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Background The decision of which arm to use to achieve a goal depends on energetic costs and performance abilities of each arm. Following a stroke, there is a reduction in the use of the more-impaired arm. Is it because the energetic costs of the more-impaired arm are increased, or because its use dictates a lower chance of success? Objective We sought to elucidate the impact of energetic cost and task success on the arm choice of stroke survivors. Methods Thirteen chronic stroke survivors and thirteen neurologically-intact subjects participated in an experiment where they reached towards visual targets in a virtual-reality environment. Energetic cost of reaching with their less-used arm (nondominant/more-impaired) was adjusted by amplifying the range of motion, while task accuracy requirement was independently modulated by changing target size. Results Reducing the energic cost of reaching increased the use of the less-used arms in both groups, but by a greater amount in the stroke survivors. In contrast, lowering task accuracy requirement altered arm choice similarly in the two groups. The time spent in decision-making (reaction time) reflected different impacts of energetic cost and task success on the arm choice of the two groups. Conversely, velocity changes were similar between the groups. Conclusions The impact of energetic cost on arm choice of stroke survivors is greater than neurologically-intact subjects. Thus, the reduction in the use of the impaired arm following stroke may be primarily due to a subjective increase in the effort it takes to use that arm.

To evaluate the surgical effects of robotic paravaginal repair and sacrocolpopexy in patients diagnosed with lateral cystocele due to paravaginal defect.Robotic paravaginal repair and sacrocolpopexy were performed contemporaneously in 43 patients with high-grade pelvic organ prolapse combined with a lateral or mixed cystocele. To objectively evaluate prolapse correction, the Pelvic Organ Prolapse Quantification (POP-Q) test was performed at the 12-month visit and the results compared to those of the preoperative period. Subjective satisfaction was scored using the Patient Global Impression of Improvement (PGI-I) questionnaire.POP-Q measurement results before and after surgery, an objective indicator of surgery, the Ba and C scores improved significantly from 2.1 ± 1.2 preoperatively to -2.0 ± 1.1 postoperatively (P.01), and from 0.3 ± 1.3 preoperatively to -4.3 ± 1.1 postoperatively (P.01), respectively. In PGI-I questionnaire, the numbers of patients who awarded scores of 1 and 2 (evidencing high-level symptom improvement) were 33 at 1 month (76.7%), 30 at 3 months (69.8%), and 28 (65.1%) at 12 months. When respondents awarding 3 points (a little improvement) were included, the numbers rose to 38 (88.4%) at 1 and 3 months and 35 (81.4%) at 12 months, indicating satisfaction with symptom improvement. There were no critical complications during and after surgery, but complications such as de novo stress urinary incontinence that lower patient satisfaction occurred in some cases.Robot-assisted paravaginal repair and sacrocolpopexy can be safely performed in patients with cystocele-predominant pelvic organ prolapse and good surgical results can be expected with excellent effects.

The electrical properties of a single facet of an individual ZnO microwire were investigated. Electrode patterns with a Hall bar structure were deposited on the surface of the top facet of the ZnO microwire. Using a suspended and cross-linked poly(methyl methacrylate) ribbon structure, it was possible to define the electrical connections only at the top surface, while avoiding those on the other five sides of the ZnO microwire. Current-voltage characteristics were examined, and Hall measurements were conducted with various magnetic fields. Through our device structure, the electrical properties could be directly probed at specific points on the ZnO surface in a reliable manner. The estimated electrical characteristics demonstrate that the carrier concentration and mobility of the ZnO surface varied along the axial direction of the wire. These results indicate that the charge carrier concentration on the surface of the micro-/nanowire can be sensitively changed according to the synthesis environment. In addition, it is worth noting that the nanoscale local Hall probes, fabricated by our technique, could probe the very slight variation of carrier concentration, which is difficult to detect by a standard transport measurement along the wire.

A dual thermistor radiosonde (DTR) comprising two (aluminium-coated and black) sensors with different emissivities was developed to correct the effects of solar radiation on temperature probes based on in situ radiation measurements. Herein, the DTR performance is characterised in terms of the uncertainty via a series of ground-based facilities and an intercomparison radiosounding test. The DTR characterisation procedure using laboratory facilities is as follows: individually calibrate the temperature of the thermistors in a climate chamber from −70 to 30 ∘C to evaluate the uncertainty of raw temperature measurement before radiation correction; test the effect of temperature on the resistance reading using radiosonde boards in the climate chamber from −70 to 20 ∘C to identify a potential source of errors owing to the boards, especially at cold temperatures; individually perform radiation tests on thermistors at room temperature to investigate the degree of heating of aluminium-coated and black sensors (the average ratio = 1 : 2.4) and use the result for obtaining unit-specific radiation correction formulas; and perform parameterisation of the radiation measurement and correction formulas with five representative pairs of sensors in terms of temperature, pressure, ventilation speed, and irradiance using an upper air simulator. These results are combined and applied to the DTR sounding test conducted in July 2021. Thereafter, the effective irradiance is measured using the temperature difference between the aluminium-coated and black sensors of the DTR. The measured irradiance is then used for the radiation correction of the DTR aluminium-coated sensor. The radiation-corrected temperature of the DTR is mostly consistent with that of a commercial radiosonde (Vaisala, RS41) within the expanded uncertainty (∼ 0.35 ∘C) of the DTR at the coverage factor k = 2. Furthermore, the components contributing to the uncertainty of the radiation measurement and correction are analysed. The DTR methodology can improve the accuracy of temperature measurement in the upper air within the framework of the traceability to the International System of Units.

Overexpression of the BCL2 protein has been reported as a poor prognostic factor for diffuse large B-cell lymphoma (DLBCL). However, there are currently no standardized criteria for evaluating BCL2 protein expression. We aimed to evaluate the prognostic value of BCL2 expression determined by immunohistochemistry (IHC), incorporating both the staining intensity and proportion, in patients with de novo DLBCL who received rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) as first-line treatment. We defined tumors with BCL2 expression in nearly all tumor cells with a uniformly strong intensity by IHC as BCL2 super-expressor. The BCL2 super-expressors (n = 35) showed significantly worse event-free survival (EFS; HR, 1.903; 95% CI, 1.159-3.126, P = 0.011) and overall survival (OS; HR, 2.467; 95% CI, 1.474-4.127, P = 0.001) compared with the non-BCL2 super-expressors (n = 234) independent of the international prognostic index (IPI), cell of origin (COO), and double expressor status in the training set (n = 269). The adverse prognostic impact of BCL2 super-expression was confirmed in the validation set (n = 195). When the survival outcomes were evaluated in the entire cohort (n = 464), BCL2 super-expressor group was significantly associated with inferior EFS and OS regardless of IPI, COO, MYC expression, and stages. BCL2 super-expressors had genetic aberrations enriched in the NOTCH and TP53 signaling pathways. This study suggests that the BCL2 super-expressor characterizes a distinct subset of DLBCL with a poor prognosis and warrants further investigation as a target population for BCL-2 inhibitors.

Brain metastases are not rare in patients with renal cell carcinoma. However, there have been few reports of isolated brain metastases. In patients with localized renal masses, urologists tend to evaluate only the chest and abdomen region. We report the case of a 65-year-old patient who presented with sudden left-sided weakness. He underwent brain surgery after a mass was found on brain imaging. Histopathology analysis revealed a single brain metastasis that occurred 15 months after robot-assisted laparoscopic radical nephrectomy for renal cell carcinoma. Although the patient had been evaluated for localized kidney cancer in preoperative staging, he had not complained of any neurological symptoms before or after radical nephrectomy. Therefore, we had not perceived a need for brain evaluation at that time. This report is intended to draw attention to the need for further evaluation in patients with large renal masses, as well as patients with moderate to high recurrence risk scores.

Background: Predicting preoperative frailty risk in emergency surgery is difficult with limited information because preoperative evaluation is not commonly performed properly. A recent study attempted to predict preoperative frailty risk using only diagnostic and surgical codes that can be extracted from the electronic medical records system. Objective: This study aimed to validate whether the prediction model of preoperative frailty risk presented in the previous study is well applied to other medical hospitals’ data. Methods: This is a retrospective cohort study including 1,557 patients (≥75 years old) who were admitted to a single institution for emergency operations between January 1, 2010, and December 31, 2019, for study analysis. The Charlson comorbidity index, Hospital Frailty Risk Score, and the recently developed Operation Frailty Risk Score (OFRS) were calculated using the patient’s diagnostic and operation codes. The predictive performances of these calculated risk scores and the American Society of Anesthesiologists-Physical Status classification for postoperative 90-day mortality were compared by using the receiver operating characteristic curve analysis. Findings: The predictive performance of the OFRS, Charlson comorbidity index, American Society of Anesthesiologists-Physical Status, and Hospital Frailty Risk Score for postoperative 90-day mortality was 0.81, 0.630, 0.699, and 0.549 on a c-statistics basis, respectively. Conclusions: The OFRS using diagnostic and operation codes may show the best predictive performance for 90-day mortality compared to other risk scores, and it can be the clinically applicable model to evaluate the preoperative frailty risk in elderly patients undergoing emergency surgery.

Purpose: To compare the stereoacuity between patients with anisometropic amblyopia who were treated and achieved normal visual acuity (VA) and normal children and evaluate the factors associated with stereoacuity.Methods: We retrospectively reviewed the records of 37 pediatric patients with anisometropic amblyopia who recovered to normal VA with glasses and occlusion treatment (amblyopia group) and 34 normal children (control group). The Worth 4-dot test, Lang II test, Titmus test, and TNO test were performed to measure stereoacuity. Clinical characteristics were compared between the two groups, and factors affecting stereoacuity outcomes were also analyzed in the amblyopic group.Results: The mean age at diagnosis of amblyopia was 5.3 ± 1.4 years, and the mean VAs at diagnosis were 0.41 ± 0.24 and 0.06 ± 0.07 in amblyopic and fellow eyes, respectively. The mean duration of occlusion was 19.00 ± 9.44 months, and VA of amblyopic eyes improved to 0.04 ± 0.04 after occlusion treatment. The patient characteristics did not differ significantly between the two groups, except for the final VA of the amblyopic eye. The final mean logarithm of minimal angle of resolution VA of the amblyopic eye in the amblyopia group was significantly worse than that in the control group. The number of patients with normal stereoacuity was significantly lower in the amblyopia group than in the control group on Lang II, Titmus, and TNO tests. Factors associated with poor stereoacuity were severe amblyopia in the Lang II test and poor post-treatment VA of the amblyopic eye in the Titmus test.Conclusions: Stereoacuity was worse in the amblyopia group than in the control group, despite normal visual development. The depth of amblyopia and post-treatment VA were associated with stereoacuity outcomes. Thus, VA improvement should be closely monitored in the amblyopic eye to obtain good stereoacuity.

Higher order modulations are the key elements to the throughput and spectral efficiency increase, especially important for the limited bandwidth scenarios. In this paper, we present a detailed analysis of the 256-QAM signal demodulation performance for the novel sidelink (SL) mode of the 5G NR communication systems. The performance is frequency offset (CFO). It was shown that the CFO has critical impact on the system performance, along with channel mobility. The simple and effective CFO studied in the non-stationary, frequency selective channel in the presence of the carrier compensation algorithm based on the slot-by-slot time-domain signal processing is proposed and investigated. Obtained simulation results have shown the feasibility of the 256-QAM modulation in applications to the main 3GPP sidelink scenarios and parameters, with the proposed CFO compensation method applied even in the case of significant user mobility.

Despite its importance, abnormal interactions between the proximal and distal upper extremity muscles of stroke survivors and their impact on functional task performance has not been well described, due in part to the complexity of upper extremity tasks. In this pilot study, we elucidated proximal–distal interactions and their functional impact on stroke survivors by quantitatively delineating how hand and arm movements affect each other across different phases of functional task performance, and how these interactions are influenced by stroke. Fourteen subjects, including nine chronic stroke survivors and five neurologically-intact subjects participated in an experiment involving transport and release of cylindrical objects between locations requiring distinct proximal kinematics. Distal kinematics of stroke survivors, particularly hand opening, were significantly affected by the proximal kinematics, as the hand aperture decreased and the duration of hand opening increased at the locations that requires shoulder abduction and elbow extension. Cocontraction of the extrinsic hand muscles of stroke survivors significantly increased at these locations, where an increase in the intermuscular coherence between distal and proximal muscles was observed. Proximal kinematics of stroke survivors was also affected by the finger extension, but the cocontraction of their proximal muscles did not significantly increase, suggesting the changes in the proximal kinematics were made voluntarily. Our results showed significant proximal-to-distal interactions between finger extension and elbow extension/shoulder abduction of stroke survivors exist during their functional movements. Increased cocontraction of the hand muscles due to increased neural couplings between the distal and proximal muscles appears to be the underlying mechanism.

Purpose: To investigate the safety and efficacy of hypofractionated radiation therapy (HFRT) in patients with non-small cell lung cancer who are unfit for surgery or stereotactic body radiation therapy (SBRT) at our institution.Materials and Methods: From May 2007 to December 2018, HFRT was used to treat 68 lesions in 64 patients who were unsuitable for SBRT because of central tumor location, large tumor size, or contiguity with the chest wall. The HFRT schedule included a dose of 50–70 Gy delivered in 10 fractions over 2 weeks. The primary outcome was freedom from local progression (FFLP), and the secondary endpoints included overall survival (OS), disease-free survival, and toxicities.Results: The median follow-up period was 25.5 months (range, 5.3 to 119.9 months). The FFLP rates were 79.8% and 67.8% at 1 and 2 years, respectively. The OS rates were 82.8% and 64.1% at 1 and 2 years, respectively. A larger planning target volume was associated with lower FFLP (p = 0.023). Dose escalation was not associated with FFLP (p = 0.964). Four patients (6.3%) experienced grade 3–5 pulmonary toxicities. Tumor location, central or peripheral, was not associated with either grade 3 or higher toxicity.Conclusion: HFRT with 50–70 Gy in 10 fractions demonstrated acceptable toxicity; however, the local control rate can be improved compared with the results of SBRT. More studies are required in patients who are unfit for SBRT to investigate the optimal fractionation scheme.

Fibroblasts can be directly reprogrammed into cardiomyocytes, endothelial cells or smooth muscle cells. Here, we report the reprogramming of mouse tail-tip fibroblasts simultaneously into cells resembling these three cell types via the microRNA-mimic miR-208b-3p, ascorbic acid and bone morphogenetic protein 4, as well as the formation of tissue-like structures formed by the directly reprogrammed cells. Implantation of the formed cardiovascular tissue into the infarcted hearts of mice led to the migration of reprogrammed cells into the injured tissue, reducing regional cardiac strain and improving cardiac function. The migrated endothelial cells and smooth muscle cells contributed to vessel formation, and the migrated cardiomyocytes, which initially displayed immature characteristics, became mature over time and formed gap junctions with host cardiomyocytes. Direct reprogramming of somatic cells to make cardiac tissue may aid the development of applications in cell therapy, disease modelling and drug discovery for cardiovascular diseases.

Accurate prediction of postoperative mortality is important for not only successful postoperative patient care but also for information-based shared decision-making with patients and efficient allocation of medical resources. This study aimed to create a machine-learning prediction model for 30-day mortality after a non-cardiac surgery that adapts to the manageable amount of clinical information as input features and is validated against multi-centered rather than single-centered data. Data were collected from 454,404 patients over 18 years of age who underwent non-cardiac surgeries from four independent institutions. We performed a retrospective analysis of the retrieved data. Only 12–18 clinical variables were used for model training. Logistic regression, random forest classifier, extreme gradient boosting (XGBoost), and deep neural network methods were applied to compare the prediction performances. To reduce overfitting and create a robust model, bootstrapping and grid search with tenfold cross-validation were performed. The XGBoost method in Seoul National University Hospital (SNUH) data delivers the best performance in terms of the area under receiver operating characteristic curve (AUROC) (0.9376) and the area under the precision-recall curve (0.1593). The predictive performance was the best when the SNUH model was validated with Ewha Womans University Medical Center data (AUROC, 0.941). Preoperative albumin, prothrombin time, and age were the most important features in the model for each hospital. It is possible to create a robust artificial intelligence prediction model applicable to multiple institutions through a light predictive model using only minimal preoperative information that can be automatically extracted from each hospital.

The decision regarding which arm to use to perform a task reflects a complex process that can be influenced by many factors, including effort requirements of acquiring the goal. In this study, we considered a virtual reality environment in which people reached to a visual target in three-dimensional space. To vary the cost of reaching, we altered the visual feedback associated with motion of one arm but not the other. This altered the extent of motion that was required to reach, thus changing the effort required to acquire the goal. We then measured how that change in effort affected the decision regarding which arm to use, as well as the preparation time for the movement that ensued. As expected, with increased visual amplification of one arm (reduced effort to reach the goal), subjects increased the probability of choosing that arm. Surprisingly, however, the reaction times to start these movements were also reduced: despite constancy of the visual representation of the target, reaction times were shorter for movements with less effort. Thus, as the perceived effort associated with accomplishing a goal was reduced for a given limb, the decision-making process was biased toward use of that limb. Furthermore, movements that were perceived to be less effortful were performed with shorter reaction times. These results suggest that visual amplification can alter the perceived effort associated with using a limb, thus increasing frequency of use. This may provide a useful method to increase use of a limb during rehabilitation. NEW & NOTEWORTHY We report that visual amplification may serve as an effective means to alter the perceived effort associated with use of a limb. This method may provide an effective tool with which use of the affected limb can be encouraged noninvasively after neurological injury.

We fabricated hybrid nanostructures consisting of MoS

Purpose The purpose of this study was to develop automated planning for whole‐brain radiation therapy (WBRT) using a U‐net‐based deep‐learning model for predicting the multileaf collimator (MLC) shape bypassing the contouring processes. Methods A dataset of 55 cases, including 40 training sets, five validation sets, and 10 test sets, was used to predict the static MLC shape. The digitally reconstructed radiograph (DRR) reconstructed from planning CT images as an input layer and the MLC shape as an output layer are connected one‐to‐one via the U‐net modeling. The Dice similarity coefficient (DSC) was used as the loss function in the training and ninefold cross‐validation. Dose‐volume‐histogram (DVH) curves were constructed for assessing the automatic MLC shaping performance. Deep‐learning (DL) and manually optimized (MO) approaches were compared based on the DVH curves and dose distributions. Results The ninefold cross‐validation ensemble test results were consistent with DSC values of 94.6 ± 0.4 and 94.7 ± 0.9 in training and validation learnings, respectively. The dose coverages of 95% target volume were (98.0 ± 0.7)% and (98.3 ± 0.8)%, and the maximum doses for the lens as critical organ‐at‐risk were 2.9 Gy and 3.9 Gy for DL and MO, respectively. The DL technique shows the consistent results in terms of the DVH parameter except for MLC shaping prediction for dose saving of small organs such as lens. Conclusions Comparable with the MO plan result, the WBRT plan quality obtained using the DL approach is clinically acceptable. Moreover, the DL approach enables WBRT auto‐planning without the time‐consuming manual MLC shaping and target contouring.

The purpose of this study is to evaluate the performance of a recurrent neural network (RNN)-based prediction algorithm to compensate for respiratory movement using an articulated robotic couch system. A prototype of a real-time respiratory motion compensation couch was built using an optical 3D motion tracking system and a six-degree-of-freedom-articulated robotic system. To compensate for the system latency from motion detection to re-positioning of the system, RNN and double exponential smoothing (ES2) prediction algorithms were applied. Three aspects of performance were evaluated, simulation and experiments for geometric and dosimetric evaluations, using data from three liver and three lung patients who underwent stereotactic body radiotherapy. Overall, the RNN algorithm showed better geometric and dosimetric results than the other approaches. In simulation tests, RNN showed 82% average improvement ratio, compared with non-predicted results. In the geometric evaluation, RNN only showed average FWHM broadening of 1.5 mm, compared with the static case. In the dosimetric evaluation, RNN showed average gamma passing rates of 97.4 ± 1.0%, 89.0 ± 2.4% under the 3%/3 mm, 2%/2 mm respectively. It may be technically feasible to use the RNN prediction algorithm to compensate for respiratory motion with an articulated robotic couch system. The RNN algorithm could be widely used for motion compensation in patients undergoing radiotherapy.

In this study, the hovering performance of contra rotating ducted rotor (CRDR) for micro air vehicle (MAV) was performed by using computational fluid dynamics technique. A rotor shape with 5-inch diameter and 4.3-inch pitch for MAV was used. Aerodynamic performance and flow structures were investigated for a single rotor (SR), Contra Rotating Open Rotor and CRDR at various operating RPMs. In case of CRDR, thrust increased by 170% compared to that of SR due to the acceleration of flow at the duct inlet, and approximately 20% thrust improvement was observed compared to CROR. Duct of the CRDR was found to produce approximately 30% of the total thrust. Because torque of rear rotor is slightly greater than that of front rotor, adjustment of RPM or rotor blade shape would be necessary for the torque cancellation. Efficiency of each system was compared based on the power loading, and it was found that CRDR configuration is the most efficient configuration to generate thrust by consuming minimum power.

Successful grasp requires that grip forces be properly directed between the fingertips and the held object. Changes in digit posture significantly affect the mapping between muscle force and fingertip force. Joint torques must subsequently be altered to maintain the desired force direction at the fingertips. Our current understanding of the roles of hand muscles in force production remains incomplete, as past studies focused on a limited set of postures or force directions. To thoroughly examine how hand muscles adapt to changing external (force direction) and internal (posture) conditions, activation patterns of six index finger muscles were examined with intramuscular electrodes in 10 healthy subjects. Participants produced submaximal isometric forces in each of six orthogonal directions at nine different finger postures. Across force directions, participants significantly altered activation patterns to accommodate postural changes in the interphalangeal joint angles but not changes in the metacarpophalangeal joint angles. Modulation of activation levels of the extrinsic hand muscles, particularly the extensors, were as great as those of intrinsic muscles, suggesting that both extrinsic and intrinsic muscles were involved in creating the desired forces. Despite considerable between-subject variation in the absolute activation patterns, principal component analysis revealed that participants used similar strategies to accommodate the postural changes. The changes in muscle coordination also helped increase joint impedance in order to stabilize the end-point force direction. This effect counteracts the increased signal-dependent motor noise that arises with greater magnitude of muscle activation as interphalangeal joint flexion is increased. These results highlight the role of the extrinsic muscles in controlling fingertip force direction across finger postures. NEW & NOTEWORTHY We examined how hand muscles adapt to changing external (force direction) and internal (posture) conditions. Muscle activations, particularly of the extrinsic extensors, were significantly affected by postural changes of the interphalangeal, but not metacarpophalangeal, joints. Joint impedance was modulated so that the effects of the signal-dependent motor noise on the force output were reduced. Comparisons with theoretical solutions showed that the chosen activation patterns occupied a small portion of the possible solution space, minimizing the maximum activation of any one muscle.

We evaluated real-world effectiveness and safety of CT-P10 (Truxima®) compared with originator rituximab in diffuse large B-cell lymphoma (DLBCL) treatment. Before and after the introduction of CT-...

In this study, a new three-dimensional (3D) volumetric dosimetry method utilizing gel dosimetry with a patient-specific (PS) 3D-printed phantom was developed. A PS 3D-printed phantom that closely mimics the actual tumor and surrounding tissues was demonstrated using a 3D printer (3Dison Plus, Lokit, Korea). MAGAT normoxic polymer gel was filled in the tumor-shaped cavity of the 3D-printed phantom to represent the real tumor. Seven identical gel samples for dosimetric calibration were irradiated at different doses and scanned using magnetic resonance imaging. A chlorinated polyethylene filament was utilized as the 3D printing material. The two-dimensional gamma passing rates using the film were 96.1% and 84.3% for the 3%/3 mm and the 2%/1 mm dose accuracy/distance-to agreement criteria, respectively. The radiation dose-R2 (relaxation rate) calibration, with a coefficient of determination (R2) of 0.997, was applied for the absolute dose calibration. The overall gross tumor volume shape and the dose distribution of the gel measurement agreed reasonably well with the plan results. The 3D gamma passing rate was 91.2% for the 3%/3 mm criteria and decreased to 82.3% for the 2%/1 mm criterion. Our results suggest that polymer gel dosimetry with the 3D-printed phantom allows direct validation of the 3D dose distribution.

The distinct clinical characteristics of patients at diagnosis of diffuse large B-cell lymphoma (DLBCL), who experience a late relapse compared with those who relapse early, require reappraisal in the era of R-CHOP. Data from the lymphoma registry of the Asan Medical Center between 2002 and 2015 were retrospectively reviewed. Among 846 DLBCL patients treated with first-line R-CHOP and achieved complete response, 169 (20%) relapsed, occurring late (2 years) in 51 (6%). Compared with early relapses, late relapses were associated with a lower International Prognostic Index score (