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Early diagnosis of traumatic wrist injuries may be challenging because wrist anatomy is complex and interpretation of radiographic findings can be difficult. Patients often present with a nonspecific complaint. Inspection for the presence of hematoma, swelling, or deformity is important, as well as range of motion assessment, palpation, and a thorough neurologic examination. Initial x-ray films should always include a posteroanterior, lateral, and oblique view. Scaphoid fractures account for roughly two thirds of all carpal fractures; optimal management is evolving, especially of nondisplaced or minimally displaced fractures. Scapholunate interosseous ligament injury is the most common ligament disorder; arthroscopic evaluation may be both diagnostic and therapeutic. Many carpal dislocations are missed on initial presentation, and poor outcomes often result. [ABSTRACT FROM AUTHOR]

Objective: The study aimed to assess the clinical effects of employing the Huangqi formula (Eefooton; EFT) for chronic kidney disease (CKD) treatment. A narrative literature review was undertaken to elucidate the specific ingredients of EFT and their potential impact on renal health., Methods: A retrospective observational study investigated EFT treatment in outpatients with stable CKD (stages 3B to 5) from March 2019 to March 2021. Patients received 20 mL of EFT thrice daily for 6 months, along with standard treatment. Control groups were matched to the EFT cohort. Regular assessments of renal, liver functions, and lipid profiles were conducted., Results: Serum creatinine (Cr) and eGFR levels consistently improved in stage 3B CKD patients at each follow-up visit. At 6 months, improvement in Cr and eGFR was observed for stage 4 and 5 CKD. Stage 3B CKD patients exhibited notable reductions in systolic blood pressure after 3 and 6 months of EFT treatment. Remarkably, a substantial decrease in HbA1C was noted in stage 4 CKD individuals after three months of therapy. Additionally, stage 4 CKD patients saw a significant reduction in LDL levels after both 3 and 6 months of EFT treatment. A literature review on EFT ingredients indicated that the positive effects of EFT might be associated with its anti-inflammatory, antioxidant, and anti-fibrotic properties., Conclusions: This research demonstrated that incorporating EFT alongside standard treatment enhanced renal function in individuals with CKD. EFT is proposed as a feasible complementary treatment for CKD patients, emphasizing the importance of early intervention.

Reading is vital for acquiring knowledge and studies have demonstrated that phonology-focused interventions generally yield greater improvements than meaning-focused interventions in English among children with reading disabilities. However, the effectiveness of reading instruction can vary among individuals. Among the various factors that impact reading skills like reading exposure and oral language skills, reading instruction is critical in facilitating children's development into skilled readers; it can significantly influence reading strategies, and contribute to individual differences in reading. To investigate this assumption, we developed a computational model of reading with an optimised MikeNet simulator. In keeping with educational practices, the model underwent training with three different instructional methods: phonology-focused training, meaning-focused training, and phonology-meaning balanced training. We used semantic reliance (SR), a measure of the relative reliance on print-to-sound and print-to-meaning mappings under the different training conditions in the model, as an indicator of individual differences in reading. The simulation results demonstrated a direct link between SR levels and the type of reading instruction. Additionally, the SR scores were able to predict model performance in reading-aloud tasks: higher SR scores were correlated with increased phonological errors and reduced phonological activation. These findings are consistent with data from both behavioral and neuroimaging studies and offer insights into the impact of instructional methods on reading behaviors, while revealing individual differences in reading and the importance of integrating OP and OS instruction approaches for beginning readers., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Chang, Chang, Lin, Kuo, Shi and Lee.)

Objective: To explore the prevalence and distinctive features of Xue-Fu-Zhu-Yu-Tang (XFZYT) prescriptions by analyzing the National Health Insurance Research Database (NHIRD) to identify the specific medical problems for which XFZYT is prescribed. Methods: This nationwide, population-based, cross-sectional study included 109,073 XFZYT users and 532,848 XFZYT non-users among Chinese herbal product (CHP) users in NHIRD. Chi-squared tests were used to analyze disparities between the XFZYT user and XFZYT non-user cohorts, and the mean age was evaluated using the Wilcoxon rank-sum test. Logistic regression was used to compute the odds ratios (ORs) and 95% confidence intervals (95% CIs). Results: XFZYT was frequently used to treat pain. The top five conditions for which the Taiwanese traditional Chinese medicine (TCM) practitioners would prescribe XFZYT were chest pain; headache; myalgia and myositis; lumbago; and neuralgia, neuritis, and radiculitis. Conclusion: This study represents an inaugural comprehensive survey conducted on the utilization of XFZYT prescriptions among patients with diverse diseases. XFZYT is mostly used to treat pain conditions in Taiwan. Combined with the combination use of other CHPs, XFZYT is used to treat symptoms of the chest and respiratory system, soft tissue conditions, menstruation disorders, and joint and back discomfort. These results suggest that further clinical trials are warranted to verify the effects of XFZYT in pain management., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Kuo, Hsu, Chen, Wu, Hung, Hsu, Tsai and Hu.)

Existing evidence supports an association between chemerin levels and cardiovascular risk, while reduced thiol levels are linked to diabetes mellitus. It is hypothesized that chemerin may contribute to autonomic dysfunction and cardiovascular risk in type 2 diabetes mellitus (T2DM), potentially mediated by the antioxidant capacity of patients with well-controlled T2DM and prediabetes. Comprehensive cardiovascular autonomic testing and biomarker assessments were conducted for all participants. The severity of cardiovascular autonomic neuropathy (CAN) was evaluated using the composite autonomic scoring scale (CASS). A mediation model was employed to explore the potential relationships among chemerin levels, antioxidant capacity (indicated by thiol levels), and CAN severity (indicated by CASS values). A total of 184 participants were enrolled in this study, comprising 143 individuals with T2DM and 40 individuals with prediabetes. The findings reveal a significant negative association between thiols levels (r = -0.38, p < 0.0001) and the CASS values, while a positive association is observed between chemerin levels (r = 0.47, p < 0.0001) and the CASS values. Linear regression analysis identified chemerin and thiols as independent variables significantly associated with CASS values. Subsequent mediation analysis elucidated that thiols levels act as mediators in the relationship between elevated chemerin levels and an increased CASS value. This study shows that poor cardiovascular function, higher chemerin levels, and reduced antioxidant capacity coexist in individuals with T2DM and prediabetes. Mediation analysis suggests a pathophysiological link between high chemerin levels and low antioxidant capacity, adversely impacting CAN severity.

Competing Interests: Declaration of Competing Interest None.

Objective: Little information is available about deep learning methods used in ultrasound images of salivary gland tumors. We aimed to compare the accuracy of the ultrasound-trained model to computed tomography or magnetic resonance imaging trained model., Materials and Methods: Six hundred and thirty-eight patients were included in this retrospective study. There were 558 benign and 80 malignant salivary gland tumors. A total of 500 images (250 benign and 250 malignant) were acquired in the training and validation set, then 62 images (31 benign and 31 malignant) in the test set. Both machine learning and deep learning were used in our model., Results: The test accuracy, sensitivity, and specificity of our final model were 93.5%, 100%, and 87%, respectively. There were no over fitting in our model as the validation accuracy was similar with the test accuracy., Conclusions: The sensitivity and specificity were comparable with current MRI and CT images using artificial intelligence., (© 2023 Wiley Periodicals LLC.)

Eight gene clusters responsible for synthesizing bioactive metabolites associated with plant growth promotion were identified in the Bacillus cereus strain D1 (BcD1) genome using the de novo whole-genome assembly method. The two largest gene clusters were responsible for synthesizing volatile organic compounds (VOCs) and encoding extracellular serine proteases. The treatment with BcD1 resulted in an increase in leaf chlorophyll content, plant size, and fresh weight in Arabidopsis seedlings. The BcD1-treated seedlings also accumulated higher levels of lignin and secondary metabolites including glucosinolates, triterpenoids, flavonoids, and phenolic compounds. Antioxidant enzyme activity and DPPH radical scavenging activity were also found to be higher in the treated seedlings as compared with the control. Seedlings pretreated with BcD1 exhibited increased tolerance to heat stress and reduced disease incidence of bacterial soft rot. RNA-seq analysis showed that BcD1 treatment activated Arabidopsis genes for diverse metabolite synthesis, including lignin and glucosinolates, and pathogenesis-related proteins such as serine protease inhibitors and defensin/PDF family proteins. The genes responsible for synthesizing indole acetic acid (IAA), abscisic acid (ABA), and jasmonic acid (JA) were expressed at higher levels, along with WRKY transcription factors involved in stress regulation and MYB54 for secondary cell wall synthesis. This study found that BcD1, a rhizobacterium producing VOCs and serine proteases, is capable of triggering the synthesis of diverse secondary metabolites and antioxidant enzymes in plants as a defense strategy against heat stress and pathogen attack.

Chromosomes are a principal target of clinical cytogenetic studies. While chromosomal analysis is an integral part of prenatal care, the conventional manual identification of chromosomes in images is time-consuming and costly. This study developed a chromosome detector that uses deep learning and that achieved an accuracy of 98.88% in chromosomal identification. Specifically, we compiled and made available a large and publicly accessible database containing chromosome images and annotations for training chromosome detectors. The database contains five thousand 24 chromosome class annotations and 2,000 single chromosome annotations. This database also contains examples of chromosome variations. Our database provides a reference for researchers in this field and may help expedite the development of clinical applications., (© 2023. The Author(s).)

Background: Opioid use disorder occurs worldwide and creates an increasing economic burden and public health crisis. Some problems are associated with using opioid agonists; therefore, there is a need to develop non-opioid treatments to improve acute and long-term opioid withdrawal syndromes., Methods: We will enroll 100 participants with opioid use disorders receiving methadone maintenance treatment at an addiction treatment center and randomly allocate them to an experimental or control group. The experimental group will receive 12 sessions of light needle therapy within 4 weeks, while the control group will receive sham light needle treatment without any laser output. Urinary morphine levels were assessed before and after treatment. Participants will be asked to self-report their number of episodes or days of heroin use and heroin craving/refusal to use heroin in the previous week before and after treatment on a visual analogue scale score of 0 to 10. Quality of life will be reported using the Short Form-12v2 before and after 4 weeks of treatment. Pulse diagnosis and heart rate variability will be evaluated before and after treatment. Baseline patient characteristics will be compared between the groups using the independent t test and the χ2 test. Data between the 2 groups will be compared using generalized estimation equations, and paired t tests., Objective: This study aims to investigate the effect of adjuvant light needle therapy in patients with opioid use disorder on methadone maintenance treatment., (Copyright © 2022 the Author(s). Published by Wolters Kluwer Health, Inc.)

Background: Upon the discovery of ovarian cysts, obstetricians, gynecologists, and ultrasound examiners must address the common clinical challenge of distinguishing between benign and malignant ovarian tumors. Numerous types of ovarian tumors exist, many of which exhibit similar characteristics that increase the ambiguity in clinical diagnosis. Using deep learning technology, we aimed to develop a method that rapidly and accurately assists the different diagnosis of ovarian tumors in ultrasound images., Methods: Based on deep learning method, we used ten well-known convolutional neural network models (e.g., Alexnet, GoogleNet, and ResNet) for training of transfer learning. To ensure method stability and robustness, we repeated the random sampling of the training and validation data ten times. The mean of the ten test results was set as the final assessment data. After the training process was completed, the three models with the highest ratio of calculation accuracy to time required for classification were used for ensemble learning pertaining. Finally, the interpretation results of the ensemble classifier were used as the final results. We also applied ensemble gradient-weighted class activation mapping (Grad-CAM) technology to visualize the decision-making results of the models., Results: The highest mean accuracy, mean sensitivity, and mean specificity of ten single CNN models were 90.51 ± 4.36%, 89.77 ± 4.16%, and 92.00 ± 5.95%, respectively. The mean accuracy, mean sensitivity, and mean specificity of the ensemble classifier method were 92.15 ± 2.84%, 91.37 ± 3.60%, and 92.92 ± 4.00%, respectively. The performance of the ensemble classifier is better than that of a single classifier in three evaluation metrics. Moreover, the standard deviation is also better which means the ensemble classifier is more stable and robust., Conclusion: From the comprehensive perspective of data quantity, data diversity, robustness of validation strategy, and overall accuracy, the proposed method outperformed the methods used in previous studies. In future studies, we will continue to increase the number of authenticated images and apply our proposed method in clinical settings to increase its robustness and reliability., (© 2022. The Author(s).)

It is very important to have good quality sleep, which can affect aspects such as memory consolidation, emotional regulation, learning, physical development, and quality of life. Diagnosing human sleep quality and problems quickly and accurately is an important issue for human well-being. Therefore, many automatic sleep scoring methods have been proposed. However, the methods have been developed using sleep data from different individuals or groups. The accuracies of these proposed methods might decrease, due to existing individual differences. In this study, the self-attention generative adversarial network (SAGAN) was applied as an advanced data augmentation technique to propose an improved personalized automatic sleep scoring classification. First, the spectrograms were converted from electroencephalography (EEG). Then, SAGAN was used to generate synthesized spectrograms for each subject. Finally, the real and synthesized spectrograms of each subject were utilized to train a personalized classifier. The averaged accuracy and standard deviation of the proposed method are 95.74% and 3.78%, respectively. Compared to the classifier trained with all subjects' training data, the average accuracy increased by 8.08%. The results proved that the generated spectrograms significantly improved the performance of the personalized automatic sleep scoring classification. The contributions of the proposed method were that made the medical staff and subjects save massive medical resources and time for manual recording and scoring., (Copyright © 2022 Elsevier Ltd. All rights reserved.)

Background: The incidence of opioid use disorder (OUD) is increasing worldwide, and the opioid-related overdose crisis is currently a major global challenge. This study investigated the effects of adjuvant laser meridian massage (LMM) in men with OUD undergoing methadone maintenance treatment (MMT)., Methods: A case-controlled study was conducted from February 2019 to April 2020. Fourteen men with OUD on MMT were enrolled from an addiction treatment center as an experimental group. An age-matched control group comprising 13 men was also enrolled. The experimental group received LMM on the back, including over the Bladder meridian and Governor Vessel, three times weekly for 4 weeks. The control group received only MMT. Urinary morphine levels, patients' self-reports of the number of episodes or days of heroin use, and visual analog scale scores for heroin craving/refusal to use heroin during the previous week were evaluated. Quality of life was reported using the Short Form (SF)-12v2., Results: The experimental group showed a significant decrease in heroin use (p < 0.05), whereas the control group showed a significant increase in heroin craving (p < 0.05). The SF-12v2 Health Survey revealed a significant improvement in physical health in the experimental group (P < 0.05)., Conclusion: The results of this study suggest that laser meridian massage can be considered a safe, well-tolerated, and potentially useful adjuvant intervention for opioid use disorder., Competing Interests: Conflicts of interest The authors declare no conflicts of interest., (Copyright © 2021 Chang Gung University. Published by Elsevier B.V. All rights reserved.)

Background: Grounding refers to having direct contact with the Earth, such as by walking barefoot or lying on the ground. Research has found that grounding can improve inflammation, free radical damage, blood pressure, sleep quality, pain, stress, mood, and wound healing. However, there has been no research on the effect of utilizing grounding for patients with Alzheimer's disease (AD). Thus, in this study, we investigated the effectiveness of grounding as a non-pharmacological therapy for treating sleep disturbances, anxiety, and depression in patients with mild AD., Methods: Patients with mild AD were enrolled in the study. The electrochemical analyzer CHI 1205b was employed to check the electrochemical signals at acupoints KI1 and GV16. We used the Pittsburgh Sleep Quality Index (PSQI), Beck Anxiety Inventory (BAI), and Beck Depression Inventory-II (BDI-II) to evaluate sleep quality, anxiety, and depression, respectively, at weeks 0 and 12., Results: This 12-week placebo-controlled study enrolled 22 patients, but only 15 patients completed the 12-week intervention and survey. Grounding significantly improved PSQI scores compared to the sham-grounding group (mean ± SD: 0.3 ± 0.7 vs. 3.0 ± 1.9, p = 0.006). The scores on the BAI and BDI-II did not change significantly after grounding in comparison to the sham-grounding group., Conclusions: Grounding can improve sleep quality, but it does not significantly improve anxiety and depression among patients with mild AD.

Objective: While radix Salvia miltiorrhiza (Danshen; RSM) is commonly used in Chinese herbal medicine, its current usage has not yet been analyzed in a large-scale survey. This study aimed to investigate the conditions for which RSM is prescribed and the utilization of RSM in Taiwan. Methods: 1 million beneficiaries enrolled in the Taiwan National Health Insurance Research Database were sampled to identify patients who were prescribed RSM. Next, the diagnoses of these patients based on the International Classification of Diseases 9th Revision Clinical Modification code were analyzed. Logistic regression analysis was employed to estimate the odds ratio (OR) for RSM utilization. Results: Patients with disorders of menstruation and abnormal bleeding from the female genital tract due to other causes were the diagnostic group most commonly treated with RSM (9.48%), followed by those with general (9.46%) and cardiovascular symptoms (4.18%). Subjects treated with RSM were mostly aged 35-49 years (30.1%). The most common combination of diseases for which RSM was prescribed (0.17%) included menopausal disorders and general symptoms. Women were more likely to receive RSM than men (OR = 1.75, 95% confidence interval = 1.73-1.78). RSM was frequently combined with Yan-Hu-Suo and Jia-Wei-Xiao-Yao-San for clinical use. Conclusion: To date, this is the first study to identify the most common conditions for which RSM is used in modern Taiwan. The results indicate RSM as a key medicinal herb for the treatment of gynecological diseases, including menstrual disorders, female genital pain, menopausal disorders, etc. The most common combination for which RSM is prescribed is menopausal disorders and general symptoms. Further research is needed to elucidate the optimal dosage, efficacy, and safety of RSM., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2021 Tseng, Hung, Kuo, Chung, Hsu, Muo, Hsu and Hu.)

Objectives: To investigate the efficacy of laser acupuncture (LA) therapy in patients with dry eye disease (DED). Design: A two-center randomized controlled trial. Settings/Location: The Department of Ophthalmology, Chinese Medicine at the Kaohsiung Chang Gung Memorial Hospital, and the Sunming Eye Clinic in South Taiwan. Subjects: Fifty-nine participants ages 20 to 65 years were enrolled and randomly assigned to the experimental group (LA plus conventional treatment) or the sham control group (LA without laser output plus conventional treatment). Interventions: Subjects underwent LA treatment three times a week for 12 weeks. The subjects in the experimental group sequentially received 0.375 J of energy at each of the following acupoints: BL2, TE23, ST2, LI4, ST36, and GB37. Subjects in the control group received a sham LA treatment, without any laser output. Outcome Measures: The primary outcome measure was ocular surface disease index (OSDI). The secondary outcome measures included tear film breakup time (TFBUT), Schirmer-I test finding, and visual analog scale (VAS) score. Results: At 4 and 12 weeks after the first visit, the experimental group showed significant improvement of dry eye symptoms as measured by OSDI, TFBUT, Shirmer-I test, and VAS. Compared with the control group, the OSDI (7.23, p  = 0.001) and TFBUT (-1.78, p  = 0.001) significantly improved in the experimental group at 12 weeks of treatment. Conclusions: LA improved the symptoms and tear stability related to DED in conjunction with conventional treatment. The authors suggest that LA be considered a complementary therapy for DED when conventional treatment does not provide satisfactory effects. Trial Registration: ClinicalTrials.gov Identifier NCT03204903.

Objective: Combinations of Chinese herbal products (CHPs) are widely used for Parkinson's disease (PD) in Taiwan. Thereby, we investigated the use of CHPs in patients with PD. Methods: This study was a population-based cohort study that analyzed the data of patients with PD from the National Health Insurance Research Database. A total of 9,117 patients were selected from a random sample of one million individuals included in this database. We used multiple logistic regression models to estimate the adjusted odds ratios of the demographic factors and analyzed the formula and single CHPs commonly used for PD. Results: Traditional Chinese medicine users were more commonly female, younger, of white-collar status, and residents of Central Taiwan. Chaihu-Jia-Longgu-Muli-Tang was the most commonly used formula, followed by Ma-Zi-Ren-Wan and then Shao-Yao-Gan-Cao-Tang. The most commonly used single herb was Uncaria tomentosa (Willd. ex Schult.) DC., followed by Gastrodia elata Blume and then Radix et Rhizoma Rhei ( Rheum palmatum L., Rheum tanguticum Maxim . ex Balf., and Rheum officinale Baill.). Chaihu-Jia-Longgu-Muli-Tang and U. tomentosa (Willd. ex Schult.) DC . have shown neuroprotective effects in previous studies, and they have been used for managing non-motor symptoms of PD. Conclusion: Chaihu-Jia-Longgu-Muli-Tang and U. tomentosa (Willd. ex Schult.) DC . are the most commonly used CHPs for PD in Taiwan. Our results revealed the preferences in medication prescriptions for PD. Further studies are warranted to determine the effectiveness of these CHPs for ameliorating the various symptoms of PD, their adverse effects, and the mechanisms underlying their associated neuroprotective effects., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2021 Lin, Chiu, Wu, Tseng, Wu, Hung, Hsu, Chen, Hsu, Kuo and Hu.)

Purpose: Sleep is an important human activity. Comfortable sensing and accurate analysis in sleep monitoring is beneficial to many healthcare and medical applications. From 2020, owing to the COVID‑19 pandemic that spreads between people when they come into close physical contact with one another, the willingness to go to hospital for receiving care has reduced; care-at-home is the trend in modern healthcare. Therefore, a home-use and real-time sleep-staging system is developed in this paper., Methods: We developed and implemented a real-time sleep staging system that integrates a wearable eye mask for high-quality electroencephalogram/electrooculogram measurement and a mobile device with MobileNETV2 deep learning model for sleep-stage identification. In the experiments, 25 all-night recordings were acquired, 17 of which were used for training, and the remaining eight were used for testing., Results: The averaged scoring agreements for the wake, light sleep, deep sleep, and rapid eye movement stages were 85.20%, 87.17%, 82.87%, and 89.30%, respectively, for our system compared with the manual scoring of PSG recordings. In addition, the mean absolute errors of four objective sleep measurements, including sleep efficiency, total sleep time, sleep onset time, and wake after sleep onset time were 1.68%, 7.56 min, 5.50 min, and 3.94 min, respectively. No significant differences were observed between the proposed system and manual PSG scoring in terms of the percentage of each stage and the objective sleep measurements., Conclusion: These experimental results demonstrate that our system provides high scoring agreements in sleep staging and unbiased sleep measurements owing to the use of EEG and EOG signals and powerful mobile computing based on deep learning networks. These results also suggest that our system is applicable for home-use real-time sleep monitoring., (© Taiwanese Society of Biomedical Engineering 2021.)

Postural orthostatic tachycardia syndrome (POTS) typically occurs in youths, and early accurate POTS diagnosis is challenging. A recent hypothesis suggests that upright cognitive impairment in POTS occurs because reduced cerebral blood flow velocity (CBFV) and cerebrovascular response to carbon dioxide (CO 2 ) are nonlinear during transient changes in end-tidal CO 2 (P ETCO 2 ). This novel study aimed to reveal the interaction between cerebral autoregulation and ventilatory control in POTS patients by using tilt table and hyperventilation to alter the CO 2 tension between 10 and 30 mmHg. The cerebral blood flow velocity (CBFV), partial pressure of end-tidal carbon dioxide (P ETCO 2 ), and other cardiopulmonary signals were recorded for POTS patients and two healthy groups including those aged >45 years (Healthy-Elder) and aged <45 years (Healthy-Youth) throughout the experiment. Two nonlinear regression functions, Models I and II, were applied to evaluate their CBFV-P ETCO 2 relationship and cerebral vasomotor reactivity (CVMR). Among the estimated parameters, the curve-fitting Model I for CBFV and CVMR responses to CO 2 for POTS patients demonstrated an observable dissimilarity in CBFV max ( p = 0.011), mid-P ETCO 2 ( p = 0.013), and P ETCO 2 range ( p = 0.023) compared with those of Healthy-Youth and in CBFV max ( p = 0.015) and CVMR max compared with those of Healthy-Elder. With curve-fitting Model II for POTS patients, the fit parameters of curvilinear ( p = 0.036) and P ETCO 2 level ( p = 0.033) displayed significant difference in comparison with Healthy-Youth parameters; range of change ( p = 0.042), P ETCO 2 level, and CBFV max also displayed a significant difference in comparison with Healthy-Elder parameters. The results of this study contribute toward developing an early accurate diagnosis of impaired CBFV responses to CO 2 for POTS patients.

Steroid hormones have been proven as a key drive of sex change in sequentially hermaphroditic organisms. However, the upstream mechanism of sex steroid hormones regulation that affect sex change remain unknown. The main glucocorticoid in teleost fish is cortisol, which both regulates steroidogenesis and has antistress action. Thus, cortisol might be one of the prime factors in sex change. In this study, the glucocorticoid-induced leucine zipper (GILZ) gene, was proven to have a dramatic effect in orange-spotted groupers (Epinephelus coioides) during sex change at the early stage of gonadal transition. The specific action of the GILZ protein is at the pouch-shaped proliferative spermatogonia instead of the degenerative oocyte at the onset of sex change. Immunohistochemical (IHC) evidence revealed that GILZ performs intensively at undifferentiated spermatogonia in the early testis stage. These results imply that cortisol provokes a rise of GILZ through regulation caused by steroid hormones leading to sex change., Competing Interests: Declaration of competing interest The authors have declared that there are no conflicts of interest., (Copyright © 2020. Published by Elsevier Inc.)

Rationale: Coccyx fracture is an injury usually caused by trauma. In most cases, the fractures recover after conservative therapy. For refractory cases that exhibit coccydynia after more than 2 months of conservative treatment, coccygectomy is indicated. However, limited information about the efficacy of this procedure is available, and it is known to have a high complication rate. As such, other therapeutic approaches are needed. Here, we report our experience using another conservative treatment option, low-level laser therapy, to successfully reduce refractory coccydynia in a patient with coccyx fracture., Patient Concerns: A 23-year-old woman had refractory coccydynia and increased pain after a traffic accident-induced coccyx fracture., Diagnoses: Initially, the patient reported transient improvement after conservative treatment with non-steroidal anti-inflammatory drugs. However, the pain increased in severity (numerical rating scale score of 8) soon after she resumed work in her office, and progressed in the following 2 months. Surgical intervention was suggested owing to the prolonged coccydynia following the failure of conservative treatment and difficulties in performing daily life activities. However, she sought other conservative therapy options, because she was concerned about the risks associated with the coccygectomy surgery., Interventions: The patient received low-level laser therapy once a week, for 24 weeks., Outcomes: After 11 weeks of treatment, the patient reported significant improvements in her symptoms; her pain was reduced to a numerical rating scale score of 2 and bone healing was noted on radiographs. The patient could eventually perform her daily activities satisfactorily, without coccydynia, after 24 weeks of treatment., Lessons: Laser acupuncture produced analgesic effects in this patient with refractory coccydynia after traumatic coccyx fracture. This is the first case report to apply laser acupuncture for refractory coccydynia after traumatic coccyx fracture. Our findings imply that laser acupuncture may be a good conservative therapy option for coccyx fracture.

Background: Sleep problem or disturbance often exists in pain or neurological/psychiatric diseases. However, sleep scoring is a time-consuming tedious labor. Very few studies discuss the 5-stage (wake/NREM1/NREM2/transition sleep/REM) automatic fine analysis of wake-sleep stages in rodent models. The present study aimed to develop and validate an automatic rule-based classification of 5-stage wake-sleep pattern in acid-induced widespread hyperalgesia model of the rat., Results: The overall agreement between two experts' consensus and automatic scoring in the 5-stage and 3-stage analyses were 92.32% (κ = 0.88) and 94.97% (κ = 0.91), respectively. Standard deviation of the accuracy among all rats was only 2.93%. Both frontal-occipital EEG and parietal EEG data showed comparable accuracies. The results demonstrated the performance of the proposed method with high accuracy and reliability. Subtle changes exhibited in the 5-stage wake-sleep analysis but not in the 3-stage analysis during hyperalgesia development of the acid-induced pain model. Compared with existing methods, our method can automatically classify vigilance states into 5-stage or 3-stage wake-sleep pattern with a promising high agreement with sleep experts., Conclusions: In this study, we have performed and validated a reliable automated sleep scoring system in rats. The classification algorithm is less computation power, a high robustness, and consistency of results. The algorithm can be implanted into a versatile wireless portable monitoring system for real-time analysis in the future.

Background: Heroin addiction remains a significant public health problem worldwide, and relapse to heroin use following cessation of agonist maintenance treatment is common. The problems associated with use of opioid agonists mean that non-opioid therapies need to be developed to ameliorate acute and protracted opioid withdrawal syndromes., Methods: Fifteen men with opioid use disorder on methadone maintenance treatment have been enrolled from an addiction treatment center as an experimental group in this case-controlled study. This group is receiving laser meridian massage on the back, including the Bladder meridian and Governor Vessel, 3 times weekly for 4 weeks. An age-matched control group that does not receive laser meridian massage has also been enrolled. Urinary morphine levels are being checked before and after 2 and 4 weeks of treatment. Subjects are requested to self-report their number of episodes or days of heroin use and 0 to 10-point visual analogue scale scores for heroin craving/refusal to use heroin during the previous week before and after 2 and 4 weeks of treatment. Quality of life will be reported using the Short Form-12v2 before and after 4 weeks of treatment. Pulse diagnosis will be recorded and heart rate variability calculated after one single treatment session. The baseline patient characteristics will be compared between the experimental and control groups using the independent t test and Chi-square test. Data are compared between the 2 groups using repeated-measures analysis of variance, generalized estimating equations, and the paired t test., Objective: To investigate the effect of adjuvant laser meridian massage in men with opioid use disorder on methadone maintenance treatment., Trial Registration: ClinicalTrials.gov NCT04003077.

The overnight polysomnographic (PSG) recordings of patients were scored by an expert to diagnose sleep disorders. Visual sleep scoring is a time-consuming and subjective process. Automatic sleep staging methods can help; however, the mechanism and reliability of these methods are not fully understood. Therefore, experts often need to rescore the recordings to obtain reliable results. Here, we propose a human-computer collaborative sleep scoring system. It is a rule-based automatic sleep scoring method that follows the American Academy of Sleep Medicine (AASM) guidelines to perform an initial scoring. Then, the reliability level of each epoch is analyzed based on physiological patterns during sleep and the characteristics of various stage changes. Finally, experts would only need to rescore epochs with a low-reliability level. The experimental results show that the average agreement rate between our system and fully manual scorings can reach 90.42% with a kappa coefficient of 0.85. Over 50% of the manual scoring time can be reduced. Due to the demonstrated robustness and applicability, the proposed approach can be integrated with various PSG systems or automatic sleep scoring methods for sleep monitoring in clinical or homecare applications in the future., Competing Interests: The authors have declared that no competing interests exist.

Background: The aim of this study was to compare the short-term and intermediate-term efficacy of acupuncture plus fire needle therapy with that of acupuncture alone in the treatment of lateral epicondylitis (LE)., Methods: Thirty-eight patients with LE who had persisted for at least 2 months were enrolled in this prospective, assessor-blinded, randomized controlled pilot trial. Twenty-one patients were randomized to the acupuncture plus fire needle group and 17 to the acupuncture-only group. The primary outcome was the visual analog scale pain score for the previous 24 hours and the secondary outcomes were the maximum grip strength, Patient-rated Forearm Evaluation Questionnaire score, and Medical Outcomes Study 36-Item Short-form Health Survey score. The values at baseline (pretreatment), at the end of treatment, and at 3 months after treatment were used to assess the short-term and intermediate-term effects of treatment. The data were analyzed using the Chi-square test and t test., Results: Within-group analyses showed better results for acupuncture plus fire needle therapy in the short term and intermediate term. Differences in the severity of pain and secondary outcomes were significant in the intermediate term in the acupuncture group. At the end of treatment, none of the differences in outcome scores were significant, except for maximum grip strength in the affected hand in the acupuncture group. No significant between-group differences in short-term or intermediate-term outcomes were observed., Conclusion: Acupuncture plus fire needle therapy was effective in the short term in patients seeking improvement of LE. Twelve treatments were effective for relieving pain and improving disability in the intermediate term in patients with chronic LE in both study groups. The findings of the pilot study confirm the feasibility of proceeding to a larger randomized controlled study of the longer-term effects of acupuncture plus fire needle therapy in patients with LE.

Background: Although corticosteroids are an effective anti-inflammatory adjuvant therapy, the role of adjunctive steroid therapy in treating adult bacterial meningitis in Taiwan remains controversial., Methods: Cases of acute bacterial meningitis were identified from the annual hospitalization discharge claims of the National Health Insurance Research Database using International Classification of Diseases, Ninth Revision codes from January 2000 to December 2013. Patients were classified into two groups: (1) steroid group (adjunctive steroids and empirical antibiotics) and (2) placebo group (empirical antibiotics only)., Results: There were 15,037 patients enrolled in this study; of these, 57% (7175/15,037) and 52% (7862/15,037) were placed in the placebo and steroid groups, respectively. The case-fatality rates were 11.5% (826/7175) in the placebo group and 19.9% (1562/7862) in the steroid groups during hospitalization (P = 0.77). Further, the hazard ratio (relative to placebo group) of in-hospital and one-year case fatality rate were 0.923 (95% confidence interval [CI]: 0.846-1.007, P = 0.073) and 1.514 (95% CI: 1.425-1.608, P < 0.0001) according to the multivariate Cox model after adjustment for age and sex., Conclusion: On the basis of these results, steroid group had a more fulminant clinical course (e.g., acute respiratory failure and pneumonia, etc.), and unfavorable outcomes than placebo group. Therefore, more prospective, randomized, double-blind trials are warranted to evaluate the efficacy of adjunctive steroid therapy in treating adult bacterial meningitis in Taiwan., (Copyright © 2018 Elsevier Ltd. All rights reserved.)

Study Objective: Do-not-resuscitate (DNR) status has been shown to be an independent risk factor for mortality in the post-operative period. Patients with DNR orders often undergo elective surgeries to alleviate symptoms and improve quality of life, but there are limited data on outcomes for informed decision making., Design: Retrospective cohort study., Setting: A multi-institutional setting including operating room, postoperative recovery area, inpatient wards, and the intensive care unit., Patients: A total of 566 patients with a DNR status and 316,431 patients without a DNR status undergoing elective procedures using the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) from 2012., Interventions: Patients undergoing elective surgical procedures., Measurements: We analyzed the risk-adjusted 30-day morbidity and mortality outcomes for the matched DNR and non-DNR cohorts undergoing elective surgeries., Main Results: DNR patients had significantly increased odds of 30-day mortality (OR 2.51 [1.55-4.05], p < 0.001) compared with non-DNR patients. In the DNR versus non-DNR cohort there was no significant difference in the occurrence of a number of 30-day complications, the rate of resuscitative measures undertaken, including cardiac arrest requiring CPR, reintubation, or return to the OR. The most common complications in both DNR and non-DNR patients undergoing elective procedures were transfusion, urinary tract infection, reoperation, and sepsis. Finally, the DNR patients had a significantly increased total length of hospital stay (7.65 ± 9.55 vs. 6.87 ± 9.21 days, p = 0.002)., Conclusions: DNR patients, as compared with non-DNR patients, have increased post-operative mortality but not morbidity, which may arise from unmeasured severity of illness or transition to comfort care in accordance with a patient's wishes. The informed consent process for elective surgeries in this patient population should include a discussion of acceptable operative risk., (Copyright © 2018 Elsevier Inc. All rights reserved.)

Objective: In this study, a wearable actigraphy recording device with low sampling rate (1 Hz) for power saving and data reduction and a high accuracy wake-sleep scoring method for the assessment of sleep were developed., Methods: The developed actigraphy recorder was successfully applied to overnight recordings of 81 subjects with simultaneous polysomnography (PSG) measurements. The total length of recording reached 639.8 h. A wake-sleep scoring method based on the concept of movement density evaluation and adaptive windowing was proposed. Data from subjects with good (N = 43) and poor (N = 16) sleep efficiency (SE) in the range of 52.7-97.42% were used for testing. The Bland-Altman technique was used to evaluate the concordance of various sleep measurements between the manual PSG scoring and the proposed actigraphy method., Results: For wake-sleep staging, the average accuracy, sensitivity, specificity, and kappa coefficient of the proposed system were 92.16%, 95.02%, 71.30%, and 0.64, respectively. For the assessment of SE, the accuracy of classifying the subject with good or poor SE reached 91.53%. The mean biases of SE, sleep onset time, wake after sleep onset, and total sleep time were -0.95%, 0.74 min, 2.84 min, and -4.3 min, respectively., Conclusion: These experimental results demonstrate the robustness and reliability of our method using limited activity information to estimate wake-sleep stages during overnight recordings., Significance: The results suggest that the proposed wearable actigraphy system is practical for the in-home screening of objective sleep measurements and objective evaluation of sleep improvement after treatment.

Objective: In this paper, the genetic fuzzy inference system based on expert knowledge for automatic sleep staging was developed., Methods: Eight features, including temporal and spectrum analyses of the EEG and EMG signals, were utilized as the input variables. The fuzzy rules and the fuzzy sets were constructed based on expert knowledge and the distributions of feature values at different sleep stages. Three experiments were designed to develop and evaluate the proposed system. PSGs of 32 healthy subjects and 16 subjects with insomnia were included in the experiment to develop and evaluate the proposed method. Finally, a complete sleep scoring system integrating two fuzzy inference models with robust performance on various subject groups is developed., Results: The overall agreement and kappa coefficient of this integrated system applied to PSG data from 8 subjects with good sleep efficiency, 8 subjects with poor sleep efficiency and 8 subjects with insomnia were 86.44 % and 0.81, respectively., Conclusion: Due to the high performance of the proposed system, it is expected to integrate the proposed method with various PSG systems for sleep monitoring in clinical or homecare applications in the future., Significance: An automatic sleep staging system integrating knowledge of the experts in scoring of PSG data and the elasticity of fuzzy systems in reasoning and decision making is proposed and the robustness and clinical applicability of the proposed method is demonstrated on data from healthy subjects and subjects with insomnia.

Background: Gestational weight gain and weight retention at 1 year after delivery are associated with long-term obesity. We aimed to investigate the effect of laser acupuncture therapy on postpartum weight control., Methods: We randomly assigned 66 subjects with postpartum weight retention to a laser acupuncture group and control group. The subjects were treated at acupoints including the stomach and hunger points of the ear, ST25, ST28, ST40, SP15, CV9, and SP6 by using verum or sham laser acupuncture over 5 sessions per week. After 12 treatment sessions, the differences in the body mass index (BMI), body fat percentage (BFP), and waist-to-buttocks ratio (WBR) of the patients were analyzed and compared between the laser acupuncture and control groups via analysis of variance, chi-square tests, and stepwise regression tests., Results: The characteristics of the patients did not significantly differ between the laser acupuncture and control groups. Analysis of repeated measures data between the laser acupuncture and control groups indicated the presence of significant differences in postpartum BMI (P < 0.001) and BFP (P < 0.001); however, no significant difference was observed for WBR (P = 0.09)., Conclusion: Laser acupuncture reduces postpartum weight retention by improving BMI and BFP, but does not impact the WBR following short-term treatment.

Background: Recently, there has been increasing interest in the development of wireless home sleep staging systems that allow the patient to be monitored remotely while remaining in the comfort of their home. However, transmitting large amount of Polysomnography (PSG) data over the Internet is an important issue needed to be considered. In this work, we aim to reduce the amount of PSG data which has to be transmitted or stored, while having as little impact as possible on the information in the signal relevant to classify sleep stages., New Method: We examine the effects of off-the-shelf lossy compression on an all-night PSG dataset from 20 healthy subjects, in the context of automated sleep staging. The popular compression method Set Partitioning in Hierarchical Trees (SPIHT) was used, and a range of compression levels was selected in order to compress the signals with various degrees of loss. In addition, a rule-based automatic sleep staging method was used to automatically classify the sleep stages., Results: Considering the criteria of clinical usefulness, the experimental results show that the system can achieve more than 60% energy saving with a high accuracy (>84%) in classifying sleep stages by using a lossy compression algorithm like SPIHT., Comparison With Existing Method(s): As far as we know, our study is the first that focuses how much loss can be tolerated in compressing complex multi-channel PSG data for sleep analysis., Conclusions: We demonstrate the feasibility of using lossy SPIHT compression for wireless home sleep staging., (Copyright © 2015 Elsevier B.V. All rights reserved.)

Background: The aim of this study was to evaluate the clinical efficacy of using western anti-tinnitus therapy with or without Chai-Hu-Jia-Long-Gu-Mu-Li-Tang (CHJLGMLT) to treat patients with chronic tinnitus., Methods: A descriptive case series with chart review was established to compare patients with chronic tinnitus who had received CHJLGMLT with western anti-tinnitus therapy (the CHJLGMIT group) with those who received western anti-tinnitus therapy alone (the non-CHJLGMIT group). We included 21 patients, 10 patients in the CHJLGMIT group with CHJLGMLT and 11 patients in the non-CHJLGMIT group. Both groups were comparable in terms of patient demographics and clinical characteristics. The follow-up examinations included the assessment of Tinnitus Handicap Inventory (THI), Pittsburgh Sleep Quality Index (PSQI), Visual Analogue Scale (VAS) of 0-10 for tinnitus intensity, pure tone audiometry (PTA), and speech reception threshold (SRT)., Results: After 2 months of treatment, THI and PSQI scores were reduced significantly more in the CHJLGMIT group (p<0.05) than in the non-CHJLGMIT group. Scores on the emotional subscale of the THI were significantly reduced in the CHJLGMIT group (p<0.05) after treatment, but the effects on the seven PSQI subscales did not differ significantly between the two groups (p>0.05). Scores on the VAS for tinnitus loudness were significantly reduced in both groups (p<0.05). No significant differences between the two groups were found on the binaural hearing tests (PTA and SRT)., Conclusions: Our study found that adjuvant CHJLGMLT therapy for chronic tinnitus may exert additional efficacy by improving psychological sensation of tinnitus and sleep quality. Future randomized controlled double-blind studies should be performed to elucidate its efficacy., (Copyright © 2015 Elsevier Ltd. All rights reserved.)

Traditional Chinese herbal products (CHPs) have been described in ancient medicine systems as treatments for various stroke-associated ailments. This study is aimed to investigate the prescription patterns and combinations of CHPs for ischemic stroke in Taiwan. Prescriptions of CHPs for ischemic stroke were obtained from the National Health Insurance Research Database (NHIRD) of Taiwan. Every prescription with a leading diagnosis of ischemic stroke made during 2000-2010 was analyzed. Descriptive statistics were applied to the pattern of co-prescriptions. Multiple logistic regression models were used to assess demographic and risk factors that are correlated with CHP use. The dataset of inpatient claims data contained information on 15,896 subjects who experienced ischemic stroke from 2000 to 2010. There was an average of 5.82 CHPs in a single prescription for subjects with ischemic stroke. Bu-yang-huan-wu-tang (BYHWT) (40.32%) was by far the most frequently prescribed formula CHP for ischemic stroke, and the most commonly used combination of two-formula-CHP was BYHWT with Shu-jin-huo-xue-tang (SJHXT) (4.40%). Dan Shen (16.50%) was the most commonly used single CHP for ischemic stroke, and the most commonly used combination of two single CHPs was Shi Chang Pua with Yuan Zhi (4.79%). We found that BYHWT and Dan Shen were the most frequently prescribed formula and single CHP for ischemic stroke, respectively. These results provide information about individualized therapy and may contribute to further pharmacologic experiments and clinical trials.

Parameter identifiability problems can plague biomodelers when they reach the quantification stage of development, even for relatively simple models. Structural identifiability (SI) is the primary question, usually understood as knowing which of P unknown biomodel parameters p1,…, pi,…, pP are-and which are not-quantifiable in principle from particular input-output (I-O) biodata. It is not widely appreciated that the same database also can provide quantitative information about the structurally unidentifiable (not quantifiable) subset, in the form of explicit algebraic relationships among unidentifiable pi. Importantly, this is a first step toward finding what else is needed to quantify particular unidentifiable parameters of interest from new I-O experiments. We further develop, implement and exemplify novel algorithms that address and solve the SI problem for a practical class of ordinary differential equation (ODE) systems biology models, as a user-friendly and universally-accessible web application (app)-COMBOS. Users provide the structural ODE and output measurement models in one of two standard forms to a remote server via their web browser. COMBOS provides a list of uniquely and non-uniquely SI model parameters, and-importantly-the combinations of parameters not individually SI. If non-uniquely SI, it also provides the maximum number of different solutions, with important practical implications. The behind-the-scenes symbolic differential algebra algorithms are based on computing Gröbner bases of model attributes established after some algebraic transformations, using the computer-algebra system Maxima. COMBOS was developed for facile instructional and research use as well as modeling. We use it in the classroom to illustrate SI analysis; and have simplified complex models of tumor suppressor p53 and hormone regulation, based on explicit computation of parameter combinations. It's illustrated and validated here for models of moderate complexity, with and without initial conditions. Built-in examples include unidentifiable 2 to 4-compartment and HIV dynamics models.

We cloned and sequenced 2C I-IFN, a two-cysteine containing type I interferon (I-IFN) gene, in orange-spotted grouper (Epinephelus coioides). The cDNA has 769 base pairs, the protein has 172 amino acids, and the predicted signal peptide has 18 amino acids with two cysteines. This gene is similar to I-FNs from sea bass and other teleosts. 2C I-IFN has 5 exons and 4 introns, also similar to other teleost I-IFNs. Immunohistochemical (IHC) analysis indicated that expression is predominantly membrane-localized in healthy grouper, but has a zonal distribution in nodavirus-infected grouper. Grouper infected with nodavirus had elevated levels of 2C I-IFN at 72 h and Mx at days 6-7. Recombinant 2C I-IFN activated grouper Mx, leading to upregulated antiviral activity. The grouper Mx promoter was highly induced after treatment with recombinant 2C I-IFN. The present results suggest that expression of grouper 2C I-IFN may participate in the immunologic barrier function against nodavirus., (Copyright © 2014 Elsevier Ltd. All rights reserved.)

Atrial fibrillation (AF) is the most frequent cardiac arrhythmia seen in clinical practice. Several therapeutical approaches have been developed to terminate the AF and the effects are evaluated by the reduction of the wavelet number after the treatments. Most of the previous studies focus on modeling and analysis the mechanism, and the characteristic of AF. But no one discusses about the prediction of the result after the drug treatment. This paper is the first study to predict whether the drug treatment for AF is active or not. In this paper, the linear autoregressive model with exogenous inputs (ARX) that models the system output-input relationship by solving linear regression equations with least squares method was developed and applied to estimate the effects of pharmacological therapy on AF. Recordings (224-site bipolar recordings) of plaque electrode arrays placed on the right and left atria of pigs with sustained AF induced by rapid atrial-pacing were used to train and test the ARX models. The cardiac mapping data from twelve pigs treated with intravenous administration of antiarrhythmia drug, propafenone (PPF) or dl-sotalol (STL), was evaluated. The recordings of cardiac activity before the drug treatment were input to the model and the model output reported the estimated wavelet number of atria after the drug treatment. The results show that the predicting accuracy rate corresponding to the PPF and STL treatment was 100% and 92%, respectively. It is expected that the developed ARX model can be further extended to assist the clinical staffs to choose the effective treatments for the AF patients in the future.

Background: Approximately one-third of the human lifespan is spent sleeping. To diagnose sleep problems, all-night polysomnographic (PSG) recordings including electroencephalograms (EEGs), electrooculograms (EOGs) and electromyograms (EMGs), are usually acquired from the patient and scored by a well-trained expert according to Rechtschaffen & Kales (R&K) rules. Visual sleep scoring is a time-consuming and subjective process. Therefore, the development of an automatic sleep scoring method is desirable., Method: The EEG, EOG and EMG signals from twenty subjects were measured. In addition to selecting sleep characteristics based on the 1968 R&K rules, features utilized in other research were collected. Thirteen features were utilized including temporal and spectrum analyses of the EEG, EOG and EMG signals, and a total of 158  hours of sleep data were recorded. Ten subjects were used to train the Discrete Hidden Markov Model (DHMM), and the remaining ten were tested by the trained DHMM for recognition. Furthermore, the 2-fold cross validation was performed during this experiment., Results: Overall agreement between the expert and the results presented is 85.29%. With the exception of S1, the sensitivities of each stage were more than 81%. The most accurate stage was SWS (94.9%), and the least-accurately classified stage was S1 (<34%). In the majority of cases, S1 was classified as Wake (21%), S2 (33%) or REM sleep (12%), consistent with previous studies. However, the total time of S1 in the 20 all-night sleep recordings was less than 4%., Conclusion: The results of the experiments demonstrate that the proposed method significantly enhances the recognition rate when compared with prior studies.

In this paper, a rule-based automatic sleep staging method was proposed. Twelve features including temporal and spectrum analyses of the EEG, EOG, and EMG signals were utilized. Normalization was applied to each feature to eliminating individual differences. A hierarchical decision tree with fourteen rules was constructed for sleep stage classification. Finally, a smoothing process considering the temporal contextual information was applied for the continuity. The overall agreement and kappa coefficient of the proposed method applied to the all night polysomnography (PSG) of seventeen healthy subjects compared with the manual scorings by R&K rules can reach 86.68% and 0.79, respectively. This method can integrate with portable PSG system for sleep evaluation at-home in the near future., (Copyright © 2012 Elsevier B.V. All rights reserved.)

Oxidative stress associated with nodavirus infection is poorly understood, especially pertaining to infection-mediated brain injury. Indirect evidence indicates that infection increases cellular abundance of reactive oxygen species (ROS) with consequent increase in cellular dityrosine production. The detection of dityrosine in nodavirus-infected grouper was demonstrated using immunohistochemical (IHC) staining. Proteomic analyses with eye tissues of healthy grouper revealed more abundant expression of crystallin protein in the eye than in various tissues, which was confirmed by real-time polymerase chain reaction and IHC analyses. Grouper crystallin belongs to a small heat shock protein family with chaperone-like function that prevents heat-induced and oxidative stress-induced protein aggregation. Recombinant crystallin induced nitric oxide (NO) production in RAW 264.7 cells after treatment. The results provide new insight into the pathogenesis of nodavirus and demonstrate an experimental rationale for antioxidant therapy research.

Mammalian secreted protein acidic and rich in cysteine (SPARC) is the primary regulator of cell shape and cell adhesion to fibronectin. We, for the first time, report the complete sequencing of SPARC cDNA from orange-spotted grouper. Despite the difference in the lengths of the SPARC transcripts, all of the SPARC molecules encoded a signal peptide, follistain-like copper binding sequence (KGHK) domain, and extracellular domain. The grouper SPARC gene was differentially expressed in vivo and contributed differently to high-level expression of SPARC in muscle. Immunohistochemical staining demonstrated a decreased level of SPARC in nodavirus-infected grouper compared with healthy grouper. Comparative real-time polymerase chain reaction analyses of eye tissues of viral nervous necrosis grouper and healthy grouper were performed. Recombinant SPARC produced changes in grouper cell shape 24 h after treatment. The results provide new insight into the pathogenesis of nodavirus, and demonstrate an experimental rationale for SPARC characterization in nodavirus-infected grouper., (Copyright © 2011 Elsevier Ltd. All rights reserved.)

In this paper, a rule-based automatic sleep staging method was proposed. Twelve features, including temporal and spectrum analyses of the EEG, EOG, and EMG signals, were utilized. Normalization was applied to each feature to reduce the effect of individual variability. A hierarchical decision tree, with fourteen rules, was constructed for sleep stage classification. Finally, a smoothing process considering the temporal contextual information was applied for the continuity. The average accuracy and kappa coefficient of the proposed method applied to the all night polysomnography (PSG) of twenty subjects compared with the manual scorings reached 86.5% and 0.78, respectively. This method can assist the clinical staff reduce the time required for sleep scoring in the future.

Purpose: Modulation of zone II flexor tendon repair healing using growth factors may reduce the incidence of complications, such as rupture and fibrosis. We hypothesized that sutures coated with growth differentiation factor 5 (GDF5) will stimulate the healing of zone II flexor tendon repairs., Methods: We created and immediately repaired zone II flexor tendon lacerations in the second and fourth toe of the right forepaw of 44 New Zealand White rabbits. One tendon was repaired with suture coated with GDF5, whereas the other tendon was repaired with suture without GDF5 (control). We randomized the allocation of GDF5 and control suture to either toe. A proximal tenotomy of the flexor digitorum profundus at the level of the wrist was performed to relieve tension on the more distal repairs. Rabbits were euthanized at 21 or 42 days after repair. Four rabbits (8 tendons) underwent histological analysis at each time point; the remaining repairs were tested biomechanically in a blinded fashion., Results: Control tendons demonstrated distinct borders at the transection site and less endogenous repair at 3 weeks. The Soslowsky histological score for collagen was better in the GDF5 group at both time points (p≤.003). All tendons failed at the repair site. The maximum load was significantly greater (p=.04) in the GDF5 group (11.6 ± 3.5 N) compared with control tendons (8.6 ± 3.0 N) at 3 weeks. The maximum load was not significantly different (p=.12) at 6 weeks. We observed no significant differences in stiffness at either time point (p>.11)., Conclusions: The results demonstrate that GDF5 has an early beneficial effect on tendon healing in zone II flexor tendon repairs in a rabbit flexor tendon injury model., (Copyright © 2010 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.)

The heat shock proteins (HSPs) family which consists of HSP90, HSP70, and low molecular mass HSPs are involved in chaperone activity. Here, we report the cloning and characterization of HSP90AB gene from orange-spotted grouper, Epinephelus coioides. The full-length of grouper HSP90AB was 727 amino acids and possessed an ATPase domain as well as an evolutionarily conserved molecular chaperone. The HSP90AB-green fluorescent protein fusion protein was evenly distributed in the cytoplasm. Immunohistochemistry (IHC) and real-time polymerase chain reaction (PCR) analyses indicated that the expression of grouper HSP90AB was marginally increased following nodavirus infection. Grouper E. coioides that received HSP90 inhibitor geldanamycin (GA) showed an increase in HSP90AB expression and growth of nodavirus supporting nodavirus replication., (2010 Elsevier Ltd. All rights reserved.)

Injuries to the scapholunate joint are the most frequent cause of carpal instability and account for a considerable degree of wrist dysfunction, lost time from work, and interference with activities. The complex arrangement and kinematics of the 2 rows of carpal bones allows for an enormous degree of physiologic motion, and a hierarchy of primary and secondary ligaments serves to balance an inherently unstable structure. Although insufficient to cause abnormal carpal posture or collapse on static radiographs, an isolated injury to the scapholunate interosseous ligament may be the harbinger of a relentless progression to abnormal joint mechanics, cartilage wear, and degenerative change. Intervention for scapholunate instability is aimed at arresting the degenerative process by restoring ligament continuity and normalizing carpal kinematics. In this review, we discuss the anatomy, kinematics, and biomechanical properties of the scapholunate articulation and provide a foundation for understanding the spectrum of scapholunate ligament instability. We propose an algorithm for treatment based on the stage of injury, degree of secondary ligamentous damage, and arthritic change.

The effects of walking speed and age on the peak external moments generated about the joints of the trailing limb during stance just prior to stepping over an obstacle and on the kinematics of the trailing limb when crossing the obstacle were investigated in 10 healthy young adults (YA) and 10 healthy older adults (OA). The peak hip and knee adduction moments in OA were 21-43% greater than those in YA (p