Muscle strength deficits are associated with low bone mineral density in young pediatric cancer survivors:The iBoneFIT project

Background Pediatric cancer survivors are at increased risk of muscle weakness and low areal bone mineral density(aBMD).However,the prevalence of muscle strength deficits is not well documented,and the associations of muscle strength with aBMD are unknown in this population.Therefore,this study aimed to investigate the prevalence of upper-and lower-body muscle strength deficits and to examine the associations of upper-and lower-body muscle strength with age-,sex,and race-specific aBMD Z-scores at the total body,total hip,femoral neck,and lumbar spine.Methods This cross-sectional study included 116 pediatric cancer survivors(12.1±3.3 years old,mean±SD;42.2%female).Upper-and lower-body muscle strength were assessed by handgrip and standing long jump test,respectively.Dual‑energy X‑ray absorptiometry was used to measure aBMD(g/cm2).Associations between muscle strength and aBMD were evaluated in multivariable linear regression models.Logistic regression was used to evaluate the contribution of muscle strength(1-decile lower)to the odds of having low aBMD(Z-score≤1.0).All analyses were adjusted for time from treatment completion,radiotherapy exposure,and body mass index.Results More than one-half of survivors were within the 2 lowest deciles for upper-(56.9%)and lower-body muscle strength(60.0%)in comparison to age-and sex-specific reference values.Muscle strength deficits were associated with lower aBMD Z-scores at all sites(B=0.133–0.258,p=0.001–0.032).Each 1-decile lower in upper-body muscle strength was associated with 30%–95%higher odds of having low aBMD Z-scores at all sites.Each 1-decile lower in lower-body muscle strength was associated with 35%–70%higher odds of having low aBMD Z-scores at total body,total hip,and femoral neck.Conclusion Muscle strength deficits are prevalent in young pediatric cancer survivors,and such deficits are associated with lower aBMD Z-scores at all sites.These results suggest that interventions designed to improve muscle strength in this vulnerable population may have the added benefit of improving aBMD.

Update in lean metabolic dysfunction-associated steatotic liver disease

BACKGROUND A new nomenclature consensus has emerged for liver diseases that were previously known as non-alcoholic fatty liver disease(NAFLD)and metabolic dysfunction-associated fatty liver disease(MAFLD).They are now defined as metabolic dysfunction-associated steatotic liver disease(MASLD),which includes cardiometabolic criteria in adults.This condition,extensively studied in obese or overweight patients,constitutes around 30%of the population,with a steady increase worldwide.Lean patients account for approximately 10%-15%of the MASLD population.However,the pathogenesis is complex and is not well understood.AIM To systematically review the literature on the diagnosis,pathogenesis,characteristics,and prognosis in lean MASLD patients and provide an interpretation of these new criteria.METHODS We conducted a comprehensive database search on PubMed and Google Scholar between January 2012 and September 2023,specifically focusing on lean NAFLD,MAFLD,or MASLD patients.We include original articles with patients aged 18 years or older,with a lean body mass index categorized according to the World Health Organization criteria,using a cutoff of 25 kg/m2 for the general population and 23 kg/m2 for the Asian population.RESULTS We include 85 studies in our analysis.Our findings revealed that,for lean NAFLD patients,the prevalence rate varied widely,ranging from 3.8%to 34.1%.The precise pathogenesis mechanism remained elusive,with associations found in genetic variants,epigenetic modifications,and adaptative metabolic response.Common risk factors included metabolic syndrome,hypertension,and type 2 diabetes mellitus,but their prevalence varied based on the comparison group involving lean patients.Regarding non-invasive tools,Fibrosis-4 index outperformed the NAFLD fibrosis score in lean patients.Lifestyle modifications aided in reducing hepatic steatosis and improving cardiometabolic profiles,with some medications showing efficacy to a lesser extent.However,lean NAFLD patients exhibited a worse prognosis compared to the obese or overweight counterpart.CONCLUSION MASLD is a complex disease comprising epigenetic,genetic,and metabolic factors in its pathogenesis.Results vary across populations,gender,and age.Limited data exists on clinical practice guidelines for lean patients.Future studies employing this new nomenclature can contribute to standardizing and generalizing results among lean patients with steatotic liver disease.

《Leaning to do》的启示:把价值观教育与TVET结合起来

这几个模块相关联的核心价值是健康,与自然和谐,达到人的身体、智力、情感、社会和精神的全面发展,实现一种人与人、人与自然环境和谐的状态.要对自身健康负责,对所有形态的生命关爱,成为一个环境的看护者.

Design Strategies for Leaning-Type Arch Bridges

This paper presents a study on the design strategy of leaning-type arch bridges.The main characteristics of leaning-type arch bridges are first introduced;Kunshan Yufeng Bridge is taken as an example to discuss different aspects of a design strategy,which includes self-system optimization,selection of beam length and bridge deck position,and other aspects.This paper can be used as a reference to further improve and develop bridge design.

Metabolic-associated fatty liver disease and sarcopenia:A double whammy

The prevalence of metabolic-associated fatty liver disease(MAFLD)has increased substantially in recent years because of the global obesity pandemic.MAFLD,now recognized as the number one cause of chronic liver disease in the world,not only increases liver-related morbidity and mortality among sufferers but also worsens the complications associated with other comorbid conditions such as cardiovascular disease,type 2 diabetes mellitus,obstructive sleep apnoea,lipid disorders and sarcopenia.Understanding the interplay between MAFLD and these comorbidities is important to design optimal therapeutic strategies.Sarcopenia can be either part of the disease process that results in MAFLD(e.g.,obesity or adiposity)or a consequence of MAFLD,especially in the advanced stages such as fibrosis and cirrhosis.Sarcopenia can also worsen MAFLD by reducing exercise capacity and by the production of various muscle-related chemical factors.Therefore,it is crucial to thoroughly understand how we deal with these diseases,especially when they coexist.We explore the pathobiological interlinks between MAFLD and sarcopenia in this comprehensive clinical update review article and propose evidence-based therapeutic strategies to enhance patient care.

Epileptic brain network mechanisms and neuroimaging techniques for the brain network

Epilepsy can be defined as a dysfunction of the brain network,and each type of epilepsy involves different brain-network changes that are implicated diffe rently in the control and propagation of interictal or ictal discharges.Gaining more detailed information on brain network alterations can help us to further understand the mechanisms of epilepsy and pave the way for brain network-based precise therapeutic approaches in clinical practice.An increasing number of advanced neuroimaging techniques and electrophysiological techniques such as diffusion tensor imaging-based fiber tra ctography,diffusion kurtosis imaging-based fiber tractography,fiber ball imagingbased tra ctography,electroencephalography,functional magnetic resonance imaging,magnetoencephalography,positron emission tomography,molecular imaging,and functional ultrasound imaging have been extensively used to delineate epileptic networks.In this review,we summarize the relevant neuroimaging and neuroelectrophysiological techniques for assessing structural and functional brain networks in patients with epilepsy,and extensively analyze the imaging mechanisms,advantages,limitations,and clinical application ranges of each technique.A greater focus on emerging advanced technologies,new data analysis software,a combination of multiple techniques,and the construction of personalized virtual epilepsy models can provide a theoretical basis to better understand the brain network mechanisms of epilepsy and make surgical decisions.

Metal-free two-dimensional phosphorene-based electrocatalyst with covalent P-N heterointerfacial reconstruction for electrolyte-lean lithium-sulfur batteries

The use of lithium-sulfur batteries under high sulfur loading and low electrolyte concentrations is severely restricted by the detrimental shuttling behavior of polysulfides and the sluggish kinetics in redox processes.Two-dimensional(2D)few layered black phosphorus with fully exposed atoms and high sulfur affinity can be potential lithium-sulfur battery electrocatalysts,which,however,have limitations of restricted catalytic activity and poor electrochemical/chemical stability.To resolve these issues,we developed a multifunctional metal-free catalyst by covalently bonding few layered black phosphorus nanosheets with nitrogen-doped carbon-coated multiwalled carbon nanotubes(denoted c-FBP-NC).The experimental characterizations and theoretical calculations show that the formed polarized P-N covalent bonds in c-FBP-NC can efficiently regulate electron transfer from NC to FBP and significantly promote the capture and catalysis of lithium polysulfides,thus alleviating the shuttle effect.Meanwhile,the robust 1D-2D interwoven structure with large surface area and high porosity allows strong physical confinement and fast mass transfer.Impressively,with c-FBP-NC as the sulfur host,the battery shows a high areal capacity of 7.69 mAh cm^(−2) under high sulfur loading of 8.74 mg cm^(−2) and a low electrolyte/sulfur ratio of 5.7μL mg^(−1).Moreover,the assembled pouch cell with sulfur loading of 4 mg cm^(−2) and an electrolyte/sulfur ratio of 3.5μL mg^(−1) shows good rate capability and outstanding cyclability.This work proposes an interfacial and electronic structure engineering strategy for fast and durable sulfur electrochemistry,demonstrating great potential in lithium-sulfur batteries.

Effect of nano-CaO particle on the microstructure,mechanical properties and corrosion behavior of lean Mg-1Zn alloy

The effects of nano-CaO contents on the microstructure,mechanical properties and corrosion resistance of lean Mg-1Zn alloy were investigated.The results showed that the addition of nano-CaO significantly refined the grain size and improved mechanical properties of the Mg-1Zn alloy.At the same time,CaO reacted with molten Mg in situ to form nano-MgO,whose corrosion product in SBF solution was the same with the degradation product of Mg matrix,resulting in the enhanced compactness of the Mg(OH)_(2) layer and reduced corrosion rate of matrix.The Mg-1Zn alloy had lower corrosion resistance due to excessively large grain size and shedding of corrosion products.The composite with 0.5 wt.%CaO had the best corrosion resistance with a weight loss of 9.875 mg·y^(-1)·mm^(-2)due to the small number of Ca_(2)Mg_(6)Zn_(3) phase and suitable grain size.While for composites with high content of CaO(0.7 wt.%and 1.0 wt.%),they had lower corrosion resistance due to the coexistence of large number of Ca_(2)Mg_(6)Zn_(3) and Mg_(2)Ca at grain boundaries,especially for 1.0 wt.%CaO composite,resulting from the strong micro-galvanic corrosion.

基于E-leaning的体育课程网络化教学改革

E-leaning可以优化教育资源、提高学习效率、降低学习成本,对于体育课程教学而言,其灵活便捷的教学方式能够解决"学训矛盾",方便学生自主学习。学习过程记录方便、教学管理和课程资源及时有效的更新,既方便了教学管理,也为体育远程教育创造了条件。E-leaning借助网络跨越了校园空间的限制,给学习者提供了一个全新的学习环境,促使了学校与学习者之间距离的缩短,让学校教育向更广泛的地区辐射。借助E-leaning进行体育精品课程和网络课程整合,开展体育远程教育有助于现有体育精品课程和网络课程的可持续发展,有利于体育教育资源共享,是未来学校体育教育和终身体育教育的重要途径。

Prevalence,clinical characteristics,risk factors,and indicators for lean Chinese adults with nonalcoholic fatty liver disease

BACKGROUND Nonalcoholic fatty liver disease(NAFLD)is one of the most common chronic diseases in the world.Nowadays,the percentage of non-obese or lean patients with NAFLD is increasing.NAFLD in non-obese populations,especially the lean subgroup with a normal waist circumference(WC),might lead to more problems than obese individuals,as these individuals may not visit clinics for NAFLD diagnosis or ignore the diagnosis of NAFLD.If the precise characteristics of these populations,especially the lean subgroup,are identified,the clinicians would be able to provide more appropriate advice and treatment to these populations.AIM To investigate the prevalence,clinical characteristics,risk factors,and possible indicators for NAFLD in lean Chinese adults with a normal WC.METHODS People without diabetes mellitus or significant alcohol consumption who underwent routine health examinations were included.Their fatty liver index(FLI),abdominal ultrasonography results,and controlled attenuation parameter were all assessed.Genotyping for single-nucleotide polymorphisms associated with NAFLD was performed in another small group consisting of biopsy-proven NAFLD subjects and healthy controls.RESULTS A total of 2715 subjects who underwent routine health examinations were included in the study.Among 810 lean participants with a normal WC,142(17.5%)fulfilled the diagnostic criteria for NAFLD.Waist-height ratio,hemoglobin,platelets,and triglycerides were significant factors associated with the presence of NAFLD in these participants.The appropriate cut-off value of the FLI score in screening for NAFLD in the lean subjects with a normal WC was 25.15,which had a 77.8%sensitivity and 75.9%specificity.There was no significant difference in the single-nucleotide polymorphisms in the SIRT1,APOC3,PNPLA3,AGTR1,and PPARGC1A genes between lean subjects with and without NAFLD(P<0.05).CONCLUSION NAFLD is not uncommon in lean Chinese adults even with a normal WC.Metabolic factors,rather than genetic factors,may play important roles in the development of NAFLD in this population.A lower cut-off value of the FLI score in screening for NAFLD should be used for lean Chinese adults with a normal WC.

Update on nutritional status,body composition and growth in paediatric inflammatory bowel disease

Growth and nutritional status are important issues in paediatric inflammatory bowel disease(IBD).While linear growth is easy to assess,nutritional status is more complicated,with reports often compromised by the use of simple measures,such as weight and the body mass index,to assess nutritional status rather than more appropriate and sophisticated techniques to measure body composition.This review is an update on what is currently known about nutritional status as determined by body composition in paediatric IBD.Further,this review will focus on the impact of biologics on growth in paediatric IBD.Significant lean mass deficits have been reported in children with IBD compared with controls,and there is evidence these deficits persist over time.Furthermore,data imply that gender differences exist in body composition,both at diagnosis and in response to treatment.With respect to growth improvements following treatment with biologics,there are conflicting data.While some studies report enhancement of growth,others do not.The relationship between disease severity,impaired growth and the requirement for biologics needs to be considered when interpreting these data.However,key features associated with improvements in growth appear to be successful clinical response to treatment,patients in early stages of puberty,and the presence of growth failure at the onset of treatment.

An integrated approach to improve the performance of lean–electrolyte lithium–sulfur batteries

While the sulfur conversion reaction kinetics in Li–S batteries is nowadays improved by the use of appropriate electrocatalysts,it remains a challenge for the batteries to perform well under the lean electrolyte condition where polysulfide shuttle,electrode passivation and the loss of electrolyte due to side reactions,are aggravated.These challenges are addressed in this study by the tandem use of a polysulfide conversion catalyst and a redox–targeting mediator in a gel sulfur cathode.Specifically,the gel cathode reduces the polysulfide mobility and hence the polysulfide shuttle and the passivation of the lithium anode by the crossover polysulfides.The redox mediator restrains the deposition of inactive sulfur species in the cathode thereby enabling the Fe–N and Co–N co–doped carbon catalyst to prolong its catalytic activity.Consequently,the integrated catalytic system is able to increase the discharge capacity of high–loading (6.8 mg cm^(-2)) lean–electrolyte (4.0μL mg^(-1)) Li–S batteries from~630 to~1316 m Ah g^(-1),concurrently with an improvement of the cycle life (600 cycles with 46%capacity retention at 1.0 m A cm^(-2)).Redox mediator assisted catalysis in a gel cathode is therefore an effective strategy to extend the application of the sulfur conversion catalyst in lean electrolyte Li–S batteries.

DSNNs:learning transfer from deep neural networks to spiking neural networks

Deep neural networks(DNNs)have drawn great attention as they perform the state-of-the-art results on many tasks.Compared to DNNs,spiking neural networks(SNNs),which are considered as the new generation of neural networks,fail to achieve comparable performance especially on tasks with large problem sizes.Many previous work tried to close the gap between DNNs and SNNs but used small networks on simple tasks.This work proposes a simple but effective way to construct deep spiking neural networks(DSNNs)by transferring the learned ability of DNNs to SNNs.DSNNs achieve comparable accuracy on large networks and complex datasets.

Dendrite-free lithium anode achieved under lean-electrolyte condition through the modification of separators with F-functionalized Ti_(3)C_(2)nanosheets

An unstable solid electrolyte interphase(SEI)and chaotic lithium ion fux are key impediments to commercial high-energy-density lithium batteries because of the uncontrolled growth of rigid lithium dendrites,which would pierce through the conventional polypropylene(PP)separator,causing short circuit and safety issues.Herein,the homogenization of lithium ion fux and the generation of stable SEI layers on lithium anodes were achieved via coating a fuorine-functionalized Ti_(3)C_(2)(F-Ti_(3)C_(2))nanosheets on PP separator(F-Ti_(3)C_(2)@PP).F-Ti_(3)C_(2)nanosheets provide abundant ions pathways to homogeneously manipulate lithium ion fux and increase the Young’s modulus and electrolyte wettability of the separators.In addition,F species derived from the F-Ti_(3)C_(2)nanosheets would promote the formation of Li F-rich SEI film.The synergistic effect contribute to the uniform lithium deposition.Symmetric Li|Li,asymmetric Li|Cu and full Li|Li Fe PO4cells incorporated with the modified separators exhibit improved electrochemical performance even under lean electrolyte conditions.This work provides a feasible strategy to improve the performance of lithium batteries through both fuoridized SEI formation and lithium ion fux manipulation.

Lean Product Development Process with Design Verification Stages in the Value Stream of Automotive Industry

In the automotive industry, lean projects and innovation creation come to life by being updated under the control of systematic interdisciplinary process flows. The lean product development process that changes the shell, defined under the light of the variables created by the competitive conditions, is today measured by the value flow efficiency and the global market spread of the final product. Consequently, the lean product development approach, which aims to identify and purify all the wastes that do none value or create value to the system or cause burdens in the new product development process, is shaped by step-by-step approvals in the flow. In the main automotive industry company practices within the scope of the research (3 national, 3 international), the beginning of the concept of lean in design is to define and optimize the steps in the product development process under the value stream map. Therefore, the product function for which the customer has paid for, the function of the new product or the physical structure used to meet the needs in question, the comfort, life, experience, innovations of the scope that constitute the new product concept are planned and verified and implemented in the simplified automotive design stages at the beginning of the lean product development process. In this research, initial automotive design objectives and stages are at the focal point of the innovation and added value creation brought by the concept of “lean” approach. The research is modelled on the determination of steps that do not create added value together with the points where the flow circuits’ or stems, the process is devalued, the interdisciplinary holistic studies intensify, the information and delay begin and end in the sequential and simultaneous design validation step transition stages, which are examined under the lean approach. As a visual and virtual tool that enables the elaboration of nominal values such as the total duration of the design verification stages and the influence of interdisciplinary stakeholders or the test level of the product design with the new product added, it reveals the value flow or losses. Hence research;from innovation creation and new product design steps, which constitute the initial stages of the lean product development process, to design verification analysis, the efficiency of the automotive company processes within the scope of the research has been measured by comparing using lean automotive design techniques, methods and concepts.

The “Static” and “Dynamic” Design Verification Stages of the Lean Development Process: Automotive Industry

he design verification steps that take place in today’s automotive industry, which constitute the values of each successive or simultaneous phase in the new product development process, create a complex structure with the inclusion of each new technology and discipline. Therefore, step by step, each design verification phase definition in the flow contains important phase transition measurements or approval tolerances that ensure the simplicity and continuity of vehicle development processes. In addition, classification of design verification stages within the framework of this study or evaluation in two classes (static and dynamic) is a new approach, but it is a synthesis with the analysis of the new product development process. The vehicle’s basic structure, which constitutes the ergonomic and functional requirements of the vehicle in a static environment, takes into account the dynamic environment variables with crash or accident tests. Increasing new technology adaptations in the automotive industry have changed the new product development process that performs this function structurally and created the concept of design verification under consecutive or simultaneous process simplicity. From the autonomous driving to the use of alternative energy, possible accident scenarios and design verification phase transitions in the integration of parts and systems of the newly developed vehicle create a new structure that models and directs the lean product development process especially in the automotive industry in the coming days. In the lean product development process that takes place in the automotive industry, the design verification transition steps or the approval-control analysis of the development stages, which form a new and effective approach, are re-modeling the entire flow. Therefore, successful execution of design verification steps used in the control of new interdisciplinary product development phase transitions provides value creation.?Within the scope of this study, the effectiveness of the static and dynamic design verification steps, which are carried out in 5 global automotive companies included in the research, which constitute the stage transitions of the new product development process, has been measured. Apart from the design verification transition stages, the process variables that differ among the automotive companies involved in the research are excluded from the scope of this study. In other words, in field researches in the automotive industry, new vehicle design steps or basic engineering steps in the new product development process steps, while creating independent fixed variables, interdisciplinary collaborations, static and dynamic design verification transition stages they perform, or their sequence in the basic flow, is accepted as a dependent variable. Therefore, in the study, the positive effect of the automotive companies that included the static and dynamic design verification phase transition approvals in the lean product development process was investigated. Under the comparative analysis structure of the research, the effect of automotive companies, which accept international vehicle specifications as static design verification input, on market performance has been examined in depth. The detailed depth in the comparison analysis conducted under the second field studies of the study is due to the prediction of dynamic design verification stages to provide a high impact on the market performance, according to the static verification analysis. The new product development stages of the dependent variables were fixed and the flow-oriented?“effect”?of the independent variables in the basic process influenced by the design verification activities was analyzed under the new automotive industry company comparisons. In addition, the impact of the automotive design activities that make up the comparison analysis of the research on the scope of the lean product development stage and its effect on the basic process flow has been demonstrated competition-oriented. Therefore, sub-variables, options, criteria, results, which form a defined comparison problem, create basic test values that affect the problem.

How Can Lean Manufacturing Lead the Manufacturing Sector during Health Pandemics Such as COVID 19: A Multi Response Optimization Framework

Lean manufacturing has been used for the last few decades as a process and performance improvement tool.Initially known as Toyota production system(TPS),lean is now used in almost all service and manufacturing sectors to deliver favorable results such as decreased operational cost,increased customer satisfaction,decreased cycle time,and enhanced profits.During the coronavirus disease(COVID 19)pandemic,the manufacturing sector struggled immensely and could not function well even after lockdown was eased in many countries.Many companies found out there are not ready to conform with new regulations made by authorities in many countries.This paper proposes the use of simulation and multi response optimization in addition to other typical lean tools in order to arrive at optimum performance at the end of each project through an established optimization framework.The framework is used in a real case study performed at an aluminum extrusion factory.Lean manufacturing helps organizations to operate with smaller number of resources.It standardizes all processes so that most of the jobs can be done by most of the workers,but this is not enough to create a healthy,sanitized work place.Our framework utilizes the strengths of lean tools and adds pandemic readiness factor to them to ensure improvement in performance and health pandemic readiness.Implementation of the framework in the case company resulted in 50%reduction in labor,$730000 in expected annual cost savings,reduction in inventory levels,improved employee morale and the achievement of pandemic ready status.

Combining Lean Concepts &Tools with the DMAIC Framework to Improve Processes and Reduce Waste

Six Sigma DMAIC methodology has been applied to systematically apply lean manufacturing concepts and tools in order to improve productivity in a local company specialized in the manufacturing of safety and fire resistance metal doors, windows, and frames. In-depth analysis of the plant processes unfolded different critical processes, specifically foam injection process and sheet metal cutting process. Throughout the different project phases, various improvements had been implemented to reduce production cycle time from 216 min to 161 min;non-value added activities in the different processes were identified and eliminated. Plant layout and machine reconfiguration reduced backtracking and unutilized space. Percentage of defective doors (needing rework) dropped from 100% to only 15%. The successful implementation of this project is largely due to top management active involvement and participation of workers and operators in all stages of the project. Finally, new policies and mentoring programs are introduced to maintain improvements.

新时代学习方法的主流——M-Leaning

在现今知识信息的新时代,随着学习需求的与日俱增,现有的教育体系、模式与人们对教育的需求之间的矛盾也逐渐暴露出来,人们渴望更新、更灵活的学习模式的出现。因此,在任何时间(Anytime)和任何地点(Anywhere)利用手持的、无线移动通讯设备(如手机、PDA)学习任何内容(Anything)的M-leaning的出现是一种必然趋势。