuong Do

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Dynamic analysis of slope under seismic condition requires the elimination of spurious reflection at the bounded domain. This paper studies the performances of wave transmitting boundaries, including the standard viscous boundary and the viscoelastic boundary to the material point method (MPM) framework. First, analytical derivations of these non-reflecting conditions particularly to the implicit MPM are presented. Then, a number of benchmark and geotechnical examples will be shown. Overall, the results agree well with analytical solutions, indicating the ability to accurately simulate the radiation at the bounded domain.

Keywords: dynamic analysis, implicit, MPM, non-reflecting boundary

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Authors: Elham Azimzadeh, Saeedeh Sepehri, Hamidollah Hassanlouei

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Obesity is associated with postural instability, might influence the quality of daily life, and could be considered a potential factor for falling in obese people. The fat body mass especially in the abdominal area may increase body sway. Furthermore, loss of visual feedback may induce a larger postural sway in obese people. Moreover, Muscle fatigue may impair the work capacity of the skeletal muscle and may alter joint proprioception. So, the purpose of this study was to investigate the effect of physical fatigue and visual feedback on body sway and strength of lower extremities in obese people. 12 obese (4 female, 8 male; BMI >30 kg/m2), and 12 normal weight (4 female, 8 male; BMI: 20-25 kg/m2) subjects aged 37- 47 years participated in this study. The postural stability test on the Biodex balance system was used to characterize postural control along the anterior-posterior (AP) and mediolateral (ML) directions in eyes open and eyes closed conditions and maximal voluntary contraction (MVC) of knee extensors and flexors were measured before and after the high-intensity exhausting exercise protocol on the ergometer bike to confirm the presence of fatigue. Results indicated that the obese group demonstrated significantly greater body sway, in all indices (ML, AP, overall) compared with the normal weight group (eyes open). However, when visual feedback was eliminated, fatigue impaired the balance in the overall and AP indicators in both groups; ML sway was higher only in the obese group after exerting the fatigue in the eyes closed condition. Also, maximal voluntary contraction of knee extensors was impaired in the fatigued normal group but, there was no significant impairment in knee flexors MVC in both group. According to the findings, peripheral fatigue was associated with altered postural control in upright standing when eyes were closed, and that mechanoreceptors of the feet may be less able to estimate the position of the body COM over the base of support in the loss of visual feedback. This suggests that the overall capability of the postural control system during upright standing especially in the ML direction could be lower due to fatigue in obese individuals and could be a predictor of future falls.

Keywords: maximal voluntary contraction, obesity, peripheral fatigue, postural control, visual feedback

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Authors: David Dolbow, Daniel Credeur, Mujtaba Rahimi, Dobrivoje Stokic, Jennifer Lemacks, Andrew Courtner

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Introduction: Obesity is at epidemic proportions in the spinal cord injury (SCI) population (66-75%), as individuals who suffer from paralysis undergo a dramatic decrease in muscle mass and a dramatic increase in adipose deposition. Obesity is a major public health concern which includes a doubling of the risk of heart disease, stroke and type II diabetes mellitus. It has been demonstrated that physical activity, and especially HIIT, can promote a healthy body composition and decrease the risk cardiometabolic disease in the able-bodied population. However, SCI typically limits voluntary exercise to the arms, but a high prevalence of shoulder pain in persons with chronic SCI (60-90%) can cause increased arm exercise to be problematic. Functional electrical stimulation (FES) cycling has proven to be a safe and effective way to exercise paralyzed leg muscles in clinical and home settings, saving the often overworked arms. Yet, HIIT-FES cycling had not been investigated prior to the current study. The purpose of this study was to investigate the body composition changes with combined HIIT-FES cycling and nutritional counseling on individuals with SCI. Design: A matched (level of injury, time since injury, body mass index) and controlled trail. Setting: University exercise performance laboratory. Subjects: Ten individuals with chronic SCI (C5-T9) ASIA impairment classification (A & B) were divided into the treatment group (n=5) for 30 minutes of HIIT-FES cycling 3 times per week for 8 weeks and nutritional counseling over the phone for 30 minutes once per week for 8 weeks and the control group (n=5) who received nutritional counseling only. Results: There was a statistically significant difference between the HIIT-FES group and the control group in mean body fat percentage change (-1.14 to +0.24) respectively, p = .030). There was also a statistically significant difference between the HIIT-FES and control groups in mean change in legs lean mass (+0.78 kg to -1.5 kg) respectively, p = 0.004. There was a nominal decrease in weight, BMI, total fat mass and a nominal increase in total lean mass for the HIIT-FES group over the control group. However, these changes were not found to be statistically significant. Additionally, there was a nominal decrease in the mean blood glucose levels for both groups 101.8 to 97.8 mg/dl for the HIIT-FES group and 94.6 to 93 mg/dl for the Nutrition only group, however, neither were found to be statistically significant. Conclusion: HIIT-FES cycling combined with nutritional counseling can provide healthful body composition changes including decreased body fat percentage in just 8 weeks. Future study recommendations include a greater number of participants, a primer electrical stimulation exercise program to better ready participants for HIIT-FES cycling and a greater volume of training above 30 minutes, 3 times per week for 8 weeks.

Keywords: body composition, functional electrical stimulation cycling, high-intensity interval training, spinal cord injury

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Authors: Natividad Natalia Angeles Manuel

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In the Dominican Republic, American-Dominican veterans face unique challenges due to their dual identities and wartime experiences. This case study examines an 85-year-old veteran with memory impairments and emotional distress linked to military service. A neuropsychological assessment using standardized tools evaluated cognitive domains and functional abilities. Significant deficits in memory, orientation, semantic memory, and executive functions, alongside symptoms of Post-Traumatic Stress Disorder and depression, were identified. A six-month cognitive stimulation program included tailored interventions to enhance memory, attention, and executive skills through weekly sessions and group activities. Medical and physical therapy support aimed to improve overall cognitive, functional, and emotional outcomes. Follow-up evaluations showed improvements in memory retention, attention, task proficiency, and reduced depressive symptoms, highlighting the program's effectiveness in promoting emotional well-being and quality of life. Despite ongoing memory challenges and military-related nightmares, the veteran responded positively to interventions, demonstrating resilience and motivation. This study emphasizes the importance of personalized neuropsychological interventions for American-Dominican veterans in the Dominican Republic. Through assessment tools and focused cognitive stimulation strategies, healthcare providers can successfully alleviate cognitive and emotional challenges stemming from traumatic experiences in elderly veterans. Overall, integrated neuropsychological assessment and stimulation programs are shown to enhance cognitive resilience and emotional well-being, thus contributing to an enhanced quality of life for aging American-Dominican veterans.

Keywords: neuropsychology, cognitive stimulation, American-Dominican veterans, Dominican Republic, PTSD, memory deficits

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Authors: Hiroko Komatsu, Kaori Yagasaki

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Background: Cancer-related cognitive impairment is a common problem seen in cancer patients undergoing chemotherapy. Physical activity may show beneficial effects on the cognitive function in such patients. Therefore, we have developed a self-directed home yoga program for cancer patients with cognitive symptoms during chemotherapy. This program involves a DVD presenting a combination of yoga courses based on patient preferences to be practiced at home. This study was performed to examine the feasibility of this program. In addition, we also examined changes in cognitive function and quality of life (QOL) in these patients participating in the program. Methods: This prospective feasibility study was conducted in a 500-bed general hospital in Tokyo, Japan. The study population consisted of breast cancer patients undergoing chemotherapy as the initial therapy. This feasibility study used a convenience sample with estimation of recruitment rate in a single facility with the availability of trained nurses and physicians to ensure safe yoga intervention. The aim of the intervention program was to improve cognitive function by means of both physical and mental activation via yoga, consisting of physical practice, breathing exercises, and meditation. Information on the yoga program was provided as a booklet, with an instructor-guided group yoga class during the orientation, and a self-directed home yoga program on DVD with yoga logs. Results: The recruitment rate was 44.7%, and the study population consisted of 18 women with a mean age of 43.9 years. This study showed high rates of retention, adherence, and acceptability of the yoga program. Improvements were only observed in the cognitive aspects of fatigue, and there were serious adverse events during the program. Conclusion: The self-directed home yoga program discussed here was both feasible and safe for breast cancer patients showing cognitive symptoms during chemotherapy. The patients also rated the program as useful, interesting, and satisfactory. Participation in the program was associated with improvements in cognitive fatigue but not cognitive function.

Keywords: yoga, cognition, breast cancer, chemotherapy, quality of life

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Authors: E. M. D. Akuoko, Eliana Vasquez Osorio, Marcel Van Herk, Marianne Aznar

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Radiotherapy is an integral part of treatment for many patients with breast cancer. However, side effects can occur, e.g., fibrosis or erythema. If patients at higher risks of radiation-induced side effects could be identified before treatment, they could be given more individual information about the risks and benefits of radiotherapy. We hypothesize that breast density is correlated with the risk of side effects and present a novel method for automatic evaluation based on radiotherapy planning CT scans. Methods: 799 supine CT scans of breast radiotherapy patients were available from the REQUITE dataset. The methodology was first established in a subset of 114 patients (cohort 1) before being applied to the whole dataset (cohort 2). All patients were scanned in the supine position, with arms up, and the treated breast (ipsilateral) was identified. Manual experts contour available in 96 patients for both the ipsilateral and contralateral breast in cohort 1. Breast tissue was segmented using atlas-based automatic contouring software, ADMIRE® v3.4 (Elekta AB, Sweden). Once validated, the automatic segmentation method was applied to cohort 2. Breast density was then investigated by thresholding voxels within the contours, using Otsu threshold and pixel intensity ranges based on Hounsfield units (-200 to -100 for fatty tissue, and -99 to +100 for fibro-glandular tissue). Volumetric breast density (VBD) was defined as the volume of fibro-glandular tissue / (volume of fibro-glandular tissue + volume of fatty tissue). A sensitivity analysis was performed to verify whether calculated VBD was affected by the choice of breast contour. In addition, we investigated the correlation between volumetric breast density (VBD) and patient age and breast size. VBD values were compared between ipsilateral and contralateral breast contours. Results: Estimated VBD values were 0.40 (range 0.17-0.91) in cohort 1, and 0.43 (0.096-0.99) in cohort 2. We observed ipsilateral breasts to be denser than contralateral breasts. Breast density was negatively associated with breast volume (Spearman: R=-0.5, p-value < 2.2e-16) and age (Spearman: R=-0.24, p-value = 4.6e-10). Conclusion: VBD estimates could be obtained automatically on a large CT dataset. Patients’ age or breast volume may not be the only variables that explain breast density. Future work will focus on assessing the usefulness of VBD as a predictive variable for radiation-induced side effects.

Keywords: breast cancer, automatic image segmentation, radiotherapy, big data, breast density, medical imaging

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Authors: Rekaya A. Shabbir, Marco Mingarelli, Glenn Flux, Ananya Choudhury, Tim A. D. Smith

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Introduction: Heterogeneity of dose distributions across a tumour is problematic for targeted radiotherapy. Gold nanoparticles (AuNPs) enhance dose-distributions of targeted radionuclides. The aim of this study is to demonstrate if tumour dose-distribution of targeted AuNPs radiolabelled with either of two radioisotopes (¹⁷⁷Lu and ⁹⁰Y) in breast cancer cells produced homogeneous dose distributions. Moreover, in vitro and in vivo studies were conducted to study the importance of receptor level on cytotoxicity of EGFR-targeted AuNPs in breast and colorectal cancer cells. Methods: AuNPs were functionalised with DOTA and OPPS-PEG-SVA to optimise labelling with radionuclide tracers and targeting with Erbitux. Radionuclides were chelated with DOTA, and the uptake of the radiolabelled AuNPs and targeted activity in vitro in both cell lines measured using liquid scintillation counting. Cells with medium (HCT8) and high (MDA-MB-468) EGFR expression were incubated with targeted ¹⁷⁷Lu-AuNPs for 4h, then washed and allowed to form colonies. Nude mice bearing tumours were used to study the biodistribution by injecting ¹⁷⁷Lu-AuNPs or ⁹⁰Y-AuNPs via the tail vein. Heterogeneity of dose-distribution in tumours was determined using autoradiography. Results: Colony formation (% control) was 81 ± 4.7% (HCT8) and 32 ± 9% (MDA-MB-468). High uptake was observed in the liver and spleen, indicating hepatobiliary excretion. Imaging showed heterogeneity in dose-distributions for both radionuclides across the tumours. Conclusion: The cytotoxic effect of EGFR-targeted AuNPs is greater in cells with higher EGFR expression. Dose-distributions for individual radiolabelled nanoparticles were heterogeneous across tumours. Further strategies are required to improve the uniformity of dose distribution prior to clinical trials.

Keywords: cancer cells, dose distributions, radionuclide therapy, targeted gold nanoparticles

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Authors: Linda Blümel, Bettina Bert, Jan Brosda, Heidrun Fink, Melanie Hamann

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Age-related cognitive decline can eventually lead to dementia, the most common mental illness in elderly people and an immense challenge for patients, their families and caregivers. Cholinesterase inhibitors constitute the most commonly used antidementia prescription medication. The standardized Ginkgo biloba leaf extract EGb 761® is approved for treating age-associated cognitive impairment and has been shown to improve the quality of life in patients suffering from mild dementia. A clinical trial with 96 Alzheimer´s disease patients indicated that the combined treatment with donepezil and EGb 761® had fewer side effects than donepezil alone. In an animal model of cognitive aging, we compared the effect of combined treatment with EGb 761® or donepezil monotherapy and vehicle. We compared the effect of chronic treatment (15 days of pretreatment) with donepezil (1.5 mg/kg p. o.), EGb 761® (100 mg/kg p. o.), or the combination of the two drugs, or vehicle in 18 – 20 month old male OFA rats. Learning and memory performance were assessed by Morris water maze testing, motor behavior in an open field paradigm. In addition to chronic treatment, the substances were administered orally 30 minutes before testing. Compared to the first day and to the control group, only the combination group showed a significant reduction in latency to reach the hidden platform on the second day of testing. Moreover, from the second day of testing onwards, the donepezil, the EGb 761® and the combination group required less time to reach the hidden platform compared to the first day. The control group did not reach the same latency reduction until day three. There were no effects on motor behavior. These results suggest a superiority of the combined treatment of donepezil with EGb 761® compared to monotherapy.

Keywords: age-related cognitive decline, dementia, ginkgo biloba leaf extract EGb 761®, learning and memory, old rats

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Authors: Iwona Kasior

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Purpose: Pelvic organ prolapse is the descent of pelvic organs into the vaginal opening. Currently, few trials have been conducted to determine the influence of pelvic floor muscle training in decreasing stage or symptoms associated with pelvic organ prolapse. The purpose of this case study is to determine whether pelvic floor muscle training can decrease the stage of pelvic organ prolapse and related symptoms. Case Presentation: This is the case of a 55-year-old female; recently diagnosed with midline cystocele, stage three. She has undergone corrective surgery that failed. She has now resorted to managing the condition with a home exercise regimen of voluntary pelvic floor muscle contractions, topical vaginal crème prescribed by her gynecologist, and slight lifestyle modifications. Methods: The patient was treated by a physical therapist for evaluation, vaginal exam, and educated in the ‘knack’ maneuver, lifestyle modifications, and proper technique of performing pelvic floor muscle contractions. The subject continued with a home exercise program with a specific regimen of pelvic floor muscle contractions and topical vaginal crème. Outcome: As determined by her physical therapist and the subject, her pelvic floor muscle strength had increased following the pelvic floor muscle training regimen and the use of the ‘knack’ maneuver. The subject reported a small decrease in the size of bulging prolapse and related symptoms of dryness, odor, vaginal discomfort, and the sensation of descent. Conclusion: Pelvic floor muscle training helped to lessen the degree of the prolapse, but not significantly enough to decrease the diagnosed stage.

Keywords: Kegel exercises, pelvic floor, pelvic organ prolapse, physical therapy

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Authors: Abigail Gragg

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The goal of this research study was to adjudicate if implementing Howard Gardner’s multiple levels of intelligence would enhance student achievement levels in an Algebra 1 College Preparatory class. This was conducted within every class by incorporating one level of the eight levels of intelligence into small group work in stations. Every class was conducted utilizing small-group instruction. Achievement levels were measured through various forms of collected data that expressed student understandings in class through formative assessments versus student understandings on summative assessments. The data samples included: assessments (i.e. summative and formative assessments), observable data, video recordings, a daily log book, student surveys, and checklists kept during the observation periods. Formative assessments were analyzed during each class period to measure in-class understanding. Summative assessments were dissected per question per accuracy to review the effects of each intelligence implemented. The data was collated into a coding workbook for further analysis to conclude the resulting themes of the research. These themes include 1) there was no correlation to multiple levels of intelligence enhancing student achievement, 2) bodily-kinesthetic intelligence showed to be the intelligence that had the most improvement on test questions and 3) out of all of the bits of intelligence, interpersonal intelligence enhanced student understanding in class.

Keywords: stations, small group instruction, multiple levels of intelligence, Mathematics, Algebra 1, student achievement, secondary school, instructional Pedagogies

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Authors: Roy B. Clariana, Ryan L. Solnosky

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Structural feedback is any form of feedback that aims to improve the quality of students’ domain-normative conceptual interrelationships. Research with structural feedback points to the potential mediating role of network graphs as feedback for tuning students’ conceptual understanding; for example, improved content knowledge and motivation were observed for undergraduate students who accessed the instructor’s networks of course content. This exploratory study uses a one-group pretest-posttest design to examine the effects of instructor-provided network feedback during lectures on students’ knowledge structure measured using a concept sorting task at the pretest and posttest. Undergraduate students in an architectural engineering course (n = 32) completed a lesson module and then an end-of-unit quiz on building with wood and wood framing. Three weeks later, as a review, students completed a sorting task that used 26 terms from that lesson, then a week later, the sorting task data were used to create a group-average network, this network along with the instructor’s expert network were added to that week’s lecture slides and were compared and discussed during class time. A week later, students completed the sorting task again. The pre and post-sorting data were rendered into pathfinder networks, and then these students’ networks were compared to five referent networks, specifically the textbook chapter network, the lecture slides network, a network of the end-of-unit quiz, the actual expert network that served as the feedback intervention, and the group-average network. Inspection of means shows that knowledge structure measures improved for all five measures from pre-to-post, becoming more like the lesson content and like the expert. Repeated measures analysis with follow-up paired samples t-tests showed pre-to-post significant increases for both the end-of-unit quiz and the expert network referents. The findings show that instructor presentation of structural feedback as networks improved or ‘tuned’ students’ knowledge structure of the lesson content. This approach only takes a few extra minutes of class time and is fairly simple to implement in ordinary classrooms, and so it has wide potential to support classroom instruction and student learning. Further research is needed to determine how critical it is to present both the group-average network along with the expert network for comparison in order to highlight group-level misconceptions, or is presenting only the expert network sufficient? If a group-level network is necessary, then a simple clicker-like classroom tool could be developed to collect sorting task data during lectures that could then immediately provide the group-average network for class discussion and reflection.

Keywords: classroom instruction, engineering education, knowledge structure, pathfinder networks, structural feedback

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Authors: Benyamina Imane, Benalioua Bahia, Mansour Meriem, Bentouami Abdelhadi

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The objective of this study is to use a synthetic route of the layered double hydroxide as a method of zinc oxide by doping a transition metal. The material is heat-treated at different temperatures then tested on the photo-fading of an acid dye indigo carmine under visible radiation compared with ZnO. The photo catalytic efficiency of Bi-ZnO in a visible light of 500 W was tested on photo-bleaching of an indigoid dye in comparison with the commercial ZnO. Indeed, a complete discoloration of indigo carmine solution of 16 mg / L was obtained after 40 and 120 minutes of irradiation in the presence of ZnO and ZnO-Bi respectively.

Keywords: LDH, POA, photo-catalysis, Bi-ZnO doping

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Authors: Chung-Yuan Wang, Kai-Chun Lee, Min-Hung Wang, Yu-Ren Chen, Hung-Sheng Lin, Sen-Shan Fan

Abstract:

Taiwan National Health Insurance (NHI) was launched in 1995. It is an important social welfare policy in Taiwan. Regardless of the diversified social and economic status, universal coverage of NHI was assured. In order to regain better self-care performance, stroke people received in-patient and out-patient rehabilitation. Though NHI limited the rehabilitation frequency to one per day, the cost of rehabilitation still increased rapidly. Through the intensive rehabilitation during the post-stroke rehabilitation golden period, stroke patients might decrease their disability and shorten the rehabilitation period. Therefore, the aim of this study was to investigate the effect of intensive post-acute stroke rehabilitation in hospital under per diem payment. This study was started from 2014/03/01. The stroke patients who were admitted to our hospital or medical center were indicated to the study. The neurologists would check his modified Rankin Scale (mRS). Only patients with their mRS score between 2 and 4 were included to the study. Patients with unclear consciousness, unstable medical condition, unclear stroke onset date and no willing for 3 weeks in-patient intensive rehabilitation were excluded. After the physiatrist’s systemic evaluation, the subjects received intensive rehabilitation programs. The frequency of rehabilitation was thrice per day. Physical therapy, occupational therapy and speech/swallowing therapy were included in the programs for the needs of the stroke patients. Activity daily life performance (Barthel Index) and functional balance ability (Berg Balance Scale) were used to measure the training effect. During 3/1 to 5/31, thirteen subjects (five male and eight female) were included. Seven subjects were aged below 60. Three subjects were aged over 70. Most of the subjects (seven subjects) received intensive post-stroke rehabilitation for three weeks. Three subjects drop out from the programs and went back home respectively after receiving only 7, 10, and 13 days rehabilitation. Among these 13 subjects, nine of them got improvement in activity daily life performance (Barthel Index score). Ten of them got improvement in functional balance ability (Berg Balance Scale). The intensive post-acute stroke rehabilitation did help stroke patients promote their health in our study. Not only their functional performance improved, but also their self-confidence improved. Furthermore, their family also got better health status. Stroke rehabilitation under per diem payment was noted in long-term care institution in developed countries. Over 95% populations in Taiwan were supported under the Taiwan's National Health Insurance system, but there was no national long-term care insurance system. Most of the stroke patients in Taiwan live with his family and continue their rehabilitation programs from out-patient department. This pilot study revealed the effect of intensive post-acute stroke rehabilitation in hospital under per diem payment. The number of the subjects and the study period were limited. Thus, further study will be needed.

Keywords: rehabilitation, post-acute stroke, per diem payment, NHI

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Authors: A. L. I. Prasanna, E. Liyanage, S. A. Rajaratne, K. P. A. P. Kariyawasam, A. A. J. Rajaratne

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Maintaining or improving the muscle strength of the injured body part is essential to optimize performance among disabled athletes. General conditioning and strengthening exercises might be ineffective if not sufficiently intense enough or targeted for each participant’s specific impairment. Specific strengthening programme, targeted to the affected body part, are essential to improve the strength of impaired muscles and increase in strength will help reducing the impact of disability. Methods: The muscle strength of hip, knee and ankle joints was assessed in a group of randomly selected disabled athletes, using the Medical Research Council (MRC) grading. Those having muscle strength of grade 4 or less were selected for this study (24 in number) and were given and a custom made exercise program designed to strengthen their hip, knee or ankle joint musculature, according to the muscle or group of muscles affected. Effectiveness of the strengthening program was assessed after a period of 3 months. Results: Statistical analysis was done using the Minitab 16 statistical software. A Mann-Whitney U test was used to compare the strength of muscle group before and after exercise programme. A significant difference was observed after the three month strengthening program for knee flexors (Left and Right) (P =0.0889, 0.0312) hip flexors (left and right) (P=0.0312, 0.0466), hip extensors (Left and Right) (P=0.0478, 0.0513), ankle plantar flexors (Left and Right) (P=0.0466, 0.0423) and right ankle dorsiflexors (P= 0.0337). No significant difference of strength was observed after the strengthening program in the knee extensors (left and right), hip abductors (left and right) and left ankle dorsiflexors. Conclusion: Impairment specific exercise programme appear to be beneficial for disabled athletes to significantly improve the muscle strength of the affected joints.

Keywords: muscle strengthening programme, disabled athletes, physiotherapy, rehabilitation sciences

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Authors: S. Sakhri

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Background: The use of Zoledronic acid (ZA) is an established place in the treatment of malignant tumors with a predilection for the skeleton of interest (in particular metastasis). Although the main target of Zoledronic acid was osteoclasts, there are preclinical data suggest that Zoledronic acid may have an antitumor effect on cells other than osteoclasts, including tumor cells. Antitumor activity, including the inhibition of tumor cell growth and the induction of apoptosis of tumor cells, inhibition of tumor cell adhesion and invasion, and anti-angiogenic effects have been demonstrated. Methods. From (2012 to 2014), 438 patients were included respondents the inclusion criteria, respectively. This is a prospective study over a 4 year period. Of all patients (N=438), 432 received neoadjuvant chemotherapy with Zoledronic acid. The primary end point was the pathologic complete response in advancer breast cancer stage. The secondary end point is to evaluate Clinical response according to RECIST criteria; estimate the bone density before and at the end of chemotherapy in women with locally advanced breast cancer, Toxicity Evaluation and Overall survival using Kaplan-Meier and log test. Result: The Objective response rate was 97% after (C4) with 3% stabilizations and 99, 3% of which 0.7% C8 after stabilization. The clinical complete response was 28% after C4 respectively, and 46.8% after C8, the pathologic complete response rate was 40.13% according to the classification Sataloff. We observed that the pathologic complete response rate was the most raised in the group including Her2 (luminal Her2 and Her2) the lowest in the triple negative group as classified by Sataloff. We found that the pCR is significantly higher in the age group (35-50 years) with 53.17%. Those who have more than 50 years in 2nd place with 27.7% and the lower in young woman 35 years pCR was 19%, not statistically significant, -The pCR was also in favor of the menopausal group in 51, 4%, and 48, 55% for non-menopausal women. The average duration of overall survival was also significantly in the subgroup (Luminal -Her2, Her2) compared with triple negative. It is 47.18 months in the luminal group vs. 38.95 in the triple negative group. -Was observed in our study a difference in quality of life between (C1) was the admission of the patient, and after (C8), we found an increase in general signs and a deterioration in the psychological state C1, in contrast to the C8 these general signs and mental status improves, up to 12, and 24 months. Conclusion The results of this study suggest that the addition of ZA to néoadjuvant CT has potential anti-cancer benefit in patients (Luminal -Her2, Her2) compared with triple negative with or without menopause status.

Keywords: HER2+, RH+, breast cancer, tyrosine kinase

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Authors: María Magdalena Méndez-González, Miguel García Rocha, Carlos Manuel Yermo De la Cruz

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Calcium phosphate (Ca5(PO4)3(X)) is widely used in orthopedic applications and is widely used as powder and granules. However, their presence in bone is in the form of nanometric needles 60 nm in length with a non-stoichiometric phase of apatite contains CO3-2, Na+, OH-, F-, and other ions in a matrix of collagen fibers. The crystal size, morphology control and interaction with cells are essential for the development of nanotechnology. The structural results of calcium phosphate, synthesized by chemical precipitation with crystal size of 22.85 nm are presented in this paper. The calcium phosphate powders were analyzed by X-ray diffraction, energy dispersive spectroscopy (EDS), infrared spectroscopy and FT-IR transmission electron microscopy. Network parameters, atomic positions, the indexing of the planes and the calculation of FWHM (full width at half maximum) were obtained. The crystal size was also calculated using the Scherer equation d (hkl) = cλ/βcosѲ. Where c is a constant related to the shape of the crystal, the wavelength of the radiation used for a copper anode is 1.54060Å, Ѳ is the Bragg diffraction angle, and β is the width average peak height of greater intensity. Diffraction pattern corresponding to the calcium phosphate called hydroxyapatite phase of a hexagonal crystal system was obtained. It belongs to the space group P63m with lattice parameters a = 9.4394 Å and c = 6.8861 Å. The most intense peak is obtained 2Ѳ = 31.55 (FWHM = 0.4798), with a preferred orientation in 121. The intensity difference between the experimental data and the calculated values is attributable to the temperature at which the sintering was performed. The intensity of the highest peak is at angle 2Ѳ = 32.11. The structure of calcium phosphate obtained was a hexagonal configuration. The intensity changes in the peaks of the diffraction pattern, in the lattice parameters at the corners, indicating the possible presence of a dopant. That each calcium atom is surrounded by a tetrahedron of oxygen and hydrogen was observed by infrared spectra. The unit cell pattern corresponds to hydroxyapatite and transmission electron microscopic crystal morphology corresponding to the hexagonal phase with a preferential growth along the c-plane was obtained.

Keywords: structure, nanoparticles, calcium phosphate, metallurgical and materials engineering

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Authors: Mrinal Kanti Bhowmik, Shawli Bardhan Jr., Debotosh Bhattacharjee

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Human skin containing temperature value more than absolute zero, discharges infrared radiation related to the frequency of the body temperature. The difference in infrared radiation from the skin surface reflects the abnormality present in human body. Considering the difference, detection and forecasting the temperature variation of the skin surface is the main objective of using Medical Infrared Thermography(MIT) as a diagnostic tool for pain detection. Medical Infrared Thermography(MIT) is a non-invasive imaging technique that records and monitors the temperature flow in the body by receiving the infrared radiated from the skin and represent it through thermogram. The intensity of the thermogram measures the inflammation from the skin surface related to pain in human body. Analysis of thermograms provides automated anomaly detection associated with suspicious pain regions by following several image processing steps. The paper represents a rigorous study based survey related to the processing and analysis of thermograms based on the previous works published in the area of infrared thermal imaging for detecting inflammatory pain diseases like arthritis, spondylosis, shoulder impingement, etc. The study also explores the performance analysis of thermogram processing accompanied by thermogram acquisition protocols, thermography camera specification and the types of pain detected by thermography in summarized tabular format. The tabular format provides a clear structural vision of the past works. The major contribution of the paper introduces a new thermogram acquisition standard associated with inflammatory pain detection in human body to enhance the performance rate. The FLIR T650sc infrared camera with high sensitivity and resolution is adopted to increase the accuracy of thermogram acquisition and analysis. The survey of previous research work highlights that intensity distribution based comparison of comparable and symmetric region of interest and their statistical analysis assigns adequate result in case of identifying and detecting physiological disorder related to inflammatory diseases.

Keywords: acquisition protocol, inflammatory pain detection, medical infrared thermography (MIT), statistical analysis

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Authors: A. Lubis, S. S. Pasulu, Z. Hikmah, A. Endaryanto, A. Harsono

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Infection by group A streptococci (GAS) can trigger an autoantibody that cause a poststreptococcal reactive arthritis (PSRA). Four patients with PSRA aged 10 years to 14 years old with the main complaint of joint pain for five days to 10 days after suffering a fever and sore throat. The joint pain was persistent, additive, and non migratory. All patients revealed an increase in erythrocyte sedimentation rate (ESR) and anti-streptolysin O (ASLO), but the chest x-ray, electrocardiography, and echocardiography were normal. Bone imaging showed no destruction on the affected joint. Jones Criteria were not fulfilled in all patients. Erythromycin and ibuprofen were given in all patients and an improvement was shown. Erythromycin was continued for one year and routine controls were conducted for cardiac evaluation. The prognosis of all the patients was good.

Keywords: arthritis, group a streptococcus, autoantibody, Jones criteria

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Authors: Cristian Crespo

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Conditional cash transfers (CCTs) have been targeted towards the poor. Thus, their targeting assessments check whether these schemes have been allocated to low-income households or individuals. However, CCTs have more than one goal and target group. An additional goal of CCTs is to increase school enrolment. Hence, students at risk of dropping out of school also are a target group. This paper analyses whether one of the most common targeting mechanisms of CCTs, a proxy means test (PMT), is suitable to identify the poor and future school dropouts. The PMT is compared with alternative approaches that use the outputs of a predictive model of school dropout. This model was built using machine learning algorithms and rich administrative datasets from Chile. The paper shows that using machine learning outputs in conjunction with the PMT increases targeting effectiveness by identifying more students who are either poor or future dropouts. This joint targeting approach increases effectiveness in different scenarios except when the social valuation of the two target groups largely differs. In these cases, the most likely optimal approach is to solely adopt the targeting mechanism designed to find the highly valued group.

Keywords: conditional cash transfers, machine learning, poverty, proxy means tests, school dropout prediction, targeting

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Authors: G. Hubert, S. Aubry

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The earth is constantly bombarded by cosmic rays that can be of either galactic or solar origin. Thus, humans are exposed to high levels of galactic radiation due to altitude aircraft. The typical total ambient dose equivalent for a transatlantic flight is about 50 μSv during quiet solar activity. On the contrary, estimations differ by one order of magnitude for the contribution induced by certain solar particle events. Indeed, during Ground Level Enhancements (GLE) event, the Sun can emit particles of sufficient energy and intensity to raise radiation levels on Earth's surface. Analyses of GLE characteristics occurring since 1942 showed that for the worst of them, the dose level is of the order of 1 mSv and more. The largest of these events was observed on February 1956 for which the ambient dose equivalent rate is in the orders of 10 mSv/hr. The extra dose at aircraft altitudes for a flight during this event might have been about 20 mSv, i.e. comparable with the annual limit for aircrew. The most recent GLE, occurred on September 2017 resulting from an X-class solar flare, and it was measured on the surface of both the Earth and Mars using the Radiation Assessment Detector on the Mars Science Laboratory's Curiosity Rover. Recently, Hubert et al. proposed a GLE model included in a particle transport platform (named ATMORAD) describing the extensive air shower characteristics and allowing to assess the ambient dose equivalent. In this approach, the GCR is based on the Force-Field approximation model. The physical description of the Solar Cosmic Ray (i.e. SCR) considers the primary differential rigidity spectrum and the distribution of primary particles at the top of the atmosphere. ATMORAD allows to determine the spectral fluence rate of secondary particles induced by extensive showers, considering altitude range from ground to 45 km. Ambient dose equivalent can be determined using fluence-to-ambient dose equivalent conversion coefficients. The objective of this paper is to analyze the GCR and SCR impacts on ambient dose equivalent considering a high number statistic of world-flight paths. Flight trajectories are based on the Eurocontrol Demand Data Repository (DDR) and consider realistic flight plan with and without regulations or updated with Radar Data from CFMU (Central Flow Management Unit). The final paper will present exhaustive analyses implying solar impacts on ambient dose equivalent level and will propose detailed analyses considering route and airplane characteristics (departure, arrival, continent, airplane type etc.), and the phasing of the solar event. Preliminary results show an important impact of the flight path, particularly the latitude which drives the cutoff rigidity variations. Moreover, dose values vary drastically during GLE events, on the one hand with the route path (latitude, longitude altitude), on the other hand with the phasing of the solar event. Considering the GLE occurred on 23 February 1956, the average ambient dose equivalent evaluated for a flight Paris - New York is around 1.6 mSv, which is relevant to previous works This point highlights the importance of monitoring these solar events and of developing semi-empirical and particle transport method to obtain a reliable calculation of dose levels.

Keywords: cosmic ray, human dose, solar flare, aviation

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Authors: Zurina Khairuddin

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The objective of this study is to explore the identities constructed and negotiated by Malaysian students in the UK and Malaysia when they interact in seminars. The study utilised classroom observation, interview and focus group discussion to collect the data. The participants of this study are the first year Malaysian students studying in the UK and Malaysia. The data collected was analysed utilising a combination of Conversation Analysis and framework. This study postulates that Malaysian students in the UK construct and negotiate flexible and different identities depending on the contexts they were in. It also shows that most Malaysian students in the UK and Malaysia are similar in the identities they construct and negotiate. This study suggests implications and recommendations for Malaysian students in the UK and Malaysia, and other stakeholders such as UK and Malaysian academic community.

Keywords: conversation analysis, interaction patterns, Malaysian students, students' identity

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Authors: Agung Sugeng Widodo

Abstract:

Water boiling system (WBS) using conventional gas stove (CGS) is relatively inefficient unless its mechanism being considered. In this study, an addition of ceramic stove cover (CSC) to a CGS and the gap between CSC and pan have been assessed. Parameters as energy produced by fuel, CSC temperature and water temperature were used to analyze the performance of a CGS. The gaps were varied by 1 – 7 mm in a step of 1 mm. The results showed that a CSC able to increase the performance of a CGS significantly. In certain fuel rate of 0.75 l/m, the efficiency of a CGS obtained in a gap of 4 mm. The best efficiency obtained in this study was 46.4 % due to the optimum condition that achieved simultaneously in convection and radiation heat transfer processes of the heating system. CSC also indicated a good characteristic for covering heat release at the initially of WBS.

Keywords: WBS, CSC, CGS, efficiency, gap

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Authors: Peng Guo

Abstract:

Objective: This study investigates the clinical characteristics of sleep disorders (SD) in patients with Alzheimer's disease (AD) and their relationship with cognitive impairment. Methods: According to the inclusion and exclusion criteria of AD, 460 AD patients were consecutively included in Beijing Tiantan Hospital from January 2016 to April 2022. Demographic data, including gender, age, age of onset, course of disease, years of education and body mass index, were collected. The Pittsburgh sleep quality index (PSQI) scale was used to evaluate the overall sleep status. AD patients with PSQI ≥7 was divided into AD with SD (AD-SD) group, and those with PSQI < 7 were divided into AD with no SD (AD-nSD) group. The overall cognitive function of AD patients was evaluated by the scales of Mini-mental state examination (MMSE) and Montreal cognitive assessment (MoCA), memory was evaluated by the AVLT-immediate recall, AVLT-delayed recall and CFT-delayed memory scales, the language was evaluated by BNT scale, visuospatial ability was evaluated by CFT-imitation, executive function was evaluated by Stroop-A, Stroop-B and Stroop-C scales, attention was evaluated by TMT-A, TMT-B, and SDMT scales. The correlation between cognitive function and PSQI score in AD-SD group was analyzed. Results: Among the 460 AD patients, 173 cases (37.61%) had SD. There was no significant difference in gender, age, age of onset, course of disease, years of education and body mass index between AD-SD and AD-nSD groups (P>0.05). The factors with significant difference in PSQI scale between AD-SD and AD-nSD groups include sleep quality, sleep latency, sleep duration, sleep efficiency, sleep disturbance, use of sleeping medication and daytime dysfunction (P<0.05). Compared with AD-nSD group, the total scores of MMSE, MoCA, AVLT-immediate recall and CFT-imitation scales in AD-SD group were significantly lower（P＜0.01，P＜0.01，P＜0.01，P＜0.05）. In AD-SD group, subjective sleep quality was significantly and negatively correlated with the scores of MMSE, MoCA, AVLT-immediate recall and CFT-imitation scales (r=-0.277，P=0.000; r=-0.216，P=0.004; r=-0.253，P=0.001; r=-0.239, P=0.004), daytime dysfunction was significantly and negatively correlated with the score of AVLT-immediate recall scale (r=-0.160，P=0.043). Conclusion The incidence of AD-SD is 37.61%. AD-SD patients have worse subjective sleep quality, longer time to fall asleep, shorter sleep time, lower sleep efficiency, severer nighttime SD, more use of sleep medicine, and severer daytime dysfunction. The overall cognitive function, immediate recall and visuospatial ability of AD-SD patients are significantly impaired and are closely correlated with the decline of subjective sleep quality. The impairment of immediate recall is highly correlated with daytime dysfunction in AD-SD patients.

Keywords: Alzheimer's disease, sleep disorders, cognitive impairment, correlation

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