Adaptive optimal tracking control for multi-joint manipulator on space robot

This paper aims to address the tracking control problem for the multi-joint manipulator on a space robot subject to model uncertainties and external disturbances. A Gauss-Newton interactive optimization algorithm is used to obtain the desired joint angle for each joint. In order to formulate the optimization problem, the Denaait-Hartenberg (D-H) method is employed to describe the model of the multi-joint manipulator. Subsequently, an adaptive controller is developed to achieve tracking control, where controller parameters updated in real time are introduced to handle the nondeterminacy of the multi-joint manipulator. Moreover, a fuzzy control strategy is composed such that our designed controller is robust against the complex environment as well. The controller design is performed by means of the Lyapunov techniques. Meanwhile, its effectiveness is verified through numerical simulations. Finally, some concluding remarks close the paper.     

Role of Inflammation and the Immune System in the Progression of Osteoarthritis

Understanding the molecular drivers and feedback loops of osteoarthritis (OA) may provide future therapeutic strategies to modulate the disease progression. The current paradigm of OA is evolving from a purely mechanical disease caused by cartilage wear toward a complex biological response connecting biomechanics, inflammation, and the immune system. The view of OA as a chronic wound highlights the role inflammation plays and also the body's attempts to repair an ongoing injury. Inflammatory signals, including cytokines such as interleukin-1 and tissue necrosis factor α, surface-expressed pattern recognition receptors such as toll-like receptors 2 and 4, complement factors such as C5, as well as pathogen-associated molecular patterns and damage-associated molecular patterns drive the enzymatic cascade that degrades cartilage matrix in OA. Considering the joint as an entire organ, interactions between the cells that reside in the synovium including macrophages and other immune cells, appear to drive enzymatic activity in cartilage, which, in turn, feeds signals back to the synovium that continues stimulating degradation in a feed-forward loop. This review will explore the potential roles of immune cells such as macrophages and T cells in the synovium in both stimulating and modulating the inflammatory response in OA. © 2019 Orthopedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 38:253-257, 2020     

基于适应性领导理论的自我管理干预对妊娠糖尿病患者的影响

目的探讨基于适应性领导理论的自我管理干预方案在门诊妊娠糖尿病患者中的应用效果。方法将89例门诊妊娠期糖尿病患者按入院顺序分为观察组44例和对照组45例。对照组给予常规门诊随访管理,观察组在此基础上实施基于适应性领导理论的自我管理干预方案,结合线上、线下干预引导患者及家属应对疾病管理中的技术性挑战和适应性挑战。结果干预后,观察组妊娠糖尿病自我管理能力总分及各维度得分显著高于对照组(均P0.01),妊娠相关焦虑总分及各维度得分显著低于对照组(均P0.01);观察组血糖及体质量增长达标情况显著优于对照组(均P0.05),但两组母婴妊娠结局差异无统计学意义(均P0.05)。结论应用基于适应性领导理论的干预方案有利于提高门诊妊娠糖尿病患者的自我管理能力,改善患者妊娠相关焦虑,促进患者血糖控制及体质量管理。     

Solving Time Dependent Fokker-Planck Equations via Temporal Normalizing Flow

In this work, we propose an adaptive learning approach based on temporal normalizing flows for solving time-dependent Fokker-Planck (TFP) equations. It is well known that solutions of such equations are probability density functions, and thus our approach relies on modelling the target solutions with the temporal normalizing flows. The temporal normalizing flow is then trained based on the TFP loss function, without requiring any labeled data. Being a machine learning scheme, the proposed approach is mesh-free and can be easily applied to high dimensional problems. We present a variety of test problems to show the effectiveness of the learning approach.     

基于MR引导放疗系统肺癌SBRT初步临床应用

目的 初步观察MR引导下非小细胞肺癌体部立体定向放疗(SBRT)的可行性,并对有无磁场环境下剂量学差异进行分析。方法 前瞻性的入组3例SBRT的非小细胞肺癌患者,均应用MR引导加速器放疗。治疗计划分别应用有磁场模型和无磁场模型进行优化和剂量计算,同时在常规加速器进行患者备用计划的制备。比较有无磁场模型剂量的分布差异。同时对靶区覆盖度、计划通过率、治疗时间进行描述,并比较常规加速器备用计划和有磁场模型下执行计划的复杂度等差异。结果 3例患者分次治疗时间为(36.67±6.11) min,在线自适应计划平均时间为(14.4±1.7) min,患者基本耐受。治疗前计划的γ通过率(3%/3mm)平均为98.9%,疗中在线计划γ通过率(3%/3mm)为98.5%,靶区覆盖度达99.1%,满足临床需求。有磁场情况下肺部低剂量区剂量略低于无磁场情况,但肋骨和皮肤剂量因磁场存在略高于无磁场计划。在线自适应计划的机器跳数略高于参考计划,常规加速器备用计划机器跳数在相同靶区覆盖度情况下明显低于MR加速器计划。随访结果显示患者无不良反应,近期疗效均为部分缓解。结论 在考虑磁场影响情况下可获得满足临床需求的治疗计划,证明MR加速器引导的肺癌SBRT放疗具有可行性,但治疗时间较长,治疗流程较为复杂。     

Image-guided Adaptive Radiotherapy for Bladder Cancer

Technological advancement has facilitated patient-specific radiotherapy in bladder cancer. This has been made possible by developments in image-guided radiotherapy (IGRT). Particularly transformative has been the integration of volumetric imaging into the workflow. The ability to visualise the bladder target using cone beam computed tomography and magnetic resonance imaging initially assisted with determining the magnitude of inter- and intra-fraction target change. It has led to greater confidence in ascertaining true anatomy at each fraction. The increased certainty of dose delivered to the bladder has permitted the safe reduction of planning target volume margins. IGRT has therefore improved target coverage with a reduction in integral dose to the surrounding tissue. Use of IGRT to feed back into plan and dose delivery optimisation according to the anatomy of the day has enabled adaptive radiotherapy bladder solutions. Here we undertake a review of the stepwise developments underpinning IGRT and adaptive radiotherapy strategies for external beam bladder cancer radiotherapy. We present the evidence in accordance with the framework for systematic clinical evaluation of technical innovations in radiation oncology (R-IDEAL).     

Adaptive self-calibrating iterative GRAPPA reconstruction

Parallel magnetic resonance imaging in k-space such as generalized auto-calibrating partially parallel acquisition exploits spatial correlation among neighboring signals over multiple coils in calibration to estimate missing signals in reconstruction. It is often challenging to achieve accurate calibration information due to data corruption with noises and spatially varying correlation. The purpose of this work is to address these problems simultaneously by developing a new, adaptive iterative generalized auto-calibrating partially parallel acquisition with dynamic self-calibration. With increasing iterations, under a framework of the Kalman filter spatial correlation is estimated dynamically updating calibration signals in a measurement model and using fixed-point state transition in a process model while missing signals outside the step-varying calibration region are reconstructed, leading to adaptive self-calibration and reconstruction. Noise statistic is incorporated in the Kalman filter models, yielding coil-weighted de-noising in reconstruction. Numerical and in vivo studies are performed, demonstrating that the proposed method yields highly accurate calibration and thus reduces artifacts and noises even at high acceleration.     

Radiation dose reduction with application of non-linear adaptive filters for abdominal CT

AIM:To evaluate the effect of non-linear adaptive filters (NLAF) on abdominal computed tomography (CT) images acquired at different radiation dose levels.METHODS:Nineteen patients (mean age 61.6 ± 7.9 years,M:F=8:11) gave informed consent for an Institutional Review Board approved prospective study involving acquisition of 4 additional image series (200,150,100,50 mAs and 120 kVp) on a 64 slice multidetector row CT scanner over an identical 10 cm length in the abdomen.The CT images acquired at 150,100 and 50 mAs were processed with the NLAF.Two radiologists reviewed unprocessed and processed images for image quality in a blinded randomized manner.CT dose index volume,dose length product,patient weight,transverse diameters,objective noise and CT numbers wererecorded.Data were analyzed using Analysis of Variance and Wilcoxon signed rank test.RESULTS:Of the 31 lesions detected in abdominal CT images,28 lesions were less than 1 cm in size.Subjective image noise was graded as unacceptable in unprocessed images at 50 and 100 mAs,and in NLAF processed images at 50 mAs only.In NLAF processed images,objective image noise was decreased by 21% (14.4 ± 4/18.2 ± 4.9) at 150 mAs,28.3% (15.7 ± 5.6/21.9 ± 4) at 100 mAs and by 39.4% (18.8 ± 9/30.4 ± 9.2) at 50 mAs compared to unprocessed images acquired at respective radiation dose levels.At 100 mAs the visibility of smaller structures improved from suboptimal in unprocessed images to excellent in NLAF processed images,whereas diagnostic confidence was respectively improved from probably confident to fully confident.CONCLUSION:NLAF lowers image noise,improves the visibility of small structures and maintains lesion conspicuity at down to 100 mAs for abdominal CT.     

The Effect of Maximum Heart Rate On Oxygen Kinetics and Exercise Performance at Low and High Workloads

The normal heart rate is lineurly related to oxygen consumption during exercise. The maximum heart rate of the normal sinus node is approximated by the formula: HR_max= (220-age) with a variance of approximately 15%. However, the nominal upper rate of most permanent pacemakers is 120 beats/min, a value that remains unchanged for many patients. As this nominal setting falls well below the maximum predicted heart rate for most patients, it is possible that the chronotropic response of rate adaptive pacemakers during moderate und maximal exercise workloads may be less than optimal. The purpose of this study was to determine the effect of the upper programmed rate on oxygen kinetics during submaximal exercise workloads and maximum exercise performance during symptom-limited treadmill exercise. Exercise performance with an upper rate programmed to 220-age was compared with an upper rate of 120 beats/min. Eleven patients (5 men and 6 women, mean age 54 ± 10 years) with complete heart block following catheter ablation of the atrioventricular junction for refractory atrial fibrillation who were implanted with permanent, rate-modulating VVIR pacemakers comprised the study population. The rate adaptive sensors were based on activity in 8 patients, minute ventilation in 2 patients, and mixed venous oxygen saturation in 1 patient. After performing a symptom-limited treadmill exercise test to determine maximum exercise capacity and to optimize programming of the rate adaptive sensor, each subject performed two treadmill exercise tests in random sequence with a rest period of at least 1 hour between tests. During one of the tests the upper rate was programmed to a value calculated by the formula: HR_max= (220-age). During the other exercise test the upper rate was programmed to 120 beats/min. Patients were blinded as to their programmed values and to the hypothesis of the study. A novel treadmill exercise protocol was used that consisted of a 6 minute, constant-workload phase at approximately 50% of maximum workload followed immedictely by incremental, symptom-limited exercise using a modified Chronotropic Assessment Exercise Protocol (CAEP) with 1 minute stages until peak exertion. Breath-by-breath analysis of expired gases was performed with subjective scoring of exertional difficulty at the end of the constant workload phase and during each stage of incremental exercise using the Borg Perceived Exertion Scale. Exercise duration was significantly longer (6.37 ± 47 vs 611 ±48 seconds. P < 0.005) with the higher programmed upper rate. Oxygen kinetics were also significantly improved with an age predicted upper rate with a lower O₂ deficit (258 ± 88 vs 395 ± 155 ml, P = 0.002) and higher VO₂ rate constant (3.6 ± 1.0 vs 2.4 ± 0.7. P < 0.001.). The V0_2maxduring peak exertion was higher with an age predicted upper rate than with an upper rate of 120 beats/min (1807 ± 751 vs 1716 ± 702 mL/min, P = 0.01). The mean Borg score was lower during the last common treadmill stage during maximum exercise with an age predicted upper rate than with an upper rate of 120 beats/min (15.7 ± 2.0 vs 16.5 ± 1.9. P = 0.04). The mean Borg score during submaximal. constant workload exercise was also lower with a higher upper rate (9.0 ±2.5 vs 9.6 ± 2.2, P = 0.10). Programming the upper rate of rate adaptive pacemakers based on the age of the patient improves exercise performance and exertional symptoms during both low and high exercise workloads as compared with a standard nominal value of 120 beats/min.     

The application of complex adaptive systems theory to clinical practice in rehabilitation

It is increasingly emphasised that effective healthcare for the growing number of chronic disease and lifestyle issues must be grounded in a non-reductionist paradigm focused on understanding relationships and applying flexible problem-solving. To address these needs, key principles of complex adaptive systems theory (CAS) are being applied to healthcare planning and research. The aim of this clinical commentary is to provide a brief overview of complex adaptive systems theory and illustrate its relevance to rehabilitation professionals. Further, the review will explore occupational therapist and physiotherapist profession-specific publications for evidence of CAS theory applications that can be used to illustrate the clinical usefulness of complexity science concepts. The commentary will also identify other resources that can assist healthcare providers in developing an understanding of the framework's assumptions and principles for affecting change. Lastly, the implications of failing to acquire a competent understanding of CAS principles and command of the terminology will be addressed and therapists challenged to assume an equal role in mapping healthcare delivery in the 21st century.