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Background This study evaluates the effectiveness of Therapeutic Hypothermia (TH) in treating poor-grade aneurysmal subarachnoid hemorrhage (SAH), focusing on functional outcomes, mortality, and complications such as vasospasm, delayed cerebral ischemia (DCI), and hydrocephalus. Methods Adhering to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines, a comprehensive literature search was conducted across multiple databases, including Medline, Embase, and Cochrane Central, up to November 2023. Nine studies involving 368 patients were selected based on eligibility criteria focusing on TH in poor-grade SAH patients. Data extraction, bias assessment, and evidence certainty were systematically performed. Results The primary analysis of unfavorable outcomes in 271 participants showed no significant difference between the TH and standard care groups (risk ratio [RR], 0.87). However, a significant reduction in vasospasm was observed in the TH group (RR, 0.63) among 174 participants. No significant differences were found in DCI, hydrocephalus, and mortality rates in the respective participant groups. Conclusions TH did not significantly improve primary unfavorable outcomes in poor-grade SAH patients. However, the reduction in vasospasm rates indicates potential specific benefits. The absence of significant findings in other secondary outcomes and mortality highlights the need for further research to better understand TH's role in treating this patient population.

Abstract To investigate the association between chemical markers (triglyceride, C-reactive protein (CRP), and inflammation markers) and perfusion markers (relative cerebral vascular reserve (rCVR)) with moyamoya disease progression and complication types. A total of 314 patients diagnosed with moyamoya disease were included. Triglyceride and CRP levels were assessed and categorized based on Korean guidelines for dyslipidemia and CDC/AHA guidelines, respectively. Perfusion markers were evaluated using Diamox SPECT. Cox proportional hazard analysis was performed to examine the relationship between these markers and disease progression, as well as complication types (ischemic stroke, hemorrhagic stroke, and rCVR deterioration). Elevated triglyceride levels (≥ 200) were significantly associated with higher likelihood of end-point events (HR: 2.292, CI 1.00–4.979, P = 0.03). Severe decreased rCVR findings on Diamox SPECT were also significantly associated with end-point events (HR: 3.431, CI 1.254–9.389, P = 0.02). Increased CRP levels and white blood cell (WBC) count were significantly associated with moyamoya disease progression. For hemorrhagic stroke, higher triglyceride levels were significantly associated with end-point events (HR: 5.180, CI 1.355–19.801, P = 0.02). For ischemic stroke, severe decreased rCVR findings on Diamox SPECT (HR: 5.939, CI 1.616–21.829, P

Abstract Background Recurrence is common in glioblastoma multiforme (GBM) because of the infiltrative, residual cells in the tumor margin. Standard therapy for GBM consists of surgical resection followed by chemotherapy and radiotherapy, but the median survival of GBM patients remains poor (~ 1.5 years). For recurrent GBM, anti-angiogenic treatment is one of the common treatment approaches. However, current anti-angiogenic treatment modalities are not satisfactory because of the resistance to anti-angiogenic agents in some patients. Therefore, we sought to identify novel prognostic biomarkers that can predict the therapeutic response to anti-angiogenic agents in patients with recurrent glioblastoma. Methods We selected patients with recurrent GBM who were treated with anti-angiogenic agents and classified them into responders and non-responders to anti-angiogenic therapy. Then, we performed proteomic analysis using liquid-chromatography mass spectrometry (LC–MS) with formalin-fixed paraffin-embedded (FFPE) tissues obtained from surgical specimens. We conducted a gene-ontology (GO) analysis based on protein abundance in the responder and non-responder groups. Based on the LC–MS and GO analysis results, we identified potential predictive biomarkers for anti-angiogenic therapy and validated them in recurrent glioblastoma patients. Results In the mass spectrometry-based approach, 4957 unique proteins were quantified with high confidence across clinical parameters. Unsupervised clustering analysis highlighted distinct proteomic patterns (n = 269 proteins) between responders and non-responders. The GO term enrichment analysis revealed a cluster of genes related to immune cell-related pathways (e.g., TMEM173, FADD, CD99) in the responder group, whereas the non-responder group had a high expression of genes related to nuclear replisome (POLD) and damaged DNA binding (ERCC2). Immunohistochemistry of these biomarkers showed that the expression levels of TMEM173 and FADD were significantly associated with the overall survival and progression-free survival of patients with recurrent GBM. Conclusions The candidate biomarkers identified in our protein analysis may be useful for predicting the clinical response to anti-angiogenic agents in patients with recurred GBM.

The brain houses vital hormonal regulatory structures such as the hypothalamus and pituitary gland, which may confer unique susceptibilities to critical illness-related corticosteroid insufficiency (CIRCI) in patients with neurological disorders. In addition, the frequent use of steroids for therapeutic purposes in various neurological conditions may lead to the development of steroid insufficiency. This abstract aims to highlight the significance of understanding these relationships in the context of patient care and management for physicians. Neurological disorders may predispose patients to CIRCI due to the role of the brain in hormonal regulation. Early recognition of CIRCI in the context of neurological diseases is essential to ensure prompt and appropriate intervention. Moreover, the frequent use of steroids for treating neurological conditions can contribute to the development of steroid insufficiency, further complicating the clinical picture. Physicians must be aware of these unique interactions and be prepared to evaluate and manage patients with CIRCI and steroid insufficiency in the context of neurological disorders. This includes timely diagnosis, appropriate steroid administration, and careful monitoring for potential adverse effects. A comprehensive understanding of the interplay between neurological disease, CIRCI, and steroid insufficiency is critical for optimizing patient care and outcomes in this complex patient population. [ABSTRACT FROM AUTHOR]

This paper comparatively reviews sensing circuit designs for the most widely used embedded memory, static random-access memory (SRAM). Many sensing circuits for SRAM have been proposed to improve power efficiency and speed, because sensing operations in SRAM dominantly determine the overall speed and power consumption of the system-on-chip. This phenomenon is more pronounced in the nanoscale era, where SRAM bit-cells implemented near minimum-sized transistors are highly influenced by variation effects. Under this condition, for stable sensing, the control signal for accessing the selected bit-cell (word-line, WL) should be asserted for a long time, leading to increases in the power dissipation and delay at the same time. By innovating sensing circuits that can reduce the WL pulse width, the sensing power and speed can be efficiently improved, simultaneously. Throughout this paper, the strength and weakness of many SRAM sensing circuits are introduced in terms of various aspects—speed, area, power, etc.

As high-density SRAMs must be designed to ensure a substantially small failure rate, the accurate yield estimation with practically acceptable runtime of circuit simulations is highly challenging. Here, a read access yield estimation method for high-density static random access memory (SRAM) is proposed. Instead of performing SPICE runs for the entire SRAM circuit, the proposed method partitions the SRAM into three parts—the control signal generation circuit, bitcell array, and sense amplifier (SA)—that determine three key parameters: word-line to SA enable delay, bit-line voltage difference, and SA offset voltage. Subsequently, the proposed method derives the probability density of these key parameters from each of the three partitioned circuits. Here, different methods are applied to derive the probability of the key parameters, considering the respective characteristics of each circuit part and parameter. According to our experimental results, the proposed method can accelerate the yield estimation by 500– $3000\times $ , compared with the brute-force Monte Carlo simulation method, and 10– $100\times $ compared with the other state-of-art methods. In addition, the proposed method can accelerate the circuit optimization procedure accompanied by multiple circuit revisions, that is, the circuit revisions can be reflected with SPICE runs only for the revised circuit part, unlike the previous methods that require SPICE runs for the entire SRAM.

An embedded level-shifting (ELS) dual-rail SRAM is proposed to enhance the availability of dual-rail SRAMs. Although dual-rail SRAM is a powerful solution for satisfying the increasing demand for low-power applications, the enormous performance degradation at low supply voltages cannot meet the high-performance cache requirement in recent computing systems. The requirement of many level shifters is another drawback of the dual-rail SRAM because it degrades the energy-savings. The proposed ELS dual-rail SRAM achieves energy-savings by using a low supply voltage to precharge bitlines while minimizing the performance overhead by appropriately assigning a high-supply voltage to critical circuit blocks with effective level-shifting circuits. The sense amplifier embeds a level-shifting operation, thereby operating with a high supply voltage for a fast sensing operation. The proposed dynamic output buffer resolves the potential static current problem and improves the read delay. The number of level shifters is reduced using a proposed write driver, which conducts level-shifting and write-driving simultaneously. The proposed ELS dual-rail SRAM achieves low-power operation with 71.4% power consumption compared to single-rail SRAM with 72% performance overhead in circuit-level simulation, while the previous hybrid dual-rail SRAM shows 67.8% energy consumption with 270% performance overhead. In architecture-level simulation using Gem5 simulator with SPEC2006 benchmarks, the system with the ELS dual-rail SRAM caches shows, on average, 29% performance improvement compared to that of the system with the hybrid dual-rail SRAM caches.

This paper comparatively analyzes the static random-access memory (SRAM) cell designs for fault tolerance. Since SRAM cells are sensitive to radiation-induced single event upsets, various circuit-level approaches have been applied. Compared to the conventional SRAM cell circuits, one possibility is adding redundant storage nodes by means of additional transistors. The strength and weakness of the SRAM cells in terms of various performance aspects—speed, area, power, stability, fault tolerance, etc.—according to the design approaches are compared analytically and discussed. The discussion concludes that, in the future, it is paramount to develop an SRAM cell design with a mitigated trade-off between read/write performance and SEU tolerance.

As technology scales down, the speed and power efficiency of digital circuits become greatly enhanced [...]