High-Frequency Discrete-Interval Binary Sequence in Asynchronous C-VEP-Based BCI for Visual Fatigue Reduction

In code-modulated visual evoked potential (c-VEP) based BCI systems, flickering visual stimuli may result in visual fatigue. Thus, we introduced a discrete-interval binary sequence (DIBS) as visual stimulus modulation, with its power spectrum optimized to emphasize high-frequency components (40 Hz-60 Hz). 8 and 17 subjects participated, respectively, in offline and online experiments on a 4-target asynchronous c-VEP-based BCI system designed to realize a high positive predictive value (PPV), a low false positive rate (FPR) during idle states, and a high true positive rate (TPR) in control states, while minimizing visual fatigue level. Two visual stimuli modulations were introduced and compared: a maximum length sequence (m-sequence) and the high-frequency discrete-interval binary sequence (DIBS). The decoding algorithm was compared among the canonical correlation analysis (CCA), the task-related component analysis (TRCA), and two approaches of sub-band component weight calculation (the traditional method and the proportional method) for FBCCA and FBTRCA. In the online experiments, the average PPV, FPR and TPR achieved, respectively [Formula: see text], [Formula: see text], [Formula: see text] with m-sequence, while [Formula: see text], [Formula: see text] and [Formula: see text] with DIBS. Estimated by objective eye-related metrics and a subjective questionnaire, the visual fatigue in DIBS cases is significantly smaller than that in m-sequence cases. In this study, the feasibility of a novel modulation approach for visual fatigue reduction was proved in an asynchronous c-VEP system, while maintaining comparable performance to existing methods, which provides further insights towards enhancing this field's long-term viability and user-friendliness.

Application of deep learning in radiation therapy for cancer

In recent years, with the development of artificial intelligence, deep learning has been gradually applied to clinical treatment and research. It has also found its way into the applications in radiotherapy, a crucial method for cancer treatment. This study summarizes the commonly used and latest deep learning algorithms (including transformer, and diffusion models), introduces the workflow of different radiotherapy, and illustrates the application of different algorithms in different radiotherapy modules, as well as the defects and challenges of deep learning in the field of radiotherapy, so as to provide some help for the development of automatic radiotherapy for cancer.

Evidence for Chiral Wobbler in Nuclei

Three ΔI=1 bands with the πg_{9/2}⊗νg_{9/2} configuration have been identified in _{35}^{74}Br_{39}. Angular distribution, linear polarization, and lifetime measurements were performed to determine the multipolarity, type, mixing ratio, and absolute transition probability of the transitions. By comparing these experimental observations with the corresponding fingerprints and the quantum particle rotor model calculations, the second and third lowest bands are, respectively, suggested as the chiral partner and one-phonon wobbling excitation built on the yrast band. The evidence indicates the first chiral wobbler in nuclei.

[Surgical plan selection and efficacy analysis in 32 cases of laryngotracheal stenosis]

Objective: To explore the optimization of surgical procedures for laryngotracheal stenosis and its effect analysis. Methods: The data of 32 patients with acquired laryngotracheal stenosis who received surgical treatment from October 2015 to December 2021 were analyzed retrospectively. The age ranged from 19 to 72 years, with an average of (34.0±9.0) years. The medical history ranged from 1 to 32 months (median 3 months). As for etiology, there were 30 cases of iatrogenic laryngotracheal stenosis, including 20 cases of tracheal intubation and 10 cases of tracheotomy (7 cases of percutaneous tracheotomy and 3 cases of traditional tracheotomy). There were 1 case of laryngotracheal trauma and 1 case of airway Penicillium marneffei infection. According to Myer-Cotton grading system, grade Ⅳ stenosis was found in 14 cases, including 12 cases involving trachea and 2 cases involving trachea and subglottic area.There were 18 cases of grade Ⅲ, all of which involved the cervical trachea 5 cases failed in operation in other hospitals. According to stenosis grading, course of disease, primary disease control and the patient's general condition, the surgical plan was determined individually. The operations of end-to-end anastomosis, circumferential tracheal partial resection, T-tube placement and CO2 laser tracheal scar resection were performed respectively. The recovery of airway function and perioperative complications were observed one year after operation. Results: End-to-end anastomosis was performed in 16 cases, and partial circumferential tracheal resection in 2 cases, and tracheal granulation (scar) resection by CO2 laser in 2 cases and T-tube insertion in 12 cases. Eighteen cases which performed end-to-end anastomosis, partial resection of circumferential trachea in and 2 cases which performed laser tracheal scar resection were all recovered airway function at one stage. After 1 year, 19 cases were cured and 1 case was effective. Of 12 patients with T tube implantation, 11 cases were successfully extubated after 6-12 months, 7 cases were cured after 1 year, 2 cases were effective and 3 cases were ineffective. Among the 3 cases of failure, 2 cases were successfully extubated by sleeve resection and end-to-end anastomosis in the second stage, and the other case refused to accept other treatment methods and the T-tube was placed again, and the tube was blocked and the patient survived. During the follow-up period, the total cure rate was 87.5%, the effective rate was 9.4%, and the total extubation rate was 96.9%.The most common complication was subcutaneous emphysema, accounting for 78% (25/32), but no serious mediastinal emphysema or pneumothorax occurred. In the T-tube implantation group, granulation tissue grew in different degrees around the neck wound after operation, and improved or disappeared after 6-9 months. Anterior cervical tracheal fistula occurred in 4 cases of T-tube implantation group after extubation, which were cured by sealing the stoma. There were no complications such as severe bleeding or perioperative death. Conclusion: When there were various factors, the optimization of the surgical plan according to the degree of stenosis, the course of disease, the control of primary disease and the general condition was an important guarantee to improve the curative effect of laryngotracheal stenosis.

Effect of motion state variability on error-related potentials during continuous feedback paradigms and their consequences for classification

BACKGROUND

An erroneous motion would elicit the error-related potential (ErrP) when humans monitor the behavior of the external devices. This EEG modality has been largely applied to brain-computer interface in an active or passive manner with discrete visual feedback. However, the effect of variable motion state on ErrP morphology and classification performance raises concerns when the interaction is conducted with continuous visual feedback.

NEW METHOD

In the present study, we designed a cursor control experiment. Participants monitored a continuously moving cursor to reach the target on one side of the screen. Motion state varied multiple times with two factors: (1) motion direction and (2) motion speed. The effects of these two factors on the morphological characteristics and classification performance of ErrP were analyzed. Furthermore, an offline simulation was performed to evaluate the effectiveness of the proposed extended ErrP-decoder in resolving the interference by motion direction changes.

RESULTS

The statistical analyses revealed that motion direction and motion speed significantly influenced the amplitude of feedback-ERN and frontal-Pe components, while only motion direction significantly affected the classification performance.

COMPARISON WITH EXISTING METHODS

Significant deviation was found in ErrP detection utilizing classical correct-versus-erroneous event training. However, this bias can be alleviated by 16% by the extended ErrP-decoder.

CONCLUSION

The morphology and classification performance of ErrP signal can be affected by motion state variability during continuous feedback paradigms. The results enhance the comprehension of ErrP morphological components and shed light on the detection of BCI's error behavior in practical continuous control.

Two-Stage Treatment Protocol of Fungal Periprosthetic Hip and Knee Joint Infections: the Clinical Experience from a Single Center Experience

PURPOSE OF THE STUDY

To evaluate the clinical results and safety of fungal periprosthetic joint Infections (fPJIs) using two-stage treatment protocol.

MATERIAL AND METHODS

8 patients with fPJIs (3 hips and 5 knees) using two-stage revision were reviewed retrospectively and followed up at least 2 years. The preoperative demographic data, two-stage treatment protocol, results of microbiology and histologic workup and postoperative follow-up results (reimplantation success rate and infection free time) were recorded.

RESULTS

7 patients got successful reimplantation, with a 75% reimplantation success rate. Two patients got knee arthrodesis eventually. All patients were infection free with a median follow-up of 4.0 ± 2.0 years (range, 2-7 years). Of them, Candida species were found in 7 patients, while non-Candida specimen was only isolated in 1 patient with Aspergillus. Only 2 patients had coexisting bacterial infection (Methicillin-resistant coagulase-negative Staphylococci and Proteus mirabilis respectively). The average interval between the initial surgery and diagnosis of fPJIs was 21.50±34.79 months (range, 4-104 months). The mean time of spacer implantation was 7.75±2.77 months (range, 6-14 months). None serious complication or above knee amputation was found.

DISCUSSION

fPJIs are very rare and considerable challenge after total hip or knee arthroplasty. The goal of therapy is to eradicate local infection and maintain function. Candida species were the most common pathogen. The duration between spacer placement and staged reimplantation was highly variable, and generally dependent upon the results of joint aspirates and infl ammatory markers. The current study shows that the two-stage treatment protocol is recommended for fungal periprosthetic hip and knee joint infections.

CONCLUSIONS

The two-stage treatment protocol is recommended for fungal periprosthetic hip and knee joint infections. The safety and effi cacy of biantibiotical impregnated (antifungal + antibiotics) cement spacer is confi rmed. Further evidence-based work is needed to determine the optimal drug dose and reimplantation time.

KEY WORDS

two-stage treatment protocol, fungal periprosthetic infections, hip spacer, knee spacer.

[Standardized diagnosis results of suspected local anesthetics allergy]

To review and investigate the diagnosis results of local anesthetics (LA) allergy and improve the understanding of LA allergy in clinician. From March 2017 to February 2022, a total of 24 patients were investigated in Allergy Center of West China Hospital,Sichuan University on suspicion of LA allergy. Clinical data and results of skin tests and drug provocation tests (DPT) with the suspected drugs were retrospectively evaluated. The value of standardized diagnostic protocol in the LA allergy were analyzed. The results showed that 24 patients (3 men/21 women) were included with age range from 20 to 74 years. Three cases (12.5%) were positive in previous LA skin tests and proved to be tolerated through standardized tests. Twenty-one patients were initially diagnosed as "LA allergy" because of adverse reactions after previous use of LA, including 20 cases of immediate-type reaction and 1 case of delayed-type reaction. Three cases were considered LA allergy through standardized diagnosis approaches, including skin tests and DPT. One patient was diagnosed with anaphylaxis caused by chlorhexidine. Of the remaining 17 patients, 7 were considered as psychosomatic reactions (29.1%), 3 of sympathetic nervous system conditions (12.5%), 1 of spontaneous urticaria (4.2%), 2 of vasovagal syncope (8.3%), drug side effects (8.3%), skin irritation (8.3%), respectively. In conclusion, true allergic reactions to LA are rare. Through standardized skin tests and DPT, allergy can be ruled out in the vast majority of patients who complain of "LA allergy". For patients who are highly suspected of LA inducing anaphylaxis, other local anesthetics that can be used as safe alternatives should be determined by diagnostic tests according to future needs.

Effects of heat shock protein 90 on complement activation in myocardial ischemia/reperfusion injury after pioglitazone preconditioning

BACKGROUND

Heat shock protein 90 (HSP90) appears to have a pivotal function in ischemic preconditioning. Pioglitazone preconditioning (PioC) attenuates myocardial ischemia/reperfusion (I/R) injuries.

OBJECTIVES

The current study aims to investigate the role of HSP90, complement C3 and C5a, and nuclear factor kappa-B (NF-κB) in PioC-induced cardioprotection.

MATERIAL AND METHODS

A total of 80 rats were randomly categorized into 4 groups, as follows: sham, I/R, PioC, and PioC+HSP90 inhibitor geldanamycin (PioC+GA). The sham group rats had a thoracotomy, in which the ligature was passed by the heart with no ligation (150 min). The other 3 groups were exposed to ischemia (30 min) followed by reperfusion (2 h). In the PioC group, pioglitazone (3 mg/kg) was administered intravenously 24 h before ischemia. In the PioC+GA group, after being pretreated with pioglitazone, GA was administered (intraperitoneally, 1 mg/kg) 30 min before ischemia. Myocardial infarct sizes (ISs), apoptosis rates, creatine kinase-MB (CK-MB), lactate dehydrogenase (LDH), and cardiac troponin I (cTnI) serum levels were determined. The HSP90, C3, NF-κB, C5a, B-cell lymphoma-2 (Bcl-2), and Bax expression levels, as well as interleukin (IL)-1β, IL-6, intercellular cell adhesion molecule-1 (ICAM-1), and tumor necrosis factor alpha (TNF-α) mRNA levels were measured.

RESULTS

The myocardial ISs, serum CK-MB, cTnI and LDH levels, apoptosis rates, IL-1β, IL-6, TNF-α, ICAM-1 release, as well as Bax, C5a, C3, and NF-κB protein expression were considerably lower in the PioC group than in the I/R group (p < 0.05). The Bcl-2 and HSP90 expression was higher in the PioC group than in the I/R group (p < 0.05). Geldanamycin inhibited the effects of PioC. These data strongly demonstrate that the PioC-induced is dependent upon HSP90 activity.

CONCLUSIONS

The HSP90 is indispensable for PioC-mediated cardioprotection. The HSP90 attenuates I/R-induced ISs, apoptosis of cardiomyocytes and myocardial inflammation through C3, C5a and NF-κB activation inhibition.

Decoding movement frequencies and limbs based on steady-state movement-related rhythms from noninvasive EEG

Objective.Decoding different types of movements noninvasively from electroencephalography (EEG) is an essential topic in neural engineering, especially in brain-computer interface. Although the widely used sensorimotor rhythm (SMR) is efficient in limb decoding, it lacks efficacy in decoding movement frequencies. Accumulating evidence supports the notion that the movement frequency is encoded in the steady-state movement-related rhythm (SSMRR). Our study has two primary objectives: firstly, to investigate the spatial-spectral representation of SSMRR in EEG during voluntary movements; secondly, to assess whether movement frequencies and limbs can be effectively decoded based on SSMRR.Approach.To comprehensively examine the representation of SSMRR, we investigated the frequency characteristics and spatial patterns associated with various rhythmic finger movements. Coherence analysis was performed between the sensor or source domain EEG and finger movements recorded by data gloves. A fusion model based on spectral SNR features and filter-bank common spatial pattern features was utilized to decode movement frequencies and limbs.Main results.At the group-level, sensor domain, and source domain coherence maps demonstrated that the accurate movement frequency (f0) and its first harmonic (f1) were encoded in the contralateral motor cortex. For the four-class classification, including two movement frequencies for both hands, the decoding accuracies for externally paced and internally paced movements were 73.14 ± 15.86% and 66.30 ± 17.26% (averaged across ten subjects, chance levels at 31.05% and 30.96%). Notably, the average results of five subjects with the highest decoding accuracies reached 87.21 ± 7.44% and 80.44 ± 7.99%.Significance.Our results verified the EEG representation of SSMRR and proved that the movement frequency and limb could be effectively decoded based on spatial-spectral features extracted from SSMRR. We suggest that SSMRR can serve as a complement to SMR to expand the range of decodable movement types and the approaches of limb decoding.

Phase-Locked Time-Shift Data Augmentation Method for SSVEP Brain-Computer Interfaces

Steady-state visual evoked potential (SSVEP) based brain-computer interfaces (BCIs) have achieved an information transfer rate (ITR) of over 300 bits/min, but abundant training data is required. The performance of SSVEP algorithms deteriorates greatly under limited data, and the existing time-shift data augmentation method fails to improve it because the phase-locked requirement between training samples is violated. To address this issue, this study proposes a novel augmentation method, namely phase-locked time-shift (PLTS), for SSVEP-BCI. The similarity between epochs at different time moments was evaluated, and a unique time-shift step was calculated for each class to augment additional data epochs in each trial. The results showed that the PLTS significantly improved the classification performance of SSVEP algorithms on the BETA SSVEP datasets. Moreover, under the condition of one calibration block, by slightly prolonging the calibration duration (from 48 s to 51.5 s), the ITR increased from 40.88±4.54 bits/min to 122.61±7.05 bits/min with the PLTS. This study provides a new perspective on augmenting data epochs for training-based SSVEP-BCI, promotes the classification accuracy and ITR under limited training data, and thus facilitates the real-life applications of SSVEP-based brain spellers.

Stereotactic Radiotherapy or Whole Brain Radiotherapy Combined with Pyrotinib and Capecitabine in HER2-Positive Advanced Breast Cancer Patients with Brain Metastases (BROPTIMA): A Prospective, Phase Ib/II Single-Arm Clinical Study

PURPOSE/OBJECTIVE(S)

Approximately half of patients with advanced HER2-positive breast cancer (BC) will develop brain metastases (BM) over time. Local therapy including stereotactic radiotherapy (SRT) and whole brain radiotherapy (WBRT) is the main initial treatment in malignant tumor patients with BM. However, more than 50% patients after radiotherapy in one year suffered intracranial recurrence. Pyrotinib, a small molecule, irreversible, pan-ErbB receptor tyrosine kinase inhibitor (TKI), has a high potency for controlling BM and reducing the occurrence of brain metastases in advanced HER2-positive BC patients. We hypothesized that SRT or WBRT combined with pyrotinib and capecitabine could decrease intracranial progression in HER2 positive BC with newly diagnosed BM.

MATERIALS/METHODS

In this prospective single-arm phase Ib/II trial (NCT04582968), eligible patients were assigned to either fractionated stereotactic radiotherapy (FSRT) or whole-brain radiation therapy (WBRT), combined with pyrotinib and capecitabine. The primary endpoint was one-year CNS progression-free survival (PFS) rate. Secondary endpoints included intracranial objective response rate (IC-ORR) according to RANO-BM criteria, progression-free survival (PFS), overall survival (OS) and evaluation of safety and neurocognitive function.

RESULTS

From January 2020 to August 2022, 40 patients were enrolled. Twenty-nine patients were treated with FSRT in 8 Gy per fraction with 3 to 5 fractions and 11 were treated with WBRT in 3 Gy per fraction with 10 fractions, and then received chemotherapy in a time frame starting from 0 to 7 days after radiotherapy. At a median follow-up of 17.3 months, 1-year CNS-PFS rate was 74.9% (95% CI 61.9-90.7%) and median CNS-PFS was 18 months (95% CI, 15.5 to NA months). One-year PFS rate was 66.9% (53.1-84.2%) and median PFS time was 17.6 months (95% CI 12.8-34.1 months). The best intracranial response rate (IC-ORR: complete response and partial response) was 92.5% (37/40). The most common grade 3 or worse toxicity was diarrhea (7.5%) and asymptomatic radiation necrosis was detected in 4 of 67(6.0%) lesions treated with FSRT. No differences of neurocognitive function evaluated by MMSE (Mini-Mental State Exam) were observed between different groups at any time point.

CONCLUSION

Radiotherapy combined with pyrotinib and capecitabine resulted in a promising efficacy that crossed the pre-specified boundary in patients with HER2-positive advanced breast cancer with brain metastases. This is the first prospective study showing the efficacy and safety of CNS radiotherapy concurrent with pyrotinib and capecitabine in patients with BM from HER2-positive breast cancer. Further investigation in a randomized controlled study is warranted.

[Airborne fungi monitoring]

Airborne fungi are an important class of aeroallergens that can lead to the development of allergic rhinitis and asthma, and reducing the exposure of fungi is an important strategy to prevent the exacerbation of symptoms in individuals with fungal allergy. Therefore, monitoring airborne fungi and understanding their dispersion patterns are important for clinical diagnosis, treatment and prevention. The purpose of this article is to review the methods of airborne fungi monitoring and factors influencing the distribution and dispersal of airborne fungi.

A Calibration-Free Hybrid Approach Combining SSVEP and EOG for Continuous Control

While SSVEP-BCI has been widely developed to control external devices, most of them rely on the discrete control strategy. The continuous SSVEP-BCI enables users to continuously deliver commands and receive real-time feedback from the devices, but it suffers from the transition state problem, a period the erroneous recognition, when users shift their gazes between targets. To resolve this issue, we proposed a novel calibration-free Bayesian approach by hybridizing SSVEP and electrooculography (EOG). First, canonical correlation analysis (CCA) was applied to detect the evoked SSVEPs, and saccade during the gaze shift was detected by EOG data using an adaptive threshold method. Then, the new target after the gaze shift was recognized based on a Bayesian optimization approach, which combined the detection of SSVEP and saccade together and calculated the optimized probability distribution of the targets. Eighteen healthy subjects participated in the offline and online experiments. The offline experiments showed that the proposed hybrid BCI had significantly higher overall continuous accuracy and shorter gaze-shifting time compared to FBCCA, CCA, MEC, and PSDA. In online experiments, the proposed hybrid BCI significantly outperformed CCA-based SSVEP-BCI in terms of continuous accuracy (77.61 ± 1.36%vs. 68.86 ± 1.08% and gaze-shifting time (0.93 ± 0.06s vs. 1.94 ± 0.08s). Additionally, participants also perceived a significant improvement over the CCA-based SSVEP-BCI when the newly proposed decoding approach was used. These results validated the efficacy of the proposed hybrid Bayesian approach for the BCI continuous control without any calibration. This study provides an effective framework for combining SSVEP and EOG, and promotes the potential applications of plug-and-play BCIs in continuous control.

Spatio-temporal evolution of human neural activity during visually cued hand movements

Making hand movements in response to visual cues is common in daily life. It has been well known that this process activates multiple areas in the brain, but how these neural activations progress across space and time remains largely unknown. Taking advantage of intracranial electroencephalographic (iEEG) recordings using depth and subdural electrodes from 36 human subjects using the same task, we applied single-trial and cross-trial analyses to high-frequency iEEG activity. The results show that the neural activation was widely distributed across the human brain both within and on the surface of the brain, and focused specifically on certain areas in the parietal, frontal, and occipital lobes, where parietal lobes present significant left lateralization on the activation. We also demonstrate temporal differences across these brain regions. Finally, we evaluated the degree to which the timing of activity within these regions was related to sensory or motor function. The findings of this study promote the understanding of task-related neural processing of the human brain, and may provide important insights for translational applications.

4*10 Gbps WDM communication system based on a tunable V-cavity semiconductor laser

This paper is about the V-cavity tunable semiconductor laser with a 1550 nm band used as a transmitter to build a wavelength division multiplexing (WDM) optical fiber communication link. In the experiment, a 20 km optical fiber communication link with a reasonable eye diagram and low bit error rate (BER) transmitted by 40 Gbps can be established. The experimental results show that a single laser can achieve a wavelength tuning range of 25 nm, reach 32 channels at a 100 GHz frequency interval, and the average side mode suppression ratio (SMSR) is above 39 dB. The advantages and application potential of V-cavity tunable semiconductor laser (VCL) for wavelength routing in optical communication networking are verified by experiments.

[The value of aspirin challenge tests in the diagnosis of non-steroidal anti-inflammatory drugs-exacerbated respiratory disease]

Objective: To investigate the value of aspirin challenge tests in the diagnosis of non-steroidal anti-inflammatory drugs-exacerbated respiratory disease (NERD). Methods: Fifty patients (22 males and 28 females; aged 16-61 years) who were diagnosed with chronic rhinosinusitis with nasal polyps (CRSwNP) with/without asthma, and underwent NERD standardized diagnosis in the Allergy Centre of West China Hospital, Sichuan University from December 2021 to November 2022 were included in the study. The first step was asking about the history of exacerbation respiratory symptoms after intake of any non-steroidal anti-inflammatory drug, including aspirin; the second step was performing intranasal aspirin challenge (IAC); and the third step was performing oral aspirin challenge (OAC). The diagnosis of NERD was made if any of the above steps was positive, and the subsequent steps were not performed, otherwise the diagnosis was made to OAC. If OAC was negative, the diagnosis was non-NERD. All patients completed the sino-nasal outcome test 22 (SNOT 22) score, Lund-Kennedy score by nasal endoscopic, allergen skin prick test, blood routine and serum total IgE test. SPSS version 20.0 was used for statistical analysis. Results: The diagnosis of NRED was confirmed in 27 patients (27/50, 54%). Seven (7/50, 14%) of them were diagnosed by clinical history and 20 (20/50, 40%) were diagnosed by aspirin challenge tests, of which 17 (17/20, 85%) were positive to IAC and 3 (3/20, 15%) to OAC. Of the 43 patients who underwent IAC testing, only 2 (2/43, 5%) developed asthma attacks during challenge. Comparing the clinical characteristics of patients in NERD and non-NERD group, there were significant differences between the two groups in gender (P=0.001), hyposmia (P=0.003), history of repeated CRSwNP surgeries (P=0.028), comorbid asthma (P=0.013), SNOT-22 score (P=0.004) and the percentage of peripheral blood eosinophil (P=0.043). Conclusions: Patients may be underdiagnosed if the diagnosis of NERD is made only by medical history, and it is necessary to carry out aspirin challenge tests. IAC is an important means to diagnose NERD with high accuracy and good safety. However, If IAC is negative, further OAC is required.

BCI Control of a Robotic Arm Based on SSVEP With Moving Stimuli for Reach and Grasp Tasks

Brain-computer interface (BCI) provides a novel technology for patients and healthy human subjects to control a robotic arm. Currently, BCI control of a robotic arm to complete the reaching and grasping tasks in an unstructured environment is still challenging because the current BCI technology does not meet the requirement of manipulating a multi-degree robotic arm accurately and robustly. BCI based on steady-state visual evoked potential (SSVEP) could output a high information transfer rate; however, the conventional SSVEP paradigm failed to control a robotic arm to move continuously and accurately because the users have to switch their gaze between the flickering stimuli and the target frequently. This study proposed a novel SSVEP paradigm in which the flickering stimuli were attached to the robotic arm's gripper and moved with it. First, an offline experiment was designed to investigate the effects of moving flickering stimuli on the SSVEP's responses and decoding accuracy. After that, contrast experiments were conducted, and twelve subjects were recruited to participate in a robotic arm control experiment using both the paradigm one (P1, with moving flickering stimuli) and the paradigm two (P2, conventional fixed flickering stimuli) using a block randomization design to balance their sequences. Double blinks were used to trigger the grasping action asynchronously whenever the subjects were confident that the position of the robotic arm's gripper was accurate enough. Experimental results showed that the paradigm P1 with moving flickering stimuli provided a much better control performance than the conventional paradigm P2 in completing a reaching and grasping task in an unstructured environment. Subjects' subjective feedback scored by a NASA-TLX mental workload scale also corroborated the BCI control performance. The results of this study suggest that the proposed control interface based on SSVEP BCI provides a better solution for robotic arm control to complete the accurate reaching and grasping tasks.

[Three cases of occupational acute trimethyltin chloride poisoning]

Trimethyltin chloride is a highly toxic substance, which is absorbed through respiratory tract, skin and digestive tract, with central nervous system injury as the main clinical manifestations, and can be accompanied by damage to various organs. In this paper, the treatment process of 3 patients with acute trimethyltin chloride poisoning was reviewed, and their clinical manifestations, auxiliary examination, diagnosis and treatment were analyzed. Three patients were misdiagnosed as mental abnormality, encephalitis, and hepatic encephalopathy in different hospitals in the early stage of medical treatment, suggesting that clinicians should pay attention to the occupational contact history of poisoned patients and conduct toxicant detection in time to avoid misdiagnosis and mistreatment.

The Extra-Islet Pancreas Supports Autoimmunity in Human Type 1 Diabetes

In autoimmune Type 1 diabetes (T1D), immune cells progressively infiltrate and destroy the islets of Langerhans - islands of endocrine tissue dispersed throughout the pancreas. However, it is unclear how this process, called 'insulitis', develops and progresses within this organ. Here, using highly multiplexed CO-Detection by indEXing (CODEX) tissue imaging and cadaveric pancreas samples from pre-T1D, T1D, and non-T1D donors, we examine pseudotemporal-spatial patterns of insulitis and exocrine inflammation within large pancreatic tissue sections. We identify four sub-states of insulitis characterized by CD8 ⁺ T cells at different stages of activation. We further find that exocrine compartments of pancreatic lobules affected by insulitis have distinct cellularity, suggesting that extra-islet factors may make particular lobules permissive to disease. Finally, we identify "staging areas" - immature tertiary lymphoid structures away from islets where CD8 ⁺ T cells appear to assemble before they navigate to islets. Together, these data implicate the extra-islet pancreas in autoimmune insulitis, greatly expanding the boundaries of T1D pathogenesis.

Bio-robotics research for non-invasive myoelectric neural interfaces for upper-limb prosthetic control: a 10-year perspective review

A decade ago, a group of researchers from academia and industry identified a dichotomy between the industrial and academic state-of-the-art in upper-limb prosthesis control, a widely used bio-robotics application. They proposed that four key technical challenges, if addressed, could bridge this gap and translate academic research into clinically and commercially viable products. These challenges are unintuitive control schemes, lack of sensory feedback, poor robustness and single sensor modality. Here, we provide a perspective review on the research effort that occurred in the last decade, aiming at addressing these challenges. In addition, we discuss three research areas essential to the recent development in upper-limb prosthetic control research but were not envisioned in the review 10 years ago: deep learning methods, surface electromyogram decomposition and open-source databases. To conclude the review, we provide an outlook into the near future of the research and development in upper-limb prosthetic control and beyond.

Neural evidence for functional roles of tactile and visual feedback in the application of myoelectric prosthesis

Objective. The primary purpose of this study was to investigate the electrophysiological mechanism underlying different modalities of sensory feedback and multi-sensory integration in typical prosthesis control tasks.Approach. We recruited 15 subjects and developed a closed-loop setup for three prosthesis control tasks which covered typical activities in the practical prosthesis application, i.e. prosthesis finger position control (PFPC), equivalent grasping force control (GFC) and box and block control (BABC). All the three tasks were conducted under tactile feedback (TF), visual feedback (VF) and tactile-visual feedback (TVF), respectively, with a simultaneous electroencephalography (EEG) recording to assess the electroencephalogram (EEG) response underlying different types of feedback. Behavioral and psychophysical assessments were also administered in each feedback condition.Results. EEG results showed that VF played a predominant role in GFC and BABC tasks. It was reflected by a significantly lower somatosensory alpha event-related desynchronization (ERD) in TVF than in TF and no significant difference in visual alpha ERD between TVF and VF. In PFPC task, there was no significant difference in somatosensory alpha ERD between TF and TVF, while a significantly lower visual alpha ERD was found in TVF than in VF, indicating that TF was essential in situations related to proprioceptive position perception. Tactile-visual integration was found when TF and VF were congruently implemented, showing an obvious activation over the premotor cortex in the three tasks. Behavioral and psychophysical results were consistent with EEG evaluations.Significance. Our findings could provide neural evidence for multi-sensory integration and functional roles of tactile and VF in a practical setting of prosthesis control, shedding a multi-dimensional insight into the functional mechanisms of sensory feedback.

1151 IMPROVING THE MEASUREMENT OF POSTURAL BLOOD PRESSURE WITH AD-HOC MOBILE TEACHING SESSIONS FOR NURSES AND HEALTHCARE ASSISTANTS

Introduction

Falls are a major cause of morbidity and mortality in patients over 65. Unrecognised postural hypotension is a significant and treatable contributor. Training nurses and health-care assistants (HCAs) in correct measurement technique can be challenging, as these groups are rarely able to fully attend single sessions due to urgent clinical commitments, night duties and staff-shortages. We aimed to improve the frequency and quality of lying-standing blood pressure (LSBP) measurement in a Geriatric inpatient cohort.

Methods

Three PDSA cycles were performed over a 10-month period on a single Care of the Elderly ward, including an initial audit in March 2021. The outcome measures were:

1. the percentage of non-bedbound patients having LSBP correctly measured (5-min recumbent, 1 and 3-min standing readings), assessed by chart review and

2. the understanding and confidence of measurers in correct technique, as assessed by a questionnaire.

The intervention was developed into three separate days of ad-hoc mobile teaching sessions to allow reinforcement of knowledge. Trainers moved from bay-to-bay delivering a 5-minute pre-prepared presentation/demonstration on the indications and correct technique of LSBP measurement. This was repeated throughout each day until all measurers had participated.

Results

On initial assessment, only 21% (6/28) of non-bedbound patients had LSBP correctly measured. This improved to 44% (8/18) by July and 62% (8/13) by December 2021. When sampled, measurers had sustained improvements from July (n=8) to December (n=7), in terms of self-rated confidence (mean 4.4/5 vs 4.9/5), correct technique (25% vs 100%), interpretation of results (25% vs 43%) and knowledge of contraindications to measurement (88% vs 100%).

Conclusions

We describe a strategy using ad-hoc mobile teaching sessions to train nurses and HCAs to measure LSBP in a Geriatric inpatient cohort, which resulted in sustained improvements. We believe this technique is readily applicable to other units and areas of practice.

[Tajectories of the self-efficacy of HIV testing among MSM based on latent class growth model]

Objective: To analyze the trajectories of HIV testing self-efficacy among men who have sex with men (MSM) based on latent class growth model. Methods: From August 2019 to May 2021, 404 MSM were recruited in Shandong Province and subjected to a 1-year follow-up study with individual intervention (pushing intervention pictures and videos in WeChat and follow-up questionnaires) and community intervention (forwarding to friends and sharing and discussing HIV testing-related information in WeChat groups). The level of HIV testing self-efficacy among MSM was measured. The long-term trend of HIV testing self-efficacy was analyzed using the latent class growth model (LCGM), and the influencing factors of the trend were analyzed. Results: A total of 404 MSM were (28.25±8.95) years old, with the oldest being 58 and the youngest being 18. The scores of HIV testing self-efficacy M(Q₁, Q₃) at baseline and 4 follow-ups were 18.00 (17.00, 21.00), 19.00 (18.00, 22.00), 19.00 (18.00, 22.00), 19.00 (18.00, 22.00) and 19.00 (18.00, 22.00). The results of the freely estimated two-category LCGM model showed that the trend of HIV testing self-efficacy among MSM could be divided into two classes, "intervention response group" [255(63.1%)] and "intervention non-response group" [149(36.9%)]. The former had a higher level of HIV testing self-efficacy which tended to increase at first and then decrease over time, while the latter had a lower and more stable level. The results of the multifactorial logistic regression analysis showed that the OR values of MSM in business or service and jobless or unemployed were 0.261 (95%CI: 0.108-0.633) and 0.186 (95%CI: 0.057-0.610), respectively, using the students as the reference group. Conclusion: There is a group heterogeneity in the trend of HIV testing self-efficacy in the intervention conditions among MSM, and occupation may be an influencing factor.

Mapping Individual Motor Unit Activity to Continuous Three-DoF Wrist Torques: Perspectives for Myoelectric Control

The surface electromyography (EMG) decomposition techniques provide access to motor neuron activities and have been applied to myoelectric control schemes. However, the current decomposition-based myoelectric control mainly focuses on discrete gestures or single-DoF continuous movements. In this study, we aimed to map the motor unit discharges, which were identified from high-density surface EMG, to the three degrees of freedom (DoFs) wrist movements. The 3-DoF wrist torques and high-density surface EMG signals were recorded concurrently from eight non-disabled subjects. The experimental protocol included single-DoF movements and their various combinations. We decoded the motor unit discharges from the EMG signals using a segment-wise decomposition algorithm. Then the neural features were extracted from motor unit discharges and projected to wrist torques with a multiple linear regression model. We compared the performance of two neural features (twitch model and spike counting) and two training schemes (single-DoF and multi-DoF training). On average, 145 ± 33 motor units were identified from each subject, with a pulse-to-noise ratio of 30.8 ± 4.2 dB. Both neural features exhibited high estimation accuracy of 3-DoF wrist torques, with an average [Formula: see text] of 0.76 ± 0.12 and normalized root mean square error of 11.4 ± 3.1%. These results demonstrated the efficiency of the proposed method in continuous estimation of 3-DoF wrist torques, which has the potential to advance dexterous myoelectric control based on neural information.

Real-Time Hand Gesture Recognition by Decoding Motor Unit Discharges Across Multiple Motor Tasks from Surface Electromyography

OBJECTIVE

Surface electromyography (EMG) decomposition techniques have been developed to decode motor neuron activities non-invasively in the past decades, showing superior performance in human-machine interfaces such as gesture recognition and proportional control. However, neural decoding across multiple motor tasks and in real-time remains challenging, which limits its wide application. In this work, we proposed a real-time hand gesture recognition method by decoding motor unit (MU) discharges across multiple motor tasks ( 10) in a motion-wise way.

METHODS

The EMG signals were first divided into numerous segments related to motions. The convolution kernel compensation algorithm was applied for each segment individually. The local MU filters, which indicate the MU-EMG correlation for each motion, were calculated iteratively in each segment and reused for global EMG decomposition to trace the MU discharges across motor tasks in real-time. The motion-wise decomposition method was applied on the high-density EMG signals recorded during twelve hand gesture tasks from eleven non-disabled participants. The neural feature of discharge count was extracted for gesture recognition based on five common classifiers.

MAIN RESULTS

On average, 164 ±34 MUs were identified for twelve motions from each subject, with a pulse-to-noise ratio of 32.1 ±5.6 dB. The average time cost of EMG decomposition in a sliding window of 50 ms was less than 5 ms. The average classification accuracy using a linear discriminant analysis classifier was 94.6 ±8.1%, which was significantly higher than that of a time-domain feature called root mean square. The superiority of the proposed method was also validated with a previously published EMG database comprising 65 gestures.

CONCLUSION AND SIGNIFICANCE

These results indicate the feasibility and superiority of the proposed method for MU identification and hand gesture recognition across multiple motor tasks, extending the potential applications of neural decoding in human-machine interfaces.

Assessment of Patient Satisfaction Among Cancer Patients Undergoing Radiotherapy

The patient-provider relationship is a key driver of patient satisfaction as it relates to overall healthcare experience. We surveyed patients undergoing radiation therapy to determine what they consider to be the most valued qualities in their interactions with the healthcare team. An ethics-approved 35-item patient satisfaction survey was developed in-house to gain insights on patients' perception of their relationship with the healthcare team throughout their cancer journey. There were 199 completed survey, median age 68 years, 54% women and 45% men. Almost all (95%) "agreed" or "strongly agreed" that their physicians had been sensitive and compassionate. Over 90% felt that they received adequate explanations about their treatment, and had their questions answered. The vast majority (93%) felt included in the decision-making process. Patients reported the 5 most highly rated qualities among their healthcare providers (HCPs) as knowledge, kindness, honesty, good communication, and a cheerful attitude. Overall satisfaction was high but areas for improvement were identified including being offered future appointments for further discussion, more information about clinical trials, other treatments, and community resources. Patients noted their HCPs tended to focus on the physical and emotional needs of patients, but spiritual and cultural needs were rarely addressed. Patients receiving radiotherapy reported high rates of satisfaction across many aspects of their care. These findings also reinforce the different aspects of holistic care that can be improved, and serve as a reminder to clinicians that patients perceive their role as more than just that of a medical expert.

Exploring the effects of head movements and accompanying gaze fixation switch on steady-state visual evoked potential

In a realistic steady-state visual evoked potential (SSVEP) based brain-computer interface (BCI) application like driving a car or controlling a quadrotor, observing the surrounding environment while simultaneously gazing at the stimulus is necessary. This kind of application inevitably could cause head movements and variation of the accompanying gaze fixation point, which might affect the SSVEP and BCI’s performance. However, few papers studied the effects of head movements and gaze fixation switch on SSVEP response, and the corresponding BCI performance. This study aimed to explore these effects by designing a new ball tracking paradigm in a virtual reality (VR) environment with two different moving tasks, i.e., the following and free moving tasks, and three moving patterns, pitch, yaw, and static. Sixteen subjects were recruited to conduct a BCI VR experiment. The offline data analysis showed that head moving patterns [F(2, 30) = 9.369, p = 0.001, effect size = 0.384] resulted in significantly different BCI decoding performance but the moving tasks had no effect on the results [F(1, 15) = 3.484, p = 0.082, effect size = 0.188]. Besides, the canonical correlation analysis (CCA) and filter bank canonical correlation analysis (FBCCA) accuracy were better than the PSDA and MEC methods in all of the conditions. These results implied that head movement could significantly affect the SSVEP performance but it was possible to switch gaze fixation to interact with the surroundings in a realistic BCI application.

A Wearable Ultrasound Interface for Prosthetic Hand Control

Ultrasound can non-invasively detect muscle deformations and has great potential applications in prosthetic hand control. Traditional ultrasound equipment was usually too bulky to be applied in wearable scenarios. This research presented a compact ultrasound device that could be integrated into a prosthetic hand socket. The miniaturized ultrasound system included four A-mode ultrasound transducers for sensing musculature deformations, a signal excitation/acquisition module, and a prosthetic hand control module. The size of the ultrasound system was 65*75*25mm, weighing only 85g. For the first time, we integrated the ultrasound system into a prosthetic hand socket to evaluate its performance in practical prosthetic hand control. We designed an experiment requiring twenty subjects to perform six commonly used gestures. The performance of decoding ultrasound signals was analyzed offline using four classification algorithms and then was assessed in online control. The average values of online classification accuracy with and without wearing the physical prosthetic were 91.5 ±6.4% and 96.5 ±3.0%, respectively. We found that wearing the prosthetic hand influenced the ultrasound gestures classification accuracy, but remarkable online classification performance could still be maintained. These experimental results demonstrated the efficacy of the designed integrated ultrasound system for practical use, paving the way for an effective HMI system that could be widely used in prosthetic hand control.

Mortality-Air Pollution Associations in Low Exposure Environments (MAPLE): Phase 2

INTRODUCTION

Mortality is associated with long-term exposure to fine particulate matter (particulate matter ≤2.5 μm in aerodynamic diameter; PM2.5), although the magnitude and form of these associations remain poorly understood at lower concentrations. Knowledge gaps include the shape of concentration-response curves and the lowest levels of exposure at which increased risks are evident and the occurrence and extent of associations with specific causes of death. Here, we applied improved estimates of exposure to ambient PM2.5 to national population-based cohorts in Canada, including a stacked cohort of 7.1 million people who responded to census year 1991, 1996, or 2001. The characterization of the shape of the concentration-response relationship for nonaccidental mortality and several specific causes of death at low levels of exposure was the focus of the Mortality-Air Pollution Associations in Low Exposure Environments (MAPLE) Phase 1 report. In the Phase 1 report we reported that associations between outdoor PM2.5 concentrations and nonaccidental mortality were attenuated with the addition of ozone (O3) or a measure of gaseous pollutant oxidant capacity (Ox), which was estimated from O3 and nitrogen dioxide (NO2) concentrations. This was motivated by our interests in understanding both the effects air pollutant mixtures may have on mortality and also the role of O3 as a copollutant that shares common sources and precursor emissions with those of PM2.5. In this Phase 2 report, we further explore the sensitivity of these associations with O3 and Ox, evaluate sensitivity to other factors, such as regional variation, and present ambient PM2.5 concentration-response relationships for specific causes of death.

METHODS

PM2.5 concentrations were estimated at 1 km2 spatial resolution across North America using remote sensing of aerosol optical depth (AOD) combined with chemical transport model (GEOS-Chem) simulations of the AOD:surface PM2.5 mass concentration relationship, land use information, and ground monitoring. These estimates were informed and further refined with collocated measurements of PM2.5 and AOD, including targeted measurements in areas of low PM2.5 concentrations collected at five locations across Canada. Ground measurements of PM2.5 and total suspended particulate matter (TSP) mass concentrations from 1981 to 1999 were used to backcast remote-sensing-based estimates over that same time period, resulting in modeled annual surfaces from 1981 to 2016.

Annual exposures to PM2.5 were then estimated for subjects in several national population-based Canadian cohorts using residential histories derived from annual postal code entries in income tax files. These cohorts included three census-based cohorts: the 1991 Canadian Census Health and Environment Cohort (CanCHEC; 2.5 million respondents), the 1996 CanCHEC (3 million respondents), the 2001 CanCHEC (3 million respondents), and a Stacked CanCHEC where duplicate records of respondents were excluded (Stacked CanCHEC; 7.1 million respondents). The Canadian Community Health Survey (CCHS) mortality cohort (mCCHS), derived from several pooled cycles of the CCHS (540,900 respondents), included additional individual information about health behaviors. Follow-up periods were completed to the end of 2016 for all cohorts. Cox proportional hazard ratios (HRs) were estimated for nonaccidental and other major causes of death using a 10-year moving average exposure and 1-year lag. All models were stratified by age, sex, immigrant status, and where appropriate, census year or survey cycle. Models were further adjusted for income adequacy quintile, visible minority status, Indigenous identity, educational attainment, labor-force status, marital status, occupation, and ecological covariates of community size, airshed, urban form, and four dimensions of the Canadian Marginalization Index (Can-Marg; instability, deprivation, dependency, and ethnic concentration). The mCCHS analyses were also adjusted for individual-level measures of smoking, alcohol consumption, fruit and vegetable consumption, body mass index (BMI), and exercise behavior.

In addition to linear models, the shape of the concentration-response function was investigated using restricted cubic splines (RCS). The number of knots were selected by minimizing the Bayesian Information Criterion (BIC). Two additional models were used to examine the association between nonaccidental mortality and PM2.5. The first is the standard threshold model defined by a transformation of concentration equaling zero if the concentration was less than a specific threshold value and concentration minus the threshold value for concentrations above the threshold. The second additional model was an extension of the Shape Constrained Health Impact Function (SCHIF), the eSCHIF, which converts RCS predictions into functions potentially more suitable for use in health impact assessments. Given the RCS parameter estimates and their covariance matrix, 1,000 realizations of the RCS were simulated at concentrations from the minimum to the maximum concentration, by increments of 0.1 μg/m3. An eSCHIF was then fit to each of these RCS realizations. Thus, 1,000 eSCHIF predictions and uncertainty intervals were determined at each concentration within the total range.

Sensitivity analyses were conducted to examine associations between PM2.5 and mortality when in the presence of, or stratified by tertile of, O3 or Ox. Additionally, associations between PM2.5 and mortality were assessed for sensitivity to lower concentration thresholds, where person-years below a threshold value were assigned the mean exposure within that group. We also examined the sensitivity of the shape of the nonaccidental mortality-PM2.5 association to removal of person-years at or above 12 μg/m3 (the current U.S. National Ambient Air Quality Standard) and 10 μg/m3 (the current Canadian and former [2005] World Health Organization [WHO] guideline, and current WHO Interim Target-4). Finally, differences in the shapes of PM2.5-mortality associations were assessed across broad geographic regions (airsheds) within Canada.

RESULTS

The refined PM2.5 exposure estimates demonstrated improved performance relative to estimates applied previously and in the MAPLE Phase 1 report, with slightly reduced errors, including at lower ranges of concentrations (e.g., for PM2.5 <10 μg/m3).

Positive associations between outdoor PM2.5 concentrations and nonaccidental mortality were consistently observed in all cohorts. In the Stacked CanCHEC analyses (1.3 million deaths), each 10-μg/m3 increase in outdoor PM2.5 concentration corresponded to an HR of 1.084 (95% confidence interval [CI]: 1.073 to 1.096) for nonaccidental mortality. For an interquartile range (IQR) increase in PM2.5 mass concentration of 4.16 μg/m3 and for a mean annual nonaccidental death rate of 92.8 per 10,000 persons (over the 1991-2016 period for cohort participants ages 25-90), this HR corresponds to an additional 31.62 deaths per 100,000 people, which is equivalent to an additional 7,848 deaths per year in Canada, based on the 2016 population. In RCS models, mean HR predictions increased from the minimum concentration of 2.5 μg/m3 to 4.5 μg/m3, flattened from 4.5 μg/m3 to 8.0 μg/m3, then increased for concentrations above 8.0 μg/m3. The threshold model results reflected this pattern with -2 log-likelihood values being equal at 2.5 μg/m3 and 8.0 μg/m3. However, mean threshold model predictions monotonically increased over the concentration range with the lower 95% CI equal to one from 2.5 μg/m3 to 8.0 μg/m3. The RCS model was a superior predictor compared with any of the threshold models, including the linear model.

In the mCCHS cohort analyses inclusion of behavioral covariates did not substantially change the results for both linear and nonlinear models. We examined the sensitivity of the shape of the nonaccidental mortality-PM2.5 association to removal of person-years at or above the current U.S. and Canadian standards of 12 μg/m3 and 10 μg/m3, respectively. In the full cohort and in both restricted cohorts, a steep increase was observed from the minimum concentration of 2.5 μg/m3 to 5 μg/m3. For the full cohort and the <12 μg/m3 cohort the relationship flattened over the 5 to 9 μg/m3 range and then increased above 9 μg/m3. A similar increase was observed for the <10 μg/m3 cohort followed by a clear decline in the magnitude of predictions over the 5 to 9 μg/m3 range and an increase above 9 μg/m3. Together these results suggest that a positive association exists for concentrations >9 μg/m3 with indications of adverse effects on mortality at concentrations as low as 2.5 μg/m3.

Among the other causes of death examined, PM2.5 exposures were consistently associated with an increased hazard of mortality due to ischemic heart disease, respiratory disease, cardiovascular disease, and diabetes across all cohorts. Associations were observed in the Stacked CanCHEC but not in all other cohorts for cerebrovascular disease, pneumonia, and chronic obstructive pulmonary disease (COPD) mortality. No significant associations were observed between mortality and exposure to PM2.5 for heart failure, lung cancer, and kidney failure.

In sensitivity analyses, the addition of O3 and Ox attenuated associations between PM2.5 and mortality. When analyses were stratified by tertiles of copollutants, associations between PM2.5 and mortality were only observed in the highest tertile of O3 or Ox. Across broad regions of Canada, linear HR estimates and the shape of the eSCHIF varied substantially, possibly reflecting underlying differences in air pollutant mixtures not characterized by PM2.5 mass concentrations or the included gaseous pollutants. Sensitivity analyses to assess regional variation in population characteristics and access to healthcare indicated that the observed regional differences in concentration-mortality relationships, specifically the flattening of the concentration-mortality relationship over the 5 to 9 μg/m3 range, was not likely related to variation in the makeup of the cohort or its access to healthcare, lending support to the potential role of spatially varying air pollutant mixtures not sufficiently characterized by PM2.5 mass concentrations.

CONCLUSIONS

In several large, national Canadian cohorts, including a cohort of 7.1 million unique census respondents, associations were observed between exposure to PM2.5 with nonaccidental mortality and several specific causes of death. Associations with nonaccidental mortality were observed using the eSCHIF methodology at concentrations as low as 2.5 μg/m3, and there was no clear evidence in the observed data of a lower threshold, below which PM2.5 was not associated with nonaccidental mortality.

Monolithic 6 × 6 transmitter-router with simultaneous sub-nanosecond port and wavelength switching

A monolithic 6 × 6 transmitter-router with both port and wavelength switching at sub-nanosecond speed is proposed and experimentally demonstrated. Based on an intra-cavity cyclic echelle diffraction grating router (EDGR) and semiconductor optical amplifier (SOA) arrays, each selectable output port can realize a selected multi-wavelength laser (MWL) output. The measurement results show that all 36 input-output combinations have a single-mode emission spectrum with a sidemode suppression ratio (SMSR) over 30 dB. Simultaneous switching of six laser wavelengths is achieved together with the switching of the output port by a single electrode selection. The switching time is less than 1 ns. It can offer a cost-effective solution to multi-wavelength multi-port optical transmitter-routers for fast distributed optical switching in datacenters and high-performance computers (HPCs).

Dynamical Synthesis of ^{4}He in the Scission Phase of Nuclear Fission

In the exothermic process of fission decay, an atomic nucleus splits into two or more independent fragments. Several aspects of nuclear fission are not properly understood, in particular the formation of the neck between the nascent fragments, and the subsequent mechanism of scission into two or more independent fragments. Using an implementation of time-dependent density functional theory, based on a relativistic energy density functional and including pairing correlations, we analyze the final phase of the process of induced fission of ^{240}Pu, and show that the timescale of neck formation coincides with the assembly of two α-like clusters. Because of its much larger binding energy, the dynamical synthesis of ^{4}He in the neck predominates over other light clusters, e.g., ^{3}H and ^{6}He. At the instant of scission the neck ruptures exactly between the two α-like clusters, which separate because of the Coulomb repulsion and are eventually absorbed by the two emerging fragments. The mechanism of light charged clusters formation at scission could also be linked to ternary fission.

[Clinical characteristics and risk factors of lower extremity arterial disease in patients with diabetic foot ulcer]

OBJECTIVE

To investigate the clinical characteristics of lower extremity arterial disease (LEAD) and its risk factors in patients with diabetic foot ulcer (DFU).

METHODS

We retrospectively collected the clinical and follow-up data of 650 patients with DFU treated in the Department of Endocrinology and Metabolism of Nanfang Hospital between January, 2017 and December, 2019. We compared the data between patients who had LEAD and those without LEAD and used a multivariate logistic regression model to analyze the risk factors of LEAD in DFU patients.

RESULTS

Among the 650 DFU patients, 470 (72.4%) had LEAD. The patients were followed up for a mean of 3.5 months, and the mean healing time of DFU was 2.55 months; healing of DFU occurred in 453 patients and 183 patients received amputation. The patients with LEAD and those without LEAD differed significantly in age, hospitalization costs, diastolic blood pressure (DBP), glycated hemoglobin, blood lipid levels, disease course, ankle brachial index, healing time, smoking history, clinical outcomes, Wagner grade and imaging results (P < 0.05). Multivariate logistic regression analysis identified age (OR=1.070, 95% CI: 1.049-1.091), smoking history (OR= 2.013, 95% CI: 1.268-3.195), and a decreased DBP (OR=0.980, 95% CI: 0.963-0.997) as independent risk factors for LEAD in DFU patients. A prolonged healing time was a prominent clinical feature of DFU complicated by LEAD.

CONCLUSION

DFU patients have a high incidence of LEAD, which leads to high rates of disability and mortality and is associated with an advanced age, high smoking rate and longer healing time. A decreased DBP is also a risk factor for LEAD in DFU patients.

A systemic review and meta-analysis of the effects of perioperative anticoagulant and antiplatelet therapy on bleeding complications in robot-assisted prostatectomy

OBJECTIVE

Robot-assisted prostatectomy is commonly performed for the management of prostate cancer. The literature has noted that prostate cancer patients are often prone to increased risk for thromboembolic complications. Normally, such situations call for long-term anticoagulant/antiplatelet therapy. However, the administration of these drugs is usually contraindicated prior to surgical intervention to limit intra- and post-operative hemorrhagic complications. Despite some recent evidence that continued administration of anticoagulant/antiplatelet drugs does not impact intra- and post-operative outcomes, no consensus in the literature exists concerning the influence of anticoagulant and antiplatelet drug administration on intra- and post-operative outcomes for robot-assisted prostatectomy. Our aim is to evaluate the influence of perioperative administration of anticoagulant and antiplatelet drugs in patients undergoing robot-assisted prostatectomy in terms of bleeding complication incidence, blood transfusion rate, blood loss, and hospital stay duration.

MATERIALS AND METHODS

The academic literature was systematically searched according to the PRISMA guidelines across five databases (Web of Science, EMBASE, CENTRAL, Scopus, and MEDLINE). Through this, we conducted a random-effect meta-analysis to evaluate the influence of perioperative administration of anticoagulant and antiplatelet drugs in patients undergoing robot-assisted prostatectomy in terms of bleeding complication incidence, blood transfusion rate, blood loss, and hospital stay duration.

RESULTS

From 993 studies, eight eligible studies containing 2516 patients (mean age: 65.7± 3.6 years) were selected for inclusion. Meta-analysis revealed a higher bleeding complication prevalence for patients receiving anticoagulants (event rate: 10.6%) compared to those receiving antiplatelets (3.4%). We also noted longer hospital stay durations for anticoagulant group patients (Hedge's g: -0.30) compared to antiplatelet group counterparts (g: -0.01).

CONCLUSIONS

The study provides preliminary evidence that anticoagulant drug administration results in higher bleeding complication incidence and longer hospital stay durations in patients undergoing robot-assisted prostatectomy relative to antiplatelet drug administration.

Roles of the protein disulphide isomerases AccPDIA1 and AccPDIA3 in response to oxidant stress in Apis cerana cerana

Protein disulphide isomerase (PDI) plays an important role in a variety of physiological processes through its oxidoreductase activity and molecular chaperone activity. In this study, we cloned two PDI family members, AccPDIA1 and AccPDIA3, from Apis cerana cerana. AccPDIA1 and AccPDIA3 had typical sequence features of PDI family members and were constitutively expressed in A. cerana cerana. The expression levels of AccPDIA1 and AccPDIA3 were generally upregulated after treatment with a variety of environmental stress factors. Inhibition assays showed that E. coli expressing recombinant AccPDIA1 and AccPDIA3 proteins was more resistant to oxidative stress than control E. coli. In addition, silencing AccPDIA1 or AccPDIA3 in A. cerana cerana resulted in significant changes in the expression levels of several antioxidant-related genes as well as the enzymatic activities of peroxidase (POD), superoxide dismutase (SOD) and catalase (CAT) and reduced the survival rate of A. cerana cerana under oxidative stress caused by high temperature. In conclusion, our results suggest that AccPDIA1 and AccPDIA3 may play important roles in the antioxidant activities of A. cerana cerana.

Effects of Gaze Fixation on the Performance of a Motor Imagery-Based Brain-Computer Interface

Motor imagery-based brain-computer interfaces (BCIs) have been studied without controlling subjects’ gaze fixation position previously. The effect of gaze fixation and covert attention on the behavioral performance of BCI is still unknown. This study designed a gaze fixation controlled experiment. Subjects were required to conduct a secondary task of gaze fixation when performing the primary task of motor imagination. Subjects’ performance was analyzed according to the relationship between motor imagery target and the gaze fixation position, resulting in three BCI control conditions, i.e., congruent, incongruent, and center cross trials. A group of fourteen subjects was recruited. The average group performances of three different conditions did not show statistically significant differences in terms of BCI control accuracy, feedback duration, and trajectory length. Further analysis of gaze shift response time revealed a significantly shorter response time for congruent trials compared to incongruent trials. Meanwhile, the parietal occipital cortex also showed active neural activities for congruent and incongruent trials, and this was revealed by a contrast analysis of R-square values and lateralization index. However, the lateralization index computed from the parietal and occipital areas was not correlated with the BCI behavioral performance. Subjects’ BCI behavioral performance was not affected by the position of gaze fixation and covert attention. This indicated that motor imagery-based BCI could be used freely in robotic arm control without sacrificing performance.

Towards optimizing the non-invasive sensory feedback interfaces in a neural prosthetic control

Objective. The somatotopic interface (SI) and non-somatotopic interface (NI) are commonly used to provide non-invasive sensory feedback. Nevertheless, differences between SI and NI are rarely reported, and objective evaluations of the corresponding brain response are missing as well. Few studies have reported how to design the stimulation encoding based on the two interfaces. The objective of this study was to investigate the difference in sensory characteristics between SI and NI, and propose an optimal encoding method for non-invasive feedback interfaces. Approach. We recruited seven amputees and compared the tactile sensitivity to stimulated positions and intensities between SI (phantom finger area) and NI (upper arm) in a tactile discrimination task. Electroencephalography (EEG) evaluation task was subsequently conducted to objectively evaluate the stimulus-evoked brain response. Finally, the two kinds of tactile information (stimulated position and intensity) was applied to an object recognition task. Specifically, the object size was reflected by the prosthetic finger position through stimulated position encoding, and the object stiffness was reflected by the contact force of prosthetic fingers through stimulated intensity encoding. We compared the performance under four feedback conditions (combinations between two kinds of tactile information and two interfaces). Results. Behavioral results showed that NI was more sensitive to position information while SI was more sensitive to intensity information. EEG results were consistent with behavioral results, showing a higher sensitivity of sensory alpha ERD for NI in the position discrimination, while the trend was opposite in the intensity discrimination. The feedback encoding allowed amputees to discriminate the size and stiffness of nine objects with the best performance of 62% overall accuracy (84% for size discrimination, 71% for stiffness discrimination) when position and intensity information was delivered on the NI and SI, respectively. Signicance. Our results provided an instructive strategy for sensory feedback via non-invasive solutions.

Exploring Fatigue Effects on Performance Variation of Intensive Brain-Computer Interface Practice

Motor imagery (MI) is an endogenous mental process and is commonly used as an electroencephalogram (EEG)-based brain-computer interface (BCI) strategy. Previous studies of P300 and MI-based (without online feedback) BCI have shown that mental states like fatigue can negatively affect participants' EEG signatures. However, exogenous stimuli cause visual fatigue, which might have a different mechanism than endogenous tasks do. Furthermore, subjects could adjust themselves if online feedback is provided. In this sense, it is still unclear how fatigue affects online MI-based BCI performance. With this question, 12 healthy subjects are recruited to investigate this issue, and an MI-based online BCI experiment is performed for four sessions on different days. The first session is for training, and the other three sessions differ in rest condition and duration-no rest, 16-min eyes-open rest, and 16-min eyes-closed rest-arranged in a pseudo-random order. Multidimensional fatigue inventory (MFI) and short stress state questionnaire (SSSQ) reveal that general fatigue, mental fatigue, and distress have increased, while engagement has decreased significantly within certain sessions. However, the BCI performances, including percent valid correct (PVC) and information transfer rate (ITR), show no significant change across 400 trials. The results suggest that although the repetitive MI task has affected subjects' mental states, their BCI performances and feature separability within a session are not affected by the task significantly. Further electrophysiological analysis reveals that the alpha-band power in the sensorimotor area has an increasing tendency, while event-related desynchronization (ERD) modulation level has a decreasing trend. During the rest time, no physiological difference has been found in the eyes-open rest condition; on the contrary, the alpha-band power increase and subsequent decrease appear in the eyes-closed rest condition. In summary, this experiment shows evidence that mental states can change dramatically in the intensive MI-BCI practice, but BCI performances could be maintained.

LncRNA SNHG3 is responsible for the deterioration of colorectal carcinoma through regulating the miR-370-5p/EZH1 axis

OBJECTIVE

To illustrate the biological function of long non-coding RNA (lncRNA) SNHG3 in the deterioration of colorectal cancer (CRC) by regulating the miR-370-5p/EZH1 axis.

PATIENTS AND METHODS

SNHG3 levels in fifty pairs of CRC and non-tumor tissues were examined by quantitative real-time polymerase chain reaction (qRT-PCR). Its correlation to tumor staging, lymph node metastasis and prognosis of CRC was analyzed. Cell counting kit-8 (CCK-8) and 5-Ethynyl-2'- deoxyuridine (EdU) assay were conducted to assess the influence of SNHG3 on CRC cell proliferation in vitro. In addition, invasive ability of CRC cells transfected with si-SNHG3 was explored by transwell assay. The binding and regulatory relations in the SNHG3/miR-370-5p/EZH1 axis were ascertained by Dual-Luciferase reporter assay.

RESULTS

SNHG3 was upregulated in CRC tissues and cell lines. Its high level was correlated to advanced tumor staging, positive lymph node metastasis and poor prognosis of CRC. Knockdown of SNHG3 reduced proliferative and invasive rates of SW480 and HT29 cells. The SNHG3/miR-370-5p/EZH1 axis was ascertained. In addition, knockdown of miR-370-5p enhanced proliferative and invasive rates of SW480 and HT29 cells.

CONCLUSIONS

LncRNA SNHG3 induces proliferative and invasive potentials of CRC by regulating the miR-370-5p/EZH1 axis.

Sulforaphane overcomes T790M-mediated gefitinib resistance in vitro through epithelial-mesenchymal transition

The purpose of the present study was to investigate the effects of sulforaphane (SFN) on gefitinib-resistant cell lines with a T790 mutation (PC-9/AB11). The PC-9 and PC-9/AB11 cells were stained with H&E and visualized with a light microscope. The CCK-8 assay method was used to evaluate the antiproliferative activity of gefitinib and SFN on the cells. Cell cycle arrest and apoptosis were analyzed via flow cytometry. The cytotoxic interaction between the two drugs was evaluated in vitro using the combination index method, and epithelial-mesenchymal transition (EMT)-related proteins and alterations in the signaling pathways were determined by Western blot analysis. Compared to the PC-9 cells, the gefitinib-resistant PC-9/AB11 cells acquired a T790M mutation and had characteristics in accordance with EMT. The combination of gefitinib and SFN induced dose-dependent antiproliferative effects in the PC-9 and PC-9/AB11 cells, while both induced cell cycle arrest and cell apoptosis only in the PC-9/AB11 cells. The synergistic effect in the PC-9/AB11 cells was associated with this drug combination, as it caused an expression change of the epithelial (E-cadherin, claudin-1) and matrix proteins (vimentin, N-cadherin) in the cells, related to the reversal of EMT, as well as an expression change of the epidermal growth factor receptor (EGFR), p-EGFR, p-AKT, and p-ERK proteins. In this study, SFN overcame T790M-mediated gefitinib resistance in vitro through EMT. Thus, a combination of gefitinib and SFN may be a beneficial treatment strategy for lung cancer patients with acquired resistance due to T790M mutation.

Ameliorative effect and mechanism of Yi-Suan-Cha against hyperuricemia in rats

BACKGROUND

This study aimed to evaluate the urate-lowering effects of Yi-Suan-Cha and explore its underlying mechanisms in experimental hyperuricemia induced in rats.

METHODS

Forty-eight male SD rats were randomly allocated into normal control, model, allopurinol, benzbromarone, low-dose Yi-Suan-Cha (0.2 g/ml), and high-dose Yi-Suan-Cha (0.4 g/ml) groups (n = 8 rats per group). Rat models of hyperuricemia were established through intragastric administration of adenine 25 mg/kg + potassium oxalate 300 mg/kg for 3 weeks. After the last administration, serum uric acid, creatinine, and urea nitrogen levels were measured. Renal histopathology was observed by hematoxylin-eosin staining. Xanthine oxidase level in serum and liver homogenates was measured by ELISA. The protein and mRNA expression of URAT1, ABCG2, OAT1, and GLUT9 in the kidney was detected by Western blotting and RT-PCR, respectively.

RESULTS

The serum uric acid levels were significantly lowered in all medication groups than in the model group. The benzbromarone and both Yi-Suan-Cha groups showed clear kidney structures with no obvious abnormalities. Compared with the normal control group, the model group showed increased URAT1/GLUT9 protein expression and decreased ABCG2/OAT1 protein expression. Compared with the model group, both Yi-Suan-Cha groups showed decreased URAT1/GLUT9 protein expression and increased ABCG2/OAT1 protein expression. Compared with that in the normal control group, URAT1/GLUT9 mRNA expression increased in the model group. Compared with the model group, the low-dose and high-dose Yi-Suan-Cha groups showed decreased URAT1/GLUT9 mRNA expression and increased ABCG2/OAT1 mRNA expression.

CONCLUSION

Yi-Suan-Cha may lower uric acid level by downregulating URAT1/GLUT9 expression and upregulating ABCG2/OAT1 expression.

[A multicenter randomized controlled study of bismuth-containing quadruple therapy followed by Jing-Hua-Wei-Kang in the treatment of patients newly diagnosed with Helicobacter pylori infection and dyspepsia]

Objective: To investigate the Helicobacter pylori (H. pylori) eradication rate and improvement of dyspepsia in patients who were newly diagnosed with H. pylori infection and dyspepsia and treated by bismuth-containing quadruple therapy followed by Jing-Hua-Wei-Kang(JHWK). Methods: Patients who were newly diagnosed with dyspepsia and H. pylori infection and treated in 16 medical centers in China between December 1, 2017 and September 30, 2019 were randomly divided into two groups. The experimental group received bismuth-containing quadruple therapy (esomeprazole+amoxicillin+furazolidone+colloidal bismuth pectin capsule, 14 days), followed by JHWK (30 days), and the course of treatment was 44 days in total. In the control group, the administration regimen was bismuth-containing quadruple therapy (esomeprazole+amoxicillin+furazolidone+colloidal bismuth pectin capsule, 14 days). The main outcome measure was H. pylori eradication rate, while the secondary outcome measures were dyspepsia symptom changes and adverse events during the treatment and the 1st month after treatment. Results: A total of 1 054 patients were included in the study. There were 522 cases enrolled in the experimental group, including 224(42.91%) men and 298(57.09%) women, and the age was 53(26, 73) years old; 532 cases enrolled in the control group, including 221(41.54%) men and 311(58.46%) women, and the age was 46(22, 71) years old. Based on PP analysis, it was found that the H. pylori eradication rate in the experimental group was significantly higher than those in the control group (93.85% vs 87.88%, P=0.001). In the group of all enrolled patients, the symptom dyspepsia after H. pylori eradication was significantly improved compared with that before treatment [4(4, 7) vs 15(10, 22), P<0.001], so was the superior and middle abdominal pain [1(1, 4) vs 4(1, 8), P<0.001], the postprandial fullness [1(1, 4) vs 4(4, 9), P<0.001], the early satiety [1(1, 1) vs 4(1, 4), P<0.001], and the heartburn [1(1, 1) vs 1(1, 4), P<0.001]. The symptom dyspepsia after treatment was significantly improved compared with that before treatment in the experimental, the control groups, the successful and the unsuccessful H. pylori eradication groups. The superior and middle abdominal pain after treatment was signifcantly improved than that before treatment [1(1, 2) vs 1(1, 4), P<0.001], so were the postprandial fullness [1(1, 3) vs 1(1, 4), P=0.002] and the dyspepsia[4(4, 7) VS 7(4, 10), P<0.001]. There was no statistically significant difference in the incidence of adverse events between the experimental group and the control group (1.34% vs 0.38%, P=0.09). Conclusions: Compared with bismuth-containing quadruple therapy, bismuth-containing quadruple therapy followed by JHWK significantly improves the H. pylori eradication rate without increasing the incidence of adverse events. H. pylori eradication therapy can improve symptoms of patients with H. pylori infection and dyspepsia.