The incidences of nausea and vomiting after general anesthesia with remimazolam versus sevoflurane: a prospective randomized controlled trial.

Background: Postoperative nausea and vomiting (PONV) refers to nausea and vomiting that occurs within 24-h after surgery or in the post-anesthesia care unit (PACU). Previous studies have reported that the use of remimazolam, a newer benzodiazepine (BDZ) hypnotic, for anesthesia results in less PONV. In this study, we compared the rate of PONV between sevoflurane and remimazolam after general anesthesia. Methods: In this prospective randomized controlled trial (RCT), participants aged 20-80 years who underwent elective laparoscopic cholecystectomy or hemicolectomy were randomized to either the remimazolam or sevoflurane group. The primary outcome was PONV incidence for 24-h after surgery. Secondary outcomes comprised of PONV at 30-min post-surgery, postoperative additional antiemetic use, and Quality of Recovery-15 (QOR-15) score at 24-h postoperatively. Results: Forty patients were enrolled in the study. The remimazolam group exhibited significantly lower rates of PONV for 24-h after surgery than did the sevoflurane group (remimazolam group vs. sevoflurane group; 5% vs. 45%, P = 0.003, respectively). The use of dexamethasone, a rescue antiemetic administered within 24 h of surgery, was substantially lower in the remimazolam group than in the sevoflurane group (0% in remimazolam vs. 30% in sevoflurane, P = 0.020). The QOR-15 score at 24-h after surgery showed no significant difference between the two groups. Conclusions: Compared to sevoflurane, opting for remimazolam as an intraoperative hypnotic may decrease the incidence of PONV and reduce antiemetic use for 24 h after laparoscopic surgery.

Dream360: Diverse and Immersive Outdoor Virtual Scene Creation via Transformer-Based 360° Image Outpainting.

360° images, with a field-of-view (FoV) of $180^{\circ}\times 360^{\circ}$, provide immersive and realistic environments for emerging virtual reality (VR) applications, such as virtual tourism, where users desire to create diverse panoramic scenes from a narrow FoV photo they take from a viewpoint via portable devices. It thus brings us to a technical challenge: 'How to allow the users to freely create diverse and immersive virtual scenes from a narrow FoV image with a specified viewport?' To this end, we propose a transformer-based 360° image outpainting framework called Dream360, which can generate diverse, high-fidelity, and high-resolution panoramas from user-selected viewports, considering the spherical properties of 360° images. Compared with existing methods, e.g., [3], which primarily focus on inputs with rectangular masks and central locations while overlooking the spherical property of 360° images, our Dream360 offers higher outpainting flexibility and fidelity based on the spherical representation. Dream360 comprises two key learning stages: (I) codebook-based panorama outpainting via Spherical-VQGAN (S-VQGAN), and (II) frequency-aware refinement with a novel frequency-aware consistency loss. Specifically, S-VQGAN learns a sphere-specific codebook from spherical harmonic (SH) values, providing a better representation of spherical data distribution for scene modeling. The frequency-aware refinement matches the resolution and further improves the semantic consistency and visual fidelity of the generated results. Our Dream360 achieves significantly lower Frechet Inception Distance (FID) scores and better visual fidelity than existing methods. We also conducted a user study involving 15 participants to interactively evaluate the quality of the generated results in VR, demonstrating the flexibility and superiority of our Dream360 framework.

Surgical treatment of interhemispheric arachnoid cysts.

OBJECTIVE: In children, interhemispheric arachnoid cysts (IHACs) are rare lesions often associated with corpus callosum dysgenesis. It is still controversial about surgical treatments for IHACs. We aim to report our experience with pediatric IHAC patients and evaluate surgical courses and neurological developments. METHODS: Pediatric IHACs treated between 2001 and 2021 were reviewed retrospectively. IHAC was observed until they represented rapid cyst enlargement or neurological symptoms. Cyst fenestration was done by microscope or endoscope, depending on the IHAC's location. Cyst size and corpus callosum dysgenesis were evaluated with neuroimaging. Neurological development was assessed from medical records at the last follow-up. RESULTS: Fifteen children received cyst fenestration surgery (mean age 11.4 months). Eleven patients (73.3%) under observation showed rapid cyst enlargement in a short period (median 5 months). Cysto-ventriculostomy (CVS) and cysto-cisternostomy (CCS) regressed the cyst size significantly (p = 0.003). The median follow-up duration was 51 months (range 14-178 months). Corpus callosum dysgenesis was observed in eleven patients (73.3%, complete = 5, partial = 6). Among eight patients (53.3%) having developmental delay, five patients (33.3%) showed speech delay, including one patient with intractable seizures. CONCLUSION: Pediatric IHACs frequently present within 1 year after birth, with rapid cyst enlargement. CVS and CCS were effective in regressing the cyst size. Corpus callosum dysgenesis accompanied by IHAC might have a risk of language achievement; however, development delay could rely on multifactorial features, such as epilepsy or other brain anomalies.

Coronal and sagittal alignment of ankle joint is significantly affected by high tibial osteotomy.

PURPOSE: Changes in coronal and sagittal alignment of the knee joint after HTO have been reported in several previous studies. However, only few of them investigated the changes only on coronal alignment of the ankle joint. The purpose of this study was to investigate changes in both coronal and sagittal alignment of the ankle joint after HTO. METHODS: 46 patients (49 cases) who underwent HTO were retrospectively analyzed. Preoperative and postoperative lower extremity scanogram and EOS imaging system were investigated. The hip-knee-ankle (HKA) angle, medial proximal tibial angle (MPTA), and knee tibia plafond angle (KTPA) were measured by scanogram to evaluate coronal alignment of the knee. Tibial anterior surface angle (TAS), talar tilt (TT), tibial plafond inclination (TPI), and ankle joint axis point on the weight-bearing-line (AAWBL) ratio were measured by scanogram to investigate coronal alignment of the ankle. Knee lateral ankle surface angle (KLAS) and tibial lateral surface angle (TLS) were measured by EOS to evaluate sagittal alignment of the ankle. RESULTS: Varus alignment of the knee was corrected by significant change of the HKA angle (5.8 ± 3.1° vs. - 2.1 ± 2.8°, p < 0.001), MPTA (85.7 ± 2.9° vs. 91.7 ± 3.3°, p < 0.001), and KTPA (5.0 ± 3.5° vs. - 2.1 ± 4.2°, p < 0.001) after HTO. Regarding the ankle coronal alignment, there was significant change in TPI (3.9 ± 3.4° vs. - 0.9 ± 3.8°, p < 0.001) and AAWBL ratio (45.5 ± 14.7% vs. 61.6 ± 13.3%, p < 0.001). In sagittal alignment of the ankle, KLAS (4.5 ± 3.1° vs. 7.7 ± 3.7°, p < 0.001) significantly increased. Among the variables, the amount of correction in AAWBL ratio (R = 0.608, p < 0.01) showed strongest relationship with tibial correction angle. CONCLUSION: Based on the present study, coronal and sagittal alignment of ankle joint was significantly affected by HTO. After HTO, AAWBL ratio increased due to lateralization of the ankle joint axis, and KLAS increased due to increased posterior tibial slope. LEVEL OF EVIDENCE: III.

Fabrication and Characterization of Three-Dimensional Microelectromechanical System Coaxial Socket Device for Semiconductor Package Testing.

With the continuous reduction in size and increase in density of semiconductor devices, there is a growing demand for contact solutions that enable high-speed testing in automotive, 5G, and artificial intelligence-based devices. Although existing solutions, such as spring pins and rubber sockets, have been effective in various applications, there is still a need for new solutions that accommodate fine-pitch, high-speed, and high-density requirements. This study proposes a novel three-dimensional microelectromechanical system spring structure coaxial socket for semiconductor chip package testing. The socket design incorporates impedance matching for high-speed testing and addresses the challenges of fine-pitch and high-density applications. Mechanical tests are conducted to evaluate the durability of the structure and electrical tests are performed to verify electrical characteristics by utilizing a vector network analyzer up to 60 GHz. Our results have revealed promising performance and will help in further optimizing the design for potential production in the field and industry.

Effects of intraoperative motor evoked potential amplification following tetanic stimulation of the pudendal nerve in pediatric craniotomy.

OBJECTIVE: Monitoring the intraoperative motor evoked potentials (MEPs) in pediatric craniotomy is challenging because of its low detection rate, which makes it unreliable. Tetanic stimulation of the peripheral nerves of the extremities and pudendal nerves prior to transcranial electrical stimulation (TES) or direct cortical stimulation (DCS) amplifies the MEPs. The authors investigated the effects of MEP amplification following tetanic stimulation of the median and tibial nerve or the pudendal nerve in pediatric patients undergoing craniotomy. METHODS: This prospective observational study included 15 patients ≤ 15 years of age (mean age 8.9 ± 4.9 years) undergoing craniotomy. MEPs were obtained with TES (15 cases) or DCS (8 cases)-conventional MEP without tetanic stimulation (c-MEP) and MEP following tetanic stimulation of the unilateral median and tibial nerves (mt-MEP) or following tetanic stimulation of the pudendal nerve (p-MEP) were used. Compound muscle action potentials were elicited from the abductor pollicis brevis, gastrocnemius, tibialis anterior, and abductor hallucis longus muscles. The authors compared the identification rate and the rate of amplitude increase of each MEP. RESULTS: For both TES and DCS, the identification and amplitude increase rates were significantly higher in cases without preoperative hemiparesis for p-MEPs than in those for c-MEPs and mt-MEPs. In comparison to patients with preoperative hemiparesis, p-MEPs displayed a higher identification rate, with fewer false negatives in DCS cases. CONCLUSIONS: In pediatric craniotomy, the authors observed the amplification effect of MEPs with pudendal nerve tetanic stimulation and the amplification effect of DCS on MEPs without increasing false negatives. These findings suggested the likelihood of more reliable intraoperative MEP monitoring in pediatric cases.

Expression and distribution of generated neurons and endogenous precursors in rat cerebral cortical venous ischemia.

Neurogenesis in the subventricular zone (SVZ), subgranular zone (SGZ), and cerebral cortex is now a familiar event to confirm by cerebral arterial ischemia in rat models. However, it remains unclear whether cerebral venous ischemia (CVI) alone causes neurogenesis, and where that neurogenesis occurs. After creating CVI rat models via a two-vein occlusion (2-VO) method, neurogenesis was immunohistochemically evaluated by double-labeling 5-bromo-2'-deoxyuridine (BrdU)-positive cells with neuronal nuclei (NeuN) or doublecortin (DCX) antibody. Fifty Wistar rats were divided into two major groups (BrdU-NeuN and BrdU-DCX) and then separated into two subgroups (2-VO or sham). The total number of double-positive cells expressed inside a predefined region of interest (ROI) covering the ischemic area was compared between the two subgroups. Then, we divided the ROI into six sections to evaluate and compare the distribution of double-positive cells generated in each section between the two subgroups. The 2-VO subgroup presented more double-positive cells than the sham group in both BrdU-NeuN and BrdU-DCX groups, while the BrdU-DCX+2-VO group showed a characteristic distribution of double-positive cells in ROI 2 and ROI 3, suggesting areas of the ischemic core and penumbra, with a significant difference compared to the BrdU-DCX+sham group. This study demonstrates that CVI has the potential to induce endogenous neurogenesis, with significant numbers of both newly generated neurons and precursors observed in the ischemic area. The distribution of these cells suggests that the cortex could be the main origin of neurogenesis after cortical CVI.

Unsupervised Contour Tracking of Live Cells by Mechanical and Cycle Consistency Losses.

Analyzing the dynamic changes of cellular morphology is important for understanding the various functions and characteristics of live cells, including stem cells and metastatic cancer cells. To this end, we need to track all points on the highly deformable cellular contour in every frame of live cell video. Local shapes and textures on the contour are not evident, and their motions are complex, often with expansion and contraction of local contour features. The prior arts for optical flow or deep point set tracking are unsuited due to the fluidity of cells, and previous deep contour tracking does not consider point correspondence. We propose the first deep learning-based tracking of cellular (or more generally viscoelastic materials) contours with point correspondence by fusing dense representation between two contours with cross attention. Since it is impractical to manually label dense tracking points on the contour, unsupervised learning comprised of the mechanical and cyclical consistency losses is proposed to train our contour tracker. The mechanical loss forcing the points to move perpendicular to the contour effectively helps out. For quantitative evaluation, we labeled sparse tracking points along the contour of live cells from two live cell datasets taken with phase contrast and confocal fluorescence microscopes. Our contour tracker quantitatively outperforms compared methods and produces qualitatively more favorable results. Our code and data are publicly available at https://github.com/JunbongJang/contour-tracking/.

Mesenchymal stem cell spheroids alleviate neuropathic pain by modulating chronic inflammatory response genes.

Chronic neuropathic pain is caused by dysfunction of the peripheral nerves associated with the somatosensory system. Mesenchymal stem cells (MSCs) have attracted attention as promising cell therapeutics for chronic pain; however, their clinical application has been hampered by the poor in vivo survival and low therapeutic efficacy of transplanted cells. Increasing evidence suggests enhanced therapeutic efficacy of spheroids formed by three-dimensional culture of MSCs. In the present study, we established a neuropathic pain murine model by inducing a chronic constriction injury through ligation of the right sciatic nerve and measured the therapeutic effects and survival efficacy of spheroids. Monolayer-cultured and spheroids were transplanted into the gastrocnemius muscle close to the damaged sciatic nerve. Transplantation of spheroids alleviated chronic pain more potently and exhibited prolonged in vivo survival compared to monolayer-cultured cells. Moreover, spheroids significantly reduced macrophage infiltration into the injured tissues. Interestingly, the expression of mouse-origin genes associated with inflammatory responses, Ccl11/Eotaxin, interleukin 1A, tumor necrosis factor B, and tumor necrosis factor, was significantly attenuated by the administration of spheroids compared to that of monolayer. These results suggest that MSC spheroids exhibit enhanced in vivo survival after cell transplantation and reduced the host inflammatory response through the regulation of main chronic inflammatory response-related genes.

Comparative Analysis of Domestic and International Test Guidelines for Various Concrete Repair Materials.

The number of aged bridges among concrete structures is increasing. Therefore, to increase their lifespans, repair and reinforcement schemes ought to be implemented. This study selected various repair materials according to crack-surface treatment, crack-filling, and crack-injection methods. These repair materials were evaluated using various test methods proposed by the Korean Standards and the American Society for Testing and Materials for structure protection, structure restoration, and crack repair; the results were analyzed and compared. Consequently, the structure restoration material exhibited a similar freezing-thawing trend as that of chloride, while also exhibiting similar flexural, compressive, bond, and splitting-tensile strengths. However, chloride yielded performance differences (up to two-fold) depending on the type of material used for comparison. The crack-repair material yielded similar trends only for bond strength but yielded differences (up to 2-4-fold) in tensile, compressive, and flexural strengths depending on the material used for comparison. These results confirmed that crack-repair materials exhibit significant differences in performance depending on the manufacturer compared with structure protection and structure restoration materials. Therefore, it is expected that repair materials appropriate for usability, durability, and structure safety, while also being environmentally friendly, could be used in future bridge repairs based on these test evaluations.

Enhancement of Bond Performance of Advanced Composite Materials Used in Cable Bridge Structures Based on Tensile Tests.

Structural steel and concrete are essential materials for the construction of social infrastructures. However, these materials undergo degradation over time, thereby causing steel corrosion. To address this problem, a fiber-reinforced polymer (FRP) is used for reinforcement. In this study, tensile tests were performed to evaluate the material properties for the application of the FRP to cable bridge structures. These tests aimed to investigate various parameters to improve bond performance. Based on experiments with different parameters, sufficient bond performance could be achieved if the following conditions are met: mortar water ≤16%, regardless of the manufacturer; a depth of splitting and steel pipe length ratio ≥75%; upward/downward directions for the mortar injection; and the use of fiber-sheet reinforcement. In addition, the steel pipe used in the test (length of 410 mm and outer diameter of 42.7 mm) performed the best in terms of workability and cost effectiveness. By conducting more accurate tests to study the basic properties of materials, more accurate conditions to accomplish sufficient bond performance can likely be achieved. This will contribute to improved cost effectiveness and safety in the use of carbon FRP cables in cable bridge constructions.

Experimental Study on Effects of Additional Prestressing Using Fiber Reinforced Polymers and Strands on Deterioration of PSC Bridge Structure.

Concrete bridge structures require reinforcement, as their performance deteriorates over time. In this regard, this study evaluated the effect of additional prestressing using fiber-reinforced polymers (FRPs) and strands applied to a demolished, deteriorated bridge. In particular, specimens were prepared for a bridge subjected to non-, near-surface mounted (NSM), and external prestressing (EP) strengthening to evaluate the stiffness and safety of the structure. In the 200-400 kN load range, the EP method exhibited the highest stiffness (15 kN/mm), followed by non-strengthening (8.5 kN/mm) and the NSM method (5.45 kN/mm). The EP method increased the stiffness by approximately two times; however, the NSM method decreased the stiffness by 0.6 times. In the 400-800 kN load range, the EP and NSM methods yielded stiffness values of 2.58 and 0.7 kN/mm, respectively. These results confirm that the EP method reinforces the structure. The results of this study are expected to be used as basic data to reinforce deteriorated bridges in actual operation.

Improvement of Anchorage Performance of Carbon Fiber-Reinforced Polymer Cables.

Prestressed concrete composed of steel materials is increasingly used in various social infrastructures, such as bridges (cables), nuclear containment structures, liquefied natural gas (LNG) tanks, and structural reinforcements. This study aimed to substitute the steel in bridge cables with fiber-reinforced polymers (FRPs) to prevent the damage caused by the performance degradation of corroded prestressed steel. An optimized single-anchorage system was derived by applying multiple variables, such as the surface treatment, number of insert layers, and sleeve processing companies, to improve the maximum load and bonding with the anchorage system sleeve using the carbon FRP (CFRP) cable. The B-L-4 specimen (sleeve specifications of company B, longitudinal surface treatment, and four insert layers) was determined to be the optimized single-anchorage system. When the tensile test was conducted after applying the optimized single-anchorage system to the three- and seven-multi-anchorage systems, the tensile performances of B-L-4 were 100 and 95% of the one-multi-anchorage system, respectively. Considering that the problems associated with the construction of three- and seven-multi-anchorage systems have been addressed, these systems can be applied to actual bridges in the future, and can significantly benefit their maintenance.

Sagittal Parameters of Spine and Pelvis in Young Adults Using the EOS Imaging System: Prospective Study of 92 Asymptomatic Subjects.

STUDY DESIGN: This study adopted a prospective study design to evaluate the sagittal parameters of the spine and pelvis in young adults using the EOS imaging system. PURPOSE: This study was designed to analyze spinopelvic sagittal alignment measurement values obtained using the EOS imaging system in asymptomatic young adults. OVERVIEW OF LITERATURE: Sagittal alignment of the spine and pelvis is important in diagnosing and treating spinal diseases. We usually take sagittal images using whole-spine standing lateral radiography. Recently, the EOS imaging system, which uses a low-dose radiation in a weight-bearing state, was developed. So, we studied the sagittal parameters of the spine and pelvis in young adults by using the EOS imaging system. METHODS: We recruited young adults aged 20-30 years and explained the EOS imaging system. They voluntarily participated in the study. We took full-body standing orthogonal anteroposterior and lateral images using the EOS imaging system (EOS imaging, Paris, France). Then, we measured the pelvic incidence (PI), sacral slope (SS), pelvic tilt (PT), sagittal vertical axis (SVA), T1/T12 kyphosis, and L1/S1 lordosis. We analyzed each parameter using Student t-test, paired t-test, and Pearson's correlation coefficient. RESULTS: Ninety-two patients were enrolled in the study. The average PI and SS were 47.18° and 36.03°, respectively. Moreover, PT and SVA were 11.17° and -10.15 mm, respectively. T1/T12 kyphosis was 37.37°, while L1/S1 lordosis was 46.64°. All parameters were enough for normal distribution. Pearson correlation coefficient analysis showed a meaningful correlation between PI and SS and PI and PT (R>0.6, p<0.05). CONCLUSIONS: Measuring spinal and pelvic sagittal values is important. Sagittal parameters could help decide how to operate patients with spinal diseases. We attempted to obtain sagittal values using the EOS imaging system. These parameters could help preoperatively estimate the lumbar lordosis restoration and could also be used as guidelines for spinopelvic sagittal balance.

Comparison of the effect of electromyogram activity during emergence on anesthetic depth monitoring between phase lag entropy and bispectral index: a prospective observational study.

BACKGROUND: The bispectral index (BIS) is the most widely used algorithm for measuring anesthetic depth. The BIS has been demonstrated as inaccurate when neuromuscular blocking drugs (NMBDs) are used. Compared with BIS, phase lag entropy (PLE), which measures the anesthetic depth based on a 4-channel EEG signal, is less affected by EMG. The purpose of this study was to compare the effect of EMG activity during emergence on anesthetic depth monitoring between PLE and BIS. METHODS: Twenty five consecutive patients with physical status I-II of American Society of Anesthesiologists undergoing general anesthesia (age range, 20-60 years). The anesthesiologist attached the sensors of BIS and PLEM 100 on the patient's forehead. NMB reversal was performed by intravenously injecting sugammadex after confirmation of shallow NMB (TOF count 1-4) under neuromuscular monitoring. The BIS and PLE scores were recorded with neuromuscular monitoring at 1-min intervals for 5 min after administration of sugammadex. RESULTS: The BIS and BIS-EMG measured at 1 min after sugammadex injection were significantly higher at 1 min [51.650 (46.100, 62.225) (P<0.001); 28.500 (27.800, 31.075) (P=0.003)] than at 0 min. However, there was no between-time point difference in the PLE score and PLE-EMG (P=0.0843, P=0.329). CONCLUSIONS: In general anesthesia using propofol-remifentanil, the BIS at 1 min after sugammadex reversal during emergence appears to be more affected by EMG activity than the PLE score. Therefore, immediately after sugammadex administration (within 1 min), it may be clinically useful to evaluate the consciousness status through the PLE score.

Optimal ICG dosage of preoperative colonoscopic tattooing for fluorescence-guided laparoscopic colorectal surgery.

BACKGROUND: Indocyanine green (ICG) is a multifunctional dye used in tumor localization, tissue perfusion, and lymph node (LN) mapping during fluorescence-guided laparoscopic colorectal surgery. PURPOSE: This study aimed to establish the optimal protocol for preoperative endoscopic submucosal ICG injection to perform fluorescence lymph node mapping (FLNM), along with undisturbed fluorescent tumor localization and ICG angiography during a single surgery. METHODS: Colorectal cancer patients (n = 192) were enrolled from May 2017 to December 2019. Colonoscopic submucosal ICG injection was performed 12 to 18 h before surgery. ICG injection protocols were modified based on the total injected ICG (mg) and tattooing site number. The concentrations of ICG were gradually decreased from the standard dose (2.5 mg/ml) to the minimum dose (0.2 mg/ml). Successful FLNM (FLNM-s) was defined as distinct fluorescent LNs observed under NIR camera. The patient's age, sex, body mass index (BMI), stage, cancer location, obstruction, and laboratory findings were compared between the FLNM-s and failed FLNM (FLNM-f) groups to identify clinical and pathological factors that affect FLNM. RESULTS: In the ICG dose section of 0.5 to 1 mg, the success rate was highest within all functions including FLNM, fluorescent tumor localization, and ICG angiography. FLNM-s was related to ICG dose (0.5-1 mg), multiple submucosal injections, location of cancer, camera light source, and lower BMI. In the multivariate analysis, camera light source, non-obesity, and multiple injections were independent factors for FLNM-s). The mean total number of harvested LNs was significantly higher in the FLNM-s group than that in the FLNM-f group (p < 0.001). The number of metastatic lymph nodes was comparable between the two groups (p = 0.859). CONCLUSIONS: Preoperative, endoscopic submucosal ICG injection with dose range 0.5 to 1 mg would be optimal protocol for multifunctional ICG applications during fluorescence-guided laparoscopic colorectal surgery.