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Being composed of blood cells and plasma, the blood flow has different rheological properties from common fluids. The viscoelastic properties of blood not only affect the flow characteristics of blood but also influence the shape of bleeding. In order to achieve the bleeding simulation with physical viscoelastic, we consider the effect of the aggregation behavior of red blood cells on the bleeding process. The elastic force caused by viscoelastic fluid elasticity is incorporated into the standard Navier–Stokes momentum equation, and an improved momentum equation that characterizes the rheological characteristics of viscoelastic blood is constructed. The effect of introducing elastic force on the particles motion is analyzed from the microscopic particle perspective by designing a two-dimensional particle system. The results of bleeding simulation show that the improved method eliminates the discontinuous boundary due to blood gushing out of the wound and forms irregular bleeding shapes in the bleeding process. In addition, the viscoelastic bleeding simulation exhibits a similar bleeding effect without distortion when the number of particles decreases, which further proves the reliability of proposed method. [ABSTRACT FROM AUTHOR]

In this research, the issue of decentralised adaptive neural finite-time prescribed performance control is discussed for nonstrict-feedback large-scale nonlinear interconnected systems subject to dead zones input and unknown control direction. The obstacle of 'explosion of complex' occurred in conventional backstepping design can be surmounted by adopting the command filter technique and nonlinearities are approximated by introducing an adaptive neural control approach. To handle the obstacles due to unknown directions and unknown interconnections, Nussbaum-type functions and two smooth functions are used and designed. Meanwhile, error compensation signals are introduced to deal with the problem associated with the dynamic surface method. To constraint the output tracking error within a predefined boundary in finite time, an improved performance function, i.e. finite-time performance function is introduced. Different from existing control results, the developed control methodology does not require any information on the boundedness of dead-zone parameters. It is further proved that the constructed controller not only assures the semi-global boundedness of all the controlled system signals, but also makes the output tracking errors reach within a predefined small set. Finally, both numerical and practical examples are supplied to further validate the effectiveness of the presented theoretic result. [ABSTRACT FROM AUTHOR]

There is a lack of studies that concurrently differentiate the effect of the holiday season from the weekend effect on mortality risk in patients with acute myocardial infarction (AMI). We evaluated the mortality risk among patients admitted with AMI who underwent percutaneous coronary intervention, using data from the Taiwan National Health Insurance Research Database. Adult AMI patients admitted during January and February between 2013 and 2020 were enrolled and classified into the holiday season (using the Chinese New Year holiday seasons as an indicator) (n = 1729), weekend (n = 4725), and weekday (n = 14,583) groups according to the first day of admission. A multivariable logistic regression model was used to assess the risk. With the weekday group or the weekend group as the reference, the holiday season group did not have increased risks of in-hospital mortality (adjusted odds ratio [aOR] 1.15; 95% confidence intervals [CI] 0.93–1.42 or aOR 1.23; 95% CI 0.96–1.56) and 7-day mortality (aOR 1.20; 95% CI 0.90–1.58 or aOR 1.24; 95% CI 0.90–1.70). Stratified and subgroup analyses showed similar trends. We conclude that holiday season-initiated admissions were not associated with higher mortality risks in AMI admission cases than weekday or weekend admissions. [ABSTRACT FROM AUTHOR]

The variable-order fractional (VOF) chaotic systems offer a promising solution for applications in secure communication due to their unique properties. This paper addresses the synchronisation problem in secure communication for these systems, which have uncertainties and external disturbances with unknown bounds. According to the variable-order fractional type Mittag-Leffler stability theorem, a fractional-order derivative is applied to a sliding surface, and suitable adaptive laws are devised to address uncertainties and disturbances. A variable-order fractional control strategy and a new criterion are developed to ensure the synchronisation error systems achieve asymptotic stability in finite time, for which the upper limit can be obtained. Simulation outcomes demonstrate the efficacy of the proposed synchronisation strategy in secure communication scenarios. [ABSTRACT FROM AUTHOR]

This paper addresses the output tracking problem of adaptive fixed-time fault-tolerant control for a class of nonlinear systems. In particular, we focus on two types of actuator faults: lock-in-place and loss of effectiveness. Specifically, a robust adaptive fault-tolerant controller is designed to compensate for the effect of actuator faults. By applying the classical backstepping design algorithm and fixed-time control theory, an adaptive fixed-time controller is developed, ensuring that the tracking error converges into a small neighbourhood around the origin within a fixed time where the convergence time is independent of initial conditions. Theoretical analysis and simulation outcomes prove that the closed-loop system is fixed-time stable and all signals are bounded by choosing the parameters appropriately. The effectiveness and feasibility of the presented control scheme are verified through the simulation results. [ABSTRACT FROM AUTHOR]

In this article, the finite-time adaptive fuzzy output-feedback control strategy is presented for a class of multi-input and multi-output (MIMO) nonlinear systems with multiple actuator constraints and unmeasured states. Fuzzy logic systems and a fuzzy adaptive state observer are adopted to estimate the nonlinear uncertainties and the unmeasured states, respectively. The inherent 'explosion of complexity' problem is eliminated by adopting command filter technology and the corresponding error compensation mechanism is exploited to alleviate the influence of the errors generated by command filters. It is further proved that all the signals can be fast finite-time bounded in the closed-loop systems based on the Lyapunov stability theory. Besides, the observer and tracking errors can reach a small region around the origin in fast finite time. Finally, the practicability of the presented theoretic result can be demonstrated through the numerical and practical examples. [ABSTRACT FROM AUTHOR]

A novel wearable upper arm tactile display device, which can simultaneously provide three types of tactile stimuli (i.e., squeezing, stretching, and vibration) is presented. The squeezing and stretching stimulation of the skin is generated by two motors simultaneously driving the nylon belt in the opposite and the same direction, respectively. In addition, four evenly spaced vibration motors are fixed around the user's arm by an elastic nylon band. There is also a unique structural design for assembling the control module and actuator, powered by two lithium batteries, making it portable and wearable. Psychophysical experiments are conducted to investigate the effect of interference on the perception of squeezing and stretching stimulation by this device. Results show that (1) different tactile stimuli actually interfere with the user's perception compared to the case where only one stimulus is applied to the user; (2) the squeezing has a considerable impact on the stretch just noticeable difference (JND) values when both stimuli are exerted on the user, and when the squeezing is strong, while the impact of stretch on the squeezing JND values is negligible. [ABSTRACT FROM AUTHOR]

Aims: Guidelines for the management of heart failure (HF) are evolving, and increasing emphasis is placed on patient‐centred care. As part of the REWOLUTION HF (REal WOrLd EdUcaTION in HF) programme, we conducted two international surveys aimed at assessing healthcare professionals' (HCPs) educational needs and patients' perspectives on the care of HF. Methods and results: Anonymous online questionnaires co‐developed by HF experts and patients assessed HCPs' educational needs (520 respondents, mostly cardiologists, in 67 countries) and patients' perceptions on HF impact and management (98 respondents in 18 countries). Among HCPs, 62.7% prioritized rapid initiation of all guideline‐mandated medications over up‐titration of some medications, and 87.7% always or frequently discussed treatment goals with patients. There was good agreement between HCPs and patients on key treatment goals, except for a greater emphasis on reducing hospitalizations among HCPs. The most frequently cited barriers to the provision of guideline‐recommended pharmacological therapy were treatment side effects/intolerance, complex treatment regimens, low blood pressure, cost/reimbursement issues, and low estimated glomerular filtration rate. Most patients (81.6%) reported no difficulties taking medications as prescribed, although 21.4% felt they were taking too many pills. Patients wanted more information about HF and its consequences, prognosis, and treatments (70.4%, 74.5% and 76.6%, respectively). Cardiologists were the preferred source of information about HF, followed by general practitioners and HF nurses. Conclusions: These surveys provide valuable insights into HCPs' needs about personalized care for patients with HF, as well as patients' perceptions, expectations and preferences. These findings will be helpful to develop patient‐centred, needs‐driven quality improvement programmes. [ABSTRACT FROM AUTHOR]

Background: Heart failure (HF) is a critical complication in elderly patients with atrial fibrillation (AF) and diabetes mellitus (DM). Recent preclinical studies suggested that non-vitamin K antagonist oral anticoagulants (NOACs) can potentially suppress the progression of cardiac fibrosis and ischemic cardiomyopathy. Whether different oral anticoagulants influence the risk of HF in older adults with AF and DM is unknown. This study aimed to evaluate the risk of HF in elderly patients with AF and DM who were administered NOACs or warfarin. Methods: A nationwide retrospective cohort study was conducted based on claims data from the entire Taiwanese population. Target trial emulation design was applied to strengthen causal inference using observational data. Patients aged ≥ 65 years with AF and DM on NOAC or warfarin treatment between 2012 and 2019 were included and followed up until 2020. The primary outcome was newly diagnosed HF. Propensity score-based fine stratification weightings were used to balance patient characteristics between NOAC and warfarin groups. Hazard ratios (HRs) were estimated using Cox proportional hazard models. Results: The study included a total of 24,835 individuals (19,710 NOAC and 5,125 warfarin users). Patients taking NOACs had a significantly lower risk of HF than those taking warfarin (HR = 0.80, 95% CI 0.74–0.86, p < 0.001). Subgroup analyses for individual NOACs suggested that dabigatran (HR = 0.86, 95% CI 0.80–0.93, p < 0.001), rivaroxaban (HR = 0.80, 95% CI 0.74–0.86, p < 0.001), apixaban (HR = 0.78, 95% CI 0.68–0.90, p < 0.001), and edoxaban (HR = 0.72, 95% CI 0.60–0.86, p < 0.001) were associated with lower risks of HF than warfarin. The findings were consistent regardless of age and sex subgroups and were more prominent in those with high medication possession ratios. Several sensitivity analyses further supported the robustness of our findings. Conclusions: This nationwide cohort study demonstrated that elderly patients with AF and DM taking NOACs had a lower risk of incident HF than those taking warfarin. Our findings suggested that NOACs may be the preferred oral anticoagulant treatment when considering the prevention of heart failure in this vulnerable population. Future research is warranted to elucidate causation and investigate the underlying mechanisms. [ABSTRACT FROM AUTHOR]

Model-based methods are widely used for the fault diagnosis of stochastic dynamic systems by simply using the input–output relationship of the system. Despite encouraging results and progress over past decades, developing a reliable and effective diagnostic method for systems with stochastic processes remains a significant challenge. In this paper, a comprehensive review on this topic is performed. Representative main approaches and results are analyzed and compared, and applications in some specific industrial processes are briefly reviewed. The perspectives on current challenges and potential opportunities of future work are discussed, hoping to shed some light on this active topic. [ABSTRACT FROM AUTHOR]

• Proposes BHTDP method to simulate thermal damage by electrocoagulation. • Introduces a deformation method for tissue post-electrocoagulation. • Applies anisotropy and positional constraints for realistic tissue deformation. • Validates model accuracy through comparison with COMSOL simulations. • Enhances visual realism in virtual neurosurgery simulations. Bipolar hemostasis electrocoagulation is a fundamental procedure in neurosurgery. A precise electrocoagulation model is essential to enable realistic visual feedback in virtual neurosurgical simulation. However, existing models lack an accurate description of the heat damage and irreversible tissue deformation caused by electrocoagulation, thus diminishing the visual realism. This work focuses on the electrocoagulation model for neurosurgery simulation. In this paper, a position-based dynamics (PBD) model with a bioheat transfer and damage prediction (BHTDP) method is developed for simulating the deformation of brain tissue caused by electrocoagulation. The presented BTHDP method uses the Arrhenius equation to predict thermal damage of brain tissue. A deformation model with energy and thermal damage constraints is developed to characterize soft tissue deformation during heat absorption before and after thermal injury. Visual effect of damaged brain tissue is re-rendered. To evaluate the accuracy of the proposed method, numerical simulations were conducted and compared with commercial finite element software. The maximum normalized error of the proposed model for predicting midpoint temperature is 10.3 % and the maximum error for predicting the thermal damage is 5.4 %. The contraction effects of heat-exposed anisotropic tissues are also simulated. The results indicate that the presented electrocoagulation model provides stable and realistic visual effects, making it applicable for simulating the electrocoagulation process in virtual neurosurgery. [ABSTRACT FROM AUTHOR]

High-intensity focused ultrasound (HIFU) is regarded as a promising alternative treatment option for localized prostate cancer (PCa) as it has been proposed to offer similar oncologic control to the standard of care, but with significantly reduced treatment-related side effects. This systematic literature review assesses the available evidence of whole-gland HIFU as primary treatment for localized PCa. MEDLINE (PubMed) was searched for studies investigating oncological and functional outcomes following whole-gland HIFU as primary treatment for localized PCa. Our primary outcomes for the review were biochemical disease-free survival rates (BDFS), overall and PCa-specific survival rates as well as negative biopsy rates. Our secondary outcomes were functional results and complications of the treatment. A total of 375 articles were identified, of which 35 were included in the present review. All 35 articles were prospective or retrospective case series. Mean/median duration of follow-up across studies was 10.9 to 94 months, and 6618 patients were included in the review. The BDFS rate varied greatly across studies from 21.7% to 89.2% during follow-up. The 10-year PCa-specific survival rate following HIFU was 90%, 99%, and 100% in 3 studies. Negative biopsy rates post-HIFU ranged from 20% to 92.7% across studies. Common side effects to HIFU included urinary incontinence (grade 1: 0%-22.7%), erectile dysfunction (11.6%-77.1%), urinary tract infections (1.5%-47.9%), and bladder outlet obstruction mainly as urethral strictures (7%-41.2%). Great variation in oncological and functional outcomes was seen across studies. More prospective trials are needed before whole-gland HIFU can be considered as a treatment option for localized PCa. [ABSTRACT FROM AUTHOR]

This paper addresses the adaptive finite-time tracking control problem for a class of multi-agent high-order systems with actuator faults. By adding a power integrator and taking advantage of the approximation capabilities of radial basis function in neural networks, an adaptive backstepping controller is developed to overcome difficulties associated with the positive odd integer terms of nonlinear multi-agent high-order systems. Moreover, fault-tolerant control is used to tackle the impact of actuator failures. The developed adaptive finite-time control scheme ensures that the outputs of all followers track synchronously the reference signal quickly in finite time, and all signals of the controlled system are semi-globally uniformly finite-time stable. Simulation results demonstrate the feasibility of the proposed scheme. [ABSTRACT FROM AUTHOR]

Summary: The time‐constrained positional synchronization control problem for a class of bilateral teleoperation systems is investigated and a novel fixed‐time event‐triggered control scheme is developed. Different from existing methods, the controller is triggered in a nonperiodic manner, which reduces considerably the triggering frequency of control devices. This not only saves communication resource, but also extends the lifespan of system devices because of the reduction of switching times. The control settling time is further considered by introducing a fixed‐time stability theorem. Theoretical analysis as well as a simulation example verifies that the proposed control method can reduce remarkably the amount of control signals transmitted between the master and slave while ensuring that the system output tracking error converges to a small neighborhood close to zero within a fixed‐time frame. [ABSTRACT FROM AUTHOR]

Background and Objectives: There is a paucity of guidance on HIV pre-exposure prophylaxis (PrEP) implementation in an academic medical center. The objectives of this study were to describe interventions by a multidisciplinary PrEP task force at an academic medical center and compare metrics of PrEP implementation pre- and post-creation of this entity. Methods: The interventions of the task force are described within the rubric of the PrEP care continuum. Participants were adults prescribed PrEP for greater than or equal to 30 days at 9 clinical sites across a university health system. Metrics of PrEP implementation were compared over 12-month intervals before and after the creation of the task force. Results: An increased proportion of participants had HIV testing within 7 days of new PrEP prescriptions (92% vs 63%, P <.001) and were prescribed PrEP in increments of 90 days or shorter (74% vs 56%, P <.001) after the creation of the task force. There were higher rates of testing for bacterial sexually transmitted infections in men who had sex with men and transgender women in the post-intervention compared with pre-intervention period. Conclusions: A multidisciplinary team that focuses on optimizing PrEP delivery along each step of the care continuum may facilitate PrEP scale-up and best practices in an academic setting. [ABSTRACT FROM AUTHOR]

The adaptive neural tracking fault‐tolerant control problem is considered for nonlinear non‐affine switched systems with sensor faults via dynamic surface control (DSC) technique under arbitrary switchings within predefined‐time interval. During the controller design process, the non‐affine formation strictly processed so that the implicit control signals can be transformed into explicit ones. The introduction of hyperbolic tangent function to design the control signal eliminates the singularity at the same time, but also avoids the tedious discussion of the segmentation function to solve the singularity. Considering Lyapunov stability theorem, an adaptive fault tolerant control approach is presented, which means that the settling‐time can be programmed by the user practical specification under arbitrary switching, the predefined time boundedness of all closed‐loop signals can be ensured, and the influence of sensor faults can be compensated. The effectiveness of the presented method is verified via simulation results. [ABSTRACT FROM AUTHOR]

In this paper, the quantisation synchronisation control problem of bilateral teleoperation systems with communication delays is investigated. The inaccurate modelling problem including the system uncertainties and the unknown disturbances are compensated by using the radial basis function networks (RBFN). By introducing the hysteretic quantiser, the control signals are quantised to a set of discrete values to ease the accuracy requirement for actual physical systems and the requirement for communication rate. The position synchronisation of joint variables between the master and slave manipulators is achieved by using the designed control signals and adaptive parameters. Simulation results verify that the synchronisation tracking errors gradually converge to a small neighbourhood around zero. [ABSTRACT FROM AUTHOR]

Summary: This article copes with the adaptive fixed‐time funnel control problem for a class of nonlinear systems with actuator faults. To deal with the difficulties due to actuator faults, which include both lock‐in‐place and loss‐of‐effectiveness models, an adaptive fault‐tolerant control scheme is proposed. By introducing the fuzzy logic system and backstepping technique, an adaptive fixed‐time controller is developed to ensure that the tracking error converges into a pre‐specified performance funnel within a fixed time, which is independent on the initial state, and in the meantime, the controlled closed‐loop system remains semi‐global fixed‐time bounded stable and all the signals are bounded. Simulation results verify the proposed approach. [ABSTRACT FROM AUTHOR]

Background: Evidence about the association between types of oral anticoagulants and hazards of diabetes complications is limited in patients with atrial fibrillation (AF) and diabetes mellitus (DM).Objective: To compare the hazards of diabetes complications and mortality between patients with AF and DM receiving non-vitamin K antagonist oral anticoagulants (NOACs) and those receiving warfarin.Design: A retrospective cohort study.Setting: Nationwide data obtained from Taiwan's National Health Insurance Research Database.Patients: Patients with AF and DM receiving NOACs or warfarin between 2012 and 2017 in Taiwan were enrolled. Treatment groups were determined by patients' first initiation of oral anticoagulants.Measurements: Hazards of diabetes complications (macrovascular complications, microvascular complications, and glycemic emergency) and mortality in the NOAC and warfarin users were investigated with a target trial design. Cause-specific Cox proportional hazards models were used to estimate hazard ratios (HRs). Propensity score methods with stabilized inverse probability of treatment weighting were applied to balance potential confounders between treatment groups.Results: In total, 19 909 NOAC users and 10 300 warfarin users were included. Patients receiving NOACs had significantly lower hazards of developing macrovascular complications (HR, 0.84 [95% CI, 0.78 to 0.91]; P < 0.001), microvascular complications (HR, 0.79 [CI, 0.73 to 0.85]; P < 0.001), glycemic emergency (HR, 0.91 [CI, 0.83 to 0.99]; P = 0.043), and mortality (HR, 0.78 [CI, 0.75 to 0.82]; P < 0.001) than those receiving warfarin. Analyses with propensity score matching showed similar results. Several sensitivity analyses further supported the robustness of our findings.Limitation: The claims-based data did not allow for detailed data on patients' lifestyles and laboratory examinations to be obtained.Conclusion: Non-vitamin K antagonist oral anticoagulants were associated with lower hazards of diabetes complications and mortality than warfarin in patients with AF and DM.Primary Funding Source: Hualien Tzu Chi Hospital. [ABSTRACT FROM AUTHOR]

Existing techniques for optical trapping and manipulation of microscopic objects, such as optical tweezers and plasmonic tweezers, are mostly based on visible and near‐infrared light sources. As it is in general more difficult to confine light to a specific length scale at a longer wavelength, these optical trapping and manipulation techniques have not been extended to the mid‐infrared spectral region or beyond. Here, it is shown that by taking advantage of the fact that many materials have large permittivity dispersions in the mid‐infrared region, optical trapping and manipulation using mid‐infrared excitation can achieve additional functionalities and benefits compared to the existing techniques in the visible and near‐infrared regions. In particular, it is demonstrated that by exploiting the exceedingly high field confinement and large frequency tunability of mid‐infrared graphene plasmonics, high‐performance and versatile mid‐infrared plasmonic tweezers can be realized to selectively trap or repel nanoscale objects of different materials in a dynamically reconfigurable way. This new technique can be utilized for sorting, filtering, and fractionating nanoscale objects in a mixture. [ABSTRACT FROM AUTHOR]

Summary: This article focuses on the finite‐time adaptive fuzzy control problem based on command filtering for stochastic nonlinear systems subject to input quantization. Fuzzy logic systems are employed to estimate unknown nonlinearities. In the control design, the hysteretic quantized input is decomposed into two bounded nonlinear functions, which solves the chattering problem. Meanwhile, an adaptive fuzzy controller is presented by the combination of command filter technique and backstepping control, which eliminates the computational complexity existing in traditional backstepping design. Under the proposed adaptive mechanism, all the closed‐loop signals remain bounded while the desired system performance can be realized within finite time. The main significance of this work is that (1) the filtering error can be solved on the basis of the designed compensating signals; (2) the requirement of adaptive parameters is decreased to only one, which simplifies the controller design process and may improve the control performance. Two simulation examples are used to validity of the developed scheme. [ABSTRACT FROM AUTHOR]

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Keywords: chronic disease; diabetes; health status disparities; Indigenous peoples EN chronic disease diabetes health status disparities Indigenous peoples 153 155 3 07/15/22 20220719 NES 220719 I To heal a nation, we must first heal the individuals, the families and the communities. i - Art Solomon, Anishinaabe Elder, Songs for the People: Teachings on the Natural Way Indigenous peoples in Canada constitute 4.9% of the population, but they endure more chronic diseases. Chronic disease, diabetes, health status disparities, Indigenous peoples. [Extracted from the article]

Localization accuracy is a fundamental requirement for Simultaneous Localization and Mapping (SLAM) systems. Traditional visual SLAM (vSLAM) schemes are usually based upon the assumption of static environments, so they do not perform well in dynamic environments. While a number of vSLAM frameworks have been reported for dynamic environments, the localization accuracy is usually unsatisfactory. In this article, we present a novel motion detection and segmentation method using Red Green Blue-Depth (RGB-D) data to improve the localization accuracy of feature-based RGB-D SLAM in dynamic environments. To overcome the problem due to undersegmentation generated by the semantic segmentation network, a mask inpainting method is developed to ensure the completeness of object segmentation. In the meantime, an optical flow-based motion detection method is proposed to detect dynamic objects from moving cameras, allowing robust detection by removing irrelevant information. Experiments performed on the public Technical University of Munich (TUM) RGB-D data set show that the presented scheme outperforms the state-of-art RGB-D SLAM systems in terms of trajectory accuracy, improving the localization accuracy of RGB-D SLAM in dynamic environments. [ABSTRACT FROM AUTHOR]

Hypoxia inducible factors (HIFs) are a hallmark of inflammation and are key regulators of hepatic immunity and metabolism, yet their role in HBV replication is poorly defined. HBV replicates in hepatocytes within the liver, a naturally hypoxic organ, however most studies of viral replication are performed under conditions of atmospheric oxygen, where HIFs are inactive. We therefore investigated the role of HIFs in regulating HBV replication. Using cell culture, animal models, human tissue and pharmacological agents inhibiting the HIF-prolyl hydroxylases, we investigated the impact of hypoxia on the HBV life cycle. Culturing liver cell-based model systems under low oxygen uncovered a new role for HIFs in binding HBV DNA and activating the basal core promoter, leading to increased pre-genomic RNA and de novo HBV particle secretion. The presence of hypoxia responsive elements among all primate members of the hepadnaviridae highlights an evolutionary conserved role for HIFs in regulating this virus family. Identifying a role for this conserved oxygen sensor in regulating HBV transcription suggests that this virus has evolved to exploit the HIF signaling pathway to persist in the low oxygen environment of the liver. Our studies show the importance of considering oxygen availability when studying HBV-host interactions and provide innovative routes to better understand and target chronic HBV infection. Viral replication in host cells is defined by the cellular microenvironment and one key factor is local oxygen tension. Hepatitis B virus (HBV) replicates in the liver, a naturally hypoxic organ. Hypoxia inducible factors (HIFs) are the major sensors of low oxygen; herein, we identify a new role for these factors in regulating HBV replication, revealing new therapeutic targets. [Display omitted] • Primate hepadnaviridae encode conserved hypoxia response elements. • Hypoxia inducible factors bind HBV DNA and activate the basal core promoter. • Pharmacological stabilization of hypoxia inducible factors and low oxygen increases HBV transcription and particle genesis. • Knockdown studies show a role for both HIF-1α and HIF-2α in regulating HBV transcription. [ABSTRACT FROM AUTHOR]

Physiological motions have a significant impact on soft tissue deformation and accuracy of surgical procedures, which is essential for realistic surgical simulation. While existing studies offer accurate simulation of soft tissue deformation, integrating physiological motions into deformation models of soft tissue remains a challenging task. This paper introduces a novel deformation model, based on complementary dynamics, to animate soft tissue deformation under physiological motion. The finite element method is incorporated to accurately characterize the elastic behavior of the soft tissue. Mathematical models of physiological motion are utilized and the physiological effects are converted into displacements of a predefined set of handles within the soft tissue mesh. Complementary displacements derived from the inherent dynamics of the soft tissue are calculated, enabling the simulation of physiological motions and elastic behaviors in soft tissue deformation. Experiments were conducted to evaluate the performance and effectiveness of the proposed method in simulating soft tissue deformation under physiological motion. The simulation results show that the soft tissues exhibit physiological motion that corresponds to the rhythm of arterial pressure fluctuations, heartbeat or respiratory. Furthermore, the presented method exhibits stable performance compared with existing force-based methods. Both elastic behaviors and physiological motions of soft tissue deformation can be governed by the proposed method. A high degree of realistic visualization is achieved for virtual surgery simulation. • Simulation of physiological motion of soft tissue based on complementary dynamics. • Both elastic behaviors and physiological motions of soft tissue deformation are characterized. • Realistic visual feedback for virtual surgery simulation. [ABSTRACT FROM AUTHOR]

SRs stimulate increased patient interaction, elicit higher levels of satisfaction, and improve performance on tasks in comparison with other remote patient-monitoring devices (eg, smart watches, digital blood pressure monitors, fitness trackers, medical alert systems, and continuous glucose monitors). Higher exercise and cardiac rehabilitation adherence were observed among patients enrolled in a SR intervention versus usual care, albeit with small sample sizes (Ns <28).[3] It is possible that SRs may mitigate the identified challenges of remote patient monitoring in cardiovascular care,[4] such as low patient engagement and patient-provider depersonalization, and may become a particularly efficacious virtual care tool. [Extracted from the article]

In surgical simulation, the Navier–Stokes (N–S) equation is commonly employed to imitate the physical characteristics of bleeding and the smooth particle hydrodynamics (SPHs) algorithm is applied to solve the numerical solution of the N–S equation. However, blood is viscous, incompressible and non-Newtonian fluid whose physical properties cannot be fully incorporated by the simple N–S equation, and the kernel approximation of the SPH algorithm may lead to both edge and volume distortions plus high computational cost. In this paper, both the tension force and the effect of platelets on the viscous force of bleeding particles are incorporated into the N–S equation in order to render more realistic visual effect and biological features of bleeding in surgical simulation. Constant core radius of the kernel function of the SPH algorithm is substituted with a function of particle density, avoiding potential edge distortions in simulating bleeding area. A repulsive force between particles is introduced, which effectively prevents volume distortions. Besides, accelerated search for particles based on the cube mesh improves the computational efficiency. The simulation results show that the presented simulation method leads to smooth bleeding surface and improves the visual effects of edge and volume in comparison with existing methods, and relatively high computational efficiency can be achieved as well. [ABSTRACT FROM AUTHOR]

Aim: To compare the risk of diabetes development in patients with atrial fibrillation (AF) treated with non‐vitamin K antagonist oral anticoagulants (NOACs) and warfarin. Materials and Methods: We conducted a nationwide retrospective cohort study using Taiwan's National Health Insurance Research Database. Adult patients with new onset of AF, treated with NOACs or warfarin between 2012 and 2016, were included. The NOAC cohort was further divided into dabigatran, rivaroxaban and apixaban groups. The primary outcome was incident diabetes requiring treatment with antidiabetic drugs. Fine and Gray subdistribution hazards models were used to estimate the adjusted hazard ratio (aHR). Propensity score matching was performed for each head‐to‐head comparison. Results: A total of 10 746 new‐onset AF patients were included in our study. During the mean 2.4‐year follow‐up, NOACs were associated with a lower risk of developing diabetes than warfarin (aHR = 0.80, 95% confidence interval [CI]: 0.68‐0.94, P =.007). Subgroup analyses confirmed that dabigatran, rivaroxaban and apixaban each had a reduced diabetes risk. Stratified analyses showed that the lower risk of diabetes associated with NOAC treatment was specific to patients aged 65 years or older (aHR = 0.74, 95% CI: 0.62‐0.89, P =.002) and those with good medication adherence (aHR = 0.70, 95% CI: 0.58‐0.84, P <.001). Conclusions: Taking an NOAC was associated with a lower risk of developing diabetes than taking warfarin in patients with AF. [ABSTRACT FROM AUTHOR]

Steerable bevel-tip needles offer higher maneuverability independent of insertion depth and consequently are preferred for many needle-steering applications compared with symmetric-tip needles. Using these needles, the clinician can reach previously inaccessible targets using traditional stiff needles, thus helping improve the efficiency of needle insertion procedures significantly. However, due to their nonholonomic kinematics inside biological tissue, path planning of these needles is complicated and requires a great deal of care. Rapidly exploring random-tree (RRT)-based approaches are proper candidates for intraoperative planning of needle motion due to their fast computation and simple implementations. They also work well in high-dimensional configuration spaces and under nonholonomic kinematic constraints, both of which are the characteristics of steerable bevel-tip needle motion inside soft tissue. We developed a new heuristic-based RRT planner to reach multiple targets inside soft tissue without having to completely retract, reorient, and reinsert the needle toward each separate target, resulting in significantly less tissue damage compared with the conventional sequential insertion of the needle toward each target. Moreover, the proposed planner can have real clinical applications, where the limited size of the workspace as well as the needle’s limited natural curvature imposes significant limitations on the needle path-planning problem inside soft tissue. Simulations demonstrate the efficiency of the proposed planner. The maximum targeting error of all targets is 1 mm and the needle’s inserted length is decreased up to 35% compared with the sequential insertion of the needle for each target. [ABSTRACT FROM AUTHOR]

Cataract is the primary cause of visual impairment and can be corrected by cataract surgery. We investigated the impact of cataract on the risk of depression along with the benefits of cataract surgery. Patients newly diagnosed with cataract by ophthalmologists between 2001 and 2015 were identified from the National Health Insurance Research Database (NHIRD) in Taiwan. Non-cataract individuals were recruited by 1:1 matching for age, sex and index year. After propensity score matching, 233,258 patients in total were included in our study: 116,629 in each of the cataract and non-cataract cohorts. The primary outcome was the new diagnosis of depression by psychiatrists. In a mean follow-up period of 7.8 years, cataract was significantly associated with increased risk of developing depression (adjusted hazard ratio [aHR] = 1.78, 95% confidence interval [CI] 1.70–1.87, p < 0.001). We further divided the cataract cohort into surgery and non-surgery groups. Notably, cataract surgery group was associated with a decreased risk of depression compared with non-surgery patients (aHR = 0.75, 95% CI 0.71–0.79, p < 0.001). Our results emphasise the importance of regular screening for depression among cataract patients and the beneficial effect of cataract surgery in reducing the risk of depression. [ABSTRACT FROM AUTHOR]

The coronavirus disease 2019 (COVID-19) pandemic has affected health and economy worldwide on an unprecedented scale. Patients have diverse clinical outcomes, but those with preexisting cardiovascular disease, hypertension, and related conditions incur disproportionately worse outcome. The high infectivity of severe acute respiratory syndrome coronavirus 2 is in part related to new mutations in the receptor binding domain, and acquisition of a furin cleavage site in the S-spike protein. The continued viral shedding in the asymptomatic and presymptomatic individuals enhances its community transmission. The virus uses the angiotensin converting enzyme 2 receptor for internalization, aided by transmembrane protease serine 2 protease. The tissue localization of the receptors correlates with COVID-19 presenting symptoms and organ dysfunction. Virus-induced angiotensin converting enzyme 2 downregulation may attenuate its function, diminish its anti-inflammatory role, and heighten angiotensin II effects in the predisposed patients. Lymphopenia occurs early and is prognostic, potentially associated with reduction of the CD4+ and some CD8+ T cells. This leads to imbalance of the innate/acquired immune response, delayed viral clearance, and hyperstimulated macrophages and neutrophils. Appropriate type I interferon pathway activation is critical for virus attenuation and balanced immune response. Persistent immune activation in predisposed patients, such as elderly adults and those with cardiovascular risk, can lead to hemophagocytosis-like syndrome, with uncontrolled amplification of cytokine production, leading to multiorgan failure and death. In addition to the airways and lungs, the cardiovascular system is often involved in COVID-19 early, reflected in the release of highly sensitive troponin and natriuretic peptides, which are all extremely prognostic, in particular, in those showing continued rise, along with cytokines such as interleukin-6. Inflammation in the vascular system can result in diffuse microangiopathy with thrombosis. Inflammation in the myocardium can result in myocarditis, heart failure, cardiac arrhythmias, acute coronary syndrome, rapid deterioration, and sudden death. Aggressive support based on early prognostic indicators with expectant management can potentially improve recovery. Appropriate treatment for heart failure, arrhythmias, acute coronary syndrome, and thrombosis remain important. Specific evidence-based treatment strategies for COVID-19 will emerge with ongoing global collaboration on multiple approaches being evaluated. To protect the wider population, antibody testing and effective vaccine will be needed to make COVID-19 history. [ABSTRACT FROM AUTHOR]

An accurate and realistic brain tissue deformation model with real-time performance is very important for virtual neurosurgical simulation. In this paper, a new finite element method (FEM) brain tissue deformation model, which is based on the optimization implicit Euler method, is introduced. Biomechanical properties of brain tissue such as anisotropy and viscoelasticity are incorporated into the model, which provides more accurate and realistic imitation of the deformation of brain tissue. A descent method with GPU-based implementation is used to solve the optimization problem, which makes it possible to achieve a high degree of computational efficiency. Simulation results show that both the anisotropic and viscoelastic behaviors are presented in the deformation model. The GPU-based implementation of the proposed model significantly improves the computational efficiency over CPU-based FEM models with the implicit integration scheme. Moreover, the result of the proposed model converges to the exact solution of implicit Euler integration after 96 iterations. The proposed model was implemented on the development of a neurosurgical simulator. A relative high degree of realistic brain tissue deformation was rendered at a refreshment rate of 32.5 frames/s on a regular PC. [ABSTRACT FROM AUTHOR]

• A new cutting concept was proposed for surgical simulation. • A novel volumetric geometric model based on volume rendering and Bézier curve, is presented for cutting procedures. • The edges of the incisions optimized by the proposed geometric model are smooth and the details of internal structures of soft tissues are clearly rendered. • The cutting effects of different types of virtual organs are properly simulated. • The computational efficiency is improved by octree and compact bounding box. Background and objectives: Cutting procedures are the most common operations in surgical simulation. In order to provide realistic visual feedback with the details of the internal structures of soft tissue to the operator, a novel volumetric geometric model is presented for cutting procedures in surgical simulation. Methods: A novel volumetric geometric model, which is based on volume rendering and the Bézier curve, is presented for cutting procedures. The Bézier curve is used to optimize the physical model of cutting simulation, making the edge of incision smooth without increasing the computational load of the physical model. Volume rendering is used to render the cutting process, which improves significantly the realism of simulation since both surface textures and the details of the internal structures of soft tissues are rendered. Results and Conclusions: The simulation results show that the edges of the incision optimized by using the proposed geometric model are smooth and the details of internal structures of soft tissue can be rendered. In comparison with other volumetric models, the computational efficiency is much improved. Compared with conventional cutting simulation methods, the proposed volumetric geometric model improves the effects of visual feedback since both surface and internal structures are rendered according to the optimized physical model. [ABSTRACT FROM AUTHOR]

This paper proposes observer-based output feedback force reflecting robust coordination control for networked bilateral shared telerobotic system with asymmetrical delay and uncertainty. We design state feedback-based force reflecting control algorithm provided that all the states are available for feedback. We then replace the unknown velocity states by model-free observer to develop output feedback-based force reflecting robust coordination control algorithm for bilateral shared autonomous system. The coordination control algorithm is designed by combining delayed position and velocity states with the reflected interaction forces from human and environment. Robust adaptive control theory is employed to deal with uncertainty. The stability analysis is shown by using Lyapunov method. The method does not require linear matrix inequality and uncertainty. Compared with other force reflection methods, the design uses reflected forces from both interaction between master and human and between slave and environment. Experimental results are presented to demonstrate the validity of the proposed design for real-time applications. [ABSTRACT FROM AUTHOR]

• A new FEM based model with constraints is proposed for brain tissue deformation. • A new energy function of constraint is introduced into the deformation model. • Distance and permanent deformation constraints are introduced. • Interactions in the convexity meningioma dissection and hemostasis are properly simulated. • The GPU-based implementation achieves high degree of accuracy and computational efficiency. Background and objectives: An accurate and real-time model of soft tissue is critical for surgical simulation for which a user interacts haptically and visually with simulated patients. This paper focuses on the real-time deformation model of brain tissue for the interactive surgical simulation, such as neurosurgical simulation. Methods: A new Finite Element Method (FEM) based model with constraints is proposed for the brain tissue in neurosurgical simulation. A new energy function of constraints characterizing the interaction between the virtual instrument and the soft tissue is incorporated into the optimization problem derived from the implicit integration scheme. Distance and permanent deformation constraints are introduced to describe the interaction in the convexity meningioma dissection and hemostasis. The proposed model is particularly suitable for GPU-based computing, making it possible to achieve real-time performance. Results and conclusions: Simulation results show that the simulated soft tissue exhibits the behaviors of adhesion and permanent deformation under the constraints. Experiments show that the proposed model is able to converge to the exact solution of the implicit Euler method after 96 iterations. The proposed model was implemented in the development of a neurosurgical simulator, in which surgical procedures such as dissection of convexity meningioma and hemostasis were simulated. [ABSTRACT FROM AUTHOR]

International marriage between foreign women and American men, in which both parties engage in the process of correspondence through the internet and marry as a result of online dating, has rapidly flourished in the recent years. Are these cyber-matched brides (CMBs) similar to immigrant women, previously labeled as "mail-ordered-brides," who were often the victims of spouse abuse? Using Chinese CMBs as a sample and the method of in-depth interview, this project explores four specific domains: (a) the demographic background of Chinese CMBs and their partners; (b) the unique situations and life experiences of their marriages; (c) the process of relational conflicts and their coping strategies; and (d) the explanations of their motivations, feelings, behaviors, and changes in their relationships. The study contributes to the literature by clarifying the myths about foreign brides as sex slaves and domestic servants, and American grooms as exploiters and abusers. [ABSTRACT FROM AUTHOR]

In this paper, we propose artificial and virtual-impedance interaction force reflection-based shared control strategy for bilateral telemanipulation of miniature aerial vehicle (MAV). The shared input for the master is designed by combining the velocity of the slave–MAV system with the scaled position–velocity of the master manipulator. The master input also uses the reflected interaction force between the slave and remote environment. The interaction force between environment and MAV is modeled by using two different approaches as the artificial and virtual impedance force field. The reflected interaction force applies to the human operators' hand through the haptic manipulator. The interaction force provides a situational awareness about the remote environment, guiding the operator to navigate and control the MAV for a safe and stable interaction with the remote environment. The shared control input for the slave is designed by combining the velocity of the MAV with the scaled position–velocity of the master manipulator. The convergence analysis of the closed-loop bilateral shared control system is shown by using the Lyapunov method. The analysis shows that the closed-loop system is input-to-state stable and ultimately bounded in the presence of passive and nonpassive interaction with the environment and the human operator. The design is implemented and evaluated on a quadrotor MAV with both artificial and virtual impedance force field based interaction interfaces to demonstrate the effectiveness for the real-time interaction with the environment. [ABSTRACT FROM AUTHOR]

The innate immune system is an evolutionarily conserved system that senses and defends against infection and irritation. Innate immune signaling is a complex cascade that quickly recognizes infectious threats through multiple germline-encoded cell surface or cytoplasmic receptors and transmits signals for the deployment of proper countermeasures through adaptors, kinases, and transcription factors, resulting in the production of cytokines. As the first response of the innate immune system to pathogenic signals, inflammatory responses must be rapid and specific to establish a physical barrier against the spread of infection and must subsequently be terminated once the pathogens have been cleared. Long-lasting and low-grade chronic inflammation is a distinguishing feature of type 2 diabetes and cardiovascular diseases, which are currently major public health problems. Cardiometabolic stress-induced inflammatory responses activate innate immune signaling, which directly contributes to the development of cardiometabolic diseases. Additionally, although the innate immune elements are highly conserved in higher-order jawed vertebrates, lower-grade jawless vertebrates lack several transcription factors and inflammatory cytokine genes downstream of the Toll-like receptors (TLRs) and retinoic acid-inducible gene-I (RIG-I)-like receptors (RLRs) pathways, suggesting that innate immune signaling components may additionally function in an immune-independent way. Notably, recent studies from our group and others have revealed that innate immune signaling can function as a vital regulator of cardiometabolic homeostasis independent of its immune function. Therefore, further investigation of innate immune signaling in cardiometabolic systems may facilitate the discovery of new strategies to manage the initiation and progression of cardiometabolic disorders, leading to better treatments for these diseases. In this review, we summarize the current progress in innate immune signaling studies and the regulatory function of innate immunity in cardiometabolic diseases. Notably, we highlight the immune-independent effects of innate immune signaling components on the development of cardiometabolic disorders. [ABSTRACT FROM AUTHOR]

In this paper, an adaptive fixed-time output feedback formation control problem is investigated for nonlinear multi-agent systems with a nonstrict-feedback structure. In the controller design procedure, the neural network state observer is designed to estimate the unmeasurable state variables. Dynamic surface control (DSC) technique is applied to avoid the repeated differentiation for the virtual control signals. The dynamic surface compensation signals can realise the practical fixed-time bounded. Utilising the classified discussion method, the difficulty of controller design caused by the existence of observer error term is addressed. The technique of transformation of the index set is employed to cope with the related variables of the neighbour states, which simplifies the controller design. Under the presented control mechanism, all closed-loop signals remain bound for a fixed period of time, the formation control performance target between all followers and leader can be achieved. And the formation errors and state observers errors are both bounded such that can converge to a little domain around zero. Simulation results are provided to test the availability of the presented strategy. [ABSTRACT FROM AUTHOR]

Human β-tryptase, a tetrameric trypsin-like serine protease, is an important mediator of the allergic inflammatory responses in asthma. During acute hypersensitivity reactions, mast cells degranulate, releasing active tetramer as a complex with proteoglycans. Extensive efforts have focused on developing therapeutic β-tryptase inhibitors, but its unique activation mechanism is less well-explored. Tryptase is active only after proteolytic removal of the pro-domain followed by tetramer formation via two distinct symmetry-related interfaces. We show that the cleaved I16G mutant cannot tetramerize, likely due to impaired insertion of its N terminus into its "activation pocket," indicating allosteric linkage at multiple sites on each protomer. We engineered cysteines into each of the two distinct interfaces (Y75C for small or I99C for large) to assess the activity of each tetramer and disulfide-locked dimer. Using size-exclusion chromatography and enzymatic assays, we demonstrate that the two large tetramer interfaces regulate enzymatic activity, elucidating the importance of this protein--protein interaction for allosteric regulation. Notably, the I99C large interface dimer is active, even in the absence of heparin. We show that a monomeric β-tryptase mutant (I99C*/Y75A/Y37bA, where C* is cysteinylated Cys-99) cannot form a dimer or tetramer, yet it is active but only in the presence of heparin. Thus heparin both stabilizes the tetramer and allosterically conditions the active site. We hypothesize that each β-tryptase protomer in the tetramer has two distinct roles, acting both as a protease and as a cofactor for its neighboring protomer, to allosterically regulate enzymatic activity, providing a rationale for direct correlation of tetramer stability with proteolytic activity. [ABSTRACT FROM AUTHOR]

• Evolution of dissection in fibrous soft tissue with elastic-plastic deformation. • Characterize dissection process and inelastic behaviors with dissection variable of representative volume element. • Simulation of the tearing process between the brain tissue and the tumor. • Realistic visual feedback for brain tumor removal. Background and objective: Realistic modeling the dissection of brain tissue is of key importance for simulation of brain tumor removal in virtual neurosurgery systems. However, existing methods are unable to characterize inelastic behaviors of brain tissue, such as plastic deformation and dissection evolution, making it ineffective in simulating brain tumor removal procedures. Methods: In this paper, a model of fibrous soft tissue dissection for the simulation of brain tumor removal is proposed. A dissection variable of representative volume element is used to characterize the dissection state of the fibrous soft tissue. The evolution of dissection with elastic-plastic deformation under the effects of external loads is presented. Results: Simulation results show that the proposed model provides realistic, stable and intuitive results in the simulation of fracture in fibrous soft tissues. As the external load increases, the fibrous soft tissue begins to crack, with the cracks growing and multiplying until they eventually merge to form a fracture. The proposed model is incorporated into the simulation of brain tumor removal. Conclusions: The experimental results demonstrate the feasibility of modeling fibrous soft tissue dissection with elastic-plastic deformation. A relative high degree of realistic visual feedback is achieved. [ABSTRACT FROM AUTHOR]

Keywords: andrology; guidelines; testosterone EN andrology guidelines testosterone 398 400 3 09/12/23 20231001 NES 231001 The function of the hypothalamic-pituitary-testicular (HPT) axis during all epochs of life is to regulate androgenization and maintain fertility through repeated incremental and decremental feedforward (stimulatory) and feedback (inhibitory) signaling among its neural and hormonal components.[1] Male hypogonadism is the clinical syndrome that results from failure to secrete sufficient testosterone (T) and/or produce spermatozoa of adequate quality or quantity due to the culmination of single, sequential or simultaneous pathophysiological abnormalities in the HPT axis.[[2], [4]] This definition is simple to apply when the cause of HPT axis failure is obvious (" I organic hypogonadism i ", e.g. due to pituitary tumor causing secondary hypogonadism or due to Klinefelter syndrome causing primary hypogonadism); however, many chronic illnesses can dysregulate the HPT axis, decrease T and impair fertility (" I functional hypogonadism i "). Testosterone therapy in men with hypogonadism: an endocrine society clinical practice guideline. European Academy of Andrology (EAA) guidelines on investigation, treatment and monitoring of functional hypogonadism in males: endorsing organization: European Society of Endocrinology. [Extracted from the article]

In this article, the problem of adaptive fixed‐time tracking control is addressed for non‐triangular structural stochastic switching nonlinear systems. Fuzzy logic systems are used to compensate for unknown nonlinearities, and in the meantime, to avoid the algebraic loop problem, which exists in traditional backstepping controller design processes for non‐triangular structural nonlinear systems. The unknown control gain problem is addressed by the construction of proper Lyapunov function candidates. By employing Lyapunov stability theorem, all the closed‐loop signals can be ensured to be semi‐globally practical fixed‐time stable, the output signal can track the desired signal, and the tracking error can converge to a small zone around the origin. The effectiveness of the developed control approach is verified through simulation results. [ABSTRACT FROM AUTHOR]

A class of heterogeneous second-order multi-agent consensus problems is studied, in which an event-triggered method is used to improve the feasibility of the control protocol. The sliding mode control method is used to achieve the robustness of the system. A special type of general radial basis function neural network is applied to estimate the uncertainties. The event-triggered mechanism is introduced to reduce the update frequency of the controller and the communication frequency among the agents. Zeno behavior is avoided by ensuring a lower bound between two adjacent trigger instants. Finally, the simulation results are provided to demonstrate that the time evolution of consensus errors eventually approaches zero. The consensus of multi-agent systems is achieved. [ABSTRACT FROM AUTHOR]