Automated Fractional Limb Volume Measurements Improve the Precision of Birth Weight Predictions in Late Third-Trimester Fetuses.

OBJECTIVES: Fetal soft tissue can be assessed by using fractional limb volume as a proxy for in utero nutritional status. We investigated automated fractional limb volume for rapid estimate fetal weight assessment. METHODS: Pregnant women were prospectively scanned for 2- and 3-dimensional fetal biometric measurements within 4 days of delivery. Performance of birth weight prediction models was compared: (1) Hadlock (Am J Obstet Gynecol 1985; 151:333-337; biparietal diameter, abdominal circumference, and femur diaphysis length); and (2) Lee (Ultrasound Obstet Gynecol 2009; 34:556-565; biparietal diameter, abdominal circumference, and automated fractional limb volume). Percent differences were calculated: [(estimated birth weight - actual birth weight) ÷ (actual birth weight] × 100. Systematic errors (accuracy) were summarized as signed mean percent differences. Random errors (precision) were calculated as ± 1 SD of percent differences. RESULTS: Fifty neonates were delivered at 39.4 weeks' gestation. The Hadlock model generated the most accurate birth weight (0.31%) with a mean random error of ±7.9%. Despite systematic underestimations, the most precise results occurred with fractional arm volume (-9.1% ± 5.1%) and fractional thigh (-5.2% ± 5.2%) models. The size and distribution of these prediction errors were improved after correction for systematic errors. CONCLUSIONS: Automated fractional limb volume measurements can improve the precision of weight predictions in third-trimester fetuses. Correction factors may be necessary to adjust underestimated systematic errors when using automated fractional limb volume with prediction models that are based on manual tracing of fetal limb soft tissue borders.

A Novel Semiautomated Fractional Limb Volume Tool for Rapid and Reproducible Fetal Soft Tissue Assessment.

The purpose of this study was to document the reproducibility and efficiency of a semiautomated image analysis tool that rapidly provides fetal fractional limb volume measurements. Fifty pregnant women underwent 3-dimensional sonographic examinations for fractional arm and thigh volumes at a mean menstrual age of 31.3 weeks. Manual and semiautomated fractional limb volume measurements were calculated, with the semiautomated measurements calculated by novel software (5D Limb Vol; Samsung Medison, Seoul, Korea). The software applies an image transformation method based on the major axis length, minor axis length, and limb center coordinates. A transformed image is used to perform a global optimization technique for determination of an optimal limb soft tissue boundary. Bland-Altman analysis defined bias with 95% limits of agreement (LOA) between methods, and timing differences between manual versus automated methods were compared by a paired t test. Bland-Altman analysis indicated an acceptable bias with 95% LOA between the manual and semiautomated methods: mean arm volume ± SD, 1.7% ± 4.6% (95% LOA, -7.3% to 10.7%); and mean thigh volume, 0.0% ± 3.8% (95% LOA, -7.5% to 7.5%). The computer-assisted software completed measurements about 5 times faster compared to manual tracings. In conclusion, semiautomated fractional limb volume measurements are significantly faster to calculate when compared to a manual procedure. These results are reproducible and are likely to reduce operator dependency. The addition of computer-assisted fractional limb volume to standard biometry may improve the precision of estimated fetal weight by adding a soft tissue component to the weight estimation process.

Therapeutic effects of a novel synthetic α-secretase.

Excessive accumulation of amyloid-ß (Aß) has been associated with the pathogenesis of Alzheimer's disease (AD). Clinical studies have further proven that elimination of Aß can be a viable therapeutic option. In the current study, we conceptualized a fusion membrane protein, referred to as synthetic α-secretase (SAS), that can cleave amyloid precursor protein (APP) and Aß specifically at the α-site. In mammalian cells, SAS indeed cleaved APP and Aß at the α-site. Overexpression of SAS in the hippocampus was achieved by direct injection of recombinant adeno-associated virus serotype 9 (AAV9) that expresses SAS (AAV9-SAS) into the bilateral ventricles of mouse brains. SAS enhanced the non-amyloidogenic processing of APP, thus reducing the levels of soluble Aß and plaques in the 5xFAD mice. In addition, SAS significantly attenuated the cognitive deficits in 5xFAD mice, as demonstrated by novel object recognition and Morris water maze tests. Unlike other Aß-cleaving proteases, SAS has highly strict substrate specificity. We propose that SAS can be an efficient modality to eliminate excessive Aß from diseased brains.

Arthroscopic excision of a symptomatic os trigonum in a lateral decubitus position.

BACKGROUND: The purpose of this study was to introduce our technique of arthroscopic excision of the os trigonum in the lateral decubitus position through anterolateral, centrolateral, and posterolateral portals and also to investigate the safety and clinical results of this technique. METHODS: Between May 2007 and May 2011, 23 ankles of 23 consecutive patients underwent subtalar arthroscopic removal of the os trigonum in a lateral decubitus position. Twenty patients were male and 3 were female. All patients injured their ankles during sports activities. Mean duration of postoperative follow-up was 18 months, and no patients were lost to follow-up. Clinical evaluations were performed using the American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score and the visual analog scale (VAS) for pain. The time to return to work and sports activities was assessed. RESULTS: Average AOFAS ankle-hindfoot score increased from 71.3 (range, 59-85) preoperatively to 94.7 (range, 90-100) postoperatively, and VAS for pain decreased from 6.7 (range, 3-10) to 1.5 (range, 0-3). Average plantarflexion of the ankle increased from 28.8 degrees (range, 15-40) preoperatively to 42.5 degrees (range, 25-50) postoperatively. Mean time to resumption of sports activities was 6.7 weeks (range, 5-12). There were no major complications in any patient. CONCLUSION: Arthroscopic excision of a symptomatic os trigonum using anterolateral, centrolateral, and posterolateral portals in the lateral decubitus position was a safe and effective technique. LEVEL OF EVIDENCE: Level IV, retrospective case series.

Development of a Machine Learning Model to Distinguish between Ulcerative Colitis and Crohn's Disease Using RNA Sequencing Data.

Crohn's disease (CD) and ulcerative colitis (UC) can be difficult to differentiate. As differential diagnosis is important in establishing a long-term treatment plan for patients, we aimed to develop a machine learning model for the differential diagnosis of the two diseases using RNA sequencing (RNA-seq) data from endoscopic biopsy tissue from patients with inflammatory bowel disease (n = 127; CD, 94; UC, 33). Biopsy samples were taken from inflammatory lesions or normal tissues. The RNA-seq dataset was processed via mapping to the human reference genome (GRCh38) and quantifying the corresponding gene models that comprised 19,596 protein-coding genes. An unsupervised learning model showed distinct clusters of four classes: CD inflammatory, CD normal, UC inflammatory, and UC normal. A supervised learning model based on partial least squares discriminant analysis was able to distinguish inflammatory CD from inflammatory UC after pruning the strong classifiers of normal CD vs. normal UC. The error rate was minimal and affected only two components: 20 and 50 genes for the first and second components, respectively. The corresponding overall error rate was 0.147. RNA-seq analysis of tissue and the two components revealed in this study may be helpful for distinguishing CD from UC.

Risk of suicide and accidental deaths among elderly patients with cognitive impairment.

BACKGROUND: The leading causes of death among the elderly with cognitive impairment are unknown. This study aims to estimate the suicide and accidental death rates on the basis of a clinical case registry of patients diagnosed with cognitive impairment. METHODS: The target sample consisted of 10,169 patients diagnosed with dementia or mild cognitive impairment (MCI), who were evaluated at the Clinical Research Center for Dementia of Korea (CREDOS) from January 2005 to December 2013. Information about whether the patients had died from suicide or in any kind of accident by December 31, 2016, was obtained from the database of the National Statistical Office (NSO). The standardized mortality ratio (SMR) and Cox-regression analysis were performed for evaluating the risk of suicide and accidental death as identified by the ICD-10. RESULTS: The average of the Clinical Dementia Rating Scale (CDR) score (0.68 vs 0.93) was lower, and the age at the time of study registration (71.42 vs 75.68 years) was younger in the suicidal death group, as compared to the accidental death group. The overall SMR for accidental death in cognitively impaired patients (1.44, 95% CI 1.22-1.71) was significantly higher than the general population. Later onset (1.43, 95% CI 1.20-1.71) and older age (2.21, 95% CI 1.04-4.68) increased the risk of accidental death in cognitively impaired patients. According to the dementia subtypes, the SMR for accidental death was higher in both Alzheimer's disease (1.72, 95% CI 1.36-2.14) and vascular dementia (2.14, 95% CI 1.27-3.38). Additionally, the SMR for accidental death showed an increasing tendency as the CDR score increased (mild 1.80, 95% CI 1.32-2.42, moderate 1.86, 95% CI 1.07-3.03, severe 3.32, 95% CI 1.08-7.76). Unemployment increased the risks of both suicide (3.71, 95% CI 1.54-8.95) and accidental death (2.09, 95% CI 1.20-3.63). CONCLUSIONS: Among people with cognitive impairment, the risk of death by suicide did not increase, whereas that of accidental death increased significantly. Preventive strategies for premature mortality in those with cognitive impairment should be implemented from the early stages and should include careful evaluation of the individual risk factors for each type of death.

Image Settings Affecting Nuchal Translucency Measurement Using Volume NT Software.

PURPOSE: To evaluate the effects of the deviation from the mid-sagittal plane, fetal image size, tissue harmonic imaging (THI), and speckle reduction filter (SRF) on the measurement of the nuchal translucency (NT) thickness using Volume NT software. MATERIALS AND METHODS: In 79 pregnant women, NT was measured using Volume NT. Firstly, the three-dimensional volumes were categorized based on the angle of deviation in 10° intervals from the mid-sagittal plane. Secondly, the operator downsized the fetal image to less than 50% of the screen (Method A) and by magnifying the image (Method B). Next, the image was magnified until the fetal head and thorax occupied 75% of the screen, and the NT was measured (Method C). Lastly, NT values were acquired with THI and SRF functions on, with each function alternately on, and with both functions off. RESULTS: The mean differences in NT measurements were -0.09 mm (p<0.01) between two-dimensional (2D) and a deviation of 31-40° and -0.10 mm (p<0.01) between 2D and 41-50°. The intraclass correlation coefficients (ICC) for 2D-NT and NT according to image size were 0.858, 0.923, and 0.928 for methods A, B, and C, respectively. The ICC for 2D-NT and NT with respect to the THI and SRF were 0.786, 0.761, 0.740, and 0.731 with both functions on, THI only, SRF only, and with both functions off, respectively. CONCLUSION: NT measurements made using Volume NT are affected by angle deviation from the mid-sagittal plane and fetal image size. Additionally, the highest correlation with 2D-NT was achieved when THI and SRF functions were used.

Design and Analysis of CMOS-Compatible III-V Compound Electron-Hole Bilayer Tunneling Field-Effect Transistor for Ultra-Low-Power Applications.

In this work, we design and analyze complementary metal-oxide-semiconductor (CMOS)-compatible III-V compound electron-hole bilayer (EHB) tunneling field-effect transistors (TFETs) by using two-dimensional (2D) technology computer-aided design (TCAD) simulations. A recently proposed EHB TFET exploits a bias-induced band-to-band tunneling (BTBT) across the electron-hole bilayer by an electric field from the top and bottom gates. This is in contrast to conventional planar p(+)-p(-)-n TFETs, which utilize BTBT across the source-to-channel junction. We applied III-V compound semiconductor materials to the EHB TFETs in order to enhance the current drivability and switching performance. Devices based on various compound semiconductor materials have been designed and analyzed in terms of their primary DC characteristics. In addition, the operational principles were validated by close examination of the electron concentrations and energy-band diagrams under various operation conditions. The simulation results of the optimally designed In0.533Ga0.47As EHB TFET show outstanding performance, with an on-state current (Ion) of 249.5 µA/µm, subthreshold swing (S) of 11.4 mV/dec, and threshold voltage (Vth) of 50 mV at VDS = 0.5 V. Based on the DC-optimized InGaAs EHB TFET, the CMOS inverter circuit was simulated in views of static and dynamic behaviors of the p-channel device with exchanges between top and bottom gates or between source and drain electrodes maintaining the device structure.

Feasibility of three-dimensional reconstruction and automated measurement of fetal long bones using 5D Long Bone.

OBJECTIVE: To evaluate the feasibility of five-dimensional Long Bone (5D LB), a new technique that automatically archives, reconstructs images, and measures lengths of fetal long bones, to assess whether the direction of volume sweep influences fetal long bone measurements in three-dimensional (3D) ultrasound and 5D LB, and to compare measurements of fetal long bone lengths obtained with 5D LB and those obtained with conventional two-dimensional (2D) and manual 3D techniques. METHODS: This prospective study included 39 singleton pregnancies at 26+0 to 32+0 weeks of gestation. Multiple pregnancies, fetuses with multiple congenital anomalies, and mothers with underlying medical diseases were excluded. Fetal long bones of the lower extremities-the femur, tibia, and fibula were measured by 2D and 3D ultrasound, and 5D LB, by an expert and non-expert examiner. First, we analyzed the 3D ultrasound and 5D LB data according to 2 different sweeping angles. We analyzed intra- and inter-observer variability and agreement between ultrasound techniques. Paired t-test, interclass correlation coefficient, and Bland-Altman plot and Passing-Bablok regression were used for statistical analysis. RESULTS: There was no statistical difference between long bone measurements analyzed according to 2 different volume-sweeping angles by 3D ultrasound and 5D LB. Intra- and inter-observer variability were not significantly different among all 3 ultrasound techniques. Comparing 2D ultrasound and 5D LB, the interclass correlation coefficient for femur, tibia, and fibula was 0.91, 0.92, and 0.89, respectively. CONCLUSION: 5D LB is reproducible and comparable with conventional 2D and 3D ultrasound techniques for fetal long bone measurement.