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The reduction of the agricultural workforce due to the rapid development of technology has resulted in labor shortages. Agricultural mechanization, such as drone use for pesticide spraying, can solve this problem. However, the terrain, culture, and operational limitations in mountainous orchards in Taiwan make pesticide spraying challenging. By combining reinforcement learning with deep neural networks, we propose to train drones to avoid obstacles and find optimal paths for pesticide spraying that reduce operational difficulties, pesticide costs, and battery consumption. We experimented with different reward mechanisms, neural network depths, flight direction granularities, and environments to devise a plan suitable for sloping orchards. Reinforcement learning is more effective than traditional algorithms for solving path planning in complex environments. &nbsp

PURPOSE Immune checkpoint inhibitors combined with antiangiogenic therapy reportedly have potential synergistic antitumor activity. We investigated the activity and safety of this regimen for recurrent/metastatic nasopharyngeal carcinoma (NPC). METHODS This single-arm, Simon two-stage study enrolled patients with recurrent/metastatic NPC who were refractory to at least first-line systemic therapy and treatment-naive to immune checkpoint inhibitors. The patients received camrelizumab 200 mg once every 3 weeks and apatinib 250 mg once per day. The primary end point was the objective response rate. Key secondary end points included disease control rate, progression-free survival, duration of response, overall survival, and safety. RESULTS Between October 14, 2020, and December 23, 2021, 58 patients were enrolled, and all were included in the efficacy and safety analysis set. The objective response rate was 65.5% (95% CI, 51.9 to 77.5), and the disease control rate was 86.2% (95% CI, 74.6 to 93.9). The median duration of response was not reached, and the median progression-free survival was 10.4 months (95% CI, 7.2 to 13.6), with a median follow-up duration of 12.4 months (range, 2.1-19.9 months). Treatment-related adverse events (TRAEs) of grade 3 or higher were reported in 34 (58.6%) patients, with the most common being hypertension (19.0%), nasopharyngeal necrosis (15.5%), headache (12.1%), AST elevation (10.3%), and creatine phosphokinase elevation (10.3%). Sixteen (27.6%) patients discontinued apatinib treatment before progression because of unbearable TRAEs, and the most common complication was nasopharyngeal necrosis (9/16; 56.3%). Recurrent nasopharyngeal lesions (odds ratio, 5.94 [95% CI, 1.45 to 24.24]) and reirradiation (odds ratio, 5.33 [95% CI, 1.15 to 24.79]) were significantly positively correlated with nasopharyngeal necrosis. CONCLUSION Camrelizumab plus apatinib had promising antitumor activity in patients with refractory recurrent/metastatic NPC who failed first-line therapy. Moderate to severe TRAEs were experienced by 58.6%, including nasopharyngeal necrosis associated with local recurrence and a history of reirradiation.

BACKGROUND: High-resolution (HR) magnetic resonance imaging (MRI) provides rich pathological information which is of great significance in diagnosis and treatment of brain lesions. However, obtaining HR brain MRI images comes at the cost of extending scan time and using sophisticated expensive instruments. OBJECTIVE: This study aims to reconstruct HR MRI images from low-resolution (LR) images by developing a deep learning based super-resolution (SR) method. METHODS: We propose a feedback network with self-attention mechanism (FNSAM) for SR reconstruction of brain MRI images. Specifically, a feedback network is built to correct shallow features by using a recurrent neural network (RNN) and the self-attention mechanism (SAM) is integrated into the feedback network for extraction of important information as the feedback signal, which promotes image hierarchy. RESULTS: Experimental results show that the proposed FNSAM obtains more reasonable SR reconstruction of brain MRI images both in peak signal to noise ratio (PSNR) and structural similarity index measure (SSIM) than some state-of-the-arts. CONCLUSION: Our proposed method is suitable for SR reconstruction of MRI images.

BACKGROUND: The incidence rate for migraine is 12% worldwide, and recurrence is common, which seriously affects the physical and mental health of patients. OBJECTIVE: To observe the clinical effect of Shallow Puncture and More Twirling method of acupuncture in treating migraine and its impact on serum 5-HT and β-EP. METHODS: A total of 76 patients with migraine were randomized into a control group and acupuncture group with 38 cases in each. In the control group, patients were orally administered flunarizine hydrochloride before sleep, 2 capsules once daily for 4 weeks. In the acupuncture group, Shallow Puncture and More Twirling method was adopted for the acupoints of Sizhukong (SJ 23), Toulinqi (GB 15) Shuaigu (GB 8), Xuanlu (GB 5), Fengchi (GB 20), Waiguan (SJ 5), Zulinqi (GB 41). Patients were given acupuncture 3 times per week for 4 weeks. Then, the total VAS (Visual Analogue Scale) scores, composite score of migraine, serum level of 5-HT and β-EP, and the clinical efficacy differences were observed before and after treatment and the side-effects were recorded among the two groups. RESULTS: The total VAS scores and composite score of migraine were significantly reduced among both groups after the treatment (P< 0.05), and the serum level of 5-HT and β-EP was significantly improved (P< 0.05). Compared with control group, the acupuncture group reported lower results in VAS score and migraine composite score (P< 0.05), and higher results in serum 5-HT and β-EP level (P< 0.05). The acupuncture group with shallow puncture and more twirling method showed a total effective rate of 86.5%, which is higher than the control group (78.4%). The difference is statistically significant (P< 0.05). CONCLUSION: Shallow Puncture and More Twirling method was superior to flunarizine hydrochloride in the treatment of clinical symptoms of migraine. Acupuncture also increases the serum level of 5-HT and β-EP in migraine.

International Myeloma Working Group (IMWG) response criteria require refrigerated 24-hour urine specimens for most patients. However, given that serum free light chain testing has been shown to outperform 24-hour urine immunofixation as a prognostic marker, the importance of maintaining urine testing options or requirements within each level of IMWG response criteria has not been investigated. We analyzed responses to induction therapy for all transplant-eligible patients with multiple myeloma at our institution over a 3-year period using traditional versus 'urine-free' IMWG response criteria (where references to urine were removed from the descriptions for every depth of response). Of 281 evaluable patients, responses changed for only 4% of patients (95% confidence interval 2-7%) using urine-free criteria. Our results call into question the continued requirement for 24-hour urine measurements as part of IMWG response assessments for all patients. Research into the prognostic performance of urine-free IMWG criteria is ongoing.

Background: Hairline rib fracture commonly happens after blunt trauma, and it is hard to be detected by X-ray. Many methods can be used, and among them, the hybrid image of single-photon emission computed tomography (SPECT) and computed tomography (CT) seems to produce higher sensitivity for diagnosis. Case presentation: A 63-year-old man came to our rehabilitation clinic after a vehicle accident 25 days earlier. He had multiple plain films focusing in injured areas, but nothing was detected. However, he persisted in pain in the right and left chest walls individually before and after, which worsened every time when he coughed and bent over. Patient was examined with whole body bone scan and SPECT/CT, and showed out the definite fracture of right ribs 3-4 and left ribs 8-10. The patient then received medicine for pain-killer and rehabilitation modalities at the chest wall. Conclusions: We present a patient with a subclinical rib fracture initially, which is later diagnosed by the hybrid images of SPECT/CT. We conclude that hybrid images of SPECT/CT produces more precise diagnoses for the hairline rib fracture in field of scintigraphic rehabilitation.

Objectives The clinical presentations of essential thrombocythemia (ET) may be quite similar to early/prefibrotic primary myelofibrosis (pre-PMF), especially in pre-PMF presenting with thrombocytosis (pre–PMF-T), but may be associated with a different outcome. It is very important to distinguish these two entities. The aim of this study was to address the clinical and prognostic relevance of distinguishing pre–PMF-T from ET. Methods All patients, including 258 with ET and 105 with pre–PMF-T, received JAK2V617F, MPL (exon 10), and CALR (exon 9) mutation analysis and allele burden measurement for JAK2V617F and CALR mutants. Results Patients with pre–PMF-T had an older age and higher leukocyte and platelet counts but lower hemoglobin levels than patients with ET. Patients with pre–PMF-T had a shorter overall, leukemia-free, and thrombosis-free survival compared with patients with ET. Patients with ET had a higher rate of cerebral ischemic stroke, whereas patients with pre–PMF-T tended to have splanchnic vein thrombosis. The frequencies of JAK2V617F, CALR, and MPL mutations and CALR allele burden were no different, but JAK2V617F allele burden was significantly higher in pre–PMF-T. Patients with pre–PMF-T with the JAK2V617F mutation had an inferior overall survival and thrombosis-free survival, whereas the status of driver gene mutations did not influence the outcomes of patients with ET. Conclusions ET and pre–PMF-T were two distinct disease entities and exhibited different clinical phenotype, genotype, and outcomes.

Yu Huang,1,2 Yilian Xie,1,3 Lei Huang,1 Zhen Han1,2 1Department of Cardiovascular Surgery, Peking University Shenzhen Hospital, Guangdong, 518036, People’s Republic of China; 2Anhui Medical University, Hefei, Anhui, 230032, People’s Republic of China; 3Shantou University Medical College, Shantou, Guangdong, 515041, People’s Republic of ChinaCorrespondence: Zhen Han, Email 2498159698@qq.comPurpose: No consensus has been established on the safety and effectiveness of out-of-hospital management of Vitamin K antagonists (VKA) therapy combining portable coagulometers and telemedicine. The present meta-analysis investigated the safety and effectiveness of this hybrid anticoagulants management model.Methods: The PubMed, Embase, Cochrane, and Web of Science databases were searched for papers published before May 1, 2022. To reduce bias, only randomized controlled trials were included. RevMan 5.3 (Cochrane) software was used to evaluate and analyze clinical outcomes, including the effectiveness and safety of patient management approaches, determined by the time in the therapeutic range (TTR) and occurrence of thrombotic and bleeding events.Results: Eight studies, comprising 3853 patients, were selected. The meta-analysis showed that anticoagulant management combining portable coagulometers and telemedicine significantly improved frequency of testing (mean difference [MD]= 12.95 days; 95% CI, 8.77– 17.12; I2= 92%; P< 0.01) and TTR (MD= 9.50%; 95% CI, 3.16– 15.85; I2= 87%; P< 0.01). Thromboembolism events were reduced (RR= 0.72; 95% CI, 0.51– 1.01; I2= 0%; P= 0.05), but the results were not statistically significant. And no significant differences in major bleeding events, rehospitalization rate, mortality, or overall treatment cost existed between the two groups.Conclusion: Although the safety of remote cardiovascular disease management is not superior to that of conventional outpatient anticoagulant management, it provides a more stable monitoring of coagulation status.Keywords: VKA therapy, warfarin, telemedicine, self-testing, randomized controlled studies, meta-analysis