Search

Klebsiella pneumoniae has been recognized to cause an invasive syndrome characterized by liver abscess and its metastatic infection. The characteristics of metastatic infection involving the central nervous system in this invasive syndrome are poorly understood. The authors report an 84-year-old woman with diabetes mellitus who developed liver abscess caused by K. pneumoniae, complicated with ventriculitis. The patient died despite the antibiotic treatment. Ventriculitis is a rare CNS complication of K. pneumoniae invasive syndrome and requires prompt diagnosis for the appropriate treatment.

Background We investigated the safety and feasibility of ultrasound-guided peripherally inserted central venous catheter (PICC) placements performed by intensive care medical trainees in comparison to PICC placements performed by intensivists. Methods This was a retrospective and observational study of adult patients who underwent PICC placement and were admitted to the intensive care unit (ICU) between July 2013 and March 2018. Ultrasound-guided PICC was performed at the bedside by an intensivist or intensive care medical trainee if intrahospital transport was inappropriate. The primary endpoint was PICC-induced complications. The secondary endpoint was initial success of PICC. Results A total of 209 patients underwent PICC placement during the study period. There were no significant differences in age, sex, body mass index, comorbidities, causes of ICU admission, or severity scores between the trainee-led PICC and intensivist-led PICC groups. Difficult venous access (42.6%) and requirement for central line infusion (39.2%) were the most common reasons for PICC placement. The basilic vein (62.2%) was the most common target vein among patients who underwent PICC. There were no significant differences in complications between the two groups (P=0.473). In addition, the initial success rate and procedural time were similar between the two groups (P=0.108 and P=0.076, respectively). There were no insertional injuries and moderate or severe bleeding in patients with PICC. Conclusion Ultrasound-guided PICC placement by an intensive care medical trainee may be safe and feasible compared to PICC placement by an intensivist.

BACKGROUND This study was conducted to analyze the activity of masticatory muscles depending on the presence of temporomandibular joint disorders (TMD) when foods of various hardness are masticated. MATERIAL AND METHODS We enrolled 20 subjects (13 men and 7 women) who met our selection criteria, and they were divided into 3 groups (the Disorder Group, the Malalignment Group, and the Control Group) based on surveys and screening inspection. The average of reference voluntary contraction (RVC) was used to measure masticatory muscle activity. Using surface electromyography (SEMG) for each group during masticatory activity, the activities of the masseter muscle and temporalis muscle were measured based on the hardness of 3 different foods (soft, sticky, and hard). RESULTS Characteristics of these 3 groups prior to the experiment were identical, and subsequent findings were as follows: First, when masticating sticky food, the Disorder Group and Malalignment Group showed significant differences from the Control Group in activities of the masseter muscle and temporalis muscle (p

As filler procedures become more popular, the frequency and types of side effects are increasing and becoming more diverse. Prior to the popularization of filler procedures, foreign body reactions and cases of granulomas caused by illegal procedures were reported as side effects. Since filler procedures have become more popular, skin necrosis and more recently, blindness has become issue due to vascular complications.

Asians view an evenly rounded forehead without angular protrusions as beautiful, although the preferred forehead shapes may differ across different cultures. Unfortunately, bilateral frontal eminence exists in the frontal bone from birth. The supraorbital rim projects forward which can create a hollowness between the frontal eminence and supraorbital rim.

The purpose of this study was to investigate the immediate effects of thoracic spinal manipulation (TSM) on pulmonary function in stroke patients.Thirty-six volunteers with stroke (20 men, 16 women) were recruited and randomized to a TSM group (n = 18) and a sham group (n = 18). All participants underwent initial pulmonary function test and then rested supine for 10 minutes before the intervention. Pulmonary function test was repeated immediately after the intervention. Forced vital capacity, forced expiratory volume at 1 second, maximum voluntary ventilation, and residual volume were measured by a spirometer in preintervention and post-intervention.Significant between-group differences were observed in forced vital capacity and forced expiratory volume at 1 second in the TSM group (P.05). No significant changes in dependent variables were seen in the sham group.The pulmonary function values for patients in the TSM group were significantly enhanced with no significant improvement in maximum voluntary ventilation and residual volume. Mechanical factors may be responsible for the improved pulmonary function in the TSM group.

Ischemic preconditioning (IP) is one of the most important endogenous mechanisms that protect the cells against ischemia-reperfusion (I/R) injury. However, the exact molecular mechanisms remain unclear. In this study, we showed that changes in the level of agmatine were correlated with ischemic tolerance. Changes in brain edema, infarct volume, level of agmatine, and expression of arginine decarboxylase (ADC) and nitric oxide synthases (NOS; inducible NOS [iNOS] and neural NOS [nNOS]) were analyzed during I/R injury with or without IP in the rat brain. After cerebral ischemia, brain edema and infarct volume were significantly reduced in the IP group. The level of agmatine was increased before and during ischemic injury and remained elevated in the early reperfusion phase in the IP group compared to the experimental control (EC) group. During IP, the level of plasma agmatine was increased in the early phase of IP, but that of liver agmatine was abruptly decreased. However, the level of agmatine was definitely increased in the ipsilateral and contralateral hemisphere of brain during the IP. IP also increased the expression of ADC—the enzyme responsible for the synthesis of endogenous agmatine—before, during, and after ischemic injury. In addition, ischemic injury increased endogenous ADC expression in the EC group. The expression of nNOS was reduced in the I/R injured brain in the IP group. These results suggest that endogenous increased agmatine may be a component of the ischemic tolerance response that is induced by IP. Agmatine may have a pivotal role in endogenous ischemic tolerance., Graphical Abstract

In the biological neural network, the learning process is achieved through massively parallel synaptic connections between neurons that can be adjusted in an analog manner. Recent developments in emerging synaptic devices and their networks can emulate the functionality of a biological neural network, which will be the fundamental building block for a neuromorphic computing architecture. However, on-chip implementation of a large-scale artificial neural network is still very challenging due to unreliable analog weight modulation in current synaptic device technology. Here, we demonstrate a binarized neural network (BNN) based on a gate-all-around silicon nanosheet synaptic transistor, where reliable digital-type weight modulation can contribute to improve the sustainability of the entire network. BNN is applied to three proof-of-concept examples: (1) handwritten digit classification (MNIST dataset), (2) face image classification (Yale dataset), and (3) experimental 3 × 3 binary pattern classifications using an integrated synaptic transistor network (total 9 × 9 × 2 162 cells) through a supervised online training procedure. The results consolidate the feasibility of binarized neural networks and pave the way toward building a reliable and large-scale artificial neural network by using more advanced conventional digital device technologies.

PURPOSE: This study was conducted to investigate the effect of the virtual reality training (VRT) using 3-dimensional video gaming technology on spatiotemporal gait parameters in older adults. METHODS: The study participants were divided into two groups: the VRT group and the control group. Those in the VRT group were enrolled in a VRT, which was conducted for 60 min per day, two times a week, during the 6-week research. The Wii-Fit balance board game was used for the VRT intervention. The VRT consisted of 6 different types of games, namely, jogging, swordplay, ski jump, hula hoop, tennis, and step dance. A 3-dimensional TV was used for 3-dimensional display. Participants in both the groups received 3 sessions of fall prevention education, at the first, third, and fifth weeks. Their gait parameters were measured by using OptoGait. RESULTS: After 6 weeks of the VRT, the spatial gait parameters of the participants, that is stride length and step length, were significantly improved compared with those of the control group participants (p

Objective: To examine the effects of different shoe weights on lower leg muscle fatigue when walking by electromyographic (EMG) analysis due to the most effective weight for loading not being established. Design: Cross-sectional study. Methods: Thirty healthy university students (15 male, 15 female) were enrolled and randomly assigned into three conditions, which included wearing athletic shoes with an addition of 300 g, 500 g, and 1,000 g weights respectively. Prior to walking, all subjects were instructed to sit in a chair for 10 minutes. All subjects walked at a speed of 3.6 m/s on a treadmill for 20 minutes without rest. EMG measurements were taken using the median power frequency to assess for the effect of the different weight of shoes on muscle fatigue of the soleus, gastrocnemius, and tibialis anterior while walking on a treadmill in an upright posture. EMG measurements were taken during the first and last 30 seconds of walking. Results: In terms of muscle fatigue, for the soleus, the median power frequency was significantly lower with 1,000 g compared with 300 g and 500 g (p

A region suffering from an attack of a nerve agent requires not only a highly sorptive material but also a fast-acting catalyst to decontaminate the lethal chemical present. The product should be capable of high sorptive capacity, selectivity and quick response time to neutralize the long lasting harmful effects of nerve agents. Herein, we have utilized organophosphorus hydrolase (OPH) as a non-toxic bio-catalytic material held in with the supporting matrix of poly-β-cyclodextrin (PCD) as a novel sorptive reinforced self-decontaminating material against organophosphate intoxication. OPH coated PCD (OPH-PCD) will not only be providing support for holding enzyme but also would be adsorbing methyl paraoxon (MPO) used as a simulant, in a host-guest inclusion complex formation. Sorption trend for PCD revealed preference towards the more hydrophobic MPO against para-nitrophenol (pNP). The results show sorption capacity of 1.26 mg/g of 100 μM MPO with PCD which was 1.7 times higher compared to pNP. The reaction rate with immobilized OPH-PCD was found to be 23% less compared to free enzyme. With the help of OPH-PCD, continuous hydrolysis (100%) of MPO into pNP was observed for a period of 24 h through packed bed reactor with good reproducibility and stability of enzyme. The long-term stability also confirmed its stable nature for the investigation period of 4 days where it maintained activity. Combined with its fast and reactive nature, the resulting self-decontaminating regenerating material provides a promising strategy for the neutralization of nerve agents and preserving the environment.

Osteoarthritis is the most common chronic joint disease in the world. With its progression, cartilage thick-ness tends to diminish, which causes severe pain to human being. One way to examine the stage of osteoarthritisis to measure the cartilage thickness. When it comes to inter-subject study, however, it is not easy task to comparecartilage thickness since every human being has different cartilage structure. In this paper, we propose a methodto assess cartilage defect using MRI inter-subject thickness comparison. First, we used manual segmentation methodto build accurate atlas images and each segmented image was labeled as articular surface and bone-cartilage interfacein order to measure the thickness. Secondly, each point in the bone-cartilage interface was assigned the measuredthickness so that the thickness does not change after registration. We used affine transformation and SyGN to getdeformation fields which were then applied to thickness images to have cartilage thickness atlas. In this way, it ispossible to investigate pixel-by-pixel thickness comparison. Lastly, the atlas images were made according to theirosteoarthritis grade which indicates the degree of its progression. The result atlas images were compared using theanalysis of variance in order to verify the validity of our method. The result shows that a significant difference isexisted among them with p < 0.001.Key words: osteoarthritis, Kellgren & Lawrence grade, cartilage thickness, magnetic resonance imaging, inter-sub-ject study, analysis of variance

[Purpose] The purpose of this study was to investigate the effects of thoracic spinal manipulation therapy on respiratory function including forced vital capacity and forced expiratory volume in one second in young healthy individuals. [Subjects and Methods] Thirty young healthy subjects recruited from a local university participated in this study. Subjects were randomly allocated into an experimental group (n=15) and a control group (n=15). The experimental group received thoracic spinal manipulation and the control group received placebo thoracic spinal manipulation. Respiratory function tests, including forced vital capacity and forced expiratory volume in one second, were measured before and after intervention. [Results] The values for both tests were significantly higher in the experimental group. The control group showed no changes after the intervention. Differences in pre- and post-intervention values for both tests were significantly different between the 2 groups. [Conclusion] Spinal manipulation therapy applied to the thoracic region improved respiratory function test results of participants in this study.

Avatar-based three-dimensional technology is a new approach to improve physical function in older adults. The aim of this study was to use three-dimensional video gaming technology in virtual reality training to improve postural balance and lower extremity strength in a population of community-dwelling older adults. The experimental group participated in the virtual reality training program for 60 min, twice a week, for 6 weeks. Both experimental and control groups were given three times for falls prevention education at the first, third, and fifth weeks. The experimental group showed significant improvements not only in static and dynamic postural balance but also lower extremity strength (p p

Decursin (D), purified fromAngelica gigasNakai, has been proven to exert neuroprotective property. Previous study revealed that D reduced Aβ25‒35-induced cytotoxicity in PC12 cells. Our study explored the underlying mechanisms by which D mediates its therapeutic effectsin vitro. Pretreatment of cells with D diminished intracellular generation of ROS in response to Aβ25‒35. Western blot revealed that D significantly increased the expression and activity of HO-1, which was correlated with its protection against Aβ25‒35-induced injury. Addition of ZnPP, an HO-1 competitive inhibitor, significantly attenuated its protective effect in Aβ25‒35-treated cells, indicating the vital role of HO-1 resistance to oxidative injury. Moreover, D induced Nrf2 nuclear translocation, the upstream of HO-1 expression. While investigating the signaling pathways responsible for HO-1 induction, D activated ERK and dephosphorylated p38 in PC12 cells. Addition of U0126, a selective inhibitor of ERK, blocked D-induced Nrf2 activation and HO-1 induction and meanwhile reversed the protection of D against Aβ25‒35-induced cell death. These findings suggest D augments cellular antioxidant defense capacity through both intrinsic free radical scavenging activity and activation of MAPK signal pathways that leads to Nrf2 activation, and subsequently HO-1 induction, thereby protecting the PC12 cells from Aβ25‒35-induced oxidative cytotoxicity.

The possible protective effects of Chlorella vulgaris extract (CVE) on carbon tetrachloride (CCl(4))-induced acute hepatic injury in mice and the mechanism underlying these effects was investigated. CCl(4) administration caused a marked increase in the levels of serum aminotransferases, lipid peroxidation and cytochrome P450-2E1 (CYP450) expression. Also, decreased glutathione (GSH) content and activities of cellular antioxidant defense enzymes such as superoxide dismutase (SOD), glutathione peroxidase (GSH-Px), catalase and glutathione-S-transferase (GST) were found after CCl(4) exposure. All of these phenotypes were markedly reversed by preadministration of the mice with CVE. In addition, CVE exhibited antioxidant effects on FeCl(2)-ascorbate induced lipid peroxidation in mouse liver homogenates, and on superoxide radical scavenging activity. Taken together, these results suggest that CVE produced a protective action on CCl(4)-induced acute hepatic injury in mice, presumably through blocking CYP-mediated CCl(4) bioactivation, inducing the GSH levels, antioxidant enzyme activities and free radical scavenging effect. Therefore, CVE may be an effective hepatoprotective agent and viable candidate for treating hepatic disorders and other oxidative stress-related diseases.

Background This study focuses on osteoarthritis (OA), which affects millions of adults and occurs in knee cartilage. Diagnosis of OA requires accurate segmentation of cartilage structures. Existing approaches to cartilage segmentation of knee imaging suffer from either lack of fully automatic algorithm, sub-par segmentation accuracy, or failure to consider all three cartilage tissues. Methods We propose a novel segmentation algorithm for knee cartilages with level set-based segmentation method and novel template data. We used 20 normal subjects from osteoarthritis initiative database to construct new template data. We adopt spatial fuzzy C-mean clustering for automatic initialization of contours. Force function of our algorithm is modified to improve segmentation performance. Results The proposed algorithm resulted in dice similarity coefficients (DSCs) of 87.1, 84.8 and 81.7 % for the femoral, patellar, and tibial cartilage, respectively from 10 subjects. The DSC results showed improvements of 8.8, 4.3 and 3.5 % for the femoral, patellar, and tibial cartilage respectively compared to existing approaches. Our algorithm could be applied to all three cartilage structures unlike existing approaches that considered only two cartilage tissues. Conclusions Our study proposes a novel fully automated segmentation algorithm adapted for three types of knee cartilage tissues. We leverage state-of-the-art level set approach with newly constructed knee template. The experimental results show that the proposed method improves the performance by an average of 5 % over existing methods.

Purpose The aim of this study was to investigate the relationship between weight-supporting asymmetry and gait symmetry in patients with stroke.Methods Sixty two stroke patients with hemiplegia stood quietly with eye opens on a force platform to calculate weight-supporting asymmetry from vertical reaction force. The GAITRite was used to evaluate their gait parameters. The data were analyzed using Pearson correlation.Results The results of this study was showed that the medio-lateral index (ML) was correlated with symmetry rate (SR), symmetry index (SI), and Gait asymmetry (GA) of step time and length but stronger correlation with spatial gait symmetry than temporal symmetry. In gait symmetry, step length has stronger correlation with weight-supporting asymmetry than step time. Conclusions The results of this study shows weight-supporting asymmetry was correlated with more spatial gait symmetry than temporal symmetry.Key Words：stroke, symmetry index, gait symmetry, weight-supporting.

STUDY DESIGN Intended to investigate whether agmatine treatment reduces collagen scar area in mice subjected to spinal cord injury (SCI). OBJECTIVE The purpose of the present study is to demonstrate the protective effect of agmatine on complete transection SCI mice. SUMMARY OF BACK GROUND DATA: The deposition of collagen that occurs at the lesion site, during the SCI, was well known. Agmatine has been reported to exert neuroprotective effect in various stress models including central nervous system injuries. In the present investigation, we hypothesized that agmatine treatment could rescue the mice subjected to SCI. METHODS Complete SCI was made at the T9 level. Agmatine was dissolved in normal saline (100 mg/kg, Sigma, St. Louis, MO) and given intraperitoneally 5 minutes after complete transection daily for 4 weeks (agmatine-treated mice, n = 30). Controls received normal saline in the same manner (experimental control, n = 30). Surface righting reflex test, expression of bone morphogenetic protein-7 (BMP-7), TGFβ-2 (transforming growth factor β-2), and collagen scar area were measured and the results were compared with Mann-Whitney U test using SAS. RESULTS Agmatine treatment improved the surface righting reflex of mice at 4 weeks after SCI (P = 0.030). The collagen scar, physical barrier to axon regeneration, was noticeably diminished by agmatine treatment at 4 weeks after SCI (P = 0.001). The expression of BMP-7, which is considered both neuroprotective and neuroregenerative, was increased in agmatine treatment group compared with experimental control group in the early stages after SCI (P = 0.015 at 1 day after SCI; P = 0.010 at 3 days; P = 0.035 at 1 week; P = 0.826 at 2 weeks). The expression of TGFβ-2 correlated with the deposition of the collagen matrix at the lesion site was decreased with agmatine treatment at 1 and 2 weeks after SCI (P = 0.001 at 1 week; P = 0.002 at 2 weeks). Survival rate was found to be higher in agmatine treatment group than in the experimental control group for 4 weeks after SCI (P = 0.076). CONCLUSION These results suggest that agmatine treatment could support neuroregeneration by reducing the collagen scar area through decreasing the expression of TGFβ-2 and increasing the expression of BMP-7 after SCI. Especially, the improved surface righting reflex of agmatine-treated group proposes that agmatine treatment have the potency to facilitate functional recovery after SCI. However, the drug (agmatine) warrants further investigation in higher mammals.

This study examined the prevalence of and risk factors for sexual abuse of boys in South Korea by asking a national sample of 1,043 adult males whether they had experienced sexual abuse during childhood. The results indicate that 13.5% experienced at least one of the nine types of child sexual abuse assessed. In addition, the majority of the sexually abused did not seek professional help at the time. The risk factors for sexual abuse include children's involvement in delinquent behaviors, lower family economic status, and residence in small cities. Findings from this study indicate that sexual abuse of boys is a serious problem in Korea, one that calls for enhanced public understanding of the issue as well as effective services and policies designed to prevent or intervene in sexual abuse.

[Purpose] The purpose of this study was to investigate the effects of motor imagery training on improvement of gait ability of patients with chronic stroke. The motor imagery training was performed using imagination of normal gait movement. [Subjects] Participants were randomly allocated to two groups: a motor imagery training group (n=13) and a control group (n=11). [Methods] Both groups received treadmill training for 3 session 30 minutes per week for 6 weeks. The motor imagery training group practiced additional motor imagery training. Measures were evaluated by gait ability. [Results] The outcomes significantly improved by motor imagery training were gait speed, step length of paretic side, step length of non-paretic side, stride length of paretic side, stride length of non-paretic side, single limb support period of paretic side, and double limb support period of both sides. [Conclusion] The motor imagery training improved gait ability. These results suggest that motor imagery training is feasible and suitable for individuals with stroke.

The explicit formulation of the J-integral and the M-integral is constructed in terms of the stress intensity factor and the higher order stress coefficients for Mode II cracks under small or large scale yielding. Furthermore, the stress intensity factor and the higher order stress coefficients as well are computed with the aid of the two-state J-and the M-integral, which is found to be accurate and efficient. It is found that the contribution from the higher order singularities to the J-integral is closely related to the configuration of the plastic zone.

Traumatic brain injury (TBI) is associated with poor neurological outcome, including necrosis and brain edema. In this study, we investigated whether agmatine treatment reduces edema and apoptotic cell death after TBI. TBI was produced by cold injury to the cerebral primary motor cortex of rats. Agmatine was administered 30 min after injury and once daily until the end of the experiment. Animals were sacrificed for analysis at 1, 2, or 7 days after the injury. Various neurological analyses were performed to investigate disruption of the blood-brain barrier (BBB) and neurological dysfunction after TBI. To examine the extent of brain edema after TBI, the expression of aquaporins (AQPs), phosphorylation of mitogen-activated protein kinases (MAPKs), and nuclear translocation of nuclear factor-κB (NF-κB) were investigated. Our findings demonstrated that agmatine treatment significantly reduces brain edema after TBI by suppressing the expression of AQP1, 4, and 9. In addition, agmatine treatment significantly reduced apoptotic cell death by suppressing the phosphorylation of MAPKs and by increasing the nuclear translocation of NF-κB after TBI. These results suggest that agmatine treatment may have therapeutic potential for brain edema and neural cell death in various central nervous system diseases. Graphical Abstract

In this paper, we present a knee cartilage assessment technique to differentiate those in different osteoarthritis grades. We construct atlas for each grade and each atlas represents an average size of cartilage thickness. We build the atlas using manual segmentation of patellar cartilage following groupwise registration. We assign thickness value at the voxels in bone-cartilage interface in ahead. The thickness atlas is used for t-test to see how our method is accurate. T-test result shows our method finds significant difference between osteoarthritis grade 0 and 4 with p less than 0.001.

Brain edema is frequently shown after cerebral ischemia. It is an expansion of brain volume because of increasing water content in brain. It causes to increase mortality after stroke. Agmatine, formed by the decarboxylation of L-arginine by arginine decarboxylase, has been shown to be neuroprotective in trauma and ischemia models. The purpose of this study was to investigate the effect of agmatine for brain edema in ischemic brain damage and to evaluate the expression of aquaporins (AQPs). Results showed that agmatine significantly reduced brain swelling volume 22 h after 2 h middle cerebral artery occlusion in mice. Water content in brain tissue was clearly decreased 24 h after ischemic injury by agmatine treatment. Blood–brain barrier (BBB) disruption was diminished with agmatine than without. The expressions of AQPs-1 and -9 were well correlated with brain edema as water channels, were significantly decreased by agmatine treatment. It can thus be suggested that agmatine could attenuate brain edema by limitting BBB disruption and blocking the accumulation of brain water content through lessening the expression of AQP-1 after cerebral ischemia.