Analysis by nanoindentation indicates that both polycrystalline biominerals and synthetic abiotic spherulites display superior toughness compared to single-crystalline geologic aragonite. Molecular dynamics (MD) simulations on bicrystals at the molecular scale indicate that aragonite, vaterite, and calcite demonstrate peak toughness values when the bicrystal grains are misaligned by 10, 20, and 30 degrees respectively. This demonstrates that a small degree of misorientation alone can substantially increase the fracture resistance of these materials. Employing slight-misorientation-toughening, synthesis of bioinspired materials utilizing a single material, unconstrained by top-down architectural limitations, is effortlessly achieved through the self-assembly of diverse components, including organic molecules (aspirin, chocolate), polymers, metals, and ceramics, ultimately surpassing biominerals in scope.
Optogenetics has been hindered by the invasive nature of brain implants and the accompanying thermal issues during the photo-modulation process. We demonstrate two upconversion hybrid nanoparticles, labeled PT-UCNP-B/G, capable of modulating neuronal activity through photo- and thermo-stimulation under near-infrared laser irradiation of 980 nm and 808 nm, respectively. PT-UCNP-B/G, undergoing upconversion at an excitation wavelength of 980 nm, emits visible light within the 410-500 nm or 500-570 nm range. At 808 nm, this material displays an effective photothermal response without generating any visible light and exhibiting minimal tissue damage. PT-UCNP-B's effect on neuro2a cells expressing channelrhodopsin-2 (ChR2) ion channels, which exhibit significant activation of extracellular sodium currents under 980-nm light, is coupled with its inhibition of potassium currents in human embryonic kidney 293 cells expressing voltage-gated potassium channels (KCNQ1) under 808-nm irradiation in laboratory studies. Stereotactically injected PT-UCNP-B into the ChR2-expressing lateral hypothalamus region of mice enables tether-free bidirectional modulation of feeding behavior under 980 or 808 nm illumination (0.08 W/cm2) in the deep brain. Furthermore, PT-UCNP-B/G presents a new opportunity to employ both light and heat for modulating neural activities, providing a practical strategy to transcend the limitations of optogenetics.
Past systematic reviews and randomized controlled trials have explored the effects of post-stroke trunk strengthening protocols on patient outcomes. Trunk training, according to the findings, results in better trunk function and the successful execution of tasks or actions by an individual. The impact of trunk training on daily activities, quality of life, and other outcomes remains uncertain.
Analyzing the effect of trunk rehabilitation following stroke on daily activities (ADLs), core strength and function, upper limb skills, participation in activities, balance during standing, lower limb capabilities, ambulation, and general well-being by comparing the results of both dose-matched and non-dose-matched control groups.
Our comprehensive search of the Cochrane Stroke Group Trials Register, CENTRAL, MEDLINE, Embase, and five additional databases concluded on October 25, 2021. Our investigation of trial registries yielded a search for additional relevant trials in various stages of publication, including published, unpublished, and ongoing trials. By hand, we searched the lists of references in the included studies.
We examined randomized controlled trials that compared trunk training to either non-dose-matched or dose-matched control therapies. Included in these studies were adults (18 years old or older) with either an ischaemic or haemorrhagic stroke. Evaluated aspects of trial success involved daily living activities, trunk functionality, arm-hand skills, equilibrium while standing, lower extremity function, walking ability, and patient well-being.
We adhered to the standard methodological protocols stipulated by Cochrane. Two key examinations were performed. The initial examination encompassed trials wherein the control intervention's treatment duration differed from the experimental group's treatment duration, without a matching dosage; the subsequent analysis involved comparing the results against a control intervention with a matched dosage, wherein both the control and experimental groups received equal therapy durations. Our study comprised 68 trials, with a total of 2585 participants enrolled. In evaluating the non-dose-matched groups (all trials involving various training lengths within both the experimental and control cohorts were collated), Analysis of the five trials, encompassing 283 participants, revealed a statistically significant positive effect of trunk training on ADLs, with a standardized mean difference (SMD) of 0.96 (95% confidence interval [CI] 0.69 to 1.24) and a p-value less than 0.0001. This finding, however, is considered very low-certainty evidence. trunk function (SMD 149, The 14 trials indicated a statistically significant result (P < 0.0001), suggesting a 95% confidence interval for the estimate from 126 to 171. 466 participants; very low-certainty evidence), arm-hand function (SMD 067, Two experimental trials demonstrated a statistically significant relationship (p = 0.0006), within a 95% confidence interval of 0.019 to 0.115. 74 participants; low-certainty evidence), arm-hand activity (SMD 084, Within a single trial, the 95% confidence interval for the effect size was found to be between 0.0009 and 1.59; this was statistically significant (p = 0.003). 30 participants; very low-certainty evidence), standing balance (SMD 057, DNQX Across 11 trials, a statistically significant result (p < 0.0001) was observed, with a 95% confidence interval of 0.035 to 0.079. 410 participants; very low-certainty evidence), leg function (SMD 110, In a single trial, a statistically significant (p<0.0001) association was found, with a 95% confidence interval ranging from 0.057 to 0.163. 64 participants; very low-certainty evidence), walking ability (SMD 073, The 95% confidence interval of the effect sizes was observed to be from 0.52 to 0.94, signifying statistical significance (p < 0.0001), and the analysis included 11 trials. In a study of 383 participants, low-certainty evidence was found for the effect, coupled with a quality of life standardized mean difference of 0.50. DNQX A statistical analysis of two trials revealed a p-value of 0.001 and a 95% confidence interval ranging from 0.11 to 0.89. 108 participants; low-certainty evidence). Trunk training protocols without consistent dosages showed no change in the rate of serious adverse events (odds ratio 0.794, 95% confidence interval 0.16 to 40,089; 6 trials, 201 participants; very low certainty evidence). A comparative analysis of the dose-matched groups was conducted (by pooling all trials with the same training duration in both experimental and control groups), Trunk training resulted in an improvement in trunk function, as quantified by a standardized mean difference of 1.03. Thirty-six trials yielded a statistically significant result (p < 0.0001), with a 95% confidence interval spanning from 0.91 to 1.16. 1217 participants; very low-certainty evidence), standing balance (SMD 100, Across 22 trials, the 95% confidence interval ranged from 0.86 to 1.15, and a statistically significant result (p < 0.0001) was attained. 917 participants; very low-certainty evidence), leg function (SMD 157, Four trials showed a statistically significant result (p<0.0001), with a 95% confidence interval for the effect size ranging from 128 to 187. 254 participants; very low-certainty evidence), walking ability (SMD 069, The 19 trials exhibited a statistically significant association (p < 0.0001), indicated by a 95% confidence interval for the effect size that spanned from 0.051 to 0.087. Among 535 participants, evidence suggests a degree of uncertainty regarding quality of life (SMD 0.70). From two trials, a statistically significant result (p < 0.0001) was established, correlating with a 95% confidence interval of 0.29 to 1.11. 111 participants; low-certainty evidence), However, for ADL (SMD 010; 95% confidence interval -017 to 037; P = 048; 9 trials; 229 participants; very low-certainty evidence), this finding does not hold. DNQX arm-hand function (SMD 076, The confidence interval (95%) ranges from -0.18 to 1.70, with a p-value of 0.11. This result is based on a single trial. 19 participants; low-certainty evidence), arm-hand activity (SMD 017, Three trials yielded a 95% confidence interval of -0.21 to 0.56, and a p-value of 0.038. 112 participants; very low-certainty evidence). The application of trunk training strategies did not affect the likelihood of serious adverse events occurring (odds ratio [OR] 0.739, 95% confidence interval [CI] 0.15 to 37238; 10 trials, 381 participants; very low-certainty evidence). A significant disparity in standing balance was observed among subgroups treated with non-dose-matched therapy after stroke, with a p-value less than 0.0001. Various trunk therapy methods employed in non-dose-matched treatment regimens produced marked effects on ADL (<0.0001), trunk function (P < 0.0001), and the ability to maintain balance in an upright position (<0.0001). A comparative analysis of subgroups receiving dose-matched therapy highlighted a statistically significant effect of the trunk therapy approach on ADL (P = 0.0001), trunk function (P < 0.0001), arm-hand activity (P < 0.0001), standing balance (P = 0.0002), and leg function (P = 0.0002). Analysis of dose-matched therapy subgroups according to post-stroke time showed a substantial difference in the outcomes of standing balance (P < 0.0001), walking ability (P = 0.0003), and leg function (P < 0.0001), emphasizing the significant impact of the time since stroke on the intervention's effectiveness. A significant proportion of the included trials focused on training methods that encompassed core-stability trunk (15 trials), selective-trunk (14 trials), and unstable-trunk (16 trials).
A significant body of evidence demonstrates that trunk training, as a component of rehabilitation after stroke, has a positive effect on independence in daily tasks, trunk strength, maintaining balance while standing, walking ability, function of the upper and lower limbs, and overall quality of life. Core-stability, selective-, and unstable-trunk training strategies were among the most commonly applied trunk training methods in the trials. When only trials with a low risk of bias were included in the analysis, the outcomes broadly reflected previous findings; however, the level of certainty, varying from very low to moderate, was contingent on the specific outcome being examined.
Rehabilitation programs incorporating trunk training have demonstrated improvements in activities of daily living (ADL), trunk stability, balance while standing, ambulation, upper and lower extremity function, and overall well-being for stroke survivors. Included trials frequently used core-stability, selective-exercise, and unstable-trunk training methods as part of their trunk training protocols.