Toward Effective Robot--Child Tutoring

Personalized learning environments have the potential to improve learning outcomes for children in a variety of educational domains, as they can tailor instruction based on the unique learning needs of individuals. Robot tutoring systems can further engage users by leveraging their potential for embodied social interaction and take into account crucial aspects of a learner, such as a student’s motivation in learning. In this article, we demonstrate that motivation in young learners corresponds to observable behaviors when interacting with a robot tutoring system, which, in turn, impact learning outcomes. We first detail a user study involving children interacting one on one with a robot tutoring system over multiple sessions. Based on empirical data, we show that academic motivation stemming from one’s own values or goals as assessed by the Academic Self-Regulation Questionnaire (SRQ-A) correlates to observed suboptimal help-seeking behavior during the initial tutoring session. We then show how an interactive robot that responds intelligently to these observed behaviors in subsequent tutoring sessions can positively impact both student behavior and learning outcomes over time. These results provide empirical evidence for the link between internal motivation, observable behavior, and learning outcomes in the context of robot--child tutoring. We also identified an additional suboptimal behavioral feature within our tutoring environment and demonstrated its relationship to internal factors of motivation, suggesting further opportunities to design robot intervention to enhance learning. We provide insights on the design of robot tutoring systems aimed to deliver effective behavioral intervention during learning interactions for children and present a discussion on the broader challenges currently faced by robot--child tutoring systems.

A novel method to detect circulating antigens of Schistosoma japonicum using a gold nanorod optical sensor

Diagnostic method of Schistosoma japonicum (S.japonicum) is the key of schistosomiasis prevention and control. In China, schistosomiasis reached the stage of transmission control, and almost of the epidemic areas tend to have low infection rate and intensity, but it is difficult for the existing detection methods to achieve accurate monitoring. In this study, a novel method to detect the circulating antigens of S.japonicum using gold nanorods optical sensor was developed. Gold nanorods were prepared by seed-mediated growth followed by deposition onto Indium-Tin-Oxide (ITO) glass to fabricate a solid phase biosensor. In order to assembly between the ITO glass and gold nanorod, hydroxylation and sulfhydrylation were carried out to modify the ITO glass. Surface of gold nanorods was conjugated with an SIEA26-28kDaSjscFv antibody against S.japonicum circulating antigens, and the sensor optical changed upon antigen-antibody recognition. The sensor was used to detect S.japonicum infection in rabbits by testing the serum once a week for 8 weeks. Results revealed different displacement of localized surface plasmon resonance (LSPR) of the gold nanorod optical sensor each week while the control group showed no such change in LSPR. Simultaneously, Indirect Hemagglutination Assay(IHA) and Fast Enzyme-Linked Immuno Sorbent Assay (F-ELISA) method were used to test these samples. Ten human serum samples from S.japonicum infected patients were analyzed using the gold nanorods optical sensor, which revealed that health human serum did not show any spectrum displacement. We developed a specificity gold nanorod optical sensor by combining the SIEA26-28kDaSjscFv, which was used to detect circulating antigens of S.japonicum. This method is expected to overcome the issues pertaining to the testing of circulating antigens of S.japonicum.

[Surgical outcomes after laparoscopy-assisted distal gastrectomy and open distal gastrectomy for patients with advanced gastric cancer: a case-control study using a propensity score method]

Objective: To investigate the surgical outcomes after the laparoscopy-assisted distal gastrectomy (LADG) for patients with advanced gastric cancer. Methods: The data of 213 patients who underwent LADG and 213 treated by open distal gastrectomy (ODG) were selected using the propensity score matching method from a prospectively constructed database of 641 patients who underwent radical distal gastrectomy between January 2005 and June 2012 in Department of Gastric Surgery, Fujian Medical University Union Hospital. The baseline characteristics and surgical outcomes were compared using a paired t-test or the Wilcoxon signed ranks test for continuous variables. The cumulative survival rates were compared using the Kaplan-Meier method and log-rank test. Results: Among all patients, there were significant differences in tumor location, digestive tract reconstruction, histologic type, pT stage, and pTNM stage between LADG and ODG group (P<0.05). After propensity score matching, patient distributions were closely balanced. There was no significant difference in clinicopathologic characteristics between the two groups (P>0.05). Regarding perioperative characteristics, the time to first flatus, and time to resumption of diet, did not differ between the two groups (P>0.05), while there were significant differences in the operation time (t=-11.28, P=0.000), blood loss (t=-5.674, P=0.000), number of dissected lymph nodes (t=4.727, P=0.000), and post-operative hospital stay (t=-2.193, P=0.038). LADG group has less morbidity than ODG group (χ²=4.777, P=0.029). Multivariate analysis revealed that the laparoscopic surgery (RR=0.392, P=0.009) was the protected factor for determining postoperative complications. There was no significant difference in the cumulative survival rate at total and each UICC stage between the two groups, either (P>0.05). Conclusion: LADG is an oncological safe minimally invasive procedure for advanced gastric cancer yields comparable oncological outcomes with ODG.

MiR-204 regulates HMGA2 expression and inhibits cell proliferation in human thyroid cancer

BACKGROUND

Analysis using publicly available algorithms has found that high mobility group AT-hook 2 (HMGA2), a key transcriptional regulatory factor, is a potential target of microRNA-204 (miR-204). Some studies have shown that both miR-204 and HMGA2 are associated with cancer development.

OBJECTIVE

We examined the possible relationship between miR-204 and HMGA2 in the development of thyroid cancer.

METHODS

We assessed miR-204 expression in thyroid cancer specimens and cell lines using real-time polymerase chain reaction (PCR). Luciferase reporter assay was used to confirm the target associations. The effect of miR-204 on cell proliferation was confirmed with tetrazolium and colony formation assays. Gene and protein expression were examined using real-time PCR and western blotting, respectively.

RESULTS

MiR-204 was downregulated in the thyroid cancer specimens and cell lines, and targeted the 3^\prime untranslated region of HMGA2 directly. MiR-204 overexpression decreased cyclin D1 and Ki67 expression and increased P21 expression, which subsequently inhibited thyroid cancer cell proliferation.

CONCLUSIONS

Our findings suggest that miR-204 plays a protective role by inhibiting thyroid cancer cell proliferation, and may identify new targets for anti-cancer treatment.

Segment-specific targeting via RNA interference mediates down-regulation of OPN expression in hepatocellular carcinoma cells

Osteopontin (OPN) plays an important role in the metastasis and recurrence of tumors after resection of hepatocellular carcinoma (HCC). In this study, the down-regulation effect on OPN expression in HCC cells of RNA interference (RNAi) molecules designed to target different segments of OPN was investigated to identify a more effective site for OPN knockdown. Specific small interfering RNAs (siRNAs A, B, and C) of OPN were synthesized and transfected into an HCC cell line (HEP-G2; representing the OPNi-A, OPNi-B, and OPNi-C groups). Fluorescent quantitative polymerase chain reaction and immunohistochemical methods were used to detect the mRNA and protein expression of OPN before and after RNAi. Results showed that after transfection, the fluorescence intensity of the OPNi-A group was greater than those of the OPNi-B and OPNi-C groups. After 48 h of transfection, the ΔCT values of OPN mRNA expression in the OPNi-A-C groups increased from 8.31 ± 1.58, 8.78 ± 1.49, and 8.25 ± 1.51 to 12.14 ± 1.43, 10.22 ± 1.97, and 10.48 ± 1.88, respectively (P < 0.05), and the OPN protein levels (immunohistochemistry scores) decreased from 6.44 ± 1.67, 5.43 ± 2.05, and 5.45 ± 2.52 to 2.84 ± 1.52, 4.43 ± 1.65, and 3.95 ± 1.43 points, respectively. These results indicated that RNAi based on different segments of the OPN gene had different down-regulatory effects on OPN expression. Synthesis of targeted siRNA aimed at specific OPN segments might have important significance for dealing with the invasiveness and metastasis of HCC cells.

Using gaze patterns to predict task intent in collaboration

In everyday interactions, humans naturally exhibit behavioral cues, such as gaze and head movements, that signal their intentions while interpreting the behavioral cues of others to predict their intentions. Such intention prediction enables each partner to adapt their behaviors to the intent of others, serving a critical role in joint action where parties work together to achieve a common goal. Among behavioral cues, eye gaze is particularly important in understanding a person's attention and intention. In this work, we seek to quantify how gaze patterns may indicate a person's intention. Our investigation was contextualized in a dyadic sandwich-making scenario in which a "worker" prepared a sandwich by adding ingredients requested by a "customer." In this context, we investigated the extent to which the customers' gaze cues serve as predictors of which ingredients they intend to request. Predictive features were derived to represent characteristics of the customers' gaze patterns. We developed a support vector machine-based (SVM-based) model that achieved 76% accuracy in predicting the customers' intended requests based solely on gaze features. Moreover, the predictor made correct predictions approximately 1.8 s before the spoken request from the customer. We further analyzed several episodes of interactions from our data to develop a deeper understanding of the scenarios where our predictor succeeded and failed in making correct predictions. These analyses revealed additional gaze patterns that may be leveraged to improve intention prediction. This work highlights gaze cues as a significant resource for understanding human intentions and informs the design of real-time recognizers of user intention for intelligent systems, such as assistive robots and ubiquitous devices, that may enable more complex capabilities and improved user experience.

Synthesis, Preferentially Hypoxic Apoptosis and Anti-Angiogenic Activity of 3- Amino-1,2,4-Benzotriazine-1,4-Dioxide Bearing Alkyl Linkers with a 3-Amino-1,2,4- Benzotriazine-1-Oxide Moiety

3-(Aminoalkylamino)-1,2,4-benzotriazine-1,4-dioxide-extended derivatives were synthesized by the structural modification of 3-amino-1,2,4-benzotriazine-1,4-dioxide (tirapazamine, TPZ) that incorporated homologue-alkyl linkers, without or with an extended 3-amino-1,2,4-benzotriazine-1-oxide moiety at the 3-position of the TPZ. According to sequential evaluation of preferentially normoxic and hypoxic cytotoxicities against MCF-7, NCI-H460 and HCT-116, most of the synthesized compounds exhibited hypoxic cytotoxicity greater than or comparable to that of TPZ. Among them, compounds 9a and 9b more powerfully inhibited the proliferation of MCF-7, NCI-H460 and HCT-116 in hypoxia than did TPZ. The representative of 3-(aminoalkylamino)-1,2,4-benzotriazine-1,4-dioxide-extended derivatives, 9a exhibited greater hypoxic cytotoxicity than TPZ, mediated by cell cycle arrest. The induction of DNA damage, the activation of caspase 3/7 and cleaved poly(ADP-ribose) polymerase-related apoptosis, which were detected in HCT-116 cells in both normoxia and hypoxia. In vitro anti-angiogenic assay of co-cultured HUVECs and fibroblasts that were exposed to the selected 7b, 8g, 9a and 9b exhibited 80-90% inhibition of tube formation at 20 μM, whereas TPZ exhibited approximately 50% inhibition of tube formation at 20 μM. At 2 μM, 9a and 9b significantly reduced the areas, lengths, paths and joints of tube formation by 70-80% and 45-50%, respectively. These results reveal that most of synthesized TPZ derivatives in this study exhibited more potent anti-angiogenesis than TPZ.

The effectiveness of an integrated multicomponent program for adolescent smoking cessation in Taiwan

If adolescents do not receive appropriate assistance in quitting smoking, they are highly likely to become regular smokers when they enter adulthood. Thus, an effective smoking-cessation program is required. A program was designed based on both the smoking-cessation barriers reported by students and effective strategies derived from the literature. We assigned 143 student smokers from 6 vocational high schools to intervention (n=78) and comparison groups (n=65). Data were collected at the baseline, the end of the program, and 1- and 4-month follow-up time points. For the intervention group, the smoking-abstinence rates confirmed using the urine cotinine test were 22.73% at the end of the program and 20.75% at the 4-month follow-up point. Days smoked in the past month, number of cigarettes smoked per day, and the Fagerström Test for Nicotine Dependence score of the intervention group decreased at all of the time points. The group differences in these variables were statistically significant; the magnitude of effect sizes ranged from 0.44 to 0.95. Multicomponent programs addressing smoking-cessation barriers that students encounter can help adolescents quit smoking.

Endocavity Ultrasound Probe Manipulators

We developed two similar structure manipulators for medical endocavity ultrasound probes with 3 and 4 degrees of freedom (DoF). These robots allow scanning with ultrasound for 3-D imaging and enable robot-assisted image-guided procedures. Both robots use remote center of motion kinematics, characteristic of medical robots. The 4-DoF robot provides unrestricted manipulation of the endocavity probe. With the 3-DoF robot the insertion motion of the probe must be adjusted manually, but the device is simpler and may also be used to manipulate external-body probes. The robots enabled a novel surgical approach of using intraoperative image-based navigation during robot-assisted laparoscopic prostatectomy (RALP), performed with concurrent use of two robotic systems (Tandem, T-RALP). Thus far, a clinical trial for evaluation of safety and feasibility has been performed successfully on 46 patients. This paper describes the architecture and design of the robots, the two prototypes, control features related to safety, preclinical experiments, and the T-RALP procedure.

Whole inactivated equine influenza vaccine: Efficacy against a representative clade 2 equine influenza virus, IFNgamma synthesis and duration of humoral immunity

Equine influenza (EI) is a serious respiratory disease of horses induced by the equine influenza virus (EIV). Surveillance, quarantine procedures and vaccination are widely used to prevent or to contain the disease. This study aimed to further characterise the immune response induced by a non-updated inactivated EI and tetanus vaccine, including protection against a representative EIV isolate of the Florida clade 2 sublineage. Seven ponies were vaccinated twice with Duvaxyn IE-T Plus at an interval of four weeks. Five ponies remained unvaccinated. All ponies were experimentally infected with the EIV strain A/eq/Richmond/1/07 two weeks after the second vaccination. Clinical signs of disease were recorded and virus shedding was measured after experimental infection. Antibody response and EIV-specific IFNgamma synthesis, a marker of cell-mediated immunity, were measured at different time points of the study. Vaccination resulted in significant protection against clinical signs of disease induced by A/eq/Richmond/1/07 and reduced virus shedding when challenged at the peak of immunity. Antigenic drift has been shown to reduce protection against EIV infection. Inclusion of a more recent and representative EIV vaccine strain, as recommended by the OIE expert surveillance panel on equine influenza vaccine, may maximise field protection. In addition, significant levels of EIV-specific IFNgamma synthesis by peripheral blood lymphocytes were detected in immunised ponies, which provided a first evidence of CMI stimulation after vaccination with a whole inactivated EIV. Duration of humoral response was also retrospectively investigated in 14 horses vaccinated under field condition and following the appropriate immunisation schedule, up to 599 days after first immunisation. This study revealed that most immunised horses maintained significant levels of cross-reactive SRH antibody for a prolonged period of time, but individual monitoring may be beneficial to identify poor vaccine responders.

Fenton-biological treatment of reverse osmosis membrane concentrate from a metal plating wastewater recycle system

Although reverse osmosis (RO) has been widely used in the recycling of metal plating wastewater, organic compounds and heavy metals in the RO concentrate are difficult to remove by conventional treatment. A combination process including Fenton oxidation and a biological aerated filter was used to treat RO concentrate containing complex Cu and Ni from metal plating. During the Fenton treatment, Cu and Ni ions were released due to degradation of organic compounds and then removed by pH adjustment and coagulation. The concentrate was further treated using by a biological aerated filter. Optimum conditions were as follows: initial pH of influent of 4.0; dosage of H2O2 of 5.0 mmol l(-1); ratio of n(Fe2+)/n(H2O2) of 0.8; precipitation pH of Cu and Ni ions of 8.0; and a hydraulic retention time of the biological aerated filter of 2.5 h. The results showed that concentrations of effluent COD, Cu and Ni ions were less than 40 mg l(-1), 0.5 mg l(-1) and 0.3 mg l(-1), respectively; this means the treated effluent meets the emission standards for pollutants from electroplating set by China's Environmental Protection Agency.

Genetic polymorphisms of the DNA repair gene MPG may be associated with susceptibility to rheumatoid arthritis

Rheumatoid arthritis (RA) is a chronic autoimmune disease and can lead to deformities and severe disabilities, due to irreversible damage of tendons, joints, and bones. A previous study indicated that a DNA repair system was involved in the development of RA. In this study, we investigated the association of four N-methylpurine-DNA glycosylase (MPG) gene polymorphisms (rs3176364, rs710079, rs2858056, and rs2541632) with susceptibility to RA in 384 Taiwanese individuals (192 RA patients and 192 control subjects). Our data show a statistically significant difference in genotype frequency distributions at rs710079 and rs2858056 SNPs between RA patients and control groups (P = 0.040 and 0.029, respectively). Our data also indicated that individuals with the GG genotype at rs2858056 SNP may have a higher risk of developing RA. In addition, compared with the haplotype frequencies between case and control groups, individuals with the GCGC haplotype appeared to be at a greater risk of RA progression (P = 0.003, OR = 1.75; 95&percnt; CI = 1.20-1.55). Our results suggest that rs710079 and rs2858056 polymorphisms and the GCGC haplotype in the MPG gene are associated with the risk of RA progression, and thus may be used as molecular markers of RA if they are confirmed by further research.

Large Seebeck coefficients of protonated titanate nanotubes for high-temperature thermoelectric conversion

Titanate nanotubes Na(2-x)H(x)Ti(3)O(7) produced by alkali hydrothermally treated ground TiO(2) aerogels are investigated as possible materials for high-temperature thermoelectric conversion by measuring their thermoelectric properties. Strikingly, the Seebeck coefficients increased sharply in the temperature range 745 to 1032 K, reaching a maximum of 302 muV/K. The electrical resistivity of the TNNTs ranged from 325 to 525 Omegam, which is lower than that of bulk TiO(2), and thermal conductivities at room temperature were also very low, ranging from 0.55 to 0.75 Wm(-1) K(-1). The hollow structure of the titanate nanotubes, with small, uniform diameters, is thought to be responsible for the ultralow thermal conductivity. The large thermoelectric power and ultralow thermal conductivity suggest that titanate nanotubes represent a new kind of p-type oxide thermoelectric material.

Analysis of ERCC2/XPD functional polymorphisms in systemic lupus erythematosus

Sunlight/ultraviolet (UV) irradiation has been recognized as an important risk factor for developing systemic lupus erythematosus (SLE). However, the interpretation of genetic variations involved in UV-light sensitivity is largely unknown. Recent studies indicated that two genetic variations of ERCC2/XPD gene (rs1799793 in exon 10 and rs13181 in exon 23) have been found to exert negative influences on nucleotide excision repair system. To analyse the possible contribution of the ERCC2/XPD functional single nucleotide polymorphisms in genetic susceptibility to SLE, the rs13181 and rs1799793 SNPs in ERCC2/XPD were genotyped by polymerase chain reaction followed by restriction fragment length polymorphism analysis. Association was studied by case-control analyses using samples from 172 SLE patients and 160 healthy controls. Haplotype analysis was performed to detect the association with genetic predisposition to SLE and the clinical features. Although these two functional genetic variations are linked to several immune dysfunction-induced diseases, no statistically significant differences in allele or genotype frequencies were observed between SLE patients and controls. Haplotype analysis showed that none of ERCC2/XPD haplotypes was associated with the incidence of SLE disease, nor the preference of clinical features. In conclusion, the ERCC2/XPD functional polymorphisms analysed in this study showed no association in genetic susceptibility to SLE.

The lysogenic cycle of the filamentous phage Cflt from Xanthomonas campestris pv. citri

A phage, Cflt, forming turbid plaques, was isolated from Xanthomonas campestris pv. citri. After infection, infected sensitive cells become immune to Cflt and produce very few phages. These properties were genetically rather stable. The phage was purified and shown to be filamentous with a size of 1157 +/- 73 nm. The genome size is about 7.62 kb. The phage does not affect the growth of host bacteria. Under natural cultivation conditions Cflt-lysogenized cells could be induced spontaneously to give high phage yields, or cured to give phage-free cells. The integration of Cflt DNA into host DNA was proved by Southern blot hybridization. The lysogenic phage was genetically stable in log phase cells and persisted in stationary phase cells through many cell generations in the absence of extracellular phage reinfection.

Effects of moderate alcohol consumption on inflammatory biomarkers

OBJECTIVES

Although light to moderate alcohol consumption has been associated with lower all-cause and cardiovascular (CV) mortality, the underlying mechanisms are only partly understood. Evidence has emerged in recent years that atherosclerosis is an inflammatory disease. We hypothesize that beneficial effects of moderate alcohol consumption on CV mortality may be linked to antiinflammatory effects.

METHODS AND RESULTS

The association between alcohol consumption and concentrations of high sensitivity C-reactive protein (hs-CRP) and fibrinogen were investigated. Six hundred and thirtysix eligible individuals apparently healthy were included. 393 (61.8%) were men and 243 (38.2%) were women. The mean ages for men and women were 51.5 +/- 12.4 y and 50.8 +/- 12.1 y, respectively. Daily alcohol intake showed an apparent U-shaped association with hs-CRP and fibrinogen values in men, with lowest levels at an alcohol intake of 20-70 g daily (0.139 +/- 0.116 mg/dl for hs-CRP and 274 +/- 51.7 mg/dl for fibrinogen). Proportional odds model analysis showed moderate alcohol consumption (20 to 70 g vs. no drinking per day, OR = 0.32, 95% CI: 0.14-0.74), and regular exercise (> or = 3 times/week vs. no, OR = 0.52, 95% CI: 0.35-0.77) were negatively correlated with elevated hs-CRP values.

CONCLUSIONS

Our results parallel the demonstration of a U-shaped relationship between alcohol consumption and cardiovascular mortality, and suggest that anti-inflammatory effects of moderate alcohol intake may partly be linked to a low cardiovascular and overall mortality.

Long-term survival and prognostic implications after coronary artery bypass grafting in Chinese patients with coronary artery disease

OBJECTIVES

This hospital-based study was conducted to determine the survival rates of patients after coronary artery bypass grafting (CABG) surgery and the associated prognostic factors related to all-cause mortality during a 7-year follow-up in Taiwan.

METHODS AND RESULTS

Between January 1997 and December 2003, the medical records of 1877 patients who underwent primary, isolated CABG surgery were studied. The Kaplan-Meier method was used to estimate survival. Multiple Cox regression was used to investigate the independence of prognostic factors associated with all-cause mortality. Of the 1877 patients who underwent CABG surgery, 192 expired during the 7-year study period. The overall patient survival rate was 85.96% (95% CI: 83.74-88.16). Using multiple Cox regression analysis, in addition to female gender, older age at surgery, pulmonary oedema, longer ischaemic time, longer cardiopulmonary bypass time, and poorer postoperative left ventricular ejection fraction were significant factors associated with all-cause mortality for both men and women. Associated prognostic factors varied by gender. For men, smoking (RR = 2.82, 95% CI: 1.06-4.16), respiratory failure (RR = 6.88, 95% CI: 3.29-14.40) and cardiogenic shock (RR = 4.04, 95% CI: 2.13-7.67) were significantly related to all-cause mortality, but not for women. Sepsis (RR = 8.97,95% CI: 1.19-19.81) and ICU stay (RR = 1.03,95% CI: 1.01-1.05) were significantly related to all-cause mortality among female patients only.

CONCLUSIONS

Several gender-related differences were noted pertaining to all-cause mortality and the relationships between smoking, sepsis, respiratory failure, cardiogenic shock, and ICU stay.

Hyaluronate improves pain, physical function and balance in the geriatric osteoarthritic knee: a 6-month follow-up study using clinical tests

OBJECTIVE

To investigate the effects of intraarticular hyaluronic acid (HA) (Artzal, Seikagaku Corp., Japan) in geriatric participants with unilateral knee osteoarthritis (OA).

METHOD

This was a prospective, observer-blind study with 6 months follow-up done in the setting of an outpatient rehabilitation department in a university-affiliated tertiary care medical center. Sixty-eight patients, aged 65 years or above, with symptoms and radiographic evidence of unilateral knee OA for at least 6 months were recruited. Patients received five weekly intraarticular injections of Artzal into symptomatic knees. Fifty-six participants completed the study. Fifty age-, body mass- and gender-matched healthy individuals were selected as control. Visual analog scale (VAS), Lequesne index and four balance tests including single-leg stance test (SLS), function reach test (FRT), timed "Up-and-Go" test (TUG) and Berg balance scale (BBS) were assessed before injection and at each follow-up visit in the OA group. Four balance tests were obtained on healthy participants for data comparison.

RESULTS

Before Artzal injections, the OA group showed significantly worse VAS, Lequesne index and four balance tests scores than did the control group (P < 0.001). Significant improvement in all outcome measures were noted at 1 week, 1, 3 and 6 months post the fifth injection compared with baseline before injection. Local adverse events were reported in four patients (7.1%).

CONCLUSION

Significant improvement in pain, physical function and balance tests was demonstrated after five weekly Artzal injections in geriatric patients with knee OA. The effect had rapid onset at 1 week and may last for 6 months.