MQTree: Secure OTA Protocol Using MQTT and MerkleTree.

The escalating advancement in Software-Defined Vehicles (SDVs) necessitates a formidable strategy for firmware updates, where traditional methods often fall short of guaranteeing absolute integrity. Although decentralization has been explored in studies for firmware integrity verification using blockchain technology, it lacks comprehensive validation in the context of automotive over-the-air (OTA) updates. By recognizing the limitations of current practices and the partial validation of decentralized approaches, such as blockchain, in the automotive sector, our study introduces a novel mechanism for firmware over-the-air (FOTA) updates. This mechanism is grounded in the widely adopted message queuing telemetry transport (MQTT) protocol, integral to the Internet of Things (IoT) domain, and leverages Merkle tree-based blockchain verification to fortify the fidelity and efficiency of firmware updates. Our proposed solution not only prioritizes the stability crucial to automotive OTA updates but also ensures that performance is not compromised. This dual focus on reliability and efficiency represents a significant stride forward in the development of secure, scalable SDV firmware update protocols.

ROMI: A Real-Time Optical Digit Recognition Embedded System for Monitoring Patients in Intensive Care Units.

With advances in the Internet of Things, patients in intensive care units are constantly monitored to expedite emergencies. Due to the COVID-19 pandemic, non-face-to-face monitoring has been required for the safety of patients and medical staff. A control center monitors the vital signs of patients in ICUs. However, some medical devices, such as ventilators and infusion pumps, operate in a standalone fashion without communication capabilities, requiring medical staff to check them manually. One promising solution is to use a robotic system with a camera. We propose a real-time optical digit recognition embedded system called ROMI. ROMI is a mobile robot that monitors patients by recognizing digits displayed on LCD screens of medical devices in real time. ROMI consists of three main functions for recognizing digits: digit localization, digit classification, and digit annotation. We developed ROMI by using Matlab Simulink, and the maximum digit recognition performance was 0.989 mAP on alexnet. The developed system was deployed on NVIDIA GPU embedded platforms: Jetson Nano, Jetson Xavier NX, and Jetson AGX Xavier. We also created a benchmark by evaluating the runtime performance by considering ten pre-trained CNN models and three NVIDIA GPU platforms. We expect that ROMI will support medical staff with non-face-to-face monitoring in ICUs, enabling more effective and prompt patient care.

Generation of ints14 Knockout Zebrafish using CRISPR/Cas9 for the Study of Development and Disease Mechanisms.

INTS14/VWA9, a component of the integrator complex subunits, plays a pivotal role in regulating the fate of numerous nascent RNAs transcribed by RNA polymerase II, particularly in the biogenesis of small nuclear RNAs and enhancer RNAs. Despite its significance, a comprehensive mutation model for developmental research has been lacking. To address this gap, we aimed to investigate the expression patterns of INTS14 during zebrafish embryonic development. We generated ints14 mutant strains using the CRISPR/Cas9 system. We validated the gRNA activity by co-injecting Cas9 protein and a single guide RNA into fertilized zebrafish eggs, subsequently confirming the presence of a 6- or 9-bp deletion in the ints14 gene. In addition, we examined the two mutant alleles through PCR analysis, T7E1 assay, TA-cloning, and sequencing. For the first time, we used the CRISPR/Cas9 system to create a model in which some sequences of the ints14 gene were removed. This breakthrough opens new avenues for in-depth exploration of the role of ints14 in animal diseases. The mutant strains generated in this study can provide a valuable resource for further investigations into the specific consequences of ints14 gene deletion during zebrafish development. This research establishes a foundation for future studies exploring the molecular mechanisms underlying the functions of ints14, its interactions with other genes or proteins, and its broader implications for biological processes.

Machine Learning Model Development and Validation for Predicting Outcome in Stage 4 Solid Cancer Patients with Septic Shock Visiting the Emergency Department: A Multi-Center, Prospective Cohort Study.

A reliable prognostic score for minimizing futile treatments in advanced cancer patients with septic shock is rare. A machine learning (ML) model to classify the risk of advanced cancer patients with septic shock is proposed and compared with the existing scoring systems. A multi-center, retrospective, observational study of the septic shock registry in patients with stage 4 cancer was divided into a training set and a test set in a 7:3 ratio. The primary outcome was 28-day mortality. The best ML model was determined using a stratified 10-fold cross-validation in the training set. A total of 897 patients were included, and the 28-day mortality was 26.4%. The best ML model in the training set was balanced random forest (BRF), with an area under the curve (AUC) of 0.821 to predict 28-day mortality. The AUC of the BRF to predict the 28-day mortality in the test set was 0.859. The AUC of the BRF was significantly higher than those of the Sequential Organ Failure Assessment score and the Acute Physiology and Chronic Health Evaluation II score (both p < 0.001). The ML model outperformed the existing scores for predicting 28-day mortality in stage 4 cancer patients with septic shock. However, further studies are needed to improve the prediction algorithm and to validate it in various countries. This model might support clinicians in real-time to adopt appropriate levels of care.

The optimal sequence of bronchial brushing and washing for diagnosing peripheral lung cancer using non-guided flexible bronchoscopy.

The optimum sequence of bronchial brushing and washing for diagnosing peripheral lung cancer, defined as an invisible endobronchial tumour, is not clear and requires further study. We prospectively obtained washing samples after brushing in patients with peripheral lung tumours during non-guided flexible bronchoscopy (FB) to investigate the diagnostic yield of these samples and conducted a retrospective review of the prospectively collected data. The study included 166 patients who met the inclusion criteria. The overall diagnostic yield of bronchial brushing and washing for peripheral lung cancer was 52.4%. The diagnostic yields of brushing and washing were 37.3% and 46.4%, respectively, and that of washing was superior according to McNemar's test (p = 0.017, κ = 0.570). Furthermore, washing was diagnostic, whereas brushing was not, in 15.1% of all cases. Comparison of positive washing cytology (brushing) with the respective pathological diagnosis yielded a concordance rate of 88.3% (90.3%), with κ = 0.769 (0.801) (p < 0.001). Performing washing after brushing during non-guided FB is a very safe, cost-effective procedure that may help improve the diagnostic yield in patients with suspected peripheral lung cancer. Our information will also benefit clinicians performing diagnostic bronchoscopy in patients with suspected peripheral lung cancer when fluoroscopic guidance or advanced bronchoscopy techniques are not available.

Clinical implications of discrepant results between genotypic MTBDRplus and phenotypic Löwenstein-Jensen method for isoniazid or rifampicin drug susceptibility tests in tuberculosis patients.

BACKGROUND: The widespread use of molecular, genotypic drug susceptibility tests (DSTs) for antituberculosis (anti-TB) drugs has led to the dilemma of interpreting discordant results between genotypic and conventional, phenotypic DSTs. We investigated the clinical characteristics, including treatment patterns and outcomes, of TB patients with a genotype-phenotype discrepancy in susceptibility to isoniazid (INH) or rifampicin (RIF). METHODS: We retrospectively reviewed the medical records of TB patients who had results for 2 DSTs (genotypic method, MTBDRplus test for INH and RIF, and phenotypic method) treated between August 2010 and October 2016 in a tertiary university hospital. RESULTS: Among 1,069 TB patients, 63 (5.9%) had discrepant results for the 2 DSTs. Of the 57 multidrug-resistant (MDR) TB cases diagnosed by either DST, 18 (31.6%) showed discordant results for INH or RIF. The most frequent pattern of discordance was genotypic susceptibility with phenotypic resistance to INH. RIF-discordant subjects with genotypic resistance were more likely to have been exposed previously to anti-TB drugs and to have an MDR TB diagnosis and concurrent INH resistance. Forty-five of the 54 patients managed in our hospital (83.3%) had a favorable outcome with a mean treatment duration of 14.0 months. Ten of the 16 INH-discrepant patients with a genotypic mutation continued taking INH, but more than half patients in the RIF-discrepant group (8/14) with a genotypic mutation discontinued taking RIF. CONCLUSIONS: Despite the low frequency, discordant results were obtained between the genotypic and phenotypic DSTs for INH or RIF, especially for patients with MDR TB or INH resistance. Furthermore, it seemed that RIF discrepancy with a genotypic mutation might have a greater impact on the clinical outcome than INH discrepancy.

Spoofing Attack Results Determination in Code Domain Using a Spoofing Process Equation.

When a user receiver is tracking an authentic signal, a spoofing signal can be transmitted to the user antenna. The question is under what conditions does the tracking point of the receiver move from the authentic signal to the spoofing signal? In this study, we develop a spoofing process equation (SPE) that can be used to calculate the tracking point of the delay lock loop (DLL) at regular chip intervals for the entire spoofing process. The condition for a successful spoofing signal is analyzed using the SPE. To derive the SPE, parameters, such as the signal strength, sweep velocity, loop filter order, and DLL bandwidth are considered. The success or failure of a spoofing attack is determined for a specific spoofing signal using the SPE. In addition, a correlation between each parameter for a successful spoofing attack could be obtained through the SPE. The simulation results show that the SPE performance is largely consistent with that of general DLL methods, even though the computational load of SPE is very low.

Greater trochanteric pain syndrome due to tumoral calcinosis in a patient with chronic kidney disease.

Tumoral calcinosis is a rare syndrome characterized by massive subcutaneous soft tissue deposits of calcium phosphate near the large joints. It is more prevalent in patients with chronic kidney disease undergoing dialysis. A 57-year-old woman was referred to our pain clinic with the complaint of severe pain in the left buttock and lateral hip. The patient had been suffering from chronic kidney disease for 10 years and had been undergoing peritoneal dialysis over the past 5 years. The patient's symptom was initially suspected to be of lumbar origin at the L5 level and a left L5 transforaminal epidural block was performed, but without success. Re-evaluation of the physical examination revealed severe tenderness over the left greater trochanter and piriformis muscle. On ultrasonographic evaluation, multiple mass-like lesions in the left buttock were observed. About 30 mL of fluid was aspirated from the cystic lesions, followed by 30 mL mixture of 0.08% levobupivacaine and triamcinolone 40 mg injected into the bursa under ultrasound guidance, which brought pain relief. Trochanteric bursitis was thought of as the cause of the symptoms. The patient was diagnosed with tumoral calcinosis based on the past medical history, simple plain radiographs, and hip magnetic resonance imaging (MRI). We diagnosed a case of greater trochanteric pain syndrome due to tumoral calcinosis related to chronic kidney disease in a patient whose symptoms had initially been considered to be radiating leg pain caused by lumbar spinal disease. We report our experience of symptomatic improvement following the repeated ultrasound-guided aspiration of calcific fluid and the injection of a mixture of local anesthetic and steroid.

Erlotinib induced trichomegaly of the eyelashes.

Epithelial growth factor receptor (EGFR) tyrosine kinase inhibitors (TKIs) have been widely used for non-small-cell lung cancer patients. Its untoward cutaneous effects are largely well known and developed in many patients treated with EGFR TKIs. However trichomegaly of eyelash is rarely reported. Although trichomegaly is not a drug-limiting side effect, it could be troublesome of continuing the treatment because of cosmetic issue or eyeball irritation by long eyelashes. Therefore clinicians are needed to pay attention to this uncommon effect. We herein describe erlotinib induced trichomegaly of eyelashes in a woman with adenocarcinoma of the lung.

Gender differences in susceptibility to smoking among patients with lung cancer.

BACKGROUND/AIMS: To determine whether female smokers are more or less susceptible to the detrimental pulmonary-function effects of smoking when compared to male smokers among patients with lung cancer. METHODS: Pack-years and pulmonary function indices were compared between 1,594 men and women with lung cancer who were smokers or had a history of smoking. Differences in individual susceptibility to smoking were estimated using a susceptibility index formula. RESULTS: Of the patients, 959 (92.8%) men and 74 (7.2%) women were current smokers. Common histological types of lung cancer were squamous cell carcinoma, adenocarcinoma, and small cell carcinoma, among others. Women had a lower number of pack-years, forced expiratory volume in 1 second (FEV(1), liters), forced vital capacity (FVC, liters), and total lung capacity (TLC, liters) compared to those of men (25.0 ± 19.2 vs. 42.9 ± 21.7 for pack-years; 1.4 ± 0.5 vs. 2.0 ± 0.6 for FEV(1); 3.0 ± 0.7 vs. 2.0 ± 0.6 for FVC; 4.5 ± 0.8 vs. 5.7 ± 1.0 for TLC; all p < 0.001). The susceptibility index for women was significantly higher compared to that of men (1.1 ± 4.1 vs. 0.7 ± 1.1; p = 0.001). A significant inverse association was shown between the susceptibility index and TLC and FVC (r = -0.200 for TLC, -0.273 for FVC; all p < 0.001). CONCLUSIONS: The results suggest that the detrimental effects of smoking on pulmonary function are greater in women, as compared to those in men, among patients with lung cancer.

Complete atrioventricular block secondary to bortezomib use in multiple myeloma.

Bortezomib is an inhibitor of 26S proteasome, which is an effective treatment for multiple myeloma. The common adverse effects of bortezomib are asthenic conditions, gastrointestinal disturbances, and peripheral neuropathy. Here we describe a patient with dyspnea and general weakness because of complete atrioventricular block while receiving bortezomib. We immediately stopped bortezomib, and after inserting a permanent VDD pacemaker, the patients' symptoms disappeared.

Implementation of a vector-based tracking loop receiver in a pseudolite navigation system.

We propose a vector tracking loop (VTL) algorithm for an asynchronous pseudolite navigation system. It was implemented in a software receiver and experiments in an indoor navigation system were conducted. Test results show that the VTL successfully tracks signals against the near-far problem, one of the major limitations in pseudolite navigation systems, and could improve positioning availability by extending pseudolite navigation coverage.

High-resolution analysis of condition-specific regulatory modules in Saccharomyces cerevisiae.

We present an approach for identifying condition-specific regulatory modules by using separate units of gene expression profiles along with ChIP-chip and motif data from Saccharomyces cerevisiae. By investigating the unique and common features of the obtained condition-specific modules, we detected several important properties of transcriptional network reorganization. Our approach reveals the functionally distinct coregulated submodules embedded in a coexpressed gene module and provides an effective method for identifying various condition-specific regulatory events at high resolution.

Surgical treatment of malignant mediastinal neurogenic tumors in children.

INTRODUCTION: The aim of this study was to identify the role of surgical resection in the treatment of malignant mediastinal neurogenic tumors in children. MATERIALS AND METHODS: Thirty-eight consecutive children, who underwent surgical resection of a malignant mediastinal neurogenic tumor between 1986 and 2004, were included in this study. The tumor cell types were neuroblastoma in 23 patients (60.5%), ganglioneuroblastoma in 14 (36.8%), and malignant neuroepithelioma in 1 (2.6%). Surgery was performed for curative resection in localized tumors and salvage resection of residual mediastinal masses after chemotherapy in stage IV tumors. Of the 16 patients (42.1%) who underwent salvage resection, 14 had neuroblastoma and 2 ganglioneuroblastoma. RESULTS: Mean patient age was 3.4+/-3.0 years (1 month-13 years) and 26 patients (68.4%) were symptomatic at presentation. Adjacent structure invasion was found in eight patients (21.1%), invasion of chest wall in four, heart and vena cava in two, lung in one, and chest wall and lung in one. Complete gross resection was possible in 30 patients (78.9%) and there was no surgical mortality. Surgical morbidity occurred in 10 patients (26.3%) and Horner's syndrome was the most frequent complication (n=7). The 5-year survival was 95.2% for a localized tumor and 52.5% for a stage IV tumor (p=0.004). The significant risk factors of long-term survival were adjacent structure invasion (p=0.002) and a stage IV tumor (p=0.002) by multivariate Cox regression analysis. CONCLUSIONS: Surgical resection of localized malignant mediastinal neurogenic tumor in children showed good long-term survival, and salvage operations after chemotherapy showed acceptable long-term survival.

Lymphadenectomy extent is closely related to long-term survival in esophageal cancer.

OBJECTIVE: The optimal extent of lymphadenectomy during esophagectomy for esophageal cancer remains debatable. The aim of this study was to identify the effect of the extent of lymphadenectomy on survival and recurrence after esophagectomy in esophageal cancer. MATERIALS AND METHODS: Two hundred thirty-three patients who were operated on between January 1995 and December 2003 due to esophageal cancer were included. The study subjects were stage I, II, and III esophageal squamous cell carcinoma patients who had undergone curative resection without neoadjuvant chemotherapy or chemoradiation therapy. To analyze the extent of lymphadenectomy, lymph node stations were classified into three regions, namely, paraesophageal, upper thoracic, and abdominal regions, and patients were allocated to one of three groups, i.e., group 1 received lymphadenectomy in one region only, group 2 in two regions, and group 3 in three regions. RESULTS: The pathologic stages were stage I in 57 (24.5%), IIA in 69 (29.6%), IIB in 27 (11.6%), and III in 80 (34.3%). There were 67 patients in group 1, 102 in group 2, and 64 in group 3. The operative mortality rate was 2.1%. Postoperative morbidity rates and hospital stay periods were no different for the three groups. The overall 5-year survivals in groups 1, 2, and 3 were 21.2, 36.3, and 53.7%, respectively, and there were statistically significant differences between groups (p=0.019). Overall 5-year survival for those with N0 disease was different significantly in the groups (26.7, 56.8, and 74.4% in groups 1, 2, and 3, respectively; p=0.001). However, overall 5-year survival differences for N1 disease were not significant. Group 1 showed more frequent locoregional recurrence than groups 2 and 3 (34.3 vs 12.7% and 15.6%, p=0.002). However, distant recurrence was no different in the three groups. CONCLUSIONS: A wider extent of lymphadenectomy in esophageal cancer was associated with better long-term survival than limited lymphadenectomy, especially in N0 patients. In addition, increased survival was found to be inversely associated with locoregional recurrence.