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To compare surgical outcomes of patients who underwent laparoendoscopic single-site total laparoscopic hysterectomy (LESS-TLH) with operative times 150 minutes and ≥150 minutes to determine the clinical factors that influence operative times. We also describe techniques that help overcome difficulties involved in this procedure.Retrospective study (Canadian Task Force classification II-2).University medical center.Two hundred thirty-four patients underwent LESS-TLH for benign uterine disease and cervical disease between September 2011 and February 2015. Thirty-seven patients (15.8%) were excluded from analysis. One hundred ninety-seven patients were divided into 2 groups according to the total operative time (median, 150 minutes):150 minutes (n = 93) and ≥150 minutes (n = 104).LESS-TLH was performed using anterior, lateral, and posterolateral colpotomy techniques, and knife-in-bag morcellation was used for specimen extraction.Patient characteristics, except for body mass index (BMI) and age, were generally similar in the 2 groups. Age, BMI, adhesiolysis, time to completion of colpotomy, stump repair time, specimen extraction time, blood loss, and weight of the uterus showed statistically significant differences between the 2 groups. Clinical factors that affected operative time were adhesiolysis of the posterior uterus (p = .010), time to completion of colpotomy (65 minutes; p = .000), specimen extraction time (34.4 minutes; p = .000), and weight of the uterus (270 g; p = .015). Conversion to additional port laparoscopy occurred in 14 patients (5.98%). Conversion to laparotomy occurred in 1 patient (.43%). The surgical complication rates were 3.2% (3 patients) in the150 minutes group and 3.8% (4 patients) in the ≥150 minutes group. No urologic injuries occurred in either group. One postoperative ileus occurred in the ≥150 minutes group; it was relieved by conservative treatment.Time to completion of colpotomy was influenced by adhesiolysis of the posterior uterus and specimen extraction time by weight of the uterus. Alternative methods for decreasing the time required to extract a large uterus and for approaching posterior adhesion of the uterus are needed for LESS-TLH.

Circulating tumor cells (CTCs) play an important role in estimating the presence and the metastatic relapse of tumor. Despite of their importance, isolation of viable CTCs is still struggling, since chemical or mechanical damages are unavoidable when separating less than 1000 of CTCs out of billions of other blood components. Furthermore, the current CTC isolation devices show low productivity, since they are produced after a series of complicated fabrication processes. Here, we present a low-cost and mass-producible fabric filters for the viable CTC isolation and the further molecular assay for profiling cancer-associated markers. The fabric filter, produced by polyester monofilament yarns, can be massively produced at extremely low-cost, by showing productivity of ~22filters/s at ~59filters/USD. By utilizing size-based sorting method, the fabric filter is capable to isolate both epithelial and mesenchymal CTCs, while slots with curved walls are beneficial for preventing the cell rupture by reducing 21.6% of mechanical stress compared to the conventional straight-walled slots. We applied our filter to 11 human blood samples and found that the number of CTCs was closely related to the expression level of Ki-67, which is highly overexpressed in proliferative tumors. The fabric filter might be an appropriate caner-screening tool in developing countries, where people suffer from insufficient healthcare services.

Tensile and fatigue tests were conducted at 50 and 70 °C for evaluating the mechanical behavior of polyethylene-terephthalate (PET) supported silver (Ag) thin films. The strain amplitude-number of cycles (S-N) curves of Ag/PET at elevated temperatures were acquired for determining the failure life under in-situ heating condition. The stretchability at elevated temperature was found to be better than the tensile behavior at room temperature, whereas the fatigue behavior is worse at elevated temperature. The adhesion between silver and PET is better at elevated temperature. However, the tensile and fatigue characteristics were different results because the adhesion of silver and PET is not homogeneous at elevated temperatures. The good adhesion between thin metal films and flexible substrates is not always beneficial effect of the mechanical behavior. Therefore, we suggest a new fatigue failure mechanism for Ag/PET at elevated temperature.

We present a tutorial introduction to the multi-rotor unmanned aerial vehicles, often simply referred as drones. We first explain typical configuration, components and construction of the drones. We then provide basic kinematic and dynamic modeling of drones and their principle of flight. Some representative motion control techniques are then presented, which take into account the issue of under-actuation of the drones. State estimation problem of the drones, that is crucial for their proper flying, yet, should be done only by using onboard sensors and their sensor fusion, is explained. Some emerging research directions requiring capability beyond typical drones are also mentioned.

Introduction: Increased arterial resistance is a potential pathophysiological mechanism in the pathogenesis of cerebral small vessel disease (cSVD). In this study, we aimed to investigate the association between puslatility index (PI) representing cerebral arterial resistance and subtypes of cSVD in patients with stroke due to small vessel occlusion (SVO). Hypothesis: Pattern of increased arterial resistance may be different between individual subtypes of cSVD. Methods: We included consecutive patients with SVO between 2010 and 2013. White matter hyperintensity (WMH) volume was rated using semi-automated quantitative methods. And the presence of old lacunar infarct (OLI), cerebral microbleed (CMB), or enlarged perivascular space (EPVS) was also evaluated. The relationship between PI, measured with transcranial Doppler sonography in each middle cerebral artery, and subtypes/burden of cSVD was analyzed in the relevant hemisphere. Results: A total of 206 patients with 412 hemispheres were included (mean age: 64 years, male: 68%). In multivariable analysis, PI was positively associated with the WMH volume [beta = 1.372, 95% confidence interval (CI) = 0.624 to 2.120, P < 0.001] after adjusting confounders. PI was also related to the presence of OLI (adjusted odds ratio = 11.37, 95% CI = 2.55-48.56, P = 0.001), however this relationship was not significant in CMB or EPVS. Regarding to the cSVD burden, PI increased according to the WMH tertiles ( P for trend < 0.001), and burden of OLI ( P for trend = 0.004) in a dose-response manner. Conclusion: Association of cerebral arterial resistance is different between subtypes of cSVD, which is suggestive of underlying pathophysiological difference. Simple measure of PI seems to be useful to estimate the arterial resistance and the burden of cSVD.

Introduction: The prediction of ischemic stroke in patients with asymptomatic carotid stenosis (ACS) is important in clinical practice. Conventional cardiovascular risk scores may be used for these purpose, although not validated. We also incorporate carotid doppler ultrasonography (CDU) parameters to validate whether they may enhance the predictive power of conventional risk scores for ischemic stroke in ACS. Hypothesis: Conventional risk score combined with CDU parameters may predict the risk of ischemic stroke in ACS. Methods: From January 2010 to December 2017, we were retrospectively enrolled consecutive asymptomatic patients with more than 50% carotid stenosis by CDU criteria. Medical records of all participants were reviewed to assess conventional risk scores (Framingham stroke risk score (FSRS) and ASCVD risk score) and to confirm the occurrence of ischemic stroke events for up to 10 years. The peak-systolic-velocity (PSV), peak-systolic-velocity-ratio and peak-systolic-and-end-diastolic-velocity-ratio (PSV/EDV, PER) between internal and common carotid artery were evaluated. Univariate Cox proportional hazard regression, time-dependent Cox regression, and net reclassification index (NRI) were used to assess the predictability of explanatory variables and models. Results: A total of 150 patients (mean age 71.5 years, 111 males) were enrolled. During the follow-up period (mean 4 years), twelve ischemic stroke events were observed. In ROC curves for prediction of ischemic stroke in ACS, the AUC of the FSRS and ASCVD was 0.606 (CI 0.449-0.762) and 0.576 (CI 0.448-0.708). Among all CDU parameters, only higher PER was significantly associated with increasing risk of ischemic stroke (HR 1.764, CI 1.089-2.439, p=0.034). The addition of PER improved the predictive power; AUC of the FRSR and ASCVD risk score combined with PER was 0.649 (CI 0.506-0.792, p Conclusion: The predictability of conventional risk scores has predictive power to ischemic stroke in ACS, although not substantial. This predictive power may be enhanced by doppler velocity ratio parameter, especially PER.

Autism spectrum disorder (ASD) is a group of neurodevelopmental disorders that are highly heterogeneous in clinical symptoms as well as etiologies. Mutations in SHANK2 are associated with ASD and accordingly, Shank2 knockout mouse shows ASD-like behavioral phenotypes, including social deficits. Intriguingly, two lines of Shank2 knockout (KO) mouse generated by deleting different exons (exon 6–7 or exon 7) showed distinct cellular phenotypes. Previously, we compared gene expressions between Shank2 KOs lacking exon 6–7 (e6–7 KO) and KOs lacking exon 7 (e7 KO) by performing RNA-seq. In this study, we expanded transcriptomic analyses to identify novel transcriptional variants in the KO mice. We found prominent expression of a novel exon (exon 4′ or e4’) between the existing exons 4 and 5 in the Shank2 e6–7 KO model. Expression of the transcriptional variant harboring this novel exon was confirmed by RT-PCR and western blotting. These findings suggest that the novel variant may function as a modifier gene, which contributes to the differences between the two Shank2 mutant lines. Furthermore, our result further represents an example of genetic compensation that may lead to phenotypic heterogeneity among ASD patients with mutations in the same gene.

BackgroundIncreased arterial resistance is a potential pathological mechanism of cerebral small vessel disease (cSVD).AimIn this study, we aimed to investigate the association between pulsatility index (PI) representing cerebral arterial resistance and subtypes of cSVD in patients with lacunar stroke.MethodsWe included consecutive lacunar stroke patients between 2010 and 2013. White matter hyperintensity (WMH) volume was rated using semi-automated quantitative methods. Additionally, the presence of old lacunar infarct (OLI), cerebral microbleed (CMB), or enlarged perivascular space (EPVS) was also evaluated. The relationship between PI, measured in each middle cerebral artery, and the subtype/burden of cSVD was analyzed in the relevant hemisphere.ResultsA total of 206 lacunar patients were included and 412 hemispheres were analyzed (mean age: 64 years, male: 68.4%). In multivariable analysis, PI was positively associated with the WMH volume [beta = 1.372, 95% confidence interval (CI) = 0.624 to 2.120, P < 0.001] after adjusting for confounders. PI was also related to the presence of OLI (adjusted odds ratio = 11.37, 95% CI = 2.55-48.56, P = 0.001); however, this relationship was not significant in CMB or EPVS. Regarding the cSVD burden, PI increased according to the WMH tertiles (P for trend < 0.001), the burden of OLI (P for trend < 0.001), and EPVS tertiles (P for trend < 0.001), showing a quantitative relationship.ConclusionsIpsilateral PI is closely associated with cSVD in patients with lacunar stroke. Furthermore, this association is different between subtypes of cSVD, which is suggestive of underlying pathophysiological differences.

SHP2 is an unusual protein phosphatase that functions as an activator for several signaling pathways, including the RAS pathway, while most other phosphatases suppress their downstream signaling cascades. The physiological and pathophysiological roles of SHP2 have been extensively studied in the field of cancer research. Mutations in the PTPN11 gene which encodes SHP2 are also highly associated with developmental disorders, such as Noonan syndrome (NS), and cognitive deficits including learning disabilities are common among NS patients. However, the molecular and cellular mechanism by which SHP2 is involved in cognitive functions is not well understood. Recent studies using SHP2 mutant mice or pharmacological inhibitors have shown that SHP2 plays critical role in learning and memory and synaptic plasticity. Here, we review the recent studies demonstrating that SHP2 is involved in synaptic plasticity, and learning and memory, by the regulation of the expression and/or function of glutamate receptors. We suggest that each cell type may have distinct paths connecting the dots between SHP2 and glutamate receptors, and these paths may also change with aging.

To investigate the usefulness of the oxidized regenerated cellulose patch (ORCP) for postbiopsy hemostasis, anxiety, and depression in patients undergoing transrectal ultrasound-guided prostate biopsy. This was a prospective-retrospective study of 300 patients who underwent systematic 12-core prostate biopsy from August 2016 through March 2018. The ORCP was inserted into the rectum immediately after prostate biopsy in the prospective group (n = 150), while the retrospective group (n = 150) underwent prostate biopsy alone. The frequency rate and duration of hematuria, rectal bleeding, and hematospermia were compared between the 2 groups. Anxiety and depression were assessed with the hospital anxiety and depression scale before and after prostate biopsy in the prospective group. The frequency rates of hematuria and hematospermia showed no significant differences between the prospective versus retrospective groups (64.7% vs 66.7%, P = .881; 18 vs 20%, P = .718; respectively). Frequency of rectal bleeding was significantly lower in the prospective group than in the retrospective group (26.7% vs 42.7%, P = .018). However, there were no significant differences in median duration of rectal bleeding, hematuria, or hematospermia between the 2 groups (2, 5, and 2 days vs 2, 7, and 1 day, P > .05, respectively, for the prospective vs retrospective group). Multivariate analysis found that ORCP insertion was a significant protective factor against postbiopsy rectal bleeding (P = .038, odds ratio 0.52). Only anxiety level in the prospective group before versus after prostate biopsy was significantly reduced (5 vs 4, P = .011). ORCP insertion after prostate biopsy is an effective and simple method for decreasing rectal bleeding. ORCP insertion may also alleviate anxiety in patients undergoing prostate biopsy.

INTRODUCTION AND OBJECTIVES:To investigate the hemostatic usefulness of oxidized regenerated cellulose patch (ORCP) used immediately after transrectal ultrasound (TRUS)-guided prostate biopsy and a...

Linear accelerators (LINAC) that generate high energy X-rays have been widely used for radiotherapy. With the combination of advanced imaging modalities, an image-guided radiation therapy (IGRT) has greatly improved the quality of radiotherapy by acquiring instant knowledge of changes in tumor volume, radiation dose distribution, and effective tumoricidal doses during treatment. In this study, we developed a compact 9.3 GHz X-band LINAC system and installed on the gantry for potential applications in IGRT. We confirmed X-ray generation using radio frequency transmission tests and measured the X-ray dose rates while the gantry was rotating, which demonstrates stable and reliable operation of the developed system. The field size of an X-ray beam was $\pmb{10.31}\ \mathbf{cm}\ \times \ \pmb{10.31}\ \mathbf{cm}$ at the solid water phantom (depth 0 cm) of the film, and the standard deviation of the Xray dose was 0.016 while rotating. Therefore, we describe the design and test results of the X-band LINAC system mounted on the O-arm gantry. We expect the use of our design for the fusion system that integrates a diagnostic imaging instrument with a radiation therapeutic device.

In the field of radiotherapy, as the treatment method which is combined with imaging devices becomes important, there is an increasing demand for miniaturization and weight reduction of linear accelerator (LINAC), which is a core part of the radiotherapy equipment. To meet these requirements, LINAC has been developed by applying X-band RF technology and side-coupled structure. The developed LINAC is operated by an RF signal with a frequency of 9.3 GHz. The length of the RF cavity is 37 cm and the shunt impedance is 116 $M$ Ω/m. The electron beam can be accelerated up to 6.3 MeV with having about beam current of 80 mA by electric field strength of 16.8 MeV/m. Based on the design parameters, the dose rate is calculated to be more than 1000 cGy/min when the source to surface distance (SSD) is 80 cm.

Medical magnetrons to operate the medical linear accelerator (LINAC) are widely used for the radiation therapy systems. The operation performances of medical LINAC generating the high energy X-ray to treat the cancers depends on the RF performances of medial magnetron. The medical 9.3 GHz coaxial magnetron is investigated by using three-dimensional particle-in-cell simulation to analyze the RF performances. The maximum output power of 1.88 MW with the efficiency of 53 % is measured at the stable $\pmb\pi-\mathbf{mode}$ resulted from the 20-electron spokes. And, the frequency bandwidth controlled by the frequency tuner shows the 1.5 $\mathbf{MHz}/\pmb\mu \mathbf{m}$ with the bandwidth of 60 MHz.

Background Magnetic resonance imaging (MRI) has unique advantages for guiding interventions, but the narrow space is a major challenge. This study evaluates the feasibility of a remote-controlled hydrostatic actuator system for MRI-guided targeted needle placement. Methods The effects of the hydrostatic actuator system on MR image quality were evaluated. Using a reference step-and-shoot method (SS) and the proposed actuator-assisted method (AA), two operators performed MRI-guided needle placement in targets (n = 12) in a motion phantom. Results The hydrostatic actuator system exhibited negligible impact on MR image quality. In dynamic targets, AA was significantly more accurate and precise than SS, with mean ± SD needle-to-target error of 1.8 ± 1.0 mm (operator 1) and 1.3 ± 0.5 mm (operator 2). AA reduced the insertion time by 50% to 80% and total procedure time by 25%, compared to SS. Conclusions The proposed hydrostatic actuator system may improve accuracy and reduce procedure time for MRI-guided targeted needle placement during motion.

Mutations in RAS signaling pathway components cause diverse neurodevelopmental disorders, collectively called RASopathies. Previous studies have suggested that dysregulation in RAS–extracellular signal–regulated kinase (ERK) activation is restricted to distinct cell types in different RASopathies. Some cases of Noonan syndrome (NS) are associated with gain-of-function mutations in the phosphatase SHP2 (encoded by PTPN11); however, SHP2 is abundant in multiple cell types, so it is unclear which cell type(s) contribute to NS phenotypes. Here, we found that expressing the NS-associated mutant SHP2(D61G) in excitatory, but not inhibitory, hippocampal neurons increased ERK signaling and impaired both long-term potentiation (LTP) and spatial memory in mice, although endogenous SHP2 was expressed in both neuronal types. Transcriptomic analyses revealed that the genes encoding SHP2-interacting proteins that are critical for ERK activation, such as GAB1 and GRB2, were enriched in excitatory neurons. Accordingly, expressing a dominant-negative mutant of GAB1, which reduced its interaction with SHP2(D61G), selectively in excitatory neurons, reversed SHP2(D61G)-mediated deficits. Moreover, ectopic expression of GAB1 and GRB2 together with SHP2(D61G) in inhibitory neurons resulted in ERK activation. These results demonstrate that RAS-ERK signaling networks are notably different between excitatory and inhibitory neurons, accounting for the cell type–specific pathophysiology of NS and perhaps other RASopathies.

Battery-powered automobiles are emerging as a promising alternative to internal combustion engine vehicles in response to the internationally strengthening regulation on carbon dioxide emissions. Due to the heavy weight of the electric drive unit, the weight savings of the electric vehicles are often attempted on body structures by using lightweight materials such as fiber-reinforced composites with traditional metal alloys. In the present study, a new multi-material design of a battery pack structure is proposed and its performance is evaluated through random vibration fatigue tests. The fatigue tests are virtually performed on a full-scale finite element model of the battery pack. The virtual tests embody boundary and loading conditions required by a real industry specification. The vibration loading is specified in the form of a power spectral density and the fatigue analysis is conducted accordingly in frequency domain. The cumulative fatigue damage and lives of each component composing the batter pack structure are predicted. The present modeling approach could benefit the preliminary design of an automotive body structure because the performance evaluation on various prototypes can be efficiently conducted without a physical model.

Summary Although medial prefrontal cortex (mPFC) is known to play important roles in social behaviors, how early social experiences affect the mPFC and its subcortical circuit remains unclear. We report that mice singly housed (SH) for 8 weeks after weaning show a social recognition deficit, even after 4 weeks of resocialization. In SH mice, prefrontal infralimbic (IL) neurons projecting to the shell region of nucleus accumbens (NAcSh) show decreased excitability compared with group-housed (GH) mice. NAcSh-projecting IL neurons are activated when GH mice encounter a familiar conspecific, which is not observed in SH mice. Chemogenetic inhibition of NAcSh-projecting IL neurons in normal mice impairs social recognition without affecting social preference, whereas activation of these neurons reverses social recognition deficit in SH mice. Our findings demonstrate that early social experience critically affects mPFC IL-NAcSh projection, the activation of which is required for social recognition by encoding information for social familiarity.

The recent development in the eco-friendly energy industry has motivated many researchers to focus on wind turbines. The advancement of wind turbine technology is in accordance with the trends in the last century. Pitch systems, which comprise wind turbines, have a high failure rate. However, the fatigue life of pitch systems has not been sufficiently studied. A pitch system, which greatly affects the power generation efficiency of a wind turbine, consists of a motor, a gearbox, and a pinion. In this work, a fatigue life analysis of a pinion is performed to improve the durability of pitch systems. Frequent changes in rotation are unique to a pitch system in operation. When an impact load exists at an inverse turn, the stress generated from the impact load is the dominant factor to consider in evaluating the fatigue life of a pinion. The stress history at the gear tooth is determined through a finite element simulation. The cumulative damage fraction is calculated via rainflow cycle counting on the basis of the Goodman relation and Miner’s rule. Therefore, we propose a method for evaluating the fatigue life of a pinion, which considers the effect of an impact load. A conservative design of pitch systems is needed to ensure the reliability of wind turbines under an impact load.

Background Potential role of vascular dysfunction has been suggested in the pathogenesis of Alzheimer's disease (AD). Previous cross-sectional studies have demonstrated relations between abnormal transcranial Doppler (TCD) parameters and cognitive impairment. We aimed to investigate the associations between longitudinal changes of TCD parameters and cognitive decline in patients with AD. Methods We have enrolled patients with mild to moderate AD who aged 60 to 79 years. Mean flow velocity and pulsatility index (PI) of anterior (ACA), middle (MCA), and posterior (PCA) cerebral arteries were evaluated. Cognitive functions were assessed using mini-mental state examination (MMSE), clinical dementia rating sum of boxes (SOB), and Alzheimer's Disease Assessment Scale (ADAS-cog), which was further categorized as praxis, language, and memory subscores. TCD and cognitive assessments were followed up 1 year later, and the longitudinal changes (Δ) between the baseline and follow-up measurements were evaluated. Results A total of 51 patients completed the follow-up evaluations (baseline age 71.5 years, MMSE 21.2). In the baseline evaluations, high PI values of ACA and MCA were associated with poor MMSE score, ADAS-cog total, memory, and praxis subscores. After 1 year, the increases of ACA and MCA PI were correlated with the aggravation of ADAS language subscore, and ΔACA PI was also correlated with ΔSOB. The decrease in mean flow velocity of ACA was associated with aggravation of ADAS-cog praxis score. Conclusions There was significant correlation between longitudinal changes of TCD parameters and cognitive dysfunction in patients with mild to moderate AD. Serial assessment of TCD may provide useful information regarding to the disease progression.

In this study, we evaluated antioxidant and antiproliferating effects of Setaria italica extract (SIE), Panicum miliaceum extract (PME) and Sorghum bicolor extract (SBE). Antioxidant effects of these extracts were determined by assessing DPPH radical scavenging activity, ABTS·+ radical scavenging activity, reducing power and superoxide dismutase (SOD)-like activity. From high concentrations (1,000 μg/mL) of each extract at DPPH radical scavenging activities of SIE, PME and SBE were 10.5%, 5.5% and 86.8% respectively, ABTS+ radical activities were 4.92%, 5.9% and 62.3% respectively, reducing powers (OD 700) were 0.15, 0.18 and 1.7 respectively, and SOD-like activities were 17.0%, 15.9% and 38.6% respectively. In addition, SBE significantly decreased the cell viability of androgen-sensitive lymph node metastasis type of prostate cancer (LNCaP) cells in a dose-dependent manner. Morphological study of SBE-treated LNCaP cells revealed distorted and shrunken cell masses. SBE-induced cell death was confirmed by observation of nuclear condensation and increased formation of apoptotic bodies. The antiproliferative effect of SBE seems to be associated with the antioxidant activity of its polyphenol content. The results of this study indicate that SBE can exert antioxidant and antiproliferative effects and may be as a useful food material.

A new Gadolinium Fine Aluminum Gallate (Ce:GFAG) scintillation crystal with both high energy resolution and fast timing properties has successfully been grown. Compared to Gd3Al2Ga3O12 (Ce:GAGG), this new inorganic scintillation crystal has a high luminosity similar to and a faster decay time. In this paper, we report on the timing and energy performance results of the new GFAG scintillation crystal read out with digital silicon photomultipliers (dSiPM) for positron emission tomography (PET) application. The best coincidence resolving time (FWHM) of polished 3×3×5 mm3 crystals was 223±6 ps for GFAG crystals compared to 396±28 ps for GAGG crystals and 131±3 ps for LYSO crystals respectively. An energy resolution (511 keV peak of Na-22) of 10.9±0.2% was attained with GFAG coupled to dSiPM after correcting for saturation effect, compared to 9.5±0.3% for Ce:GAGG crystals and 11.9±0.4% for LYSO crystals respectively. It is expected that this new scintillator may be competitive in terms of overall properties such as energy resolution, timing resolution and growing (raw material) cost, compared to existing scintillators for positron emission tomography (PET).

In this study, natural gas hydrate (NGH) regasification process combined with liquefied natural gas (LNG) receiving terminal is designed. Since NGH contains excess water, the process needs a dehydration step to avoid reproduction of hydrate in the pipelines. As a method for dehydrating NGH, the enhanced dew point shift is chosen, and the last water specification is achieved by mixing with a LNG stream, which contains negligible water. To cool down the compressed NGH stream, the cryogenic energy of LNG receiving terminal is used. After designing the NGH regasification process, the economic analysis is carried out according to the shipping distance, type of refrigerant, capacity of carrier, and mixing ratio of NGH over LNG. Then, comparison between the conventional LNG chain to the proposed chain that utilizes both LNG and NGH is made. When the quantity of regasified natural gas is fixed at 3.7 million metric tons per year (MTPA), the proposed chain is able to reduce the total chain cost by up to 10.6% compared to the conventional LNG chain in the case of natural gas (NG) delivery to South Korea. Lastly, the risk on investment with respect to the NG liquefaction cost is conducted. According to this, as the shipping distance increases, the risk of the proposed chain decreases.

We firstly show the prototype of an ohmic contact Single-Pole Double-Throw Radio Frequency Micro-Electro-Mechanical Systems (SPDT RF MEMS) switch operating at 50-100GHz. The fabricated ohmic contact SPDT RF MEMS silicon switch moves both laterally and vertically, to improve the isolation at high frequencies by initially misaligning the contact part of the switch over a Coplanar Waveguide (CPW) transmission line. The lateral and vertical movement of the switch is operated by using comb and parallel plate actuators, respectively. The proposed switch was fabricated using Silicon-On-Glass (SiOG) bonding process. The insertion loss of the fabricated switch is measured according to the different operation states of the switch, in the range from 50 to 100GHz. The fabricated length of the transmission line is 4.6mm and the measured insertion loss and isolation are 9.13dB and 24.37dB at 70GHz, respectively. Display Omitted A SPDT RF MEMS metal-contact switch for 50-100GHz applications is proposed.The switch is driven by a bidirectional comb actuator and parallel plate actuator.The RF characteristics of the switch are measured in the lateral and vertical movement sequentially.The measurement results show that the isolation can be increased using the proposed design.

In this paper, the magnetic field design of a superconducting fixed-frequency isochronous cyclotron with four spiral sectors for proton therapy was performed. The basic parameters of the isochronous cyclotron magnet and its characteristics are described. Several magnet sectors were designed during the iteration process to achieve an isochronous magnetic field. The result of 3-D magnetic field simulation using OPERA-3D and the analysis of the designed magnetic field are presented. A special geometry was introduced into the sector gap to achieve the isochronous condition, and the spiral angle was adjusted to control the vertical focusing parameter. The equilibrium orbits were checked for the designed magnetic field, and a single particle tracking simulation was performed with CYCLONE code.

Percutaneous transhepatic biliary drainage (PTBD) is a modality that is used to decompress obstructive jaundice due to impacted stones, benign stricture or cancer. The PTBD catheter is removed percutaneously after the restoration of internal biliary drainage. We experienced a case of a 62-year-old man with peritonitis due to the migration of the PTBD catheter into the peritoneal cavity; we successfully removed it using peroral endoscopy. Although rare, the PTBD catheter may migrate into the peritoneal cavity during the removal of it. In these cases, clinicians should consider the peroral endoscopic removal of the PTBD catheter.

Objectives To evaluate the clinical efficacy of initial combined treatment of alpha-blocker plus dose-dependent anticholinergic agent compared to the alpha-blocker monotherapy in benign prostatic hyperplasia patients with overactive bladder. Methods Male lower urinary tract symptoms (LUTS) patients with International Prostate Symptom Score (IPSS) of 8 or higher, total overactive bladder Symptom Score (OABSS) of 3 or higher, and 2 points or higher in the OABSS questionnaire number 2 were enrolled. Eligible subjects (total n = 146) were randomly assigned to receive tamsulosin 0.2 mg (Group I, n = 44), tamsulosin 0.2 mg plus solifenacin 5 mg (Group II, n = 55), or tamsulosin 0.2 mg plus solifenacin 10 mg (Group III, n = 47) for 12 weeks. Efficacy and safety assessments for each group were done using detailed questionnaires, and evaluating urinary parameters such as maximal urinary flow rate (Qmax) and postvoid residual volume (PVR) at 4 and 12 weeks. Results Groups II and III (combined use of tamsulosin and solifenacin) showed significant improvement in storage symptoms compared to group I (tamsulosin monotherapy), as reflected by IPSS storage subscore and OABSS (P

A compact X-band linear accelerator (LINAC) system equipped with a small and lightweight magnetron was constructed to develop a high-precision image-guided radiotherapy system. The developed LINAC system was installed in an O-ring gantry where cone-beam computed tomography (CBCT) was embedded. When the O-arm gantry is rotated, an x-ray beam is stably generated, which resulted from the stable transmission of radio frequency power into the X-band LINAC system. Quality assurance (QA) tests, including mechanical and dosimetry checks, were carried out to ensure safety and operation performance according to the American Association of Physicists in Medicine's TG-51, 142, an international standard protocol established by accredited institutions. In addition, delivery QA of the radiotherapy planning system was conducted to verify intensity-modulated radiotherapy techniques. Therefore, it was demonstrated that the developed X-band LINAC system mounted on the O-arm gantry proved to be valid and reliable for potential use in CBCT image-guided radiation therapy.

The present authors describe an uncommon case of iatrogenic bladder stone formation in a patient who underwent surgery for pelvic organ prolapse. A female patient who underwent high uterosacral ligament suspension ten years ago presented with pyuria and irritable bladder symptoms that did not respond to treatment. She had not experienced any specific urinary symptoms during the previous ten years. Patient evaluation revealed bladder stone formation on the non-absorbable suture material used during the previous operation. Cystoscopy during the previous operation did not find the suture material, and the suture knot that was tied extravesically during the operation was found inside the bladder. These strongly suggest delayed migration and rotation of the'suture knot after surgery rather than direct penetration of the bladder during operation. Delayed suture migration is a long-term complication that clinicians should consider in a patient who suffers from recurrent urinary symptoms after pelvic surgery around the bladder.

Summary Pain sensation is powerfully modulated by signal processing in the brain, and pain becomes chronic with the dysfunction of the pain modulatory system; however, the underlying mechanisms are unclear. We found that the metabotropic glutamate receptor 5 (mGluR5) in the periaqueductal gray (PAG), the key area of endogenous pain modulation, is persistently active in normal conditions to maintain an appropriate sensory perception. In the neuropathic pain condition, Homer1a, an activity-dependent immediate early gene product, disrupted the persistent mGluR5 activity resulting in chronic pain. Remarkably a single-time blockage of the mGluR5 resulted in chronic neuropathic pain-like symptoms even in the absence of nerve injury. The decline of mGluR5 activity induced the pain modulatory dysfunction with a profound reduction of excitability of PAG neurons. These findings uncover the role of the persistent mGluR5 activity in vivo and provide new insight into how pain becomes chronic with the maladaptive coping of the PAG to pain sensation.

This paper proposes an automatic blade control system in a Cartesian space for leveling of bulldozer blades, which controls the position of blade cutting edge to the position of design surface for leveling in a Cartesian space. To control the position of blade cutting edge in a Cartesian space, this paper developed a Cartesian-space control algorithm by applying a mathematical model of the homogeneous transformation matrix, based on a virtual spring-damper tucked between the blade cutting edge and design surface. After applying the proposed control system at an actual construction site, this paper compared the results with those of an expert operator and analyzes their accuracy and precision.

Introduction REM sleep Behavior Disorder (RBD) is characterized by dream enacting behaviors and a loss of atonia during REM sleep. Early detection of RBD is important because it is considered premonitory symptoms neurodegenerative disorders. In this study, we investigated the slow and fast sigma band power of patients with RBD using frequency analysis. Methods Twenty patients who were diagnosed as RBD according to the ICSD-3 criteria and 20 age-matched controls who underwent polysomnography (PSG) for other sleep disorders (insomnia, snoring) and showed normal to mild obstructive sleep apnea (OSA). NREM sleep EEG data was extracted and N1 sleep data was excluded to minimize arousal artifact. Fast Fourier transform-based spectral power analysis was used to compute the power spectral densities of the EEG in the MATLAB environment. The sigma bands were divided into 2 discrete bands: slow sigma (11 to 13 Hz) and- fast sigma (13 to 15 Hz). Mann-Whitney U test by SPSS was used. Results RBD patients (61.9 ± 7.1 years old; 12 men) had a significantly lower sigma band power than the control group (61.5 ± 1.1 years old; 11 men) in central region (p = 0.028). Particularly, the slow sigma band power showed a bigger difference in all regions except O1 (F3 = 0.017, F4 = 0.027, C3 = 0.004, C4 = 0.009, O2 = 0.017). Conclusion Sigma power was lower in the RBD patients than in the control. It suggests that RBD has impaired cortical activity. Thus, decreased spindle activity during NREM sleep may be a potential biomarker of RBD. Support

Background: Although there is a standard guideline for performing revascularization surgery in patients with Moyamoya diseases (MMD), more objective and easily obtainable predictors are still needed. Objectives: In this study, we aimed to evaluate the relationship between an ipsilateral ivy sign and ischemic stroke recurrence in adult MMD patients without revascularization surgery. Methods: We included consecutive MMD patients without revascularization surgery between 2006 and 2014. The ivy sign was defined as a linear or focal high-signal intensity on fluid-attenuated inversion recovery images, and the burdens of ivy sign were rated in each hemisphere. The ischemic stroke recurrence was defined as a new clinical event that accompanied a new brain lesion on magnetic resonance imaging. Results: Overall, 84 patients with 154 hemispheres were analyzed. We found recurrent ischemic stroke in 9 (6%) hemispheres within 3 years. In multivariate analysis, an ipsilateral ivy sign remained an independent predictor of 3-year ischemic recurrence (adjusted hazard ratio [aHR] 10.15, 95% CI 2.10–49.14, p = 0.004). An initial presentation as infarction was also significant (aHR 7.15, 95% CI 1.36–36.78, p = 0.019). The burdens of ivy sign showed a dose-response tendency with the 3-year ischemic recurrence rate (p < 0.001). When comparing the ischemic recurrence rate among 4 groups with and without ivy sign and perfusion defect, the “Ivy sign (+) Perfusion defect (+) group” showed a significantly higher risk in both observed (p = 0.005) and estimated (p = 0.003) 3-year ischemic recurrence than did the other group. Additionally, the “Ivy sign (+) Perfusion defect (–) group” showed a higher recurrence rate than did the “Ivy sign (–) Perfusion defect (+) group”. Conclusions: The ivy sign is associated with ischemic recurrence in adult MMD patients in a dose-response manner. It would be helpful for selecting high-risk patients who need revascularization surgery.

Background Adrenal insufficiency (AI) is associated with high morbidity and mortality. The aim of this systematic review was to enhance diagnostic approaches and summarize therapeutic strategies in the management of AI in patients with systematic lupus erythematosus (SLE) or antiphospholipid syndrome (APS). Methods A literature search of PubMed and Medline databases was performed and 91 publications containing 105 cases were included for the final analysis. Results The following frequency of clinical signs and symptoms was noted: abdominal pain (39.04%) was the leading symptom, followed by fever (33.33%), vomiting (23.81%), and nausea (19.05%). APS was present in 73%, SLE in 17% of the patients, while 2% had a diagnosis of both, SLE and APS. ACTH stimulation test (ACTHst) was performed in 18% of cases and 76.6% of them were unresponsive towards stimulation. Variable treatment approaches were used: hydrocortisone was most commonly used (38.09%), followed by fludrocortisone (26.67%), prednisolone (20.00%) and volume replacement treatment (11.43%), respectively. Conclusions This analysis highlights the importance of an early diagnosis and initiation of therapeutic management when AI is suspected. In line, signs and symptoms related to autoimmune diseases in patients with AI should be reviewed crtitically.

What is memory? How does the brain process the sensory information and modify an organism's behavior? Many neuroscientists have focused on the activity- and experience-dependent modifications of synaptic functions in order to solve these fundamental questions in neuroscience. Recently, the plasticity of intrinsic excitability (called intrinsic plasticity) has emerged as an important element for information processing and storage in the brain. As the cerebellar Purkinje cells are the sole output neurons in the cerebellar cortex and the information is conveyed from a neuron to its relay neurons by forms of action potential firing, the modulation of the intrinsic firing activity may play a critical role in the cerebellar learning. Many voltage-gated and/or Ca2+-activated ion channels are involved in shaping the spiking output as well as integrating synaptic inputs to finely tune the cerebellar output. Recent studies suggested that the modulation of the intrinsic excitability and its plasticity in the cerebellar Purkinje cells might function as an integrator for information processing and memory formation. Moreover, the intrinsic plasticity might also determine the strength of connectivity to the sub-cortical areas such as deep cerebellar nuclei and vestibular nuclei to trigger the consolidation of the cerebellar-dependent memory by transferring the information., Graphical Abstract

With continuous development in the IC advanced technologies, physical verification is becoming increasingly more complex in the semiconductor manufacturing process. Currently, different regression patterns-based techniques are widely adopted in the design rules checking (DRC) verification. As complexity of design rules increases, limitations of those traditional techniques emerge such as focusing only on the rule final output, missing some of the underlying defects in the DRC Code, requiring many QA cycles for the rule deck to be released, and lacking well-defined measure of the DRC Coverage. This paper presents a new methodology in verifying the design rules checks, complementing the traditional Regression technique, through performing DRC rule deck line-by-line comparison with the regression layout patterns. This offers in-depth and quantitative analysis of all the DRC components, captures the possible defects in very early stages of the QA process, and reduces the time consumed in verification significantly compared to using just the traditional QA techniques.

The 14-3-3 family of proteins performs key regulatory functions in phosphorylation-dependent signaling pathways including cell survival and proliferation, apoptosis, regulation of chromatin structure and autophagy. In this study, the zeta isoform of 14-3-3 proteins (designated as Tm14-3-3ζ) was identified from the expressed sequence tags (ESTs) and RNA sequencing (RNA-Seq) database of the coleopteran pest, Tenebrio molitor. Tm14-3-3ζ messenger RNA (mRNA) is expressed at higher levels in the immune organs of the larval and adult stages of the insect and exhibit almost five-fold induction within 3 h post-infection of the larvae with Escherichia coli and Candida albicans. To investigate the biological function of Tm14-3-3ζ, a peptide-based Tm14-3-3ζ polyclonal antibody was generated in rabbit and the specificity was confirmed using Western blot analysis. Immunostaining and confocal microscopic analyses indicate that Tm14-3-3ζ is mainly expressed in the membranes of midgut epithelial cells, the nuclei of fat body and the cytosol of hemocytes. Gene silencing of Tm14-3-3ζ increases mortality of the larvae at 7 days post-infection with E. coli and C. albicans. Our findings demonstrate that 14-3-3ζ in T. molitor is essential in the host defense mechanisms against bacteria and fungi.