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Abstract Background Dilated perivascular spaces (DPVS), known as one of imaging markers in cerebral small vessel disease, may be found in patients with moyamoya disease (MMD). However, little is known about DPVS in MMD. The purpose of this study was to investigate the distribution pattern of dPVS in children and adults with MMD and determine whether it is related to steno-occlusive changes of MMD. Methods DPVS was scored in basal ganglia (BG) and white matter (WM) on T2-weighted imaging, using a validated 4-point semi-quantitative score. The degree of dPVS was classified as high (score > 2) or low (score ≤ 2) grade. The steno-occlusive changes on MR angiography (MRA) was scored using a validated MRA grading. Asymmetry of DPVS and MRA grading was defined as a difference of 1 grade or higher between hemispheres. Results Fifty-one patients with MMD (mean age 24.9 ± 21.1 years) were included. Forty-five (88.2%) patients had high WM-DPVS grade (degree 3 or 4). BG-DPVS was found in 72.5% of all patients and all were low grade (degree 1 or 2). The distribution patterns of DPVS degree in BG (P = 1.000) and WM (P = 0.767) were not different between child and adult groups. The asymmetry of WM-DPVS (26%) and MRA grade (42%) were significantly correlated to each other (Kendall’s tau-b = 0.604, P

Background: The nose is located at the center of the face, and it is possible to determine race, sex, and the like. Research using the nasal index (NI) classification method to classify the shape of the nose is currently in progress. However, domestic research is required as most research is being conducted abroad. In this study, we used a 3D program to confirm the ratio of the nose shape of Koreans.Methods: One hundred patients (50 males and 50 females) in their 20s were evaluated (IRB approval no. DKUDH IRB 2020-01-007). Cone beam computed tomography was performed using the Mimics ver.22 (Materialise Co., Leuven, Belgium) 3D program to model the patient’s skull and soft tissues into three views: coronal, sagittal, and frontal. To confirm the ratio of measurement metrics, analysis was performed using the SPSS ver. 23.0 (IBM Co., Armonk, NY, USA) program. Results: Ten leptorrhine (long and narrow) type, 76 mesorrhine (moderate shape) type, and 14 platyrrhine (broad and short) type noses were observed. In addition, as a result of sex comparison, five males had the leptorrhine (long and narrow) type, 40 mesorrhine (moderate shape), and five platyrrhine (broad and short) types. For females, five patients had the leptorrhine (long and narrow) type, 36 patients had the mesorrhine (moderate shape) type, and nine patients had the platyrrhine (broad and short) type. Conclusion: This study will be helpful when performing nose-related surgeries and procedures in clinical practice and for similar studies in the future.

Abstract Background Cerebral venous and sinus thrombosis (CVST) can cause increased intracranial pressure, often leading to papilledema. In this study, we investigated the association between papilledema and venous stasis on susceptibility weighted imaging (SWI) in CVST. Methods Patients with CVST between 2008 and 2020 were reviewed. Patients without fundoscopic examination or SWI were excluded in this study. Venous stasis was evaluated and scored for each cerebral hemisphere: each hemisphere was divided into 5 regions according to the venous drainage territories (superior sagittal sinus, Sylvian veins, transverse sinus and vein of Labbé, deep cerebral veins, and medullary veins) and 1 point was added if venous prominence was confirmed in one territory on SWI. The venous stasis score on SWI between cerebral hemispheres with and without papilledema was compared. Results Eight of 19 patients with CVST were excluded because of the absence of fundoscopic examination or SWI. Eleven patients (26.5 ± 2.1 years) were included in this study. Papilledema was identified in 6 patients: bilateral papilledema in 4 patients and unilateral papilledema in 2 patients. The venous stasis score on SWI was significantly higher (P = 0.013) in the hemispheres with papilledema (median, 4.0; 95% CI, 3.038–4.562) than in the hemispheres without papilledema (median, 2.5; 95% CI, 0.695–2.805). Conclusions This study shows that higher score of venous stasis on SWI is associated with papilledema. Therefore, the venous stasis on SWI may be an imaging surrogate marker of increased intracranial pressure in patients with CVST.

Background and Purpose We investigated the impact of comorbidity burden on troponin elevation, with separate consideration of neurological conditions, in patients with acute ischemic stroke (AIS). Methods This prospective, observational cohort study consecutively enrolled patients with AIS for 2 years. Serum cardiac troponin I was repeatedly measured, and disease-related biomarkers were collected for diagnosis of preassigned comorbidities, including atrial fibrillation (AF), ischemic heart disease (IHD), myocardial hypertrophy (MH), heart failure (HF), renal insufficiency (RI), and active cancer. The severity of neurological deficits and insular cortical ischemic lesions were assessed as neurological conditions. Adjusted associations between these factors and troponin elevation were determined using a multivariate ordinal logistic regression model and area under the receiver operating characteristic curve (AUC). Cox proportional hazards model was used to determine the prognostic significance of comorbidity beyond neurological conditions. Results Among 1,092 patients (66.5±12.4 years, 63.3% male), 145 (13.3%) and 335 (30.7%) had elevated (≥0.040 ng/mL) and minimally-elevated (0.040–0.010 ng/mL) troponin, respectively. In the adjusted analysis, AF, MH, HF, RI, active cancer, and neurological deficits were associated with troponin elevation. The multivariate model with six comorbidities and two neurological conditions exhibited an AUC of 0.729 (95% confidence interval [CI], 0.698–0.759). In Cox regression, AF, IHD, and HF were associated with adverse cardio-cerebrovascular events, whereas HF and active cancer were associated with mortality. Conclusion Troponin elevation in patients with AIS can be explained by the burden of comorbidities in combination with neurological status, which explains the prognostic significance of troponin assay.

Suaeda glauca, a halophyte in the Amaranthaceae family, exhibits remarkable resilience to high salt and alkali stresses despite the absence of salt glands or vesicles in its leaves. While there is growing pharmacological interest in S. glauca, research on its secondary metabolites remains limited. In this study, chemical constituents of the aerial parts of S. glauca were identified using 1D- and 2D-NMR experiments, and its biological activity concerning hair loss was newly reported. Eight compounds, including alkaloids (1~3), flavonoids (4~6), and phenolics (7 and 8), were isolated. The compounds, except the flavonoids, were isolated for the first time from S. glauca. In the HPLC chromatogram, quercetin-3-O-β-d-glucoside, kaempferol-3-O-β-d-glucoside, and kaempferol were identified as major constituents in the extract of S. glauca. Additionally, the therapeutic potential of the extract of S. glauca and the isolated compounds 1~8 on the expressions of VEGF and IGF-1, as well as the regulation of Wnt/β-catenin signaling, were evaluated in human follicle dermal papilla cells (HFDPCs) and human umbilical vein endothelial cells (HUVECs). Among the eight compounds, compound 4 was the most potent in terms of increasing the expression of VEGF and IGF-1 and the regulation of Wnt/β-catenin. These findings suggest that S. glauca extract and its compounds are potential new candidates for preventing or treating hair loss.

Background and PurposeCardiac biomarkers including, elevated troponin (ET) and prolonged heart rate-corrected QT (PQTc) interval on electrocardiography are known to frequent and have a prognostic significance in patients with acute ischemic stroke (AIS). However, it is still challenging to practically apply the results for appropriate risk stratification. This study evaluate whether combining ET and PQTc interval can better assess the long-term prognosis in AIS patients.MethodsIn this prospectively registered observational study between May 2007 and December 2011, ET was defined as serum troponin-I ≥ 0.04 ng/ml and PQTc interval was defined as the highest tertile of sex-specific QTc interval (men ≥ 469 ms or women ≥ 487 ms).ResultsAmong the 1,668 patients [1018 (61.0%) men; mean age 66.0 ± 12.4 years], patients were stratified into four groups according to the combination of ET and PQTc intervals. During a median follow-up of 33 months, ET (hazard ratio [HR]: 4.38, 95% confidence interval [CI]: 2.94–6.53) or PQTc interval (HR: 1.53, 95% CI: 1.16–2.01) alone or both (HR: 1.77, 95% CI: 1.16–2.71) was associated with increased all-cause mortality. Furthermore, ET, PQTc interval alone or both was associated with vascular death, whereas only ET alone was associated with non-vascular death. Comorbidity burden, especially atrial fibrillation and congestive heart failure, and stroke severity gradually increased both with troponin value and QTc-interval.ConclusionsIn patients with AIS, combining ET and PQTc interval on ECG enhances risk stratification for long-term mortality while facilitating the discerning ability for the burden of comorbidities and stroke severity.

Background Brainstem encephalitis is a rare, severe, and potentially life-threatening inflammation of the central nervous system, exhibiting various treatment responses and outcomes owing to multiple etiologies. Case Report We describe the favorable outcome of salvage immunotherapy using a combination of infliximab and methotrexate in a 62-year-old woman with refractory brainstem encephalitis. The patient was initially presumed to be at a subacute stage of medullary infarction but showed progressively worsening conditions involving cervical myelopathy, despite having completed the schedule of subsequent immunotherapy with intravenous methylprednisolone, immunoglobulin, and rituximab. After completion of four sessions of weekly rituximab injection, she was treated with 5 mg/kg of infliximab, scheduled at 0, 2, and 6 weeks, along with methotrexate (weekly 12.5 mg). After completion of infliximab injection and maintenance with methotrexate treatment, she showed an improving course of quadriplegia. Conclusion This case report provides evidence for the potential efficacy of infliximab with methotrexate in cases of refractory brainstem encephalitis.

We present a simple but effective video interpolation framework that can be applied to various types of videos including conventional videos and 360° videos. Our main idea is to predict the latent feature of an intermediate frame, through the latent feature encoders between encoder and decoder networks, without explicitly computing optical flow or depth maps. The latent feature encoders take latent features of input images and then predict the latent feature of a target image, i.e. an intermediate frame. Afterward, the decoder network reconstructs the target image from the latent feature. The proposed framework consists of fully convolutional networks, and it is therefore end-to-end trainable from scratch without requiring additional information except for consecutive frames. We experimentally verify the superiority of proposed method by comparing it to state-of-the-art methods with various types of datasets. Moreover, an ablation study is carried out to analyze the key components of the proposed method. Our proposed method performs interpolation in latent domain, it is advantageous to apply various video interpolation (e. g. NIR and depth videos) without limiting the type of input data.

This paper investigates the potential of cloud-free virtual optical imagery generated using synthetic-aperture radar (SAR) images and conditional generative adversarial networks (CGANs) for early crop mapping, which requires cloud-free optical imagery at the optimal date for classification. A two-stage CGAN approach, including representation and generation stages, is presented to generate virtual Sentinel-2 spectral bands using all available information from Sentinel-1 SAR and Sentinel-2 optical images. The dual-polarization-based radar vegetation index and all available multi-spectral bands of Sentinel-2 imagery are particularly considered for feature extraction in the representation stage. A crop classification experiment using Sentinel-1 and -2 images in Illinois, USA, demonstrated that the use of all available scattering and spectral features achieved the best prediction performance for all spectral bands, including visible, near-infrared, red-edge, and shortwave infrared bands, compared with the cases that only used dual-polarization backscattering coefficients and partial input spectral bands. Early crop mapping with an image time series, including the virtual Sentinel-2 image, yielded satisfactory classification accuracy comparable to the case of using an actual time-series image set, regardless of the different combinations of spectral bands. Therefore, the generation of virtual optical images using the proposed model can be effectively applied to early crop mapping when the availability of cloud-free optical images is limited.

Background Skull base osteomyelitis (SBO) is a rare but life-threatening disease occurring as a complication of malignant otitis externa, and accompanied by venous sinus thrombosis, meningitis, abscess, cranial neuropathies, and carotid invasion as complications. Central SBO may originate from a paranasal infection, such as sphenoidal or ethmoidal sinusitis without associated external otitis. Case Report We describe a 36-year-old Sri Lankan male with central SBO presenting with multiple embolic infarctions and meningitis caused by a nasopharyngeal Klebsiella infection that had invaded the left internal carotid artery. Despite complications, such as endogenous endophthalmitis, abscesses in the brain parenchyma, and mycotic aneurysms in cerebral vessels, the patient recovered after 8 weeks of intensive antibiotics treatment except for a remnant mycotic aneurysmal dilatation in the internal carotid artery. Conclusion This is the first report of central SBO caused by a nasopharyngeal Klebsiella infection, which invaded the left internal carotid artery and led to multiple complications.

Background New-onset refractory status epilepticus (NORSE) refers to the newly established concept of a disease characterized by refractory status epilepticus without an identifiable etiology. Recent reports have indicated the importance of immunotherapy for NORSE. Case Report A 37-year-old man with no past history of epilepsy was admitted for a presenting complaint of confusion. He was treated with acyclovir and anti-epileptic drug (AED) for presumed herpes encephalitis. However, he developed generalized tonic-clonic seizures on day 6 of admission that worsened despite treatment with multiple AEDs. NORSE was considered to be a probable diagnosis and immunotherapy with methylprednisolone and immunoglobulin was scheduled. However, persistent seizure activity was observed on the electroencephalogram after the completion of initial immunotherapy. Subsequently, rituximab was administered for 4 weeks. He eventually regained consciousness and was able to resume social activity. Conclusion Our patient exhibited a favorable outcome with early-intensive immunotherapy and subsequent rituximab treatment for NORSE.

Background and Purpose: The aim of this study was to determine the relationship between the heart rate-corrected QT (QTc) interval and the risk of incident long-term mortality in patients with acute ischemic stroke (AIS), considering the impact of sex differences on clinical characteristics, outcomes, and QTc intervals.Methods: We analyzed prospectively registered data included patients with AIS who visited the emergency room within 24 h of stroke onset and underwent routine cardiac testing, such as measurements of cardiac enzymes and 12-lead ECG. QTc interval was corrected for heart rate using Fridericia's formula and was stratified by sex-specific quartiles. Cox proportional hazards models were used to examine the association between baseline QTc interval and incident all-cause death.Results: A total of 1,668 patients with 1,018 (61.0%) men and mean age 66.0 ± 12.4 years were deemed eligible. Based on the categorized quartiles of the QTc interval, cardiovascular risk profile, and stroke severity increased with prolonged QTc interval, and the risk of long-term mortality increased over a median follow-up of 33 months. Cox proportional hazard model analysis showed that the highest quartile of QTc interval (≥479 msec in men and ≥498 msec in women; hazard ratio [HR]: 1.49, 95% confidence interval [CI]: 1.07–2.08) was associated with all-cause death. Furthermore, dichotomized QTc interval prolongation, defined by the highest septile of the QTc interval (≥501 ms in men and ≥517 m in women: HR: 1.33, 95% CI: 1.00–1.80) was significantly associated with all-cause mortality after adjusting for all clinically relevant variables, such as stroke severity.Conclusions: Prolonged QTc interval was associated with increased risk of long-term mortality, in parallel with the increasing trend of prevalence of cardiovascular risk profiles and stroke severity, across sex differences in AIS patients.

We present a simple yet effective pipeline for absolute three-dimensional (3D) human pose estimation from two-dimensional (2D) joint keypoints, namely, the 2D-to-3D human pose lifting problem. Our method comprises two simple baseline networks, a 3D conversion function, and a correction network. The former two networks predict the root distance and the root-relative joint distance simultaneously. Given the input and predicted distances, the 3D conversion function recovers the absolute 3D pose, and the correction network reduces 3D pose noise caused by input uncertainties. Furthermore, to cope with input noise implicitly, we adopt a Siamese architecture that enforces the consistency of features between two training inputs, i.e., ground truth 2D joint keypoints and detected 2D joint keypoints. Finally, we experimentally validate the advantages of the proposed method and demonstrate its competitive performance over state-of-the-art absolute 2D-to-3D pose-lifting methods.

The purpose of this randomized controlled clinical trial was to assess the short-term clinical effectiveness of sealer-based root canal obturation using calcium-silicate-based sealer (CSBS) and epoxy-resin-based sealer (ERBS). A total of eighty patients (eighty teeth) were enrolled and seventy-two patients (seventy-two teeth) were randomly assigned into four different sealer groups: AH Plus (AH, Dentsply Sirona), ADseal (AD, Meta Biomed), CeraSeal (CS, Meta Biomed), or EndoSeal TCS (ES, Maruchi). At the first visit, root canal treatment was performed using ProTaper. Next, the NiTi file system and passive ultrasonic irritation was applied with 2.5% NaOCl. At the second visit, the teeth were obturated with a sealer-based obturation technique using the assigned sealer. The quality of filling obturation was evaluated with postoperative radiographs in terms of the presence of voids and sealer extrusion. The patients were recalled at 1-week, 1-month, and 3-month intervals, and pain levels were measured using visual analog scales (VAS), and clinical examination performed with percussion and palpation. Radiographs were also taken. The results were statistically compared by using the χ2 test or Fisher exact test. Among the 80 teeth included, 72 teeth received allocated intervention and 71 teeth were included in the analysis (98.6% recall). There was no significant difference among the sealers in void and sealer extrusion (p > 0.05). Postoperative pain was not indicated prominently regardless of the type of sealer. For a 3-month follow-up period, all cases were maintained successfully except for one case from AD. According to the findings, there was no significant difference between CSBS and ERBS in terms of postoperative pain or the healing process, and the variation in filling quality appears to be linked to the properties of each product.

Capsule endoscopy (CE) is a preferred diagnostic method for analyzing small bowel diseases. However, capsule endoscopes capture a sparse number of images because of their mechanical limitations. Post-procedural management using computational methods can enhance image quality. Additional information, including depth, can be obtained by using recently developed computer vision techniques. It is possible to measure the size of lesions and track the trajectory of capsule endoscopes using the computer vision technology, without requiring additional equipment. Moreover, the computational analysis of CE images can help detect lesions more accurately within a shorter time. Newly introduced deep leaning-based methods have shown more remarkable results over traditional computerized approaches. A large-scale standard dataset should be prepared to develop an optimal algorithms for improving the diagnostic yield of CE. The close collaboration between information technology and medical professionals is needed.

There is an urgent need for better detection and understanding of vascular abnormalities at the micro-level, where critical vascular nourishment and cellular metabolic changes occur. This is especially the case for structures such as the midbrain where both the feeding and draining vessels are quite small. Being able to monitor and diagnose vascular changes earlier will aid in better understanding the etiology of the disease and in the development of therapeutics. In this work, thirteen healthy volunteers were scanned with a dual echo susceptibility weighted imaging (SWI) sequence, with a resolution of 0.22 ​× ​0.44 ​× ​1 ​mm3 at 3T. Ultra-small superparamagnetic iron oxides (USPIO) were used to induce an increase in susceptibility in both arteries and veins. Although the increased vascular susceptibility enhances the visibility of small subvoxel vessels, the accompanying strong signal loss of the large vessels deteriorates the local tissue contrast. To overcome this problem, the SWI data were acquired at different time points during a gradual administration (final concentration ​= ​4 ​mg/kg) of the USPIO agent, Ferumoxytol, and the data was processed to combine the SWI data dynamically, in order to see through these blooming artifacts. The major vessels and their tributaries (such as the collicular artery, peduncular artery, peduncular vein and the lateral mesencephalic vein) were identified on the combined SWI data using arterio-venous maps. Dynamically combined SWI data was then compared with previous histological work to validate that this protocol was able to detect small vessels on the order of 50 ​μm–100 ​μm. A complex division-based phase unwrapping was also employed to improve the quality of quantitative susceptibility maps by reducing the artifacts due to aliased voxels at the vessel boundaries. The smallest detectable vessel size was then evaluated by revisiting numerical simulations, using estimated true susceptibilities for the basal vein and the posterior cerebral artery in the presence of Ferumoxytol. These simulations suggest that vessels as small as 50 ​μm should be visible with the maximum dose of 4 ​mg/kg.

Purpose Intra-arterial revascularization therapy (IART) for acute ischemic stroke has become increasingly popular recently. However, early change in apparent diffusion coefficient (ADC) values after full recanalization in human stroke has not received much attention. The aim of this study was to evaluate ADC changes immediately after interventional full-recanalization in patients with acute ischemic stroke. Materials and Methods ADC values of 25 lesions from 18 acute ischemic stroke patients were recorded with both pre- and post-recanalization ADC maps. Measurement was done by placing region of interests over the representative images of the lesion. For analysis, lesions were divided into territorial infarction (TI) and watershed infarction (WI). Results Mean ADC values of the overall 25 lesions before IART were 415.12 × 10-6 mm2/sec, and increased to 619.08 × 10-6 mm2/sec after the IART. Average relative ADC (rADC) value for 22 TI increased from 0.59 to 0.92 (p < 0.000), whereas, average rADC value for 3 WI did not change significantly. Conclusion There was a conspicuous increase of ADC values immediately after full-recanalization in TI lesions. On the other hand, WI lesions did not show significant change in ADC values after recanalization.

Background and Purpose Susceptibility-weighted imaging (SWI) can show an intravascular thrombus as a hypointense susceptibility vessel sign (SVS). In this study, we investigated the usefulness of SWI in the detection of an intravascular thrombus in acute cardioembolic stroke by comparing the SVS on SWI to the vessel status on time-of-flight magnetic resonance angiography (MRA). Methods We consecutively enrolled patients with cardioembolic stroke in the anterior circulation within 3 days from stroke onset. The frequency and location of the SVS on SWI were compared with those of occlusion on MRA. Results One hundred and twenty-two patients were conclusively enrolled in this study. The SVS was observed in 75.4% (92/122) of the enrolled patients. MRA showed occlusion in 57% (70/122) of the enrolled patients. The SVS was identified in all 70 patients with occlusion on MRA. The SVS was observed in 22 (42.3%) of 52 patients without occlusion on MRA (P

We present two algorithms for aligning two colored point clouds. The two algorithms are designed to minimize a probabilistic cost based on the color-supported soft matching of points in a point cloud to their K-closest points in the other point cloud. The first algorithm, like prior iterative closest point algorithms, refines the pose parameters to minimize the cost. Assuming that the point clouds are obtained from RGB-depth images, our second algorithm regards the measured depth values as variables and minimizes the cost to obtain refined depth values. Experiments with our synthetic dataset show that our pose refinement algorithm gives better results compared to the existing algorithms. Our depth refinement algorithm is shown to achieve more accurate alignments from the outputs of the pose refinement step. Our algorithms are applied to a real-world dataset, providing accurate and visually improved results.