Objective To address the issue of motion misclassification caused by individual gait differences and fixed time window data extraction in motion intention recognition for intelligent lower limb prostheses,this study proposes a motion intention recognition method based on adaptive temporal alignment.Methods In lower limb motion analysis,for continuous gait cycle data,inter-class variability across different steady-state modes was utilized to detect gait pattern consistency through inter-cycle frame differencing.For samples identified as single steady-state modes,the dynamic time warping algorithm was introduced to align adjacent mo-tion sequences,thereby reducing individual variability.Haar wavelet 4-level decomposition was applied to ex-tract low-frequency coefficients for feature vector construction,and classification was performed using a support vector machine.The experimental protocol was designed as follows:three inertial measurement units were used to collect lower limb acceleration and angular velocity data from subjects performing thirteen locomotion modes.The test subjects included ten healthy participants and one transtibial amputee.The locomotion modes consisted of five steady-state modes(level walking,stair ascent,stair descent,ramp ascent,and ramp descent)and eight transition modes(mutual transitions between level walking and stair ascent/descent,as well as ramp ascent/de-scent).Results Simulation tests on ten healthy individuals and one amputee showed recognition accuracies of 99.24%and 100%for five steady-state modes,and 98.51%and 89.11%for all thirteen motion modes,respectively.Conclusion This study proposes an adaptive temporal alignment-based motion intention recognition method.The pro-posed approach effectively reduces the interference of individual gait variability on feature representation,en-hances the consistency and discriminability of gait features,and ultimately improves recognition performance.

Objective To address the issue of motion misclassification caused by individual gait differences and fixed time window data extraction in motion intention recognition for intelligent lower limb prostheses,this study proposes a motion intention recognition method based on adaptive temporal alignment.Methods In lower limb motion analysis,for continuous gait cycle data,inter-class variability across different steady-state modes was utilized to detect gait pattern consistency through inter-cycle frame differencing.For samples identified as single steady-state modes,the dynamic time warping algorithm was introduced to align adjacent mo-tion sequences,thereby reducing individual variability.Haar wavelet 4-level decomposition was applied to ex-tract low-frequency coefficients for feature vector construction,and classification was performed using a support vector machine.The experimental protocol was designed as follows:three inertial measurement units were used to collect lower limb acceleration and angular velocity data from subjects performing thirteen locomotion modes.The test subjects included ten healthy participants and one transtibial amputee.The locomotion modes consisted of five steady-state modes(level walking,stair ascent,stair descent,ramp ascent,and ramp descent)and eight transition modes(mutual transitions between level walking and stair ascent/descent,as well as ramp ascent/de-scent).Results Simulation tests on ten healthy individuals and one amputee showed recognition accuracies of 99.24%and 100%for five steady-state modes,and 98.51%and 89.11%for all thirteen motion modes,respectively.Conclusion This study proposes an adaptive temporal alignment-based motion intention recognition method.The pro-posed approach effectively reduces the interference of individual gait variability on feature representation,en-hances the consistency and discriminability of gait features,and ultimately improves recognition performance.

Objective To investigate the effects and mechanisms of silica dust on the apoptosis of alveolar epithelial cell (AEC) through in vitro and animal experiments. Methods i) In vitro experiment. A549 cells were stimulated with 100 mg/L silica suspension for 0, 12, 24 and 48 hours. The cell apoptosis rate was detected by flow cytometry. ii) Animal experiment. Specific pathogen-free male C57BL/6 mice were randomly divided into control, 14-day, 28-day, and 56-day groups, with five mice in each group. The mice in the control group were sacrificed at 56 days after being treated with 40.0 μL 0.9% sodium chloride solution, and the mice in the last three groups were sacrificed at 14, 28 and 56 days after being treated with 40.0 μL silica suspension with a mass concentration of 125 g/L via tracheal exposure method. The lung tissues of mice were collected to measure lung organ coefficients. Masson staining was used to detect the degree of pulmonary fibrosis, and Ashcroft scores were evaluated. The apoptosis of AEC in mice was observed by TUNEL immunofluorescence assay. iii) The mRNA relative expression of apoptosis-related genes in A549 cells and mouse lung tissue was detected using reverse transcription and real-time fluorescence quantitative polymerase chain reaction. Results i) In vitro experiment. The apoptosis rate of A549 cells increased with longer silica exposure (all P<0.05). The relative expression of B cell lymphoma-2 (BCL-2) mRNA in A549 cells in 24 h group and 48 h group decreased (both P<0.05), and the relative expression of BCL-2 associated X protein (BAX) mRNA increased (both P<0.05), compared with 0 h group. The mRNA relative expression of caspase (CASP) -3 and CASP-9 in A549 cells increased with longer silica exposure (all P<0.05). ii) Animal experiment. The lung organ coefficients and Ashcroft score in mice progressively increased (all P<0.05), the degree of pulmonary fibrosis was gradually aggravated, and TUNEL positive cells in lung tissue were gradually increased, while Bax, Casp-3 and Casp-9 mRNA relative expression increased with longer silica exposure (all P<0.05). Conclusion Silica dust may cause pulmonary fibrosis by inducing apoptosis of AEC, with a time-dependent effect. The mechanism may be related to the effect of silica dust on mitochondrial apoptosis through Bcl-2/Bax/Caspase-3 signaling pathway.

Objective: To investigate the role of surfactant associated protein-A (SP-A) in the development and progression of silicosis, and its mechanism. Methods: Homozygous and heterozygous mice of SP-A knockout of specific pathogen free (SPF) grade were selected for mating, and mice with SP-A^-/- genotype were selected for subsequent experiments. SP-A wild-type (SP-A^+/+) and SP-A^-/- mice were divided into SP-A^+/+ control group, SP-A^-/- control group, SP-A^+/+ silicosis group and SP-A^-/- silicosis group with six mice in each group by random number table method. Mice in both silicosis groups were given 20.0 μL 250 g/L silica suspension by tracheal exposure, and mice in both control groups were injected with 0.9% sodium chloride solution at the same volume. On the 28th day after modeling, mice were sacrificed. Lung tissues were used for lung histopathology examination. The apoptosis of alveolar type Ⅱ epithelial cells of mice was detected by TUNEL method. The mRNA expression of B-lymphoblastoma 2 (Bcl-2), Bcl-2 associated X protein (Bax), cysteinyl aspartate specific proteinase (Caspase)-3 and Caspase-9 in lung tissues of mice was detected by quantitative real-time polymerase chain reaction. Results: The histopathological result of mice showed that thickened alveolar septum, scattered silicon nodule and collagen fiber formation were observed in the mice lungs of SP-A^+/+ silicosis group, and a large number of inflammatory cells were observed in silicosis nodule, after exposure to silica dust. SP-A^-/- silicosis group resulted in a more severe pulmonary inflammation and interstitial fibrosis compared to SP-A^+/+ silicosis group. The apoptosis of alveolar type Ⅱ epithelial cells and the mRNA relative expression levels of Bax, Caspase-3 and Caspase-9 in lung tissues of mice in each silicosis groups were increased compared with their control groups (all P<0.05). The above four indexes of mice in SP-A^-/- silicosis group were higher than those in SP-A^+/+ silicosis group (all P<0.05). There was no significant difference in the expression of Bcl-2 mRNA in lung tissues of these four groups (P>0.05). Conclusion: Knockout of SP-A can aggravate inflammation and pulmonary fibrosis in silicosis model mice, and promote apoptosis of alveolar type Ⅱ epithelial cells. The mechanism may be related to the Bcl-2/Bax/Caspase-3 signaling pathway which affects the apoptosis of mitochondrial pathway.

Objective:To investigate the current status of polypharmacy among elderly outpatients with 4 types of chronic diseases such as hypertension, diabetes mellitus, coronary atherosclerotic heart disease, and cerebrovascular disease.Methods:A retrospective study was conducted on the drug use of elderly (≥65 years old) outpatients with hypertension, diabetes mellitus, coronary atherosclerotic heart disease, and cerebrovascular disease with data of Beijing Municipal Health Insurance Centre database from July 2017 to September 2017. The included patients had at least 1 of 4 types of chronic diseases. Polypharmacy was defined as ≥5 different types of medication at the first visit, and non-polypharmacy was defined as <5 types of medication. The number and severity of comorbidity were quantified using the Charlson Comorbidity Index (CCI), and the prognosis of patient was evaluated at 4 levels of 0, 1, 2, and ≥3 scores. The larger the value, the more severe the disease. Based on the Beers Criteria 2015, the potential inappropriate medication (PIM) was identified using the prescription review system of Puhua Health.Results:A total of 405 608 patients were included in this study, with a median age of 74 (65-107) years, and 204 219 patients (50.35%) were female. According to the type of medication used by patients, they were divided into polypharmacy group (113 594 cases, 28.01%) and non-polypharmacy group (292 014 cases, 71.99%). The CCI of the polypharmacy group was significantly higher than that of the non-polypharmacy group ( P<0.001). The proportion of patients with 0, 1, 2, and ≥3 scores in the polypharmacy group was significantly higher than that of the non-polypharmacy group, and the differences were statistically significant (all P<0.001). In terms of comorbidity, the proportions of patients among the 4 types of chronic diseases were higher in the polypharmacy group than in the non-polypharmacy group ( P<0.001). In terms of concomitant diseases, the proportion of patients with hyperlipidemia, cognitive impairment, heart failure, and osteoporosis in the polypharmacy group was higher than that in the non-polypharmacy group (all P<0.001). In terms of medical treatment behaviour, the median number of medical visits was higher in the polypharmacy group than in the non-polypharmacy group [2(1,3) vs. 1(1,2), P<0.001]. In terms of evaluating the unsuitability of medication, the proportion of patients with PIM in the polypharmacy group was higher than that in the non-polypharmacy group, including repeated medication [4.60% (5 227/113 594) vs. 1.64% (4 486/292 014)], contraindications [2.97% (3 376/113 594) vs. 1.13% (3 294/292 014)], interactions [6.51% (7 399/113 594) vs. 1.94% (5 658/292 014)], and lack of indications [22.39% (25 432/113 594) vs. 13.54% (39 543/292 014)], and the differences were all significant (all P<0.001). In terms of drug use categories, the top 5 most commonly prescribed drugs in the polypharmacy group were HMG-CoA reductase inhibitors (68 318 cases, 60.14%), dihydropyridines (60 951 cases, 53.66%), angiotensin receptor antagonists(45 050 cases, 39.66%), β-receptor blockers (25 675 cases, 22.60%) and sulfonylureas (16 023 cases, 14.11%). Conclusions:Polypharmacy is common in elderly patients with hypertension, diabetes mellitus, coronary artery disease, and cerebrovascular disease. The elderly patients with polypharmacy have a worse baseline status and more problems with PIM.

Objective:To investigate the current status of polypharmacy among elderly outpatients with 4 types of chronic diseases such as hypertension, diabetes mellitus, coronary atherosclerotic heart disease, and cerebrovascular disease.Methods:A retrospective study was conducted on the drug use of elderly (≥65 years old) outpatients with hypertension, diabetes mellitus, coronary atherosclerotic heart disease, and cerebrovascular disease with data of Beijing Municipal Health Insurance Centre database from July 2017 to September 2017. The included patients had at least 1 of 4 types of chronic diseases. Polypharmacy was defined as ≥5 different types of medication at the first visit, and non-polypharmacy was defined as <5 types of medication. The number and severity of comorbidity were quantified using the Charlson Comorbidity Index (CCI), and the prognosis of patient was evaluated at 4 levels of 0, 1, 2, and ≥3 scores. The larger the value, the more severe the disease. Based on the Beers Criteria 2015, the potential inappropriate medication (PIM) was identified using the prescription review system of Puhua Health.Results:A total of 405 608 patients were included in this study, with a median age of 74 (65-107) years, and 204 219 patients (50.35%) were female. According to the type of medication used by patients, they were divided into polypharmacy group (113 594 cases, 28.01%) and non-polypharmacy group (292 014 cases, 71.99%). The CCI of the polypharmacy group was significantly higher than that of the non-polypharmacy group ( P<0.001). The proportion of patients with 0, 1, 2, and ≥3 scores in the polypharmacy group was significantly higher than that of the non-polypharmacy group, and the differences were statistically significant (all P<0.001). In terms of comorbidity, the proportions of patients among the 4 types of chronic diseases were higher in the polypharmacy group than in the non-polypharmacy group ( P<0.001). In terms of concomitant diseases, the proportion of patients with hyperlipidemia, cognitive impairment, heart failure, and osteoporosis in the polypharmacy group was higher than that in the non-polypharmacy group (all P<0.001). In terms of medical treatment behaviour, the median number of medical visits was higher in the polypharmacy group than in the non-polypharmacy group [2(1,3) vs. 1(1,2), P<0.001]. In terms of evaluating the unsuitability of medication, the proportion of patients with PIM in the polypharmacy group was higher than that in the non-polypharmacy group, including repeated medication [4.60% (5 227/113 594) vs. 1.64% (4 486/292 014)], contraindications [2.97% (3 376/113 594) vs. 1.13% (3 294/292 014)], interactions [6.51% (7 399/113 594) vs. 1.94% (5 658/292 014)], and lack of indications [22.39% (25 432/113 594) vs. 13.54% (39 543/292 014)], and the differences were all significant (all P<0.001). In terms of drug use categories, the top 5 most commonly prescribed drugs in the polypharmacy group were HMG-CoA reductase inhibitors (68 318 cases, 60.14%), dihydropyridines (60 951 cases, 53.66%), angiotensin receptor antagonists(45 050 cases, 39.66%), β-receptor blockers (25 675 cases, 22.60%) and sulfonylureas (16 023 cases, 14.11%). Conclusions:Polypharmacy is common in elderly patients with hypertension, diabetes mellitus, coronary artery disease, and cerebrovascular disease. The elderly patients with polypharmacy have a worse baseline status and more problems with PIM.

Objective:To investigate the influence of potentially inappropriate medication (PIM) on emergency treatment or hospitalization events due to heart failure in elderly outpatients.Methods:The data of outpatient, emergency patient, and inpatient above 65 years old collected in Beijing Medical Insurance Affairs Management Center database from July 1, 2016 to September 30, 2016 were retrospectively analyzed. PIM in the outpatient western medicine prescription was identified using the 2015 Beers Criteria ?. PIM exposure was defined as at least one PIM was prescribed within 3 months and patients were divided into the PIM exposure and non-PIM exposure groups accordingly. Clinical outcome events were defined as experiencing emergency treatment or hospitalization events due to heart failure after ≥14 days of PIM exposure. Clinical characteristics in patients between the 2 groups were compared and the exposure of specific PIM (PIM with the 3 highest use frequency) in the PIM exposure group was described. Influencing factors of clinical outcome events were analyzed using logistic regression analysis. Results:A total of 506 214 patients were entered in the study, including 252 604 males (49.90%) and 253 610 females (50.10%), aged from 65 to 105 years with a median age of 74 (68, 80) years. Definition of PIM exposure was met in 192 740 patients (38.07%); clinical outcome events occurred in 249 patients, of which 131 patients (0.03%) received emergency treatment and 118 patients (0.02%) hospitalized due to heart failure. Incidences of emergency treatment and hospitalization due to heart failure in patients of the PIM exposure group were higher than those of the non-PIM exposure group [0.04% (78/192 740) vs. 0.02% (53/313 474), P<0.001; 0.04% (71/192 740) vs. 0.01% (47/313 474), P<0.001]. The 3 PIM that used most frequently were vasodilators, diuretics, and central nervous system drugs. Multivariate analysis showed that PIM exposure and use of vasodilators and central nervous system drugs had no significant effects on the occurrence of emergency treatment and hospitalization events due to heart failure, while age ≥75 years old and use of diuretics had significant effects. Compared with the 65-74 age group, the risk of emergency treatment for heart failure in patients of the 75-84 age group and ≥85 age group increased by 3.00 times ( OR=4.00, 95 %CI: 2.46-6.51) and 7.14 times ( OR=8.14, 95 %CI: 4.64-14.29), respectively, and the risk of hospitalization for heart failure increased by 1.33 times ( OR=2.33, 95 %CI: 1.52-3.57) and 2.59 times ( OR=3.59, 95 %CI: 2.03-6.36), respectively. Compared with patients without diuretics treatment, patients treated with diuretics had a 1.91-fold increase in the risk of emergency treatment and hospitalization events due to heart failure ( OR=2.91, 95 %CI: 1.72-4.93) and 1.72-fold increase ( OR=2.72, 95 %CI: 1.56-4.74), respectively. Conclusions:PIM increases the risk of emergency treatment or hospitalization due to heart failure in elderly outpatients, but it is not an independent influencing factor. Age ≥75 years and diuretics use were independent influencing factors of emergency treatment or hospitalization in elderly patients.

Objective:To investigate the influence of potentially inappropriate medication (PIM) on emergency treatment or hospitalization events due to heart failure in elderly outpatients.Methods:The data of outpatient, emergency patient, and inpatient above 65 years old collected in Beijing Medical Insurance Affairs Management Center database from July 1, 2016 to September 30, 2016 were retrospectively analyzed. PIM in the outpatient western medicine prescription was identified using the 2015 Beers Criteria ?. PIM exposure was defined as at least one PIM was prescribed within 3 months and patients were divided into the PIM exposure and non-PIM exposure groups accordingly. Clinical outcome events were defined as experiencing emergency treatment or hospitalization events due to heart failure after ≥14 days of PIM exposure. Clinical characteristics in patients between the 2 groups were compared and the exposure of specific PIM (PIM with the 3 highest use frequency) in the PIM exposure group was described. Influencing factors of clinical outcome events were analyzed using logistic regression analysis. Results:A total of 506 214 patients were entered in the study, including 252 604 males (49.90%) and 253 610 females (50.10%), aged from 65 to 105 years with a median age of 74 (68, 80) years. Definition of PIM exposure was met in 192 740 patients (38.07%); clinical outcome events occurred in 249 patients, of which 131 patients (0.03%) received emergency treatment and 118 patients (0.02%) hospitalized due to heart failure. Incidences of emergency treatment and hospitalization due to heart failure in patients of the PIM exposure group were higher than those of the non-PIM exposure group [0.04% (78/192 740) vs. 0.02% (53/313 474), P<0.001; 0.04% (71/192 740) vs. 0.01% (47/313 474), P<0.001]. The 3 PIM that used most frequently were vasodilators, diuretics, and central nervous system drugs. Multivariate analysis showed that PIM exposure and use of vasodilators and central nervous system drugs had no significant effects on the occurrence of emergency treatment and hospitalization events due to heart failure, while age ≥75 years old and use of diuretics had significant effects. Compared with the 65-74 age group, the risk of emergency treatment for heart failure in patients of the 75-84 age group and ≥85 age group increased by 3.00 times ( OR=4.00, 95 %CI: 2.46-6.51) and 7.14 times ( OR=8.14, 95 %CI: 4.64-14.29), respectively, and the risk of hospitalization for heart failure increased by 1.33 times ( OR=2.33, 95 %CI: 1.52-3.57) and 2.59 times ( OR=3.59, 95 %CI: 2.03-6.36), respectively. Compared with patients without diuretics treatment, patients treated with diuretics had a 1.91-fold increase in the risk of emergency treatment and hospitalization events due to heart failure ( OR=2.91, 95 %CI: 1.72-4.93) and 1.72-fold increase ( OR=2.72, 95 %CI: 1.56-4.74), respectively. Conclusions:PIM increases the risk of emergency treatment or hospitalization due to heart failure in elderly outpatients, but it is not an independent influencing factor. Age ≥75 years and diuretics use were independent influencing factors of emergency treatment or hospitalization in elderly patients.