Analysis of Differences in Single-Joint Movement of Dominant and Non-Dominant Hands for Human-like Robotic Control.

Although several previous studies on laterality of upper limb motor control have reported functional differences, this conclusion has not been agreed upon. It may be conjectured that the inconsistent results were caused because upper limb motor control was observed in multi-joint tasks that could generate different inter-joint motor coordination for each arm. Resolving this, we employed a single wrist joint tracking task to reduce the effect of multi-joint dynamics and examined the differences between the dominant and non-dominant hands in terms of motor control. Specifically, we defined two sections to induce feedback (FB) and feedforward (FF) controls: the first section involved a visible target for FB control, and the other section involved an invisible target for FF control. We examined the differences in the position errors of the tracer and the target. Fourteen healthy participants performed the task. As a result, we found that during FB control, the dominant hand performed better than the non-dominant hand, while we did not observe significant differences in FF control. In other words, in a single-joint movement that is not under the influence of the multi-joint coordination, only FB control showed laterality and not FF control. Furthermore, we confirmed that the dominant hand outperformed the non-dominant hand in terms of responding to situations that required a change in control strategy.

Localization Technique Using Mixture of Indigo Carmine and Lipiodol of Pulmonary Nodule via Bronchoscopic Navigation.

Background and Objectives: As the number of minimally invasive surgeries, including video-assisted thoracoscopic surgery, increases, small, deeply located lung nodules are difficult to visualize or palpate; therefore, localization is important. We studied the use of a mixture of indigo-carmine and lipiodol, coupled with a transbronchial approach-to achieve accurate localization and minimize patient discomfort and complications. Materials and Methods: A total of 60 patients were enrolled from May 2019 to April 2022, and surgery was performed after the bronchoscopy procedure. Wedge resection or segmentectomy was performed, depending on the location and size of the lesion. Results: In 58/60 (96.7%) patients, the localization of the nodules was successful after localization, and 2/60 required c-arm assistance. None of the patients complained of discomfort during the procedure; in all cases, margins were found to be free from carcinoma, as determined by the final pathology results. Conclusions: We recommend this localization technique using mixture of indigo carmine and lipiodol, in concert with the transbronchial approach, because the procedure time is short, patient's discomfort is low, and success rate is high.

Effects of Inhalation versus Total Intravenous Anesthesia on Postoperative Pulmonary Complications after Anatomic Pulmonary Resection.

BACKGROUND: No consensus exists regarding whether volatile anesthetics are superior to intravenous anesthetics for reducing postoperative pulmonary complications (PPCs) in patients undergoing general anesthesia for surgery. Studies of this issue focused on anatomic pulmonary resection are lacking. This study compared the effects of total intravenous anesthesia (TIVA) versus volatile anesthesia on PPCs after anatomic pulmonary resection in patients with lung cancer. METHODS: This retrospective study examined the medical records of patients with lung cancer who underwent lung resection at our center between January 2018 and October 2020. The primary outcome was the incidence of PPCs, which included prolonged air leak, pneumonia, acute respiratory distress syndrome, empyema, atelectasis requiring bronchofiberscopy (BFS), acute lung injury (ALI), bronchopleural fistula (BPF), pulmonary embolism, and pulmonary edema. Propensity score matching (PSM) was used to balance the 2 groups. In total, 579 anatomic pulmonary resection cases were included in the final analysis. RESULTS: The analysis showed no statistically significant difference between the volatile anesthesia and TIVA groups in terms of PPCs, except for prolonged air leak. Neither of the groups showed atelectasis requiring BFS, ALI, BPF, pulmonary embolism, or pulmonary edema after PSM. However, the length of hospitalization, intensive care unit stay, and duration of chest tube indwelling were shorter in the TIVA group. CONCLUSION: Volatile anesthetics showed no superiority compared to TIVA in terms of PPCs after anatomical pulmonary resection in patients with lung cancer. Considering the advantages of each anesthetic modality, appropriate anesthetic modalities should be used in patients with different risk factors and situations.

Electroencephalography Reflects User Satisfaction in Controlling Robot Hand through Electromyographic Signals.

This study addresses time intervals during robot control that dominate user satisfaction and factors of robot movement that induce satisfaction. We designed a robot control system using electromyography signals. In each trial, participants were exposed to different experiences as the cutoff frequencies of a low-pass filter were changed. The participants attempted to grab a bottle by controlling a robot. They were asked to evaluate four indicators (stability, imitation, response time, and movement speed) and indicate their satisfaction at the end of each trial by completing a questionnaire. The electroencephalography signals of the participants were recorded while they controlled the robot and responded to the questionnaire. Two independent component clusters in the precuneus and postcentral gyrus were the most sensitive to subjective evaluations. For the moment that dominated satisfaction, we observed that brain activity exhibited significant differences in satisfaction not immediately after feeding an input but during the later stage. The other indicators exhibited independently significant patterns in event-related spectral perturbations. Comparing these indicators in a low-frequency band related to the satisfaction with imitation and movement speed, which had significant differences, revealed that imitation covered significant intervals in satisfaction. This implies that imitation was the most important contributing factor among the four indicators. Our results reveal that regardless of subjective satisfaction, objective performance evaluation might more fully reflect user satisfaction.

Brain Activity Reflects Subjective Response to Delayed Input When Using an Electromyography-Controlled Robot.

In various experimental settings, electromyography (EMG) signals have been used to control robots. EMG-based robot control requires intrinsic parameters for control, which makes it difficult for users to understand the input protocol. When a proper input is not provided, the response time of the system varies; as such, the user's subjective delay should be investigated regardless of the actual delay. In this study, we investigated the influence of the subjective perception of delay on brain activation. Brain recordings were taken while subjects used EMG signals to control a robot hand, which requires a basic processing delay. We used muscle synergy for the grip command of the robot hand. After controlling the robot by grasping their hand, one of four additional delay durations (0 ms, 50 ms, 125 ms, and 250 ms) was applied in every trial, and subjects were instructed to answer whether the delay was natural, additional, or whether they were not sure. We compared brain activity based on responses ("sure" and "not sure"). Our results revealed a significant power difference in the theta band of the parietal lobe, and this time range included the interval in which the subjects could not feel the delay. Our study provides important insights that should be considered when constructing an adaptive system and evaluating its usability.

Cancer Testis Antigen, NOL4, Is an Immunogenic Antigen Specifically Expressed in Small-Cell Lung Cancer.

To identify cancer/testis (CT) antigens and immunogenic proteins, immunoscreening of testicular and small-cell lung cancer cell line NCI-H889 cDNA libraries was performed using serum obtained from a small-cell lung cancer (SCLC) patient. We obtained 113 positive cDNA clones comprised of 74 different genes, designated KP-SCLC-1 through KP-SCLC-74. Of these genes, 59 genes were found to be related to cancers by EMBASE analysis. Three of these antigens, including KP-SCLC-29 (NOL4), KP-SCLC-59 (CCDC83), and KP-SCLC-69 (KIF20B), were CT antigens. RT-PCR and western blot analysis showed that NOL4 was frequently present in small-cell lung cancer cell lines (8/9, 8/9). In addition, NOL4 mRNA was weakly, or at a low frequency, or not detected in various cancer cell lines. Our results reveal that NOL4 was expressed at protein levels in small-cell lung cancer tissues (10/10) but not detected in lung adenocarcinoma and squamous cell carcinoma by immunohistochemical analysis. Serological response to NOL4 was also evaluated by western blot assay using NOL4 recombinant protein. A humoral response against NOL4 proteins was detected in 75% (33/44) of small-cell lung cancer patients and in 65% (13/20) of healthy donors by a serological western blot assay. These data suggest that NOL4 is a specific target that may be useful for diagnosis and immunotherapy in SCLC.

The Effect of ICA and Non-negative Matrix Factorization Analysis for EMG Signals Recorded From Multi-Channel EMG Sensors.

Surface electromyography (EMG) measurements are affected by various noises such as power source and movement artifacts and adjacent muscle activities. Hardware solutions have been found that use multi-channel EMG signal to attenuate noise signals related to sensor positions. However, studies addressing the overcoming of crosstalk from EMG and the division of overlaid superficial and deep muscles are scarce. In this study, two signal decompositions-independent component analysis and non-negative matrix factorization-were used to create a low-dimensional input signal that divides noise, surface muscles, and deep muscles and utilizes them for movement classification based on direction. In the case of index finger movement, it was confirmed that the proposed decomposition method improved the classification performance with the least input dimensions. These results suggest a new method to analyze more dexterous movements of the hand by separating superficial and deep muscles in the future using multi-channel EMG signals.

Characteristics of female lung cancer in Korea: analysis of Korean National Lung Cancer Registry.

BACKGROUNDS: The present study evaluated Korean women with lung cancer and compared the clinical characteristics of ever-smoker and never-smoker groups using the National Lung Cancer Registry. METHODS: In affiliation with the Korean Central Cancer Registry, the Korean Association for Lung Cancer constructed a registry into which 10% of the lung cancer cases in Korea were registered. Female lung cancer patients with valid smoking history were evaluated. RESULTS: Among 735 female lung cancer patients, 643 (87.5%) were never-smokers and 92 (12.5%) were smokers. The median survival was significantly longer in the never-smoker group (28 vs. 14 months; P<0.001). Among 683 patients with non-small cell lung cancer (NSCLC), the never-smoker group showed significantly longer median survival (29 vs. 14 months; P=0.002) and a higher proportion of stage I cancer (40.3% vs. 25.7%; P<0.001). Survival analysis of the NSCLC patients showed that smoking status, receiving only supportive care, EGFR mutation status, lung cancer stage, and forced vital capacity (FVC) (%) were significantly associated with mortality in the multivariate analysis (P=0.025, HR 2.39, 95% CI: 1.12-5.11; P=0.017, HR 3.14, 95% CI: 1.22-8.06; P=0.033, HR 0.63, 95% CI: 0.41-0.96; P<0.001, HR 11.88, 95% CI: 5.79-24.38; P=0.002, HR 0.98, 95% CI: 0.96-0.99, respectively). CONCLUSIONS: In Korean women with NSCLC, smoking status, not receiving active anticancer treatment, EGFR mutation status, lung cancer stage, and pulmonary function were significantly associated with mortality.

Muscle Synergy and Musculoskeletal Model-Based Continuous Multi-Dimensional Estimation of Wrist and Hand Motions.

In this study, seven-channel electromyography signal-based two-dimensional wrist joint movement estimation with and without handgrip motions was carried out. Electromyography signals were analyzed using the synergy-based linear regression model and musculoskeletal model; they were subsequently compared with respect to single and combined wrist joint movements and handgrip. Using each one of wrist motion and grip trial as a training set, the synergy-based linear regression model exhibited a statistically significant performance with 0.7891 ± 0.0844 Pearson correlation coefficient (r) value in two-dimensional wrist motion estimation compared with 0.7608 ± 0.1037 r value of the musculoskeletal model. Estimates on the grip force produced 0.8463 ± 0.0503 r value with 0.2559 ± 0.1397 normalized root-mean-square error of the wrist motion range. This continuous wrist and handgrip estimation can be considered when electromyography-based multi-dimensional input signals in the prosthesis, virtual interface, and rehabilitation are needed.

Finger Angle Estimation From Array EMG System Using Linear Regression Model With Independent Component Analysis.

Surface ElectroMyoGraphy (EMG) signals from the forearm used in prosthetic hand and finger control systems require precise anatomy data of finger muscles that are small and located deep within the forearm. The main problem of this method is that the signal quality depends on the placement of EMG sensor, which can significantly affects the accuracy and precision to estimate joint angles or forces. Moreover, in case of amputees, the location of finger muscles is unknown and needed to be identified manually for EMG recording. As a result, most modern prosthetic hands utilize limited number of muscles with pattern recognition to control finger according to pre-defined grip which is unable to mimic natural finger motion. To address such issue, we used array EMG sensors to obtain EMG signals from all possible positions on the forearm and applied regression method to produce natural finger motion. The signals were analyzed using independent component analysis (ICA) to find the best-fitted independent component (IC) that matches the anatomical data taken after the experiment. Next, from the IC and EMG signals, finger angles were estimated using linear regression model (LRM). Each finger was assigned EMG and IC component for flexion and extension muscles, to assess the possibility of controlling each finger angle separately. We compared the joint angles of each finger between calculated from IC and EMG by correlation coefficients (CC) for all fingers. The average CC values were higher than 0.7, demonstrating the strength of the linear relationship. The different between IC and EMG methods suggests that the IC method can reduce noise and increase the signal to noise ratio. The performance of ICA method showed higher CC value at around 0.2 ± 0.10. In order to confirm the performance of ICA method, we also tested mathematical musculoskeletal model (MSM). The result from this study showed that not only array EMG sensors with ICA significantly improve the quality of signal detected from forearm but also reduce problems of conventional EMG sensors and consequently improve the performance of regression method to imitate natural finger motion.

Erratum: Clinical Characteristics and Prognostic Factors of Lung Cancer in Korea: A Pilot Study of Data from the Korean Nationwide Lung Cancer Registry.

This corrects the article on p. 118 in vol. 82, PMID: 29926550.

Report of the Korean Association of Lung Cancer Registry (KALC-R), 2014.

PURPOSE: The aim of this study was to investigate epidemiology, clinical characteristics and sex differences of patients with lung cancer using nationwide registry in Korea. MATERIALS AND METHODS: The Korean Association for Lung Cancer developed a registry in cooperation with the Korean Central Cancer Registry, and surveyed about 10% of lung cancer cases. For this first survey of cases diagnosed in 2014, cases were selected through a systematic sampling method. RESULTS: Total 2,621 lung cancer patients were surveyed, and the median patient age was 70 years. During the study period, adenocarcinoma was the most frequent histologic type, the proportion of female patients was 28.4%, and women had a better prognosis (median survival, not reached vs. 13 months; p<0.001) than did men for non-small cell lung cancer. The proportion of never-smokers was 36.4%, and never-smoking was more prevalent in women than in men (87.5 vs. 16.0%, p<0.001). Epidermal growth factor receptor (EGFR) mutations were found in 36.8% of stage IV adenocarcinoma patients, and higher in female compared to male patients (51.2 vs. 26.6%, p<0.001). In addition, patients with EGFR mutation showed better survival (median survival, 18 vs. 8 months; p<0.001) than patients without EGFR mutation in these patients. CONCLUSION: This is the first survey to gather unbiased nationwide lung cancer statistics in Korea. More than one-third of lung cancer patients had no smoking history. Female had a high proportion of non-smoker, more adenocarcinoma with EGFR mutation and generally better prognosis than male.

Clinical Characteristics and Prognostic Factors of Lung Cancer in Korea: A Pilot Study of Data from the Korean Nationwide Lung Cancer Registry.

BACKGROUND: Lung cancer is a leading cause of morbidity and mortality worldwide, and the incidence continues to rise. Although many prognostic factors have been identified, the clinical characteristics and outcomes in Korean lung cancer patients are not well defined. METHODS: Of the 23,254 new lung cancer cases registered at the Korea Central Cancer Registry in 2013, total 489 patients from 19 hospitals were abstracted by the Korean Central Cancer Registry. The clinical data retrospectively analyzed, patients were followed up until December 2015. RESULTS: The median age was 69 years (interquartile range, 60-74 years); 65.4% were male and 62.1% were ever-smokers. Cough was the most common initial symptom (33.5%); 13.1% of patients were asymptomatic. While squamous cell carcinoma was the most common subtype in male patients (37.2%), adenocarcinoma was the most frequent histological type in all patients (48.7%) and females (76.3%). The majority of patients received treatment (76.5%), which included surgery, radiation therapy, and chemotherapy. Older age (hazard ratio [HR], 1.037), lower body mass index (HR, 0.904), ever-smoker (HR, 2.003), small cell lung cancer (HR, 1.627), and distant metastasis (HR, 3.990) were independent predictors of mortality. Patients without symptoms (HR, 0.387) and without treatment (HR, 0.364) were associated with a favorable outcome in multivariate Cox analysis. CONCLUSION: Lung cancer in Korea occurs predominantly in elderly patients, with adenocarcinoma being the most frequent subtype. The prognosis was poorer in ever-smokers and older, malnourished, and untreated patients with advanced lung cancer.

Does Surgical Repair Still have a Role for Iatrogenic Tracheobronchial Rupture? Clinical Analysis of a Thoracic Surgeon's Opinion.

PURPOSE: The choice of surgical repair or conservative treatment for iatrogenic tracheobronchial rupture (ITBR) remains controversial. However, thoracic surgeons consider that surgical repair is an important treatment modality. The purpose of this study was to evaluate the clinical results from the perspective of the surgery-preferred group. METHODS: We treated 11 patients (8 women and 3 men; age: 52.6 ± 22.9 years) with ITBR from January 2011 to January 2016. A posterolateral thoracotomy or a trans-tracheal approach was performed according to the mechanism of injury. RESULTS: Nine patients underwent surgery, and all patients received primary repair. Five patients received a right posterolateral thoracotomy, whereas one patient received a left posterolateral thoracotomy. No mortality or morbidity related to the surgery was observed. The mechanical ventilation time was 65.9 ± 99.2 hours. The intensive care unit duration was 19.7 ± 33.3 days. Two patients received conservative treatment, and all patients died of another disease that was not related to the conservative treatment. CONCLUSION: Our mortality or morbidity due to surgery was not higher than world literature results of conservative treatment. We thought surgery is the primary treatment choice for ITBR in the absence of a good indication for conservative treatment.

Discriminating between Terminal- and Non-Terminal Respiratory Unit-Type Lung Adenocarcinoma Based on MicroRNA Profiles.

Lung adenocarcinomas can be classified into terminal respiratory unit (TRU) and non-TRU types. We previously reported that non-TRU-type adenocarcinoma has unique clinical and morphological features as compared to the TRU type. Here we investigated whether micro (mi)RNA expression profiles can be used to distinguish between these two subtypes of lung adenocarcinoma. The expression of 1205 human and 144 human viral miRNAs was analyzed in TRU- and non-TRU-type lung adenocarcinoma samples (n = 4 each) by microarray. Results were validated by quantitative real-time (qRT-)PCR and in situ hybridization. A comparison of miRNA profiles revealed 29 miRNAs that were differentially expressed between TRU- and non-TRU adenocarcinoma types. Specifically, hsa-miR-494 and ebv-miR-BART19 were up regulated by > 5-fold, whereas hsa-miR-551b was down regulated by > 5-fold in the non-TRU relative to the TRU type. The miRNA signature was confirmed by qRT-PCR analysis using an independent set of paired adenocarcinoma (non-TRU-type, n = 21 and TRU-type, n = 12) and normal tissue samples. Non-TRU samples showed increased expression of miR-494 (p = 0.033) and ebv-miR-BART19 (p = 0.001) as compared to TRU-type samples. Both miRNAs were weakly expressed in the TRU type but strongly expressed in the non-TRU type. Neither subtype showed miR-551b expression. TRU- and non-TRU-type adenocarcinomas have distinct miRNA expression profiles, suggesting that tumorigenesis in lung adenocarcinoma occur via different pathways.

Notch1 modulates oxidative stress induced cell death through suppression of apoptosis signal-regulating kinase 1.

Notch1 genes encode receptors for a signaling pathway that regulates various aspects of cell growth and differentiation; however, the role of Notch1 signaling in p38 mitogen-activated protein kinase (MAPK) signaling pathway is still not well defined. In this study, we found that Notch1 intracellular domain (Notch1-IC) prevents oxidative stress-induced cell death through the suppression of the Apoptosis signal-regulating kinase (ASK) 1 signaling pathway. Notch1-IC inhibited H2O2-induced activation of ASK1 and the activation of downstream kinases in the p38 MAPK signaling cascade. The results of both in vivo binding and kinase studies have revealed that ASK1 is the direct target of Notch1-IC, whereas it produced no effect on either MAP kinase kinase (MKK) 3 or p38 MAPK. Notch1-IC blocked both the homooligomerization of ASK1 and inhibited ASK1 activity. Furthermore, Notch1-IC facilitated the translocation of activated ASK1 toward the nucleus. Notch1 knockdown was determined to be highly susceptible to oxidative stress-induced activation of ASK1-MKK3/MKK6-p38 MAPK signaling cascade and cell death. Taken together, our findings suggest that Notch1-IC may act as a negative regulator in ASK1 signaling cascades.

The Effect of Thoracoscopic Pleurodesis in Primary Spontaneous Pneumothorax: Apical Parietal Pleurectomy versus Pleural Abrasion.

BACKGROUND: The standard operative treatment of primary spontaneous pneumothorax (PSP) is thoracoscopic wedge resection, but necessity of pleurodesis still remains controversial. Nevertheless, pleural procedure after wedge resection such as pleurodesis has been performed in some patients who need an extremely low recurrence rate. MATERIALS AND METHODS: From January 2000 to July 2010, 207 patients who had undergone thoracoscopic wedge resection and pleurodesis were enrolled in this study. All patients were divided into two groups according to the methods of pleurodesis; apical parietal pleurectomy (group A) and pleural abrasion (group B). The recurrence after surgery had been checked by reviewing medical record through follow-up in ambulatory care clinic or calling to the patients, directly until January 2011. RESULTS: Of the 207 patients, the recurrence rate of group A and B was 9.1% and 12.8%, respectively and there was a significant difference (p=0.01, Cox's proportional hazard model). There was no significant difference in age, gender, smoking status, and body mass index between two groups. CONCLUSION: This study suggests that the risk of recurrence after surgery in PSP is significantly low in patients who underwent thoracoscopic wedge resection with parietal pleurectomy than pleural abrasion.

Pattern of cancer/testis antigen expression in lung cancer patients.

Cancer/testis (CT) antigens represent promising targets for immunotherapy. We investigated the composite expression of 13 CT antigens by RT-PCR in 79 lung cancer tissues and by immunohistochemistry in 22 lung cancer tissues. In the 79 lung cancer tissues, MAGE-3 (42%) was expressed most frequently and followed by NY-SAR-35 (33%), NY-ESO-1 (30%), MAGE-1 (27%), CT-7 (20%), MAGE-4 (19%), LAGE-1 (16%), and MAGE-10 (14%). Twenty-one tissues did not express any of the CT antigens tested, 58 (73%) expressed at least one, 36 (46%) co-expressed two, 24 (30%) co-expressed three, 17 (22%) co-expressed four, 14 (18%) co-expressed five, 8 (10%) co-expressed six, 4 (6%) co-expressed seven and 2 tissues expressed 9 of the 13 examined CT antigens. Expression of CT antigens was significantly associated with age (P<0.001), smoking history (P=0.009), and gender (P=0.001) of patients, whereas no correlation was found between the expression of CT antigens and other clinical factors, such as pT status, pN status, tumor stage, and histology history. The present results show that CT antigens are potential candidates in lung cancer patients for polyvalent immunotherapy.

Symptomatic posterior mediastinal angioleiomyoma.

We report a case of a symptomatic angioleiomyoma in the left posterior mediastinum. A 66-year-old woman presented with left back and flank pain for 6 months. Chest computed tomography (CT) and magnetic resonance imaging (MRI) revealed a well-circumscribed 4.3 cm round mass. The mass was initially diagnosed as nerve sheath tumor, because of her symptoms and its close location to the sympathetic trunk and intercostal nerve. It was uneventfully removed through video-assisted thoracoscopic surgery. The pathology revealed an angioleiomyoma.

Oxidation of thioredoxin reductase in HeLa cells stimulated with tumor necrosis factor-alpha.

Stimulation of cells with tumor necrosis factor-alpha (TNF-alpha) results in the increase in generation of H(2)O(2) in mitochondria that leads to apoptosis. The effect of H(2)O(2) produced by TNF-alpha on the redox status of selenocysteine (SeCys) residue essential for mitochondrial thioredoxin reductase (TrxR2) was investigated in HeLa cells. TNF-alpha caused accumulation of oxidized TrxR2 with a thioselenide bond. The conditional induction of SeCys-deficient TrxR2 resulted in the increased production of H(2)O(2) and apoptosis. These results suggest that the SeCys residue of TrxR2 plays a critical role in cell survival by serving as an electron donor for Trx-II and subsequent peroxiredoxin-III, which is a primary line of defense against H(2)O(2) in mitochondria.