Self-powered soft robot in the Mariana Trench.

The deep sea remains the largest unknown territory on Earth because it is so difficult to explore1-4. Owing to the extremely high pressure in the deep sea, rigid vessels5-7 and pressure-compensation systems8-10 are typically required to protect mechatronic systems. However, deep-sea creatures that lack bulky or heavy pressure-tolerant systems can thrive at extreme depths11-17. Here, inspired by the structure of a deep-sea snailfish15, we develop an untethered soft robot for deep-sea exploration, with onboard power, control and actuation protected from pressure by integrating electronics in a silicone matrix. This self-powered robot eliminates the requirement for any rigid vessel. To reduce shear stress at the interfaces between electronic components, we decentralize the electronics by increasing the distance between components or separating them from the printed circuit board. Careful design of the dielectric elastomer material used for the robot's flapping fins allowed the robot to be actuated successfully in a field test in the Mariana Trench down to a depth of 10,900 metres and to swim freely in the South China Sea at a depth of 3,224 metres. We validate the pressure resilience of the electronic components and soft actuators through systematic experiments and theoretical analyses. Our work highlights the potential of designing soft, lightweight devices for use in extreme conditions.

Pathogenicity and immunogenicity of gI/gE/TK-gene-deleted Felid herpesvirus 1 variants in cats.

BACKGROUND: Felid herpesvirus 1 (FHV-1) is a major pathogenic agent of upper respiratory tract infections and eye damage in felines worldwide. Current FHV-1 vaccines offer limited protection of short duration, and therefore, do not reduce the development of clinical signs or the latency of FHV-1. METHODS: To address these shortcomings, we constructed FHV ∆gIgE-eGFP, FHV ∆TK mCherry, and FHV ∆gIgE/TK eGFP-mCherry deletion mutants (ΔgI/gE, ΔTK, and ΔgIgE/TK, respectively) using the clustered regularly interspaced palindromic repeats (CRISPR)/CRISP-associated protein 9 (Cas9) system (CRISPR/Cas9), which showed safety and immunogenicity in vitro. We evaluated the safety and efficacy of the deletion mutants administered with intranasal (IN) and IN + subcutaneous (SC) vaccination protocols. Cats in the vaccination group were vaccinated twice at a 4-week interval, and all cats were challenged with infection 3 weeks after the last vaccination. The cats were assessed for clinical signs, nasal shedding, and virus-neutralizing antibodies (VN), and with postmortem histological testing. RESULTS: Vaccination with the gI/gE-deleted and gI/gE/TK-deleted mutants was safe and resulted in significantly lower clinical disease scores, fewer pathological changes, and less nasal virus shedding after infection. All three mutants induced virus-neutralizing antibodies after immunization. CONCLUSIONS: In conclusion, this study demonstrates the advantages of FHV-1 deletion mutants in preventing FHV-1 infection in cats.

Nucleolin (NCL) inhibits the growth of peste des petits ruminants virus.

Peste des petits ruminants (PPR) is a highly contagious disease of small ruminants that is caused by peste des petits ruminants virus (PPRV). To date, the molecular mechanism of PPRV infection is still unclear. It is well known that host proteins might be involved in the pathogenesis process for many viruses. In this study, we first proved that nucleolin (NCL), a highly conserved host factor, interacts with the core domain of PPRV N protein through its C terminus and co-locates with the N protein in the nucleus of cells. To investigate the role of NCL in PPRV infection, the expression level of NCL was inhibited with small interfering RNAs of NCL, and the results showed that PPRV growth was improved. However, the proliferation of PPRV was inhibited when the expression level of NCL was improved. Further analysis indicated that the inhibitory effect of NCL on the PPRV was caused by stimulating the interferon (IFN) pathways in host cells. In summary, our results will help us to understand the mechanism of PPRV infection.

Web-Based Privacy-Preserving Multicenter Medical Data Analysis Tools Via Threshold Homomorphic Encryption: Design and Development Study.

BACKGROUND: Data sharing in multicenter medical research can improve the generalizability of research, accelerate progress, enhance collaborations among institutions, and lead to new discoveries from data pooled from multiple sources. Despite these benefits, many medical institutions are unwilling to share their data, as sharing may cause sensitive information to be leaked to researchers, other institutions, and unauthorized users. Great progress has been made in the development of secure machine learning frameworks based on homomorphic encryption in recent years; however, nearly all such frameworks use a single secret key and lack a description of how to securely evaluate the trained model, which makes them impractical for multicenter medical applications. OBJECTIVE: The aim of this study is to provide a privacy-preserving machine learning protocol for multiple data providers and researchers (eg, logistic regression). This protocol allows researchers to train models and then evaluate them on medical data from multiple sources while providing privacy protection for both the sensitive data and the learned model. METHODS: We adapted a novel threshold homomorphic encryption scheme to guarantee privacy requirements. We devised new relinearization key generation techniques for greater scalability and multiplicative depth and new model training strategies for simultaneously training multiple models through x-fold cross-validation. RESULTS: Using a client-server architecture, we evaluated the performance of our protocol. The experimental results demonstrated that, with 10-fold cross-validation, our privacy-preserving logistic regression model training and evaluation over 10 attributes in a data set of 49,152 samples took approximately 7 minutes and 20 minutes, respectively. CONCLUSIONS: We present the first privacy-preserving multiparty logistic regression model training and evaluation protocol based on threshold homomorphic encryption. Our protocol is practical for real-world use and may promote multicenter medical research to some extent.

High Intensity Exercise for Walking Competency in Individuals with Stroke: A Systematic Review and Meta-Analysis.

OBJECTIVE: To assess the effects of high intensity exercise on walking competency in individuals with stroke. DATA SOURCES: A systematic electronic searching of the PubMed, EMBASE, Web of Science, Cochrane Central Register of Controlled Trials (CENTRAL), CINAHL (EBSCOhost), and SPORTSDiscus (EBSCOhost) was initially performed up to June 25, 2019. STUDY SELECTION: Randomized controlled trials or clinical controlled trials comparing any walking or gait parameters of the high intensity exercise to lower intensity exercise or usual physical activities were included. The risk of bias of included studies was assessed by the Cochrane risk of bias tool. The quality of evidence was assessed using GRADE (Grading of Recommendations, Assessment, Development and Evaluation) system. DATA EXTRACTION: Data were extracted by 2 independent coders. The mean and standard deviation of the baseline and endpoint scores after training for walking distance, comfortable gait speed, gait analysis (cadence, stride length, and the gait symmetry), cost of walking, Berg Balance Scale , Time Up&Go (TUG) Test and adverse events were extracted. DATA SYNTHESIS: A total of 22 (n = 952) studies were included. Standardized mean difference (SMD), weighted mean difference (WMD), and odds ratios (ORs) were used to compute effect size and subgroup analysis was conducted to test the consistency of results with different characteristics of exercise and time since stroke. Sensitivity analysis was used to assess the robustness of the results, which revealed significant differences on walking distance (SMD = .32, 95% CI, .17-.46, P < .01, I2 = 39%; WMD = 21.76 m), comfortable gait speed (SMD = .28, 95% CI, .06-.49, P = .01, I2 = 47%; WMD = .04 m/s), stride length (SMD = .51, 95% CI, .13-.88, P < .01, I2 = 0%; WMD = .12 m) and TUG (SMD = -.36, 95% CI, -.72 to .01, P = .05, I2 = 9%; WMD = -1.89 s) in favor of high intensity exercise versus control group. No significant differences were found between the high intensity exercise and control group in adverse events, including falls (OR = 1.40, 95% CI, .69-2.85, P = .35, I2 = 11%), pain (OR = 3.34, 95% CI, .82-13.51, P = .09, I2 = 0%), and skin injuries (OR = 1.08, 95% CI, .30-3.90, P = .90, I2 = 0%). CONCLUSIONS: This systematic review suggests that high intensity exercise could be safe and more potent stimulus in enhancing walking competency in stroke survivors, with a capacity to improve walking distance, comfortable gait speed, stride length, and TUG compared with low to moderate intensity exercise or usual physical activities.

Prevalence and variance of the sternalis muscle: a study in the Chinese population using multi-detector CT.

OBJECTIVE: To analyze the prevalence, anatomical features, as well as variance of the sternalis muscle in the Chinese population using multi-detector computed tomography (MDCT). METHODS: We retrospectively reviewed 6,000 adult axial MDCT images to determine the overall and gender prevalence of the sternalis muscles. We also analyzed the side prevalence and anatomical features, including shape, size, location and course. RESULTS: The sternalis muscle was present in 347 (5.8 %) of 6,000 adults. This muscle was more common in males (6.0 %, 187/3091) than in females (5.5 %, 160/2909). Among the 347 adults, 118 (34.0 %) had bilateral sternalis muscles; 148 (42.7 %) had right sternalis muscles; and 81 (23.3 %) had left sternalis muscles. The sternalis muscle was either flat or nodular and located superficial to the major pectoral muscles on CT axial transverse images. According to the muscle morphology and course, we classified sternalis muscles as three different types and nine subtypes. The muscles appeared with a single head and single belly in 58.5 %, double or multiple heads in 18.1 %, and double or multiple bellies in 23.4 %. The mean length, width and thickness were 111.1 ± 33.0, 17.7 ± 9.9 and 4.1 ± 1.7 mm measured on MDCT. CONCLUSION: The sternalis muscle was highly prevalent in normal Chinese adults. MDCT is an effective method to demonstrate this muscle in vivo.

Zero-shot prediction of mutation effects with multimodal deep representation learning guides protein engineering.

Mutations in amino acid sequences can provoke changes in protein function. Accurate and unsupervised prediction of mutation effects is critical in biotechnology and biomedicine, but remains a fundamental challenge. To resolve this challenge, here we present Protein Mutational Effect Predictor (ProMEP), a general and multiple sequence alignment-free method that enables zero-shot prediction of mutation effects. A multimodal deep representation learning model embedded in ProMEP was developed to comprehensively learn both sequence and structure contexts from ~160 million proteins. ProMEP achieves state-of-the-art performance in mutational effect prediction and accomplishes a tremendous improvement in speed, enabling efficient and intelligent protein engineering. Specifically, ProMEP accurately forecasts mutational consequences on the gene-editing enzymes TnpB and TadA, and successfully guides the development of high-performance gene-editing tools with their engineered variants. The gene-editing efficiency of a 5-site mutant of TnpB reaches up to 74.04% (vs 24.66% for the wild type); and the base editing tool developed on the basis of a TadA 15-site mutant (in addition to the A106V/D108N double mutation that renders deoxyadenosine deaminase activity to TadA) exhibits an A-to-G conversion frequency of up to 77.27% (vs 69.80% for ABE8e, a previous TadA-based adenine base editor) with significantly reduced bystander and off-target effects compared to ABE8e. ProMEP not only showcases superior performance in predicting mutational effects on proteins but also demonstrates a great capability to guide protein engineering. Therefore, ProMEP enables efficient exploration of the gigantic protein space and facilitates practical design of proteins, thereby advancing studies in biomedicine and synthetic biology.

Pressure optimization for hydraulic-electric hybrid biped robot power unit based on genetic algorithm.

Biped robots have attracted increasing attention because of their flexible movement and strong adaptability to the surroundings. However, the small output torque and the weak impact resistance of the motor drive, as well as the large energy consumption of the hydraulic drive limit the performance of the biped robot drive system. Aiming at these shortcomings, an electric-hydraulic hybrid drive system of biped robot was proposed in this paper. The robot platform was designed based on the prototype of the Zhejiang Lab biped robot. The model of the hydraulic drive system and mechanical structure was established to analyze the dynamic characteristic and the load force during walking. The value function reflecting the energy consumption of the hydraulic drive system was proposed. The pressure of the accumulator in the hydraulic power unit was selected as the control parameter. In order to get the minimum value of the value function, so as to reduce the energy consumption of the hydraulic driving system, the control parameters were optimized by using the genetic algorithm. From the simulation results, the proposed optimization algorithm can improve efficiency by 3.49%.

Inverse Design and Numerical Investigations of an Ultra-Compact Integrated Optical Switch Based on Phase Change Material.

The miniaturization of optical switches is a promising prospect with the use of phase-change materials (PCMs), and exploring various strategies to effectively integrate PCMs with integrated optical waveguides represents an intriguing research question. In this study, an ultra-compact integrated optical switch based on PCM is proposed. This device consists of a Ge2Sb2Te5 nano-disk and an inverse-designed pixelated sub-wavelength structure. The pixelated sub-wavelength structure offers customized refractive indices that conventional materials or structures cannot achieve, leading to an improved insertion loss (IL) and extinction ratio (ER) performance of the device. Furthermore, this structure enhances the interaction between the optical field and GST, resulting in a reduction of the device size and the inserted GST footprint. With an ultra-compact device footprint of 0.9 µm × 1.5 µm, the simulation results exhibit a low IL of 0.45 dB, and a high ER of 18.0 dB at 1550 nm. Additionally, relevant studies show that this device is able to perform reliably despite minor variations in the manufacturing process.

Human-Powered Master Controllers for Reconfigurable Fluidic Soft Robots.

Fluidic soft robots have the advantages of inherent compliance and adaptability, but they are significantly restricted by complex control systems and bulky power devices, including fluidic valves, fluidic pumps, electrical motors, as well as batteries, which make it challenging to operate in narrow space, energy shortage, or electromagnetic sensitive situations. To overcome the shortcomings, we develop portable human-powered master controllers to provide an alternative solution for the master-slave control of the fluidic soft robots. Each controller can supply multiple fluidic pressures to the multiple chambers of the soft robots simultaneously. We use modular fluidic soft actuators to reconfigure soft robots with various functions as control objects. Experimental results show that flexible manipulation and bionic locomotion can be simply realized using the human-powered master controllers. The developed controllers which eliminate energy storage and electronic components can provide a promising candidate of soft robot control in surgical, industrial, and entertainment applications.

B2C-AFM: Bi-Directional Co-Temporal and Cross-Spatial Attention Fusion Model for Human Action Recognition.

Human Action Recognition plays a driving engine of many human-computer interaction applications. Most current researches focus on improving the model generalization by integrating multiple homogeneous modalities, including RGB images, human poses, and optical flows. Furthermore, contextual interactions and out-of-context sign languages have been validated to depend on scene category and human per se. Those attempts to integrate appearance features and human poses have shown positive results. However, with human poses' spatial errors and temporal ambiguities, existing methods are subject to poor scalability, limited robustness, and sub-optimal models. In this paper, inspired by the assumption that different modalities may maintain temporal consistency and spatial complementarity, we present a novel Bi-directional Co-temporal and Cross-spatial Attention Fusion Model (B2C-AFM). Our model is characterized by the asynchronous fusion strategy of multi-modal features along temporal and spatial dimensions. Besides, the novel explicit motion-oriented pose representations called Limb Flow Fields (Lff) are explored to alleviate the temporal ambiguity regarding human poses. Experiments on publicly available datasets validate our contributions. Abundant ablation studies experimentally show that B2C-AFM achieves robust performance across seen and unseen human actions. The codes are available at https://github.com/gftww/B2C.git.

Construction of the dynamic model of SCI rehabilitation using bidirectional stimulation and its application in rehabilitating with BCI.

Patients with complete spinal cord injury have a complete loss of motor and sensory functions below the injury plane, leading to a complete loss of function of the nerve pathway in the injured area. Improving the microenvironment in the injured area of patients with spinal cord injury, promoting axon regeneration of the nerve cells is challenging research fields. The brain-computer interface rehabilitation system is different from the other rehabilitation techniques. It can exert bidirectional stimulation on the spinal cord injury area, and can make positively rehabilitation effects of the patient with complete spinal cord injury. A dynamic model was constructed for the patient with spinal cord injury under-stimulation therapy, and the mechanism of the brain-computer interface in rehabilitation training was explored. The effects of the three current rehabilitation treatment methods on the microenvironment in a microscopic nonlinear model were innovatively unified and a complex system mapping relationship from the microscopic axon growth to macroscopic motor functions was constructed. The basic structure of the model was determined by simulating and fitting the data of the open rat experiments. A clinical rehabilitation experiment of spinal cord injury based on brain-computer interface was built, recruiting a patient with complete spinal cord injury, and the rehabilitation training and follow-up were conducted. The changes in the motor function of the patient was simulated and predicted through the constructed model, and the trend in the motor function improvement was successfully predicted over time. This proposed model explores the mechanism of brain-computer interface in rehabilitating patients with complete spinal cord injury, and it is also an application of complex system theory in rehabilitation medicine. Supplementary Information: The online version contains supplementary material available at 10.1007/s11571-022-09804-3.

Development of a versatile nuclease prime editor with upgraded precision.

The applicability of nuclease-based form of prime editor (PEn) has been hindered by its complexed editing outcomes. A chemical inhibitor against DNA-PK, which mediates the nonhomologous end joining (NHEJ) pathway, was recently shown to promote precise insertions by PEn. Nevertheless, the intrinsic issues of specificity and toxicity for such a chemical approach necessitate development of alternative strategies. Here, we find that co-introduction of PEn and a NHEJ-restraining, 53BP1-inhibitory ubiquitin variant potently drives precise edits via mitigation of unintended edits, framing a high-activity editing platform (uPEn) apparently complementing the canonical PE. Further developments involve exploring the effective configuration of a homologous region-containing pegRNA (HR-pegRNA). Overall, uPEn can empower high-efficiency installation of insertions (38%), deletions (43%) and replacements (52%) in HEK293T cells. When compared with PE3/5max, uPEn demonstrates superior activities for typically refractory base substitutions, and for small-block edits. Collectively, this work establishes a highly efficient PE platform with broad application potential.

Magnetic field reversal in the turbulent environment around a repeating fast radio burst.

Fast radio bursts (FRBs) are brief, intense flashes of radio waves from unidentified extragalactic sources. Polarized FRBs originate in highly magnetized environments. We report observations of the repeating FRB 20190520B spanning 17 months, which show that the FRB's Faraday rotation is highly variable and twice changes sign. The FRB also depolarizes below radio frequencies of about 1 to 3 gigahertz. We interpret these properties as being due to changes in the parallel component of the magnetic field integrated along the line of sight, including reversing direction of the field. This could result from propagation through a turbulent magnetized screen of plasma, located 10-5 to [Formula: see text] parsecs from the FRB source. This is consistent with the bursts passing through the stellar wind of a binary companion of the FRB source.

Application of a Brain-Computer Interface System with Visual and Motor Feedback in Limb and Brain Functional Rehabilitation after Stroke: Case Report.

(1) Objective: To investigate the feasibility, safety, and effectiveness of a brain-computer interface (BCI) system with visual and motor feedback in limb and brain function rehabilitation after stroke. (2) Methods: First, we recruited three hemiplegic stroke patients to perform rehabilitation training using a BCI system with visual and motor feedback for two consecutive days (four sessions) to verify the feasibility and safety of the system. Then, we recruited five other hemiplegic stroke patients for rehabilitation training (6 days a week, lasting for 12-14 days) using the same BCI system to verify the effectiveness. The mean and Cohen's w were used to compare the changes in limb motor and brain functions before and after training. (3) Results: In the feasibility verification, the continuous motor state switching time (CMSST) of the three patients was 17.8 ± 21.0s, and the motor state percentages (MSPs) in the upper and lower limb training were 52.6 ± 25.7% and 72.4 ± 24.0%, respectively. The effective training revolutions (ETRs) per minute were 25.8 ± 13.0 for upper limb and 24.8 ± 6.4 for lower limb. There were no adverse events during the training process. Compared with the baseline, the motor function indices of the five patients were improved, including sitting balance ability, upper limb Fugel-Meyer assessment (FMA), lower limb FMA, 6 min walking distance, modified Barthel index, and root mean square (RMS) value of triceps surae, which increased by 0.4, 8.0, 5.4, 11.4, 7.0, and 0.9, respectively, and all had large effect sizes (Cohen's w ≥ 0.5). The brain function indices of the five patients, including the amplitudes of the motor evoked potentials (MEP) on the non-lesion side and lesion side, increased by 3.6 and 3.7, respectively; the latency of MEP on the non-lesion side was shortened by 2.6 ms, and all had large effect sizes (Cohen's w ≥ 0.5). (4) Conclusions: The BCI system with visual and motor feedback is applicable in active rehabilitation training of stroke patients with hemiplegia, and the pilot results show potential multidimensional benefits after a short course of treatment.

BCI system with lower-limb robot improves rehabilitation in spinal cord injury patients through short-term training: a pilot study.

In the recent years, the increasing applications of brain-computer interface (BCI) in rehabilitation programs have enhanced the chances of functional recovery for patients with neurological disorders. We presented and validated a BCI system with a lower-limb robot for short-term training of patients with spinal cord injury (SCI). The cores of this system included: (1) electroencephalogram (EEG) features related to motor intention reported through experiments and used to drive the robot; (2) a decision tree to determine the training mode provided for patients with different degrees of injuries. Seven SCI patients (one American Spinal Injury Association Impairment Scale (AIS) A, three AIS B, and three AIS C) participated in the short-term training with this system. All patients could learn to use the system rapidly and maintained a high intensity during the training program. The strength of the lower limb key muscles of the patients was improved. Four AIS A/B patients were elevated to AIS C. The cumulative results indicate that clinical application of the BCI system with lower-limb robot is feasible and safe, and has potentially positive effects on SCI patients. Supplementary Information: The online version contains supplementary material available at 10.1007/s11571-022-09801-6.

The Clinical Efficacy of Platelet-Rich Plasma versus Conventional Drug Injection in the Treatment of Knee Osteoarthritis: A Study Protocol for a Randomized Controlled Trial.

Knee osteoarthritis is a common chronic degenerative joint disease in middle-aged and elderly people. Intra-articular injection for the treatment of knee osteoarthritis is a regularly utilized nonsurgical treatment in modern medicine. Hyaluronic acid (HA) and platelet-rich plasma (PRP) are two frequently employed intra-articular devices. Hyaluronic acid (HA) is an accepted nonsurgical treatment for symptomatic KOA, and platelet-rich plasma is a popular option in the treatment of KOA in recent years. The purpose of this research is to compare the efficacy and safety of intra-articular injection of platelet-rich plasma (PRP) versus hyaluronic acid (HA) on the pain score scale, knee function, and related inflammatory biomarkers in KOA patients using a clinical randomized controlled trial. Participants are being randomized into either the hyaluronic acid (HA) or into the platelet-rich plasma (PRP) group. All patients receive 4 weeks of treatment (once a week), and well-being support and quadriceps training (3 times a week). The primary outcomes are measured using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and the visual analog scale (VAS). The secondary outcomes include the activities of daily living score, erythrocyte sedimentation rate, C-reactive protein testing, interleukin-6 levels, and X-ray examination. In order to monitor the occurrence of irregularities and abnormalities, patients are assessed at each visit, and restorative treatment is given if necessary. The results of this clinical trial will verify the efficacy of PRP and HA in the treatment of KOA and provide important evidence for the clinical treatment of KOA. The trial was enlisted at the Chinese Clinical Trial Registry on 26 September 2020 (ChiCTR2000038635).

Multicenter Privacy-Preserving Cox Analysis Based on Homomorphic Encryption.

The Cox proportional hazards model is one of the most widely used methods for analyzing survival data. Data from multiple data providers are required to improve the generalizability and confidence of the results of Cox analysis; however, such data sharing may result in leakage of sensitive information, leading to financial fraud, social discrimination or unauthorized data abuse. Some privacy-preserving Cox regression protocols have been proposed in past years, but they lack either security or functionality. In this paper, we propose a privacy-preserving Cox regression protocol for multiple data providers and researchers. The proposed protocol allows researchers to train models on horizontally or vertically partitioned datasets while providing privacy protection for both the sensitive data and the trained models. Our protocol utilizes threshold homomorphic encryption to guarantee security. Experimental results demonstrate that with the proposed protocol, Cox regression model training over 9 variables in a dataset of 113,035 samples takes approximately 44 min, and the trained model is almost the same as that obtained with the original nonsecure Cox regression protocol; therefore, our protocol is a potential candidate for practical real-world applications in multicenter medical research.

EHR-Oriented Knowledge Graph System: Toward Efficient Utilization of Non-Used Information Buried in Routine Clinical Practice.

Non-used clinical information has negative implications on healthcare quality. Clinicians pay priority attention to clinical information relevant to their specialties during routine clinical practices but may be insensitive or less concerned about information showing disease risks beyond their specialties, resulting in delayed and missed diagnoses or improper management. In this study, we introduced an electronic health record (EHR)-oriented knowledge graph system to efficiently utilize non-used information buried in EHRs. EHR data were transformed into a semantic patient-centralized information model under the ontology structure of a knowledge graph. The knowledge graph then creates an EHR data trajectory and performs reasoning through semantic rules to identify important clinical findings within EHR data. A graphical reasoning pathway illustrates the reasoning footage and explains the clinical significance for clinicians to better understand the neglected information. An application study was performed to evaluate unconsidered chronic kidney disease (CKD) reminding for non-nephrology clinicians to identify important neglected information. The study covered 71,679 patients in non-nephrology departments. The system identified 2,774 patients meeting CKD diagnosis criteria and 10,377 patients requiring high attention. A follow-up study of 5,439 patients showed that 82.1% of patients who met the diagnosis criteria and 61.4% of patients requiring high attention were confirmed to be CKD positive during follow-up research. The application demonstrated that the proposed approach is feasible and effective in clinical information utilization. Additionally, it's valuable as an explainable artificial intelligence to provide interpretable recommendations for specialist physicians to understand the importance of non-used data and make comprehensive decisions.

[Effect of internal heat-type acupuncture needle on the expression of osteoprotegerin, receptor activator of NF-κB ligand and receptor activator of NF-κB of subchondral bone in knee osteoarthritis rabbits].

OBJECTIVE: To investigate the effect of internal heat-type acupuncture needle on the expression of osteoprotegerin (OPG), receptor activator of NF-κB ligand (RANKL), and receptor activator of NF-κB (RANK) in knee osteoarthritis (KOA) rabbits, so as to explore its mechanisms in relieving KOA. METHODS: Thirty New Zealand rabbits were randomly divided into control, model and treatment groups, with 10 rabbits in each group. The KOA model was established by using Hulth method. The rabbits of the treatment group received internal heat-type acupuncture needles (42 ℃) on the left hind limb 20 min, once a week for 4 weeks. The behavioral scores were assessed according to the pain severity, gait, joint motion range and articular swelling severity in reference to the modified Lequesne's methods. Toluidine Blue staining was performed to observe the structure of the subchondral bone and to analyze the difference of morphometric parameters. The protein and mRNA expressions of OPG, RANKL and RANK were detected by Western blot and real-time PCR, respectively. RESULTS: Compared with the control group, the Lequesne total score, the separation degree of trabecular bone, the protein and mRNA expressions of RANKL and RANK in subchondral bone tissues were significantly increased in the model group, while the percentage of trabecular bone area, number of trabecular bone, the expression of OPG protein and mRNA were decreased (P<0.05, P<0.01). The above indexes were all reversed in the treatment group relevant to those of the model group (P<0.05). CONCLUSION: The internal heat-type acupuncture needle therapy can improve the motor function of rabbits with KOA, which may be related to its effects in up-regulating the expression of OPG and down-regulating the RANKL and RANK in subchondral bone tissue.