Actual conditions for returning home after hospitalization among older patients receiving home medical care in Japan: OHCARE Study.

AIM: To examine the actual conditions of older patients receiving home medical care after hospitalization over a period of 2 years in Japan. METHODS: The study population included 102 participants, aged ≥65 years, receiving home medical care, who consented to participate in the Osaka Home Care Registry (OHCARE) study in Japan over a period of 2 years. We investigated the actual conditions for returning home after hospitalization. RESULTS: The median age of the 102 participants was 84 years, and 61 (59.8%) were women. In the group that returned home, 42 (55.3%) of the respondents desired to recuperate in a familiar place, as in advanced care planning (ACP). During the 2-year follow-up period, the group that did not return home had significantly more deaths. A multivariate analysis showed the association in the presence of ACP (odds ratio: 4.72, 95% confidence interval: 1.60-13.86) and cardiac disease (odds ratio: 0.25, 95% confidence interval: 0.08-0.76). The lack of ACP in the medical records when the patient was admitted to the hospital may have prevented the return home. CONCLUSION: In older patients who had difficulty returning home after hospitalization, the lack of ACP in home medical care may have been an influencing factor. ACP could help continue with home medical care. Geriatr Gerontol Int 2024; 24: 320-326.

Bioinspired Soft Spine Enables Small-Scale Robotic Rat to Conquer Challenging Environments.

For decades, it has been difficult for small-scale legged robots to conquer challenging environments. To solve this problem, we propose the introduction of a bioinspired soft spine into a small-scale legged robot. By capturing the motion mechanism of rat erector spinae muscles and vertebrae, we designed a cable-driven centrally symmetric soft spine under limited volume and integrated it into our previous robotic rat SQuRo. We called this newly updated robot SQuRo-S. Because of the coupling compliant spine bending and leg locomotion, the environmental adaptability of SQuRo-S significantly improved. We conducted a series of experiments on challenging environments to verify the performance of SQuRo-S. The results demonstrated that SQuRo-S crossed an obstacle of 1.07 body height, thereby outperforming most small-scale legged robots. Remarkably, SQuRo-S traversed a narrow space of 0.86 body width. To the best of our knowledge, SQuRo-S is the first quadruped robot of this scale that is capable of traversing a narrow space with a width smaller than its own width. Moreover, SQuRo-S demonstrated stable walking on mud-sand, pipes, and slopes (20°), and resisted strong external impact and repositioned itself in various body postures. This work provides a new paradigm for enhancing the flexibility and adaptability of small-scale legged robots with spine in challenging environments, and can be easily generalized to the design and development of legged robots with spine of different scales.

A review on microrobots driven by optical and magnetic fields.

Due to their small sizes, microrobots are advantageous for accessing hard-to-reach spaces for delivery and measurement. However, their small sizes also bring challenges in on-board powering, thus usually requiring actuation by external energy. Microrobots actuated by external energy have been applied to the fields of physics, biology, medical science, and engineering. Among these actuation sources, light and magnetic fields show advantages in high precision and high biocompatibility. This paper reviews the recent advances in the design, actuation, and applications of microrobots driven by light and magnetic fields. For light-driven microrobots, we summarized the uses of optical tweezers, optoelectronic tweezers, and heat-mediated optical manipulation techniques. For magnetically driven microrobots, we summarized the uses of torque-driven microrobots, force-driven microrobots, and shape-deformable microrobots. Then, we compared the two types of field-driven microrobots and reviewed their advantages and disadvantages. The paper concludes with an outlook for the joint use of optical and magnetic field actuation in microrobots.

Programmable aniso-electrodeposited modular hydrogel microrobots.

Systems with programmable and complex shape morphing are highly desired in many fields wherein sensing, actuation, and manipulation must be performed. Living organisms use nonuniform distributions of their body structural composition to achieve diverse shape morphing, motion, and functionality. However, for the microrobot fabrication, these designs often involve complicated robotic architectures requiring time-consuming and arduous fabrication processes. This paper proposes a single-step aniso-electrodeposition method for fabricating modular microrobots (MMRs) with distinct functions in each modular segment. By programming the electric field, the microscale stripe-shaped structure can be endowed with diverse shape-morphing capabilities, such as spiraling, twisting, bending, and coiling. The proposed fabrication method can develop MMRs with multiple independent modules onto which cells, drugs, and magnetic nanoparticles can be loaded to achieve multifunctionality. Thus, MMRs can perform multiple tasks, such as propulsion, grasping, and object delivery, simultaneously under magnetic control and ionic and pH stimuli.

Intelligent Gait Analysis and Evaluation System Based on Cane Robot.

Gait analysis and evaluation are vital for disease diagnosis and rehabilitation. Current gait analysis technologies require wearable devices or high-resolution vision systems within a limited usage space. To facilitate gait analysis and quantitative walking-ability evaluation in daily environments without using wearable devices, a mobile gait analysis and evaluation system is proposed based on a cane robot. Two laser range finders (LRFs) are mounted to obtain the leg motion data. An effective high-dimensional Takagi-Sugeno-Kang (HTSK) fuzzy system, which is suitable for high-dimensional data by solving the saturation problem caused by softmax function in defuzzification, is proposed to recognize the walking states using only the motion data acquired from LRFs. The gait spatial-temporal parameters are then extracted based on the gait cycle segmented by different walking states. Besides, a quantitative walking-ability evaluation index is proposed in terms of the conventional Tinetti scale. The plantar pressure sensing system records the walking states to label training data sets. Experiments were conducted with seven healthy subjects and four patients. Compared with five classical classification algorithms, the proposed method achieves the average accuracy rate of 96.57%, which is improved more than 10%, compared with conventional Takagi-Sugeno-Kang (TSK) fuzzy system. Compared with the gait parameters extracted by the motion capture system OptiTrack, the average errors of step length and gait cycle are only 0.02 m and 1.23 s, respectively. The comparison between the evaluation results of the robot system and the scores given by the physician also validates that the proposed method can effectively evaluate the walking ability.

Development of High-Cell-Density Tissue Method for Compressed Modular Bioactuator.

Bioactuators have been developed in many studies in the recent decade for actuators of micro-biorobots. However, bioactuators have not shown the same power as animal muscles. Centrifugal force was used in this study to increase the cell density of cultured muscle cells that make up the bioactuator. The effect of the centrifugal force on cells in the matrix gel before curing was investigated, and the optimal centrifugal force was identified to be around 450× g. The compressed modular bioactuator (C-MBA) fabricated in this study exhibited 1.71 times higher cell density than the conventional method. In addition, the contractile force per unit cross-sectional area was 1.88 times higher. The proposed method will contribute to new bioactuators with the same power as living muscles in animals.

Unraveling Atomic-Scale Origins of Selective Ionic Transport Pathways and Sodium-Ion Storage Mechanism in Bi2 S3 Anodes.

It is a major challenge to achieve a high-performance anode for sodium-ion batteries (SIBs) with high specific capacity, high rate capability, and cycling stability. Bismuth sulfide, which features a high theoretical specific capacity, tailorable morphology, and low cost, has been considered as a promising anode for SIBs. Nevertheless, due to a lack of direct atomistic observation, the detailed understanding of fundamental intercalation behavior and Bi2 S3 's (de)sodiation mechanisms remains unclear. Here, by employing in situ high-resolution transmission electron microscopy, consecutive electron diffraction coupled with theoretical calculations, it is not only for the first time identified that Bi2 S3 exhibits specific ionic transport pathways preferred to diffuse along the (110) direction instead of the (200) plane, but also tracks their real-time phase transformations (de)sodiation involving multi-step crystallographic tuning. The finite-element analysis further disclosed multi-reaction induced deformation and the relevant stress evolution originating from the combined effect of the mechanical and electrochemical interaction. These discoveries not only deepen the understanding of fundamental science about the microscopic reaction mechanism of metal chalcogenide anodes but also provide important implications for performance optimization.

A clamp-free micro-stretching system for evaluating the viscoelastic response of cell-laden microfibers.

Viscoelastic hydrogel microfibers have extensive applications in tissue engineering and regenerative medicine, however, their viscoelasticity is still difficult to be directly characterized because microfiber-specific measuring system is lacking for quantitative studies. In this paper, we develop a two-probe micro-stretching system to quantitatively investigate viscoelasticity of the microfiber by evaluating the storage and loss modulus: E' and E″. A liquid bridge-based fixation method enables single microfiber to be easily fixed to be stably stretched by a two-probe actuator. Afterward, multi-frequency stretching force loading is automatically implemented based on real-time force control, and the resulting stress and strain in the frequency spectrum are measured to evaluate the E' and E″ of pure GelMA, alginate-GelMA composite and GelMA core-alginate shell microfibers. The measured E' and E″ are verified by the response of NIH/3T3 fibroblast cells to the composite microfibers with different alginate concentrations. Moreover, benefiting from the low-damaged stretching process, our system can also detect the difference of the E' and E″ between two cellular processes including growth and differentiation of the aligned mesenchymal stem cells in the same one core-shell microfiber. These results all show that our proposed system provides a valuable reference tool for biomaterials design, the study of cell-matrix interaction and disease etiology from the perspective of mechanics.

Milli-scale cellular robots that can reconfigure morphologies and behaviors simultaneously.

Modular robot that can reconfigure architectures and functions has advantages in unpredicted environment and task. However, the construction of modular robot at small-scale remains a challenge since the lack of reliable docking and detaching strategies. Here we report the concept of milli-scale cellular robot (mCEBOT) achieved by the heterogeneous assembly of two types of units (short and long units). Under the magnetic field, the proposed mCEBOT units can not only selectively assemble (e.g., end-by-end and side-by-side) into diverse morphologies corresponding to the unstructured environments, but also configure multi-modes motion behaviors (e.g., slipping, rolling, walking and climbing) based on the on-site task requirements. We demonstrate its adaptive mobility from narrow space to high barrier to wetting surface, and its potential applications in hanging target taking and environment exploration. The concept of mCEBOT offers new opportunities for robot design, and will broaden the field of modular robot in both miniaturization and functionalization.

A comparison of cerebral amyloid angiopathy in the cerebellum and CAA-positive occipital lobe of 60 brains from routine autopsies.

We semiquantitatively compared the frequency and severity of cerebral amyloid angiopathy (CAA) in the cerebellum and CAA-positive occipital lobe of 60 subjects from routine autopsies. In the 60 subjects with a CAA-positive occipital lobe, cerebellar CAA was observed in 29 subjects (48.3%), and the severity of cerebellar CAA was relatively mild compared with occipital lobe CAA. Capillary CAA was observed in the occipital lobe of 12 subjects and the cerebellum of three subjects. CAA-related vasculopathies were observed in the occipital lobe of 15 subjects and the cerebellum of two subjects. The severity of CAA-related vasculopathy was mild in both of these subjects. Amyloid-ß plaques were observed in the occipital lobe of 54 subjects (90%) and the cerebellum of 16 subjects (26.7%). The severity of amyloid-ß plaques in the cerebellum was mild compared with the occipital lobe. In summary, we confirmed that cerebellar CAA is frequently observed in the cerebellum but with a lower severity than CAA in the occipital lobe.

Accurate modulation of photoprinting under stiffness imaging feedback for engineering ECMs with high-fidelity mechanical properties.

Engineered extracellular matrices (ECMs) that replicate complex in-vivo features have shown great potential in tissue engineering. Biocompatible hydrogel microstructures have been widely used to replace these native ECMs for physiologically relevant research. However, accurate reproduction of the 3D hierarchical and nonuniform mechanical stiffness inside one integrated microstructure to mimic the complex mechanical properties of native ECMs presents a major challenge. Here, by using digital holographic microscopy (DHM)-based stiffness imaging feedback, we propose a novel closed-loop control algorithm to achieve high-accuracy control of mechanical properties for hydrogel microstructures that recapitulate the physiological properties of native ECMs with high fidelity. During photoprinting, the photocuring area of the hydrogel is divided into microscale grid areas to locally control the photocuring process. With the assistance of a motorized microfluidic channel, the curing thickness is controlled with layer-by-layer stacking. The DHM-based stiffness imaging feedback allows accurate adjustment of the photocuring degree in every grid area to change the crosslinking network density of the hydrogel, thus enabling large-span and high-resolution modulation of mechanical properties. Finally, the gelatin methacrylate was used as a typical biomaterial to construct the high-fidelity biomimetic ECMs. The Young's modulus could be flexibly modulated in the 10 kPa to 50 kPa range. Additionally, the modulus gradient was accurately controlled to within 2.9 kPa. By engineering ECM with locally different mechanical properties, cell spreading along the stiff areas was observed successfully. We believe that this method can regenerate complex biomimetic ECMs that closely recapitulate in-vivo mechanical properties for further applications in tissue engineering and biomedical research.

Electrically Controlled Aquatic Soft Actuators with Desynchronized Actuation and Light-Mediated Reciprocal Locomotion.

Soft-bodied aquatic invertebrates can overcome hydrodynamic resistance and display diverse locomotion modes in response to environmental cues. Exploring the dynamics of locomotion from bioinspired aquatic actuators will broaden the perspective of underwater manipulation of artificial systems in fluidic environments. Here, we report a multilayer soft actuator design based on a light-driven hydrogel and a laser-induced graphene (LIG) actuator, minimizing the effect of the time delay by a monolithic hydrogel-based system while maintaining shape-morphing functionality. Moreover, different time scales in the response of actuator materials enable a real-time desynchronization of energy inputs, holding great potential for applications requiring desynchronized stimulation. This hybrid design principle is ultimately demonstrated with a high-performance aquatic soft actuator possessing an underwater walking speed of 0.81 body length per minute at a relatively low power consumption of 3 W. When integrated with an optical sensor, the soft actuator can sense the variation in light intensity and achieve mediated reciprocal motion. Our proposed locomotion mechanism could inspire other multilayer soft actuators to achieve underwater functionalities at the same spatiotemporal scale. The underwater actuation platform could be used to study locomotion kinematics and control mechanisms that mimic the motion of soft-bodied aquatic organisms.

Controllable Melting and Flow of Ag in Self-Formed Amorphous Carbonaceous Shell for Nanointerconnection.

Nanointerconnection has been selected as a promising method in the post-Moore era to realize device miniaturization and integration. Even with many advances, the existing nanojoining methods still need further developments to meet the three-dimensional nanostructure construction requirements of the next-generation devices. Here, we proposed an efficient silver (Ag)-filled nanotube fabrication method and realized the controllable melting and ultrafine flow of the encapsulated silver at a subfemtogram (0.83 fg/s) level, which presents broad application prospects in the interconnection of materials in the nanometer or even subnanometer. We coated Ag nanowire with polyvinylpyrrolidone (PVP) to obtain core-shell nanostructures instead of the conventional well-established nanotube filling or direct synthesis technique, thus overcoming obstacles such as low filling rate, discontinuous metalcore, and limited filling length. Electromigration and thermal gradient force were figured out as the dominant forces for the controllable flow of molten silver. The conductive amorphous carbonaceous shell formed by pyrolyzing the insulative PVP layer was also verified by energy dispersive spectroscopy (EDS), which enabled the continued outflow of the internal Ag. Finally, a reconfigurable nanointerconnection experiment was implemented, which opens the way for interconnection error correction in the fabrication of nanoelectronic devices.

Bio-inspired engineering of a perfusion culture platform for guided three-dimensional nerve cell growth and differentiation.

Collagen provides a promising environment for 3D nerve cell culture; however, the function of perfusion culture and cell-growth guidance is difficult to integrate into such an environment to promote cell growth. In this paper, we develop a bio-inspired design method for constructing a perfusion culture platform for guided nerve cell growth and differentiation in collagen. Based on the anatomical structure of peripheral neural tissue, a biomimetic porous structure (BPS) is fabricated by two-photon polymerization of IP-Visio. The micro-capillary effect is then utilized to facilitate the self-assembly of cell encapsulated collagen into the BPS. 3D perfusion culture can be rapidly implemented by inserting the cell-filled BPS into a pipette tip connected with syringe pumps. Furthermore, we investigate the nerve cell behavior in the BPS. 7-channel aligned cellular structures surrounded with a Schwann cell layer can be stably formed after a long-time perfusion culture. Differentiation of PC12 cells and mouse neural stem cells shows 3D neurite outgrowth alignment and elongation in collagen. The calcium activities of differentiated PC12 cells are visualized for confirming the preliminary formation of cell function. These results demonstrate that the proposed bio-inspired 3D cell culture platform with the advantages of miniaturization, structure complexity and perfusion has great potential for future application in the study of nerve regeneration and drug screening.

An autopsy case of amyloid angiopathy-related cerebellar hemorrhage.

An 80-year-old man with dementia demonstrated cerebellar hemorrhage. Autopsy revealed pathology compatible with Alzheimer's disease and cerebral amyloid angiopathy (CAA). CAA was more prevalent in the occipital lobe than in the frontal, parietal, and temporal lobes; however, amyloid-ß (Aß)-containing senile plaques were less abundant in the occipital cortex than in the other cortices. In the cerebellum, abundant CAA-involved vessels were observed in the subarachnoid space and molecular layer and to a lesser extent in the Purkinje and granule layers. On consecutive sections, Aß1-42 immunohistochemistry revealed senile plaques and CAA-involved vessels with strong immunoreactivity whereas Aß1-40 immunohistochemistry identfied CAA-involved vessels with strong immunoreactivity and senile plaques with weak immunoreactivity in the cerebellar cortices.

[Seasonal changes in blood pressure and related factors among older patients receiving home medical care].

AIM: We investigated seasonal variations in blood pressure (BP) and factors related to these variations among older patients receiving home medical care. METHOD: A total 57 patients ≥ 65 years old receiving home medical care who participated in the Osaka Home Care REgistry study (OHCARE), a prospective cohort study, were included. We investigated the seasonal patient characteristics and variations in the BP. In addition, to determine the influence of seasonal variations in the systolic blood pressure (SBP) on the occurrence of clinical events (hospitalization, falls and death), we classified patients into larger- and smaller- change groups based on the median seasonal variations in SBP. RESULT: About 60% of subjects were very frail or bedridden. The mean BP was higher in winter than in summer (124.7±11/69.5±7 vs.120.5±12/66.9±8 mmHg) (P< 0.01). On comparing the characteristics of the two groups with larger and smaller changes in the SBP, the group with large BP changes had a significantly lower BP in summer than the group with small BP changes. In addition, the incidence of "hospitalization" was significantly higher in the group with large BP changes than in the group with small BP changes (P = 0.03). CONCLUSION: The present study revealed that there were seasonal changes in the BP in older patients receiving home medical care. It was also suggested that seasonal changes in the BP might be associated with the risk of hospitalization events. Given these BP variations, doctors and visiting nurses should be alert for systemic abnormalities, especially in frail patients receinving home medical care.

A tetrahedral DNA nanorobot with conformational change in response to molecular trigger.

Dynamic DNA origami nanostructures that respond to external stimuli are promising platforms for cargo delivery and nanoscale sensing. However, the low stability of such nanostructures under physiological conditions presents a major obstacle for their use in biomedical applications. This article describes a stable tetrahedral DNA nanorobot (TDN) programmed to undergo a controlled conformational change in response to epithelial cell adhesion molecule (EpCAM), a molecular biomarker specifically expressed on the circulating tumor cells. Multiresolution molecular dynamics simulations verified the overall stability of the folded TDN design and characterized local distortions in the folded structure. Atomic force microscopy and gel electrophoresis results showed that tetragonal structures are more stable than unfolded DNA origami sheets. Live cell experiments demonstrated the low cytotoxicity and target specificity of TDN. In summary, the proposed TDN can not only effectively resist nuclease catalysis but also has the potential to monitor EpCAM-positive cells precisely.

Development of Cultured Muscles with Tendon Structures for Modular Bio-Actuators.

In this article, we propose a new actuator named the modular bio-actuator (MBA). The MBA has two tendon structures made of polydimethylsiloxane (PDMS) at both ends of the bio-actuator. The MBA can be easily handled and fixed on an artificial micro-robot body to increase its design flexibility and output power. The tendon structures were connected to a bio-actuator in the form of a chain structure, and the connection between the tendon structures and the bio-actuator was maintained for more than three weeks. The contraction length of the MBA was linearly increased when the DC voltage applied to the MBA was increased. The MBA contracted over 200 µm when a DC voltage of 10 V and 1 Hz was applied to the bio-actuator. The output power of the MBA was measured using a PDMS cantilever, and the total output power of the MBA increased linearly when multiple MBAs were stacked on a PDMS cantilever. This study was aimed at improving the design flexibility and controllability of micro-robots and bionic systems.

Ionic shape-morphing microrobotic end-effectors for environmentally adaptive targeting, releasing, and sampling.

Shape-morphing uses a single actuation source for complex-task-oriented multiple patterns generation, showing a more promising way than reconfiguration, especially for microrobots, where multiple actuators are typically hardly available. Environmental stimuli can induce additional causes of shape transformation to compensate the insufficient space for actuators and sensors, which enriches the shape-morphing and thereby enhances the function and intelligence as well. Here, making use of the ionic sensitivity of alginate hydrogel microstructures, we present a shape-morphing strategy for microrobotic end-effectors made from them to adapt to different physiochemical environments. Pre-programmed hydrogel crosslinks were embedded in different patterns within the alginate microstructures in an electric field using different electrode configurations. These microstructures were designed for accomplishing tasks such as targeting, releasing and sampling under the control of a magnetic field and environmental ionic stimuli. In addition to structural flexibility and environmental ion sensitivity, these end-effectors are also characterized by their complete biodegradability and versatile actuation modes. The latter includes global locomotion of the whole end-effector by self-trapping magnetic microspheres as a hitch-hiker and the local opening and closing of the jaws using encapsulated nanoparticles based on local ionic density or pH values. The versatility was demonstrated experimentally in both in vitro environments and ex vivo in a gastrointestinal tract. Global locomotion was programmable and the local opening and closing was achieved by changing the ionic density or pH values. This 'structural intelligence' will enable strategies for shape-morphing and functionalization, which have attracted growing interest for applications in minimally invasive medicine, soft robotics, and smart materials.