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Abstract Introduction About 17–80% stroke survivors experience the deficit of upper limb function, which strongly influences their independence and quality of life. Robot-assisted training and functional electrical stimulation are commonly used interventions in the rehabilitation of hemiplegia upper extremities, while the effect of their combination remains unclear. The aim of this trial is to explore the effect of robot-assisted upper limb training combined with functional electrical stimulation, in terms of neuromuscular rehabilitation, compared with robot-assisted upper limb training alone. Methods Individuals (n = 60) with the first onset of stroke (more than 1 week and less than 1 year after stroke onset) will be considered in the recruitment of this single-blinded, three-arm randomized controlled trial. Participants will be allocated into three groups (robot-assisted training combined with functional electrical stimulation group, robot-assisted training group, and conventional rehabilitation therapies group) with a ratio of 1:1:1. All interventions will be executed for 45 min per session, one session per day, 5 sessions per week for 6 weeks. The neuromuscular function of the upper limb (Fugl-Meyer Assessment of upper extremity), ability of daily life (modified Barthel Index), pain (visual analogue scale), and quality of life (EQ-5D-5L) will be assessed at the baseline, at the end of this trial and after 3 months follow-up. Two-way repeated measures analysis of variance will be used to compare the outcomes if the data are normally distributed. Simple effects tests will be used for the further exploration of interaction effects by time and group. Scheirer-Ray-Hare test will be used if the data are not satisfied with normal distribution. Discussion We expect this three-arm randomized controlled trial to explore the effectiveness of robot-assisted training combined with functional electrical stimulation in improving post-stroke upper limb function compared with robot-assisted training alone. Trial registration Effect of upper limb robot on improving upper limb function after stroke, identifier: ChiCTR2300073279. Registered on 5 July 2023.

BACKGROUND: Aedes albopictus is a major vector for several tropical infectious diseases. Characterization of Ae. albopictus development under natural conditions is crucial for monitoring vector population expansion, dengue virus transmission, and disease outbreak preparedness. METHODS: This study employed mosquito traits as a proxy to understanding life-table traits in mosquitoes using a semi-field study. Ae. albopictus larval and adult life-table experiments were conducted using microcosms under semi-field conditions in Guangzhou. Stage-specific development times and survivorship rates were determined and compared under semi-field conditions in different seasons from early summer (June) to winter (January), to determine the lower temperature limit for larval development and adult survivorship and reproductivity. RESULTS: The average egg- hatching rate was 60.1%, with the highest recorded in October (77.1%; mid-autumn). The larval development time was on average 13.2 days (range, 8.5-24.1 days), with the shortest time observed in September(8.7 days; early autumn) and longest in November (22.8 days). The pupation rates of Ae. albopictus larvae were on average 88.9% (range, 81.6-93.4%); they were stable from June to September but decreased from October to November. The adult emergence rates were on average 82.5% (range, 76.8-87.9%) and decreased from July to November. The median survival time of Ae. albopictus adults was on average 7.4 (range, 4.5-9.8), with the shortest time recorded in September. The average lifetime egg mass under semi-field conditions was 37.84 eggs/female. The larvae could develop into adults at temperatures as low as 12.3°C, and the adults could survive for 30.0 days at 16.3°C and still produce eggs. Overall, correlation analysis found that mean temperature and relative humidity were variables significantly affecting larval development and adult survivorship. CONCLUSION: Ae. albopictus larvae could develop and emerge and the adults could survive and produce eggs in early winter in Guangzhou. The major impact of changes in ambient temperature, relative humidity, and light intensity was on the egg hatching rates, adult survival time, and egg mass production, rather than on pupation or adult emergence rates.

Background Vertebral artery injury (VAI) during cervical spine surgery is rare. Anterior controllable ante‐displacement and fusion (ACAF) surgery is a novel technique for treating degenerative cervical spine disorders, especially ossification of the posterior longitudinal ligament. To date, there have been no reports of VAI during cervical ACAF surgery. Here, we report a rare case of perioperative complication of VAI during ACAF surgery. The available English literature that provides treatment instructions were reviewed. Case Presentation A patient diagnosed with mixed ossification of the posterior longitudinal ligament (OPLL) underwent ACAF surgery from C2–C6. Two level transverse foramina were ruptured, and severe bleeding was encountered during ACAF osteotomy. Hemostatic tamponade was performed using bone waxes. The patient had delayed hemorrhage on postoperative day 6. Emergence angiography revealed two vertebral artery pseudoaneurysms in the ruptured transverse foramina. A balloon‐expandable covered stent was deployed to treat the pseudoaneurysm. The patient recovered without complications. Conclusion ACAF surgery is a good choice for multiple‐level OPLL disease, but special attention should be paid to VAI in the perioperative period. Intraoperative tamponade with bone wax and postoperative digital subtraction angiography (DSA) are effective in preventing disaster‐related hemorrhage.

Background There is limited data on antibiotic treatment in hospitalized neonates in low- and middle-income countries (LMICs). We aimed to describe patterns of antibiotic use, pathogens, and clinical outcomes, and to develop a severity score predicting mortality in neonatal sepsis to inform future clinical trial design. Methods and findings Hospitalized infants A total of 3,204 infants were enrolled, with median birth weight of 2,500 g (IQR 1,400 to 3,000) and postnatal age of 5 days (IQR 1 to 15). 206 different empiric antibiotic combinations were started in 3,141 infants, which were structured into 5 groups based on the World Health Organization (WHO) AWaRe classification. Approximately 25.9% (n = 814) of infants started WHO first line regimens (Group 1-Access) and 13.8% (n = 432) started WHO second-line cephalosporins (cefotaxime/ceftriaxone) (Group 2-'Low' Watch). The largest group (34.0%, n = 1,068) started a regimen providing partial extended-spectrum beta-lactamase (ESBL)/pseudomonal coverage (piperacillin-tazobactam, ceftazidime, or fluoroquinolone-based) (Group 3-'Medium' Watch), 18.0% (n = 566) started a carbapenem (Group 4-'High' Watch), and 1.8% (n = 57) a Reserve antibiotic (Group 5, largely colistin-based), and 728/2,880 (25.3%) of initial regimens in Groups 1 to 4 were escalated, mainly to carbapenems, usually for clinical deterioration (n = 480; 65.9%). A total of 564/3,195 infants (17.7%) were blood culture pathogen positive, of whom 62.9% (n = 355) had a gram-negative organism, predominantly Klebsiella pneumoniae (n = 132) or Acinetobacter spp. (n = 72). Both were commonly resistant to WHO-recommended regimens and to carbapenems in 43 (32.6%) and 50 (71.4%) of cases, respectively. MRSA accounted for 33 (61.1%) of 54 Staphylococcus aureus isolates. Overall, 350/3,204 infants died (11.3%; 95% CI 10.2% to 12.5%), 17.7% if blood cultures were positive for pathogens (95% CI 14.7% to 21.1%, n = 99/564). A baseline NeoSep Severity Score had a C-index of 0.76 (0.69 to 0.82) in the validation sample, with mortality of 1.6% (3/189; 95% CI: 0.5% to 4.6%), 11.0% (27/245; 7.7% to 15.6%), and 27.3% (12/44; 16.3% to 41.8%) in low (score 0 to 4), medium (5 to 8), and high (9 to 16) risk groups, respectively, with similar performance across subgroups. A related NeoSep Recovery Score had an area under the receiver operating curve for predicting death the next day between 0.8 and 0.9 over the first week. There was significant variation in outcomes between sites and external validation would strengthen score applicability. Conclusion Antibiotic regimens used in neonatal sepsis commonly diverge from WHO guidelines, and trials of novel empiric regimens are urgently needed in the context of increasing antimicrobial resistance (AMR). The baseline NeoSep Severity Score identifies high mortality risk criteria for trial entry, while the NeoSep Recovery Score can help guide decisions on regimen change. NeoOBS data informed the NeoSep1 antibiotic trial (ISRCTN48721236), which aims to identify novel first- and second-line empiric antibiotic regimens for neonatal sepsis. Trial registration ClinicalTrials.gov, (NCT03721302)., Author(s): Neal J. Russell 1,*, Wolfgang Stöhr 2, Nishad Plakkal 3, Aislinn Cook 1, James A. Berkley 4,5,6, Bethou Adhisivam 3, Ramesh Agarwal 7, Nawshad Uddin Ahmed 8, Manica Balasegaram [...]

To study the influence of buildings layout on the wind environment of residential district, this paper takes a residential district in Zhuhai as the research object. Based on the local climatic characteristics, the PHOENICS software is used to conduct CFD (computational fluid dynamics) simulation of wind environment for two kinds of buildings layout with and without podium buildings. The ventilation conditions and comfort of the two kinds of layout under the background of east, south and northnortheast wind were compared and analyzed, and the results are as follows: 1) When there is no podium building, the wind environment of the residential district under the three wind directions are improved without the obstruction of large-scale buildings, the unevenness of the wind speed is reduced, the size and number of areas with good ventilation conditions and good comfort are increased, the size and number of areas with low wind speed are reduced, and the ventilation corridors are increased. 2) Whether there are podium buildings or not, when the angle between the incoming flow direction and the passage of the building is small, the building's wind blocking and weakening effect is small, and ventilation corridors are more easily formed between buildings with better ventilation conditions. When the angle between the incoming flow direction and the passage of the building is large, the building's blocking effect is significant, the wind speed of the residential district is significantly weakened and it is prone to be uneven, so the ventilation conditions are poor. 3) The wind environment of residential district is jointly affected by buildings layout and wind direction, and the local dominant wind should be taken into account in the planning and design of residential district. [ABSTRACT FROM AUTHOR]

The study investigates the relationship between traffic accidents in expressway tunnels and their influencing factors, with the aim of predicting traffic accidents within tunnels and presenting reasonable recommendations to improve tunnel safety. The study utilizes a dataset of 586 traffic accidents occurring exclusively within 8 tunnels along a Guangdong Province expressway from 2017 to 2021. It applies the geometric alignment consistency principle to segment road sections, defines tunnel boundaries based on driving behavior, and employs a Bayesian-modified negative binomial regression model (B-NB model) to identify 6 significant variables from a pool of 17 factors. The predictive performance of the B-NB model demonstrated similarities to that of the fixed parametric model. This outcome might be attributed to the chosen prior distribution settings and the limited amount of data. Nonetheless, the model effectively captures relationships among variables, leading to improved accuracy in accident prediction and the predictive model achieves a 76.1% accuracy rate. Drawing from the estimation results, practical measures are suggested across three dimensions: road geometric alignment design, tunnel traffic safety facilities, and traffic emergency management. These proposals aim to ameliorate the severe consequences of tunnel accidents. Future research will explore an in-depth comparison of estimation results, considering the impact of time and variable correlation on the prediction model by expanding the existing data. This will guide the direction of subsequent research endeavors. [ABSTRACT FROM AUTHOR]

Cisplatin, a potent chemotherapy agent, is highly effective against various cancers but is hindered by resistance and toxicities. This study aims to investigate the roles of SLC7A11, a cystine/glutamate transporter, in cisplatin resistance, and explored Tanshinone IIA as a therapeutic option. Cisplatin reduced SLC7A11 in renal cells, worsening toxicity. Cisplatin‐resistant gastric cancer cells show increased SLC7A11, driving resistance, while SLC7A11 knockdown curbed resistance. Tanshinone IIA showed promise in alleviating cisplatin toxicity by enhancing SLC7A11 expression and reducing associated adverse effects, while it effectively reversed cisplatin resistance in gastric cancer cells by suppressing SLC7A11. Additionally, Tanshinone IIA counteracted cisplatin resistance by inhibiting PIAS4‐mediated SUMOylation of SLC7A11. Simultaneously, overexpressing miR‐375, which has been shown to target SLC7A11, exacerbated cisplatin toxicity via SLC7A11 downregulation, which Tanshinone IIA attenuates. In summary, our study unveils complex SLC7A11 regulation in cisplatin resistance and toxicity. Tanshinone IIA emerges as a promising modulator of SLC7A11 through individual pathways, offering novel insights into overcoming cisplatin resistance and reducing toxicities in cancer therapy. [ABSTRACT FROM AUTHOR]

Alpha‐2‐glycoprotein 1, zinc‐binding (AZGP1) is a secreted protein, which has been shown to be a potential biomarker of cancer progression; however, its roles in breast cancer are still unclear. Currently, we analyzed the online datasets and found that AZGP1 was highly expressed in breast cancer tissues and its expression was negatively correlated with the survival of breast cancer patients. Functional experiments through AZGP1 knockdown revealed that AZGP1 could promote the proliferation, migration, and invasion ability of breast cancer cells. In vivo experiments obtained a consistent result. Mechanistically, it was found that AZGP1 interacted with tripartite motif‐containing protein 25 (TRIM25), which subsequently promoted AZGP1 degradation through facilitating the ubiquitination. Furthermore, overexpression of TRIM25 partially reversed the promoting effects of AZGP1 overexpression on breast cancer progression. Therefore, this study indicates that AZGP1 might be a potential therapeutic target for breast cancer treatment. [ABSTRACT FROM AUTHOR]