Evolving Therapeutic Landscape of Intracerebral Hemorrhage: Emerging Cutting-Edge Advancements in Surgical Robots, Regenerative Medicine, and Neurorehabilitation Techniques.

Intracerebral hemorrhage (ICH) is the most serious form of stroke and has limited available therapeutic options. As knowledge on ICH rapidly develops, cutting-edge techniques in the fields of surgical robots, regenerative medicine, and neurorehabilitation may revolutionize ICH treatment. However, these new advances still must be translated into clinical practice. In this review, we examined several emerging therapeutic strategies and their major challenges in managing ICH, with a particular focus on innovative therapies involving robot-assisted minimally invasive surgery, stem cell transplantation, in situ neuronal reprogramming, and brain-computer interfaces. Despite the limited expansion of the drug armamentarium for ICH over the past few decades, the judicious selection of more efficacious therapeutic modalities and the exploration of multimodal combination therapies represent opportunities to improve patient prognoses after ICH.

A new modular framework for high-level application development at HEPS.

As a representative of the fourth-generation light sources, the High Energy Photon Source (HEPS) in Beijing, China, utilizes a multi-bend achromat lattice to obtain an approximately 100 times emittance reduction compared with third-generation light sources. New technologies bring new challenges to operate the storage ring. In order to meet the beam commissioning requirements of HEPS, a new framework for the development of high-level applications (HLAs) has been created. The key part of the new framework is a dual-layer physical module to facilitate the seamless fusion of physical simulation models with the real machine, allowing for fast switching between different simulation models to accommodate the various simulation scenarios. As a framework designed for development of physical applications, all variables are based on physical quantities. This allows physicists to analytically assess measurement parameters and optimize machine parameters in a more intuitive manner. To enhance both extensibility and adaptability, a modular design strategy is utilized, partitioning the entire framework into discrete modules in alignment with the requirements of HLA development. This strategy not only facilitates the independent development of each module but also minimizes inter-module coupling, thereby simplifying the maintenance and expansion of the entire framework. To simplify the development complexity, the design of the new framework is implemented using Python and is called Python-based Accelerator Physics Application Set (Pyapas). Taking advantage of Python's flexibility and robust library support, we are able to develop and iterate quickly, while also allowing for seamless integration with other scientific computing applications. HLAs for both the HEPS linac and booster have been successfully developed. During the beam commissioning process at the linac, Pyapas's ease of use and reliability have significantly reduced the time required for the beam commissioning operators. As a development framework for HLA designed for the new-generation light sources, Pyapas has the versatility to be employed with HEPS, as well as with other comparable light sources, due to its adaptability.

The Role of ICP Monitoring in Minimally Invasive Surgery for the Management of Intracerebral Hemorrhage.

Intracerebral hemorrhage (ICH) is the second major stroke type, with high incidence, high disability rate, and high mortality. At present, there is no effective and reliable treatment for ICH. As a result, most patients have a poor prognosis. Minimally invasive surgery (MIS) is the fastest treatment method to remove hematoma, which is characterized by less trauma and easy operation. Some studies have confirmed the safety of MIS, but there are still no reports showing that it can significantly improve the functional outcome of ICH patients. Intracranial pressure (ICP) monitoring is considered to be an important part of successful treatment in traumatic brain diseases. By monitoring ICP in real time, keeping stable ICP could help patients with craniocerebral injury get a good prognosis. In the course of MIS treatment of ICH patients, keeping ICP stable may also promote patient recovery. In this review, we will take ICP monitoring as the starting point for an in-depth discussion.

Surgical Robotics for Intracerebral Hemorrhage Treatment: State of the Art and Future Directions.

Intracerebral hemorrhage (ICH) is a stroke subtype with high mortality and disability, and there are no proven medical treatments that can improve the functional outcome of ICH patients. Robot-assisted neurosurgery is a significant advancement in the development of minimally invasive surgery for ICH. This review encompasses the latest advances and future directions of surgical robots for ICH. First, three robotic systems for neurosurgery applied to ICH are illustrated. Second, the key technologies of robot-assisted surgery for ICH are introduced in aspects of stereotactic technique and navigation, the puncture instrument, and hematoma evacuation. Finally, the limitations of current surgical robots are summarized, and the possible development direction is discussed, which is named "multisensor fusion and intelligent aspiration control of minimally invasive surgical robot for ICH". It is expected that the new generation of surgical robots for ICH will facilitate quantitative, precise, individualized, standardized treatment strategies for ICH.

Multi-mode information fusion navigation system for robot-assisted vascular interventional surgery.

BACKGROUND: Minimally invasive vascular intervention (MIVI) is a powerful technique for the treatment of cardiovascular diseases, such as abdominal aortic aneurysm (AAA), thoracic aortic aneurysm (TAA) and aortic dissection (AD). Navigation of traditional MIVI surgery mainly relies only on 2D digital subtraction angiography (DSA) images, which is hard to observe the 3D morphology of blood vessels and position the interventional instruments. The multi-mode information fusion navigation system (MIFNS) proposed in this paper combines preoperative CT images and intraoperative DSA images together to increase the visualization information during operations. RESULTS: The main functions of MIFNS were evaluated by real clinical data and a vascular model. The registration accuracy of preoperative CTA images and intraoperative DSA images were less than 1 mm. The positioning accuracy of surgical instruments was quantitatively assessed using a vascular model and was also less than 1 mm. Real clinical data used to assess the navigation results of MIFNS on AAA, TAA and AD. CONCLUSIONS: A comprehensive and effective navigation system was developed to facilitate the operation of surgeon during MIVI. The registration accuracy and positioning accuracy of the proposed navigation system were both less than 1 mm, which met the accuracy requirements of robot assisted MIVI.

Incremental robust PCA for vessel segmentation in DSA sequences.

In intervention surgery, DSA images provide a new way to observe the vessels and catheters inside the patient. Extracting coronary artery from the dynamic complex background fast improves the effectiveness directly in clinical interventional surgery. This article proposes an incremental robust principal component analysis (IRPCA) method to extract contrast-filled vessels from x-ray coronary angiograms. RPCA is a matrix decomposition method that decomposes a video matrix into foreground and background, commonly used to model complex backgrounds and extract target objects. IRPCA pre-optimizes an x-ray image sequence. When a new x-ray sequence is received, IRPCA optimizes it based on the pre-optimized matrix according to the strategy of minimizing the energy function to obtain the foreground matrix of the new sequence. Besides, based on the idea that the new x-ray sequence introduces new information to the pre-optimized matrix, we propose UIRPCA to improve the performence of IRPCA. Compared with the traditional RPCA method, IRPCA and UIRPCA save much time while ensuring that other indicators remain basically unchanged. The experiment results based on real data show the superiority of the proposed method over other RPCA algorithms.

Transfer Learning for Nonrigid 2D/3D Cardiovascular Images Registration.

Cardiovascular image registration is an essential approach to combine the advantages of preoperative 3D computed tomography angiograph (CTA) images and intraoperative 2D X-ray/digital subtraction angiography (DSA) images together in minimally invasive vascular interventional surgery (MIVI). Recent studies have shown that convolutional neural network (CNN) regression model can be used to register these two modality vascular images with fast speed and satisfactory accuracy. However, CNN regression model trained by tens of thousands of images of one patient is often unable to be applied to another patient due to the large difference and deformation of vascular structure in different patients. To overcome this challenge, we evaluate the ability of transfer learning (TL) for the registration of 2D/3D deformable cardiovascular images. Frozen weights in the convolutional layers were optimized to find the best common feature extractors for TL. After TL, the training data set size was reduced to 200 for a randomly selected patient to get accurate registration results. We compared the effectiveness of our proposed nonrigid registration model after TL with not only that without TL but also some traditional intensity-based methods to evaluate that our nonrigid model after TL performs better on deformable cardiovascular image registration.

Traditional uses, phytochemistry, and pharmacology of Toxicodendron vernicifluum (Stokes) F.A. Barkley - A review.

ETHNOPHARMACOLOGICAL RELEVANCE: Toxicodendron vernicifluum (Stokes) F.A. Barkley (syn. Rhus verniciflua or vernicifera Stokes, Anacardiaceae) (RVS), the lacquer tree, also known as sumac, has been used in China, Japan and South Korea for thousands of years as a highly durable coating material and a traditional herbal medicine, which contains medicinal ingredients with anti-tumor, anti-inflammatory, antiviral, and anti-rheumatic activities. AIM OF THIS REVIEW: This review intends to provide a comprehensive and critical appraisal of RVS, including its phytochemical data, botanical and pharmacological literature that support its therapeutic potential in treatment on human diseases, with emphasis on the isolation of natural occurring compounds and detailed pharmacological investigations. MATERIALS AND METHODS: Specific information of RVS was collected by using the key words "Toxicodendron vernicifluum", "Rhus verniciflua Stokes", "Rhus vernicifera Stokes" and "Lacquer tree" through published scientific materials (including PubMed, ScienceDirect, Wiley, ACS, CNKI, Scifinder, Springer, Web of Science, Google Scholar, and Baidu Scholar) and other literature sources. RESULTS: The major phytoconstituents, 175 of which are presented in this review, including flavonoids, urushiols, terpenes, phenolic acids and other types of compounds, of which flavonoids and urushiols are main components. The extracts and isolates purified from RVS showed a wide range of in vitro and in vivo pharmacological effects, such as anti-cancer, anti-oxidation, anti-inflammatory, antimicrobial, tyrosinase inhibition and so on. CONCLUSION: The modern pharmacological research of RVS mainly focus on the pharmacological effects of crude extract or active constituents, of which the flavonoids are widely studied. However, there are few reports on the relationship between pharmacological effects and their structures. And at present, there is still a lack of researches that are of both effective and in-depth. Meanwhile, there is little research on quality control. Apart from the wood and lacquer, other botanical parts also need to be explored further. In addition to phenolic compounds, the study on other types of components in T. vernicifluum would start more sparks for the discovery of new bioactive principles.

Efficacy of Dexamethasone implant injection in the treatment of persistent diabetic macular edema / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To investigate the efficacy of dexamethasone implant injection in the treatment of persistent diabetic macular edema(DME).<p>METHODS: The clinical data of 30 DME patients(30 eyes)after anti-vascular endothelial growth factor(anti-VEGF)agents from June 2019 to January 2020 were retrospectively analyzed. All patients had underwent intravitreal injection of DEX. Best corrected visual acuity(BCVA), intraocular pressure(IOP), central macular thickness(CMT)and adverse events were recorded.<p>RESULTS:BCVA(LogMAR)was significantly improved from(0.86±0.47)to(0.57±0.53, 0.42±0.48, 0.43±0.26, 0.45±0.66 and 0.51±0.37)at 1, 2, 3, 4 and 6mo after treatment. CMT improved significantly from baseline(495.64±107.23)μm to(412.57±74.55, 370.21±23.83, 371.53±52.66, 373.28±68.49, 389.35±95.61)μm 1, 2, 3, 4 and 6mo post-injection. The drug reached its peak efficacy 2mo after administration. 4 eyes were given repeated injection at 3mo, 5 eyes were given at 5mo and 2 eyes were given at 6mo following the primary injection. Cataract progression was showed in 1 case. 4 patients demonstrated IOP levels above 22mmHg and were mostly controllable by IOP-lowering medications. None of patients showed any adverse events at 6mo of follow-up.<p>CONCLUSION: Dexamethasone implant injection showed significant BCVA and CMT improvement. DEX injection may be utilized as an effective DME therapy for patients who are persistent after anti-VEGF treatment.

Investigation on resources allocation of chronic disease management services in a county in Shanxi province / 中华医院管理杂志

Objective:To provide information for further development of chronic disease management, by studying the allocation of resources required to provide services in a county in Shanxi province as required by to the pathway of China-Gates Rural Primary Health Care Service project.Methods:A questionnaire survey was made to evaluate the deployment of manpower, equipment, and drugs required by levels of county, township and village medical institutions in the health management services of hypertension and diabetes in the rural areas of Yangqu county, Shanxi province from July to August 2019.Results:A total of one county hospital, 10 township health centers and 101 village clinics participated in the investigation. In terms of service personnel participating in the project, 9 township-level medical institutions were manned with personnel who could provide diagnosis, intervention planning, and follow-up visits, and only one of them had annual evaluators; village-level medical institutions basically didn′t have diagnosis, intervention planning, and annual evaluation staff. In terms of technical equipments, there was a general lack of diabetes assessment equipment at county, township and village level medical institutions. The mandatory equipments for diabetes assessment was equipped for only 80.0%, 79.0%, and 37.8% of the three levels of institutions, respectively. Village clinics lack hypertension assessment equipment and had no diabetes diagnosis equipment at all.Conclusions:The chronic disease management personnel, equipment, and drug supply in the rural areas of a county in Shanxi province are unbalanced among counties, townships, and villages. The quality of chronic disease management services should be improved through effective and rational use of resources.

An influence study of the different types of wound dressings on red light transmittance / 中华老年医学杂志

Objective:To investigate the influence of different types of wound dressings on red light transmittance.Methods:A treatment environment for wounds exposed to red light was simulated.Red light transmittance of four types of 19 dressings commonly used in clinic were detected respectively and compared.The transmittance was calculated as the ratio of the intensity of the red light through the dressing to the intensity of the injected red light.Results:The red light transmittance for each dressing was the following: (1)Cotton gauze and pad: 29.4% for one piece of coarse gauze, 10.5% for one cotton pad; (2)Oil dressings: 73.0%~79.1% for light-color oil dressings, 41.7% for dark-color oil dressings-Atrauman ?; (3)Hydrocolloid dressings: 87.8%~90.2%; (4)Foams: 74.7% for light-color ultra-thin foam-Mepilex ? sheet, 0.8% for black-color thicker foam dressings-Mepilex ? Ag dressing, and 20.5%-54.2% for the other foam dressings. Conclusions:The red light transmittance of hydrocolloid dressing, light-colored oil gauze dressing and light-colored ultra-thin foam dressing is higher, with less red light-blocking effect, and the dark-color or thicker dressings had more blocking effect, which showed different therapeutic effect on wound.Gauze and cotton pad have great blocking influence on red light transmittance, and are not suitable for temporary covering of wound during red light treatment.Hence, the effect of wound dressing on red light transmittance should be taken into account when the wound is treated with red light.

Arc Adjacency Matrix-Based Fast Ellipse Detection.

Fast and accurate ellipse detection is critical in certain computer vision tasks. In this paper, we propose an arc adjacency matrix-based ellipse detection (AAMED) method to fulfill this requirement. At first, after segmenting the edges into elliptic arcs, the digraph-based arc adjacency matrix (AAM) is constructed to describe their triple sequential adjacency states. Curvature and region constraints are employed to make the AAM sparse. Secondly, through bidirectionally searching the AAM, we can get all arc combinations which are probably true ellipse candidates. The cumulative-factor (CF) based cumulative matrices (CM) are worked out simultaneously. CF is irrelative to the image context and can be pre-calculated. CM is related to the arcs or arc combinations and can be calculated by the addition or subtraction of CF. Then the ellipses are efficiently fitted from these candidates through twice eigendecomposition of CM using Jacobi method. Finally, a comprehensive validation score is proposed to eliminate false ellipses effectively. The score is mainly influenced by the constraints about adaptive shape, tangent similarity, distribution compensation. Experiments show that our method outperforms the 12 state-of-the-art methods on 9 datasets as a whole, with reference to recall, precision, F-measure, and time-consumption.

Study on health management service specification and support systems for chronic patients / 中华医院管理杂志

This article introduces the health management service specification for a chronic patient population. The concept of this specification comes from the whole process of people-centered and integrated health management of the chronic patient population. It is also based on the World Health Organization′s integrated chronic patient population management model. The completion of the specification has gone through several rounds of expert discussion in related fields in China. The contents include seven key links: suspect selection, clinical diagnosis, health assessment, intervention plan development, intervention plan implementation, follow-up, and health reassessment. It also includes establishing a professional team and developing a support system and mechanism of financing, compensation, and incentives. The specification aims at integrating regional health resources through standardizing service technology and scientific management concepts. It would help to improve the efficiency and quality of health management of chronic patient population in China, thereby reducing the economic burden of chronic diseases for patients and their families, and achieving the goal of improving residents′ health.

Prevention and control strategy of nosocomial infection in elderly COVID-19 patients / 中华医院管理杂志

Elderly patients with COVID-19 are at high risk of nosocomial infection due to the factors such as advanced age, frequent invasive operations, extensive use of antimicrobial agents, and lower compliance of medical staff to implement hospital infection control measures during epidemic prevention and control. During the COVID-19 epidemic, on the basis of actively treating patients, we should pay attention to the prevention and control of nosocomial infection in elderly patients, and strictly prevent and control the aggregation and outbreak of nosocomial infection.

Effectiveness and safety of carbapenem antimicrobial management / 中华医院管理杂志

Objective To investigate the effectiveness and safety of carbapenem antimicrobial management programs (ASP). Methods 671 patients who were discharged from the emergency department of the hospital from January 2017 to April 2018 were enrolled. These patients were subject to before-and-after self-control studies, using such intervention measures as MDT proactive management-feedback-training. January-September of 2017 was set as the pre-intervention stage, and September 2017-April 2018 as the post-intervention stage. The two stages were compared in such indicators as the monthly antibacterial use, quality of care and hospital acquired infection. Results Thanks to the ASP measure against antibiotics like carbapenems, the use rate of carbapenems at the emergency department ward fell from 36.7% to 18.6% , the defined drug doses (DDDs) of carbapenems fell from 211.92 to 82.22, and the antibiotics use density (AUD) of carbapenems fell from 29. 18 DDDs/100 day/patient to 11. 56. The pathogen detected rate increased significantly (0.61 ± 0.08 versus 0.78 ± 0.16), with a difference of statistical significance (P=0.020). On the other hand, the mean days of stay, average cost per hospitalization, proportion of antibiotics use, incidence of hospital acquired infections, and the infection/colonization rate of carbapenem-resistant organisms ( CROs ) present no significant changes. There was a moderate positive correlation between carbapenem DDDs and mean days of stay ( P=0.034), and also a moderate positive correlation between hospital acquired infection incidence and CROs infection/colonization rate ( r = 0.545, P = 0.029 ). Conclusions The carbapenem ASP at the hospital proves safe and effective. CROs infection/colonization may be the cause of hospital acquired infection. Prevention and control against multi-drug resistant bacteria on the basis of ASP may add to the effect of ASP.

The HEPS project.

The High Energy Photon Source (HEPS), a 6 GeV green-field diffraction-limited storage ring light source, will be built in Beijing, China. The HEPS design has been evolving for about ten years, and is now mostly finished and ready for construction. The storage ring is based on a modified hybrid seven-bend achromat (7BA) design, where bending magnets with reverse bending angles and longitudinal gradients are adopted to reach an ultralow natural emittance of 34.2 pm with a circumference of 1360.4 m. The central slice of the dipole in the middle of the modified hybrid 7BA, with flexible magnetic field, is used as the source of the bending-magnet beamline. Moreover, alternating high- and low-beta sections are specially designed to generate and deliver X-ray synchrotron radiation with high brightness of 5 × 1022 photons s-1 mm-2 mrad-2 (0.1% bandwidth)-1. Here, the HEPS storage ring design and solutions to the challenges inherent in this ultralow-emittance design are presented.

Identification and characterization of a chondroitin synthase from Avibacterium paragallinarum.

Avibacterium paragallinarum is a Gram-negative bacterium that causes infectious coryza in chicken. It was reported that the capsule polysaccharides extracted from Av. paragallinarum genotype A contained chondroitin. Chondroitin synthase of Av. paragallinarum (ApCS) encoded by one gene within the presumed capsule biosynthesis gene cluster exhibited considerable homology to identified bacterial chondroitin synthases. Herein, we report the identification and characterization of ApCS. This enzyme indeed displays chondroitin synthase activity involved in the biosynthesis of the capsule. ApCS is a bifunctional protein catalyzing the elongation of the chondroitin chain by alternatively transferring the glucuronic acid (GlcA) and N-acetyl-D-galactosamine (GalNAc) residues from their nucleotide forms to the non-reducing ends of the saccharide chains. GlcA with a para-nitrophenyl group (pNP) could serve as the acceptor for ApCS; this enzyme shows a stringent donor tolerance when the acceptor is as small as this monosaccharide. Then, UDP-GalNAc and GlcA-pNP were injected sequentially through the chip-immobilized chondroitin synthases, and the surface plasmon resonance data demonstrated that the up-regulated extent caused by the binding of the donor is one possibly essential factor in successful polymerization reaction. This conclusion will, therefore, enhance the understanding of the mode of action of glycosyltransferase. Surprisingly, high activity at near-zero temperature as well as weak temperature dependence of this novel bacterial chondroitin synthase indicate that ApCS was a cold-active enzyme. From all accounts, ApCS becomes the fourth known bacterial chondroitin synthase, and the potential applications in artificial chondroitin sulfate and glycosaminoglycan synthetic approaches make it an attractive glycosyltransferase for further investigation.

Region Based CNN for Foreign Object Debris Detection on Airfield Pavement.

In this paper, a novel algorithm based on convolutional neural network (CNN) is proposed to detect foreign object debris (FOD) based on optical imaging sensors. It contains two modules, the improved region proposal network (RPN) and spatial transformer network (STN) based CNN classifier. In the improved RPN, some extra select rules are designed and deployed to generate high quality candidates with fewer numbers. Moreover, the efficiency of CNN detector is significantly improved by introducing STN layer. Compared to faster R-CNN and single shot multiBox detector (SSD), the proposed algorithm achieves better result for FOD detection on airfield pavement in the experiment.

Effects of needleless connectors on central venous catheter-related thrombotic occlusions: a systematic review / 中国实用护理杂志

Objective To evaluate the influence of different types of needleless connector on central venous catheter-related thrombotic occlusions. Methods A detailed search was performed to identify literature about the impact of needleless connector on central venous catheter-related thrombotic occlusions , using the Cochrane Library and the databases of Pubmed,EMbase,CINAHL,CBM,CNKI and WanFang. The meta-analysis or descriptive review were performed after two authors independently searching databases,extracting data and assessing quality of included studies. Results Nine published studies were included for systematic review,which contained three randomized controlled trials,three non-randomized experimental studies and three retrospective observational studies. The results of meta-analysis for five studies showed that the split septum connector was associated with a significantly higher incidence of catheter-related thrombotic occlusions(complete occlusions and partial occlusions) than positive-displacement mechanical valve(RR=0.59,95％CI0.39-0.91,P=0.02). Standard connector and negative- displacement mechanical valve had a higher occlusions rates than positive- displacement mechanical valve ,but the difference did not reach statistical significance after merging the studies( P>0.05). Conclusion It is difficult to decide which needleless connector has the lowest rate of central venous catheter-related thrombotic occlusions because of the insufficient evidence. More large-scale and high-quality randomized controlled trials are required for further confirmation.

Relationship between spinal Sonic Hedgehog signaling pathway and inflammatory responses in rats with neuropathic pain / 中华麻醉学杂志

Objective To evaluate the relationship between spinal Sonic hedgehog (Shh) signaling pathway and inflammatory responses in rats with neuropathic pain (NP).Methods Forty-eight cleangrade healthy male Sprague-Dawley rats,aged 8 weeks,weighing 250-300 g,were divided into 4 groups (n=12 each) using a random number table method:sham operation group (group S),group NP,dimethyl sulfoxide (DMSO) group (group D) and specific Shh signaling pathway inhibitor cyclopamine group (group CP).Spared nerve injury was produced by exposing the sciatic nerve and branches followed by ligation and transection of tibial and common fibular nerves in anesthetized rats.The mechanical paw withdrawal threshold (MWT) was measured at 1 day before establishing the model and 1 and 7 days after establishing the model.,The animals were sacrificed after measurement of pain threshold at 7 days after operation,and the lumbar segment L4-6 of the spinal cord was obtained for determination of the expression of Shh,Patched homolog (Ptch),Smoothened (Smo) and zinc finger-containing transcription factors 1 (Gli1) (by Western blot) and contents of tumor necrosis factor-alpha (TNF-α) and interleukin-1beta (IL-1β) (by enzyme-linked immunosorbent assay).Results Compared with group S,the MWT was significantly decreased,the expression of Shh,Patched,Smo and Gli1 was up-regulated,and the contents of TNF-α and IL-1β were increased in NP,D and CP groups (P＜0.05).Compared with group NP,the MWT was significantly increased,the expression of Shh,Patched,Smo and Gli1 was down-regulated,and the contents of TNF-α and IL-1β were decreased in group CP (P＜0.05),and no significant change was found in the parameters mentioned above in group D (P＜0.05).Conclusion The mechanism by which Shh signaling pathway is involved in the development and mainterance of inflammatory responses is related to inhibiting inflammatory responses of the spinal cord in rats with NP.