Artificial Neural Network Learns Clinical Assessment of Spasticity in Modified Ashworth Scale.

OBJECTIVE: To propose an artificial intelligence (AI)-based decision-making rule in modified Ashworth scale (MAS) that draws maximum agreement from multiple human raters and to analyze how various biomechanical parameters affect scores in MAS. DESIGN: Prospective observational study. SETTING: Two university hospitals. PARTICIPANTS: Hemiplegic adults with elbow flexor spasticity due to acquired brain injury (N=34). INTERVENTION: Not applicable. MAIN OUTCOME MEASURES: Twenty-eight rehabilitation doctors and occupational therapists examined MAS of elbow flexors in 34 subjects with hemiplegia due to acquired brain injury while the MAS score and biomechanical data (ie, joint motion and resistance) were collected. Nine biomechanical parameters that quantify spastic response described by the joint motion and resistance were calculated. An AI algorithm (or artificial neural network) was trained to predict the MAS score from the parameters. Afterwards, the contribution of each parameter for determining MAS scores was analyzed. RESULTS: The trained AI agreed with the human raters for the majority (82.2%, Cohen's kappa=0.743) of data. The MAS scores chosen by the AI and human raters showed a strong correlation (correlation coefficient=0.825). Each biomechanical parameter contributed differently to the different MAS scores. Overall, angle of catch, maximum stretching speed, and maximum resistance were the most relevant parameters that affected the AI decision. CONCLUSIONS: AI can successfully learn clinical assessment of spasticity with good agreement with multiple human raters. In addition, we could analyze which factors of spastic response are considered important by the human raters in assessing spasticity by observing how AI learns the expert decision. It should be noted that few data were collected for MAS3; the results and analysis related to MAS3 therefore have limited supporting evidence.

Highly Sensitive Sensors Based on Metal-Oxide Nanocolumns for Fire Detection.

A fire detector is the most important component in a fire alarm system. Herein, we present the feasibility of a highly sensitive and rapid response gas sensor based on metal oxides as a high performance fire detector. The glancing angle deposition (GLAD) technique is used to make the highly porous structure such as nanocolumns (NCs) of various metal oxides for enhancing the gas-sensing performance. To measure the fire detection, the interface circuitry for our sensors (NiO, SnO2, WO3 and In2O3 NCs) is designed. When all the sensors with various metal-oxide NCs are exposed to fire environment, they entirely react with the target gases emitted from Poly(vinyl chlorides) (PVC) decomposed at high temperature. Before the emission of smoke from the PVC (a hot-plate temperature of 200 °C), the resistances of the metal-oxide NCs are abruptly changed and SnO2 NCs show the highest response of 2.1. However, a commercial smoke detector did not inform any warning. Interestingly, although the NiO NCs are a p-type semiconductor, they show the highest response of 577.1 after the emission of smoke from the PVC (a hot-plate temperature of 350 °C). The response time of SnO2 NCs is much faster than that of a commercial smoke detector at the hot-plate temperature of 350 °C. In addition, we investigated the selectivity of our sensors by analyzing the responses of all sensors. Our results show the high potential of a gas sensor based on metal-oxide NCs for early fire detection.

Current Health Data Standardization Project and Future Directions to Ensure Interoperability in Korea.

OBJECTIVES: The need for interoperability at the national level was highlighted in Korea, leading to a consensus on the importance of establishing national standards that align with international technological standards and reflect contemporary needs. This article aims to share insights into the background of the recent national health data standardization policy, the activities of the Health Data Standardization Taskforce, and the future direction of health data standardization in Korea. METHODS: To ensure health data interoperability, the Health Data Standardization Taskforce was jointly organized by the public and private sectors in December 2022. The taskforce operated three working groups. It reviewed international trends in interoperability standardization, assessed the current status of health data standardization, discussed its vision, mission, and strategies, engaged in short-term standardization activities, and established a governance system for standardization. RESULTS: On September 15, 2023, the notice of "Health Data Terminology and Transmission Standards" in Korea was thoroughly revised to improve the exchange of health information between information systems and ensure interoperability. This notice includes the Korea Core Data for Interoperability (KR CDI) and the Korea Core Data Transmission Standard (HL7 FHIR KR Core), which are outcomes of the taskforce's efforts. Additionally, to reinforce the standardized governance system, the Health-Data Standardization Promotion Committee was established. CONCLUSIONS: Active interest and support from medical informatics experts are needed for the development and widespread adoption of health data standards in Korea.

Multitemporal analysis of land subsidence induced by open-pit mining activity using improved combined scatterer interferometry with deep learning algorithm optimization.

Mine operational safety is an important aspect of maintaining the operational continuity of a mining area. In this study, we used the InSAR time series to analyze land surface changes using the ICOPS (improved combined scatterers with optimized point scatters) method. This ICOPS method combines persistent scatterers (PS) with distributed scatterers (DS) to increase surface deformation analysis's spatial coverage and quality. One of the improvements of this study is the use of machine learning in postprocessing, based on convolutional neural networks, to increase the reliability of results. This study used data from the Sentinel-1 SAR C-band satellite during the 2016-2022 observation period at the Musan mine, North Korea. In the InSAR surface deformation time analysis, the maximum average rate of land subsidence was approximately > 15.00 cm per year, with total surface deformation of 170 cm and 70 cm for the eastern dumping area and the western dumping area, respectively. Analyzing the mechanism of land surface changes also involved evaluating the geological conditions in the Musan mining area. Our research findings show that combining machine learning and statistical methods has great potential to enhance the understanding of mine surface deformation.

5-Fluorouracil, mitomycin-c, and polysaccharide-k versus uracil-ftorafur and polysaccharide-K as adjuvant chemoimmunotherapy for patients with locally advanced gastric cancer with curative resection.

BACKGROUND: Despite the small but significant survival benefit of adjuvant chemotherapy in locally advanced gastric cancer (LAGC), the optimal regimen remains to be determined. We conducted a randomized trial comparing oral (PO) chemoimmunotherapy (CITX) with intravenous (IV) CITX in LAGC patients (stages IB-IIIB) with curative resection (≥ D2 dissection). METHODS: The patients were randomized to the IV (5-fluorouracil 500 mg/m(2) weekly for 24 weeks, mitomycin-C 8 mg/m(2) every 6 weeks × 4) or the PO (uracil-ftorafur (UFT) 400-600 mg/day for 12 months) group. Patients in both groups received PO polysaccharide-K (3 g/day for 4 months). The planned number of patients was 368 for proving the non-inferiority of PO CITX compared to IV CITX for overall survival. RESULTS: The trial was closed prematurely after enrolling 82 patients (44 in the IV group, 38 in the PO group). With a median follow-up of 82 months, there were no significant differences in the 5-year disease-free survival (73% vs. 55%, p = 0.358) and overall survival (77% vs. 66%, p = 0.159) between the 2 groups. The IV group demonstrated a higher incidence of grade 2 or 3 neutropenia, thrombocytopenia, and vomiting. CONCLUSIONS: PO CITX with UFT appeared to be at least non-inferior to 5-fluorouracil and mitomycin-C CITX, with lower toxicity in the adjuvant treatment for LAGC.

Role of graphene quantum dots with discrete band gaps on SnO2 nanodomes for NO2 gas sensors with an ultralow detection limit.

NO2 is a major air pollutant that should be monitored due to its harmful effects on the environment and human health. Semiconducting metal oxide-based gas sensors have been widely explored owing to their superior sensitivity towards NO2, but their high operating temperature (>200 °C) and low selectivity still limit their practical use in sensor devices. In this study, we decorated graphene quantum dots (GQDs) with discrete band gaps onto tin oxide nanodomes (GQD@SnO2 nanodomes), enabling room temperature (RT) sensing towards 5 ppm NO2 gas with a noticeable response ((Ra/Rg) - 1 = 4.8), which cannot be matched using pristine SnO2 nanodomes. In addition, the GQD@SnO2 nanodome based gas sensor shows an extremely low detection limit of 1.1 ppb and high selectivity compared to other pollutant gases (H2S, CO, C7H8, NH3, and CH3COCH3). The oxygen functional groups in GQDs specifically enhance NO2 accessibility by increasing the adsorption energy. Strong electron transfer from SnO2 to GQDs widens the electron depletion layer at SnO2, thereby improving the gas response over a broad temperature range (RT-150 °C). This result provides a basic perspective for utilizing zero-dimensional GQDs in high-performance gas sensors operating over a wide range of temperatures.

Isolated Oculomotor Nerve Palsy After Temporoparietal Lobar Hemorrhage With a Mass Effect: A Case Report.

We report a case of a patient who presented with ipsilateral oculomotor nerve palsy after a spontaneous left temporoparietal lobar hemorrhage with mass effect. Primary symptomatology included ipsilateral ptosis, dilated fixed pupil, and a lack of superior and medial movement with limited inferior left eye movements. Brain imaging revealed compression of the left upper midbrain due to subtentorial herniation of the hemorrhage, and susceptibility-weighted images sequences showed cerebral microbleed in the left midbrain substantia nigra. Based on our observation from this case, physicians should consider temporoparietal lobar hemorrhage with mass effect as an attributable factor in the etiologic cause of ipsilateral oculomotor nerve palsy.

Nanostructured Gallium Nitride Membrane at Wafer Scale for Photo(Electro)catalytic Polluted Water Remediation.

Photo(electro)catalysis methods have drawn significant attention for efficient, energy-saving, and environmental-friendly organic contaminant degradation in wastewater. However, conventional oxide-based powder photocatalysts are limited to UV-light absorption and are unfavorable in the subsequent postseparation process. In this paper, a large-area crystalline-semiconductor nitride membrane with a distinct nanoporous surface is fabricated, which can be scaled up to a full wafer and easily retrieved after photodegradation. The unique nanoporous surface enhances broadband light absorption, provides abundant reactive sites, and promotes the dye-molecule reaction with adsorbed hydroxyl radicals on the surface. The superior electric contact between the nickel bottom layer and nitride membrane facilitates swift charge carrier transportation. In laboratory tests, the nanostructure membrane can degrade 93% of the dye in 6 h under illumination with a small applied bias (0.5 V vs Ag/AgCl). Furthermore, a 2 inch diameter wafer-scale membrane is deployed in a rooftop test under natural sunlight. The membrane operates stably for seven cycles (over 50 h) with an outstanding dye degradation efficiency (>92%) and satisfied average total organic carbon removal rate (≈50%) in each cycle. This demonstration thus opens the pathway toward the production of nanostructured semiconductor layers for large-scale and practical wastewater treatment using natural sunlight.

Intestinal pseudo-obstruction caused by neuromyopathy in a patient with systemic sclerosis.

Although gastrointestinal involvement in systemic sclerosis is common, the pathophysiology of small-bowel involvement in systemic sclerosis is not fully understood. We report a case of a 56-year-old woman who has systemic sclerosis with intestinal pseudo-obstruction. The small-bowel manometric findings showed low-amplitude intestinal contraction and absence of the migrating myoelectric complex, and the electrogastrography revealed no increase of the slow-wave power. The manometric and electrogastrographic findings demonstrate that neuromyopathy may play a role in pseudo-obstruction of systemic sclerosis.

Intestinal pseudo-obstruction caused by neuromyopathy in a patient with systemic sclerosis.

Although gastrointestinal involvement in systemic sclerosis is common, the pathophysiology of small-bowel involvement in systemic sclerosis is not fully understood. We report a case of a 56-year-old woman who has systemic sclerosis with intestinal pseudo-obstruction. The small-bowel manometric findings showed low-amplitude intestinal contraction and absence of the migrating myoelectric complex, and the electrogastrography revealed no increase of the slow-wave power. The manometric and electrogastrographic findings demonstrate that neuromyopathy may play a role in pseudo-obstruction of systemic sclerosis.

Rare-Earth-Doped Barium Molybdate Up-Conversion Phosphor with Potential Application in Optical Temperature Sensing.

A BaMoO4:[Er3+]/[Yb3+] up-conversion (UC) phosphor was synthesized by co-precipitation and calcination of the precursor at 800 °C. The main peak (112) for the synthesized phosphor was strongly detected in the XRD pattern and had a tetragonal structure. The doping of rare-earth ions affected the crystal lattice by shifting the main peak, decreasing the lattice constant, and shifting the position of the Raman signal. The synthesized upconverted phosphor exhibited strong green signals at 530 and 553 nm and weak red signals at 657 nm when excited at 980 nm. The green light emission intensity of the UC phosphor increased as the pump power of the laser increased due to the two-photon effect. The synthesized upconverted phosphor was prepared as a pellet and flexible composite. Thermal quenching led to a decrease in luminescence intensity as the temperature increased, which means that the phosphor can be applied to optical temperature sensing.

Improved Performance of GaN-Based Light-Emitting Diodes Grown on Si (111) Substrates with NH3 Growth Interruption.

We demonstrate the highly efficient, GaN-based, multiple-quantum-well light-emitting diodes (LEDs) grown on Si (111) substrates embedded with the AlN buffer layer using NH3 growth interruption. Analysis of the materials by the X-ray diffraction omega scan and transmission electron microscopy revealed a remarkable improvement in the crystalline quality of the GaN layer with the AlN buffer layer using NH3 growth interruption. This improvement originated from the decreased dislocation densities and coalescence-related defects of the GaN layer that arose from the increased Al migration time. The photoluminescence peak positions and Raman spectra indicate that the internal tensile strain of the GaN layer is effectively relaxed without generating cracks. The LEDs embedded with an AlN buffer layer using NH3 growth interruption at 300 mA exhibited 40.9% higher light output power than that of the reference LED embedded with the AlN buffer layer without NH3 growth interruption. These high performances are attributed to an increased radiative recombination rate owing to the low defect density and strain relaxation in the GaN epilayer.

Asymptomatic Bladder Diverticulum Can Develop New Urinary Symptoms after a New Onset of Stroke: a Case Report.

Bladder diverticulum can be caused by many varying factors. It is usually asymptomatic in nature and thus often found by chance. In adult males, it can develop as a result of increased intravesicular pressure in the presence of an underlying benign prostatic hyperplasia. We observed a case in which a patient with asymptomatic bladder diverticulum developed new urinary symptoms owing to an underlying neurogenic lower urinary tract disorder which occurred following a cerebral infarction.

Dynamical Interconversion between Excitons and Geminate Charge Pairs in Two-Dimensional Perovskite Layers Described by the Onsager-Braun Model.

Time-resolved photoluminescence (PL) and femtosecond transient absorption (TA) spectroscopy are employed to study the photoexcitation dynamics in a highly emissive two-dimensional perovskite compound (en)4Pb2Br9·3Br with the ethylene diammonium (en) spacer. We find that while the PL kinetics is substantially T-dependent over the whole range of studied temperatures T ∼ 77-350 K, the PL quantum yield remains remarkably nearly T-independent up to T ∼ 280-290 K, appreciably decreasing only at higher temperatures. Considerable differences are also revealed between the TA spectra and the responses to the excitation power at low and at room temperatures. Numerical solutions of Onsager-Braun-type kinetic-diffusion equations illustrate that the salient features of the experimental observations are consistent with the picture of a T-dependent dynamic interplay between tightly bound emissive excitons and larger-size, loosely bound, nonemissive geminate charge pairs arising already at earlier relaxation times. The geminate pairs play the role of "reservoir" states providing a delayed feeding into the emitting excitons, thus giving rise to the longer-time PL decay components and accounting for a stable PL output at lower temperatures. At higher temperatures, the propensity for thermal dissociation of excitons and bound pairs increases, leading subsequently to the precipitous decrease of the PL.

High-Contrast Optical Modulation from Strain-Induced Nanogaps at 3D Heterogeneous Interfaces.

The realization of high-contrast modulation in optically transparent media is of great significance for emerging mechano-responsive smart windows. However, no study has provided fundamental strategies for maximizing light scattering during mechanical deformations. Here, a new type of 3D nanocomposite film consisting of an ultrathin (≈60 nm) Al2O3 nanoshell inserted between the elastomers in a periodic 3D nanonetwork is proposed. Regardless of the stretching direction, numerous light-scattering nanogaps (corresponding to the porosity of up to ≈37.4 vol%) form at the interfaces of Al2O3 and the elastomers under stretching. This results in the gradual modulation of transmission from ≈90% to 16% at visible wavelengths and does not degrade with repeated stretching/releasing over more than 10 000 cycles. The underlying physics is precisely predicted by finite element analysis of the unit cells. As a proof of concept, a mobile-app-enabled smart window device for Internet of Things applications is realized using the proposed 3D nanocomposite with successful expansion to the 3 × 3 in. scale.

Interleukin-27 polymorphisms are associated with inflammatory bowel diseases in a Korean population.

BACKGROUND AND AIMS: The cytokine interleukin (IL)-27 is composed of two subunits, Epstein-Barr virus-induced gene 3 (EBI3) and p28, and IL-27 is a novel IL-12 family member that mediates between the innate and adaptive immune systems. We previously identified four polymorphisms in the human IL-27 gene and we suggested that the polymorphism of IL-27 is associated with the susceptibility to asthma. IL-27 transcripts are significantly elevated in active Crohn's disease (CD) but not in ulcerative colitis (UC). To determine whether these IL-27 single nucleotide polymorphisms are associated with the susceptibility to inflammatory bowel disease (IBD), the genotype and allelic frequencies of the IL-27 polymorphisms were analyzed between the IBD patients and the healthy controls. METHODS: Genotype analysis of the IL-27 gene was performed by the single-base extension (SBE) method. The haplotype frequencies of IL-27 for multiple loci were estimated using the expectation maximization (EM) algorithm. RESULTS: The genotype frequencies of the g.-964A > G polymorphism in the IBD patients were significantly different from those of the healthy control group (P = 0.001). In both the UC and CD patients, the genotype frequencies of the g.-964A > G polymorphism were also significantly different from the frequencies of the healthy control group (P = 0.009). The frequencies of the AGT and GGT haplotypes were significantly different between the healthy control group and the IBD patient group (P = 0.00004 and 0.021, respectively). CONCLUSION: Our results suggest that the g.-964A > G polymorphism of the IL-27 gene located on the IBD1 locus might be associated with the susceptibility to IBD.

Efficacy and Safety of Adding Omega-3 Fatty Acids in Statin-treated Patients with Residual Hypertriglyceridemia: ROMANTIC (Rosuvastatin-OMAcor iN residual hyperTrIglyCeridemia), a Randomized, Double-blind, and Placebo-controlled Trial.

PURPOSE: The purpose of this study was to examine the efficacy and safety of adding ω-3 fatty acids to rosuvastatin in patients with residual hypertriglyceridemia despite statin treatment. METHODS: This study was a multicenter, randomized, double-blind, placebo-controlled study. After a 4-week run-in period of rosuvastatin treatment, the patients who had residual hypertriglyceridemia were randomized to receive rosuvastatin 20 mg/d plus ω-3 fatty acids 4 g/d (ROSUMEGA group) or rosuvastatin 20 mg/d (rosuvastatin group) with a 1:1 ratio and were prescribed each medication for 8 weeks. FINDINGS: A total of 201 patients were analyzed (mean [SD] age, 58.1 [10.7] years; 62.7% male). After 8 weeks of treatment, the percentage change from baseline in triglycerides (TGs) and non-HDL-C was significantly greater in the ROSUMEGA group than in the rosuvastatin group (TGs: -26.3% vs -11.4%, P < 0.001; non-HDL-C: -10.7% vs -2.2%, P = 0.001). In the linear regression analysis, the lipid-lowering effect of ω-3 fatty acids was greater when baseline TG or non-HDL-C levels were high and body mass index was low. The incidence of adverse events was not significantly different between the 2 groups. IMPLICATIONS: In patients with residual hypertriglyceridemia despite statin treatment, a combination of ω-3 fatty acids and rosuvastatin produced a greater reduction of TGs and non-HDL-C than rosuvastatin alone. Further study is needed to determine whether the advantages of this lipid profile of ω-3 fatty acids actually leads to the prevention of cardiovascular event. ClinicalTrials.gov identifier: NCT03026933.

Advanced Fast 3-D Electromagnetic Solver for Microwave Tomography Imaging.

This paper describes a fast-forward electromagnetic solver (FFS) for the image reconstruction algorithm of our microwave tomography system. Our apparatus is a preclinical prototype of a biomedical imaging system, designed for the purpose of early breast cancer detection. It operates in the 3-6-GHz frequency band using a circular array of probe antennas immersed in a matching liquid; it produces image reconstructions of the permittivity and conductivity profiles of the breast under examination. Our reconstruction algorithm solves the electromagnetic (EM) inverse problem and takes into account the real EM properties of the probe antenna array as well as the influence of the patient's body and that of the upper metal screen sheet. This FFS algorithm is much faster than conventional EM simulation solvers. In comparison, in the same PC, the CST solver takes ~45 min, while the FFS takes ~1 s of effective simulation time for the same EM model of a numerical breast phantom.

Vertically stacked nanocellulose tactile sensor.

Paper-based electronic devices are attracting considerable attention, because the paper platform has unique attributes such as flexibility and eco-friendliness. Here we report on what is claimed to be the firstly fully integrated vertically-stacked nanocellulose-based tactile sensor, which is capable of simultaneously sensing temperature and pressure. The pressure and temperature sensors are operated using different principles and are stacked vertically, thereby minimizing the interference effect. For the pressure sensor, which utilizes the piezoresistance principle under pressure, the conducting electrode was inkjet printed on the TEMPO-oxidized-nanocellulose patterned with micro-sized pyramids, and the counter electrode was placed on the nanocellulose film. The pressure sensor has a high sensitivity over a wide range (500 Pa-3 kPa) and a high durability of 104 loading/unloading cycles. The temperature sensor combines various materials such as poly(3,4-ethylenedioxythiophene)-poly(styrenesulfonate) (PEDOT:PSS), silver nanoparticles (AgNPs) and carbon nanotubes (CNTs) to form a thermocouple on the upper nanocellulose layer. The thermoelectric-based temperature sensors generate a thermoelectric voltage output of 1.7 mV for a temperature difference of 125 K. Our 5 × 5 tactile sensor arrays show a fast response, negligible interference, and durable sensing performance.

Development of elbow spasticity model for objective training of spasticity assessment of patients post stroke.

Reliable assessment is essential for the management of spasticity, one of the most frequent complication of various neurological diseases. For the spasticity assessment, several clinical tools have been developed and widely used in clinics. The most popular one is modified Ashworth scale (MAS). It has a simple protocol, but is subjective and qualitative. To improve its reliability, quantitative measurement and consistent training would be needed. This study presents an elbow spasticity simulator which mimics spastic response of adult post stroke survivors. First, spastic responses (i.e. resistance and joint motion) from patients with a stroke were measured during conventional MAS assessment. Each grade of MAS was quantified by using three parameters representing three characteristics of the spasticity. Based on the parameters, haptic models of MAS were developed for implementing repeatable and consistent haptic training of novice clinicians. Two experienced clinicians participated in preliminary evaluation of the models.