Design of Digital-Twin Human-Machine Interface Sensor with Intelligent Finger Gesture Recognition.

In this study, the design of a Digital-twin human-machine interface sensor (DT-HMIS) is proposed. This is a digital-twin sensor (DT-Sensor) that can meet the demands of human-machine automation collaboration in Industry 5.0. The DT-HMIS allows users/patients to add, modify, delete, query, and restore their previously memorized DT finger gesture mapping model and programmable logic controller (PLC) logic program, enabling the operation or access of the programmable controller input-output (I/O) interface and achieving the extended limb collaboration capability of users/patients. The system has two main functions: the first is gesture-encoded virtual manipulation, which indirectly accesses the PLC through the DT mapping model to complete control of electronic peripherals for extension-limbs ability by executing logic control program instructions. The second is gesture-based virtual manipulation to help non-verbal individuals create special verbal sentences through gesture commands to improve their expression ability. The design method uses primitive image processing and eight-way dual-bit signal processing algorithms to capture the movement of human finger gestures and convert them into digital signals. The system service maps control instructions by observing the digital signals of the DT-HMIS and drives motion control through mechatronics integration or speech synthesis feedback to express the operation requirements of inconvenient work or complex handheld physical tools. Based on the human-machine interface sensor of DT computer vision, it can reflect the user's command status without the need for additional wearable devices and promote interaction with the virtual world. When used for patients, the system ensures that the user's virtual control is mapped to physical device control, providing the convenience of independent operation while reducing caregiver fatigue. This study shows that the recognition accuracy can reach 99%, demonstrating practicality and application prospects. In future applications, users/patients can interact virtually with other peripheral devices through the DT-HMIS to meet their own interaction needs and promote industry progress.

Post-Operative Sleep Endoscopy with Target-Controlled Infusion After Palatopharyngoplasty for Obstructive Sleep Apnea: Anatomical and Polysomnographic Outcomes.

INTRODUCTION: The findings of drug-induced sleep endoscopy (DISE) are not always correlated with the outcome of upper airway surgery for obstructive sleep apnea (OSA), and whether multilevel surgery is truly required in treating multilevel obstruction identified in preoperative DISE remains an issue. We attempted to compare DISE findings before and after palatopharyngoplasty in patients with OSA because changes in DISE may be beneficial to better understand polysomnographic and anatomical outcomes. METHODS: This was a prospective cohort study for 34 patients with moderate to severe OSA who underwent palatopharyngoplasty at a tertiary care center from 2016 to 2018. We recorded the patients' demographic characteristics, procedures, and surgical outcomes and compared the preoperative and postoperative DISE staging patterns. RESULTS: The apnea-hypopnea index (AHI) values of 34 adults improved significantly after surgery (40.6 ± 23.3 versus 25.6 ± 20.6, P < 0.001). The majority of patients, 26/34, had preoperative complete concentric collapse at the velum, and for most (20/26, 77%) there was a change of the collapse pattern into anteroposterior collapse postoperatively. Patients with postoperative velar collapse had higher follow-up AHI values than those who without (27.8 ± 21.9 versus 15.2 ± 7.7, P = 0.023). Patients with preoperative complete tongue base collapse had higher follow-up AHI values than did those with no or partial collapse (40.6 ± 21.0 versus 21.0 ± 18.6, P = 0.017). Patients with postoperative complete tongue base collapse also had higher follow-up AHI values than the others (42.7 ± 22.1 versus 18.5 ± 15.4, P = 0.001). CONCLUSION: Palatopharyngoplasty could change the collapse pattern at the velum in most patients. Preoperative and postoperative complete tongue base collapse and postoperative velar collapse identified in TCI-DISE were associated with relatively poor outcomes.

Using polyethylene glycol as nonionic osmoticum to promote growth and lipid production of marine microalgae Nannochloropsis oculata.

To promote the economic feasibility of Nannochloropsis oculata, efficacy of using polyethylene glycol (PEG) to increase microalgal growth and lipid accumulation was investigated. We first examined the effects of PEG concentrations on microalgal growth using 0-5 % (w/v) PEG-6000, and followed by exploring the effects of PEG molecular weights (400, 600, 2,000, 4,000, 6,000, and 20,000) on microalgal growth, size, as well as on yields of biomass, total lipids, and eicosapentaenoic acid. In addition, the capacity of PEG to reduce the effect of oxygen inhibition on microalgal growth was also investigated to evaluate its adaptability for use in large-scale and closed setting. Our results showed that PEG-induced osmotic stress (Π) in the range of 2.465-2.472 MPa can raise microalgal growth. The PEG with higher molecular weight exhibited greater efficacy of growth promotion but less lipid content under equal concentration. In this study, 0.5 % (w/v) PEG-20000 (Π = 2.466 MPa) remarkably enhanced microalgal growth without interference of intracellular lipid productivity and cellular size, yielding >50 % (w/w) increases in biomass, total lipid, and eicosapentaenoic acid amounts after 7 days that provided the optimal condition for microalgal cultivation. These positive effects possibly resulted from the moderate enhancement of osmotic stress in the medium and stronger chaotrope-like behavior from higher molecular weight PEG. With further verification that 0.5 % (w/v) PEG-20000 enabled to reduce the effect of oxygen inhibition on microalgal growth, the PEG-20000-mediated cultivation offers a feasible means for mass culture of N. oculata in closed setting.

Timing of epidural analgesia intervention for labor pain in nulliparous women in Taiwan: a retrospective study.

BACKGROUND: Labor pain is probably the most painful event in a woman's life. By the present consensus, epidural analgesia is the most effective and least depressive treatment for labor pain. Recent systematic reviews concluded that the risk of cesarean delivery or instrumental vaginal delivery for women receiving early epidural analgesia has not increased. However, studies designed for discussing this topic in Taiwan are few. In this study, the association of the intervention timing with labor outcomes in nulliparous women in Taiwan is discussed. METHODS: We performed a retrospective chart review in parturients who underwent epidural analgesia for labor pain. Only nulliparae were included and divided into four groups based on the cervical dilatation width of 1, 2, 3, and 4 cm when they underwent epidural analgesia. We retrieved each patient's demographic characteristics, the course of labor and delivery, and the management of epidural analgesia from the medical chart. RESULTS: A total of 799 nulliparae was included. The numbers of parturients with cervical dilatation width of 1, 2, 3, and 4 cm were 119, 338, 258, and 84 respectively. There was no significant difference in demographic factors, regimen of epidural analgesia, loading volume, and anesthesiologist in charge among the four groups. The percentages of cesarean delivery in the four groups were 27.73%, 20.71%, 15.89%, and 20.24%, respectively, and there was no significant difference among these four groups (p = 0.0651). The incidences of instrumental delivery in four groups were 13.51%, 14.59%, 18.65%, and 21.43% respectively, and there was no significant difference among these four groups either (p = 0.2278). CONCLUSION: Our results revealed that the timing of epidural intervention affects neither the cesarean delivery rate nor the instrumental delivery rate on nulliparae in Taiwan with the cervical dilatation width ranging from 1 cm to 4 cm. The fear of increasing cesarean section rate after early epidural analgesia is unfounded. Women in labor can choose pain relief at any time.

Using fluorochemical as oxygen carrier to enhance the growth of marine microalga Nannochloropsis oculata.

The commercial value of marine Nannochloropsis oculata has been recognized due to its high content of eicosapentaenoic acid (>50% w/w). To make it as a profitable bioresource, one of the most desirable goals is to develop a quality-controlled, cost-effective, and large-scale photobioreactor for N. oculata growth. Generally, closed culture system can offer many advantages over open system such as small space requirement, controllable process and low risk of contamination. However, oxygen accumulation is often a detrimental factor for enclosed microalgal culture that has seriously hampered the development of microalga-related industries. In this study, we proposed to use fluorochemical as oxygen carrier to overcome the challenge where four liquid fluorochemicals namely perfluorooctyl bromide, perfluorodecalin, methoxynonafluorobutane, and ethoxynonafluorobutane were investigated separately. Our results showed that the microalgal proliferation with different fluorinated liquids was similar and comparable to the culture without a fluorochemical. When cultured in the photobioreactor with 60% oxygen atmosphere, the N. oculata can grow up in all the fluorochemical photobioreactors, but completely inhibited in the chamber without a fluorochemical. Moreover, the perfluorooctyl bromide system exhibited the most robust efficacy of oxygen removal in the culture media (perfluorooctyl bromide > perfluorodecalin > methoxynonafluorobutane > ethoxynonafluorobutane), and yielded a >3-fold increase of biomass production after 5 days. In summary, the developed fluorochemical photobioreactors offer a feasible means for N. oculata growth in closed and large-scale setting without effect of oxygen inhibition.

Fast preparation of fungal DNA for PCR screening.

Rapid DNA preparation for the quick screening is highly demanded in diverse research fields. Here, we combined an extraction buffer and heat treatment to generate DNA templates from yeast and filamentous fungal materials for PCR. This method may be widely applicable to diverse fungal species in clinical and basic studies.

A screening for suppressor mutants reveals components involved in the blue light-inhibited sexual filamentation in Cryptococcus neoformans.

Blue light regulates diverse physiological and developmental processes in fungi. Our prior studies demonstrated that the evolutionally conserved Cwc1 and Cwc2 proteins mediate the blue light-inhibited sexual filamentation in Cryptococcus neoformans. To characterize the putative domains of the Cwc1 and Cwc2 proteins, we generated partially deleted versions of these genes under the GPD1 promoter and examined their effects. The results confirmed that LOV and PAS domains are essential for the function of the Cwc1 protein, and the PAS domain and zinc finger DNA-binding motif are also crucial for the Cwc2 protein. To further understand how light inhibits filamentous growth, a genome wide mutant screening was conducted to identify genes important for this process. Mutants which suppressed the light-dependent CWC1 overexpression phenotype and restored mating filamentation were identified. In the one with fully restored filamentation, the T-DNA was found to disrupt the expression of the CWC2 gene. Additionally, a mediator component, the SSN8 gene, known to involve in transcriptional regulation was also identified. Our results demonstrate that Cwc1 and Cwc2 are two central regulators of the C. neoformans photoresponses and the roles of other components identified in the screen are under investigation.

Detection of right to left shunt by transesophageal echocardiography in a patient with postoperative hypoxemia.

Intracardiac right to left shunt through a patent foramen ovale (PFO) may result in the development of hypoxemia after cardiac surgery. Cardiac tamponade and mechanical ventilation with high positive endexpiratory pressure are the most common factors responsible for enhancing intracardiac right to left shunt through a PFO. We report an 83-year-old woman with Stanford type A dissecting aneurysm who developed hypoxemia and paradoxical air embolism after reconstruction of ascending aorta and Bental's procedure. Transesophageal echocardiography (TEE) revealed right to left shunting via a PFO. Surgical closure of the PFO was done without delay. This case illustrates the role of TEE in prompt diagnosis of intracardiac right to left shunting through a PFO causing postoperative hypoxemia after cardiac surgery.

Intraoperative latrogenic superior vena cava syndrome complicated by ensuing insidious critical airway--a case report.

Superior vena cava (SVC) syndrome mostly presents the typical and unmistakable symptoms and signs, such as edema and venous distension of the face, neck, arms, and upper chest wall. Dyspnea and symptoms of airway obstruction are often the complaints of conscious patients. However, SVC syndrome if develops intraoperatively may become indistinguishable in view of the lack of utterable complaints of the patient and variable degrees of clinical presentation. We present a male patient who sustained an iatrogenic subclinical SVC syndrome in the course pneumonectomy. Airway obstruction was initially noted during the replacement of the double lumen endobronchial tube (DLT) by an ordinary endotracheal tube at the end of operation, which threw the patient into an acute precarious condition. Although he was conservatively treated with thrombolytic agent and anticoagulant, the patient eventually expired due to pulmonary embolism. The possible reasons for delayed diagnosis, intraoperative management, and prognosis of this case are discussed.