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OBJECTIVE Resting-state functional MRI (RS-fMRI) enables the mapping of function within the brain and is emerging as an efficient tool for the presurgical evaluation of eloquent cortex. Models capable of reliable and precise mapping of resting-state networks (RSNs) with a reduced scanning time would lead to improved patient comfort while reducing the cost per scan. The aims of the present study were to develop a deep 3D convolutional neural network (3DCNN) capable of voxel-wise mapping of language (LAN) and motor (MOT) RSNs with minimal quantities of RS-fMRI data. METHODS Imaging data were gathered from multiple ongoing studies at Washington University School of Medicine and other thoroughly characterized, publicly available data sets. All study participants (n = 2252 healthy adults) were cognitively screened and completed structural neuroimaging and RS-fMRI. Random permutations of RS-fMRI regions of interest were used to train a 3DCNN. After training, model inferences were compared using varying amounts of RS-fMRI data from the control data set as well as 5 patients with glioblastoma multiforme. RESULTS The trained model achieved 96% out-of-sample validation accuracy on data encompassing a large age range collected on multiple scanner types and varying sequence parameters. Testing on out-of-sample control data showed 97.9% similarity between results generated using either 50 or 200 RS-fMRI time points, corresponding to approximately 2.5 and 10 minutes, respectively (96.9% LAN, 96.3% MOT true-positive rate). In evaluating data from patients with brain tumors, the 3DCNN was able to accurately map LAN and MOT networks despite structural and functional alterations. CONCLUSIONS Functional maps produced by the 3DCNN can inform surgical planning in patients with brain tumors in a time-efficient manner. The authors present a highly efficient method for presurgical functional mapping and thus improved functional preservation in patients with brain tumors.

Objectives: Portal sites have become places to share queries about performing nursing and obtain expert know-how. This study aimed to analyze topics of interest in the field of infusion nursing among nurses working in clinical settings.Methods: In total, 169 user query data were collected from October 5, 2018 to December 25, 2021. This exploratory study analyzed the semantic structure of posts on the nurse question-and-answer board of an infusion nursing-related internet portal by extracting major keywords through text data analysis and conducting term frequency (TF) and term frequency-inverse document frequency (TF-IDF) analysis, N-gram analysis, and CONvergence of iteration CORrelation (CONCOR) analysis. Word cloud visualization was conducted utilizing the “wordcloud” package of Python to provide a visually engaging and concise summary of information about the extracted terms.Results: “Infusion” was the most frequent keyword and the highest-importance word. “Infusion→line” had the strongest association, followed by “vein→catheter,” “line→change,” and “peripheral→vein.” Three topics were identified: the replacement of catheters, maintenance of the patency of the catheters, and securement of peripheral intravenous catheters, and the subtopics were blood sampling through central venous catheter, peripherally inserted central catheter management, evidence-based infusion nursing, and pediatric infusion nursing.Conclusions: These findings indicate that nurses have various inquiries in infusion nursing. It is necessary to re-establish the duties and roles of infusion nurses, and to develop effective infusion nursing training programs.

Oncogene-induced senescence (OIS), characterized by irreversible cell cycle arrest by oncogene activation, plays an important role in the pathogenesis of aging and age-related diseases. Recent research indicates that OIS is driven by activation of mitogen-activated protein kinase (MAPK). However, it is not apparent whether MAPK inhibition helps to recover senescence. In our previous study, we uncovered p38 MAPK inhibitor, SB203580, as an effective agent to reduce reactive oxygen species and increase proliferation in premature senescent cells. In this study, we evaluated whether SB203580 could ameliorate senescence in normal senescent cells. The senescence-improving effect was observed in the results that SB203580 treatment restored lysosomal function, as evidenced by a decrease in lysosomal mass and an increase in autophagic vacuoles. Then, SB203580-mediated lysosomal function restoration triggered the clearance of damaged mitochondria, leading to metabolic reprogramming necessary for amelioration of senescence. Indeed, p38 MAPK inhibition by SB203580 improved key senescent phenotypes. Our findings suggest a novel mechanism by which modulation of p38 MAPK activity leads to senescence improvement through functional restoration of lysosome and mitochondria.

The field study was undertaken to examine the potential for adverse effects of transgenic soybean expressing bioactive human epidermal growth factor (with tolerance to the herbicide glufosinate, PPT) on the abundance and diversity of plant-dwelling arthropods by comparing with those of a non-GM parental cultivar, Gwangan soybean. Field surveys of soybean fields were carried out over two consecutive years, 2016 and 2017 at Ochang and Jeonju, Korea. The number of captured individuals associated with either of EGF and Gwangan soybean plants increased in 2017 compared with 2016 in both Ochang and Jeonju. During the survey period, the diversity and richness of the occurred insects and arachnids increased, dominance decreased, and the evenness of the insects remained static. The insects of Hymenoptera Order occurred most often comprised 25.4% of total captured insect pests. On the contrary, natural enemy from Hymenoptera Order and other insects from Diptera Order occurred more frequently (29.9% and 19.0%, respectively) in both the survey regions during the study periods. The score from PROXSCAL multidimensional scaling using combined data showed that the occurrence of insects and arachnids were separated due to their cultivation regions and years, irrespective of soybean cultivars. Consequently, the results indicated that there happened no notable change in the composition of arthropod communities in soybean agroecosystem due to GM event in soybean expressing EGF.

Background: In critically ill patients, the most common manifestation of brain dysfunction is delirium, which is independently associated with higher morbidity and mortality. While electrolyte imbalance is one of the precipitating factors, the impact of hypomagnesemia on the incidence of delirium remains unknown.Methods: We retrospectively analyzed patients admitted to the medical intensive care unit (ICU) of a tertiary referral center between January and June 2020. Patients with ICU stay ≥48 hours and aged 40–85 years were included. The primary outcome was cumulative incidence of delirium in the ICU. Patients were divided into two groups based on serum magnesium level at ICU admission. Multivariable Cox proportional hazards regression analysis was performed, and covariates were selected using the least absolute shrinkage and selection operator (LASSO) method.Results: A total of 109 patients included 43 (39.4%) women and had a median age of 69.0 years (interquartile range [IQR], 60.0–76.0 years). The median magnesium level was 1.7 mg/dl (IQR, 1.5–1.9 mg/dl), and the cumulative incidence of delirium was 32.1% (35 patients). Hypomagnesemia was independently associated with delirium (adjusted hazard ratio [aHR], 2.12; 95% confidence interval [CI], 1.03–4.38), along with prior use of immunosuppressants (aHR, 3.08; 95% CI, 1.46–6.48) or benzodiazepines (aHR, 4.02; 95% CI, 1.54–10.50), body mass index (aHR, 0.93; 95% CI, 0.84–1.02), and alcohol history (aHR, 1.68; 95% CI, 0.74–3.80).Conclusions: In critically ill adults, hypomagnesemia increases the risk of delirium by more than two-fold compared to patients with normal magnesium level.

Background Smart-bar device (SBD) is a newly developed device to measure the body range of motion (ROM) by a kinetic sensor and to provide an exercise program with augmented reality (AR) guidance of body-frame image and audio feedback by mobile application. Objective This study aims to compare the performance of SBD with AR function with a goniometer and to verify the clinical utility of SBD with AR guide function` Methods Ten healthy individuals were enrolled and measured the ROM of body lateral flexion, extension, and rotation using a goniometer and SBD simultaneously. To evaluate the accuracy of an AR-guided exercise, we enrolled three patients with adolescent idiopathic scoliosis and measured the ROM of trunk lateral flexion and rotation during stretching exercises using SBD with or without AR guidance. Results Concurrent validity between the goniometer and SBD was statistically significant, with a very high correlation coefficient from r = 0.836–0.988 (p p Conclusions The SBD could be a valid device to measure the joint angle of neck, shoulder, and trunk. AR guidance increased the accuracy of the stretching exercise, and mobile application of AR-guided stretching exercises with SBD should be useful for scoliosis patients to correct their posture.

Background: The purpose of this study was to investigate the levels of attitude and practice regarding sexual health care in patients with cancer among nurses.Methods: This study used a cross-sectional descriptive design. Participants were 152 nurses who care patients with cancer at a general hospital in Gangwon province. Data were collected from November 7 to 10, 2016 using self-report questionnaire including each 17 item of sexual health care scale-practice and attitude.Results: The subjects’ average age was 29.8±6.3 years, and oncology nursing experience was 7.3±6.2 years. Nurses’ attitude was the average score of 26.6 out of 51. Practice was 2.63 out of 21. Formal education about sexual health care (t=2.01, P=0.048) had significant influenced on nurses’ attitude and age (F=4.45, P=0.013) and working site (F=3.28, P=0.013) on nurses’ practice. The relationship between nurses´attitude and practice toward cancer patients´ sexual health nursing was statistically significant (r=0.33, P=0.001).Conclusions: The findings of this study indicate that it is imminent for nurses to acquire various information about sexual problems with patients during cancer treatment. Educational programs for sexual health care for nurses need to be developed to provide cancer patients to improve their sexual health.

Purpose: The study aims to identify the theme list and priority criteria of patient safety theme reports in South Korea.Methods: The survey was conducted twice, and the importance of each criterion and theme was measured on a nine-point scale using the Delphi technique by a panel of 19 patient safety experts. The criteria included severity, universality, preventability, and organizational-social impact. Descriptive statistics such as frequency, percentage, mean, standard deviation, median, and interval quartile range were used to analyze the data.Results: The parameters were assigned a weighted average of 35% for severity, 20% for universality, 30% for preventability, and 15% for organizational-social impact, respectively. The final top three rankings were surgery safety, blood transfusion safety, and medication safety. In addition to expert opinion, for the theme that is selected based on the priority ranking, one to five sub-topics can be derived from the theme based on the priority ranking, societal demands, or the yearly priority list of patient safety incidents.Conclusion: It is recommended that the official patient safety center distribute the report in the form of a summary that can be utilized nationwide at medical institutions, government institutions, and other places. Updates, as well as accumulated theme reports, will serve as the baseline data for the proposal of the system and for the policy designed to implement and improve institutions’ safety practices as a standard of domestic patient safety practice guidelines.

We report a unique case of vertebrobasilar transient ischemic attacks manifesting as isolated, recurrent, orthostatic dizziness with posterior inferior cerebellar artery (PICA) stenosis. A 57-year-old male patient without past medical history, presented with brief orthostatic dizziness for 2 weeks. There was no associated nausea, vomiting, diplopia, or weakness. On neuro-otologic examination, the patient did not show spontaneous, positional, or gaze-evoked nystagmus. Vestibular function tests such as caloric test, head impulse test, video-oculography, and tilt table test were normal. Brain diffusion-weighted images showed multiple small high signal intensities in the bilateral cerebellar hemispheres. Brain magnetic resonance angiography revealed hypoplasia of the right vertebral artery without focal intracranial focal stenosis. Four-vessel cerebral angiogram showed severe stenosis at the right PICA artery. Our patient’s clinical scenario appears unique hemodynamic spells without symptoms or signs of posterior circulation ischemia. Physicians should also consider cerebrovascular ischemic when the patient suffers repeated orthostatic dizziness that is not explained clinically.

The purpose of this study was to develop a safe and effective method of inserting one tuberosity screw and to determine whether retro-tubercular (RT)-Open-wedge high tibial osteotomy (OWHTO) with tuberosity screw fixation can be conducted to overcome the problem of osteotomized tubercle and produce favorable outcomes compared to RT-OWHTO without tuberosity screw fixation.From 2018 to 2020, patients who underwent bi-planar RT-OWHTO were allocated as two groups (RT-OWHTO without tuberosity screw fixation as group I and with screw fixation as group II). Computed tomography (CT) was used to analyze osteotomy configurations such as RT gap and tip distance, and union of the main and second plane osteotomy sites. The RT gap distance was measured as the length of the osteotomy gap. The RT tip distance was measured as the length of the gap at the tip of the tibial tubercle. Post-operative complications were analyzed also. To evaluate the neurovascular (NV) approximity of screw fixation group, the pre-operative magnetic resonance imaging (MRI) images were referenced on the post-operative CT for the assessment of the safe zone.In total, 44 knees in group I and 46 knees in group II were enrolled. The RT gap distance (2.58 ± 0.69 mm vs. 0.57 ± 0.57 mm; p .001) and RT tip distance (4.31 ± 1.60 mm vs. 1.48 ± 1.42 mm; p .001) were significantly larger in group I than in group II. The sum of union grade in the second plane osteotomy site (17.93 ± 2.18 points vs. 22.24 ± 2.57 points; p .001) was statistically different between two groups at three months post operatively. Post-operative tuberosity prominence occurred in five knees only in group I (p = 0.025), although tibial tuberosity fracture developed in seven cases in group II compared with two cases in group I with no statistical significance. NV was safe when the screw was inserted medially.RT-OWTHO with one-screw fixation for the tuberosity was effective in terms of tuberosity prominence and the union of the second plane osteotomy site. However, it also produced another problem, such as tuberosity fracture. In addition, a tuberosity screw was safe when it was inserted in the medial-distal direction.Cohort study; level III.

BACKGROUND: Home oxygen therapy is well known to improve survival among patients with severe chronic obstructive pulmonary disease (COPD). In Korea, home oxygen therapy has been reimbursed by national health care insurance since 2006. However, an adequate management strategy for home oxygen therapy is not yet established in Korea. This pilot study aimed to develop a new management strategy for home oxygen therapy. METHODS: We developed a new home oxygen service strategy for COPD patients. The new strategy consists of patient education materials, “oxygen notes” for oxygen use self-monitoring, and provision of ambulatory oxygen. Using a structured questionnaire, we explored the usefulness of the new strategy and health status changes among patients before and after the study period. RESULTS: Among 29 participants, the mean age was 69.6 years, and 62.1% were male. At the end of the study, the proportion of patients with severe dyspnea [modified Medical Research Council (mMRC) grade 4] decreased from 62.1% to 41.4%. The mean COPD assessment test score improved from 30.3 to 24.7, and 68.9% of patients scored above the minimum clinically important difference. The mean time and amount of ambulatory oxygen administration changed significantly by the end of the study. More than three-quarters of patients were satisfied with the educational material and oxygen note. CONCLUSIONS: We showed that the new home oxygen service strategy improved the health status of COPD patients. Larger-scale and longer-term research to validate these results is warranted.

Rationale: While the history of pulmonary tuberculosis (PTB) is a risk factor for developing both chronic obstructive pulmonary disease (COPD) and lung cancer, it remains unclear whether the histor...

We report an energy-efficient, cancellation-free, bit-wise time-division duplex (B-TDD) transceiver (TRX) for real-time closed-loop control of high channel count neural interfaces. The proposed B-TDD architecture consists of a duty-cycled ultra-wide band (UWB) transmitter (3.1-5 GHz) and a switching U-NII band (5.2 GHz) receiver. An energy-efficient duplex is realized in a single antenna without power-hungry self-interference cancellation circuits which are prevalently used in the conventional full-duplex, single antenna transceivers. To suppress the interference between up- and down-links and enhance the isolation between the two, we devised a fast-switching scheme in a low noise amplifier and used 5× oversampling with a built-in winner-take-all voting in the receiver. The B-TDD transceiver was fabricated in 65 nm CMOS RF process, achieving low energy consumption of 0.32 nJ/b at 10 Mbps in the receiver and 9.7 pJ/b at 200 Mbps in the transmitter, respectively. For validation, the B-TDD TRX has been integrated with a μLED optoelectrode and a custom analog frontend integrated circuit in a prototype wireless bidirectional neural interface system. Successful in-vivo operation for simultaneously recording broadband neural signals and optical stimulation was demonstrated in a transgenic rodent.

Differentiation of spinocerebellar ataxia type 17 (SCA17) from Huntington's disease (HD) is often challenging since they share the clinical features of chorea, parkinsonism, and dystonia. The ocular motor findings remain to be elucidated in SCA17, and may help differentiating SCA17 from HD. We retrospectively compared the ocular motor findings of 11 patients with SCA17 with those of 10 patients with HD. In SCA17, abnormal ocular motor findings included impaired smooth pursuit (9/11, 82%), dysmetric saccades (9/11, 82%), central positional nystagmus (CPN, 7/11, 64%), abnormal head-impulse tests (4/11, 36%), and horizontal gaze-evoked nystagmus (GEN, 3/11, 27%). Among these, CPN was more frequently observed in SCA17 than in HD (7/11 (64%) vs. 0/10 (0%), p = 0.004) while saccadic slowing was more frequently observed in HD than in SCA17 (8/10 (80%) vs. 2/11 (18%), p = 0.009). Of six patients with follow-up evaluation, five later developed bilateral saccadic hypermetria (n = 4), GEN (n = 1), CPN (n = 1), bilaterally abnormal smooth pursuit (n = 1), and hyperactive head-impulse responses (n = 1) along with a clinical decline. Ocular motor abnormalities can be utilized as a diagnostic marker for differentiation of SCA17 from HD as well as a surrogate marker for clinical decline in SCA17.

We report a miniaturized, minimally invasive high-density neural recording interface that occupies only a 1.53 mm2 footprint for hybrid integration of a flexible probe and a 256-channel integrated circuit chip. To achieve such a compact form factor, we developed a custom flip-chip bonding technique using anisotropic conductive film and analog circuit-under-pad in a tiny pitch of 75 m. To enhance signal-to-noise ratios, we applied a reference-replica topology that can provide the matched input impedance for signal and reference paths in low-noise aimpliers (LNAs). The analog front-end (AFE) consists of LNAs, buffers, programmable gain amplifiers, 10b ADCs, a reference generator, a digital controller, and serial-peripheral interfaces (SPIs). The AFE consumes 51.92 W from 1.2 V and 1.8 V supplies in an area of 0.0161 mm2 per channel, implemented in a 180 nm CMOS process. The AFE shows > 60 dB mid-band CMRR, 6.32 Vrms input-referred noise from 0.5 Hz to 10 kHz, and 48 M input impedance at 1 kHz. The fabricated AFE chip was directly flip-chip bonded with a 256-channel flexible polyimide neural probe and assembled in a tiny head-stage PCB. Full functionalities of the fabricated 256-channel interface were validated in both in vitro and in vivo experiments, demonstrating the presented hybrid neural recording interface is suitable for various neuroscience studies in the quest of large scale, miniaturized recording systems.

Background: Although respiratory tract infection is one of the most important factors triggering acute exacerbation of chronic obstructive pulmonary disease (AE-COPD), limited data are available to suggest an epidemiologic pattern of microbiology in South Korea.Methods: A multicenter observational study was conducted between January 2015 and December 2018 across 28 hospitals in South Korea. Adult patients with moderate-to-severe acute exacerbations of COPD were eligible to participate in the present study. The participants underwent all conventional tests to identify etiology of microbial pathogenesis. The primary outcome was the percentage of different microbiological pathogens causing AE-COPD. A comparative microbiological analysis of the patients with overlapping asthma–COPD (ACO) and pure COPD was performed.Results: We included 1,186 patients with AE-COPD. Patients with pure COPD constituted 87.9% and those with ACO accounted for 12.1%. Nearly half of the patients used an inhaled corticosteroid-containing regimen and one-fifth used systemic corticosteroids. Respiratory pathogens were found in 55.3% of all such patients. Bacteria and viruses were detected in 33% and 33.2%, respectively. Bacterial and viral coinfections were found in 10.9%. The most frequently detected bacteria were Pseudomonas aeruginosa (9.8%), and the most frequently detected virus was influenza A (10.4%). Multiple bacterial infections were more likely to appear in ACO than in pure COPD (8.3% vs. 3.6%, p=0.016).Conclusion: Distinct microbiological patterns were identified in patients with moderate-to-severe AE-COPD in South Korea. These findings may improve evidence-based management of patients with AE-COPD and represent the basis for further studies investigating infectious pathogens in patients with COPD.

ObjectTo study multimodal neuroimaging study including resting state functional MRI (rs-fMRI), anatomical connectivity and brain morphology in patients with bilateral vestibulopathy (BVP) and relationship with clinical correlation.MethodsThirteen patients with BVP (7 women; mean age ± SD = 63.5 ± 14.7 years, 22–80 years) and eighteen age and gender-matched controls were compared rs-fMRI and anatomical MRI. Also, we analyzed the relationship between multimodal neuroimaging and Dizziness Handicap Inventory score (DHI), Vestibular Disorders Activities of Daily Living Scale (VDRL), Geriatric Depression Scale (GDS) and Hospital Anxiety and Depression Scale (HADS).ResultsCompared with controls, BVP patients showed decreased functional connectivity among the key nodes of the salience network, auditory (including vestibular) network, bilateral posterior parahippocampal gyri, bilateral paracingulate gyri, and right frontoparietal network, and the anatomical connectivity in the right cerebellum, corpus callosum tapetum, and left fornix. BVP patients showed decreased gray matter volume in the bilateral parahippocampal gyri, right precentral gyrus, anterior cingulate gyrus, and right middle temporal gyrus and increased gray matter volume in the right superior frontal gyrus compared with controls. Correlation analyses showed rs-fMRI and clinical variables showed no significant result. DHI correlated negatively with anatomical connectivity in the bilateral frontal parahippocampal cingulum, corpus callosum, right inferior fronto-occipital fasciculus, bilateral fornix, and gray matter volumes in the bilateral middle occipital gyri, right superior occipital gyrus, left angular gyrus, and right cuneus in BVP. VADL correlated negatively with Anatomical connectivity in the corpus callosum, bilateral fornix, bilateral cerebellum, bilateral superior and anterior thalamic radiation, right inferior fronto-occipital fasciculus, bilateral fronto-parietal cingulum, right dentatoruburothalamic tract and gray matter volumes in the right angular gyri, bilateral parahippocampal gyri, right middle temporal gyrus, right cuneus, bilateral inferior occipital gyri, left middle occipital gyrus, right superior frontal gyrus, left fusiform gyrus, bilateral caudate, left cerebellar crus, and bilateral calcarine gyri in BVP.ConclusionsThis study identified reductions in the volume of the hippocampus and alterations in functional and anatomical connectivity that concurs with previously established characteristics of BVP. The degree of disability can be inferred from the change in the connectivity and volume between vestibular cortical areas and their network.