Automatic identification of posteroanterior cephalometric landmarks using a novel deep learning algorithm: a comparative study with human experts.

This study aimed to propose a fully automatic posteroanterior (PA) cephalometric landmark identification model using deep learning algorithms and compare its accuracy and reliability with those of expert human examiners. In total, 1032 PA cephalometric images were used for model training and validation. Two human expert examiners independently and manually identified 19 landmarks on 82 test set images. Similarly, the constructed artificial intelligence (AI) algorithm automatically identified the landmarks on the images. The mean radial error (MRE) and successful detection rate (SDR) were calculated to evaluate the performance of the model. The performance of the model was comparable with that of the examiners. The MRE of the model was 1.87 ± 1.53 mm, and the SDR was 34.7%, 67.5%, and 91.5% within error ranges of < 1.0, < 2.0, and < 4.0 mm, respectively. The sphenoid points and mastoid processes had the lowest MRE and highest SDR in auto-identification; the condyle points had the highest MRE and lowest SDR. Comparable with human examiners, the fully automatic PA cephalometric landmark identification model showed promising accuracy and reliability and can help clinicians perform cephalometric analysis more efficiently while saving time and effort. Future advancements in AI could further improve the model accuracy and efficiency.

Bactericidal Effect of Underwater Plasma Treatment on Waste Brine from Kimchi Production Process and the Evaluation of Reusability of Plasma-Treated Waste Brine in Salting Kimchi Cabbage.

Recycling waste brine from the Kimchi production process is an important environmental and industry issue. We applied an underwater plasma to reduce food-borne pathogens in the waste brine. The capillary electrodes supplied by alternating current (AC) bi-polar pulsed power were applied to treat 100 L of waste brine. The inactivation efficacy was analyzed using four different agars (Tryptic Soy Agar (TSA), Marine agar (MA), de Man Rogosa Sharpe Agar (MRS), and Yeast Extract-Peptone-Dextrose (YPD), respectively. The microbial population was reduced linearly with treatment time, irrespective of culturing medium. The inactivation followed the log-linear model (R2: 0.96-0.99). The reusability of plasma-treated waste brine (PTWB) was determined by five parameters (salinity, pH, acidity, reducing sugar, and the population of microorganisms) of salted Kimchi cabbage, and they were compared with newly made brine (NMB) and waste brine (WB), respectively. The results showed that the quality of salted Kimchi cabbage prepared by PTWB was not significantly different from that of NMB, indicating that the underwater plasma treatment is feasible to reuse waste brine in the salting process of Kimchi production.

In-package cold plasma treatment for microbial inactivation in plastic-pouch packaged steamed rice cakes.

In-package atmospheric cold plasma (ICP) treatment was investigated as a method to inactivate microorganisms in Korean steamed rice cakes (SRCs) packaged in plastic pouches. The effect against Escherichia coli O157:H7 increased with increasing ICP treatment power and time and using nylon-containing pouches. Moreover, E. coli O157:H7 growth was effectively inhibited at 4 and 25 °C when SRCs were in a pouch filled with an O2-CO2 (70 % and 30 %) gas. Under optimal treatment power (30 W), treatment time (4 min), and headspace-to-SRC volume ratio (7:1) conditions, ICP effectively inactivated E. coli O157:H7, Bacillus cereus spores, Penicillium chrysogenum, and indigenous aerobic bacteria, as well as yeast and molds in SRCs packaged with air in the nylon/low density polyethylene pouch by 2.2 ± 0.2 log CFU/g, 1.4 ± 0.2 log spores/g, 2.2 ± 0.3 log spores/g, 1.1 ± 0.2 log CFU/g, and 1.0 ± 0.1 log CFU/g, respectively. Furthermore, post-treatment storage was effective in preventing the growth of E. coli O157:H7 in SRCs at 4 °C and 25 °C when the pouch was filled with N2-CO2 (50 % and 50 %) or O2-CO2 (70 % and 30 %). Collectively, these findings indicate that ICP treatment effectively decontaminates SRCs and represents a potential non-thermal microbial decontamination technology for SRCs in pouch packaging.

The Effect of Gap Distance between a Pin and Water Surface on the Inactivation of Escherichia coli Using a Pin-to-Water Plasma.

Atmospheric plasmas have been applied for the inactivation of microorganisms. Industrials demand to investigate the relation of the key reactive species induced by plasmas and the operating parameters including boundary conditions in order to control plasma treatment processes. In this study, we investigated the effect of gap distance between a pin-electrode and water surface on inactivation efficacy. When the gap distance decreased from 5 mm to 1 mm, the reduction of Escherichia coli (E. coli) was increased to more than 4 log CFU/mL. The reactive oxygen species measured optically and spectrophotometrically were influenced by gap distance. The results from electron spin resonance (ESR) analysis showed that the pin-to-water plasma generated hydroxyl radical (OH•) and singlet oxygen (1O2) in the water and superoxide radical (O2-•) served as a precursor of OH•. The inactivation of E. coli was significantly alleviated by sodium azide (1O2 scavenger), indicating that 1O2 contributes the most to bacterial inactivation. These findings provide a potentially effective strategy for bacterial inactivation using a pin-to-water plasma.

Plasma-catalytic ethylene removal by a ZSM-5 washcoat honeycomb monolith impregnated with palladium.

The effective removal of dilute ethylene in a novel honeycomb plasma reactor was investigated using a honeycomb catalyst (Pd/ZSM-5/monolith) sandwiched between two-perforated electrodes operating at ambient temperature. Herein, the dependence of catalyst performance on the binder fraction, catalyst preparation method, and catalyst loading was examined. Ethylene removal was carried out by a process comprising cycles of 30-min adsorption conjugated with 15-min plasma-catalytic oxidation. Interestingly, the performance of the cyclic process was superior to continuous plasma-catalytic oxidation and thermally activated catalyst in terms of energy conservation, i.e., ~36 compared to ~105 and ~300 J/L, respectively. Hence, the novel cyclic process can be considered advanced-oxidation technology that features room-temperature oxidation, offers low energy consumption, negligible hazardous by-products emissions such as NOx and O3. Moreover, the process operated under described conditions: low-pressure drop, ambient atmosphere, a mechanically stable system, and a simple reactor configuration, suggesting the practical applicability of this plasma process.

Removal of ethyl acetate in air by using different types of corona discharges generated in a honeycomb monolith structure coated with Pd/γ-alumina.

A method based on the corona discharge produced by high voltage alternating current (AC) and direct current (DC) over a Pd/γ-Al2O3 catalyst supported on a honeycomb structure monolith was developed to eliminate ethyl acetate (EA) from the air at atmospheric pressure. The characteristics of the AC and DC corona discharge generated inside the honeycomb structure monolith were investigated by varying the humidity, gas hourly space velocity (GHSV), and temperature. The results showed that the DC corona discharge is more stable and easily operated at different operating conditions such as humidity, GHSV, and gas temperature compared to the AC discharge. At a given applied voltage, the EA conversion in the DC honeycomb catalyst discharge is, therefore, higher compared with that in the AC honeycomb catalyst discharge (e.g., 96% of EA conversion compared with approximately 68%, respectively, at 11.2 kV). These new results can open opportunities for wide applications of DC corona discharge combined with honeycomb catalysts to VOC treatment.

[Danger in the pocket: explosive e-cigarette]. / Gefahr in der Hosentasche ­ explosive E-Zigarette.

INTRODUCTION: Be it as a nicotine replacement or a fashionable seduction for young people or casual smokers with or without nicotine additives - the popularity of e-cigarettes in Europe has increased during the past decade. In addition to the potential of long-term pulmonary damage, which is still largely unknown to date, there is a risk of battery explosion with specific injury patterns. Most users are unaware of the danger in their pockets. MATERIAL AND METHODS: Between February and July 2019, four patients were treated with burns from exploded e-cigarettes in the burn centre at Sana Hospital in Offenbach am Main (Germany). This article describes the cause and extent of the injury and its treatment. RESULTS: In all patients, the cause of the explosion was what is called "thermal runaway" (very rapid discharge of the battery). The average age of the patients, who were exclusively male, was 37 (25-50) years. The combustion depth ranged from grade I to deep grade IIb. The burnt body surface averaged 3 % (0.5-4.5 %) TBSA and affected the body regions that are typically in direct contact with the e-cigarette: thighs, genitals and hands. Conservative treatment was successful in one case and surgical treatment in two cases (two alloplastic covers, one meshed split-skin transplant). One patient discharged himself from hospital against medical advice after initial treatment. The average time in hospital for the three remaining patients was 15.6 days (6-17). CONCLUSION: Burns from an exploding e-cigarette represent a rare new entity. The force of the explosion of the battery body leads to injury patterns that require treatment in specialised centres with the entire spectrum of burn care. Mixed injuries with deep burns occur at the predilection sites due to thermal action, colliquative necrosis due to leaking electrolyte fluid and contamination by foreign bodies (metallic lithium, splinters of the destroyed housing) and require special initial measures. The extinction of fire caused by e-cigarettes also requires special measures. Proper handling of CE-certified devices is essential. Manipulation of the device in the event of defective functions or defective batteries is highly dangerous and should be strictly prohibited. General security requirements must be observed.

Non-thermal dielectric-barrier discharge plasma induces reactive oxygen species by epigenetically modifying the expression of NADPH oxidase family genes in keratinocytes.

We have previously shown that non-thermal dielectric-barrier discharge (DBD) plasma induces the generation of reactive oxygen species (ROS) in cells; however, the underlying mechanism has not been elucidated. This study aimed to identify the mechanisms through which DBD plasma induces the expression of NADPH oxidase (NOX) family members by epigenetic modification in human keratinocytes (HaCaT). Cell exposure to DBD plasma in 10% oxygen and 90% argon resulted in the generation of ROS, triggering oxidative stress that manifested in various forms, including lipid membrane peroxidation, DNA base modification, and protein carbonylation. DBD plasma upregulated the expression of NOX1, NOX5, and DUOX2 at the mRNA and protein levels; and siRNAs targeting NOX1, NOX5, and DUOX2 attenuated the generation of DBD plasma-induced ROS. DBD plasma upregulated the transcriptional activators TET1, MLL1, and HAT1 and downregulated the transcriptional repressors DNMT1, EZH2, and HDAC1. Additionally, DBD plasma increased the binding of transcriptional activators and decreased the binding of transcriptional repressors to the DUOX2 promoter. Methyl-specific polymerase chain reaction and bisulfite sequencing indicated that DBD plasma decreased methylation at the DUOX2 promoter. These results suggest that DBD plasma induces ROS generation by enhancing the expression of the NOX system through epigenetic DNA and histone modifications.

Emerging Plasma Technology That Alleviates Crop Stress During the Early Growth Stages of Plants: A Review.

Crops during their early growth stages are vulnerable to a wide range of environmental stressors; thus, earlier seed invigoration and seedling establishment are essential in crop production. As an alternative to synthetic chemical treatments, plasma technology could be one of the emerging technologies to enhance seed germination and seedling vigor by managing environmental stressors. Recent studies have shown its beneficial effects in various stress conditions, suggesting that plasma treatment can be used for early crop stress management. This paper reviewed the effects of different types of plasma treatments on plant responses in terms of the seed surface environment (seed scarification and pathogen inactivation) and physiological processes (an enhanced antioxidant system and activated defense response) during the early growth stages of plants. As a result, plasma treatment can enhance seed invigoration and seedling establishment by alleviating the adverse effects of environmental stressors such as drought, salinity, and pathogen infection. More information on plasma applications and their mechanisms against a broad range of stressors is required to establish a better plasma technology for early crop stress management.

Mutual Interaction between Plasma Characteristics and Liquid Properties in AC-driven Pin-to-Liquid Discharge.

This study investigated the mutual interaction between the plasma and plasma treated water (PTW). Many works have shown that the plasma treatment decreases the pH of PTW due to nitric oxide electrolyte ion but the interactions between PTW and the plasma are still largely unknown. We investigated the effect of PTW on a plasma as well as the effect of a plasma on PTW using a pin-to-liquid discharge system. It is found that PTW affects not only the chemical properties but also the physical properties of the plasma such as breakdown voltage and concentration of plasma column. The decrease of the liquid surface tension of PTW due to nitric oxide electrolyte ion from the plasma results in the increase of plasma current onto the surface of PTW and vice versa. The feedback process will be continued until the transition from normal discharge to abnormal discharge. These results can be basic data for the development of plasma sources to treat liquids.

[Plastic Surgical Correction of Buried Penis]. / Plastisch-chirurgische Korrektur des "Buried Penis".

A "buried penis" causes functional problems and embarrassment. In the past, this complex condition was only seen in extremely overweight patients or as a result of severe inflammations in this region. More recently, this problem has also been observed in patients with massive weight loss following bariatric surgery. In these patients there is an abundance of extremely flaccid skin in the suprapubic region, which covers the penis and causes it to "disappear". This leads to balanitis and, in turn, further retraction of the penis. The only solution to this condition is a sophisticated surgical approach in 3 phases: At first, suprapubic tissues must be lifted. Secondly, the penis must be completely denuded and debrided and the correct penopubic/penoscrotal angles must be reconstructed. The last phase includes a strainless coverage of the remaining defect of the penis. This condition has not been widely described in the literature. The general incidence and prevalence in the postbariatric population is unknown, probably due to patients' embarrassment and lack of knowledge on the physicians' end. Nevertheless, the buried penis can be successfully exposed through careful, structured surgical treatment and an interdisciplinary approach between plastic surgeons and urologists.

Impact of wedge-shaped resection of the posterior bony arch on postoperative outcomes after open door laminoplasty in the cervical spine: a 2-year follow-up study.

BACKGROUND CONTEXT: Open door laminoplasty (ODLP) can also lead to significant postoperative motion restriction that further increases over time, for which one of the possible factors is the bony impingement between neighboring posterior bony arches. Previously, we reported this phenomenon and modified technique of ODLP, wedge-shaped resection of the posterior bony arch that produced greater range of motion (ROM) of the cervical spine and less posterior neck pain compared with conventional ODLP (cODLP) in 1-year follow-up time, but no longer follow-up outcomes of the surgical technique has been reported. PURPOSE: The study aimed to thoroughly evaluate the impact of posterior bony impingement following ODLP on postoperative cervical motion and related outcomes, and to compare postoperative outcomes of conventional ODLP (cODLP with those of modified ODLP (mODLP) in 2-year follow-up times. STUDY DESIGN: This is a retrospective comparative study. PATIENT SAMPLE: A total of 145 patients who underwent cODLP or mODLP and were followed up for at least 2 years were classified into two groups: Group A (cODLP, 79 patients) and Group B (mODLP, 66 patients). OUTCOME MEASURES: The primary outcome measure was ROM of the cervical spine. Secondary outcome measures included (1) patient satisfaction, (2) radiological outcomes, including the rate of bony impingement and spontaneous fusion, and bone regrowth of the resection site, (3) clinical outcomes based on pain intensity and scores on the 12-item short-form health survey (SF-12) and neck disability index (NDI), (4) surgical outcomes, and (5) surgery-related complications. METHODS: We compared baseline data in both groups. To evaluate the impact of our surgical modification on postoperative outcome after ODLP, we compared the outcome measures in 2-year follow-up times. No funds were received in support of this work. No benefits in any form have been or will be received from a commercial party related directly or indirectly to the subject of this manuscript. RESULTS: The ROM of the cervical spine was significantly greater in Group B 2 years after surgery than in Group A (p=.001). Patient satisfaction (p=.02) at 2 years after surgery and pain intensity of the posterior neck at 1 (p=.01) and 2 years (p<.01) after surgery were better in Group B than in Group A. Radiological evidence of posterior bony impingement and spontaneous fusion between ODLPsegments were definitely fewer less in Group B than in Group A (p<.001 and<0.001, respectively). The mean value of bone regrowth was 1.2 mm (range, 0-3 mm). The NDI and SF-12 scores did not differ significantly between groups. Surgical outcomes and postoperative complications were similar between groups. CONCLUSIONS: These results indicate that posterior bony impingement can be a factor in ROM restriction after cODLP surgery and that wedge-shaped resection during ODLP can be a reliable option for preserving cervical ROM and improving postoperative clinical and radiological outcomes.

A Severely Burned Hemophiliac.

Patients suffering from moderate or severe hemophilia A are particularly vulnerable to trauma injury, being on high risk of immediate exsanguination. Due to a rareness of this disease, there are very few reports about the management of severe injuries of the affected patients. No guidelines for the management of burn trauma of hemophiliac patients have been yet established. Since, to our knowledge, this is the first case report about a successful treatment of a severely burned hemophiliac, requiring intensive care, long-time intubation, and multiple epifascial necrosectomies of third grade wounds, the authors are proposing the approach to this condition. The factor VIII has been substituted, enhancing its activity to over 70% during the planned interventions and keeping it above 30% in the intervals between the operations. To minimize the risk of surgical bleeding, our therapeutic strategy consisted of multiple short radical operations. The patient was healed and was dismissed after 68 days. The surgical blood loss was comparable with noncoagulopathic patients with similar burn extension. In case of a vast burn injury of the moderate or severe hemophiliacs, where the trauma-related consumption coagulopathy is expected and deep necrosectomies are required, the authors suggest starting a substitution of the factor VIII immediately after the admission, followed by a structured operative planning.

A case of oral myiasis caused by Lucilia sericata (Diptera: Calliphoridae) in Korea.

We report here a case of oral myiasis in the Republic of Korea. The patient was a 37-year-old man with a 30-year history of Becker's muscular dystrophy. He was intubated due to dyspnea 8 days prior to admission to an intensive care unit (ICU). A few hours after the ICU admission, 43 fly larvae were found during suction of the oral cavity. All maggots were identified as the third instars of Lucilia sericata (Diptera: Calliphoridae) by morphology. We discussed on the characteristics of myiasis acquired in Korea, including the infection risk and predisposing factors.

Immunotherapy of murine hepatocellular carcinoma by alpha-fetoprotein DNA vaccination combined with adenovirus-mediated chemokine and cytokine expression.

Most hepatocellular carcinomas (HCCs) express oncofetal alpha-fetoprotein (AFP). We and others have demonstrated efficient tumor control mediated by cellular immune responses in mice bearing subcutaneous tumors derived from the AFP-expressing murine HCC cell line Hepa 1-6 by DNA vaccination against AFP. In the present study, we examined AFP DNA vaccination in the AFP-expressing primary murine HCC model BW7756. In this model AFP DNA vaccination resulted in only minimal lymphocytic infiltration and failed to control tumor growth. To augment the AFP-specific cellular immune response, intratumoral expression of chemokine IP-10 (interferon-inducible protein-10) and the proinflammatory cytokine interleukin (IL)-12 by adenoviral vectors (AdmIL-12 and AdmIP-10) was analyzed. Intratumoral injection of AdmIL-12 and AdmIP-10 resulted in transient tumor regressions, without prolongation of animal survival. By contrast, AFP DNA vaccination followed by intratumoral injection of AdmIL-12 and AdmIP-10 resulted in tumor regression in all animals and in prolongation of animal survival; in 25% of animals the tumors became undetectable. This study demonstrates for the first time that activation of effector cells against a tumor antigen induced by the combination of DNA vaccination and intratumoral chemokine and cytokine expression is superior to the respective treatment strategies alone. This effect may be mediated by attraction of activated effector cells to the tumor tissue.

Safety, complications, and satisfaction of patients undergoing submuscular breast augmentation via the inframammary and endoscopic transaxillary approach.

BACKGROUND: Since its introduction, augmentation mammaplasty has gained widespread popularity, as demonstrated by the fact that an estimated 2 million women in the United States have received implants. During recent decades, several surgical approaches have evolved in terms of implant placement or site of access to the surgical plane. Debate has existed concerning the questionable superiority of a particular technique for achievement of optimal results. Thus, the inframammary approach, an established and widely accepted technique for breast augmentation, and endoscopically assisted transaxillary breast augmentation were retrospectively compared in terms of safety and aesthetic outcome, as measured, respectively, by the rate of postoperative complications and patient satisfaction. METHODS: This study analyzed 78 patients undergoing augmentation mammaplasty between 1997 and 2004. Only patients seeking primary augmentation mammaplasty solely for aesthetic reasons were included in the study. Previously performed breast surgery and simultaneously conducted ipsilateral mastopexy were among the exclusion criteria. Patient satisfaction was assessed using the client satisfaction questionnaire (CSQ-8) because of its easy applicability. RESULTS: The complication rate was low in both patient subsets, thus confirming the safety of the transaxillary approach, as compared with the more common submammary technique. However, a higher level of satisfaction was detected in the former patient group, indicating a more favorable aesthetic outcome with the transaxillary augmentation mammaplasty. CONCLUSION: Endoscopically assisted transaxillary augmentation mammaplasty is a safe method with predictable results associated with a high level of patient satisfaction. If applied in the setting of appropriate indications, it is an excellent tool for use with patients who prefer to have an incision at a distant site.