Combining molecular docking and molecular dynamics to predict the binding modes of flavonoid derivatives with the neuraminidase of the 2009 H1N1 influenza A virus.

Control of flavonoid derivatives inhibitors release through the inhibition of neuraminidase has been identified as a potential target for the treatment of H1N1 influenza disease. We have employed molecular dynamics simulation techniques to optimize the 2009 H1N1 influenza neuraminidase X-ray crystal structure. Molecular docking of the compounds revealed the possible binding mode. Our molecular dynamics simulations combined with the solvated interaction energies technique was applied to predict the docking models of the inhibitors in the binding pocket of the H1N1 influenza neuraminidase. In the simulations, the correlation of the predicted and experimental binding free energies of all 20 flavonoid derivatives inhibitors is satisfactory, as indicated by R(2) = 0.75.

Volumetric modulated arc therapy for nasopharyngeal carcinoma: a dosimetric comparison with TomoTherapy and step-and-shoot IMRT.

PURPOSE: Volumetric modulated arc therapy (VMAT), a novel technique, employs a linear accelerator to conduct dynamic modulation rotation radiotherapy. The goal of this study was to compare VMAT with helical tomotherapy (HT) and step-and-shoot intensity-modulated radiation therapy (IMRT) for nasopharyngeal carcinoma (NPC) patients with regard to the sparing effect on organs at risk (OARs), dosimetric quality, and efficiency of delivery. MATERIALS AND METHODS: Twenty patients with NPC treated by HT were re-planned by VMAT (two arcs) and IMRT (7-9 fields) for dosimetric comparison. The target area received three dose levels (70, 60, and 54 Gy) in 33 fractions using simultaneous integrated boosts technique. The Philips Pinnacle Planning System 9.0 was adopted to design VMAT, using SmartArc as the planning algorithm. For a fair comparison, the planning target volume (PTV) coverage of the 3 plans was normalized to the same level. Dosimetric comparisons between VMAT, HT, and IMRT plans were analyzed to evaluate (1) coverage, homogeneity, and conformity of PTV, (2) sparing of OARs, (3) delivery time, and (4) monitor units (MUs). RESULTS: The VMAT, HT, and IMRT plans had similar PTV coverage with an average of 96%. There was no significant difference between VMAT and HT in homogeneity, while the homogeneity indices of VMAT (1.06) and HT (1.06) were better than IMRT plans (1.07, p<0.05). HT plans provided a better conformity index (1.17) than VMAT (1.28, p=0.01) and IMRT (1.36, p=0.02). When compared with IMRT, VMAT and HT had a better sparing effect on brain stem and spinal cord (p<0.05). The effect of parotid sparing was similar between VMAT (mean=26.3 Gy) and HT (mean=27.5 Gy), but better than IMRT (mean=31.3 Gy, p<0.01). The delivery time per fraction for VMAT (5.7 min) were much lower than for HT (9.5 min, p<0.01) and IMRT (9.2 min, p<0.01). CONCLUSIONS: Our results indicate that VMAT provides better sparing of normal tissue, homogeneity, and conformity than IMRT, and shorter delivery time than HT.

Pulse transit time reveals drug kinetics on vascular changes affected by propofol.

Pulse transit time (PTT) is the duration in which a pulse wave travels between two arterial sites within the same cardiac cycle. The aim of our study is to use PTT to examine propofol's effects on the vascular system. Methods. We collected data from 50 healthy women, between 28 and 51 years old, who underwent gynaecological surgery under general anaesthesia. The general anaesthesia was induced with propofol injection (2 mg/kg). PTT measurements were obtained from the R-wave of electrocardiogram and the pulse wave of photoplethysmograph. Two PTT values were obtained; one before (the control) and the other after propofol injection. The results were analysed by Student's t-test. Results. After propofol injection, the PTT was prolonged. The change in the PTT value from that of baseline was significant statistically (P < 0.05, by Student's t-test). The PTT change over time correlated with the degree of vasodilatation over time. Monitoring of PTT not only revealed the magnitude of vascular changes but also demonstrated the onset of vascular dilation, its peak and duration. We conclude that PTT is a useful guide in monitoring the drug kinetics of propofol.

Postoperative intensity-modulated radiotherapy for squamous cell carcinoma of the external auditory canal and middle ear: treatment outcomes, marginal misses, and perspective on target delineation.

PURPOSE: To report outcomes of the rare disease of squamous cell carcinoma (SCC) of the external auditory canal (EAC) and middle ear treated with surgery and postoperative intensity-modulated radiotherapy (IMRT). Failure patterns related to spatial dose distribution were also analyzed to provide insight into target delineation. METHODS AND MATERIALS: A retrospective review was conducted of the records of 11 consecutive patients with SCC of the EAC and middle ear who were treated with curative surgery and postoperative IMRT at one institution between January 2007 and February 2010. The prescribed IMRT dose was 60 to 66 Gy at 2 Gy per fraction. Three patients also received concurrent cisplatin-based chemotherapy, and 1 patient received concurrent oral tegafur/uracil. The median follow-up time was 19 months (range, 6-33 months). RESULTS: Four patients had locoregional recurrence, yielding an estimated 2-year locoregional control rate of 70.7%. Among them, 1 patient had persistent disease after treatment, and 3 had marginal recurrence. Distant metastasis occurred in 1 patient after extensive locoregional recurrence, yielding an estimated 2-year distant control rate of 85.7%. The estimated 2-year overall survival was 67.5%. The three cases of marginal recurrence were near the preauricular space and glenoid fossa of the temporomandibular joint, adjacent to the apex of the ear canal and glenoid fossa of the temporomandibular joint, and in the postauricular subcutaneous area and ipsilateral parotid nodes, respectively. CONCLUSIONS: Marginal misses should be recognized to improve target delineation. When treating SCC of the EAC and middle ear, care should be taken to cover the glenoid fossa of the temporomandibular joint and periauricular soft tissue. Elective ipsilateral parotid irradiation should be considered. The treatment planning procedure should also be refined to balance subcutaneous soft-tissue dosimetry and toxicity.

Combination of frequency and amplitude-modulated model for the synthesis of normal and wheezing sounds.

Based on communication theory, this study proposes a model to synthesize normal and wheezing sounds. The model included five parts: the flow source as a transmitter, the frequency and amplitude-modulated (FM-AM) sounds, the accompanying noise as a modulator, the airway wall as a medium, and the microphone as a receiver. The hypothesis of modulation builds on that the deviation of frequency and amplitude of the sounds which cause from the deviation of collision speed of the air flow on the wall. The model was successful to simulate the normal breath and wheezing sounds. Furthermore, it provided a correct proof for the CORSA description, which indicates that the wheeze was contained in the domain frequency at 400 Hz, but a number of investigators have suggested that the range is actually between 80-1,600 Hz and 350-950 Hz by filter theory. This study modifies the signal source in Wodicka et al. model, and describes it in functional blocks. In fact, the design of the signal source base on the knowledge of the lung sound studies, especially the analysis of components in the frequency and time domains. We synthesized the required components to reproduce the lung sounds, and proposed a mechanism of wheeze which was examined by the computer simulation in the points of the system engineering view.

A framework of medical equipment management system for in-house clinical engineering department.

Medical equipment management is an important issue for safety and cost in modern hospital operation. In addition, the use of an efficient information system effectively promotes the managing performance. In this study, we designed a framework of medical equipment management system used for in-house clinical engineering department. The system was web-based, and it integrated clinical engineering and hospital information system components. Through related information application, it efficiently improved the operation management of medical devices immediately and continuously. This system has run in the National Taiwan University Hospital. The results showed only few examples in the error analysis of medical equipment by the maintenance sub-system. The information can be used to improve work quality, to reduce the maintenance cost, and to promote the safety of medical device used in patients and clinical staffs.

Electric compass aided global positioning system navigation for powered wheelchairs.

Powered wheelchairs are an important mobility aid for the elderly and for persons with disability. According to World Health Organization statistics, most of the accidents were due to personal mistakes; if there is an auto-navigating system such as auxiliary, mistaken manipulation will decrease efficiency. This study attempted to improve the global positioning system (GPS) navigation of electric powered wheelchairs (EPWs) through the addition of an electric compass (EC) and tested the navigation of EPWs with EC-aided and non-EC-aided GPS navigation along a 25 m road. According to these tests, the use of the EC significantly reduces the errors in GPS navigation during movements such as go straight ahead, turn right and turn left. Therefore, the navigation reduced the error of the expected trajectories with the EC-aided navigation.

Higher order statistics-based radial basis function network for evoked potentials.

In this study, higher order statistics-based radial basis function network (RBF) was proposed for evoked potentials (EPs). EPs provide useful information on diagnosis of the nervous system. They are time-varying signals typically buried in ongoing EEG, and have to be extracted by special methods. RBF with least mean square (LMS) algorithm is an effective method to extract EPs. However, using LMS algorithm usually encounters gradient noise amplification problem, i.e., its performance is sensitive to the selection of step sizes and additional noise. Higher order statistics technique, which can effectively suppress Gaussian and symmetrically distributed non-Gaussian noises, was used to reduce gradient noise amplification problem on adaptation in this study. Simulations and human experiments were also carried out in this study.

Electrophysiological and functional effects of shock waves on the sciatic nerve of rats.

Extracorporeal shockwave therapy (ESWT) has been applied in lithotripsy and treatments of musculoskeletal disorders over the past decade, but its effects on peripheral nerves remain unclear. This study investigated the short-term effects of shockwaves on the sciatic nerve of rats. The nerves were surgically exposed and then stimulated with shockwaves at three intensities. We evaluated the motor nerve conduction velocity (MNCV) of treated sciatic nerves before, immediately after (day 0) and at 1, 4, 7 and 14 d after shockwave treatment. Two functional tests-the sciatic functional index and the withdrawal reflex latency-were evaluated before and at 1, 4, 7 and 14 d after shockwave application. The rats were sacrificed on days 0, 1, 4, 7 and 14 for morphologic observation. The degassed treatment group received high-intensity shockwave treatment using degassed normal saline as the contact medium, and MNCV was measured before and on days 0, 1, 4, 7 and 14. The sham group received the same procedure as the treatment groups (i.e., the surgical operation to expose the sciatic nerve) but with no shockwave treatment. The control group received no surgical operation or shockwave treatment. The results showed moderate decrease in the MNCV after shockwave treatment and damage to the myelin sheath of large-diameter myelinated fibers. The effect was largest (reduction to 60.9% of baseline MNCV) and of longest duration (7 to 14 d) in the high-intensity group. There were no significant changes in functional tests. These results indicated that direct application of shockwaves can induce reversible segmental demyelination in large-diameter fibers, with the electrophysiological changes being positively correlated with the intensity of the shockwaves.

Thermal effect of sonophoresis for accelerating the analgesic effect of local anesthetics on rat tail nerve.

Sonophoresis is an ultrasound transdermal drugs delivery system. The eutectic mixture of local anesthetics (EMLA) has been used clinically for anesthesia but requires at least one hour to take effect and lacks of analgesia's objective assessment. We proposed that sonophoresis could reduce the duration of EMLA analgesia effect onset and be assessed by sensory conduction studies. Thirty Wistar adult rats were randomized into normal, control, ultrasound-, and heat-treatment groups. Normal group was received no EMLA cream or ultrasound and heat treatment. The control group received the EMLA cream on the rat tail at 3.5 cm distal to the rat tail base for local anesthesia of tail nerve. Ultrasound- and heat-treatment groups were received ultrasound with different parameters and heat treatment, respectively, before EMLA cream applied. Sensory conduction studies of tail nerve were made before and after treatment every 5 min at least for 60 min in all rats. There was no significant difference between the EMLA control group and heat treatment group. All rats in ultrasound-treatment group exhibit significant difference with EMLA control group and heat-treatment group in time for decreased 20% SNCV except for the 2 W/cm(2), 25 min, 20% in ultrasound-treatment group having no significant difference with heat-treatment group. There was no significant difference between ultrasound-treatment subgroups. In the decrease of amplitude, only the 2 W/cm(2), 5 min, 100% and the 2 W/cm(2), 10 min, 50% in ultrasound-treatment group had significant difference between EMLA control and heat-treatment groups. We have objectively examined the sonophoresis effect of ultrasound by investigating the effects of EMLA. Applying ultrasound for 5 min reduces the onset time of EMLA analgesia from 60 min to less than 20 min. Ultrasound sonophoresis of analgesic drugs is potentially useful in the treatment of carpal tunnel syndrome, tooth extraction, and other applications of analgesia.

The electrophysiological and functional effect of shock wave on peripheral nerves.

Recently, extracorporeal shock wave therapy (ESWT) is found to be effective for musculoskeletal disorders, such as calcific tendonitis, epicondylitis, and plantar fasciitis. Until now, there is no study on the influence of ESWT on motor nerve and the underlying mechanism of ESWT on musculoskeletal disorders remains unclear. This study evaluated the effects of shock wave of different intensity on peripheral nerves and the tracking of long term observation on induced injury. Shock wave treatments of different intensity were applied on the sciatic nerve of rat and electrophysiological changes were recorded. Besides, the functional activities were estimated with sciatic functional index (SFI). The results showed a decrease of motor nerve conduction velocity (MNCV) after shock wave treatment, but recovery was observed within 14 days. When the intensity of shock wave was higher, the decrease of MNCV sustained longer. There was no significant change in functional assessment. It is suggested that ESWT may be harmless to peripheral nerves and can be used in the treatment of musculoskeletal disorders.

Wheeze detection using cepstral analysis in Gaussian Mixture Models.

Traditional wheezes detection methods are based on the frequency and durations of acoustic signal or the location of peaks from successive spectra. In these methods, the discriminative threshold used to identify peaks usually is fixed empirically. Therefore, accuracy of detected wheeze is affected by environment noise and artificial factors. The objective of this study is to classify normal and abnormal (wheezing) respiratory sounds using Cepstral analysis in Gaussian Mixture Models. The sound signal is divided in overlapped segments, which are characterized by a reduced dimension feature vectors using Mel-Frequency Cepstral Coefficients. In this study the ;speaker' is wheeze. During the test phase, an unknown sound is compared to all the GMM models and the classification decision is based on the Maximum Likelihood criterion. In these processes, identification is based on threshold value. If the threshold is bigger than zero, the sound is normal. Otherwise, the sound is wheeze. From experimental results, when the Gaussian mix number is 16, the accuracy of identification of wheeze is up to 90%.

Set-up errors due to endorectal balloon positioning in intensity modulated radiation therapy for prostate cancer.

PURPOSE: To investigate the set-up errors and deformation associated with daily placement of endorectal balloons in prostate radiotherapy. MATERIALS AND METHODS: Endorectal balloons were placed daily in 20 prostate cancer patients undergoing radiotherapy. Electronic portal images (EPIs) were collected weekly from anterior-posterior (AP) and lateral views. The EPIs were compared with digitally reconstructed radiographs from computed tomography scans obtained during pretreatment period to estimate displacements. The interfraction deformation of balloon was estimated with variations in diameter in three orthogonal directions throughout the treatment course. RESULTS: A total of 154 EPIs were evaluated. The mean displacements of balloon relative to bony landmark were 1.8mm in superior-inferior (SI), 1.3mm in AP, and 0.1mm in left-right (LR) directions. The systematic errors in SI, AP, and LR directions were 3.3mm, 4.9 mm, and 4.0mm, respectively. The random (interfraction) displacements, relative to either bony landmarks or treatment isocenter, were larger in SI direction (4.5mm and 4.5mm), than in AP (3.9 mm and 4.4mm) and LR directions (3.0mm and 3.0mm). The random errors of treatment isocenter to bony landmark were 2.3mm, 3.2mm, and 2.6mm in SI, AP, and LR directions, respectively. Over the treatment course, balloon deformations of 2.8mm, 2.5mm, and 2.6mm occurred in SI, AP, and LR directions, respectively. The coefficient of variance of deformation was 7.9%, 4.9%, and 4.9% in these directions. CONCLUSIONS: Larger interfractional displacement and the most prominent interfractional deformation of endorectal balloon were both in SI direction.

Higher-order-statistics-based radial basis function networks for signal enhancement.

In this paper, a higher-order-statistics (HOS)-based radial basis function (RBF) network for signal enhancement is introduced. In the proposed scheme, higher order cumulants of the reference signal were used as the input of HOS-based RBF. An HOS-based supervised learning algorithm, with mean square error obtained from higher order cumulants of the desired input and the system output as the learning criterion, was used to adapt weights. The motivation is that the HOS can effectively suppress Gaussian and symmetrically distributed non-Gaussian noise. The influence of a Gaussian noise on the input of HOS-based RBF and the HOS-based learning algorithm can be mitigated. Simulated results indicate that HOS-based RBF can provide better performance for signal enhancement under different noise levels, and its performance is insensitive to the selection of learning rates. Moreover, the efficiency of HOS-based RBF under the nonstationary Gaussian noise is stable.

RTWPMS: a real-time wireless physiological monitoring system.

This paper demonstrates the design and implementation of a real-time wireless physiological monitoring system for nursing centers, whose function is to monitor online the physiological status of aged patients via wireless communication channel and wired local area network. The collected data, such as body temperature, blood pressure, and heart rate, can then be stored in the computer of a network management center to facilitate the medical staff in a nursing center to monitor in real time or analyze in batch mode the physiological changes of the patients under observation. Our proposed system is bidirectional, has low power consumption, is cost effective, is modular designed, has the capability of operating independently, and can be used to improve the service quality and reduce the workload of the staff in a nursing center.

A study of heart sound and lung sound separation by independent component analysis technique.

In the hospital, using percussion and auscultation are the most common ways for physical examination. Recently, in order to develop tele-medicine and home care system and to assist physician getting better auscultation results; electric stethoscope and computer analysis have become an inevitable trend. However, two important physical signals heart sound and lung sound recorded from chest overlap on spectrum chart. Therefore, in order to reduce human factor (ex. misplace or untrained of using) and minimize correlated effect in computer analysis; it's necessary for separated heart sound and lung sound. Independent component analysis can divide these sounds efficiency. In this paper, we use two microphones to collect signals from left and right chest. We have successfully divide heart and lung sounds by fast ICA algorithm. Therefore, it can assist physician examine and also using on tele-medicine and home care by this way.

Using web technique in the managing regulatory requirements of medical equipment for the nursing department.

The centralized and information management are in common use technique of modern management. The management of the medical equipment emphasized in the purchase and the maintenance management in early days,and cost down now is import factor for medical equipment management because the health insurance system causes the hospital budget reduced, so in the cost down strategy is to reduce the amount of money and promoting the efficient of use . Another important subject in medical equipment management is patient safety, so how to ensuring the quality of medical equipment is also having to notice. In the paper, we will provide an architecture for assistant the nursing department to develop a information system on the centralized and information management of valuable medical equipment. Through the system operation we hope can promote the effect and the quality of the medical equipment usage. This system implement up to now has more than half a year, and could acquired some concrete result: the utilization rate promotes doubly, the rate of breaking downs, the borrowed time cuts 75%, the cost downs for equipment purchase and satisfaction increases for user. In this paper, in addition to explaining the above-mentioned result,also discusses the design principle and structure on the whole system. We hope the protocol could be used as for clinical unit to control their valuable equipments and match the authority expectation.

The Development of M3S-Based GPS Navchair and Tele-Monitor System.

The purpose of this study is to develop a M3S- Based GPS navigation system for power wheelchair. The wheelchair steered with GPS and electronic compass can move automatically toward a specific destination through a GIS-Map in the computer. The topic of this study is to help people with disabilities regain independence of transportation in specific areas of their daily activities. This system is now designed to operate in special locations, for example, campuses or airports. Safety of the system is enhanced according to "M3S", which is an international standard for power wheelchair. In the proposed architecture, modules are easily and securely integrated to the wheelchair, which includes a tele-monitor system implemented with computer network, mobile-phone and physiological sensors. Bio-signals, wheelchair location and other information of the user are acquired by the nursing staff or any other medical personnel by using this system.

Power-line Interference Removal of Bioelectric Signal Measurement by using Genetic Adaptive Filter.

In this study, we proposed a genetic adaptive filter to removing power-line interference. In previous work, the proposed structure, which extracts the interference component from the input biomedical signal to be a reference signal of the adaptive filter to estimate power-line interference, is effective for removing interference. Since this adaptive filter with least-mean square algorithm is sensitive to the eigenvalue spread of the autocorrelation matrix of the reference signals, and the selection of its step-size. Thus, we employ the genetic parallel search technique to improve the least-mean square algorithm. Through simulations, it shows that the adaptive filter with genetic algorithm provides better performance with any step-size.

Respiratory wheeze detection system.

Respiratory sound is associated with many lung diseases. By observing respiratory sound symptoms, we can know more about lung conditions. In this research, we construct an efficient lung sound recording system according to CORSA, and develop a spectrogram process flow technique to object wheeze. It is a low cost and efficient system. In clinic test, we also can precisely objective wheeze up to about 89%.