PAIP 2020: Microsatellite instability prediction in colorectal cancer.

Microsatellite instability (MSI) refers to alterations in the length of simple repetitive genomic sequences. MSI status serves as a prognostic and predictive factor in colorectal cancer. The MSI-high status is a good prognostic factor in stage II/III cancer, and predicts a lack of benefit to adjuvant fluorouracil chemotherapy in stage II cancer but a good response to immunotherapy in stage IV cancer. Therefore, determining MSI status in patients with colorectal cancer is important for identifying the appropriate treatment protocol. In the Pathology Artificial Intelligence Platform (PAIP) 2020 challenge, artificial intelligence researchers were invited to predict MSI status based on colorectal cancer slide images. Participants were required to perform two tasks. The primary task was to classify a given slide image as belonging to either the MSI-high or the microsatellite-stable group. The second task was tumor area segmentation to avoid ties with the main task. A total of 210 of the 495 participants enrolled in the challenge downloaded the images, and 23 teams submitted their final results. Seven teams from the top 10 participants agreed to disclose their algorithms, most of which were convolutional neural network-based deep learning models, such as EfficientNet and UNet. The top-ranked system achieved the highest F1 score (0.9231). This paper summarizes the various methods used in the PAIP 2020 challenge. This paper supports the effectiveness of digital pathology for identifying the relationship between colorectal cancer and the MSI characteristics.

Comparison of intrarectal heated lidocaine gel and periprostatic nerve block for pain control in transrectal ultrasound-guided prostate biopsy: A randomized controlled non-inferiority trial.

Background: To investigate whether intrarectal local anesthesia with heated lidocaine gel (IRLAH) is non-inferior to periprostatic nerve block (PNB) for reducing pain in patients undergoing transrectal ultrasound (TRUS)-guided prostate biopsy. Methods: We performed a randomized controlled non-inferiority trial with 100 participants who underwent systematic TRUS-guided, 12-core prostate biopsy from August 2019 to July 2020. These participants were randomly assigned to a group receiving intrarectal local anesthesia with 20 mL of heated (40°C) 2% lidocaine gel (n = 50) or PNB (n = 50). The primary outcome was a pain score on a 0-10 visual analogue scale (VAS) at four time points with the non-inferiority margin of 1; VAS-1: during local anesthesia application; VAS-2: during probe insertion; VAS-3: during biopsy; VAS-4: 30 minutes after the procedure. The secondary outcome included complications during and after the procedure. Results: The IRLAH group (0.1) met non-inferiority as well as superiority criteria for mean VAS-1 score vs. the PNB group (2.33) (P < 0.001), as the difference (95% confidence interval [CI]) between the two groups was -2.23 (-2.66 to -1.79) and the upper bound of the 95% CI were both below the prespecified non-inferiority margin and below zero. For mean VAS-3 score, the difference (95% CI) was 0.3 (-0.38 to 0.98) and the upper bound of the 95% CI did not exceed the predefined non-inferiority margin indicating that IRLAH was non-inferior (IRLAH group, 3.44; PNB group, 3.14). Also, non-inferiority was shown for pain scores at VAS-2 and VAS-4. There were no significant differences in complications. Conclusion: IRLAH is a noninvasive and non-inferior alternative to PNB for pain control in TRUS-guided prostate biopsy without increased risk of complications.

Trends of genital wart in Korea according to treatment method classification: Big data analysis of health care in 2010-2019.

PURPOSE: The purpose of this study is to investigate disease trend of genital wart through changes in each treatment method over the past 10 years in Korea. MATERIALS AND METHODS: From 2010 to 2019, surgical treatment including cauterization, excision, cryotherapy, and laser therapy, non-surgical treatment such as podophyllin, and surgical treatment for anorectal lesion were extracted and analyzed from 2010 to 2019. For each treatment method, characteristics such as sex, age, region, medical cost and average number of procedures were analyzed. RESULTS: The number of patients following all treatment modalities increased every year. Surgical treatment of genital wart and anorectal wart showed a significant increase in male patients. Number of non-surgical treatment decreased in males but increased in females. Surgical removal of the anorectal wart increased more than 250% in over 10 years, and males underwent surgery 4 times more than females. In both surgery and non-surgery, the mean session was higher in males. Most of them were carried out in primary medical institutions. In Seoul and Gyeonggi-do, the largest number of patients received treatment regardless of treatment method. CONCLUSIONS: Treatment for genital warts has increased rapidly over the past 10 years, and the increase in males is remarkable. The main treatment was surgery, and males mainly received surgical treatment, and females mainly received drug treatment. The primary medical institution was in charge of the most treatment. As the number of patients and related medical expenses are increasing rapidly, more attention and response to diseases are needed.

The change of antibiotic susceptibility in febrile urinary tract infection in childhood and adolescence during the last decade.

PURPOSE: The purpose of this study was to clarify the pattern of antibiotic resistance in pediatric urinary tract infections (UTIs). MATERIALS AND METHODS: We analyzed the data of entire urine culture tests and antibiotic susceptibility tests performed on hospitalized patients for febrile UTI at the Uijeongbu St. Mary's Hospital during 2010-2020. A retrospective analysis was performed using medical records of urine culture results and antibiotic susceptibility results in patients with UTIs. RESULTS: We performed urine cultures from 2,491 patients, and identified bacterial types in 1,651 cases. We found that the resistance rates to ampicillin, ampicillin/sulbactam, cefazolin, gentamicin, piperacillin, tobramycin, and trimethoprim/sulfamethoxazole were already over 20% in 2010. The resistance rates to many other antibiotics also steadily increased over time. Among the antibiotics tested in 2020, only amikacin, cefoxitin, imipenem, piperacillin/tazobactam, and tigecycline showed the resistance rates below 20%. Noticeably, ciprofloxacin also showed an increase in the resistance rate from 7.3% in 2010 (S 139 vs. R 11) to 27.78% in 2019 (S 104 vs. R 40) and even over 30% (33.96%) in 2020 (S 35 vs. R 18). CONCLUSIONS: Antibiotic resistance is a serious problem in pediatric UTIs. In the treatment of pediatric UTIs, more caution is needed in the use of antibiotics. It may be necessary to apply appropriate antibiotic management programs such as antibiotics steward program for pediatric patients. Failure of a proper response strategy coping with antibiotic resistance may accelerate the resistance crisis.

Clinical Efficacy of Multi-Focal Low-Intensity Extracorporeal Shockwave Therapy in the Treatment of Chronic Prostatitis/Chronic Pelvic Pain Syndrome: Prospective-Randomized, Double Blind, Placebo-Controlled Study.

PURPOSE: To assess the safety and effect of the multifocal low-intensity extracorporeal shockwave therapy (MESWT) in the treatment of chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS). MATERIALS AND METHODS: We randomly separated 30 patients with CP/CPPS into a MESWT and placebo group of same number using prospective-randomized, double-blind design. The participants' National Institutes of Health Chronic Prostatitis Symptom Index (NIH-CPSI) total and subdomain scores, International Prostate Symptom Score (IPSS), International Index of Erectile Function-5 (IIEF-5), and visual analogue scale (VAS) were assessed and compared at baseline and at finishing immediately and 4 weeks after procedure and also were compared between MESWT and placebo group. RESULTS: A total of 30 participants were randomized a MESWT or placebo group. Twenty of thirty participants completed this trial. NIH-CPSI total and subdomain scores, IPSS, IIEF-5, and VAS had significantly ameliorated compared with baseline in the MESWT group at 4 weeks assessment. Furthermore, comparison of the results from MESWT and placebo groups represented statistically significant differences in NIH-CPSI total and subdomain scores, IPSS, IIEF-5, and VAS. No side effects or events were occurred in both groups of the participants during study periods. CONCLUSIONS: MESWT can be an effective treatment modality in patients with CP/CPPS as it improves pain and QoL.

An artificial neural-network approach to identify motor hotspot for upper-limb based on electroencephalography: a proof-of-concept study.

BACKGROUND: To apply transcranial electrical stimulation (tES) to the motor cortex, motor hotspots are generally identified using motor evoked potentials by transcranial magnetic stimulation (TMS). The objective of this study is to validate the feasibility of a novel electroencephalography (EEG)-based motor-hotspot-identification approach using a machine learning technique as a potential alternative to TMS. METHODS: EEG data were measured using 63 channels from thirty subjects as they performed a simple finger tapping task. Power spectral densities of the EEG data were extracted from six frequency bands (delta, theta, alpha, beta, gamma, and full) and were independently used to train and test an artificial neural network for motor hotspot identification. The 3D coordinate information of individual motor hotspots identified by TMS were quantitatively compared with those estimated by our EEG-based motor-hotspot-identification approach to assess its feasibility. RESULTS: The minimum mean error distance between the motor hotspot locations identified by TMS and our proposed motor-hotspot-identification approach was 0.22 ± 0.03 cm, demonstrating the proof-of-concept of our proposed EEG-based approach. A mean error distance of 1.32 ± 0.15 cm was measured when using only nine channels attached to the middle of the motor cortex, showing the possibility of practically using the proposed motor-hotspot-identification approach based on a relatively small number of EEG channels. CONCLUSION: We demonstrated the feasibility of our novel EEG-based motor-hotspot-identification method. It is expected that our approach can be used as an alternative to TMS for motor hotspot identification. In particular, its usability would significantly increase when using a recently developed portable tES device integrated with an EEG device.

Region-aggregated attention CNN for disease detection in fruit images.

BACKGROUND: Diseases and pests have a profound effect on a yearly harvest and productivity in agriculture. A precise and accurate detection of the diseases and pests could facilitate timely treatment and management of the diseases and pests and lessen the resultant loss in economy and health. Herein, we propose an improved design of the disease detection system for plant images. METHODS: Built upon the two-stage framework of object detection neural networks such as Mask R-CNN, the proposed network involves three types of extensions, including the addition of additional level of feature pyramids to improve the exploration and proposal of candidate regions, the aggregation of feature maps from all levels of feature pyramids per candidate region to fully exploit the information from feature pyramids, and the introduction of a squeeze-and-excitation block to the construction of feature pyramids and the aggregated feature maps to improve the representation of feature maps. RESULTS: The proposed network was evaluated using 74 images of infected apple fruits. In 3-fold cross-validation, the proposed network achieved averaged precision (AP) of 72.26, AP at 0.5 threshold of 88.51 and AP at 0.75 threshold of 82.30. In the comparative experiments, the proposed network outperformed the other competing networks. The utility of the three extensions was also demonstrated in comparison to Mask R-CNN. CONCLUSIONS: The experimental results suggest that the proposed network could identify and localize the symptom of the disease with high accuracy, leading to an early diagnosis and treatment of the disease, and thus holding the potential for improving crop yield and quality.

Estimation of Emotional Arousal Changes of a Group of Individuals During Movie Screening Using Steady-State Visual-Evoked Potential.

Neurocinematics is an emerging discipline in neuroscience, which aims to provide new filmmaking techniques by analyzing the brain activities of a group of audiences. Several neurocinematics studies attempted to track temporal changes in mental states during movie screening; however, it is still needed to develop efficient and robust electroencephalography (EEG) features for tracking brain states precisely over a long period. This study proposes a novel method for estimating emotional arousal changes in a group of individuals during movie screening by employing steady-state visual evoked potential (SSVEP), which is a widely used EEG response elicited by the presentation of periodic visual stimuli. Previous studies have reported that the emotional arousal of each individual modulates the strength of SSVEP responses. Based on this phenomenon, movie clips were superimposed on a background, eliciting an SSVEP response with a specific frequency. Two emotionally arousing movie clips were presented to six healthy male participants, while EEG signals were recorded from the occipital channels. We then investigated whether the movie scenes that elicited higher SSVEP responses coincided well with those rated as the most impressive scenes by 37 viewers in a separate experimental session. Our results showed that the SSVEP response averaged across six participants could accurately predict the overall impressiveness of each movie, evaluated with a much larger group of individuals.

The effect of heated lidocaine gel on pain reduction during transrectal ultrasound-guided prostate biopsy: a randomized-controlled study.

PURPOSE: To determine whether intrarectal local anesthesia (IRLA) with heated lidocaine gel provides pain reduction during transrectal ultrasound (TRUS)-guided prostate biopsy. METHODS: We conducted a randomized-controlled study with 153 participants who underwent TRUS-guided, systematic 12-core prostate biopsy from May 2018 to June 2019. These participants were divided into three test groups. Before prostate biopsy, group A (51 patients) received no local anesthesia, group B (51 patients) received IRLA with 20 mL 2% lidocaine gel stored at room temperature, and group C (51 patients) received IRLA with heated (40 ℃) 20 mL 2% lidocaine gel. Pain was assessed using the 0-10 visual analogue scale (VAS) at three time points: VAS-1: during probe insertion, VAS-2: during biopsy, VAS-3: 30 min after the procedure. Complications during and after the procedure were evaluated. RESULTS: The mean VAS-2 score was significantly lower in group C compared to groups A and B (A, 4.6; B, 4.2; and C, 3.2; p < 0.05). There was no significant difference among the three groups in mean VAS-1 and VAS-3 scores. No significant difference was detected in incidence of complications between the three groups. No allergic reactions to lidocaine gel were observed. CONCLUSION: IRLA with heated lidocaine gel provides more effective pain control during TRUS-guided prostate biopsy than does conventional IRLA and no local anesthesia, without an increase of complications.

Asian guidelines for urinary tract infection in children.

The followings are the level of evidence (LE) and grade of recommendation (GR) on pediatric UTI in Asia. Classification according to the sites of infection (lower versus upper tract), the number of episode (first versus recurrent), the severity (simple versus severe), or the existence of complicating factor (uncomplicated versus complicated) is useful to differentiate children with UTI whether they are at risk of renal damage or not (LE: 2, GR: B). Diagnosis of UTI requires both urinalysis that suggests infection and positive urine culture (LE:3, GR B). For pre-toilet trained children, urine specimen for culture should be collected by urethral catheterization or suprapubic aspiration. For toilet trained children, midstream clean catch urine is reliable (LE: 3, GR: A). Urine culture is considered positive if it demonstrates growth of a single bacterium with the following colony counts: (1) any growth by suprapubic aspiration, (2) >5 × 104 CFU/ml by urethral catheterization, or (3) >100,000 CFU/ml by midstream clean catch (LE:3, GR: B). For children with febrile UTI, renal and bladder ultrasonography (RBUS) should be routinely performed as soon as possible (LE: 3, GR: C). RBUS should be followed up 6 months later in children with acute pyelonephritis and/or VUR (LE: 3, GR: C). Acute DMSA scan can be performed when severe acute pyelonephritis or congenital hypodysplasia is noted on RBUS or when the diagnosis of UTI is in doubt by the clinical presentation (LE: 3, GR: C). Late DMSA scan (>6 months after the febrile UTI) can be performed in children with severe acute pyelonephritis, high-grade VUR, recurrent febrile UTIs, or abnormal renal parenchyma on the follow-up RBUS (LE: 3, GR: C). Top-down or bottom-up approach for febrile UTI is suggested for the diagnosis of VUR. For top-down approach, VCUG should not be performed routinely for children after the first febrile UTI. VCUG is indicated when abnormalities are apparent on either RBUS or DMSA scan or both (LE: 2, GR: B). VCUG is also suggested after a repeat febrile UTI (LE:2, GR: B). Appropriate antibiotic should be given immediately after urine specimen for culture has been obtained (LE:2, GR: A). Initiating therapy with oral or parenteral antibiotics is equally efficacious for children (>3 months) with uncomplicated UTI (LE: 2: GR: A). The choice of empirical antibiotic agents is guided by the expected pathogen and the local resistance patterns (LE: 2, GR: A). For children with febrile UTI, the total course of antibiotic therapy should be 7-14 days (LE: 2, GR: B). Circumcision may, but not definitively, reduce the risk of febrile UTI in males and breakthrough febrile UTI in males with VUR. Circumcision should be offered to uncircumcised boys with febrile UTI and VUR in countries where circumcision is accepted by the general population (LE: 3, GR: B), while in countries where childhood circumcision is rarely performed, other measures for febrile UTI/VUR should be the preferred choice (LE: 4, GR: C). Bladder bowel dysfunction (BBD) is one of the key factors of progression of renal scarring (LE: 2). Early recognition and management of BBD are important in prevention of UTI recurrence (LE:2, GR: A). Antibiotic prophylaxis to prevent recurrent febrile UTI is indicated in children with moderate to high grade (III-V) VUR (LE: 1b, GR: A). Surgical intervention may be used to treat VUR in the setting of recurrent febrile UTI because it has been shown to decrease the incidence of recurrent pyelonephritis (LE: 2, GR: B).

Semi-supervised learning for an improved diagnosis of COVID-19 in CT images.

Coronavirus disease 2019 (COVID-19) has been spread out all over the world. Although a real-time reverse-transcription polymerase chain reaction (RT-PCR) test has been used as a primary diagnostic tool for COVID-19, the utility of CT based diagnostic tools have been suggested to improve the diagnostic accuracy and reliability. Herein we propose a semi-supervised deep neural network for an improved detection of COVID-19. The proposed method utilizes CT images in a supervised and unsupervised manner to improve the accuracy and robustness of COVID-19 diagnosis. Both labeled and unlabeled CT images are employed. Labeled CT images are used for supervised leaning. Unlabeled CT images are utilized for unsupervised learning in a way that the feature representations are invariant to perturbations in CT images. To systematically evaluate the proposed method, two COVID-19 CT datasets and three public CT datasets with no COVID-19 CT images are employed. In distinguishing COVID-19 from non-COVID-19 CT images, the proposed method achieves an overall accuracy of 99.83%, sensitivity of 0.9286, specificity of 0.9832, and positive predictive value (PPV) of 0.9192. The results are consistent between the COVID-19 challenge dataset and the public CT datasets. For discriminating between COVID-19 and common pneumonia CT images, the proposed method obtains 97.32% accuracy, 0.9971 sensitivity, 0.9598 specificity, and 0.9326 PPV. Moreover, the comparative experiments with respect to supervised learning and training strategies demonstrate that the proposed method is able to improve the diagnostic accuracy and robustness without exhaustive labeling. The proposed semi-supervised method, exploiting both supervised and unsupervised learning, facilitates an accurate and reliable diagnosis for COVID-19, leading to an improved patient care and management.

PAIP 2019: Liver cancer segmentation challenge.

Pathology Artificial Intelligence Platform (PAIP) is a free research platform in support of pathological artificial intelligence (AI). The main goal of the platform is to construct a high-quality pathology learning data set that will allow greater accessibility. The PAIP Liver Cancer Segmentation Challenge, organized in conjunction with the Medical Image Computing and Computer Assisted Intervention Society (MICCAI 2019), is the first image analysis challenge to apply PAIP datasets. The goal of the challenge was to evaluate new and existing algorithms for automated detection of liver cancer in whole-slide images (WSIs). Additionally, the PAIP of this year attempted to address potential future problems of AI applicability in clinical settings. In the challenge, participants were asked to use analytical data and statistical metrics to evaluate the performance of automated algorithms in two different tasks. The participants were given the two different tasks: Task 1 involved investigating Liver Cancer Segmentation and Task 2 involved investigating Viable Tumor Burden Estimation. There was a strong correlation between high performance of teams on both tasks, in which teams that performed well on Task 1 also performed well on Task 2. After evaluation, we summarized the top 11 team's algorithms. We then gave pathological implications on the easily predicted images for cancer segmentation and the challenging images for viable tumor burden estimation. Out of the 231 participants of the PAIP challenge datasets, a total of 64 were submitted from 28 team participants. The submitted algorithms predicted the automatic segmentation on the liver cancer with WSIs to an accuracy of a score estimation of 0.78. The PAIP challenge was created in an effort to combat the lack of research that has been done to address Liver cancer using digital pathology. It remains unclear of how the applicability of AI algorithms created during the challenge can affect clinical diagnoses. However, the results of this dataset and evaluation metric provided has the potential to aid the development and benchmarking of cancer diagnosis and segmentation.

Design of Wearable EEG Devices Specialized for Passive Brain-Computer Interface Applications.

Owing to the increased public interest in passive brain-computer interface (pBCI) applications, many wearable devices for capturing electroencephalogram (EEG) signals in daily life have recently been released on the market. However, there exists no well-established criterion to determine the electrode configuration for such devices. Herein, an overall procedure is proposed to determine the optimal electrode configurations of wearable EEG devices that yield the optimal performance for intended pBCI applications. We utilized two EEG datasets recorded in different experiments designed to modulate emotional or attentional states. Emotion-specialized EEG headsets were designed to maximize the accuracy of classification of different emotional states using the emotion-associated EEG dataset, and attention-specialized EEG headsets were designed to maximize the temporal correlation between the EEG index and the behavioral attention index. General purpose electrode configurations were designed to maximize the overall performance in both applications for different numbers of electrodes (2, 4, 6, and 8). The performance was then compared with that of existing wearable EEG devices. Simulations indicated that the proposed electrode configurations allowed for more accurate estimation of the users' emotional and attentional states than the conventional electrode configurations, suggesting that wearable EEG devices should be designed according to the well-established EEG datasets associated with the target pBCI applications.

Enhanced Performance of a Brain Switch by Simultaneous Use of EEG and NIRS Data for Asynchronous Brain-Computer Interface.

Previous studies have shown the superior performance of hybrid electroencephalography (EEG)/ near-infrared spectroscopy (NIRS) brain-computer interfaces (BCIs). However, it has been veiled whether the use of a hybrid EEG/NIRS modality can provide better performance for a brain switch that can detect the onset of the intention to turn on a BCI. In this study, we developed such a hybrid EEG/NIRS brain switch and compared its performance with single modality EEG- and NIRS-based brain switch respectively, in terms of true positive rate (TPR), false positive rate (FPR), onset detection time (ODT), and information transfer rate (ITR). In an offline analysis, the performance of a hybrid EEG/NIRS brain switch was significantly improved over that of EEG- and NIRS-based brain switches in general, and in particular a significantly lower FPR was observed for the hybrid EEG/NIRS brain switch. A pseudo-online analysis was additionally performed to confirm the feasibility of implementing an online BCI system with our hybrid EEG/NIRS brain switch. The overall trend of pseudo-online analysis results generally coincided with that of the offline analysis results. No significant difference in all performance measures was also found between offline and pseudo online analysis schemes when the amount of training data was same, with one exception for the ITRs of an EEG brain switch. These offline and pseudo-online results demonstrate that a hybrid EEG/NIRS brain switch can be used to provide a better onset detection performance than that of a single neuroimaging modality.

Prediction of Individual User's Dynamic Ranges of EEG Features from Resting-State EEG Data for Evaluating Their Suitability for Passive Brain-Computer Interface Applications.

With the recent development of low-cost wearable electroencephalogram (EEG) recording systems, passive brain-computer interface (pBCI) applications are being actively studied for a variety of application areas, such as education, entertainment, and healthcare. Various EEG features have been employed for the implementation of pBCI applications; however, it is frequently reported that some individuals have difficulty fully enjoying the pBCI applications because the dynamic ranges of their EEG features (i.e., its amplitude variability over time) were too small to be used in the practical applications. Conducting preliminary experiments to search for the individualized EEG features associated with different mental states can partly circumvent this issue; however, these time-consuming experiments were not necessary for the majority of users whose dynamic ranges of EEG features are large enough to be used for pBCI applications. In this study, we tried to predict an individual user's dynamic ranges of the EEG features that are most widely employed for pBCI applications from resting-state EEG (RS-EEG), with the ultimate goal of identifying individuals who might need additional calibration to become suitable for the pBCI applications. We employed a machine learning-based regression model to predict the dynamic ranges of three widely used EEG features known to be associated with the brain states of valence, relaxation, and concentration. Our results showed that the dynamic ranges of EEG features could be predicted with normalized root mean squared errors of 0.2323, 0.1820, and 0.1562, respectively, demonstrating the possibility of predicting the dynamic ranges of the EEG features for pBCI applications using short resting EEG data.

Development of a Brain-Computer Interface Toggle Switch with Low False-Positive Rate Using Respiration-Modulated Photoplethysmography.

Asynchronous brain-computer interfaces (BCIs) based on electroencephalography (EEG) generally suffer from poor performance in terms of classification accuracy and false-positive rate (FPR). Thus, BCI toggle switches based on electrooculogram (EOG) signals were developed to toggle on/off synchronous BCI systems. The conventional BCI toggle switches exhibit fast responses with high accuracy; however, they have a high FPR or cannot be applied to patients with oculomotor impairments. To circumvent these issues, we developed a novel BCI toggle switch that users can employ to toggle on or off synchronous BCIs by holding their breath for a few seconds. Two states-normal breath and breath holding-were classified using a linear discriminant analysis with features extracted from the respiration-modulated photoplethysmography (PPG) signals. A real-time BCI toggle switch was implemented with calibration data trained with only 1-min PPG data. We evaluated the performance of our PPG switch by combining it with a steady-state visual evoked potential-based BCI system that was designed to control four external devices, with regard to the true-positive rate and FPR. The parameters of the PPG switch were optimized through an offline experiment with five subjects, and the performance of the switch system was evaluated in an online experiment with seven subjects. All the participants successfully turned on the BCI by holding their breath for approximately 10 s (100% accuracy), and the switch system exhibited a very low FPR of 0.02 false operations per minute, which is the lowest FPR reported thus far. All participants could successfully control external devices in the synchronous BCI mode. Our results demonstrated that the proposed PPG-based BCI toggle switch can be used to implement practical BCIs.

Effects of low-frequency intravaginal electrical stimulation on female urinary incontinence, quality of life, and urinary symptoms: A pilot study.

This study investigated the effects of a low-frequency home-based incontinence therapy device on quality of life (QoL) and urinary symptoms in women with urinary incontinence. From May 2017 to February 2018, 34 patients, aged ≥ 20 years, with involuntary urine leakage >2 times/week, were recruited to this study. Patients with severe pelvic organ prolapse, pregnancy, virgin status, and psychological problems were excluded. The incontinence home-care device treatments were administered in 12-minute sessions, twice daily for 8 weeks. Simultaneously, hyperthermic conditions of 35°C to 40°C and microvibrations were administered. All patients completed urinary incontinence questionnaires (King's Health Questionnaire [KHQ], Bristol Female Lower Urinary Tract Symptoms [BFLUTS] questionnaire, and the Overactive Bladder Symptom Score [OABSS]) before treatment, as well as 4 and 8 weeks into treatment. Changes in the questionnaire responses over time were compared. Two participants dropped out of the study and there was one screening failure, leaving 31 patients for analysis. After 4 weeks treatment, there were significant improvements in symptoms, such as role limitation, physical limitation, social limitation, personal relationship, emotion, sleep/energy, and severity measures. After 8 weeks treatment, almost all parameters on the KHQ revealed symptomatic improvement. On the BFLUTS, voiding times during activity, nocturia, urgency, urge incontinence, incontinence frequency, stress incontinence, volume leakage, strain to start, intermittency, reduced stream, acute retention, incomplete emptying, and stopping flow showed significant improvements. On the OABSS, almost all storage symptoms improved. Low-frequency electrical stimulation devices were effective at improving urinary incontinence, which became evident as the duration of treatment increased. Improvement of urgency and frequency was more evident after treatment.

A multi-day and multi-band dataset for a steady-state visual-evoked potential-based brain-computer interface.

BACKGROUND: A steady-state visual-evoked potential (SSVEP) is a brain response to visual stimuli modulated at certain frequencies; it has been widely used in electroencephalography (EEG)-based brain-computer interface research. However, there are few published SSVEP datasets for brain-computer interface. In this study, we obtained a new SSVEP dataset based on measurements from 30 participants, performed on 2 days; our dataset complements existing SSVEP datasets: (i) multi-band SSVEP datasets are provided, and all 3 possible frequency bands (low, middle, and high) were used for SSVEP stimulation; (ii) multi-day datasets are included; and (iii) the EEG datasets include simultaneously obtained physiological measurements, such as respiration, electrocardiography, electromyography, and head motion (accelerator). FINDINGS: To validate our dataset, we estimated the spectral powers and classification performance for the EEG (SSVEP) datasets and created an example plot to visualize the physiological time-series data. Strong SSVEP responses were observed at stimulation frequencies, and the mean classification performance of the middle frequency band was significantly higher than the low- and high-frequency bands. Other physiological data also showed reasonable results. CONCLUSIONS: Our multi-band, multi-day SSVEP datasets can be used to optimize stimulation frequencies because they enable simultaneous investigation of the characteristics of the SSVEPs evoked in each of the 3 frequency bands, and solve session-to-session (day-to-day) transfer problems by enabling investigation of the non-stationarity of SSVEPs measured on different days. Additionally, auxiliary physiological data can be used to explore the relationship between SSVEP characteristics and physiological conditions, providing useful information for optimizing experimental paradigms to achieve high performance.

Hemostatic effect and psychological impact of an oxidized regenerated cellulose patch after transrectal ultrasound-guided prostate biopsy: A prospective and retrospective study.

To investigate the usefulness of the oxidized regenerated cellulose patch (ORCP) for postbiopsy hemostasis, anxiety, and depression in patients undergoing transrectal ultrasound-guided prostate biopsy.This was a prospective-retrospective study of 300 patients who underwent systematic 12-core prostate biopsy from August 2016 through March 2018. The ORCP was inserted into the rectum immediately after prostate biopsy in the prospective group (n = 150), while the retrospective group (n = 150) underwent prostate biopsy alone. The frequency rate and duration of hematuria, rectal bleeding, and hematospermia were compared between the 2 groups. Anxiety and depression were assessed with the hospital anxiety and depression scale before and after prostate biopsy in the prospective group.The frequency rates of hematuria and hematospermia showed no significant differences between the prospective versus retrospective groups (64.7% vs 66.7%, P = .881; 18 vs 20%, P = .718; respectively). Frequency of rectal bleeding was significantly lower in the prospective group than in the retrospective group (26.7% vs 42.7%, P = .018). However, there were no significant differences in median duration of rectal bleeding, hematuria, or hematospermia between the 2 groups (2, 5, and 2 days vs 2, 7, and 1 day, P > .05, respectively, for the prospective vs retrospective group). Multivariate analysis found that ORCP insertion was a significant protective factor against postbiopsy rectal bleeding (P = .038, odds ratio 0.52). Only anxiety level in the prospective group before versus after prostate biopsy was significantly reduced (5 vs 4, P = .011).ORCP insertion after prostate biopsy is an effective and simple method for decreasing rectal bleeding. ORCP insertion may also alleviate anxiety in patients undergoing prostate biopsy.

Effects of a combination of herbal extracts (modified Ojayeonjonghwan (Wuzi Yanzong wan)) on partial urethral obstruction-induced detrusor overactivity in rats: impact on the nitric oxide pathway and oxidative stress.

BACKGROUND: We investigated the effects of a berry mixture formula (modified Ojayeonjonghwan (Wuzi Yanzong Wan, MO formula) on detrusor overactivity (DO). METHODS: The MO formula consisted of 5 seeds obtained from 5 types of berry plants. Twenty-four Sprague-Dawley rats were randomly assigned to four groups: sham-operated (control), partial urethral obstruction-induced DO (DO group), 0.03 mg/kg solifenacin-treated DO (solifenacin group) and 200 mg/kg MO formula -treated DO (berry mixture). The control and overactive groups were administered distilled water for 4 weeks, and the solifenacin and MO formula groups were treated with the respective medication for 4 weeks. After treatment, cystometrography was performed. At the endo of cystometrography, their bladder tissues were used for identifying the muscarinic receptors, endothelial nitric oxide synthase(eNOS), RhoA, Rock-I & II, 8-hydroxy-2' -deoxyguanosine(8-OHdG), superoxide dismutase(SOD), interleukin-6 &-8(IL-6, IL-8), and tumor necrosis factor-alpha(TNF-a). The tissues were stained and the muscle-to-collagen ratio was identified. RESULTS: The presence of the muscarinic receptors were not significantly different between the solifenacin and MO formula groups. However, significant differences were found between the solifenacin and MO formula groups in terms of eNOS, RhoA, Rock-I and -II levels. The muscle-to-collagen ratio was statistically lower in the DO and solifenacin groups; however, no significant difference was observed between the control and MO formula groups. Under oxidative stress, SOD showed a similar result as 8-OHgG. The MO formula group exhibited anti-inflammatory effects, showing that no significant difference was found between the control and MO formula groups regarding values of IL-6, IL-8, and TNF-a. However, the DO and solifenacin groups showed increased IL-6, IL-8, and TNF-a levels. Cystometrography showed that the OAB and solifenacin groups having a significantly lower value than the control and MO formula groups. The mean contraction interval was shorter in the DO, MO formula, and solifenacin groups and the highest in the control group. CONCLUSIONS: The MO formula exhibited a similar pharmacologic effect to that of solifenacin, with anti-inflammatory and antioxidant effects. Enhancement of the MO formula by the nitric oxide pathway affected DO including BPH-related DO. The MO formula may be one of the alternative choices of anticholinergics, a treatment for DO.