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An interpatient classification method using the second lead for the Association for the Advancement of Medical Instrumentation (AAMI) standard is introduced. This study includes three parts. In the first part, the fuzzy matching algorithm is used to locate the key waveform points of Electrocardiogram (ECG) data. In the second part, the feature engineering algorithm is used to filter the extracted data sets. In the third part, the random forest model is carried out to realize the five classifications of heart disease by the selected features. The final precision, recall, and F1-score are 91%, 89%, and 90%, respectively.

This study proposes a personal healthcare system to monitor, identify ectopic heartbeats, and provide services to patients with heart diseases. The proposed system includes three subsystems: (1) an electrocardiography (ECG) signal acquisition device to acquire ECG signals accurately; (2) an Android-based smartphone to display the actual ECG waveform and upload the signal to the Web platform for analysis of cardiac disorder events; and (3) a Web platform for feature selection and arrhythmia classification with the support vector machine algorithm. The classification algorithm can identify three types of heartbeats, namely, normal, atrial premature beat, and premature ventricular contraction. The average sensitivity, specificity, and accuracy of the classification algorithm over the training set are 98.5%, 96.7%, and 97.7%, respectively.

Power efficiency and stability are critical for wearable ECG application. The paper presents a Pulse-Width-Modulation (PWM) voltage type DC-DC converter, which has a small area of 0.32 mm2 on active chip, output voltage range of 0.8V to 3.5V, output power up to 7.5 mW, and peak efficiency of 95.8%. The simulation results show that the output voltage of the system is 1.8V, the output current is 4mA, the ripple voltage is 13mV and the efficiency is 86.1%, which meets the requirements of a presented system. The circuit will be fabricated by the SMIC in the near future with $0.18\ \mu\mathrm{m}$ Bipolar-CMOS-DMOS (BCD) process.

This study presents a low-power multi-lead wearable electrocardiogram (ECG) signal sensor system design that can simultaneously acquire the electrocardiograms from three leads, I, II, and V1. The sensor system includes two parts, an ECG test clothing with five electrode patches and an acquisition device. Compared with the traditional 12-lead wired ECG detection instrument, which limits patient mobility and needs medical staff assistance to acquire the ECG signal, the proposed vest-type ECG acquisition system is very comfortable and easy to use by patients themselves anytime and anywhere, especially for the elderly. The proposed study incorporates three methods to reduce the power consumption of the system by optimizing the micro control unit (MCU) working mode, adjusting the radio frequency (RF) parameters, and compressing the transmitted data. In addition, Huffman lossless coding is used to compress the transmitted data in order to increase the sampling rate of the acquisition system. It makes the whole system operate continuously for a long period of time and acquire abundant ECG information, which is helpful for clinical diagnosis. Finally, a series of tests were performed on the designed wearable ECG device. The results have demonstrated that the multi-lead wearable ECG device can collect, process, and transmit ECG data through Bluetooth technology. The ECG waveforms collected by the device are clear, complete, and can be displayed in real-time on a mobile phone. The sampling rate of the proposed wearable sensor system is 250 Hz per lead, which is dependent on the lossless compression scheme. The device achieves a compression ratio of 2.31. By implementing a low power design on the device, the resulting overall operational current of the device is reduced by 37.6% to 9.87 mA under a supply voltage of 2.1 V. The proposed vest-type multi-lead ECG acquisition device can be easily employed by medical staff for clinical diagnosis and is a suitable wearable device in monitoring and nursing the off-ward patients.

Acute respiratory distress syndrome is an often fatal disease that develops after acute lung injury and trauma. How released tissue damage signals, or alarmins, orchestrate early inflammatory events is poorly understood. Herein we reveal that IL-33, an alarmin sequestered in the lung epithelium, is required to limit inflammation after injury due to an unappreciated capacity to mediate Foxp3(+) Treg control of local cytokines and myeloid populations. Specifically, Il33(–/–) mice are more susceptible to lung damage–associated morbidity and mortality that is typified by augmented levels of the proinflammatory cytokines and Ly6C(hi) monocytes in the bronchoalveolar lavage fluid. Local delivery of IL-33 at the time of injury is protective but requires the presence of Treg cells. IL-33 stimulates both mouse and human Tregs to secrete IL-13. Using Foxp3(Cre) × Il4/Il13(fl/fl) mice, we show that Treg expression of IL-13 is required to prevent mortality after acute lung injury by controlling local levels of G-CSF, IL-6, and MCP-1 and inhibiting accumulation of Ly6C(hi) monocytes. Our study identifies a regulatory mechanism involving IL-33 and Treg secretion of IL-13 in response to tissue damage that is instrumental in limiting local inflammatory responses and may shape the myeloid compartment after lung injury.

Objective: To analysis of risk factors for length of stay in intensive care unit and survival outcome from premature infants with premature rupture of membranes (PROM). Methods: A retrospective study including 189 singleton pregnant women with PPROM at 28– 34 gestational weeks was conducted. Gestational age at delivery, route of delivery, oligohydramnios, maternal age and maternal complications including gestational diabetes, preeclampsia and chorioamnionitis, newborn birth weight, gender, premature retinopathy (ROP), necrotizing enterocolitis (NEC), sepsis, fetal growth retardation (FGR), intracranial hemorrhage (ICH), bronchopulmonary dysplasia (BPD), respiratory distress syndrome (RDS), primary pulmonary hypertension (PPH), congenital cardiac disease (CCD), patent ductus arteriosus (PDA) and use of betamethasone were used to predict neonatal outcomes in terms of length of stay in the ICU and survival. Results: The preeclampsia, low birth weight, ROP, CCD, BPD, and PDA were significant confounders for length of stay in the ICU. Among them, low birth weight was the most powerful confounder for prolongation of the ICU stay (P

Motion artifact removal is one of the most important issues in portable ECG (electrocardiogram) monitoring. Motion artifacts are usually accompanied by significant baseline drift. Adaptive filtering has been used to filter motion artifacts and baseline drift. The 3-axis acceleration signal is selected as the noise reference signal. Results show that motion artifacts and baseline drift have been removed in filtered ECG, and the QRS complex of the filtered ECG has clearly appeared.

Although extracorporeal membrane oxygenation (ECMO) has been used frequently as a bridge to primary lung transplantation, active centers are conservative with this approach in patients requiring redo lung transplantation. We report the use of extracorporeal carbon dioxide removal, using the Hemolung respiratory assist system, as a prolonged bridge to lung transplantation, and the first use of the Hemolung as a bridge to redo lung transplantation. Hemolung support improved the patient's clinical status and allowed redo lung transplantation.

A three-lead electrocardiogram acquisition system is constructed with an analog front-end circuit (ADS1293), a microprocessor (MSP430X), and a personal phone or computer. The acquired three-lead (namely, Lead I, Lead II, and Lead V1) ECG data can not only be displayed on a personal computer by a MATLAB simulator but can also be stored in the cloud.

Systemic sclerosis (SSc), or scleroderma, is a heterogeneous and complex autoimmune disease characterized by varying degrees of skin and organ fibrosis and obliterative vasculopathy. The disease results in significant morbidity and mortality, and to date, available treatments are limited. Lung involvement is the leading cause of death of patients with SSc. Over the past year, significant advances have been made in our understanding of SSc-associated lung disease, and this review attempts to encapsulate these most recent findings and place them in context.We divide our discussion of the most recent literature into the following: first, clinical aspects of SSc lung management, including classification, imaging, biomarkers, and treatment; second, promising new animal models that may improve our ability to accurately study this disease; and third, studies that advance or change our understanding of SSc lung disease pathogenesis, thereby raising the potential for new targets for therapeutic intervention.Recent advances have resulted in a better understanding of SSc-associated lung disease, the development of new in-vivo models for exploring disease pathogenesis, and the identification of potential novel targets for the development of therapies.

This paper presents a bandgap reference and an output-capacitorless LDO regulator with adaptive power transistors. The bandgap reference consists of a current reference circuit, a bipolar transistor and proportional-to-absolute-temperature (PTAT) voltage generators. The proposed LDO improves load transient and light load efficiency by permitting the regulator to transform itself between 2-stage and 3-stage topologies, depending on the load current condition. Cadence simulation with SMIC 0.18 μm process shows that the bandgap reference generates a reference voltage 569 mV and the quiescent current is only 0.23 μA, the proposed LDO generates an output voltage 1 V, the quiescent current is 0.88 μA (including bandgap reference) at no-load condition, the undershoot /overshoot voltage is 187 mV/152 mV and the settling time is 5 μs as load current suddenly changes from 0 to 100 mA, or vice versa.

This paper describes in detail an electrocardiogram (ECG) acquisition system comprised of ADS1291, MSP430 and CC2541. ADS1291 amplifies weak analog ECG signal and changes it into digital signals, and then sends it to back-end system and displays it. Patient can use it to acquire ECG signals effectively and simply.

Although advances in surgical technique, immunosuppressive regimens, and medical management have led to improved survival and quality of life after solid organ transplantation, infection continues to represent a major cause of morbidity and mortality in transplant recipients. Immunosuppressive therapy after transplantation compromises cell-mediated immunity in particular, leaving the patient at risk for opportunistic as well as routine community-acquired infections. Mycobacterial infection is a rare but important complication of solid organ transplantation, presenting significant risk to the patient and challenges in terms of treatment. The available literature consists predominantly of case reports and institutional experiences. This article examines both Mycobacterium tuberculosis and nontuberculous mycobacterial infection in the transplant setting.

Due to the difficulties in diagnosing arrhythmia and patients' enthusiasm to attach greater attention to their health, traditional electrocardiogram (ECG) monitoring is facing many challenges. In addition, medical resource distribution problems are particularly obvious. Therefore, the ECG network system for medical resource comprehensive application is proposed in this paper. It is conducive to increasing the cure rate significantly and reducing imbalance of distribution in medical resources. The network system can also effectively improve medical services. The initial implementation proves that ECG network system proposed in this paper is feasible and reasonable.

Acetaminophen toxicity is the most common cause of acute liver failure in the United States and Europe. Although much is known about the metabolism of acetaminophen, many questions remain regarding the pathogenesis of liver injury. In this study, we examined the role of lipopolysaccharide-binding protein (LBP), a protein important in mediating cellular response to lipopolysaccharides, by using LBP wild-type and knockout (KO) mice. We found that LBP KO mice were protected from acetaminophen-induced hepatotoxicity. At 350 mg/kg of acetaminophen, LBP KO mice had significantly less liver injury and necrosis than wild-type mice. Repletion studies in LBP KO mice using an LBP-adenoviral construct resulted in significantly more hepatic injury and necrosis after acetaminophen exposure compared with mice receiving the control adenoviral construct. In conclusion, LBP KO mice are protected from toxicity with a decrease in hepatic necrosis following acetaminophen challenge. This suggests a novel role for LBP in modulating acetaminophen-induced liver injury. Supplementary material for this article can be found on the HEPATOLOGY website (http://interscience.wiley.com/jpages/O270-9139/suppmat/index.html).

The resection of primary and secondary liver tumors has become accepted as the only curative therapy that can be offered to patients with these cancers. Technical advances made over the last two decades have improved the ability of the surgeon to perform these procedures with decreased morbidity. This article reviews hepatic anatomy, the preoperative evaluation of patients and various technical aspects involved in liver resections. The latter includes the role of intraoperative ultrasound and techniques of vascular occlusion and hepatic parenchymal dissection.

Septic complications and the emergence of drug-resistant microbes represent serious risks to patients. Recently, naturally occurring peptides have been discovered that possess potent and broad-spectrum antimicrobial activity. Protegrin-1 is particularly attractive for clinical use in human wounds because, unlike defensins, protegrin-1 retains broad antimicrobial and antifungal activity at physiologic salt concentration and in the presence of serum. The objective of this study was to examine the efficacy of protegrin-1 in killing multiple drug-resistant microbes isolated from human burn patients.For thein vitroexperiment, bilayer radial diffusion was performed comparing standard antibiotics with protegrin-1 on multiple-drug-resistant microbial organisms isolated from infected burn wounds. In vivo, rats received a 20% total body surface area partial-thickness burn by immersion in 60 degrees C water for 20 secs followed by wound seeding with 106 colony forming units of Silvadene-resistant Pseudomonas aeruginosa.University of Michigan research laboratory.Adult, male Sprague-Dawley rats.Rats were randomized into three groups: those receiving synthetic protegrin-1, acetic acid (carrier), or gentamicin (positive control). Protegrin-1 was administered by topical application or intradermal injection. Wound tissues were harvested aseptically at different time points for quantitative bacterial counts.In vivo and in vitro experiments revealed rapid and significant decreases in bacterial counts for protegrin-1-treated groups compared with controls.This study shows that protegrin-1 potentially may be used as an alternative or adjunct therapy to standard agents used to treat wound infections.

Background: We previously demonstrated an essential role for lipopolysaccharide binding protein (LBP) in the pulmonary immune response to Gram-negative bacterial infection. LBP knockout mice had significantly higher mortality, greater rates of bacteremia, and higher counts of viable bacteria in their lungs at killing than did wild-type controls. We postulate that systemic LBP gene therapy will reconstitute a protective innate immune response in LBP knockout mice and that overexpression of LBP in wild-type mice may offer a survival advantage. Methods: Twelve-to 16-week-old female C57BL/6 wild-type mice and age-matched LBP knockout mice were given 5 × 109 plaque-forming units of recombinant adenovirus containing either the gene for LBP or the irrelevant control protein β-galactosidase by tail vein injection; 72 hours later; each mouse was administered 1 × 103 colony-forming units of Klebsiella pneumoniae by intratracheal injection. Results: Administration of LBP by systemic gene therapy to LBP knockout mice improved survival from Klebsiella pneumonia to a level equivalent to or better than that in wild-type mice exposed to the same dose of bacteria (36% versus 25%). Wild-type mice given the LBP gene therapy demonstrated increased 7-day survival from Klebsiella pneumonia when compared with controls treated with β-galactosidase (68% versus 30%; p = 0.03). Conclusion: Systemic gene therapy with intravenous adenoviral vector transfer of LBP significantly improves survival in LBP knockout mice. Overexpression of LBP in wild-type mice improves survival from Klebsiella pneumonia. Raising levels of LBP in the setting of Gram-negative pneumonia may be of therapeutic benefit.

As semiconductor manufacturing moves to the 90nm node and below, shrinking feature sizes and increasing IC complexity have combined to significantly stretch out the time needed to optimize and qualify process anchored OPC models and recipes. Process distortion and non-linearity become non-trivial issues and conspire to reduce the quality of the resulting corrections. Additionally, optimizing the OPC model and recipe on a limited set of test chip designs may not provide sufficient coverage across the range of designs to be produced in the process. Finally, the increased complexity of the transformation of the target pattern into a corrected mask pattern also increases the probability of system lithography errors. Fatal errors (pinch or bridge) or poor CD distribution may still occur. As a result, more than one reticle tape-out cycle is non uncommon to prove models and recipes that approach the center of process for a range of designs. In this paper, we describe a full-chip simulation based verification flow using a commercialized product that serves both OPC model and recipe development as well as post OPC verification after production release of the OPC.

Background An altered Kupffer cell (KC) response is thought to be responsible for the characteristic phenotype observed after biliary obstruction: a phenotype marked by a defect in the hepatic reticuloendothelial system and a hypersensitivity to endotoxin. Few studies, however, have directly examined KC function. We have sought to define the specific alterations in function and phenotype that occur in the KC after biliary obstruction. Methods KCs were isolated from female C57BL/6 mice 4 days after a sham or common bile duct ligation (CBDL) operation. Phagocytosis, oxidative burst potential, and intracellular bacterial killing were measured as markers of reticuloendothelial system function. The KC response to endotoxin was assessed by measuring tumor necrosis factor alpha and interleukin 6 levels in the media after stimulation with lipopolysaccharide (LPS) or with LPS plus LPS-binding protein (LBP). Results CBDL KCs demonstrated a significant increase in phagocytic ability and significantly decreased baseline oxidative stress, compared with Shams. The oxidative burst potential, however, was equivalent or higher for CBDL KCs. CBDL KCs also demonstrated increased numbers of viable intracellular bacteria after infection; however, it is unclear if this finding represents impaired intracellular bacterial killing or increased phagocytosis of bacteria. With respect to the KC response to endotoxin, CBDL KCs were found to be less sensitive to the stimulatory effects of LPS alone but were exquisitely sensitive to the effects of LBP. LBP levels were found to be significantly elevated in CBDL animals, and CBDL KCs demonstrated a dose-dependent, exaggerated tumor necrosis factor alpha and interleukin 6 response to LPS administered with LBP. Conclusions KC function is clearly altered after biliary obstruction. Phagocytic ability is actually increased, although the ability of CBDL KCs to kill bacteria within the phagosome remains ill defined. CBDL KCs are exquisitely sensitive to the effects of LBP, and LBP levels are elevated after biliary obstruction. LBP may be responsible for the increased proinflammatory response observed after endotoxin challenge in animals with biliary obstruction.

Using a full via first (FVF) dual damascene (DD) scheme for copper processing with low-k dielectrics has presented many new challenges to the semiconductor industry. Among those challenges, for photolithography, resist poisoning at the trench level has been the most daunting. Resist and bottom anti-reflective coating (BARC) screenings for poisoning at the 0.13 micrometers and 0.10 micrometers technology nodes have been performed on a variety of KrF and ArF resist and BARC platforms using a simple semi-qualitative method. By varying resist parameters such as resin, photoacid generator (PAG), and solvent types, a lithographically suitable KrF resist is found for the 0.13 micrometers node with minimal sensitivity to poisoning. In addition, ArF resists and BARCs were screened for their sensitivity to poisoning for the 0.10 micrometers node. Suitable resist and BARC candidates are identified for preliminary use for the 0.10 micrometers node.

Skin is equipped with an array of immune mediators aimed at fighting invading microbes. CD14 has been shown to play a key role in modulating the activation of cells by LPS. Since LPS levels within burn wounds are often found to be elevated, we sought to examine the expression of CD14 within human skin following thermal injury.Patients who sustained partial thickness burns, were recruited into the study (n=57). Total RNA was isolated from both burn and normal (control) skin. Northern blot analysis and TaqMan RT-PCR were used to determine skin CD14 mRNA levels. Immunohistochemistry was used to localize CD14 expression in burned and normal skin.Quantitative PCR showed significantly increased CD14 expression levels in the immediate post-burn period (P0.05 burn versus non-burn). Immunohistochemistry revealed more pronounced CD14 staining 24 h after the injury, reaching normal levels approximately 5-7 days post-burn.CD14 expression peaks within the first week post-burn before declining, reaching normal levels after 14 days. This loss of supranormal CD14 expression locally within the wound may contribute to a weakened host defense response 5-6 days after injury, when patients become especially vulnerable to infection.

Inspite of dramatic improvements in the management of burns, infection still remains a serious risk for the burn patient. Bacterial infection and thermal injury have been shown to trigger the inflammatory response. The aim of this study was to shed light on the impact of acute and subacute burn injury with or without infection on cytokine profiles. Sprague-Dawley rats (n =20) were randomized into three groups: 1) burn only 2) burn and bacteria (106 colony forming units of multi-drug resistant pseudomonas aeruginosa) and 3) sham burn. Animals in the first two groups received a 30% TBSA partial thickness burn. Weight changes were monitored daily. Blood was collected after 12,24,48,72 h and 6 and 12 days, and was used for cytokine ELISAs, LPS quantification, and peripheral blood analysis. Animals were sacrificed either after 6 or 12 days. Skin was harvested for bacterial counts, histological analysis and RNA isolation for microarray analysis. Infected animals showed substantial weight loss until day 6 postburn. We also found higher plasma levels (p

As the feature sizes continue to shrink, the requirements for precision and accuracy of CD-SEM metrology become moreand more critical. For line width measurements, the uncertainty in edge position determination due to measurementalgorithms is an important source of error in CD metrology. To improve the accuracy of CD-SEM system, an appropriatealgorithm for a specified type of feature must be determined by comparison to a suitable reference tool. A good algorithmshould also be sensitive to process variation and therefore characterize the process drift accurately. In this report we presenta systematic method to optimize linear approximation algorithm for monitoring 0.25 jm polygate pattern linewidthmeasurement on Hitachi high resolution CDSEM.Keywords: Critical dimension, Line width, Algorithm, Scanning electron microscopy, Metrology, AMP settings, Cross-sectional SEM, Accuracy, Sensitivity

Chemically amplified deep UV photoresist is well known with its sensitivity towards base contaminants either from track and stepper ambience or from substrate. The former gives 'T- top' formation whereas the latter leads to 'footing' in line pattern. This sensitivity originates from the chemically amplification nature that uses photoacid to catalyze the deprotection of resin. To overcome environmental unstability, a variety of chemically stable resists have been formulated. However, during evaluation of some of these new deep UV photoresist, 'bottom pinching' (BP) effect was observed for photoresist on top of organic bottom anti-reflection coating (BARC). BP effect is the slimming of photoresist line immediately above the substrate, which shows the photoresist actually dissolutes at a higher rate near the substrate. This might be caused by higher concentration of acid in the photoresist near the substrate. It is believed that the excess amount of acid diffuses out from the BARC layer. Thus, the softbake of BARC and photoresist, the post-exposure bake of photoresist are to be optimized for the 'bottom pinching' effect.

In the development of i-line 0.35 micrometers technology, the reflection from the poly-Si substrates become so severe that notching was observed in al the areas with larger than 2000 angstrom topological difference during the lithographical masking. As a result, microtrenches and poor electrical characteristics were obtained after etching. By applying 1520 angstrom of organic bottom anti-reflective coating, the reflection from the substrates was greatly reduced from 50 percent to less than 5 percent. Consequently, the design rules developed for i-line 0.35 micrometers technology could be preserved without microtrench formation. The organic BARC also provided additional advantages of planarizing the different topological features on the substrates. And, its etching rate was about the same as the photoresists. The exposure energy and usable depth of focus latitudes were slightly improved with the application of organic BARC. There were basically no differences in masking linearity and iso-dense bias when comparing the critical dimensions of the photoresists with or without applying the organic BARC. The experimental data agreed with the computer simulation data very well. Furthermore, good and were acceptable to the manufacturing environment. Defect density induced by the additional step of coating the organic BARC was very low. Therefore, the implementation of organic BARC was relatively simple and was essential to reduce the notching produced by substrate reflection in the critical layers of the 0.35 micrometers devices.© (1997) COPYRIGHT SPIE--The International Society for Optical Engineering. Downloading of the abstract is permitted for personal use only.

LOCOS is the most widely used method for 0.35 micrometers process isolation. 2000 angstrom silicon nitride on 200 angstrom padoxide was selected as oxidation barrier before process optimization for the need of control the bird's beak and stress which affects the subsequent gate oxide quality. However, resist profile is prone to footing at this film stack. Severe footing could make minimum space CD too small, even not opened, to cause isolation failure. Experiment data shows that if nitride thickness varies from 1.9 K to 2.1 K, line CD variation can be up to 0.08 micrometers for a 0.6 micrometers line, which is about 80 percent of CD variation budget. Based on simulation results, 8 different nitride thickness in the range of 1750 angstrom to 2100 angstrom with step of 50 angstrom were deposited on 200 angstrom padoxide. Swing curve, CD versus nitride thickness for resist Emax and Emin, CD versus different exposure dose charts were obtained. Resist profile cross-sectional SEM pictures were also done to confirm simulation and in-line CD SEM measurement. An optimum combination of substrate film stack and resist thickness was selected. After implementation of this optimization, the sensitivity of CD to the nitride thickness was greatly reduced. Better resist profile and CD control were obtained. This was well confirmed by in-line monitoring data.© (1997) COPYRIGHT SPIE--The International Society for Optical Engineering. Downloading of the abstract is permitted for personal use only.