Earticle

본 도시 교통 혼잡은 간선도로망 전반에서 장시간의 지연, 배출 증가, 그리고 안전성 저하를 초래한다. 본 논문 은 스마트 폴 엣지 컴퓨팅과 연합형 다중 에이전트 강화학습을 결합한 교차로 제어용 엣지-네이티브 프레임워크를 제안 한다. 각 교차로의 경량 에이전트는 폴 탑재 센서로부터 로컬 학습을 수행하고, 프라이버시를 보존하는 연합 절차가 네 트워크 전역에서 주기적으로 모델 업데이트를 집계한다. 통신 계층은 저지연 로컬 V2X 교환을 위한 IEEE 802.11p와 모니터링 및 모델 조정을 위한 MQTT 5.0을 통합한다. 평가는 802.11p와 NR-V2X 링크 동작을 반영하기 위해 VEINS(OMNeT++–SUMO)와 Simu5G를 결합한 디지털 트윈-인-더-루프 환경에서 수행된다. 배출량은 SUMO의 HBEFA 기반 모형으로 추정한다. 고정주기, 감응식, 비연합형 MARL 기준선과 비교할 때, 제안 방법은 네트워크 전역 평균 지연과 대기행렬 길이를 줄이는 동시에 CO₂와 NOx를 낮출 잠재력을 보인다. 본 논문은 아키텍처, 학습 및 통신 설계, 그리고 시나리오 구성·평가지표·통계 검정을 위한 재현 가능한 프로토콜을 상세히 기술한다.

Urban traffic congestion leads to prolonged delays, elevated emissions, and diminished safety across arterial networks. This paper proposes an edge‑native framework for intersection control that combines smart‑pole edge computing with federated multi‑agent reinforcement learning. Lightweight agents at each intersection learn locally from on‑pole sensors while a privacy‑preserving federated procedure periodically aggregates model updates across the network. The communication layer integrates IEEE 802.11p for low‑latency local V2X exchange and MQTT 5.0 for monitoring and model coordination. Evaluation is conducted in a digital‑twin‑in‑the‑loop environment that couples VEINS (OMNeT++–SUMO) with Simu5G to account for 802.11p and NR‑V2X link behavior. Emissions are estimated using SUMO’s HBEFA‑based model. Compared with fixed‑time, actuated, and non‑federated MARL baselines, the proposed approach shows the potential to reduce network‑wide average delay and queue length while simultaneously lowering CO₂ and NOx. The paper details the architecture, the learning and communication design, and a reproducible protocol for scenario construction, metrics, and statistical testing.

Purpose: The purpose of this study was to investigate the disease-related knowledge, stress and quality of life for the patients with varicose veins. Methods: Data were collected via questionnaire from 138 patients with varicose veins in C University Hospital in Korea from November in Korea 2012 to August 2013. Results: Knowledge of the symptoms and diagnosis was the lowest. The scores from patients with disease-related knowledge tended to be low for both subjects over the age of 60 and subjects with low education (less than high school). The score for stress over complications was the highest. The level of stress is higher for women, subjects without spouses, subjects with higher severity of disease and patients who had been taking hormones in the past or are still taking hormones. The disease-related quality of life tended to be lower for women and subjects without spouses. 21% of the variance in quality of life was explained by the level of disease-related stress, disease severity and knowledge. Conclusion: Education and the management of nurses to improve disease-related knowledge for patients with varicose veins is highly recommended. Intervention, by reducing stress, is necessary to improve the quality of life for women, subjects without spouses, and subjects with higher severity of the disease.

This paper deals with a new approach for detection of finger veins. The method is split into four subsequent steps. The first of them consists of basic series of image filtering of the vein pattern and the other three are sequences of image filters for determination of the finger contour used for the background masking. At the end the finger veins with finger contour are extracted and sent to the template generation unit.

In cases of replantation, accurate closure of all structures, including bone, tendons, arteries, nerves, and veins is essential. Among these, the vein is a weaker structure and is damaged severely in most amputation cases. After fixation of bone, repair of tendons, nerves, and arteries, surgeons often experience difficulty in performing venous anastomoses. We found that in such cases, venous anastomosis is easy to perform using an additional incision after closure of the original wound. In a 33-year-old male patient with amputation of all four fingers at the metacarpophalangeal joint level, venous anastomoses were performed with dorsal veins using additional incisions after completion of the fixation of bones and repair of all other structures and closure of the skin due to surgical site tension.

An early detection of infiltration in veins is essential to minimize the injuries caused during infusion therapy, which is one of the most important tasks for nurses in clinical settings. We report that bioelectrical impedance analysis is useful in the early detection of infiltration at puncture sites. When infiltration was intentionally induced in the vein of a rabbit's ear, impedance parameters showed significant difference before and after infiltration. In particular, the relative resistance at 20 kHz in the vein of rabbit's ear reduced largely at infiltration, decreased slowly, and then stayed at a constant value. This indicates that the vein in the ear of the rabbit is small, and hence the infiltrated intravenous (IV) solution no longer accumulates after 3 minutes of infiltration. However, when infiltration was induced in the vein of a human's forearm, the relative resistance at 20 kHz decreased gradually over time. In the $R-X_c$ graph, the positions in infiltration induced in the rabbit's ear rapidly shifted before and after infiltration whereas the positions in infiltration induced in the human's forearm changed gradually during infiltration. Our findings suggest that bioelectrical impedance analysis is an effective method to detect the infiltration early in a noninvasive and quantitative manners.

Chronic venous insufficiency (CVI) of the lower extremities manifests itself in various clinical spectrums, ranging from asymptomatic but cosmetic problems to severe symptoms, such as venous ulcer. CVI is a relatively common medical problem but is often overlooked by healthcare providers because of an underappreciation of the magnitude and impact of the problem, as well as incomplete recognition of the various presenting manifestations of primary and secondary venous disorders. The prevalence of CVI in South Korea is expected to increase, given the possible underdiagnoses of CVI, the increase in obesity and an aging population. This article reviews the pathophysiology of CVI of the lower extremities and highlights the role of duplex ultrasound in its diagnosis and radiofrequency ablation, and iliac vein stenting in its management.

Background: Cryosurgery was recently introduced as a treatment for varicose veins in the lower extremities. Cryosurgery with freezing probes can be used to remove the great saphenous vein (GSV) via an inguinal incision alone. The aim of this study was to assess early outcomes and the feasibility of cryosurgery for varicose veins. Materials and Methods: Forty patients were enrolled in the present study from March 2009 to July 2010. All patients underwent careful physical examinations, and their GSV reflux was demonstrated by duplex ultrasonography. Clinical severity was measured according to the clinical-etiology-anatomy-pathophysiology (CEAP) classification. The impaired GSVs were removed with rigid cryoprobes after freezing. Patients had follow-up appointments at 1 week, 1 month, 3 months, and 6 months after surgery. Sclerotherapy was performed during follow-up on an outpatient basis as needed. Results: A total of 19 men and 21 women were enrolled. The mean follow-up duration was 3.4 months (range, 1 to 12 months). The clinical severity ranged from CEAP 2 to CEAP 6a. Thirty-eight patients underwent concomitant phlebectomy during surgery. No recurrences were reported during follow-up. There were three cases of minor complications. Two patients had paresthesia, and one had thrombophlebitis. Conclusion: Using cryosurgery techniques to treat varicose veins, the complication rates were minimal and outcomes were comparable to those of previous reports. This procedure is a safe and feasible treatment modality for varicose veins.

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An early detection of intravenous (IV) infiltration is essential to minimize the injuries during infusion therapy, which is one of the most important tasks for nurses in nursing settings. We report that bioelectrical impedance analysis is useful in the early detection of infiltration at puncture sites. When infiltration was intentionally induced in the vein of a pig's posterior ear, impedance parameters (R, $X_C$, $C_m$) showed significant differences before and after infiltration. In particular, the relative resistance ($R/R_{BI}$) decreased significantly at infiltration and then slowly decreased. This indicates that the vein in pig's ear is thin and the amount of surrounding subcutaneous tissue, and hence the infiltrated solution accumulates slowly after infiltration. However, when infiltration was induced in the vein of human's forearm, the relative resistance at 20 kHz decreased gradually over time. In the $R-X_C$ graph, the positions in the case of infiltration induced in the pig' ear shifted rapidly before and after infiltration, whereas the positions in the case of infiltration induced in the human's forearm moved gradually during infiltration. Our findings suggest that the impedance parameters (R, $R/R_{BI}$, $X_C$, R vs. $X_C$, and $C_m$) are effective indicators to detect the infiltration early in a non-invasive and quantitative manners.

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Background: Lower-limb varicose veins (VVs) are common and known to have a higher prevalence among people who work in occupations requiring prolonged standing. In the Republic of Korea, however, VV-related occupational factors have seldom been examined. This study was conducted to assess the prevalence of VVs among nurses, an occupational group considered to be at high risk of VVs, and determine the occupational risk factors of prolonged standing. Methods: Between March and August 2014, a questionnaire survey coupled with Doppler ultrasonography was conducted on the nurses working at a university hospital. Results: A total of 414 nurses participated in the survey and diagnostic testing. From the survey analysis and test results, the prevalence of VVs in nurses was estimated to be 16.18%. Significant factors for venous reflux were age [odds ratio (OR) = 1.06, 95% confidence interval (CI) = 1.03-1.10], pregnancy (OR = 2.15, 95% CI = 1.17-3.94), and delivery (OR = 2.02, 95% CI = 1.08-3.78). The statistical significance of these factors was verified after risk adjustment for sociodemographic factors (OR = 3.40, 95% CI = 1.27-9.09). Conclusion: Factors significantly associated with venous reflux were increasing age and prolonged working hours (${\geq}4hours$) in a standing position (OR = 2.80, 95% CI = 1.08-7.25), even after risk adjustment for sociodemographic factors. This study is significant in that an objective diagnosis of VVs preceded the analysis of the risk factors for VV incidence, thus verifying objectively that VVs are associated with occupations requiring prolonged hours of working in a standing position.

목적： SAAV sequence를 이용하여 동시에 획득한 동맥과 정맥의 두 MRA 영상을 Color Mapping으로 동맥과 정맥을 구분하여 한 영상에 나타냄으로써 AVM 이나 DAVF 등과 같은 혈관질환의 임상적 진단 및 치료에 도움을 주고자 하였다. 대상 및 방법： 일반적으로 MRA 영상은 사전 포화방법(presaturation)을 이용한 2D TOF 기법을 통하여 동맥과 정맥을 구분하여 영상을 획득한다. 이러한 일반적인 사전포화방법을 응용한 SAAV 기법은 일정영역을 미리 포화(saturation)시킨 후 포화영역의 위, 아래의 영역을 한번에 영상화하여 동맥과 정맥의 구분된 영상을 한번에 획득할 수 있다. 마산 삼성병원의 0.3T MRI system(Megfinder, AILab. Korea)에서 SAAV sequence를 이용하여 정상적인 피험자로부터 목 부위의 동맥과 정맥 혈관영상을 동시에 얻었다. 이들의 각 2D 영상을 Color Mapping으로 조합한 후 Maximum Intensity Projection(MIP) 기법을 통해 3D Artery-Vein Color Mapping(AVCM) MRA 영상으로 재구성하였다. 3명의 피험자에 대한 SAAV MRA data를 256$\times$256$\times$64(resolution： 0.89$\times$0.89$\times$2㎣)로 획득하였다.

Background: Although venous invasion (VI) is associated with distant metastasis and observed in >50% of pT2?4 colorectal cancers (CRCs), the role of VI in pT1 CRCs is not well-defined. Methods: Thirty-four surgically resected pT1 CRCs were reevaluated for 2-dimensional (2D) VI using hematoxylin and eosin (H&E)?stained slides with additional elastic and desmin immunohistochemical staining (cohort A). Additionally, 27 pT1 CRCs without knowing VI status were selected for 3-dimensional (3D) VI evaluation only (cohort B). All 61 cases (cohorts A and B) were studied in 3D using tissue clearing. Results: VI was detected more commonly in 3D (17/34, 50.0%) than in 2D H&E slide evaluation (9/34, 26.5%, p = .047). When VI was identified in 3D (27/61, 44.3%), the most common phase was that of intraluminal growth (22/27, 81.5%), followed by intravasation (7/27, 25.9%) and extravasation (5/27, 18.5%). E-cadherin expression was characterized in 3D in foci of VI and varied in each phase of invasion. Conclusions: All three phases were observed in VI of pT1 CRCs. The extravasation of neoplastic cells from foci of VI in pT1 CRC suggests that VI could be a route of intratumoral spreading in a subset of pT1 CRCs.

Background: Conventional stripping is considered to be the standard procedure for great saphenous vein (GSV) varicosities, but many other alternative treatments such as cryostripping, endovenous laser therapy (EVLT), radiofrequency ablation, and ultrasound-guided foam sclerotherapy have been developed. Among them, both cryostripping and laser therapy have been reported to be less traumatic, with lower rates of complications and recurrences when compared to conventional stripping. To compare the efficacy of these treatments, we have analyzed and compared the mid-term clinical outcomes of cryostripping and EVLT. Methods: Patients diagnosed with varicose veins of the GSV and treated with cryostripping or laser therapy between September 2008 and April 2013 were enrolled in this study. Duplex ultrasonography was used for the diagnosis and evaluation of varicosity and reflux, and the clinical-etiology-anatomy-pathophysiology classification was used to measure the clinical severity. The symptoms, Venous Clinical Severity Score (VCSS), recurrence rates, and complication rates of the cryostripping and laser therapy groups were analyzed and compared. Results: A total of 68 patients were enrolled in this study. 32 patients were treated with cryostripping, and 36 patients were treated with laser therapy. The median follow-up period was 29.6 months. Recurrence was noted in three patients from the cryostripping group and in two patients from the EVLT group. There was no difference in the VCSS score, operative time, duration of hospital stay, and complication rate between the cryostripping group and the EVLT group. Conclusion: The mid-term clinical outcomes of cryostripping were not inferior to those of EVLT. Further, considering its cost-effectiveness, cryostripping seems to be a safe and feasible method for the treatment of varicose veins.

Background: Dopamine is an inotropic agent that is often selected for continuous infusion. For hemodynamic stability, the rate of infusion is controlled in the range of 5-15 μg/kg/min. This study aimed to compare the time intervals from the administration of dopamine to the onset of its hemodynamic effects when dopamine was administered through three different peripheral veins (the cephalic vein [CV], the great saphenous vein [GSV], and the external jugular vein [EJV]). Methods: Patients in group 1, group 2, and group 3 received dopamine infusions in the CV, GSV, and EJV, respectively. A noninvasive continuous cardiac output monitor (NICCOMO™, Medis, Ilmenau, Germany) was used to assess cardiac output (CO) and systemic vascular resistance (SVR). Six minutes after intubation, baseline heart rate (HR), systolic blood pressure (BP), diastolic BP, mean arterial pressure (MAP), CO, and SVR values were recorded and dopamine infusion was initiated at a dose of 10 μg/kg/min. Hemodynamic changes at 0, 4, 8, 12, and 15 minutes postinfusion were recorded. Results: No statistically significant differences were observed among the three groups with respect to the rate of hemodynamic change. In all groups, systolic BP, diastolic BP, MAP, and SVR tended to increase after decreasing for the first 4 minutes; in contrast, HR and CO decreased until 8 minutes, after which they tended to reach a plateau. Conclusions: For patients under general anesthesia receiving dopamine at 10 μg/kg/min, there were no clinical differences in the effect of dopamine administered through three different peripheral veins.

Purpose: The improvement of testicular volume, testosterone levels and sperm concentration was suggested to be significantly associated with the number of internal spermatic veins (ISVs) ligated during varicocelectomy. Herein, we investigated preoperative color Doppler ultrasonography (CDU) findings as potential preoperative predictors of the number of ISVs requiring ligation during microsurgical subinguinal varicocelectomy. Materials and Methods: In a prospective evaluation of 40 patients, maximal vein size and maximal reflux velocity were measured,while the total cross-sectional area of the affected testicular veins during a Valsalva maneuver was calculated using CDU by a single uroradiologist. Microsurgical subinguinal varicocelectomies were performed by one urologist. Results: Among the semen parameters, semen morphology showed significant improvement (p=0.033), which was much clearer in the patients with a higher number of ISVs ligated than a lower number of ISVs ligated. Among the various preoperative variables, maximal reflux velocity and total cross-sectional area on CDU were related to the number of ISVs ligated (r=-0.442, p=0.004; r=0.594, p=0.000, respectively). Furthermore, univariate and multivariate linear regression analyses showed that maximal reflux velocity and total cross-sectional area on CDU were independent predictive factors of the number of ISVs ligated. Conclusion: Maximal reflux velocity and total cross-sectional area on CDU were related to the number of ISVs ligated. This means that the maximal reflux velocity and total cross-sectional area measured by preoperative CDU can predict the number of ISVs requiring ligation during microsurgical subinguinal varicocelectomy, which might be related to significant improvement of semen parameters after varicocelectomy.