As part of the roundtable “International Institutions and Peaceful Change,” this essay focuses on the “Kindleberger trap,” a term coined by Joseph Nye Jr. referring to the situation in which no country takes the lead to maintain international institutions in the international system. President Trump's destructive policies toward many international institutions seem to push the current international order to the brink of the Kindleberger trap. Ironically, China has pledged, at least rhetorically, to support and even save these existing international institutions. (...) Based on an institutional-balancing perspective, we suggest that the worry about the Kindleberger trap is unwarranted because the international institutional order will not easily collapse after the decline of U.S. hegemony. Institutional competition among great powers and institutional changes within the institutional order have become two remedies to maintain international institutions and to avoid the Kindleberger trap during the international order transition. What states, including the United States and China, should do is to reembrace and reinvigorate the role of multilateralism in world politics so that the dynamics of institutional balancing and consequential institutional changes in the context of U.S.-China competition do not deprive international society of the public goods and normative values of international institutions. The future international order should not be led by a single country, but by dynamic and balanced international institutions. (shrink)

ObjectiveThis study aims to investigate anxiety and its influencing factors in patients with drug-induced liver injury (DILI).Materials and MethodsNinety-four patients with DILI were enrolled and evaluated with a self-rating anxiety scale (SAS). According to the anxiety score, they were divided into four groups: the non-anxiety, mild anxiety, moderate anxiety, or severe anxiety groups, and the scores were analyzed based on demographic and biochemical indicators.ResultsOf the 94 patients with DILI, 63 did not have anxiety and 31 had anxiety (32.9%), of which (...) 27 had mild, 3 had moderate, and 1 had severe anxiety. There were no statistically significant differences in gender, age, occupation, and level of education between the groups (F= 1.42,H= 2.361,H= 6.751,H= 1.796, andP> 0.05); anxiety score and degree of anxiety between the types of drugs that led to the liver injury (H= 0.812,H= 1.712, andP> 0.05); anxiety score between the different degrees of liver injury (H= 2.836,H= 4.957,P> 0.05); or length of hospital stay or prognosis between the degrees of anxiety (F= 1.487,H= 0.761,P> 0.05). However, there were statistically significant differences in the degree of anxiety between different degree and types of liver injury (H= 7.981,H= 8.208,P< 0.05).ConclusionPatients with DILI may have anxiety, especially mild anxiety. The occurrence of anxiety in patients with DILI is not related to gender, age, occupation, or level of education but may be related to the degree and type of liver injury. Anxiety has no impact on the length of stay in hospital or the prognosis of the DILI. These findings may contribute to the development of management strategies for patients with DILI. (shrink)

BackgroundExercise is one of the effective ways to improve cognition. Different forms of exercises, such as aerobic exercise, resistance exercise, and coordination exercise, have different effects on the improvement of cognitive impairment. In recent years, exergames based on Non-Immersive Virtual Reality have been widely used in entertainment and have gradually been applied to clinical rehabilitation. However, the mechanism of NIVR-Exergames on improving motor cognition has not been clarified. Therefore, the aim of this study is to find whether NIVR-Exergames result in (...) a better neural response mechanism to improve the area of the cerebral cortex related to motor cognition under functional near-infrared spectroscopy dynamic monitoring in comparison with resistance exercise.MethodsA cross-over study design was adopted in this study, and 15 healthy young subjects were randomly divided into group A and group B according to a computerized digital table method. Task 1 was an NIVR-Exergame task, and Task 2 was resistance band stretching. Group A first performed Task 1, rested for 30 min, and then performed Task 2. Group B had the reverse order. The fNIRS test was synchronized in real time during exercise tasks, and heart rate measurements, blood pressure measurements, and 2-back task synchronization fNIRS tests were performed at baseline, Post-task 1, and Post-task 2. The primary outcomes were beta values from the general linear model in different regions of interest, and the secondary outcomes were heart rate, blood pressure, reaction time of 2-back, and accuracy rate of 2-back.ResultsThe activation differences of Task 1 and Task 2 in the right premotor cortex and the left PMC were statistically significant. There were statistically significant differences in the activation of the right supplementary motor area, left dorsolateral prefrontal cortex, left and right PMC between baseline and Post-task 1. The differences in systolic pressure between the two groups at three time points among women were statistically significant.ConclusionIn this study, we found that NIVR-Exergames combined with motor and challenging cognitive tasks can promote the activation of SMA, PMC and DLPFC in healthy young people compared with resistance exercise alone, providing compelling preliminary evidence of the power for the rehabilitation of motor and cognitive function in patients with central nervous system diseases. (shrink)