Bottom Deposition Enables Stable All-Solid-State Batteries with Ultrathin Lithium Metal Anode.

Modern strides in energy storage underscore the significance of all-solid-state batteries (ASSBs) predicated on solid electrolytes and lithium (Li) metal anodes in response to the demand for safer batteries. Nonetheless, ASSBs are often beleaguered by non-uniform Li deposition during cycling, leading to compromised cell performance from internal short circuits and hindered charge transfer. In this study, the concept of "bottom deposition" is introduced to stabilize metal deposition based on the lithiophilic current collector and a protective layer composed of a polymeric binder and carbon black. The bottom deposition, wherein Li plating ensues between the protective layer and the current collector, circumvents internal short circuits and facilitates uniform volumetric changes of Li. The prepared functional binder for the protective layer presents outstanding mechanical robustness and adhesive properties, which can withstand the volume expansion caused by metal growth. Furthermore, its excellent ion transfer properties promote uniform Li bottom deposition even under a current density of 6 mA·cm-2 . Also, scanning electron microscopy analysis reveals a consistent plating/stripping morphology of Li after cycling. Consequently, the proposed system exhibits enhanced electrochemical performance when assessed within the ASSB framework, operating under a configuration marked by a high Li utilization rate reliant on an ultrathin Li.

Ultrathin Serpentine Insulation Layer Architecture for Ultralow Power Gas Sensor.

Toxic gases have surreptitiously influenced the health and environment of contemporary society with their odorless/colorless characteristics. As a result, a pressing need for reliable and portable gas-sensing devices has continuously increased. However, with their negligence to efficiently microstructure their bulky supportive layer on which the sensing and heating materials are located, previous semiconductor metal-oxide gas sensors have been unable to fully enhance their power efficiency, a critical factor in power-stringent portable devices. Herein, an ultrathin insulation layer with a unique serpentine architecture is proposed for the development of a power-efficient gas sensor, consuming only 2.3 mW with an operating temperature of 300 °C (≈6% of the leading commercial product). Utilizing a mechanically robust serpentine design, this work presents a fully suspended standalone device with a supportive layer thickness of only ≈50 nm. The developed gas sensor shows excellent mechanical durability, operating over 10 000 on/off cycles and ≈2 years of life expectancy under continuous operation. The gas sensor detected carbon monoxide concentrations from 30 to 1 ppm with an average response time of ≈15 s and distinguishable sensitivity to 1 ppm (ΔR/R0 = 5%). The mass-producible fabrication and heating efficiency presented here provide an exemplary platform for diverse power-efficient-related devices.

Comparison of radiological and functional outcomes of conservative treatment with teriparatide and denosumab in thoracolumbar osteoporotic vertebral fracture.

Teriparatide and denosumab, anti-osteoporosis medications with different mechanisms, have been widely used in the patients with osteoporotic vertebral fracture (OVF) considered as advanced osteoporosis. Teriparatide has been shown to enhance bone formation and fracture healing in OVF, but there are still no sufficient evidences discussing about the role of denosumab in newly developed OVF. In this study, we found the similar radiological deformation and functional outcomes of conservative treatment with teriparatide and denosumab in thoracolumbar (TL) OVF, and teriparatide showed a more frequent incidence of fracture union with paravertebral bone bridge formation compared to denosumab. INTRODUCTION: Teriparatide and denosumab have been widely used to treat advanced osteoporosis and prevent subsequent fractures in patients with OVCF. Unlike teriparatide, which is considered to be effective in fracture healing, there is still no clear role and evidence for the effect of denosumab in acute OVCF. This study compared the radiological and functional outcomes of conservative treatment with teriparatide and denosumab in TL-OVF. METHODS: This retrospective study enrolled 78 women with mean age of 74.69 ± 7.66 (60-92) years diagnosed as a TL-OVF with no neurological deficits. All patients were treated conservatively with teriparatide (34 of group T, once-daily 20 µg) or denosumab (44 of group D, once-6 months 60 mg) for 6 months. We evaluated the radiological deformation (kyphotic angle, segmental vertebral kyphotic angle, and compression ratio) and the incidence of fracture union with paravertebral bone bridge formation (FUPB) and functional outcomes using the visual analog scale (VAS) and Oswestry Disability Index (ODI) at 0, 3, and 6 months. RESULTS: In the radiological deformation and functional outcomes, there were no significant differences at 0, 3, and 6 months between the two groups (P > 0.05). However, the incidence of FUPB at 6 months was higher in group T (20/34, 58.8%) compared to group D (11/44, 25.0%) (P = 0.004), and teriparatide was the most statistically significant factor for achieving FUPB (OR 4.486, P = 0.012) in multivariable logistic analysis. CONCLUSIONS: Teriparatide and denosumab, despite of their different pharmacological mechanisms, showed similar radiological deformation and functional outcomes in the conservative treatment of TL-OVF. However, teriparatide showed a significantly higher incidence of fracture union with paravertebral bone bridge formation.

S-LIGHT: Synthetic Dataset for the Separation of Diffuse and Specular Reflection Images.

Several studies in computer vision have examined specular removal, which is crucial for object detection and recognition. This research has traditionally been divided into two tasks: specular highlight removal, which focuses on removing specular highlights on object surfaces, and reflection removal, which deals with specular reflections occurring on glass surfaces. In reality, however, both types of specular effects often coexist, making it a fundamental challenge that has not been adequately addressed. Recognizing the necessity of integrating specular components handled in both tasks, we constructed a specular-light (S-Light) DB for training single-image-based deep learning models. Moreover, considering the absence of benchmark datasets for quantitative evaluation, the multi-scale normalized cross correlation (MS-NCC) metric, which considers the correlation between specular and diffuse components, was introduced to assess the learning outcomes.

In-hospital extracorporeal cardiopulmonary resuscitation for patients with out-of-hospital cardiac arrest: an analysis by time-dependent propensity score matching using a nationwide database in Japan.

BACKGROUND: Extracorporeal cardiopulmonary resuscitation (ECPR) has been proposed as a rescue therapy for patients with refractory cardiac arrest. This study aimed to evaluate the association between ECPR and clinical outcomes among patients with out-of-hospital cardiac arrest (OHCA) using risk-set matching with a time-dependent propensity score. METHODS: This was a secondary analysis of the JAAM-OHCA registry data, a nationwide multicenter prospective study of patients with OHCA, from June 2014 and December 2019, that included adults (≥ 18 years) with OHCA. Initial cardiac rhythm was classified as shockable and non-shockable. Patients who received ECPR were sequentially matched with the control, within the same time (minutes) based on time-dependent propensity scores calculated from potential confounders. The odds ratios with 95% confidence intervals (CI) for 30-day survival and 30-day favorable neurological outcomes were estimated for ECPR cases using a conditional logistic model. RESULTS: Of 57,754 patients in the JAAM-OHCA registry, we selected 1826 patients with an initial shockable rhythm (treated with ECPR, n = 913 and control, n = 913) and a cohort of 740 patients with an initial non-shockable rhythm (treated with ECPR, n = 370 and control, n = 370). In these matched cohorts, the odds ratio for 30-day survival in the ECPR group was 1.76 [95%CI 1.38-2.25] for shockable rhythm and 5.37 [95%CI 2.53-11.43] for non-shockable rhythm, compared to controls. For favorable neurological outcomes, the odds ratio in the ECPR group was 1.11 [95%CI 0.82-1.49] for shockable rhythm and 4.25 [95%CI 1.43-12.63] for non-shockable rhythm, compared to controls. CONCLUSION: ECPR was associated with increased 30-day survival in patients with OHCA with initial shockable and even non-shockable rhythms. Further research is warranted to investigate the reproducibility of the results and who is the best candidate for ECPR.

Enhancement of faradaic current in an electrochemical cell integrated into silicon microfluidic channels.

Implantable electrochemical sensors enable fast and sensitive detection of analytes in biological tissue, but are hampered by bio-foulant attack and are unable to be recalibrated in-situ. Herein, an electrochemical sensor integrated into ultra-low flow (nL/min) silicon microfluidic channels for protection from foulants and in-situ calibration is demonstrated. The small footprint (5 µm radius channel cross-section) of the device allows its integration into implantable sampling probes for monitoring chemical concentrations in biological tissues. The device is designed for fast scan cyclic voltammetry (FSCV) in the thin-layer regime when analyte depletion at the electrode is efficiently compensated by microfluidic flow. A 3X enhancement of faradaic peak currents is observed due to the increased flux of analytes towards the electrodes. Numerical analysis of in-channel analyte concentration confirmed near complete electrolysis in the thin-layer regime below 10 nL/min. The manufacturing approach is highly scalable and reproducible as it utilizes standard silicon microfabrication technologies.

Handwritten Multi-Scale Chinese Character Detector with Blended Region Attention Features and Light-Weighted Learning.

Character-level detection in historical manuscripts is one of the challenging and valuable tasks in the computer vision field, related directly and effectively to the recognition task. Most of the existing techniques, though promising, seem not powerful and insufficiently accurate to locate characters precisely. In this paper, we present a novel algorithm called free-candidate multiscale Chinese character detection FC-MSCCD, which is based on lateral and fusion connections between multiple feature layers, to successfully predict Chinese characters of different sizes more accurately in old documents. Moreover, cheap training is exploited using cheaper parameters by incorporating a free-candidate detection technique. A bottom-up architecture with connections and concatenations between various dimension feature maps is employed to attain high-quality information that satisfies the positioning criteria of characters, and the implementation of a proposal-free algorithm presents a computation-friendly model. Owing to a lack of handwritten Chinese character datasets from old documents, experiments on newly collected benchmark train and validate FC-MSCCD to show that the proposed detection approach outperforms roughly all other SOTA detection algorithms.

Lossless Data Compression for Time-Series Sensor Data Based on Dynamic Bit Packing.

In this paper, we propose a bit depth compression (BDC) technique, which performs bit packing by dynamically determining the pack size based on the pattern of the bit depth level of the sensor data, thereby maximally reducing the space wastage that may occur during the bit packing process. The proposed technique can dynamically perform bit packing according to the data's characteristics, which may have many outliers or several multidimensional variations, and therefore has a high compression ratio. Furthermore, the proposed method is a lossless compression technique, which is especially useful as training data in the field of artificial intelligence or in the predictive analysis of data science. The proposed method effectively addresses the spatial inefficiency caused by unpredictable outliers during time-series data compression. Additionally, it offers high compression efficiency, allowing for storage space savings and optimizing network bandwidth utilization while transmitting large volumes of data. In the experiment, the BDC method demonstrated an improvement in the compression ratio of up to 247%, with 30% on average, compared with other compression algorithms. In terms of energy consumption, the proposed BDC also improves data transmission using Bluetooth up to 34%, with 18% on average, compared with other compression algorithms.

Galvanic vestibular stimulation to counteract leans illusion: comparing step and ramped waveforms.

Leans is a common type of Spatial Disorientation (SD) illusion that causes pilots to be confused about the position of the aircraft during a flight. This illusion could lead to serious adverse effects and even flight mishaps. Therefore, an effective means to deal with leans is crucial for flight safety. This study aims to investigate the effects of Galvanic Vestibular Stimulation (GVS) technology with different waveforms as a tool to mitigate the negative effects of leans. 20 Air Force pilots participated in leans-induced flight simulation experiment with three GVS conditions (without-GVS, step-GVS, ramped-GVS). Bank angle error, subjective SD, perceived strength, and annoyance were measured as the dependent variables. Analysis revealed that step-GVS and ramped-GVS yielded lower bank angle errors and subjective SD than without-GVS. In addition, annoyance ratings were lower for ramped-GVS than step-GVS. This study suggests that GVS has the potential to be utilised as a counteracting tool to cope with leans.Practitioner summary: Galvanic Vestibular Stimulation (GVS) can be utilised as a tool to counteract the detrimental effects of leans illusion, specifically the ramped style GVS, considering that it is less annoying and distracting for the pilots. In general, GVS induces a roll sensation that can offset the false sensation caused by the leans, which can potentially help maintain flight safety and avoid spatial disorientation-related accidents.Abbreviations: SD: spatial disorientation; GVS: galvanic vestibular stimulation; MSSQ: motion sickness susceptibility questionniare; SSQ: simulator sickness questionnaire; BLE: bluetooth low energy; PCB: printed circuit board; RPM: revolution per minute.

Immunohistochemical analysis of extracellular signal-regulated kinase expression in mature and immature bulls' testes and epididymides.

Extracellular signal-regulated kinase (ERK) has been implicated in mammalian testicular and epididymal development. This study aimed to investigate ERK expression in the immature and mature testes and epididymides of bulls. We evaluated ERK expression using immunoblot analysis and immunohistochemistry. Immunoblot analysis revealed that immature bull testes and epididymides had higher phosphorylated ERK (pERK) expression than mature bull testes and epididymides. pERK immunoreactivity was higher in immature epididymides than in immature testes. pERK was localised mostly in spermatogonia, undifferentiated sustentacular (Sertoli) cells, and interstitial (Leydig) cells in immature testes, as well as in some spermatocytes and spermatids in mature testes. In immature epididymides, the body and tail had higher pERK expression than the head, whereas pERK was broadly distributed throughout the stereocilia, basal cells, and connective tissues. pERK distribution in the head of mature epididymides was similar to that in immature epididymides, whereas few connective tissue cells were expressed in the body and tail of mature epididymides. Collectively, these results suggest that ERK is expressed in the testis and epididymis of immature and mature bulls with varying intensities, and the role of ERK in male reproductive organs may include the specific function of its development.

Attomole-Level Multiplexed Detection of Neurochemicals in Picoliter Droplets by On-Chip Nanoelectrospray Ionization Coupled to Mass Spectrometry.

While droplet microfluidics is becoming an effective tool for biomedical research, sensitive detection of droplet content is still challenging, especially for multiplexed analytes compartmentalized within ultrasmall droplets down to picoliter volumes. To enable such measurements, we demonstrate a silicon-based integrated microfluidic platform for multiplexed analysis of neurochemicals in picoliter droplets via nanoelectrospray ionization (nESI)-mass spectrometry (MS). An integrated silicon microfluidic chip comprising downscaled 7 µm-radius channels, a compact T-junction for droplet generation, and an integrated nESI emitter tip is used for segmentation of analytes into picoliter compartments and their efficient delivery for subsequent MS detection. The developed system demonstrates effective detection of multiple neurochemicals encapsulated within oil-isolated plugs down to low picoliter volumes. Quantitative measurements for each neurochemical demonstrate limits of detection at the attomole level. Such results are promising for applications involving label-free and small-volume detection for monitoring a range of brain chemicals.

Early prognostic impact of serum sodium level among out-of-hospital cardiac arrest patients: a nationwide multicentre observational study in Japan (the JAAM-OHCA registry).

Dysnatremia is an electrolytic disorder commonly associated with mortality in various diseases. However, little is known about dysnatremia in out-of-hospital cardiac arrest (OHCA) cases. Here, we investigated the association between serum sodium level on hospital arrival and neurological outcomes after OHCA. This nationwide hospital-based observational study (The Japanese Association for Acute Medicine Out-of-Hospital Cardiac Arrest registry) enrolled patients with OHCA between 2014 and 2017. We included adult patients aged ≥ 18 years with non-traumatic OHCA who achieved return of spontaneous circulation (ROSC) and whose serum sodium level on hospital arrival was available. Based on the serum sodium level, patients were divided into three levels: hyponatremia (Na < 135 mEq/L), normal sodium level (Na ≥ 135 or ≤ 145 mEq/L), and hypernatremia (Na > 145 mEq/L). The primary outcome was 1-month survival with favourable neurological outcomes. Altogether, 34 754 patients with OHCA were documented, and 5160 patients with non-traumatic OHCA and who achieved ROSC were eligible for our analyses. The proportion of favourable neurological outcomes was highest in patients with normal sodium levels at 17.6% (677/3854), followed by patients with hyponatremia at 8.2% (57/696) and patients with hypernatremia at 5.7% (35/610). Moreover, hyponatremia and hypernatremia were associated with a decreased probability of favourable neurological outcomes compared with normal sodium level (vs. hyponatremia, adjusted odds ratio [AOR] 0.97, 95% confidence interval [CI] 0.95-0.99; vs. hypernatremia, AOR 0.96, 95% CI 0.94-0.98). Hypo- and hypernatremia on hospital arrival were associated with a decreased probability of favourable neurological outcomes in patients with non-traumatic OHCA who achieved ROSC.

GPS Spoofing Detection Method for Small UAVs Using 1D Convolution Neural Network.

The navigation of small unmanned aerial vehicles (UAVs), such as quadcopters, significantly relies on the global positioning system (GPS); however, UAVs are vulnerable to GPS spoofing attacks. GPS spoofing is an attempt to manipulate a GPS receiver by broadcasting manipulated signals. A commercial GPS simulator can cause a GPS-guided drone to deviate from its intended course by transmitting counterfeit GPS signals. Therefore, an anti-spoofing technique is essential to ensure the operational safety of UAVs. Various methods have been introduced to detect GPS spoofing; however, most methods require additional hardware. This may not be appropriate for small UAVs with limited capacity. This study proposes a deep learning-based anti-spoofing method equipped with 1D convolutional neural network. The proposed method is lightweight and power-efficient, enabling real-time detection on mobile platforms. Furthermore, the performance of our approach can be enhanced by increasing training data and adjusting the network architecture. We evaluated our algorithm on the embedded board of a drone in terms of power consumption and inference time. Compared to the support vector machine, the proposed method showed better performance in terms of precision, recall, and F-1 score. Flight test demonstrated our algorithm could successfully detect GPS spoofing attacks.

Association between initial body temperature on hospital arrival and neurological outcome among patients with out-of-hospital cardiac arrest: a multicenter cohort study (the CRITICAL study in Osaka, Japan).

BACKGROUND: The association between spontaneous initial body temperature on hospital arrival and neurological outcomes has not been sufficiently studied in patients after out-of-hospital cardiac arrest (OHCA). METHODS: From the prospective database of the Comprehensive Registry of Intensive Care for OHCA Survival (CRITICAL) study in Osaka, Japan, we enrolled all patients with OHCA of medical origin aged > 18 years for whom resuscitation was attempted and who were transported to participating hospitals between 2012 and 2019. We excluded patients who were not witnessed by bystanders and treated by a doctor car or helicopter, which is a car/helicopter with a physician. The patients were categorized into three groups according to their temperature on hospital arrival: ≤35.9 °C, 36.0-36.9 °C (normothermia), and ≥ 37.0 °C. The primary outcome was 1-month survival, with a cerebral performance category of 1 or 2. Multivariable logistic regression analyses were performed to evaluate the association between temperature and outcomes (normothermia was used as the reference). We also assessed this association using cubic spline regression analysis. RESULTS: Of the 18,379 patients in our database, 5014 witnessed adult OHCA patients of medical origin from 16 hospitals were included. When analyzing 3318 patients, OHCA patients with an initial body temperature of ≥37.0 °C upon hospital arrival were associated with decreased favorable neurological outcomes (6.6% [19/286] odds ratio, 0.51; 95% confidence interval, 0.27-0.95) compared to patients with normothermia (16.4% [180/1100]), whereas those with an initial body temperature of ≤35.9 °C were not associated with decreased favorable neurological outcomes (11.1% [214/1932]; odds ratio, 0.78; 95% confidence interval, 0.56-1.07). The cubic regression splines demonstrated that a higher body temperature on arrival was associated with decreased favorable neurological outcomes, and a lower body temperature was not associated with decreased favorable neurological outcomes. CONCLUSIONS: In adult patients with OHCA of medical origin, a higher body temperature on arrival was associated with decreased favorable neurologic outcomes.

Mobile Health Application for Seizure Management: A Human-Systems Integration Approach.

OBJECTIVE: The study aims to develop a mHealth application for seizure management based on the human system integration (HSI) approach. BACKGROUND: Unmet healthcare needs among people with epilepsy continue to exist despite the advancement in healthcare technology. Current seizure management methods are found to be ineffective. Therefore, a more efficient strategy such as mHealth technology is necessary to aid seizure management. METHOD: The needs identification phase involved identifying the user requirements by interviewing 10 stakeholders and conducting thematic analysis and needs interpretation technique. In the solution identification phase, the system requirements were derived using various human-centered design and systems engineering approaches and were evaluated through quality function deployment to determine design targets. For the design and evaluation phase, the design targets were reflected in the app through the iterative prototyping process, and the interface and functional design were evaluated by seven human factors and ergonomics experts and four stakeholders, respectively. RESULTS: Three primary needs and ten user requirements were derived from the needs identification phase. Ten out of fifteen system requirements were selected as design targets to be included in the final prototype. Results of the evaluation showed that the interface design of the proposed app showed superior usability compared to a competitor app and that the app functions were beneficial for the stakeholders. CONCLUSION: The mHealth app designed through the HSI framework showed good potential in addressing the main issues in seizure management. APPLICATION: The mHealth app design methodology based on the HSI approach can be applied to the design of small-scale systems in various domains.

Transcriptome Profiling in the Hippocampi of Mice with Experimental Autoimmune Encephalomyelitis.

Experimental autoimmune encephalomyelitis (EAE), an animal model of multiple sclerosis (MS), approximates the key histopathological, clinical, and immunological features of MS. Hippocampal dysfunction in MS and EAE causes varying degrees of cognitive and emotional impairments and synaptic abnormalities. However, the molecular alterations underlying hippocampal dysfunctions in MS and EAE are still under investigation. The purpose of this study was to identify differentially expressed genes (DEGs) in the hippocampus of mice with EAE in order to ascertain potential genes associated with hippocampal dysfunction. Gene expression in the hippocampus was analyzed by RNA-sequencing and validated by reverse transcription-quantitative polymerase chain reaction (RT-qPCR). Gene expression analysis revealed 1202 DEGs; 1023 were upregulated and 179 were downregulated in the hippocampus of mice with EAE (p-value < 0.05 and fold change >1.5). Gene ontology (GO) analysis showed that the upregulated genes in the hippocampi of mice with EAE were associated with immune system processes, defense responses, immune responses, and regulation of immune responses, whereas the downregulated genes were related to learning or memory, behavior, and nervous system processes in the GO biological process. The expressions of hub genes from the search tool for the retrieval of interacting genes/proteins (STRING) analysis were validated by RT-qPCR. Additionally, gene set enrichment analysis showed that the upregulated genes in the hippocampus were associated with inflammatory responses: interferon-γ responses, allograft rejection, interferon-α responses, IL6_JAK_STAT3 signaling, inflammatory responses, complement, IL2_STAT5 signaling, TNF-α signaling via NF-κB, and apoptosis, whereas the downregulated genes were related to synaptic plasticity, dendritic development, and development of dendritic spine. This study characterized the transcriptome pattern in the hippocampi of mice with EAE and signaling pathways underpinning hippocampal dysfunction. However, further investigation is needed to determine the applicability of these findings from this rodent model to patients with MS. Collectively, these results indicate directions for further research to understand the mechanisms behind hippocampal dysfunction in EAE.

Effects of thermal and mechanical cycling on the mechanical strength and surface properties of dental CAD-CAM restorative materials.

STATEMENT OF PROBLEM: The properties of dental computer-aided design and computer-aided manufacturing (CAD-CAM) materials vary. Studies regarding the effects of aging on the properties of these materials are lacking. PURPOSE: The purpose of this in vitro study was to evaluate the changes in the mechanical and surface properties of different CAD-CAM materials after thermocycling and mechanical loading. MATERIAL AND METHODS: In total, 150 bar-shaped specimens (17.0×4.0×2.0 mm) were prepared from feldspathic glass-ceramic (VM; Vitablocs Mark II), lithium disilicate glass-ceramic (EX; IPS e.max CAD), zirconia-reinforced lithium silicate glass-ceramic (CD; Celtra Duo), polymer-infiltrated ceramic network (VE; Vita Enamic), and resin-nanoceramic (CS; Cerasmart). Each type was divided into 2 groups (n=15; each). One group was subjected to thermocycling in distilled water at 5 °C to 55 °C for 6000 cycles and 50 N mechanical loading for 1.2×106 cycles. The other group was stored in 37 °C water for 24 hours. Nanoindentation hardness, Young modulus, and 3-point flexural strength were measured for the analyses of the mechanical properties. Surface roughness, surface microstructure, and elemental composition were measured to analyze the surface characteristics. Statistical analyses were performed with 1-way ANOVA with the Tukey HSD post hoc test, independent samples t test, Kruskal-Wallis test with Bonferroni post hoc test, Mann-Whitney U test, and 2-way ANOVA (α=.05). RESULTS: Before and after aging, CS exhibited the lowest hardness (1.20 to 1.04 GPa) and Young modulus (13.76 to 13.48 GPa) values (P<.05). EX exhibited the highest flexural strengths (393.43 to 391.86 MPa), and VM exhibited the lowest (109.98 to 112.73 MPa) values (P<.05). CS exhibited the highest surface roughness (Sa and Sq; 10.60 to 28.82, 14.21 to 38.27 nm) values (P<.05). After aging, the hardness and Young modulus of VM, EX, and VE decreased significantly (P<.001). No significant difference was observed in the flexural strengths of the CAD-CAM materials (P>.05). Significant increases were observed in the surface roughness of all the materials (P<.05), with altered microstructures. Except for the flexural strength, the mechanical properties and surface characteristics of the CAD-CAM materials were significantly affected by the material type after aging. CONCLUSIONS: Before and after aging, resin-nanoceramic exhibited the lowest hardness and Young modulus, and the highest surface roughness. Lithium disilicate glass-ceramic exhibited the highest flexural strength and feldspathic glass-ceramic exhibited the lowest value. After aging, increased surface roughness and microstructure alterations were observed. Significant interactions between aging process and material type were found for the mechanical properties and surface characteristics except for the flexural strength.

Reducing amount of contrast agent after compression of right brachial artery using a blood pressure cuff in computed tomography cerebrovascular angiography.

OBJECTIVE: To invastgate feasibility of low-dose contrast agent in cerebral computed tomography angiography (CTA) to alleviate side effects. METHOD: Siemens' Somatom Definition AS+CT scanner, Heine's blood pressure monitor G7-M237 (BP cuff) and Ultravist contrast agent (370 mg Iodine/ml) are used. CTA is acquired using following scan parameters including slice thickness of 1mm, image acquisition parameters of 128×0.6 mm, pitch size of 0.8 mm, 175 effective mAs, 120 kVp tube voltage, scan delay time of 3 seconds, and the scan time of 4 seconds. This study is conducted by securing the IV route in the left antecubital vein before injection of contrast agent, wrapping BP cuff around the branchial artery of the opposite right arm after setting the pressure to 200 mmHg. Then, the injection rate of the contrast agent is fixed at 4.5 cc/sec and contrast agent was injected in three different amounts (70, 80, and 100 cc). Bp cuff is released from this moment when HU value reachs 100. RESULT: In this study, the mean HU values measured from common carotid artery are 412.45±5.89 when injecting 80cc contrast agent and using BP cuff and 399.64±5.51 when injecting 100 cc contrast agenet and not using BP cuff, respectively. In middle cerebral artery M1, the mean HU values are 325.23±38.29 when injecting 80cc contrast agent and using BP cuff and 325.00±30.63 when injecting 100cc contrast agent blood and not using pressure cuff, respectively. Difference of mean HU values is not statistically significant (p > 0.05) with and without using BP cuff. CONCLUSION: This study demonstrates that reducing amount of contrast agent is possible when the right brachial artery is compressed using BP cuff. Study results indicate that reducing 20% injection of contrast agent in CT cerebrovascular angiography can still yield comparable imaging results with conventional contrast angent usage, which implies that less side effects are expected with a contrast agent injection. Thus, this study can serve as a reference for potential reducing side effect during CT cerebrovascular angiography.

Effects of dexamethasone on VEGF-induced MUC5AC expression in human primary bronchial epithelial cells: Implications for asthma.

Mucins are major macromolecular components of lung mucus that are mainly responsible for the viscoelastic property of mucus. MUC5AC is a major mucin glycoprotein that is hypersecreted in asthmatic individuals. Vascular endothelial growth factor (VEGF) has been implicated in inflammatory and airway blood vessel remodeling in asthmatics. Our previous studies indicate that VEGF upregulates MUC5AC expression by interacting with VEGF receptor 2 (VEGFR2). It has been shown that dexamethasone (Dex) downregulates MUC5AC expression; however, the underlying mechanisms have not been completely elucidated. Therefore, we sought to investigate the effect of Dex on MUC5AC expression induced by VEGF and study the underlying mechanisms. We tested the effects of Dex on VEGFR2 and RhoA activation, caveolin-1 expression, and the association of caveolin-1 and VEGFR2 in primary bronchial epithelial cells. Dex downregulated MUC5AC mRNA and protein levels in a dose- and time-dependent manner, and suppressed the activation of VEGFR2 and RhoA induced by VEGF. Additionally, Dex upregulated caveolin-1 protein levels in a dose- and time-dependent manner. Furthermore, phospho-VEGFR2 expression was decreased through overexpression of caveolin-1 and increased after caveolin-1 knockdown. Dex treatment attenuated the VEGF-decreased association of caveolin-1 and VEGFR2. Collectively, our findings suggest that Dex downregulates VEGF-induced MUC5AC expression by inactivating VEGFR2 and RhoA. Furthermore, decreased MUC5AC expression by Dex was related to the increased association of caveolin-1 with VEGFR2. Further studies characterizing these mechanisms are required to facilitate the development of improved treatment strategies for asthma.

Evaluation of a single surgeon's learning curve of laparoscopic pancreaticoduodenectomy: risk-adjusted cumulative summation analysis.

BACKGROUND: Laparoscopic pancreaticoduodenectomy (LPD) is technically demanding and there is much controversy about its safety. We evaluated the learning curve for pure LPD based on the clinical outcomes of consecutive patients treated by a single surgeon. METHODS: We reviewed the medical records of 119 consecutive patients who underwent LPD by a single surgeon between June 2013 and August 2018. The learning curve was evaluated using the cumulative summation (CUSUM) and risk-adjusted CUSUM (RA-CUSUM) methods. Perioperative outcomes were compared among the learning curve phases. RESULTS: CUSUM analysis of the operation time showed that the operation time improved after the 47th case. RA-CUSUM analysis showed the learning curve for surgical failure, defined as severe complications (Clavien-Dindo grade ≥ 3) or open conversion, comprised three phases (phase 1: cases 1-60; phase 2: cases 61-83; phase 3: cases 84-119). There were no significant differences in operation time among the three phases. Intraoperative blood loss decreased significantly over the three phases (P = 0.032). There were no postoperative deaths. The rates of postoperative complications, pancreatic fistula (grade B/C), and post-pancreatic hemorrhage were significantly lower in phase 3 than in phase 2 (2.8% vs. 21.7%, P = 0.019; 2.8% vs. 17.4%, P = 0.049; 0% vs. 13.0%, P = 0.026), but not between phases 1 and 2. Postoperative hospital stay decreased progressively, and was significantly shorter in phase 3 than in phase 1 (9.1 vs. 16.7 days, P = 0.001). CONCLUSIONS: The LPD failure rate decreased after the first 60 cases and stabilized after 84 cases. For safe dissemination of LPD, it is important to shorten the long learning curve and decrease the unfavorable outcomes in the early phase of the learning curve.