Forward kinematics analysis of parallel manipulator using modified global Newton-Raphson method

In order to obtain direct solutions of parallel manipulator without divergence in real time,a modified global Newton-Raphson(MGNR) algorithm was proposed for forward kinematics analysis of six-degree-of-freedom(DOF) parallel manipulator.Based on geometrical frame of parallel manipulator,the highly nonlinear equations of kinematics were derived using analytical approach.The MGNR algorithm was developed for the nonlinear equations based on Tailor expansion and Newton-Raphson iteration.The procedure of MGNR algorithm was programmed in Matlab/Simulink and compiled to a real-time computer with Microsoft visual studio.NET for implementation.The performance of the MGNR algorithms for 6-DOF parallel manipulator was analyzed and confirmed.Applying the MGNR algorithm,the real generalized pose of moving platform is solved by using the set of given positions of actuators.The theoretical analysis and numerical results indicate that the presented method can achieve the numerical convergent solution in less than 1 ms with high accuracy(1×10-9 m in linear motion and 1×10-9 rad in angular motion),even the initial guess value is far from the root.

Estimating glomerular filtration rate preoperatively for patients undergoing hepatectomy

AIM:To compare creatinine clearance(Ccr) with estimated glomerular filtration rate(eGFR) in preoperative renal function tests in patients undergoing hepatectomy.METHODS:The records of 197 patients undergoing hepatectomy between August 2006 and August 2008 were studied,and preoperative Ccr,a three-variable equation for eGFR(eGFR3) and a five-variable equation for eGFR(eGFR5) were calculated.Abnormal values were defined as Ccr < 50 mL/min,eGFR3 and eGFR5 < 60 mL/min per 1.73 m2.The maximum increases in the postoperative serum creatinine(post Cr) level and postoperative rate of increase in the serum Cr level(post Cr rate) were compared.RESULTS:There were 37 patients(18.8%) with abnormal Ccr,31(15.7%) with abnormal eGFR3,and 40(20.3%) with abnormal eGFR5.Although there were no significant differences in the post Cr rate between patients with normal and abnormal Ccr,eGFR3 and eGFR5 values,the post Cr level was significantly higher in patients with eGFR3 and eGFR5 abnormality than in normal patients(P < 0.0001).Post Cr level tended to be higher in patients with Ccr abnormality(P = 0.0936 and P = 0.0875,respectively).CONCLUSION:eGFR5 and the simpler eGFR3,rather than Ccr,are recommended as a preoperative renal function test in patients undergoing hepatectomy.

Is extended biopsy protocol justified in all patients with PSA≥20ng/mL?

The aim of this study was to investigate whether it was necessary to increase the number of cores at initial prostate biopsy with patients of prostate-specific antigen （PSA） ≥ 20 ng/mL and to explore an appropriate individualized transrectal ultrasonograhpy （TRUS）-guided prostate biopsy for the detection of prostate cancer in men suspicious of prostate cancer. Methods： A total of 115 patients with PSA ≥ 20 ng/mL and suspicious of prostate cancer were prospectively randomized to perform TRUS-guided biopsy. Patients were randomized to a ＂6 ＋ X＂ cores or a ＂10 ＋ X＂ cores protocol. The primary end point was cancer detection rate. Secondary end points were cancer characteristics, rate of complications and the level of pain experienced by patients during TRUS-guided prostate biopsy. Results： Preoperative variables were similar in both groups. The overall prostate cancer detection rate was 73.9%. The ＂10 ＋ X＂ cores strategy increased cancer detection rate only 9.7% in patients with PSA ≥ 20 ng/mL but 〈 50 ng/mL, while there was no difference between the two strategies for cancer detection in patients with PSA ≥ 50.1 ng/mL. The number of extended biopsy cores and pain score of extended biopsy in prostate cancer patients increased significantly （P 〈 0.001）. Conclusion： Our findings suggest that there is no significant advantage in using extended biopsy protocol in all patients with PSA≥20 ng/mL.

Sentinel lymph node biopsy in renal malignancy: The past, present and future

Sentinel lymph node biopsy （SLNB） is now an establishedtechnique in penile and pelvic cancers, resulting in alower mortality and morbidity when compared withthe traditional lymph node dissection. In renal cancer however, despite some early successes for the SLNB technique, paucity of data remains a problem, thus lymph node dissection and extended lymph node dissection remain the management of choice in clinically node positive patients, with surveillance of lymph nodes in those who are clinically node negative. SLNB is a rapidly evolving technique and the introduction of new techniques such as near infra-red fuorescence optical imaging agents and positron emission tomography/computed tomography scans, may improve sensitivity. Evidence in support of this has already been recorded in bladder and prostate cancer.Although the lack of large multi-centre studies and issues around false negativity currently prevent its widespread use, with evolving techniques improving accuracy and the support of large-scale studies, SLNB does have the potential to become an integral part of staging in renal malignancy.

Do Small Family Firms Outperform Non-family Firms？ A Research Agenda Based on Agency and Stewardship Theories＊

The aim of this study is to examine the effects of family involvement and altruism on agency costs of equity and debt, as well on the performance of small family businesses. To achieve this objective, the authors reviewed the literature on family business. Drawing from agency theory and stewardship theory, the authors also proposed a research model that highlights the links among the variables. In so doing, this paper makes some contributions to the literature in three ways. Firstly, it takes an integrative framework that may help to explain behaviors oriented towards maximizing potential performance within a context in which pro-organizational attitudes co-exist with self-serving motivations. Secondly, it advances the understanding of corporate governance mechanisms in small family businesses, and finally, it deepens the discussion of prior research by advancing a set of propositions based on two theoretical approaches. Thus, the authors believe that a systematic comparison of different contexts provides new insights into small family business governance. The implications and directions for future research are in the last section.

TGF-β may be complimentary to PSA in Chinese prostate cancer

Objective： To investigate the value of the plasma transforming growth factor β1 （TGF-β1） level in diagnosis and prognosis of prostate cancer （PCa）. Methods： The ELISA kits for human TGF-β1 were used to measure the TGF-β1 level in plasmas. A cohort of 295 consecutive PCa patients in recent more than two years in the First Hospital of Peking University of China was enrolled to the study. Furthermore, 55 control subjects were healthy and without evidence of PCa, who were random people that came to the hospital and were identified by prostate biopsy. Results： An age-related frequency chart indicated that 99% confidence interval of the difference with PCa was at the age of 53-85 years. The PCa patients aged 53-85 were classified into three groups according to TNM staging. Group A had Stages TO, T1 and T2. Group B had Stage T3 and Group C had Stage T4. Compared with control group, Group A had the lower level of plasma TGF-β1 （P 〈 0.05）, Group B had the higher level of plasma TGF-β1 （P 〈 0.05） and Group C had the even higher level of plasma TGF-β1 （P 〈 0.01）. According to TNM staging, Group D had Stages TO, T1 and T2 with the normal level of total PSA （tPSA）. Group E with the normal level of tPSA had metastasis after resection. Compared with control group, Group D had the lower plasma level of TGF-β1 （P 〈0.05） and Group E had higher plasma level of TGF-β1 （P 〈 0.01）. Conclusion： The plasma TGF-β1 level decreases at early stage of PCa and increases at later stage of PCa, especially at tumor metastasis after the resection. The plasma TGF-β1 level may therefore be complementary to PSA for PCa prognosis.

Sorafenib in hepatocellular carcinoma:efficacy and predictive factors

Objective:To evaluate the efficacy and safety in patients with hepatocellular carcinoma treated with sorafenib and determine the predictive factors for survival.Methods:From April 2009 to December 2010,all patients with hepatocellular carcinoma treated with sorafenib were included in the study.Clinical data and survival time were collected.Survival analysis was conducted using the Kaplan-Meier method,and predictive factors for survival were analysed using the Cox's model.Results:A total of 51 patients were included in the study,the median time of follow-up was 10 months(range 1-22).All the 51 patients had one or more adverse events,of which 2 patients died of upper gastrointestinal bleeding and 6 patients discontinued treatment.The mean survival time was 11 months and 1-year survival was 60.8%.On univariate analysis,the median survival time of patients with tumors of BCLC A,B and C were 17,12.5 and 8.5 months,and 1-year survival were 71.4%,61.1%,and 23.1%, respectively(P=0.006).Compared with those with mild and poor arterial supply tumors,patients with good arterial supply tumors had longer median survival time(12 months vs 8 months and 9 months) and higher 1-year survival(52.0%vs 30.8%and 38.5%)(P=0.037).Patients with portal invasion had shorter median survival time and lower 1-year survival(8.5 months vs 13 months and 57.6%vs 16.7%,respectively) than those without(P=0.012).Patients with prealbumin≥170 mg/L had longer median survival time and higher 1-year survival(13.5 months vs 9 months and 55.6%vs 36.4%,respectively) than those with prealbumin<170 mg/L(P=0.016).Early tumor BCLC staging and high level of prealbumin were independent predictive factors for survival on multivariate analysis using Cox's regression model,the hazard ratio were 3.69(95%CI:1.30-10.53,P=0.015) and 3.53(95%CI:1.40-8.91,P=0.008) respectively.Conclusion:Upper gastrointestinal bleeding was a severe event need to be concerned in patients with hepatocellular carcinoma treated with sorafenib.Patients with high level of prealbumin could benefit more from sorafenib treatment,and prealbumin could be a predictor for survival in HCC patients treated with sorafenib.

Can palliative radiotherapy influence prostate-specific antigen response in patients with castrate-resistant prostate cancer treated with systemic therapy(chemotherapy or abiraterone)?——a report of three cases

Palliative radiotherapy(pRT) is primarily employed for palliation of bone pain in patients with castrate-resistant prostate cancer(CRPC). However, evidence that p RT influences prostate-specific antigen response in patients with CRPC on systemic therapy is lacking. We describe three cases of CRPC progressing after treatment with docetaxel(n=2) and abiraterone(n=1), who responded unusually after p RT for bone pain with the development of a significant biochemical response and restoration of response to systemic therapy. The possibility of p RT influencing metastatic disease in CRPC has not been previously reported, and raises the possibility of radiation-induced modulation of anti-tumor immune response mechanisms that may play a role in the restoration of response to systemic treatment.

Optimizing prostate biopsy for repeat transrectal prostate biopsies patients

Objective： Diagnosis of patients with negative prostate biopsy and persistent suspicion of prostate cancer re- mains a serious problem. In this study, we investigated the application of optimizing prostate biopsy for patients who need repeat prostate biopsy. Methods： In this prospective, non-randomized phase-I clinical trial, the prostate cancer detection rate of initial detection scheme was compared with optimizing prostate biopsy scheme. The number of punctures of initial detection scheme was the same as that of optimizing prostate biopsy scheme. The puncture direction of optimizing prostate biopsy was a 45~ angle to the sagittal plane from front, middle, and back. The two cores from each lateral lobe were horizontally inwardly inclined 45~. Results： A total of 45 patients with initial negative biopsy for cancer were received the optimizing prostate biopsy scheme. The cancer detection rate was 17.8% （8/45）, and prostate intraepithelial neoplasm （PIN） was 6.7% （3/45）. The pa- tients receiving repeat transrectal prostate biopsies were pathologically diagnosed as lower Gleason grade prostate cancers. Conclusion： The cancer detection rate of repeat biopsy prostate cancer is lower than that of initial biopsy. Our study showed that the optimizing prostate biopsy is important to improve the detection rate of repeat transrecta~ prostate biopsies patients.

Evaluation of the optimal field arrangement for conformal radiotherapy for prostate cancer patients

Objective:The aim of this study was to evaluate the optimal field arrangement for conformal radiotherapy (CFRT) for prostate cancer patients.Methods:Thirty patients with prostate cancer of different grades and stages were treated with 3D conformal radiotherapy to minimize the dose to bladder,rectum and head of both femora using four fields (4F),five fields (5F),six fields (6F) and ARC techniques to minimize the risk of over dose to bladder,rectum and femoral heads.Patients received a total dose between 76 to 78 Gy given in 38 to 39 fractions over 7.5 to 8 weeks.Results:It was observed that V95,D95,D50 and D5 values for planning target volume (PTV) were comparatively higher when planned by 5 fields technique than when planned by fixed field technique (91%,91%,90% and 91.4% for skip-scan technique versus 85%,87%,86% and 88% by fixed field).The organs like rectum and urinary bladder get much higher dose when treated by fixed field techniques than rotation or 5 fields technique,when comparison was made for V95,V50 and DM values for rectum and urinary bladder obtained by 5 fields technique planning and 4/6 field planning,the value for 5 fields technique was found to be lower than 4/6 field technique (1%,70% and 51% versus 13%,91% and 55% for rectum and 4%,25% and 51% versus 16%,38% and 56% for urinary bladder respectively).Conclusion:Similarly for femoral heads,planning by full rotational technique had been observed to be beneficial as compared to when planning was done by fixed field technique (0%,0% and 29% versus 0%,1% and 28%).

Clinical application of intraperitoneal chemotherapy before surgery for ovarian cancer and its evaluation

Objective： To investigate the clinical efficacy of intraperitoneal chemotherapy before surgery for ovarian cancer. Methods： 60 patients with stages Ⅱ-Ⅳ of ovarian cancer were treated with intraperitoneal chemotherapy of CAP or TP regimen followed by a surgery treatment and another chemotherapy for 6 cycles. And then the efficiency of the therapy was evaluated by analyzing the changes of ascites, the serum CA-125 and CA-19-9 levels and the findings in the operation, and investigating the recurrence of cancer and the survival. Results： After 1-3 cycles of intraperitoneal chemotherapy, serum levels of CA-125 and CA-19-9 and carcinous ascites significantly reduced in all patients, ascites reduce was over 50% in 98.3% cases; all cases were successfully treated with cytoreduction and it was found during the operation that bulky tumor was reduced and looser so as to be easily isolated and removed; PFS of the patients was prolonged, while the toxicity and side-effects were not so serious as beyond the patient toleration. Conclusion： Intraperitoneal chemotherapy before surgery for ovarian cancer has an active efficacy in clinic, being able to improve conditions of surgery and increase the opportunity of maximal cytoreduction, and prolong survival of the patients, and should be a good selection for the treatment of advanced ovarian cancer.

Prehospital care for multiple trauma patients in Germany

For the German speaking countries, Tscherne＇s definition of ＂polytrauma＂ which represents an injury of at least two body regions with one or a combination being life-threatening is still valid. The timely and adequate management including quick referral of the trauma patient into a designated trauma center may limit secondary injury and may thus improve outcomes already during the prehospital phase of care. The professional treatment of multiple injured trauma patients begins at the scene in the context of a well structured prehospital emergency medical system. The ＂Primary Survey＂ is performed by the emergency physician at the scene according to the Prehospital Trauma Life Support （PHTLS）-concept. The overall aim is to rapidly assess and treat life-threatening conditions even in the absence of patient history and diagnosis （＂treat-first-what-kills-first＂）. If no immediate treatment is necessary, a ＂Secondary Sur- vey＂ follows with careful and structured body examination and detailed assessment of the trauma mechanism. Massive and life-threatening states of hemorrhage should be addressed immediately even disregarding the ABCDE-scheme. Critical trauma patients should be referred without any delay （＂work and go＂） to TR-DGU certified trauma centers of the local trauma networks. Due to the difficult prehospital environment the number of quality studies in the field is low and, as consequence, the level of evidence for most recommendations is also low. Much information has been obtained from different care systems and the interchangeability of results is limited. The present article provides a synopsis of recommendations for early prehospital care for the severely injured based upon the 2011 updated multidisciplinary S3-Guideline ＂Polytrauma/Schwerstverletzten Behandlung＂, the most recently updated European Trauma guideline and the current PHTLS-algorithms including grades of recommendation whenever possible.

Effects of Acupuncture at 7-9 am and 3-5 pm on Plasma Thromboxane and Prostaglandin in Patients with Ischemic Cerebrovascular Disease

Objective:To observe the effects of acupuncture at different times on plasma thromboxane(TXB2) and prostaglandin 6-Keto-PGF1a(6-K-P) in patients with ischemic cerebrovascular disease.Methods:Totally 90 patients were randomly divided into a group acupunctured at 7-9 am,a group acupunctured at 3-5 pm and a drug control group,with 30 cases in each group.The contents of plasma TXB2 and 6-K-P from venous blood before treatment were compared with those 15 days after treatment.Results:The plasma TXB2 levels of the two acupuncture groups were obviously lower than those before treatment(P<0.05,P<0.01) ,but the 6-K-P levels of both the acupuncture groups were remarkably higher than those before treatment(P<0.05,P<0.01) . And the TXB2 level in the 3-5 pm acupuncture group was obviously lower than that in the 7-9 am acupuncture group(P<0.05) ,and the 6-K-P level of the former was obviously higher than that of the latter(P<0.05) .Conclusion:Acupuncture can promote functional recovery in patients with ischemic cerebrovascular disease and enhance their survival quality.