Surgical intervention combined with weight-bearing walking training promotes recovery in patients with chronic spinal cord injury:a randomized controlled study

For patients with chronic spinal cord injury,the co nventional treatment is rehabilitation and treatment of spinal cord injury complications such as urinary tract infection,pressure sores,osteoporosis,and deep vein thrombosis.Surgery is rarely perfo rmed on spinal co rd injury in the chronic phase,and few treatments have been proven effective in chronic spinal cord injury patients.Development of effective therapies fo r chronic spinal co rd injury patients is needed.We conducted a randomized controlled clinical trial in patients with chronic complete thoracic spinal co rd injury to compare intensive rehabilitation(weight-bearing walking training)alone with surgical intervention plus intensive rehabilitation.This clinical trial was registered at ClinicalTrials.gov(NCT02663310).The goal of surgical intervention was spinal cord detethering,restoration of cerebrospinal fluid flow,and elimination of residual spinal cord compression.We found that surgical intervention plus weight-bearing walking training was associated with a higher incidence of American Spinal Injury Association Impairment Scale improvement,reduced spasticity,and more rapid bowel and bladder functional recovery than weight-bearing walking training alone.Overall,the surgical procedures and intensive rehabilitation were safe.American Spinal Injury Association Impairment Scale improvement was more common in T7-T11 injuries than in T2-T6 injuries.Surgery combined with rehabilitation appears to have a role in treatment of chronic spinal cord injury patients.

Evolution of United States Technology Alliance Strategy and Reshaping of International Strategic Landscape

Building a technology alliance is the main strategy for the United States to maintain its scientific and technological hegemony under its technopolitical strategic framework.After Joe Biden took office,the United States implemented“small yard with high fences”strategy for scientific and technological competition,as the first step toward building a technology alliance.The main goal is to restrict the flow of strategic emerging technologies and factors of innovation to rival countries.

Effect of Brisk Walking on Self-Care Agency or Care Dependency among Colorectal Cancer Patients with Permanent Stoma

Objective:The purpose of this study was to determine the effectiveness of brisk walking as an intervention for self-care agency and care dependency in patients with permanent colorectal cancer stoma.Method:This study adopted a quasi-experimental research design,specifically a non-equivalent control group pre-test and post-test design.Utilizing the Exercise of Self-Care Agency Scale(ESCA)and Care Dependency Scale(CDS),a survey was administered to 64 patients from a hospital in Shandong Province.The statistical methods used for analyzing data included frequency,mean,standard deviation(SD),independent t-test,P-value calculation,and dependent t-test.Result:After two months of a brisk walking exercise program,participants in the experimental group had a higher level of self-care agency than before the experiment(P<0.05),and their level of care dependency was significantly reduced(P<0.05).Participants in the control group also showed higher levels of self-care agency(P<0.05)and lower levels of care dependency(P<0.05)after two months compared to their levels before the two months.Conclusion:The brisk walking program had a positive impact on patients’self-care agency and reduced their care dependency.

Synthesis of Branched Polyethylene via Bulky α-Diimine Nickel(II)-Catalyzed Ethylene Chain-Walking Polymerization

The catalysis of olefin polymerization through the chain-walking process is a subject of great interest. In this contribution, the successful synthesis of a Brookhart-type unsymmetrical α-diimine nickel catalyst Ni, which contains both dibenzhydryl and phenyl groups, was determined by X-ray crystallography. The compound has a pseudo-tetrahedral geometry at the Ni center, showing pseudo-C2-symmetry. Upon activation with modified methylaluminoxane (MMAO), Ni1 exhibits high catalytic activity up to 1.02 × 107 g PE (mol Ni h)−1 toward ethylene polymerization, enabling the synthesis of high molecular weight branched polyethylene. The molecular weights and branching densities could be tuned over a very wide range. The polymerization results indicated the possibility of precise microstructure control, depending on the polymerization temperature. The branching densities were decreased with increasing the polymerization temperature.

Significant risk factors for intensive care unit-acquired weakness:A processing strategy based on repeated machine learning

BACKGROUND Intensive care unit-acquired weakness(ICU-AW)is a common complication that significantly impacts the patient's recovery process,even leading to adverse outcomes.Currently,there is a lack of effective preventive measures.AIM To identify significant risk factors for ICU-AW through iterative machine learning techniques and offer recommendations for its prevention and treatment.METHODS Patients were categorized into ICU-AW and non-ICU-AW groups on the 14th day post-ICU admission.Relevant data from the initial 14 d of ICU stay,such as age,comorbidities,sedative dosage,vasopressor dosage,duration of mechanical ventilation,length of ICU stay,and rehabilitation therapy,were gathered.The relationships between these variables and ICU-AW were examined.Utilizing iterative machine learning techniques,a multilayer perceptron neural network model was developed,and its predictive performance for ICU-AW was assessed using the receiver operating characteristic curve.RESULTS Within the ICU-AW group,age,duration of mechanical ventilation,lorazepam dosage,adrenaline dosage,and length of ICU stay were significantly higher than in the non-ICU-AW group.Additionally,sepsis,multiple organ dysfunction syndrome,hypoalbuminemia,acute heart failure,respiratory failure,acute kidney injury,anemia,stress-related gastrointestinal bleeding,shock,hypertension,coronary artery disease,malignant tumors,and rehabilitation therapy ratios were significantly higher in the ICU-AW group,demonstrating statistical significance.The most influential factors contributing to ICU-AW were identified as the length of ICU stay(100.0%)and the duration of mechanical ventilation(54.9%).The neural network model predicted ICU-AW with an area under the curve of 0.941,sensitivity of 92.2%,and specificity of 82.7%.CONCLUSION The main factors influencing ICU-AW are the length of ICU stay and the duration of mechanical ventilation.A primary preventive strategy,when feasible,involves minimizing both ICU stay and mechanical ventilation duration.

Engineering Strategies for Suppressing the Shuttle Effect in Lithium–Sulfur Batteries

Lithium–sulfur(Li–S)batteries are supposed to be one of the most potential next-generation batteries owing to their high theoretical capacity and low cost.Nevertheless,the shuttle effect of firm multi-step two-electron reaction between sulfur and lithium in liquid electrolyte makes the capacity much smaller than the theoretical value.Many methods were proposed for inhibiting the shuttle effect of polysulfide,improving corresponding redox kinetics and enhancing the integral performance of Li–S batteries.Here,we will comprehensively and systematically summarize the strategies for inhibiting the shuttle effect from all components of Li–S batteries.First,the electrochemical principles/mechanism and origin of the shuttle effect are described in detail.Moreover,the efficient strategies,including boosting the sulfur conversion rate of sulfur,confining sulfur or lithium polysulfides(LPS)within cathode host,confining LPS in the shield layer,and preventing LPS from contacting the anode,will be discussed to suppress the shuttle effect.Then,recent advances in inhibition of shuttle effect in cathode,electrolyte,separator,and anode with the aforementioned strategies have been summarized to direct the further design of efficient materials for Li–S batteries.Finally,we present prospects for inhibition of the LPS shuttle and potential development directions in Li–S batteries.

The characteristics of walking strategy in elderly patients with type 2 diabetes

Objective:To explore the walking strategy by monitoring the characteristics of center of pressure(COP)of gait in the elderly with type2 diabetes.Methods:All of the elderly patients with type2 diabetes(n=543)were enrolled from Huadong Hospital Affiliated to Fudan University.Dynamic barefoot plantar pressure was assessed by Footscan7 USB2 flat.Outcome measures included excursion,the x-and ycoordinates displacement of COP and falling frequency.Results:There were 64.5%of cases with abnormal COP trajectory.Among them,45.2%were with abnormal fold-back,14.0%with two or more abnormal fold-back,20.5%with abnormal beginning point deviating from the heel to the arch and metatarsal region,18.0%with abnormal terminal point deviating from the hallux to toe 2e5 and the x-and y-coordinates displacement of COP in both feet are asymmetry.Conclusions:It highlights to put forward the walking strategy according to the abnormal COP trajectory.Due to the elderly diabetics with high risks of falling,the rehabilitation nursing should be strengthened mainly including the training of enhancing proprioception to prevent the elderly patients with type2 diabetes from falling.

A Wire-Driven Series Elastic Mechanism Based on Ultrasonic Motor for Walking Assistive System

In order to improve the elderly people's quality of life,supporting their walking behaviors is a promising technology.Therefore,based on one ultrasonic motor,a wire-driven series elastic mechanism for walking assistive system is proposed and investigated in this research.In contrast to tradition,it innovatively utilizes an ultrasonic motor and a wire-driven series elastic mechanism to achieve superior system performances in aspects of simple structure,high torque/weight ratio,quiet operation,quick response,favorable electromagnetic compatibility,strong shock resistance,better safety,and accurately stable force control.The proposed device is mainly composed of an ultrasonic motor,a linear spring,a steel wire,four pulleys and one rotating part.To overcome the ultrasonic motor's insufficient output torque,a steel wire and pulleys are smartly combined to directly magnify the torque instead of using a conventional gear reducer.Among the pulleys,there is one tailored pulley playing an important role to keep the reduction ratio as 4.5 constantly.Meanwhile,the prototype is manufactured and its actual performance is verified by experimental results.In a one-second operating cycle,it only takes 86 ms for this mechanism to output an assistive torque of 1.6 N·m.At this torque,the ultrasonic motor's speed is around 4.1 rad/s.Moreover,experiments with different operation periods have been conducted for different application scenarios.This study provides a useful idea for the application of ultrasonic motor in walking assistance system.

Drug resistance mechanisms in cancers:Execution of prosurvival strategies

One of the quintessential challenges in cancer treatment is drug resistance.Several mechanisms of drug resistance have been described to date,and new modes of drug resistance continue to be discovered.The phenomenon of cancer drug resistance is now widespread,with approximately 90% of cancer-related deaths associated with drug resistance.Despite significant advances in the drug discovery process,the emergence of innate and acquired mechanisms of drug resistance has impeded the progress in cancer therapy.Therefore,understanding the mechanisms of drug resistance and the various pathways involved is integral to treatment modalities.In the present review,I discuss the different mechanisms of drug resistance in cancer cells,including DNA damage repair,epithelial to mesenchymal transition,inhibition of cell death,alteration of drug targets,inactivation of drugs,deregulation of cellular energetics,immune evasion,tumor-promoting inflammation,genome instability,and other contributing epigenetic factors.Furthermore,I highlight available treatment options and conclude with future directions.

Theoretical and Numerical Studies on the Coupling Deformation of Global Lateral Buckling and Walking of Submarine Pipeline

Buckling initiation devices/techniques,including sleepers,distributed buoyancy,snake lay,and residual curvature method(RCM),have recently been widely applied in engineering.These initiated buckles may induce a long pipeline to transform into multiple short pipeline segments,which promote the occurrence of pipeline walking.Thus,a pipeline,which is designed to buckle laterally,may laterally and axially displace over time when subjected to repeated heating and cooling cycles.This study aims to reveal the coupling mechanism of pipeline walking and global lateral buckling.First,an analytic solution is proposed to estimate the walking of pipeline segments between two adjacent buckles.Then,the sensitivity of this method to heating and cooling cycles is analyzed.Results show the applicability of the proposed walking analytical solution of buckling pipelines.Subsequently,an influence analysis of walking on global buckling,including the capacity of buckling initiation,buckling amplitude,buckling mode,and failure assessment of the buckling pipeline,is performed.The results reveal that the effect of walking on the buckling axial force is negligible.However,pipeline walking will aggravate the asymmetry of the pipeline buckling and the failure parameters of the pipeline during the post-buckling.

A new passive transfemoral prosthesis mechanism based on 3R36 knee and ESAR foot providing walking and squatting

Researchers have proposed various linkage mechanisms to connect knee and ankle joints for above-knee prosthe-ses,but most of them only offer natural walking.However,studies have shown that people assume a squatting posture during daily activities.This paper introduces a novel mechanism that connects the knee joint with the foot-ankle joint to enable both squatting and walking.The prosthetic knee used is the well-known 3R36,while the energy storing and return(ESAR)prosthetic foot is used for the ankle-foot joint.To coordinate knee and ankle joint movements,a six-bar linkage mechanism structure is proposed.Simulation results demonstrate that the proposed modular transfemoral prosthesis accurately mimics the motion patterns of a natural human leg during walking and squatting.For instance,the prosthesis allows a total knee flexion of more than 140°during squatting.The new prosthesis design also incorporates energy-storing mechanisms to reduce energy expenditure during walking for amputees.

How do the landslide and non-landslide sampling strategies impact landslide susceptibility assessment? d A catchment-scale case study from China

The aim of this study is to investigate the impacts of the sampling strategy of landslide and non-landslide on the performance of landslide susceptibility assessment(LSA).The study area is the Feiyun catchment in Wenzhou City,Southeast China.Two types of landslides samples,combined with seven non-landslide sampling strategies,resulted in a total of 14 scenarios.The corresponding landslide susceptibility map(LSM)for each scenario was generated using the random forest model.The receiver operating characteristic(ROC)curve and statistical indicators were calculated and used to assess the impact of the dataset sampling strategy.The results showed that higher accuracies were achieved when using the landslide core as positive samples,combined with non-landslide sampling from the very low zone or buffer zone.The results reveal the influence of landslide and non-landslide sampling strategies on the accuracy of LSA,which provides a reference for subsequent researchers aiming to obtain a more reasonable LSM.

Overview of the immunological mechanisms in hepatitis B virus reactivation:Implications for disease progression and management strategies

Hepatitis B virus(HBV)reactivation is a clinically significant challenge in disease management.This review explores the immunological mechanisms underlying HBV reactivation,emphasizing disease progression and management.It delves into host immune responses and reactivation’s delicate balance,spanning innate and adaptive immunity.Viral factors’disruption of this balance,as are interac-tions between viral antigens,immune cells,cytokine networks,and immune checkpoint pathways,are examined.Notably,the roles of T cells,natural killer cells,and antigen-presenting cells are discussed,highlighting their influence on disease progression.HBV reactivation’s impact on disease severity,hepatic flares,liver fibrosis progression,and hepatocellular carcinoma is detailed.Management strategies,including anti-viral and immunomodulatory approaches,are critically analyzed.The role of prophylactic anti-viral therapy during immunosuppressive treatments is explored alongside novel immunotherapeutic interventions to restore immune control and prevent reactivation.In conclusion,this compre-hensive review furnishes a holistic view of the immunological mechanisms that propel HBV reactivation.With a dedicated focus on understanding its implic-ations for disease progression and the prospects of efficient management stra-tegies,this article contributes significantly to the knowledge base.The more profound insights into the intricate interactions between viral elements and the immune system will inform evidence-based approaches,ultimately enhancing disease management and elevating patient outcomes.The dynamic landscape of management strategies is critically scrutinized,spanning anti-viral and immunomodulatory approaches.The role of prophylactic anti-viral therapy in preventing reactivation during immunosuppressive treatments and the potential of innovative immunotherapeutic interventions to restore immune control and proactively deter reactivation.

Strong invariance principle for a counterbalanced random walk

We study a counterbalanced random walkS_(n)=X_(1)+…+X_(n),which is a discrete time non-Markovian process andX_(n) are given recursively as follows.For n≥2,X_(n) is a new independent sample from some fixed law̸=0 with a fixed probability p,andX_(n)=−X_(v(n))with probability 1−p,where v(n)is a uniform random variable on{1;…;n−1}.We apply martingale method to obtain a strong invariance principle forS_(n).

Mobility edges and localization characteristics in one-dimensional quasiperiodic quantum walk

We construct a one-dimensional quasiperiodic quantum walk to investigate the localization–delocalization transition.The inverse participation ratio and Lyapunov exponent are employed as two indexes to determine the mobility edge, a critical energy to distinguish the energy regions of extended and localized states. The analytical solution of mobility edge is obtained by the Lyapunov exponents in global theory, and the consistency of the two indexes is confirmed. We further study the dynamic characteristics of the quantum walk and show that the probabilities are localized to some specific lattice sites with time evolution. This phenomenon is explained by the effective potential of the Hamiltonian which corresponds to the phase in the coin operator of the quantum walk.

LDAS&ET-AD:Learnable Distillation Attack Strategies and Evolvable Teachers Adversarial Distillation

Adversarial distillation(AD)has emerged as a potential solution to tackle the challenging optimization problem of loss with hard labels in adversarial training.However,fixed sample-agnostic and student-egocentric attack strategies are unsuitable for distillation.Additionally,the reliability of guidance from static teachers diminishes as target models become more robust.This paper proposes an AD method called Learnable Distillation Attack Strategies and Evolvable Teachers Adversarial Distillation(LDAS&ET-AD).Firstly,a learnable distillation attack strategies generating mechanism is developed to automatically generate sample-dependent attack strategies tailored for distillation.A strategy model is introduced to produce attack strategies that enable adversarial examples(AEs)to be created in areas where the target model significantly diverges from the teachers by competing with the target model in minimizing or maximizing the AD loss.Secondly,a teacher evolution strategy is introduced to enhance the reliability and effectiveness of knowledge in improving the generalization performance of the target model.By calculating the experimentally updated target model’s validation performance on both clean samples and AEs,the impact of distillation from each training sample and AE on the target model’s generalization and robustness abilities is assessed to serve as feedback to fine-tune standard and robust teachers accordingly.Experiments evaluate the performance of LDAS&ET-AD against different adversarial attacks on the CIFAR-10 and CIFAR-100 datasets.The experimental results demonstrate that the proposed method achieves a robust precision of 45.39%and 42.63%against AutoAttack(AA)on the CIFAR-10 dataset for ResNet-18 and MobileNet-V2,respectively,marking an improvement of 2.31%and 3.49%over the baseline method.In comparison to state-of-the-art adversarial defense techniques,our method surpasses Introspective Adversarial Distillation,the top-performing method in terms of robustness under AA attack for the CIFAR-10 dataset,with enhancements of 1.40%and 1.43%for ResNet-18 and MobileNet-V2,respectively.These findings demonstrate the effectiveness of our proposed method in enhancing the robustness of deep learning networks(DNNs)against prevalent adversarial attacks when compared to other competing methods.In conclusion,LDAS&ET-AD provides reliable and informative soft labels to one of the most promising defense methods,AT,alleviating the limitations of untrusted teachers and unsuitable AEs in existing AD techniques.We hope this paper promotes the development of DNNs in real-world trust-sensitive fields and helps ensure a more secure and dependable future for artificial intelligence systems.

Interpretation of Chinese Expert Consensus on the Diagnosis and Management Strategy of Patients with Statin Intolerance: A guiding file for helping to lipid management for Chinese population

It is well-known that elevated low-density lipoprotein cholesterol(LDL-C)is a causal risk factor for atheroscler-otic cardiovascular disease(ASCVD),statins are cornerstone drugs for the cause-based treatment of ASCVD,which has created a new era for ASCVD therapy.However,statin intolerance is not clinically uncommon,which there are several issues with confu-sion and misunderstandings.Hence,a file named Chinese Expert Consensus on the Diagnosis and Management Strategy of Pa-tients With Statin Intolerance,like a navigator,has recently been published written by a team of experts from the Cardiovascular Metabolic Medicine Professional Committee,Expert Committee of the National Center for Cardiovascular Diseases aiming to en-hance the standardized clinical application of statins and improve the prevention and clinical outcome.In this article,author briefly summarized the key points of above consensus in order to helping to comprehending the content of the consensus sugges-tions.

Eradication Treatment of Helicobacter pylori Infection: Evaluation of Therapeutic Strategies in N’Djamena

Background: Helicobacter pylori (Hp) infection is the most widespread bacterial infection in the world. The infection is generally acquired in childhood, but can persist into adulthood. Eradication therapy has undergone several modifications. The aim of this study was to evaluate the different therapeutic strategies used in the eradication of Helicobacter pylori infection in the Centre Hospitalier Universitaire La Reference Nationale of N’Djaména. Patients and Methods: This was a prospective, descriptive analytical study spread over one year, from September 2021 to September 2022. Patients at least 15 years of age presenting with dyspeptic symptoms, seen consecutively in a hepato-gastroenterology consultation and with a positive stool test for H. pylori infection, were included in the study. Equally, 1/3 of patients were treated with dual or triple therapy. The remaining third received quadritherapy. Results: A total of 268 patients were included in the study (mean age 38.40 ± 14.66 with extremes of 16 and 80 years). Males predominated in 58% of cases. Overall therapeutic efficacy was 88.9%. According to different therapeutic strategies, efficacy was 90.75% for dual therapy with PPI (Rabeprazole) and Amoxicillin. On the other hand, efficacy was 87% and 88.88% for PPI-based triple therapy and dual antibiotic therapy, and for PPI-based quadruple therapy and triple antibiotic therapy. Conclusion: H. pylori infection is a common disease in Chad. Dual therapy with rabeprazole combined with a high dose of amoxicillin over a period of at least two weeks showed similar if not better efficacy than triple or quadruple therapy.

Accurate models and nutritional strategies for specific oxidative stress factors: Does the dose matter in swine production?

Oxidative stress has been associated with a number of physiological problems in swine,including reduced production efficiency.Recently,although there has been increased research into regulatory mechanisms and antioxidant strategies in relation to oxidative stress-induced pig production,it remains so far largely unsuccessful to develop accurate models and nutritional strategies for specific oxidative stress factors.Here,we discuss the dose and dose intensity of the causes of oxidative stress involving physiological,environmental and dietary factors,recent research models and the antioxidant strategies to provide theoretical guidance for future oxidative stress research in swine.

Practice of Infection Prevention and Control Strategies in Risk Departments during the COVID-19 Epidemic

Objective: To explore the practice and application of infection prevention and control strategies in risk departments during the COVID-19 epidemic, and to formulate the infection prevention and control measures to provide advice and guidance in risk departments. Methods: According to the latest plan of diagnosis and treatment, prevention and control issued by the National Health Commission, expert advice and consensus, combined with the actual situation in our hospital, a series of infection prevention and control measures of COVID-19 in risk department was formulated. Results: During the epidemic period, the prevention and control measures of nine risk departments including emergency operation, anesthesiology, endoscopy center, blood purification center, otolaryngology, stomatology, medical imaging department, medical cosmetology department and pulmonary function room were established from six aspects, including pre-examination and screening, medical technology control, personnel management, personal protection, environmental disinfection, medical waste disposal, etc. Conclusion: During the epidemic period, the infection prevention and control strategy of risk departments is one of the key links to control the spread of the epidemic, and risk departments must pay attention to and strictly implement various infection prevention and control measures.