Convolutional neural network-based vocal cord tumor classification technique for home-based self-prescreening purpose.

BACKGROUND: In this study, we proposed a deep learning technique that can simultaneously detect suspicious positions of benign vocal cord tumors in laparoscopic images and classify the types of tumors into cysts, granulomas, leukoplakia, nodules and polyps. This technique is useful for simplified home-based self-prescreening purposes to detect the generation of tumors around the vocal cord early in the benign stage. RESULTS: We implemented four convolutional neural network (CNN) models (two Mask R-CNNs, Yolo V4, and a single-shot detector) that were trained, validated and tested using 2183 laryngoscopic images. The experimental results demonstrated that among the four applied models, Yolo V4 showed the highest F1-score for all tumor types (0.7664, cyst; 0.9875, granuloma; 0.8214, leukoplakia; 0.8119, nodule; and 0.8271, polyp). The model with the lowest false-negative rate was different for each tumor type (Yolo V4 for cysts/granulomas and Mask R-CNN for leukoplakia/nodules/polyps). In addition, the embedded-operated Yolo V4 model showed an approximately equivalent F1-score (0.8529) to that of the computer-operated Yolo-4 model (0.8683). CONCLUSIONS: Based on these results, we conclude that the proposed deep-learning-based home screening techniques have the potential to aid in the early detection of tumors around the vocal cord and can improve the long-term survival of patients with vocal cord tumors.

Deep learning-based monitoring technique for real-time intravenous medication bag status.

Accidents related to the administration of intravenous (IV) medication, such as drug overdose/underdose, drug/patient mis-identification, and delayed bag exchange, occur consistently in clinical fields. Several previous studies have suggested various contact-sensing and image-processing methodologies; however, most of them can increase the workload of nursing staffs during the long-term, continuous monitoring. In this study, we proposed a smart IV pole that can monitor the infusion status of up to four IV medications (patient/drug identification, and liquid residue) with various sizes and hanging positions to reduce IV-related accidents and improve patient safety with the least additional workload; the system consists of 12 cameras, one code scanner, and four controllers. Two types of deep learning models for automated camera selection (CNN-1) and liquid residue monitoring (CNN-2), and three drug residue estimation equations were implemented. The experimental results demonstrated that the accuracy of identification code-checking (60 tests) was 100%. The classification accuracy and the mean inference time of CNN-1 (1200 tests) were 100% and 140 ms. The mean average precision and the mean inference time of CNN-2 (300 tests) were 0.94 and 144 ms. The average error rates between the alarm setting (20, 30, and 40 mL) and the actual drug residue when the alarm first generated were 4.00%, 7.33%, and 4.50% for a 1,000 mL bag; 6.00%, 4.67%, and 2.50% for a 500 mL bag; and 3.00%, 6.00%, and 3.50% for a 100 mL bag, respectively. Our results suggest that the implemented AI-based prototype IV pole is a potential tool for reducing IV-related accidents and improving in-hospital patient safety. Supplementary Information: The online version contains supplementary material available at 10.1007/s13534-023-00292-w.

Novel chemical inhibitor against SOD1 misfolding and aggregation protects neuron-loss and ameliorates disease symptoms in ALS mouse model.

Amyotrophic Lateral Sclerosis (ALS) is a fatal neurodegenerative disease characterized by selective death of motor neurons. Mutations in Cu, Zn-superoxide dismutase (SOD1) causing the gain of its toxic property are the major culprit of familial ALS (fALS). The abnormal SOD1 aggregation in the motor neurons has been suggested as the major pathological hallmark of ALS patients. However, the development of pharmacological interventions against SOD1 still needs further investigation. In this study, using ELISA-based chemical screening with wild and mutant SOD1 proteins, we screened a new small molecule, PRG-A01, which could block the misfolding/aggregation of SOD1 or TDP-43. The drug rescued the cell death induced by mutant SOD1 in human neuroblastoma cell line. Administration of PRG-A01 into the ALS model mouse resulted in significant improvement of muscle strength, motor neuron viability and mobility with extended lifespan. These results suggest that SOD1 misfolding/aggregation is a potent therapeutic target for SOD1 related ALS.

Convolutional neural network-based ambient light-independent panel digit surveillance technique for infusion pumps.

For effective patient therapy and improved patient safety, it is critical to administer medication accurately in accordance with doctor's prescription. However, accidents owing to the erroneous programing of infusion pumps caused by users have been consistently reported in several documents. In this study, the authors propose a novel surveillance technique for infusion pumps to continuously monitor the variations in panel digits using a convolutional neural network model, and evaluate the performance of the implemented technique. During the experimental evaluation, 1st-step ROIs and 2nd-step ROIs were successfully extracted from the frame images regardless of the ambient lighting conditions. The final accuracies of the implemented CNN model are 99.9% for both the training (172,800 images) and validation (1080 images) dataset while the final losses for the training and validation datasets are 0.48 and 0.45 after 13th epoch, respectively. In the 24-h continuous monitoring test, the accuracy of the model for volume recognition considering all the 1440 measurements (960 for day-lighting and 480 for night-lighting) is 95.5%, whereas in day-lighting and night-lighting modes the accuracies of the model are 98.2% and 90.0%, respectively. Based on these experimental results, the proposed surveillance technique incorporating infusion pumps is expected to improve the safety of patients who need long-term treatments via infusion pumps, reducing the burden on the nurses and hospitals.

Multi-modal infusion pump real-time monitoring technique for improvement in safety of intravenous-administration patients.

Intravenous (IV) medication administration processes have been considered as high-risk steps, because accidents during IV administration can lead to serious adverse effects, which can deteriorate the therapeutic effect or threaten the patient's life. In this study, we propose a multi-modal infusion pump (IP) monitoring technique, which can detect mismatches between the IP setting and actual infusion state and between the IP setting and doctor's prescription in real time using a thin membrane potentiometer and convolutional-neural-network-based deep learning technique. During performance evaluation, the percentage errors between the reference infusion rate (IR) and average estimated IR were in the range of 0.50-2.55%, while those between the average actual IR and average estimated IR were in the range of 0.22-2.90%. In addition, the training, validation, and test accuracies of the implemented deep learning model after training were 98.3%, 97.7%, and 98.5%, respectively. The training and validation losses were 0.33 and 0.36, respectively. According to these experimental results, the proposed technique could provide improved protection functions to IV-administration patients.

A single-pieced, fully air-driven, cuff-inserted pseudo-blood pressure generator for on-site pre-screening test of non-invasive blood pressure monitor by nurses.

BACKGROUND: It is crucial to frequently inspect the proper operation of non-invasive electronic blood pressure monitors in various sites to prevent accidents from inaccurate blood pressure measurements, especially for large-scale hospitals. However, most conventional blood pressure monitor inspection devices are not suitable for such on-site investigation purpose. In this study, we propose a new single-pieced, fully air-driven pseudo blood pressure generator that is suitable for frequent on-site pre-screening tests of the blood pressure monitor by nurses. RESULTS: The proposed model comprises a rigid cylindrical body, two simulated brachial arteries, two air-pumps, an electronic controller, and a pressure sensor. Control algorithm based on polynomial curve fitting was implemented to generate various user-instructed systolic blood pressure and heart-rate conditions automatically. To evaluate the performance and clinical feasibility of the proposed model, various experiments were performed using ten commercial electronic blood pressure monitors. Experimental results demonstrated that the values of the Pearson coefficient between the reference pseudo-blood pressure waveforms and the actually generated pressure waveforms were 0.983, 0.983 and 0.997 at 60, 70 and 80 beats/min, respectively (p < 0.05). Besides, during the experiments using ten commercial blood pressure monitors, the maximum error in average systolic blood pressure was 2.9 mmHg, the maximum standard deviation in average systolic blood pressure was 3.5 mmHg, and the maximum percentage error in average pumping rate was 3.2%, respectively. CONCLUSIONS: We expect that the proposed model can give an easy and comprehensive way for frequent on-site investigations of the blood pressure monitors by nurses, and improve the safety of patients with abnormal blood pressure, especially in most large-scale hospitals.

Acid-Treated Water-Soluble Chitosan Suitable for Microneedle-Assisted Intracutaneous Drug Delivery.

Chitosan has been widely used as a nature-derived polymeric biomaterial due to its high biocompatibility and abundance. However, poor solubility in aqueous solutions of neutral pH and multiple fabrication steps for the molding process limit its application to microneedle technology as a drug delivery carrier. Here, we present a facile method to prepare water-soluble chitosan and its application for sustained transdermal drug delivery. The water-soluble chitosan was prepared by acid hydrolysis using trifluoroacetic acid followed by dialysis in 0.1 M NaCl solutions. We successfully fabricated bullet-shaped microneedle (MN) arrays by the single molding process with neutral aqueous chitosan solutions (pH 6.0). The chitosan MN showed sufficient mechanical properties for skin insertion and, interestingly, exhibited slow dissolving behavior in wet conditions, possibly resulting from a physical crosslinking of chitosan chains. Chitosan MN patches loading rhodamine B, a model hydrophilic drug, showed prolonged release kinetics in the course of the dissolving process for more than 72 h and they were found to be biocompatible to use. Since the water-soluble chitosan can be used for MN fabrication in the mild conditions (neutral pH and 25 °C) required for the loading of bioactive agents such as proteins and achieve a prolonged release, this biocompatible chitosan MN would be suitable for sustained transdermal drug delivery of a diverse range of drugs.

Detection of intravenous infiltration using impedance parameters in patients in a long-term care hospital.

This study was aimed to evaluate the changes of impedance parameters of patients who were admitted to a long-term care hospital by measuring bioelectrical impedance. The subjects were 18 patients who had infusion therapy through peripheral intravenous (IV) catheters and had at least an infiltration. The impedance parameters were measured with a multi-channel impedance measuring instrument (Vector Impedance Meter) twice; at starting IV infusion after catheter insertion and infiltration detected. As results, the resistance (R) after infiltration significantly decreased compared to the initial resistance. At 50 kHz, the resistances were 498.2±79.3 [Ω] before infiltration and 369.4±85.6 [Ω] after infiltration. The magnitude of the reactance (XC) decreased after infiltration. At 50 kHz, the measured reactance was -31.1±8.3 [Ω] before infiltration and -24.5±5.9 [Ω] after infiltration. The data points plotted in the R-XC graph shifted from the first quadrant before infiltration to third quadrant after infiltration. Our findings suggest that bioelectrical impedance is an effective method for detection of infiltration in a noninvasive and quantitative manner.

Intracutaneous delivery of gelatins induces lipolysis and suppresses lipogenesis of adipocytes.

Due to growing interest in cosmetics and medical applications, therapeutic medications that reduce the amount of local subcutaneous adipose tissue have potential for obesity treatment. However, conventional methods such as surgical operation are restricted due to risk of complications. Here, we report a simple and effective method for local reduction of subcutaneous adipose tissue (AT) by using microneedle-assisted transdermal delivery of natural polymers. After in vitro screening tests, gelatin was selected as a therapeutic polymer to reduce accumulation of AT. An in vitro study showed that the level of released glycerol as an indicator of lipolysis was elevated in isolated adipocytes after gelatin treatment. In addition, gelatins suppressed expression levels of lipogenesis-associated genes. Following application of gelatin microneedle (GMN) patches to high-fat diet (HD)-induced obese rats, the amount of subcutaneous AT at the site of GMN application was significantly reduced, which was also confirmed by histological analysis and micro-computed tomography scanning. In addition, lipogenesis-associated genes were down-regulated in GMN-treated subcutaneous AT. These findings suggest that GMN patches induce lipolysis and simultaneously inhibit lipogenesis, thereby reducing deposition of subcutaneous AT. This platform using GMNs may provide a new strategy to treat excess subcutaneous AT with minimal complications. STATEMENT OF SIGNIFICANCE: (1) Significance This work reports a new approach for the local reduction of subcutaneous adipose tissue using a dissolving microneedle patch prepared using gelatin to enable suppression of lipogenesis and acceleration of lipolysis in adipocytes. The gelatin microneedle patch exhibited a significant reduction of local subcutaneous fat up to 60% compared to control groups without any change in total weight. (2) Scientific impact This is the first report demonstrating the direct anti-obesity effects of gelatin administrated in a transdermal route and the feasibility of natural polymer therapeutics for regional reduction of subcutaneous fat. We believe that our work will excite interdisciplinary readers of Acta Biomaterialia, those who are interested in the natural polymers, drug delivery, and obesity.

[Culture and polymerase chain reaction of Helicobacter pylori from rectal and terminal ileal fluid after polyethylene glycol (colyte) ingestion in healthy adults with positive urea breath test].

BACKGROUND/AIMS: Helicobacter pylori (H. pylori) transmission route is not yet clearly understood. Isolating H. pylori from stool, saliva, and vomitus is very difficult. However, H. pylori could be cultured from feces in the setting of rapid gastrointestinal tract transit. The aim of this study was to isolate H. pylori by culture and PCR in the rectum and terminal ileum during colonoscopy. METHODS: Twenty subjects with positive UBT (urea breath test) were included. We performed polymerase chain reaction (PCR) test and culture of H. pylori with the rectal fluid and terminal ileal fluid during colonoscopy. RESULTS: H. pylori was cultured with rectal fluid from 9 (45.0%) of 20 subjects and with ileal fluid from 11 (55.0%) of 20 subjects. H. pylori was a little more frequently cultured from the terminal ileal fluid than the rectal fluid without statistical significance (p>0.05). PCR test detected flaA (16/20, 80.0% and 17/20, 85.0%), 16S rRNA gene (16/20, 80.0% and 17/20, 85.0%), cagA (10/20, 50.0% and 12/20, 60.0%), and ureC (9/20, 45% and 11/20, 54.5%) from the rectal fluid and the terminal ileal fluid, respectively. The specificity and sensitivity of ureC were 100%. CONCLUSIONS: H. pylori could be cultured from the rectal fluid and terminal ileal fluid in the setting of rapid gastrointestinal tract transit. These results suggest of fecal-oral transmission of H. pylori.