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Abstract. Background:. As an essential part of health services, rehabilitation is of great significance to improve the health and quality of life of the whole population. Accelerating aging calls for a significant expansion of rehabilitation services in China, but rehabilitation needs remain unclear. We conducted the study to explore the rehabilitation needs in China and project the trend of rehabilitation needs from 2020 to 2034. Methods:. The data of health conditions that might potentially benefit from rehabilitation were obtained from Global Burden of Disease (GBD) study. Estimated annual percentage changes (EAPCs) were calculated to quantify the trends of the age-standardized rates. Projections of rehabilitation needs were made until 2034 using Bayesian age–period–cohort analysis (BAPC). Results:. Approximately 460 million persons (33.3% of the total population) need rehabilitation in China, contributing to 63 million years lived with disabilities (YLDs) in 2019. The number of prevalent cases that need rehabilitation increased from around 268 (95% uncertainty interval [UI]: 257–282) million in 1990 to almost 460 (95% UI: 443–479) million in 2019, representing an increase of 71.3%. The highest contribution to the need for rehabilitation was musculoskeletal disorders with about 322 (95% UI: 302–343) million persons in seven aggregate disease and injury categories, and hearing loss with over 95 (95% UI: 84–107) million people among 25 health conditions. Based on the projection results, there will be almost 636 million people (45% of the total population) needing rehabilitation services in China by 2034, representing an increase of 38.3%. The rehabilitation needs of neoplasms, cardiovascular diseases, and neurological disorders are expected to increase significantly from 2019 to 2034, with increases of 102.3%, 88.8% and 73.2%, respectively. Conclusions:. The need for rehabilitation in China substantially increased over the last 30 years. It is predicted that over two in five people will require rehabilitation by 2034, thus suggesting the need to develop rehabilitation services that meet individuals’ rehabilitation needs.

Abstract Bridge widening involves phased construction of adjacent structures to maintain uninterrupted traffic flow. This process exposes freshly placed longitudinal joints between staged deck constructions to vehicle-induced vibrations, potentially compromising their mechanical integrity. This study investigates the flexural behavior of ultra-high-performance concrete (UHPC) longitudinal joints under such vibrations through model tests. To simulate actual site conditions, we developed a novel vibration test setup that replicates the dynamic environment experienced by these joints during construction. Micro- and meso-scale tests were conducted to examine the flexural behavior of longitudinal joints following vibration exposure. Results revealed that vibration amplitude significantly influences fiber orientation and flexural strength of ultra-high-performance concrete (UHPC) wet joint specimens. Low-amplitude vibrations (3 Hz at 1 mm and 3 mm) enhanced fiber orientation, increasing flexural strength by 11.5% to 19.8% and ultimate load capacity by 17% compared to non-vibrated specimens. Conversely, high-amplitude vibrations (3 Hz at 5 mm) adversely affected fiber orientation, decreasing flexural strength by 23.9% and ultimate load capacity by 19% relative to non-vibrated specimens.

Abstract Objective The objective was to explore the characteristics of risk factors in children with cerebral palsy (CP), focusing on the effects of single risk factors and the number of risk factors on the classification, GMFCS level, and comorbidities of children with CP. Methods The medical records of children with CP hospitalized from 2015 to 2023 were reviewed. The effects of nine risk factors, such as hyperbilirubinemia, asphyxia, and HIE, on the classification, GMFCS level and comorbidities of children with CP were studied. Results In Part 1, among the 536 children with CP, 476 (88.8%) had obvious risk factors. Preterm birth and/or low birth weight were the most common risk factor (243 cases (45.3%)). CP combined with two risk factors was the most common, with 147 cases (27.4%). In Part 2, neonatal seizures were associated with epilepsy, and HIE and hyperbilirubinemia were associated with intellectual disability. Asphyxia was associated with high GMFCS levels and mixed CP. Preterm birth and/or low birth weight was associated with spastic diplegia, and hyperbilirubinemia was associated with involuntary movement. In Part 3, the number of risk factors in children with CP with epilepsy and/or hearing impairment seemed to be lower, but those with spastic quadriplegia were more likely to have more risk factors (≥ 4). In the six groups with 1–6 risk factors, intellectual disability and a GMFCS level ≥ level IV were more common in the various risk factor groups, but spastic hemiplegia and ataxia were less common. Conclusion Most children with CP have apparent risk factors, and the combination of two risk factors is relatively common. Preterm birth/low birth weight is the most common risk factor. The analysis of single risk factors revealed that the risk factors were related to the classification, GMFCS level and comorbidities. This correlation is consistent with the current research. Risk factors were more common in children with severe CP, high GMFCS levels, spastic quadriplegia, and intellectual disability.

Aim: This study aims to address the key question of the causal relationship between serum levels of 25-hydroxyvitamin D (vitamin D) and autism spectrum disorders (ASD). Methods: Publicly available Genome-Wide Association Study (GWAS) datasets were used to conduct the bidirectional Two-sample MR analyses using methods including inverse-variance weighted (IVW), weighted median, MR-Egger regression, simple mode, MR-PRESSO test, Steiger filtering, and weighted mode, followed by BWMR for validation. Results: The MR analysis indicated that there was no causal relationship between Vitamin D as the exposure and ASD as the outcome in the positive direction of the MR analysis (IVW: OR = 0.984, 95 % CI: 0.821–1.18, P = 0.866). The subsequent BWMR validation stage yielded consistent results (OR = 0.984, 95 % CI 0.829–1.20, P = 0.994). Notably, in the reverse MR analysis with ASD as the exposure and Vitamin D as the outcome, the results suggested that the occurrence of ASD could lead to decreased Vitamin D levels (IVW: OR = 0.976, 95 % CI: 0.961–0.990, P = 0.000855), with BWMR findings in the validation stage confirming the discovery phase (OR = 0.975, 95 % CI: 0.958–0.991, P = 0.00297). For the positive MR analysis, no pleiotropy was detected in the instrumental variables. Similarly, no pleiotropy or heterogeneity was detected in the instrumental variables for the reverse MR analysis. Sensitivity analysis using the leave-one-out approach for both positive and reverse instrumental variables suggested that the MR analysis results were robust. Conclusion: Through the discovery and validation analysis process, we can confidently assert that there is no causative link between Vitamin D and ASD, and that supplementing Vitamin D is not expected to provide effective improvement for patients with ASD. Our study significantly advances a new perspective in ASD research and has a positive impact on medication guidance for patients with ASD.

Ultra-high-performance concrete is widely used in bridge strengthening to improve mechanical performance and bridge durability. Interfacial bonding performance is a key factor in ensuring the effectiveness of ultra-high-performance concrete strengthening. The bending test of the UHPC–NC composite structure was carried out in this article. The effects of groove treatment type and epoxy resin bonding were considered to discuss the damage modes, load–deflection relationships, and strengths. The interfacial tensile strength of the UHPC–NC composite structure and the distribution pattern of cracks were clarified. The results of the test showed that (a) only 22.2% of the groove-treated specimens failed due to bonding surface failure, indicating that the UHPC–NC bonding surface has a high degree of reliability; (b) the strength of specimens with an epoxy adhesive interface was the lowest. It was only 21% higher than the pure normal concrete specimen, and the effective synergistic force of UHPC–NC cannot be achieved; (c) the specimens treated with a positive trapezoidal keyway exhibited the highest strength, with an increase of approximately 200% compared to the pure normal concrete specimens. The strength of bending specimens with right-angled and inverted trapezoidal grooves increased by approximately 100% compared with pure normal concrete specimens. Based on the established three-dimensional numerical model and the analysis of test results under economic and safe conditions, the positive trapezoidal keyway specimen exhibits superior interfacial bonding–tensile performances.

Box beams constructed earlier were prone to inadequate bending capacity owing to low construction standards, overloading, and environmental degradation. To resolve the challenge, three full-scale box slab beams in service for 15 years were strengthened with a high-strength mortar layer and an ultra-high-performance concrete (UHPC) layer in this paper. The flexural performances of unstrengthened beams (control beam) and strengthened beams (mortar beam, UHPC beam) were investigated by in situ four-point bending tests and numerical simulations. The experimental results showed that the cracking of box beams, strengthened with high-strength mortar and UHPC layers, was effectively mitigated. In comparison to the control beam, the cracking load of the mortar beam and the UHPC beam increased by 20%, and the ultimate load increased by 23.5% and 35.3%, respectively. The high-strength mortar layer had little influence on the elastic-phase stiffness of box beams. In contrast, the stiffness of the elastic phase of the box beam, strengthened by the UHPC layer, increased by 32.9%. In the numerical simulations, the load-deflection curves obtained from finite elements and tests coincided well. The characteristic loads showed relatively good agreement with the test results, with errors below 10%. Combined with the tests and numerical analyses, the proposed equations for predicting the ultimate bearing capacities of the control beam, mortar beam, and UHPC beam were presented with a better prediction accuracy.

The rising incidence of Autism Spectrum Disorder (ASD) has become a major concern, affecting children's psychological well-being and placing a significant strain on healthcare systems. Despite its impact, the etiological mechanisms underpinning ASD remain elusive. This study leveraged dorsolateral prefrontal cortex gene data from 452 individuals of European descent, sourced from the CommonMindConsortium, and examined ASD-related gene expression data from the Gene Expression Omnibus (GEO) database (GSE18123), along with Genome-Wide Association Studies (GWAS) data from the Lundbeck Foundation Integrated Psychiatric Research and Psychiatric Genomics Consortium. Expression quantitative trait loci data were sourced from the GTExv8 database. We employed Transcriptome-Wide Association Studies (TWAS) and Weighted Gene Co-expression Network Analysis (WGCNA) to pinpoint genes within ASD-associated susceptibility gene families (ARHGAP, MAP). Four genes-ARHGAP27, MAPT, ARHGAP19, and MAP1B-were scrutinized, and their biological implications were elucidated through Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) enrichment analyses. Protein-Protein Interaction (PPI) analysis and conditional analysis within the TWAS framework helped identify pivotal genes (ARHGAP27, MAPT). A subsequent verification phase involving Mendelian Randomization (MR) evaluated the potential causal links between the identified genes and ASD. The findings revealed no causal association between ARHGAP19, MAP1B, and ASD. In contrast, significant causal relationships were established for ARHGAP27 and MAPT, suggesting that ARHGAP27 may elevate ASD risk as a susceptibility gene, whereas MAPT appears to reduce the risk as a protective gene.

Ultra-high performance concrete (UHPC) is a new class of structural material with outstanding properties of high strength, excellent ductility, and durability, which has an extremely broad application field. To examine the rehabilitation potential of UHPC on the existing masonry structures, the mechanical behavior of square masonry columns strengthened with UHPC under eccentric loading was investigated in this paper. A total of six masonry columns with or without the confinement of UHPC jackets were axially and eccentrically loaded. The strengthening effectiveness of UHPC on masonry columns was explored in terms of failure mode, deformation capacity, and carrying capacity. The results showed that UHPC jacketing is a highly effective technique for strengthening masonry columns, significantly increasing both the load-carrying capacity and transverse deformability of eccentrically compressed masonry columns (up to 103.64% and 71.43%, respectively). Furthermore, the UHPC strengthening technique modified brittle damage in unconfined masonry columns. A theoretical calculation was carried out for determining the bearing capacity of masonry columns strengthened with UHPC under eccentric loading. The accuracy of the theoretical calculation method was verified by comparing the theoretical values with the experimental values. Thus, this study provides a theoretical basis for the practical application of masonry structures strengthened with UHPC.

Rehabilitation and strengthening of existing masonry structures can improve their safety, prolong life and save economic costs. In this study, a total of eighteen masonry column specimens strengthened by ultra-high performance concrete (UHPC) were fabricated and tested in compression. The effects of strengthening method, strengthening thickness and loading eccentricity were investigated. The failure mode, bearing capacity, strain, ductility, and energy dissipation were discussed in before and after strengthening to evaluate the UHPC strengthening effectiveness. A three-dimensional numerical model established using finite element analysis (FEA) was validated with the experimental results. Results indicated that the brittle failure of masonry columns in compression could be significantly avoided using UHPC strengthening. Among three methods of strengthening, hoop strengthening was the most effective in increasing the ultimate load, ductility, and dissipated energy of masonry columns by 185.81%, 49.09%, and 297.12%, respectively. With the strengthening thickness increased from 0 to 20 and 30 mm, the ultimate bearing capacity of masonry columns was respectively increased by 29.17% and 117.26%, while the corresponding lateral displacement was decreased by 32.44% and 37.24%, respectively. The horizontal buckling of masonry columns can be relieved by UHPC, and the increase in eccentricity did not weaken the contribution of UHPC in strengthened masonry columns. The numerical results were in good agreement with the test results, with errors below 7.6%.

In bridge reinforcement projects, damaged T-beams are the most common objects for reinforcement, yet the interface bonding and bending performance of UHPC reinforcement on T-beams have hardly been studied. To ensure the reliability and stability of UHPC-strengthened T-beams in practical applications, this study introduced a post-installed rebar bonding technique to efficiently connect T-beams with UHPC layers. Initially, using ABAQUS software [2020 version] for finite element simulation, this study investigated the effects of various post-installed rebar parameters (horizontal spacing, yield strength, diameter, and matrix concrete strength) on the shear performance of the UHPC and RC interface, obtaining the optimal connection parameters. Subsequently, by comparing shear formulas in domestic and international standards, a new UHPC-RC steel bar interface shear strength theoretical formula with 93.6% accuracy was derived. Finally, finite element simulations analyzed the impact of different post-installed reinforcing bar layout forms and longitudinal spacing, as well as UHPC-strengthened location and layer thickness, on the bending performance of damaged T-beams. The results showed a good match between simulation outcomes and experimental results, applicable for further reinforcement analysis of T-beams. When the horizontal spacing of post-installed rebars is 12d, with diameters ranging from 10 mm to 14 mm, their anchoring capability is efficiently utilized. A square form of a post-installed rebar with a longitudinal spacing of 300 mm effectively improves the ultimate bending load capacity of the strengthened beam. The simulation analysis and theoretical results help in the design and application of post-installed steel connections and UHPC-strengthened structures in UHPC-strengthened reinforced concrete T-beam structures.

This systematic review aims to offer an updated understanding of the relationship between omega-3 supplementation and/or vitamin D and autism spectrum disorders (ASD). The databases PubMed, Cochrane Library, Web of Science, EMBASE, CINAHL, Vip, CNKI, Wanfang, China Biomedical Database databases were searched using keywords, and relevant literature was hand-searched. Papers (n = 1,151) were systematically screened and deemed eligible since 2002. Twenty clinical controlled studies were included in the final review. The findings were analyzed for intervention effects focusing on the core symptoms of ASD, included social functioning, behavioral functioning, speech function and biomarkers changes. The review found that the effects of omega-3 supplementation on ASD were too weak to conclude that core symptoms were alleviated. Vitamin D supplementation improved core symptoms, particularly behavioral functioning, however, the results of the literatures included in this study were slightly mixed, we cannot directly conclude that vitamin D supplementation has a beneficial effect on a specific symptom of ASD, but the overall conclusion is that vitamin D supplementation has a positive effect on behavioral functioning in ASD. Omega-3 and vitamin D combination supplementation has a good combined effect on social and behavioral outcomes in patients with ASD.

ObjectiveTo study the worldwide prevalence and associated factors of epilepsy in children and adolescents with Cerebral Palsy (CP) and to analyze the differences between various subgroups.MethodWe identified all potential studies on the prevalence of epilepsy in children and adolescents with CP from PubMed, Web of Science, and Embase. The search time was from the establishment of the database to November 2022. Randomized effects meta-analysis models were used to calculate the prevalence of epilepsy in CP. Subgroup analysis and meta-regression were utilized to further explore heterogeneity between articles and prevalence disparities between subgroups. The funnel plot and Egger's test were used to investigate potential publication bias.ResultsSeventy-two articles, comprising 53,969 children and adolescents with CP, were included in this study. The results indicated a total epilepsy prevalence of 38.0% (95% CI: 34.8%–41.2%) in CP. The prevalence of epilepsy was 46.4% (95% CI: 41.4%–51.5%) in clinical sample-based studies and 31.6% (95% CI: 28.7%–34.5%) in population-based studies. Meta-regression demonstrated that the sample source, neonatal seizure, family history of epilepsy, EEG or cranial imaging abnormalities, intellectual/cognitive impairment, and topographical types of CP were heterogeneous contributors to the epilepsy prevalence in CP.ConclusionApproximately one-third of children and adolescents with CP have epilepsy, and the sample source can significantly impact the total prevalence of epilepsy. Neonatal seizures, family history of epilepsy, EEG abnormalities, cranial imaging abnormalities, severe intellectual disability, and quadriplegia may be contributing factors to epilepsy comorbid in CP. Further study is required to verify the strength of these associations with epilepsy. This study aids in identifying the clinical characteristics of young people with CP at risk of developing epilepsy, which may assist clinicians in the early prevention and diagnosis of epilepsy within this population.Systematic Review Registration:https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=367766, identifier CRD42022367766.

ObjectiveTo comprehensively evaluate the efficacy of non-invasive brain stimulation (NIBS) in patients with autism spectrum disorder (ASD) in randomized controlled trials (RCT), providing a reference for future research on the same topic.MethodsFive databases were searched (Pubmed, Web of Science, Medline, Embase, and Cochrane library) and tracked relevant references, Meta-analysis was performed using RevMan 5.3 software.ResultsTwenty-two references (829 participants) were included. The results of the meta-analysis showed that NIBS had positive effects on repetitive and stereotypical behaviors, cognitive function, and executive function in autistic patients. Most of the included studies had a moderate to high risk of bias, Mainly because of the lack of blinding of subjects and assessors to treatment assignment, as well as the lack of continuous observation of treatment effects.ConclusionAvailable evidence supports an improvement in some aspects of NIBS in patients with ASD. However, due to the quality of the original studies and significant publication bias, this evidence must be treated with caution. Further large multicenter randomized double-blind controlled trials and appropriate follow-up observations are needed to further evaluate the specific efficacy of NIBS in patients with ASD.

Radiotherapy remains the mainstay treatment for a variety of cancer forms. However, the therapeutic efficiency of radiation is significantly limited by several aspects, including high radiation resistance caused by low reactive oxygen species concentrations and a low absorption rate of radiation by tumor tissue, inappropriate tumor cell cycle and tumor cell apoptosis, and serious radiation damage to normal cells. In recent years, nanoparticles have been widely used as radiosensitizers due to their unique physicochemical properties and multifunctionalities for potentially enhancing radiation therapy efficacy. In this study, we systematically reviewed several nanoparticle-based radiosensitization strategies for radiation therapy use, including designing nanoparticles that upregulate the levels of reactive oxygen species, designing nanoparticles that enhance the radiation dose deposit, designing chemical drug-loaded nanoparticles for enhancing cancer cell sensitivity to radiation, designing antisense oligonucleotide gene-loaded nanoparticles, and designing nanoparticles using a unique radiation-activable property. The current challenges and opportunities for nanoparticle-based radiosensitizers are also discussed.

As the first-line clinical drugs for tuberculosis (TB), isoniazid (INH), pyrazinamide (PZA), and rifampicin (RMP) are playing important roles for preventing the rapid spread of TB. Precise quantification of these drugs in biological samples is crucial to evaluate or improve the efficacy of advanced TB drug delivery systems, which are designed for reducing drug resistance, minimizing side effects, etc. Herein, a simple and sensitive method based on UPLC–UV was established and investigated for simultaneous quantification of PZA, INH, and RMP in human plasma and was applied to anti-TB drug therapeutic drug monitoring. The analytes were implemented on an HSS T3 C18 column at 40°C. The separation was performed with a gradient elution with methanol–acetonitrile–water (3:3:94) at 0.1 ml/min. The analysis only involved plasma with a small volume of 100 µL and a rapid one-step protein precipitation with methanol–acetonitrile (1:1). The results showed that the calibration curves for INH, PZA, and RMP were linear in a range of 0.5–20 μg/ml, 5–60 μg/ml, and 5–60 μg/ml, respectively. The intra- and inter-day precisions were both smaller than 15%, and the lower limit of quantitation (LLOQ) was identifiable and reproducible at 0.5 μg/ml for INH and 5 μg/ml for both PZA and RMP, respectively. The target drugs in plasma were stable after 21 days of storage at −80°C. The results indicated that our developed method is suitable for the simultaneous monitoring of INH, PZA, and RMP in human plasma.