Capacitive Electrode-Based Electric Field Treatments on Redox-Toxic Iron Deposits in Transgenic AD Mouse Models: The Electroceutical Targeting of Alzheimer's Disease Feasibility Study.

Iron accumulation in the brain accelerates Alzheimer's disease progression. To cure iron toxicity, we assessed the therapeutic effects of noncontact transcranial electric field stimulation to the brain on toxic iron deposits in either the Aß fibril structure or the Aß plaque in a mouse model of Alzheimer's disease (AD) as a pilot study. A capacitive electrode-based alternating electric field (AEF) was applied to a suspension of magnetite (Fe3O4) to measure field-sensitized reactive oxygen species (ROS) generation. The increase in ROS generation compared to the untreated control was both exposure-time and AEF-frequency dependent. The frequency-specific exposure of AEF to 0.7-1.4 V/cm on a magnetite-bound Aß-fibril or a transgenic Alzheimer's disease (AD) mouse model revealed the degradation of the Aß fibril or the removal of the Aß-plaque burden and ferrous magnetite compared to the untreated control. The results of the behavioral tests show an improvement in impaired cognitive function following AEF treatment on the AD mouse model. Tissue clearing and 3D-imaging analysis revealed no induced damage to the neuronal structures of normal brain tissue following AEF treatment. In conclusion, our results suggest that the effective degradation of magnetite-bound amyloid fibrils or plaques in the AD brain by the electro-Fenton effect from electric field-sensitized magnetite offers a potential electroceutical treatment option for AD.

Control of localization and optical properties with deep-subwavelength engineered disorder.

The effect of deep subwavelength disorder in one-dimensional dichromic multilayer films on the optical transmission, localization length, and Goos-Hänchen shift around the critical angle is analyzed using sets of disordered multilayer films with different degrees of order metric τ. For each Gaussian-perturbed multilayer film designed by a Metropolis algorithm targeting the predetermined order metric τ, the numerically obtained localization length and transmission show excellent agreement with the recent theoretical analysis developed for disordered multilayer films, further revealing τ-dependence of the Goos-Hänchen shift across the critical angle. Emphasizing the role of deep subwavelength structures in disorder-induced transmission enhancement, our result thus paves the way toward the inverse design of a deep subwavelength disordered structural landscape for the targeted order metric τ or abnormal optical responses - including the Goos-Hänchen shift.

A boy with a congenital cerebellar mass.

PURPOSE: Tumorigenesis of medulloblastoma is believed to be associated with granule cell progenitor neurogenesis of the cerebellum. Nevertheless, congenital medulloblastomas are rarely found. Here, we report a case of congenital medulloblastoma that showed spontaneous albeit transient regression. METHODS: A one-month-old baby presented with abnormal antenatal and postnatal imaging findings. Upon ultrasonography at 26 weeks of gestational age, Dandy-Walker malformation with vermian hypoplasia and cystic change was suspected. Brain MRI at 1 week after birth revealed gadolinium-enhancing lesions in the cerebellum with apparent infiltrative features along the cerebellar folia accompanied by three independent cysts in the upper and inferolateral sides of the lesion. Serial MRIs taken up to 5 months of age showed a decrease in the size and extent of enhancing solid portions. The baby did not show any abnormal signs or developmental delay. MRI at the age of 7 months showed enlargement of the lesion, and surgery was performed. RESULTS: The lesion was diagnosed as medulloblastoma with histologically extensive nodularity (MBEN), genetically SHH-activated and TP53-wildtype. CONCLUSION: This case provides an unusual chance of observing an early phase of medulloblastoma development and raises a suspicion that medulloblastoma may initiate itself very early in cerebellar organogenesis and progress later at a certain time of postnatal development.

Long-term clinical outcomes in patients with untreated non-culprit intermediate coronary lesion and evaluation of predictors by using virtual histology-intravascular ultrasound; a prospective cohort study.

BACKGROUND: It is uncertain whether the coronary lesion with intermediate stenosis is more likely to cause cardiovascular events than a normal or minimal lesion. We conducted a single-center, prospective cohort study to identify long-term clinical outcomes of patients with untreated non-culprit intermediate lesion and evaluate its predictor of cardiovascular events by using virtual histology-intravascular ultrasound (VH-IVUS). METHODS: Subjects with non-culprit intermediate lesion underwent VH-IVUS were prospectively registered after percutaneous coronary intervention at the culprit lesion. Intermediate lesion was defined as 30 to 70% stenosis in coronary angiography and primary outcome was an occurrence of major adverse cardiovascular events (MACE) defined as all-cause death, intermediate lesion revascularization (InLR), minimal lesion revascularization (MnLR, unplanned revascularization elsewhere in the target vessel or in other coronary arteries which looked normal or minimal stenosis), cerebrovascular events, or non-fatal myocardial infarction (MI). The mean follow-up period was 4.2 years. RESULTS: Total 25 MACE, approximately 7% incidence annually, were identified during a follow-up period in 86 patients with 89 intermediate lesions. InLR (n = 13) was a most common event followed by MnLR (n = 6), non-fatal MI (n = 4), all-cause death (n = 3), and cerebrovascular events (n = 1). Diameter stenosis (OR 1.07, 95% CI 1.01-1.12, p = 0.015), plaque burden (PB, OR 1.07, 95% CI 1.00-1.15, p = 0.040), fibrofatty area (FFA, OR 1.61, 95% CI 1.10-2.38, p = 0.016), PB ≥ 70% (OR 3.93, 95% CI 1.28-12.07, p = 0.018), and area stenosis ≥ 50% (OR 2.94, 95% CI 1.01-8.56, p = 0.042) showed significant relationships with an occurrence of MACE. In multivariable Cox-proportional hazard analysis, FFA in intermediate lesion was an only independent predictor of MACE (HR 1.36, 95% CI 1.05-1.77, p = 0.019). CONCLUSIONS: Untreated intermediate lesions had a significantly higher chance for requiring revascularization compared with a normal or minimal lesion. And also, a large FFA in intermediate lesion was a significant predictor of cardiovascular events and which finding was mainly driven by coronary-related events, in particularly intermediate lesion progression.

Resonant absorption of electromagnetic waves in transition anisotropic media.

We study the mode conversion and resonant absorption phenomena occurring in a slab of a stratified anisotropic medium, optical axes of which are tilted with respect to the direction of inhomogeneity, using the invariant imbedding theory of wave propagation. When the tilt angle is zero, mode conversion occurs if the longitudinal component of the permittivity tensor, which is the one in the direction of inhomogeneity in the non-tilted case, varies from positive to negative values within the medium, while the transverse component plays no role. When the tilt angle is nonzero, the wave transmission and absorption show an asymmetry under the sign change of the incident angle in a range of the tilt angle, while the reflection is always symmetric. We calculate the reflectance, the transmittance and the absorptance for several configurations of the permittivity tensor and find that resonant absorption is greatly enhanced when the medium from the incident surface to the resonance region is hyperbolic than when it is elliptic. For certain configurations, the transmittance and absorptance curves display sharp peaks at some incident angles determined by the tilt angle.

Giant enhancement of reflectance due to the interplay between surface confined wave modes and nonlinear gain in dielectric media.

We study theoretically the interplay between the surface confined wave modes and the linear and nonlinear gain of the dielectric layer in the Otto configuration. The surface confined wave modes, such as surface plasmons or waveguide modes, are excited in the dielectric-metal bilayer by obliquely incident p waves. In the purely linear case, we find that the interplay between linear gain and surface confined wave modes can generate a large reflectance peak with its value much greater than 1. As the linear gain parameter increases, the peak appears at smaller incident angles, and the associated modes also change from surface plasmons to waveguide modes. When the nonlinear gain is turned on, the reflectance shows very strong multistability near the incident angles associated with surface confined wave modes. As the nonlinear gain parameter is varied, the reflectance curve undergoes complicated topological changes and sometimes displays separated closed curves. When the nonlinear gain parameter takes an optimally small value, a giant amplification of the reflectance by three orders of magnitude occurs near the incident angle associated with a waveguide mode. We also find that there exists a range of the incident angle where the wave is dissipated rather than amplified even in the presence of gain. We suggest that this can provide the basis for a possible new technology for thermal control in the subwavelength scale.

Multifunctional Woven Structure Operating as Triboelectric Energy Harvester, Capacitive Tactile Sensor Array, and Piezoresistive Strain Sensor Array.

This paper presents a power-generating sensor array in a flexible and stretchable form. The proposed device is composed of resistive strain sensors, capacitive tactile sensors, and a triboelectric energy harvester in a single platform. The device is implemented in a woven textile structure by using proposed functional threads. A single functional thread is composed of a flexible hollow tube coated with silver nanowires on the outer surface and a conductive silver thread inside the tube. The total size of the device is 60 × 60 mm² having a 5 × 5 array of sensor cell. The touch force in the vertical direction can be sensed by measuring the capacitance between the warp and weft functional threads. In addition, because silver nanowire layers provide piezoresistivity, the strain applied in the lateral direction can be detected by measuring the resistance of each thread. Last, with regard to the energy harvester, the maximum power and power density were measured as 201 µW and 0.48 W/m², respectively, when the device was pushed in the vertical direction.

Excitation of surface waves on the interfaces of general bi-isotropic media.

We study theoretically the characteristics of surface waves excited at the interface between a metal and a general bi-isotropic medium, which includes isotropic chiral media and Tellegen media as special cases. We derive an analytical dispersion relation for surface waves, using which we calculate the effective index and the propagation length numerically. We also calculate the absorptance, the cross-polarized reflectance and the spatial distribution of the electromagnetic fields for plane waves incident on a bilayer system consisting of a metal layer and a bi-isotropic layer in the Kretschmann configuration, using the invariant imbedding method. The results obtained using the invariant imbedding method agree with those obtained from the dispersion relation perfectly. In the case of chiral media, the effective index is an increasing function of the chirality index, whereas in Tellegen media, it is a decreasing function of the Tellegen parameter. The propagation length for surface waves in both cases increase substantially as either the chirality index or the Tellegen parameter increases. In Tellegen media, it diverges to infinity when the effective index goes to zero, whereas in chiral media, it does when the parameters approach the cutoff values where quasi surface waves are excited. We investigate the characteristics of quasi surface waves excited when the chirality index is sufficiently large.

Resonant absorption and amplification of circularly-polarized waves in inhomogeneous chiral media.

It has been found that in the media where the dielectric permittivity ε or the magnetic permeability µ is near zero and in transition metamaterials where ε or µ changes from positive to negative values, there occur a strong absorption or amplification of the electromagnetic wave energy in the presence of an infinitesimally small damping or gain and a strong enhancement of the electromagnetic fields. We attribute these phenomena to the mode conversion of transverse electromagnetic waves into longitudinal plasma oscillations and its inverse process. In this paper, we study analogous phenomena occurring in chiral media theoretically using the invariant imbedding method. In uniform isotropic chiral media, right-circularly-polarized and left-circularly-polarized waves are the eigen-modes of propagation with different effective refractive indices n(+) and n(-), whereas in the chiral media with a nonuniform impedance variation, they are no longer the eigenmodes and are coupled to each other. We find that both in uniform chiral slabs where either n(+) or n(-) is near zero and in chiral transition metamaterials where n(+) or n(-) changes from positive to negative values, a strong absorption or amplification of circularly-polarized waves occurs in the presence of an infinitesimally small damping or gain. We present detailed calculations of the mode conversion coefficient, which measures the fraction of the electromagnetic wave energy absorbed into the medium, for various configurations of ε and µ with an emphasis on the influence of a nonuniform impedance. We propose possible applications of these phenomena to linear and nonlinear optical devices that react selectively to the helicity of the circular polarization.

Anderson localization of electromagnetic waves in randomly-stratified magnetodielectric media with uniform impedance.

The propagation and the Anderson localization of electromagnetic waves in a randomly-stratified slab, where both the dielectric permittivity and the magnetic permeability depend on one spatial coordinate in a random manner, is theoretically studied. The case where the wave impedance is uniform, while the refractive index is random, is considered in detail. The localization length and the disorder-averaged transmittance of s and p waves incident obliquely on the slab are calculated as a function of the incident angle θ and the strength of randomness in a numerically precise manner, using the invariant imbedding method. It is found that the waves incident perpendicularly on the slab are delocalized, while those incident obliquely are localized. As the incident angle increases from zero, the localization length decreases from infinity monotonically to some finite value. The localization length is found to depend on the incident angle as θ-4 and a simple analytical formula, which works quite well for weak disorder and small incident angles, is derived. The localization length does not depend on the wave polarization, but the disorder-averaged transmittance generally does.

Enhanced optical phase conjugation in nonlinear metamaterials.

Optical phase conjugation by degenerate four-wave mixing in nonlinear metamaterials is studied theoretically by solving the coupled wave equations using a generalized version of the invariant imbedding method. The phase-conjugate reflectance and the lateral shift of the phase-conjugate reflected beams are calculated and their dependencies on the frequency, the polarization, the incident angle, the material properties and the structure are investigated in detail. It is found that the efficiency of phase conjugation can be significantly enhanced due to the enhancement of electromagnetic fields in various metamaterial structures.

Binding Position Dependent Modulation of Smoothened Activity by Cyclopamine.

Cyclopamine is a natural alkaloid that is known to act as an agonist when it binds to the Cysteine Rich Domain (CRD) of the Smoothened receptor and as an antagonist when it binds to the Transmembrane Domain (TMD). To study the effect of cyclopamine binding to each binding site experimentally, mutations in the other site are required. Hence, simulations are critical for understanding the WT activity due to binding at different sites. Additionally, there is a possibility that cyclopamine could bind to both sites simultaneously especially at high concentration, the implications of which remain unknown. We performed three independent sets of simulations to observe the receptor activation with cyclopamine bound to each site independently (CRD, TMD) and bound to both sites simultaneously. Using multi-milliseconds long aggregate MD simulations combined with Markov state models and machine learning, we explored the dynamic behavior of cyclopamine's interactions with different domains of WT SMO. A higher population of the active state at equilibrium, a lower activation free energy barrier of ~ 2 kcal/mol, and expansion of the hydrophobic tunnel to facilitate cholesterol transport agrees with the cyclopamine's agonistic behavior when bound to the CRD of SMO. A higher population of the inactive state at equilibrium, a higher free energy barrier of ~ 4 kcal/mol and restricted the hydrophobic tunnel to impede cholesterol transport showed cyclopamine's antagonistic behavior when bound to TMD. With cyclopamine bound to both sites, there was a slightly larger inactive population at equilibrium and an increased free energy barrier (~ 3.5 kcal/mol). The tunnel was slightly larger than when solely bound to TMD, and showed a balance between agonism and antagonism with respect to residue movements exhibiting an overall weak antagonistic effect.

Enhancing the Evaluation System of Training Hospitals for Neurosurgical Residency Training and Education in South Korea : Striving for Balanced Participation and Differentiation.

The Korean Neurosurgical Society, with its 62 years of history, has witnessed substantial growth in the field of neurosurgery, producing over 3,400 neurosurgeons, establishing 12 divisions and 9 regional branches, and advancing in clinical management, diagnostic methods and academic research. Despite these developments, the regulations governing neurosurgical training and evaluation methods for training hospitals have remained largely unchanged, necessitating comprehensive revisions in response to evolving medical environments. To provide balanced participation opportunities for neurosurgery residents, the Korean Neurosurgical Society formed the Training Status Investigation Standard Change Task Force (TF Team) under the Training Education Committee. This paper presents the TF Team's findings and proposals for revising training status investigation standards and evaluation criteria. Through the processes including a lot of team meetings, workshops, education programs, official communications with 12 division societies, benchmarking from other societies and analysis of encrypted data from the past 5 years for neurosurgical training hospitals, the TF Team created a revised training status investigation proposal, supplemented main surgery criteria. And we applied this revised proposal to the training status investigation data collected from training hospitals in 2022 for simulation. We reduced the score for main surgeries to 10 points, introduced core competency surgery standards, allocating 5 points each for brain core competency surgery and spine and peripheral core competency surgery, for a total of 10 points. We also adjusted the major surgery score to 13 points, expanding the total surgery index score to 33 points. We introduced additional definitions for main surgeries in the areas of spine, pediatrics, and functional surgery. The equipment score was reduced from 17 points to 9 points. We specified minimum requirements for resident allocation eligibility, and if a hospital meets all of these criteria, they become eligible to apply for resident allocation. We introduced a new bonus point system for hospitals performing mechanical thrombectomy or stenting and peripheral nerve. The proposed revisions aim to improve the training and education of neurosurgical residents and overall neurosurgical care in Korea by creating a balanced and differentiated evaluation system for training hospitals. Further monitoring, communication, and adjustments are crucial for successful implementation.

A Rare Case of Stroke in a 76-Year-Old Woman: Left Atrial Papillary Fibroelastoma as the Culprit.

BACKGROUND Papillary fibroelastoma is the most common type of benign primary cardiac tumor and is usually asymptomatic. However, tumor fragments or surface thrombus can embolize and cause transient ischemic attacks, strokes, or myocardial infarction. This report describes a 76-year-old woman who presented with dysarthria and right-sided weakness due to a stroke associated with a left atrial papillary fibroelastoma. CASE REPORT A 76-year-old woman visited the Emergency Department because she had right-sided weakness and dysarthria from 12 h ago. Brain magnetic resonance image was done at the Emergency Department, showing multiple small embolic, acute infarction in left basal ganglia and fronto-temporo-parietal lobes. Transthoracic and transesophageal echocardiogram showed a hypermobile echogenic mass (0.8×1.5 cm) with villous surface on the orifice of left atrial appendage. Twenty-four-hour Holter monitoring was performed to evaluate the cause of cerebral infarction, and there was no paroxysmal atrial fibrillation. Thoracic computed tomography angiography also showed a sea anemone-shaped mass around the left atrial appendage. Cardiac tumor excision was done via a lower partial sternotomy. Histopathologic analysis showed multiple delicate fronds, and the avascular fibroelastic cores were lined by a single layer of CD31-positive endothelial cells. Histopathologic findings were consistent with papillary fibroelastoma. The patient was discharged without any other complications on day 30 of hospitalization. CONCLUSIONS This case highlights the importance of cardiac imaging in patients with acute stroke, including transthoracic and transesophageal echocardiography, which can show the typical imaging features of papillary fibroelastoma and other intracardiac sources of embolus.

Echocardiography-Based Deep Learning Model to Differentiate Constrictive Pericarditis and Restrictive Cardiomyopathy.

BACKGROUND: Constrictive pericarditis (CP) is an uncommon but reversible cause of diastolic heart failure if appropriately identified and treated. However, its diagnosis remains a challenge for clinicians. Artificial intelligence may enhance the identification of CP. OBJECTIVES: The authors proposed a deep learning approach based on transthoracic echocardiography to differentiate CP from restrictive cardiomyopathy. METHODS: Patients with a confirmed diagnosis of CP and cardiac amyloidosis (CA) (as the representative disease of restrictive cardiomyopathy) at Mayo Clinic Rochester from January 2003 to December 2021 were identified to extract baseline demographics. The apical 4-chamber view from transthoracic echocardiography studies was used as input data. The patients were split into a 60:20:20 ratio for training, validation, and held-out test sets of the ResNet50 deep learning model. The model performance (differentiating CP and CA) was evaluated in the test set with the area under the curve. GradCAM was used for model interpretation. RESULTS: A total of 381 patients were identified, including 184 (48.3%) CP, and 197 (51.7%) CA cases. The mean age was 68.7 ± 11.4 years, and 72.8% were male. ResNet50 had a performance with an area under the curve of 0.97 to differentiate the 2-class classification task (CP vs CA). The GradCAM heatmap showed activation around the ventricular septal area. CONCLUSIONS: With a standard apical 4-chamber view, our artificial intelligence model provides a platform to facilitate the detection of CP, allowing for improved workflow efficiency and prompt referral for more advanced evaluation and intervention of CP.

Enhanced nonlinear optical effects due to the excitation of optical Tamm plasmon polaritons in one-dimensional photonic crystal structures.

We suggest optimally designed one-dimensional metal/photonic crystal structures for the excitation of optical Tamm plasmon polaritons, which show strongly enhanced electromagnetic field intensities compared to those due to conventional surface plasmon excitations. We assume that the photonic crystal is made of weakly nonlinear optical materials and calculate the reflectance and the electromagnetic field distribution precisely, using the invariant imbedding method generalized to nonlinear media. We find field intensity enhancement factors as large as 3,000 at the metal/photonic crystal interface. We verify that due to this strong enhancement, nonlinear optical effects such as optical bistability can be observed for very small values of the incident wave power. Our results imply that using our structure, very strong surface enhanced Raman scattering signals can be achieved and optical switching devices can be operated in much lower threshold light intensities.

Update of Rehabilitation in Huntington's Disease: Narrative Review.

Huntington's disease (HD) is a neurodegenerative disease that has motor dysfunction, predominantly chorea, cognitive impairment, and psychiatric disturbances as symptoms. Treatment is directed to reduce the severity of symptoms, although there are few studies and no clinical guidelines for rehabilitation in HD. Therefore, this review aimed to establish an effective rehabilitation approach for HD according to the stage of the disease. In the early stage of HD, the motor symptoms are mild, and psychological symptoms occur. Treatment in this period should focus on aerobic and resistance exercises, task-specific training, secondary prevention education, cognitive training, and psychological management. In the middle stage of HD, the motor symptoms are more severe. Task-specific rehabilitation approaches, education for the patient and caregiver, functional respiratory exercises, activities of daily living training, multidisciplinary and multimodal daycare rehabilitation are helpful to patients in this stage. At the late stage of HD, most patients need complete support for activity of daily living. Mobility and balance evaluation and prevention strategies should be focused on for safety, and respiratory exercises and physical exercise to prevent complications in patients with severely impaired mobility should be considered based on the patient's condition. Programmed rehabilitation management based on the stage of the disease is effective for patients with HD.

Fact Sheet on Cardiac Rehabilitation for Cardiovascular Disease in South Korea.

Cardiovascular disease (CVD) poses a significant health challenge globally, including in Korea, due to its status as a leading cause of death and its impact on cardiopulmonary function. Cardiac rehabilitation (CR) is a well-established program that not only aids in restoring cardiopulmonary function, but also improves physical and social conditions. The benefits of CR are widely recognized, and it is implemented globally. While the effectiveness of CR has been proven in Korea, it is underutilized. This fact sheet summarizes the current status of CR in Korea, including the prevalence of CVD, the clinical practice guidelines for CR programs, and the challenges of implementing CR in Korea.

Incidental Meningiomas: Potential Predictors of Growth and Current State of Management.

The rise in availability of neuroimaging has led to an increase in incidentally discovered meningiomas. These tumors are typically asymptomatic and tend to display slow growth. Treatment options include observation with serial monitoring, radiation, and surgery. Although optimal management is unclear, clinicians recommend a conservative approach, which preserves quality of life and limits unnecessary intervention. Several risk factors have been investigated for their potential utility in the development of prognostic models for risk assessment. Herein, the authors review the current literature on incidental meningiomas, focusing their discussion on potential predictive factors for tumor growth and appropriate management practices.

High-Level Expression of Recombinant VHSV Glycoprotein Using Transformed C. vulgaris and Verification of Vaccine Efficacy.

The demand for aquaculture is increasing, but production is declining due to high feed costs and disease outbreaks. Viral hemorrhagic septicemia (VHS) is a viral disease that seriously affects seawater and freshwater fish in aquaculture, including the olive flounder (Paralichthys olivaceus), a major aquaculture fish in Korea. However, very few vaccines are currently available for viral hemorrhagic septicemia virus (VHSV). The nutrient-rich microalga Chlorella vulgaris has been used as a feed additive in aquaculture and as a host for the industrial production of recombinant VHSV glycoprotein as an oral vaccine. In this study, VHSV glycoprotein was cloned with a salt-inducible promoter, and high levels of expression up to 41.1 mg/g wet C. vulgaris, representing 27.4% of total extracted soluble protein, were achieved by growing the transformed C. vulgaris for 5 days in the presence of 250 mM NaCl. The production of a neutralizing antibody was detected in the serum of fish given feed containing 9% VHSV glycoprotein-expressing C. vulgaris. Furthermore, relative survival rates of 100% and 81.9% were achieved following challenges of these fish with VHSV at 106 and 107 pfu/fish, respectively, indicating that C. vulgaris could be used as a platform for the production of recombinant proteins for use as oral vaccines in the control of viral diseases in aquaculture.