The Effect of Mobile Neurofeedback Training in Children with Attention Deficit Hyperactivity Disorder: A Randomized Controlled Trial.

Objective: : To examine the effect of mobile neurofeedback training on the clinical symptoms, attention abilities, and execution functions of children with attention deficit hyperactivity disorder (ADHD). Methods: : The participants were 74 children with ADHD aged 8-15 years who visited the Department of Child and Adolescent Psychiatry at Seoul National University Children's Hospital. The participants were randomly assigned to the mobile neurofeedback (n = 35) or control (sham; n = 39) group. Neurofeedback training was administered using a mobile app (equipped with a headset with a 2-channel electroencephalogram [EEG] sensor) for 30 min/day, 3 days/week, for 3 months. Children with ADHD were individually administered various neuropsychological tests, including the continuous performance test, Children's Color Trails Test-1 and 2, and Stroop Color and Word Tests. The effects of mobile neurofeedback were evaluated at baseline and at 3 and 6 months after treatment initiation. Results: : Following treatment, both mobile neurofeedback-only and sham-only groups showed significant improvements in attention and response inhibition. In the visual continuous performance test, omission errors decreased to the normal range in the mobile neurofeedback-only group after training, suggesting that mobile neurofeedback effectively reduced inattention in children with ADHD. In the advanced test of attention, auditory response times decreased in the mobile neurofeedback + medication group after training, but increased in the sham+medication group. Overall, there were no significant between-group differences in other performance outcomes. Conclusion: : Mobile neurofeedback may have potential as an additional therapeutic option alongside medication for children with ADHD.

Comparing the Expression of Canonical and Non-Canonical Inflammasomes Across Glioma Grades: Evaluating Their Potential as an Aggressiveness Marker.

BACKGROUND: Inflammasomes are key in the initiation of inflammatory responses and serve to defend the organism. However, when the immune system is imbalanced, these complexes contribute to tumor progression. The purpose of this study was to investigate the effect of non-canonical inflammasomes on glioma malignancy. METHODS: We performed bioinformatics analysis to confirm the expression of canonical and non-canonical inflammasome-related molecules according to the degree of malignancy through immunohistochemical examination of glioma tissues obtained with patient consent from our institution. RESULTS: Bioinformatics analysis confirmed that the expression levels of non-canonical inflammasome-related molecules were significantly higher in tumor tissues than in normal tissues, and they also increased according to malignancy, which adversely affected the survival rate. Furthermore, in gliomas, positive correlations were found between N-form gasdermin-D, a key molecule associated with the non-canonical inflammasome, and other related molecules, including NLRP3, caspase-1, caspase-4, and caspase-5. These results were verified by immunohistochemical examination of glioma tissues, and the expression levels of these molecules also increased significantly with increasing grade. In addition, the features of pyroptosis were confirmed. CONCLUSION: This study identified the potential of non-canonical inflammasomes as aggressiveness markers for gliomas and presented a perspective for improving glioma treatment.

Sagnac Effect Compensations and Locked States in a Ring Laser Gyroscope.

Frequency lock-in-induced deadband phenomena are major problems of ring laser gyroscopes (RLGs), which deteriorate linear responses to changes in the applied rotation rate. In this work, the frequency lock-in phenomenon occurring in the RLG was successfully investigated by compensating for the Sagnac effect through frequency analysis using a newly defined error function. Integrative and generalized viewpoints from the analyzed results provide new possibilities for relevant performance improvements of optical gyroscopes, as well as a deeper understanding of locked states in principle aspects.

Association of Pre- and Perinatal Risk Factors With Tourette Syndrome or Chronic Tic Disorders in a Korean School-Age Population.

Objectives: Tic disorders are highly heritable; however, growing evidence suggests that environmental factors play a significant role in their pathogenesis. Studies on these factors have been inconsistent, with conflicting results. Therefore, this study aimed to examine the associations of pre- and perinatal exposure to Tourette syndrome (TS) or chronic tic disorders (CTD) in Korean school-aged children. Methods: This case-control study used data from a large prospective cohort study. The primary outcome was TS/CTD diagnosis according to the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5) criteria and Kiddie-Schedule for Affective Disorders and Schizophrenia-Present and Lifetime Version-Korean Version. Demographic, pre-, and perinatal information was obtained from the maternal questionnaires. Data between the TS/CTD and control groups were compared using the chi-squared or Student's t-test, as appropriate. Two-step logistic regression analyses were used to test the association between TS/CTD and pre- and perinatal risk factors. Results: We included of 223 children (78 with TS/CTD and 145 controls). Significant differences in the demographic data between the two groups were observed. The male sex ratio, mean parental age, parental final education level, and family history of tics were included as confounders. In the final adjusted multivariable model, TS/CTD was significantly associated with antiemetic exposure during pregnancy (odds ratio [OR]=16.61, 95% confidence interval [CI] 1.49-185.22, p=0.02) and medically assisted reproduction (OR=7.89, 95% CI 2.28-27.28, p=0.01). Conclusion: Antiemetic exposure and medically assisted reproduction are significantly associated with the risk of TS/CTD. These results should be replicated in future prospective and gene-by-environment studies.

On-Chip Integrated Atomically Thin 2D Material Heater as a Training Accelerator for an Electrochemical Random-Access Memory Synapse for Neuromorphic Computing Application.

An artificial synapse based on oxygen-ion-driven electrochemical random-access memory (O-ECRAM) devices is a promising candidate for building neural networks embodied in neuromorphic hardware. However, achieving commercial-level learning accuracy in O-ECRAM synapses, analog conductance tuning at fast speed, and multibit storage capacity is challenging because of the lack of Joule heating, which restricts O2- ionic transport. Here, we propose the use of an atomically thin heater of monolayer graphene as a low-power heating source for O-ECRAM to increase thermally activated O2- migration within channel-electrolyte layers. Heating from graphene manipulates the electrolyte activation energy to establish and maintain discrete analog states in the O-ECRAM channel. Benefiting from the integrated graphene heater, the O-ECRAM features long retention (>104 s), good stability (switching accuracy <98% for >103 training pulses), multilevel analog states for 6-bit analog weight storage with near-ideal linear switching, and 95% pattern-identification accuracy. The findings demonstrate the usefulness of 2D materials as integrated heating elements in artificial synapse chips to accelerate neuromorphic computation.

Characterizing the Bounce and Separation Dynamics of Janus Drop on Macrotextured Surface.

Janus drops are thermodynamically stable when a high-viscosity fluid is imposed on a low-viscosity fluid. To understand physical mechanisms in Janus drop impact on macrotextured surfaces, several challenges in finding parameters or strategies still remain. Here, this study investigates the asymmetric bounce and separation of impinging Janus drops on non-wettable surfaces decorated with a macroridge to explore the effect of the drop size, viscosity ratio, and ridge size on the dynamics. Through numerical simulations, we determine the threshold Weber number, above which separation occurs, by varying drop diameters and viscosity ratios of the Janus drops. We investigate the initial bouncing directions of separated drops as a function of the impact velocity and viscosity ratio. We also predict how the separation efficiency is affected by the ridge's height and width. The asymmetric impact dynamics of Janus drops on macrotextured surfaces can provide new strategies to control drop bouncing in applications, such as liquid separation and purification.

The Impact of Left Atrial Reduction During Surgical Ablation of Atrial Fibrillation.

Enlarged left atrium (LA) is a risk factor for ablation failure after atrial fibrillation (AF) surgery. It predisposes patients to thromboembolic events, even in successful ablation; therefore, concomitant resection of the LA wall during surgical ablation was introduced. This study examined the clinical impacts of LA reduction in patients undergoing concomitant ablation for AF. This study enrolled 1484 patients with enlarged LA (≥50 mm) who underwent surgical AF ablation during major cardiac surgery between January 2001 and August 2018. Among them, 876 (59%) patients underwent concomitant LA reduction (Reduction group), whereas in the remaining 608 (41%), the LA wall was unresected (Preservation group). The primary outcome of interest was overall stroke. The secondary outcomes were overall mortality, late recurrence of AF, early postoperative complications and postoperative echocardiographic parameters. Outcomes were compared after adjusting baseline characteristics with inverse probability of treatment weighting (IPTW) using propensity score. The median follow-up was 60.1 months. After IPTW adjustment, long-term mortality (P = 0.250) and AF-free rates (P = 0.196) did not significantly differ between groups. However, the Reduction group showed a decreased risk of stroke (hazard ratio 0.54; 95% confidence interval 0.32-0.90; P = 0.018). Early postoperative complications rate such as mortality or reoperation for bleeding, was not significantly different between the 2 groups. The Reduction group showed smaller LA diameter (50.6 ± 8.0 mm vs 53.6 ± 8.9 mm; P < 0.001) on follow-up echocardiography. LA reduction effectively decreased LA size and appeared to decrease the stroke risk in patients with enlarged LA undergoing ablation for AF.

An Updated Meta-Analysis of Remote Blood Pressure Monitoring in Urban-Dwelling Patients with Hypertension.

Following the coronavirus disease-2019 pandemic, this study aimed to evaluate the overall effects of remote blood pressure monitoring (RBPM) for urban-dwelling patients with hypertension and high accessibility to healthcare and provide updated quantitative summary data. Of 2721 database-searched articles from RBPM's inception to November 2020, 32 high-quality studies (48 comparisons) were selected as primary data for synthesis. A meta-analysis was undertaken using a random effects model. Primary outcomes were changes in office systolic blood pressure (SBP) and diastolic blood pressure (DBP) following RBPM. The secondary outcome was the BP control rate. Compared with a usual care group, there was a decrease in SBP and DBP in the RBPM group (standardized mean difference 0.507 (95% confidence interval [CI] 0.339-0.675, p < 0.001; weighted mean difference [WMD] 4.464 mmHg, p < 0.001) and 0.315 (CI 0.209-0.422, p < 0.001; WMD 2.075 mmHg, p < 0.001), respectively). The RBPM group had a higher BP control rate based on a relative ratio (RR) of 1.226 (1.107-1.358, p < 0.001). RBPM effects increased with increases in city size and frequent monitoring, with decreases in intervention duration, and in cities without medically underserved areas. RBPM is effective in reducing BP and in achieving target BP levels for urban-dwelling patients with hypertension.

Ionic Sieving Through One-Atom-Thick 2D Material Enables Analog Nonvolatile Memory for Neuromorphic Computing.

The first report on ion transport through atomic sieves of atomically thin 2D material is provided to solve critical limitations of electrochemical random-access memory (ECRAM) devices. Conventional ECRAMs have random and localized ion migration paths; as a result, the analog switching efficiency is inadequate to perform in-memory logic operations. Herein ion transport path scaled down to the one-atom-thick (≈0.33 nm) hexagonal boron nitride (hBN), and the ionic transport area is confined to a small pore (≈0.3 nm2 ) at the single-hexagonal ring. One-atom-thick hBN has ion-permeable pores at the center of each hexagonal ring due to weakened electron cloud and highly polarized B-N bond. The experimental evidence indicates that the activation energy barrier for H+ ion transport through single-layer hBN is ≈0.51 eV. Benefiting from the controlled ionic sieving through single-layer hBN, the ECRAMs exhibit superior nonvolatile analog switching with good memory retention and high endurance. The proposed approach enables atomically thin 2D material as an ion transport layer to regulate the switching of various ECRAM devices for artificial synaptic electronics.

Outcomes after Extracorporeal Membrane Oxygenation in Neonates with Congenital Diaphragmatic Hernia: A Single-Center Experience.

BACKGROUND: Congenital diaphragmatic hernia (CDH) is a rare disease often requiring mechanical ventilation after birth. In severe cases, extracorporeal membrane oxygenation (ECMO) may be needed. This study analyzed the outcomes of patients with CDH treated with ECMO and investigated factors related to in-hospital mortality. METHODS: Among 254 newborns diagnosed with CDH between 2008 and 2020, 51 patients needed ECMO support. At Asan Medical Center, a multidisciplinary team approach has been applied for managing newborns with CDH since 2018. Outcomes were compared between hospital survivors and nonsurvivors. RESULTS: ECMO was established at a median of 17 hours after birth. The mean birth weight was 3.1±0.5 kg. Twenty-three patients (23/51, 45.1%) were weaned from ECMO, and 16 patients (16/51, 31.4%) survived to discharge. The ECMO mode was veno-venous in 24 patients (47.1%) and veno-arterial in 27 patients (52.9%). Most cannulations (50/51, 98%) were accomplished through a transverse cervical incision. No significant between-group differences in baseline characteristics and prenatal indices were observed. The oxygenation index (1 hour before: 90.0 vs. 51.0, p=0.005) and blood lactate level (peak: 7.9 vs. 5.2 mmol/L, p=0.023) before ECMO were higher in nonsurvivors. Major bleeding during ECMO more frequently occurred in nonsurvivors (57.1% vs. 12.5%, p=0.007). In the multivariate analysis, the oxygenation index measured at 1 hour before ECMO initiation was identified as a significant risk factor for in-hospital mortality (odds ratio, 1.02; 95% confidence interval, 1.01-1.04; p=0.05). CONCLUSION: The survival of neonates after ECMO for CDH is suboptimal. Timely application of ECMO is crucial for better survival outcomes.

Symmetry-Breaking Drop Bouncing on Superhydrophobic Surfaces with Continuously Changing Curvatures.

Controlling the residence time of drops on the solid surface is related to a wide spectrum of engineering applications, such as self-cleaning and anti-icing. The symmetry-breaking dynamics induced by the initial drop shape can promote drop bouncing. Here, we study the bouncing features of spherical and ellipsoidal drops on elliptical surfaces that continuously change curvatures inspired by natural succulent leaves. The bounce characteristics highly depend on the geometric relations between the ellipsoidal drops and curved surfaces. Numerical results show that ellipsoidal shapes of the drops amplify asymmetries of the mass and momentum in synergy with an influence of the surface curvature during the impact, which is verified by experiments. Effects of the surface anisotropy and drops' ellipticity on the residence time are investigated under various surface morphologies and Weber numbers. The residence time is closely associated with an initial surface curvature at the apex. The underlying principle of modifying the residence time via the drops' ellipticity and initial surface curvature is elucidated based on momentum asymmetry. The understanding of the bouncing features on curved surfaces will offer practical implications for enhanced heat transfer performances and controlled water repellency, etc.

Nurse-Coordinated Blood Pressure Telemonitoring for Urban Hypertensive Patients: A Systematic Review and Meta-Analysis.

Coronavirus disease 2019 (COVID-19) has put hypertensive patients in densely populated cities at increased risk. Nurse-coordinated home blood pressure telemonitoring (NC-HBPT) may help address this. We screened studies published in English on three databases, from their inception to 30 November 2020. The effects of NC-HBPT were compared with in-person treatment. Outcomes included changes in blood pressure (BP) following the intervention and rate of BP target achievements before and during COVID-19. Of the 1916 articles identified, 27 comparisons were included in this review. In the intervention group, reductions of 5.731 mmHg (95% confidence interval: 4.120-7.341; p < 0.001) in systolic blood pressure (SBP) and 2.342 mmHg (1.482-3.202; p < 0.001) in diastolic blood pressure (DBP) were identified. The rate of target BP achievement was significant in the intervention group (risk ratio, RR = 1.261, 1.154-1.378; p < 0.001). The effects of intervention over time showed an SBP reduction of 3.000 mmHg (-5.999-11.999) before 2000 and 8.755 mmHg (5.177-12.334) in 2020. DBP reduced by 2.000 mmHg (-2.724-6.724) before 2000 and by 3.529 mmHg (1.221-5.838) in 2020. Analysis of the target BP ratio before 2010 (RR = 1.101, 1.013-1.198) and in 2020 (RR = 1.906, 1.462-2.487) suggested improved BP control during the pandemic. NC-HBPT more significantly improves office blood pressure than UC among urban hypertensive patients.

Neural Network Training Acceleration With RRAM-Based Hybrid Synapses.

Hardware neural network (HNN) based on analog synapse array excels in accelerating parallel computations. To implement an energy-efficient HNN with high accuracy, high-precision synaptic devices and fully-parallel array operations are essential. However, existing resistive memory (RRAM) devices can represent only a finite number of conductance states. Recently, there have been attempts to compensate device nonidealities using multiple devices per weight. While there is a benefit, it is difficult to apply the existing parallel updating scheme to the synaptic units, which significantly increases updating process's cost in terms of computation speed, energy, and complexity. Here, we propose an RRAM-based hybrid synaptic unit consisting of a "big" synapse and a "small" synapse, and a related training method. Unlike previous attempts, array-wise fully-parallel learning is possible with our proposed architecture with a simple array selection logic. To experimentally verify the hybrid synapse, we exploit Mo/TiOx RRAM, which shows promising synaptic properties and areal dependency of conductance precision. By realizing the intrinsic gain via proportionally scaled device area, we show that the big and small synapse can be implemented at the device-level without modifications to the operational scheme. Through neural network simulations, we confirm that RRAM-based hybrid synapse with the proposed learning method achieves maximum accuracy of 97 %, comparable to floating-point implementation (97.92%) of the software even with only 50 conductance states in each device. Our results promise training efficiency and inference accuracy by using existing RRAM devices.

Improved synaptic functionalities of Li-based nano-ionic synaptic transistor with ultralow conductance enabled by Al2O3barrier layer.

In this study, we investigated the effect of an Al2O3barrier layer in an all-solid-state inorganic Li-based nano-ionic synaptic transistor (LST) with Li3PO4electrolyte/WOxchannel structure. Near-ideal synaptic behavior in the ultralow conductance range (∼50 nS) was obtained by controlling the abrupt ion migration through the introduction of a sputter-deposited thin (∼3 nm) Al2O3interfacial layer. A trade-off relationship between the weight update linearity and on/off ratio with varying Al2O3layer thickness was also observed. To determine the origin of the Al2O3barrier layer effects, cyclic voltammetry analysis was conducted, and the optimal ionic diffusivity and mobility were found to be key parameters in achieving ideal synaptic behavior. Owing to the controlled ion migration, the retention characteristics were considerably improved by the Al2O3barrier. Finally, a highly improved pattern recognition accuracy (83.13%) was achieved using the LST with an Al2O3barrier of optimal thickness.

Coronary Artery Bypass Grafting in an Infant after an Arterial Switch Operation.

Coronary artery bypass grafting (CABG) is rarely performed in infants because of its technical difficulty and unclear long-term results. A 90-day-old male infant weighing 3.5 kg who underwent an arterial switch operation (ASO) for transposition of the great arteries developed left coronary artery insufficiency despite augmentation and reimplantation of the left coronary button. On-pump beating heart CABG was performed using an internal mammary artery graft to revascularize the left anterior descending artery. Postoperative computed tomography angiography revealed that the graft was patent. At 7 months postoperatively, the patient weighed 8.5 kg, and echocardiography revealed good ventricular function. CABG can be an alternative treatment for post-ASO coronary complications in early infancy.

One-directional flow of ionic solutions along fine electrodes under an alternating current electric field.

Electric fields are widely used for controlling liquids in various research fields. To control a liquid, an alternating current (AC) electric field can offer unique advantages over a direct current (DC) electric field, such as fast and programmable flows and reduced side effects, namely the generation of gas bubbles. Here, we demonstrate one-directional flow along carbon nanotube nanowires under an AC electric field, with no additional equipment or frequency matching. This phenomenon has the following characteristics: First, the flow rates of the transported liquid were changed by altering the frequency showing Gaussian behaviour. Second, a particular frequency generated maximum liquid flow. Third, flow rates with an AC electric field (approximately nanolitre per minute) were much faster than those of a DC electric field (approximately picolitre per minute). Fourth, the flow rates could be controlled by changing the applied voltage, frequency, ion concentration of the solution and offset voltage. Our finding of microfluidic control using an AC electric field could provide a new method for controlling liquids in various research fields.

Highly sensitive and accurate estimation of bloodstain age using smartphone.

The estimation of bloodstain age is an important factor in forensic analysis. Previously, we have reported a smartphone-based colorimetric system for age estimation of bloodstain, in which Whole blood and EDTA whole blood were dropped on 4 different materials (700 µL) and captured using a smartphone for 72 h. In order to enhance sensitivity and accuracy of the previous system, the current work is dedicated towards the application of pattern recognition and classification of bloodstain images based on a smartphone. Three detection methods (blood pool, crack ratio, and colorimetric analysis) in terms of 6 steps of drying process of the bloodstain (coagulation, gelation, edge desiccation, center desiccation, crack propagation, and final desiccation) were applied to estimate age of the bloodstain accurately. Three parameters from the bloodstain images were then classified as comparing to those of stored reference images with similar trends in database. The bloodstain age was successfully determined by 9 h, 18 h, and 48 h with respect to the three detection methods mentioned above, respectively. The differences in bloodstain images were clearly distinguished every hour by using smartphone-based pattern recognition analysis. Therefore, our system is expected to shed a light on the field of forensic science by estimating bloodstain age in real time.

Approximate Solution for Electroosmotic Flow of Power-Law Fluids in a Planar Microchannel with Asymmetric Electrochemical Boundary Conditions.

Electroosmotic flow (EOF) is widely used in microfluidic systems and chemical analysis. It is driven by an electric force inside microchannel with highly charged boundary conditions. In practical applications, electrochemical boundary conditions are often inhomogeneous because different materials as walls are commonly utilized in routine fabrication methods. In the present study, we focus on the analytic solutions of the EOF generated in a planar microchannel with asymmetric electrochemical boundary conditions for non-Newtonian fluids. The velocity profile and flow rate are approximated by employing the power-law model of fluids in the Cauchy momentum equation. The hydrodynamic features of the EOF under asymmetric zeta potentials are scrutinized as a function of the fluid behavior index of the power-law fluid, thickness of Debye length, and zeta potential ratios between planes. The approximate solutions of the power-law model are comparable to the numerically obtained solutions when the Debye length is small and the fluid behavior index is close to unity. This study provides insights into the electrical control of non-Newtonian fluids, such as biological materials of blood, saliva, and DNA solution, in lab-on-a-chip devices.

An Exact Solution for Power-Law Fluids in a Slit Microchannel with Different Zeta Potentials under Electroosmotic Forces.

Electroosmotic flow (EOF) is one of the most important techniques in a microfluidic system. Many microfluidic devices are made from a combination of different materials, and thus asymmetric electrochemical boundary conditions should be applied for the reasonable analysis of the EOF. In this study, the EOF of power-law fluids in a slit microchannel with different zeta potentials at the top and bottom walls are studied analytically. The flow is assumed to be steady, fully developed, and unidirectional with no applied pressure. The continuity equation, the Cauchy momentum equation, and the linearized Poisson-Boltzmann equation are solved for the velocity field. The exact solutions of the velocity distribution are obtained in terms of the Appell's first hypergeometric functions. The velocity distributions are investigated and discussed as a function of the fluid behavior index, Debye length, and the difference in the zeta potential between the top and bottom.

Recent Progress on Microelectrodes in Neural Interfaces.

Brain‒machine interface (BMI) is a promising technology that looks set to contribute to the development of artificial limbs and new input devices by integrating various recent technological advances, including neural electrodes, wireless communication, signal analysis, and robot control. Neural electrodes are a key technological component of BMI, as they can record the rapid and numerous signals emitted by neurons. To receive stable, consistent, and accurate signals, electrodes are designed in accordance with various templates using diverse materials. With the development of microelectromechanical systems (MEMS) technology, electrodes have become more integrated, and their performance has gradually evolved through surface modification and advances in biotechnology. In this paper, we review the development of the extracellular/intracellular type of in vitro microelectrode array (MEA) to investigate neural interface technology and the penetrating/surface (non-penetrating) type of in vivo electrodes. We briefly examine the history and study the recently developed shapes and various uses of the electrode. Also, electrode materials and surface modification techniques are reviewed to measure high-quality neural signals that can be used in BMI.