A Multi-modal Teacher-student Framework for Improved Blood Pressure Estimation.

Blood pressure (BP) is a critical vital sign that hypertensive patients regularly measure. In this study, we propose a novel BP estimation framework to distill the knowledge from a multi-modal model to a uni-modal BP estimation model through teacher-student training. The multi-modal BP estimation model consists of three components: first, a gated recurrent unit network that generates features from photoplethysmogram, electrocardiogram, age, height, and weight; second, an attention mechanism that integrates each feature into joint embeddings; and third, a regression layer that estimates BP from the joint embeddings. The uni-modal BP estimation model has similar components to the multi-modal model but uses only PPG signal. BP is predicted by the embeddings extracted from the uni-modal model, and these embeddings are trained to be as similar as possible to the joint embeddings extracted from the multi-modal model. The proposed method demonstrates absolute prediction errors of 5.24±6.41 and 3.49±3.85 mmHg for systolic blood pressure and diastolic blood pressure in the MIMIC-III dataset, satisfying the AAMI standard.

Deep-learning-based blood pressure estimation using multi channel photoplethysmogram and finger pressure with attention mechanism.

Recently, several studies have proposed methods for measuring cuffless blood pressure (BP) using finger photoplethysmogram (PPG) signals. This study presents a new BP estimation system that measures PPG signals under progressive finger pressure, making the system relatively robust to errors caused by finger position when using the cuffless oscillometric method. To reduce errors caused by finger position, we developed a sensor that can simultaneously measure multi-channel PPG and force signals in a wide field of view (FOV). We propose a deep-learning-based algorithm that can learn to focus on the optimal PPG channel from multi channel PPG using an attention mechanism. The errors (ME ± STD) of the proposed multi channel system were 0.43±9.35 mmHg and 0.21 ± 7.72 mmHg for SBP and DBP, respectively. Through extensive experiments, we found a significant performance difference depending on the location of the PPG measurement in the BP estimation system using finger pressure.

Thermotherapy as an alternative to exercise for metabolic health in obese postmenopausal women: focus on circulating irisin level.

Irisin is a myokine caused by exercise that improves insulin resistance and weight loss. However, under unfavorable conditions such as air pollution, and during the pandemic, outdoor activities are uncomfortable. Therefore, in this study, the effect of heat therapy (half bath 42 ± 0.5°C for 30 min) on irisin circulation levels as an exercise alternative for middle-aged obese women after menopause was investigated. Subjects were 33 women aged 49.54 ± 6.04 years, with parameters of height, 160.12 ± 4.33 cm, weight, 69.71 ± 7.52 kg, body surface area 1.73 ± 0.13 m2, body mass index, 27.19 ± 3.40 kg/m2. The results suggest that circulating irisin levels showed a significant increase after one-time thermotherapy (TH-1). However, the increase in circulating irisin levels after 15 treatments (TH-15, 5 days/week, 3 weeks) was significantly varied. The level of adiponectin, which increases fatty oxidation to reduce fatty deposition, increased significantly at TH-1, but further increased at TH-15, which was significantly different from the level of TH-1. In addition, the basic serum free fatty acid (FFA) level was significantly increased at TH-15 compared to TH-1. Significant differences were also found in the lipid profile (body mass index, waist circumference, and % body fat). Thermotherapy can significantly increase the tympanic temperature and induce changes in circulating irisin and adiponectin levels. Thus, it resulted in positive changes in FFA and lipid profiles. Therefore, repeated thermotherapy is effective in increasing circulating irisin levels in postmenopausal obese women.

The mitochondrial genome of Nigidius miwai Nagel (Coleoptera: Lucanidae), a carnivorous lucanid from South Korea.

The complete mitochondrial genome of carnivorous Nigidius miwai was analyzed prior to a study on evolution of carnivorous pathway within the family. This species' genome had a total length of 18,462 bp (GenBank accession number: OL597607), comprising 36 genes along with 13 protein-coding genes, 21 tRNA genes, two rRNA genes, and an A + T rich region. The nucleotide composition was 37.2% A, 33.8% T, 9.2% G, and 19.8% C (GC contents 29.0%). The phylogenetic tree indicated that N. miwai is a distinctive species within Nigidiini of Lucaninae.

Unilateral sudden sensorineural hearing loss with vertigo as a first symptom of bilateral internal auditory canal metastases: a case report.

There have been relatively few reports of bilateral internal auditory canal metastases of asymptomatic primary pulmonary adenocarcinoma presenting as unilateral sudden sensorineural hearing loss and vertigo. We report a case of a 60-year-old male patient who complained of sudden hearing loss in the right ear and vertigo. Upon a physical examination, no definite neurological signs or nystagmus were observed. Pure-tone audiometry showed deafness in the right ear at all frequencies and high-frequency sensorineural hearing loss in the left ear. The video head impulse test suggested bilateral vestibulopathy. Magnetic resonance imaging of the brain (with gadolinium contrast) revealed bilateral internal auditory canal enhancement and a variable-sized nodular and peripheral-enhancing lesion in the cerebrum and the right cerebellum. A computed tomographic and bronchoscopic biopsy identified asymptomatic primary pulmonary adenocarcinoma in the left upper lobe of the lungs. This is a rare report of bilateral internal auditory canal metastases in an asymptomatic patient with primary pulmonary adenocarcinoma who initially presented with symptoms of unilateral sudden sensorineural hearing loss with vertigo.

Pelletized adsorbent of alum sludge and bentonite for removal of arsenic.

Powder adsorbents show an excellent adsorption capacity for arsenic(As) due to the large specific surface area. However, the performance of powder adsorbents decreases significantly by channeling in the adsorption bed, and the powder is released from the bed. Pelletization of power adsorbent can solve the problems, and bentonite was proposed as a binder to improve the strength. The adsorption capacity and lifetime of pelletized adsorbent were evaluated through a batch and column study. The addition of bentonite decreased adsorption capacity by 16% of pellet without bentonite, but improved compressive strength of adsorbent up to 3.6 times. In the batch test, the maximum adsorption capacity of pelletized adsorbent is 22.2 mg As/g, which is about 40% of powder adsorbent. However, in the column study, pellet adsorbent showed similar adsorption performance and lifetime to commercial and powder adsorbent. As a result, the pellet adsorbent using bentonite is a potential low-cost adsorbent to remove effectively As in the aqueous phase.

Dual radicals-enhanced wet chemical oxidation of non-biodegradable chemicals.

Total organic carbon (TOC) has been suggested and utilized as an index of organic matter in aqueous phases. The overall performance of TOC is highly dependent on the method of oxidation of organic matter to carbon dioxide, such as high-temperature combustion (HTC) and wet chemical oxidation (WCO). HTC requires more energy and maintenance cost, it is a major barrier to the field application. In contrast, WCO is more suitable for the application of on-line monitoring systems due to requiring lower energy and easy maintenance. However, WCO shows lower oxidation than HTC, thus, oxidation performance should be improved for the application to the field. In this study, a dual radical system (DRS), including sulfate and hydroxyl radicals, was proposed to enhance oxidation ability. The DRS uses alkaline pH and persulfate to generate sulfate radicals, which have been used to activate hydroxyl radicals and oxidize organic matter. The oxidation mechanism for the DRS has been verified using model chemicals with different reaction rate constants. The applicability of the DRS has been confirmed using authentic wastewater with a high concentration of chloride. In this study, the DRS showed similar performance compared to the HTC within 10 % error range. The DRS shows similar oxidation performance with HTC even at a high concentration of chloride. DRS did not show interference by the presence of chloride up to 30,000 mg/L of chloride. Results of this study indicate that the DRS can enhance overall oxidation performance compared to the conventional WCO system.

Bifunctional iron-modified graphitic carbon nitride (g-C3N4) for simultaneous oxidation and adsorption of arsenic.

Iron-modified graphitic carbon nitride (FG materials) was prepared through a simple and cost-effective method using iron oxide and melamine to achieve simultaneous oxidation and adsorption of arsenic. We hypothesized that graphitic carbon nitride oxidizes As(III) to As(V) under light irradiation, and the converted As(V) is adsorbed by the amorphous iron phase on FG materials. FG materials were characterized by X-ray diffraction, Fourier transform infrared spectra, field-emission scanning electron microscopy, specific surface area, ultraviolet-visible light spectroscopy, photoluminescence, and X-ray photoelectron spectroscopy. As(III) was efficiently transformed to As(V) due to the photocatalytic-oxidation ability of graphic carbon nitride under visible and UV light irradiation, the oxidized As(V) was adsorbed by the amorphous iron phases, and As species were removed from the system. The removal efficiency of As(III) decreased from 50%, 41%, and 33% under UV light, visible light and dark, respectively. FG materials exhibited the photocatalytic-oxidation ability and adsorption capacity, and a synergistic effect was observed between graphitic carbon nitride and iron oxide. Removal of As can be achieved even under visible light, confirming the field applicability of low-cost FG materials.

Umbilicated Hairy Auricular Mass Mimicking Accessory Tragus.

Trichofolliculoma (TF) is a follicular hamartoma in which hairs protruding out of single orifice. To the best of my knowledge, only two auricular TF has been reported in the English literature. Moreover, clinically TF have been described to mimic malignancy. I present a case of an adult female with mass at the intertragal notch of the left auricle for several years. The clinical diagnosis was thought to be epidermoid cyst, accessory tragus, and other benign skin adnexal tumor. To prevent recurrence, the wide local excision of the mass was performed. The final diagnosis of TF was made. No recurrence was noted during the follow-up of 1 year. It is important for otologists to be familiar with the clinical and pathologic characterization of TF, to make the correct diagnosis.

Smooth Auricular Cutaneous Granular Cell Tumor Mimics Epidermoid Cyst.

Granular cell tumor (GCT) is a rare, benign neoplasm of Schwann cell origin. GCT is composed of cells with eosinophilic granular cytoplasm. GCT presents as a solitary painless nodule. Because of their subtle clinical presentation, GCTs are often misdiagnosed. This report of a 47-year-old woman with an auricular GCT serves to highlight that complete excision and histopathological evaluation should be attempted even in apparently benign cases, to ensure complete cure.

Helical Rim Advancement Flap with an Additional Postauricular Skin Flap: A Case Report.

The auricle is a three-dimensional cartilaginous frame covered with thin overlying skin. Due to its complex features, reconstructing helical rim defects after the excision of an auricular mass is challenging. Shortage of subcutaneous tissue and the presence of a tightly bound epithelium further hamper the primary closure of lateral (anterior) auricular skin defects. We present herein a case in which we used a helical rim advancement flap along with an additional postauricular skin flap. We achieved a satisfactory esthetic result with minimal loss of helical diameter and a low risk of flap necrosis by preserving the vascular network of the flap. This technique is less traumatic and will facilitate faster healing as well as improved patient recovery.

Photo-induced redox coupling of dissolved organic matter and iron in biochars and soil system: Enhanced mobility of arsenic.

Dissolved organic matter (DOM) elucidated from biochars enhances the dissolution of iron oxides and reduction of iron. However, given that reduction mechanism of iron (Fe(III)) in the practical biochar applications for soil amendment and environmental remediation have not been fully elucidated, this study laid great emphasis on the photo-induced Fe(II) liberated from DOM-Fe(III) complexes. Thus, pyrolysis of biomass was carried out at 300 °C to maximize DOM release from biochars. Moreover, three different biomass samples (rice straw (R), granular sludge (G) from an anaerobic digester, and spent coffee grounds (C)) were chosen as carbon substrates for biochars preparation. To demonstrate the transformation of Fe(III), 1 and 5 wt% biochar was applied to the clean (S1) and arsenic-contaminated (S2) soil with/without the light. The results indicate that the light condition produces more Fe(II). The amount of Fe(II) accounts for 25.3, 28.6, and 30.7% of total iron under the light with 5 wt% GB, RB, and CB in S1, and 10.6, 13.1, and 13.8% in S2. This study demonstrates that Fe(II) is generated more under ultraviolet irradiation than visible light and dark condition. In addition, a control experiment without biochar showed that DOM plays an important role in the reduction of Fe(III). The mobility of arsenic increased under the light condition since the intermediates of DOM photo-degradation accelerates the dissolution of iron oxides and arsenic competes with DOM for the adsorption. Therefore, there was no significant correlation between the elution of arsenic and the formation of Fe(II) during the reductive dissolution of iron oxide under the light condition.

Necroptosis and Apoptosis Contribute to Cisplatin and Aminoglycoside Ototoxicity.

Ototoxic side effects of cisplatin and aminoglycosides have been extensively studied, but no therapy is available to date. Sensory hair cells, upon exposure to cisplatin or aminoglycosides, undergo apoptotic and necrotic cell death. Blocking these cell death pathways has therapeutic potential in theory, but incomplete protection and lack of therapeutic targets in the case of necrosis, has hampered the development of clinically applicable drugs. Over the past decade, a novel form of necrosis, termed necroptosis, was established as an alternative cell death pathway. Necroptosis is distinguished from passive necrotic cell death, in that it follows a cellular program, involving the receptor-interacting protein kinase (RIPK) 1 and RIPK3. In this study, we used pharmacological and genetic interventions in the mouse to test the relative contributions of necroptosis and caspase-8-mediated apoptosis toward cisplatin and aminoglycoside ototoxicity. We find that ex vivo, only apoptosis contributes to cisplatin and aminoglycoside ototoxicity, while in vivo, necroptosis as well as apoptosis are involved in both sexes. Inhibition of necroptosis and apoptosis using pharmacological compounds is thus a viable strategy to ameliorate aminoglycoside and cisplatin ototoxicity.SIGNIFICANCE STATEMENT The clinical application of cisplatin and aminoglycosides is limited due to ototoxic side effects. Here, using pharmaceutical and genetic intervention, we present evidence that two types of programmed cell death, apoptosis and necroptosis, contribute to aminoglycoside and cisplatin ototoxicity. Key molecular factors mediating necroptosis are well characterized and druggable, presenting new avenues for pharmaceutical intervention.

Cochlear Fistula in Chronic Otitis Media without Cholesteatoma.

Cochlear fistula in the chronic otitis media (COM) without cholesteatoma is an extremely rare with only a few cases reported in the literature to this date. We describe a case of cochlear fistula observed in a female with COM without cholesteatoma. This report presents the first clinical case of a transtympanic iatrogenic trauma by habitual cotton swabs probably causing cochlear fistula.

An introduction to the septal extension graft.

The septal extension graft is a very useful method of controlling nasal lengthening and tip projection, rotation, and shape by fixing a graft to the septum, which leads to a strong supporting structure. Enhancing graft stability is important for better long-term outcomes and minimizing complications or relapse, and even more efficient application of these methods is needed for East Asians who lack enough cartilage to be harvested in addition to possessing a weak cartilage framework. In this paper, the methods for overcoming the drawbacks of the septal extension graft, such as instability, a fixed tip, and insufficiency of cartilage, are presented, and the applications of each method for greater satisfaction with surgical outcomes are also discussed.

Pharyngo-vertebral fistula secondary to cervical vertebral fracture in a patient with stab wound.

Pharyngo-vertebral fistula (PVF) associated with cervical (C) spinal fracture is an extremely rare event that may lead to life-threatening infectious complications if not recognized promptly. Successful management of PVF depends on the physicians' awareness of the causes, prompt recognition of the symptoms and clinical findings, and immediate institution of treatment. I report a case of PVF after C3 vertebral body fracture that was initially neglected and subsequently developed into osteomyelitis involving adjacent vertebrae. On computed tomography and magnetic resonance imaging showed a PVF. Despite conservative care, spontaneous closure of the fistula was not achieved. Removal of PVF and surrounding granulation was achieved without any complication. To the best of my knowledge, PVF as a complication of C spine fracture has not hitherto been reported in the English literature.