Assistive Robotics for Upper Limb Physical Rehabilitation:A Systematic Review and Future Prospects

Physical assistive robotics are oriented to support and improve functional capacities of people.In physical rehabilitation,robots are indeed useful for functional recovery of affected limb.However,there are still open questions related to technological aspects.This work presents a systematic review of upper limb rehabilitation robotics in order to analyze and establish technological challenges and future directions in this area.A bibliometric analysis was performed for the systematic literature review.Literature from the last six years,conducted between August 2020 and May 2021,was reviewed.The methodology for the literature search and a bibliometric analysis of the metadata are presented.After a preliminary search resulted in 820 articles,a total of 66 articles were included.A concurrency network and bibliographic analysis were provided.And an analysis of occurrences,taxonomy,and rehabilitation robotics reported in the literature is presented.This review aims to provide to the scientific community an overview of the state of the art in assistive robotics for upper limb physical rehabilitation.The literature analysis allows access to a gap of unexplored options to define the technological prospects applied to upper limb physical rehabilitation robotics.

Spatiotemporal Characteristics of Typical Ecosystem Services and Their Spatial Responses to Driving Factors in Ecologically Fragile Areas in Upper Yellow River,China

The identification of dominant driving factors for different ecosystem services(ESs)is crucial for ecological conservation and sustainable development.However,the spatial heterogeneity of the dominant driving factors affecting various ESs has not been adequately elucidated,particularly in ecologically fragile regions.This study employed the integrated valuation of ESs and trade-offs(InVEST)model to evaluate four ESs,namely,water yield(WY),soil conservation(SC),habitat quality(HQ),and carbon storage(CS),and then to identify the dominant driving factors of spatiotemporal differentiation of ES and further to characterize the spatial heterogeneity characteristics of the dominant driving factors in the eco-fragile areas of the upper Yellow River,China from 2000 to 2020.The results demonstrated that WY exhibited northeast-high and northwest-low patterns in the upper Yellow River region,while high values of SC and CS were distributed in central forested areas and a high value of HQ was distributed in vast grassland areas.The CS,WY,and SC exhibited decreasing trends over time.The most critical factors affecting WY,SC,HQ,and CS were the actual evapotranspiration,precipitation,slope,and normalized difference vegetation index,respectively.In addition,the effects of different factors on various ESs exhibited spatial heterogeneity.These results could provide spatial decision support for eco-protection and rehabilitation in ecologically fragile areas.

MH-STRALP:A scoring system for prognostication in patients with upper gastrointestinal bleeding

BACKGROUND Upper gastrointestinal bleeding(UGIB)is a common medical emergency and early assessment of its outcomes is vital for treatment decisions.AIM To develop a new scoring system to predict its prognosis.METHODS In this retrospective study,692 patients with UGIB were enrolled from two cen-ters and divided into a training(n=591)and a validation cohort(n=101).The clinical data were collected to develop new prognostic prediction models.The en-dpoint was compound outcome defined as(1)demand for emergency surgery or vascular intervention,(2)being transferred to the intensive care unit,or(3)death during hos-pitalization.The models’predictive ability was compared with previously esta-blished scores by receiver operating characteristic(ROC)curves.RESULTS Totally 22.2%(131/591)patients in the training cohort and 22.8%(23/101)in the validation cohort presented poor outcomes.Based on the stepwise-forward Lo-gistic regression analysis,eight predictors were integrated to determine a new post-endoscopic prognostic scoring system(MH-STRALP);a nomogram was de-termined to present the model.Compared with the previous scores(GBS,Rock-all,ABC,AIMS65,and PNED score),MH-STRALP showed the best prognostic prediction ability with area under the ROC curves(AUROCs)of 0.899 and 0.826 in the training and validation cohorts,respectively.According to the calibration cur-ve,decision curve analysis,and internal cross-validation,the nomogram showed good calibration ability and net clinical benefit in both cohorts.After removing the endoscopic indicators,the pre-endoscopic model(pre-MH-STRALP score)was conducted.Similarly,the pre-MHSTRALP score showed better predictive value(AUROCs of 0.868 and 0.767 in the training and validation cohorts,respectively)than the other pre-endoscopic scores.CONCLUSION The MH-STRALP score and pre-MH-STRALP score are simple,convenient,and accurate tools for prognosis prediction of UGIB,and may be applied for early decision on its management strategies.

Predictive utility of the Rockall scoring system in patients suffering from acute nonvariceal upper gastrointestinal hemorrhage

BACKGROUND Acute non-variceal upper gastrointestinal bleeding(ANVUGIB)represents a sig-nificant clinical challenge due to its unpredictability and potentially severe out-comes.The Rockall risk score has emerged as a critical tool for prognostic asse-ssment in patients with ANVUGIB,aiding in the prediction of rebleeding and mo-rtality.However,its applicability and accuracy in the Chinese population remain understudied.AIM To assess the prognostic value of the Rockall risk score in a Chinese cohort of patients with ANVUGIB.METHODS A retrospective analysis of 168 ANVUGIB patients’medical records was condu-cted.The study employed statistical tests,including the t-test,χ^(2) test,spearman correlation,and receiver operating characteristic(ROC)analysis,to assess the re-lationship between the Rockall score and clinical outcomes,specifically focusing on rebleeding events within 3 months post-assessment.RESULTS Significant associations were found between the Rockall score and various clinical outcomes.High Rockall scores were significantly associated with rebleeding events(r=0.735,R2=0.541,P<0.001)and strongly positively correlated with adverse outcomes.Low hemoglobin levels(t=2.843,P=0.005),high international normalized ratio(t=3.710,P<0.001),active bleeding during endoscopy(χ^(2)=7.950,P=0.005),large ulcer size(t=6.348,P<0.001),and requiring blood transfusion(χ^(2)=6.381,P=0.012)were all significantly associated with rebleeding events.Furthermore,differences in treatment and management strategies were identified between patients with and without rebleeding events.ROC analysis indicated the excellent discriminative power(sensitivity:0.914;specificity:0.816;area under the curve:0.933;Youden index:0.730)of the Rockall score in predicting rebleeding events within 3 months.CONCLUSION This study provides valuable insights into the prognostic value of the Rockall risk score for ANVUGIB in the Chinese population.The results underscore the potential of the Rockall score as an effective tool for risk strati-fication and prognostication,with implications for guiding risk-appropriate management strategies and optimizing care for patients with ANVUGIB.

Virtual Reality-Based Mirror Therapy for Upper Extremity Function among Stroke Patients:A Meta-analysis and Systematic Review

[Objectives]To investigate the evidence-based effect of virtual reality-based mirror therapy system(VR-MT)on upper extremity function among stroke patients.[Methods]A systematic electronic searching of the Medline,PubMed,Web of Science and CNKI was initially performed up to June 10,2024.The risk of bias of the included studies was evaluated using RevMan 5.4 software based on the Cochrane Handbook for Systematic Reviews.The random-effects model or fixed-effects models was employed to estimate the standardized mean difference(SMD).The subgroup analyses were conducted exploring theVR-MT type(immersive or non-immersive)and comparing with MT or control group.[Results]In total 8 studies with a total of 273 stroke patients were included in this review.The pooled analysis of these trials showed a statistically significant enhancement inFMA-UE scores(6 studies,SMD=0.72,[95%CI 0.37 to 1.06];P<0.0001,I^(2)=31%)and Box and Block Test(BBT)(3 studies,SMD=0.49,[95%C/0.05 to 0.93];P=0.03,I^(2)=0%),rather than Manual Function Test(MFT)scores(3 studies,SMD=0.38,[95%CI-0.09 to 0.84];P=0.11,I^(2)=0%)following the application of reality-based mirror therapy.Additionally,the subgroup analysis results indicated that immersive VR-MT can significantly improve FMA-UE(5studies,SMD=0.73,[95%CI 0.24 to 1.23];P=0.004,I^(2)=43%).In contrast,the overall effect of non-immersive VR-MT was non-significant(2 studies,SMD=0.33,[95%CI-0.69 to 1.34];P=0.53,I^(2)=72%).[Conclusions]In this systematic review and meta-analysis,our findings indicate that immersiveVR-MT has the potential to improve upper extremity function among stroke patients.

Effects of Repetitive TranscranialMagnetic Stimulation on Upper Extremity Function in Acute Stroke:A Meta-analysis and Systematic Review

[Objectives]To conduct a comprehensive examination of the evidence-based impact of repetitive transcranial magnetic stimulation(rTMS)on upper extremity functionality in patients with acute stroke.[Methods]A rigorous and systematic electronic search was conducted across the Medline,PubMed,and Web of Science databases,encompassing literature up to July 1,2024.To ensure the reliability of the in-cluded studies,an assessment of their risk of bias was conducted using RevMan 5.4 software,in accordance with the rigorous standards out-lined in the Cochrane Handbook for Systematic Revieus.Subsequently,we employed either the random-effects model or the fixed-effects model,depending on the heterogeneity of the data,to estimate the standardized mean difference(SMD)in outcomes,utilizing Stata 18.0 software for statistical analysis.[Results]Our review encompassed a total of five studies,involving 252 patients with acute stroke.The pooled analysis of these studies revealed a statistically significant improvement in Fugl-Meyer Assessment of the Upper Extremity(FMA-UE)scores among pa-tients who received rTMS therapy(SMD=2.71,95%CI:0.85 to 4.56;P<0.0001),albeit with considerable heterogeneity(I^(2)=97.65%)across the trials.[Conclusions]The results of this systematic review and meta-analysis underscore the promising potential of rTMS in enhancing upper extremity function in patients who have experienced an acute stroke.These findings provide compelling evidence for the therapeutic benefits of rTMS in this patient population.

The burden of upper motor neuron involvement is correlated with the bilateral limb involvement interval in patients with amyotrophic lateral sclerosis:a retrospective observational study

Amyotrophic lateral sclerosis is a rare neurodegenerative disease characterized by the involvement of both upper and lower motor neurons.Early bilateral limb involvement significantly affects patients'daily lives and may lead them to be confined to bed.However,the effect of upper and lower motor neuron impairment and other risk factors on bilateral limb involvement is unclear.To address this issue,we retrospectively collected data from 586 amyotrophic lateral sclerosis patients with limb onset diagnosed at Peking University Third Hospital between January 2020 and May 2022.A univariate analysis revealed no significant differences in the time intervals of spread in different directions between individuals with upper motor neuron-dominant amyotrophic lateral sclerosis and those with classic amyotrophic lateral sclerosis.We used causal directed acyclic graphs for risk factor determination and Cox proportional hazards models to investigate the association between the duration of bilateral limb involvement and clinical baseline characteristics in amyotrophic lateral sclerosis patients.Multiple factor analyses revealed that higher upper motor neuron scores(hazard ratio[HR]=1.05,95%confidence interval[CI]=1.01–1.09,P=0.018),onset in the left limb(HR=0.72,95%CI=0.58–0.89,P=0.002),and a horizontal pattern of progression(HR=0.46,95%CI=0.37–0.58,P<0.001)were risk factors for a shorter interval until bilateral limb involvement.The results demonstrated that a greater degree of upper motor neuron involvement might cause contralateral limb involvement to progress more quickly in limb-onset amyotrophic lateral sclerosis patients.These findings may improve the management of amyotrophic lateral sclerosis patients with limb onset and the prediction of patient prognosis.

Validation of the Rockall scoring system for outcomes from non-variceal upper gastrointestinal bleeding in a Canadian setting

AIM: To validate the Rockall scoring system for predicting outcomes of rebleeding, and the need for a surgical procedure and death. METHODS: We used data extracted from the Registry of Upper Gastrointestinal Bleeding and Endoscopy including information of 1869 patients with non-variceal upper gastrointestinal bleeding treated in Canadian hospitals. Risk scores were calculated and used to classify patients based on outcomes. For each outcome, we used χ2 goodness-of-fit tests to assess the degree of calibration, and built receiver operating characteristic curves and calculated the area under the curve (AUC) to evaluate the discriminative ability of the scoring system. RESULTS: For rebleeding, the χ2 goodness-of-fit test indicated an acceptable fit for the model [χ2 (8) = 12.83, P = 0.12]. For surgical procedures [χ2 (8) = 5.3, P = 0.73] and death [χ2 (8) = 3.78, P = 0.88], the tests showed solid correspondence between observed proportions and predicted probabilities. The AUC was 0.59 (95% CI: 0.55-0.62) for the outcome of rebleeding and 0.60 (95% CI: 0.54-0.67) for surgical procedures, representing apoor discriminative ability of the scoring system. For the outcome of death, the AUC was 0.73 (95% CI: 0.69-0.78), indicating an acceptable discriminative ability. CONCLUSION: The Rockall scoring system provides an acceptable tool to predict death, but performs poorly for endpoints of rebleeding and surgical procedures.

Update on risk scoring systems for patients with upper gastrointestinal haemorrhage

Upper gastrointestinal haemorrhage (UGIH) remains a common medical emergency worldwide. It is increasingly recognised that early risk assessment is an important part of management, which helps direct appropriate patient care and the timing of endoscopy. Several risk scores have been developed, most of which include endoscopic findings, although a minority do not. These scores were developed to identify various end-points including mortality, rebleeding or clinical intervention in the form of transfusion, endoscopic therapy or surgery. Recent studies have reported accurate identification of a very low risk group on presentation, using scores which require simple clinical or laboratory parameters only. This group may not require admission, but could be managed with early out-patient endoscopy. This article aims to describe the existing pre- and post-endoscopy risk scores for UGIH and assess the published data comparing them in the prediction of outcome. Recent data assessing their use in clinical practice, in particular the early identification of low-risk patients, are also discussed.

Upper Paleozoic coal measures and unconventional natural gas systems of the Ordos Basin,China

Upper Paleozoic coal measures in the Ordos Basin consist of dark mudstone and coal beds and are important source rocks for gas generation. Gas accumulations include coal-bed methane （CBM）, tight gas and conventional gas in different structural areas. CBM accumulations are mainly distributed in the marginal area of the Ordos Basin, and are estimated at 3.5 × 1012 m3. Tight gas accumulations exist in the middle part of the Yishan Slope area, previously regarded as the basin-centered gas system and now considered as stratigraphic lithologic gas reservoirs. This paper reviews the characteristics of tight gas accumulations： poor physical properties （porosity 〈 8%, permeability 〈 0.85 × 10 3 μm2）, abnormal pressure and the absence of well-defined gas water contacts. CBM is a self-generation and self- reservoir, while gas derived from coal measures migrates only for a short distance to accumulate in a tight reservoir and is termed near-generation and near-reservoir. Both CBM and tight gas systems require source rocks with a strong gas generation ability that extends together over wide area. However, the producing area of the two systems may be significantly different.

Two Village Ecosystems in the Upper Minjiang River, China: A Comparison of Emergy Flow

By using the concept of emergy and method of emergy analysis, this paper has studied two mountain settlement (village) ecosystems in two aspects: input and output of energy in the agro-systems and the use of fuel energy. The result reveals that the settlement agro-system in the valley of Minjiang River is better in both structure and function than that at the so-called half-high mountain. The former one is higher than the latter one regarding such indices as emergy yield ratio, labor productivity of emergy and emergy sustainable index, but lower than the latter one regarding environmental loading ratio. In terms of fuel emergy, the settlement in the valley enjoys more diversified sources and is less depending on bio-energy while the settlement at the half-high mountain has only one source (i. e. fuel wood) , much depending on bio-energy, may exert a greater pressure on environment.

Sedimentary system characteristics and depositional filling model of Upper Permian——Lower Triassic in South Yellow Sea Basin

In the South Yellow Sea Basin,Mesozoic–Paleozoic marine strata are generally well developed with large thickness,and no substantial breakthroughs have been made in hydrocarbon exploration.Through research,it is believed that the Upper Permian–Lower Triassic can be regarded as a long-term base-level cycle.Based on drilling data,characteristics of the lithology–electric property combination cyclicity,and the special lithology,the long-term base-level cycle was divided into five medium-term base-level cycles(MC1–MC5).On this basis,the Permian–Triassic sedimentary systems and their filling model were analyzed in accordance with the change of base-level cycle and transition of sedimentary environment,as well as characteristics of the drilling sedimentary facies and seismic facies.The results show that there were six sedimentary systems(fluvial,delta,tidal flat,open platform,restricted platform,and continental shelf)developed in the Upper Permian–Lower Triassic,the sedimentary systems were distributed such that the water was deep in the northwest and shallow in the southeast,and there were two base-level cycle filling models(a relatively stable tidal flat facies and a rapidly transgressive continental shelf facies to stable platform facies)developed in the Upper Permian–Lower Triassic.These models can provide a basis for evaluation of the Mesozoic–Paleozoic hydrocarbon geology in the South Yellow Sea Basin.

Photodynamic therapy for middle-advanced stage upper gastrointestinal carcinomas: A systematic review and meta-analysis

AIM To determine the therapeutic effect of photodynamic therapy(PDT) for middle-advanced stage upper gastrointestinal carcinomas. METHODS We searched PubM ed, EMBASE, the Cochrane Library, China National Knowledge Infrastructure, China Science and Technology Journal Database, and Wanfang Database from inception to April 2018 for randomized controlled studies. These studies compared PDT with other palliative therapies(radiotherapy, chemotherapy, or Nd:YAG laser) and compared PDT, radiotherapy, or chemotherapy alone with PDT combined with chemotherapy/radiotherapy. In our meta-analysis, both fixed and random effects models were used to estimate the risk ratio(RR) for dichotomous outcomes(the response rate and one-year survival rate).RESULTS Ten random controlled clinical studies with 953 patients were included in the analysis. The effective rate for PDT was better than that of radiotherapy or Nd:YAG laser for the treatment of middle-advanced upper gastrointestinal carcinomas [RR = 1.36; 95% confidence interval(CI): 1.13-1.65; P = 0.001]. In addition, PDT combined with chemotherapy had significantly better efficacy and a higher one-year survival rate than PDT or chemotherapy alone(significant remission rate, RR = 1.62; 95%CI: 1.34-1.97; P < 0.00001; one-year survival rate, RR = 1.81; 95%CI: 1.13-2.89; P = 0.01).CONCLUSION PDT is a useful method for the treatment of middleadvanced stage upper gastrointestinal carcinomas. PDT combined with chemotherapy or radiotherapy can enhance its efficacy and prolong survival time.

A comprehensive musculoskeletal and peripheral nervous system assessment of war-related bilateral upper extremity amputees

Background: Upper limb amputations are one of the unpleasant war injuries that armed forces are exposed to frequently. The present study aimed to assess the musculoskeletal and peripheral nervous systems in Iraq-Iran war veterans with bilateral upper extremity amputation.Methods: The study consisted of taking a history and clinical examinations including demographic data, presence and location of pain, level of amputation, passive and active ranges of movement of the joints across the upper and lower extremities and spine, manual palpation, neurological examination, blood circulation pulses and issues related to a prosthetic limb. In this study, 103 Iranian bilateral upper extremity amputees(206 amputations) from the IranIraq war were evaluated, and a detailed questionnaire was also administered.Results: The most common level of amputation was the finger or wrist level(108, 52.4%). Based on clinical examination, we found high frequencies of limited active and passive joint range of movement across the scapula, shoulder, elbow, wrist and metacarpophalangeal, interphalangeal and thumb joints. Based on muscle strength testing, we found varying degrees of weakness across the upper limbs. Musculoskeletal disorders included epicondylitis(65, 31.6%), rotator cuff injury(24, 11.7%), bicipital tendonitis(69, 33.5%), shoulder drop(42, 20.4%) and muscle atrophy(19, 9.2%). Peripheral nerve disorders included carpal tunnel syndrome in 13(6.3%) and unilateral brachial plexus injury in 1(1%). Fifty-three(51.5%) were diagnosed with facet joint syndrome at the level of the cervical spine(the most frequent site). Using a prosthesis was reported by 65(63.1%), both left and right sides. The back was the most common site of pain(71.8%).Conclusion: The high prevalence of neuro-musculoskeletal disorders among bilateral upper extremity amputees indicates that they need regular rehabilitation care.

Upper Paleozoic total petroleum system and geological model of natural gas enrichment in Ordos Basin, NW China

Based on the analysis of Upper Paleozoic source rocks, source-reservoir-caprock assemblage, and gas accumulation characteristics in the Ordos Basin, the gas accumulation geological model of total petroleum system is determined. Then, taking the Carboniferous Benxi Formation and the Permian Taiyuan Formation and Shanxi Formation as examples, the main controlling factors of gas accumulation and enrichment are discussed, and the gas enrichment models of total petroleum system are established. The results show that the source rocks, faults and tight reservoirs and their mutual coupling relations control the distribution and enrichment of gas. Specifically, the distribution and hydrocarbon generation capacity of source rocks control the enrichment degree and distribution range of retained shale gas and tight gas in the source. The coupling between the hydrocarbon generation capacity of source rocks and the physical properties of tight reservoirs controls the distribution and sweet spot development of near-source tight gas in the basin center. The far-source tight gas in the basin margin is mainly controlled by the distribution of faults, and the distribution of inner-source, near-source and far-source gas is adjusted and reformed by faults. Generally, the Upper Paleozoic gas in the Ordos Basin is recognized in four enrichment models: inner-source coalbed gas and shale gas, inner-source tight sandstone gas, near-source tight gas, and far-source fault-transported gas. In the Ordos Basin, inner-source tight gas and near-source tight gas are the current focuses of exploration, and inner-source coalbed gas and shale gas and far-source gas will be important potential targets in the future.

Upper bound for the time derivative of entropy for a stochastic dynamical system with double singularities driven by non-Gaussian noise

A stochastic dynamical system with double singularities driven by non-Gaussian noise is investigated. The Fokker Plank equation of the system is obtained through the path-integral approach and the method of transformation. Based on the definition of Shannon＇s information entropy and the Schwartz inequality principle, the upper bound for the time derivative of entropy is calculated both in the absence and in the presence of non-equilibrium constraint. The present calculations can be used to interpret the effects of the system dissipative parameter, the system singularity strength parameter, the noise correlation time and the noise deviation parameter on the upper bound.

Completeness of system of root vectors of upper triangular infinitedimensional Hamiltonian operators appearing in elasticity theory

This paper deals with a class of upper triangular infinite-dimensional Hamilto- nian operators appearing in the elasticity theory. The geometric multiplicity and algebraic index of the eigenvalue are investigated. Furthermore, the algebraic multiplicity of the eigenvalue is obtained. Based on these properties, the concrete completeness formulation of the system of eigenvectors or root vectors of the Hamiltonian operator is proposed. It is shown that the completeness is determined by the system of eigenvectors of the operator entries. Finally, the applications of the results to some problems in the elasticity theory are presented.

UPPER SEMI-CONTINUITY OF RANDOM ATTRACTORS FOR A NON- AUTONOMOUS DYNAMICAL SYSTEM WITH A WEAK CONVERGENCE CONDITION

In this paper,we develop the criterion on the upper semi-continuity of random attractors by a weak-to-weak limit replacing the usual norm-to-norm limit.As an application,we obtain the convergence of random attractors for non-autonomous stochastic reactiondiffusion equations on unbounded domains,when the density of stochastic noises approaches zero.The weak convergence of solutions is proved by means of Alaoglu weak compactness theorem.A differentiability condition on nonlinearity is omitted,which implies that the existence conditions for random attractors are sufficient to ensure their upper semi-continuity.These results greatly strengthen the upper semi-continuity notion that has been developed in the literature.

Systematic Design and Coordination Acts of Ecological Security in Upper Yangtze River in China

In this paper, systematic design and act of eco-security is discussed as a focal point of conflict and unrest. The situation of ecosystem, the schematic framework of eco-security design, the main acts of ecosystem improvement, major difficulties and challenges have also been analyzed. The purpose of this study was to formulate the systematic framework of eco-security maintenance, to highlight systematic idea or philosophy of ecological rehabilitation and eco-security. A three-dimensional schematic model is applied to design the security of ecosystem. It was concluded that: 1) maintaining ecological security requires far better and sophisticated resource management skill and ecological improvement measures, and is also a continuing and multifac-eted task. It cannot be permanently accomplished by a single action and program; 2) at present, technical system and policy and law system dimensions of ecological security are not enough even in short; 3) development of ecological industries is beneficial to local economic development and ecosystem protection.

A Lower and Upper Bound Method for Complex System Reliability Evaluation

It is hard for the existing methods to obtain the expression of the system reliability for most of the practical complex systems with a large number of components and possible stales. A new regression algorithm based on the lower and upper bounds is presented in this paper, which can obtain the system reliability analytically without concerning the structure of the complex system. The method has been applied to a real system and the reliability results are compared with those acquired by the classical method and the parametric method. The effectiveness and accuracy of the proposed method have been testified.