Integrating Artificial Intelligence and Wearable IoT System in Long-Term Care Environments

With the rapid advancement of information and communication technology (ICT), big data, and artificial intelligence (AI), intelligent healthcare systems have emerged, including the integration of healthcare systems with capital, the introduction of healthcare systems into long-term care institutions, and the integration of measurement data for care or exposure. These systems provide comprehensive communication and home exposure reports and enable the involvement of rehabilitation specialists and other experts. Silver technology enables the realization of health management in long-term care services, workplace care, and health applications, facilitating disease prevention and control, improving disease management, reducing home isolation, alleviating family burden in terms of nursing, and promoting health and disease control. Research and development efforts in forward-looking cross-domain precision health technology, system construction, testing, and integration are carried out. This integrated project consists of two main components. The Integrated Intelligent Long-Term Care Service Management System focuses on building a personalized care service system for the elderly, encompassing health, nutrition, diet, and health education aspects. The Wearable Internet of Things Care System primarily supports the development of portable physiological signal detection devices and electronic fences.

Rapid progression of acute sciatica to cauda equina syndrome

OBJECTIVE

To demonstrate the importance of clinical examination and continued vigilance for neurologic deterioration in patients with sciatica. Cauda equina syndrome, a rare sequela of sciatica, is considered a medical emergency requiring surgical decompression.

CLINICAL FEATURES

A 32-year-old woman had sciatica that rapidly progressed to cauda equina syndrome. Magnetic resonance imaging revealed the presence of a large nonsequestered disk fragment in the lower lumbar spine.

INTERVENTION AND OUTCOME

The disk fragment was surgically excised. The patient experienced immediate pain relief after surgery but retained neurologic deficits. After 6 months of rehabilitation, neurologic integrity was restored, aside from patchy sensory loss of the left foot and buttocks. At the 6-month follow-up, the patient's sciatica had not returned.

CONCLUSIONS

Most cases of sciatica, regardless of cause, will self-resolve; as a result, there might be a tendency to maintain a low index of suspicion for serious, progressive disorders such as cauda equina syndrome. Patients need to be educated as to signs of this emergency condition and informed as to the possible consequences of delaying treatment. By maintaining a high index of suspicion for any case that fails to respond as expected to a course of conservative therapy or that demonstrates signs of cauda equina syndrome, chiropractors can assume a pivotal role by investigating and referring appropriately and by aiding in active rehabilitation postoperatively.

Quality assurance in clinical laboratories in Taiwan

BACKGROUND AND PURPOSE

In 1994, the Taiwan National Health Administration assigned the execution of a quality assurance (QA) survey program to the Association of Laboratory Medicine. The purpose of this program was to investigate the quality of clinical laboratory assessments and to promote QA in the fields of clinical microscopy, hematology, chemistry, microbiology, serology, and blood banking. We report the findings of QA surveys conducted in 1998 and the effect of voluntary training on improvement of clinical laboratory testing.

METHODS

A total of 1,008 clinical laboratories were included in the program in 1998. Proficiency testing (PT) was performed to evaluate various laboratory tests. Continuing education programs were conducted and experts visited laboratories that sought guidance before the PT was conducted. The full mark was set at a score of 100 for each PT scheme. The criterion for acceptability of PT results was set at a score of 80 or more.

RESULTS

The rates of acceptable results were 82.4% (607/736) for hematology, 57.4% (267/465) for blood banking, 69.3% (561/810) for chemistry, and 80.1% (321/401) for microbiology. The rates of acceptable microscopy results were 90.9% (509/560) for urine chemical tests and 84.6% (610/721) for others. The rates of acceptable serology tests were 73.3% (384/524) for hepatitis and 85.6% (441/515) for syphilis. The rates of acceptable performance differed significantly among clinical laboratories with different rankings: clinical laboratories at institutions classified below the level of district hospital showed comparatively poor performance. Laboratories that received guidance showed significant improvement in performance from 1997 to 1998.

CONCLUSIONS

A QA program is urgently needed in Taiwan to improve laboratory performance.

Posterior tibial stress fracture: a report of three cases

OBJECTIVE

To discuss the specific clinical and radiographic features of posterior tibial stress fracture, as well as appropriate clinical management, including imaging and treatment, in the presence of suspected or confirmed tibial stress fracture.

CLINICAL FEATURES

Three patients suffered from exercise-related lower leg pain, clinical features, and risk factors specific for posterior tibial stress fracture. Diagnosis was confirmed for all three individuals by radiographic imaging.

INTERVENTION AND OUTCOME

Treatment included rest and modified activity, followed by a graded return to activity commensurate with bony healing. This approach was successful for two of the individuals diagnosed with posterior tibial stress fracture. In the third individual treatment recommendations were not adhered to, resulting in three separate stress fractures of the posterior tibia over 27 months.

CONCLUSION

Stress fractures may go undiagnosed for a long period of time; therefore a high index of suspicion, along with knowledge of its clinical and predisposing factors, is necessary for recognition. Inappropriate management of individuals with tibial stress fracture may result in recurrence or frank fracture. Chiropractors have a role in the prevention of stress fractures by identifying and educating patients at risk for this condition.

Fully automated assay of blood D-3-hydroxybutyrate for ketosis

Ketone bodies are derived from the accelerated beta-oxidation of fatty acids during prolonged starvation or severely impaired carbohydrate metabolism. D-3-hydroxybutyrate (3OHB) is the major ketone circulating in the blood. Fully automated assay of 3OHB using a centrifugal analyzer was developed. The within-run and between-run levels of precision were acceptable, with coefficients of variation of from 0.75% to 4.35%. The recovery was 101.00 +/- 3.71%. The linearity was up to 5 mmol/L. Delayed serum separation even after 24 hours had no effect. The stability of 3OHB at -20 degrees C was greater than that at 4 degrees C when the serum was stored. No significant interference was observed with hemoglobin, bilirubin or triacylglycerol. NaF-treated plasma gave a significant underestimation of 3OHB. There was no significant difference in blood 3OHB between normal (blood glucose < or = 110 mg/dL, n = 87) and hyperglycemic subjects (blood glucose 110-200 mg/dL, n = 42), but when the blood glucose concentration was greater than 200 mg/dL, the difference in blood 3OHB between normal subjects and hyperglycemic patients became significant. The blood 3OHB concentrations increased according to the degree of hyperglycemia. There were sensitive changes in blood 3OHB during the treatment of a patient with diabetic ketoacidosis. The monitoring of blood 3OHB can be used clinically as an index of ketosis and as a signal of metabolic control in diabetes.

Causes of death in aged burn patients: analysis of 36 cases

Over a 10-year period 110 patients over the age of 65 years were admitted to the Burn Center, Rui Jin Hospital and 36 (32.7 per cent) died. Significant differences between the survivors and non-survivors were related to the total burn surface area and full skin thickness burn size. Among the causes of death, pre-existing cardiopulmonary diseases and associated inhalation injury were particularly important since pneumonia was considered as a primary cause of death in 13 patients, myocardial disease in two, cor-pulmonale and heart failure in two. Care of the early fluid resuscitation, early excision of deep burn wounds and grafting, prevention or treatment of a variety of life-threatening complications, and nutritional supplementation appeared to decrease the mortality of aged burn patients.

Clinical significance of urinary N-acetyl-beta-D-glucosaminidase and alanine aminopeptidase

The excretion of urinary N-acetyl-beta-D-glucosaminidase (NAG) and Alanine Aminopeptidase (AAP) increases with renal damage. The variation in enzyme activity due to the fluctuation of urine flow rate could almost be eliminated by expressing it as the ratio of enzyme activity to urinary creatinine concentration. The urinary enzyme activities increased not only by tubular damage but also by the reduced creatinine clearance due to glomerular injury. The normal reference values of NAG were 2.84 +/- 2.50U/g creatinine for 24-hour urine and 3.23 +/- 2.76U/g creatinine for random urine. The normal reference values of AAP were 9.71 +/- 6.68U/g creatinine for both 24-hour urine and random urine. Although 128 patients were with abnormal enzymuria, only 39.1%, 52.3%, 83.6%, and 86.7% of the patients were with abnormal serum creatinine, serum urea N, creatinine clearance, and urine protein, respectively. In view of the sensitivity, the determinations of urinary NAG and AAP are suitable for early detection of renal diseases.

Changes in lymphocyte response to phytohaemagglutinin and serum immunosuppressive activity after thermal injury

The present study consisted of two parts. In part one, 14 cases were divided into an invasive infection group (4 cases) and a non-invasive infection group (10 cases). A total of 68 assays for lymphocyte responses to PHA stimulation were carried out. The invasive infection group showed a significantly suppressed lymphocyte response, which occurred during invasive infection but neither before nor after the infection. The extent of third-degree burns was statistically significant between these two groups (P less than 0.05), but no significance was found between the total body surface area burned. In part two, 18 burn patients were studied for serum immunosuppressive activity. Both invasive infection cases and non-invasive infection cases showed serum immunosuppression during the course of the study and no significant difference was found between these two groups (P greater than 0.05). It is concluded that the extent of third-degree burn and the complicated systemic infection contribute to the impairment of lymphocyte responses to PHA stimulation, while the post-burn serum immunosuppression is unrelated to the occurrence of systemic infection.

Changes of serum amino acids in severely burned patients

The serum amino acids profile in ten severe burn patients was basically similar with the findings in major burns reported in our proceeding article, supporting the conclusion that burn patients might have a particular amino acid pattern. The larger was the burn size, the more severe was the nitrogen loss. Following a severe burn, the patient was faced with the challenge of acute protein malnutrition. After severe burns, the ratio of serum Phe/Tyr rose to a higher level than in the major burns. Moreover, the elevation of serum Met/Cys ratio indicated a more serious metabolic disturbance. During the first two weeks postburn, acute decrease of serum BCAA by 20-30 per cent of the normal value was associated with a striking increase of mortality. This fact indicated the level of BCAA might be of prognostic value. In severe burns, other than huge amount of calories and protein supplied, enriched BCAA, and perhaps, carnitine might be beneficial.

Serum and erythrocyte amino acid pattern: studies on major burn cases

Venous serum amino acids were measured in 13 patients with major burns. Erythrocyte amino acids and plasma cortisol, blood sugar and urine catecholamine were measured in two representative subgroups respectively. After burn injury, serum proline, glycine, valine, isoleucine and arginine were significantly decreased; phenylalanine, cysteine, methionine, leucine, glutamate, alanine, aspartic acid and tyrosine were significantly increased. Histidine and lysine fluctuated. This serum amino acid profile is considered as a specific pattern for major burns. Serum phenylalanine was markedly elevated in the hypermetabolic burn patients, its fluctuation coincided with the burn course and was negatively correlated with serum albumin level (P less than 0.001). These findings suggest that the ratio of phenylalanine tyrosine is a useful clinical parameter for assessing the patient's nutritional condition. Twenty-three simultaneous determinations of both serum and erythrocyte amino acid concentrations show similar changes, suggesting that the serum amino acid profile might reflect the change of total free amino acid pool. After burn injury, plasma cortisol, blood sugar and urine catecholamine were elevated as well as urine urea nitrogen. However, although the first three returned to normal by the end of the second week post burn, urine urea nitrogen remained high. This indicates that there are other factors controlling nitrogen loss in patients with major burns, it is also postulated that, due to the abnormal amino acid pattern revealed after major burns, the constituents of commercially available amino acid solutions should be modified.