This review article aims to explore the major challenges that the healthcare system is currently facing and propose a new paradigm shift that harnesses the potential of wearable devices and novel theoretical frameworks on health and disease. Lifestyle-induced diseases currently account for a significant portion of all healthcare spending, with this proportion projected to increase with population aging. Wearable devices have emerged as a key technology for implementing large-scale healthcare systems focused on disease prevention and management. Advancements in miniaturized sensors, system integration, the Internet of Things, artificial intelligence, 5G, and other technologies have enabled wearable devices to perform high-quality measurements comparable to medical devices. Through various physical, chemical, and biological sensors, wearable devices can continuously monitor physiological status information in a non-invasive or minimally invasive way, including electrocardiography, electroencephalography, respiration, blood oxygen, blood pressure, blood glucose, activity, and more. Furthermore, by combining concepts and methods from complex systems and nonlinear dynamics, we developed a novel theory of continuous dynamic physiological signal analysis-dynamical complexity. The results of dynamic signal analyses can provide crucial information for disease prevention, diagnosis, treatment, and management. Wearable devices can also serve as an important bridge connecting doctors and patients by tracking, storing, and sharing patient data with medical institutions, enabling remote or real-time health assessments of patients, and providing a basis for precision medicine and personalized treatment. Wearable devices have a promising future in the healthcare field and will be an important driving force for the transformation of the healthcare system, while also improving the health experience for individuals.
Humans ; Artificial Intelligence ; Wearable Electronic Devices ; Monitoring, Physiologic/methods*

Patients with acute heart failure (AHF) often experience dyspnea, and monitoring and quantifying their breathing patterns can provide reference information for disease and prognosis assessment. In this study, 39 AHF patients and 24 healthy subjects were included. Nighttime chest-abdominal respiratory signals were collected using wearable devices, and the differences in nocturnal breathing patterns between the two groups were quantitatively analyzed. Compared with the healthy group, the AHF group showed a higher mean breathing rate (BR_mean) [(21.03 ± 3.84) beat/min vs. (15.95 ± 3.08) beat/min, P < 0.001], and larger R_RSBI_cv [70.96% (54.34%-104.28)% vs. 58.48% (45.34%-65.95)%, P = 0.005], greater AB_ratio_cv [(22.52 ± 7.14)% vs. (17.10 ± 6.83)%, P = 0.004], and smaller SampEn (0.67 ± 0.37 vs. 1.01 ± 0.29, P < 0.001). Additionally, the mean inspiratory time (TI_mean) and expiration time (TE_mean) were shorter, TI_cv and TE_cv were greater. Furthermore, the LBI_cv was greater, while SD1 and SD2 on the Poincare plot were larger in the AHF group, all of which showed statistically significant differences. Logistic regression calibration revealed that the TI_mean reduction was a risk factor for AHF. The BR_ mean demonstrated the strongest ability to distinguish between the two groups, with an area under the curve (AUC) of 0.846. Parameters such as breathing period, amplitude, coordination, and nonlinear parameters effectively quantify abnormal breathing patterns in AHF patients. Specifically, the reduction in TI_mean serves as a risk factor for AHF, while the BR_mean distinguishes between the two groups. These findings have the potential to provide new information for the assessment of AHF patients.
Humans ; Heart Failure/diagnosis* ; Prognosis ; Respiration ; Wearable Electronic Devices ; Acute Disease

In recent years, wearable devices have seen a booming development, and the integration of wearable devices with clinical settings is an important direction in the development of wearable devices. The purpose of this study is to establish a prediction model for postoperative pulmonary complications (PPCs) by continuously monitoring respiratory physiological parameters of cardiac valve surgery patients during the preoperative 6-Minute Walk Test (6MWT) with a wearable device. By enrolling 53 patients with cardiac valve diseases in the Department of Cardiovascular Surgery, West China Hospital, Sichuan University, the grouping was based on the presence or absence of PPCs in the postoperative period. The 6MWT continuous respiratory physiological parameters collected by the SensEcho wearable device were analyzed, and the group differences in respiratory parameters and oxygen saturation parameters were calculated, and a prediction model was constructed. The results showed that continuous monitoring of respiratory physiological parameters in 6MWT using a wearable device had a better predictive trend for PPCs in cardiac valve surgery patients, providing a novel reference model for integrating wearable devices with the clinic.
Humans ; Lung ; Walking/physiology* ; Walk Test ; Heart Valves/surgery* ; Postoperative Period ; Postoperative Complications/etiology*

To achieve continuously physiological monitoring on hospital inpatients, a ubiquitous and wearable physiological monitoring system SensEcho was developed. The whole system consists of three parts: a wearable physiological monitoring unit, a wireless network and communication unit and a central monitoring system. The wearable physiological monitoring unit is an elastic shirt with respiratory inductive plethysmography sensor and textile electrocardiogram (ECG) electrodes embedded in, to collect physiological signals of ECG, respiration and posture/activity continuously and ubiquitously. The wireless network and communication unit is based on WiFi networking technology to transmit data from each physiological monitoring unit to the central monitoring system. A protocol of multiple data re-transmission and data integrity verification was implemented to reduce packet dropouts during the wireless communication. The central monitoring system displays data collected by the wearable system from each inpatient and monitors the status of each patient. An architecture of data server and algorithm server was established, supporting further data mining and analysis for big medical data. The performance of the whole system was validated. Three kinds of tests were conducted: validation of physiological monitoring algorithms, reliability of the monitoring system on volunteers, and reliability of data transmission. The results show that the whole system can achieve good performance in both physiological monitoring and wireless data transmission. The application of this system in clinical settings has the potential to establish a new model for individualized hospital inpatients monitoring, and provide more precision medicine to the patients with information derived from the continuously collected physiological parameters.

Objective: To investigate retrospectively a modified procedure of two-stage urethroplasty with distal urethral preset for proximal pediatric hypospadias and evaluate the feasibility and advantages of the method. Methods: From January 2013 to January 2018, two-stage urethroplasty with distal urethral preset was performed in 36 boys from 19 months to 15 years old (median age 36 months) with proximal hypospadias. The penile straightening and distal urethroplasty were performed at the first stage, meanwhile, the original urethral opening was preserved. After the distal reconstructed urethra performed in 6 months, the neourethra was connected with proximal meatus to re-establish the continuous urethra. The wound infection, urinary leakage, urethral stricture, appearance of penis and urination were observed after the second stage operation. Results: One case had skin infection around the wound after first stage operation and healed after wound management. Another one case had the distal urethra dehiscence but the wound has no signs of infection. The child had moderate anemia, and the hemoglobin is 80 g/L.It was therefore considered that anemia was the cause. The hemoglobin level was normal during the second stage operation, and repaired by Snodgrass method in the second stage. Five cases had the balanue dehiscence.Thirty case had being succeeded after the first stage, included a case of wound infection 5 days after operation. Three cases developed urethral fistula after the second stage repair, which were mended in the third stage. At a mean follow-up of 20 months postoperatively (14 to 48 months), all patients had satisfied appearance of penis, unobstructed urination and continuous urine line, without urinary fistula, urethral stricture and urethrocele at the second stage repair. Conclusions The distal urethral preset and staged procedure is a feasible operation that corrects proximal hypospadias with few complications and with good cosmetic and functional outcomes.

Objective In view of the controversy over radiotherapy target volume for patients with limited-stage small cell lung cancer ( SCLC), a prospective randomized controlled trial was conducted to compare the impact of different radiotherapy target volumes on prognosis. Methods After 2 cycles of EP chemotherapy,patients without progressive disease were randomly assigned to receive thoracic radiotherapy (TRT) to either the post-or pre-chemotherapy primary tumour extent as study arm or control. Involved field radiotherapy (IFRT) to the entire metastatic lymph node regions was applied for both arms. TRT consisted of 45 Gy/30Fx/19 d administered concurrently with cycle 3 chemotherapy. Prophylactic cranial irradiation was administered to patients achieved complete or partial remission. Kaplan-Meier method was used for survival analysis. Results Between June 2002 and December 2017,159 and 150 patients were randomly assigned to study arm and control respectively. The 1-,2-,and 5-year local/regional control rates were 79. 4%,61. 5% and 60. 1% respectively in the study arm versus 79. 8%,66. 5%,and 57. 3% in the control arm (P=0. 73). The median OS time was 22. 1 months in the study arm (95%CI,18. 2-26. 0 months) and 26. 9 months (95%CI,23. 5-30. 3 months) in the control arm,the 1-,3-,5-,and 7-year OS rates were 81. 1%,31. 6%, 23. 9% and 22. 2% respectively in the study arm versus 85. 3%,36. 6%,26. 1% and 20. 0% in the control arm (P=0. 51).Grade 2-3 acute esophagitis was developed in 32. 9% and 43. 2% of patients respectively in study arm and control arm (P=0. 01),while grade 2-3 pulmonary fibrosis was observed in 2. 0% and 10. 9% of patients ( P= 0. 01 ) respectively. Conclusions For patients with limited-stage SCLC who received induction chemotherapy,thoracic radiotherapy can be limited to post-chemotherapy tumour extent and IFRT can be routinely applied.

OBJECTIVEThis study aims to evaluate the efficacy and safety of crizotinib for advanced ALK-positive non-small cell lung cancer (NSCLC) patients.

METHODSTwenty-eight patients with advanced ALK-positive NSCLC were given orally crizotinib 250 mg b. i.d., and were followed up to evaluate the therapeutic efficacy and safety.

RESULTSAmong the 28 patients, the objective response rate (ORR) was 71.4% (20/28) and disease control rate (DCR) was 92.9% (26/28). Three patients achieved complete response. Seventeen patients had partial response. The most common drug-related adverse events were mild flickering vision and gastrointestinal reaction. Eleven patients experienced flickering vision. Nine patients had nausea and vomiting. Eight patients had diarrhea. They were all reversible and of grade I or II. Only one patient had grade III myelosuppression. Among the 28 patients, 16 cases were disease-free and 12 cases had progressive disease, with a progression-free survival of 8.2 months.

CONCLUSIONSCrizotinib is effective and tolerable in the treatment of advanced ALK-positive NSLCC. However, its long-term treatment efficacy requires to be further studied.

Antineoplastic Agents ; adverse effects ; therapeutic use ; Carcinoma, Non-Small-Cell Lung ; drug therapy ; enzymology ; pathology ; Diarrhea ; chemically induced ; Disease-Free Survival ; Humans ; Lung Neoplasms ; drug therapy ; enzymology ; pathology ; Nausea ; chemically induced ; Protein Kinase Inhibitors ; adverse effects ; therapeutic use ; Pyrazoles ; adverse effects ; therapeutic use ; Pyridines ; adverse effects ; therapeutic use ; Receptor Protein-Tyrosine Kinases ; Vomiting ; chemically induced

Objective This study aims to evaluate the efficacy and safety of crizotinib for advanced ALK?positive non?small cell lung cancer ( NSCLC) patients. Methods Twenty?eight patients with advanced ALK?positive NSCLC were given orally crizotinib 250 mg b. i. d., and were followed up to evaluate the therapeutic efficacy and safety. Results Among the 28 patients, the objective response rate ( ORR) was 71.4%(20/28) and disease control rate (DCR) was 92.9% (26/28). Three patients achieved complete response. Seventeen patients had partial response. The most common drug?related adverse events were mild flickering vision and gastrointestinal reaction. Eleven patients experienced flickering vision. Nine patients had nausea and vomiting. Eight patients had diarrhea. They were all reversible and of grade Ⅰ or Ⅱ. Only one patient had grade Ⅲ myelosuppression. Among the 28 patients, 16 cases were disease?free and 12 cases had progressive disease, with a progression?free survival of 8.2 months. Conclusions Crizotinib is effective and tolerable in the treatment of advanced ALK?positive NSLCC. However, its long?term treatment efficacy requires to be further studied.

Objective This study aims to evaluate the efficacy and safety of crizotinib for advanced ALK?positive non?small cell lung cancer ( NSCLC) patients. Methods Twenty?eight patients with advanced ALK?positive NSCLC were given orally crizotinib 250 mg b. i. d., and were followed up to evaluate the therapeutic efficacy and safety. Results Among the 28 patients, the objective response rate ( ORR) was 71.4%(20/28) and disease control rate (DCR) was 92.9% (26/28). Three patients achieved complete response. Seventeen patients had partial response. The most common drug?related adverse events were mild flickering vision and gastrointestinal reaction. Eleven patients experienced flickering vision. Nine patients had nausea and vomiting. Eight patients had diarrhea. They were all reversible and of grade Ⅰ or Ⅱ. Only one patient had grade Ⅲ myelosuppression. Among the 28 patients, 16 cases were disease?free and 12 cases had progressive disease, with a progression?free survival of 8.2 months. Conclusions Crizotinib is effective and tolerable in the treatment of advanced ALK?positive NSLCC. However, its long?term treatment efficacy requires to be further studied.

BACKGROUNDThe preclinical experiments and several clinical studies showed icotinib, an oral epidermal growth factor receptor (EGFR) tyrosine kinase inhibitor, in Chinese patients with advanced non-small cell lung cancer (NSCLC) who failed previous chemotherapy. We performed a retrospective study of the efficacy and safety of icotinib monotherapy in a different and more recent sample of Chinese patients.

METHODSThe clinical data of 149 patients with advanced NSCLC who were admitted to Zhejiang Cancer Hospital from August 1, 2011 to July 31, 2012 were retrospectively analyzed. All patients were given icotinib treatment after the failure of previous chemotherapy. Univariate and multivariate analyses were conducted based on the Kaplan Meier method and Cox proportional hazards model.

RESULTSThe objective response rate was 33/149 and disease control rate was 105/149. No complete response occurred. Median progression free survival (PFS) with icotinib treatment was 5.03 months (95% CI: 3.51 to 6.55). Median overall survival was 12.3 months (95% CI: 10.68 to 13.92). Multivariate analysis showed that the mutation of EGFR and one regimen of prior chemotherapy were significantly associated with longer PFS. At least one drug related adverse event was observed in 65.8% (98/149) of patients, but mostly grade 1 or 2 and reversible and none grade 4 toxicity.

CONCLUSIONSIcotinib monotherapy is an effective and well tolerated regimen for Chinese patients with NSCLC after the failure of chemotherapy. It is a promising agent and further study with icotinib in properly conducted trials with larger patient samples and other ethnic groups is warranted.

Adult ; Aged ; Aged, 80 and over ; Antineoplastic Agents ; adverse effects ; therapeutic use ; Carcinoma, Non-Small-Cell Lung ; drug therapy ; Crown Ethers ; adverse effects ; therapeutic use ; Female ; Humans ; Lung Neoplasms ; drug therapy ; Male ; Middle Aged ; Multivariate Analysis ; Proportional Hazards Models ; Quinazolines ; adverse effects ; therapeutic use ; Retrospective Studies