[Objectives]To quantify the efficacy of Extracorporeal Shock Wave Therapy(ESWT)for upper limb spasticity in stroke patients using Modified Ashworth Scale(MAS)across three timeframes:immediate,short-term(24 h-4 wks),an...[Objectives]To quantify the efficacy of Extracorporeal Shock Wave Therapy(ESWT)for upper limb spasticity in stroke patients using Modified Ashworth Scale(MAS)across three timeframes:immediate,short-term(24 h-4 wks),and long-term(>4 wks).[Methods]Six databases(PubMed,EMBASE,CENTRAL,CINAHL,Scopus,Web of Science)until May 2025,were systematically searched,identifying 11 RCTs(n=505)meeting inclusion criteria(adults≥18 yrs old with stroke-related spasticity[MAS≥1]).Risk of bias was rigorously assessed using Cochrane criteria,revealing uniformly low risk across all domains.Random-effects meta-analyses(REML model)calculated Hedges'g with 95%CI for MAS outcomes,with subgroup analyses for joint-specific effects.[Results]ESWT demonstrated non-significant immediate MAS reduction(g=-0.69,p=0.07;=93.95%),but statistically significant short-term(g=-0.58,p=0.02;I^(2)=89.64%)and long-term effects(g=-0.52,p=0.02;I^(2)=78.72%).Effects were driven by composite MAS scores(short-term g=-0.63;long-term g=-0.56,both p<0.05)rather than isolated joints(elbow/finger/wrist all non-significant).Substantial heterogeneity persisted across analyses,particularly in joint-specific subgroups(I^(2)>90%).[Conclusions]ESWT provides statistically significant,clinically relevant reductions in global upper limb spasticity with durable efficacy beyond four weeks,supporting its use as a non-invasive adjunct therapy despite substantial heterogeneity warranting protocol standardization.展开更多
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...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.展开更多
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 c...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.展开更多
[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 a...[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.展开更多
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 ...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.展开更多
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 ...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.展开更多
[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,Pub...[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.展开更多
Background China is seeing a growing demand for rehabilitation treatments for post-stroke upper limb spastic paresis(PSSP-UL).Although acupuncture is known to be effective for PSSP-UL,there is room to enhance its effi...Background China is seeing a growing demand for rehabilitation treatments for post-stroke upper limb spastic paresis(PSSP-UL).Although acupuncture is known to be effective for PSSP-UL,there is room to enhance its efficacy.Objective This study explored a semi-personalized acupuncture approach for PSSP-UL that used three-dimensional kinematic analysis(3DKA)results to select additional acupoints,and investigated the feasibility,efficacy and safety of this approach.Design,setting,participants and interventions This single-blind,single-center,randomized,controlled trial involved 74 participants who experienced a first-ever ischemic or hemorrhagic stroke with spastic upper limb paresis.The participants were then randomly assigned to the intervention group or the control group in a 1:1 ratio.Both groups received conventional treatments and acupuncture treatment 5 days a week for 4 weeks.The main acupoints in both groups were the same,while participants in the intervention group received additional acupoints selected on the basis of 3DKA results.Follow-up assessments were conducted for 8 weeks after the treatment.Main outcome measures The primary outcome was the Fugl-Meyer Assessment for Upper Extremity(FMA-UE)response rate(≥6-point change)at week 4.Secondary outcomes included changes in motor function(FMA-UE),Brunnstrom recovery stage(BRS),manual muscle test(MMT),spasticity(Modified Ashworth Scale,MAS),and activities of daily life(Modified Barthel Index,MBI)at week 4 and week 12.Results Sixty-four participants completed the trial and underwent analyses.Compared with control group,the intervention group exhibited a significantly higher FMA-UE response rate at week 4(χ^(2)=5.479,P=0.019)and greater improvements in FMA-UE at both week 4 and week 12(both P<0.001).The intervention group also showed bigger improvements from baseline in the MMT grades for shoulder adduction and elbow flexion at weeks 4 and 12 as well as thumb adduction at week 4(P=0.007,P=0.049,P=0.019,P=0.008,P=0.029,respectively).The intervention group showed a better change in the MBI at both week 4 and week 12(P=0.004 and P=0.010,respectively).Although the intervention group had a higher BRS for the hand at week 12(P=0.041),no intergroup differences were observed at week 4(all P>0.05).The two groups showed no differences in MAS grades as well as in BRS for the arm at weeks 4 and 12(all P>0.05).Conclusion Semi-personalized acupuncture prescription based on 3DKA results significantly improved motor function,muscle strength,and activities of daily living in patients with PSSP-UL.展开更多
Upper gastrointestinal cancers,mainly comprising esophageal and gastric cancers,are among the most prevalent cancers worldwide.There are many new cases of upper gastrointestinal cancers annually,and the survival rate ...Upper gastrointestinal cancers,mainly comprising esophageal and gastric cancers,are among the most prevalent cancers worldwide.There are many new cases of upper gastrointestinal cancers annually,and the survival rate tends to be low.Therefore,timely screening,precise diagnosis,appropriate treatment strategies,and effective prognosis are crucial for patients with upper gastrointestinal cancers.In recent years,an increasing number of studies suggest that artificial intelligence(AI)technology can effectively address clinical tasks related to upper gastrointestinal cancers.These studies mainly focus on four aspects:screening,diagnosis,treatment,and progno-sis.In this review,we focus on the application of AI technology in clinical tasks related to upper gastrointestinal cancers.Firstly,the basic application pipelines of radiomics and deep learning in medical image analysis were introduced.Furthermore,we separately reviewed the application of AI technology in the aforementioned aspects for both esophageal and gastric cancers.Finally,the current limitations and challenges faced in the field of upper gastrointestinal cancers were summarized,and explorations were conducted on the selection of AI algorithms in various scenarios,the popularization of early screening,the clinical applications of AI,and large multimodal models.展开更多
The Tan-Lu Fault Zone is a large NNE-trending fault zone that has a substantial effect on the development of eastern China and its earthquake disaster prevention efforts. Aiming at the azimuthally anisotropic structur...The Tan-Lu Fault Zone is a large NNE-trending fault zone that has a substantial effect on the development of eastern China and its earthquake disaster prevention efforts. Aiming at the azimuthally anisotropic structure in the upper crust and seismogenic tectonics in the Hefei segment of this fault, we collected phase velocity dispersion data of fundamental mode Rayleigh waves from ambient noise cross-correlation functions of ~400 temporal seismographs in an area of approximately 80 × 70 km along the fault zone. The period band of the dispersion data was ~0.5–10 s. We inverted for the upper crustal three-dimensional(3-D) shear velocity model with azimuthal anisotropy from the surface to 10 km depth by using a 3-D direct azimuthal anisotropy inversion method. The inversion result shows the spatial distribution characteristics of the tectonic units in the upper crust. Additionally, the deformation of the Tan-Lu Fault Zone and its conjugated fault systems could be inferred from the anisotropy model. In particular, the faults that have remained active from the early and middle Pleistocene control the anisotropic characteristics of the upper crustal structure in this area. The direction of fast axes near the fault zone area in the upper crust is consistent with the strike of the faults, whereas for the region far away from the fault zone, the direction of fast axes is consistent with the direction of the regional principal stress caused by plate movement. Combined with the azimuthal anisotropy models in the deep crust and uppermost mantle from the surface wave and Pn wave, the different anisotropic patterns caused by the Tan-Lu Fault Zone and its conjugated fault system nearby are shown in the upper and lower crust. Furthermore,by using the double-difference method, we relocated the Lujiang earthquake series, which contained 32 earthquakes with a depth shallower than 10 km. Both the Vs model and earthquake relocation results indicate that earthquakes mostly occurred in the vicinity of structural boundaries with fractured media, with high-level development of cracks and small-scale faults jammed between more rigid areas.展开更多
Dear Editor,In this letter,a constrained networked predictive control strategy is proposed for the optimal control problem of complex nonlinear highorder fully actuated(HOFA)systems with noises.The method can effectiv...Dear Editor,In this letter,a constrained networked predictive control strategy is proposed for the optimal control problem of complex nonlinear highorder fully actuated(HOFA)systems with noises.The method can effectively deal with nonlinearities,constraints,and noises in the system,optimize the performance metric,and present an upper bound on the stable output of the system.展开更多
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 ...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.展开更多
The Upper Cretaceous of Tantou Basin in western Henan has yielded many vertebrate fossils,which are featured by several non-avian dinosaurs.Meanwhile,studies on their eggs were yet inadequate though many eggshells hav...The Upper Cretaceous of Tantou Basin in western Henan has yielded many vertebrate fossils,which are featured by several non-avian dinosaurs.Meanwhile,studies on their eggs were yet inadequate though many eggshells have been reported.The newly discovered material 41HⅤ0199 was excavated from the Upper Cretaceous Qiupa Formation in 2021.The block preserves eight complete eggs arranged in two partial rings that form a partial clutch,and there are some scattered eggshells preserved closely with the block,showing a concave-up to concave-down ratio of 54.5:45.5,which indicates that the scattered eggshells come from the clutch and the clutch had been partially broken before it was buried.Based on morphological and microstructural characteristics,the eggs and eggshells can be assigned to Macroolithus yaotunensis(Elongatoolithidae),an oospecies known to be related to oviraptorids,which leads Yulong mini to be its probable producer.Besides,some eggshells show microstructural signs indicating egg retention,which marks the second example of egg retention in the oofamily Elongatoolithidae.展开更多
[Objective]Implementation of the Ten-Year Fishing Ban policy may alter fish diversity and niche characteristics of dominant species in spawning grounds within the National Nature Reserve for Rare and Endemic Fish in t...[Objective]Implementation of the Ten-Year Fishing Ban policy may alter fish diversity and niche characteristics of dominant species in spawning grounds within the National Nature Reserve for Rare and Endemic Fish in the Upper Yangtze River.This study initiated continuous monitoring of natural spawning habitats from February 2022 to assess these ecological changes.[Methods]Environmental DNA(eDNA)metabarcoding was employed to analyze fish species composition,biodiversity patterns,and niche parameters of dominant species.Water sampling followed the CEN/TS 19461 standard across five monitoring transects(ZT1-ZT5).[Results]The eDNA analysis detected 45 species of fish belonging to 38 genera,13 families,and 3 orders were detected through environmental DNA(eDNA)in this survey,including 10 species endemic to the upper reaches of the Yangtze River,such as Procypris rabaudi and Myxocyprinus asiaticus.The fish community was mainly composed of bottom-dwelling,settling ovum-producing,omnivorous fish.The variation ranges of the Chao1 index,ACE index,Shannon index,and Simpson index are 736~996,719~965,1.58~3.23,and 0.83~0.99,respectively,indicating that fish species in spawning sites are abundant and community distribution uniformity is high.All indexes are highest at ZT1 monitoring points.Cluster analysis showed that,at a certain similarity level,fish community types in spawning sites could be basically divided into two groups:ZT1,ZT3,and ZT5 clustered together,and ZT2 and ZT4 clustered together,indicating similar fish community habitats.There are 9 dominant fish species in typical deep pool habitats in the reserve,with niche widths(Bi)ranging from 1.13 to 3.87.The dominant fish species are broad and medium niche fish,such as Cyprinus carpio and Hemiculter tchangi,with the niche overlap index(Oik)of some dominant fish species reaching more than 0.95.This indicates fierce competition for resources among the fish in this spawning ground.[Conclusion]The Zhutuo spawning ground demonstrates high species richness with homogeneous community structure and intense resource competition.This study establishes an eDNA-based monitoring framework that enhances conventional survey method,providing critical baseline data for adaptive management under the fishing moratorium regime.展开更多
With the widespread application of WIFI networks and embedded system technology, the device monitoring system based on Embedded System and wireless network came into being. In this paper, we introduce a device monitor...With the widespread application of WIFI networks and embedded system technology, the device monitoring system based on Embedded System and wireless network came into being. In this paper, we introduce a device monitoring system based on ARM upper computer and WIFI transmission, and we tested this system on workshop equipment. The hardware adopts ARM Cortex-A8 processor architecture of TI company as the main control chip, using IAC-335X-Kit development board for system design, external USB camera module and WIFI wireless module for video capture and data transmission. The software is based on embedded Linux as the platform. The system will collect production data accurately and objectively, and the statistical analysis. At the same time, the system uses QT to develop the upper computer software GUI interface. Compared with the traditional system based on the wired network, our design is more convenient and flexible, which reduces the implementation restriction and maintenance cost of traditional network cabling.展开更多
OBJECTIVE:To investigate the effects of acupuncture combined with upper limb rehabilitation robot on neural remodeling and functional recovery in post-stroke patients.METHODS:There were 50 stroke patients were randoml...OBJECTIVE:To investigate the effects of acupuncture combined with upper limb rehabilitation robot on neural remodeling and functional recovery in post-stroke patients.METHODS:There were 50 stroke patients were randomly divided into an experimental group(acupuncture combined with upper limb rehabilitation robot assisted training)and a control group(upper limb rehabilitation robot assisted training).Various assessments were conducted to compare the effects of the two treatments on neural remodeling and functional recovery.Functional near-infrared spectroscopy technology was used to assess the effects of different treatments on neural plasticity and their impact on upper limb function and activities of daily living.RESULTS:The experimental group showed significantly higher concentrations of oxygenated hemoglobin and total hemoglobin in specific brain regions compared to the control group(P<0.05).Additionally,the experimental group had significantly lower concentrations of deoxygenated hemoglobin(P<0.05).After treatment,both groups showed improvements in various measures,but the experimental group had significantly greater improvements(P<0.05).CONCLUSION:Acupuncture combined with upper limb rehabilitation robot can effectively improve upper limb function and neural remodeling in stroke patients.This study supports the integration of Traditional Chinese and Western Medicine in improving limb dysfunction poststroke.展开更多
Objective:This article reviews the latest updates and outcomes of kidney-sparing surgery(KSS)in patients with upper tract urothelial carcinoma(UTUC).Methods:A comprehensive literature search was performed using the Pu...Objective:This article reviews the latest updates and outcomes of kidney-sparing surgery(KSS)in patients with upper tract urothelial carcinoma(UTUC).Methods:A comprehensive literature search was performed using the PubMed and Embase databases to identify related English-language studies published within the last 10 years.Key search words included“upper urinary tract tumour/cancer/carcinoma”,“kidney-sparing surgery or approach”,“endoscopic treatment for upper tract tumour/cancer/carcinoma”,“topical instillation in the upper urinary tract”,and“urinary marker for urothelial carcinoma”.References within the identified literature were explored and evaluated for relevance.Results:KSS is recommended for both low-risk and selected high-risk UTUC with imperative indications such as solitary kidney.Studies have shown comparable oncological outcomes after KSS including endoscopic ablation,segmental ureterectomy,and topical instillation of novel agents when compared to radical nephroureterectomy in well-selected cases.The development of novel diagnostic tools and risk-stratifying models allows optimal case selection for KSS without compromising oncological outcomes.Conclusion:Kidney-sparing approach for UTUC is an evolving and promising area in urologic oncology,driven by advances in technology,better diagnostic tools,and novel therapeutic agents.Our article provides a comprehensive review of the latest advancements and clinical recommendations.While current evidence is mainly based on retrospective studies,prospective trials are required to address important but unanswered clinical questions in this field.展开更多
The Upper Cretaceous successions of Wadi Umm-Khayshar,southern Galala Plateau,North Eastern Desert,Egypt,are composed of highly diversified faunas and subdivided from base to top into the Galala(Middle-Late Cenomanian...The Upper Cretaceous successions of Wadi Umm-Khayshar,southern Galala Plateau,North Eastern Desert,Egypt,are composed of highly diversified faunas and subdivided from base to top into the Galala(Middle-Late Cenomanian),Maghra El Hadida(Latest Cenomanian-Late Turonian),Matulla(Coniacian-Santonian),and Sudr(Campanian-Maastrichtian)formations.Five ammonite biozones are recorded in the studied section:Neolobites vibrayeanus,Vascoceras cauvini(late Cenomanian),Vascoceras proprium,Choffaticeras segne,and Coilopoceras requienianum(Turonian)zones.The paleoenvironments of the Upper Cretaceous succession are interpreted based on detailed study and microfacies analysis that reflect a deposition in a homoclinal ramp platform ranging from intertidal to deep subtidal.The paleoecology of the Cenomanian-Turonian succession in the studied section is explained based on a detailed study of macrofaunal associations and sedimentary facies.Quantitative analysis(Q-mode cluster analysis,using the Raup-Crick Paired group method)of 1029 macrobenthic specimens,including 45 species of mollusks and echinoids yielded five macrofaunal associations(A-E)that are described and interpreted as remnants of communities.The nektonic elements are represented by 235 cephalopod specimens of 20 species;heatmap cluster analyses show the distribution of these specimens during the Upper Cenomanian-Turonian stages.Environmental parameters(substrate consistency,rate of sedimentation,water energy,surface-water productivity,and oxygen availability)controlled the distribution of the studied macrofauna.The five associations are divided into two major groups:low-stress associations(A,B,C,and D),and a highstress association(E).The low stress associations are recorded from two different habitats:(1)a high-energy,firm substrate habitat,dominated by epifaunal bivalves,large epifaunal gastropods and a regular echinoid;(2)a low-energy,soft substrate habitat dominated by infaunal bivalves and echinoids.The high stress association is dominated by only two species and recorded from a high-energy shoal environment during a regression phase.A detailed study of macrobenthos and cephalopods provides a good paleoecological understanding of Cenomanian-Turonian succession in the Wadi Umm-Khayshar section.展开更多
Upper gastrointestinal bleeding (UGIB) refers to the bleeding caused by the digestive tract above the flexor ligament, including esophageal, gastric, duodenal, pancreatic and biliary diseases, and lesions after gastro...Upper gastrointestinal bleeding (UGIB) refers to the bleeding caused by the digestive tract above the flexor ligament, including esophageal, gastric, duodenal, pancreatic and biliary diseases, and lesions after gastrojejunostomy. UGIB is one of the common diseases in the clinical work of gastroenterology. There are many causes that can lead to upper gastrointestinal bleeding, which are mainly divided into two categories: one is non-variceal upper gastrointestinal bleeding (NVUGIB), and the other is variceal upper gastrointestinal bleeding (VUGIB). This article reviews various causes of UGIB and the latest progress in treatment, aiming to improve the efficiency of diagnosis and treatment in future clinical work, and reduce the risk of rebleeding and mortality.展开更多
Objective:To explore the rehabilitation effect of upper limb rehabilitation robots combined with isokinetic muscle strength training on hemiplegic patients in the recovery phase of stroke,and to provide a more effecti...Objective:To explore the rehabilitation effect of upper limb rehabilitation robots combined with isokinetic muscle strength training on hemiplegic patients in the recovery phase of stroke,and to provide a more effective intervention plan for clinical rehabilitation treatment.Methods:One hundred and sixty type 2 stroke patients with hemiplegia in recovery phase treated at Jintan First People’s Hospital from May 2020 to May 2025 were selected as the research subjects.They were divided into a control group(n=80)and an observation group(n=80)using a random number table method.The control group received isokinetic muscle strength training,while the observation group received additional upper limb rehabilitation robot-assisted intervention based on the control group’s treatment.The general information(age,gender,course of disease),Brunnstrum staging,Barthel index,FMA score,and facial expression pain score were compared between the two groups.Results:After treatment,the indicators of both groups improved compared to before treatment.The observation group showed significant advantages in improving various indicators.In terms of Brunnstrum staging,the number of patients in stage IV and above was significantly higher than that in the control group;in terms of the Barthel index,the increase was more significant than that of the control group(P=0.000<0.001).In terms of the FMA score,the increase was more pronounced(P=0.000<0.001);and in terms of facial expression pain assessment,the decrease was more evident(P=0.000<0.01).Conclusion:The combination of upper limb rehabilitation robots and isokinetic muscle strength training can significantly improve the recovery of limb function and activities of daily living in hemiplegic patients during the recovery phase of stroke,and reduce pain.Compared with simple isokinetic muscle strength training,the rehabilitation effect is better,and it is worthy of clinical application.展开更多
文摘[Objectives]To quantify the efficacy of Extracorporeal Shock Wave Therapy(ESWT)for upper limb spasticity in stroke patients using Modified Ashworth Scale(MAS)across three timeframes:immediate,short-term(24 h-4 wks),and long-term(>4 wks).[Methods]Six databases(PubMed,EMBASE,CENTRAL,CINAHL,Scopus,Web of Science)until May 2025,were systematically searched,identifying 11 RCTs(n=505)meeting inclusion criteria(adults≥18 yrs old with stroke-related spasticity[MAS≥1]).Risk of bias was rigorously assessed using Cochrane criteria,revealing uniformly low risk across all domains.Random-effects meta-analyses(REML model)calculated Hedges'g with 95%CI for MAS outcomes,with subgroup analyses for joint-specific effects.[Results]ESWT demonstrated non-significant immediate MAS reduction(g=-0.69,p=0.07;=93.95%),but statistically significant short-term(g=-0.58,p=0.02;I^(2)=89.64%)and long-term effects(g=-0.52,p=0.02;I^(2)=78.72%).Effects were driven by composite MAS scores(short-term g=-0.63;long-term g=-0.56,both p<0.05)rather than isolated joints(elbow/finger/wrist all non-significant).Substantial heterogeneity persisted across analyses,particularly in joint-specific subgroups(I^(2)>90%).[Conclusions]ESWT provides statistically significant,clinically relevant reductions in global upper limb spasticity with durable efficacy beyond four weeks,supporting its use as a non-invasive adjunct therapy despite substantial heterogeneity warranting protocol standardization.
基金Supported by Militar Nueva Granada University of Colombia (Grant No.IMP-ING-3127)。
文摘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.
文摘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.
文摘[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.
基金Under the auspices of National Natural Science Foundation of China (No.41977402,41977194)。
文摘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.
基金Supported by Key Disciplines Group Construction Project of Shanghai Pudong New Area Health Commission,No.PWZxq2022-06Medical discipline Construction Project of Pudong Health Committee of Shanghai,No.PWYgf2021-02+1 种基金Joint Tackling Project of Pudong Health Committee of Shanghai,No.PW2022D08the Medical Innovation Research Project of the Shanghai Science and Technology Commission,No.22Y11908400.
文摘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.
文摘[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.
基金funded by Science Foundation for Youth supported by Shanghai Municipal Health Commission(No.20204Y0313)Sailing Program with the support of Science and Technology Commission of Shanghai Municipality(No.21YF1443800).
文摘Background China is seeing a growing demand for rehabilitation treatments for post-stroke upper limb spastic paresis(PSSP-UL).Although acupuncture is known to be effective for PSSP-UL,there is room to enhance its efficacy.Objective This study explored a semi-personalized acupuncture approach for PSSP-UL that used three-dimensional kinematic analysis(3DKA)results to select additional acupoints,and investigated the feasibility,efficacy and safety of this approach.Design,setting,participants and interventions This single-blind,single-center,randomized,controlled trial involved 74 participants who experienced a first-ever ischemic or hemorrhagic stroke with spastic upper limb paresis.The participants were then randomly assigned to the intervention group or the control group in a 1:1 ratio.Both groups received conventional treatments and acupuncture treatment 5 days a week for 4 weeks.The main acupoints in both groups were the same,while participants in the intervention group received additional acupoints selected on the basis of 3DKA results.Follow-up assessments were conducted for 8 weeks after the treatment.Main outcome measures The primary outcome was the Fugl-Meyer Assessment for Upper Extremity(FMA-UE)response rate(≥6-point change)at week 4.Secondary outcomes included changes in motor function(FMA-UE),Brunnstrom recovery stage(BRS),manual muscle test(MMT),spasticity(Modified Ashworth Scale,MAS),and activities of daily life(Modified Barthel Index,MBI)at week 4 and week 12.Results Sixty-four participants completed the trial and underwent analyses.Compared with control group,the intervention group exhibited a significantly higher FMA-UE response rate at week 4(χ^(2)=5.479,P=0.019)and greater improvements in FMA-UE at both week 4 and week 12(both P<0.001).The intervention group also showed bigger improvements from baseline in the MMT grades for shoulder adduction and elbow flexion at weeks 4 and 12 as well as thumb adduction at week 4(P=0.007,P=0.049,P=0.019,P=0.008,P=0.029,respectively).The intervention group showed a better change in the MBI at both week 4 and week 12(P=0.004 and P=0.010,respectively).Although the intervention group had a higher BRS for the hand at week 12(P=0.041),no intergroup differences were observed at week 4(all P>0.05).The two groups showed no differences in MAS grades as well as in BRS for the arm at weeks 4 and 12(all P>0.05).Conclusion Semi-personalized acupuncture prescription based on 3DKA results significantly improved motor function,muscle strength,and activities of daily living in patients with PSSP-UL.
基金supported by the National Key R&D Program of China(grant number:2023YFC2415200)National Natural Science Foundation of China(grant numbers:82361168664,U24A20759,82441018,82372053,92259302,62027901,82302296)+6 种基金Science and Technology Development Fund of Macao Special Administrative Region(grant number:0006/2023/AFJ)Strategic Priority Research Program of the Chinese Academy of Sciences(grant number:XDB38040200)Beijing Natural Science Foundation(grant numbers:Z20J00105,JQ24048)Scientific and Technological Innovation Project of China Academy of Chinese Medical Sciences(grant number:CI2023C008YG)Key-Area Re-search and Development Program of Guangdong Province(grant number:2021B0101420005)the Youth Innovation Promotion Association CAS(grant number:Y2021049)China Postdoctoral Science Foun-dation under Grant(grant number:2022M720357)。
文摘Upper gastrointestinal cancers,mainly comprising esophageal and gastric cancers,are among the most prevalent cancers worldwide.There are many new cases of upper gastrointestinal cancers annually,and the survival rate tends to be low.Therefore,timely screening,precise diagnosis,appropriate treatment strategies,and effective prognosis are crucial for patients with upper gastrointestinal cancers.In recent years,an increasing number of studies suggest that artificial intelligence(AI)technology can effectively address clinical tasks related to upper gastrointestinal cancers.These studies mainly focus on four aspects:screening,diagnosis,treatment,and progno-sis.In this review,we focus on the application of AI technology in clinical tasks related to upper gastrointestinal cancers.Firstly,the basic application pipelines of radiomics and deep learning in medical image analysis were introduced.Furthermore,we separately reviewed the application of AI technology in the aforementioned aspects for both esophageal and gastric cancers.Finally,the current limitations and challenges faced in the field of upper gastrointestinal cancers were summarized,and explorations were conducted on the selection of AI algorithms in various scenarios,the popularization of early screening,the clinical applications of AI,and large multimodal models.
基金financially supported by the National Key Research and Development Program of China (2022YFC3005600)the Foundation of the Anhui Educational Commission (2023AH051198)+1 种基金the National Natural Science Foundation of China (42125401 and 42104063)the Joint Open Fund of Mengcheng National Geophysical Observatory (MENGO-202201)。
文摘The Tan-Lu Fault Zone is a large NNE-trending fault zone that has a substantial effect on the development of eastern China and its earthquake disaster prevention efforts. Aiming at the azimuthally anisotropic structure in the upper crust and seismogenic tectonics in the Hefei segment of this fault, we collected phase velocity dispersion data of fundamental mode Rayleigh waves from ambient noise cross-correlation functions of ~400 temporal seismographs in an area of approximately 80 × 70 km along the fault zone. The period band of the dispersion data was ~0.5–10 s. We inverted for the upper crustal three-dimensional(3-D) shear velocity model with azimuthal anisotropy from the surface to 10 km depth by using a 3-D direct azimuthal anisotropy inversion method. The inversion result shows the spatial distribution characteristics of the tectonic units in the upper crust. Additionally, the deformation of the Tan-Lu Fault Zone and its conjugated fault systems could be inferred from the anisotropy model. In particular, the faults that have remained active from the early and middle Pleistocene control the anisotropic characteristics of the upper crustal structure in this area. The direction of fast axes near the fault zone area in the upper crust is consistent with the strike of the faults, whereas for the region far away from the fault zone, the direction of fast axes is consistent with the direction of the regional principal stress caused by plate movement. Combined with the azimuthal anisotropy models in the deep crust and uppermost mantle from the surface wave and Pn wave, the different anisotropic patterns caused by the Tan-Lu Fault Zone and its conjugated fault system nearby are shown in the upper and lower crust. Furthermore,by using the double-difference method, we relocated the Lujiang earthquake series, which contained 32 earthquakes with a depth shallower than 10 km. Both the Vs model and earthquake relocation results indicate that earthquakes mostly occurred in the vicinity of structural boundaries with fractured media, with high-level development of cracks and small-scale faults jammed between more rigid areas.
基金supported in part by the National Natural Science Foundation of China(62173255,62188101)Shenzhen Key Laboratory of Control Theory and Intelligent Systems(ZDSYS20220330161800001)
文摘Dear Editor,In this letter,a constrained networked predictive control strategy is proposed for the optimal control problem of complex nonlinear highorder fully actuated(HOFA)systems with noises.The method can effectively deal with nonlinearities,constraints,and noises in the system,optimize the performance metric,and present an upper bound on the stable output of the system.
基金supported by the National Natural Science Foundation of China,Nos.82071426,81873784Clinical Cohort Construction Program of Peking University Third Hospital,No.BYSYDL2019002(all to DF)。
文摘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.
文摘The Upper Cretaceous of Tantou Basin in western Henan has yielded many vertebrate fossils,which are featured by several non-avian dinosaurs.Meanwhile,studies on their eggs were yet inadequate though many eggshells have been reported.The newly discovered material 41HⅤ0199 was excavated from the Upper Cretaceous Qiupa Formation in 2021.The block preserves eight complete eggs arranged in two partial rings that form a partial clutch,and there are some scattered eggshells preserved closely with the block,showing a concave-up to concave-down ratio of 54.5:45.5,which indicates that the scattered eggshells come from the clutch and the clutch had been partially broken before it was buried.Based on morphological and microstructural characteristics,the eggs and eggshells can be assigned to Macroolithus yaotunensis(Elongatoolithidae),an oospecies known to be related to oviraptorids,which leads Yulong mini to be its probable producer.Besides,some eggshells show microstructural signs indicating egg retention,which marks the second example of egg retention in the oofamily Elongatoolithidae.
文摘[Objective]Implementation of the Ten-Year Fishing Ban policy may alter fish diversity and niche characteristics of dominant species in spawning grounds within the National Nature Reserve for Rare and Endemic Fish in the Upper Yangtze River.This study initiated continuous monitoring of natural spawning habitats from February 2022 to assess these ecological changes.[Methods]Environmental DNA(eDNA)metabarcoding was employed to analyze fish species composition,biodiversity patterns,and niche parameters of dominant species.Water sampling followed the CEN/TS 19461 standard across five monitoring transects(ZT1-ZT5).[Results]The eDNA analysis detected 45 species of fish belonging to 38 genera,13 families,and 3 orders were detected through environmental DNA(eDNA)in this survey,including 10 species endemic to the upper reaches of the Yangtze River,such as Procypris rabaudi and Myxocyprinus asiaticus.The fish community was mainly composed of bottom-dwelling,settling ovum-producing,omnivorous fish.The variation ranges of the Chao1 index,ACE index,Shannon index,and Simpson index are 736~996,719~965,1.58~3.23,and 0.83~0.99,respectively,indicating that fish species in spawning sites are abundant and community distribution uniformity is high.All indexes are highest at ZT1 monitoring points.Cluster analysis showed that,at a certain similarity level,fish community types in spawning sites could be basically divided into two groups:ZT1,ZT3,and ZT5 clustered together,and ZT2 and ZT4 clustered together,indicating similar fish community habitats.There are 9 dominant fish species in typical deep pool habitats in the reserve,with niche widths(Bi)ranging from 1.13 to 3.87.The dominant fish species are broad and medium niche fish,such as Cyprinus carpio and Hemiculter tchangi,with the niche overlap index(Oik)of some dominant fish species reaching more than 0.95.This indicates fierce competition for resources among the fish in this spawning ground.[Conclusion]The Zhutuo spawning ground demonstrates high species richness with homogeneous community structure and intense resource competition.This study establishes an eDNA-based monitoring framework that enhances conventional survey method,providing critical baseline data for adaptive management under the fishing moratorium regime.
文摘With the widespread application of WIFI networks and embedded system technology, the device monitoring system based on Embedded System and wireless network came into being. In this paper, we introduce a device monitoring system based on ARM upper computer and WIFI transmission, and we tested this system on workshop equipment. The hardware adopts ARM Cortex-A8 processor architecture of TI company as the main control chip, using IAC-335X-Kit development board for system design, external USB camera module and WIFI wireless module for video capture and data transmission. The software is based on embedded Linux as the platform. The system will collect production data accurately and objectively, and the statistical analysis. At the same time, the system uses QT to develop the upper computer software GUI interface. Compared with the traditional system based on the wired network, our design is more convenient and flexible, which reduces the implementation restriction and maintenance cost of traditional network cabling.
基金Supported by Zhejiang Province Traditional Chinese Medicine Science and Technology Project(2024ZL769):Effect of Xingshen Kaiqiao Acupuncture Method combined with Upper Limb Robot-assisted Training on Upper Limb Function and Neuroplasticity Mechanism of Hemiplegia after Stroke based on Functional Near-Infrared Spectroscopy Technology。
文摘OBJECTIVE:To investigate the effects of acupuncture combined with upper limb rehabilitation robot on neural remodeling and functional recovery in post-stroke patients.METHODS:There were 50 stroke patients were randomly divided into an experimental group(acupuncture combined with upper limb rehabilitation robot assisted training)and a control group(upper limb rehabilitation robot assisted training).Various assessments were conducted to compare the effects of the two treatments on neural remodeling and functional recovery.Functional near-infrared spectroscopy technology was used to assess the effects of different treatments on neural plasticity and their impact on upper limb function and activities of daily living.RESULTS:The experimental group showed significantly higher concentrations of oxygenated hemoglobin and total hemoglobin in specific brain regions compared to the control group(P<0.05).Additionally,the experimental group had significantly lower concentrations of deoxygenated hemoglobin(P<0.05).After treatment,both groups showed improvements in various measures,but the experimental group had significantly greater improvements(P<0.05).CONCLUSION:Acupuncture combined with upper limb rehabilitation robot can effectively improve upper limb function and neural remodeling in stroke patients.This study supports the integration of Traditional Chinese and Western Medicine in improving limb dysfunction poststroke.
文摘Objective:This article reviews the latest updates and outcomes of kidney-sparing surgery(KSS)in patients with upper tract urothelial carcinoma(UTUC).Methods:A comprehensive literature search was performed using the PubMed and Embase databases to identify related English-language studies published within the last 10 years.Key search words included“upper urinary tract tumour/cancer/carcinoma”,“kidney-sparing surgery or approach”,“endoscopic treatment for upper tract tumour/cancer/carcinoma”,“topical instillation in the upper urinary tract”,and“urinary marker for urothelial carcinoma”.References within the identified literature were explored and evaluated for relevance.Results:KSS is recommended for both low-risk and selected high-risk UTUC with imperative indications such as solitary kidney.Studies have shown comparable oncological outcomes after KSS including endoscopic ablation,segmental ureterectomy,and topical instillation of novel agents when compared to radical nephroureterectomy in well-selected cases.The development of novel diagnostic tools and risk-stratifying models allows optimal case selection for KSS without compromising oncological outcomes.Conclusion:Kidney-sparing approach for UTUC is an evolving and promising area in urologic oncology,driven by advances in technology,better diagnostic tools,and novel therapeutic agents.Our article provides a comprehensive review of the latest advancements and clinical recommendations.While current evidence is mainly based on retrospective studies,prospective trials are required to address important but unanswered clinical questions in this field.
文摘The Upper Cretaceous successions of Wadi Umm-Khayshar,southern Galala Plateau,North Eastern Desert,Egypt,are composed of highly diversified faunas and subdivided from base to top into the Galala(Middle-Late Cenomanian),Maghra El Hadida(Latest Cenomanian-Late Turonian),Matulla(Coniacian-Santonian),and Sudr(Campanian-Maastrichtian)formations.Five ammonite biozones are recorded in the studied section:Neolobites vibrayeanus,Vascoceras cauvini(late Cenomanian),Vascoceras proprium,Choffaticeras segne,and Coilopoceras requienianum(Turonian)zones.The paleoenvironments of the Upper Cretaceous succession are interpreted based on detailed study and microfacies analysis that reflect a deposition in a homoclinal ramp platform ranging from intertidal to deep subtidal.The paleoecology of the Cenomanian-Turonian succession in the studied section is explained based on a detailed study of macrofaunal associations and sedimentary facies.Quantitative analysis(Q-mode cluster analysis,using the Raup-Crick Paired group method)of 1029 macrobenthic specimens,including 45 species of mollusks and echinoids yielded five macrofaunal associations(A-E)that are described and interpreted as remnants of communities.The nektonic elements are represented by 235 cephalopod specimens of 20 species;heatmap cluster analyses show the distribution of these specimens during the Upper Cenomanian-Turonian stages.Environmental parameters(substrate consistency,rate of sedimentation,water energy,surface-water productivity,and oxygen availability)controlled the distribution of the studied macrofauna.The five associations are divided into two major groups:low-stress associations(A,B,C,and D),and a highstress association(E).The low stress associations are recorded from two different habitats:(1)a high-energy,firm substrate habitat,dominated by epifaunal bivalves,large epifaunal gastropods and a regular echinoid;(2)a low-energy,soft substrate habitat dominated by infaunal bivalves and echinoids.The high stress association is dominated by only two species and recorded from a high-energy shoal environment during a regression phase.A detailed study of macrobenthos and cephalopods provides a good paleoecological understanding of Cenomanian-Turonian succession in the Wadi Umm-Khayshar section.
文摘Upper gastrointestinal bleeding (UGIB) refers to the bleeding caused by the digestive tract above the flexor ligament, including esophageal, gastric, duodenal, pancreatic and biliary diseases, and lesions after gastrojejunostomy. UGIB is one of the common diseases in the clinical work of gastroenterology. There are many causes that can lead to upper gastrointestinal bleeding, which are mainly divided into two categories: one is non-variceal upper gastrointestinal bleeding (NVUGIB), and the other is variceal upper gastrointestinal bleeding (VUGIB). This article reviews various causes of UGIB and the latest progress in treatment, aiming to improve the efficiency of diagnosis and treatment in future clinical work, and reduce the risk of rebleeding and mortality.
基金Changzhou Applied Basic Research Program(Project No.:CJ20241042)。
文摘Objective:To explore the rehabilitation effect of upper limb rehabilitation robots combined with isokinetic muscle strength training on hemiplegic patients in the recovery phase of stroke,and to provide a more effective intervention plan for clinical rehabilitation treatment.Methods:One hundred and sixty type 2 stroke patients with hemiplegia in recovery phase treated at Jintan First People’s Hospital from May 2020 to May 2025 were selected as the research subjects.They were divided into a control group(n=80)and an observation group(n=80)using a random number table method.The control group received isokinetic muscle strength training,while the observation group received additional upper limb rehabilitation robot-assisted intervention based on the control group’s treatment.The general information(age,gender,course of disease),Brunnstrum staging,Barthel index,FMA score,and facial expression pain score were compared between the two groups.Results:After treatment,the indicators of both groups improved compared to before treatment.The observation group showed significant advantages in improving various indicators.In terms of Brunnstrum staging,the number of patients in stage IV and above was significantly higher than that in the control group;in terms of the Barthel index,the increase was more significant than that of the control group(P=0.000<0.001).In terms of the FMA score,the increase was more pronounced(P=0.000<0.001);and in terms of facial expression pain assessment,the decrease was more evident(P=0.000<0.01).Conclusion:The combination of upper limb rehabilitation robots and isokinetic muscle strength training can significantly improve the recovery of limb function and activities of daily living in hemiplegic patients during the recovery phase of stroke,and reduce pain.Compared with simple isokinetic muscle strength training,the rehabilitation effect is better,and it is worthy of clinical application.
