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Purpose Twitter is an increasingly popular social media platform within the health care community. The objective of this analysis is to characterize the profile of radiation oncology–related tweets and Twitter users over the past 6 years. Methods and Materials Using the web-based social media analytics platform Symplur Signals, we filtered tweets containing at least 1 of the following hashtags or key words: #radonc, #radiationoncology, "rad onc," or "radiation oncology." We evaluated radiation oncology–related Twitter activity between October 2014 and March 2020 for tweet frequency, tweet content, and individuals or groups posting tweets. We identified the most influential Twitter users contributing to radiation oncology–related tweets. Results From 2014 to 2020, the quarterly volume of radiation oncology–related tweets increased from 5027 to 29,763. Physicians contributed the largest growth in tweet volume. Academic radiation oncologists comprise 60% of the most influential Twitter accounts responsible for radiation oncology–related content. The number of radiation-oncology resident physicians on Twitter increased from 25 to 328 over the past 6 years, and 20% of radiation-oncology residency programs have a Twitter account. Seventy-one percent of radiation oncology–related tweets generated direct communication via mentions, and 59% of tweets contain links to external sources, including scientific articles. Conclusions The number of physicians contributing radiation oncology–related Twitter content has increased significantly in recent years. Academic radiation oncologists are the primary influencers of radiation oncology–related Twitter activity. Twitter is used by radiation oncologists to both professionally network and discuss findings related to the field. There remains the opportunity for radiation oncologists to broaden their audience on Twitter to encompass a more diverse community, including patients.

Purpose Our objective was to establish a random forest model and to evaluate its predictive capability of the treatment effect of neoadjuvant chemotherapy–radiation therapy. Methods This retrospective study included 82 patients with locally advanced cervical cancer who underwent scanning from March 2013 to May 2018. The random forest model was established and optimised based on the open source toolkit scikit-learn. Byoptimising of the number of decision trees in the random forest, the criteria for selecting the final partition index and the minimum number of samples partitioned by each node, the performance of random forest in the prediction of the treatment effect of neoadjuvant chemotherapy–radiation therapy on advanced cervical cancer (> IIb) was evaluated. Results The number of decision trees in the random forests influenced the model performance. When the number of decision trees was set to 10, 25, 40, 55, 70, 85 and 100, the performance of random forest model exhibited an increasing trend first and then a decreasing one. The criteria for the selection of final partition index showed significant effects on the generation of decision trees. The Gini index demonstrated a better effect compared with information gain index. The area under the receiver operating curve for Gini index attained a value of 0.917. Conclusion The random forest model showed potential in predicting the treatment effect of neoadjuvant chemotherapy–radiation therapy based on high-resolution T2WIs for advanced cervical cancer (> IIb).

The issue of limited labeled samples is still grave in hyperspectral image (HSI) classification. Collaborative learning promotes a solution to this issue by combining active learning (AL) and semisupervised learning. However, it has been found that the performance of wrong pseudolabels added into the iteration may seriously deteriorate classification performance. To tackle this problem, we propose a reverification of pseudolabels algorithm based on superpixels segmentation, which is tripartite, including two AL selection strategies, the first-verification procedure based on three classifiers, and reverification procedure improving the correctness of pseudolabeled samples based on superpixels segmentation. Specifically, two AL strategies mainly generate training samples sets for two check classifiers, and three classifiers are main forces to implement the first-verification for unlabeled samples with predictive labels. Subsequently, a reverification procedure based on local similarity in superpixels is applied to reverify these unlabeled samples with predictive labels passing the first-verification procedure. The proposed algorithm is tested on three widely used HSI datasets and compared with three state-of-the-art collaborative learning algorithms with onefold verification. Experimental results illustrate numerically and visually the significantly superior performance of our proposed algorithm considering the spatial information to reverify the correctness of pseudolabels to unlabeled samples.

IMPORTANCE: Preclinical studies suggest that inhibition of single-stranded DNA repair by ataxia telangiectasia and Rad3 (ATR) may enhance the cytotoxicity of cisplatin, gemcitabine, and other chemotherapeutic agents. Cisplatin with gemcitabine remains the standard up-front therapy for treatment in patients with metastatic urothelial cancer. OBJECTIVE: To determine whether the use of the selective ATR inhibitor, berzosertib, could augment the activity of cisplatin with gemcitabine. DESIGN, SETTING, AND PARTICIPANTS: In a phase 2 randomized clinical trial, 87 patients across 23 centers in the National Cancer Institute Experimental Therapeutics Clinical Trials Network were randomized to receive either cisplatin with gemcitabine alone (control arm) or cisplatin with gemcitabine plus berzosertib (experimental arm). Key eligibility criteria included confirmed metastatic urothelial cancer, no prior cytotoxic therapy for metastatic disease, 12 months or more since perioperative therapy, and eligibility for cisplatin receipt based on standard criteria. The study was conducted from January 27, 2017, to December 15, 2020. INTERVENTIONS: In the control arm, cisplatin, 70 mg/m(2), was given on day 1 and gemcitabine, 1000 mg/m(2), was given on days 1 and 8 of a 21-day cycle. In the experimental arm, cisplatin, 60 mg/m(2), was given on day 1; gemcitabine, 875 mg/m(2), on days 1 and 8; and berzosertib, 90 mg/m(2), on days 2 and 9 of a 21-day cycle. MAIN OUTCOMES AND MEASURES: The primary end point of the study was progression-free survival. The analysis was on all patients who started therapy. RESULTS: Of the total of 87 patients randomized, 41 patients received cisplatin with gemcitabine alone and 46 received cisplatin with gemcitabine plus berzosertib. Median age was 67 (range, 32-84) years, and 68 patients (78%) were men. Median progression-free survival was 8.0 months for both arms (Bajorin risk-adjusted hazard ratio, 1.22; 95% CI, 0.72-2.08). Median overall survival was shorter with cisplatin with gemcitabine plus berzosertib compared with cisplatin with gemcitabine alone (14.4 vs 19.8 months; Bajorin risk-adjusted hazard ratio, 1.42; 95% CI, 0.76-2.68). Higher rates of grade 3 vs grade 4 thrombocytopenia (59% vs 39%) and neutropenia (37% vs 27%) were observed with cisplatin with gemcitabine and berzosertib compared with cisplatin with gemcitabine alone; consequently, more dose reductions were needed in the experimental arm. Patients in the experimental arm received a median cisplatin dose of 250 mg/m(2), which was significantly lower than the median dose of 370 mg/m(2) in the control arm (P

Neuroendocrine tumors (NETs) are often misdiagnosed because they can involve any part of the body and have non-specific symptoms. Here, we report a case of a 39-year-old man with rectal neuroendocrine tumor (RNET) and hepatic metastases treated with a combination of radical surgery and Everolimus therapy. The patient complained of abdominal distension, pain, and constipation of one month duration. Enhanced CT scan of the abdomen, colonoscopy and Biopsy findings confirmed the diagnosis of rectal neuroendocrine tumor. As the anatomical structures were clear and the masses seemed to be resectable, we decided to initiate treatment with radical operation and Everolimus therapy. The patient has responded well to the treatment with no evidence of recurrence after 4 years of follow-up. This case is interesting because of the rarity of this neoplasm and its initial misdiagnosis as a giant hepatic carcinoma (hepatoma). It also demonstrates that a combination of curative surgical resection and Everolimus is a good option in a patient with large colorectal neuroendocrine tumors and massive hepatic metastases.

The combination of network communication and medical education gave birth to distance medical education (DME). Now the fifth generation of mobile communication technology (5G) with high data rate, low delay, save energy, reduce cost and other advantages to the telemedicine education has provided a substantial change. It can make the utilization of excellent resources have sufficiency and high efficiency, which equalize educational resources. Teachers can stay face-to-face with students, even if they are in different places. It makes the teaching content is updated in time and so on. This paper reviews the development history of distance medicine education and looks forward to the prospect brought by the combination of 5G communication technology. How to guide clinical practice and improve the learning efficiency and interest.

Purpose This paper aims to propose a fast machine compression scheme, which can solve the problem of low-bandwidth transmission for underwater images. Design/methodology/approach This fast machine compression scheme mainly consists of three stages. Firstly, raw images are fed into the image pre-processing module, which is specially designed for underwater color images. Secondly, a divide-and-conquer (D&C) image compression framework is developed to divide the problem of image compression into a manageable size. And extreme learning machine (ELM) is introduced to substitute for principal component analysis (PCA), which is a traditional transform-based lossy compression algorithm. The execution time of ELM is very short, thus the authors can compress the images at a much faster speed. Finally, underwater color images can be recovered from the compressed images. Findings Experiment results show that the proposed scheme can not only compress the images at a much faster speed but also maintain the acceptable perceptual quality of reconstructed images. Originality/value This paper proposes a fast machine compression scheme, which combines the traditional PCA compression algorithm with the ELM algorithm. Moreover, a pre-processing module and a D&C image compression framework are specially designed for underwater images.

Brain–computer interface (BCI) has developed rapidly over the past two decades, mainly due to advancements in machine learning. Subjects must learn to modulate their brain activities to ensure a successful BCI. Feedback training is a practical approach to this learning process; however, the commonly used classifier-dependent approaches have inherent limitations such as the need for calibration and a lack of continuous feedback over long periods of time. This paper proposes an online data visualization feedback protocol that intuitively reflects the EEG distribution in Riemannian geometry in real time. Rather than learning a hyperplane, the Riemannian geometry formulation allows iterative learning of prototypical covariance matrices that are translated into visualized feedback through diffusion map process. Ten subjects were recruited for MI-BCI (motor imagery-BCI) training experiments. The subjects learned to modulate their sensorimotor rhythm to centralize the points within one category and to separate points belonging to different categories. The results show favorable overall training effects in terms of the class distinctiveness and EEG feature discriminancy over a 3-day training with 30% learners. A steadily increased class distinctiveness in the last three sessions suggests that the advanced training protocol is effective. The optimal frequency band was consistent during the 3-day training, and the difference between subjects with good or low MI-BCI performance could be clearly observed. We believe that the proposed feedback protocol has promising application prospect.

This study is to examine the cost-effectiveness of deployment strategies of oral cholera vaccines (OCVs) in controlling cholera in Bangladesh. We developed a dynamic compartment model to simulate costs and health outcomes for 12 years for four OCVs deployment scenarios: (1) vaccination of children aged one and above with two doses of OCVs, (2) vaccination of population aged 5 and above with a single dose of OCVs, (3) vaccination of children aged 1-4 with two doses of OCVs; and (4) combined strategy of (2) and (3). We obtained all parameters from the literature and performed a cost-effectiveness analysis from both health systems and societal perspectives, in comparison with the base scenario of no vaccination.The incremental cost-effectiveness ratios (ICERs) for the four strategies from the societal perspective were $2,236, $2,250, $1,109, and $2,112 per DALY averted, respectively, with herd immunity being considered. Without herd immunity, the ICERs increased substantially for all four scenarios except for the scenario that vaccinates children aged 1-4 only. The major determinants of ICERs were the case fatality rate and the incidence of cholera, as well as the efficacy of OCVs. The projection period and frequency of administering OCVs would also affect the cost-effectiveness of OCVs. With the cut-off of 1.5 times gross domestic product per capita, the four OCVs deployment strategies are cost-effective. The combined strategy is more efficient than the strategy of vaccinating the population aged one and above with two doses of OCVs and could be considered in the resource-limited settings.

Individually tailoring education over time may help more patients, especially racial/ethnic minorities, get waitlisted and pursue deceased and living donor kidney transplant (DDKT and LDKT, respectively). We enrolled 802 patients pursuing transplant evaluation at the University of California, Los Angeles Transplant Program into a randomized education trial. We compared the effectiveness of Your Path to Transplant (YPT), an individually tailored coaching and education program delivered at 4 time points, with standard of care (SOC) education on improving readiness to pursue DDKT and LDKT, transplant knowledge, taking 15 small transplant-related actions, and pursuing transplant (waitlisting or LDKT rates) over 8months. Survey outcomes were collected prior to evaluation and at 4 and 8 months. Time to waitlisting or LDKT was assessed with at least 18months of follow-up. At 8months, compared to SOC, the YPT group demonstrated increased LDKT readiness (47% vs 33%, P=.003) and transplant knowledge (effect size [ES]=0.41, P&nbsp

Inefficient delivery is a major obstacle to the development of peptide-based drugs targeting the intracellular compartment. We recently showed that selectively inhibiting integrin outside-in signaling using a peptide (mP6) derived from the Gα13-binding ExE motif within the integrin β3 cytoplasmic domain had antithrombotic effects. Here, we engineered lipid-stabilized, high-loading peptide nanoparticles (HLPN), in which a redesigned ExE peptide (M3mP6) constituted up to 70% of the total nanoparticle molarity, allowing efficient in vivo delivery. We observed that M3mP6 HLPN inhibited occlusive thrombosis more potently than a clopidogrel/aspirin combination without adverse effects on hemostasis in rodents. Furthermore, M3mP6 HLPN synergized with P2Y12 receptor inhibitors or the clopidogrel/aspirin combination in preventing thrombosis, without exacerbating hemorrhage. M3mP6 HLPN also inhibited intravascular coagulation more potently than the P2Y12 inhibitor cangrelor. Postischemia injection of M3mP6 HLPN protected the heart from myocardial ischemia-reperfusion injury in a mouse model. This study demonstrates an efficient in vivo peptide delivery strategy for a therapeutic that not only efficaciously prevented thrombosis with minimal bleeding risk but also protected from myocardial ischemia-reperfusion injury in mice.

Background Medical litigation represents a growing cost to healthcare systems. Mediation, arbitration, and other alternative dispute resolution (ADR) methods are increasingly used to help solve the disputes and improve healthcare satisfaction. In China, the increasing number of medical disputes has contributed to concern for the safety of physicians and mistrust between physician and patients resulting in ADR processes being established in several provinces in recent years. Our aim was to describe and explain the impact of this new mediation process in the Chinese healthcare system. Methods Our study investigated mediation practices in China using case-level data from 5614 mediation records in Guangdong Province between 2013 and 2015. We investigated how the resolution success as well as the compensations are associated with the case characteristics using regression analysis. Results Among the cases analyzed, 1995 (41%) were solved with agreement through mediation, 1030 were closed by reconciliation, 559 were closed by referring to court and 1017 cases were withdrawn after mediation. Five hundred five Yinao cases were solved with the help of mediators on the spot. We find that mediation solved about 90% of medical disputes under present mechanisms, while more police support is needed to cope with Yinao. The average compensation of mediation is CNY60,200 and average length of mediation is 87 days. Longer time taken to reach resolution and more money claimed by patients are associated with lower resolution success rate (p Conclusion Our results show the performance of mediation mechanisms in China to help solve medical disputes. ADR plays a role in reducing the need for initiating litigation and may ultimately increase satisfaction with the healthcare system.

Author(s): Waterman, Amy D; Peipert, John D; Xiao, Huiling; Goalby, Christina J; Kawakita, Satoru; Cui, Yujie; Lentine, Krista L | Abstract: BackgroundTransplant education in dialysis centers can increase access to kidney transplant; however, dialysis center transplant barriers are common, and limited research identifies the most effective transplant education approaches.MethodsWe surveyed transplant educators in 1694 US dialysis centers about their transplant knowledge, use of 12 education practices, and 8 identified education barriers. Transplant wait-listing rates were calculated using US Renal Data System data.ResultsFifty-two percent of educators orally recommended transplant to patients, 31% had in-center transplant discussions with patients, 17% distributed print educational resources, and 3% used intensive education approaches. Distribution of print education (incident rate ratio: 1.021.151.30) and using g1 intensive education practice (1.001.111.23) within dialysis centers were associated with increased wait-listing rates. Several dialysis center characteristics were associated with reduced odds of using education strategies leading to increased wait-listing. Centers with greater percentages of uninsured patients (odds ratio [OR]: 0.960.970.99), in rural locations (OR: 0.660.790.95), with for-profit ownership (OR: 0.640.770.91), and with more patients older than 65 years (OR: 0.050.110.23) had lower odds of recommending transplant, while centers with a higher patient-to-staff ratio were more likely to do so (OR: 1.011.031.04). Language barriers (OR: 0.480.640.86) and having competing work priorities (OR: 0.400.530.70) reduced the odds of distributing print education. Providers with greater transplant knowledge were more likely to use g1 intensive educational strategy (OR: 1.011.271.60) while providers who reported competing work priorities (OR: 0.510.660.84) and poor communication with transplant centers (OR: 0.580.760.98) were less likely to do so.ConclusionsEducators should prioritize transplant education strategies shown to be associated with increasing wait-listing rates.

Supplemental Digital Content is available in the text., Background. Socioeconomic barriers can prevent successful kidney transplant (KT) but are difficult to measure efficiently in clinical settings. We created and validated an individual-level, single score Kidney Transplant Derailers Index (KTDI) and assessed its association with waitlisting and living donor KT (LDKT) rates. Methods. The dataset included 733 patients presenting for KT evaluation in a transplant center in California. Exploratory factor analysis was used to identify socioeconomic barriers to KT (derailers) to include in the index. Potential KT derailers included health insurance, employment, financial insecurity, educational attainment, perception of neighborhood safety, access to a vehicle, having a washer/dryer, and quality of social support. Validity was tested with associations between KTDI scores and the following: (1) the Area Deprivation Index (ADI) and (2) time to KT waitlisting and LDKT. Results. Nine derailers were retained, omitting only social support level from the original set. The KTDI was scored by summing the number of derailers endorsed (mean: 3.0; range: 0–9). Black patients had higher estimated KTDI scores than other patient groups (versus White patients, 3.8 versus 2.1; P < 0.001, effect size = 0.81). In addition, the KTDI was associated with the ADI (γ = 0.70, SE = 0.07; P < 0.001). Finally, in comparison to the lower tertile, patients in the upper and middle KTDI tertiles had lower hazard of waitlisting (upper tertile hazard ratio [HR]: 0.34, 95% confidence interval [CI]: 0.25-0.45; middle tertile HR: 0.54, 95% CI: 0.40-0.72) and receiving an LDKT (upper tertile HR: 0.15, 95% CI: 0.08-0.30; middle tertile HR: 0.35, 95% CI: 0.20-0.62). These associations remained significant when adjusting for the ADI and other patient characteristics. Conclusions. The KTDI is a valid indicator of socioeconomic barriers to KT for individual patients that can be used to identify patients at risk for not receiving a KT.

The Toll-like receptor 4 (TLR4)-mediated neuroinflammation plays a key role in inducing secondary brain injury after intracerebral hemorrhage (ICH). However, how TLR4 is regulated during this pathological process is not well understood. In the present study, by taking advantage of a rat ICH model, we show that miR-140-5p is reversely correlated with TLR4 expression in the peri-hematomal striatum following ICH. In vitro, miR-140-5p directly targets TLR4 and suppresses its expression in a rat neuronal PC12 cell line. Moreover, an intracerebral ventricular injection of miR-140-5p mimics improves neurological function and reduces apoptotic cell death and limits the production of inflammatory cytokines following ICH, indicating that miR-140-5p attenuates brain injury and neuroinflammation in vivo. Furthermore, miR-140-5p suppresses TLR4 expression and inhibits the downstream MyD88/TRIF inflammatory pathway and NF-κB activity following ICH, suggesting that the inhibition of TLR4-mediated neuroinflammation at least in part accounts for the neuroprotective role of miR-140-5 against ICH-induced brain injury in rats. Collectively, these results identify miR-140-5 as a negative regulator of TLR4 and downstream inflammatory pathway following ICH, implicating that miR-140-5 might represent as a potential therapeutic target for alleviating ICH-induced brain injury.

ObjectivesThe study analysed medical malpractice claims to assess patient safety in hospitals. The information derived from malpractice claims reflects potential risks and could help lead to reducing medical errors and improving patient safety.Design, settingWe analysed 4380 medical malpractice claims from 351 grade-A tertiary hospitals in China for 2008–2017. We examined the characteristics of medical errors and patient safety, including the types of medical errors, proportionate liabilities and payments for medical malpractice in different clinical specialties.Main outcome measuresWe assessed claim characteristics, payment amounts and liability.ResultsOur data analysis demonstrated that 72.5% of the claims involved medical errors, with average payments of US$31 430. The hospital’s errors in medical malpractice resulted in 41.4% average liability in patient injury payments. Most medical malpractice cases occurred in Shanghai (817 claims, 18.7%) and Beijing (468 claims, 10.7%). The highest risks for medical error and malpractice claims were related to orthopaedics (11.3% of all claims, 72.8% with medical errors) and obstetrics and gynaecology (10.0% of all claims, 76.0% with medical errors). The highest rates related to proportionate liabilities were observed in otolaryngology (51.9%) and endocrinology (47.7%). Respiratory medicine had the highest proportion of claims in death rates (77.3%). Medical technology errors accounted for 91.8% of the claims and medical ethics errors for 5.8%. The highest average payment was found in cardiovascular surgery (US$41 733) and the lowest in stomatology (US$8822).ConclusionsA previous study found that grade-A tertiary hospitals in China have similar medical error rates to general Chinese hospitals. 36Different specialties had different risk characteristics regarding medical errors, payments and proportionate liabilities. Orthopaedics had the highest number of malpractices claims and higher proportionate liability but lower death rates.

The benefit of training on economic outcomes has been well-documented in previous literature, as training is generally recognized as one of the important approaches in human capital investment. However, the return of employee training on organizational level performance is not verified sufficiently, especially in the healthcare field. By taking advantage of a dataset with the information on all medical institutions in Sichuan, China over 2012–2016, this paper investigates the effects of employee training on medical institution’s performance through the Propensity Score Matching (PSM) method and the Event Study approach. The results show that training benefits medical institution performance in some indicators, such as total visits, outpatient visits, non-medical-insurance, and local competitiveness. These effects, however, vary across different types of medical institutions. Grassroot medical institutions in the county area that serve as a health gatekeeper (known as primary health care institution, PHCIs) gain most in hospital visits after training. In addition, training results in a 16.5% increase in the average performance wage for county-PHCIs, and a 52.8% increase in the employees’ performance wage for higher-level general hospitals in cities. In general, by participating in training, PHCIs in county region gain more in the overall revenue through the non-medical-insurance income.

Objective: The aim of this meta-analysis of randomized controlled trials (RCT) and retrospective cohort studies (CS) regarding the use of volar locking plate (VLP) and external fixation (EF) in distal radius fractures was to determine whether there was any evidence that one treatment was superior to the other. Methods: The meta-analysis followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. Electrical databases (PubMed, EMBASE and the Cochrane library) were retrieved to find RCTs and CSs met the eligibility criteria. Two reviewers screened the studies, extracted the data and evaluated the methodological quality, and performed data analysis with RevMan 5.1. The publication bias was test by Stata 14.0. The Begg's and Egger's test were performed by Stata 14.0. The quality of evidence was graded according to the criteria of GRADE. We ultimately included ten RCTs and eleven CSs. Results: A total of 1590 subjects were reported. Publication bias was detected by funnel plot in RCTs. VLP could provide better results such as DASH scores (RCT: MD = −6.12, 95%CI = −12.07–0.17; CS: MD = −6.43, 95%CI = −12.53–0.3), ulnar variance (RCT: MD = −0.81, 95%CI = −1.25–0.37) and infection rate (RCT: RR = 0.25, 95%CI = 0.10–0.65; CS: RR = 0.15, 95%CI = 0.06–0.40). There were no significant differences for G-W scores, VAS and grip strength between the VLP group and EF group. There was significantly greater loss of volar tilt (P = 0.01) and radial inclination (P = 0.02) in patients receiving EF, basing on the CSs. Conclusions: VLP could provide better results, such as DASH scores, ulnar variance, volar tilt, radial inclination and infection rate. The use of VLP appear to be associated with better results of ROM (flexion, pronation, supination and radial deviation), radiographic parameters (volar tilt and radial inclination) and lower total complication rate and CRPS rate in CSs. Level of evidence: Level 1, Therapeutic study. Keywords: Distal radial fractures, Volar locking plate, External fixation, Meta-analysis, GRADE analysis

The most challenging difficulties for teleoperation systems are well recognized as the Internet uncertain time delays, which might degrade system performance or even lead to system instability. This paper proposes a novel control framework for Internet-based teleoperation systems which is based on the prediction of jitter of Internet one-way time-delay. Internet jitter is predicated based on the sparse multivariate linear regression method. The slave system can be controlled using a virtual system provided at the master site, which is updated according to historical commands transmitted to the slave site and Internet jitter prediction results. The presented control framework is deployed in a virtual inverted pendulum teleoperation system developed. In the experiments, users successfully stabilize the remote virtual pendulum through the Internet, which demonstrate the effectiveness and prospect of the proposed Internet control framework.

Iron deficiency is a common cause of anemia. In end-stage renal disease (ESRD), iron deficiency impairs the therapeutic efficacy of recombinant erythropoietin. Oral or parental iron supplements usually are effective in treating iron deficiency anemia (IDA). Some patients, however, respond poorly to iron supplements and are diagnosed as having iron-refractory iron deficiency anemia (IRIDA). The disease represents a medical challenge but its underlying mechanism was unclear. Hepcidin is a central player in iron homeostasis. It down-regulates the iron exporter ferroportin, thereby inhibiting iron absorption, release and recycling. In ESRD, plasma hepcidin levels are elevated, which contributes to iron deficiency in patients. Matriptase-2, a liver transmembrane serine protease, has been found to have a major role in controlling hepcidin gene expression. In mice, defects in the Tmprss6 gene encoding matriptase-2 result in high hepcidin expression and cause severe microcytic anemia. Similarly, mutations in the human TMPRSS6 gene have been identified in patients with IRIDA. Thus, matriptase-2 is critical for iron homeostasis and may play a role in renal disease.

BACKGROUND Primary Sjogren's syndrome (pSS) is one of the most common chronic systemic autoimmune diseases, and thrombocytopenia is one of the hematological manifestations of pSS. When platelet and endothelial cells are activated, P-selectin is expressed on the cell surface. This study aimed to investigate the role of P-selectin autoantibodies in the pathogenesis of thrombocytopenia in pSS. MATERIAL AND METHODS P-selectin autoantibodies were measured by enzyme-linked immunosorbent assay (ELISA) in 38 pSS patients without thrombocytopenia and 32 pSS patients with thrombocytopenia, 32 idiopathic thrombocytopenic purpura (ITP) patients, and 35 healthy controls. RESULTS The plasma P-selectin autoantibodies (A490) in ITP patients and pSS patients with/without thrombocytopenia were significantly higher than those in healthy controls, but there were no significant differences between ITP patients and pSS patients with thrombocytopenia. The positive rate of P-selectin autoantibodies in pSS patients with thrombocytopenia was significantly higher than that in ITP patients. The platelet count was lower in P-selectin autoantibodies-positive patients, while among pSS patients with thrombocytopenia, the platelet count was lower in P-selectin autoantibodies-positive patients than in P-selectin autoantibodies-negative patients. In ITP patients and pSS patients with thrombocytopenia, the platelet count was lower in P-selectin autoantibodies-positive patients. CONCLUSIONS Elevated plasma P-selectin autoantibodies may play a role in the pathogenesis of thrombocytopenia in pSS patients.

Background Diabetic cardiomyopathy (DCM), a fatal cardiovascular complication of diabetes mellitus, often leads to progressive heart failure, however its pathogenesis remains unclear. Corin, a cardiac serine protease, is responsible for converting pro-atrial natriuretic peptide (pro-ANP) to biologically active atrial natriuretic peptide (ANP). It has been well established that corin deficiency is associated with the progression of hypertension, cardiac hypertrophy and heart failure. However, because the involvement of corin-mediated pro-ANP processing in DCM has not been clarified, this study aims to investigate the role of corin in the pathogenesis of DCM. Methods Diabetes mellitus was induced by a single intraperitoneal injection of streptozotocin (STZ 65 mg/kg) to Sprague–Dawley rats (180–220 g). DCM was confirmed by monitoring continuously transthoracic echocardiography every 4 weeks and hemodynamic measurements at 20 weeks. Myocardial disorder and fibrosis were detected by HE staining and Masson’s trichrome staining. The mRNA and protein levels of corin and ANP in rat hearts and cardiomyocytes were determined by quantitative real-time PCR, western blotting and immunohistochemical staining, respectively. H9c2 cardiomyoblasts proliferation was detected by MTT colorimetric assay and viable cell counting with trypan blue. The effect of Corin-siRNA H9c2 cardiomyoblasts on EA.hy926 cells migration was measured by the wound healing scratch assay. Results The corin and ANP expression in mRNA and protein levels was decreased in DCM rat hearts. Corin and ANP levels of neonatal rat cardiomyocytes and H9c2 cardiomyoblasts treated with high glucose were significantly lower than that of normal glucose treated. Precisely, corin and ANP levels decreased in DCM rats at 12, 16, 20 and 33 weeks; neonatal cardiomyocytes and H9c2 cardiomyoblasts treated with high glucose at 36, 48 and 60 h demonstrated significant reduction in corin and ANP levels. Corin-siRNA H9c2 cardiomyoblasts showed decreased proliferation. Culture supernatants of Corin-siRNA H9c2 cardiomyoblasts prevented endothelial cell line EA.hy926 migration in the wound healing scratch assay. Furthermore, iso-lectin expression in arteriole and capillary endothelium was down-regulated in DCM rats. Conclusions Our results indicate that corin plays an important role in cardioprotection by activating pro-atrial natriuretic peptide pathway in DCM. Corin deficiency leads to endothelial dysfunction and vascular remodeling. Electronic supplementary material The online version of this article (doi:10.1186/s12933-015-0298-9) contains supplementary material, which is available to authorized users.

In virtual reality (VR)-based telerobotic systems, system performance depends highly on the accuracy of the virtual model constructed at the master site. However, state errors between virtual and slave system exist inevitably due to unknown environment parameters and random time delay of communication media. A popular strategy to tackle the problem is by means of virtual environment technology, in which the environment impedance is estimated on slave site and transmitted and recreated as a virtual environment on master site, and then, the virtual model is updated on the fly according to estimated parameters from slave site. As distinct from the existing parameter estimation methods, this article tries to synchronize master and slave sites of telerobotic systems with an Internet one way time delay (OWTD) jitter prediction approach. A virtual manipulator system is constructed as the slave system and can be controlled with an identical virtual manipulator model displayed on the screen of the master site, which is corrected and updated according to historical commands transmitted to the slave site and Internet OWTD jitter prediction results. Three prediction algorithms for time series prediction, i.e., multiple linear regression (MLR), grey model (GM), and autoregressive moving average model (ARMA), are adopted during the implementation of the proposed approach. The developed approach has been validated with a teleoperated free motion task and experimental results indicate that the proposed approach can be used to synchronize master and slave sites and ARMA outperforms GM and MLR in Internet OWTD jitter prediction.

It has been noted that human operating skills had a great impact on performance of human-machine systems. Cognitive behaviors of human operators have been naturally considered as important research contents and have received more and more concern from academia. Research on human cognitive behaviors plays an important role in development of autonomous mechatronic systems and progress in rehabilitation engineering. This paper concerns the design and implementation of a human-machine interaction system on which EEG signals and behavior data can be recorded simultaneously. On this platform, we can set different operating conditions under which operators perform the human-machine interaction tasks, such as the size of time-delay, different multimedia feedback, and etc. This work establishes the foundation for research on cognitive behaviors of human operators in human-machine interaction systems and neural control systems.

The laboratory air handling unit (LAHU) system for laboratory buildings has been developed and optimized. Theoretical study has concluded that the LAHU with optimal outside air control and optimal heat recovery control significantly reduces thermal energy use, saves pump power consumption and improves office indoor air quality. This paper presents validation experiments of the LAHU energy performance for the winter operation in a large university research building including detailed experimental methodology, procedures and experimental energy savings results. The experiments establish that the LAHU can reduce annual heating energy consumption by over 30% and can reduce heat recovery pump power by over 50%peryear for this typical laboratory building. The experimental validation of the LAHU for the summer operation will be reported in a followup paper.

Optimal operation and control of heat recovery in an integrated Laboratory Air Handling Unit (LAHU) system differs substantially from that in conventional dedicated AHUs for laboratory buildings with a 100% outside air AHU for laboratory spaces, since the LAHU allows economizer operation for both offices and laboratories. Optimal operation and control schedules of the heat recovery systems in the LAHU have been developed to minimize the total thermal energy cost. This paper presents the procedure, methodology, and results of generic optimal heat recovery control schedules for the LAHU and investigates its impact on the LAHU potential thermal and pump energy savings. The optimal control schedule can potentially save 14% to 27% thermal energy and 17% to 100% pump energy during the winter under weather conditions that prevail in Omaha, Nebraska. The findings discussed in this paper also apply to any heat recovery system, where AHU has an economizer function.

The Laboratory Air Handling Unit (LAHU) system conditions both the office section and the laboratory section. It improves indoor air quality by maximizing outside air intake to the office section and minimizes thermal energy consumption by re-circulating the office section air to the laboratory section. This paper presents a theoretical linear optimization method and results of optimal outside air control in LAHUs. The optimal outside airflows are expressed as functions of the weather conditions (outside air temperature and enthalpy), office and laboratory airflow rates, office and laboratory supply air temperatures, and four dimensionless parameters that describe the building system and energy characteristics. The optimization method used in this paper can be used to identify the optimal control schedules in other HVAC systems.

Constant speed fan exhaust systems are the most popular exhaust system in laboratory buildings since they satisfy building architectural requirement, and have low initial costs with reliable performance. The constant speed fan exhaust system maintains constant stack exit velocity to prevent toxic exhaust air downwash back to occupied areas near the building or on the roof top. To achieve constant velocity when the exhaust airflow is less than the design value, makeup air is introduced to the system at the inlet of the exhaust fan. Since the laboratory exhaust airflow is often significantly less than the design airflow, exhaust fans consume significantly more energy than is necessary. Multi-stack and Variable frequency drive techniques can reduce both the make-up airflow rate and fan energy in the constant speed fan exhaust system retrofit. This paper introduces the application principles, describes the optimal methods of stack sizing, and presents an example. The application example showed that the average annual fan power is 50% of the design fan power for a two-stack system, and 47% for a three-stack system.

This paper proposes a method for balancing a virtual inverted pendulum through Internet based on the prediction of jitter of Internet one-way time delay. The sparse multivariate linear regression method is used to give prediction on Internet time delay jitter. The remote virtual pendulum can be controlled with an identical virtual pendulum model displayed on the screen of the master site, which is updated according to historical commands transmitted to the slave site and Internet jitter prediction results. In the experiments, operators succeed in balancing the remote virtual pendulum through the Internet, which demonstrate the effectiveness and prospect of the proposed Internet based control method.

Internet random time delay constitutes a major challenge for Internet-based teleoperation systems. Since the uncertain time delay may degrade the system performance, and even lead to instability. Although large-scale research works have been conducted on the understanding, testing, and analysis of Internet round trip time delay (RTT), it is not appropriate to use RTT in control methods design. It is well known that control commands arrive at the slave site in an aperiodic manner as a result of Internet random time delay. The subsequent control command will terminate the execution of the current command. Consequently, we will get precise information for slave system once the time delay jitter can be known in advance. This paper proposes a novel research idea for Internet-based teleoperation system from the point of view of delay jitter prediction. Statistical properties of the time delay jitter are investigated. Furthermore, the sparse multivariate linear regression method is used to give prediction on Internet time delay jitter. Simulation results demonstrate that sparse multivariate linear regressive method gives a precise prediction, which indicates that the proposed control method based on Internet time delay jitter has a broad prospect in teleoperation systems.

African Americans represent a high risk population for salt-sensitive hypertension and heart disease but the underlying mechanism remains unclear. Corin is a cardiac protease that regulates blood pressure by activating natriuretic peptides. A corin gene variant (T555I/Q568P) was identified in African Americans with hypertension and cardiac hypertrophy. In this study, we test the hypothesis that the corin variant contributes to the hypertensive and cardiac hypertrophic phenotype in vivo. Transgenic mice were generated to express wild-type or T555I/Q568P variant corin in the heart under the control of α-myosin heavy chain promoter. The mice were crossed into a corin knockout background to create KO/TgWT and KO/TgV mice that expressed WT or variant corin, respectively, in the heart. Functional studies showed that KO/TgV mice had significantly higher levels of pro-atrial natriuretic peptide in the heart compared with that in control KO/TgWT mice, indicating that the corin variant was defective in processing natriuretic peptides in vivo. By radiotelemetry, corin KO/TgV mice were found to have hypertension that was sensitive to dietary salt loading. The mice also developed cardiac hypertrophy at 12–14 months of age when fed a normal salt diet or at a younger age when fed a high salt diet. The phenotype of salt-sensitive hypertension and cardiac hypertrophy in KO/TgV mice closely resembles the pathological findings in African Americans who carry the corin variant. The results indicate that corin defects may represent an important mechanism in salt-sensitive hypertension and cardiac hypertrophy in African Americans.

User clustering-based Web service discovery method is presented to deal with lower efficiency of query in current Web service discovery methods. In order to solve this problem, by analyzing the characteristics of Web service and user, get the conclusion that user with similar interest will be interested in similar services. Therefore, by clustering users and establishing recommendation service library, can recommend the service to the user. And a QoS matching is added to satisfy the need of QoS. Experimental results showed that this method is effective and is able to increase the preciseness and ensure the QoS.

Because of the traditional BP neural network's limitation, including easily falling into local minimum, slow convergence and iteration for a long time, we propose a diagnostic system of mental disorders based on Levenberg-Marquardt algorithm. This article illustrates the basic principles of the neural network algorithm and establishes a mental diagnosis model based on L-M algorithm which uses common mental illness among college students as subjects. The outcome of the simulation illustrates the fact that it is effective to apply the neural network to establish a mental diagnostic system because it has reduced the training iterations and training period and it has high accuracy as well.

As a main type of agricultural robot, fruit harvesting robot has a great potential in agriculture production. In this context, a formulation of the manipulator based on Danevit - Hartenberg is educed for the kinematics equation, and the virtual model of manipulator is developed. The kinematics is studied and inverse kinematics is obtained based on algebraic method. The kinematics simulation of the manipulator based on ADAMS is presented. And the kinematics simulation produced the processing motion course and relevant kinematics curves. The results indicate that the manipulator could implement the process according to the expected trajectory successfully.

Telepresence is a critical problem in robotic teleoperation systems. For the sake of collision avoidance between the end-effecter and the object, the human operator has to make close observations on the visual information. This overloads the visual sense of the human operator. On the other hand, there are some potential obstacles in gathering vision information. As a result, the advance notice of collision might be missed or neglected. In order to settle this issue, a virtual force guided control method for robotic teleoperation system is proposed in this paper. This approach combines position-force command strategy and virtual force feedback to perform proper operations, where the virtual force is generated by transforming visual information into reflective force. This control approach improves the operability of teleoperation system and enhances the effectiveness. Experiments are conducted and demonstrate the effectiveness of the virtual force guided control method.

This article addresses the hybrid control method for wheeled mobile robot in constrained environment. Wheeled mobile robots, which are characterized by nonholonomic constraints, are particularly difficult to control since environment constraints should be taken into account sometimes. Traditional control methods, which are based on precise models of environment, may lead to great challenges in determining suitable control laws to steer wheeled mobile robots. To enhance autonomy of wheeled mobile robots, hybrid system frameworks which consider simultaneously the control and decision-making issues are required. In this paper, the wheeled mobile robot which operates in a constrained environment is modeled as a 3-layered hybrid architecture: finite state machine for the decision-making process, wheeled mobile robot system for the continuous state plant, while the interface as the interaction between the continuous dynamics and the decision-making process. It is obvious that this hybrid architecture is particularly useful in describing the interactions between discrete and continuous components that exist simultaneously in robotic systems. Simulation results show that the proposed method is effective for the control of wheeled mobile robots.

sure are increased, ANP is secreted from the heart. It binds to its receptor in the kidney and blood vessels, and promotes salt excretion, lowers blood volume and relaxes the vessel. This endocrine mechanism links the heart and kidney in maintaining a fine balance of electrolytes and body fluid. The physiological importance of the ANP pathway has been shown in many animal studies. In mice, for example,ANPdeficiencycauseshypertension[9],whereasANP overexpression results in hypotension [10]. The hypertension in ANP null mice is sensitive to high dietary salts, indicating that ANP is critical in regulating the response to salt in vivo. The heart also makes another peptide, brain or B-type natriuretic peptide (BNP), which has similar natriuretic and diuretic activity to that of ANP. BNP null mice, however, had normal blood pressure but developed cardiac fibrosis [11], suggesting that the physiological function of BNP may differ from that of ANP. In humans, several single nucleotide polymorphisms (SNPs) have been found in the ANP gene. One of them (-C664G) is located in the promoter region. Genetic studies showed that the -664G allele was associated with low plasma ANP levels, high blood pressure and left ventricular hypertrophy in patients [12,13]. Most recently, a frameshift mutation in the ANP gene was reported in a family of European ancestry [14]. This mutation abolished the stop codon, creating a mutant molecule with 12 extra amino acids at the C-terminus of ANP. The members of this family with the mutant gene developed atrial fibrillation. Some of them also had hypertension that required medical intervention. In an animal model, the mutant ANP was shown to shorten monophasic action potential in cardiomyocytes, which may explain the phenotype of atrial fibrillation in the patients.

The Laboratory Air Handling Unit (LAHU) system for laboratory buildings has been developed and optimized. Theoretical study has concluded that the LAHU with optimal outside air control and optimal heat recovery control significantly reduces thermal energy use, saves pump power consumption and improves office indoor air quality. This paper presents validation experiments of LAHU energy performance in a large university research building including detailed experimental methodology, procedures and preliminary experimental energy savings results. The experiments establish that the LAHU can reduce annual heating by over 30% and can reduce heat recovery pump power by over 50% for this typical laboratory building.Copyright © 2005 by ASME

Optimal operation and control of heat recovery in the Laboratory Air Handling Unit (LAHU) system differs from the optimal control and operation schedule used in 100% outside air AHU. In the LAHU system, economizers can be used in both the office section and the laboratory section. An optimal operation and control schedule for the heat recovery systems has been developed by using the first derivative test for local extreme values to minimize the total thermal energy consumption. The schedule turns off the heat recovery system when the outside air temperature is higher than the LAHU free cooling temperature, which is much lower than the AHU discharge air temperature. The optimal schedule actually also reduces the electricity consumption of heat recovery water circulation pump and improves room relative humidity condition. The optimal operation and control schedule developed in the paper also applies to AHUs where economizer is used. The study also found that a heat recovery system may not be necessary for LAHUs under certain conditions.Copyright © 2004 by ASME

A multi-stack exhaust system has been developed for use in laboratory buildings. The multi-stack system activates different stacks and uses a variable speed drive (VSD) to change the fan speed when the laboratory exhaust airflow changes. This system satisfies safety requirements and uses less fan power than a conventional system. The typical fan power savings is 40% or higher, depending on the flow usage profile and the exhaust system duct design characteristics. This paper presents the system models and optimization procedures for the design of a multi-stack system.Copyright © 2002 by ASME