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Recent studies have highlighted the effectiveness of using antisense oligonucleotides (ASOs) for cellular RNA regulation, including targets that are considered undruggable; however, manually designing optimal ASO sequences can be labor intensive and time consuming, which potentially limits their broader application. To address this challenge, we introduce a platform, the ASOptimizer, a deep-learning-based framework that efficiently designs ASOs at a low cost. This platform not only selects the most efficient mRNA target sites but also optimizes the chemical modifications for enhanced performance. Indoleamine 2,3-dioxygenase 1 (IDO1) promotes cancer survival by depleting tryptophan and producing kynurenine, leading to immunosuppression through the aryl-hydrocarbon receptor (Ahr) pathway within the tumor microenvironment. We used ASOptimizer to identify ASOs that target IDO1 mRNA as potential cancer therapeutics. Our methodology consists of two stages: sequence engineering and chemical engineering. During the sequence-engineering stage, we optimized and predicted ASO sequences that could target IDO1 mRNA efficiently. In the chemical-engineering stage, we further refined these ASOs to enhance their inhibitory activity while reducing their potential cytotoxicity. In conclusion, our research demonstrates the potential of ASOptimizer for identifying ASOs with improved efficacy and safety.

The objective and scope of this Limited Output Transcranial Electrical Stimulation 2023 (LOTES-2023) guidance is to update the previous LOTES-2017 guidance. These documents should therefore be considered together. The LOTES provides a clearly articulated and transparent framework for the design of devices providing limited output (specified low-intensity range) transcranial electrical stimulation for a variety of intended uses. These guidelines can inform trial design and regulatory decisions, but most directly inform manufacturer activities - and hence were presented in LOTES-2017 as “Voluntary industry standard for compliance controlled limited output tES devices”. In LOTES-2023 we emphasize that these standards are largely aligned across international standards and national regulations (including those in USA, EU, and South Korea), and so might be better understood as “Industry standards for compliance controlled limited output tES devices”. LOTES-2023 is therefore updated to reflect a consensus among emerging international standards, as well as best available scientific evidence. “Warnings” and “Precautions” are updated to align with current biomedical evidence and applications. LOTES standards applied to a constrained device dose range, but within this dose range and for different use-cases, manufacturers are responsible to conduct device-specific risk management.

BackgroundOligomeric Aβ (OAβ) is a promising candidate marker for Alzheimer’s disease (AD) diagnosis. Electroencephalography (EEG) is a potential tool for early detection of AD. Still, whether EEG power ratios, particularly the theta/alpha ratio (TAR) and theta/beta ratio (TBR), reflect Aβ burden—a primary mechanism underlying cognitive impairment and AD. This study investigated the association of TAR and TBR with amyloid burden in older adults based on MDS-OAβ levels.Methods529 individuals (aged ≥60 years) were recruited. All participants underwent EEG (MINDD SCAN, Ybrain Inc., South Korea) and AlzOn™ test (PeopleBio Inc., Gyeonggi-do, Republic of Korea) for quantifying MDS-OAβ values in the plasma. EEG variables were log-transformed to normalize the data distribution. Using the MDS-OAβ cutoff value (0.78 ng/mL), all participants were classified into two groups: high MDS-OAβ and low MDS-OAβ.ResultsParticipants with high MDS-OAβ levels had significantly higher TARs and TBRs than those with low MDS-OAβ levels. The log-transformed TBRs in the central lobe (β = 0.161, p = 0.0026), frontal lobe (β = 0.145, p = 0.0044), parietal lobe (β = 0.166, p = 0.0028), occipital lobe (β = 0.158, p = 0.0058), and temporal lobe (beta = 0.162, p = 0.0042) were significantly and positively associated with increases in MDS-OAβ levels. After adjusting for the Bonferroni correction, the TBRs in all lobe regions, except the occipital lobe, were significantly associated with increased MDS-OAβ levels.ConclusionWe found a significant association of MDS-OAβ with TBR in older adults. This finding indicates that an increase in amyloid burden may be associated with an increase in the low-frequency band and a decrease in the relatively high-frequency band.

Purpose – The purpose of this study is to examine how perceived authenticity of ethnic restaurants interacts with personality traits (ethnocentrism and xenocentrism) to predict behavioural intentions. Methodology –A self-administered online questionnaire was utilized. First, participants answered questions to measure their level of ethnocentrism or xenocentrism, Next, they were presented with one of two scenarios (low or high authentic ethnic restaurant), followed by questions to measure their behavioural intentions. Approach – A total of 581 responses were analysed using regression analyses to examine the interaction effect of perceived authenticity and personality traits on behavioural intentions toward ethnic restaurants. Findings – Both ethnocentrism and xenocentrism attenuated the positive impact of perceived authenticity on behavioural intention. The extent to which people are influenced by the authenticity of ethnic restaurants was reduced for consumers with higher levels of ethnocentrism and xenocentrism, Originality of the research – This study examined the role of personality traits (ethnocentrism and xenocentrism), which are important but under-researched in the hospitality literature. Such a study is particularly important because a better understanding of these traits could demonstrate, contrary to popular belief, that authenticity is not always a factor in the success of ethnic restaurants

A high-frequency surface wave radar (HFSWR) is the only sensor that provides inexpensive surveillance for up to 200 nautical miles (NM) of the exclusive economic zone in the 3–5 MHz band. However, because of its long wavelength, its angular resolution is low. Multiple-input multiple-output (MIMO) technology is an attractive method to improve angular resolution. This paper proposes MIMO waveforms and their processing that can be used in HFSWR systems. This dual modulation method applies linear frequency modulation to each pulse and orthogonal polyphase codes for a few consecutive pulses to enable MIMO processing. The proposed method can effectively remove the correlation of mutual interference and exhibits excellent performance in removing multiple-time-around echoes.

OBJECTIVES: As hospitals rapidly implement mechanical thrombectomy (MT) into stroke protocols following the pivotal trials in 2015, access to and outcomes from MT may be poorer for weekend-admitted patients. We sought to investigate whether a “weekend effect” influences MT outcomes nationally. MATERIALS AND METHODS: We identified stroke patients from 2010–2014 (pre-trials) to 2015–2017 (posttrials) using the Nationwide Readmissions Database. On multivariate analyses, we determined factors independently associated with receiving MT. Among MT patients, we then determined whether weekend admission was independently associated with inpatient mortality and unfavorable discharge. RESULTS: We identified 2,121,462 patients from 2010 to 2014, of whom 1.11% of weekday-admitted and 1.08% of weekend-admitted patients underwent MT. Of the 1,286,501 patients identified from 2015 to 2017, MT was performed in 2.82% and 2.91%, respectively. In the earlier cohort, weekend admission was independently associated with reduced odds of MT (odds ratio [OR] = 0.92, 95% confidence interval [CI]: 0.89–0.95, P < 0.0001), although this was not statistically significant in the later cohort. During both periods, age >80 years was independently associated with a reduced likelihood of receiving MT, and status as a teaching or large bed-size hospital was associated with a greater likelihood. Weekend admission was independently associated with unfavorable discharge only in the 2015–2017 cohort (OR = 1.11, 95% CI: 1.02–1.22, P = 0.02). CONCLUSIONS: While nationwide access to MT has improved for weekend-admitted patients, the elderly and those at smaller, nonteaching hospitals remain underserved. Although we found no effect of weekend admission on inpatient mortality, since the major shift in practice, an emerging “weekend effect” may influence discharge outcomes. Data suggest that some hospitals are being challenged to provide this new standard of care efficiently and equitably.

BackgroundMisperception of body weight is associated with various psychological and health problems, including obesity, eating disorders, and mental problems. To date, female-specific risk factors, including socioeconomic or health-related lifestyle features, or their indicative performance for the misperception in Asian women according to age groups remain unknown.ObjectivesTo investigate the prevalence and associated risk factors for the mismatch in self-perceived body weight and evaluated the classification performance of the identified risk factors across age groups in female adults.MethodsWe analyzed data of 22,121 women (age 19–97 years) from the 7-year Korea National Health and Nutrition Examination Survey dataset (2010-2016). We evaluated self-perceived body weight of the participants with their actual weight using the body mass index cut-off and grouped them by age: early adulthood (19–45), middle adulthood (46–59), and late adulthood (≥60). Logistic regression was conducted in each age group based on their weight misperception. The classification performance of the identified risk factors was evaluated with a bagging tree ensemble model with 5-fold cross-validation.Results22.2% (n=4,916) of the study participants incorrectly perceived their body weight, of which 14.1% (n=3,110) and 8.2% (n=1,806) were in the underestimated and overestimated groups. Among the age groups, the proportion of participants who misperceived their body weight was highest in late adulthood (31.8%) and the rate of overestimation was highest in early adulthood (14.1%). We found that a lower education level, absence of menopause, perception of themselves as unhealthy, and efforts for weight management were significantly associated with the overall misperception (overestimation or underestimation) of body weight across age groups. Based on the identified risk factors, the highest area under the receiver operating curve (AUROC) and accuracy of the best classification model (weight overestimation in all participants) were 0.758 and 0.761, respectively. Adding various associated lifestyle factors to the baseline model resulted in an average increase of 0.159 and 0.135 in AUROC for classifying weight underestimation and overestimation, respectively.ConclusionsAge, education level, marital status, absence of menopause, amount of exercise, efforts for weight management (gain, loss, and maintenance), and self-perceived health status were significantly associated with the mismatch of body weight.

This study introduces a multi-cloud model that combines private and public cloud services for processing and managing satellite images. The multi-cloud service is established by incorporating private clouds within organizations and integrating them with external public cloud services to utilize the data. Private clouds can maintain data security within an organization or between organizations, while public clouds offer easy processing options for general users with access accounts. The model for the private cloud service utilizes open-source OpenStack software to create virtual machines, allowing users to manage analysis ready data (ARD) of the Korea Multi-Purpose Satellite (KOMPSAT)-3/3A images simultaneously. The public cloud service through Amazon Web Services (AWS) offers four services and uses the Open Data Cube (ODC) to manage data and provide web-based time-series visualization and processing. The model utilizes OpenStack to create virtual machines, and the public cloud service through AWS offers various services using ODC to manage data. A system that handles large amounts of satellite imagery in a multi-cloud environment has benefits such as improved availability, cost savings through open-source, and enhanced scalability. We present a prototyped utilization model that can be used with the ODC user interface (UI) that applies the proposed multi-cloud model. The multi-cloud model of this study can be applied to constructing a country-scale data cube system, that deals with large-scale satellite image data. It can also be applied to systems that need to be built with data that is tailored to a specific user’s needs at any institution.

BackgroundEarly identification of people at risk for cognitive decline is an important step in delaying the occurrence of cognitive impairment. This study investigated whether multimodal signals assessed using electroencephalogram (EEG) and gait kinematic parameters could be used to identify individuals at risk of cognitive impairment.MethodsThe survey was conducted at the Veterans Medical Research Institute in the Veterans Health Service Medical Center. A total of 220 individuals volunteered for this study and provided informed consent at enrollment. A cap-type wireless EEG device was used for EEG recording, with a linked-ear references based on a standard international 10/20 system. Three-dimensional motion capture equipment was used to collect kinematic gait parameters. Mild cognitive impairment (MCI) was evaluated by Seoul Neuropsychological Screening Battery-Core (SNSB-C).ResultsThe mean age of the study participants was 73.5 years, and 54.7% were male. We found that specific EEG and gait parameters were significantly associated with cognitive status. Individuals with decreases in high-frequency EEG activity in high beta (25–30 Hz) and gamma (30–40 Hz) bands increased the odds ratio of MCI. There was an association between the pelvic obliquity angle and cognitive status, assessed by MCI or SNSB-C scores. Results from the ROC analysis revealed that multimodal signals combining high beta or gamma and pelvic obliquity improved the ability to discriminate MCI individuals from normal controls.ConclusionThese findings support prior work on the association between cognitive status and EEG or gait, and offer new insights into the applicability of multimodal signals to distinguish cognitive impairment.

Spinal traction is a physical intervention that provides constant or intermittent stretching axial force to the lumbar vertebrae to gradually distract spinal tissues into better alignment, reduce intervertebral disc (IVD) pressure, and manage lower back pain (LBP). However, such axial traction may change the normal lordotic curvature, and result in unwanted side effects and/or inefficient reduction of the IVD pressure. An alternative to axial traction has been recently tested, consisting of posteroanterior (PA) traction in supine posture, which was recently shown effective to increase the intervertebral space and lordotic angle using MRI. PA traction aims to maintain the lumbar lordosis curvature throughout the spinal traction therapy while reducing the intradiscal pressure. In this study, we developed finite element simulations of mechanical therapy produced by a commercial thermo-mechanical massage bed capable of spinal PA traction. The stress relief produced on the lumbar discs by the posteroanterior traction system was investigated on human subject models with different BMI (normal, overweight, moderate obese and extreme obese BMI cases). We predict typical traction levels lead to significant distraction stresses in the lumbar discs, thus producing a stress relief by reducing the compression stresses normally experienced by these tissues. Also, the stress relief experienced by the lumbar discs was effective in all BMI models, and it was found maximal in the normal BMI model. These results are consistent with prior observations of therapeutic benefits derived from spinal AP traction.

Automatic thermal and mechanical massage beds support self-managed treatment, including reduction of pain and stress, enhanced circulation, and improved mobility. As the devices become more sophisticated (increasing the degrees of freedom), it is essential to identify the settings that best target the desired tissue. To that end, we developed an MRI-derived model of the lower back and simulated the physiological effects of a commercial thermal-mechanical massage bed. Here we specifically estimated the tissue temperature and increased circulation under steady-state conditions for typical thermal actuator settings (i.e., 45–65°C). Energy transfer across nine tissues was simulated with finite element modeling (FEM) and the resulting heating was coupled to blood flow with an empirically-guided model of temperature-dependent circulation. Our findings indicate that thermal massage increases tissue temperature by 3–8°C and 1–3°C at depths of 2 and 3 cm, respectively. Importantly, due to the rapid (non-linear) increase of circulation with local temperature, this is expected to increase blood flow four-fold (4x) at depths occupied by deep tissue and muscle. These predictions are consistent with prior clinical observations of therapeutic benefits derived from spinal thermal massage.

Background: Higher tDCS current may putatively enhance efficacy, with tolerability the perceived limiting factor. Objective: We designed and validated electrodes and an adaptive controller to provide tDCS up to 4 mA, while managing tolerability. The adaptive 4 mA controller included incremental ramp up, impedance-based current limits, and a Relax-mode where current is transiently decreased. Relax-mode was automatically activated by self-report VAS-pain score >5 and in some conditions by a Relax-button available to participants. Methods: In a parallel-group participant-blind design with 50 healthy subjects, we used specialized electrodes to administer 3 daily session of tDCS for 11 min, with a lexical decision task as a distractor, in 5 study conditions: adaptive 4 mA, adaptive 4 mA with Relax-button, adaptive 4 mA with historical-Relax-button, 2 mA, and sham. A tablet-based stimulator with a participant interface regularly queried VAS pain score and also limited current based on impedance and tolerability. An Abort-button provided in all conditions stopped stimulation. In the adaptive 4 mA with Relax-button and adaptive 4 mA with historical-Relax-button conditions, participants could trigger a Relax-mode ad libitum, in the latter case with incrementally longer current reductions. Primary outcome was the average current delivered during each session, VAS pain score, and adverse event questionnaires. Current delivered was analyzed either excluding or including dropouts who activated Abort (scored as 0 current). Results: There were two dropouts each in the adaptive 4 mA and sham conditions. Resistance based current attenuation was rarely activated, with few automatic VAS pain score triggered relax-modes. In conditions with Relax-button option, there were significant activations often irrespective of VAS pain score. Including dropouts, current across conditions were significantly different from each other with maximum current delivered during adaptive 4 mA with Relax-button. Excluding dropouts, maximum current was delivered with adaptive 4 mA. VAS pain score and adverse events for the sham was only significantly lower than the adaptive 4 mA with Relax-button and adaptive 4 mA with historical-Relax-button. There was no difference in VAS pain score or adverse events between 2 mA and adaptive 4 mA. Conclusions: Provided specific electrodes and controllers, adaptive 4 mA tDCS is tolerated and effectively blinded, with acceptability likely higher in a clinical population and absence of regular querying. Indeed, presenting participants with overt controls increases rumination on sensation.

Introduction: Transcutaneous electrical nerve stimulation (TENS) for migraine involves the application of pulsatile stimulation through electrodes placed on the forehead to target the underlying trigeminal nerves. It is a simple, safe modality and has secured clinical approval in several markets including the European Union and the United States. Despite nearing almost 7 years of use (postclinical approval), the exact mechanism of action is not fully known. Guided by the need to stimulate the trigeminal nerves bilaterally, electrode dimensions are simply required to extend enough to cover the underlying nerves. The goal of this study is to examine induced current flow [magnitude and spatial distribution of electric field (EF)] and another driver of stimulation [activating function (AF)] due to TENS therapy for migraine for the first time. We further consider the effect of changing the electrode dimension and shape and propose a design modification to deliver optimal flow.Methods: We developed the first ultra-high-resolution finite element (FE) model of TENS for migraine incorporating the target supratrochlear (ST) and the supraorbital (SO) nerves. We first simulated the clinically approved V-shaped geometry. We then considered three additional designs: extended V-shaped, idealized pill-shaped, and finally an extended V-shaped but with greater contact spacing (extended V-shaped +CS).Results: Our findings revealed that the clinically approved electrode design delivered substantially higher mean current flow to the ST nerve in comparison with the SO nerves (Medial: 53% and Lateral: 194%). Consideration of an extended design (~10 mm longer and ~ 4 mm shorter) and a pill-like design had negligible impact on the induced current flow pattern. The extended V-shaped +CS montage delivered relatively comparable current flow to each of the three target nerves. The EF induced in the ST nerve was 49 and 141% higher in the Medial and Lateral SO nerve, respectively. When considering maximum induced values, the delivery of comparable stimulation was further apparent. Given the existing electrode design's established efficacy, our results imply that preferential targeting of the ST nerve is related to the mechanism of action. Additionally, if comparable targeting of all three nerves continues to hold promise, the extended V-shaped +CS montage presents an optimized configuration to explore in clinical studies.

Abstract After traumatic brain injury (TBI), motor impairment is less common than neurocognitive or behavioral problems. However, about 30% of TBI survivors have reported motor deficits limiting the activities of daily living or participation. After acute primary and secondary injuries, there are subsequent changes including increased GABA-mediated inhibition during the subacute stage and neuroplastic alterations that are adaptive or maladaptive during the chronic stage. Therefore, timely and appropriate neuromodulation by transcranial direct current stimulation (tDCS) may be beneficial to patients with TBI for neuroprotection or restoration of maladaptive changes. Technologically, combination of imaging-based modelling or simultaneous brain signal monitoring with tDCS could result in greater individualized optimal targeting allowing a more favorable neuroplasticity after TBI. Moreover, a combination of task-oriented training using virtual reality with tDCS can be considered as a potent tele-rehabilitation tool in the home setting, increasing the dose of rehabilitation and neuromodulation, resulting in better motor recovery. This review summarizes the pathophysiology and possible neuroplastic changes in TBI, as well as provides the general concepts and current evidence with respect to the applicability of tDCS in motor recovery. Through its endeavors, it aims to provide insights on further successful development and clinical application of tDCS in motor rehabilitation after TBI.

We had previously demonstrated that phlorotannins, which are marine polyphenols, enhance sleep in mice via the GABAA-benzodiazepine (BZD) receptor. Among the constituents of phlorotannin, dieckol is a major marine polyphenol from the brown alga Ecklonia cava. Although phlorotannins are known to exert hypnotic effects, the sleep-enhancing effect of dieckol has not yet been determined. We evaluated the effect of dieckol on sleep-wake state of mice by analyzing electroencephalograms (EEGs) and electromyograms. Flumazenil, a GABAA-BZD antagonist, was used to investigate the molecular mechanism underlying the effects of dieckol on sleep. The polygraphic recordings and corresponding hypnograms revealed that dieckol accelerated the initiation of non-rapid eye movement sleep (NREMS); it shortened sleep latency and increased NREMS duration. According to the change in time-course, dieckol showed sleep-enhancing effects by increasing the amount of NREMS and decreasing wakefulness during the same hours. Additionally, sleep quality was evaluated by analyzing the EEG power density, and dieckol was found to not affect sleep intensity while zolpidem was found to reduce it. Finally, we treated mice with zolpidem or dieckol in combination with flumazenil and found the latter to inhibit the sleep-enhancing effect of dieckol and zolpidem, thereby indicating that dieckol exerts sleep-enhancing effects by activating the GABAA-BZD receptor, similar to zolpidem. These results implied that dieckol can be used as a promising herbal sleep aid with minimal side effects, unlike the existing hypnotics.

Two mRNA COVID-19 vaccines (mRNA-1273, Moderna; and BNT162b2, Pfizer-BioNTech) and one viral vector vaccine (JNJ-78436735, Janssen/Johnson and Johnson) are authorized in the US to hinder COVID-19 infections. We analyzed severe and common adverse events in response to COVID-19 vaccines using real-world, Vaccine Adverse Effect Reporting System (VAERS) data. From 14 December 2020 to 30 September 2021, 481,172 (50.7 ± 17.5 years, males 27.89%, 12.35 per 100,000 people) individuals reported adverse events (AEs). The median time to severe AEs was 2 days after injection. The risk of severe AEs following the one viral vector vaccine (OR = 1.044, 95% CI = 1.005–1.086) was significantly higher than that after the two mRNA vaccines, and the risk among males (OR = 1.374, 95% CI = 1.342–1.406) was higher than among females, except for anaphylaxis. For common AEs, however, the risk to males (OR = 0.621, 95% CI = 0.612–0.63) was lower than to females. In conclusion, we provided medical insight and clinical guidance about vaccine types by characterizing AEs using real-world data. In particular, COVID-19 mRNA vaccines are safer than viral vector vaccines with regard to coagulation disorders, whereas inflammation-related AEs are lower in the viral vaccine. The risk–benefit ratio of vaccines should be carefully considered, and close monitoring and management of severe AEs is needed.

The majority of cloud applications are created or delivered to provide users with access to system resources or prebuilt processing algorithms for efficient data storage, management, and production. The number of cases linking cloud computing to the use of global observation satellite data continues to rise, owing to the benefits of cloud computing. This study aims to develop a cloud software as a service (SaaS) that yields reflectance products in high-resolution Korea Multi-Purpose Satellite (KOMPSAT)-3/3A satellite images. The SaaS model was designed as three subsystems: a Calibration Processing System (CPS), a Request System for CPS supporting RESTful application programming interface (API), and a Web Interface Application System. Open-source components, libraries, and frameworks were used in this study’s SaaS, including an OpenStack for infrastructure as a service. An absolute atmospheric correction scheme based on a Second Simulation of a Satellite Signal in the Solar Spectrum (6S) radiative transfer code with atmospheric variable inputs was used to generate the top-of-atmosphere (TOA) and top-of-canopy (TOC) reflectance products. The SaaS implemented in this study provides users with the absolute atmospheric calibration functionality to apply their KOMPSAT-3/3A satellite image set through a web browser and obtain output directly from this service. According to experiments to check the total performance time for images, bundled with four bands of red, green, blue, and near-infrared, it took approximately 4.88 min on average for the execution time to obtain all reflectance results since satellite images were registered into the SaaS. The SaaS model proposed and implemented in this study can be used as a reference model for the production system to generate reflectance products from other optical sensor images. In the future, SaaS, which offers professional analysis functions based on open source, is expected to grow and expand into new application fields for public users and communities.

Summary: Fetal hematopoietic stem cells (HSCs) undergo a developmental switch to become adult HSCs with distinct functional properties. To better understand the molecular mechanisms underlying the developmental switch, we have conducted deep sequencing of the 3D genome, epigenome, and transcriptome of fetal and adult HSCs in mouse. We find that chromosomal compartments and topologically associating domains (TADs) are largely conserved between fetal and adult HSCs. However, there is a global trend of increased compartmentalization and TAD boundary strength in adult HSCs. In contrast, intra-TAD chromatin interactions are much more dynamic and widespread, involving over a thousand gene promoters and distal enhancers. These developmental-stage-specific enhancer-promoter interactions are mediated by different sets of transcription factors, such as TCF3 and MAFB in fetal HSCs, versus NR4A1 and GATA3 in adult HSCs. Loss-of-function studies of TCF3 confirm the role of TCF3 in mediating condition-specific enhancer-promoter interactions and gene regulation in fetal HSCs. : A developmental transition occurs between fetal and adult hematopoietic stem cells. How the 3D genome folding contributes to this transition is poorly understood. Chen et al. show global genome organization is largely conserved, but a large fraction of enhancer-promoter interactions is re-organized and regulate genes contributing to the phenotypic differences. Keywords: 3D genome, hematopoiesis, enhancer-promoter interaction, epigenomics, transcriptome

Patients with brain injury of any etiology are at risk for developing increased intracranial pressure. Acute intracranial hypertension is a medical emergency requiring immediate intervention to prevent permanent damage to the brain. Intracranial pressure as an absolute value is not as valuable as when one investigates other important associated variables such as cerebral perfusion pressure and contributing factors for an adequate cerebral blood flow. This manuscript reviews a number of various interventions that can be used to treat acute intracranial hypertension and optimize cerebral perfusion pressure. Management options are presented in an algorithm-format focusing on current treatment strategies and treatment goals. In addition to the efficacy, clinicians must consider significant adverse events that are associated with each therapy prior to initiating treatment. The initial step includes elevation of head of the bed and adequate sedation followed by osmotic agents such as mannitol and hypertonic saline infusion. Hypothermia and pentobarbital therapy represent more aggressive steps, and utilize different mechanisms by which the pressure is controlled, likely causing significant reduction in metabolism. Surgical intervention may precede any medical therapy in order to provide more robust response in controlling intracranial hypertension in certain cases.

Background and Purpose Hemicraniectomy is a decompressive surgery used to remove a large bone flap to allow edematous brain tissue to bulge extracranially. However, early indicators of the decompressive effects of hemicraniectomy are unclear. We investigated whether reduction of midline shift following hemicraniectomy is associated with improved consciousness and survival in patients with malignant middle cerebral artery infarctions. Methods We studied 70 patients with malignant middle cerebral artery infarctions (MMI) who underwent hemicraniectomies. Midline shift was measured preoperatively and postoperatively using computed tomography (CT). Consciousness level was evaluated using the Glasgow Coma Scale on postoperative day 1. Patient survival was assessed six months after stroke onset. Results The median time interval between preoperative and postoperative CT was 8.3 hours (interquartile range, 6.1–10.2 hours). Reduction in midline shift was associated with higher postoperative Glasgow Coma Scale scores (P

Background and Purpose The use of decompressive hemicraniectomy (DHC) for the treatment of malignant cerebral edema can decrease mortality rates. However, this benefit is not sufficient to justify its use in elderly patients. We investigated the effects of therapeutic hypothermia (TH) on safety, feasibility, and functional outcomes in elderly patients with malignant middle cerebral artery (MCA) infarcts. Methods Elderly patients 60 years of age and older with infarcts affecting more than two-thirds of the MCA territory were included. Patients who could not receive DHC were treated with TH. Hypothermia was started within 72 hours of symptom onset and was maintained for a minimum of 72 hours with a target temperature of 33°C. Modified Rankin Scale (mRS) scores at 3 months following treatment and complications of TH were used as functional outcomes. Results Eleven patients with a median age of 76 years and a median National Institutes of Health Stroke Scale score of 18 were treated with TH. The median time from symptom onset to initiation of TH was 30.3±23.0 hours and TH was maintained for a median of 76.7±57.1 hours. Shivering (100%) and electrolyte imbalance (82%) were frequent complications. Two patients died (18%). The mean mRS score 3 months following treatment was 4.9±0.8. Conclusions Our results suggest that extended use of hypothermia is safe and feasible for elderly patients with large hemispheric infarctions. Hypothermia may be considered as a therapeutic alternative to DHC in elderly individuals. Further studies are required to validate our findings.

Surface reflectance products obtained through the absolute atmospheric correction of multispectral satellite images are useful for precise scientific applications. For broader applications, the reflectance products computed using high-resolution images need to be validated with field measurement data. This study dealt with 2.2-m resolution Korea Multi-Purpose Satellite (KOMPSAT)-3A images with four multispectral bands, which were used to obtain top-of-atmosphere (TOA) and top-of-canopy (TOC) reflectance products. The open-source Orfeo Toolbox (OTB) extension was used to generate these products. Next, these were subsequently validated by considering three sites (i.e., Railroad Valley Playa, NV, USA (RVUS), Baotou, China (BTCN), and La Crau, France (LCFR)) in RadCalNet, as well as a calibration and validation portal for remote sensing. We conducted the validations comparing satellite image-based reflectance products and field measurement reflectance based on data sets acquired at different times. The experimental results showed that the overall trend of validation accuracy of KOPSAT-3A was well fitted in all the RadCalNet sites and that the accuracy remained quite constant. Reflectance bands showing the minimum and maximum differences between the sets of experimental data are presented in this paper. The vegetation indices (i.e., the atmospherically resistant vegetation index (ARVI) and the structure insensitive pigment index (SIPI)) and three TOC reflectance bands obtained from KOMPSAT-3A were computed as a case study and used to achieve a detailed vegetation interpretation; finally, the correspondent results were compared with those obtained from Landsat-8 images (downloaded from the Google Earth Engine (GEE)). The validation and the application scheme presented in this study can be potentially applied to the generation of analysis ready data from high-resolution satellite sensor images.

An electric railway vehicle is supplied with electricity by an OCL (Overhead Contact Line) through the contact strip of its pantograph. This transmitted electricity is then used to power the electrical equipment of the railway vehicle. This contact strip wears out due to contact with the OCL. In particular, deformations due to chipping and material loss occur because of friction with the fittings on the OCL. These deformations on the contact strip affect its power transmission quality because of contact loss with the OCL. However, it is difficult to monitor the contact strip during operation and judge its condition in order to implement accident prevention measures. Thus, in this study, we developed a contact strip monitoring method based on image processing for inspection. The proposed method measures the deformation in the contact strip based on an algorithm that determines the wear on the deformed contact strip using deep learning and image processing. The image of the contact strip is acquired by installing a camera and laser to capture the pantograph as it passes the setup. The proposed algorithm is able to determine the wear size by extracting the edges of the laser line using deep learning and estimating the fitted line of the deformations based on the least squares method.

Surface reflectance data obtained by the absolute atmospheric correction of satellite images are useful for land use applications. For Landsat and Sentinel-2 images, many radiometric processing methods exist, and the images are supported by most types of commercial and open-source software. However, multispectral KOMPSAT-3A images with a resolution of 2.2 m are currently lacking tools or open-source resources for obtaining top-of-canopy (TOC) reflectance data. In this study, an atmospheric correction module for KOMPSAT-3A images was newly implemented into the optical calibration algorithm in the Orfeo Toolbox (OTB), with a sensor model and spectral response data for KOMPSAT-3A. Using this module, named OTB extension for KOMPSAT-3A, experiments on the normalized difference vegetation index (NDVI) were conducted based on TOC reflectance data with or without aerosol properties from AERONET. The NDVI results for these atmospherically corrected data were compared with those from the dark object subtraction (DOS) scheme, a relative atmospheric correction method. The NDVI results obtained using TOC reflectance with or without the AERONET data were considerably different from the results obtained from the DOS scheme and the Landsat-8 surface reflectance of the Google Earth Engine (GEE). It was found that the utilization of the aerosol parameter of the AERONET data affects the NDVI results for KOMPSAT-3A images. The TOC reflectance of high-resolution satellite imagery ensures further precise analysis and the detailed interpretation of urban forestry or complex vegetation features.

Malignant brain edema (MBE) due to hemispheric infarction can result in brain herniation, poor outcomes, and death; outcome may be improved if certain interventions, such as decompressive craniectomy, are performed early. We sought to generate a prediction score to easily identify those patients at high risk for MBE. 121 patients with large hemispheric infarction (LHI) (2011 to 2014) were included. Patients were divided into two groups: those who developed MBE and those who did not. Independent predictors of MBE were identified by logistic regression and a score was developed. Four factors were independently associated with MBE: baseline National Institutes of Health Stroke Scale (NIHSS) score (p = 0.048), Alberta Stroke Program Early Computed Tomography Score (ASPECTS) (p = 0.007), collateral score (CS) (p8 (= 0); CS

Malignant cerebral edema following ischemic stroke is life threatening, as it can cause inadequate blood flow and perfusion leading to irreversible tissue hypoxia and metabolic crisis. Increased intracranial pressure and brain shift can cause herniation syndrome and finally brain death. Multiple randomized clinical trials have shown that preemptive decompressive hemicraniectomy effectively reduces mortality and morbidity in patients with malignant middle cerebral artery infarction. Another life-saving decompressive surgery is suboccipital craniectomy for patients with brainstem compression by edematous cerebellar infarction. In addition to decompressive surgery, cerebrospinal fluid drainage by ventriculostomy should be considered for patients with acute hydrocephalus following stroke. Medical treatment begins with sedation, analgesia, and general measures including ventilatory support, head elevation, maintaining a neutral neck position, and avoiding conditions associated with intracranial hypertension. Optimization of cerebral perfusion pressure and reduction of intracranial pressure should always be pursued simultaneously. Osmotherapy with mannitol is the standard treatment for intracranial hypertension, but hypertonic saline is also an effective alternative. Therapeutic hypothermia may also be considered for treatment of brain edema and intracranial hypertension, but its neuroprotective effects have not been demonstrated in stroke. Barbiturate coma therapy has been used to reduce metabolic demand, but has become less popular because of its systemic adverse effects. Furthermore, general medical care is critical because of the complex interactions between the brain and other organ systems. Some challenging aspects of critical care, including ventilator support, sedation and analgesia, and performing neurological examinations in the setting of a minimal stimulation protocol, are addressed in this review.

Despite significant regional and risk factor-related variations, the overall mortality rate in patients suffering from aneurysmal subarachnoid hemorrhage (SAH) remains high. Compared to ischemic stroke, which is typically irreversible, hemorrhagic stroke tends to carry a higher mortality, but patients who do survive have less disability. Technologies to monitor and treat complications of SAH have advanced considerably in recent years, but good long-term functional outcome still depends on prompt diagnosis, early aggressive management, and avoidance of premature withdrawal of support. Endovascular procedures and open craniotomy to secure a ruptured aneurysm represent some of the numerous critical steps required to achieve the best possible result. In this review, we have attempted to provide a contemporary, evidence-based outline of the perioperative critical care management of patients with SAH. This is a challenging and potentially fatal disease with a wide spectrum of severity and complications and an often protracted course. The dynamic nature of this illness, especially in its most severe forms, requires considerable flexibility in clinician management, especially given the panoply of available treatment modalities. Judicious hemodynamic monitoring and adaptive therapy are essential to respond to the fluctuating nature of cerebral vasospasm and the varying oxygen demands of the injured brain that may readily induce acute or delayed cerebral ischemia.

This study was conducted to develop a national quality competitiveness index (NQCI), necessary to establish national policy standards for quality improvements. For the NQCI, the World Economic Forum (WEF) and the International Institute for Management Development (IMD), internationally recognized indices for national competitiveness, were used. Based on the WEF and IMD, a NQCI composed of four perspectives (capabilities) and 34 indicators was devised. Through the results of implementing the NQCI in 20 selected countries, it shows the comparison and identification of the current standings of countries in national quality competitiveness. From these findings, it is likely that countries’ quality competitiveness weaknesses can be identified and improved through policy suggestions.

Recently, web application services based on cloud computing technologies are being offered. In the web-based application field of geo-spatial data management or processing, data processing services are produced or operated using various information communication technologies. Platform-as-a-Service (PaaS) is a type of cloud computing service model that provides a platform that allows service providers to implement, execute, and manage applications without the complexity of establishing and maintaining the lower-level infrastructure components, typically related to application development and launching. There are advantages, in terms of cost-effectiveness and service development expansion, of applying non-proprietary PaaS cloud computing. Nevertheless, there have not been many studies on the use of PaaS technologies to build geo-spatial application services. This study was based on open source PaaS technologies used in a geo-spatial image processing service, and it aimed to evaluate the performance of that service in relation to the Web Processing Service (WPS) 2.0 specification, based on the Open Geospatial Consortium (OGC) after a test application deployment using the configured service supported by a cloud environment. Using these components, the performance of an edge extraction algorithm on the test system in three cases, of 300, 500, and 700 threads, was assessed through a comparison test with another test system, in the same three cases, using Infrastructure-as-a-Service (IaaS) without Load Balancer-as-a-Service (LBaaS). According to the experiment results, in all the test cases of WPS execution considered in this study, the PaaS-based geo-spatial service had a greater performance and lower error rates than the IaaS-based cloud without LBaaS.

Managing geo-based indoor content is important, because the components used to construct an urban environment are complex. Geospatial data are available worldwide, but services are tailored only to local features. As the accuracy of online maps increases, the buildings in a web-mapping service can be created exactly as they are, in terms of actual features and geometric properties, and can provide some information on indoor elements. Nevertheless, not many practical use cases exist, as the available scope and volume of indoor content are limited. In Korea’s metropolitan areas, an indoor geospatial information management scheme was built to manage internal facility information for public and underground buildings on a three-dimensional (3D) basis and to provide online visualization services for users. Based on this enterprise system for public use of indoor 3D content, we conducted a case study with add-on features to manipulate and manage data by adding two-dimensional (2D) building data that are linked to the 3D models. We also changed the classification system of the points of interest (POIs) for each internal facility. To enhance public usability, a portion of the usable information in this scheme can be offered via an open application programming interface (Open API). To create a 2D POIs obtained from an indoor 3D object that was provided as a relative coordinate with only 3D geometric features, several steps were needed: adding the object to the system, storing the object as an absolute coordinate, and linking the object with an outdoor mapping service. In addition, to provide more useful information about indoor POIs generated from 3D models for users, detailed information should be further managed by directly using the Open APIs designed in this study. Subsequently, a mobile web mapping service system to visualize indoor contents was deployed to deliver practical processing and improvements based on the deployed Open API. The possibility of effective management and application of POIs related to indoor contents was confirmed through the mobile web-mapping demo service that was established using Open API.

There are many cases wherein services offered in geospatial sectors are integrated with other fields. In addition, services utilizing satellite data play important roles in daily life and in sectors such as environment and science. Therefore, a management structure appropriate to the scale of the system should be clearly defined. The motivation of this study is to resolve issues, apply standards related to a target system, and provide practical strategies with a technical basis. South Korea uses the e-Government Standard Framework, using the Java-based Spring framework, to provide guidelines and environments with common configurations and functions for developing web-based information systems for public services. This web framework offers common sources and resources for data processing and interface connection to help developers focus on business logic in designing a web system. In this study, a geospatial image processing system—linked with the Open Geospatial Consortium (OGC) Web Processing Service (WPS) 2.0 standard for real geospatial information processing, and based on this standard framework—was designed and built utilizing fully open sources. This is the first case of implementation based on WPS 2.0 running on the e-Government Standard Framework. Establishing a standard for its use will be important, and the system built in this study can serve as a reference for the foundational architecture in building geospatial web service systems with geodata-processing functionalities in government agencies.

Cloud computing is a base platform for the distribution of large volumes of data and high-performance image processing on the Web. Despite wide applications in Web-based services and their many benefits, geo-spatial applications based on cloud computing technology are still developing. Auto-scaling realizes automatic scalability, i.e., the scale-out and scale-in processing of virtual servers in a cloud computing environment. This study investigates the applicability of auto-scaling to geo-based image processing algorithms by comparing the performance of a single virtual server and multiple auto-scaled virtual servers under identical experimental conditions. In this study, the cloud computing environment is built with OpenStack, and four algorithms from the Orfeo toolbox are used for practical geo-based image processing experiments. The auto-scaling results from all experimental performance tests demonstrate applicable significance with respect to cloud utilization concerning response time. Auto-scaling contributes to the development of web-based satellite image application services using cloud-based technologies.

Pulmonary complications are prevalent in the critically ill neurological population. Respiratory failure, pneumonia, acute lung injury and the acute respiratory distress syndrome (ALI/ARDS), pulmonary edema, pulmonary contusions and pneumo/hemothorax, and pulmonary embolism are frequently encountered in the setting of severe brain injury. Direct brain injury, depressed level of consciousness and inability to protect the airway, disruption of natural defense barriers, decreased mobility, and secondary neurological insults inherent to severe brain injury are the main cause of pulmonary complications in critically ill neurological patients. Prevention strategies and current and future therapies need to be implemented to avoid and treat the development of these life-threatening medical complications.

Introduction. Amyloid-beta-related angiitis (ABRA) is a form of CNS vasculitis in which perivascular beta-amyloid in the intracerebral vessels is thought to act as a trigger for inflammation mediated by CD68+ macrophages and CD3+ T lymphocytes. Patients with severe ABRA may develop coma responsive to immunosuppressive treatment. Case Presentation. A 57-year-old man presented to the neurological intensive care unit febrile, obtunded, and with a left hemiparesis. He had suffered from intermittent left arm weakness and numbness for several months prior. Serum and cerebrospinal fluid studies showed a lymphocytic leukocytosis in the cerebrospinal fluid (CSF), but no other evidence of infection, and the patient underwent a brain biopsy. Histopathological examination demonstrated amyloid angiopathy, with an extensive perivascular lymphocytic infiltrate, indicative of ABRA. The patient was started on cyclophosphamide and steroids. Following a week of treatment he awakened and over several weeks made a significant neurological recovery. Conclusions. ABRA can have a variety of clinical presentations, including impairments in consciousness and coma. Accurate pathological diagnosis, followed by aggressive immunosuppression, can lead to impressive neurological improvements. This diagnosis should be considered in patients with paroxysmal recurrent neurological symptoms and an accelerated progression.