c.202_204del in NUP214 causes late onset form of febrile encephalopathy

Nucleoporins (NUPs) are a group of transporter proteins that maintain homeostasis of nucleocytoplasmic transport of proteins and ribonucleic acids under physiological conditions. Biallelic pathogenic variants in NUP214 are known to cause susceptibility to acute infection-induced encephalopathy-9 (IIAE9, MIM#618426), which is characterized by severe and early-onset febrile encephalopathy causing neuroregression, developmental delay, microcephaly, epilepsy, ataxia, brain atrophy, and early death. NUP214-related IIAE9 has been reported in eight individuals from four distinct families till date. We identified a novel in-frame deletion, c.202_204del p.(Leu68del), in NUP214 by exome sequencing in a 20-year-old male with episodic ataxia, seizures, and encephalopathy, precipitated by febrile illness. Neuroimaging revealed progressive cerebellar atrophy. In silico predictions show a change in the protein conformation that may alter the downstream protein interactions with the NUP214 N-terminal region, probably impacting the mRNA export. We report this novel deletion in NUP214 as a cause for a late onset and less severe form of IIAE9.

Machine Learning Techniques for the Diagnosis of Attention-Deficit/Hyperactivity Disorder from Magnetic Resonance Imaging: A Concise Review

Background

Attention-deficit/hyperactivity disorder (ADHD) is a neuro-developmental disease commonly seen in children and it is diagnosed via extensive interview procedures, behavioral studies, third-party observations, and comprehensive personal history. ADHD causes regional atrophy in brain regions and alters the pattern of functional brain connectivity networks. Automated/computerized methods based on magnetic resonance imaging (MRI) can replace subjective methods for the identification of ADHD.

Objectives

The aim of this study was to analyze various machine-learning algorithms for ADHD by feeding in vital input features extracted from functional brain connectivity and different existing methods and to review factors crucial for the diagnosis of ADHD.

Methods

This paper is a concise review of machine learning methods for the diagnosis of ADHD from MRI. Techniques for feature extraction, dimensionality reduction/feature selection, and classification, employed in the computerized techniques for the diagnosis of ADHD from MRI and the accuracy of classification offered by the individual methods, are focussed on the review.

Conclusions

Machine learning algorithms with features of functional brain connectivity networks as input, with hierarchical sparse feature elimination, exhibits the highest accuracy. Augmentation of the behavioral features does not contribute much to increased accuracy. The level of accuracy offered by the frameworks meant for the computer-aided diagnosis of ADHD, available in the literature, does not justify their feasibility in clinical practice. Computerized methods that exploit highly specific biomarkers of ADHD like brain iron concentration in Globus Pallidus, Putamen, Caudate nucleus, and thalamus as features are not available.

Biomechanical Properties of the Foot Sole in Diabetic Mellitus Patients

This aricle evaluates and quantifies the biomechanical properties of the foot sole like – loss of protective sensation, hardness of the foot sole and pressure distribution parameter called Power ratio (PR) and its alterations, which have a direct effect on ulcer formation. A new parameter PRS Index is developed to understand the interplay between these parameters and its role in ulcer formation. All diabetic subjects attending the Diabetic foot clinic from Dec2003 to June 2007 undergo a standard foot examination.A total of 652 diabetic patients including 57 ulcer patients are taken for our study. The biomechanical properties include loss of protective sensation (LOPS) which is measured by 10 gm Semmes Weinstein Monofilament (SWMF). Hardness of the foot sole or absence of suppleness is tested using the Durometer (ASTM-D 2240 standards). Plantar pressure measurement is done using the PedoPowerGraph(p) which measures pressure distribution parameter PR. Foot wear properties like hardness of the insole affecting the formation of plantar ulcers was also measured. The above mentioned important parameters can be measured objectively and calculate PRS index value for diabetic with history of previous ulcer patients. We found a single entity of either the PR or shore independently cannot predict the risk for ulcer formation.In this study we found newPRS index value for diabetic with history of previous ulcer patients show significant correlation (i.e. p<0.05 level) between footwear shore and PRS index for history of previous ulcer patients. No significant correlation was shown for diabetic without history of previous ulcer patients and this may be due to diabetic patients are wearing footwear randomly with different degree Shore. From the case studies we found that the PRS index values and other biomechanical parameter of the foot sole can be reversed if the patients wear proper MCR footwear with 20 degree Shore. Use of appropriate footwear has shown that these easily measurable parameters and thus prevent ulcer formation as mentioned in the earlier studies. Several methods are used previously for predicting ulceration in DM patients. But in this study the new index PRS was studied and its role in predicting ulceration. Use of appropriate footwear will reverse the hypertrophic response; this can be quantified by the PRS index. We have found that there is decrease in PRS index by proper off loading the pressure using 20-degree shore MCR footwear.

The effect of foot arch on plantar pressure distribution during standing

The aim of this study was to explore how foot type affects plantar pressure distribution during standing. In this study, 32 healthy subjects voluntarily participated and the subject feet were classified as: normal feet (n = 23), flat feet (n = 14) and high arch feet (n = 27) according to arch index (AI) values obtained from foot pressure intensity image analysis. Foot pressure intensity images were acquired by a pedopowergraph system to obtain a foot pressure distribution parameter-power ratio (PR) during standing in eight different regions of the foot. Contact area and mean PR were analysed in hind foot, mid-foot and fore foot regions. One-way analysis of variance was used to determine statistical differences between groups. The contact area and mean PR value beneath the mid-foot was significantly increased in the low arch foot when compared to the normal arch foot and high arch foot (p < 0.001) in both feet. However, subjects with low-arch feet had significantly higher body mass index (BMI) compared to subjects with high-arch feet (p < 0.05) and subjects with normal arch feet (p < 0.05) in both feet. In addition, subjects with low-arch feet had significant differences in arch index (AI) value as compared to subjects with high-arch feet (p < 0.001) and subjects with normal arch feet (p < 0.05) in both feet. Mean mid-foot PR value were positively (r = 0.54) correlated with increased arch index (AI) value. A significant (p < 0.05) change was obtained in PR value beneath the mid-foot of low arch feet when compared with other groups in both feet. The findings suggest that there is an increased mid-foot PR value in the low arch foot as compared to the normal arch foot and high arch foot during standing. Therefore, individuals with low arch feet could be at high risk for mid-foot collapse and Charcot foot problems, indicating that foot type should be assessed when determining an individual's risk for foot injury.

Prevalence of standing plantar pressure distribution variation in north Asian Indian patients with diabetes mellitus: a study to understand ulcer formation

Diabetes Mellitus is a disorder of metabolism. Foot problems are common in diabetes and altered plantar pressures distribution may lead to ulceration in people with Diabetes Mellitus. Therefore the aim of this study was to investigate standing plantar pressure distribution variations in north Asian Indian diabetes mellitus subjects and its association with duration of diabetes. Thirty three subjects with age range from 40 to 75 years are recruited from AIIMS Endocrinology & metabolism lab Delhi, India and divided into three groups: 11 control subjects (non-diabetic), 11 diabetic subjects without neuropathy (DNN) and II diabetic subjects with neuropathy (DN). Neuropathy status was assessed by measuring loss of protective sensation to 10 gm Semen's Weinstein monofilament. Plantar pressure distributions parameter-Power ratio (PR) was measured during barefoot standing using portable PedoPowerGraph and results are analyzed using one way analysis of variance to detect significant difference between the groups. We found significant (p < 0.05; p < 0.01) difference in PR value between DN and CG groups in fore foot and hind foot but no significant (p > 0.05) difference in PR value was found between DNN and CG groups in the foot. As compared to DNN, DN group have maximum PR variations in the fore foot. Plantar pressure distribution parameter-PR was higher with longer duration of diabetes among type 2 diabetes subjects. In this study we conclude that plantar pressure distribution parameter-PR was able to distinguish the DN groups from the CG group in hind and fore foot during standing. Increased forefoot PR value is prevalent in the diabetic neuropathic subjects and may be responsible for the occurrence of foot sole ulcers but additional prospective studies are needed. In the future we will investigate the plantar pressure distribution parameter-PR variations in diabetes with obese and osteoarthritis subject.

Foot pressure distribution variation in pre-obese and non-obese adult subject while standing

BACKGROUND

To investigate foot pressure distribution parameter-power ratio (PR) difference between pre-obese and non-obese adults subjects during standing and show the correlation between body mass index (BMI) and PR value.

METHODS

We examined 22 healthy adult subjects aged from 20 to 45 years were classified into two groups according to their BMI values, as 11 non-obese and 11 pre-obese subjects. Foot pressure distribution image during standing was obtained using PedoPowerGraph system. Pedopowergraphic parameters such as percentage medial impulse, forefoot to hind foot pressure distribution ratio and PR were evaluated and compared between the groups. Correlation between BMI value and PR value was assessed.

RESULTS

Our result shows significant change in contact area between the groups in mid foot regions. Also we found significant differences in mid foot PR values (p<0.05) between the groups, but no significant differences in hind foot and forefoot PR values. In addition BMI value was found to have positive correlation with right and left mid foot PR value (r=0.60 & 0.61) for all the subjects.

CONCLUSION

This study provides for the first time new insights into foot pressure distribution difference in mid foot among pre-obese subjects as compared to non-obese adult subject while standing. Hence knowledge of high mid foot PR value among pre-obese subjects can provide suitable guidelines for designing orthotic devices.

Association of limited joint mobility and increased plantar hardness in diabetic foot ulceration in north Asian Indian: a preliminary study

The aim of this article is to investigate the association of limited joint mobility and foot sole hardness in north Asian Indian type 2 diabetic patients. Limited joint mobility and hardness of the foot sole were measured for 39 subjects attending the AIIMS Endocrinology & Metabolism Clinic. The total subject divided into three groups: 13 control subjects (nondiabetic), 13 diabetic patients without neuropathy and 13 diabetic neuropathy patients. Neuropathy status was assessed using 10 gm Semen's Weinstein monofilament. Joint mobility parameters, such as ankle dorsiflexion/plantar flexion and metatarsophalangeal-1 dorsiflexion/plantar flexion, are measured using a goniometer. Foot sole hardness was measured using a durometer or shore meter. We found that diabetic patients with a neuropathic foot had significantly reduced joint mobility and increased foot sole hardness, placing them at risk for subsequent ulceration. Metatarsophalangeal-1 dorsiflexion/plantar flexion of both feet of diabetic patients had significant correlation (at p < 0.05, p < 0.001, p < 0.001 level) over age and body mass index. Also ankle plantar flexion/dorsiflexion and metatarsophalangeal-1 dorsiflexion/plantar flexion has a significant correlations (at p < 0.01, p < 0.05, p < 0.001, p < 0.001 level) with foot sole hardness in both feet of diabetic neuropathy subjects. Also linear regression analysis showed that duration of diabetes was significantly associated with the joint mobility parameters. In this study we conclude that joint mobility had reduced further if neuropathy and increased foot sole hardness coexisted owing to high plantar pressures. Hence, both limited joint mobility and increased foot sole hardness appears to be important determinants of foot sole ulceration in diabetic neuropathic subject.

The effect of aging on the hardness of foot sole skin: a preliminary study

BACKGROUND

Foot problems are common in older people and altered biomechanical parameters under the foot sole has been proposed as a key risk factor for foot lesions. Therefore the aim of this study was to investigate the age-related differences in the hardness of foot sole skin.

METHODS

Twenty-six healthy volunteers without foot problems, aged from 26 to 65 years, were examined using shore meter. The hardness of the foot sole under the big toe (area 8), 1st metatarsal head (area 5), 3rd metatarsal head (area 6), 5th metatarsal head (area 7), mid foot (area 3, 4) and hind foot (area 1, 2) were measured. The correlation between age and hardness of foot sole was examined and comparisons were made between two age groups.

RESULTS

From the result we observe statistical significant (p<0.05; p<0.01; p<0.005) differences in hardness between age groups in hind foot, metatarsal heads (1st, 3rd & 5th) and big toe. Strong positive correlations between age and hardness of the foot sole were found at the big toe (r=0.57; p<0.005), 1st metatarsal head (r=0.567; p<0.00001), 3rd metatarsal head (r=0.565; p<0.00001), 5th metatarsal head (r=0.55; p<0.00001), and heel (r=0.59; p<0.0001).

CONCLUSION

The loss of compliance in the foot sole may be one of the factors responsible for the higher incidence of foot problems in aged people. Routine foot examination and appropriate therapeutic intervention including the use of foot orthoses and optimal hardness of foot wear insole may help to prevent the serious foot injuries.

Preliminary investigation of foot pressure distribution variation in men and women adults while standing

BACKGROUND

Women and men are anatomically and physiologically different in a number of ways. They differ in both shape and size. These differences could potentially mean foot pressure distribution variation in men and women. The purpose of this study was to analyze standing foot pressure image to obtain the foot pressure distribution parameter - power ratio variation between men and women using image processing in frequency domain.

METHODS

We examined 28 healthy adult subjects (14 men and 14 women) aged between 20 and 45 years was recruited for our study. Foot pressure distribution patterns while standing are obtained by using a PedoPowerGraph plantar pressure measurement system for foot image formation, a digital camera for image capturing, a TV tuner PC-add on card, a WinDvr software for still capture and Matlab software with dedicated image processing algorithms have been developed. Various PedoPowerGraphic parameters such as percentage medial impulse (PMI), fore foot to hind foot pressure distribution ratio (F/H), big toe to fore foot pressure distribution ratio (B/F) and power ratio (PR) were evaluated.

RESULTS

In men, contact area was significantly larger in all regions of the foot compared with women. There were significant differences in plantar pressure distribution but there was no significant difference in F/H and B/F ratio. Mean PR value was significantly greater in men than women under the hind foot and fore foot. PMI value was greater in women than men. As compared to men, women have maximum PR variations in the mid foot. Hence there is significant difference at level p<0.05 in medial mid foot and mid foot PR of women as compared to men.

CONCLUSION

There was variation in plantar pressure distribution because the contact area of the men foot was larger than that of women foot. Hence knowledge of pressure distributions variation of both feet can provide suitable guidelines to biomedical engineers and doctor for designing orthotic devices for reliving the area of excessively high pressure.

Correlation between two-point discrimination with other measures of sensory loss in diabetes mellitus patients

Diabetic neuropathy is one of the most important factors for foot ulceration in diabetes mellitus (DM) patients. Among different sensibility measures of neuropathy, two-point discrimination (TPD) has been suggested as a reliable method; however, the correlation of TPD with other well-known measures is not known. We measured the loss of protective sensation using Semmes-Weinstein Monofilaments (SWMF), hardness of the foot sole using shore meter (sh), power ratio (PR) using pedopowergraph and TPD using esthesiometer in foot areas of both left and right legs in 14 DM subjects. We have found no correlation either between TPD and shore values (sh) or between TPD and PR. The SWMF (10 g) is found not to provide any additional value in measuring loss of sensation in comparison to TPD. The TPD appears to be measuring different property of the foot compared to other measures. The mechanism of this independence is not well understood and more investigation is required to understand the mechanism.

Vibration perception threshold and the law of mobility in diabetic mellitus patients

BACKGROUND

Diabetic neuropathy is a family of nerve disorders with progressive loss of nerve function in 15% of diabetes mellitus (DM) subjects. Vibration Perception Threshold (VPT) is one of the modalities of testing loss of protective sensation. Law of mobility for VPT is well known for normal subjects, but not for diabetic subjects. This is a pilot study to evaluate and plot the law of mobility for VPT among DM subjects.

METHODS

We used biothesiometer to find the VPT of several areas in upper and lower extremities for normal and diabetic subjects. VPT of normal and diabetic subjects for different foot areas from proximal to distal is evaluated for 30 subjects. All the subjects are screened for peripheral artery occlusive disease with ankle brachial pressure index (0.9 or above). VPT values of different areas are arranged in a proximal to distal order for the analysis.

RESULTS

VPT values monotonically decrease from proximal to distal areas. Vierodt's law of mobility holds well for normal subjects in both feet areas. The law of mobility does not hold good for the DM subjects in one or both feet areas.

CONCLUSIONS

The VPT value of diabetic subjects reveals that the law of mobility do not holds good for diabetic subjects in foot areas. Though the number of subjects is small, all the subjects defied the law.

Changes in two point discrimination and the law of mobility in diabetes mellitus patients

Background

Diabetic neuropathy is a family of nerve disorders with progressive loss of nerve function in 15% of diabetes mellitus (DM) subjects. Two-point discrimination (TPD) is one method of quantitatively testing for loss of nerve function. The law of mobility for TPD is known for normal subjects in earlier studies but has not been studied for diabetic subjects. This is a pilot study to evaluate and plot the law of mobility for TPD among DM subjects.

Methods

The Semmes Weinstein monofilament (SWMF) was used to measure the loss of protective sensation. An Aesthesiometer was used to find the TPD of several areas in upper and lower extremities for normal and diabetic subjects. All the subjects were screened for peripheral artery occlusive disease with ankle brachial pressure index (0.9 or above).

Results

TPD of normal and diabetic subjects for different areas of hands and legs from proximal to distal is evaluated for 18 subjects. TPD values decrease from proximal to distal areas. Vierodt's law of mobility for TPD holds good for normal subjects in the hand and foot areas. The law of mobility for TPD in DM subjects holds well in the hand but doesn't hold well in foot areas with or without sensation.

Conclusion

TPD is a quantitative and direct measure of sensory loss. The TPD value of diabetic subjects reveals that the law of mobility do not hold well for Diabetic subjects in foot areas. The significance of this result is that the TPD of the diabetic subjects could provide direct, cost effective and quantitative measure of neuropathy.