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An upper-air simulator (UAS) has been developed at the Korea Research Institute of Standards and Science (KRISS) to study the effects of solar irradiation of commercial radiosondes. In this study, the uncertainty of the radiation correction of a Vaisala RS41 temperature sensor is evaluated using the UAS at KRISS. First, the effects of environmental parameters including the temperature (T), pressure (P), ventilation speed (v), and irradiance (S) are formulated in the context of the radiation correction. The considered ranges of T, P, and v are −67 to 20 °C, 5–500 hPa, and 4–7 m·s−1, respectively, with a fixed S0 = 980 W·m−2. Second, the uncertainties in the environmental parameters determined using the UAS are evaluated to calculate their contribution to the uncertainty in the radiation correction. In addition, the effects of rotation and tilting of the sensor boom with respect to the irradiation direction are investigated. The uncertainty in the radiation correction is obtained by combining the contributions of all uncertainty factors. The expanded uncertainty associated with the radiation correction for the RS41 temperature sensor is 0.119 °C at the coverage factor k = 2 (approximately 95 % confidence level). The findings obtained by reproducing the environment of the upper air by using the ground-based facility can provide a basis to increase the measurement accuracy of radiosondes within the framework of traceability to the International System of Units.

We developed a one-minute, one-step SARS-CoV-2 antigen assay based on protein-induced fluorescence enhancement of a DNA aptamer. The system showed significant selectivity and sensitivity towards both nucleocapsid protein and SARS-CoV-2 virus lysate, but with marked improvements in speed and manufacturability. We hence propose this platform as a mix-and-read testing strategy for SARS-CoV-2 that can be applied to POC diagnostics in clinical settings, especially in low- and middle-income countries.

INTRODUCTION AND OBJECTIVE:Since urine is not sterile, inflammatory reactions caused by dysbiosis of urinary microbiota may induce interstitial cystitis. A study was conducted to find out whether B...

In this report, we present an enzyme deposited Au electrode for an electrochemical measurement of acetylacetic acid (AcAc) in urine. The electrode has an immobilized layer of a mixture of D-β-hydroxybutyrate dehydrogenase (HBDH) and nicotinamide adenine dinucleotide (NADH) as sensing material to investigate its electroanalytical properties by means of cyclic voltammetry (CV). The modified electrodes are used for the detection of AcAc and present a linear current increase when the AcAc concentration increases. The electrode presents a limit of detection (LOD) of 6.25 mg/dL in the range of 6.25–100 mg/dL for investigation of clinical relevance. Finally, the electrode was evaluated using 20 patient samples. The measured results of urine ketone by the developed electrode were compared with the clinical results from a commercial kit, and the analysis showed good agreement. The proposed electrode was demonstrated to be a very promising platform as a miniaturized electrochemical analyzer for point-of-care monitoring of the critical biochemical parameters such as urine ketone.

Skin cancer usually occurs in the facial area relatively exposed to sunlight. Medical imaging can confirm the invasiveness and metastasis of skin cancer, which is used to establish a surgical plan. However, there is no method of directly marking this information on the patient's skin in the operating room. We evaluated a skin cancer resection guide that marks resection areas including safety margins on the patient's skin based on medical images and in-vitro phantom fabricated via 3D printing. The in-vitro phantom, which includes the skull, skin, and five different cancer locations was designed and fabricated based on a CT image of a patient. Skin cancer resection guides were designed using a CT image of an in-vitro phantom, with a safety margin, and four injection points at each cancer. The guide was used to insert 16 cc intravenous catheters into each cancer of the phantom, which was rescanned by CT. The catheter insertion point and angle were evaluated. The accuracy of the insertion points was 2.09 ± 1.06 mm and cosine similarities was 0.980 ± 0.020. In conclusion, skin cancer resection guides were fabricated to mark surgical plans on the patient's skin in the operating room. They demonstrated reasonable accuracies in actual clinical settings.

Despite central nervous system (CNS) relapse occurring in >10% of high-risk diffuse large B-cell lymphoma (DLBCL) patients, the role of CNS-directed prophylaxis is controversial in the absence of randomized controlled trials. In this retrospective study, we aimed to evaluate the safety and efficacy of prophylactic high-dose methotrexate (HD-MTX) on CNS relapse and survival outcomes in 258 newly diagnosed R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone)–treated high-risk DLBCL patients, based on the initial treatment intent (ITT) of the physician on the use of prophylactic HD-MTX. Patients were classified into an ITT HD-MTX group (n = 128) and a non-ITT HD-MTX group (n = 130). The CNS relapse rate was not significantly different between these groups, with 2-year CNS relapse rates of 12.4% and 13.9%, respectively (P = 0.96). Three-year progression-free survival and overall survival rates in the ITT HD-MTX and non-ITT HD-MTX groups were 62.4% vs 64.5% (P = 0.94) and 71.7% vs 71.4% (P = 0.7), respectively. Also, propensity score–matched analyses showed no significant differences in the time-to-CNS-relapse, progression-free survival, or overall survival. The ITT HD-MTX group showed a higher incidence of grade ≥ 3 oral mucositis and elevated alanine aminotransferase. Prophylactic HD-MTX does not improve CNS relapse rate or survival outcomes in high-risk DLBCL patients, and it is accompanied by increased toxicities.

Background Coronary arteriovenous fistulas (CAFs) are rare but can cause myocardial ischaemia and other complications. However, the haemodynamic and physiologic characteristics of significant CAFs requiring treatment are poorly described. We report a case of CAF causing coronary steal syndrome in which haemodynamic changes were assessed before and after surgical closure using a Doppler wire and computational fluid dynamics (CFD) technique. Case summary A 51-year-old woman presented with exertional chest pain for 3 years. Progressive dyspnoea occurred with exertion. Treadmill and cardiopulmonary exercise tests showed suspicious myocardial ischaemia. Coronary angiography and contrast-enhanced coronary computed tomography angiography (CCTA) revealed a coronary fistula arising from the distal left main coronary artery that drained into the pulmonary artery trunk. We observed a persistent coronary steal phenomenon at baseline and during hyperaemia and a systolic dominant flow rate pattern inside the CAF by Doppler wire-based flow rate measurement. According to CFD analysis based on CCTA, low wall shear stress and a high focal oscillatory shear index were observed at the ostial sites of aneurysmal sacs in the CAF. After successful surgical closure of the CAF, the vessel sizes and flow rate distributions of the coronary arteries increased. Discussion Doppler wire-based flow rate distribution measurements and CFD analysis may facilitate the identification of significant coronary steal syndrome requiring closure and the evaluation of future risks of life-threatening complications such as thrombosis and rupture.

Purpose To investigate the patterns of recurrence in patients with neuroblastoma treated with radiation therapy to the primary tumor site. Materials and methods We retrospectively analyzed patients with high-risk neuroblastoma managed with definitive treatment with radiation therapy to the primary tumor site between January 2003 and June 2017. These patients underwent three-dimensional conformal radiation therapy or intensity-modulated radiation therapy. A total of 14-36 Gy was delivered to the planning target volume, which included the primary tumor bed and the selected metastatic site. The disease stage was determined according to the International Neuroblastoma Staging System (INSS). We evaluated the recurrence pattern (i.e., local or systemic), progression-free survival, and overall survival. Results A total of 40 patients with high-risk neuroblastoma were included in this study. The median patient age was 4 years (range, 1 to 11 years). Thirty patients (75%) had INSS stage 4 neuroblastoma. At the median follow-up of 58 months, there were 6 cases of local recurrence and 10 cases of systemic recurrence. Among the 6 local failure cases, 4 relapsed adjacent to the radiation field. The other 2 relapsed in the radiation field (i.e., para-aortic and retroperitoneal areas). The main sites of distant metastasis were the bone, lymph nodes, and bone marrow. The 5-year progression-free survival was 70.9% and the 5-year overall survival was 74.3%. Conclusion Radiation therapy directed at the primary tumor site provides good local control. It seems to be adequate for disease control in patients with high-risk neuroblastoma after chemotherapy and surgical resection.

BACKGROUND AND PURPOSE: Early detection of local recurrence is important to increase the chance of cure because local recurrence is the main cause of treatment failure in head and neck squamous cell carcinoma. We evaluated the added value of voxel-based color maps of dynamic contrast-enhanced MR imaging compared with conventional MR imaging alone for detecting local recurrence of head and neck squamous cell carcinoma. MATERIALS AND METHODS: We retrospectively enrolled 63 consecutive patients with head and neck squamous cell carcinoma after definitive treatment and posttreatment surveillance MR imaging studies that demonstrated focal enhancement at the primary site. Three independent readers assessed conventional MR imaging and a pair of color maps of initial and final 90-second time-signal intensity areas under the curve from dynamic contrast-enhanced MR imaging. The sensitivities, specificities, and accuracies of both conventional MR imaging alone and combined interpretation of conventional and dynamic contrast-enhanced MR imaging were assessed using the clinicopathologic diagnosis as the criterion standard. κ statistics were used to evaluate interreader agreement. RESULTS: There were 28 patients with subsequently documented local recurrence and 35 with posttreatment change. Adding dynamic contrast-enhanced MR imaging to conventional MR imaging significantly increased the diagnostic accuracies for detecting local recurrence (48%–54% versus 87%–91%; P < .05), with excellent interreader agreement (κ = 0.8; 95% CI, 0.67–0.92 to κ = 0.81; 95% CI, 0.69–0.93). By all 3 readers, the specificities were also significantly improved by adding dynamic contrast-enhanced MR imaging to conventional MR imaging (22%–43% versus 87%–91%; P < .001) without sacrificing the sensitivities (68%–82% versus 86%–89%; P > .05). CONCLUSIONS: Adding voxel-based color maps of initial and final 90-second time-signal intensity areas under the curve from dynamic contrast-enhanced MR imaging to conventional MR imaging increases the diagnostic accuracy to detect local recurrence in head and neck squamous cell carcinoma by improving the specificity without sacrificing the sensitivity.

Primary central nervous system lymphoma (PCNSL) is a rare extranodal non-Hodgkin lymphoma for which standard treatment has yet to be established. High-dose chemotherapy followed by autologous stem cell transplantation (ASCT) is a suitable consolidation strategy for patients who respond to induction chemotherapy. The purpose of this study was to compare the outcome and toxicity profile of the combination of busulfan, cyclophosphamide, and etoposide (BuCyE) with that of the combination of thiotepa, busulfan, and cyclophosphamide (TBC) as conditioning regimens of upfront ASCT for consolidation therapy in PCNSL. The PCNSL registry data set, prospectively collected from March 1993 to May 2017 at Asan Medical Center, was reviewed retrospectively. Patients with objective response to induction chemotherapy who received BuCyE or TBC as conditioning regimen for ASCT were included in the analysis. Primary endpoints were overall survival (OS) and progression-free survival (PFS). Among 241 patients with a diagnosis of PCNSL, 53 received ASCT as upfront consolidation therapy with TBC (28 patients) or BuCyE (25 patients) as conditioning regimen. No median OS or PFS was reached in the TBC group, while the BuCyE group reached a median OS of 4.9 years (p = 0.02) and median PFS of 1.1 years (p = 0.007). The incidence of oral mucositis, nausea, and vomiting was higher with TBC than BuCyE. The median admission duration and days to engraftment were similar between the two groups. Despite the greater incidence of adverse events, TBC showed better outcomes than BuCyE in terms of survival.

One of the difficulties in measurements of relative humidity in a variety of environments is temperature-dependence especially at cold temperatures. Here, we report on the reduction and the compensation of temperature effects on humidity measurements using dual humidity sensors based on quartz crystal microbalance (QCM). Graphene oxide film is coated on quartz crystals as a humidity sensing layer for the detection of water sorption by the change of resonance frequency. Relative humidity in a test chamber, where dual QCM humidity sensors are located, is precisely controlled using a humidity generator at the temperature range from 20 °C to −60 °C. It is found that single QCM humidity sensors measure humidity significantly higher than reference relative humidity by the generator as temperature is lowered due to the temperature-dependent resonance of quartz crystals. In an attempt to cancel out the temperature-dependent oscillation of QCM sensors, the ratio of resonance frequencies of dual QCM humidity sensors is used. Consequently, temperature-dependent errors in humidity measurement at low temperatures are evidently reduced. For the compensation of the remaining errors in the humidity measurement by dual QCM humidity sensors, a single formula is empirically obtained. After the compensation of low temperature effects, the dual QCM humidity sensors provide the measurement capability in terms of residual errors less than 1.1%rh throughout temperatures from 20 °C to −60 °C. This study provides a useful insight to extend the applicability of QCM-based humidity sensors to environments with cold temperatures.

Type I interferon (IFN-I) plays a critical role in the antitumor immune response. In our previous study, we showed that IFN-I-inducible 2′-5′ oligoadenylate synthetase-like 1 (OASL1) negatively regulated IFN-I production upon tumor challenge similar to that of viral infection. Thus, OASL1-deficient (Oasl1−/−) mice were more resistant to implanted tumor growth than wild-type (WT) mice. In this study, we investigated whether targeting or suppressing OASL1 could show synergistic effects on tumor clearance with conventional cancer therapies (such as chemotherapy and radiotherapy) using Oasl1−/− mice and a transplantable lung metastatic tumor cell model. Upon treatment with the anticancer drug cisplatin, we found that Oasl1−/− mice showed enhanced resistance to injected tumors compared to untreated Oasl1−/− mice. Similarly, irradiated Oasl1−/− mice showed better resistance to tumor challenge than untreated Oasl1−/− mice. Additionally, we found that Oasl1−/− mice applied with both types of the cancer therapies contained more cytotoxic effector cells, such as CD8+ T cells and NK cells, and produced more cytotoxic effector cytokine IFN-γ as well as IFN-I in their tumor-containing lungs compared to untreated Oasl1−/− mice. Collectively, these results show that targeting OASL1 together with conventional cancer therapies could be an effective strategy to enhance treatment efficacy.

Three-dimensional (3D) printing technology, with additive manufacturing, can aid in the production of various kinds of patient-specific medical devices and implants in medical fields, which cannot be covered by mass production systems for producing conventional devices/implants. The simulator-based medical image demonstrates the anatomical structure of the disease, which can be used for education, diagnosis, preparation of treatment plan and preoperative surgical guide, etc. The surgical guide is used as a patient-specific medical device for guiding incision, resection, insertion, and marking. As 3D printers can output materials that can be inserted into the human body, the patient-specific implant device that reflects the patient’s anatomy and surgical plan could be of relevance. In addition, patient-specific aids, including gibs, splints, prostheses, and epitheses, could be used for a better outcome. Finally, bio-printing is also used to cultivate cells to produce functional artificial tissues.

We evaluated the feasibility of a magnetic resonance (MR) tumor model and the accuracy of 3D dosimetry for evaluating brain stereotactic radiotherapy (SRT). We first validated the stability of the BANG3 polymer gel dosimeter and performed a pre-clinical verification of this device for brain SRT. Gel-filled vials were irradiated with 6-MV beams to generate a dose calibration curve in relation to the R2 (1/T2) values on 9.4 T MR images. The dose linearity, inter-reproducibility and intra-reproducibility, and dose-rate dependence of the gel dosimeters were evaluated. We also developed an image tumor model for pre-clinical testing. A calibration kit for the gel dosimeter and two spherical tumor representations were fabricated by using 3D printing. Two planning target volumes (PTVs) were contoured onto the MR images of the tumor models comprised of dosimetric gel. To evaluate the geometric and dosimetric accuracy, we created a treatment plan such that the D95s for PTV1 and shifted PTV2 were more than the prescribed dose. The shifted PTV2 was produced by an intentional shift of 5 mm from the true target position. A 2 arc VMAT plan was created to deliver 35 Gy in 5 fractions. After irradiation, calibration vials and tumor model phantoms were scanned by using 9.4 T MRI, and the acquired images were then analyzed using ImageJ and DCMTK software libraries. Scanned MRI images of the tumor models were imported into a treatment planning system and registered to CT images. We also compared the agreement of results between the planned and the measured data in 1D (ion chamber), 2D (2D film), and 3D (gel dosimeter). The best dose linearity achieved was 0.99 (R2) at 180 TE (ms) under which conditions the reproducibility and dose rate dependence were less than 2.2% and 3.5%, respectively. The mean dose differences between the treatment plan and the ion-chamber results were 3.3%, 0.4%, and 4.5%, respectively, for PTV1 and 2 and for the shifted PTV. Moreover, the point dose differences between the treatment plan and the gel results were 0.9%, 2.6% and 3.7%, respectively, for PTV1 and 2 and for the shifted PTV. The gamma passing rates with 3%/3 mm criteria were greater than 99% for all plans. The isodose distributions and profiles showed good qualitative agreement between the gel dosimeter, EBT film and RTP data for all PTVs. Our present study results, thus, indicate that an MR tumor model can effectively evaluate the geometric and dosimetric accuracy of brain SRT. Image tumor models using gel dosimeters are, therefore, useful for validating the 3D dose distributions for patient-specific whole treatment processes. We are planning to improve this image tumor model by facilitating respiratory mobility and utilizing more complex tumor shapes for liver stereotactic body radiotherapy (SBRT) cases.

Purpose As computed tomography (CT) imaging is the most commonly used modality for treatment planning in radiation therapy, metal artifacts in the planning CT images may complicate the target delineation and reduce the dose calculation accuracy. Although current CT scanners do provide certain correction steps, it is a common understanding that there is not a universal solution yet to the metal artifact reduction (MAR) in general. Particularly noting the importance of MAR for radiation treatment planning, we propose a novel MAR method in this work that recruits an additional tilted CT scan and synthesizes nearly metal‐artifact‐free CT images. Methods The proposed method is based on the facts that the most pronounced metal artifacts in CT images show up along the x‐ray beam direction traversing multiple metallic objects and that a tilted CT scan can provide complementary information free of such metal artifacts in the earlier scan. Although the tilted CT scan would contain its own metal artifacts in the images, the artifacts may manifest in a different fashion leaving a chance to concatenate the two CT images with the metal artifacts much suppressed. We developed an image processing technique that uses the structural similarity (SSIM) for suppressing the metal artifacts. On top of the additional scan, we proposed to use an existing MAR method for each scan if necessary to further suppress the metal artifacts. Results The proposed method was validated by a simulation study using the pelvic region of an XCAT numerical phantom and also by an experimental study using the head part of the Rando phantom. The proposed method was found to effectively reduce the metal artifacts. Quantitative analyses revealed that the proposed method reduced the mean absolute percentages of the error by up to 86% and 89% in the simulation and experimental studies, respectively. Conclusions It was confirmed that the proposed method, using complementary information acquired from an additional tilted CT scan, can provide nearly metal‐artifact‐free images for the treatment planning.

Background The 2-week schedule of hypofractionated radiotherapy as a salvage treatment for hepatocellular carcinoma (HCC) has previously exhibited promising results; this study aimed to assess its long-term clinical outcomes in patients with recurrent HCC ineligible for curative treatments. Methods We retrospectively enrolled 77 patients (84 lesions) with HCC who were treated with hypofractionated radiotherapy between December 2008 and July 2013. Primary inclusion criteria were HCC unsuitable for curative treatments and HCC located within 2 cm of a critical normal organ. We administered 3.5–5 Gy/fraction for 2 weeks, resulting in a total dose of 35–50 Gy. Results The median follow-up period was 33.6 (range, 4.8–78.3) months. The 3- and 5-year overall survival rates were 52.3% and 40.9%, respectively, and local control rates were 79.5% and 72.6% in all treated lesions, respectively. The 5-year local control rate was better in the higher radiation dose group than in the lower radiation dose group (50 Gy: 79.7% vs.

OBJECTIVE We investigated the effect of optimization in dose-limiting shell method on the dosimetric quality of CyberKnife (CK) plans in treating brain metastases (BMs). METHODS We selected 19 BMs previously treated using CK between 2014 and 2015. The original CK plans (CKoriginal) had been produced using 1 to 3 dose-limiting shells : one at the prescription isodose level (PIDL) for dose conformity and the others at lowisodose levels (10-30% of prescription dose) for dose spillage. In each case, a modified CK plan (CKmodified) was generated using 5 dose-limiting shells : one at the PIDL, another at intermediate isodose level (50% of prescription dose) for steeper dose fall-off, and the others at low-isodose levels, with an optimized shell-dilation size based on our experience. A Gamma Knife (GK) plan was also produced using the original contour set. Thus, three data sets of dosimetric parameters were generated and compared. RESULTS There were no differences in the conformity indices among the CKoriginal, CKmodified, and GK plans (mean 1.22, 1.18, and 1.24, respectively; p=0.079) and tumor coverage (mean 99.5%, 99.5%, and 99.4%, respectively; p=0.177), whereas the CKmodified plans produced significantly smaller normal tissue volumes receiving 50% of prescription dose than those produced by the CKoriginal plans (p

Noninvasive continuous arterial pressure monitoring may be clinically useful in patients who require continuous blood pressure monitoring in situations where arterial catheter placement is limited. Many previous studies on the accuracy of the noninvasive continuous blood pressure monitoring method reported various results. However, there is no research on the effectiveness of noninvasive arterial pressure monitoring during one-lung ventilation. The purpose of this study was to compare arterial blood pressure obtained through invasive method and noninvasive method by using ClearSight during one-lung ventilation. In this retrospective observational study, a total of 26 patients undergoing one-lung ventilation for thoracic surgery at a single institution between March and July 2019 were recruited. All patients in this study were cannulated on their radial artery to measure continuously invasive blood pressures and applied ClearSight on the ipsilateral side of the cannulated arm. We compared and analyzed the agreement and trendability of blood pressure recorded with invasive and noninvasive methods during one-lung ventilation. Blood pressure and pulse rate showed a narrower limit of agreement with a percentage error value of around 30%. In addition, the tracking ability of each measurement could be determined by the concordance rate, all of which were below acceptable limits (92%). In noninvasive arterial blood pressure monitoring using ClearSight, mean blood pressure and pulse rate show acceptable agreement with the invasive method.

The quantitative flow ratio (QFR) is a novel angiography-based computational method assessing functional ischemia caused by coronary stenosis. This study aimed to evaluate the diagnostic performance of quantitative flow ratio (QFR) in patients with angina and acute myocardial infarction (AMI) and to identify the conditions with low diagnostic performance. We assessed the QFR for 1077 vessels under fractional flow ratio (FFR) evaluation in 915 patients with angina and AMI. The diagnostic accuracies of the QFR for identifying an FFR ≤ 0.8 were 95.98% (95% confidence interval [CI] 94.52 to 97.14%) for the angina group and 92.42% (95% CI 86.51 to 96.31%) for the AMI group. The diagnostic accuracy of the QFR in the borderline FFR zones (> 0.75, ≤ 0.85) (91.23% [95% CI 88.25 to 93.66%]) was significantly lower than that in others (difference: 4.32; p = 0.001). The condition accompanying both AMI and the borderline FFR zone showed the lowest QFR diagnostic accuracy in our data (83.93% [95% CI 71.67 to 92.38]). The diagnostic accuracy was reduced for tandem lesions (p = 0.04, not correcting for multiple testing). Our study found that the QFR method yielded a high overall diagnostic performance in real-world patients. However, low diagnostic accuracy has been observed in borderline FFR zones with AMI, and the hybrid FFR approach needs to be considered.

BackgroundSensory tricks (SeT) are various maneuvers that can alleviate dystonic contractions and are a characteristic feature of cervical dystonia (CD). The neurophysiology underlying SeT, however, remains largely unknown. Reducing the abnormal cortical facilitation and modulating the abnormal cortical and subcortical oscillatory activity are mechanisms that have been proposed. The supplementary motor area (SMA) and primary sensorimotor cortices are thought to be relevant to this phenomenon.ObjectiveIn the current study, using concurrent EEG recording during transcranial magnetic stimulation (TMS) of the SMA and primary motor cortex (M1), we aimed at determining the changes in cortical reactivity and oscillatory changes induced by SeT.MethodsWe recruited 13 patients with CD who exhibited SeT and equal number of age- and gender-matched healthy controls. Single TMS pulses were delivered over the SMA and M1 either at rest or during SeT. 32-channel EEG was recorded, and TMS-evoked potentials (TEP) were obtained. Further, time-frequency analysis was performed on the induced data. Correlation analysis for significant neurophysiological parameters was done with clinical measures.ResultsWe found that SeT induced a significant decrease in the amplitude of TEP elicited from M1 stimulation at ∼210-260ms in patients, which correlated with symptom duration. Post hoc analysis of EMG activity in the neck muscles revealed that this effect on TEP was present only in the subset of patients with effective SeT.ConclusionOur results suggest that SeT reduces cortical reactivity over M1 approximately 200ms after stimulation. This adds support to the idea that reduced cortical facilitation underlies the phenomenon.

We used 3D printed-breast surgical guides (3DP-BSG) to designate the original tumor area from the pre-treatment magnetic resonance imaging (MRI) during breast-conserving surgery (BCS) in breast cancer patients who received neoadjuvant systemic therapy (NST). Targeting the original tumor area in such patients using conventional localization techniques is difficult. For precise BCS, a method that marks the tumor area found on MRI directly to the breast is needed. In this prospective study, patients were enrolled for BCS after receiving NST. Partial resection was performed using a prone/supine MRI-based 3DP-BSG. Frozen biopsies were analyzed to confirm clear tumor margins. The tumor characteristics, pathologic results, resection margins, and the distance between the tumor and margin were analyzed. Thirty-nine patients were enrolled with 3DP-BSG for BCS. The median nearest distance between the tumor and the resection margin was 3.9 cm (range 1.2–7.8 cm). Frozen sections showed positive margins in 4/39 (10.3%) patients. Three had invasive cancers, and one had carcinoma in situ; all underwent additional resection. Final pathology revealed clear margins. After 3-year surveillance, 3/39 patients had recurrent breast cancer. With 3DP-BSG for BCS in breast cancer patients receiving NST, the original tumor area can be identified and marked directly on the breast, which is useful for surgery. Trial Registration: Clinical Research Information Service (CRIS) Identifier Number: KCT0002272. First registration number and date: No. 1 (27/04/2016).

Traditionally, the diagnostic mainstay of recurrent urinary tract infection has been urinary culture. However, the causative uropathogen of recurrent cystitis has not been well established. Urine DNA next-generation sequencing (NGS) can provide additional information on these infections. Herein, we compared urine NGS results and urine cultures in patients with acute uncomplicated cystitis (AUC) and recurrent cystitis (RC), and evaluated the difference in microbiome patterns in the NGS results. Patients who underwent urine culture and NGS due to AUC or RC were retrospectively reviewed. All urine samples were collected via a transurethral catheter and studied utilizing a type of NGS called 16S ribosomal RNA gene amplification and sequencing. The sensitivity of urine NGS was significantly higher than that of conventional urine culture (69.0% vs. 16.7%, p &lt, 0.05). The detection rate of urine NGS was slightly lower in the RC group than in the AUC group (67.7% vs. 72.7%). Microbiome diversity was significantly higher in the RC group compared to the AUC group (p = 0.007), and the microbiome composition was significantly different between the AUC and RC groups. In the urine NGS results, Pseudomonas, Acinetobacter, and Enterobacteriaceae were found in the AUC group, and Sphingomonas, Staphylococcus, Streptococcus, and Rothia spp. were detected in the RC group. Urine NGS can significantly increase the diagnostic sensitivity compared to traditional urine culture methods, especially in RC patients. AUC and RC patients had significant differences in bacterial diversity and patterns. Therefore, recurrent cystitis might be approached from a different perspective.

Drums are difficult to recognize not only because the sounds overlap when many instruments are played simultaneously, but also the notes and beats vary depending on how they are played. This study compared the Recurrent Neural Network (RNN) algorithm that analyzes the sequence of time and the Conversion Neural Network (CNN) algorithm that analyzes data in image form to compare which machine learning algorithms show better performance for drum sound recognition. Through this, this research wanted to study which algorithm to recognize musical instruments is appropriate, and contribute to the area of Music Information Retrieval (MIR).

A drum is a polyphonic instrument composed of several instruments such as Snare, Symbol, Tom, and Hi-hat. Each constituent instrument has a different sound (pitch, tone), and it sounds differ depending on the playing method, tuning condition, drum manufacturer, and whether it is an acoustic or electronic drum. In addition, it is an instrument in which frequencies are overlapped between the instruments constituting the drum. For this reason, in order to contribute to the improvement of the drum sound recognition rate that previous researches were not high, this paper attempted to discriminate the sound of electronic and acoustic drums, which had not been studied. This paper used the IDMT-SMT-Drums data set (https://www.idmt.fraunhofer.de/en/business_units/m2d/smt/drums.html), which was already used in several previous studies as the learning and test data of this study, and 70% of the drum sound WAV files of the data set were used for learning and 30% used for testing. For the analysis, a Convolutional Neural Network (CNN) was used, and WAV files, which are drum sound files, were converted into spectrogram files (Image files) using Mel Spectrogram technology for input of CNN. As a result of this study, the recognition rate was 78–92% for each type of hyper-parameter application. It was found that the pixel size of the input spectrogram and the number of CNN filters affect the recognition rate. In future research, it is necessary to study the improvement of recognition rate by applying various hyper-parameters by securing additional learning and test data.

Through the utilization and convergence of technologies, such as artificial intelligence, big data, and the Internet of Things, that can represent the fourth industrial revolution, today’s world is changing rapidly. However, public organizations in Korea are still manually entering reports written by hand in many fields into the information system by a government official in charge. This study studies the improvement method for optical character recognition (OCR) of hand-written General Educational Development (GED) application. Through learning using cursive fonts, separating images for items subject to information service, and managing whitelist by item, the recognition rate is to be improved. In the field of optical character recognition (OCR), the recognition rate of printed texts written in Hangeul font is over 90%, but the recognition rate of cursive writing is very low. Various tables and letters of different sizes in hand-written application form documents hinder the recognition rate. Although the recognition rate has improved a lot recently with various studies using Deep Learning, there is a problem that takes too much processing time. Of the 11,172 Hangeul characters, 2350 are used. On the other hand, English has 52 case-sensitive characters. The recognition rate of Hangeul, which consists of a combination of initial sound, medial vowels, and final consonant, is bound to drop significantly. As mentioned earlier about a performance issue, software with open source-based neural network learning engines was used. In addition, the status of Hangeul used in names and addresses was investigated for the application of whitelists. The cursive font learning, image separation and whitelist proposed in this study have been effective in improving recognition rates.

Urachal adenocarcinoma is rare, accounting for only 10% of adenocarcinomas of the bladder and the prognosis of urachal adenocarcinomas is poor since most cases are detected late. Since urachal adenocarcinoma is a rare disease, no effective standard treatment has yet been established. However, in recent studies, resection of carcinoma is considered the only treatment considered for non-metastatic cases. Although for large sized urachal adenocarcinoma, open surgery or laparoscopic surgery is usually considered, we have recently experienced huge urachal carcinoma by robotic surgery. We used cystoscopy and the robot to assess the cancer margins and safely perform the operation. A 71-year-old man with a medical history of hypertension and arrhythmia visited our urology department with urachal cancer detected by computed tomography (CT). CT showed a lobulated low-density mass, most likely urachal carcinoma, abutting the anterior dome of the bladder and anterior abdominal wall. We performed preoperative cystoscopy to assess the extent of the protrusion of the urachal cancer into the bladder wall and the area requiring resection during surgery. We confirmed the size and extent of the mass protruding into the anterior wall of the urinary bladder and Robot-assisted laparoscopic intracorporeal urachal mass resection and partial cystectomy using cystoscopy together was performed. After one month, the patient has no complications and no complaining symptoms complaints without any abnormal finding of follow up imaging test. Although more procedures must be performed to ensure the safety of robotic surgery as a treatment strategy for large urachal carcinomas, we confirm that robotic surgery can replace open or laparoscopic surgery for such tumors.

Objectives: A sepsis clinical decision support system (CDSS) can facilitate quicker sepsis detection and treatment and consequently improve outcomes. We developed a qSOFA-based sepsis CDSS and evaluated its impact on compliance with a 3-hour resuscitation bundle for patients with sepsis. Methods: This before-and-after study included consecutive adult patients with suspected infection and qSOFA scores of ≥ 2 at their emergency department (ED) presentation of a tertiary care hospital. Sepsis was defined according to the Sepsis-3 criteria. We evaluated the 3-hour resuscitation bundle compliance rate for control patients from July through August 2016, for patients using the qSOFA-based sepsis CDSS from September through December 2016, and the impact of the system using multivariable logistic regression analysis. Results: Of 306 patients with suspected infection and positive qSOFA scores at presentation, 265 patients (86.6%) developed sepsis (including 71 patients with septic shock). The 3-hour resuscitation bundle compliance rate did not differ significantly between the patients before and after the routine implementation of the qSOFA-based sepsis CDSS (63.7% vs. 52.6%; P = 0.071). Multivariate analysis showed that age (AOR [adjusted odds ratio], 1.033; P = 0.002) and body temperature (AOR, 1.677; P < 0.001) were associated with bundle compliance. Conclusions: Among patients with a positive qSOFA score at presentation, sepsis developed in 86.6%, which means the qSOFA-based sepsis CDSS may be helpful; however, it was not associated with improved bundle compliance. Future quality improvement studies with multifactorial, hospital-wide approaches using sepsis CDSS tools are warranted.

There are two types of dystonic tremor syndromes (DTS), dystonic tremor (DT) and tremor associated with dystonia (TAWD), and neither is understood. DTS likely share some mechanisms with nontremulous dystonia, and there may also be overlaps with essential tremor (ET). We studied 21 ET (8 females, 13 males) and 22 DTS human patients (10 females, 12 males), including 13 human patients with DT (writer's cramp with writing tremor) and 9 human patients with tremor associated with dystonia (TAWD; cervical dystonia with hand tremor). Tremors were analyzed using accelerometry and surface EMG of the antagonist pairs of arm muscles during posture, simple kinetic movement, and writing. Cerebellar inhibition was performed to assess cerebello-thalamo-cortical involvement. DT exhibited higher variability of peak frequency and greater instability of tremor burst intervals over time (higher tremor stability index) than ET or TAWD regardless of tasks. Intermuscular coherence magnitude between the antagonist pairs increased during the writing task in DT, but not ET or TAWD. ET and TAWD exhibited different phase relationships of the temporal fluctuations of voluntary movement and tremor in the kinetic condition. A linear discriminant classifier based on these tremor parameters was able to distinguish the three groups with a classification accuracy of 95.1%. Cerebellar inhibition was significantly reduced in DT, but not in TAWD, compared with ET and healthy controls. Our study shows that the two DTS are distinct entities with DT closer to nontremorous dystonia and TAWD closer to ET.SIGNIFICANCE STATEMENTThis study provides novel findings about characteristics and pathophysiology of the two different types of dystonic tremor syndromes compared with essential tremor. Patients with DTS are classified into DT who have dystonia and tremor in the same area, and tremor associated with dystonia (TAWD) who have dystonia and tremor elsewhere. Our results showed that DT exhibits increased tremor variability, instability, and intermuscular coherence, and decreased cerebello-thalamo-cortical inhibition compared with TAWD. Our study shows that DT and TAWD are distinct phenotypes, and that the physiological characteristics of DT are more similar to nontremorous dystonia, and TAWD is closer to ET.