Changes in Nasal Tip Aesthetics Over Time Following Asian Tip Plasty.

OBJECTIVES: This study aimed to evaluate the sequential postoperative changes in tip aesthetics, by evaluating the aesthetic performance of the septal extension graft with or without tip grafting. METHODS: A total of 62 patients who underwent rhinoplasty with tip plasty were included. Using a three-dimensional scanner, we measured anthropometric aesthetic features of the nasal tip, including tip height, tip width, nasolabial angle, and columellar lobular angle. Preoperative and 1-month and 12-month postoperative anthropometric parameters were compared. The patients were grouped according to surgical techniques (i.e., septal extension only and septal extension plus tip grafting groups) and subtype of tip graft. RESULTS: The 1-month postoperative values of all four aesthetic features were significantly increased compared with the preoperative values. The tip height, tip width, and nasolabial angle at 12 months were significantly decreased compared with 1 month post-operation values, whereas the tip height and width were still greater than the preoperative values. No difference was found between 1 and 12 month values of columellar lobular angle. There were no differences in the degree of decrease in tip height, tip width, nasolabial angle, and columellar lobular angle between the septal extension graft only and septal extension graft plus tip graft groups. There were no differences in the tip graft by subtypes, single- and multi-layer tip grafts. CONCLUSIONS: Increased tip height, tip width, and widened nasolabial angle gained immediately after septal extension grafting surgery gradually decreased over the year regardless of addition of tip graft or tip grafting methods. LEVEL OF EVIDENCE: 4 Laryngoscope, 134:678-683, 2024.

The Antioxidant Activity of Undaria pinnatifida Sporophyll Extract Obtained Using Ultrasonication: A Focus on Crude Polysaccharide Extraction Using Ethanol Precipitation.

Undaria pinnatifida, a marine biological resource from which antioxidants such as polysaccharides can be obtained, is primarily distributed in the coastal areas of East Asia. Reactive oxygen species (ROS) are essential for physiological processes; however, excess ROS levels in the body result in cellular oxidative damage. Several extraction methods exist; however, factors such as long extraction times and high temperatures degrade polysaccharides. Therefore, this study aimed to increase the yield of U. pinnatifida sporophyll extract (UPE), a U. pinnatifida byproduct, using ultrasonication, an environmentally friendly extraction method, and identify UPE components with antioxidant activity. UPE_2, 4, 6, and 8 extracts were obtained at extraction times of 2, 4, 6, and 8 h, respectively. UPE_8 had the highest yield (31.91%) and polysaccharide (69.22%), polyphenol, (8.59 GAE µg/mg), and fucoxanthin contents (2.3 µg/g). UPE_8 showed the greatest protective and inhibitory effects on ROS generation in H2O2-damaged Vero cells. Ethanol precipitation of UPE_8 confirmed that UPE_8P (precipitate) had superior antioxidant activity in Vero cells compared to UPE_8S (supernatant). UPE_8P contained a large amount of polysaccharides, a major contributor to the antioxidant activity of UPE_8. This study shows that UPE_8 obtained using ultrasonication can be a functional food ingredient with excellent antioxidant activity.

Using a Deep Learning Model to Address Interobserver Variability in the Evaluation of Ulcerative Colitis (UC) Severity.

The use of endoscopic images for the accurate assessment of ulcerative colitis (UC) severity is crucial to determining appropriate treatment. However, experts may interpret these images differently, leading to inconsistent diagnoses. This study aims to address the issue by introducing a standardization method based on deep learning. We collected 254 rectal endoscopic images from 115 patients with UC, and five experts in endoscopic image interpretation assigned classification labels based on the Ulcerative Colitis Endoscopic Index of Severity (UCEIS) scoring system. Interobserver variance analysis of the five experts yielded an intraclass correlation coefficient of 0.8431 for UCEIS scores and a kappa coefficient of 0.4916 when the UCEIS scores were transformed into UC severity measures. To establish a consensus, we created a model that considered only the images and labels on which more than half of the experts agreed. This consensus model achieved an accuracy of 0.94 when tested with 50 images. Compared with models trained from individual expert labels, the consensus model demonstrated the most reliable prediction results.

Identification of the primary ciliary proteins IFT38 and IFT144 to enhance serum-mediated YAP activation and cell proliferation.

Primary cilia are essential cellular antennae that transmit external signals into intracellular responses. These sensory organelles perform crucial tasks in triggering intracellular signaling pathways, including those initiated by G protein-coupled receptors (GPCRs). Given the involvement of GPCRs in serum-induced signaling, we investigated the contribution of ciliary proteins in mitogen perception and cell proliferation. We found that depletion of cilia via IFT88 silencing impaired cell growth and repressed YAP activation against serum and its mitogenic constituents, namely lysophosphatidic acid (LPA) and sphingosine 1-phosphate (S1P). To identify the key player of serum mitogen signaling, a mutant cell line library with 30 ablated individual ciliary proteins was established and screened based on YAP dephosphorylation and target gene induction. While 9 of them had altered signaling, ablation of IFT38 or IFT144 led to a particularly robust repression of YAP activation upon LPA and S1P. The deficiency of IFT38 and IFT144 attenuated cell proliferation, as corroborated in either 2-dimensional cultures or tumor spheroids. In subcutaneous skin melanoma patients, expression of IFT38 and IFT144 was associated with unfavorable outcomes in overall survival. In conclusion, our study demonstrates the involvement of ciliary proteins in mitogen signaling and identifies the regulatory roles of IFT38 and IFT144 in serum-mediated Hippo pathway signaling and cellular growth.

The experience of device failure after cochlear implantation.

BACKGROUND: The present study describes the treatment of patients at a tertiary institution who experienced device failure after Cochlear Implantation (CI), as well as identifying prodromic symptoms that could assist in the timely identification and management of device failure. STUDY DESIGN: Retrospective database review (January 2000-May 2017). SETTING: Single tertiary hospital. METHODS: Factors recorded included the etiology of hearing loss; age at first and revision CI surgeries; surgical information, including operation time and approach; electrical outcomes after implantation; device implanted; symptoms of device failure; history of head trauma; and audiologic outcomes as determined by categories of auditory performance (CAP). RESULTS: From January 2000 to May 2017, 1431 CIs were performed, with 27 (1.9%) undergoing revision surgeries due to device failure. The most common etiology of hearing loss was idiopathic (12/27), followed by cochlear hypoplasia (5/27). Mean age at initial CI was 11.8 (1-72) years, with 21 being pre-lingual and 6 being post-lingual. Of the total devices initially implanted, 80.5% were from Cochlear, 15.9% from MED-EL, and 3.5% from Advanced Bionics. The failure rates of these devices were 1.3%, 3.1%, and 10.0%, respectively. The most suggestive symptom of device failure was intermittent loss of signal. Mean CAP scores were 5.17 before reimplantation and 5.54 and 5.81 at 1- and 3-years, respectively, after reimplantation. CONCLUSION: The most suggestive symptom preceding device failure was intermittent loss of signal. Patients who present with this symptom should undergo electrical examination for suspected device failure. Audiologic outcomes showed continuous development despite revision surgeries.

Revision Rhinoplasty Using Glued Diced Costal Cartilage Shaped With Mold for Management of Complicated Silicone Rhinoplasty.

BACKGROUND: Complicated silicone nose is a common clinical problem. Selection of replacement material for revision dorsal augmentation is a challenging task. OBJECTIVES: The authors presented their experience in the use of molded glued diced cartilage graft (GDCG) for revision rhinoplasty in patients who had complicated silicone augmentation. METHODS: The authors performed a retrospective review of the medical records of 28 patients who underwent silicone implant removal and revision dorsal augmentation with costal cartilage at a tertiary center between February 1, 2018, and February 28, 2022. Patient demographics, surgical technique, anthropometric measurements, and complication data were retrieved and analyzed. Aesthetic outcome scoring and anthropometric measurements were performed. RESULTS: Twenty-eight patients (9 males and 19 females) who underwent revision rhinoplasty with augmentation were reviewed. The principal indication for revision was cosmetic dissatisfaction. Mean postoperative follow-up duration was 18.3 months. All patients had revision dorsal augmentation with molded GDCG. Other key surgical techniques include the use of caudal septal extension and extended spreader and tip grafts. The majority of the patients were judged to have good or excellent outcomes (91.1%). There were significant percentage increases in dorsal height, radix height, nasal length, and nasal tip projection (2.78%, 2.26%, 7.53%, and 2.40%, respectively; P < .05) and reduction of nasal axis deviation of 1.15° (P < .05) postoperatively. Two patients had postoperative complications, including infection and cosmetic dissatisfaction. CONCLUSIONS: Revision rhinoplasty following unsuccessful silicone augmentation is commonly encountered in the Asian population. Molded GDCG for revision dorsal augmentation is a reliable option that delivers good to excellent aesthetic outcomes with acceptable complication rates.

Early Ambulation to Prevent Delirium After Long-Time Head and Neck Cancer Surgery.

Objective: Postoperative delirium is known to have various adverse effects on head and neck surgery patients. This study was designed to identify possible risk factors of delirium following long periods of head and neck cancer surgery and to help prevent postoperative delirium. Methods: We enrolled 197 patients who underwent long-time (>6 h) head and neck surgery at the Asan Medical Center from January 2017 to December 2018 in this study. Clinical covariates that may be associated with delirium were analyzed retrospectively using univariate and multivariate analyses. Results: Delirium occurred in 18 patients (9.1%). Within the first 7 days, 16 patients (88.9%) experienced delirium. Upon univariate analysis, delirium was associated with old age (≥75, p = 0.001), past neurological history (p = 0.019), time to ambulation (p = 0.014), and postoperative hospital day (p = 0.048). In multivariate analysis, old age (≥75, odds ratios (OR) 6.16, CI 2.00-19.00, p = 0.002), time to ambulation (OR 1.04, CI 1.01-1.07, p = 0.017), and past neurological history (OR 5.26, CI 1.09-25.37, p = 0.039) were significant risk factors associated with postoperative delirium. Conclusions: Older patients or patients with neurologic history must be attended with care, especially early after surgery. Encouraging early ambulation might lower the incidence of postoperative delirium and, subsequently, reduce adverse effects. This result could benefit patients by helping them avoid undesirable outcomes.

Investigation of Flow Changes in Intracranial Vascular Disease Models Constructed with MRA Images.

This study aimed to develop a magnetic resonance imaging (MRI)-compatible flow delivery system and individualized models of circle of Willis (CoW), which include 50% and 100% blockage in internal carotid artery (ICA50 and ICA100), and 100% blockage in vertebral artery (VA100). Images were obtained using 3D time-of-flight and phase-contrast magnetic resonance angiography (MRA) sequences, and changes in velocity and flow direction at CoW models were analyzed. For the ICA50 and VA100 models, the flow was similar to that of the normal model. For the ICA 50 model, it was found that 50% blockage did not affect cerebral blood flow. For the VA100 model, decreased flow in the posterior cerebral artery and a change to the flow direction in the posterior communicating artery were found. For the ICA100 model, particularly, decreased flow in the ipsilateral middle and anterior cerebral arteries and a change to the flow direction in the ipsilateral anterior cerebral artery of the CoW were found. These results demonstrated that the flow system with various CoW disease models tailored to individual characteristics could be used to predict stroke onset more quickly. For the ICA50 and VA100 models, the possibility of cerebral infarction was significantly lower. On the other hand, for the ICA100 model, there was a high possibility of decreased flow, which could lead to cerebral infarction.

Immune-enhancing effects of polysaccharide extract of by-products of Korean liquor fermented by Saccharomyces cerevisiae.

To increase the value of yeast-fermented Korean liquor by-products, we obtained crude polysaccharide (CPS) fractions via ultrasound-assisted extraction and stepwise-gradient ethanol precipitation and investigated their functionality. Nitric oxide production in RAW 264.7 cells was increased following treatment with the CPSs derived from extract. Analysis of the monosaccharide and amino acid composition of the CPS fractions using HPLC revealed that the polysaccharides were mainly composed of glucose (57.2%), mannose (22.6%), and galactose (17.6%), and no amino acids were detected. In addition, a higher concentration of ethanol solvent for fractionation yielded polysaccharides with lower molecular weights (<15 kDa). CPS 3 and 4 fractions increased the production of TNF-α (15 and 17-fold, respectively) and IL-6 (20 and 18-fold, respectively) and iNOS (65 and 35-fold, respectively) expression at concentration 12.5 µg/mL compared with levels in non-treated RAW 264.7 cells. Especially, CPS 4 at 200 and 400 µg/mL significantly increased the proliferation of mouse spleen cells by 126% and 153%, respectively. These results indicated that CPS 4 enhanced the proliferation of mouse spleen cells in vivo, indicating its immune-enhancing effects. Therefore, this research can contribute to the development of eco-friendly extraction techniques and immune-enhancing materials.

Active Contours Using Additive Local and Global Intensity Fitting Models for Intensity Inhomogeneous Image Segmentation.

This paper introduces an improved region based active contour method with a level set formulation. The proposed energy functional integrates both local and global intensity fitting terms in an additive formulation. Local intensity fitting term influences local force to pull the contour and confine it to object boundaries. In turn, the global intensity fitting term drives the movement of contour at a distance from the object boundaries. The global intensity term is based on the global division algorithm, which can better capture intensity information of an image than Chan-Vese (CV) model. Both local and global terms are mutually assimilated to construct an energy function based on a level set formulation to segment images with intensity inhomogeneity. Experimental results show that the proposed method performs better both qualitatively and quantitatively compared to other state-of-the-art-methods.

Segmentation of Regions of Interest Using Active Contours with SPF Function.

Segmentation of regions of interest is a well-known problem in image segmentation. This paper presents a region-based image segmentation technique using active contours with signed pressure force (SPF) function. The proposed algorithm contemporaneously traces high intensity or dense regions in an image by evolving the contour inwards. In medical image modalities these high intensity or dense regions refer to tumor, masses, or dense tissues. The proposed method partitions an image into an arbitrary number of subregions and tracks down salient regions step by step. It is implemented by enforcing a new region-based SPF function in a traditional edge-based level set model. It partitions an image into subregions and then discards outer subregion and partitions inner region into two more subregions; this continues iteratively until a stopping condition is fulfilled. A Gaussian kernel is used to regularize the level set function, which not only regularizes it but also removes the need of computationally expensive reinitialization. The proposed segmentation algorithm has been applied to different images in order to demonstrate the accuracy, effectiveness, and robustness of the algorithm.

Segmentation of intensity inhomogeneous brain MR images using active contours.

Segmentation of intensity inhomogeneous regions is a well-known problem in image analysis applications. This paper presents a region-based active contour method for image segmentation, which properly works in the context of intensity inhomogeneity problem. The proposed region-based active contour method embeds both region and gradient information unlike traditional methods. It contains mainly two terms, area and length, in which the area term practices a new region-based signed pressure force (SPF) function, which utilizes mean values from a certain neighborhood using the local binary fitted (LBF) energy model. In turn, the length term uses gradient information. The novelty of our method is to locally compute new SPF function, which uses local mean values and is able to detect boundaries of the homogenous regions. Finally, a truncated Gaussian kernel is used to regularize the level set function, which not only regularizes it but also removes the need of computationally expensive reinitialization. The proposed method targets the segmentation problem of intensity inhomogeneous images and reduces the time complexity among locally computed active contour methods. The experimental results show that the proposed method yields better segmentation result as well as less time complexity compared with the state-of-the-art active contour methods.

Influence of radiologically evident residual intimal tear on expansion of descending aorta following surgery for acute type I aortic dissection.

BACKGROUND: Although a residual intimal tear may contribute to the dilatation of the descending aorta following surgical repair of acute type I aortic dissection (AD), its causal relationship has not been elucidated by clinical data due to the limited resolution of imaging modalities. METHODS: This study enrolled 41 patients (age, 55.2±11.9 years) who were evaluated with dual-source computed tomography (CT) imaging of the whole aorta in the setting of the surgical repair of acute type I AD. Logistic regression models were used to determine the predictors of a composite of the aortic aneurysm formation (diameter >55 mm) and rapid aortic expansion (>5 mm/yr). RESULTS: On initial CT, a distal re-entry tear was identified in 9 patients. Two patients failed to achieve proximal tear exclusion by the surgery. Serial follow-up CT evaluations (median, 24.6 months; range, 6.0 to 67.2 months) revealed that 14 patients showed rapid expansion of the descending aorta or aortic aneurysm formation. A multivariate analysis revealed that the residual intimal tear (odds ratio [OR], 4.31; 95% confidence interval [CI], 1.02 to 19.31) and the patent false lumen in the early postoperative setting (OR, 4.64; 95% CI, 0.99 to 43.61) were predictive of the composite endpoint. CONCLUSION: The presence of a residual intimal tear following surgery for acute type I AD adversely influenced the expansion of the descending aorta.

Device/Circuit co-design guide for passive memristor array with non-linear current-voltage behavior.

In this paper, the non-linearity in memristor's current-voltage relationship that can affect half-selected cells is analyzed. From the simulation, for the V(DD)/2 scheme, if the non-linear coefficient is larger than 8, unwanted resistance loss during the write time can be suppressed less than 10%. Comparing the V(DD)/2 and V(DD)/3 scheme, the V(DD)/2 scheme can reduce the current consumption by 2 orders of magnitude with little larger resistance change in half-selected cells than the V(DD)/3.

Multipass active contours for an adaptive contour map.

Isocontour mapping is efficient for extracting meaningful information from a biomedical image in a topographic analysis. Isocontour extraction from real world medical images is difficult due to noise and other factors. As such, adaptive selection of contour generation parameters is needed. This paper proposes an algorithm for generating an adaptive contour map that is spatially adjusted. It is based on the modified active contour model, which imposes successive spatial constraints on the image domain. The adaptability of the proposed algorithm is governed by the energy term of the model. This work focuses on mammograms and the analysis of their intensity. Our algorithm employs the Mumford-Shah energy functional, which considers an image's intensity distribution. In mammograms, the brighter regions generally contain significant information. Our approach exploits this characteristic to address the initialization and local optimum problems of the active contour model. Our algorithm starts from the darkest region; therefore, local optima encountered during the evolution of contours are populated in less important regions, and the important brighter regions are reserved for later stages. For an unrestricted initial contour, our algorithm adopts an existing technique without re-initialization. To assess its effectiveness and robustness, the proposed algorithm was tested on a set of mammograms.

Lipid products of phosphoinositide 3-kinase abrogate genistein-induced fusion inhibition in myoblasts.

Genistein (4',5,7-trihydroxyisoflavone) is a tyrosine kinase inhibitor. Although the agent has shown to inhibit myoblast differentiation, neither intracellular target(s) as a tyrosine kinase inhibitor nor action mechanism of the agent is well known. Here we studied the effect of genistein on the differentiation of myoblasts. Genistein strongly but reversibly blocked both myoblast fusion and synthesis of the muscle-specific proteins. The agent also reversibly reduced the phosphorylation level of focal adhesion kinase (FAK), a cytoplasmic tyrosine kinase, and its interaction with p85, the regulatory subunit of phosphoinositide 3-kinase (PI3-kinase). In addition, genistein indirectly inhibited PI3-kinase activity and blocked calcium influx which is required for myoblast fusion. However, both genistein-induced inhibition of cell fusion and calcium influx were abrogated by the lipid products of PI3-kinase. These results demonstrate that genistein can exert their effect on the signaling pathway from FAK to calcium influx via PI3-kinase in the differentiation of myoblasts.