Comparison of different direct oral anticoagulant regimens in atrial fibrillation patients with high bleeding risk.

BACKGROUND: The optimal dose of direct oral anticoagulants (DOACs) to prevent ischemic stroke (IS) and systemic thromboembolism (STE) in atrial fibrillation (AF) patients with a predisposing bleeding risk remains unclear. OBJECTIVE: The purpose of this study was to compare the effectiveness and safety of different DOAC dosage regimens in AF patients with high bleeding risk but low thrombosis risk. METHODS: This retrospective observational study was conducted with the National Health Insurance claims database in Taiwan to include AF patients aged 20 up to 75 years, under DOAC therapy, with CHA2DS2-VASc score of 1 for males and 2 for females and HAS-BLED score ≥3. Standard-dose regimen was defined as dabigatran 300 mg, rivaroxaban 20 mg, apixaban 10 mg, or edoxaban 60 mg per day. Any other lower-dose regimen were defined as the low-dose regimen. The primary outcomes were IS and major bleeding (MB). The secondary outcomes were STE, gastrointestinal bleeding, intracranial hemorrhage, and cardiovascular death. RESULTS: A total of 964 patients were included (52.1% standard-dose regimen). Median HAS-BLED score was 3 [interquartile range 3-3]. Compared with standard-dose group, patients in the low-dose group had a significantly increased risk of IS (adjusted hazard ratio [aHR] 5.13; 95% confidence interval 1.37-19.22) and STE (aHR 3.14 [1.05-9.37]) but similar risk of MB (aHR 0.45 [0.12-1.67]). The risks of other hemorrhage and cardiovascular death were similar between the 2 dose groups. CONCLUSION: Among patients with a predominant bleeding risk but relatively low thrombosis risk, the low-dose DOAC regimen is not a more appropriate selection than standard-dose regimen.

An Improved Sensing Method of a Robotic Ultrasound System for Real-Time Force and Angle Calibration.

An ultrasonic examination is a clinically universal and safe examination method, and with the development of telemedicine and precision medicine, the robotic ultrasound system (RUS) integrated with a robotic arm and ultrasound imaging system receives increasing attention. As the RUS requires precision and reproducibility, it is important to monitor the real-time calibration of the RUS during examination, especially the angle of the probe for image detection and its force on the surface. Additionally, to speed up the integration of the RUS and the current medical ultrasound system (US), the current RUSs mostly use a self-designed fixture to connect the probe to the arm. If the fixture has inconsistencies, it may cause an operating error. In order to improve its resilience, this study proposed an improved sensing method for real-time force and angle calibration. Based on multichannel pressure sensors, an inertial measurement unit (IMU), and a novel sensing structure, the ultrasonic probe and robotic arm could be simply and rapidly combined, which rendered real-time force and angle calibration at a low cost. The experimental results show that the average success rate of the downforce position identification achieved was 88.2%. The phantom experiment indicated that the method could assist the RUS in the real-time calibration of both force and angle during an examination.

A Real-Time Speech Separation Method Based on Camera and Microphone Array Sensors Fusion Approach.

In the context of assisted human, identifying and enhancing non-stationary speech targets speech in various noise environments, such as a cocktail party, is an important issue for real-time speech separation. Previous studies mostly used microphone signal processing to perform target speech separation and analysis, such as feature recognition through a large amount of training data and supervised machine learning. The method was suitable for stationary noise suppression, but relatively limited for non-stationary noise and difficult to meet the real-time processing requirement. In this study, we propose a real-time speech separation method based on an approach that combines an optical camera and a microphone array. The method was divided into two stages. Stage 1 used computer vision technology with the camera to detect and identify interest targets and evaluate source angles and distance. Stage 2 used beamforming technology with microphone array to enhance and separate the target speech sound. The asynchronous update function was utilized to integrate the beamforming control and speech processing to reduce the effect of the processing delay. The experimental results show that the noise reduction in various stationary and non-stationary noise environments were 6.1 dB and 5.2 dB respectively. The response time of speech processing was less than 10ms, which meets the requirements of a real-time system. The proposed method has high potential to be applied in auxiliary listening systems or machine language processing like intelligent personal assistant.

A Clinical Trial of the Effect of a Blood Leakage Detection Device for Patients during Hemodialysis.

In hemodialysis, vascular access is usually achieved through an arteriovenous fistula, and a dislodged needle can cause varying degrees of injury to patients. In severe cases, the loss of blood can prove to be fatal. This study proposed a blood leakage detection device for patients during hemodialysis (HD). First, the device was tested on a phantom arm, and later in a clinical test on patients receiving HD. The thoughts of the patients and the nursing staff involved were surveyed before and after the introduction of the device. Analysis of the results indicated that the device achieved 100% and 98.9% accuracy rates on the phantom arm test and clinical test, respectively. The results suggested that patients believed the device could reduce their mental anxiety, and the nursing staff considered the device reliable and that it would enhance the quality of care. The proposed detection device can be extended to similar applications for preventing catheter dislodgement, and to improve patient safety and reduce the stress of clinical nursing staff.

Novel Wearable Device for Blood Leakage Detection during Hemodialysis Using an Array Sensing Patch.

Hemodialysis (HD) is a clinical treatment that requires the puncturing of the body surface. However, needle dislodgement can cause a high risk of blood leakage and can be fatal to patients. Previous studies proposed several devices for blood leakage detection using optical or electrical techniques. Nonetheless, these methods used single-point detection and the design was not suitable for multi-bed monitoring. This study proposed a novel wearable device for blood leakage monitoring during HD using an array sensing patch. The array sensing patch combined with a mapping circuit and a wireless module could measure and transmit risk levels. The different risk levels could improve the working process of healthcare workers, and enhance their work efficiency and reduce inconvenience due to false alarms. Experimental results showed that each point of the sensing array could detect up to 0.1 mL of blood leakage and the array sensing patch supports a risk level monitoring system up to 8 h to alert healthcare personnel of pertinent danger to the patients.