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Compliant and safe human–robot interaction is an important requirement in lower limb exoskeleton design. Motivated by this need, this paper presents the design of a compatible lower limb exoskeleton with variable stiffness actuation and anthropomorphic joint mechanisms, for walking assistance and gait rehabilitation. A novel variable stiffness actuator (VSA) based on a guide-bar mechanism was designed, to provide force and impedance controllability. By changing the crank length of the mechanism, the stiffness of the actuator is adjusted in a wide range (from 0 to 1301 Nm/rad), at fast speed (about 2582 Nm/rad/s), and with low-energy cost. These features make it possible for online stiffness adjustment during one gait cycle, to change the human–robot coupling behavior and improve the performance of the exoskeleton. An anthropomorphic hip joint mechanism was designed based on a parallelogram linkage and a passive joint compensation approach, which absorbs misalignment and improves kinematic compatibility between the human and the exoskeleton joint. Furthermore, a torque control-based multimode control strategy, which consists of passive mode, active mode, and hybrid mode, was developed for different disease stages. Finally, the torque control performance of the actuator was verified by benchtop test, and experimental validations of the exoskeleton with a human subject were carried out, which demonstrate that compliant human–robot interaction was achieved, and stiffness variation benefits for control performance improvement when the control mode changes.
The sulfur microbial diet (SMD), a dietary pattern associated with 43 sulfur-metabolizing bacteria, may influence gut microbiota composition and contribute to aging process through gut-produced hydrogen sulfide (H2S). We aimed to explore the association between SMD and biological age acceleration, using the cross-sectional study included 71,579 individuals from the UK Biobank. The SMD score was calculated by multiplying β-coefficients by corresponding serving sizes and summing them, based on dietary data collected using the Oxford WebQ, a 24-hour dietary assessment tool. Biological age (BA) was assessed using Klemerae-Doubal (KDM) and PhenoAge methods. The difference between BA and chronological age refers to the age acceleration (AgeAccel), termed “KDMAccel” and “PhenoAgeAccel”. Generalized linear regression was performed. Mediation analyses were used to investigate underlying mediators including body mass index (BMI) and serum aspartate aminotransferase/alanine aminotransferase (AST/ALT) ratio. Following adjustment for multiple variables, a positive association was observed between consuming a dietary pattern with a higher SMD score and both KDMAccel (βQ4vsQ1 = 0.35, 95%CI = 0.27 to 0.44, P<0.001) and PhenoAgeAccel (βQ4vsQ1 = 0.32, 95%CI = 0.23 to 0.41, P<0.001). Each 1-standard deviation increase in SMD score was positively associated with the acceleration of biological age by 7.90% for KDMAccel (P<0.001) and 7.80% for PhenoAgeAccel (P<0.001). BMI and AST/ALT mediated the association. The stratified analysis revealed stronger accelerated aging impacts in males and smokers. Our study indicated a higher SMD score is associated with elevated markers of biological aging, supporting the potential utility of gut microbiota-targeted dietary interventions in attenuating the aging process.
The COVID-19 pandemic has impacted patient’s visits to general practitioners (GPs). However, it is unclear what the impact of COVID-19 has been on the interaction among the local primary care clinics, the GP Department within the hospital and specialists.
Methods:
The interaction among GPs referring to hospital-based specialists and specialists to local doctors was determined, comparing pre-pandemic 2019 and 2020 during the pandemic.
Results:
Reduced referrals from GPs to specialists were consistent with the reduction in specialist referrals back to the local doctors, which dropped by approximately 50% in 2020, particularly in the two most common chronic conditions (hypertension and diabetes mellitus).
Discussion:
Reduced referral of patients from local clinics to Tongren Hospital is probably due to the extensive online training provided to the local GPs to become more competent in handling local patients via telehealth. Our data provide some insight to assist in combatting the pandemic of COVID-19, offering objective evidence of the impact of COVID-19 on patient management by GPs.
This study aimed to estimate the nationwide prevalence of cardiometabolic diseases (CMD) among adults with underweight in the US general population. Using data from the National Health and Nutrition Examination Survey (1999–2020), we estimated the age-standardised prevalence of dyslipidemia, hypertension, diabetes, chronic kidney disease, CVD and the presence of zero or at least two CMD. Multivariable Poisson regressions were used to compare CMD prevalence between subgroups, adjusting for age, sex and race/ethnicity. Among the 855 adults with underweight included, the weighted mean age was 40·8 years, with 68·1 % being women and 70·4 % non-Hispanic White. The estimated prevalence rates were 23·4 % for dyslipidemia (95 % CI 19·4 %, 27·5 %), 15·6 % for hypertension (95 % CI 13·3 %, 17·8 %), 2·5 % for diabetes (95 % CI 1·5 %, 3·5 %), 7·9 % for chronic kidney disease (95 % CI 6·9 %, 8·8 %) and 6·1 % for CVD (95 % CI 4·3 %, 7·9 %). The prevalence of having zero and at least two CMD was 50·6 % (95 % CI 44·1 %, 57·0 %) and 12·3 % (95 % CI 8·1 %, 16·4 %), respectively. Non-Hispanic Black adults had significantly higher prevalence of diabetes (adjusted prevalence ratio, 3·35; 95 % CI 1·35, 8·30) compared with non-Hispanic White adults. In conclusion, approximately half of the underweight adults had at least one CMD, and 12·3 % had at least two CMD. Prevention and management of CMD in underweight adults are critical yet neglected public health challenges.
Barnyardgrass [Echinochloa crus-galli (L.) P. Beauv.] is increasingly infesting imidazolinone-tolerant (IMI-T) rice (Oryza sativa L.) fields in China, and E. crus-galli imazamox resistance has become the major concern for weed management in IMI-T rice fields. In this study, the susceptible population JLGY-3 (S) and the suspected resistant population JHXY-2 (R) collected from IMI-T rice fields were used as research subjects. When treated with imazamox, the JHXY-2 (R) population showed a high level of herbicide resistance with a resistance index of 31.2. JHXY-2 (R) was cross-resistant to all five acetolactate synthase (ALS) inhibitors from different chemical families, but sensitive to herbicides inhibiting acetyl-CoA carboxylase. To understand the reason why JHXY-2 (R) was resistant to imazamox, we performed experiments to characterize potential target-site resistance (TSR) and non–target site resistance (NTSR) mechanisms. A Trp-574-Leu amino acid mutation in ALS and low imazamox ALS sensitivity were the main mechanisms underlying imazamox resistance in this JHXY-2 (R) population. There was no significant difference in ALS gene expression and ALS protein abundance between R and S populations. High-performance liquid chromatography–tandem mass spectrometry analysis showed enhanced metabolism of imazamox in JHXY-2 (R), which was in contrast to the results of pretreatment with a metabolic enzyme inhibitor. Treatments with cytochrome P450 monooxygenase/glutathione S-transferase (P450/GST) inhibitors did not alter the resistance level of JHXY-2 (R) against imazamox. Transcriptome sequencing showed that there was almost no significant difference in the expression of P450 and GST metabolic enzyme genes between R and S populations, and only GSTU1 showed a significant upregulation in the R population, further clarifying the NTSR mechanism of JHXY-2 (R). In conclusion, amino acid mutation and higher enzyme activity of ALS are the main causes of imazamox resistance in JHXY-2 (R). However, given the differences in imazamox residues in the leaves of E. crus-galli, there may still be undetectable NTSR mechanisms that are causing imazamox resistance in the R population.
Kawasaki disease is a systemic vascular disease with an unclear pathophysiology that primarily affects children under the age of five. Research on immune control in Kawasaki disease has been gaining attention. This study aims to apply a bibliometric analysis to examine the present and future directions of immune control in Kawasaki disease.
Methods:
By utilizing the themes “Kawasaki disease,” “Kawasaki syndrome,” and “immune control,” the Web of Science Core Collection database was searched for publications on immune control in Kawasaki disease. This bibliometric analysis was carried out using VOSviewers, CiteSpace, and the R package “bibliometrix.”
Results:
In total, 294 studies on immune control in Kawasaki disease were published in Web of Science Core Collection. The three most significant institutions were Chang Gung University, the University of California San Diego, and Kaohsiung Chang Gung Memorial Hospital. China, the United States, and Japan were the three most important countries. In this research field, Clinical and Experimental Immunology was the top-referred journal, while the New England Journal of Medicine was the most co-cited journal. The Web of Science Core Collection document by McCrindle BW et al. published in 2017 was the most cited reference. Additionally, the author keywords concentrated on “COVID-19,” “SARS-CoV-2,” and “multisystem inflammatory syndrome in children” in recent years.
Conclusion:
The research trends and advancements in immune control in Kawasaki disease are thoroughly summarised in this bibliometric analysis, which is the first to do so. The data indicate recent research frontiers and hot directions, making it easier for researchers to study the immune control of Kawasaki disease.
Fused silica is an optical material with excellent performance, and it is widely used in the fabrication of optics in various high-power laser systems. With the gradual improvement of laser systems, the quality of optics becomes crucial. Taking magnetorheological finishing (MRF), ion beam sputtering etching (IBSE), and advanced mitigation processing (AMP) as the means, this work focuses on exploring the damage characteristics evolution of fused silica under different techniques. In this work, IBSE technique was used to determinedly polish the optical surface after removing damage layer by MRF technique, and AMP technique was applied to etch the surface with a certain depth. Then, 10 J/cm2 (355 nm, 5 ns) laser was used to irradiate the optical surface, and the damage density of optics maintained at a low level, about 0.001/mm2, which proves that MRF, IBSE, and AMP techniques can effectively improve the laser damage resistance of optics.
Maternal syphilis not only seriously affects the quality of life of pregnant women themselves but also may cause various adverse pregnancy outcomes (APOs). This study aimed to analyse the association between the related factors and APOs in maternal syphilis. 7,030 pregnant women infected with syphilis in Henan Province between January 2016 and December 2022 were selected as participants. Information on their demographic and clinical characteristics, treatment status, and pregnancy outcomes was collected. Multivariate logistic regression models and chi-squared automatic interaction detector (CHAID) decision tree models were used to analyse the factors associated with APOs. The multivariate logistic regression results showed that the syphilis infection history (OR = 1.207, 95% CI, 1.035–1.409), the occurrence of abnormality during pregnancy (OR = 5.001, 95% CI, 4.203–5.951), not receiving standard treatment (OR = 1.370, 95% CI, 1.095–1.716), not receiving any treatment (OR = 1.313, 95% CI, 1.105–1.559), and a titre ≥1:8 at diagnosis (OR = 1.350, 95%CI, 1.079–1.690) and before delivery (OR = 1.985, 95%CI, 1.463–2.694) were risk factors. A total of six influencing factors of APOs in syphilis-infected women were screened using the CHAID decision tree model. Integrated prevention measures such as early screening, scientific eugenics assessment, and standard syphilis treatment are of great significance in reducing the incidence of APOs for pregnant women infected with syphilis.
We present the third data release from the Parkes Pulsar Timing Array (PPTA) project. The release contains observations of 32 pulsars obtained using the 64-m Parkes ‘Murriyang’ radio telescope. The data span is up to 18 yr with a typical cadence of 3 weeks. This data release is formed by combining an updated version of our second data release with $\sim$3 yr of more recent data primarily obtained using an ultra-wide-bandwidth receiver system that operates between 704 and 4032 MHz. We provide calibrated pulse profiles, flux density dynamic spectra, pulse times of arrival, and initial pulsar timing models. We describe methods for processing such wide-bandwidth observations and compare this data release with our previous release.
A new compact wideband filtering balun based on substrate-integrated suspended line technology is presented in this brief. The proposed device is composed of a λg/4 suspended stripline open-circuited stub, a λg/2 suspended stripline resonator, and a λg/2 suspended slotline resonator. These striplines and slotline are encapsulated in an electromagnetic (EM) shielding box consisting of air cavity, surrounding substrate layers, and metal layers to achieve EM shielding performance. By properly exciting the suspended stripline and slotline resonators, three transmission poles are generated to achieve high frequency selectively. The intrinsic 180∘ phase difference between the two output ports can be obtained by using the electric field distribution caused by the perpendicular coupling between the suspension stripline and the slotline resonator. The wideband passband is achieved with magnitude balance and out-of-phase properties. To validate our proposal, a wideband filtering balun operating at 2.56 GHz with fractional bandwidth of 65.6% is designed and fabricated.
Two wideband bandstop filters (BSFs) for single and dual-band are proposed and then extended to reflectionless BSFs based on the analysis from input impedance/admittance perspective. Also, topologies of higher-number-stopband input-reflectionless BSF are provided to broaden the design scope. Open/shorted coupled lines are adopted to obtain multi transmission zeros and desired stopband bandwidth by adjusting the even-/odd-mode impedance of coupled lines. Resistor-loaded coupled lines are connected with Port 1 to absorb unwanted signals and obtain input-reflectionless behavior. For validation of the proposed theory analysis, BSFs with corresponding absorptive prototypes are constructed and measured.
Genetic approaches are increasingly advantageous in characterizing treatment-resistant schizophrenia (TRS). We aimed to identify TRS-associated functional brain proteins, providing a potential pathway for improving psychiatric classification and developing better-tailored therapeutic targets.
Methods
TRS-related proteome-wide association studies (PWAS) were conducted on genome-wide association studies (GWAS) from CLOZUK and the Psychiatric Genomics Consortium (PGC), which provided TRS individuals (n = 10,501) and non-TRS individuals (n = 20,325), respectively. The reference datasets for the human brain proteome were obtained from ROS/MAP and Banner, with 8,356 and 11,518 proteins collected, respectively. We then performed colocalization analysis and functional enrichment analysis to further explore the biological functions of the proteins identified by PWAS.
Results
In PWAS, two statistically significant proteins were identified using the ROS/MAP and then replicated using the Banner reference dataset, including CPT2 (PPWAS-ROS/MAP = 4.15 × 10−2 and PPWAS-Banner = 3.38 × 10−3) and APOL2 (PPWAS-ROS/MAP = 4.49 × 10−3 and PPWAS-Banner = 8.26 × 10−3). Colocalization analysis identified three variants that were causally related to protein expression in the human brain, including CCDC91 (PP4 = 0.981), PRDX1 (PP4 = 0.894), and WARS2 (PP4 = 0.757). We extended PWAS results from gene-based analysis to pathway-based analysis, identifying 14 gene ontology (GO) terms and the only candidate pathway for TRS, metabolic pathways (all P < 0.05).
Conclusions
Our results identified two protein biomarkers, and cautiously support that the pathological mechanism of TRS is linked to lipid oxidation and inflammation, where mitochondria-related functions may play a role.
Objectives: Medical devices and the hospital environment can be contaminated easily by multidrug-resistant bacteria. The effectiveness of cleaning practices is often suboptimal because environmental cleaning in hospitals is complex and depends on human factors, the physical and chemical characteristics of environment, and the viability of the microorganisms. Ultraviolet-C (UV-C) lamps can be used to reduce the spread of microorganisms. We evaluated the effectiveness of an ultraviolet-C (UV-C) device on terminal room cleaning and disinfection. Methods: The study was conducted at an ICU of a medical center in Taiwan. We performed a 3-stage evaluation for the effectiveness of UV-C radiation, including pre–UV-C radiation, UV-C radiation, and a bleaching procedure. The 3 stages of evaluation were implemented in the ICU rooms from which a patient had been discharged or transferred. We collected the data from adenosine triphosphate (ATP) bioluminescence testing, colonized strains, and their corresponding colony counts by sampling from the environmental surfaces and air. We tested 8 high-touch surfaces, including 2 sides of bed rails, headboards, footboards, bedside tables, monitors, pumping devices, IV stands, and oxygen flow meters. Results: In total, 1,696 environmental surfaces and 72 air samples were analyzed. The levels of ATP bioluminescence and colony counts of isolated bacteria decreased significantly after UV-C radiation and bleaching disinfection for both the environmental and air samples (P < .001). Resistant bacteria (vancomycin-resistant Enterococcus, VRE) were commonly isolated on the hard-to-clean surfaces of monitors, oxygen flow meters, and IV pumps. However, they were also eradicated (P < .001). Conclusions: UV-C can significantly reduce environmental contamination by multidrug-resistant microorganisms. UV-C is an effective device to assist staff in cleaning the hospital environment.
To explore the effect of yield stress on the secondary breakup of gel drops, experimental and theoretical investigations are carried out by employing a high-speed camera. A unique hemline-type breakup, as a modified behaviour of sheet-thinning breakup, occurs when the air velocity increases to a high region. The edges of the drops constantly deform into thin membranes when the high-velocity air skims over the gel drops. These membranes vibrate vertically, and breaking points occur at high amplitudes, causing the formation of reticular fragments. The results of linear stability analysis indicated that the yield stress of the gel drops has an influence on the formation and breakup of the gel membranes. The breakup regime map and breakup times are also studied.
Recently, the collisionless pitch-angle scattering for relativistic runaway electrons (REs) in toroidal geometries such as tokamaks was discovered through a full orbit simulation approach (Liu et al., Nucl. Fusion, vol. 56, 2016, p. 064002), and it was then theoretically investigated that a new expression for the magnetic moment, including the second-order corrections, could essentially reproduce the so-called collisionless pitch-angle scattering process (Liu et al., Nucl. Fusion, vol. 58, 2018, p. 106018). In this paper, with synchrotron radiation, extensive numerical verification of the validity of the high-order guiding-centre theory is given for simulations involving REs by incorporating such an expression for the magnetic moment into our particle tracing code. A high-order guiding-centre simulation approach with synchrotron radiation (HGSA) is applied. Synchrotron radiation plays an essential role in the life cycle of REs. The energy of REs first increases and then becomes saturated until the electric field acceleration is balanced by the radiation dissipation. Unfortunately, the process cannot be simulated accurately with the standard guiding-centre model, i.e. the first-order guiding-centre model. Remarkably, it is found that the HGSA can effectively produce the fundamental process of REs. Since the time scale of the energy saturation of REs is close to seconds, the computational cost becomes significant. In order to save costs, it is necessary to estimate the time of energy saturation. An analytical estimate is derived for the time it takes for synchrotron drag to balance an accelerating electric field and the provided formula has been numerically verified. Test calculations reveal that HGSA is favourable for exploiting the dynamics of REs in tokamak plasmas.
In this study, a toroidal quartz (
$20\overline{2}3$
) crystal is designed for monochromatic X-ray imaging at 72.3°. The designed crystal produces excellent images of a laser-produced plasma emitting He-like Ti X-rays at 4.75 keV. Based on the simulations, the imaging resolutions of the spherical and toroidal crystals in the sagittal direction are found to be 15 and 5 μm, respectively. Moreover, the simulation results show that a higher resolution image of the source can be obtained by using a toroidal crystal. An X-ray backlight imaging experiment is conducted using 4.75 keV He-like Ti X-rays, a 3 × 3 metal grid, an imaging plate and a toroidal quartz crystal with a lattice constant of 2d = 0.2749 nm. The meridional and sagittal radii of the toroidal α-quartz crystal are 295.6 and 268.5 mm, respectively. A highly resolved image of the microgrid, with a spatial resolution of 10 μm, is obtained in the experiment. By using similar toroidal crystal designs, the application of a spatially resolved spectrometer with high-resolution X-ray imaging ability is capable of providing imaging data with the same magnification ratio in the sagittal and meridional planes.
Based on hubs of neural circuits associated with addiction and their degree centrality (DC), this study aimed to construct the addiction-related brain networks for patients diagnosed with heroin dependence undertaking stable methadone maintenance treatment (MMT) and further prospectively identify the ones at high risk for relapse with cluster analysis.
Methods
Sixty-two male MMT patients and 30 matched healthy controls (HC) underwent brain resting-state functional MRI data acquisition. The patients received 26-month follow-up for the monthly illegal-drug-use information. Ten addiction-related hubs were chosen to construct a user-defined network for the patients. Then the networks were discriminated with K-means-clustering-algorithm into different groups and followed by comparative analysis to the groups and HC. Regression analysis was used to investigate the brain regions significantly contributed to relapse.
Results
Sixty MMT patients were classified into two groups according to their brain-network patterns calculated by the best clustering-number-K. The two groups had no difference in the demographic, psychological indicators and clinical information except relapse rate and total heroin consumption. The group with high-relapse had a wider range of DC changes in the cortical−striatal−thalamic circuit relative to HC and a reduced DC in the mesocorticolimbic circuit relative to the low-relapse group. DC activity in NAc, vACC, hippocampus and amygdala were closely related with relapse.
Conclusion
MMT patients can be identified and classified into two subgroups with significantly different relapse rates by defining distinct brain-network patterns even if we are blind to their relapse outcomes in advance. This may provide a new strategy to optimize MMT.