Opportunities and Challenges for Chinese Elderly Care Industry in Smart Environment Based on Occupants' Needs and Preferences.

New developments in intelligent devices for assisting elderly people can provide elders with friendly, mutual, and personalized interactions. Since the intelligent devices should continually make an important contribution to the smart elderly care industry, smart services or policies for the elders are recently provided by a large number of government programs in China. At present, the smart elderly care industry in China has attracted numerous investors' attention, but the smart elderly care industry in China is still at the beginning stage. Though there are great opportunities in the market, many challenges and limitations still need to be solved. This study analyzes 198 news reports about opportunities and challenges in the smart elderly care industry from six major Chinese portals. The analysis is mainly based on needs assessment for elderly people, service providers, and the Chinese government. It is concluded that smart elderly care services satisfy the elders' mental wants and that needs for improving modernization services are the most frequently mentioned opportunities. Also, the frequently mentioned challenges behind opportunities are intelligent products not being able to solve the just-needed, user-consumption concept and the ability to pay, which is the most frequently mentioned challenge. The results of this study will enable stakeholders in the smart elderly care industry to clarify the opportunities and challenges faced by smart elderly care services in China's development process and provide a theoretical basis for better decision making.

[Study on development and biomechanics test of plastic rod-hook plate].

OBJECTIVE: To develop a new type of internal fixation device which can be used to treat the minor avulsion fracture of the medial malleolus, lateral malleolus, the base of the fifth metatarsal, and the ulnar styloid process, and investigate the reliability and effectiveness of the device through biomechanical test. METHODS: Eighty human's bone specimens with complete medial malleolus, lateral malleolus, the base of the fifth metatarsal, and the ulnar styloid process were selected and measured the anatomic indexes (the height, width, and thickness of medial malleolus, lateral malleolus, the base of the fifth metatarsal, and the ulnar styloid process). The CT three-dimensional reconstruction data of 200 healthy adults which including medial malleolus, lateral malleolus, the base of the fifth metatarsal, and the ulnar styloid process was also selected and measured the anatomic indexes by Mimics software. The plastic rod-hook plate was designed according to the measured results and prepared. Forty fresh porcine lower limb specimens were randomly divided into groups A and B (20 in each group), and 8 adult lower limb specimens including 4 left and 4 right were also randomly divided into groups A and B (4 in each group). All specimens were prepared for avulsion fracture of medial malleolus. Then, the fractures were fixed with plastic rod-hook plate in group A and wire anchor in group B. The load and axial torsion test of ankle joint were carried out by universal biomechanical testing machine. RESULTS: According to the anatomical characteristics, a plastic rod-hook plate was designed successfully. The biomechanical test results between animal and human specimens were consistent. There was a linear relationship between load and displacement in the ankle distal load test. The displacement when loaded to the maximum load was significantly lower in group A than in group B ( P<0.05). The torsion angle and torque were significantly higher in group A than in group B when the internal fixation failed in the axial torsion test of the ankle joint ( P<0.05), and the torsion angle was significantly smaller in group A than in group B when the torque was 1 N·m ( P<0.05), and the maximum torque was also significantly higher in group A than in group B ( P<0.05). However, there was no significant difference in torsion angle between the two groups in the maximum torque ( P>0.05). CONCLUSION: The biomechanical properties of plastic rod-hook plate is obviously better than wire anchor, and the fixation of avulsion fracture with plastic rod-hook plate is easy to operate, which is expected to be used in the clinical treatment of minor avulsion fractures such as medial malleolus, lateral malleolus, base of the fifth metatarsal, and ulna styloid process.

[Application of three-dimensional printing technology in treatment of internal or external ankle distal avulsed fracture].

Objective: To explore the effectiveness and advantage of three-dimensional (3D) printing technology in treatment of internal or external ankle distal avulsed fracture. Methods: Between January 2015 and January 2017, 20 patients with distal avulsed fracture of internal or external ankle were treated with the 3D guidance of shape-blocking steel plate fixation (group A), and 18 patients were treated with traditional plaster external fixation (group B). There was no significant difference in gender, age, injury cause, disease duration, fracture side, and fracture type between 2 groups ( P>0.05). Recording the fracture healing rate, fracture healing time, the time of starting to ankle functional exercise, residual ankle pain, and evaluating ankle function recovery of both groups by the American Orthopaedic Foot and Ankle Society (AOFAS) score. Results: All patients were followed up 8-24 months, with an average of 15.5 months. In group A: all incisions healed by first intention, the time of starting to ankle functional exercise was (14±3) days, fracture healing rate was 100%, and the fracture healing time was (10.15±2.00) weeks. At 6 months, the AOFAS score was 90.35±4.65. Among them, 13 patients were excellent and 7 patients were good. All patients had no post-operative incision infection, residual ankle pain, or dysfunction during the follow-up. In group B: the time of starting to ankle functional exercise was (40±10) days, the fracture healing rate was 94.44%, and the fracture healing time was (13.83±7.49) weeks. At 6 months, the AOFAS score was 79.28±34.28. Among them, 15 patients were good, 2 patients were medium, and 1 patient was poor. During the follow-up, 3 patients (16.67%) had pain of ankle joint with different degrees. There were significant differences in the postoperative fracture healing rate, fracture healing time, the time of starting to ankle functional exercise, and postoperative AOFAS score between 2 groups ( P<0.05). Conclusion: Application of 3D printing technology in treatment of internal or external ankle distal avulsed fracture is simple, safe, reliable, and effective. In particular, it is an ideal treatment for avulsed fracture.

Bioinformatics analysis of key genes and pathways for hepatocellular carcinoma transformed from cirrhosis.

OBJECTIVE: We aimed to identify some pivotal genes and pathways for hepatocellular carcinoma (HCC) transformation from cirrhosis and explore potential targets for treatment of the disease. METHODS: The GSE17548 microarray data were downloaded from Gene Expression Omnibus database, and 37 samples (20 cirrhosis and 17 HCC samples) were used for analysis. The differentially expressed genes (DEGs) in HCC tissues were compared with those in cirrhosis tissues and analyzed using the limma package. Gene ontology-biological process and Kyoto encyclopedia of genes and genomes (KEGG) pathway enrichment analyses were performed using ClueGO and CluePedia tool kits, and the key KEGG pathway was analyzed using the R package pathview. The regulatory factor miRNA of DEGs was extracted from 3 verified miRNAs-target databases using the multiMiR R package. Moreover, a protein-protein interaction (PPI) network was constructed using the Cytoscape software. RESULTS: DEGs including cyclin-dependent Kinase 1 (CDK1), PDZ-binding kinase (PBK), ribonucleotide reductase M2 (RRM2), and abnormal spindle homolog, and microcephaly-associated drosophila (ASPM) were the hub proteins with higher degrees in the PPI network. The cell cycle pathway (CDK1 enriched) and p53 signaling pathway (CDK1 and RRM2 enriched) were significantly enriched by DEGs. CONCLUSION: CDK1, PBK, RRM2, and ASPM may be key genes for HCC transformation from cirrhosis. Furthermore, cell cycle and p53 signaling pathways may play vital mediatory roles; CDK1 may play crucial roles in HCC transformed from cirrhosis via cell cycle and p53 signaling pathways, and RRM2 might be involved in HCC transformed from cirrhosis via the p53 signaling pathway.

Candidate miRNAs and pathogenesis investigation for hepatocellular carcinoma based on bioinformatics analysis.

The present study aimed to explore the mechanisms behind the development and progression of hepatocellular carcinoma (HCC) and identify information regarding HCC-related microRNAs (miRNAs) or marker genes for the gene therapy of HCC. Gene expression profile of GSE67882, generated from 4 hepatitis B virus infected HCC tissue samples (HCC group) and 8 chronic hepatitis B tissue samples with no fibrosis (control group) were downloaded from the Gene Expression Omnibus database. The differentially expressed miRNAs functional enrichment and pathway analyses of HCC were revealed, followed by transcription factor-miRNA interaction network construction and analyses. A total of 14 upregulated miRNAs and 16 downregulated miRNAs between HCC and control samples were obtained. Differentially expressed miRNAs were mainly involved in biological processes like the regulation of histone H3-K9 methylation, and the KEGG pathways in cancer map05200 demonstrates their involvement in cancer. A total of 3 outstanding regulatory networks of miRNAs: hsa-miR-15a, hsa-miR-125b and hsa-miR-122 were revealed. A total of 11 differentially expressed miRNAs including hsa-miR-146p-5b that regulated the marker genes of HCC were explored. miRNAs such as hsa-miR-15a, hsa-miR-125b, hsa-miR-122 and hsa-miR-146b-5p may be new biomarkers for the gene therapy of HCC. Furthermore, histone H3-K9 methylation and other pathways in cancer observed in the KEGG map05200 may be closely related with the development of HCC.

Bioinformatics analysis of gene expression alterations in microRNA­122 knockout mice with hepatocellular carcinoma.

Reduced microRNA (miR)­122 expression levels are frequently observed in hepatocellular carcinoma (HCC). The present study was conducted to investigate potential targets of miR­122 and determine the underlying regulatory mechanisms of miR­122 in HCC development. The public dataset GSE31731 was utilized, consisting of 8 miR­122 knockout (KO) mice (miR­122 KO) and 8 age­matched wild­type mice (WT group). Following data preprocessing, the differentially expressed genes (DEGs) were selected, followed by enrichment analysis. A protein­protein interaction (PPI) network was established, and a module network was further extracted. Combining the DEGs with microRNA targeting databases permitted the screening of the overlapping targets of miR­122. Furthermore, previously reported genes were screened out by literature mining. Transcription factors (TFs) of the targets were subsequently investigated. DEGs between miR­122 KO and WT groups were selected, including 713 upregulated and 395 downregulated genes. Of these, upregulated genes were enriched in cell cycle­associated processes [including nucleolar and spindle associated protein 1 (NUSAP1)], the cytokine­cytokine receptor interaction pathway [including C­X­C motif chemokine receptor 4 (CXCR4) and C­C motif chemokine receptor 2 (CCR2)], and the extracellular matrix­receptor interaction pathway [including integrin subunit alpha V (ITGAV)]. In addition, multiple overlapping targets were highlighted in the PPI network, including NUSAP1, CXCR4, CCR2 and ITGAV. Notably, CXCR4 and CCR2 were linked in module C, enriched in the cytokine­cytokine receptor interaction pathway. Furthermore, upregulated sex determining region Y­box 4 (SOX4) was identified as a TF. The results of the present study may provide a theoretical basis for further studies on the mechanisms of miR­122 in the development of HCC.

Contrast-enhanced ultrasonography used for post-treatment responses evaluation of radiofrequency ablations for hepatocellular carcinoma: a meta-analysis.

OBJECTIVE: This meta-analysis aims to analyze the usefulness of contrast-enhanced ultrasonography (CEUS) for post-treatment responses evaluation of radiofrequency ablation (RFA) for hepatocellular carcinoma (HCC) management. METHODS: Literature retrieval in three databases PubMed, Embase and Cochrane Library was conducted up to September 2015, with pre-defined criteria. The technical success rate, local tumour recurrence and local tumour progression were the measurement indexes. Cochran's Q test and I(2) were used for heterogeneity detection. Subgroup analyses were performed for complete ablation rate stratified by study designs, contrast agents and post-operative testing time points. Statistical analyses were conducted using Stata(®) 12.0 software (Stata Corporation, College Station, TX). RESULTS: 12 studies consisting of 772 patients were included in this study. The CEUS-evaluated success rate of RFA for HCCs was 91%. The proportion of ablative margin <5 mm was 53%. The local tumour recurrence rate and local tumour progression rate were 4% and 8%, respectively. Subgroup analysis indicated that the CEUS-assessed technical success rate with Sonazoid™ (Daiichi-Sankyo, Tokyo, Japan) as the contrast agent was higher (95%) than those with other agents [SH U 508A (Schering AG, Berlin, Germany) 86%; SonoVue (Bracco SpA, Milan, Italy) 87%]. The success rate assessed within 24 h (94%) after treatment was higher than longer time (1-3 days 86%; 1 month 91%). CONCLUSION: The meta-analysis showed that the CEUS-evaluated success rate of RFA for HCCs was 91%. The local tumour recurrence rate and local tumour progression rate were 4% and 8%, respectively. ADVANCES IN KNOWLEDGE: Using meta-analysis, the study provided more reliable assessment of usefulness of CEUS, which could provide guidelines for HCC treatment.

[COMPARATIVE STUDY ON FIXATION WITH PERCUTANEOUS CANNULATED SCREWS ASSISTED BY ROBOT NAVIGATION AND CONVENTIONAL SURGERY WITH MANUAL POSITIONING FOR FEMORAL NECK FRACTURES].

OBJECTIVE: To investigate the effectiveness and the advantage of fixation with percutaneous cannulated screws assisted by robot navigation in the treatment of femoral neck fractures by comparing with the conventional surgery. METHODS: Between January 2013 and December 2014, 20 patients with femoral neck fracture were treated by internal fixation with percutaneous cannulated screws assisted by robot navigation (navigation group), another 18 patients undergoing conventional surgery with manual positioning were chosen as the control group. There was no significant difference in gender, age, cause of injury, the injury side, time from injury to operation, and the classification of fractures between 2 groups (P > 0.05). The operation time, X-ray fluoroscopy time, blood loss, frequency of guide pin insertion, and healing time were recorded. At 1 week after operation, the parallel degree of screws was measured on the anteroposterior and lateral X-ray films; the Harris score was used to evaluate the hip function. RESULTS: All incisions of 2?groups healed by first intention after operation. There was no significant difference in operation time between 2?groups (t= -1.139, P=0.262). The blood loss, frequency of guide pin insertion, and X-ray fluoroscopy time of navigation group were significantly less than those of control group (P < 0.05). There were 2 screws penetrating into the joint cavity in control group. The patients were followed up 12-24 months with an average of 18 months. The navigation group got significantly better parallel degree of screws than control group on the anteroposterior and lateral X-ray films (t=25.021, P=0.000; t=18.659, P=0.000). Fractures healed in all patients of navigation group (100%), and the healing time was (21.8±2.8) weeks; fracture healed in 16 patients of control group (88.9%), and the healing time was (24.0 ± 3.7) weeks. There was no significant difference in healing rate and healing time between 2 groups (χ2=2.346, P=0.126; t=1.990, P=0.055). The Harris score of navigation group (87.1±3.7) was significantly higher than that of control group (79.3±4.7) at last follow-up (t= -5.689, P=0.000). CONCLUSIONS: Cannulated screw fixation assisted by robot navigation is a good method to treat femoral neck fractures, which has the advantages of more accurate positioning, better hip function recovery, less surgical trauma, and shorter X-ray exposure time.