Subacute Neurological Deterioration with Selective Axonal Injury in Patients with Acute Ischemic Stroke following Reperfusion of Middle Cerebral Artery Occlusion

To date, the long-term effects of reperfusion on the salvaged brain tissues have not been addressed in the literature. We report 4 cases presenting subacute neurological deteriorations with selective axonal injury following reperfusion therapies for acute ischemic stroke. Our case series based on 4 patients showed common features distinct from those of early reperfusion injury in that (1) the neurological symptoms developed after 1-2 months of reperfusion therapies, (2) these symptoms were accompanied by the subcortical white matter changes on brain MRI, and (3) these findings were mostly reversible with time. This suggests that axons in the reperfused brain may be vulnerable to further neurological injury

Changes in the Contribution of Termites to Mass Loss of Dead Wood among Three Tree Species during 23 Months in a Lowland Tropical Rainforest

This study investigated the contribution of termites to mass loss of dead wood (Macaranga bancana, Elateriospermum tapos, and Dillenia beccariana) in a lowland tropical rainforest, Brunei Darussalam. Mesh bag method was used to exclude termites, and the mass remaining was monitored after 3, 7, 13, and 23 months. C/N ratio of the samples was analyzed after 13 and 23 months. Initial wood density was 0.63, 0.92, and 1.02 g/cm3 for M. bancana, E. tapos, and D. beccariana, respectively, and the termite contribution to mass loss was an average (range) of 13.05±5.68 (4.17-29.59%), 3.48±1.13 (2.20-6.49), and 3.40±1.92% (0.74-10.78), respectively. Until 7 months, termites contributed highly to mass loss, given the low initial wood density, and interaction effect of species and treatment was significant. After 7 months, the contribution decreased in M. bancana and E. tapos, whereas it increased consistently in D. beccariana. The interaction effect was not significant, whereas differences in C/N ratio among the species were significant, with a lower C/N ratio in M. bancana and E. tapos than in D. beccariana. After 23 months, the differences in C/N ratio were not significant, and ants were present at 40% of control samples in M. bancana and E. tapos. Our results suggest that the contribution of termites to mass loss varies by dead wood species and is temporally variable. Initial wood traits could affect the termite feeding in the beginning, however, termites thereafter could forage in response to the varying C/N ratio among species and predators

International consensus conference recommendations on ultrasound education for undergraduate medical students

Objectives: The purpose of this study is to provide expert consensus recommendations to establish a global ultrasound curriculum for undergraduate medical students. Methods: 64 multi-disciplinary ultrasound experts from 16 countries, 50 multi-disciplinary ultrasound consultants, and 21 medical students and residents contributed to these recommendations. A modified Delphi consensus method was used that included a systematic literature search, evaluation of the quality of literature by the GRADE system, and the RAND appropriateness method for panel judgment and consensus decisions. The process included four in-person international discussion sessions and two rounds of online voting. Results: A total of 332 consensus conference statements in four curricular domains were considered: (1) curricular scope (4 statements), (2) curricular rationale (10 statements), (3) curricular characteristics (14 statements), and (4) curricular content (304 statements). Of these 332 statements, 145 were recommended, 126 were strongly recommended, and 61 were not recommended. Important aspects of an undergraduate ultrasound curriculum identified include curricular integration across the basic and clinical sciences and a competency and entrustable professional activity-based model. The curriculum should form the foundation of a life-long continuum of ultrasound education that prepares students for advanced training and patient care. In addition, the curriculum should complement and support the medical school curriculum as a whole with enhanced understanding of anatomy, physiology, pathophysiological processes and clinical practice without displacing other important undergraduate learning. The content of the curriculum should be appropriate for the medical student level of training, evidence and expert opinion based, and include ongoing collaborative research and development to ensure optimum educational value and patient care. Conclusions: The international consensus conference has provided the first comprehensive document of recommendations for a basic ultrasound curriculum. The document reflects the opinion of a diverse and representative group of international expert ultrasound practitioners, educators, and learners. These recommendations can standardize undergraduate medical student ultrasound education while serving as a basis for additional research in medical education and the application of ultrasound in clinical practice

Comparative Study on the Pulse Wave Variables and Sasang Constitution in Cerebral Infarction Patients and Healthy Subjects

This study was performed to determine whether a pulse analyzer was useful 1) to characterize the variables of pulse wave of cerebral infarction patieno (CI), compared with those of healthy subjects, as well as 2) to determine Sasang Constitution in CI and healthy subjects. 1. Calibrated in Gwan, the amount of energy(Energy), height of main peak(H1), height of aorticvalley(H2), height of aortic peak(H3), total area of pulse wave(At), and area of main peak width(Aw) of the CI group were higher than those of the healthy group. 2. Calibrated in Cheek, Energy, H1, H2, H3, height of valve valley(H4), At, Aw, and main peak angle(MPA) of the CI group were higher than those of the healthy group. 3. Among the healthy (subjects) group, Taeumin showed the highest contact pressure(CP) and height of valve peak(H5) calibrated in Chon. The main peak width divided by whole time of pulse wave(MPW/T) calibrated in Gwan and Cheok, was highest in Soyangin and was lowest in Taeumin. The H3 divided by H1(H3/H1) and the time to valve valley minus the time to main peak and divided by T[(T4-T1)/T] calibrated in Cheek were highest in Soyangin. The time to main peak(T1) was longest in Soumin. 4. Among the CI group, At calibrated in Chon was widest in Taeumin and was narrowest in Soumin The time to aortic peak(T3) calibrated in Cheek was longest in Soumin and was shortest in Soyangin. The time to valve peak(T5) was shortest in Soyangin. 5. There were main effects of cerebral infarction in the area of systolic period(As) and area of diastolic period(Ad) calibrated in Chon, Energy calibrated in Cwan, and Energy, H1, H2, H3, (H4+H5)/Hl, and MPA calibrated in Cheek. 6. There were main effects of Sasang Constitution in (T4-T1)/T, area of systolic period(As), and Ad calibrated in Chon. 7. The interactions between the cerebral infarction and Sasang Constitution were observed in H5/H1 , T, At, As, Ad, and MPA calibrated in Chon, H4, T4, (T4-T1)/T, As, and Ad calibrated in Cwan, and 74,75, and MPW calibrated in Cheok. Therefore, we concluded that pulse analyzer was useful to determine the risk degree of cerebral infarction and Sasang Constitution

New Radiation-Hardened Design of a CMOS Instrumentation Amplifier and its Tolerant Characteristic Analysis

A radiation-hardened instrumentation amplifier (IA) that allows precise measurement in radiation environments, including nuclear power plants, space environments, and radiation therapy rooms, was designed and manufactured, and its characteristics were verified. Most electronic systems are currently designed using silicon-based complementary metal-oxide semiconductor (CMOS) integrated circuits (ICs) to achieve a highly integrated low-power design. However, fixed charges induced in silicon by ionization radiation cause various negative effects, resulting in, for example, the generation of leakage current in circuits, performance degradation, and malfunction. Given that such problems in radiation environments may directly lead to a loss of life or environmental contamination, it is critical to implement radiation-hardened CMOS IC technology. In this study, an IA used to amplify fine signals of the sensors was designed and fabricated in the 0.18 μm CMOS bulk process. The IA contained sub-circuits that ensured the stable voltage supply needed to implement system-on-chip (SoC) solutions. It was also equipped with special radiation-hardening technology by applying an I-gate n-MOSFET that blocks the radiation-induced leakage currents. Its ICs were verified to provide the intended performance following a total cumulative dose of up to 25 kGy(Si), ensuring its safety in radiation environments

Cardiac Arrhythmias and Abnormal Electrocardiograms After Acute Stroke

Cardiac arrhythmias and electrocardiogram (ECG) abnormalities occur frequently but are often underrecognized after strokes. Acute ischemic and hemorrhagic strokes in some particular area of brain can disrupt central autonomic control of the heart, precipitating cardiac arrhythmias, ECG abnormalities, myocardial injury and sometimes sudden death. Identification of high-risk patients after acute stroke is important to arrange appropriate cardiac monitoring and effective management of arrhythmias, and to prevent cardiac morbidity and mortality. More studies are needed to better clarify pathogenesis, localization of areas associated with arrhythmias and practical management of arrhythmias and abnormal ECGs after acute stroke

Modeling and Simulation-Based Layout Optimization for Tolerance to TID Effect on n-MOSFET

In the present study, the layout structure of an n-MOSFET, which is vulnerable to radiation, was designed in a different way to enhance its tolerance to radiation. Radiation damage assessment was conducted using modeling and simulation (M&S) techniques before actual semiconductor process fabrication and radiation tests to verify its tolerance properties. Based on the M&S techniques, the role of each layer was determined to improve the radiation tolerance of semiconductors, and the layout design of an n-MOSFET with enhanced radiation tolerance was optimized. The optimized radiation-tolerant n-MOSFET design was implemented in the 0.18-um CMOS bulk process, and radiation exposure tests were conducted on the device. A cumulative radiation dose up to 2 Mrad(Si) was applied to verify its radiation-tolerant performance. Developing new devices using M&S techniques for radiation damage assessment allows reliable estimates of their electrical and radiation-tolerant properties to be obtained in advance of the actual manufacturing process, thereby minimizing development costs and time

Dynamic Game Level Generation Using On-Line Learning

In recent years, many researchers are attracted to computer games research. Capable gamers can easily get bored, while beginners tend to give up after trying several times because the game does not correspond to their level of interest. Therefore, this paper proposes that the user’s play pattern to be modeled on the basis of probability and level designer will dynamically generates the gaming level accordingly. We analyze user’s play pattern and design pattern based on GMM (probability model) and dynamically generate the level with online learning technique adapting the reinforcement technique. The play pattern is modeled using GMM and in order to create game level dynamically, the method of updating the weight of enemy creation using online script is proposed. Finally, we apply our proposed method to a 2D shooting game and introduce user’s play pattern leading to design pattern in the game