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Investigating the Role of Cereblon (CRBN) in the Lung Cancer Metastasis Through Regulating Cystathionine β-Synthase (CBS)
Cereblon (CRBN)은 Cullin-RING E3 ubiquitin ligase (CRL4) 복합체의 구성 요소로, 표적 단백질의 polyubiquitination을 통한 분해에 관여한다. 이전 연구에서는 CRBN의 결손이 폐암 세포의 이동성과 침습성을 증가시킨다고 보고했으나, 그 기작은 명확히 밝혀지지 않았다. 본 연구는 CRBN이 폐암 세포에서 대사 조절을 통해 전이에 미치는 새로운 역할을 규명하는 것을 목표로 한다.
본 연구에서는 CRBN 결손이 폐암 세포에서 Cystathionine β-Synthase(CBS) 단백질 발현을 증가시킨다는 것을 발견하였다. 또한, CRBN이 CBS와 직접 결합하여 CBS의 polyubiquitination에 기여한다는 것을 확인했다. 우리의 연구 결과는 CRBN 결손이 폐암 세포의 이동과 침습을 가속화하며, CBS의 활성화가 이러한 효과에 기여한다는 것을 시사한다. 또한, CRBN 결손이 transsulfuration pathway와 관련된 대사물질의 수준을 변화시키며, 이 대사물질들이 CRBN 결손 폐암 세포의 이동을 촉진한다고 관찰하였다. 더 나아가, 우리는 CRBN 결손이 암세포 이동성과 관련된 유전자들의 발현을 변화시킨다는 사실을 확인하였다.
결론적으로, 본 연구 결과는 CRBN의 결손이 transsulfuration pathway에서 CBS 단백질 발현과 대사물질을 조절함으로써 폐암 세포의 이동성과 침습을 가속한다는 것을 시사한다.|Cereblon (CRBN), as a component of the Cullin-RING E3 ubiquitin ligase (CRL4) complex, is involved in the degradation of target proteins through polyubiquitination. A previous study reported that the loss of CRBN enhances the migration and invasion of lung cancer cells; however, the underlying mechanism remains unclear. This study aims to identify a new role for CRBN in lung cancer metastasis by modulating cancer cell metabolism.
In this study, we found that the depletion of CRBN increases Cystathionine β-Synthase (CBS) protein expression in lung cancer cells. Moreover, we demonstrated that CRBN directly binds to CBS and contributes to its polyubiquitination. Our findings also indicated that the depletion of CRBN accelerated the migration and invasion of lung cancer cells, and the activity of CBS contributed to these effects.
In addition, we observed that the depletion of CRBN altered the levels of metabolites involved in the transsulfuration pathway, and these metabolites contributed to the migration capabilities of CRBN-depleted lung cancer cells. Furthermore, we found that CRBN depletion leads to the differential expression of genes associated with cancer cell migration.
In summary, these findings indicate that the loss of CRBN accelerates the migration and invasion of lung cancer cells by regulating CBS protein expression and metabolites in the transsulfuration pathway.Maste
Optical wireless data transfer through skin for implantable biomedical electronics
As the global population ages, the demand for implantable medical electronic devices for physiological monitoring and functional support continues to grow. In such systems, wireless data exchange is essential for device control and real-time physiological data acquisition. While coil-based methods are widely used, the method may pose challenges such as electromagnetic interference, or unwanted induced currents in diverse clinical environments. Here, we introduce a soft, flexible optical wireless communication system capable of reliable, real-time data exchange through biological tissues without the need for antenna coils. Microscale light-emitting diodes (LEDs) and photodetector (PD), microfabricated and integrated into flexible platforms, enable wireless data transmission via light modulation through biological skin, in a relatively small form factor. In vivo experiments validate wireless bi-directional data transfer with integrated physiological sensors, demonstrating on-demand, real-time monitoring of signals such as electrocardiogram and body temperature. This approach offers a promising pathway toward safer, miniaturized wireless implantable electronics.TRUEsciescopu
Introducing a new clustering-based method for regionalization framework for continental-scale rainfall estimates from soil moisture dynamics using machine learning methods
Rainfall estimation plays a key role in various hydrological applications, ranging from flood forecasting and drought monitoring to water resource management. Traditional methods, which depend on ground-based gauges and remote-sensing products, can be expensive and limited by geography, and they often suffer from issues like sensor resolution or atmospheric interference. To tackle these problems, “bottom-up” strategies have emerged that use soil moisture as a stand-in for rainfall. By leveraging soil's natural capacity to capture precipitation, these methods can reduce the reliance on high-resolution sensors and intricate modeling. Nonetheless, their performance still depends heavily on careful calibration, a process that usually calls for plenty of on-site data, extended observation periods, or location-specific fine-tuning. To address these hurdles, we present a calibration parameters regionalization framework that does away with the need for a dedicated calibration phase. This framework uses both unsupervised (K-means clustering) and supervised (rainfall-intensity classification) techniques together with a genetic algorithm to automatically determine model parameters, without depending on adjustments tailored to specific regions. We illustrate our method using the soil moisture to rainfall (SM2RAIN)-Net Water Flux (NWF) algorithm, demonstrating its ability to accurately estimate rainfall across the well-monitored contiguous United States (CONUS). Our findings indicate that SM2RAIN[sbnd]NWF performs particularly well in areas with higher rainfall intensity, outperforming the classic SM2RAIN methods that are commonly used for estimating rainfall from soil moisture dynamics. In fact, this is the first time K-means, a genetic algorithm, and rainfall clustering have been combined to estimate rainfall without requiring a separate calibration period, achieving a 20 % improvement in Nash–Sutcliffe efficiency and a 10 % reduction in root mean square error compared to classical methods. © 2025 Elsevier B.V., All rights reserved.FALSEsciescopu
Optically readable synaptic modulators based on Tamm plasmon for adaptive multispectral image processing
The increasing demand for visual data processing reveals the limitations of traditional electronic systems in speed, energy efficiency, and adaptability. While optical computing offers a promising alternative, current systems often lack the flexibility required for multispectral and adaptive visual tasks. Here, we present an efficient way for highly adaptive, multispectral image filtering based on active Tamm plasmon resonators. We realize precise control over resonant wavelengths, enabling selective spectral targeting with high-quality factors. To achieve a gradual on/off function in the Tamm plasmon resonator, we integrate PEDOT:PSS, whose doping state modulates its metallic or dielectric properties. The partial doping of PEDOT:PSS allows for memorizing states, facilitating long-term potentiation and depression, and is essential for forming multiple synaptic states. By combining the high modulation depth, theoretically reaching 99%, with the non-volatile nature of PEDOT:PSS, we achieve stable multiple synaptic states with subtle saturation, resulting in 256 stable synaptic weights. © 2025 The AuthorsTRUEsciescopu
Irradiating P3HT Solution with Various Wavelengths of Light: Effects on Preaggregation and Film Morphology
Poly(3-hexylthiophene) (P3HT) is recognized as a conjugated polymer with a high optical excitation efficiency. Given this characteristic, preaggregation processes leveraging P3HT’s optical excitation have been extensively explored. In this study, we present a distinct preaggregation mechanism that depends on the wavelength of the irradiated light. The study involves irradiating the P3HT solution with various lights (red, green, blue, and UV) and subsequently analyzing the morphology of both the solution and the film through absorbance measurement, microscopy, and X-ray diffraction. The results indicate that irradiation with red and UV light enhances the charge transport properties of the P3HT films due to increased aggregation. Conversely, green and blue light irradiation results in diminished electrical performance and aggregation. Contrary to conventional expectations, our findings suggest that more than one mechanism may coexist in inducing preaggregation, depending on the wavelength. Specifically, UV light irradiation appears to increase the likelihood of excitation of tilted chains, thereby enhancing polymer linearity and promoting preaggregation. In contrast, red light irradiation predominantly induces excitation within the polymer crystals through π-π stacking interactions rather than along the polymer chains. This study provides that different excitation mechanisms are activated depending on the wavelength of the incident light and provides a systematic analysis of the distinct aggregation patterns observed. © 2025 American Chemical Society.FALSEsciescopu
A wireless, skin-integrated system for continuous pressure distribution monitoring to prevent ulcers across various healthcare environments
Pressure ulcers remain a persistent challenge in healthcare, particularly for individuals with limited mobility or compromised sensation. Early detection is critical to prevent ischemic damage leading to necrosis, infections, and prolonged hospital stays. Conventional sensing technologies that integrate into the mattress, while effective in gathering data on pressure distributions, are restricted to stationary environments, and they can miss significant periods when patients leave their beds or shift positions. Furthermore, these systems do not offer consistent information on the specific spatial distribution of pressure across the body, because the sensors integrate with the mattress and not the body. Recent research establishes capabilities in soft, skin-interfaced wireless alternatives, but in designs that require specialized processes and materials that might not scale effectively for practical production and use. Here, we present a wireless, skin-integrated pressure monitoring system that mounts on the skin, in anatomically matched forms and with soft mechanical interfaces, for continuous data collection. This platform, built on manufacturable components and designs, features an array of soft, elastomer-encapsulated pressure sensors that minimize discomfort, with wireless communications and an independent power management system to enable operation across diverse healthcare settings, including homes, outpatient facilities, and operating rooms, all without physical tethers. Additionally, an external alarm satellite device delivers vibratory and visual alerts if predefined pressure thresholds are exceeded, guiding caregivers or patients to take timely action. Experimental and finite element analysis support the design principles, and deployments on patients in hospital settings illustrate modes for practical use.TRUEsciescopu
Measurement and Monitoring of Cardiorespiratory System Parameters in Operating Room and Postanesthesia Settings
This study addresses the pressing issue of cardiovascular diseases (CVDs), the leading global cause of death, by emphasizing the need for continuous monitoring of vital signs, particularly in critical care settings like surgery and ICUs. It aims to develop innovative bio-sensing and noise-reduction technologies to enhance the clarity and reliability of heart and lung sound recordings. The core problem tackled is the interference of excessive ambient noise with auscultation accuracy in noisy clinical environments. By integrating wearable sensors, adaptive noise cancellation, and real-time data processing, the study proposes practical, patient-friendly solutions. Its significance lies in advancing continuous, non-invasive monitoring systems that support early detection, improve clinical decision-making, and ultimately enhance patient safety and outcomes.
Chapter 1 of this work introduces cardiovascular diseases (CVDs) as the leading global cause of death, highlighting their historical context, evolving understanding, and classification into various types such as coronary artery disease, stroke, and heart failure. It emphasizes the importance of managing shared risk factors like hypertension and sedentary lifestyles. The chapter also underscores the crucial role of vital sign monitoring—particularly heart rate, respiratory rate, and blood pressure—in detecting early signs of deterioration and guiding interventions. In surgical and ICU settings, continuous monitoring of heart and lung sounds, ECG, and hemodynamic parameters is essential for patient safety. Technological advancements such as AI-driven tools and wearable devices are enhancing early detection, remote monitoring, and proactive clinical decision-making.
Chapter 2 explores the evolution of wearable biosensors, highlighting their capacity for continuous, non-invasive monitoring of physiological and biochemical signals. These technologies, integrated into wearables like patches and smartwatches, have transformed cardiovascular care by enabling early detection of conditions such as arrhythmias and myocardial ischemia. Their use extends beyond clinical settings, supporting remote monitoring, post-surgical recovery, and chronic disease management. Integration with AI and cloud platforms enhances predictive analytics and telemedicine capabilities. Despite challenges like accuracy, data privacy, and regulatory compliance, wearable biosensors are poised to play a vital role in personalized and preventive heart healthcare.
Chapter 3 of the study discusses the sources and impacts of excessive noise in operating rooms, which can impair communication, raise stress levels, and compromise patient safety. Common noise contributors include surgical tools, alarms, and staff conversations, often exceeding recommended sound levels. The chapter outlines solutions such as sound-absorbing materials, adaptive signal processing, equipment redesign, and behavioral protocols to mitigate noise. These interventions aim to improve surgical performance, reduce fatigue, and enhance both patient outcomes and healthcare provider wellbeing.
Chapter 4 presents the design of a digital esophageal stethoscope system for improved auscultation during surgeries under general anesthesia. To address the challenge of excessive background noise in operating rooms, a 3D-printed case filled with Polydimethylsiloxane (PDMS) was developed to house two electret microphones. One microphone captures heart and lung sounds via an esophageal catheter, while the other records ambient OR noise. An adaptive noise canceling algorithm was applied to filter out background noise from the primary biosignal. The processed signal is displayed through a custom software interface. The PDMS-filled case alone reduced some noise, while the adaptive filter significantly enhanced signal clarity. The final system is lightweight, effective, and capable of delivering cleaner heart and lung sound recordings for clinical use.
Chapter 5 introduces a wearable bedside monitoring system design for continuous cardiovascular monitoring for postanesthesia and ICU patients. Unlike previous tools that mainly served as screening devices, this system displays real-time cardiopulmonary parameters. It uses a lightweight patch sensor to collect heart and lung sounds via a chest stethoscope and microphones. An adaptive noise cancellation algorithm filters out ambient noise for clearer auscultation. In addition, a short-distance ECG signal is acquired using electrodes and a high-precision analog front end. A high-speed microcontroller enables real-time data processing and waveform display. A custom tablet-based application presents the processed data and vital signals. The system seamlessly integrates heart sounds and ECG monitoring. Rigid–flex PCBs provide both wearability and patient comfort. The solution offers high-quality signal acquisition and holds strong potential as a continuous health monitoring tool.
Lastly, Chapter 6 presents a study that explores the acoustic properties of Ecoflex™ 00-35, a soft silicone rubber, for vibration and noise control. Researchers varied curing parameters—like the Part A/B mixing ratio, thinning agent addition, and curing pressure—to examine their effects on sound absorption. SEM was used to analyze microstructure, and impedance tubes measured acoustic performance. Results showed that applying vacuum and using thinning agents increased average cell diameter, enhancing sound absorption (0.35–0.60) in low to mid frequencies. Low-pressure curing further improved low-frequency absorption. Thinning agents also boosted high-frequency performance. The findings demonstrate how curing conditions impact acoustic behavior. This work offers insights into designing soft silicone materials for advanced noise control systems that can be applicable in medical field.
In conclusion, this study presents a comprehensive approach to improving cardiovascular monitoring through the integration of wearable biosensors, adaptive noise reduction, and real-time data visualization technologies. By addressing both physiological monitoring needs and environmental challenges such as operating room noise, it advances the field of patient-centered care. The proposed systems demonstrate the potential to enhance diagnostic accuracy, support early intervention, and improve clinical outcomes. This work lays the groundwork for future innovations in continuous, non-invasive health monitoring for critical care and beyond.DoctorAbstract i
Acknowledgements iv
List of Tables. x
List of Figures xi
Chapter 1. Introduction 1
1.1. Cardiovascular Disease: Background 1
1.2. The Importance of Vital Signs Monitoring in Patients 3
1.3. The Importance and Methods for Heart Monitoring during Surgery and in Post-Anesthesia and Intensive Care Units (PACU/ICU) 5
1.3.1. Heart and Lung Sounds Monitoring 5
1.3.2. Electrocardiography (ECG) Monitoring 5
1.3.3. Other Monitoring Methods 6
Chapter 2. Advancements in Wearable Biosensors and Their Role in Heart Health 8
2.1. Background 8
2.2. Leveraging Wearable Technologies for Heart Health Monitoring 10
Chapter 3. Acoustic Challenges in the Operating Room: Origins, Effects, and Solutions 12
3.1. Noise in Operating Rooms: Sources, Impacts, and Mitigation 12
3.1.1. Sources of Operating Room Noise 12
3.1.2. Impacts on Surgical Team Performance 12
3.1.3. Patient Safety and Outcomes 13
3.2. Strategies for Noise Reduction in the Operating Room (OR) 13
3.2.1. Installation of Sound-Absorbing Materials 14
3.2.2. Adaptive Filtering and Digital Signal Processing 14
3.2.3. Equipment Design and Alarm Optimization 15
3.2.4. Behavioral and Team Communication Strategies 15
Chapter 4. Heart and Lung Sound Measurement Using an Esophageal Stethoscope with Adaptive Noise Cancellation 16
4.1. Introduction 16
4.1.1. Heart and Lung Sound Recording Techniques 17
4.1.2. Sound-Absorbing Materials 18
4.1.3. Adaptive Noise Cancellation 19
4.2. Materials and Methods 21
4.2.1. Microphone Case 21
4.2.2. Microphone 23
4.2.3. Processing Unit 24
4.2.4. System Software 26
4.3. Results 27
4.3.1. System Hardware 27
4.3.2. PDMS Microphone Case Results 29
4.3.3. SIMULINK Model Results 30
4.3.4. System Experimental Results 30
4.4. Discussion 32
4.5. Conclusions 33
Chapter 5. Tablet-Based Wearable Patch Sensor Design for Continuous Cardiovascular System Monitoring in Postoperative Settings 34
5.1. Introduction 34
5.2. Materials and Methods 37
5.2.1. Hardware Architecture 38
5.2.2. Stethoscope Head Design 38
5.2.3. Acquisition and Processing Units 39
5.2.3.1. PCG Signal Acquisitions Circuit 40
5.2.3.2. ECG Signal Acquisition Circuit 40
5.2.3.3. Patch Processing Unit 41
5.2.4. System Software 43
5.3. Results 44
5.3.1. System Hardware 44
5.3.2. System Software and Experimental Results 46
5.4. Discussion 48
5.5. Conclusions 52
Chapter 6. Exploring the Sound Absorption Potential of Ecoflex™ 00-35 for Soft and Flexible Noise Reduction 53
6.1. Introduction 53
6.2. Materials and Methods 54
6.2.1. Materials 54
6.2.2. Experimental Protocol 55
6.2.2.1. A/B Ratio 55
6.2.2.2. Thinning Agent 55
6.2.2.3. Pressure 55
6.2.3. Measurement method 56
6.2.3.1. Microgeometry Analysis 56
6.2.3.2. Absorption Coefficient and Surface Impedance 56
6.3. Results and Discussion 57
6.3.1. Microstructure Characteristics 57
6.3.2. Acoustic behavior 58
6.3.2.1. Effect of Pressure Variation at Fixed Curing Time 58
6.3.2.2. Effect of Time Variation at Fixed Curing Pressure 59
6.3.2.3. Effect of Small pressure change and less curing time 60
6.3.2.4. Effect of changing both the A/B ratio and curing pressure 61
6.3.2.5. Impact of Thinning Agent Addition 62
6.4. Validation of the Fabricated Material for Medical Use 64
6.5. Conclusions 65
Chapter 7. Summary, Limitations and Future Perspectives 66
References 68
Curriculum Vitae 7
Endogenous formation of phosphatidylhomoserine in Escherichia coli through phosphatidylserine synthase
Biological membranes, which comprise proteins, lipids, and glycans, serve as essential gatekeepers protecting cells from the external environment. In bacteria, phospholipids are a major class of membrane lipids, whose biology has extensively been studied in the Gram-negative organism Escherichia coli. As an adaptive mechanism, E. coli dynamically remodels its phospholipids in response to its environment, which may involve alterations of the structures and/or levels of existing lipids or the incorporation of exogenous substrates to form new phospholipid classes. Intriguingly, an unknown lipid was detected in E. coli and other Enterobacteriaceae. Detection of this lipid in E. coli grown in minimal media suggested its production using an endogenous metabolite. By coupling liquid chromatography mass spectrometry and metabolic incorporation, the lipid was identified as phosphatidylhomoserine (PHS). In E. coli, PHS was produced endogenously by phosphatidylserine synthase A (PssA), confirmed by the absence of PHS in an E. coli ΔpssA mutant, and its inability to incorporate exogenously supplied L-homoserine into its phospholipids. Furthermore, purified E. coli PssA (EcPssA) exhibited activity to utilize L-homoserine as an alternative substrate to make PHS in vitro. Interestingly, E. coli and other Enterobacteriaceae can decarboxylate PHS to form phosphatidylpropanolamine endogenously. When treated with L-homoserine, accumulation of PHS in E. coli was accompanied by a reduction in phosphatidylglycerol and phosphatidylethanolamine, due to competition for common metabolic intermediates. Overall, our findings on the endogenous production of PHS and phosphatidylpropanolamine re-established the baseline phospholipidome of E. coli and provided biochemical and cellular evidence on the substrate promiscuity of EcPssA. © 2025 The AuthorsTRUEsciescopu
Single local delivery of 5′‐(N‐ethylcarboxamido)adenosine depots ameliorates myocardial infarction‐induced cardiac dysfunction via the enhancement of mitostasis
Myocardial infarction (MI) stands as a prominent contributor to global mortality. Despite existing therapies, there are notable shortcomings in delivering optimal cardiac support and reversing pathological progression, particularly within early stages. Adenosine presents a promising therapeutic target; however, its clinical utility is impeded by inherent limitations. In this study, an advanced strategy using adenosine agonist is pioneered to ameliorate MI‐induced myocardial damage. Herein, an adenosine derivative 5′‐(N‐ethylcarboxamido) adenosine (NECA) is employed, and its therapeutic efficacy is evaluated via single local delivery into infarcted myocardium following MI. NECA displays remarkable benefits in endothelial cells and cardiomyocytes under both normoxic and hypoxic conditions. Likewise, single localized NECA delivery via newly developed NECA‐loaded micro‐depots demonstrates advanced improvement in cardiac function and prevention of myocardial damage in a MI mouse model, with notable promotion of angiogenesis and suppression in inflammation, oxidation, and apoptosis. Mechanistically, NECA exerts myocardial benefits via the enhancement of mitostasis by triggering AMP‐activated protein kinase α (AMPKα) phosphorylation and Peroxisome proliferator‐activated receptor gamma coactivator 1‐alpha(PGC‐1α) activation. These findings highlight the clinical significance of adenosine agonist NECA in cardiac support and recovery, with the single‐delivered depots providing an advanced intervention for individuals with critically severe MI in the early phase.TRUEscopu
Design of an in-sensor refraction-correcting optical system for underwater-to-air object tracking
물속에서 공중의 물체를 관측하고 추적하는 기술은 해안 감시, 해양 보안, 그리고 자율 무인 잠수정(AUV) 시스템 통합 등 다양한 응용 분야에서 필수적이다. 기존의 수중 이미징 시스템은 공기-물 경계면에서 발생하는 굴절로 인한 왜곡을 카메라 내부 또는 외부 소프트웨어에 통합된 후처리 알고리즘을 통해 보정하는 방식을 사용해왔다. 그러나 이러한 방식은 상당한 계산 부하를 초래하며, 실시간 데이터 처리 효율을 저해한다. 이러한 문제를 해결하기 위해, 센서 내부에서 굴절 왜곡을 보정하는 개념을 적용한 광학 이미징 시스템이 연구될 예정이다. 이 시스템에서는 곡면 이미지 센서 위에 픽셀을 불균일하게 배열함으로써 굴절로 인한 이미지 왜곡을 본질적으로 보정하도록 설계된다. 기존의 소프트웨어 기반 보정 방식과 달리, 제안된 접근법은 픽셀 배열과 광학계를 공동으로 최적화하여 센서 단에서 굴절 왜곡을 직접적으로 완화한다. 이 방법은 계산 복잡도를 크게 줄이며, 수중에서 공중을 관측하는 상황에서도 견고하고 정밀한 물체 추적을 가능하게 한다.|Observation and tracking of airborne objects from underwater environments are essential for various applications, including coastal surveillance, maritime security, and integrated autonomous underwater vehicle (AUV) systems. Conventional underwater imaging systems typically compensate for refraction-induced distortions at the air- water interface through post-processing algorithms integrated within cameras or external software. However, this approach imposes significant computational overhead, limiting the efficiency of real-time data processing. To address these challenges, an optical imaging system incorporating an in-sensor refraction correction concept will be studied. In this system, pixels on a curved image sensor are arranged in an inhomogeneous distribution to intrinsically compensate for refraction-induced image distortions. In contrast to conventional software-based correction methods, the proposed approach employs a co-optimized pixel arrangement and optical system design to intrinsically mitigate refraction-induced distortions at the sensor level. This method significantly reduces computational complexity, thereby enabling robust and precise object tracking in underwater-to-air observation applications.Master1 Introduction 1
1.1 Motivation: Beyond conventional imaging for robotic vision 1
1.2 Fundamental challenges in underwater-to-air imaging 2
1.3 Paradigm shift to in-sensor architecture 3
2 Optical design and pixel distribution 6
2.1 System optimization 6
2.2 Optical performance evaluation 9
2.3 Pixel placement and array architecture 11
3 Fabrication and experimental validation 16
3.1 Aperture stop fabrication and optical validation 16
3.2 Housing design and assembly 19
4 Imaging simulation and data reconfiguration 22
4.1 Imaging simulation in non-sequential ray-tracing mode 22
4.2 Data reconfiguration and quantitative analysis 27
5 Discussion: Toward 3D object tracking using in-sensor refraction-
correcting systems 31
6 Conclusion 35
References 37
Acknowledgements 4