Blood purification for treatment of non-liquefied multiple liver abscesses and improvement of T-cell function: A case report.

BACKGROUND: Non-liquefied multiple liver abscesses (NMLA) can induce sepsis, septic shock, sepsis-associated kidney injury (SA-AKI), and multiple organ failure. The inability to perform ultrasound-guided puncture and drainage to eradicate the primary disease may allow for the persistence of bacterial endotoxins and endogenous cytokines, exacerbating organ damage, and potentially causing immunosuppression and T-cell exhaustion. Therefore, the search for additional effective treatments that complement antibiotic therapy is of great importance. CASE SUMMARY: A 45-year-old critically ill female patient presented to our hospital's intensive care unit with intermittent vomiting, diarrhea, and decreased urine output. The patient exhibited a temperature of 37.8 °C. Based on the results of liver ultrasonography, laboratory tests, fever, and oliguria, the patient was diagnosed with NMLA, sepsis, SA-AKI, and immunosuppression. We administered antibiotic therapy, entire care, continuous renal replacement therapy (CRRT) with an M100 hemofilter, and hemoperfusion (HP) with an HA380 hemofilter. The aforementioned treatment resulted in a substantial reduction in disease severity scores and a decrease in the extent of infection and inflammatory factors. In addition, the treatment stimulated the expansion of the cluster of differentiation 8+ (CD8+) T-cells and led to the complete recovery of renal function. The patient was discharged from the hospital. During the follow-up period of 28 d, she recovered successfully. CONCLUSION: Based on the entire therapeutic regimen, the early combination of CRRT and HP therapy may control sepsis caused by NMLA and help control infections, reduce inflammatory responses, and improve CD8+ T-cell immune function.

Probabilistic Model-Based Learning Control of a Soft Pneumatic Glove for Hand Rehabilitation.

OBJECTIVE: Stroke survivors are usually unable to perform activities of daily living (ADL) independently due to loss of hand functions. Soft pneumatic gloves provide a promising assistance approach for stroke survivors to conduct ADL tasks. However, few studies have explored effective control strategies for the 'human-soft robot' integrated system due to challenges in the nonlinearities of soft robots and uncertainties of human intentions. Therefore, this work aims to develop control approaches for the system to improve stroke survivors' hand functions. METHODS: Firstly, a soft pneumatic glove was utilized to aid with stroke-impaired hands. Secondly, a probabilistic model-based learning control approach was proposed to overcome the challenges. Then a task-oriented intention-driven training modality was designed. Finally, the control performance was evaluated on three able-bodied subjects and three stroke survivors who attended 20-session rehabilitation training. RESULTS: The proposed approach could enable the soft pneumatic glove to provide adaptive assistance for all participants to accomplish different tasks. The tracking error and muscle co-contraction index showed decreasing trends while the hand gesture index showed an increasing tendency over training sessions. All stroke survivors showed improved hand functions and better muscle coordinations after training. CONCLUSION: This work developed a learning-based soft robotic glove training system and demonstrated its potential in post-stroke hand rehabilitation. SIGNIFICANCE: This work promotes the application of soft robotic training systems in stroke rehabilitation.

Effects of a Soft Robotic Hand for Hand Rehabilitation in Chronic Stroke Survivors.

OBJECTIVES: Soft robotic hands are proposed for stroke rehabilitation in terms of their high compliance and low inherent stiffness. We investigated the clinical efficacy of a soft robotic hand that could actively flex and extend the fingers in chronic stroke subjects with different levels of spasticity. METHODS: Sixteen chronic stroke subjects were recruited into this single-group study. Subjects underwent 20 sessions of 1-hour EMG-driven soft robotic hand training. Training effect was evaluated by the pre-training and post-training assessments with the clinical scores: Action Research Arm Test(ARAT), Fugl-Meyer Assessment for Upper Extremity(FMA-UE), Box-and-Block test(BBT), Modified Ashworth Scale(MAS), and maximum voluntary grip strength. RESULTS: For all the recruited subjects (n = 16), significant improvement of upper limb function was generally observed in ARAT (increased mean=2.44, P = 0.032), FMA-UE (increased mean=3.31, P = 0.003), BBT (increased mean=1.81, P = 0.024), and maximum voluntary grip strength (increased mean=2.14 kg, P < 0.001). No significant change was observed in terms of spasticity with the MAS (decreased mean=0.11, P = 0.423). Further analysis showed subjects with mild or no finger flexor spasticity (MAS<2, n = 9) at pre-training had significant improvement of upper limb function after 20 sessions of training. However, for subjects with moderate and severe finger flexor spasticity (MAS=2,3, n = 7) at pre-training, no significant change in clinical scores was shown and only maximum voluntary grip strength had significant increase. CONCLUSION: EMG-driven rehabilitation training using the soft robotic hand with flexion and extension could be effective for the functional recovery of upper limb in chronic stroke subjects with mild or no spasticity.

Soft Rehabilitation Actuator With Integrated Post-stroke Finger Spasticity Evaluation.

Strokes cause severe impairment of hand function because of the spasticity in the affected upper extremities. Proper spasticity evaluation is critical to facilitate neural plasticity for rehabilitation after stroke. However, existing methods for measuring spasticity, e.g. Modified Ashworth Scale (MAS), highly depends on clinicians' experiences, which are subjective and lacks quantitative details. Here, we introduce the first rehabilitation actuator that objectively reflects the condition of post-stroke finger spasticity. The actuator is 3D printed with soft materials. By considering the finger and the actuator together, the spasticity, i.e. stiffness, in finger is obtained from the pressure-angle relationship. The method is validated by simulations using finite element analysis (FEA) and experiments on mannequin fingers. Furthermore, it is examined on four stroke subjects and four healthy subjects. Results show the finger stiffness increases significantly from healthy subjects to stroke subjects, particularly those with high MAS score. For patients with the same MAS score, stiffness variation can be a few times. With this soft actuator, a hand rehabilitation robot that may tell the therapeutic progress during the rehabilitation training is readily available.

Verification of Finger Joint Stiffness Estimation Method With Soft Robotic Actuator.

Stroke has been the leading cause of disability due to the induced spasticity in the upper extremity. The constant flexion of spastic fingers following stroke has not been well described. Accurate measurements for joint stiffness help clinicians have a better access to the level of impairment after stroke. Previously, we conducted a method for quantifying the passive finger joint stiffness based on the pressure-angle relationship between the spastic fingers and the soft-elastic composite actuator (SECA). However, it lacks a ground-truth to demonstrate the compatibility between the SECA-facilitated stiffness estimation and standard joint stiffness quantification procedure. In this study, we compare the passive metacarpophalangeal (MCP) joint stiffness measured using the SECA with the results from our designed standalone mechatronics device, which measures the passive metacarpophalangeal joint torque and angle during passive finger rotation. Results obtained from the fitting model that concludes the stiffness characteristic are further compared with the results obtained from SECA-Finger model, as well as the clinical score of Modified Ashworth Scale (MAS) for grading spasticity. These findings suggest the possibility of passive MCP joint stiffness quantification using the soft robotic actuator during the performance of different tasks in hand rehabilitation.

Design of a 3D Printed Soft Robotic Hand for Stroke Rehabilitation and Daily Activities Assistance.

In this paper, we present the new personalized 3D printed soft robotic hand for providing rehabilitation training and daily activities assistance to stroke survivors. The Soft-Elastic Composite Actuator (SECA) on the robotic hand is direct 3D printed to accommodate with different finger sizes. Flexion and extension can be actively facilitated on the SECA using the same pressurizing source. Iterative learning model predictive control (ILMPC) method is used to be the control algorithm of SECA. At 160 kPa of maximum input pressure, results show that the actuator bending angles can reach to 137 °, and tip output force can also reach to 2.45 N. Multiple 3D printed SECAs are integrated to a 3D printed hand base and then to be worn on stroke survivors. Two stroke survivors are recruited to evaluate the intention-based rehabilitation training with the 3D printed soft robotic hand, which improvement of their hand function can be observed on performing some daily tasks such as grasping a coin.

[Relationship between levels of antibody to schistosome of armed police officers and soldiers and their camp environment].

OBJECTIVE: To understand the schistosome infection status of armed police officers and soldiers in endemic areas of the middle and lower reaches of the Yangtze River and the impact caused by the camp environment. METHODS: The inside and outside environments of camps were investigated and they were classified as Grade A, B and C according to scores. The levels of antibody to schistosome of the armed police officers and soldiers were tested with ELISA. RESULTS: A total of 23 780 officers and soldiers in 201 camps were investigated. The positive rates of antibody to schistosome of officers and soldiers stationed in the inner embankment areas, river beach areas and island areas were 1.88%, 3.89% and 4.73%, respectively. In the aforementioned three types areas, the positive rates of antibody to schistosome of soldiers and officers in the camp environment scored as Grade A were 1.23%, 3.28% and 3.33%, respectively, while the positive rates in the environment scored as Grade B were 2.03%, 3.81% and 4.24%, respectively, and the positive rates in the environment scored as Grade C were 3.17%, 5.79% and 5.83%, respectively. CONCLUSIONS: There are certain correlation between the prevalence of schistosomiasis in armed police forces and the internal and external environments of their camps. The comprehensive environment management is one of the key measures of schistosomiasis control for armed police forces.

[Endemic situation and control strategies on schistosomiasis in Armed Police Forces in marshland and lake regions].

OBJECTIVE: To investigate the prevalence of schistosomiasis in Armed Police Forces in marshland and lake regions so as to provide the evidence for policy-making of the disease control. METHODS: The different types of duty were selected by the stratified cluster random sampling method in endemic areas of marshland and lake regions, and the snail survey was conducted, and the infectious status and epidemic factors of officers and soldiers who served more than 2 years were investigated. RESULTS: The geographical features included the embankment type, island type and islet type, and the serological positive rates were 1.88%, 4.73% and 3.89% in the 3 types of endemic areas respectively and he total positive rate was 3.10%, that was lower than the national population level in 2009. The infection risk factors included fighting flood, and the contact with infested water in daily life and production. CONCLUSIONS: We should strengthen the surveillance and control of schistosomiasis in this particular group of officers and soldiers, especially in their implementation of fighting flood and other tasks.

Smad4 expression in hepatocellular carcinoma differs by hepatitis status.

AIMS: Primary hepatocellular carcinoma (HCC) is a common malignancy often related to hepatitis viral infection. Smad4 is known to mediate the TGF-ß pathway to suppress tumorigenesis. However, the function of Smad4 in HCC is still controversial. In this study we compared levels of Smad4 in HCC tissues with or without hepatitis virus infection and adjacent normal-appearing liver. METHODS: Samples from HCC patients were analyzed for Smad4 protein and mRNA expression by immunohistochemistry (IHC), RT-PCR and Western blotting. RESULTS: We found that tumor tissues expressed less Smad4 mRNA and protein than the adjacent tissues. Most HCC tumor tissues were negative for Smad4 in IHC staining, while the majority of adjacent tissues were positively stained. Interestingly, protein levels were higher in HCC tissues with viral hepatitis than those without virus infection. Suppression of expression appeared closely related to HCC, so that Smad4 appears to function as a tumor suppressor gene (TSG). CONCLUSION: Patients with hepatitis viral infection, at higher risk for HCC, exhibited increased Smad4 protein expression suggesting hepatitis virus may modulate Smad4 expression, which is functionally distinct from its putative role as a TSG. Smad4 expression may thus be an applicable marker for diagnosis and/or a target to develop therapeutic agents for HCC.

Metabolism and effect of para-toluene-sulfonamide on rat liver microsomal cytochrome P450 from in vivo and in vitro studies.

AIM: To study the in vivo and in vitro metabolism and the effect of para-toluene-sulfonamide (PTS) on cytochrome P450 enzymes (CYP450). METHODS: Total CYP450 and microsome protein content were determined after iv pretreatment of rats with PTS. CYP-specific substrates were incubated with rat liver microsomes. Specific CYP isoform activities were determined by using HPLC. CYP chemical inhibitors added to the incubation mixture were used to investigate the principal CYP isoforms involved in PTS metabolism. The effect of PTS on CYP isoforms was investigated by incubating PTS with specific substrates. RESULTS: The groups treated with 33 and 99 mg/kg per d PTS, respectively, had a total CYP content of 0.66+/-0.17 and 0.60+/-0.12 nmol/mg. The K(m) and V(max) were 92.2 micromol/L and 0.0137 nmol/min per mg protein. CYP2C7, CYP2D1 and CYP3A2 might contribute to PTS metabolism in the rat liver. The inhibitory effects of sulfaphenazole and ketoconazole on PTS metabolism were shown to have a mixed mechanism, whereas PTS metabolism was inhibited noncompetitively by quinidine. PTS had little effect on the activities of the selected CYP isoforms. CONCLUSION: Generally speaking, it is relatively safe for PTS to be co-administered with other drugs. However, care should be taken when administering PTS with CYP inhibitors and the substrates of CYP2C, CYP2D and CYP3A.

[Practical control methods for the dose individualization of anticancer drugs].

Most anticancer drugs are characterized by a narrow therapeutic index, wide inter-patient variability of pharmacokinetic parameters and high toxicity. The need for dose individualization of anticancer drugs is now well accepted. The strategies that can be employed for optimizing dosage regimen were reviewed. The aim of this paper was to provide an insight into the feasibility of these techniques in anticancer chemotherapy and their application at all stages of clinical trials and practice.