Liver regeneration of living donor after liver donation for transplantation: Disparity in the left and right remnant liver.

Donor safety is crucial for living donor liver transplantation (LDLT), and sufficient liver regeneration significantly affects outcomes of living donors. This study aimed to investigate clinical factors associated with liver regeneration in living donors. The study retrospectively reviewed 380 living donors who underwent liver donation at Chang Gung Memorial Hospital in Linkou. The clinical characteristics and medical parameters of donors were analyzed and compared according to liver donation graft type. There were 355 donors (93.4%) with right hemi-liver donations and 25 donors (6.6%) with left hemi-liver donations. Left hemi-liver donors had a higher body mass index (BMI) and a larger ratio of remnant liver volume (RLV) to total liver volume (TLV). However, the 2 groups showed no significant difference in the liver regeneration ratio. The type of remnant liver (P < .001), RLV/body weight (P = .027), RLV/TLV (P < .001), serum albumin on postoperative day 7 and total bilirubin levels on postoperative day 30 were the most significant factors affecting liver regeneration in living donors. In conclusion, adequate liver regeneration is essential for donor outcome after liver donation. The remnant liver could eventually regenerate to an adequate volume similar to the initial TLV before liver donation. However, the remnant left hemi-liver had a faster growth rate than the remnant right hemi-liver in donors.

Global epidemiology and burden of tetanus from 1990 to 2019: A systematic analysis for the Global Burden of Disease Study 2019.

OBJECTIVES: Tetanus is a serious infectious disease. In recent decades, the epidemiology and disease characteristics of tetanus have been reported by many medical workers, but these studies usually have limited sample sizes. METHODS: We retrieved all the epidemiological data related to tetanus from the Global Burden of Disease Study 2019, and a secondary analysis was performed to report the global epidemiology and disease burden of tetanus. RESULTS: From 1990 to 2019, the incidence and death rate of tetanus decreased worldwide. In general, high sociodemographic index (SDI) countries have lower age-standard incidence rates and age-standard death rates than low SDI countries. Moreover, in low SDI regions, newborns were the highest-risk group for tetanus. In high SDI areas, half of the tetanus cases occurred in the 70+ years age group. The disease burden of tetanus was significantly higher in males than in females. CONCLUSION: The disease burden of tetanus decreased significantly worldwide from 1990 to 2019. Neonatal tetanus is serious in low SDI areas, whereas the proportion of elderly tetanus is the highest in high SDI areas. The containment of tetanus in all age groups and sex still requires effort from all sectors.

High-Power Electromagnetic Pulse Exposure of Healthy Mice: Assessment of Effects on Mice Cognitions, Neuronal Activities, and Hippocampal Structures.

Electromagnetic pulse (EMP) is a high-energy pulse with an extremely rapid rise time and a broad bandwidth. The brain is a target organ sensitive to electromagnetic radiation (EMR), the biological effects and related mechanisms of EMPs on the brain remain unclear. The objectives of the study were to assess the effects of EMP exposure on mouse cognitions, and the neuronal calcium activities in vivo under different cases of real-time exposure and post exposure. EMP-treated animal model was established by exposing male adult C57BL/6N mice to 300 kV/m EMPs. First, the effects of EMPs on the cognitions, including the spatial learning and memory, avoidance learning and memory, novelty-seeking behavior, and anxiety, were assessed by multiple behavioral experiments. Then, the changes in the neuronal activities of the hippocampal CA1 area in vivo were detected by fiber photometry in both cases of during real-time EMP radiation and post-exposure. Finally, the structures of neurons in hippocampi were observed by optical microscope and transmission electron microscope. We found that EMPs under this condition caused a decline in the spatial learning and memory ability in mice, but no effects on the avoidance learning and memory, novelty-seeking behavior, and anxiety. The neuron activities of hippocampal CA1 were disturbed by EMP exposure, which were inhibited during EMP exposure, but activated immediately after exposure end. Additionally, the CA1 neuron activities, when mice entered the central area in an Open field (OF) test or explored the novelty in a Novel object exploration (NOE) test, were inhibited on day 1 and day 7 after radiation. Besides, damaged structures in hippocampal neurons were observed after EMP radiation. In conclusion, EMP radiation impaired the spatial learning and memory ability and disturbed the neuronal activities in hippocampal CA1 in mice.

Assessment of standing passenger traumatic brain injury caused by ground impact in subway collisions.

Human head is the most vulnerable region in subway collisions. To design a safer subway, the head impact biomechanical response should be studied first. This paper aims to investigate the standing passenger head-ground impact dynamic response and traumatic brain injury (TBI) in subway collisions. A standing passenger-subway interior dynamic model was numerically developed by using our previous validated finite element (FE)-multibody (MB) coupled human body model, which was integrated by the Total Human Model for Safety (THUMS) head-neck FE model and the extracted remaining body segments pedestrian MB model of TNO. A parametric study considering the handrail type, standing angle, and friction coefficient between the shoes and ground was performed. Results show that the passenger dynamic response could be divided into two categories according to whether the passenger hit handrails. Passenger TBIs severity could be efficiently alleviated by the passenger body (excluding the head) hitting the handrail first before head-ground impact. The probabilities of DAI in the cerebellum and brain stem were low. A statistical analysis of TBIs demonstrated that the risks of TBIs were sensitive to the handrail type in subway collisions, but did not to the standing angle and friction coefficient. This study provides practical help for improving the interior crashworthiness performance of subways.

Chromium Contamination and Health Risk Assessment of Soil and Agricultural Products in a Rural Area in Southern China.

With the rapid development of industry, chromium (Cr) pollutants accumulate constantly in the soil, causing severe soil Cr pollution problems. Farmland Cr pollution hurts the safety of agricultural production and indirectly affects human health and safety. However, the current situation of Cr pollution in farmland soil and crops has not been detailed enough. In this study, the evaluation of Cr potential risk in soil-crop systems was conducted in a rural area that was affected by industry and historic sewage irrigation. Ten different crops and rhizosphere soils were sampled from four fields. The results showed that Cr contents in farmland soil exceeded the national standard threshold in China (>21.85%), and the Cr content in edible parts of some agricultural products exceeded that too. According to the PCA and relation analysis, the Cr accumulation in edible parts showed a significant correlation with soil Cr contents and available potassium contents. Except for water spinach, the target hazard quotient (THQ) of the other crops was lower than 1.0 but the carcinogenic health risks all exceeded the limits. The carcinogenic risks (CR) of different types of crops are food crops > legume crops > leafy vegetable crops and root-tuber crops. A comprehensive assessment revealed that planting water spinach in this area had the highest potential risk of Cr pollution. This study provided a scientific and reliable approach by integrating soil environmental quality and agricultural product security, which helps evaluate the potential risk of Cr in arable land more efficiently and lays technical guidelines for local agricultural production safety.

Oral health: The first step to sustainable development goal 3.

The 17 sustainable development goals (SDGs) were established by the United Nations Agenda 2030 plan of action to achieve peace, prosperity, and well-being for all by 2030. SDG 3 aims to ensure healthy lives and promote well-being for all at all ages. However, oral health is not specifically mentioned and targeted in SDG 3. Numerous studies have demonstrated a connection between oral health and general health. Oral disease and the common non-communicable diseases have the co-existing modifying risk factors. In addition, oral health is associated with social, economic, cultural, and environmental problems. By the implementation of oral health care, oral health promotion, and universal health coverage, these could not only be good for oral health but also benefit for general health and well-being. Taken together, oral health is the first step to SDG 3.

Assessment of relationship between maxillary sinus membrane thickening and the adjacent teeth health by cone-beam computed tomography.

BACKGROUND/PURPOSE: Maxillary posterior teeth have close anatomical proximity to the maxillary sinus floor. The aim of this retrospective study was to evaluate the associations between maxillary sinus membrane thickening and the adjacent teeth health by cone-beam computed tomography (CBCT). MATERIALS AND METHODS: CBCT images were collected from 235 Taiwanese patients. The sinus mucosal thickening >2 mm is considered a pathologic sinus membrane. Demographic data such as sex, age, the thickness of sinus membrane, and the adjacent teeth health were recorded, graded, and analyzed. RESULTS: A total prevalence of maxillary sinus membrane thickening of 36.6% (86/235) was found in this study. The sinus membrane thickening was significantly associated with periodontal bone loss (p < 0.001) and periapical lesions (p < 0.001), respectively. A multivariate logistic regression model demonstrated that males had a significantly higher risk of sinus membrane thickening than females (OR: 2.08, 95% CI = 1.21-3.56). The patients in the age group ≥60 years showed a 4.35-fold increased risk of sinus membrane thickening compared with the patients in the age group ≤35 years (95% CI: 1.94-9.77). Severe periodontal bone loss was significantly associated with mucosal thickening with an OR of 4.78 as compared with normal to mild group (95% CI: 1.69-13.58). The patients having teeth with apical lesions had a 5.04 time OR for sinus membrane thickening than those having teeth without apical lesions (95% C.I.: 2.37-10.69). CONCLUSION: The prevalence of maxillary sinus membrane thickening was more frequently occurred in male and older people. Periodontal bone loss and periapical lesions were significantly associated with maxillary sinus membrane thickening.

Thermomass Theory in the Framework of GENERIC.

Thermomass theory was developed to deal with the non-Fourier heat conduction phenomena involving the influence of heat inertia. However, its structure, derived from an analogy to fluid mechanics, requires further mathematical verification. In this paper, General Equation for Non-Equilibrium Reversible-Irreversible Coupling (GENERIC) framework, which is a geometrical and mathematical structure in nonequilibrium thermodynamics, was employed to verify the thermomass theory. At first, the thermomass theory was introduced briefly; then, the GENERIC framework was applied in the thermomass gas system with state variables, thermomass gas density ρh and thermomass momentum mh, and the time evolution equations obtained from GENERIC framework were compared with those in thermomass theory. It was demonstrated that the equations generated by GENERIC theory were the same as the continuity and momentum equations in thermomass theory with proper potentials and eta-function. Thermomass theory gives a physical interpretation to the GENERIC theory in non-Fourier heat conduction phenomena. By combining these two theories, it was found that the Hamiltonian energy in reversible process and the dissipation potential in irreversible process could be unified into one formulation, i.e., the thermomass energy. Furthermore, via the framework of GENERIC, thermomass theory could be extended to involve more state variables, such as internal source term and distortion matrix term. Numerical simulations investigated the influences of the convective term and distortion matrix term in the equations. It was found that the convective term changed the shape of thermal energy distribution and enhanced the spreading behaviors of thermal energy. The distortion matrix implies the elasticity and viscosity of the thermomass gas.

Continuous Self-Cycling Fermentation Leads to Economical Lycopene Production by Saccharomyces cerevisiae.

The economic feasibility and waste treatment problem are challenges to the industrialization of lycopene production from Saccharomyces cerevisiae. In this study, fermentation wastewater, biomass residue, and residual D-galactose are recycled for lycopene production. Results show that when fresh water is totally replaced by wastewater, lycopene titer attains 1.21 ± 0.02 g/L, which is 14.2% higher than the fresh water group (P < 0.05). An 80% replacement ratio of yeast extract by biomass residue causes no significant difference to lycopene production while 100% replacement ratio significantly lowers lycopene titer compared with the yeast extract group. Then, a novel fermentation medium containing wastewater and biomass residue with supplementing 3 g/L yeast extract and D-galactose is used for lycopene production. Lycopene titer increases 22.4% than the traditional fermentation in shake flasks (P < 0.05). Continuous self-cycling strategy using wastewater and biomass residue was tested in shake flasks. The mean lycopene titer of the first five recycles shows no significant difference with the start batch. Scaling up to 70 L fermenter, the mean lycopene titer attains 5.88 ± 0.15 g/L in three recycles, which is 22.25% higher than the start batch (P < 0.05). Economic analysis shows that the lowest unite product cost is achieved when four recycles are accomplished, which is 29.6% lower than the traditional fermentation while the chemical oxygen demand decreases 64.0%. Our study shows that continuous self-cycling fermentation process for lycopene production is feasible for the first time. The comprehensive utilization of wastewater and biomass residue from lycopene production by S. cerevisiae and achievement of high lycopene titer will hopefully accelerate industrialization of microbial production of lycopene.

Gaze Tracking and Point Estimation Using Low-Cost Head-Mounted Devices.

In this study, a head-mounted device was developed to track the gaze of the eyes and estimate the gaze point on the user's visual plane. To provide a cost-effective vision tracking solution, this head-mounted device is combined with a sized endoscope camera, infrared light, and mobile phone; the devices are also implemented via 3D printing to reduce costs. Based on the proposed image pre-processing techniques, the system can efficiently extract and estimate the pupil ellipse from the camera module. A 3D eye model was also developed to effectively locate eye gaze points from extracted eye images. In the experimental results, average accuracy, precision, and recall rates of the proposed system can achieve an average of over 97%, which can demonstrate the efficiency of the proposed system. This study can be widely used in the Internet of Things, virtual reality, assistive devices, and human-computer interaction applications.

The diagnosis value of endobronchial ultrasound transbronchial lung biopsy combined with rapid on-site evaluation in peripheral lung cancer.

INTRODUCTION: Rapid on-site evaluation (ROSE) has the potential to increase endobronchial ultrasound transbronchial lung biopsy with guide sheath (EBUS-GS-TBLB) accuracy in the diagnosis of peripheral lung cancer. However, studies have reported controversial results. OBJECTIVES: The aim of the study was to evaluate the diagnosis value of EBUS-GS-TBLB combination with ROSE in peripheral lung cancer. METHODS: A total of 138 patients undergoing EBUS-GS-TBLB and ultimately diagnosed with lung cancer were allocated into the ROSE group and non-ROSE group. The result of the diagnostic yields, number of biopsy sites, the complication, cytopathological diagnostic cost and procedure times of EBUS-GS-TBLB with ROSE and without ROSE were compared. RESULTS: The diagnostic yields of TBLB were 87.8% and 78.1% in ROSE group and non-ROSE group, respectively (P < .05). The number of biopsy, procedure times and the percentage of the complication in ROSE group was significantly lower than in non-ROSE group (P < .05, respectively). The cytopathological diagnostic cost of ROSE group was lower compared with non-ROSE group (P < .05). CONCLUSIONS: EBUS-GS-TBLB combined with ROSE could be helpful to diagnose peripheral lung cancer, and could reduce the number of biopsy, procedure times, cytopathological diagnostic cost and complication.

A Computational Biomechanics Human Body Model Coupling Finite Element and Multibody Segments for Assessment of Head/Brain Injuries in Car-To-Pedestrian Collisions.

It has been challenging to efficiently and accurately reproduce pedestrian head/brain injury, which is one of the most important causes of pedestrian deaths in road traffic accidents, due to the limitations of existing pedestrian computational models, and the complexity of accidents. In this paper, a new coupled pedestrian computational biomechanics model (CPCBM) for head safety study is established via coupling two existing commercial pedestrian models. The head-neck complex of the CPCBM is from the Total Human Model for Safety (THUMS, Toyota Central R&D Laboratories, Nagakute, Japan) (Version 4.01) finite element model and the rest of the parts of the body are from the Netherlands Organisation for Applied Scientific Research (TNO, The Hague, The Netherlands) (Version 7.5) multibody model. The CPCBM was validated in terms of head kinematics and injury by reproducing three cadaveric tests published in the literature, and a correlation and analysis (CORA) objective rating tool was applied to evaluate the correlation of the related signals between the predictions using the CPCBM and the test results. The results show that the CPCBM head center of gravity (COG) trajectories in the impact direction (YOZ plane) strongly agree with the experimental results (CORA ratings: Y = 0.99 ± 0.01; Z = 0.98 ± 0.01); the head COG velocity with respect to the test vehicle correlates well with the test data (CORA ratings: 0.85 ± 0.05); however, the correlation of the acceleration is less strong (CORA ratings: 0.77 ± 0.06). No significant differences in the behavior in predicting the head kinematics and injuries of the tested subjects were observed between the TNO model and CPCBM. Furthermore, the application of the CPCBM leads to substantial reduction of the computation time cost in reproducing the pedestrian head tissue level injuries, compared to the full-scale finite element model, which suggests that the CPCBM could present an efficient tool for pedestrian brain-injury research.

Image-guided pedicle screws using intraoperative cone-beam CT and navigation. A cost-effectiveness study.

Image-guided surgery using intraoperative cone-beam CT and navigation improves screw placement accuracy rates. However, this technology is associated with high acquisition costs. The aim of this study is to evaluate the costs of revision surgery from symptomatic pedicle screw malposition to justify whether the costs of acquiring intraoperative navigation justify the expected benefits. This is a retrospective cost-effectiveness analysis of consecutive patients who had pedicle screw instrumentation using intraoperative cone-beam CT and navigation compared with patients who underwent freehand pedicle screw instrumentation at our institution over 4 years. The costs associated with revision surgery for symptomatic pedicle screw malposition (excess length of stay, intensive care, theatre time, implants and additional outpatient appointments) were calculated. A total of 19 patients had symptomatic screw malpositioning requiring revision surgery. None of these patients had screws inserted under navigation. Revision surgery accounted for an extra 304 bed days and an additional 97 h theatre time. The total extra spent over 4 years was £464,038. When compared to the costs of revision surgery for screw malpositioning, it was cost neutral to acquire and maintain this technology. Intraoperative image-guided surgery reduces reoperation rates for symptomatic screw malposition and is cost-effective in high volume centers with improved patients outcomes. High acquisition and maintenance cost of such technologies is economically justifiable.

Preliminary assessment of the feasibility of autologous myeloid-derived suppressor cell infusion in non-human primate kidney transplantation.

Myeloid-derived suppressor cells (MDSC) are a heterogenous population of immunosuppressive myeloid cells now considered important immune regulatory cells in diverse clinical conditions, including cancer, chronic inflammatory disorders and transplantation. In rodents, MDSC administration can inhibit graft-versus-host disease lethality and enhance organ or pancreatic islet allograft survival. There is also evidence, however, that under systemic inflammatory conditions, adoptively-transferred MDSC can rapidly lose their suppressive function. To our knowledge, there are no reports of autologous MDSC administration to either human or clinically-relevant non-human primate (NHP) transplant recipients. Monocytic (m) MDSC have been shown to be more potent suppressors of T cell responses than other subsets of MDSC. Following their characterization in rhesus macaques, we have conducted a preliminary analysis of the feasibility and preliminary efficacy of purified mMDSC infusion into MHC-mismatched rhesus kidney allograft recipients. The graft recipients were treated with rapamycin and the high affinity variant of the T cell co-stimulation blocking agent cytotoxic T lymphocyte antigen 4 Ig (Belatacept) that targets the B7-CD28 pathway. Graft survival and histology were not affected by infusions of autologous, leukapheresis product-derived mMDSC on days 7 and 14 post-transplant (cumulative totals of 3.19 and 1.98 × 106 cells/kg in n = 2 recipients) compared with control monkeys that did not receive MDSC (n = 2). Sequential analyses of effector T cell populations revealed no differences between the groups. While these initial findings do not provide evidence of efficacy under the conditions adopted, further studies in NHP, designed to ascertain the appropriate mMDSC source and dose, timing and anti-inflammatory/immunosuppressive agent support are likely to prove instructive regarding the therapeutic potential of MDSC in organ transplantation.

Validated Assessment Scales for the Female Asian Calf.

BACKGROUND: Clinical photonumeric scales have been developed and validated to objectively measure the effectiveness of aesthetic treatments in specific anatomical areas; however, these are based on the typical features of Caucasian patients. No clinical scale for Asian calf appearance currently exists. OBJECTIVE: To develop and validate a calf assessment scale for use in the female Asian patient population. METHODS AND MATERIALS: During 2 validation sessions, 13 raters assessed calf images of female Asian subjects (N = 35) viewed from behind with feet flat on the floor (at rest) and on tiptoes (dynamic). Images were rated from 0 (very slim, linear profile) to 4 (very severe convex profile). RESULTS: Inter-rater and intra-rater reliability were "substantial" (≥0.6, intraclass correlation coefficient [ICC] and weighted kappa) for the calf-at rest, calf-dynamic, and calf summary score. Reliability was "substantial" for calf-at rest and calf-dynamic (≥0.6, ICC and weighted kappa) and "almost perfect" (0.85) for the calf summary score. BMI and calf circumference were highly correlated with scale ratings, and calf circumference was a significant predictor. CONCLUSION: This new photonumeric assessment scale has value for assessing the female Asian calf, providing a standardized measure of calf appearance in clinical practice and clinical research settings.

Validated Assessment Scales for Cellulite Dimples on the Buttocks and Thighs in Female Patients.

BACKGROUND: New treatment methods for cellulite require globally accepted scales for aesthetic research and patient evaluation. OBJECTIVE: To develop a set of grading scales for objective assessment of cellulite dimples on female buttocks and thighs and assess their reliability and validity. MATERIALS AND METHODS: Two photonumeric grading scales were created and validated for dimples in the buttocks in female patients: Cellulite Dimples-At Rest, and Cellulite Dimples-Dynamic. Sixteen aesthetic experts rated photographs of 50 women in 2 validation sessions. Responses were analyzed to assess inter-rater and intra-rater reliability. RESULTS: Overall inter-rater reliability and intra-rater reliability were both "almost perfect" (≥0.81, intraclass correlation efficient and weighted kappa) for the At Rest scale. For the Dynamic scale, inter-rater reliability and intra-rater reliability were "substantial" (0.61-0.80). There was a high correlation between the cellulite scales and body mass index, age, weight, and skin laxity assessments. CONCLUSION: Consistent outcomes between raters and by individual raters at 2 time points confirm the reliability of the cellulite dimple grading scales for buttocks and thighs in female patients and suggest they will be a valuable tool for use in research and clinical practice.

Validated Assessment Scales for Skin Laxity on the Posterior Thighs, Buttocks, Anterior Thighs, and Knees in Female Patients.

BACKGROUND: The demand for noninvasive skin-tightening body procedures is increasing. OBJECTIVE: To develop a set of grading scales for the objective assessment of skin laxity and assess their reliability and validity. MATERIALS AND METHODS: Two photonumeric grading scales were created and validated for skin laxity in female patients: Skin Laxity-Posterior Thighs/Buttocks, and Anterior Thighs/Knees. Fifteen aesthetic experts rated photographs of 50 women in 2 validation sessions. Responses were analyzed to assess inter-rater and intra-rater reliability. RESULTS: Overall inter-rater reliability according to intraclass correlation efficient (ICC) 2.1 and weighted kappa was at least "substantial" for both scales in both sessions, and "almost perfect" (≥0.81) for the Anterior Thighs and Knees scale in session 2. Intra-rater reliability was "almost perfect" for both scales (ICC 2.1) and "substantial" to "almost perfect" by weighted kappa. A correlation between the skin laxity scales and body mass index, age, weight, sun exposure, and cellulite severity was observed. CONCLUSION: The skin laxity photonumeric grading scales are valid and reliable instruments for assessing laxity on the posterior thighs and buttocks, and anterior thighs and knees. The scales will be of value for standardizing clinical evaluations and quantifying outcome measurements in research and clinical practice.

A Validated Assessment Scale for Asian Chin Projection.

BACKGROUND: As the number of different aesthetic treatments increase, numerous photonumeric assessment scales have been developed and validated to measure the effectiveness of these new treatments and techniques. Photonumeric rating scales have been developed to objectively assess improvements in anatomical areas; however, these have been based on the features of Caucasian patients. OBJECTIVE: To develop and validate a Chin Projection Scale for use in the female Asian patient population. METHODS AND MATERIALS: During 2 validation sessions, 13 raters assessed full frontal and lateral facial views of 50 Asian subjects and also estimated their age and the aesthetic treatment effort required for each subject. Chin projection was rated on a scale from 0 (optimal) to 4 (very severely receding). RESULTS: Inter-rater reliability was 0.80 (substantial) for Validation Session 1 and 0.83 (almost perfect) for Validation Session 2. The results for Estimated Age and Estimated Treatment Effort were essentially the same. CONCLUSION: This study demonstrated the validity of the first photonumeric assessment scale for assessing the appearance of the female Asian chin. This new scale will provide a standardized measure of chin projection for Asian patients in clinical practice and clinical research settings.

Validation of a Photonumeric Assessment Scale for Grading the Slope of the Asian Forehead.

BACKGROUND: As the number of aesthetic treatments has grown, so have the number of photonumeric assessment scales used to compare the effectiveness of these aesthetic treatments in specific anatomical areas; however, these are primarily based on Caucasian features. OBJECTIVE: To assess the validity of the first aesthetic scale for assessing the slope of the Asian forehead. A secondary objective was to correlate this scale with subject demographics and baseline characteristics. METHODS: During 2 validation sessions, 13 raters assessed full frontal and lateral facial images of female (n = 28; 56.0%) and male (n = 22; 44%) subjects. For each subject, the severity of forehead sloping was graded from 0 (convex forehead, optimal forehead volume) to 4 (concave forehead, very severe sloping). Raters also assessed the age of each subject and the estimated aesthetic treatment effort required to treat each subject. RESULTS: Inter-rater reliability was "substantial" with scores of 0.67 and 0.68 for the first and second validation sessions, indicating high reliability. BMI showed the highest correlation with the scale and was a significant predictor in the final regression model. CONCLUSION: This photonumeric assessment scale will be useful for assessing the slope of the Asian forehead in both clinical and research settings.

Inverse reinforcement learning for intelligent mechanical ventilation and sedative dosing in intensive care units.

BACKGROUND: Reinforcement learning (RL) provides a promising technique to solve complex sequential decision making problems in health care domains. To ensure such applications, an explicit reward function encoding domain knowledge should be specified beforehand to indicate the goal of tasks. However, there is usually no explicit information regarding the reward function in medical records. It is then necessary to consider an approach whereby the reward function can be learned from a set of presumably optimal treatment trajectories using retrospective real medical data. This paper applies inverse RL in inferring the reward functions that clinicians have in mind during their decisions on weaning of mechanical ventilation and sedative dosing in Intensive Care Units (ICUs). METHODS: We model the decision making problem as a Markov Decision Process, and use a batch RL method, Fitted Q Iterations with Gradient Boosting Decision Tree, to learn a suitable ventilator weaning policy from real trajectories in retrospective ICU data. A Bayesian inverse RL method is then applied to infer the latent reward functions in terms of weights in trading off various aspects of evaluation criterion. We then evaluate how the policy learned using the Bayesian inverse RL method matches the policy given by clinicians, as compared to other policies learned with fixed reward functions. RESULTS: Results show that the inverse RL method is capable of extracting meaningful indicators for recommending extubation readiness and sedative dosage, indicating that clinicians pay more attention to patients' physiological stability (e.g., heart rate and respiration rate), rather than oxygenation criteria (FiO2, PEEP and SpO2) which is supported by previous RL methods. Moreover, by discovering the optimal weights, new effective treatment protocols can be suggested. CONCLUSIONS: Inverse RL is an effective approach to discovering clinicians' underlying reward functions for designing better treatment protocols in the ventilation weaning and sedative dosing in future ICUs.