Fuzzy Logic and Control: Principal Approach and Potential Applications in Medicine

Abstract: During the last few years intelligent machines appeared in nearly all technical areas, such as consumer electronics, robotics, and industrial control systems. There are for example washing machines that work very effectively, need comparably less power than in the past, and have short execution times because they adjust their washing cycles to each set of clothes and change their washing strategies as the clothes become clean. These intelligent systems are based on fuzzy control strategies, i.e., common sense rules are used to describe a system's behavior instead of complex mathematical models. We have applied this new technology to control problems as well as to reasoning problems in biomedical engineering where appropriate mathematical models could not be built due to the complexity of the problem. After a short introduction to the concepts of fuzzy logic two approaches in the field are described: a fuzzy control strategy for the pump rate adjustment of a novel total artificial heart and an intelligent alarm system based on fuzzy inference which supports the anesthetist in monitoring and evaluating the hemodynamic state of a patient undergoing cardiac surgery. These examples indicate the inherent reliability and stability of this technique in the field of complex dynamic systems. Such properties are highly significant especially in medical applications.     

组织工程骨的牛血清白蛋白残余量检测

目的检测体外构建的组织工程骨中的牛血清白蛋白(Bovine serum albumin,BSA)残余量,并探讨减少残余量的方法。方法体外分离培养hBMSCs,将第2代细胞消化、离心、洗涤3次,获取细胞洗涤液样品。取第2代h BMSCs接种于β-TCP支架材料,体外成骨诱导2周,构建组织工程骨。生理盐水浸洗3次,获取洗涤液样品。然后加入PBS,37℃振荡浸提24h,获取浸提液样品。同法获取未接种细胞的单纯支架材料的浸提液样品作为对照。采用酶联免疫法检测洗涤液与组织工程骨样品浸提液中BSA的残余量,观察洗涤次数与洗涤液中BSA含量的变化关系。结果随洗涤次数增多,洗涤液与浸提液中的BSA含量明显降低。酶联免疫法测定的组织工程骨与单纯支架材料浸提液中BSA残余量分别为(19.54±6.70)ng和(15.67±5.49)ng,单位重量的残余量分别为(0.656±0.213)ng/mg和(0.796±0.205)ng/mg,两组无显著差异(P>0.05)。结论酶联免疫法适用于组织工程骨中BSA残余量的检测。因为支架材料较细胞更易吸附BSA,现有条件下构建的组织工程骨BSA残余量仍然较高,需要进一步探索降低残余量的方法 。     

臭氧水冲洗及中药液熏蒸在肛门疾病术后的应用

为探讨臭氧水冲洗及中药液熏蒸在肛门疾病术后的应用效果,本研究将108例行手术治疗的肛门疾病患者随机分为观察组和对照组,各54例,观察组术后应用LC—C多功能熏蒸治疗机对患处进行臭氧水冲洗和中药液熏蒸,对照组术后应用高锰酸钾溶液熏洗患处,每天1次,3d为一疗程,连续治疗3个疗程,对比两组患者疗效。结果显示,观察组总有效率明显高于对照组,P〈0.05。观察组术后肛门最剧烈疼痛评分、肛缘水肿评分、肛门疼痛消失时间、肛缘水肿消失时间、创面愈合时间均明显短于对照组,P〈0．05。结果表明,肛门疾病术后应用LC—C多功能熏蒸治疗机对患处进行臭氧水冲洗和中药液熏蒸可减轻肛门疼痛、肛缘水肿,促进创面愈合,从而提高手术疗效。     

Graft Protection Against Cold Ischemia Preservation: An Institute George Lopez 1 and Histidine-tryptophan-ketoglutarate Solution Appraisal

Cold storage of organs in preservation solutions, such as Institute George Lopez 1 (IGL-1) or histidine-tryptophan-ketoglutarate (HTK), is a mandatory step for organ transplantation. This preservation leads to an ischemic injury that affects the outcome of the organ. This article studies the liver graft eluate after organ recovery using IGL-1 or HTK solutions. We explore the influence of the volume used for washing out the liver and the consequences in the graft preservation when both solutions are used. Livers were washed out with different volumes of HTK and IGL-1 according to manufacturers' instructions and then preserved in both solutions for 24 hours at 4°C. Tissue and eluates were collected for subsequent analyses. We measured transaminases (aspartate aminotransferase and alanine aminotransferase), histology by hematoxylin/eosin staining, and red blood cell and hemoglobin counts, respectively. After washing out and cold storage, the IGL-1 processed livers showed better preservation than those with HTK solution; however, in this latter case, an important accumulation of erythrocytes was found when compared to IGL-1. These data were consistent with the higher hemoglobin and red blood cell counts observed for IGL-1 eluates after 24 hours. The volume used for washing out the organ depends on the composition and properties of the organ preservation solutions (ie, IGL-1 and HTK); this is an important factor for the graft cold preservation. The total volume used for washing out the graft should be considered because it has a direct impact on the total cost for clinical transplantations.     

合成洗涤剂配方最佳化及其数学模型

本文运用试验设计法和方差分析得到液体洗涤剂配方最佳化的条件,并由此通过数学回归分析处理,建立能应用于预测和控制液体洗涤剂主要洗涤效果(去污力)与其各组分之间相互关系的数学模型。     

肝储备功能测定中三种静脉注药方法的比较

目的 比较肝储备功能测定中三种不同的静脉注药方法,合理选取最佳方法,达到简化流程,节约成本,提高检测准确性的目的。方法 选取肝脏术后停留中心静脉导管并需进行肝储备功能测定的患者 100 例,每名患者都按照三种不同的静脉注药方法进行检测,比较三种测定方法得到的K 和R15 值有无统计学差异。方法一,在肘静脉留置针推注药液后立即予生理盐水冲管;方法二,药液量增加留置针管道的容量 0.4 mL,经肘静脉留置针推注后无须冲管;方法三,经中心静脉导管推注药液,不冲管。结果 三种方法得到的K 值和R15 值均无统计学差异;方法三血药浓度峰值出现时间更早,但并不影响最终检测结果。结论 肝储备功能测定的三种静脉注药方法均可顺利完成给药过程,结果数据接近,但采用中心静脉导管给药效果更好。     

泌尿系统结石经皮肾镜手术后发生尿源性脓毒血症的影响因素

目的 探讨泌尿系统结石微创取石术后发生尿源性脓毒血症的影响因素.方法 选取在本院行微创经皮肾镜手术患者328例,根据PCNL术后是否发生尿源性脓毒血症,分为尿源性脓毒血症组和非尿源性脓毒血症组.统计患者一般临床资料和各实验室指标,对比分析各个因素对尿源性脓毒血症发生的影响.结果 尿源性脓毒血症组和非尿源性脓毒血症组在性别比例、结石体积、结石数量、手术时间、存在肾功能不全、是否为鹿角型结石、术中灌注压力、是否存在术前尿路感染和hs-CRP方面比较存在显著性差异(P＜0.05).经Logistic回归分析显示,结石体积、结石数量、手术时间、肾功能不全、鹿角型结石、术中灌注压力和术前尿路感染是皮肾镜取石术后发生尿源性脓毒血症的独立危险因素(P＜0.05).结论 结石体积、结石数量、手术时间、肾功能不全、鹿角型结石、术中灌注压力和术前尿路感染是皮肾镜取石术后发生尿源性脓毒血症的独立危险因素.     

Hydrodynamics of the active drainage of the mediastinum using lavage and aspiration]

The results of experimental studies of hydrodynamics in acute drainage are described. Four series of experiments were carried on a transparent model filled with a liquid. The authors have revealed the phenomenon of dyraulic "strokes" which promote mechanical purification of the cavity from the purulent content. It has been established that a running-water fractional regimen of washing should be used for the cavities of more than 15--20 cm3 volume.     

等体温冲洗液在经皮肾镜钬激光碎石术患者中应用的效果观察

目的 探索等体温冲洗液在经皮肾镜钬激光碎石术患者中应用的效果.方法 选取本院2015年8月至2016年1月治疗的60例肾结石患者,按手术顺序排序,奇数为实验组(30例),偶数为对照组(30例),对照组患者术中施行常温冲洗液冲洗,实验组予以等体温冲洗液冲洗,观察患者入室时、术中(30、60、90 min)、术后体温变化情况.结果 实验组患者术中及术后体温均高于对照组(P<0.05).对照组患者在手术开始后第30、60、90 min及手术结束时体温较术前的基础体温相比有明显降低(P<0.05).结论 适当的保温干预在经皮肾镜钬激光碎石术患者中有利于防止术后低体温的发生.     

Qualité du sang récupéré en chirurgie orthopédique par le lavage des compresses

ObjectiveTo establish the feasibility and safety of recuperating blood absorbed by swabs used during orthopaedic surgery.Study designOpen, prospective study.PatientsIncluded were children undergoing potentially haemorrhagic orthopaedic surgery for whom intraoperative blood salvage seemed possible. Excluded were those with contraindications for this procedure such as septic surgery and cancer surgery.MethodIntraoperative swabs used within the surgical field were collected by a surgical assistant, also in charge of weighing and washing them. The liquid was collected by the aspiration system of a recuperation-washing machine (RWM). The salvaged red blood cells were collected and retransfused at the end of surgery. Several samples of the washing liquid of the swabs and salvaged blood were taken during the procedure. The correlation between the quantity of blood shed and salvaged was calculated. The biological and clinical tolerance of the transfusion was assessed.ResultsTwelve patients undergoing surgery for scoliosis have been included. An average of 278 mL of blood were salvaged. In the washed cell concentrates the haematocrit was 54% and the free haemoglobin concentration was 3.84 g·L⁻¹. All the bacteriological tests were negative over the first 24 hours.ConclusionProvided that a strict operatory protocol is followed, this study demonstrates the possibility of recuperating blood from swabs used during major orthopaedic surgery.     

大鼠同种异体节段性小肠移植并发症的预防

为减少大鼠小肠移植手术并发症，提高手术成功率，对Ｍｏｎｃｈｉｋ和Ｒｕｓｓｅｌｌ法进行改良，做了３２例大鼠节段性异位小肠移植。手术成功率９６．９％，大于１０天生存率为８１．２５％。最长生存期超过５００天。认为充分的液体补充、合理而完善的血管吻合技术、对供体进行有铲的保护是手术成功的关键，此外无菌原则和定期供体冲洗也不容忽视。     

Human sperm motility--enhancement and inhibition measured by laser Doppler spectroscopy

Laser Doppler spectroscopy is an excellent instrument to measure motility parameters of human spermatozoa. Experiments have been performed by the aid of a now commercially available instrumental setup called LAZYMOT to study enhancement and inhibition as well as influences of different physical treatments on the motility of human spermatozoa. The motility enhancing influence of Kallikrein (up to 40% with 4 KU/ml) and prostaglandin E2 could be proven, thereby verifying some sort of mechanism of action within the Kallikrein-Kinin system. Furthermore tested substances in this context were bradykinin (no effect), caffeine (enhancement), salicylic acid (slight decrease), and other prostaglandins (no effect). The influence of washing, centrifugation, resuspension liquid, and temperature has been examined. It turned out that the lowest motility degradation is to be achieved by washing twice at a pH value of 7.4 at forces of 200 g for 10 min each time. The optimal temperature during this process and the measurements thereafter was found to be 36 degrees C. Unsaturated fatty acids like arachidonic acid have been found to be very strong motility inhibiting substances, which can totally block any movement of spermatozoa.     

Machinery penile injuries associated with traditional trousers of the Yoruba of South-western Nigeria: A consideration for proper work clothes

Appropriateness of garments for different vocations to avoid unintended injury to the worker has always been recognized. This report of two cases of machinery penile injuries in patients wearing the traditional trousers of the Yoruba tribe of south-western Nigeria emphasizes the need for wearing appropriate clothes when operating machines.     

A case of urethral recurrence found 15 years after radical cystectomy

PURPOSE: A case of a urethral recurrence found 15 years after radical cystectomy is reported. METHODS/RESULTS: A 78-year-old man, who had undergone radical cystectomy at age 63, presented with urethral bleeding and positive cytology in urethral washing. The urethra was surgically resected. Pathologic examination revealed transitional cell carcinoma located in the distal and mid portion of the penile urethra. CONCLUSION: Evidence suggested that urethral recurrence resulted from the implantation from the primary bladder tumor; in addition, the urethral neoplasm had scarcely grown in the penile urethra for 15 years.     

A comparative study of the sensitivity of bladder washing flow cytometry, voided urine cytology and bladder washing cytology in the detection of bladder carcinoma

In order to evaluate flow cytometric deoxyribonucleic acid measurement (FCM) of bladder washing in the diagnosis of bladder carcinoma, the sensitivity of voided urine cytology, bladder washing cytology and bladder washing FCM was tested in 76 samples from 56 patients with histologically proven bladder carcinomas. The positive rates were 43.2% and 75.7% in bladder washing cytology and bladder washing FCM, respectively. On the other hand, 36.5% and 57.1% positive rates for once- and three-times-voided urine cytology, respectively, were obtained. Bladder washing cytology and bladder washing FCM were positive in 20% and 70% patients with a histological diagnosis of atypia or dysplasia, respectively. The sensitivity of bladder washing FCM according to the tumor grade was 33.3%, 81.9% and 88.9% for grade-1 (G-1), G-2 and G-3 tumors, respectively. The sensitivity of bladder washing cytology according to the tumor grade was 0, 40.9% and 77.8% for G-1, G-2 and G-3 tumors, respectively. The sensitivity of three-times-voided urine cytology was 25.0%, 55.6% and 83.3% for G-1, G-2 and G-3 bladder tumors, respectively, and it was superior to that of single bladder washing cytology. These results indicate that FCM is more sensitive than voided urine cytology and/or bladder washing cytology in patients with bladder carcinoma. FCM may indicate urothelial neoplasia before it is apparent on urine cytology, especially against a background of inflammation. Therefore, FCM is valuable for case finding in suspect populations or for follow-up cases with diagnosed bladder cancer.     

气雾熏蒸法与浸泡消毒法消毒吸痰管效果比较

目的比较2%强化戊二醛(下称戊二醛)气雾熏蒸法与浸泡消毒法消毒吸痰管的效果.方法消毒按5周期(1个周期12 d)进行,每周期将200根使用过的吸痰管经初步处理,即5% 84消毒液浸泡30 min后清水冲洗干净晾干.将每周期200根吸氮管随机均分为实验组和对照组,实验组采用戊二醛原液气雾熏蒸法消毒4 h,对照组采用戊二醛原液浸泡消毒30 min,12 d为1个周期.两组分别于第1、6、12天对消毒后的吸痰管及消毒过程中的戊二醛采样行细菌菌落数计数,并观察有无细菌生长.结果两组每周期第1、6天吸痰管和消毒液标本均未检测出细菌,且无致病微生物生长;每周期第12天对照组吸痰管和消毒液标本均检测出细菌,实验组未检测出细菌.结论气雾熏蒸法消毒灭菌效果可靠,具有节约开支、使用方便、有利于吸痰管的保存与放置等优点.     

Prevention of Peritoneal Carcinomatosis from Colon Cancer Cell Seeding Using a Pirarubicin Solution in Rats and Nude Mice

Free malignant cells, which are frequently detected in the washing liquid from the peritoneal cavity before and after resection of human colorectal cancer, are suspected to cause recurrent peritoneal cancer. We carried out an experimental study to compare the prophylactic efficacy of washing the peritoneum with several anticancer drugs and the antiseptic povidone-iodine against the development of peritoneal carcinomatosis from colonic origin in rats and nude mice. The in vitro anticancer activity of a short, 15-minute exposure of pirarubicin, doxorubicin, 5-fluorouracil, cisplatin, mitomycin C, and 1% povidone-iodine was first evaluated by an MTT assay on DHD/K12/PROb rat and LS174T human colon cancer cells. For the in vivo experiments, BDIX rats were inoculated intraperitoneally (IP) with 1 x 10⁶ DHD/K12/PROb cells followed by peritoneal scarring and a colocolic anastomosis. A 15-minute peritoneal washing with the anticancer drugs or povidone-iodine was then performed. Nude mice were IP-inoculated with 1 × 10⁷ LS174T human cells and treated 2 hours later with IP pirarubicin. Only pirarubicin, mitomycin C, and povidone-iodine were fully cytotoxic in vitro against DHD/K12/PROb rat colon cancer cells. In contrast to pirarubicin and povidone-iodine, mitomycin C was not completely active against LS174Tcells. In vivo, pirarubicin cured DHD/K12/PROb-inoculated rats, even at the site of the peritoneal scarring and intestinal anastomosis. IP pirarubicin prevented the development of peritoneal carcinomatosis and liver metastasis in LS174T-inoculated mice. IP washing with pirarubicin cured 2-day-old, but not 7-day-old, peritoneal carcinomatosis in rats. Short exposure to IP pirarubicin is nontoxic and more active than povidone-iodine and other anticancer drugs in preventing the development of peritoneal carcinomatosis from colonic origin in rats and mice. The prophylactic effect of preoperative peritoneal washing with pirarubicin on the development of recurrent peritoneal cancer should be evaluated in a randomized clinical trial.     

预充回流试验法预防硬膜外局麻药毒性反应与提高阻滞成功率的临床研究

目的 观察探讨预充回流试验法用于预防硬膜外局麻药毒性反应与提高硬膜外阻滞成功率的可行性.方法 择期硬膜外麻醉手术患者2 000例,所有患者均左侧卧位,采用直入法穿刺进针,以气泡压缩法确认进入硬膜外腔后,硬膜外腔内留置导管5 cm,导管末端连接装有盐水的玻璃注射器.对照1 ml/2 s的推注力度,测试导管阻力,同时硬膜外腔内导管退至3 cm.回抽玻璃注射器无脑脊液或血液,即硬膜外腔预充注入生理盐水3 ml,观察1 min玻璃注射器内有无问流液.观察回流液性状(-清;+微红;++显红;+++深红;++++血性)5 min,回流液性状为(+++)以下,给予试验量、维持量完成手术.观察记录麻醉全程回流液性状,麻醉效果和并发症发生情况.结果 预充回流液与麻醉效果存在相关关系.1例患者手术开始42 min发现回流液为血液,停止硬膜外注药,有效避免了局麻药毒性反应.所有患者均未出现神经、脊髓损伤,有1例患者术毕回流液为血液.结论 预充回流试验法可作为硬膜外麻醉成功的可靠指征,有效避免局麻药毒性反应,及时监测、处理硬膜外血肿的发生.     

Glutaraldehyde affects biocompatibility of bioprosthetic heart valves.

A marked release of glutaraldehyde from commercially available pericardial bioprosthetic heart valve (BHV) material in washing solutions was found by high performance liquid chromatography (up to 1.8 ppm of glutaraldehyde per gram of dry tissue). In vitro endothelial cell proliferation rate was impaired dose-dependently in the presence of increasing glutaraldehyde concentrations of the cultivation medium (r = 0.9; p less than 0.05). Cultivation of endothelial cells was impossible on the surface of commercially available BHV material, but successful and uninhibited when toxic glutaraldehyde ligands of the BHV material were antagonized by treatment with L-glutamic acid.     

Transection of the aerodigestive tract after blunt neck trauma

Survival after blunt neck trauma resulting in combined tracheal and esophageal injury is uncommon. We present the case of a young boy who sustained complete transection of the trachea and subtotal transection of the esophagus after a clothes line type injury.