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Artificial intelligence methods including deep neural networks (DNN) can provide rapid molecular classification of tumors from routine histology with accuracy that matches or exceeds human pathologists. Discerning how neural networks make their predictions remains a significant challenge, but explainability tools help provide insights into what models have learned when corresponding histologic features are poorly defined. Here, we present a method for improving explainability of DNN models using synthetic histology generated by a conditional generative adversarial network (cGAN). We show that cGANs generate high-quality synthetic histology images that can be leveraged for explaining DNN models trained to classify molecularly-subtyped tumors, exposing histologic features associated with molecular state. Fine-tuning synthetic histology through class and layer blending illustrates nuanced morphologic differences between tumor subtypes. Finally, we demonstrate the use of synthetic histology for augmenting pathologist-in-training education, showing that these intuitive visualizations can reinforce and improve understanding of histologic manifestations of tumor biology.

This study proposes an analytical method (AM) for V-type consequent-pole permanent magnet (V-CPM) machines to quickly determine the suitable permanent magnet (PM) volume while reducing the PM volume compared to that of the V-type interior PM (V-IPM) machine. Special air-gap magnetic flux density modeling is adopted in the AM, which consists of 4 asymmetric regions under one PM and the iron pole of the V-CPM. This specific modeling is utilized for the V-CPM topology, which has a different magnetic saturation trend from the conventional surface-mounted CPM (S-CPM). Hence, additional consideration of rotor saturation by novel method has been done compared to the previous works. To achieve average torque similar to that of the V-IPM machine, a V-CPM machine is designed by the proposed AM to have the same fundamental harmonic value of air-gap flux density. Furthermore, two conditions are considered for the V-CPM machine design to prevent unnecessary saturation and to minimize torque ripple. All the performance metrics of the designed V-CPM machine are compared with those of the other machines to demonstrate its superiority.

This paper proposes a rotary-linear surface-mounted permanent magnet (PM) voice coil motor (RL-SVCM) with PM flux bridges in place of the iron flux bridges in a traditional RL-SVCM for enhancing average torque and force ripple but slight damage of torque ripple and average linear force. The iron flux bridges in a basic RL-SVCM cannot participate in the generation of rotary torque. In contrast, the PM flux bridges in the proposed RL-SVCM can participate in the generation of rotary torque. The magnetic equivalent circuit (MEC) is used to analyze the magnetic circuits of the basic and proposed models. The results explain the reasons for the performance improvements achieved by the proposed motor. The finite element method (FEM) is used to derive the precise output performance of the basic and proposed motors. Additionally, a prototype of the proposed RL-SVCM with PM flux bridges was manufactured for experimental verification. Close agreement between the experimental results and FEM results validates the feasibility of the proposed RL-SVCM.

A high gear ratio flux switching permanent magnet machine (HFSPM) was proposed to improve the torque performance in flux switching permanent magnet machine (FSPM). Conventional FSPMs address flux bypass issue when designed with a high gear ratio. The HFSPM adopts a dual rotor structure to overcome this flux bypass issue. First, the cause and effect of flux bypass issue was discussed using a magnetic equivalent circuit (MEC). Further, the process of overcoming the flux bypass issue using dual rotor structure was discussed. An alternative HFSPM, consequent pole HFSPM (CP-HFSPM), was proposed to enhance torque performance. The CP-HFSPM was optimized for high torque performance and proper power factor.

This paper proposes a low-cost dual-mechanical-port dual-excitation machine for washing machine application. The proposed machine artfully combines two machines (vernier and permanent magnet synchronous machine (PMSM)). An outer vernier rotor is used for the low-speed washing operations, and an inner PMSM rotor is used for the high-speed drying operations of the washing machine. The proposed machine is compared with a similar recently presented machine to verify its cost-effectiveness. Comparison using the finite element analysis (FEA) shows that the ferrite magnets used in the proposed topology are more cost-effective. Furthermore, compared to the existing machine, the power factor of the proposed machine is high during the drying operation; hence, a lower rating inverter is sufficient to drive the machine, which further reduces the overall cost. In addition, the proposed machine provides similar efficiencies as the existing machine for both washing and drying operations.

This paper proposes a two-phase dual-stator axial-flux permanent magnet brushless dc motor with an ironless rotor for higher torque per magnet volume using the only-pull drive technique. The advantage of the ironless rotor is that it reduces magnet volume by providing an effective flux linkage, while the only-pull drive technique, which involves only the pull process, benefits from the use of thin magnets that do not experience the irreversible demagnetization. The axial-flux configuration of the proposed dual-stator motor was adopted because of its capability of achieving the desired trapezoidal back electromotive force that maximizes the advantages of the only-pull drive technique. The thin magnets were fixed on the ironless rotor using a non-magnetic structure, and the stator was particularly designed to implement the only-pull drive technique. The performance of the motor was analyzed in terms of torque per magnet volume using the finite element analysis and validated by the experimental results.

This paper proposes the novel topology of a high-efficiency dual output stator-permanent magnet (PM) machine (DOSPMM) for two different washing machine operating speeds. The proposed machine consists of two machines integrated into a single machine: Machine I is an outer rotor type Vernier machine with low speed and high torque for washing mode operations. Machine II is an inner rotor type flux-reversal PM (FRPM) machine with high speed and low torque for dehydrating mode operations. Each machine was designed to be highly efficient for the assigned operating mode. Both machines also possess robust rotors due to stator positioned PMs. To demonstrate the superiority of the proposed machine, performance comparisons with conventional machines for general washing machine applications were performed via finite-element method (FEM) analysis. A prototype of the proposed machine was built and experimental results of the prototype machine were presented for a validation of the work.

Background Symmetrical peripheral gangrene (SPG) is an uncommon syndrome showing symmetrical gangrene in acral regions without evidence of large-vessel occlusion or vasculitis. Intravenous vasopressors are frequently used to manage hemodynamically unstable patients. There have been few reports about SPG after using inotropics. However, risk factors for SPG have not been extensively studied. Therefore, the objective of this study was to analyze several cases of SPG and identify risk factors for SPG. Methods From October 2013 to October 2016, 36 patients with SPG after using vasopressors were included in this study. SPG is an extremely rare disease entity. Therefore, this work was designed as a matched case-control study. For the control group, 42 patients (25 men and 17 women) with similar age, admission department, sex, and vasopressor usage in intensive care unit patients during the same period were selected. Retrospective chart review was performed to identify risk factors within the following categories: medical conditions, vasopressor-related factors, and Sequential Organ Failure Assessment scores. Results Differences between the 2 groups concerning medical condition-related variables did not exist. Statistically significant differences were found in intensive care unit duration (P = 0.0011) and survival. All vasopressor-related factors were adjusted according to weights of patients. Weight-compensated mean dose of dopamin significantly (P = 0.028) affected the occurrence of SPG. Weight-compensated peak dose of norpin, dopamin, and epinephrine also significantly contributed to SPG. Conclusions Symmetrical peripheral gangrene is a rare clinical syndrome related with a high mortality and up to 70% of patients who survive require amputation. Several studies have mentioned that there are several factors affecting the result of SPG. Few studies on SPG have been reported and most of them are case reports. In this study, we revealed the influence of vasopressors to the occurrence of SPG, and this was the first matched case-control study based on the analysis of multiple risk factors.

Unlike somatic cells mitosis, germ cell meiosis consists of 2 consecutive rounds of division that segregate homologous chromosomes and sister chromatids, respectively. The meiotic oocyte is characterized by an absence of centrioles and asymmetric division. Centriolin is a relatively novel centriolar protein that functions in mitotic cell cycle progression and cytokinesis. Here, we explored the function of centriolin in meiosis and showed that it is localized to meiotic spindles and concentrated at the spindle poles and midbody during oocyte meiotic maturation. Unexpectedly, knockdown of centriolin in oocytes with either siRNA or Morpholino micro-injection, did not affect meiotic spindle organization, cell cycle progression, or cytokinesis (as indicated by polar body emission), but led to a failure of peripheral meiotic spindle migration, large polar body emission, and 2-cell like oocytes. These data suggest that, unlike in mitotic cells, the centriolar protein centriolin does not regulate cytokinesis, but plays an important role in regulating asymmetric division of meiotic oocytes.

Background Settlements between doctors and patients provide a solution to complicated disputes. However, some disputes may be renewed as a result of negligence by both parties. The purpose of this study was to review the legal issues that may potentially arise during the preparation of settlement agreements and to propose a list of requirements for ensuring the effectiveness of these settlement agreements. Methods Data from 287 civil cases concerning aesthetic surgery that took place between 2000 and 2015 were collected from a court database in South Korea. Factors that influenced the effectiveness of settlement agreements were analyzed. Results Among the 287 court precedents, there were 68 cases of covenant not to sue. Eighteen cases were dismissed because the settlement agreements were recognized as effective, and 50 cases were sent forward for judgment on their merits because the agreements were not recognized as effective. The types of surgery and types of complications were classified by frequency. We evaluated the geographical distribution of the precedents, the settlement timing, and the effectiveness and economic impact of the settlements. We found that there was no statistically significant relationship among these factors. Four major factors that made a settlement agreement legally effective were identified, and the data showed that fee-free reoperations were not considered by the court in determining the compensation amount. Conclusions When preparing a settlement agreement, it is advisable to review the contents of the agreement rather than to take the preparation of a settlement agreement per se to be legally meaningful.

This paper proposes a novel multistep design and optimization strategy to minimize torque pulsations in a spoke-type permanent magnet motor with phase-group concentrated-coil windings. Different from the conventional techniques that work on the motor itself, in the first step, an auxiliary inner stator is designed to suppress torque pulsations with the aid of a finite-element method (FEM). In the second step, the optimization by using the Kriging method and genetic algorithm, is then applied to the auxiliary inner stator to further reduce torque pulsations. In the third step, the harmonic injected current is utilized to suppress torque ripple by maintaining the required power, while the optimal input current waveform is optimized by the aforementioned algorithms based on the harmonic analysis of back electromotive force. Through the analysis results by the FEM, it shows that the cogging torque and torque ripple of the final model are significantly reduced by 95.7% and 70.0%, respectively, when compared with those of the initial model.

Background In an increasing number of lawsuits doctors lose, despite providing preoperative patient education, because of failure to prove informed consent. We analyzed judicial precedents associated with insufficient informed consent to identify judicial factors and trends related to aesthetic surgery medical litigation. Methods We collected data from civil trials between 1995 and 2015 that were related to aesthetic surgery and resulted in findings of insufficient informed consent. Based on these data, we analyzed the lawsuits, including the distribution of surgeries, dissatisfactions, litigation expenses, and relationship to informed consent. Results Cases were found involving the following types of surgery: facial rejuvenation (38 cases), facial contouring surgery (27 cases), mammoplasty (16 cases), blepharoplasty (29 cases), rhinoplasty (21 cases), body-contouring surgery (15 cases), and breast reconstruction (2 cases). Common reasons for postoperative dissatisfaction were deformities (22%), scars (17%), asymmetry (14%), and infections (6%). Most of the malpractice lawsuits occurred in Seoul (population 10 million people; 54% of total plastic surgeons) and in primary-level local clinics (113 cases, 82.5%). In cases in which only invalid informed consent was recognized, the average amount of consolation money was KRW 9,107,143 (USD 8438). In cases in which both violation of non-malfeasance and invalid informed consent were recognized, the average amount of consolation money was KRW 12,741,857 (USD 11,806), corresponding to 38.6% of the amount of the judgment. Conclusions Surgeons should pay special attention to obtaining informed consent, because it is a double-edged sword; it has clinical purposes for doctors and patients but may also be a litigation strategy for lawyers.

Postoperative infections are rare after plastic surgery; however, when present, they can affect the aesthetic outcome. Currently, many malpractice lawsuits are associated with surgical site infection. The present study aimed to analyze malpractice claims associated with surgical site infection in the field of plastic surgery through a review of Korean precedents. We analyzed the type of procedure, associated complications, and legal judgment in these cases. Most claimants were women, and claims were most often related to breast surgery. The common complications related to surgical site infection were deformity, scar, and asymmetry. Among the 40 cases, 34 were won by the plaintiff, and the mean claim settlement was 2,832,654 KRW (USD 2,636.6). The reasons for these judgements were as follows: 1) immediate bacterial culture tests were not performed and appropriate antibiotics were not used; 2) patients were not transferred to a high-level hospital or the infection control department was not consulted; 3) surgical site infection control measures were not appropriate; and 4) surgical procedures were performed without preoperative explanation about surgical site infection. The number of claims owing to surgical site infection after surgery is increasing. Infection handling was one of the key factors that influenced the judgement, and preoperative explanation about the possibility of infection is important. The findings will help surgeons achieve high patient satisfaction and reduce liability concerns., Graphical Abstract

We herein propose a novel high-torque-density flux-switching permanent magnet machine (FSPMM) which adopted phase-group concentrated-coil (PGCC) winding and a cogging torque reduction technique. The PGCC winding was applied to increase the torque density. In order to maximize the torque of the FSPMM that utilizes the PGCC windings, the performance according to stator slots/rotor poles combinations were compared. A machine which had 12 stator slots and 13 rotor poles (12S13P) was selected for its top average torque value. However, the 12S13P PGCC FSPMM contains high cogging torque that must be reduced. The cogging torque reduction technique is applied, and the parameters used in the technique are further optimized to achieve the target average torque, while suppressing the cogging torque as much as possible. The optimization process was performed with a collaboration of the genetic algorithm and Kriging method. The analysis results of the optimized design exhibited huge reductions in the cogging torque and eventually in the torque ripple from the initial machine, with reasonable average torque reduction. The entire work was evaluated experimentally using a manufactured prototype.

Mitochondria are major powerhouses in all eukaryotic cells, producing ATP through oxidative phosphorylation and the citric acid cycle. An increase in ATP production is required during oocyte maturation, fertilization, and early embryo development in mammals [1, 2]. Previous studies have also reported an association between mitochondrial DNA (mtDNA) copy number and oocyte quality during maturation [1, 3]. For example, mtDNA copy number is an indicator of fertilization potential and oocyte maturation, and oocytes with a low mtDNA copy number have a significantly lower developmental potency [4, 5]. mtDNA copy number also increases during the in vitro maturation of porcine oocytes and after the treatment of oocytes with follicular fluids or EGF (epidermal growth factor), which likely affects the developmental potential of oocytes [6]. Mitochondrial membrane potential (Δφm) is also critical for the production of ATP. During oocyte maturation, there is a significant increase in mitochondrial Δφm [7], and in the absence of an increase, the developmental potential of oocytes decreases [8, 9]. In addition, a high mitochondrial Δφm in mouse and human oocytes and early preimplantation stage embryos is associated with ionic and metabolic regulation [10]. To date, few maternal genes in mammalian oocytes have been characterized. Among these maternal transcripts, C-mos, Cyclin B1, Cdc2 (cell division cycle 2), Gdf9 (growth differentiation factor 9), and Bmp15 (bone morphogenetic protein 15) are well-studied genes considered to be markers of female germ cells. One of the essential regulators of meiosis resumption is formed by Cyclin B1 and Cdc2 kinase [11]. It has been reported that the dynamic change in levels of cyclin B1 is mainly controlled by cytoplasmic polyadenylation during mouse [12] and bovine [13] oocyte maturation. GDF9 and BMP15 belong to the transforming growth factor-β (TGF-β) superfamily, which contains many members with important roles in regulating fertility [14]. GDF9 and BMP15 were recently identified as oocyte-secreted factors involved in folliculogenesis and oocyte maturation, as well as in cooperative regulation of granulosa cells [15]. Recently Ge et al. [16] reported a connection between mouse oocyte quality and both mitochondrial metabolic activity and DNA copy number, specifically with spindle formation, chromosomal alignment, and embryo development. However, the underlying molecular mechanism has not been addressed. In vitro maturation of pig oocytes is useful in the study of the molecular mechanisms that underlie meiosis and fertilization as well as in the production of cloned and transgenic embryos and pigs [17,18,19]. While in vitro culture conditions and/or micromanipulations such as enucleation and injection of DNA or sperm can affect mitochondrial activity in oocytes from several species, this information is not available for porcine oocytes. To determine the effects of mitochondrial metabolic activity and mtDNA copy number on oocyte maturation and developmental competence, we treated immature porcine oocytes with FCCP, which inhibited mitochondrial oxidative phosphorylation, and ddC (2’3-dideoxycytidine), which depleted mtDNA. The effects of these two inhibitors on oocyte dynamics were assessed by determining the mitochondrial Δφm, mtDNA copy number, ATP concentration, target mRNA expression and poly(A) tail length of maternal genes. P34cdc2 kinase activity and mitogen-activated protein kinase (MAPK) phosphorylation were also investigated following FCCP and ddC treatment. To the best of our knowledge, this is the first report to address the relationship among mitochondrial Δφm and copy number, the in vitro maturation of porcine oocytes, and the developmental competence of embryos.

Background: Aortic valve disease (AVD) is a cell-mediated pathology without pharmacotherapy whose early pathogenesis is poorly understood. In mice, the study of later-stage fibrotic & calcific AVD requires aggressive dietary/genetic induction unsuitable for the study of early AVD progression. Here, we examined the initial extracellular matrix & cellular changes induced in the mouse aortic valve by a mildly atherogenic diet. Methods: Male WT C57Bl/6J mice were fed control or high-fat (HF, BioServ F3282) diets for 4 or 16 months (n = 6-10 per group). Aortic valve function was assessed by echocardiography. Valve sections were (immuno)stained for Movat’s pentachrome, proteoglycans (PG), Sox9, & αSMA. Valve interstitial cells (VICs) from porcine aortic valves were cultured with 5 ng/ml TGF-β1 for 5 days. PG synthesis & mRNA levels were measured by g-HCL & qPCR, respectively. Results: At 4 months, valve function was unaffected by the HF diet (transvalvular velocity: 123.5 ± 8.5 vs. 128.2 ± 9.2 cm/s, p = 0.75), & no leaflets expressed αSMA. Distal tips of HF leaflets were thickened (84.4 ± 10.4 vs. 37.3 ± 2.7 μm) due to PG accumulation (11435 ± 1920 vs. 5448 ± 762 μm 2 , p < 0.01), not collagen deposition (1729 ± 815 vs. 1771 ± 663 μm 2 , p = 0.87). Versican was the only PG increased in HF leaflets (2.38-fold, p < 0.05), with no alterations in decorin or biglycan (p = 0.69 & 0.59). Chondrogenic processes were activated in HF leaflets, with a 3.42-fold increase in Sox9-positive leaflet area (p < 0.01). By 16 months, HF mice had elevated transvalvular velocities (169.7 ± 20.3 vs. 115.4 ± 3.6 cm/s, p < 0.05) & leaflets were αSMA-positive & myofibrogenic. Histology of 16-month mice for PGs & Sox9 is ongoing. Early PG expression patterns were recapitulated in culture: total PG production was increased 2.14-fold in TGF-β1-treated VICs (p < 0.05), while versican mRNA was solely elevated (1.53-fold, p < 0.05) & decorin & biglycan were decreased (-2.05-fold, p < 0.01 & -2.62-fold, p < 0.05 respectively). Conclusions: Diet-induced de novo PG synthesis is versican-rich, occurs along with increased Sox9 expression, & develops prior to myofibroblast activation, fibrosis, or deficits in valve function. These studies provide new insight into early AVD pathogenesis & the involvement of specific PGs therein.

Zinc is an extremely important trace element that plays important roles in several biological processes. However, the function of zinc in meiotic division of porcine oocytes is unknown. In this study, we investigated the role of zinc during meiotic resumption in in vitro matured porcine oocytes. During meiotic division, a massive release of zinc was observed. The level of free zinc in the cytoplasm significantly increased during maturation. Depletion of zinc using N, N, N', N'-tetrakis (2-pyridylmethyl) ethylenediamine (TPEN), a Zn2+ chelator, blocked meiotic resumption in a dose dependent manner. The level of phosphorylated mitogen activated protein kinase (MAPK) and p34(cdc2) kinase activity were reduced when zinc was depleted. Moreover, zinc depletion reduced the levels of phosphorylated protein kinase C (PKC) substrates in a dose dependent manner. Real-time PCR analysis showed that expression of the MAPK-and maturation promoting factor related genes C-mos, CyclinB1, and Cdc2 was downregulated following zinc depletion. Treatment with the PKC agonist phorbol 12-myristate 13-acetate (PMA) increased phosphorylation of PKC substrates and MAPK and increased p34(cdc2) kinase activity. This rescued the meiotic arrest, even in the presence of TPEN. Activation of PKC by PMA increased the level of zinc in the cytoplasm. These data demonstrate that zinc is required for meiotic resumption in porcine oocytes, and this appears to be regulated via a PKC related pathway.

A sialo-cutaneous fistula is a communication between the skin and a salivary gland or duct discharging saliva. Trauma and iatrogenic complications are the most common causes of this condition. Treatments include aspiration, compression, and the administration of systemic anticholinergics; however, their effects are transient and unsatisfactory in most cases. We had a case of a patient who developed an iatrogenic sialo-cutaneous fistula after wide excision of squamous cell carcinoma in the parotid region that was not treated with conventional management, but instead completely resolved with the injection of botulinum toxin. Based on our experience, we recommend the injection of botulinum toxin into the salivary glands, especially the parotid gland, as a conservative treatment option for sialo-cutaneous fistula.