Evaluating adaptiveness of an active back exosuit for dynamic lifting and maximum range of motion.

Back exosuits deliver mechanical assistance to reduce the risk of back injury, however, minimising restriction is critical for adoption. We developed the adaptive impedance controller to minimise restriction while maintaining assistance by modulating impedance based on the user's movement direction and nonlinear sine curves. The objective of this study was to compare active assistance, delivered by a back exosuit via our adaptive impedance controller, to three levels of assistance from passive elastics. Fifteen participants completed five experimental blocks (4 exosuits and 1 no-suit) consisting of a maximum flexion and a constrained lifting task. While a higher stiffness elastic reduced back extensor muscle activity by 13%, it restricted maximum range of motion (RoM) by 13°. The adaptive impedance approach did not restrict RoM while reducing back extensor muscle activity by 15%, when lifting. This study highlights an adaptive impedance approach might improve usability by circumventing the assistance-restriction trade-off inherent to passive approaches.Practitioner summary: This study demonstrates a soft active exosuit that delivers assistance with an adaptive impedance approach can provide reductions in overall back muscle activity without the impacts of restricted range of motion or perception of restriction and discomfort.

Reducing Back Exertion and Improving Confidence of Individuals with Low Back Pain with a Back Exosuit: A Feasibility Study for Use in BACPAC.

OBJECTIVE: Low back pain (LBP) is hallmarked by activity limitations, especially for tasks involving bending. Back exosuit technology reduces low back discomfort and improves self-efficacy of individuals with LBP during bending and lifting tasks. However, the biomechanical efficacy of these devices in individuals with LBP is unknown. This study sought to determine biomechanical and perceptual effects of a soft active back exosuit designed to assist individuals with LBP sagittal plane bending. To understand patient-reported usability and use cases for this device. METHODS: Fifteen individuals with LBP performed two experimental lifting blocks once with and without an exosuit. Trunk biomechanics were measured by muscle activation amplitudes, and whole-body kinematics and kinetics. To evaluate device perception, participants rated task effort, low back discomfort, and their level of concern completing daily activities. RESULTS: The back exosuit reduced peak back extensor: moments by 9%, and muscle amplitudes by 16% when lifting. There were no changes in abdominal co-activation and small reductions maximum trunk flexion compared to lifting without an exosuit. Participants reported lower task effort, back discomfort, and concern about bending and lifting with an exosuit compared to without. CONCLUSIONS: This study demonstrates a back exosuit not only imparts perceptual benefits of reduced task effort, discomfort, and increased confidence in individuals with LBP but that it achieves these benefits through measurable biomechanical reductions in back extensor effort. The combined effect of these benefits implies back exosuits might be a potential therapeutic aid to augment physical therapy, exercises, or daily activities.

[Clinicopathological analysis of lung metastatic tumor].

Objective: To investigate the clinicopathological features and differential diagnosis of metastatic tumors in the lung. Methods: The clinicopathological data of 226 metastatic tumors in the lung were collected at Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, from January 2014 to December 2018, and the pathomorphological characteristics were analyzed. Results: There were 84 males and 142 females, with an age range from 13 to 77 years. There were 122 patients with multiple pulmonary nodules and 104 patients with solitary pulmonary nodule. The tumors of the highest frequencies were colorectal cancer (n=59), followed by trophoblast tumor (n=44), kidney cancer (n=31), breast cancer (n=20), cervix cancer (n=14), and urinary urothelium cancer (n=8). The time from the diagnosis of primary tumors to metastasis and the status of surgical treatment varied by tumor origin. The morphology of metastatic lung tumors overlapped with that of the primary tumors to some extent. The relative specific morphological characteristics and the presence of carcinoma in situ surrounding the tumors should be carefully searched for to confirm the tumor origin. The metastatic tumors of the lung had morphological characteristics, immunohistochemical TTF1 (-) and tumor of various sources, while the primary tumor differentiation had relatively specific antibodies: colorectal cancer CK20 (+), CDX2 (+), CK7 (-); malignant trophoblastic tumor, HCG (+); renal clear cell carcinoma CD10 (+), vimentin (+), CK7 (-); breast cancer, GATA3 and ER (+); cervical cancer, p16 (+); urothelial carcinoma, CK20, p63 and GATA3 (+). Conclusions: There is overlap between pulmonary metastatic tumor and primary tumor in morphology. Therefore, the diagnosis should be made by combining clinical history, pathological morphology and immunophenotypic characteristics.

"But I did not touch nobody!"-Patients' and nurses' perspectives and recommendations after aggression on psychiatric wards-A qualitative study.

AIMS: To gain a deeper understanding of the differences in patients and staff perspectives in response to aggression and to explore recommendations on prevention. DESIGN: Qualitative, grounded theory study. METHODS: We conducted semi-structured interviews with patients and nurses involved in an aggressive incident. Data collection was performed from May 2016 - March 2017. RESULTS: Thirty-one interviews were conducted concerning 15 aggressive incidents. Patients and nurses generally showed agreement on the factual course of events, there was variation in agreement on the perceived severity (PS). Patients' recommendations on prevention were mostly personally focussed, while nurses suggested general improvements. CONCLUSION: Patients are often capable to evaluate aggression and give recommendations on prevention shortly after the incident. Patients and nurses differ in the PS of aggression. Recommendations on prevention of patients and nurses are complementary. IMPACT: What problem did the study address? Perspectives of patients and nurses differ with respect to aggression, but how is unclear. What were the main findings? Patients and nurses generally described a similar factual course of events concerning the incident, patients often perceive the severity less than nurses. Patients are capable to give recommendations on prevention of aggressive incidents, shortly after the incident. Where and on whom will the research have impact? Factual course of events can be a common ground to start evaluating aggressive incidents and post-incident review should address the severity of incidents. Asking recommendations from patients on how to improve safety and de-escalation can lead to innovative and personal de-escalation strategies and supports patients autonomy.

Sarcopenia in overweight and obese patients is a predictive factor for postoperative complication in gastric cancer: A prospective study.

BACKGROUND: Sarcopenia is a syndrome characterized by progressive and generalized loss of skeletal muscle mass and strength. This study aims to explore the prevalence of sarcopenia in overweight and obese gastric cancer (GC) patients and figured out the impacts of sarcopenia on the postoperative complication of overweight and obese GC patients. METHODS: According to the recommended body-mass index (BMI) for Asian populations by WHO, we conducted a prospective study of overweight and obese gastric cancer patients (BMI ≥ 23 kg/m2) under curative gastrectomy from August 2014 to December 2015. Including lumbar skeletal muscle index, handgrip strength and gait speed as the sarcopenic components were measured before surgery. Patients were followed up after gastrectomy to gain the actual clinical outcomes. Factors contributing to postoperative complications were analyzed by univariate and multivariate analysis. RESULTS: Total of 206 overweight or obese patients were enrolled in this study, 14 patients were diagnosed sarcopenia and were demonstrated having significantly association with higher risk of postoperative complications, higher hospital costs, and higher rate of 30-days readmission compared with the non-sarcopenic ones. On the basis of univariate and multivariate analysis, sarcopenia was an independent risk factor for postoperative complication of overweight and obese patients with gastric cancer (P = 0.002). CONCLUSION: Sarcopenia is an independent predictor of postoperative complications in overweight or obese patients with gastric cancer after radical gastrectomy.

Circulating chemerin levels are increased in first-degree relatives of type 2 diabetic patients.

BACKGROUND: Chemerin is an important risk factor of insulin resistance and metabolic syndrome. The aim of this study was to explore the potential role of chemerin in the early stage of diabetes development. METHODS: 63 control subjects without any family history of diabetes and with normal glucose tolerance (NGT) and 74 healthy, first-degree relatives (FDRs) of type 2 diabetic patients were recruited in the study. All subjects underwent a 75 g oral glucose tolerance (OGTT) test after having fasted overnight. Plasma glucose, insulin, total cholesterol, HDL cholesterol, triglycerides, chemerin, and adiponectin were measured. RESULTS: FDR subjects had higher BMI, WHR, waist, fasting plasma glucose, fasting insulin, TG, UA, HOMA-IR, LDL-C, and lower HDL- C levels than control subjects (p < 0.05). The FDRs group had significantly lower adiponectin levels while chemerin was higher. Plasma chemerin levels were independently correlated with HOMA-IR, FINS, TG, FPG, and adiponectin level. Multiple stepwise regression analysis showed that HOMA-IR and TG were independent risk factors that influenced circulating chemerin levels. CONCLUSIONS: These findings showed a significant increase of chemerin levels in FDR subjects which suggested that chemerin may be involved in the development and progression of insulin resistance.

Preoperative Maximal Oxygen Uptake and Exercise-induced Changes in Pulse Oximetry Predict Early Postoperative Respiratory Complications in Lung Cancer Patients.

BACKGROUND: Postoperative respiratory complications often arise in lung cancer patients after lung resection, although these are often difficult to predict. We sought to identify reliable predictors of early-onset postoperative respiratory complications in lung cancer patients who had moderate-to-severe preoperative respiratory impairment. METHODS: This was a prospective observational study that included 107 consecutive lung cancer patients with forced expiratory volume in 1 s <60% of predicted who were scheduled for thoracotomy and lung resection. Preoperative functional assessments included pulmonary function testing by spirometry, single breath diffusion capacity of lung for carbon monoxide, and cardiopulmonary exercise testing. Risk factors for early-onset postoperative respiratory complications that occurred within 30 days postoperatively were sought from among these pulmonary function testing and cardiopulmonary exercise testing results. RESULTS: By multivariable logistic regression, peak oxygen uptake (V'O2max%; p < 0.001) and the transcutaneous pulse oxygen saturation difference during load exercise (ΔSPO2%; p < 0.001) were independent predictors of postoperative respiratory complications. A receiver operating characteristic curve had an area under the curve of 0.846 for the combination of V'O2max% and ΔSPO2%, while the area under the curve with V'O2max% only was 0.726. From this, the probability of postoperative respiratory complications was [Formula: see text]. Pcomplication ≥ 0.202 for postoperative respiratory complications had a sensitivity of 80.8% and a specificity of 81.5%. CONCLUSIONS: For lung cancer patients with forced expiratory volume in 1 s <60% of predicted, in addition to common preoperative tests, V'O2max% and ΔSPO2% may be an aid for predicting early-onset postoperative respiratory complications.

Synthetic peptides cytomodulin-1 (CM-1) and cytomodulin-2 (CM-2) promote collagen synthesis and wound healing in vitro.

Transforming growth factor-beta1 (TGF-beta1) is believed to be a key player in wound healing, promoting cell proliferation, migration, and matrix synthesis in a variety of cell types. We have designed two peptides, i.e., cytomodulin-1 (CM-1) and cytomodulin-2 (CM-2), to simulate the binding domain of TGF-beta1. In this study we examined the bioactivity of the two synthetic peptides CM-1 and CM-2 on human foreskin fibroblasts (HFF). Synthetic peptides CM-1 and CM-2 in culture media increased wound healing of fibroblasts in an injury model in vitro. In addition, CM-1 and CM-2 enhanced the gene expression of collagen I and increased the production of pro-collagen I peptide in HFF. These results suggest that CM-1 and CM-2 have potentially useful clinical applications in wound healing.

Mass resolved MPI spectra of methyl iodide in the 430-490 nm region.

The mass resolved multiphoton ionization (MPI) spectra of methyl iodide were obtained in the 430-490 nm region using a time-of-flight (TOF) mass spectrometer. They have the same vibrational structure, which testifies that the fragment species, in the wavelength region under study, are from the photodissociation of multiphoton ionized molecular parent ions. Some features in the spectra are identified as three-photon excitations to 6p and 7s Rydberg states of methyl iodide. Two new vibrational structures of some Rydberg states are observed. The mechanism of ionization and dissociation is also discussed.

Photoelectron spectroscopy of ammonia via a fast predissociative state

We report a study on resonance enhanced multiphoton ionization photoelectron spectroscopy (REMPI-PES) involving the fast predissociative A state of ammonia, using nano- and femtosecond lasers. The multiphoton scheme involves (1 + 1), (2 + 2), (2 + 2) + 1 and (2 + 2) + 2 photon processes. We have found a progression of stretching vibrations v1 in the PE spectrum when pumping NH3 A v2 = 0, 1 and 3 as intermediate states. The stretching vibration intensity distributions in the photoelectron spectrum are calculated by using the Chebychev method of the wavepacket propagation. The femtosecond spectrum shows a similar feature to the nanosecond spectrum. However, high laser power also causes band broadening and shifting effect as well as above threshold multiphoton ionization.

Oxidative and malondialdehyde modification of low-density lipoprotein: a comparative study.

Low-density lipoprotein (LDL) was modified with copper ions (Cu2+) and malondialdehyde (MDA), and the differences were compared. The results show that both oxidative and MDA modification produce a decrease in free amino groups in LDL and enhance its electrophoretic mobility on agarose gel, and that these observations are linked. However, differences produced by the two forms of modification were observed. Oxidative modification of LDL involves free radical-mediated lipid peroxidation which produces large amounts of thiobarbituric acid-reactive substances (TBARS) and conjugated dienes. In addition, vitamin E was reduced considerably and cholesterol lowered, and apolipoprotein B (apo B) fragmentation and aggregation were seen. Similar changes were not seen with MDA modification which does not involve lipid peroxidation. Fluorescence emission spectra of both forms of modified LDL show that emission intensity increases gradually as the modification progresses, but maximum emission wavelength and spectrum patterns are not the same. These findings may be of some significance in the study of the antigenicity, scavenger receptor multiplicity and toxic effects of modified LDL.