Optimal view detection for ultrasound-guided supraclavicular block using deep learning approaches.

Successful ultrasound-guided supraclavicular block (SCB) requires the understanding of sonoanatomy and identification of the optimal view. Segmentation using a convolutional neural network (CNN) is limited in clearly determining the optimal view. The present study describes the development of a computer-aided diagnosis (CADx) system using a CNN that can determine the optimal view for complete SCB in real time. The aim of this study was the development of computer-aided diagnosis system that aid non-expert to determine the optimal view for complete supraclavicular block in real time. Ultrasound videos were retrospectively collected from 881 patients to develop the CADx system (600 to the training and validation set and 281 to the test set). The CADx system included classification and segmentation approaches, with Residual neural network (ResNet) and U-Net, respectively, applied as backbone networks. In the classification approach, an ablation study was performed to determine the optimal architecture and improve the performance of the model. In the segmentation approach, a cascade structure, in which U-Net is connected to ResNet, was implemented. The performance of the two approaches was evaluated based on a confusion matrix. Using the classification approach, ResNet34 and gated recurrent units with augmentation showed the highest performance, with average accuracy 0.901, precision 0.613, recall 0.757, f1-score 0.677 and AUROC 0.936. Using the segmentation approach, U-Net combined with ResNet34 and augmentation showed poorer performance than the classification approach. The CADx system described in this study showed high performance in determining the optimal view for SCB. This system could be expanded to include many anatomical regions and may have potential to aid clinicians in real-time settings.Trial registration The protocol was registered with the Clinical Trial Registry of Korea (KCT0005822, https://cris.nih.go.kr ).

Effect of Processing Parameters on Bonding Performance of a Carbon Fiber/Polyetheretherketone Thermoplastic Composite Prepared by Induction Welding.

Among the various welding techniques used to bond thermoplastic composites, induction welding stands out as a fast, clean, and contact-free process that shortens the welding time and prevents the weight increase of mechanical fastening, such as rivets and bolts. In this study, we manufactured polyetheretherketone (PEEK)-resin-based thermoplastic carbon fiber (CF) composite materials at different automated fiber placement laser powers (3569, 4576, and 5034 W) and investigated their bonding and mechanical characteristics after induction welding. The quality of the composite was evaluating using various techniques, including optical microscopy, C-scanning, and mechanical strength measurements, and a thermal imaging camera was used to monitor the surface temperature of the specimen during its processing. The results revealed that the preparation conditions of the polymer/carbon fiber composites, such as the laser power and surface temperature, significantly affect the quality and performance of the induction-welding-bonded composites. A lower laser power during preparation resulted in weaker bonding between components of the composite and yielded samples with a lower shear stress.

Manufacturing of Carbon Fibers/Polyphenylene Sulfide Composites via Induction-Heating Molding: Morphology, Mechanical Properties, and Flammability.

Conventional thermosetting composites exhibit advantageous mechanical properties owing to the use of an autoclave; however, their wide usage is limited by high production costs and long molding times. In contrast, the fabrication of thermoplastic composites involves out-of-autoclave processes that use press equipment. In particular, induction-heating molding facilitates a quicker thermal cycle, reduced processing time, and improved durability of the thermoplastic polymers; thus, the process cost and production time can be reduced. In this study, carbon fiber/polyphenylene sulfide thermoplastic composites were manufactured using induction-heating molding, and the relationships among the process, structure, and mechanical properties were investigated. The composites were characterized using optical and scanning electron microscopy, an ultrasonic C-scan, and X-ray computed tomography. In addition, the composites were subjected to flammability tests. This study provides novel insights into the optimization of thermoplastic composite manufacturing and thermoset composite curing processes.

Hydrothermal Preparation of Ag/TiO2/GO Nanocomposites with Ammonia-Treated Graphene Oxide for Enhanced Conductivity.

In this study, Ag/TiO2/GO nanocomposites were successfully fabricated by a facile hydrothermal method. Nitrogen-doped GO was prepared using ammonia treatment to improve its conductivity. The Ag/TiO2/GO nanocomposites were characterized by scanning electron microscopy (SEM), transmission electron microscopy (TEM), X-ray diffraction (XRD), UV-vis diffuse reflectance spectroscopy (DRS), zeta potential, and photoluminescence spectroscopy (PL). A homogeneous dispersion of Ag/TiO2 nanoparticles was shown on the surface of GO. Increasing the nitrogen doping concentration increased hydrophilicity, thereby improving the conductivity of Ag/TiO2/GO nanocomposites.

One-Pot Synthesis of Ag-TiO2/Nitrogen-Doped Graphene Oxide Nanocomposites and Its Photocatalytic Degradation of Methylene Blue.

In this study, we report Ag-TiO2/graphene oxide (GO) nanocomposites prepared by a simple one-pot synthesis using TiO2, AgNO3, and N-doped graphene (NDG). The NDG was synthesized using a microwave-assisted hydrothermal (MHT) method as a function of MHT time. The morphology and structure of Ag-TiO2/GO nanocomposites were characterized by scanning electron microscopy (SEM), transmission electron microscope (TEM), X-ray diffraction (XRD), Raman, and Fourier-transform infrared spectroscopy (FTIR). The photocatalytic activity of Ag-TiO2/GO nanocomposites in visible light was explored using the degradation, of methylene blue (MB) dye under the ultraviolet (UV) light. The result showed that Ag-TiO2/GO-3 was very efficient for the degradation of MB with nitrogen doping time. The degradation efficiency of the photocatalytic nanoparticles after 6 h of irradiation was about 80%. Increasing the N-doping time increased their hydrophilicity, thereby improving the photocatalytic performance of Ag-TiO2/GO nanocomposites.

Asiatic acid inhibits pulmonary inflammation induced by cigarette smoke.

Asiatic acid (AA) is one of the major components of Titrated extract of Centella asiatica (TECA), which has been reported to possess antioxidant and anti-inflammatory activities. The purpose of this study was to investigate the protective effect of AA on pulmonary inflammation induced by cigarette smoke (CS). AA significantly attenuated the infiltration of inflammatory cells in bronchoalveolar lavage fluid (BALF) of CS exposure mice. AA also decreased ROS production and NE activity, and inhibited the release of proinflammatory cytokines in BALF. AA reduced the recruitment of inflammatory cells and MCP-1 expression in lung tissue of CS exposure mice. AA also attenuated mucus overproduction, and decreased the activation of MAPKs and NF-kB in lung tissue. Furthermore, AA increased HO-1 expression and inhibited the reduced expression of SOD3 in lung tissue. These findings indicate that AA effectively inhibits pulmonary inflammatory response, which is an important process in the development of chronic obstructive pulmonary disease (COPD) via suppression of inflammatory mediators and induction of HO-1. Therefore, we suggest that AA has the potential to treat inflammatory disease such as COPD.

Development of Analytical Method and Monitoring of Veterinary Drug Residues in Korean Animal Products.

This study was conducted to determine the residual amount of veterinary drugs such as meloxicam, flunixin, and tulathromycin in animal products (beef, pork, horsemeat, and milk). Veterinary drugs have been widely used in the rearing of livestock to prevent and treat diseases. A total of 152 samples were purchased from markets located in major Korean cities (Seoul, Busan, Incheon, Daegu, Daejeon, Gwangju, Ulsan and Jeju), including Jeju. Veterinary drugs were analyzed by liquid chromatography-tandem mass spectrometry according to the Korean Food Standards Code. The resulting data, which are located within 70-120% of recovery range and less than 20% of relative standard deviations, are in compliance with the criteria of CODEX. A total of five veterinary drugs were detected in 152 samples, giving a detection rate of approximately 3.3%; and no food source violated the guideline values. Our result indicated that most of the veterinary drug residues in animal products were below the maximum residue limits specified in Korea.

Development and evaluation of a semifield test for repellent efficacy testing.

Estimation of the efficacy of mosquito repellents requires both laboratory and field tests. The results of field tests are more meaningful, but the safety of volunteers in such tests may be a significant concern. In the current study, we compared tests of mosquito repellent efficacy under semifield conditions in an outdoor enclosure with those under laboratory and field conditions. In this study, we assessed the efficacy of N,N-diethyl-meta-toluamide under laboratory conditions with human volunteers and under semifield and field conditions with Centers for Disease Control and Prevention traps and experimental mice. A semifield test may be a suitable replacement for the more difficult field test for assessment of mosquito repellent efficacy. Semifield tests should be considered when developing new guidelines for testing.

Simultaneous analysis and monitoring of 16 UV filters in cosmetics by high-performance liquid chromatography.

Sixteen UV filters were simultaneously analyzed using the high-performance liquid chromatographic method. They were drometrizole (USAN Drometrizole), 4-methylbenzylidene camphor (USAN Enzacamene), menthyl anthranilate (USAN Menthyl anthranilate), benzophenone-3 (USAN Oxybenzone), benzophenone-8 (USAN Dioxybenzone), butyl methoxydibenzoylmethane (USAN Avobenzone), ethylhexyl triazone (USAN Octyl triazone), octocrylene (USAN Octocrylene), ethylhexyl dimethyl p-aminobenzoic acid (USAN Padimate O), ethylhexyl methoxycinnamate (USAN Octinoxate), p-aminobenzoic acid (USAN Aminobenzoic acid), 2-phenylbenzimidazole-5-sulfonic acid (USAN Ensulizole), isoamyl p-methoxycinnamate (USAN Amiloxate), and recent UV filters such as diethylhexyl butamidotriazone (USAN Iscotrizinol), methylene bis-benzotriazolyl tetramethylbutylphenol (USAN Bisoctrizole), and terephthalylidene dicamphor sulfonic acid (USAN Ecamsule). Separation of the UV filters was carried out in a C(18) column with a gradient of methanol-phosphate buffer, and the UV detection was at 300, 320, or 360 nm without any interference. The limits of detection were between 0.08 and 1.94 µg/ml, and the limits of quantitation were between 0.24 and 5.89 µg/ml. The extracting solvent for the UV filters was methanol, except for ethylhexyl triazone and methylene bis-benzotriazolyl tetramethylbutylphenol, which were prepared with tetrahydrofuran. The recoveries from spiked samples were between 94.90% and 116.54%, depending on the matrixes used. The developed method was applied to 23 sunscreens obtained from local markets, and the results were acceptable to their own criteria and to maximum authorized concentrations. Consequently, these results would provide a simple extracting method and a simultaneous determination for various UV filters, which can improve the quality control process as well as the environmental monitoring of sunscreens.

Characteristics of flux and gel layer on microfilter and non-woven fabric filter surface based on anoxic-aerobic MBRs.

Non-woven fabric filter- (NWFF) and microfilter-MBR modules were made using 100 µm polypropylene and 0.25 µm polyethylene materials, respectively. The performances and mechanisms of the two processes were investigated, including additional batch filtration tests to find the function of the dynamic gel layer on the membrane surface. The HRT of both MBRs was 9 h and the operating permeate flux was 13 L/m(2)/h. The two MBRs consisted of an anoxic and aerobic reactor. The NWFF or microfilter (MF) was submerged in each of the aerobic reactors. The two MBRs showed similar performances for the removal of organic matters, suspended solids and nitrogen. Cake formation on the NWFF contributed to major resistance, while the gel layer on the microfilter or internal fouling of the pores played a key role in the fouling of the membrane surface. The amount of soluble extracellular polymer substances (EPS) (13 mg/L) of the attached sludge on the NWFF surface was larger than that (11 mg/L) of that suspended sludge. Consequently, the functional gel layer for the coarse and microfilter is established based on the relationship among the EPS, transmembrane pressure and MLSS.

Bladder rupture in immediate postrenal transplant period of uncertain cause.

Bladder rupture in patients undergoing renal transplant is rare. A 26-year-old man underwent a deceased-donor renal transplant. Postoperatively, he showed a good clinical course, but after removal of the urethral catheter, he complained of pain in the lower aspect of the abdomen and in the left flank. Findings of abdominal computed tomography and retrograde cystography revealed an extraperitoneal bladder rupture. We did not identify specific causes for this condition and believe that the bladder rupture was spontaneous. However, we could not rule out the possibility of traumatic rupture by the double-J ureteral stent. We decided to manage this case conservatively, with an indwelling urethral catheter and antibiotics, instead of by surgical repair. Results of repeated serial cystography during the treatment showed decreased contrast extravasation, and cystographic findings at 6 weeks showed no leakage of contrast medium. We confirmed complete healing of the ruptured bladder and removed the urethral catheter. Since then, the patient has maintained good renal function without any complications.

Successful treatment of a ruptured aortic arch aneurysm using a hybrid procedure.

Aortic rupture has a high mortality rate and can be considered a medical emergency. The standard treatment for aortic rupture is surgical repair. An aortic stent graft for a ruptured descending aorta is considered an effective alternative treatment. However, an aortic stent graft is difficult when the aortic aneurysm is in the aortic arch due to supra-aortic vessels. We report on a patient with a ruptured aortic arch aneurysm treated with a hybrid procedure, which involved a carotid to carotid bypass operation and an aortic stent graft. A 71-year-old male patient visited our cardiovascular center suffering from hemoptysis. The chest CT and aortography showed a 9 cm sized aortic arch aneurysm 0.5 cm distal to the left subclavian artery and a hemothorax in the left lung. The patient refused to undergo a full open operation. We performed a carotid to carotid bypass in advance, and two pieces of aortic stent grafts were placed across the left carotid artery and left subclavian artery. The follow up CT showed the aortic stent grafts, no endoleaks and no thrombus in the aortic arch aneurysm. The patient was discharged from the hospital without complication.

Predictive value of post-transplant bone marrow plasma cell percent in multiple myeloma patients undergone autologous transplantation.

BACKGROUND/AIMS: Autologous stem cell transplantation (ASCT) has become the treatment of choice for patients with multiple myeloma (MM). Studies have shown that maintenance treatment with interferon-alpha is associated with improved survival rates following ASCT. However, despite these recent advances in regimes, relapses are inevitable; thus, the prediction of relapse following ASCT requires assessment. METHODS: We retrospectively analyzed 39 patients who received ASCT between 2003 and 2008. All patients received chemotherapy with vincristine, adriamycin, and dexamethasone (VAD), and ASCT was performed following high-dose melphalan conditioning therapy. We evaluated the influence of the post-transplant day +14 (D+14) bone marrow plasma cell percent (BMPCp) (≥ 2 vs. < 2%), international scoring system (ISS) stage (II vs. III), response after 3 cycles of VAD therapy (complete response [CR] vs. non-CR), deletion of chromosome 13q (del[13q]) (presence of the abnormality vs. absence), and BMPCp at diagnosis (≥ 50 vs. < 50%) on progression-free survival (PFS) and overall survival (OS). RESULTS: During the median follow-up of 28.0 months, the median PFS and OS were 29.1 and 42.1 months, respectively. By univariate analysis, ISS stage III at diagnosis, BMPCp ≥ 50% at diagnosis, CR after 3 cycles of VAD therapy, del (13q) by fluorescence in situ hybridization, and BMPCp ≥ 2% at post-transplant D+14 were correlated with PFS and OS. A multivariate analysis revealed that a post-transplant D+14 BMPCp ≥ 2% (PFS, hazard ratio [HR] = 4.426, p = 0.008; OS, HR = 3.545, p = 0.038) and CR after 3 cycles of VAD therapy (PFS, HR = 0.072, p = 0.014; OS, HR = 0.055, p = 0.015) were independent prognostic parameters. CONCLUSIONS: Post-transplant D+14 BMPCp is a useful parameter for predicting the outcome for patients with MM receiving ASCT.

Renal and Splenic Infarction Associated with Hyperthyroidism / 대한신장학회지

A 59-year-old female was admitted with left flank pain. She had heat intolerance and dyspnea for the last 3 years. She was diagnosed as having renal and splenic infarction. 2 phase computed tomography (CT) scan on abdomen and pelvis showed a non-enhancing portion at the anterior aspect of the left kidney and multifocal low density at the spleen. Laboratory examinations revealed TSH 0.0004 uIU/mL, Free T4 2.69 ng/dL, T3 1.67 ng/mL, anti TPO antibody 207 U/mL (positive), anti TG antibody 52.7 U/mL (positive) and TSH receptor antibody >40 U/mL. A diagnosis of hyperthyroidism was made. Factor VIII activity increased over 160% (normal range 60-140), which has been known to increase in the cases of hyperthyroidism. Except for an increased factor VIII activity there were no thrombogenic abnormalities. She recovered well after the treatment with methimazole in addition to warfarin followed by intravenous heparin. This case is consistent with the assumption that hyperthyroidism, probably through a factor VIII-mediated hypercoagulability, may be a predisposing factor for the development of renal and splenic infarction.

Impact of metabolic syndrome on in-stent restenosis and clinical outcomes after percutaneous coronary stent implantation.

We investigated the impact of metabolic syndrome (MS) on the occurrence of in-stent restenosis (ISR) and long-term major adverse cardiac events (MACEs), including cardiovascular death, myocardial infarction, and target vessel revascularization (TVR) during a follow-up period of 36 months after percutaneous coronary intervention (PCI) with stent implantation in patients with significant preexisting coronary artery disease. MS was not an independent predictor of increased ISR and MACE after PCI.

Molecular epidemiology of community-associated antimicrobial-resistant Staphylococcus aureus in Seoul, Korea (2003): pervasiveness of multidrug-resistant SCCmec type II methicillin-resistant S. aureus.

There is an extremely high incidence of antimicrobial resistance of the clinical isolates of Staphylococcus aureus in Korea. This study carried out a molecular investigation to determine the prevalence of the community-associated antimicrobial-resistant S. aureus and methicillin-resistant S. aureus (MRSA). The percentage resistance from the nasal swabs of healthy volunteers in 2003 in Seoul is as follows: penicillin (91%), erythromycin (EM, 14%), gentamicin (GM, 9.3%), tetracycline (TE, 8.2%), cephalothin (4%), oxacillin (OX, MRSA; 3.8%), clindamycin (CC, 2.6%), ciprofloxacin (CIP, 0.8%), and sulfamethoxazole/trimethoprim (0.6%). The community-associated MRSA (C-MRSA) strains were examined by pulsed-field gel electrophoresis (PFGE) analysis of the SmaI macro-fragments, multilocus sequence typing (MLST), and staphylococcal cassette chromosome mec (SCCmec) typing using the PCR analysis. The Korean C-MRSA isolates were clustered into three distinct groups. One PFGE group containing the C-MRSA strains showed resistance to CC, EM, and GM, a high level (32-96 microg/ml) of resistance to methicillin, sequence type 5 (ST5), and SCCmec type II, which is the most common hospital associated-MRSA (H-MRSA) isolated in Korea. These results highlight the heterogeneous genetic background of the C-MRSA as well as the pervasiveness of the H-MRSA isolates in this community.

Comparative analysis of the effects of rice and bread meals on bioavailability of itraconazole using NONMEM in healthy volunteers.

OBJECTIVE: The objectives of this retrospective study were to examine the relationship between the bioavailability of itraconazole and the type of food consumed and to determine the effects of food consumption on the pharmacokinetic parameters following a single oral dose of itraconazole in healthy volunteers. METHODS: The plasma itraconazole concentration-time data were pooled from four pharmacokinetic studies in 144 healthy subjects. Individual pharmacokinetic values were estimated as model-independent (AUC, C (max), and T (max)) and model-dependent (T (lag), K (a), K (cp), K (pc), K (el), and V (d)/F; two-compartment open model with lag time) parameters using the WinNonlin software program. We estimated the population characteristics of the food effects using NONMEM. RESULTS: The consumption of a bread meal before the administration of itraconazole caused a significant increase in its bioavailability, as well as increases in the peak plasma concentration and lag time for itraconazole absorption. On the contrary, consumption of a rice meal before the administration of itraconazole caused a significant decrease in its bioavailability. CONCLUSION: Therefore, although a dose of itraconazole is normally administered immediately after a meal to increase its bioavailability, this is not an effective strategy after a rice meal.