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1.
Horm Metab Res ; 55(11): 771-780, 2023 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-37402380

RESUMEN

The influence of acute glycemic variability (GV) on early outcomes of patients after cardiac surgery remains not fully determined. We performed a systematic review and meta-analysis to evaluate the association between acute GV and in-hospital outcomes of patients after cardiac surgery. Relevant observational studies were obtained by search of electronic databases including Medline, Embase, Cochrane Library, and Web of Science. A randomized-effects model was selected to pool the data by incorporating the influence of potential heterogeneity. Nine cohort studies involving 16 411 patients after cardiac surgery were included in this meta-analysis. Pooled results showed that a high acute GV was associated with an increased risk of major adverse events (MAE) during hospitalization for patients after cardiac surgery [odds ratio [OR]: 1.29, 95% CI: 1.15 to 1.45, p<0.001, I22=38%]. Sensitivity analysis limited to studies of on-pump surgery and GV evaluated by coefficient of variation of blood glucose showed similar results. Subgroup analysis suggested that a high acute GV was related to an increased incidence of MAE in patients after coronary artery bypass graft, but not for those after isolated valvular surgery (p=0.04), and the association was weakened after adjustment of glycosylated hemoglobin (p=0.01). Moreover, a high acute GV was also related to an increased risk of in-hospital mortality (OR: 1.55, 95% CI: 1.15 to 2.09, p=0.004; I22=0%). A high acute GV may be associated with poor in-hospital outcomes in patients after cardiac surgery.


Asunto(s)
Procedimientos Quirúrgicos Cardíacos , Hiperglucemia , Humanos , Procedimientos Quirúrgicos Cardíacos/efectos adversos , Glucemia , Hemoglobina Glucada , Hospitalización , Hiperglucemia/etiología
2.
J Neuroeng Rehabil ; 20(1): 10, 2023 01 21.
Artículo en Inglés | MEDLINE | ID: mdl-36681852

RESUMEN

BACKGROUND: Few, if any estimates of cost-effectiveness for locomotor training strategies following spinal cord injury (SCI) are available. The purpose of this study was to estimate the cost-effectiveness of locomotor training strategies following spinal cord injury (overground robotic locomotor training versus conventional locomotor training) by injury status (complete versus incomplete) using a practice-based cohort. METHODS: A probabilistic cost-effectiveness analysis was conducted using a prospective, practice-based cohort from four participating Spinal Cord Injury Model System sites. Conventional locomotor training strategies (conventional training) were compared to overground robotic locomotor training (overground robotic training). Conventional locomotor training included treadmill-based training with body weight support, overground training, and stationary robotic systems. The outcome measures included the calculation of quality adjusted life years (QALYs) using the EQ-5D and therapy costs. We estimate cost-effectiveness using the incremental cost utility ratio and present results on the cost-effectiveness plane and on cost-effectiveness acceptability curves. RESULTS: Participants in the prospective, practice-based cohort with complete EQ-5D data (n = 99) qualified for the analysis. Both conventional training and overground robotic training experienced an improvement in QALYs. Only people with incomplete SCI improved with conventional locomotor training, 0.045 (SD 0.28), and only people with complete SCI improved with overground robotic training, 0.097 (SD 0.20). Costs were lower for conventional training, $1758 (SD $1697) versus overground robotic training $3952 (SD $3989), and lower for those with incomplete versus complete injury. Conventional overground training was more effective and cost less than robotic therapy for people with incomplete SCI. Overground robotic training was more effective and cost more than conventional training for people with complete SCI. The incremental cost utility ratio for overground robotic training for people with complete spinal cord injury was $12,353/QALY. CONCLUSIONS: The most cost-effective locomotor training strategy for people with SCI differed based on injury completeness. Conventional training was more cost-effective than overground robotic training for people with incomplete SCI. Overground robotic training was more cost-effective than conventional training for people with complete SCI. The effect estimates may be subject to limitations associated with small sample sizes and practice-based evidence methodology. These estimates provide a baseline for future research.


Asunto(s)
Procedimientos Quirúrgicos Robotizados , Robótica , Traumatismos de la Médula Espinal , Humanos , Análisis de Costo-Efectividad , Estudios Prospectivos , Caminata
3.
Sensors (Basel) ; 23(5)2023 Feb 23.
Artículo en Inglés | MEDLINE | ID: mdl-36904680

RESUMEN

Specific emitter identification (SEI) and automatic modulation classification (AMC) are generally two separate tasks in the field of radio monitoring. Both tasks have similarities in terms of their application scenarios, signal modeling, feature engineering, and classifier design. It is feasible and promising to integrate these two tasks, with the benefit of reducing the overall computational complexity and improving the classification accuracy of each task. In this paper, we propose a dual-task neural network named AMSCN that simultaneously classifies the modulation and the transmitter of the received signal. In the AMSCN, we first use a combination of DenseNet and Transformer as the backbone network to extract the distinguishable features; then, we design a mask-based dual-head classifier (MDHC) to reinforce the joint learning of the two tasks. To train the AMSCN, a multitask cross-entropy loss is proposed, which is the sum of the cross-entropy loss of the AMC and the cross-entropy loss of the SEI. Experimental results show that our method achieves performance gains for the SEI task with the aid of additional information from the AMC task. Compared with the traditional single-task model, our classification accuracy of the AMC is generally consistent with the state-of-the-art performance, while the classification accuracy of the SEI is improved from 52.2% to 54.7%, which demonstrates the effectiveness of the AMSCN.

4.
J Opt Soc Am A Opt Image Sci Vis ; 39(8): 1498-1504, 2022 Aug 01.
Artículo en Inglés | MEDLINE | ID: mdl-36215595

RESUMEN

This research explores the focusing characteristics of a polarization mixing quadratic space-variant phase-modulated sinh-Gaussian vortex beam. Various intriguing evolutionary trends of the focal pattern are demonstrated by the modulation of each parameter. The results show that the adjustable parameter C makes the focusing spot form an optical chain structure. The length of the structure and the number of dark optical traps in the structure can be altered by adjusting C. Simultaneously, the variation of beam order m will cause focal spot deformation. Moreover, the variation of the focal pattern indicates that polarization parameter B has the ability to adjust the position of the spot. In addition, the influence of topological charge l on the component field is also discussed. With the introduction of a polarization mixing quadratic space-variant phase, the focal pattern obtains a series of unique characteristics. These results have potential value for cutting-edge optical applications such as optical shaping, optical transmission, and multiple optical capture.

5.
Arch Phys Med Rehabil ; 103(4): 665-675, 2022 04.
Artículo en Inglés | MEDLINE | ID: mdl-34648804

RESUMEN

OBJECTIVE: To characterize individuals with spinal cord injuries (SCI) who use outpatient physical therapy or community wellness services for locomotor training and predict the duration of services, controlling for demographic, injury, quality of life, and service and financial characteristics. We explore how the duration of services is related to locomotor strategy. DESIGN: Observational study of participants at 4 SCI Model Systems centers with survival. Weibull regression model to predict the duration of services. SETTING: Rehabilitation and community wellness facilities at 4 SCI Model Systems centers. PARTICIPANTS: Eligibility criteria were SCI or dysfunction resulting in motor impairment and the use of physical therapy or community wellness programs for locomotor/gait training. We excluded those who did not complete training or who experienced a disruption in training greater than 45 days. Our sample included 62 participants in conventional therapy and 37 participants in robotic exoskeleton training. INTERVENTIONS: Outpatient physical therapy or community wellness services for locomotor/gait training. MAIN OUTCOME MEASURES: SCI characteristics (level and completeness of injury) and the duration of services from medical records. Self-reported perceptions of SCI consequences using the SCI-Functional Index for basic mobility and SCI-Quality of Life measurement system for bowel difficulties, bladder difficulties, and pain interference. RESULTS: After controlling for predictors, the duration of services for the conventional therapy group was an average of 63% longer than for the robotic exoskeleton group, however each visit was 50% shorter in total time. Men had an 11% longer duration of services than women had. Participants with complete injuries had a duration of services that was approximately 1.72 times longer than participants with incomplete injuries. Perceived improvement was larger in the conventional group. CONCLUSIONS: Locomotor/gait training strategies are distinctive for individuals with SCI using a robotic exoskeleton in a community wellness facility as episodes are shorter but individual sessions are longer. Participants' preferences and the ability to pay for ongoing services may be critical factors associated with the duration of outpatient services.


Asunto(s)
Dispositivo Exoesqueleto , Traumatismos de la Médula Espinal , Femenino , Marcha , Humanos , Masculino , Pacientes Ambulatorios , Modalidades de Fisioterapia , Calidad de Vida , Traumatismos de la Médula Espinal/rehabilitación
6.
Spinal Cord ; 60(6): 522-532, 2022 06.
Artículo en Inglés | MEDLINE | ID: mdl-35094007

RESUMEN

STUDY DESIGN: Clinical trial. OBJECTIVE: To demonstrate that a 12-week exoskeleton-based robotic gait training regimen can lead to a clinically meaningful improvement in independent gait speed, in community-dwelling participants with chronic incomplete spinal cord injury (iSCI). SETTING: Outpatient rehabilitation or research institute. METHODS: Multi-site (United States), randomized, controlled trial, comparing exoskeleton gait training (12 weeks, 36 sessions) with standard gait training or no gait training (2:2:1 randomization) in chronic iSCI (>1 year post injury, AIS-C, and D), with residual stepping ability. The primary outcome measure was change in robot-independent gait speed (10-meter walk test, 10MWT) post 12-week intervention. Secondary outcomes included: Timed-Up-and-Go (TUG), 6-min walk test (6MWT), Walking Index for Spinal Cord Injury (WISCI-II) (assistance and devices), and treating therapist NASA-Task Load Index. RESULTS: Twenty-five participants completed the assessments and training as assigned (9 Ekso, 10 Active Control, 6 Passive Control). Mean change in gait speed at the primary endpoint was not statistically significant. The proportion of participants with improvement in clinical ambulation category from home to community speed post-intervention was greatest in the Ekso group (>1/2 Ekso, 1/3 Active Control, 0 Passive Control, p < 0.05). Improvements in secondary outcome measures were not significant. CONCLUSIONS: Twelve weeks of exoskeleton robotic training in chronic SCI participants with independent stepping ability at baseline can improve clinical ambulatory status. Improvements in raw gait speed were not statistically significant at the group level, which may guide future trials for participant inclusion criteria. While generally safe and tolerable, larger gains in ambulation might be associated with higher risk for non-serious adverse events.


Asunto(s)
Dispositivo Exoesqueleto , Procedimientos Quirúrgicos Robotizados , Robótica , Traumatismos de la Médula Espinal , Terapia por Ejercicio , Marcha , Humanos , Traumatismos de la Médula Espinal/complicaciones , Caminata
7.
Sensors (Basel) ; 22(7)2022 Mar 25.
Artículo en Inglés | MEDLINE | ID: mdl-35408157

RESUMEN

With autonomous driving developing in a booming stage, accurate object detection in complex scenarios attract wide attention to ensure the safety of autonomous driving. Millimeter wave (mmWave) radar and vision fusion is a mainstream solution for accurate obstacle detection. This article presents a detailed survey on mmWave radar and vision fusion based obstacle detection methods. First, we introduce the tasks, evaluation criteria, and datasets of object detection for autonomous driving. The process of mmWave radar and vision fusion is then divided into three parts: sensor deployment, sensor calibration, and sensor fusion, which are reviewed comprehensively. Specifically, we classify the fusion methods into data level, decision level, and feature level fusion methods. In addition, we introduce three-dimensional(3D) object detection, the fusion of lidar and vision in autonomous driving and multimodal information fusion, which are promising for the future. Finally, we summarize this article.


Asunto(s)
Conducción de Automóvil , Radar , Algoritmos , Calibración , Visión Ocular
8.
Opt Express ; 29(10): 14336-14344, 2021 May 10.
Artículo en Inglés | MEDLINE | ID: mdl-33985156

RESUMEN

We have demonstrated the generation of multicolor noise-like pulse complex in a passively Yb-doped mode-locked fiber laser based on a single mode-graded index multimode-single mode fiber (SMF-GIMF-SMF) device as the saturable absorber (SA). The stimulated Raman scattering (SRS) effect leads to the cascaded generation of the main noise-like pulse (NLP) at 1028.8 nm together with the noise like Raman pulse (RP) at 1076.1 nm. The generated dual wavelength pulses demonstrate the unique properties of mutually synchronization and coherence. The autocorrelation traces show that each of the synchronously mode-locked pulses exhibits a double-scale structure with a narrow peak which consists of a train of quasi-periodic beat pulses with a 35.7 fs pulse width and a pulse separation of about 77.2 fs. The total output power reaches 102.5 mW with 34% of it belonging to the RP. And furthermore, by separating the two pulses with spectral filters, the modulation fringes cannot be observed anymore. These results indicate that the Raman component participates in the mode-locking operation as a 'signal' instead of 'noise'. Such a coherent Raman pulse source provides a novel platform for numerous applications, such as frequency comb spectroscopy and so on.

9.
Opt Lett ; 46(22): 5695-5698, 2021 Nov 15.
Artículo en Inglés | MEDLINE | ID: mdl-34780439

RESUMEN

In this Letter, we have demonstrated the generation of dissipative solitons (DSs) or multi-wavelength noise-like pulses (NLPs) directly from a common linear Yb-doped fiber laser in the presence of stimulated Raman scattering (SRS). For the DSs, the pulse energy of the solitons with a pulse width of 74.2 ps reaches 21.2 nJ. For the NLPs, the generation of the main NLP (1032 nm) together with the first-order Raman NLP (1080 nm) is realized. The narrow peak of the double-scale autocorrelation trace is characterized by quasi-periodic beat pulses with a pulse beating of 40.6 fs and a pulse separation of 79 fs, indicating that the generated solitons at dual wavelengths are mutually coherent. Furthermore, a three-color stable NLP complex with a broader spectrum is also obtained. The results contribute to an in-depth understanding of nonlinear dynamics and ultrafast physics.

10.
Opt Lett ; 46(1): 118-121, 2021 Jan 01.
Artículo en Inglés | MEDLINE | ID: mdl-33362030

RESUMEN

In this Letter, we implement a multimode fiber (MMF) laser system mode-locked by a nonlinear polarization rotation technique for controllable synchronous multi-wavelength soliton generation. The synchronization of the repetition rates for different wavelengths is realized by the special mode transmission in MMF. For dual-wavelength mode-locking at 1566.7 nm and 1617.2 nm, each of the synchronously mode-locked solitons consists of a train of quasi-periodic beat pulses with a pulse width of 84 fs and period of 162 fs. The total output power reaches 532 mW with optimally balanced two-color intensities. Furthermore, switchable dual- and tri-wavelength synchronized femtosecond pulses are also obtained. In contrast to previous reports, this synchronously mode-locked multi-wavelength is output directly from a laser oscillator, which provides a simpler candidate to achieve pulse synchronization.

11.
Appl Opt ; 60(21): 6128-6134, 2021 Jul 20.
Artículo en Inglés | MEDLINE | ID: mdl-34613276

RESUMEN

Based on the vector diffraction theory, this paper investigates the focusing properties of linearly polarized Lorentz-Gaussian vortex beams with sinusoidal phase modulation and discusses the focused light intensity under different parameters in detail. Results show that the focus pattern in the horizontal direction at the focal region can be compressed by increasing the relative Gaussian parameter wx. As the relative Lorentz parameter γy increases, the focus pattern will separate in the vertical direction of the optical field. With the topological charge number m increases, a special tunable optical dark trap focusing mode can be obtained. Through changing the sinusoidal modulation parameter n, the regular trilateral, quadrangle, pentagon, and hexagon shapes of the focusing mode can be correspondingly constructed. Besides, on increasing propagation distance z, the focusing mode in the near focusing region gradually extends outside and always exhibits hexagon-shaped patterns, which reflects that this special focusing mode has a good stability. In addition, the optical gradient force distributions and the field intensity distributions in the longitudinal plane are also investigated to illuminate the applications of these alterable focal patterns. Those novel, to the best of our knowledge, findings may be helpful in applications such as optical manipulation, optical focusing, and imaging.

12.
Arch Phys Med Rehabil ; 101(4): 599-606, 2020 04.
Artículo en Inglés | MEDLINE | ID: mdl-31821798

RESUMEN

OBJECTIVE: To investigate the feasibility of conducting exoskeleton-assisted gait training (EGT) and the effects of EGT on gait, metabolic expenditure, and physical function in persons with multiple sclerosis (MS). DESIGN: Single-group pilot study. SETTING: Research laboratory in a rehabilitation hospital. PARTICIPANTS: Individuals with MS (N=10; mean age, 54.3±12.4y) and Expanded Disability Status Scale 6.0-7.5. INTERVENTIONS: All participants completed up to 15 sessions of EGT. MAIN OUTCOME MEASURES: Timed 25-foot walk test at self-selected and fast speed, 6-minute walk test, metabolic expenditure of walking and timed Up and Go test were assessed during walking without the exoskeleton at baseline and immediate post training. RESULTS: All participants tolerated the training intensity and completed training without adverse events. After training, gait speed was improved and metabolic expenditure was reduced significantly during the timed 25-foot walk test at self-selected speed. CONCLUSIONS: EGT is not only feasible but may also improve gait efficiency for persons with MS. Our observed improvement in gait speed was associated with reduced metabolic expenditure, which was likely because of improved neuromotor coordination. Further studies are required to investigate the effectiveness and integration of EGT in the continuum of MS rehabilitation.


Asunto(s)
Dispositivo Exoesqueleto , Trastornos Neurológicos de la Marcha/rehabilitación , Esclerosis Múltiple/rehabilitación , Adulto , Anciano , Prueba de Esfuerzo , Estudios de Factibilidad , Femenino , Humanos , Masculino , Persona de Mediana Edad , Consumo de Oxígeno , Proyectos Piloto , Velocidad al Caminar
13.
J Neuroeng Rehabil ; 17(1): 4, 2020 01 10.
Artículo en Inglés | MEDLINE | ID: mdl-31924224

RESUMEN

BACKGROUND: We know little about the budget impact of integrating robotic exoskeleton over-ground training into therapy services for locomotor training. The purpose of this study was to estimate the budget impact of adding robotic exoskeleton over-ground training to existing locomotor training strategies in the rehabilitation of people with spinal cord injury. METHODS: A Budget Impact Analysis (BIA) was conducted using data provided by four Spinal Cord Injury (SCI) Model Systems rehabilitation hospitals. Hospitals provided estimates of therapy utilization and costs about people with spinal cord injury who participated in locomotor training in the calendar year 2017. Interventions were standard of care walking training including body-weight supported treadmill training, overground training, stationary robotic systems (i.e., treadmill-based robotic gait orthoses), and overground robotic exoskeleton training. The main outcome measures included device costs, training costs for personnel to use the device, human capital costs of locomotor training, device demand, and the number of training sessions per person with SCI. RESULTS: Robotic exoskeletons for over-ground training decreased hospital costs associated with delivering locomotor training in the base case analysis. This analysis assumed no difference in intervention effectiveness across locomotor training strategies. Providing robotic exoskeleton overground training for 10% of locomotor training sessions over the course of the year (range 226-397 sessions) results in decreased annual locomotor training costs (i.e., net savings) between $1114 to $4784 per annum. The base case shows small savings that are sensitive to parameters of the BIA model which were tested in one-way sensitivity analyses, scenarios analyses, and probability sensitivity analyses. The base case scenario was more sensitive to clinical utilization parameters (e.g., how often devices sit idle and the substitution of high cost training) than device-specific parameters (e.g., robotic exoskeleton device cost or device life). Probabilistic sensitivity analysis simultaneously considered human capital cost, device cost, and locomotor device substitution. With probabilistic sensitivity analysis, the introduction of a robotic exoskeleton only remained cost saving for one facility. CONCLUSIONS: Providing robotic exoskeleton for over-ground training was associated with lower costs for the locomotor training of people with SCI in the base case analyses. The analysis was sensitive to parameter assumptions.


Asunto(s)
Dispositivo Exoesqueleto/economía , Rehabilitación Neurológica/economía , Rehabilitación Neurológica/instrumentación , Traumatismos de la Médula Espinal/rehabilitación , Adulto , Femenino , Costos de Hospital , Humanos , Masculino , Persona de Mediana Edad , Modelos Económicos
14.
Sensors (Basel) ; 20(4)2020 Feb 11.
Artículo en Inglés | MEDLINE | ID: mdl-32053909

RESUMEN

For autonomous driving, it is important to detect obstacles in all scales accurately for safety consideration. In this paper, we propose a new spatial attention fusion (SAF) method for obstacle detection using mmWave radar and vision sensor, where the sparsity of radar points are considered in the proposed SAF. The proposed fusion method can be embedded in the feature-extraction stage, which leverages the features of mmWave radar and vision sensor effectively. Based on the SAF, an attention weight matrix is generated to fuse the vision features, which is different from the concatenation fusion and element-wise add fusion. Moreover, the proposed SAF can be trained by an end-to-end manner incorporated with the recent deep learning object detection framework. In addition, we build a generation model, which converts radar points to radar images for neural network training. Numerical results suggest that the newly developed fusion method achieves superior performance in public benchmarking. In addition, the source code will be released in the GitHub.

15.
Sensors (Basel) ; 19(8)2019 Apr 18.
Artículo en Inglés | MEDLINE | ID: mdl-31003484

RESUMEN

Offline-trained Siamese networks are not robust to the environmental complication in visual object tracking. Without online learning, the Siamese network cannot learn from instance domain knowledge and adapt to appearance changes of targets. In this paper, a new lightweight Siamese network is proposed for feature extraction. To cope with the dynamics of targets and backgrounds, the weight in the proposed Siamese network is updated in an online manner during the tracking process. In order to enhance the discrimination capability, the cross-entropy loss is integrated into the contrastive loss. Inspired by the face verification algorithm DeepID2, the Bayesian verification model is applied for candidate selection. In general, visual object tracking can benefit from face verification algorithms. Numerical results suggest that the newly developed algorithm achieves comparable performance in public benchmarks.

16.
J Cell Mol Med ; 22(12): 5909-5918, 2018 12.
Artículo en Inglés | MEDLINE | ID: mdl-30246456

RESUMEN

Although targeted therapy is usually the first-line treatment for advanced renal cell carcinoma (RCC), some patients can experience drug resistance. Cancer stem cells are tumour-initiating cells that play a vital role in drug resistance, metastasis and cancer relapse, while galectins (Gal) participate in tumour progression and drug resistance. However, the exact role of galectins in RCC stemness is yet unknown. In this study, we grew a subpopulation of RCC cells as tumour spheres with higher levels of stemness-related genes, such as Oct4, Sox2 and Nanog. Among the Gal family, Gal-3 in particular was highly expressed in RCC tumour spheres. To further investigate Gal-3's role in the stemness of RCC, lentivirus-mediated knockdown and overexpression of Gal-3 in RCC cells were used to examine both in vitro and in vivo tumorigenicity. We further assessed Gal-3 expression in RCC tissue microarray using immunohistochemistry. Upon suppressing Gal-3 in parental RCC cells, invasion, colony formation, sphere-forming ability, drug resistance and stemness-related gene expression were all significantly decreased. Furthermore, CXCL6, CXCL7 and CXCR2 were down-regulated in Gal-3-knockdown tumour spheres, while CXCR2 overexpression in Gal-3-knockdown RCC restored the ability of sphere formation. Gal-3 overexpression in RCC promoted both in vitro and in vivo tumorigenicity, and its expression was correlated with CXCR2 expression and tumour progression in clinical tissues. RCC patients with higher co-expressions of Gal-3 and CXCR2 demonstrated a worse survival rate. These results indicate that highly expressed Gal-3 may up-regulate CXCR2 to augment RCC stemness. Gal-3 may be a prognostic and innovative target of combined therapy for treating RCC.


Asunto(s)
Carcinoma de Células Renales/metabolismo , Carcinoma de Células Renales/patología , Galectina 3/metabolismo , Neoplasias Renales/metabolismo , Neoplasias Renales/patología , Células Madre Neoplásicas/metabolismo , Células Madre Neoplásicas/patología , Receptores de Interleucina-8B/metabolismo , Animales , Carcinogénesis/metabolismo , Carcinogénesis/patología , Línea Celular Tumoral , Movimiento Celular , Autorrenovación de las Células , Quimiocinas/metabolismo , Progresión de la Enfermedad , Regulación hacia Abajo , Resistencia a Antineoplásicos , Humanos , Masculino , Ratones Endogámicos NOD , Ratones SCID , Pronóstico , Esferoides Celulares/metabolismo , Esferoides Celulares/patología , Ensayo de Tumor de Célula Madre
17.
J Neurol Phys Ther ; 42(4): 256-267, 2018 10.
Artículo en Inglés | MEDLINE | ID: mdl-30199518

RESUMEN

BACKGROUND AND PURPOSE: Refinement of robotic exoskeletons for overground walking is progressing rapidly. We describe clinicians' experiences, evaluations, and training strategies using robotic exoskeletons in spinal cord injury rehabilitation and wellness settings and describe clinicians' perceptions of exoskeleton benefits and risks and developments that would enhance utility. METHODS: We convened focus groups at 4 spinal cord injury model system centers. A court reporter took verbatim notes and provided a transcript. Research staff used a thematic coding approach to summarize discussions. RESULTS: Thirty clinicians participated in focus groups. They reported using exoskeletons primarily in outpatient and wellness settings; 1 center used exoskeletons during inpatient rehabilitation. A typical episode of outpatient exoskeleton therapy comprises 20 to 30 sessions and at least 2 staff members are involved in each session. Treatment focuses on standing, stepping, and gait training; therapists measure progress with standardized assessments. Beyond improved gait, participants attributed physiological, psychological, and social benefits to exoskeleton use. Potential risks included falls, skin irritation, and disappointed expectations. Participants identified enhancements that would be of value including greater durability and adjustability, lighter weight, 1-hand controls, ability to navigate stairs and uneven surfaces, and ability to balance without upper extremity support. DISCUSSION AND CONCLUSIONS: Each spinal cord injury model system center had shared and distinct practices in terms of how it integrates robotic exoskeletons into physical therapy services. There is currently little evidence to guide integration of exoskeletons into rehabilitation therapy services and a pressing need to generate evidence to guide practice and to inform patients' expectations as more devices enter the market.Video Abstract available for more insights from the authors (see Video, Supplemental Digital Content 1, available at: http://links.lww.com/JNPT/A231).


Asunto(s)
Actitud del Personal de Salud , Dispositivo Exoesqueleto , Rehabilitación Neurológica/instrumentación , Rehabilitación Neurológica/métodos , Traumatismos de la Médula Espinal/rehabilitación , Adulto , Dispositivo Exoesqueleto/normas , Femenino , Grupos Focales , Humanos , Masculino , Persona de Mediana Edad , Investigación Cualitativa
18.
Appl Opt ; 55(32): 9067-9073, 2016 Nov 10.
Artículo en Inglés | MEDLINE | ID: mdl-27857291

RESUMEN

Color-tunable LED light fixtures generally change colors by controlling LEDs of multiple colors. This type of light source requires additional secondary optics and light-mixing distances to deliver color-mixing functions and perform high color uniformity. However, the color-mixing elements increase the optics size, resulting in more difficulties in making tiny lighting fixtures. Therefore, in this study, we introduce a LED primary optics design method that retains standard LED package size while featuring a color-mixing chamber. This method combines a lens having a rotational symmetry with a freeform profile and a zigzag structure by using double total internal reflection to disperse light uniformly. In contrast to a typical hemispherical lens, our design effectively lowers the weighted average color difference from 0.03 to 0.0035, and maintains optical efficiency of at least 90% without using any optical diffuser.

19.
Nucleic Acids Res ; 42(22): 13788-98, 2014 Dec 16.
Artículo en Inglés | MEDLINE | ID: mdl-25414336

RESUMEN

Mammalian splicing regulatory protein RNA-binding motif protein 4 (RBM4) has an alanine repeat-containing C-terminal domain (CAD) that confers both nuclear- and splicing speckle-targeting activities. Alanine-repeat expansion has pathological potential. Here we show that the alanine-repeat tracts influence the subnuclear targeting properties of the RBM4 CAD in cultured human cells. Notably, truncation of the alanine tracts redistributed a portion of RBM4 to paraspeckles. The alanine-deficient CAD was sufficient for paraspeckle targeting. On the other hand, alanine-repeat expansion reduced the mobility of RBM4 and impaired its splicing activity. We further took advantage of the putative coactivator activator (CoAA)-RBM4 conjoined splicing factor, CoAZ, to investigate the function of the CAD in subnuclear targeting. Transiently expressed CoAZ formed discrete nuclear foci that emerged and subsequently separated-fully or partially-from paraspeckles. Alanine-repeat expansion appeared to prevent CoAZ separation from paraspeckles, resulting in their complete colocalization. CoAZ foci were dynamic but, unlike paraspeckles, were resistant to RNase treatment. Our results indicate that the alanine-rich CAD, in conjunction with its conjoined RNA-binding domain(s), differentially influences the subnuclear localization and biogenesis of RBM4 and CoAZ.


Asunto(s)
Alanina , Empalme Alternativo , Estructuras del Núcleo Celular/química , Proteínas Nucleares/química , Péptidos , Señales de Clasificación de Proteína , Proteínas de Unión al ARN/química , Células HEK293 , Células HeLa , Humanos , Proteínas Nucleares/análisis , Proteínas Nucleares/metabolismo , Proteínas de Unión al ARN/análisis , Proteínas de Unión al ARN/metabolismo , Secuencias Repetitivas de Aminoácido
20.
J Am Soc Nephrol ; 25(7): 1486-95, 2014 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-24511119

RESUMEN

Galectin-1, a ß-galactoside-binding lectin, is involved in many physiologic and pathologic processes, including cell adhesion, differentiation, angiogenesis, and tumor progression. However, the role of galectin-1 in kidney cancer remains elusive. This study evaluated the role of galectin-1 in the progression and clinical prognosis of renal cell carcinoma. We found significant overexpression of galectin-1 in both kidney cancer cell lines and metastatic tissue specimens from patients with renal cell carcinoma. Knockdown of galectin-1 gene expression in renal cancer cell lines reduced cell invasion, clonogenic ability, and epithelial-mesenchymal transition in vitro; reduced tumor outgrowth in vivo; and inhibited the angiogenesis-inducing activity of these cells in vitro and in vivo. Galectin-1 knockdown decreased CXCR4 expression levels in kidney cancer cells, and restoration of CXCR4 expression in galectin-1-silenced cells rescued cell motility and clonogenic ability. Additional studies suggested that galectin-1 induced CXCR4 expression through activation of nuclear factor-κB (NF-κB). Analysis of patient specimens confirmed the clinical significance and positive correlation between galectin-1 and CXCR4 expression levels and revealed concomitant overexpression of galectin-1 and CXCR4 associated adversely with overall and disease-free survival. Our findings suggest that galectin-1 promotes tumor progression through upregulation of CXCR4 via NF-κB. The coordinated upregulation of galectin-1 and CXCR4 may be a novel prognostic factor for survival in patients with renal cell carcinoma and the galectin-1-CXCR4 axis may serve as a therapeutic target in this disease.


Asunto(s)
Carcinoma de Células Renales/mortalidad , Carcinoma de Células Renales/patología , Galectina 1/fisiología , Neoplasias Renales/mortalidad , Neoplasias Renales/patología , Receptores CXCR4/fisiología , Regulación hacia Arriba , Progresión de la Enfermedad , Humanos , Pronóstico , Tasa de Supervivencia , Células Tumorales Cultivadas
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