An action recognition method for manual acupuncture techniques using a tactile array finger cot.

The current measurement systems for the physical parameters (rotation frequency, and amplitude) of Traditional Chinese Medicine (TCM) manual acupuncture tend to cause disturbance and inconvenience in clinical application and do not accurately capture the tactile signals from the physician's finger during manual acupuncture operations. In addition, the literature rarely discusses classification of the four basic manual acupuncture techniques (reinforcing by twirling and rotating (RFTR), reducing by twirling and rotating (RDTR), reinforcing by lifting and thrusting (RFLT), and reducing by lifting and thrusting (RDLT)). To address this problem, we developed a multi-PVDF film-based tactile array finger cot to collect piezoelectric signals from the acupuncturist's finger-needle contact during manual acupuncture operations. In order to recognize the four typical TCM manual acupuncture techniques, we developed a method to capture piezoelectric signals in related "windows" and subsequently extract features to model acupuncture techniques. Next, we created an ensemble learning-based action classifier for manual acupuncture technique recognition. Finally, the proposed classifier was employed to recognize the four types of manual acupuncture techniques performed by 15 TCM physicians based on the piezoelectric signals collected using the tactile array finger cot. Among all the approaches, our proposed feature-based CatBoost ensemble learning model achieved the highest validation accuracy of 99.63% and the highest test accuracy of 92.45%. Moreover, we provide the efficiency and limitations of using this action recognition method.

[Development and application of computer vision-based acupuncture manipulation classification system].

OBJECTIVE: To improve the accuracy of acupuncture manipulation modeling and inheritance, this article explores the feasibility of automatically classifying "twirling" and "lifting and thrusting", two basic acupuncture manipulations in science of acupuncture and moxibustion, with the computer vision technology. METHODS: A hybrid deep learning network model was designed based on 3D convolutional neural network and long-short term memory neural network to extract the spatial-temporal features of video frame sequences, which were then input into the classifier for classification. RESULTS: The model discriminated between "twirling" and "lifting and thrusting" manipulations in 200 videos, with the training and verification accuracy reaching up to 95.4% and 95.3%, respectively. CONCLUSION: This computer vision-based acupuncture manipulation classification system provides an effective way for the data extraction and inheritance of acupuncture manipulations.

[Recognition system of acupuncture manipulations based on an array PVDF tactile sensor and machine learning].

In learning and evaluation of acupuncture manipulations, there are lack of quantitative physical parameters on exertion strength, duration and direction of acupuncture technique at present. Based on the tactile parameters collected during "twirling" and "lifting-thrusting" of needling, a kind of array polyvinylidene fluoride (PVDF) tactile sensor was designed. Followed by, a window segmentation method for tactile signal was proposed and the time domain features of the window were extracted. Finally, an identification method of acupuncture manipulation based on FCM (Fuzzy C-Means) was constructed. Through the experiment, it was proved that this sensor can effectively identify the four kinds of basic acupuncture manipulations, i.e. reinforcing by twirling and rotating, reducing by twirling and rotating, reinforcing by lifting and thrusting and reducing by lifting and thrusting and it was conductive to the quantification and dissemination of acupuncture manipulations.

Pharmacokinetics-based chronoefficacy of Fuzi against chronic kidney disease.

OBJECTIVES: Identifying drugs with time-varying efficacy or toxicity, and understanding the underlying mechanisms would help to improve treatment efficacy and reduce adverse effects. In this study, we uncovered that the therapeutic effect of Fuzi (the lateral root of Aconitum carmichaelii Debeaux) depended on the dosing time in mice with adenine-induced chronic kidney disease (CKD). METHODS: The Fuzi efficacy was determined by biomarker measurements [i.e. plasma creatinine (CRE), blood urea nitrogen (BUN) and urinary N-acetyl-ß-D-glucosaminidase (NAG)], as well as inflammation, fibrosis and histological analyses. Circadian regulation of Fuzi pharmacokinetics and efficacy was evaluated using brain and muscle Arnt-like protein-1 (Bmal1)-deficient (Bmal1-/-) mice. KEY FINDINGS: The Fuzi efficacy was higher when the drug was dosed at ZT10 and was lower when the drug was dosed at other times (ZT2, ZT6, ZT14, ZT18 and ZT22) according to measurements of plasma CRE, BUN and urinary NAG. Consistently, ZT10 (5 PM) dosing showed a stronger protective effect on the kidney (i.e. less extensive tubular injury) as compared to ZT22 (5 AM) dosing. This was supported by lower levels of inflammatory and fibrotic factors (IL-1ß, IL-6, Tnf-α, Ccl2, Tgfb1 and Col1a1) at ZT10 than at ZT22. Pharmacokinetic analyses showed that the area under the curve (AUC) values (reflective of systemic exposure) and renal distribution of aconitine, hypaconitine and mesaconitine (three putative active constituents) for Fuzi dosing at ZT10 were significantly higher than those for herb dosing at ZT22, suggesting a role of circadian pharmacokinetics in Fuzi chronoefficacy. Drug efficacy studies confirmed that aconitine, hypaconitine and mesaconitine possessed a kidney-protecting effect. In addition, genetic knockout of Bmal1 in mice abolished the time-dependency of Fuzi pharmacokinetics and efficacy. This reinforced the existence of chronoefficacy for Fuzi and supported the role of circadian pharmacokinetics in Fuzi chronoefficacy. CONCLUSIONS: The efficacy of Fuzi against CKD depends on the dosing time in mice, which is associated with circadian pharmacokinetics of the three main active constituents (i.e. aconitine, hypaconitine and mesaconitine). These findings highlight the relevance of dosing time in the therapeutic outcomes of herbal medicines.

A TCM acupoints ranking approach towards post-stroke dysphagia based on an improved MCTS decision method.

Traditional Chinese Medicine (TCM) multiple-acupoints stimulation is widely used to improve dysphagia among post-stroke patients. However, prior research in evidence-based acupuncture mostly focused on the treatment effects of single acupoint's on dysphagia, while the evidence of optimal sequence of multiple-acupoints stimulation remains limited. In this paper, we developed an evaluation method of hybrid knowledge (deterministic knowledge and the experiential group decision knowledge) sequences based on segmentation mechanism of sub-sequence fragments, and then, we proposed a Monte Carlo Tree Search (MCTS) sequential decision-making method under the hybrid knowledge. Thereafter, we applied this proposed sequential decision-making approach to optimizing sequential decision-making schema of multiple-acupoints stimulation, to treat dysphagia among post-stroke patients. Finally, we verified the validity and the feasibility of this method by comparing it to other sequential decision-making search methods.

SIRveNIB: Selective Internal Radiation Therapy Versus Sorafenib in Asia-Pacific Patients With Hepatocellular Carcinoma.

Purpose Selective internal radiation therapy or radioembolization (RE) shows efficacy in unresectable hepatocellular carcinoma (HCC) limited to the liver. This study compared the safety and efficacy of RE and sorafenib in patients with locally advanced HCC. Patients and Methods SIRveNIB (selective internal radiation therapy v sorafenib), an open-label, investigator-initiated, phase III trial, compared yttrium-90 (90Y) resin microspheres RE with sorafenib 800 mg/d in patients with locally advanced HCC in a two-tailed study designed for superiority/detriment. Patients were randomly assigned 1:1 and stratified by center and presence of portal vein thrombosis. Primary end point was overall survival (OS). Efficacy analyses were performed in the intention-to-treat population and safety analyses in the treated population. Results A total of 360 patients were randomly assigned (RE, 182; sorafenib, 178) from 11 countries in the Asia-Pacific region. In the RE and sorafenib groups, 28.6% and 9.0%, respectively, failed to receive assigned therapy without significant cross-over to either group. Median OS was 8.8 and 10.0 months with RE and sorafenib, respectively (hazard ratio, 1.1; 95% CI, 0.9 to 1.4; P = .36). A total of 1,468 treatment-emergent adverse events (AEs) were reported (RE, 437; sorafenib, 1,031). Significantly fewer patients in the RE than sorafenib group had grade ≥ 3 AEs (36 of 130 [27.7%]) v 82 of 162 [50.6%]; P < .001). The most common grade ≥ 3 AEs were ascites (five of 130 [3.8%] v four of 162 [2.5%] patients), abdominal pain (three [2.3%] v two [1.2%] patients), anemia (zero v four [2.5%] patients), and radiation hepatitis (two [1.5%] v zero [0%] patients). Fewer patients in the RE group (27 of 130 [20.8%]) than in the sorafenib group (57 of 162 [35.2%]) had serious AEs. Conclusion In patients with locally advanced HCC, OS did not differ significantly between RE and sorafenib. The improved toxicity profile of RE may inform treatment choice in selected patients.

Single administration of Selective Internal Radiation Therapy versus continuous treatment with sorafeNIB in locally advanced hepatocellular carcinoma (SIRveNIB): study protocol for a phase iii randomized controlled trial.

BACKGROUND: Approximately 20 % of hepatocellular carcinoma (HCC) patients diagnosed in the early stages may benefit from potentially curative ablative therapies such as surgical resection, transplantation or radiofrequency ablation. For patients not eligible for such options, prognosis is poor. Sorafenib and Selective Internal Radiation Therapy (SIRT) are clinically proven treatment options in patients with unresectable HCC, and this study aims to assess overall survival following either SIRT or Sorafenib therapy for locally advanced HCC patients. METHODS: This investigator-initiated, multi-centre, open-label, randomized, controlled trial will enrol 360 patients with locally advanced HCC, as defined by Barcelona Clinic Liver Cancer stage B or stage C, without distant metastases, and which is not amenable to immediate curative treatment. Exclusion criteria include previous systemic therapy, metastatic disease, complete occlusion of the main portal vein, or a Child-Pugh score of >7. Eligible patients will be randomised 1:1 and stratified by centre and presence or absence of portal vein thrombosis to receive either a single administration of SIRT using yttrium-90 resin microspheres (SIR-Spheres®, Sirtex Medical Limited, Sydney, Australia) targeted at HCC in the liver by the trans-arterial route or continuous oral Sorafenib (Nexavar®, Bayer Pharma AG, Berlin, Germany) at a dose of 400 mg twice daily until disease progression, no further response, complete regression or unacceptable toxicity. Patients for both the Sorafenib and SIRT arms will be followed-up every 4 weeks for the first 3 months and 12 weekly thereafter. Overall survival is the primary endpoint, assessed for the intention-to-treat population. Secondary endpoints are tumour response rate, time-to-tumour progression, progression free survival, quality of life and down-staging to receive potentially curative therapy. DISCUSSION: Definitive data comparing these two therapies will help to determine clinical practice in the large group of patients with locally advanced HCC and improve outcomes for such patients. TRIAL REGISTRATION: ClinicalTrials.gov identifier, NCT01135056 , first received 24, May 2010.

Multidetector computed tomography diagnosis of splenic flexure volvulus: usefulness of multiplanar reformats.

Splenic flexure volvulus is the least common form of colonic volvulus. Preoperative radiological diagnosis is usually made presumptively, based on plain radiographs and/or barium contrast enema study in patients presenting with acute large bowel obstruction. We report a case in which multidetector computer tomography (CT) findings were diagnostic of this condition, thus highlighting the usefulness of multiplanar reformatting.

Multidetector computed tomography diagnosis of splenic flexure volvulus: usefulness of multiplanar reformats

Splenic flexure volvulus is the least common form of colonic volvulus. Preoperative radiological diagnosis is usually made presumptively, based on plain radiographs and/or barium contrast enema study in patients presenting with acute large bowel obstruction. We report a case in which multidetector computer tomography (CT) findings were diagnostic of this condition, thus highlighting the usefulness of multiplanar reformatting.