A hybrid sensory feedback system for thermal nociceptive warning and protection in prosthetic hand.

Background: Advanced prosthetic hands may embed nanosensors and microelectronics in their cosmetic skin. Heat influx may cause damage to these delicate structures. Protecting the integrity of the prosthetic hand becomes critical and necessary to ensure sustainable function. This study aims to mimic the sensorimotor control strategy of the human hand in perceiving nociceptive stimuli and triggering self-protective mechanisms and to investigate how similar neuromorphic mechanisms implemented in prosthetic hand can allow amputees to both volitionally release a hot object upon a nociceptive warning and achieve reinforced release via a bionic withdrawal reflex. Methods: A steady-state temperature prediction algorithm was proposed to shorten the long response time of a thermosensitive temperature sensor. A hybrid sensory strategy for transmitting force and a nociceptive temperature warning using transcutaneous electrical nerve stimulation based on evoked tactile sensations was designed to reconstruct the nociceptive sensory loop for amputees. A bionic withdrawal reflex using neuromorphic muscle control technology was used so that the prosthetic hand reflexively opened when a harmful temperature was detected. Four able-bodied subjects and two forearm amputees randomly grasped a tube at the different temperatures based on these strategies. Results: The average prediction error of temperature prediction algorithm was 8.30 ± 6.00%. The average success rate of six subjects in perceiving force and nociceptive temperature warnings was 86.90 and 94.30%, respectively. Under the reinforcement control mode in Test 2, the median reaction time of all subjects was 1.39 s, which was significantly faster than the median reaction time of 1.93 s in Test 1, in which two able-bodied subjects and two amputees participated. Results demonstrated the effectiveness of the integration of nociceptive sensory strategy and withdrawal reflex control strategy in a closed loop and also showed that amputees restored the warning of nociceptive sensation while also being able to withdraw from thermal danger through both voluntary and reflexive protection. Conclusion: This study demonstrated that it is feasible to restore the sensorimotor ability of amputees to warn and react against thermal nociceptive stimuli. Results further showed that the voluntary release and withdrawal reflex can work together to reinforce heat protection. Nevertheless, fusing voluntary and reflex functions for prosthetic performance in activities of daily living awaits a more cogent strategy in sensorimotor control.

Experimental and Numerical Investigations on Thermal-Hydraulic Performance of Three-Dimensional Overall Jagged Internal Finned Tubes.

To satisfy the demand for efficient heat transfer, a novel three-dimensional overall jagged internal finned tube (3D-OJIFT) was fabricated, using the rolling-ploughing/extruding method. The thermal performance of the 3D-OJIFT were studied and compared in experiments and three-dimensional numerical simulations. The RNG k-ε turbulence model is well verified with the experimental results. By analyzing the distributions of velocity, temperature, and turbulence kinetic energy, it was found that the 3D-OJIFT destroyed the development of the velocity and thermal boundary layers, increased the turbulence disturbance, and reduced the temperature gradient, thus improving the heat transfer. The influences of the jagged height and jagged spiral angle of the 3D-OJIFT are discussed. The Nu and f increased as the jagged height of the 3D-OJIFT increased. The Nusselt number of the 3D-OJIFT was 1.67-2.04 times the value for the smooth tube. In addition, the comprehensive heat transfer performance of the 3D-OJIFT improved after increasing the jagged spiral angle. Compared with conventional internal helical-finned tubes and other reinforcement structures reported in the literature, the 3D-OJIFT demonstrated better comprehensive heat transfer performance. Finally, empirical correlations of the 3D-OJIFT were obtained.

Precision Control of Fingertip Force by a Biorealistic Hand with a Pair of Neuromorphic Muscles.

In this paper, the ability of precision control of fingertip forces was investigated in an antagonistic cable-driven prosthetic hand with neuromorphic twin of muscles. Surface electromyography (sEMG) signals collected from able-bodied subjects' forearm were processed and used as alpha motor commands to drive the neuromorphic muscle models. A pair of antagonistic muscles were cascaded by two servo motors to control the index finger. Force control performance was tested by pressing a spring with a fixed stiffness using the fingertip, where forces with varying target levels were regulated with visual feedback. Two able-bodied subjects performed the precision force control task with the prosthetic index finger by sEMG signals and the intact hand. One subject was tested with force level changes of 0.1N, and another subject with force level changes of 0.2N. The ability of force regulation by the prosthetic finger was compared to that of the intact finger. Results showed that the overall root-mean-squares (RMS) error of the prosthetic finger was low, although significantly higher than the intact finger, 75% higher in subject 1 and 57% in subject 2. However, the correlation coefficient between the forces of prosthetic finger and intact finger was high, 75% for subject 1 and 84% for subject 2, respectively. This preliminary study is encouraging, illustrating the feasibility of accurate and stable control of different levels of fingertip forces by the prosthetic finger, which is comparable to that of the intact finger. This capability may allow the prosthetic hand for fine manipulation tasks, such as grasping brittle objects, or response to object slip during grasp.Clinical Relevance-This work attempts to restore the ability of a prosthetic hand for precision fingertip force control that may enrich the functionality for users in activities of daily living.

Predictive Warning of Nociceptive Temperature during Prosthetic Hand Prehension.

Grasping hot objects may be harmful, and a warning of nociceptive temperature should be provided to prevent prosthetic hands from damage. This study developed a fast algorithm to predict the steady state temperature of grasped objects based on a thermoresistant sensor, and verified a bi-state sensory encoding strategy to inform either contact force or nociceptive temperature at prosthetic finger. Below the threshold, a buzz percept was used to encode fingertip force, and above the threshold, a tingling pain sensation was induced to warn harmful temperature. This sensory encoding mechanism was tested in one able-bodied subject with a psychophysical experimental paradigm. Results indicated that fast identification of the steady state temperature could be achieved in 0.75±0.00 s with an error of 8.3±6.0%. The subject was able to recognize whether the object temperature was above or below the threshold of nociceptive temperature with an average success rate of 98.2% and 97.0%, respectively. The action to release the tube could be executed in 0.80±0.32 s. The reaction time of successful identification and execution was 1.55 ± 0.32 s. The probability that a release reaction was triggered at the threshold of 60.0°C was calculated with tube temperatures varying from 30.0°C to 80.0°C. The 50% percentile point on the fitted stimulus-response curve corresponded to a temperature of 59.5°C, nearly identical to the internally set threshold. The psychophysical behavior test verified the sensory function to recognize and notify unsafe temperatures in real time.Clinical Relevance-The method of identifying and alerting nociceptive temperatures may restore the sensory ability of amputees to avoid potential damage of grasping hot objects with a prosthetic hand in activities of daily life.

Frequency of metastases within the hypothalamic-pituitary area and the associated high-risk factors in patients with brain metastases.

Objective: Brain radiotherapy often results in impairment of hypothalamic-pituitary (HT-P) function, which in turn causes secretory dysfunction of related hormones. In this paper, the frequency of metastasis in the HT-P area and its high-risk factors in patients with brain metastasis were retrospectively analyzed, and thus provide experimental evidence for protecting HT-P area during whole brain radiotherapy (WBRT). Methods: A retrospective analysis was performed on the data of patients with brain metastasis diagnosed by cranial magnetic resonance imaging (MRI) at the First Hospital of Lanzhou University from 2017 to 2020. The anatomical positions of the hypothalamus and pituitary were delineated, followed by their expansion by 5 mm outwards, respectively, in the three-dimensional direction, and the hypothalamus +5 mm and pituitary +5 mm were obtained as the avoidance area, in which the frequency of brain metastasis was evaluated. Univariate and multivariate logistic regression models were used to analyze the high risk factors of brain metastasis in HT-P area. Results: A total of 3,375 brain metastatic lesions from 411 patients were included in the analysis. The rates of brain metastasis in the hypothalamus +5 mm and pituitary +5 mm in the whole group of cases were 2.9% (12/411) and 1.5% (6/411) respectively; the frequency of lesions was 0.4% (13/3375) and 0.2% (6/3375) respectively. Univariate and multivariate analyses showed that the number of brain metastases (OR = 14.946; 95% CI = 4.071-54.880; p < 0.001), and the occurrence of brain metastasis in the pituitary (OR = 13.331; 95% CI = 1.511-117.620; p = 0.020) were related to brain metastasis in the hypothalamus, and that the only relevant factor for brain metastasis in the pituitary was the occurrence of that in the hypothalamus (OR = 0.069; 95% CI = 0.010-0.461; p = 0.006). There was no correlation between tumor pathological types, the maximum diameter, the total volume of brain metastatic lesions and the risk of brain metastasis in hypothalamus and pituitary. Conclusion: The frequency of brain metastasis in the HT-P area is extremely low. The risk of brain metastases in the hypothalamus is correlated with their number. The larger the number of metastatic lesions, the higher the frequency of brain metastasis. Protection of the HT-P area during WBRT may be unlikely to compromise the tumor recurrence rate for patients with a relatively small number of brain metastases.

Dosimetric comparison between stereotactic body radiotherapy and carbon-ion radiation therapy for prostate cancer.

Background: Prostate cancer rates have been steadily increasing in recent years. As high-precision radiation therapy methods, stereotactic body radiation therapy (SBRT) and carbon-ion radiation therapy (CIRT) have unique advantages. Analyzing the dosimetric differences between SBRT and CIRT in the treatment of localized prostate cancer can help provide patients with more accurate, individualized treatment plans. Methods: We selected computed tomography positioning images and the contours of target volumes of 16 patients with localized prostate cancer who received radiotherapy. We delineated the organs at risk (OARs) on the CyberKnife (CK) treatment planning system (TPS) MultiPlan4.0, which were imported into the CIRT uniform scanning TPS HIMM-1 ci-Plan. Two treatment plans, SBRT and CIRT, were designed for the same patient, and we used SPSS 22.0 for the statistical analysis of data. Results: Both SBRT and CIRT plans met the prescribed dose requirements. In terms of target volume exposure dose, D2 (P<0.001), D5 (P<0.001), D50 (P<0.001), D90 (P=0.029), D95 (P<0.001), D98 (P<0.001), and Dmean (P<0.001) under SBRT were significantly higher than those under CIRT; the conformity index (CI) under SBRT was significantly better than that under CIRT (P<0.001); the target volume coverage rate (V95%) and dose homogeneity index (HI) under CIRT were significantly better than those under SBRT (P<0.001). In terms of OAR exposure dosage, the Dmax of the bladder and rectum under SBRT was significantly lower than that under CIRT (P<0.001), but Dmean was in the other direction; the exposure dose of the intestinal tract under CIRT was significantly lower than that under SBRT (P<0.05); Dmax of the femoral head under CIRT was significantly lower than that under SBRT (P<0.05), and there was no statistical difference between them at other doses. Conclusions: In this study, we found that when CIRT was used for treating localized prostate cancer, the dose distribution in target volume was more homogeneous and the coverage rate was higher; the average dose of OARs was lower. SBRT had a better CI and higher dose in target volume; the dose hotspot was lower in OARs. It is important to comprehensively consider the dose relationship between local tumor and surrounding tissues when selecting treatment plans.

Prognostic value of extrahepatic metastasis on colon cancer with liver metastasis: a retrospective cohort study.

Introduction: The occurrence of metastasis is a threat to patients with colon cancer (CC), and the liver is the most common metastasis organ. However, the role of the extrahepatic organs in patients with liver metastasis (LM) has not been distinctly demonstrated. Therefore, this research aimed to explore the prognostic value of extrahepatic metastases (EHMs). Methods: In this retrospective study, a total of 13,662 colon patients with LM between 2010 and 2015 were selected from the Surveillance, Epidemiology, and End Results database (SEER). Fine and Gray's analysis and K-M survival analysis were utilized to explore the impacts of the number of sites of EHMs and different sites of EHMs on prognosis. Finally, a prognostic nomogram model based on the number of sites of EHMs was constructed, and a string of validation methods was conducted, including concordance index (C-index), receiver operating characteristic curves (ROC), and decision curve analysis (DCA). Results: Patients without EHMs had better prognoses in cancer-specific survival (CSS) and overall survival (OS) than patients with EHMs (p < 0.001). Varied EHM sites of patients had different characteristics of primary location site, grade, and histology. Cumulative incidence rates for CSS surpassed that for other causes in patients with 0, 1, 2, ≥ 3 EHMs, and the patients with more numbers of sites of EHMs revealed worse prognosis in CSS (p < 0.001). However, patients with different EHM sites had a minor difference in cumulative incidence rates for CSS (p = 0.106). Finally, a nomogram was constructed to predict the survival probability of patients with EHMs, which is based on the number of sites of EHMs and has been proven an excellent predictive ability. Conclusion: The number of sites of EHMs was a significant prognostic factor of CC patients with LM. However, the sites of EHMs showed limited impact on survival. Furthermore, a nomogram based on the number of sites of EHMs was constructed to predict the OS of patients with EHMs accurately.

A Plasmon Resonance Enhanced Photo-Electrode to Promote NH3 Yield in Sustainable N2 Conversion.

A key challenge for electrochemical nitrogen reduction reactions (NRR) is the difficulty for conventional catalysts to achieve high currents at low H* coverage to produce appreciable NH3 . Herein, we specially designed an Au nanoparticle-embedded ZnSe photo-electrode to solve the problem. As-designed photo-electrode achieves excellent NRR performance with a high NH3 yield (12.2 µg cm-2 h-1 ) and Faradaic efficiency (27.3 %). Our work reveals that the unique plasmon resonance effect of embedded Au nanoparticles plays a key role in increasing catalytic current when the H* coverage is decreased. Moreover, we successfully established a correlation between H* coverage and NRR performance based on theoretical calculations and experimental observations. This work paves the path for the future design of catalytic materials to overcome the selectivity and yield challenge of sustainable NH3 production.

Fusion of dual modalities of non-invasive sensory feedback for object profiling with prosthetic hands.

Introduction: Either non-invasive somatotopic or substitute sensory feedback is capable of conveying a single modality of sensory information from prosthetic hands to amputees. However, the neurocognitive ability of amputees to integrate multi-modality sensory information for functional discrimination is unclear. The purpose of this study was to assess the fusion of non-invasive somatotopic tactile and substitute aperture feedbacks for profile perception of multiple physical features during grasping objects. Methods: Two left transradial amputees with somatotopic evoked tactile sensation (ETS) of five fingers participated in the study. The tactile information of prosthetic hand was provided to amputees by the ETS feedback elicited on the stump projected finger map. Hand aperture information was conveyed to amputees with substitute electrotactile stimulation on the forearm or upper arm. Two types of sensory feedback were integrated to a commercial prosthetic hand. The efficacy of somatotopic ETS feedback on object length identification task was assessed with or without substitute aperture stimulation. The object size identification task was utilized to assess how ETS stimulation at the stump may affect aperture perception with stimulation on the ipsilateral upper arm or forearm. Finally, the task of identifying combined length and size was conducted to evaluate the ability of amputees to integrate the dual modalities of sensory feedback for perceiving profile features. Results: The study revealed that amputee subjects can effectively integrate the ETS feedback with electrotactile substitutive feedback for object profile discrimination. Specifically, ETS was robust to provide object length information with electrotactile stimulation at either the forearm or upper arm. However, electrotactile stimulation at the upper arm for aperture perception was less susceptible to the interference of ETS stimulation than at the forearm. Discussion: Amputee subjects are able to combine somatotopic ETS and aperture feedbacks for identifying multi-dimensional features in object profiling. The two sensory streams of information can be fused effectively without mutual interference for functional discrimination.

The Effects of Deep Brain Stimulation on Motor Unit Activities in Parkinson's Disease based on High-Density Surface EMG Analysis.

Tremor in Parkinson's disease (PD) is caused by synchronized activation bursts in limb muscles. Deep Brain Stimulation (DBS) is an effective clinical therapy for inhibiting tremor and improving movement disorders in PD patients. However, the neural mechanism of how tremor symptom is suppressed by DBS at motor unit (MU) level remains unclear. This paper developed a data acquisition platform for collecting physiological data in PD patients. Both high-density surface Electromyography (HD-sEMG) and kinematics data were collected concurrently before and after DBS surgery. The MU behaviors were obtained via HD-sEMG decomposition algorithm to reveal the effect of DBS on PD tremor. A data set of one tremor dominant PD patient acquired in pre-operation and post-operation (DBS-on) phases was analyzed. Preliminary results showed significant changes in MU firing rate and MU synchronization. The analysis approach introduced in this paper provides a novel perspective for studying the neural mechanism of DBS as revealed by MU activities. Clinical Relevance- This study presented an approach to investigate the effect of DBS therapy on improving tremor disorder of PD patients.

Non-Invasive Stable Sensory Feedback for Closed-Loop Control of Hand Prosthesis.

The absence of somatotopic sensory feedback limits the function of conventional prosthetic hands. In this study, we integrated a non-invasive sensory feedback system into a commercial Bebionic hand with new customized surface stimulation electrodes. Multiple modalities of tactile and hand aperture sensory information were conveyed to the amputee via the technique of evoked tactile sensation (ETS) elicited at projected finger map (PFM) of residual limb and an additional electrotactile stimulation in the ipsilateral upper arm. A previously developed anti-stimulus artifact module was used to remove the stimulus artifact from surface electromyographic (sEMG) signals, and the filtered sEMG envelops controlled the speed of open/close of the Bebionic hand. The Ag/AgCl surface stimulation electrode in 10-mm diameter was specially designed to fit the restricted PFM areas for stable perception. We evaluated the alternating-current (AC) impedance magnitude of this electrode stimulated over 12 hours. The perceptual and upper thresholds in pulse-width over 200 days at PFM areas were recorded to assess the stability of the non-invasive sensory neural interface. The efficacy of multi-modality feedback for identification of physical properties of objects was also assessed. Results showed that the AC impedance of customized surface stimulation electrode was stable over 12 hours of stimulation. The perceptual and upper thresholds were stable over 200 days. This non-invasive sensory feedback enabled a forearm amputee to identify the compliance and length of grasped objects with an accuracy of 100 %. Results illustrated that the multi-modality sensory feedback system provided stable and sufficient sensory information for perceptual discrimination of physical features of grasped objects. Clinical Relevance- This study demonstrated a promising and novel way to restore stable sensory feedback non-invasively for commercial hand prostheses.

Antagonistic Control of a Cable-Driven Prosthetic Hand with Neuromorphic Model of Muscle Reflex.

In this paper, a novel prototype of a cable-driven prosthetic hand with biorealisitic muscle property was developed. A pair of antagonistic muscles controlled the flexion and extension of the prosthetic index finger. Biorealistic properties of muscle were emulated using a neuromorphic model of muscle reflex in real time. The model output was coupled to a servo motor that tracked the computed muscle force. The servo motor was able to track model output within a frequency range from 0 to 8.29 (Hz) with a phase shift from 2 to 205 (deg). Surface electromyography signals collected from the amputee's forearm were used as α commands to drive the muscle model. With this prototype system, we evaluated its characteristics for force and stiffness control. Results of the force variability test showed that the standard deviation of fingertip force was linear to the mean fingertip force, indicating that force variability was proportional to the background force. At different levels of antagonistic co-contraction, the index finger and muscles displayed different levels of stiffness corresponding to the degree of co-activation. This prototype system showed the similar compliant behaviors of human limbs actuated with biological muscles. In further studies, this prototype system would be thoroughly evaluated for its biorealistic properties, and integrated with sensors to investigate feedback strategies of various sensory information for individuals with amputation. Clinical Relevance- This article established an antagonistic control of a cable-driven prosthetic hand with biorealistic properties of muscle reflex for application to individuals with amputation.

Identification of Autophagy-Related LncRNA to Predict the Prognosis of Colorectal Cancer.

Objective: To establish a prediction model based on autophagy-related lncRNAs and investigate the functional enrichment of autophagy-related lncRNAs in colorectal cancer. Methods: TCGA database was used to extract the transcriptome data and clinical features of colorectal cancer patients. HADb was used to obtain autophagy-related genes. Pearson correlation analysis was performed to identify autophagy-related lncRNAs. The autophagy-related lncRNAs with prognostic values were selected. Based on the selected lncRNAs, the risk score model and nomogram were constructed, respectively. Calibration curve, concordance index, and ROC curve were performed to evaluate the predictive efficacy of the prediction model. GSEA was performed to figure out the functional enrichment of autophagy-related lncRNAs. Results: A total of 13413 lncRNAs and 938 autophagy-related genes were obtained. A total of 709 autophagy-related genes were identified in colon cancer tissues, and 11 autophagy-related lncRNAs (AL138756.1, LINC01063, CD27-AS1, LINC00957, EIF3J-DT, LINC02474, SNHG16, AC105219.1, AC068580.3, LINC02381, and LINC01011) were finally selected and set as prognosis-related lncRNAs. According to the risk score, patients were divided into the high-risk and low-risk groups, respectively. The survival K-M (Kaplan-Meier) curve showed the low-risk group exhibits better overall survival than the high-risk group. The AUCs under the ROC curves were 0.72, 0.814, and 0.83 at 1, 3, and 5 years, respectively. The C-index (concordance index) of the model was 0.814. The calibration curves at 1, 3, and 5 years showed the predicting values were consistent with the actual values. Functional enrichment analysis showed that autophagy-related lncRNAs were enriched in several pathways. Conclusions: A total of 11 specific autophagy-related lncRNAs were identified to own prognostic value in colon cancer. The predicting model based on the lncRNAs and clinical features can effectively predict the OS. Furthermore, functional enrichment analysis showed that autophagy-related genes were enriched in various biological pathways.

Metabolic Syndrome Predicts Response to Neoadjuvant Chemotherapy in Breast Cancer.

Purpose: This research investigated the predictive role of metabolic syndrome (MetS) in breast cancer neoadjuvant chemotherapy (BCNACT) response. Methods: One hundred fifty primary breast cancer (BC) patients who underwent neoadjuvant chemotherapy (NACT) were included retrospectively. MetS, MetS components [waist circumference (WC), fasting blood glucose (FBG), blood pressure, triglycerides (TG), and high-density lipoprotein cholesterol (HDL-C)], serum lipid, and other MetS-related laboratory indicators within two weeks before BCNACT were evaluated. Univariate, multivariate, and subgroup analyses were performed to determine the predictors of BCNACT pathologic complete response (pCR), clinical response, and pathologic response. The effectiveness of the model was evaluated via receiver operating characteristic curve (ROC) and calibration curve. External validation was performed through 135 patients. Results: Univariate analysis revealed that MetS before BCNACT predicted poor BCNACT response (pCR, P = 0.003; clinical response, P = 0.033; pathologic response, P < 0.001). Multivariate analysis confirmed that MetS before BCNACT predicted lower pCR rate (P = 0.041). Subgroup analysis showed that this relationship was significant in estrogen receptor (ER) (-) (RR = 0.266; 95% CI, 0.074-0.954), human epidermal growth factor 2 (HER2) (-) (RR = 0.833; 95% CI, 0.740-0.939) and TNBC (RR = 0.833; 95% CI, 0.636-0.995). Multivariate analysis of external validation confirmed that pretreatment MetS was associated with a lower pCR rate (P = 0.003), and subgroup analysis also confirmed that this relationship had significant statistical differences in ER (-), HER2 (-), and TNBC subgroups. Conclusions: MetS before BCNACT predicted a lower pCR rate. Intervention on MetS status, especially in ER (-), HER2 (-), and TNBC subgroups, is expected to improve the response rate of BCNACT further.

A pilot study of synergy-based FES for upper-extremity poststroke rehabilitation.

A previous study indicated that synergy-based functional electrical stimulation (FES) may improve instantaneous upper-limb motor performance for stroke survivors. However, it remains unclear whether the improvements will sustain over time to achieve functional gains associated with a task-oriented training (TOT). This pilot study was designed to investigate whether there is any promising sign of functional benefits. A TOT protocol with repeated forward and lateral reaching movements assisted by synergy-based FES was conducted in 16 patients (9 FES, 7 Sham) with post-stroke hemiparesis. FES stimuli were applied to 7 upper-extremity muscles of elbow and shoulder during patient movements. Envelopes of stimuli were individualized by re-composing the muscle synergies extracted from a healthy subject. After a five-day training for one hour each day, synergy-based FES induced higher increases in Fugl-Meyer scores (6.67 ± 5.20) than did the Sham (2.00 ± 2.38, p < 0.05). Peak velocity of forward reaching movements increased with a slope 73% steeper in FES group than Sham. In lateral reaching movements, the change in synergy similarity correlated with the change in elbow flexion for the FES group, but not the Sham group. Our results indicate that synergy-based FES therapy induced clinically traceable signs of improvements in poststroke motor performance. The muscle activation in patients also showed promising sign of alteration by FES. Results suggest that a larger scale clinical trial of synergy-based FES may be feasible towards an individualized therapeutic regimen.

The Risk of Hippocampal Metastasis and the Associated High-Risk Factors in 411 Patients With Brain Metastases.

BACKGROUND AND AIMS: To retrospectively analyze the incidence of hippocampal metastasis and the associated high-risk factors in patients with brain metastases and evaluate the safety of hippocampal avoidance whole-brain radiation therapy (HA-WBRT). METHODS: We retrospectively analyzed the data of patients with brain metastases diagnosed by contrast-enhanced cranial Magnetic resonance imaging (MRI) at the First Hospital of Lanzhou University from 2017 to 2020. The boundaries of the hippocampus, hippocampus + 5 mm area, hippocampus + 10 mm area, and hippocampus + 20 mm area were delineated, and the distances from the brain metastases to the hippocampus were measured. Univariate and multivariate logistic regressions were adopted to analyze the high-risk factors of hippocampal metastasis. RESULTS: A total of 3,375 brain metastases in 411 patients were included in the analysis. The metastasis rates in the hippocampus and surrounding areas of the entire group were as follows: 7.3% (30/411) in the hippocampus, 16.5% (68/411) in the hippocampus + 5 mm area, 23.8% (98/411) in the hippocampus + 10 mm area, and 36.5% (150/411) in the hippocampus + 20 mm area. Univariate logistic regression showed that the pathological type, the number of metastases, the maximum diameter of metastases, and the volume of brain metastases were all correlated with hippocampal metastasis. Multivariate logistic regression showed that the pathological type, the number of metastases, and the total volume of metastases were correlated with hippocampal metastasis. CONCLUSION: The pathological type, the number of metastases, and the total volume of metastases are the high-risk factors associated with hippocampal metastasis. Small cell lung cancer (SCLC) has a significantly higher rate of hippocampal metastasis than other tumor types. The greater the number and total volume of metastases, the more likely the hippocampal metastasis. For patients with SCLC or a greater number and total volume of brain metastases, the implementation of HA-WBRT may bring a higher risk of tumor recurrence.

The Impact and Clinical Prediction of Hyperglycemia During Parenteral Nutrition for Nondiabetic Patients After Gastrectomy for Gastric Cancer.

BACKGROUND AND PURPOSE: Hyperglycemia (HG) is associated with increased postoperative complications. This study aims to evaluate the effect of HG during supplemental parenteral nutrition (SPN) on short-term prognosis in non-diabetic patients undergoing gastrectomy for cancer and to analyse the risk factors and prevention methods for HG. METHODS: A total of 359 patients were divided into three groups according to blood glucose (BG) during SPN: normoglycemic patients ( ≤ 125 mg/dL), mild HG (125~200 mg/dL), and severe HG (>200 mg/dL). The effect of BG on postoperative short-term outcomes was analyzed. Multivariate regression was performed to investigate influencing factors for severe HG. The safety and efficacy of insulin addition to total nutrient admixture (TNA) for the prevention and management of HG were assessed by propensity score matching (PSM). In addition, regression analysis was performed in the noninsulin group to investigate the predictive factors of severe HG, and a nomogram was plotted. RESULTS: The postoperative complication rate was 18.9%, but it was significantly higher in patients with severe HG than in mild HG and normoglycemic patients (25.2, 15.0, and 10.0%, respectively, p < 0.05). Multivariate logistic regression analysis showed that anemia, myosteatosis, higher postoperative capillary blood glucose (CBG) before TNA infusion, and insulin in the TNA were independent influencing factors for severe HG. Based on the above factors, 75 pairs of patients (insulin group and non-insulin group) with comparable baseline data were successfully matched by PSM. The HG incidence and the glycemic fluctuation were significantly improved through 1 U insulin/6 g glucose (1/6 scheme) to TNA. A nomogram containing hemoglobin, skeletal muscle radiodensity, pre-SPN CBG, and pTNM stage with good predictive efficacy (C-index: 0.750) was constructed based on the noninsulin group. CONCLUSION: Poor postoperative glycemic control was related to worse outcomes in non-diabetic patients undergoing gastrectomy for cancer. Pre-operative anemia, myosteatosis, and high postoperative CBG before TNA infusion are risk factors for severe HG. Insulin in TNA can improve the blood glucose control of patients. Our proposed nomogram rendered an individualized predictive tool for HG during SPN, which helps screen high-risk patients requiring insulin therapy. Future studies with larger samples are needed to develop a complete insulin application protocol for SPN.

Insulin for hyperglycemia prevention and management during postgastrectomy nutrition support in gastric cancer: Reduced complications in a retrospective cohort study in China.

BACKGROUND AND OBJECTIVES: To evaluate the effectiveness of insulin addition to the total nutrition admixture (TNA) for glycemic control among patients with gastric cancer (GC) receiving supplementary parenteral nutrition (SPN) after gastrectomy. METHODS AND STUDY DESIGN: A retrospective cohort study was conducted among 208 noncritical ill patients who underwent gastrectomy for GC from 2017 to 2019 at a tertiary teaching hospital in Lanzhou, China. All the included patients received individualized SPN and enteral nutrition treatment after gastrectomy. The patients were randomly divided into insulin and noninsulin groups based on the TNA composition. Blood glucose (BG) measurements, glycemic fluctuation, and hypoglycemia incidence during SPN were compared between the two groups. The postoperative comprehensive complications index (CI) and infections were compared according to insulin regimen and postoperative glycemic status. RESULTS: The mean BG was significantly lower and fluctuated less in the insulin group than in the noninsulin group (p<0.05). One unit of insulin per 6 g of parenteral nutrition glucose addition to TNA did not increase hypoglycemia incidence (p>0.05). Comparing CI and the infection rate, no significance was observed between the insulin and noninsulin groups, but a higher postoperative CI was observed in patients with hyperglycemia than in euglycemic patients (p<0.05). CONCLUSIONS: Appropriate insulin addition to TNA has an overall positive effect on glycemic management in patients with noncritical GC who received SPN after gastrectomy. Postoperative glycemic status was associated with the incidence of relevant complications. Further research is needed for conclusive recommendations.

Evaluation of multiple perceptual qualities of transcutaneous electrical nerve stimulation for evoked tactile sensation in forearm amputees.

Objective. Evoked tactile sensation (ETS) elicited by transcutaneous electrical nerve stimulation (TENS) is promising to convey digit-specific sensory information to amputees naturally and non-invasively. Fitting ETS-based sensory feedback to amputees entails customizing coding of multiple sensory information for each stimulation site. This study was to elucidate the consistency of percepts and qualities by TENS at multiple stimulation sites in amputees retaining ETS.Approach. Five transradial amputees with ETS and fourteen able-bodied subjects participated in this study. Surface electrodes with small size (10 mm in diameter) were adopted to fit the restricted projected finger map on the forearm stump of amputees. Effects of stimulus frequency on sensory types were assessed, and the map of perceptual threshold for each sensation was characterized. Sensitivity for vibration and buzz sensations was measured using distinguishable difference in stimulus pulse width. Rapid assessments for modulation ranges of pulse width at fixed amplitude and frequency were developed for coding sensory information. Buzz sensation was demonstrated for location discrimination relating to prosthetic fingers.Main results. Vibration and buzz sensations were consistently evoked at 20 Hz and 50 Hz as dominant sensation types in all amputees and able-bodied subjects. Perceptual thresholds of different sensations followed a similar strength-duration curve relating stimulus amplitude to pulse width. The averaged distinguishable difference in pulse width was 12.84 ± 7.23µs for vibration and 15.21 ± 6.47µs for buzz in able-bodied subjects, and 14.91 ± 10.54µs for vibration and 11.30 ± 3.42µs for buzz in amputees. Buzz coding strategy enabled five amputees to discriminate contact of individual fingers with an overall accuracy of 77.85%.Significance. The consistency in perceptual qualities of dominant sensations can be exploited for coding multi-modality sensory feedback. A fast protocol of sensory coding is possible for fitting ETS-based, non-invasive sensory feedback to amputees.

Benzobisthiadiazole and Its Derivative-Based Semiconducting Polymer Nanoparticles for Second Near-Infrared Photoacoustic Imaging.

Photoacoustic (PA) imaging has received more and more attention on disease diagnosis and fundamental scientific research. It is still challenging to amplify their imaging ability and reduce the toxicity of inorganic materials and exogenous contrast agents. Semiconducting polymer nanoparticles (SPNs), as a new type of contrast agent, have the advantages of low toxicity, flexible structure adjustment, good photostability, and excellent photothermal conversion efficiency. SPNs containing benzo(1,2-c;4,5-c')bis(1,2,5)thiadiazole (BBT) units, as the most classic second near-infrared window (NIR-II, 1,000-1700 nm) PA contrast agents, can achieve light absorption in the NIR-II region, thereby effectively reducing light loss in biological tissues and improving imaging resolution. This mini review summarizes the recent advances in the design strategy of BBT and its derivative-based semiconducting polymer nanoparticles for second near-infrared photoacoustic imaging. The evolution process of BBT blocks provides a unique perspective for the design of high-performance NIR-II PA contrast agents.