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Tai Joon An,1 Yeun Jie Yoo,2 Jeong Uk Lim,1 Wan Seo,3 Chan Kwon Park,1 Chin Kook Rhee,4 Hyoung Kyu Yoon1 1Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Yeouido St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea; 2Department of Rehabilitation Medicine, St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, Suwon, Korea; 3Department of Internal Medicine, St. Peter’s Hospital, Seoul, Korea; 4Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, KoreaCorrespondence: Hyoung Kyu Yoon Tel +82 2-3779-2213Email cmcyhg@gmail.comBackground: Evaluating the diaphragm muscle in chronic obstructive pulmonary disease (COPD) is important. However, the role of diaphragm ultrasound (DUS) in distinguishing the exacerbation status of COPD (AECOPD) is not fully understood. We set this study to evaluate the role of DUS as a biomarker for distinguishing the AECOPD.Methods: COPD patients who underwent DUS were enrolled between March 2020 and November 2020. The diaphragm thickening fraction (TFmax) and diaphragm excursion (DEmax) during maximal deep breathing were measured. Patients were divided into exacerbation and stable groups. Demographics, lung function, and DUS findings were compared between the two groups. Receiver operating characteristic curve and univariate/multivariate logistic regression analyses were performed.Results: Fifty-five patients were enrolled. The exacerbation group had a lower body mass index (BMI) (20.9 vs 24.2, p = 0.003), lower TFmax (94.8 ± 8.2% vs 158.4 ± 83.5%, p = 0.010), and lower DEmax (30.8 ± 11.1 mm vs 40.5 ± 12.5 mm, p = 0.007) compared to stable group. The areas under the TFmax (0.745) and DEmax (0.721) curves indicated fair results for distinguishing AECOPD. The patients were divided into low and high TFmax and DEmax groups based on calculated cut-off values. Low TFmax (odds ratio [OR] 8.40; 95% confidence interval [CI] 1.55– 45.56) and low DEmax (OR 11.51; 95% CI 1.15– 115.56) were associated with AECOPD after adjusting for age, sex, BMI, and lung functions.Conclusion: DUS showed the possibility of an imaging biomarker distinguishing AECOPD from stable status.Keywords: COPD, exacerbation, diaphragm, ultrasound, biomarker

Background: Transcranial direct current stimulation (tDCS) has emerged as a promising tool for stroke rehabilitation, supported by evidence demonstrating its beneficial effects on post-stroke recovery. However, patients with skull defects, such as burr holes, have been excluded from tDCS due to limited knowledge regarding the effect of skull defects on the electric field., Objective: We investigated the effect of burr holes on the electric field induced by tDCS and identified the electrode location that modulates the electric field., Methods: We generated mesh models of the heads of five patients with burr holes and five age-matched control patients who had never undergone brain surgery, based on magnetic resonance imaging. Then we conducted tDCS simulations, with the cathode fixed in one position and the anode in various positions. Regression analysis was employed to investigate the relationship between the electric field at the burr hole and the distance from the burr hole to the anode., Results: In patients with burr holes, the electric field intensity increased as the anode approached the burr hole, reaching a maximum electric field when the anode covered it, with this pattern remaining consistent across all patient models. Assuming the holes were filled with cerebrospinal fluid, the maximum electric field was 1.20 ± 0.20 V/m (mean ± standard deviation, SD). When the anode was positioned more than 60 mm away from the burr hole, the electric field at the burr hole remained low and constant, with an average value of 0.29 ± 0.04V/m (mean ± SD). In contrast, for all patients without burr holes, the electric field intensity stayed constant regardless of the anode's position, with a maximum amplitude of 0.36 ± 0.04 V/m (mean ± SD). Furthermore, when the burr hole was assumed to be filled with scar tissue, the mean peak electric field was 0.93 ± 0.16 V/m, indicating that the electric field strength varies depending on the conductivity of the tissue filling the burr hole., Conclusion: Based on the simulations, the minimum recommended distance from the burr hole to the anode is 60 mm to prevent unintended stimulation of the brain cortex during tDCS. These findings will contribute to the development of safe and effective tDCS treatments for patients with burr holes., Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships that may be considered potential competing interests: Donghyeon Kim has equity in Neurophet, Inc. Hyungtaek Kim is employed by Neurophet, Inc. No other author has any potential conflict of interest relevant to this article., (Copyright © 2024. Published by Elsevier Ltd.)

Remote epitaxy is taking center stage in creating freestanding complex oxide thin films with high crystallinity that could serve as an ideal building block for stacking artificial heterostructures with distinctive functionalities. However, there exist technical challenges, particularly in the remote epitaxy of perovskite oxides associated with their harsh growth environments, making the graphene interlayer difficult to survive. Transferred graphene, typically used for creating a remote epitaxy template, poses limitations in ensuring the yield of perovskite films, especially when pulsed laser deposition (PLD) growth is carried out, since graphene degradation can be easily observed. Here, we employ spectroscopic ellipsometry to determine the critical factors that damage the integrity of graphene during PLD by tracking the change in optical properties of graphene in situ . To mitigate the issues observed in the PLD process, we propose an alternative growth strategy based on molecular beam epitaxy to produce single-crystalline perovskite membranes.

Post-Acute Sequelae of SARS-CoV-2 infection (PASC), also known as Long-COVID, encompasses a variety of complex and varied outcomes following COVID-19 infection that are still poorly understood. We clustered over 600 million condition diagnoses from 14 million patients available through the National COVID Cohort Collaborative (N3C), generating hundreds of highly detailed clinical phenotypes. Assessing patient clinical trajectories using these clusters allowed us to identify individual conditions and phenotypes strongly increased after acute infection. We found many conditions increased in COVID-19 patients compared to controls, and using a novel method to associate patients with clusters over time, we additionally found phenotypes specific to patient sex, age, wave of infection, and PASC diagnosis status. While many of these results reflect known PASC symptoms, the resolution provided by this unprecedented data scale suggests avenues for improved diagnostics and mechanistic understanding of this multifaceted disease., (© 2024. The Author(s).)

The present study aimed to evaluate the elbow flexor force induced by perineural intramuscular stimulation compared with surface electrical stimulation (ES) and maximal voluntary contraction. Thirty nondominant arms of healthy volunteers were evaluated. Isometric elbow flexion force was evaluated using a surface electrode stimulation at the biceps brachii muscle, a perineural intramuscular stimulation around the musculocutaneous nerve, and maximum voluntary contraction. The elbow flexion force was measured at the wrist volar area in a 90° elbow flexion posture, fixed with a rigid elbow orthosis. Pain and discomfort associated with ES were evaluated using a numeric rating scale. The mean maximum elbow flexion force was 16.6 ± 4.1 kgf via voluntary contraction. The mean elbow flexion force by ES was 2.9 ± 2.0 kgf, stimulation intensity was 24.8 ± 5.5 mA, and the numeric rating scale was 5.0 ± 2.5 via surface electrode stimulation and 3.1 ± 2.0 kgf, 5.0 mA, and 3.8 ± 1.9 via perineural stimulation, respectively. ES provides 16% to 18% of the maximal voluntary contraction force in elbow flexion, which corresponds to a fair grade of muscle force. Perineural intramuscular stimulation can generate an equivocal contraction force with less discomfort in elbow flexion than surface electrode stimulation., (Copyright © 2024 the Author(s). Published by Wolters Kluwer Health, Inc.)

Introduction: The aim of this study was to evaluate the efficacy of different irrigation needles and passive ultrasonic activation in removing Ca(OH) 2 from an endodontic model that duplicated a root canal configuration of a human natural tooth., Methods: An extracted human maxillary premolar was subjected to root canal preparation and scanned with microcomputed tomography. A 3-dimensional reconstruction model of the natural tooth was printed to endodontic models using a polyjet printer. The root canals of the models were filled with Ca(OH) 2 paste and divided into 2 groups based on the irrigation protocol: conventional syringe-needle irrigation (conventional group) and passive ultrasonic irrigation (PUI) group. Each group was subdivided into 3 groups (n = 10) according to the type of needle: half-cut, side-vented, and TruNatomy irrigation needle. Microcomputed tomographyimaging was used to assess the percentage of reduction of Ca(OH) 2 . Data were analyzed using two-way analysis of variance test (α = .05)., Results: The side-vented and TruNatomy irrigation needles showed significantly higher percentage reductions than the half-cut needle (P < .05) in the conventional irrigation group. The PUI group showed significantly higher percentage reductions of Ca(OH) 2 than the conventional group regardless of the type of needle (P < .05). However, no significant difference was found among the needles in the PUI group., Conclusions: The type of irrigation needle and the use of PUI influenced the removal efficacy of Ca(OH) 2 . PUI enhanced the removal of Ca(OH) 2 regardless of the type of irrigation needle., (Copyright © 2024 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.)

Butterfly wings possess distinct micro/nanostructures that contribute to their vibrant coloration, light-trapping capabilities, and sensitivity to various stimuli. These complex features have inspired the creation of diverse devices and systems, such as sensors, photovoltaics, photocatalysis, and robotics. Specifically, the wing scales of the Emerald Swallowtail (Papilio palinurus) display iridescent, polarization-sensitive, and retroreflective colors due to their hierarchical structures. However, current technologies fail to mimic these natural designs fully, limiting their practical application in everyday life. In this study, we introduce a groundbreaking method for fabricating artificial wing scales that emulate the biological structure's functionality with a much simpler geometry. By integrating self-graded lossy media into metallic micro-concavity arrays, we achieve pronounced iridescent effects in both coaxial and non-coaxial arrangements, while preserving retroreflective properties. In particular, the simplified design allows for switchable color patterns based on the viewing angle. Demonstrating the concept, we successfully employ these conspicuous retroreflectors in hydrogen gas detection and the bi-directional/switchable recognition of patterned signals., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier B.V. All rights reserved.)

The aqueous dispersibility and processability of graphene oxide (GO) are pivotal for various applications, including the fluid assembly of macroscopic materials and nanofluidic systems. Despite the widespread utilization of ultrasonic treatment to achieve homogeneous dispersions, the rheological changes of GO during sonication have remained relatively unexplored, leading to conflicting research findings. In this study, we demonstrate that the viscoelastic evolution of GO can significantly differ under ultrasonic fragmentation depending on the balance between repulsion force and attraction force at the initial state before fragmentation. When electrostatic repulsion is in delicate equilibrium with attractive forces, gelation occurs under ultrasonic fragmentation, leading to increased viscosity under sonication. Conversely, when electrostatic repulsion predominates, viscosity decreases during sonication. This study reconciles conflicting observations on the rheological evolution of GO dispersions under ultrasonic fragmentation and provides valuable guidance and insights for the rheological engineering of GO colloidal systems., Competing Interests: The authors declare that they have no competing interests., (This journal is © The Royal Society of Chemistry.)

Background: The surplus cytokines remaining after use in the early stages of the inflammatory response stimulate immune cells even after the response is over, causing a secondary inflammatory response and ultimately damaging the host, which is called a cytokine storm. Inhibiting heat shock protein 90 (Hsp90), which has recently been shown to play an important role in regulating inflammation in various cell types, may help control excessive inflammatory responses and cytokine storms., Methods: We discovered an anti-inflammatory compound by measuring the inhibitory effect of CD86 expression on spleen DCs (sDCs) using the chemical compounds library of Hsp90 inhibitors. Subsequently, to select the hit compound, the production of cytokines and expression of surface molecules were measured on the bone marrow-derived DCs (BMDCs) and peritoneal macrophages. Then, we analyzed the response of antigen-specific Th1 cells. Finally, we confirmed the effect of the compound using acute lung injury (ALI) and delayed-type hypersensitivity (DTH) models., Results: We identified Be01 as the hit compound, which reduced CD86 expression the most in sDCs. Treatment with Be01 decreased the production of pro-inflammatory cytokines (IL-6, TNF-α, and IL-1β) in BMDC and peritoneal macrophages stimulated by LPS. Under the DTH model, Be01 treatment reduced ear swelling and pro-inflammatory cytokines in the spleen. Similarly, Be01 treatment in the ALI model decreased neutrophil infiltration and lower levels of secreted cytokines (IL-6, TNF-α)., Conclusions: Reduction of CD80 and CD86 expression on DCs by Be01 indicates reduced secondary inflammatory response by Th1 cells, and reduced release of pro-inflammatory cytokines by peritoneal macrophages may initially control the cytokine storm., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024. Published by Elsevier B.V.)

Background: Repetitive transcranial magnetic stimulation (rTMS) is one of the non-invasive brain stimulations that modulate cortical excitability through magnetic pulses. However, the effects of rTMS on Parkinson's disease (PD) have yielded mixed results, influenced by factors including various rTMS stimulation parameters as well as the clinical characteristics of patients with PD. There is no clear evidence regarding which patients should be applied with which parameters of rTMS. The study aims to investigate the efficacy and safety of personalized rTMS in patients with PD, focusing on individual functional reserves to improve ambulatory function., Methods: This is a prospective, exploratory, multi-center, single-blind, parallel-group, randomized controlled trial. Sixty patients with PD will be recruited for this study. This study comprises two sub-studies, each structured as a two-arm trial. Participants are classified into sub-studies based on their functional reserves for ambulatory function, into either the motor or cognitive priority group. The Timed-Up and Go (TUG) test is employed under both single and cognitive dual-task conditions (serial 3 subtraction). The motor dual-task effect, using stride length, and the cognitive dual-task effect, using the correct response rate of subtraction, are calculated. In the motor priority group, high-frequency rTMS targets the primary motor cortex of the lower limb, whereas the cognitive priority group receives rTMS over the left dorsolateral prefrontal cortex. The active comparator for each sub-study is bilateral rTMS of the primary motor cortex of the upper limb. Over 4 weeks, the participants will undergo 10 rTMS sessions, with evaluations conducted pre-intervention, mid-intervention, immediately post-intervention, and at 2-month follow-up. The primary outcome is a change in TUG time between the pre- and immediate post-intervention evaluations. The secondary outcome variables are the TUG under cognitive dual-task conditions, Movement Disorder Society-Unified Parkinson's Disease Rating Scale Part III, New Freezing of Gait Questionnaire, Digit Span, trail-making test, transcranial magnetic stimulation-induced motor-evoked potentials, diffusion tensor imaging, and resting state functional magnetic resonance imaging., Discussion: The study will reveal the effect of personalized rTMS based on functional reserve compared to the conventional rTMS approach in PD. Furthermore, the findings of this study may provide empirical evidence for an rTMS protocol tailored to individual functional reserves to enhance ambulatory function in patients with PD., Trial Registration: ClinicalTrials.gov NCT06350617. Registered on 5 April 2024., (© 2024. The Author(s).)

Background: The mesocircuit model describes a complex network that includes the prefrontal cortical-striatopallidal-thalamo-cortical loop systems and is involved in the mechanism underlying consciousness in patients with disorders of consciousness (DoC). Inhibitory signals to the thalamus become hyperactive in DoC patients, leading to a loss of consciousness. Reactivating this mesocircuit system is important for recovering consciousness in these patients. We investigated how the residual integrity of the thalamo-dorsolateral prefrontal cortex tract (TDLPFCT) influences consciousness in patients with DoC., Methods: This retrospective case-control study included three groups: prolonged DoC ( n  = 20), stroke without DoC ( n  = 20), and healthy controls ( n  = 20). Diffusion tensor imaging (DTI) was performed at least 4 weeks after the onset. Thalamo-DLPFC tracts were reconstructed using diffusion tensor tractography, and fractional anisotropy (FA) and tract volume (TV) were measured for each hemisphere. Consciousness was assessed using the revised coma recovery scale (CRS-R) within a week of brain imaging., Results: Significant differences in DLPFCT TV were observed across all three groups, in both affected and less-affected lobes, with the DoC group showing the greatest reduction. A significant correlation was found between the TV of the less-affected TDLPFCT and CRS-R score., Conclusion: The integrity of the TDLPFCT, particularly in the less affected hemisphere, is associated with consciousness levels in patients with prolonged DoC. This finding suggests its potential importance in assessing prognosis and further developing therapeutic strategies for patients with DoC., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. The author(s) declared that they were an editorial board member of Frontiers, at the time of submission. This had no impact on the peer review process and the final decision., (Copyright © 2024 Jung, Yoo, Yoon, Hong, Kim, Park, Lee, Lee, Im and Lim.)

Objectives: This study evaluated the phase composition, phase transformation behaviour, and mechanical properties of five heat-treated NiTi instruments., Methods: ProTaper NEXT (M-wire, PTN), ProTaper Gold (Gold-wire, PTG), One Curve (C-wire, OC), EdgeTaper Platinum (Fire-wire, ETP), NeoNiTi (electrical discharge machining-wire, NNA), and ProTaper Universal (conventional wire, PTU, control) with #25-tip size were tested (n = 12/group) for cyclic fatigue resistance (number of cycles to failure; NCF) and torsional resistance (angle of rotation to fracture and maximum torque at fracture [ultimate torsional strength]). The geometry and fracture surfaces of the tested instruments were examined by scanning electron microscopy. The phase transformation temperature and phase composition of the instruments were evaluated using differential scanning calorimetry and X-ray diffraction. Data were statistically analysed using one-way ANOVA and Tukey's post hoc test, with the significance level set at 5%., Results: PTG showed the highest NCF (P < .05) at 37°C, while ETP exhibited the highest angle of rotation to fracture, ultimate torsional strength, and stiffness (P < .05). Scanning electron microscopy demonstrated typical clusters of fatigue striations and numerous cracks after cyclic fatigue fracture, whereas there was a concentric abrasion pattern with a dimple and microvoids at the centre after torsional fracture. In differential scanning calorimetry curves, austenite-finishing temperatures of heat-treated instruments were higher than 37°C, whereas that of PTU was lower than 37°C. PTU showed strong peaks of austenite at 25 and 37°C, whereas ETP showed a strong peak of R-phase at 25°C, but mostly austenite phase at 37°C in X-ray diffraction., Conclusions: Geometry, alloy type, and phase transformation temperatures of NiTi instruments affected their mechanical behaviour., Clinical Relevance: PTG showed the highest NCF, suitable for markedly curved canals. ETP had the highest torsional resistance, appropriate for narrow and constricted canals., Competing Interests: Conflict of interest The authors declare no competing interests., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)

Objective: To determine the normative values of the Korean version of the Modified Barthel Index (K-MBI) score for typically developing children in Korea and assess its suitability for use in children., Methods: Rehabilitation physicians and occupational therapists with children were invited through an online platform to participate in a survey assessing their children's performance of activity of daily living (ADL) using the K-MBI. The questionnaire encompassed queries on sociodemographic information of children and the assessment criteria outlined in the K-MBI. The standardized K-MBI scores by age were estimated using the nonlinear least squares method., Results: The analysis incorporated responses from a total of 206 individuals. K-MBI total scores showed a rapid increase over the first 8 years of life, with 99% of children achieving a score of 90 or higher by age 8. Mobility scores exhibited a swift increase during early childhood, surpassing 90% of the maximum score at 3 years of age and nearing 100% at 7 years of age. In contrast, self-care scores demonstrated a more gradual advancement, achieving approximately 100% of the maximum score by the age of 10 years., Conclusion: Age-specific normative values for K-MBI scores of typically developing children were established, which can be used as a reference in clinical care. While the K-MBI captured the overall trajectory of children's ADL development, it did not discern subtle differences across various developmental stages. There is a need for the development of more refined assessment tools tailored specifically to children.

Introduction: Microbiota associated with primary endodontic infection (PEI) and secondary/persistent endodontic infection (SPEI) must be characterized to elucidate pathogenesis in apical periodontitis and bacterial biomarkers identified for diagnostic and therapeutic applications., Methods: This study analyzed the microbial community profiles of root canals and gingival sulci (sulcus-E) for teeth with PEI (n = 10) or SPEI (n = 10), using the Illumina MiSeq platform. Bacterial samples from gingival sulci (sulcus-C) of healthy contralateral teeth served as controls., Results: There were 15 phyla, 177 genera, and 340 species identified. The number and diversity of bacteria in root canals did not differ significantly between PEI and SPEI. Proteobacteria, Firmicutes, Fusobacteria, Bacteroidetes, and Actinobacteria were the dominant phyla in both groups. At the genus level, Lancefieldella, Bifidobacterium, Stomatobaculum, and Schaalia were enriched in root canals with SPEI. Of significance, Lancefieldella was observed in both root canals and sulcus-E of teeth with SPEI. At the species level, Neisseria macacae, Streptococcus gordonii, Bifidobacterium dentium, Stomatobaculum longum, and Schaalia odontolytica were increased significantly in root canals with SPEI compared to PEI. Oribacterium species, Streptococcus salivarius, Lancefieldella parvula, Prevotella denticola, and Oribacterium asaccharolyticum were more abundant in sulcus-E of teeth with SPEI compared to PEI., Conclusions: There were distinctive and differing predominant bacterial species associated with the root canals and gingival sulci between teeth with PEI and SPEI. Specific bacteria identified in sulcus-E and root canals of teeth with SPEI could serve as noninvasive diagnostic biomarkers for detecting SPEI., (Copyright © 2024 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.)

Background: Although the COVID-19 pandemic has persisted for over 3 years, reinfections with SARS-CoV-2 are not well understood. We aim to characterize reinfection, understand development of Long COVID after reinfection, and compare severity of reinfection with initial infection., Methods: We use an electronic health record study cohort of over 3 million patients from the National COVID Cohort Collaborative as part of the NIH Researching COVID to Enhance Recovery Initiative. We calculate summary statistics, effect sizes, and Kaplan-Meier curves to better understand COVID-19 reinfections., Results: Here we validate previous findings of reinfection incidence (6.9%), the occurrence of most reinfections during the Omicron epoch, and evidence of multiple reinfections. We present findings that the proportion of Long COVID diagnoses is higher following initial infection than reinfection for infections in the same epoch. We report lower albumin levels leading up to reinfection and a statistically significant association of severity between initial infection and reinfection (chi-squared value: 25,697, p-value: <0.0001) with a medium effect size (Cramer's V: 0.20, DoF = 3). Individuals who experienced severe initial and first reinfection were older in age and at a higher mortality risk than those who had mild initial infection and reinfection., Conclusions: In a large patient cohort, we find that the severity of reinfection appears to be associated with the severity of initial infection and that Long COVID diagnoses appear to occur more often following initial infection than reinfection in the same epoch. Future research may build on these findings to better understand COVID-19 reinfections., (© 2024. The Author(s).)

Background: In patients with esophageal squamous cell carcinoma (ESCC), accurately predicting a pathologic complete response (pCR) to preoperative chemoradiotherapy (PCRT) has the potential to enable an active surveillance strategy without esophagectomy. We aimed to establish a reliable multiparameter nomogram model that combines tumor characteristics, imaging modalities, and hematologic markers to predict pCR in patients with ESCC who underwent PCRT and esophagectomy., Methods: We retrospectively reviewed the medical records of 457 patients with ESCC who received PCRT followed by esophagectomy between January 2005 and October 2020. The nomogram model was developed using logistic regression analysis with a training cohort and externally validated with a validation cohort., Results: In the training and validation cohorts, 44.2% (126/285) and 48.3% (83/172) of patients, respectively, achieved pCR after PCRT. The 5-year rates of overall survival, progression-free survival, and freedom from local progression in the training cohort were 51.6%, 48.5%, and 77.6%, respectively. The parameters included in the nomogram were histologic grade, clinical N stage, maximum standardized uptake value on positron emission tomography, and post-PCRT biopsy. Hematologic markers were significantly associated with survival outcomes but not with pCR. The area under the receiver operating characteristic curve of the nomogram was 0.717, 0.704, and 0.707 for the training cohort, internal validation cohort, and external validation cohort, respectively., Conclusion: Our nomogram model based on four parameters obtained from standard clinical practice demonstrated good performance in both the training and validation cohorts and could be useful to aid clinical decision-making to determine whether surgery or active surveillance strategy should be pursued., Competing Interests: We have no conflicts of interest to declare., (© The Author(s) 2024. Published by Oxford University Press and Sixth Affiliated Hospital of Sun Yat-sen University.)

Background: Repetitive transcranial magnetic stimulation (rTMS) is widely used therapy to enhance motor deficit in stroke patients. To date, rTMS protocols used in stroke patients are relatively unified. However, as the pathophysiology of stroke is diverse and individual functional deficits are distinctive, more precise application of rTMS is warranted. Therefore, the objective of this study was to determine the effects of personalized protocols of rTMS therapy based on the functional reserve of each stroke patient in subacute phase., Methods: This study will recruit 120 patients with stroke in subacute phase suffering from the upper extremity motor impairment, from five different hospitals in Korea. The participants will be allocated into three different study conditions based on the functional reserve of each participant, measured by the results of TMS-induced motor evoked potentials (MEPs), and brain MRI with diffusion tensor imaging (DTI) evaluations. The participants of the intervention-group in the three study conditions will receive different protocols of rTMS intervention, a total of 10 sessions for 2 weeks: high-frequency rTMS on ipsilesional primary motor cortex (M1), high-frequency rTMS on ipsilesional ventral premotor cortex, and high-frequency rTMS on contralesional M1. The participants of the control-group in all three study conditions will receive the same rTMS protocol: low-frequency rTMS on contralesional M1. For outcome measures, the following assessments will be performed at baseline (T0), during-intervention (T1), post-intervention (T2), and follow-up (T3) periods: Fugl-Meyer Assessment (FMA), Box-and-block test, Action Research Arm Test, Jebsen-Taylor hand function test, hand grip strength, Functional Ambulatory Category, fractional anisotropy measured by the DTI, and brain network connectivity obtained from MRI. The primary outcome will be the difference of upper limb function, as measured by FMA from T0 to T2. The secondary outcomes will be the differences of other assessments., Discussion: This study will determine the effects of applying different protocols of rTMS therapy based on the functional reserve of each patient. In addition, this methodology may prove to be more efficient than conventional rTMS protocols. Therefore, effective personalized application of rTMS to stroke patients can be achieved based on their severity, predicted mechanism of motor recovery, or functional reserves., Clinical Trial Registration: https://clinicaltrials.gov/, identifier NCT06270238., Competing Interests: DK was employed by NEUROPHET Inc. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Lee, Kim, Seo, Im, Yoo, Kim, Lee, Kim, Park, Yoon, Kim, Kim and Chang.)

Intracranial growing teratoma syndrome (iGTS) is a rare phenomenon in patients with non-germinomatous germ cell tumor (NGGCT) after chemotherapy or radiotherapy. It manifests as paradoxical growth of teratomatous components, with multiple cystic lesions on cranial imaging despite normalized tumor markers. This paper presents a 22-year-old male with iGTS, diagnosed one month after chemotherapy against NGGCT. Initially diagnosed with presumptive pineal NGGCT causing obstructive hydrocephalus, the patient underwent endoscopic third ventriculostomy and extraventricular drainage with tumor biopsy followed by two chemotherapy cycles. Despite normalization of tumor markers, follow-up MRI showed increased tumor size with honeycomb-like cystic patterns. The patient underwent suboccipital craniotomy for tumor removal via combined telovelar and infratentorial supracerebellar approaches. The final pathology confirmed mature teratoma. However, postoperative bleeding and left thalamic infarction occurred, resulting in severe neurological deficits. Despite challenges, the patient eventually regained the ability to follow simple commands. To understand iGTS pathophysiology, several hypotheses, including the differentiation of immature components and the uninhibited growth of mature components induced by chemotherapy or radiotherapy, were explored. Surgical intervention remains as an ideal treatment, while clinical trials investigate chemotherapy options. Frequent imaging follow-ups are crucial for early detection in iGTS for NGGCT patients., Competing Interests: The authors have no potential conflicts of interest to disclose., (Copyright © 2024 The Korean Brain Tumor Society, The Korean Society for Neuro-Oncology, and The Korean Society for Pediatric Neuro-Oncology.)

Introduction: This retrospective cohort study aimed to evaluate long-term healing outcomes (10-17.5 years) after contemporary endodontic microsurgery (EMS) and identify the associated prognostic factors., Methods: Clinical and radiographic data of an EMS cohort (2006-2013) from the electronic database of the dental hospital were reviewed retrospectively by 2 independent examiners to determine their survival and healing outcomes, and potential prognostic factors were analyzed by Cox proportional hazards regression and logistic regression (α = 0.05)., Results: Through strict inclusion and exclusion criteria and 721 EMS-treated teeth in the cohort, 309 (42.9%) were included (male = 35.0%; female = 65.0%; age = 45.83 ± 15.53 years) with a mean final follow-up of 152.26 ± 26.37 months (range, 120-211 months; median = 148 months). Clinical and radiographic assessments found an 80.5% 10-year survival rate with 63.4% of success. Collectively, tooth type, tooth mobility, preoperative lesion size, clinical crown-to-root ratio, and crown restorations at follow-up were significantly associated with long-term success and survival over 10 years., Conclusions: The preoperative status and condition of the tooth including its alveolar bone support and adequate full-crown restorations may be relevant prognostic determinants of success and survival after EMS over time., (Copyright © 2024 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.)

Dysphagia is prevalent among the elderly and can lead to serious complications, often manifesting as a clinical symptom of various neurological or muscular pathologies, including Guillain-Barré Syndrome (GBS). GBS is an acute immune-mediated polyradiculoneuropathy, and dysphagia may arise during its course due to cranial nerve involvement. In rare GBS variants, dysphagia may present as the initial or sole clinical manifestation, posing diagnostic challenges. In this study, we present the case of an elderly female patient with dysphagia, eventually diagnosed with an atypical variant of GBS. Initially, the patient required nasogastric tube feeding; however, complete recovery was achieved through immunotherapy. This case underscores the importance of clinicians conducting thorough evaluations of factors influencing the swallowing mechanism and remaining vigilant about identifying uncommon causative factors. Such approaches enable the implementation of effective disease-modifying therapies, potentially leading to the resolution of dysphagic symptoms., Competing Interests: The authors declare no conflicts of interest.

The aim of this study was to investigate the pathologic prognostic factors such as tumor cell clusters (TCCs) in the fallopian tube lumen, myometrial invasion patterns, and positive peritoneal cytology (PPC) in women with Stage I endometrial endometrioid carcinoma (EEC). From 2009 to 2020, consecutive patients with Stage I EEC who underwent hysterectomy and bilateral salpingectomy were included. The primary outcome was the recurrence-free survival (RFS) rate, and the clinicopathological factors affecting RFS were analyzed. A total of 765 patients were enrolled. Seventeen patients (2.2%) had TCC in the fallopian tube lumen, and 58 patients showed a microcystic elongated and fragmented pattern (7.6%). PPC was found in 19 patients (2.5%). The median follow-up period was 61.0 months (range: 2.0-149.7). The majority (88.6%) of patients had Stage IA EEC. The 5-year RFS and overall survival rates were 97.5% and 98.5%, respectively. In multivariate analysis for RFS, the significant prognostic factors were lymphovascular invasion (hazard ratio = 4.604; 95% CI: 1.387-15.288; P = 0.013) and grade (grade 2; hazard ratio = 4.949; 95% CI: 1.035-23.654; P = 0.045, and grade 3; hazard ratio = 5.469; 95% CI: 1.435-20.848; P = 0.013). Other pathologic factors including TCC in the fallopian tube lumen, myometrial invasion patterns, PPC, and hormonal status had no prognostic significance. TCC in the fallopian tube lumen, myometrial invasion pattern, PPC, and estrogen and progesterone receptor positivity were not significant prognostic factors in Stage I EEC. In contrast, lymphovascular invasion and grade were significant prognostic factors., Competing Interests: The authors declare no conflict of interest., (Copyright © 2024 by the International Society of Gynecological Pathologists.)

In this paper, we propose an artificial intelligence (AI)-based sarcopenia diagnostic technique for stroke patients utilizing bio-signals from the neuromuscular system. Handgrip, skeletal muscle mass index, and gait speed are prerequisite components for sarcopenia diagnoses. However, measurement of these parameters is often challenging for most hemiplegic stroke patients. For these reasons, there is an imperative need to develop a sarcopenia diagnostic technique that requires minimal volitional participation but nevertheless still assesses the muscle changes related to sarcopenia. The proposed AI diagnostic technique collects motor unit responses from stroke patients in a resting state via stimulated muscle contraction signals (SMCSs) recorded from surface electromyography while applying electrical stimulation to the muscle. For this study, we extracted features from SMCS collected from stroke patients and trained our AI model for sarcopenia diagnosis. We validated the performance of the trained AI models for each gender against other diagnostic parameters. The accuracy of the AI sarcopenia model was 96%, and 95% for male and females, respectively. Through these results, we were able to provide preliminary proof that SMCS could be a potential surrogate biomarker to reflect sarcopenia in stroke patients., Competing Interests: Conflict of Interest: The authors have no potential conflicts of interest to disclose., (Copyright © 2024. Korean Society for Neurorehabilitation.)

Background: The risk of stroke increases with age, and although previous reports have suggested that infection risk may increase with antipsychotic use, relevant studies after stroke are scarce. We aimed to investigate whether antipsychotics increase post-stroke infection risk in the acute stroke period., Methods: This propensity score matching study included adults diagnosed with first-ever stroke between 2011 and 2020 at five university hospitals. In-hospital antipsychotic exposure was defined as any administration during hospitalisation for stroke. The primary outcome was post-stroke infection after the first 2 days of hospitalisation, and the secondary outcome was the presence of pneumonia, bacteraemia and/or bacteriuria., Result: Among 23,885 first-ever stroke patients, 2,773 antipsychotic users (age 71.6 ± 12.4, male 54.6%) and 2,773 non-users (age 71.2 ± 13.2, male 54.6%) were selected as matched cohorts. After adjusting for propensity score, antipsychotics were not associated with an increased risk of post-stroke infection (odds ratio 0.99, 95% confidence interval 0.87-1.14)., Conclusion: While our study did not find conclusive evidence linking antipsychotic medication to an increased risk of post-stroke infection, prescribing these medications should still be approached with prudence. Until further research can provide more definitive insights, clinicians should carefully weigh the potential infection risks when considering antipsychotic treatment during the acute stroke care period., (© The Author(s) 2024. Published by Oxford University Press on behalf of the British Geriatrics Society. All rights reserved. For permissions, please email: journals.permissions@oup.com.)

Coating building envelopes with a passive daytime radiative cooling (PDRC) material has attracted enormous attention as an alternative cooling technique with minimal energy consumption and carbon footprint. Despite the exceptional performance and scalability of porous polymer coating (PPC), achieving consistent performance over a wide range of drying environments remains a major challenge for its commercialization as a radiative cooling paint. Herein, we demonstrate the humidity vulnerability of PPC during the drying process and propose a simple strategy to greatly mitigate the issue. Specifically, we find that the solar reflectance of the PPC rapidly decreases with increasing humidity from 30% RH, and the PPC completely losses its PDRC ability at 45% RH and even become a solar-heating material at higher humidity. However, by adding a small amount of polymer reinforcement to the PPC, it maintains its PDRC performance up to 60% RH, resulting in a 950% increase in estimated areal coverage compared to PPC in the United States. This study sheds light on a crucial consistency issue that has thus far been rarely addressed, and offers engineering guidance to handle this fundamental threat to the development of dependable PDRC paint for industrial applications., (© 2024. The Author(s).)

Purpose: We aimed to design, develop, and evaluate an internet of things-enabled patch (IoT patch) for real-time remote monitoring of adherence (or patch wear time) during patch treatment in child participants in clinical trials. This study provides healthcare providers with a tool for objective, real-time, and remote assessment of adherence and for making required adjustments to treatment plans., Methods: The IoT patch had two temperature microsensors and a wireless chip. One sensor was placed closer to the skin than the other, resulting in a temperature difference depending on whether the patch was worn. When the patch was worn, it measured temperatures every 30 seconds and transmitted temperature data to a cloud server via a mobile application every 15 seconds. The patch was evaluated via 2 experiments with 30 healthy adults and 40 children with amblyopia., Results: Excellent monitoring accuracy was observed in both adults (mean delay of recorded time data, 0.4 minutes) and children (mean, 0.5 minutes). The difference between manually recorded and objectively recorded patch wear times showed good agreement in both groups. Experiment 1 showed accurate monitoring over a wide range of temperatures (from 0 to 30°C). Experiment 2 showed no significant differences in wearability (ease-of-use and comfort scores) between the IoT and conventional patches., Conclusions: The IoT patch offers an accurate, real-time, and remote system to monitor adherence to patch treatment. The patch is comfortable and easy to use. The utilization of an IoT patch may increase adherence to patch treatment based on accurate monitoring., Translational Relevance: Results show that the IoT patch can enable real-time adherence monitoring in clinical trials, improving treatment precision, and patient compliance to enhance outcomes.

Objective: The objective of this study was to examine the effect of periodontitis on renal function and morphology in rats with or without nephrectomy (Nx)-induced chronic kidney disease (CKD)., Methods: Rats were divided into sham surgery (Sham), Sham with tooth ligation (ShamL), Nx, and NxL groups. Periodontitis was induced by tooth ligation at 16-week olds. Creatinine, alveolar bone area, and renal histopathology were analyzed at 20-week olds., Results: Creatinine did not differ between the Sham and ShamL groups or between the Nx and NxL groups. The ShamL and NxL groups (both p = 0.002) had less alveolar bone area than the Sham group. The NxL group had fewer glomeruli than the Nx group (p < 0.000). The periodontitis groups demonstrated more tubulointerstitial fibrosis (Sham vs. ShamL p = 0.002, Nx vs. NxL p < 0.000) and macrophage infiltration (Sham vs. ShamL p = 0.002, Nx vs. NxL p = 0.006) than the groups without periodontitis. Only the NxL group had greater renal TNFα expression than the Sham group (p < 0.003)., Conclusions: These suggest that periodontitis increases renal fibrosis and inflammation in the presence or absence of CKD but does not affect renal function. Periodontitis also increases TNFα expression in the presence of CKD., (© 2023 Wiley Periodicals LLC.)

Background: We aimed to develop a consensus on the need for and priorities of exercise to treat preexisting sarcopenia with hemiplegic stroke., Methods: A modified three-round Delphi study was conducted. The panelists responded to the questionnaire on a 7-point Likert scale. Responses were returned with descriptive statistics in the next round. Consensus was defined as >75% agreement (score of 5-7) with a median > 5. The percentage of strong agreement (score of 6-7) and Kendall's coefficient of concordance were calculated to demonstrate a more refined interpretation of the consensus., Results: Fifteen panelists contributed to all rounds. The need for exercise was demonstrated. The consensus was reached on 53 of 58 items in the first round and all items in the second and final rounds. The percentage of strong agreement was high for all but eight items., Conclusions: This study is the first Delphi study to investigate the need for and priorities of exercise for treating preexisting sarcopenia in stroke hemiplegia. We present a standard recommendation including 57 priorities and a strong recommendation including 49 priorities. The eight items that were excluded reflected factors that are less important to hemiplegic patients with poor balance, cognitive decline, or mental vulnerability.

Activation of the innate immune system counteracts tumor-induced immunosuppression. Hence, small molecule-based toll-like receptor 7/8 agonists (TLR7/8a), which can modulate immunosuppression in the tumor microenvironment along with the activation of innate immunity, are emerging as essential components of cancer immunotherapy. However, the clinical application of synthetic TLR7/8a therapies is limited by systemic immune-associated toxicity and immune tolerance induced by uncontrolled stimulatory activities and repeated treatments. To address these limitations, a dynamic immunomodulation strategy incorporating masking and temporal recovery of the activity of TLR7/8a through prodrug-like TLR7/8a (pro-TLR7/8a) at the molecular level and a sustained and controlled release of active TLR7/8a from nanoliposome (pro-TLR7/8a) (NL(pro-TLR7/8)) in a macroscale depot are designed. Immunization with cationic NL(pro-TLR7/8) and anionic antigens triggers robust activation of innate immune cells as well as antigen-specific T cell responses, eliciting reprogramming of immunosuppressive cells into tumor-suppressive cells, with decreased systemic adverse effects and immune tolerance. Combination treatment with NL(pro-TLR7/8a) and immune checkpoint inhibitors (anti-CTLA-4 plus anti-PD-L1) or nanoliposomes (Doxorubicin) has synergistic effects on antitumor immunity in various tumor models. The concept of pro-TLR7/8a suggested herein may facilitate the advancement of small-molecule-based immunomodulators for clinical translation and safe and effective cancer immunotherapy., (© 2023 Wiley-VCH GmbH.)

Although adoptive cell-based therapy is illuminated as one of the promising approaches in cancer immunotherapy, it shows low antitumor efficacy because transferred cells adapt and alter toward a pro-tumoral phenotype in response to the tumor's immunosuppressive milieu. Herein, nanoengineered macrophages anchored with functional liposome armed with cholesterol-conjugated Toll-like receptor 7/8 agonist (masked TLR7/8a, m7/8a) are generated to overcome the shortcomings of current macrophage-based therapies and enhance the remodeling of the immunosuppressive tumor microenvironment (TME). The liposome-anchored macrophages (LAMΦ-m7/8a), are fabricated by anchoring dibenzocyclooctyne-modified liposome(m7/8a) onto azido-expressing macrophages via a bio-orthogonal click reaction, are continuously invigorated due to the slow internalization of liposome(m7/8a) and sustained activation. LAMΦ-m7/8a secreted ≈3 and 33-fold more IL-6 and TNF-α than conventional M1-MΦ, maintained the M1 phenotype, and phagocytosed tumor cells for up to 48 h in vitro. Both intratumoral and intravenous injections of LAMΦ-m7/8a induced effective antitumor efficacy when treated in combination with doxorubicin-loaded liposomes in 4T1-tumor bearing mice. It not only increases the infiltration of antigen-specific CD8 + T cells secreting granzyme B, IFN-γ, and TNF-α within the TME, but also reduces myeloid-derived suppressor cells. These results suggest that LAMΦ-m7/8a may provide a suitable alternative to next-generation cell-based therapy platform., (© 2023 Wiley‐VCH GmbH.)

Transcranial Direct Current Stimulation (tDCS) has benefits for motor rehabilitation in stroke patients, but its clinical application is limited due to inter-individual heterogeneous effects. Recently, optimized tDCS that considers individual brain structure has been proposed, but the utility thereof has not been studied in detail. We explored whether optimized tDCS provides unique electrode positions for each patient and creates a higher target electric field than the conventional approach. A comparative within-subject simulation study was conducted using data collected for a randomized controlled study evaluating the effect of optimized tDCS on upper extremity function in stroke patients. Using Neurophet tES LAB 3.0 software, individual brain models were created based on magnetic resonance images and tDCS simulations were performed for each of the conventional and optimized configurations. A comparison of electrode positions between conventional tDCS and optimized tDCS was quantified by calculation of Euclidean distances. A total of 21 stroke patients were studied. Optimized tDCS produced a higher electric field in the hand motor region than conventional tDCS, with an average improvement of 20% and a maximum of 52%. The electrode montage for optimized tDCS was unique to each patient and exhibited various configurations that differed from electrode placement of conventional tDCS. Optimized tDCS afforded a higher electric field in the target of a stroke patient compared to conventional tDCS, which was made possible by appropriately positioning the electrodes. Our findings may encourage further trials on optimized tDCS for motor rehabilitation after stroke., (© 2024. The Author(s).)

Purpose: To evaluate the effectiveness of whitening toothpaste in restoring tooth color after coffee staining and its potential impact on enamel surfaces compared with regular toothpaste., Methods: Bovine tooth enamel specimens were prepared and stained with coffee solutions before undergoing brushing simulation with different toothpaste slurries (whitening, regular, reference). For precise evaluation, spectrophotometric measurements were taken at intervals to assess color changes using the CIELAB (Commission Internationale de l'Éclairage Lab*) color space. Additionally, profilometric measurements were taken to determine the impact of toothpaste type on the roughness and abraded depth of the enamel surface. To understand the effects of toothpaste and brushing on color change, surface roughness, and abraded depth, while also considering correlations between these factors, the findings were analyzed using mixed-effects models., Results: The whitening toothpaste group demonstrated the highest recovery rate (71%) after 10,000 brushstrokes, followed by the regular toothpaste group (48%) and the reference slurry group (43%). The mixed-effects model analysis revealed that the reference group had a smaller change in lightness (ΔL) than those in the regular toothpaste group. The whitening toothpaste group showed a greater change in lightness on average than those in the regular toothpaste group, with an increase in lightness as the number of brushstrokes increased. According to the roughness and abraded depth data, the whitening toothpaste group was least affected by brushing, while the reference and regular toothpaste groups showed higher levels of roughness and abraded depth at all intervals., Clinical Significance: Gaining a thorough understanding of the effectiveness of whitening toothpaste and its impact on the enamel surface plays a crucial role in refining toothpaste formulations and advancing tooth whitening techniques in dental care., Competing Interests: The authors declare no conflicts of interest related to this research. Ms. Kim and Dr. Yoo contributed equally to this work. This research was supported by Korea Medical Device Development Fund grant funded by the Korea government (the Ministry of Science and ICT, the Ministry of Trade, Industry and Energy, the Ministry of Health & Welfare, the Ministry of Food and Drug Safety) (Project Number: 1711134912, RS-2020-KD000002), and partly supported by the Basic Science Research Program through the National Research Foundation of Korea (NRF) funded by the Ministry of Education (2021R1l1A2048516)., (Copyright©American Journal of Dentistry.)

Conventional statistical investigations have primarily focused on the comparison of the simple one-dimensional characteristics of protein cavities, such as number, surface area, and volume. These studies have failed to discern the crucial distinctions in cavity properties between thermophilic and mesophilic proteins that contribute to protein thermostability. In this study, the significance of cavity properties, i.e., flexibility and location, in protein thermostability was investigated by comparing structural differences between homologous thermophilic and mesophilic proteins. Three dimensions of protein structure were categorized into three regions (core, boundary, and surface) and a comparative analysis of cavity properties using this structural index was conducted. The statistical analysis revealed that cavity flexibility is closely related to protein thermostability. The core cavities of thermophilic proteins were less flexible than those of mesophilic proteins (averaged B' factor values, -0.6484 and -0.5111), which might be less deleterious to protein thermostability. Thermophilic proteins exhibited fewer cavities in the boundary and surface regions. Notably, cavities in mesophilic proteins, across all regions, exhibited greater flexibility than those in thermophilic proteins (>95% probability). The increased flexibility of cavities in the boundary and surface regions of mesophilic proteins, as opposed to thermophilic proteins, may compromise stability. Recent protein engineering investigations involving mesophilic xylanase and protease showed results consistent with the findings of this study, suggesting that the manipulation of flexible cavities in the surface region can enhance thermostability. Consequently, our findings suggest that a rational or computational approach to the design of flexible cavities in surface or boundary regions could serve as an effective strategy to enhance the thermostability of mesophilic proteins.

Over recent decades, machine learning, an integral subfield of artificial intelligence, has revolutionized diverse sectors, enabling data-driven decisions with minimal human intervention. In particular, the field of educational assessment emerges as a promising area for machine learning applications, where students can be classified and diagnosed using their performance data. The objectives of Diagnostic Classification Models (DCMs), which provide a suite of methods for diagnosing students' cognitive states in relation to the mastery of necessary cognitive attributes for solving problems in a test, can be effectively addressed through machine learning techniques. However, the challenge lies in the latent nature of cognitive status, which makes it difficult to obtain labels for the training dataset. Consequently, the application of machine learning methods to DCMs often assumes smaller training sets with labels derived either from theoretical considerations or human experts. In this study, the authors propose a supervised diagnostic classification model with data augmentation (SDCM-DA). This method is designed to utilize the augmented data using a data generation model constructed by leveraging the probability of correct responses for each attribute mastery pattern derived from the expert-labeled dataset. To explore the benefits of data augmentation, a simulation study is carried out, contrasting it with classification methods that rely solely on the expert-labeled dataset for training. The findings reveal that utilizing data augmentation with the estimated probabilities of correct responses substantially enhances classification accuracy. This holds true even when the augmentation originates from a small labeled sample with occasional labeling errors, and when the tests contain lower-quality items that may inaccurately measure students' true cognitive status. Moreover, the study demonstrates that leveraging augmented data for learning can enable the successful classification of students, thereby eliminating the necessity for specifying an underlying response model., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Yoon et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Microalgae are one of the promising feedstocks for biorefinery, contributing significantly to net-zero emissions through carbon capture and utilization. However, the disposal of microalgal byproducts from the manufacturing process causes additional environmental pollution, thus, a new application strategy is required. In this study, the Tetraselmis suecica byproduct from the carotenoid extraction process was carbonized and converted into biochar. The converted biochar was proved to be nitrogen-doped biochar (NDB), up to 4.69%, with a specific surface area of 206.59 m 2 /g and was used as an electrode for a supercapacitor. The NDB electrode (NDB-E) in half-cell showed a maximum specific capacitance of 191 F/g. In a full-cell test, the NDB-E exhibited a high energy density of 7.396 Wh/kg and a high-power density of 18,100 W/kg, and maintained specific capacity of 95.5% after charge and discharge of 10,000 cycles. In conclusion, our study demonstrated that the carotenoid-extracted microalgal byproducts are a useful resource for the supercapacitor production. This approach is the first to convert T. suecica into active materials for supercapacitors., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024. Published by Elsevier B.V.)

Competing Interests: The authors report no conflicts of interest.

In a patient whose sudden vision loss is suspected on the side of a previously operated sphenoid or ethmoid sinus, an ischemic insult to the optic nerve may occur due to a compressing mucocele, especially when there is bony dehiscence of the orbital apex. We report a case of a 41-year-old healthy male patient who had a history of previous sinus surgery, and visited the emergency department for an abrupt left ocular pain following visual loss of the affected eye. The patient's left eye's best corrected visual acuity (BCVA) was hand motions with a reduced light reflex. A sphenoethmoidal sinus cell (Onodi cell) mucocele with bone dehiscence in the left orbital apex was seen on computed tomography. Upon suspicion of compressive ischemic optic neuropathy, urgent endoscopy-assisted endonasal marsupialization of the Onodi cell mucocele with high-dose pulse intravenous dexamethasone was performed. The pathology showed an inflamed nasal mucosa, confirming a mucocele. On the second postoperative day, his BCVA slightly improved in counting fingers at 30 cm. However, even though the nasalized Onodi cell remained intact, his eyesight did not show further improvement. The optic nerve may be directly insulted when a mucocele in the Onodi cell takes place, especially when there is bony dehiscence in the orbital apex. Despite accelerated surgical marsupialization and high-dose steroids, the chance of visual recovery remains very low, as demonstrated in our case., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Severe stress endangers outdoor workers who are in an exceedingly hot workplace. Although recent studies quantify stress levels on the human skin, they still rely on rigid, bulky sensor modules, causing data loss from motion artifacts and limited field-deployability for continuous health monitoring. Moreover, no prior work shows a wearable device that can endure heat exposure while showing continuous monitoring of a subject's stress under realistic working environments. Herein, a soft, field-deployable, wearable bioelectronic system is introduced for detecting outdoor workers' stress levels with negligible motion artifacts and controllable thermal management. A nanofabric radiative cooler (NFRC) and miniaturized sensors with a nanomembrane soft electronic platform are integrated to measure stable electrodermal activities and temperature in hot outdoor conditions. The NFRC exhibits outstanding cooling performance in sub-ambient air with high solar reflectivity and high thermal emissivity. The integrated wearable device with all embedded electronic components and the NFRC shows a lower temperature (41.1%) in sub-ambient air than the NFRC-less device while capturing improved operation time (18.2%). In vivo human study of the bioelectronics with agricultural activities demonstrates the device's capability for portable, continuous, real-time health monitoring of outdoor workers with field deployability., (© 2023 Wiley-VCH GmbH.)

Fano resonance, known for its unique asymmetric line shape, has gained significant attention in photonics, particularly in sensing applications. However, it remains difficult to achieve controllable Fano parameters with a simple geometric structure. Here, a novel approach of using a thin-film optical Fano resonator with a porous layer to generate entire spectral shapes from quasi-Lorentzian to Lorentzian to Fano is proposed and experimentally demonstrated. The glancing angle deposition technique is utilized to create a polarization-dependent Fano resonator. By altering the linear polarization between s- and p-polarization, a switchable Fano device between quasi-Lorentz state and negative Fano state is demonstrated. This change in spectral shape is advantageous for detecting materials with a low-refractive index. A bio-particle sensing experiment is conducted that demonstrates an enhanced signal-to-noise ratio and prediction accuracy. Finally, the challenge of optimizing the film-based Fano resonator due to intricate interplay among numerous parameters, including layer thicknesses, porosity, and materials selection, is addressed. The inverse design tool is developed based on a multilayer perceptron model that allows fast computation for all ranges of Fano parameters. The method provides improved accuracy of the mean validation factor (MVF = 0.07, q-q') compared to the conventional exhaustive enumeration method (MVF = 0.37)., (© 2023 The Authors. Advanced Science published by Wiley-VCH GmbH.)

Mucoceles are cystic formations characterized by the presence of mucus-secreting epithelial cells, which enlarge when the excretory duct becomes obstructed. Posterior ethmoidal mucoceles are rare conditions that can lead to severe ocular complications requiring immediate intervention. The close anatomical proximity of posterior ethmoidal mucoceles to the optic nerve underscores their significance. In this case report, we present a case of rapidly progressing compressive optic neuropathy secondary to a posterior ethmoidal mucocele. A previously healthy forty-six-year-old woman presented with sudden visual loss in her left eye, preceded by left-sided headache and periorbital pain. Clinical examination and imaging studies revealed an oval-shaped mass within the posterior ethmoid cell compressing the left optic nerve. Emergency surgery was performed to alleviate optic nerve compression, which successfully relieved periocular pain. However, the patient's visual acuity and visual field defect remained unchanged postoperatively. Thinning of the ganglion cell layer in the macula region was observed during follow-up examinations. The role of corticosteroids and antibiotics in visual rehabilitation and the impact of delayed surgical decompression on visual outcome remain subjects of debate. Additional cases of mucocele-associated optic neuropathy should be published and analyzed to establish optimal treatment approaches., (© 2023. BioMed Central Ltd., part of Springer Nature.)

Background: Optical coherence tomography (OCT) can detect visual alterations associated with Parkinson disease, such as damage to the retinal nerve fiber layer or changes in retinal vasculature. Macula thinning in association with Parkinson disease (PD) remains controversial. Therefore, we conducted a meta-analysis to investigate the central retina thickness in PD measured using spectral-domain OCT (SD-OCT)., Methods: We searched PubMed and the Excerpta Medica database to identify studies that compared macular thickness between patients with PD and healthy controls published before July 31, 2021. A random-effects model was used to examine PD-associated changes in macular thickness. Meta-regression analysis was performed by assessing heterogeneity, publication bias, and study quality., Results: Thirty-two studies with a cross-sectional design were selected, including 2118 patients with PD and 2338 controls. We identified significant differences in the thickness of the ganglion cell-inner plexiform layer (standardized mean difference [SMD], -0.41; 95% confidence interval [CI], -0.66 to -0.16; I2 = 80%), ganglion cell complex (SMD, -0.33; 95% CI, -0.50 to -0.17; I2 = 0%), and of all inner and outer sectors of the macula (SMD range, -0.21 to -0.56; all P < .05) between patients with PD and controls., Discussion: These results corroborate the increased prevalence of changes in OCT measures in individuals with PD, highlighting the efficacy of SD-OCT-determined macular thickness as a biomarker for PD. Our findings may provide helpful guidelines for clinicians in rapidly evolving areas of PD diagnosis., Competing Interests: The authors have no conflicts of interest to disclose., (Copyright © 2023 the Author(s). Published by Wolters Kluwer Health, Inc.)

Objectives: As the impact of chronic kidney disease (CKD) severity on different bone types remains unclear, we induced increasing levels of CKD severity in a rat model and investigated hormone and mineral levels as well as alveolar and tibia bone histomorphology., Methods: Rats were divided into sham operation (sham), 4/6 nephrectomy (4/6Nx), 5/6Nx, and 4/6Nx with hyperphosphorous (HP) diet (4/6NxHP). At week 20, BUN, FGF23, PTH, and P were estimated in plasma. Bone parameters were evaluated by microCT, and osteoclasts and osteoid areas were evaluated by TRAP and H&E stains, respectively., Results: The 4/6NxHP and 5/6Nx groups had elevated PTH, and the 4/6NxHP group alone had elevated P. Compared to the 4/6Nx group, the 4/6NxHP group demonstrated increased FGF23 and P. In the alveolar bone, the 4/6NxHP group had reduced bone volume and BMD compared to the sham and 4/6Nx groups. In the tibia cortical bone, bone surface density was higher in the 4/6NxHP group compared to the sham group. Tibia cortical bone volume was negatively correlated with FGF23 and P. Moreover, alveolar bone volume was negatively correlated with FGF23, PTH, and P., Conclusions: Our results demonstrate that hormone and mineral levels vary with CKD severity, and alveolar bone loss strongly correlates with these hormone and mineral alterations., (© 2022 Wiley Periodicals LLC.)

Background/purpose: One of the challenges in adhesive ceramic restorations is deterioration of tooth-cement-ceramic interfaces. This study was to quantitatively investigate lipopolysaccharide (LPS) penetration through adhesive ceramic restorations., Materials and Methods: Standardized holes were formed on ceramic (IPS Empress CAD, Ivoclar Vivadent) and human dentin discs. Prepared discs were randomly assigned to experimental groups (n = 6/group): SC, self-adhesive resin cement (SmartCem 2, Dentsply Sirona) bonded to ceramic discs; ST, self-adhesive resin cement bonded to dentin discs; VC, etch-and-rinse resin cement (Variolink II, Ivoclar Vivadent AG) bonded to ceramic discs; VT, etch-and-rinse resin cement bonded to dentin discs. The specimens underwent thermocycling (10,000 cycles; 5-55 °C) then LPS penetration test until 5-weeks. A mixed effect analysis using R statistical language was performed for data analysis., Results: Dentin and ceramic bonded with etch-and-rinse resin cements (groups VT and VC) showed significantly less penetration than those with self-adhesive resin cement (groups ST and SC) ( P  < 0.05). ST showed significantly lower penetration than SC ( P  < 0.05), that showed similar penetration with positive control ( P  > 0.05). VC showed minimal penetration during observed time of period ( P  < 0.05). Scanning electron microscope observations showed different interfacial characteristics among the groups., Conclusion: Within the limitation of this study, etch-and-rinse resin cement showed less LPS penetration than self-adhesive resin cement on both ceramic and dentin surfaces., Competing Interests: The authors declare no conflicts of interest., (© 2022 Association for Dental Sciences of the Republic of China. Publishing services by Elsevier B.V.)

This study was to investigate the new analysis manner of dental hard tissue change using in vivo micro-computed tomography (CT) in rat. Scanning, registration, analyzing, and presenting method to track longitudinal in vivo micro-CT data on dental hard tissues were validated in murine models: formative, dentin thickness after direct pulp capping with mineral trioxide aggregate; resorptive, development of apical bone rarefaction in apical periodontitis model. Serial in vivo micro-CT scans were analyzed through rigid-registration, active-contouring, deformable-registration, and motion vector-based quantitative analyses. The rate and direction of hard tissue formation after direct pulp capping was datafied by tracing coordinate shift of fiducial points on pulp chamber outline in formative model. The development of apical periodontitis could be monitored with voxel counts, and quantitatively analyzed in terms of lesion size, bone loss, and mineral density in resorptive model. This study supports the application of longitudinal in vivo micro-CT for resorptive- and formative-phase specific monitoring of dental hard tissues.

Phase Change Materials (PCMs) have demonstrated tremendous potential as a platform for achieving diverse functionalities in active and reconfigurable micro-nanophotonic devices across the electromagnetic spectrum, ranging from terahertz to visible frequencies. This comprehensive roadmap reviews the material and device aspects of PCMs, and their diverse applications in active and reconfigurable micro-nanophotonic devices across the electromagnetic spectrum. It discusses various device configurations and optimization techniques, including deep learning-based metasurface design. The integration of PCMs with Photonic Integrated Circuits and advanced electric-driven PCMs are explored. PCMs hold great promise for multifunctional device development, including applications in non-volatile memory, optical data storage, photonics, energy harvesting, biomedical technology, neuromorphic computing, thermal management, and flexible electronics., Competing Interests: The authors declare no competing interests., (© 2023 The Author(s).)