Association of High-Density Lipoprotein Cholesterol with Sarcopenia in Chinese Community-Dwelling Middle-Aged and Older Adults: Evidence from 4-Year Longitudinal Study.

INTRODUCTION: There is inconsistent evidence on the associations between high-density lipoprotein cholesterol (HDL-C) and risk of sarcopenia. The aim of the study was to determine the evidence existing between HDL-C and sarcopenia in Chinese middle-aged and older adults. METHODS: We used a panel study design of the China Health and Retirement Longitudinal Study (CHARLS), with 7,415 participants (mean age 57.5 years) from 2011, 2013, and 2015. HDL-C was measured by colorimetric test of venous serum samples. Sarcopenia was defined as low muscle mass, plus low muscle strength, or low physical performance. Muscle mass was estimated by anthropometric measures. Muscle strength was measured by handgrip strength using dynamometer. Physical performance was measured by 5-time chair stand test, gait speed test, and short physical performance battery. RESULTS: With 961 (13.0%) sarcopenia cases, each 1-unit increase (1 SD = 15.4 mg/dL) of HDL-C levels was associated with 42% increased odds of incident sarcopenia (OR = 1.42, 95% confidence interval [CI] = 1.28-1.58) at 4-year follow-up. Females with high HDL-C levels (HDL-C >60 mg/dL) had a higher risk of sarcopenia (OR = 2.49, 95% CI = 1.76-3.52). The restricted cubic spline curves showed a J-shaped association between HDL-C and risk of sarcopenia in females. HDL-C was negatively associated with muscle mass (ß = -0.23, 95% CI = -0.27 to -0.20) and hand grip strength (ß = -0.05, 95% CI = -0.19 to 0.09). CONCLUSION: High HDL-C levels were associated with higher risk of sarcopenia among middle-aged and older Chinese adults, and appropriate control of its high levels informs the management of sarcopenia.

Prevalence of psychological distress among people living with HIV/AIDS: a systematic review and meta-analysis.

Although people living with HIV/AIDS (PLWHA) are known to be vulnerable to psychological distress (PD), little is known about the prevalence of PD among PLWHA. A systematic literature search of several databases was conducted from inception to August 2021 focusing on studies reporting on PD symptoms among PLWHA. The overall prevalence estimates were pooled using a random-effects meta-analysis. Differences according to study-level characteristics were examined using stratified meta-analysis. We pooled and analyzed data from 15 studies comprising 5593 PLWHA. The prevalence rate of PD among PLWHA was 43.7% (95% Confidence Interval: 29.9-57.5%). Subgroup analyses by gender, country, CD4 count, employment status and ever attended school found no statistically significant differences in the prevalence of PD. Heterogeneity in the prevalence of PD among PLWHA was partially explained by the assessment tool. Further large-scale studies of high quality are warranted to identify risk factors of PD in PLWHA in their respective socio-cultural contexts.

Construction of an evaluation index system for undergraduate nursing teachers' curriculum humanistic competence: a Delphi study in China.

BACKGROUND: The curriculum humanistic competence of nursing teachers is important to cultivate the humanistic qualities of undergraduate nursing students. However, there are no evaluation tools for the curriculum humanistic competence of undergraduate nursing teachers in China. OBJECTIVE: To develop an index system to evaluate the curriculum humanistic competence of undergraduate nursing teachers. DESIGN: This research conducted a Delphi study. PARTICIPANTS: Semi-structured interviews were held with 19 experts, and Delphi rounds were conducted with 18 experts. SETTINGS: This study was conducted in 12 universities and 4 Grade A tertiary hospitals in China. METHODS: A literature review and semi-structured interviews were conducted to develop an initial framework. A two-round Delphi survey was employed to build the index system for undergraduate nursing teachers' curriculum humanistic competence. RESULTS: After two rounds of consultation, the index system included 5 first-level indicators, 11 second-level indicators and 41 third-level indicators. The Cr for two rounds of consultation were 0.929 and 0.923, and Kendall's W was 0.152(P<0.001). CONCLUSIONS: The index system for the evaluation of undergraduate nursing teachers' curriculum humanistic competence offers guidelines for undergraduate nursing teachers in China. It can be used in practice to develop high humanistic qualities in undergraduate nursing teachers.

Effect of horticultural therapy on apathy in nursing home residents with dementia: a pilot randomized controlled trial.

Objectives: This study aimed to examine (1) the feasibility of the study procedures (i.e. recruitment, retention, attendance, and assessment completion rates), and (2) the effects of horticultural therapy (HT) on apathy, cognitive ability, quality of life, and functional capacity.Methods: This was a parallel-group, match-paired, randomized controlled trial. Thirty-two participants were allocated to either the experimental or the control group. Data were collected at baseline (T0), immediately postintervention (T1), and 3 months postintervention (T2). The Apathy Evaluation Scale-informant version (AES-I); Mini-Mental State Examination (MMSE); Quality of Life in Alzheimer's disease (QoL-AD) scale; Barthel index (BI) were used to measure apathy, cognitive ability, quality of life, and functional capacity, respectively.Results: The recruitment, retention, attendance and assessment completion rates were 22.7%, 87.5%, 100% and 100%, respectively. The between-group differences in AES-I (p = 0.007) and MMSE (p = 0.034) scores were statistically significant at T1. In the experimental group, the AES-I (p = 0.001), MMSE (p = 0.010), and QoL-AD (p = 0.017) scores were significantly different over time. In the post hoc pair-wise analysis, the AES-I scores of the experimental group observed at T1 were significantly lower than that at T0 (p = 0.032). In the control group, the MMSE scores (p = 0.001) were significantly different over time.Conclusion: HT is feasible for residents with dementia and apathy. The HT program effectively reduced apathy and promoted cognitive function, but its effects on quality of life and functional capacity were not observed.

Role of self-efficacy in nursing organizational climate: A way to develop nurses' humanistic practice ability.

AIM: This study aimed to investigate the impact of self-efficacy on the relationship between organizational climate and humanistic practice ability (HPA) in Chinese nurses. BACKGROUND: To date, studies on the effect of organizational climate on nursing care have focused on care outcomes rather than care processes. Thus, this effect remains poorly understood. METHODS: A total of 757 participants were sampled from three tertiary hospitals in Guangdong Province from November to December 2019; subsequently, they completed a structured electronic questionnaire. A structural equation model was used to explore the impact of nursing organizational climate on nurses' HPA. RESULTS: A total of 688 valid questionnaires were collected. The nurses' average HPA score was 107.82 (SD 12.47). There was a positive correlation between organizational climate and HPA (r = .409, p < .05). Additionally, self-efficacy mediated this relationship (p < .01). CONCLUSIONS: This study provides new insights into nursing organizational climate, self-efficacy and nurses' HPA. IMPLICATIONS FOR NURSING MANAGEMENT: The significant mediating effect of self-efficacy suggests that managers should implement nurse professional development programmes using targeted strategies to foster greater self-efficacy, which could improve the quality of care and nurse-patient relationships.

The association among apathy, leisure activity participation, and severity of dementia in nursing home residents with Alzheimer's disease: A cross-sectional study.

The purpose of this study was to examine 1) the relationship between apathy and leisure activity participation in nursing home residents with Alzheimer disease (AD) and 2) the moderator effect of the severity of dementia on this relationship. Data were collected from 290 residents with AD using the Apathy Evaluation Scale-informant version (AES-I), Leisure Activities Questionnaire (LAQ), and Clinical Dementia Rating scale (CDR). The multiple linear regression model showed that leisure activity participation (ß=-0.452, p<0.001) was negatively associated with apathy, while the severity of dementia (ß=0.515, p<0.001) was positively associated with apathy. The severity of dementia moderated the effect of leisure activity participation on apathy (ß=-0.108, p=0.015). The results indicate that the effects of leisure activity participation on apathy diminish with the aggravation of AD. The severity of dementia should be considered when designing and delivering leisure activity interventions to manage apathy in nursing home residents with AD.

The role of work resources between job demands and burnout in male nurses.

AIMS AND OBJECTIVES: To explore the regulation role of work resources in male nurses' job burnout and job demands. BACKGROUND: Burnout syndrome affects a wide range of nurses. Although burnout and turnover rate have drawn many researchers' attention, little is known of work characteristics that may cause a high burnout and turnover rate in male nurses. DESIGN: A survey design was used. METHOD: A total of 366 male nurses in Guangzhou hospitals were included in this survey using the Burnout Scale (MBI-GS) and the Job demands Resources Scale. Data were processed by hierarchical regression analysis. (Followed the STROBE checklist) RESULTS: The male nurse's MBI score was (2.72 ± 1.02). Job demands affected the severity of male nurses' job burnout. Work resources are in a low level, especially at the social support, reward and skill diversity. The regression coefficients ß of job demands, work resources and interaction items of job demands and work resources were 0.277, 0.314 and -0.006, respectively, and both passed the significance test (p < .01).). The new explanatory quantity ΔR2 after introducing the interaction between job demands and working resources was also statistically significant (ΔR2  = 0.254, p < .01). CONCLUSION: Male nurses are at a mild level of job burnout, and work resources are in shortage. Work resources play a regulating role in job demands and burnout. RELEVANCE TO CLINICAL PRACTICE: The mild burnout may be a surface phenomenon or was a sign of trend of male nurses' intention to leave the job. Managers should pay attention to the emotional needs and mental health problems of male nurses' work environment.

Effect of Male House Mouse Pheromone Components on Behavioral Responses of Mice in Laboratory and Field Experiments.

Urine of male house mice, Mus musculus, is known to have primer pheromone effects on the reproductive physiology of female mice. Urine-mediated releaser pheromone effects that trigger certain behavioral responses are much less understood, and no field studies have investigated whether urine deposits by male or female mice, or synthetic mouse pheromone, increase trap captures of mice. In field experiments, we baited traps with bedding soiled with urine and feces of caged female or male mice, and recorded captures of mice in these and in control traps containing clean bedding. Traps baited with female bedding preferentially captured adult males, whereas traps baited with male bedding preferentially captured juvenile and adult females, indicating the presence of male- and female-specific sex pheromones in soiled bedding. Analyses of headspace volatiles emanating from soiled bedding by gas chromatography/mass spectrometry revealed that 3,4-dehydro-exo-brevicomin (DEB) was seven times more prevalent in male bedding and that 2-sec-butyl-4,5-dihydrothiazole (DHT) was male-specific. In a follow-up field experiment, traps baited with DEB and DHT captured 4 times more female mice than corresponding control traps, thus indicating that DEB and DHT are sex attractant pheromone components of house mouse males. Our study provides impetus to identify the sex attractant pheromone of female mice, and to develop synthetic mouse pheromone as a lure to enhance the efficacy of trapping programs for mouse control.

Total Synthesis, Stereochemical Assignment, and Field-Testing of the Sex Pheromone of the Strepsipteran Xenos peckii.

The sex pheromone of the endoparasitoid insect Xenos peckii (Strepsiptera: Xenidae) was recently identified as (7E,11E)-3,5,9,11-tetramethyl-7,11-tridecadienal. Herein we report the asymmetric synthesis of three candidate stereostructures for this pheromone using a synthetic strategy that relies on an sp(3) -sp(2) Suzuki-Miyaura coupling to construct the correctly configured C7-alkene function. Comparison of (1) H NMR spectra derived from the candidate stereostructures to that of the natural sex pheromone indicated a relative configuration of (3R*,5S*,9R*). Chiral gas chromatographic (GC) analyses of these compounds supported an assignment of (3R,5S,9R) for the natural product. Furthermore, in a 16-replicate field experiment, traps baited with the synthetic (3R,5S,9R)-enantiomer alone or in combination with the (3S,5R,9S)-enantiomer captured 23 and 18 X. peckii males, respectively (mean±SE: 1.4±0.33 and 1.1±0.39), whereas traps baited with the synthetic (3S,5R,9S)-enantiomer or a solvent control yielded no captures of males. These strong field trapping data, in combination with spectroscopic and chiral GC data, unambiguously demonstrate that (3R,5S,9R,7E,11E)-3,5,9,11-tetramethyl-7,11-tridecadienal is the X. peckii sex pheromone.

Catalytic Asymmetric Synthesis of Morpholines. Using Mechanistic Insights To Realize the Enantioselective Synthesis of Piperazines.

An efficient and practical catalytic approach for the enantioselective synthesis of 3-substituted morpholines through a tandem sequential one-pot reaction employing both hydroamination and asymmetric transfer hydrogenation reactions is described. Starting from ether-containing aminoalkyne substrates, a commercially available bis(amidate)bis(amido)Ti catalyst is utilized to yield a cyclic imine that is subsequently reduced using the Noyori-Ikariya catalyst, RuCl [(S,S)-Ts-DPEN] (η6-p-cymene), to afford chiral 3-substituted morpholines in good yield and enantiomeric excesses of >95%. A wide range of functional groups is tolerated. Substrate scope investigations suggest that hydrogen-bonding interactions between the oxygen in the backbone of the ether-containing substrate and the [(S,S)-Ts-DPEN] ligand of the Ru catalyst are crucial for obtaining high ee's. This insight led to a mechanistic proposal that predicts the observed absolute stereochemistry. Most importantly, this mechanistic insight allowed for the extension of this strategy to include N as an alternative hydrogen bond acceptor that could be incorporated into the substrate. Thus, the catalytic, enantioselective synthesis of 3-substituted piperazines is also demonstrated.

Evidence for a Nest Defense Pheromone in Bald-Faced Hornets, Dolichovespula Maculata, and Identification of Components.

In eusocial insects like Bald-faced hornets, Dolichovespula maculata, nest defense is essential because nests contain a large number of protein-rich larvae and pupae, and thus are attractive to nest predators. Our objectives were to investigate whether D. maculata exhibit pheromone-mediated nest defense, and to identify and field test any pheromone components. We tested for pheromone-mediated nest defense behavior of D. maculata by placing a paired box-apparatus near the entrance of D. maculata nests, and treating both boxes with a solvent control, or one of the two boxes with a solvent control and the other with either venom sac extract, the putative source of nest defense pheromone, or synthetic pheromone. The sound impulses caused by nest mates attempting to sting or strike the boxes were recorded for 3 min. Compared to the double-control treatment, the number of strikes increased 27-fold when one of the two boxes was treated with venom sac extract, providing evidence for an alarm response. The box treated with venom sac extract also induced a significantly greater proportion of strikes than the corresponding control box, providing evidence for a target-oriented response. Analyzing venom sac extract by gas chromatographic-electroantennographic detection (GC-EAD) and GC-mass spectrometry resulted in the identification of seven candidate pheromone components: (a) dimethylaminoethanol, (b) dimethylamino ethyl acetate, (c) 2,5-dimethylpyrazine, (d) N-3-methylbutylacetamide, (e) 2-heptadecanone, (f) (Z)-8-heptadecen-2-one, and (g) (Z)-10-nonadecen-2-one. Testing in paired-box bioassays blends of the nitrogen-containing volatile components a-d, the less volatile ketones e-g, or both (a-g), indicated that a-d primarily have an alarm function. The ketones e-g, in contrast, induced target-oriented responses, possibly marking the box, or potential nest predators, for guided and concerted attacks, or enhancing the alarm-inducing effect of the volatile pheromone components, as shown in honey bees. Comparing the behavioral effects of venom sac extract, blends a-d, e-g, and a-g, venom sac extract was most effective in triggering the full complement of alarm and target-oriented responses. These comparisons further suggested that a component is missing in the group of components that triggers the alarm rather than the target-oriented response.

The Sex Attractant Pheromone of Male Brown Rats: Identification and Field Experiment.

Trapping brown rats is challenging because they avoid newly placed traps in their habitat. Herein, we report the identification of the sex pheromone produced by male brown rats and its effect on trap captures of wild female brown rats. Collecting urine- and feces-soiled bedding material of laboratory-kept rats and comparing the soiled-bedding odorants of juvenile and adult males, as well as of adult males and females, we found nine compounds that were specific to, or most prevalent in, the odor profiles of sexually mature adult males. When we added a synthetic blend of six of these compounds (2-heptanone, 4-heptanone, 3-ethyl-2-heptanone, 2-octanone, 2-nonanone, 4-nonanone) to one of two paired food-baited trap boxes, these boxes attracted significantly more laboratory-strain female rats in laboratory experiments, and captured ten times more wild female rats in a field experiment than the corresponding control boxes. Our data show that the pheromone facilitates captures of wild female brown rats.

(7E,11E)-3,5,9,11-Tetramethyltridecadienal: Sex Pheromone of the Strepsipteran Xenos peckii.

Xenos peckii is a strepsipteran parasitoid of the common North American paper wasp, Polistes fuscatus. Mate-seeking X. peckii males respond to a long-range sex pheromone emitted by the female, which remains permanently embedded within the abdomen of a mobile host wasp. During peak pheromone signalling, we excised the female from her host, severed the cephalothorax containing the pheromone gland, extracted it in hexane, and analyzed aliquots of combined extracts by coupled gas chromatographic-electroantennographic detection (GC-EAD). These analyses revealed a candidate pheromone component (CPC) that consistently elicited strong responses from male antennae. We identified the CPC as (7E,11E)-3,5,9,11-tetramethyltridecadienal based on its retention indices (RI) on three GC-columns, RI inter-column differentials, mass and NMR spectra, and synthesis of an authentic standard that matched the GC-retention and spectrometric characteristics of the CPC. For a field experiment, we prepared (7E,11E)-3,5,9R,11-tetramethyltridecadienal and (7E,11E)-3,5,9S,11-tetramethyltridecadienal. Xenos peckii males were caught in traps baited with either compound singly or a 1:1 mixture of the two but not in unbaited control traps. The sex pheromone of X. peckii resembles that reported for the strepsipterans Stylops mellittae and S. muelleri, (R,R,R)-3,5,9-trimethyldodecanal, suggesting a common biosynthetic pathway across taxonomic genera.

Reliability and validity of the Chinese version of the Short Musculoskeletal Function Assessment questionnaire in patients with skeletal muscle injury of the upper or lower extremities.

BACKGROUND: The Short Musculoskeletal Function Assessment (SMFA) questionnaire is one of the most commonly used scales to evaluate functional status and quality of life (QOL) of patients with a broad range of musculoskeletal disorders. However, a Chinese version of the SMFA questionnaire for the psychometric properties of skeletal muscle injury patients in China is still lacking. The current study translated the SMFA into Chinese and assessed its reliability and validity among Chinese patients with skeletal muscle injury of the upper or lower extremities. METHODS: The original SMFA was translated from English into Chinese and culturally adapted according to cross-cultural adaptation guidelines. A multicenter cross-sectional study was conducted, comprising 339 skeletal muscle injury patients (aged 20-75 years) from 4 hospitals. The SMFA, the health survey short form (SF-36) along with a region-specific questionnaire (including the disabilities of the arm, shoulder, and hand questionnaire (DASH), the hip disability and osteoarthritis outcome score (HOOS), the knee injury and osteoarthritis outcome score (KOOS), and the foot function index (FFI)) were completed according to the region of injury. Reliability was estimated from the internal consistency using Cronbach's α and validity was assessed via convergent validity, known-groups comparison, and construct validity. RESULTS: Cronbach's α coefficient was over 0.75 for two subscales and four categories of the SMFA, suggesting that the internal consistency reliability of the SMFA was satisfactory. Known-groups comparison showed that the dysfunction index and the bother index of the SMFA discriminated well between patients who differed in age, gender, injury location, and operation status rather than in subgroups based on the body mass index (BMI). The convergent validity of the SMFA was good, as moderate to excellent correlations were found between the subscales of the SMFA and the four subscales of SF-36 (physical function, role-physical, bodily pain, and social functioning) and the region-specific questionnaires. The construct validity was proved by the presence of a six-factor structure that accounted for 66.85 % of the variance. CONCLUSION: The Chinese version of the SMFA questionnaire is a reliable and valid instrument to measure patient-reported impact of musculoskeletal injuries in the upper or lower extremities.

Bed bug aggregation pheromone finally identified.

Bed bugs have become a global epidemic and current detection tools are poorly suited for routine surveillance. Despite intense research on bed bug aggregation behavior and the aggregation pheromone, which could be used as a chemical lure, the complete composition of this pheromone has thus far proven elusive. Here, we report that the bed bug aggregation pheromone comprises five volatile components (dimethyl disulfide, dimethyl trisulfide, (E)-2-hexenal, (E)-2-octenal, 2-hexanone), which attract bed bugs to safe shelters, and one less-volatile component (histamine), which causes their arrestment upon contact. In infested premises, a blend of all six components is highly effective at luring bed bugs into traps. The trapping of juvenile and adult bed bugs, with or without recent blood meals, provides strong evidence that this unique pheromone bait could become an effective and inexpensive tool for bed bug detection and potentially their control.

A narrative review of anxiety regulation in PhD students based on Green model.

To gain a better understanding of the factors that contribute to anxiety among PhD students and the reasons for poor regulation in the current situation, this paper analyses the existing literature on anxiety among PhD students using Green's model. It also compares and evaluates various methods of regulating anxiety. The literature review to extract information on the causes and levels of anxiety, methods and outcomes of anxiety intervention and regulation, and to make comparisons. The study reveals that the phenomenon of PhD students' anxiety has intensified globally in recent years, especially after the end of the epidemic. PhD students experience anxiety due to research pressure, economic pressure, future development, and interpersonal pressure. The main influencing factors are currently the relationship with the supervisor, development prospects, social support, and peer comparison. Among the stress relief methods, the regulation of self-relaxation was found to have better effects on mild anxiety, such as positive thinking, meditation, yoga and physical exercise can be helpful for emotion release then help focus on problem solved. Whereas severe anxiety may require institutional and pharmacological support, also including using psychological therapy such as behavioral cognitive therapy and systematic desensitization methods. For university, competence to provide course-assisted guidance, such as writing groups, peer support, and time management, is also important. Academic communities should pay attention to the guidance on academic fairness. However, PhD students are often unaware of the resources available to them for coping with stress and may not take the initiative to seek psychological counseling or institutional assistance. Therefore, PhD students should receive support from various sources, be guided to express their thoughts, and receive additional education and academic assistance to manage stress. This will enhance their confidence and aid in improving their scientific research.

New Insight into HIV-Related Psychological Distress: A Concept Analysis.

Psychological distress is a frequently reported outcome measure in HIV research. However, because of its poor conceptualization, many studies only partially capture it because they focus solely on depression or anxiety based on symptoms. This study undertook a concept analysis of HIV-related psychological distress (HRPD) using Walker and Avant's method. The findings include HRPD's (a) attributes, including changes to emotional status, symptom burden, HIV disclosure distress and HIV-related stigma; (b) antecedents, including HIV-related stressors, cognitive appraisal of stressors and difficulty coping with the disease or treatment; and (c) consequences, including poor health outcomes and posttraumatic growth. Lazarus and Folkman's theory and the conservation of resources theory were adapted to further understand HRPD. This article provides insight into HRPD and increases the awareness of how to screen and assess HRPD at an early stage. The findings indicate the need to develop specific and rigorous measures and to provide appropriate interventions.

An α-chloroaldehyde-based formal synthesis of eribulin.

Eribulin (Halaven) is the most structurally complex non-peptidic drug made by total synthesis and has challenged preconceptions of synthetic feasibility in drug discovery and development. However, despite decades of research, the synthesis and manufacture of eribulin remains a daunting task. Here, we report syntheses of the most complex fragment of eribulin (C14-C35) used in two distinct industrial routes to this important anticancer drug. Our convergent strategy relies on a doubly diastereoselective Corey-Chaykovsky reaction to affect the union of two tetrahydrofuran-containing subunits. Notably, this process relies exclusively on enantiomerically enriched α-chloroaldehydes as building blocks for constructing the three densely functionalized oxygen heterocycles found in the C14-C35 fragment and all associated stereocenters. Overall, eribulin can now be produced in a total of 52 steps, which is a significant reduction from that reported in both academic and industrial syntheses.

Development and Validation of a New Comprehensive Assessment Scale of HIV-Related Psychological Distress in China: A Methodological Study.

ABSTRACT: Instruments evaluating HIV-related psychological distress (HRPD) in people living with HIV may lack sensitivity to capture patients' psychological burden. We developed a comprehensive scale measuring HRPD and evaluated its psychometric properties. A mixed-method study was conducted from July 2021 to April 2022; it involved a literature review, semistructured interviews ( n = 15), three rounds of panel discussions, two rounds of Delphi studies ( n = 20), a pilot test ( n = 20) to generate new scale items, and a cross-sectional survey ( n = 659) to evaluate the psychometric properties of the HIV-related psychological distress scale. The scale contains 22 items across 4 subscales (i.e., disease-related distress, treatment adherence distress, identity distress, and disclosure distress). The confirmatory factor analysis revealed high goodness of fit (χ 2 /df = 2.412, comparative fit index = 0.916, incremental fit index = 0.917, and Tucker‒Lewis index = 0.902), showing that the HIV-related psychological distress scale is a reliable (Cronbach's α = 0.871 overall) and valid scale for evaluating HRPD in China and can be used to dynamically evaluate and monitor HRPD levels during patient follow-up.