Background Treatment of patients with a giant pituitary neuroendocrine tumor (GPitNET) is challenging. Here, we present the methods used for the clinical management of patients who underwent GPitNET resection mainly via endoscopic endonasal surgery along with multimodal support to avoid surgical complications, which can affect the outcomes. Methodology The medical records of 25 patients with a GPitNET who underwent endonasal endoscopic surgery were retrospectively reviewed. Complications were analyzed and factors affecting the extent of resection were evaluated. Results Gross total resection was achieved in six (24%), near-total resection (>90%) in nine (36%), and partial resection in 10 (40%) patients. Multivariate analyses revealed that tumors invading the middle fossa had negative effects on the extent of resection (odds ratio = 0.092, p = 0.047). Postoperative vision improved or normalized in 16 (64%), remained stable in eight (32%), and worsened in one (4%), while a new hormonal deficit was noted in seven (28%) patients. Complications included permanent oculomotor nerve palsy in one (4%) and transient oculomotor palsy in one (4%), apoplexy of the residual tumor resulting in ischemic stroke in one (4%), postoperative cerebrospinal fluid leakage in one (4%), and permanent diabetes insipidus in six (24%) patients. Conclusions For GPitNETs that extend into the middle fossa, our study underscored the difficulties in surgical extraction and the necessity for tailored treatment approaches. To ensure the safest and most complete removal possible, the surgical strategy must be specifically adapted to each case. Additionally, employing a comprehensive support approach is essential to reduce the chance of complications in patients impacted by this condition.
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.
Obesity triggers inflammatory responses in the microenvironment of white adipose tissue, resulting in chronic systemic inflammation and the subsequent development of non-communicable diseases, including type 2 diabetes, coronary heart disease, and breast cancer. Current therapy approaches for obesity-induced non-communicable diseases persist in prioritizing symptom remission while frequently overlooking the criticality of targeting and alleviating inflammation at its source. Accordingly, this review highlights the importance of the microenvironment of obese white adipose tissue and the promising potential of employing immunotherapy to target it as an effective therapeutic approach for non-communicable diseases induced by obesity. Additionally, this review discusses the challenges and offers perspective about the immunotherapy targeting the microenvironment of obese white adipose tissue.
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.
Arachnoid Cysts , Nervous System Malformations , Child , Humans , Infant , Arachnoid Cysts/surgery , Retrospective Studies , Agenesis of Corpus Callosum , Ventriculostomy/methods , Nervous System Malformations/complications , Magnetic Resonance Imaging
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.
Objectives: Pravastatin sodium is reported to have multiple beneficial effects in cerebral atherosclerosis and neuronal injury; however, the preventive effects on cerebral venous ischemia are still unknown. Herein, we aimed to examine the neuroprotective effects of transoral prior administration of pravastatin sodium against cerebral cortical venous ischemia with suppression of apoptosis. Methods: Thirty 8-week-old male Wistar rats were divided equally into two study groups (n = 15 vs. n = 15); the pravastatin group was fed 1% pravastatin sodium with their usual diet for 2 weeks, while the control group only received the usual diet. Two-vein occlusion (2VO) model was applied for this study, and two adjacent cortical veins in each animal were permanently occluded photochemically with rose bengal dye. During photo-thrombosis, regional changes of the cerebral blood flow (CBF) in area of the venous ischemia were recorded. At 48-h after 2VO, animals were euthanized using perfusion fixation, and we histologically measured ratios of infarcted area to contralateral hemisphere, and counted Bax- and Bcl-2-positive cells in the penumbra to investigate the implications for apoptosis. Results: The ratio of infarcted area was significantly decreased in the pravastatin group compared to the control group (P < 0.01). The number of Bax-positive cells also decreased significantly in the pravastatin group (P < 0.01). In contrast, immunolabeling for Bcl-2 was essentially negative in all areas in both groups. There were also no significant differences in regional CBF changes after 2VO between the two groups (P = 0.13). Conclusions: Pre-emptive administration of pravastatin sodium mixed in the food has neuroprotective effects against cerebral cortical venous ischemia with suppression of apoptosis associated with inhibition of Bax expression but has little influence on regional CBF.
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.
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/.
PURPOSE: Delayed hyponatremia can occur after pituitary surgery, resulting in prolonged hospitalization. However, the influence of surgical factors after such a procedure has not been well established. The impact of surgery and related factors on delayed hyponatremia was investigated. METHODS: This was a retrospective analysis of 137 consecutive patients who underwent transsphenoidal surgery for a nonfunctioning pituitary adenoma between 2008 and 2019. Preoperative (demographics, comorbidities), intraoperative (resection extent, operation time, blood loss volume, cerebrospinal fluid leak, tumor consistency), and postoperative [hematoma, meningitis, diabetes insipidus (DI), hormonal assessment] data were collected, with statistical analysis of each factor performed. RESULTS: Among the 137 patients, delayed hyponatremia occurred in 31 (22.6%). Multivariate analysis revealed that those with hypertension had a significantly higher likelihood of avoiding delayed hyponatremia (p = 0.004). Although no correlations of direct surgical factors with delayed hyponatremia were found, multivariate analysis of indirect surgical factors showed that presence of a firm tumor, transient DI, and meningitis were significantly associated with delayed hyponatremia (p = 0.014, 0.001, and 0.047, respectively). There was also a significant association of severe hyponatremia with appearance of symptoms (p = 0.002). CONCLUSION: There was a tendency for hypertension to be associated with delayed hyponatremia avoidance, with indirect surgical factors including tumor consistency, transient DI, and meningitis found to have an influence on delayed hyponatremia. It was concluded that attention should be given to non-hypertensive patients with a firm tumor, transient DI, or meningitis after pituitary surgery, as delayed hyponatremia may occur.
Adenoma , Diabetes Insipidus , Hypertension , Hyponatremia , Meningitis , Pituitary Diseases , Pituitary Neoplasms , Humans , Pituitary Neoplasms/surgery , Pituitary Neoplasms/diagnosis , Hyponatremia/etiology , Hyponatremia/diagnosis , Retrospective Studies , Adenoma/complications , Adenoma/surgery , Adenoma/diagnosis , Postoperative Complications/epidemiology , Postoperative Complications/etiology , Treatment Outcome
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.
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.
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.
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.
Event cameras sense brightness changes in each pixel and yield asynchronous event streams instead of producing intensity images. They have distinct advantages over conventional cameras, such as a high dynamic range (HDR) and no motion blur. To take advantage of event cameras with existing image-based algorithms, a few methods have been proposed to reconstruct images from event streams. However, the output images have a low resolution (LR) and are unrealistic. Low-quality outputs stem from broader applications of event cameras, where high-quality and high-resolution (HR) images are needed. In this work, we consider the problem of reconstructing and super-resolving images from LR events when no ground truth (GT) HR images and degradation models are available. We propose a novel end-to-end joint framework for single image reconstruction and super-resolution from LR event data. Our method is primarily unsupervised to handle the absence of real inputs from GT and deploys adversarial learning. To train our framework, we constructed an open dataset, including simulated events and real-world images. The use of the dataset boosts the network performance, and the network architectures and various loss functions in each phase help improve the quality of the resulting image. Various experiments showed that our method surpasses the state-of-the-art LR image reconstruction methods for real-world and synthetic datasets. The experiments for super-resolution (SR) image reconstruction also substantiate the effectiveness of the proposed method. We further extended our method to more challenging problems of HDR, sharp image reconstruction, and color events. In addition, we demonstrate that the reconstruction and super-resolution results serve as intermediate representations of events for high-level tasks, such as semantic segmentation, object recognition, and detection. We further examined how events affect the outputs of the three phases and analyze our method's efficacy through an ablation study.
This paper presents an unsupervised clustering random-forest-based metric for affinity estimation in large and high-dimensional data. The criterion used for node splitting during forest construction can handle rank-deficiency when measuring cluster compactness. The binary forest-based metric is extended to continuous metrics by exploiting both the common traversal path and the smallest shared parent node. The proposed forest-based metric efficiently estimates affinity by passing down data pairs in the forest using a limited number of decision trees. A pseudo-leaf-splitting (PLS) algorithm is introduced to account for spatial relationships, which regularizes affinity measures and overcomes inconsistent leaf assign-ments. The random-forest-based metric with PLS facilitates the establishment of consistent and point-wise correspondences. The proposed method has been applied to automatic phrase recognition using color and depth videos and point-wise correspondence. Extensive experiments demonstrate the effectiveness of the proposed method in affinity estimation in a comparison with the state-of-the-art.
The performance of concrete structures deteriorates over time. Thus, improving their performance using fiber-reinforced polymers (FRPs), PS strands, and various strengthening methods is important. Reinforced concrete (RC) and prestressed concrete (PSC) structures develop initial cracks in concrete during bending tests, and destruction occurs over a certain period of time after a certain load is generated, and then after the reinforcements and strands yield. However, in the case of FRP structures, after an initial concrete crack occurs, FRPs exhibit a rapid shape deformation of the structure after yielding. Thus, in this study we used FRP and PS strand materials and evaluated the ductility index using the load-displacement results obtained from structural tests conducted using various strengthening methods. The ductility index evaluation method compares and analyzes the change rates in the ductility index of PSC and RC structures based on a method that uses structural deflection and the derivation of the energy area ratio. The ductility evaluation results based on the energy area ratio at the crack, yield, and ultimate points showed that all the RC structures, except for the specimens strengthened with reinforcing materials from company H, were in the ductility and semi-ductility sections. Thus, all the PSC structures, except for the control specimens and PH4NP, were found to be brittle.
BACKGROUND: Low serum cholesterol is known to be associated with poor prognosis in sepsis patients. On the other hand, there have been few studies on the association between high serum cholesterol, one of the major risk factors for cardiovascular adverse events, and prognosis of sepsis patients. We investigated the relationship between the serum total cholesterol concentration and outcome of sepsis patients. METHODS: We conducted a multicenter retrospective cohort study at the emergency departments (EDs) of three urban tertiary teaching hospitals. Patients were divided into three groups according to the initial serum total cholesterol concentration: low cholesterol (cholesterol <120 mg/dL), normal cholesterol (cholesterol 120-200 mg/dL), and high cholesterol (cholesterol >200 mg/dL). Multivariable Cox proportional hazard regression model was used to identify the independent association between the serum total cholesterol concentrations and mortality at 28 days. RESULTS: A total of 4,512 patients were included in the final analysis. The mortality at 28 days of the low, normal, and high cholesterol groups were 24.1%, 14.5%, and 20.5%, respectively (P<0.001). Both the low and high cholesterol groups had a higher risk of death than the normal cholesterol group (low cholesterol group [hazard ratio (HR), 1.46; 95% confidence interval (CIs), 1.25-1.71] and high cholesterol group (HR, 1.57; 95% CI, 1.14-2.16). CONCLUSIONS: Both low and high serum total cholesterol concentrations were associated with higher mortality at 28 days in sepsis patients.
Sepsis , Cholesterol , Humans , Prognosis , Retrospective Studies , Risk Factors
AIM OF STUDY: To investigate whether regional cerebral oxygen saturation (rSO2) differs in out-of-hospital cardiac arrest (OHCA) survivors undergoing targeted temperature management (TTM) 36 °C versus 33 °C. METHODS: A randomized clinical trial was conducted at intensive care units in two referral hospitals. Fifty-seven comatose OHCA survivors were randomized into either a 36 °C or 33 °C group. Patients were cooled and maintained at an oesophageal temperature of either 36 °C or 33 °C for 24 hours, rewarmed at a rate of 0.25 °C/hour, and maintained at <37.5 °C until 72 hours. During 72 hours of TTM, rSO2 was continuously monitored on the left forehead using near-infrared spectroscopy (INVOSTM 5100C). The rSO2 level at 72 hours was compared between the two groups. Next, serial rSO2 levels for 72 hours were compared using mixed effects regression. The association between rSO2 levels and 6-month neurological outcomes was also evaluated. RESULTS: There were no significant differences in the rSO2 level at 72 hours between the 36 °C and 33 °C groups (p = 0.372). Furthermore, serial rSO2 levels for 72 hours of TTM were not different between the two groups (p = 0.733). However, low rSO2 levels, particularly at 24 hours of TTM, were significantly associated with poor 6-month neurological outcomes (odds ratio = 0.899, 95% confidence interval: 0.831-0.974). The area under the receiver operating characteristic curve of the rSO2 level at 24 hours for poor neurological outcomes was 0.800. CONCLUSIONS: Regardless of target temperatures, low rSO2 levels during TTM were significantly associated with poor 6-month neurological outcomes in OHCA survivors.
Hypothermia, Induced , Out-of-Hospital Cardiac Arrest , Humans , Out-of-Hospital Cardiac Arrest/therapy , Oxygen , Spectroscopy, Near-Infrared , Survivors
A prestressed concrete (PSC) structure is subject to prestress losses in the long and short terms, and the structure ages over time. The structure is susceptible to corrosion from exposure to environmental factors such as moisture, chloride, and carbonation, thus causing prestress loss. Therefore, strengthening the structure is needed to address this problem. Here, the near surface mounted (NSM) method and the external prestressing (EP) method were selected because they are capable of applying additional prestressing. Further, we used fiber-reinforced plastics or polymers, or carbon fiber-reinforced plastics or polymers because of their high tensile strength and noncorrosive properties. For EP tests, prestressed strands were used. Accordingly, this study performs four-point flexural tests and evaluations for 12 types of specimens fabricated with different PSC methods. All specimens fabricated with the NSM (prestressing, no prestressing) and EP methods achieved stiffness that was 50-60% higher than that of the control PSC specimen. It was observed that the EP method in conjunction with prestressing yielded the best strengthening effect. It is expected that the results of this study will be applied to real structures for strengthening them and improving their performances.
Reinforced concrete (RC) structures age with time, which results in performance degradation and cracks. These performance degradations do not recover easily, but a performance higher than the existing structures can be expected through reinforcement. There are various reinforcement methods for RC structures. This study selected four reinforcement methods: near-surface mounting (NSM), external prestressing (EP), external bonding (EB), and section enlargement (SE). In the past, steel bars were often used as reinforcements. However, this study uses fiber-reinforced polymer (FRP), which is an alternative to steel bars owing to its high tensile strength, and its non-corrosive and lightweight properties. It is a basic strengthening material, along with a carbon-fiber-reinforced polymer (CFRP) and glass-fiber-reinforced polymer (GFRP) in bar and sheet forms. Various strengthening materials such as a CFRP, GFRP, and prestressing (PS) strand are applied to the NSM, EP, EB, and SE methods, followed by flexural experiments. In addition, changes in the ductility of the RC structures were examined. The concrete EP and near-surface mounting prestressing (NSM(P)) methods have a stiffness that is almost double the non-strengthened specimen. However, because the EP and EB methods are brittle, the NSM(P) method with ductile behavior is considered the most effective.
