Proactive consultation of laboratory medicine increased diagnostic rate of multiple myeloma: One single center's 12-year experience.

Multiple myeloma (MM) was one of the hardest cancers to diagnose because of numerous nonspecific symptoms, leading to diagnostic delay. Proactive consultation of laboratory medicine (PCLM) could help timely diagnosis of blood cancers, avoiding diagnostic delay. This study aimed to evaluate the effect of PCLM on diagnosis and outcomes in MM. This retrospective study was conducted in newly diagnosed MM patients from 2011 to 2022. Implementation of PCLM initiated in 2015 with a laboratory-oriented algorithm. The annual diagnostic rate, patient demographics, the time intervals from symptom onset to diagnosis and to treatment, and clinical outcomes were analyzed. A total of 134 patients were newly diagnosed during the study interval. The diagnostic rate increased from 4.65 ±â€…1.59 to 7.43 ±â€…1.52 per million patient-visits after implementation of PCLM. The median time interval from symptom onset to diagnosis was significantly shortened after implementation of PCLM (50 days with interquartile range [IQR]: 24-136 days vs 150 days with IQR: 41-385 days, P = .003). Besides, the 1-year survival was significantly higher in patients diagnosed as MM after implementation of PCLM (72.4% vs 51.7%, P = .035). Implementation of PCLM not only increased diagnostic rate of MM and improved outcomes, but also raise awareness for MM and promote multidisciplinary collaboration in healthcare.

GPS-Free Wireless Precise Positioning System for Automatic Flying and Landing Application of Shipborne Unmanned Aerial Vehicle.

This research is dedicated to developing an automatic landing system for shipborne unmanned aerial vehicles (UAVs) based on wireless precise positioning technology. The application scenario is practical for specific challenging and complex environmental conditions, such as the Global Positioning System (GPS) being disabled during wartime. The primary objective is to establish a precise and real-time dynamic wireless positioning system, ensuring that the UAV can autonomously land on the shipborne platform without relying on GPS. This work addresses several key aspects, including the implementation of an ultra-wideband (UWB) circuit module with a specific antenna design and RF front-end chip to enhance wireless signal reception. These modules play a crucial role in achieving accurate positioning, mitigating the limitations caused by GPS inaccuracy, thereby enhancing the overall performance and reception range of the system. Additionally, the study develops a wireless positioning algorithm to validate the effectiveness of automatic landing on the shipborne platform. The platform's wave vibration is considered to provide a realistic landing system for shipborne UAVs. The UWB modules are practically installed on the shipborne platform, and the UAV and the autonomous three-body vessel are tested simultaneously in the outdoor open water space to verify the functionality, precision, and adaptability of the proposed UAV landing system. Results demonstrate that the UAV can autonomously fly from 200 m, approach, and automatically land on the moving shipborne platform without relying on GPS.

Range-Extension Algorithms and Strategies for TDOA Ultra-Wideband Positioning System.

The Internet of Things (IoT) for smart industry requires the surveillance and management of people and objects. The ultra-wideband positioning system is an attractive solution for achieving centimeter-level accuracy in target location. While many studies have focused on improving the accuracy of the anchor coverage range, it is important to note that in practical applications, positioning areas are often limited and obstructed by furniture, shelves, pillars, or walls, which can restrict the placement of anchors. Furthermore, some positioning regions are located beyond anchor coverage, and a single group with few anchors may not be able to cover all rooms and aisles on a floor due to non-line-of-sight errors causing severe positioning errors. In this work, we propose a dynamic-reference anchor time difference of arrival (TDOA) compensation algorithm to enhance accuracy beyond anchor coverage by eliminating local minima of the TDOA loss function near anchors. We designed a multidimensional and multigroup TDOA positioning system with the aim of broadening the coverage of indoor positioning and accommodating complex indoor environments. By employing an address-filter technique and group-switching process, tags can seamlessly move between groups with a high positioning rate, low latency, and high accuracy. We deployed the system in a medical center to locate and manage researchers with infectious medical waste, demonstrating its usefulness for practical healthcare institutions. Our proposed positioning system can thus facilitate precise and wide-range indoor and outdoor wireless localization.

The effects of dietary linoleic acid on reducing serum cholesterol and atherosclerosis development are nullified by a high-cholesterol diet in male and female apoE-deficient mice.

Linoleic acid (LA) has a two-sided effect with regard to serum cholesterol-lowering and pro-inflammation, although whether this fatty acid reduces serum cholesterol and the development of atherosclerosis under high-cholesterol conditions has yet to be ascertained. In this study, we examine the effects of dietary LA on reducing serum cholesterol and atherosclerosis development under high-cholesterol conditions. Male and female apoE-deficient (ApoE-/-) mice were fed AIN-76-based diets containing 10% SFA and 0·04 % cholesterol, 10% LA and 0·04% low cholesterol (LALC), or 10% LA and 0·1% high cholesterol (LAHC) for 9 weeks. The results revealed significant reduction in serum cholesterol levels and aortic lesions with increasing levels of pro-inflammatory biomarkers (urinary isoprostane and aortic MCP-1 mRNA) in male and female LALC groups compared with those in the SFA groups (P < 0·05). Furthermore, whereas there were significant increases in the serum cholesterol levels and aortic lesions (P < 0·05), there was no difference in aortic MCP-1 mRNA levels in male and female LAHC groups compared with those in the LALC groups. A high-dietary intake of cholesterol eliminated the serum cholesterol-lowering activity of LA but had no significant effect on aortic inflammation in either male or female ApoE-/- mice. The inhibitory effect of LA on arteriosclerosis is cancelled by a high-cholesterol diet due to a direct increase in serum cholesterol levels. Accordingly, serum cholesterol levels might represent a more prominent pathogenic factor than aortic inflammation in promoting the development of atherosclerosis.

Precision Enhancement of Wireless Localization System Using Passive DOA Multiple Sensor Network for Moving Target.

Determining the direction-of-arrival (DOA) of any signal of interest has long been of great interest to the wireless localization research community for military and civilian applications. To efficiently facilitate the deployment of DOA systems, the accuracy of wireless localization is critical. Hence, this paper proposes a novel method to improve the prediction result of a wireless DOA localization system. By considering the signal variation existing in the complex environment, the actual location of the target can be determined including the maximum prediction error. Moreover, the scenario of the moving target is further investigated by incorporating the adaptive Kalman Filter algorithm to obtain the prediction route of the flying drone based on the accuracy assessment method. This proposed adaptive Kalman Filter is a high-efficiency algorithm that can filter out the noise in the multipath area and optimize the predicted data in real-time. The simulation result agrees well with the measured data and thus validates the proposed DOA system with the adaptive Kalman Filter algorithm. The measured DOA of the fixed radiation source obtained by a single base station and the moving route of a flying drone from a two-base station localization system are presented and compared with the calculated results. Results show that the prediction error in an outdoor region of 500×500 m2 is about 10−20 m, which demonstrate the usefulness of the proposed wireless DOA system deployment in practical applications.

Revisional sleeve gastrectomy after failed gastric clipping for obesity: Report of two cases and review of literature.

Laparoscopic gastric clipping (LGC) is one of the bariatric surgeries that are minimally invasive and demonstrates effectiveness in reducing body weight for obese patients. However, the patients may later regain body weight and other treatments may be needed. In this case report, two cases with obesity received LGC, which initially reduced their weight. However, they presented with a progressive regaining of body weight a few years after the surgery. Thus, revisional sleeve gastrectomy was conducted in an institute to control their weight regain. Postoperative courses were smooth, and there was no complication. Thus, laparoscopic removal of gastric clipping accompanied with revisional sleeve gastrectomy is technically feasible for the patients.

Ultra-Wideband Positioning Sensor with Application to an Autonomous Ultraviolet-C Disinfection Vehicle.

Due to the COVID-19 virus being highly transmittable, frequently cleaning and disinfecting facilities is common guidance in public places. However, the more often the environment is cleaned, the higher the risk of cleaning staff getting infected. Therefore, strong demand for sanitizing areas in automatic modes is undoubtedly expected. In this paper, an autonomous disinfection vehicle with an Ultraviolet-C (UVC) lamp is designed and implemented using an ultra-wideband (UWB) positioning sensor. The UVC dose for 90% inactivation of the reproductive ability of COVID-19 is 41.7 J/m2, which a 40 W UVC lamp can achieve within a 1.6 m distance for an exposure time of 30 s. With this UVC lamp, the disinfection vehicle can effectively sterilize in various scenarios. In addition, the high-accuracy UWB positioning system, with the time difference of arrival (TDOA) algorithm, is also studied for autonomous vehicle navigation in indoor environments. The number of UWB tags that use a synchronization protocol between UWB anchors can be unlimited. Moreover, this proposed Gradient Descent (GD), which uses Taylor method, is a high-efficient algorithm for finding the optimal position for real-time computation due to its low error and short calculating time. The generalized traversal path planning procedure, with the edge searching method, is presented to improve the efficiency of autonomous navigation. The average error of the practical navigation demonstrated in the meeting room is 0.10 m. The scalability of the designed system to different application scenarios is also discussed and experimentally demonstrated. Hence, the usefulness of the proposed UWB sensor applied to UVC disinfection vehicles to prevent COVID-19 infection is verified by employing it to sterilize indoor environments without human operation.

Identification of a Common Epitope in Nucleocapsid Proteins of Euro-America Orthotospoviruses and Its Application for Tagging Proteins.

The NSs protein and the nucleocapsid protein (NP) of orthotospoviruses are the major targets for serological detection and diagnosis. A common epitope of KFTMHNQIF in the NSs proteins of Asia orthotospoviruses has been applied as an epitope tag (nss-tag) for monitoring recombinant proteins. In this study, a monoclonal antibody TNP MAb against the tomato spotted wilt virus (TSWV) NP that reacts with TSWV-serogroup members of Euro-America orthotospoviruses was produced. By truncation and deletion analyses of TSWV NP, the common epitope of KGKEYA was identified and designated as the np sequence. The np sequence was successfully utilized as an epitope tag (np-tag) to monitor various proteins, including the green fluorescence protein, the coat protein of the zucchini yellow mosaic virus, and the dust mite chimeric allergen Dp25, in a bacterial expression system. The np-tag was also applied to investigate the protein-protein interaction in immunoprecipitation. In addition, when the np-tag and the nss-tag were simultaneously attached at different termini of the expressed recombinant proteins, they reacted with the corresponding MAbs with high sensitivity. Here, we demonstrated that the np sequence and TNP MAb can be effectively applied for tagging and detecting proteins and can be coupled with the nss-tag to form a novel epitope-tagging system for investigating protein-protein interactions.

Dietary egg white protein hydrolysate improves orotic acid-induced fatty liver in rats by promoting hepatic phospholipid synthesis and microsomal triglyceride transfer protein expression.

We investigated the effects of egg white protein hydrolysates (EWH) on orotic acid (OA)-induced nonalcoholic fatty liver (NAFL) in rats. Effects of the egg white protein (EWP) and EWH were also compared. Four groups of male Sprague-Dawley rats were separately fed AIN-76-based diets, supplemented with 20% casein for control, or with 1% OA, together with either 20% casein (OA), 20% EWP, or 20% EWH, respectively, for 3 d (developing stage) and 14 d (developed stage). In both feeding periods, animals from the OA group showed higher accumulation hepatic triacylglycerol (TAG) compared with those from the control group. In the 14-d experiment, dietary EWP and EWH significantly reduced the hepatic TAG levels. Intake of EWP reduced liver fat in OA-fed rats by 61%, while EWH reduced it by 92%. In addition, EWH restored the OA-induced high serum-TAG level to that seen in the control group. The 3 d experiment showed that consumption of EWH improved the expression of hepatic MTP, that was reduced by OA, without changing Mttp gene expression. It also increased the hepatic synthesis of PC and PE by enhancing the transcription of Pcyt1 and Pemt genes. Inclusion of EWP and EWH in the diet improves the OA-induced NAFL. EWH reduces the liver TAG better than EWP, and works more rapidly. Dietary EWH ameliorates OA-induced NAFL by promoting the secretion of hepatic TAG.

α-globulin-rich rice cultivar, low glutelin content-1 (LGC-1), decreases serum cholesterol concentration in exogenously hypercholesterolemic rats.

BACKGROUND: Rice α-globulin has been reported to have serum cholesterol-lowering activity in rats. However, it is still unclear whether α-globulin exerts this effect when taken as one of the dietary components. In the present study, we investigated the effect of two cultivars of rice, low glutelin content (LGC)-1 and LGC-Jun, on reducing serum cholesterol in exogenously hypercholesterolemic (ExHC) rats. LGC-1 is enriched in α-globulin (10.6 mg g-1 rice flour, which is an approximately 1.5 times higher α-globulin content than in Koshihikari a predominant rice cultivar in Japan), whereas LGC-Jun is a globulin-negative cultivar. METHODS: ExHC rats, the model strain of diet-induced hypercholesterolemia, were fed 50% LGC-1 or LGC-Jun and 0.5% cholesterol-containing diets for 2 weeks, followed by measurement of cholesterol metabolism parameters in serum and tissues. RESULTS: Serum cholesterol and non-high-density lipoprotein cholesterol levels were significantly lower in the LGC-1 group compared to the LGC-Jun group. Cholesterol intestinal absorption markers, hepatic and serum levels of campesterol and ß-sitosterol, and lymphatic cholesterol transport were not different between the two groups. Levels of 7α-hydroxycholesterol, an intermediate of bile acid synthesis, showed a downward trend in the livers of rats that were fed LGC-1 (P = 0.098). There was a significant decrease in the hepatic mRNA expression of Cyp7a1 (a synthetic enzyme for 7α-hydroxycholesterol) in the LGC-1 group compared to the LGC-Jun group. CONCLUSION: Dietary LGC-1 significantly decreased serum cholesterol levels in ExHC rats. The possible mechanism for the cholesterol-lowering activity of LGC-1 is partial inhibition of bile acid and cholesterol synthesis in the liver. © 2021 Society of Chemical Industry.

Soyasaponin ameliorates obesity and reduces hepatic triacylglycerol accumulation by suppressing lipogenesis in high-fat diet-fed mice.

Soyasaponins are triterpenoid glycosides found in soybean. We investigated whether soyasaponin ameliorates lipid metabolism and its possible mechanisms. In C57BL/6J mice fed a high-fat diet (HFD), soyasaponin (SAP) was orally administered for 9 weeks. Additionally, we evaluated the effect of soyasapogenols on 3T3-L1 adipocytes. In HFD-fed mice, the SAP significantly reduced body weight by 7% and relative adipose tissue weight by 35%. X-ray computed tomography demonstrated that the SAP reduced visceral and subcutaneous adipose tissue weights during week 3 of feeding. The SAP reduced sterol regulatory element-binding protein-1c (SREBP-1c) mRNA levels by 32% in the epididymal adipose tissue, significantly decreasing the triacylglycerol (TAG) content by 37% and SREBP-1c and fatty acid synthase mRNA levels by 52% and 61%, respectively, in the liver. In 3T3-L1 adipocytes, soyasapogenol B significantly decreased lipid droplets. The SAP containing soyasaponin A and B as conjugates demonstrate anti-obesity effects by suppressing adipocyte differentiation and lipogenesis, with a preventive effect on hepatic TAG accumulation by suppressing lipogenesis. PRACTICAL APPLICATION: Soyasaponin is one of the oleanane triterpenoids in soybeans. We have demonstrated that soyasaponin potently reduces body weight and white adipose tissue weight, and hepatic triacylglycerol accumulation in high-fat diet-fed mice. Thus, soyasaponin is a beneficial compound to prevent obesity and fatty liver.

Clinical and Hematological Predictors for Return of Spontaneous Circulation in Patients With Out-of-Hospital Cardiac Arrest.

BACKGROUND: To investigate the association of clinical and hematological parameters with return of spontaneous circulation (ROSC) in out-of-hospital cardiac arrest (OHCA). METHODS: Clinical data of successive non-traumatic adult OHCA patients with available laboratory data of complete blood count and peripheral blood smear at emergency department (ED) arrival were requested. Hematological parameters were collected and calculated, and logistic regression and survival analysis were performed for association of ROSC with the parameters. RESULTS: From December 2015 to December 2016, a total of 188 OHCA patients transported to our ED were enrolled. In ROSC group, neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) were signifi cantly higher and smudge cell count was signifi cantly lower when compared with non-ROSC group. In the univariate regression, NLR more than 2.0 (odds ratio [OR]: 2.40, 95% confi dence interval [CI]: 1.31-4.41; p = 0.004) and smudge cell count less than 0.45 °- 109/L (OR: 0.33, 95% CI: 0.15-0.71; p = 0.004) were signifi cantly associated with ROSC in OHCA. In logistic regression, bystander witnessed (OR: 3.15, 95% CI: 1.59-6.27; p = 0.001) and prehospital epinephrine use (OR: 2.15, 95% CI: 1.10-4.23; p = 0.026) were signifi cantly associated with ROSC in OHCA. NLR and smudge cell count were also seemingly related to ROSC in OHCA, but without statistical signifi cance. In survival analysis, neither NLR nor smudge cell count was associated with patient survival to discharge in OHCA. CONCLUSIONS: NLR and smudge cell count at ED arrival could be potential indicators of ROSC in OHCA.

The efficacy of semi-quantitative urine protein-to-creatinine (P/C) ratio for the detection of significant proteinuria in urine specimens in health screening settings.

BACKGROUND: Urine protein detection could be underestimated using the conventional dipstick method because of variations in urine aliquots. This study aimed to assess the efficacy of the semi-quantitative urine protein-to-creatinine (P/C) ratio compared with other laboratory methods. METHODS: Random urine samples were requested from patients undergoing chronic kidney disease screening. Significant proteinuria was determined by the quantitative P/C ratio of at least 150 mg protein/g creatinine. The semi-quantitative P/C ratio, dipstick protein and quantitative protein concentrations were compared and analyzed. RESULTS: In the 2932 urine aliquots, 156 (5.3 %) urine samples were considered as diluted and 60 (39.2 %) were found as significant proteinuria. The semi-quantitative P/C ratio testing had the best sensitivity (70.0 %) and specificity (95.9 %) as well as the lowest underestimation rate (0.37 %) when compared to other laboratory methods in the study. In the semi-quantitative P/C ratio test, 19 (12.2 %) had positive, 52 (33.3 %) had diluted, and 85 (54.5 %) had negative results. Of those with positive results, 7 (36.8 %) were positive detected by traditional dipstick urine protein test, and 9 (47.4 %) were positive detected by quantitative urine protein test. Additionally, of those with diluted results, 25 (48.1 %) had significant proteinuria, and all were assigned as no significant proteinuria by both tests. CONCLUSIONS: The semi-quantitative urine P/C ratio is clinically applicable based on its better sensitivity and screening ability for significant proteinuria than other laboratory methods, particularly in diluted urine samples. To establish an effective strategy for CKD prevention, urine protein screening with semi-quantitative P/C ratio could be considered.

Clinical Significance of Smudge Cells in Peripheral Blood Smears in Hematological Malignancies and Other Diseases.

BACKGROUND: It is reported that the percentage of smudge cells in the blood smear could be a prognostic indicator in chronic lymphocytic leukemia. However, the clinical significance of smudge cells in other hematological malignancies, solid tumors or non-malignant diseases is less clear. Hence, this study was conducted to survey the clinical significance of smudge cells in hematological cancers and other disorders. MATERIALS AND METHODS: From January to November, 2015, the clinical data of patients who received blood examination with differential counts for clinical purpose and were found to have smudge cells in the peripheral blood film in Far Eastern Memorial Hospital were selected. The percentage of smudge cells and patient outcomes were evaluated for further univariate and survival analyses. RESULTS: A total of 102 patients with smudge cells in their blood smears were included. Smudge cells were frequently presented in out-of-hospital cardiac arrest (OHCA; n=30), infections (n=23), hematological cancers (n=23) and solid cancers (n=10). There was no relationship between the percentage of smudge cells and the patient mortality in all diseases (OR: 1.08, 95% CI: 0.47-2.48, P=1.000) as well as the OHCA group (OR: 1.91, 95% CI: 0.38-9.60, P=0.694). It was observed that in patients with all cancers with the percentage of smudge cells less than 50% had a lower mortality rate in comparison with those who had the percentage of smudge cells of 50% or more (OR: 22.29, 95% CI: 2.38-208.80, <0.001). Additionally, it was seemingly that patients with smudge cells of 50% or more had a lower survival rate than those with smudge cells less than 50% in all cancers with follow-up at 2-month intervals, but without statistical significance (P=0.064). CONCLUSIONS: Our survey indicated that in all cancers, those who had higher percentage of smudge cells were prone to have poor outcomes when compared with the subjects with lower percentage of smudge cells. This finding was quite different from the results of previous studies in which the race-ethnicity of most study populations was non-Asian; hence, further investigations are required. Besides, there was no apparent association of the percentage of smudge cells with patient outcomes in all diseases, including OHCA.

An automatic mass detection system in mammograms based on complex texture features.

It is difficult for radiologists to identify the masses on a mammogram because they are surrounded by complicated tissues. In current breast cancer screening, radiologists often miss approximately 10-30% of tumors because of the ambiguous margins of lesions and visual fatigue resulting from long-time diagnosis. For these reasons, many computer-aided detection (CADe) systems have been developed to aid radiologists in detecting mammographic lesions which may indicate the presence of breast cancer. This study presents an automatic CADe system that uses local and discrete texture features for mammographic mass detection. This system segments some adaptive square regions of interest (ROIs) for suspicious areas. This study also proposes two complex feature extraction methods based on cooccurrence matrix and optical density transformation to describe local texture characteristics and the discrete photometric distribution of each ROI. Finally, this study uses stepwise linear discriminant analysis to classify abnormal regions by selecting and rating the individual performance of each feature. Results show that the proposed system achieves satisfactory detection performance.