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Objectives Loneliness is considered to be a crucial factor in mental health of elderly people. However, the effects of loneliness on behavioral and psychological symptoms of dementia (BPSD) have not been fully examined. The aim of this study was to investigate whether loneliness in patients with dementia is related to BPSD. Methods A total of 152 patients with dementia were assessed using the Neuropsychiatric Inventory (NPI-12) and the revised University of California at Los Angeles (UCLA) loneliness scale. Spearman correlation analysis and Mann-Whitney U-tests were used to examine factors associated with the revised UCLA loneliness scale. Logistic regression analysis with a forced entry method was performed to identify risk factors for BPSD. Results The revised UCLA loneliness scale score was not significantly associated with age, years of education, mini-mental state examination (MMSE) score, gender, living status, visual impairment, hearing impairment, and marital status. However, this score was a significant predictor of NPI delusion and hallucination subscale scores and GDS-15 score. The MMSE score was a significant predictor of NPI anxiety and apathy subscale scores. Conclusions Loneliness is a risk factor for BPSD, especially for depressive symptoms and psychosis. Paying attention to loneliness in patients with dementia will help medical staff to intervene in psychiatric symptoms of these patients at an early stage. This article is protected by copyright. All rights reserved.

Reduction of the incidence of depression and improvement of quality of life (QOL) of elderly people have become important subjects. Various factors are related to depressive symptoms in elderly people, and sensory impairment is a key to health, QOL, and depressive symptoms. In this cross-sectional study, a visual acuity test and audiometry were used to examine the relationships of visual and hearing impairment and other factors with depressive symptoms in elderly people. A group of 490 community-dwelling people aged over 65 years old underwent vision and hearing tests, the Center for Epidemiologic Studies Depression Scale (CES-D), Mini-Mental State Examination (MMSE), and questionnaires on social isolation, QOL, and physical condition. Logistic regression analysis was used to examine factors affecting CES-D. Multivariate logistic regression analysis indicated that hearing impairment, pain score, and satisfaction with human relationships and activities of daily living (ADL) were independent predictors of CES-D scores. Satisfaction with human relationships and ADL can reduce depressive symptoms in elderly people. Hearing impairment, pain, and social contact are also important. Therefore, improvement of social networks, interpersonal relationships, ADL, and hearing impairment may be effective in improving these symptoms in elderly people.

Background In prior studies, higher citrus consumption was associated with higher risk of cutaneous malignant melanoma, squamous cell carcinoma (SCC), and basal cell carcinoma (BCC). Furocoumarins, compounds with phototoxicity and photocarcinogenicity in citrus, may be responsible for the association. Objectives The objective of the study was to investigate the association between furocoumarin intake and skin cancer risk. Methods A total of 47,453 men from the Health Professionals Follow-Up Study (HPFS) and 75,291 women from the Nurses' Health Study (NHS) with diet data collected every 2-4 y in the 2 prospective cohort studies were included. A furocoumarin food composition database for 7 common furocoumarins [bergaptol, psoralen, 8-methoxypsoralen, bergapten, 6',7'-dihydroxybergamottin (6'7'-DHB), epoxybergamottin, and bergamottin] was developed and used to calculate participants' cumulative average and energy-adjusted furocoumarin intake. Multivariate HRs and 95% CIs of the associations between furocoumarin intake and skin cancer risk were estimated using Cox proportional hazards models. Analyses were performed separately in each cohort as well as pooled using a fixed-effects model. Results Throughout follow-up (1984-2012 in the NHS and 1986-2012 in the HPFS), we identified 1593 melanoma, 4066 SCC, and 28,630 BCC cases. Higher intake of total furocoumarins was associated with an increased risk of BCC; the pooled HR comparing the top with the bottom quintile was 1.16 (95% CI: 1.11, 1.21; P-trend = 0.002). Higher intakes of bergaptol, bergapten, 6'7'-DHB, and bergamottin were also significantly associated with increased BCC risk. No significant associations were found between intake of total furocoumarins and the risks of SCC or melanoma. Conclusions Intakes of total furocoumarins as well as some individual furocoumarins were associated with an increased risk of skin cancer, especially BCC, in 2 cohorts of US health professionals.

Incisional double-eyelid blepharoplasty is widely applied because of its extensive indications and robust results. The orbicularis-levator fixation method is an incisional approach that provides stronger adhesion than traditional techniques. However, there remains the risk of postoperative relapse or suture spitting out. The authors introduced a modified technique for supratarsal crease formation. When necessary soft tissue removal was completed, the orbicularis oculi muscle was anchored on the tarsus. Then the muscle edges near canthus were reattached to prevent muscle retraction. For skin closure, the skin-pretarsal fascia-skin maneuver was adopted to enhance cicatricial adhesion. Six hundred and fifty-nine patients underwent double eyelidplasty by the same surgeon using this modified technique. Patients were followed up from 2 to 38 months, with a mean period of 15 months. Short-term complications included mild edema, bruising or reddish change of the upper eyelid, yet all gradually relieved in 6–8 weeks. Fourteen cases of palpebral fold asymmetry and nine cases of unsatisfactory fold formation near the inner canthus were encountered, and all the defects had been well improved by revision surgeries. Ninety-five percent of the patients were satisfied with the long-term outcomes, which showed as natural and well-defined palpebral folds without scar hypertrophy, suture spitting out or crease depression. Besides, no supratarsal crease drooping or disappearing was observed 3 years postoperatively. The authors introduced an orbicularis-tarsus fixation method for upper eyelid blepharoplasty. It is a reliable technique that enables high feasibility and long-lasting result, and with lower risk of suture spitting out. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Summary Background A plump single eyelid with medial epicanthal fold is the morphological feature of the East Asian population. This study describes a practical technique that combines orbicularis oculi muscle resection-based epicanthoplasty and orbicularis-tarsus fixation double-eyelid plasty for cosmetic blepharoplasty and reports on surgical outcomes in a large number of Chinese patients. Methods For supratarsal crease formation, the soft tissue was removed in a conservative manner and the orbicularis oculi muscle was anchored on the tarsus to build a reliable attachment. To correct the epicanthal fold, a modified redraping technique was used for the design of skin incision, and most importantly, a triangular muscle block composed of the orbicularis oculi muscle was selectively removed to release the abnormal tension in the epicanthal fold. Results From January 2015 to February 2019, 475 patients underwent double-eyelid blepharoplasty combined with epicanthoplasty using this technique. The follow-up period ranged from 2 to 38 months, with a mean period of 16 months. Of these, 97% of the patients were satisfied with surgical outcomes, presenting well-defined palpebral folds and naturally improved inner canthus contour, with no conspicuous scar. The photographic analysis in 84 patients showed significant improvement in palpebral fissure proportion postoperatively. No supratarsal crease drooping or recurrence of the epicanthal fold was observed up to 38 months after the surgery. Conclusions This method is a safe and reliable technique to achieve an elongated and more balanced eye shape in Chinese patients, with minimal scarring and a low risk of postoperative complication in a long follow-up period.

Normalization of clinical text involves linking different ways of talking about the same clinical concept to the same term in the standardized vocabulary. To date, very few annotated corpora for normalization have been available, and existing corpora so far have been limited in scope and only dealt with the normalization of diseases and disorders. In this paper, we describe the annotation methodology we developed in order to create a new manually annotated wide-coverage corpus for clinical concept normalization, the Medical Concept Normalization (MCN) corpus. In order to ensure wider coverage, we applied normalization to the text spans corresponding to the medical problems, treatments, and tests in the named entity corpus released for the fourth i2b2/VA shared task. In contrast to previous annotation efforts, we do not assign multiple concept labels to the named entities that do not map to a unique concept in the controlled vocabulary. Nor do we leave that named entity without a concept label. Instead, our normalization method that splits such named entities, resolving some of the core ambiguity issues. Lastly, we supply a sieve-based normalization baseline for MCN which combines MetaMap with multiple exact match components. The resulting corpus consists of 100 discharge summaries and provides normalization for the total of 10,919 concept mentions, using 3792 unique concepts from two controlled vocabularies. Our inter-annotator agreement is 67.69% pre-adjudication and 74.20% post-adjudication. Our sieve-based normalization baseline for MCN achieves 77% accuracy in cross-validation. We also detail the challenges of creating a normalization corpus, including the limitations deriving from both the mention span selection and the ambiguity and inconsistency within the current standardized terminologies. In order to facilitate the development of improved concept normalization methods, the MCN corpus will be publicly released to the research community in a shared task in 2019.

Normalization maps clinical terms in medical notes to concepts in standardized medical vocabularies. To complement the traditional lexical transformation based approach, we propose a hybrid normalization system which incorporates a deep learning model to capture semantic similarity between different surface expressions of the same concept. When evaluating our system against the mentions which may be normalized to existing concepts in the ShARe/CLEF eHealth 2013 dataset, our hybrid system achieves 90.6% in accuracy and outperforms a strong exact match + edit distance baseline by 2.6%. The results suggest the potential of the deep learning model to further improve the performance of normalization by mapping concept mentions to concepts using semantic similarity.

Electrolytic manganese is conventionally produced through low-grade manganese ore leaching in SO2, with the combustion of high sulfur coal. Subsequently the coal ash and manganese slag, produced by the combustion of high sulfur coal and preparation of electrolytic manganese, can be used as raw ingredients for the preparation of sulphoaluminate cement. In order to realize the ‘coal-electricity-sulfur-manganese-building material’ system of complementary resource utilization, the conditions of material inflow and outflow in each process were determined using material flow analysis. The material flow models in each unit and process can be obtained by analyzed of material flow for new technology, and the input-output model could be obtained. Through the model, it is possible to obtain the quantity of all the input and output material in the condition of limiting the quantity of a substance. Taking one ton electrolytic manganese as a basis, the quantity of other input material and cements can be determined with the input-output model. The whole system had thusly achieved a cleaner production level. Therefore, the input-output model can be used for guidance in practical production.

Cerebral autoregulation is defined as the mechanism by which constant cerebral blood flow is maintained despite changes of arterial blood pressure, and arterial blood pressure represents the principle aspect of cerebral autoregulation. The impairment of cerebral autoregulation is reported to be involved in several diseases. However, the concept, mechanisms, and pathological dysfunction of cerebral autoregulation are beyond full comprehension. Nitric oxide control and sympathetic control are main contributors to cerebral autoregulation. Although impaired cerebral autoregulation after nitric oxide inhibition or sympathetic ganglia blockade is reported, managing the inhibition or blockade can have negative consequences and needs further exploration. Additionally, impaired cerebral autoregulation following subarachnoid hemorrhage and traumatic brain injury has been proven by several descriptive studies, although without corresponding explanations. As the most important mechanisms of cerebral autoregulation, the changes of nitric oxide and sympathetic stimulation play significant roles in these insults. Therefore, the in-depth researches of nitric oxide and sympathetic nerve in cerebral autoregulation may help to develop new therapeutic targets.

Participants in the 2012 i2b2 Shared-Task and Workshop on Challenges in Natural Language Processing for Clinical Data created a variety of systems for processing temporal relations in clinical records. The different ways of conceptualizing the shared-task Tracks reflects the complexity of temporal analysis of narratives even for humans, and the use of hybrid systems, world knowledge, and other sources of linguistic information reflect the difficulty of formulating temporal analysis for automated methods. Despite their promising results, and significant advancement on the state of the art in temporal relations in medical records, the 2012 i2b2 challenge systems only scratched the surface in this task. Open questions remain about the applicability of the developed systems for real life practical questions, such as the determination of the progression of diseases in patients, for example, heart disease in diabetic populations. Nevertheless, the 2012 i2b2 Challenge corpus of temporal annotations remains a valuable asset to the medical NLP community, and we hope will serve as the basis for further innovation in temporal relations, resulting in systems that can be applied to real life clinical problems.

Background The Sixth Informatics for Integrating Biology and the Bedside (i2b2) Natural Language Processing Challenge for Clinical Records focused on the temporal relations in clinical narratives. The organizers provided the research community with a corpus of discharge summaries annotated with temporal information, to be used for the development and evaluation of temporal reasoning systems. 18 teams from around the world participated in the challenge. During the workshop, participating teams presented comprehensive reviews and analysis of their systems, and outlined future research directions suggested by the challenge contributions. Methods The challenge evaluated systems on the information extraction tasks that targeted: (1) clinically significant events, including both clinical concepts such as problems, tests, treatments, and clinical departments, and events relevant to the patient's clinical timeline, such as admissions, transfers between departments, etc; (2) temporal expressions, referring to the dates, times, durations, or frequencies phrases in the clinical text. The values of the extracted temporal expressions had to be normalized to an ISO specification standard; and (3) temporal relations, between the clinical events and temporal expressions. Participants determined pairs of events and temporal expressions that exhibited a temporal relation, and identified the temporal relation between them. Results For event detection, statistical machine learning (ML) methods consistently showed superior performance. While ML and rule based methods seemed to detect temporal expressions equally well, the best systems overwhelmingly adopted a rule based approach for value normalization. For temporal relation classification, the systems using hybrid approaches that combined ML and heuristics based methods produced the best results.

Laser microdissection followed by mass spectrometry has been successfully used for amyloid typing. However, sample contamination can interfere with proteomic analysis, and overnight digestion limits the analytical throughput. Moreover, current quantitative analysis methods are based on the spectrum count, which ignores differences in protein length and may lead to misdiagnoses. Here, we developed a microwave-assisted filter-aided sample preparation (maFASP) method that can efficiently remove contaminants with a 10-kDa cutoff ultrafiltration unit and can accelerate the digestion process with the assistance of a microwave. Additionally, two parameters (P- and D-scores) based on the exponentially modified protein abundance index were developed to define the existence of amyloid deposits and those causative proteins with the greatest abundance. Using our protocol, twenty cases of systemic amyloidosis that were well-typed according to clinical diagnostic standards (training group) and another twenty-four cases without subtype diagnoses (validation group) were analyzed. Using this approach, sample preparation could be completed within four hours. We successfully subtyped 100% of the cases in the training group, and the diagnostic success rate in the validation group was 91.7%. This maFASP-aided proteomic protocol represents an efficient approach for amyloid diagnosis and subtyping, particularly for serum-contaminated samples.

We analyze the RI-TIMEXes in temporally annotated corpora and propose two hypotheses regarding the normalization of RI-TIMEXes in the clinical narrative domain: the anchor point hypothesis and the anchor relation hypothesis. We annotate the RI-TIMEXes in three corpora to study the characteristics of RI-TMEXes in different domains. This informed the design of our RI-TIMEX normalization system for the clinical domain, which consists of an anchor point classifier, an anchor relation classifier and a rule-based RI-TIMEX text span parser. We experiment with different feature sets and perform error analysis for each system component. The annotation confirmed the hypotheses that we can simplify the RI-TIMEXes normalization task using two multi-label classifiers. Our system achieves anchor point classification, anchor relation classification and rule-based parsing accuracy of 74.68%, 87.71% and 57.2% (82.09% under relaxed matching criteria) respectively on the held-out test set of the 2012 i2b2 temporal relation challenge. Experiments with feature sets reveals some interesting findings such as the verbal tense feature does not inform the anchor relation classification in clinical narratives as much as the tokens near the RI-TIMEX. Error analysis shows that underrepresented anchor point and anchor relation classes are difficult to detect. We formulate the RI-TIMEX normalization problem as a pair of multi-label classification problems. Considering only the RI-TIMEX extraction and normalization, the system achieves statistically significant improvement over the RI-TIMEX results of the best systems in the 2012 i2b2 challenge., Comment: Draft version

Temporal information in clinical narratives plays an important role in patients’ diagnosis, treatment and prognosis. In order to represent narrative information accurately, medical natural language processing (MLP) systems need to correctly identify and interpret temporal information. To promote research in this area, the Informatics for Integrating Biology and the Bedside (i2b2) project developed a temporally annotated corpus of clinical narratives. This corpus contains 310 de-identified discharge summaries, with annotations of clinical events, temporal expressions and temporal relations. This paper describes the process followed for the development of this corpus and discusses annotation guideline development, annotation methodology, and corpus quality.

Objectives To provide an overview of the problem of temporal reasoning over clinical text and to summarize the state of the art in clinical natural language processing for this task. Target audience This overview targets medical informatics researchers who are unfamiliar with the problems and applications of temporal reasoning over clinical text. Scope We review the major applications of text-based temporal reasoning, describe the challenges for software systems handling temporal information in clinical text, and give an overview of the state of the art. Finally, we present some perspectives on future research directions that emerged during the recent community-wide challenge on text-based temporal reasoning in the clinical domain.