Spinal posture assessment and low back pain.

Postural assessment can help doctors and therapists identify risk factors for low back pain and determine appropriate follow-up treatment. Postural alignment is not perfectly symmetrical, and small asymmetries can instead represent norms and criteria for postural evaluation. It is necessary to comprehensively observe patients' posture in all directions and analyze the factors related to posture evaluation. The results of reliability show that in general intra-rater reliability is higher than inter-rater reliability, and inclinometers are being more reliable than other instrumentations. Some common postural problems can cause lumbar discomfort, and prolonged poor posture is a potential risk factor for lumbar spine injuries. On the basis of previous studies on posture evaluation, a unified standardized method for posture evaluation must be established in future research.

Tai Chi Quan Versus Physical Therapy on Pain and Cognitive Performance for Elderly People With Chronic Low Back Pain: Study Protocol for a Randomized Controlled Trial.

Objectives: Chronic low back pain has become a major cause of global disability and caused a huge economic burden to society. Physical therapy is a vital strategy for rehabilitation of chronic low back pain. Although several trials have shown that Tai Chi Quan is a beneficial treatment, the comparative effectiveness of Tai Chi Quan versus physical therapy is unknown. We are conducting a randomized controlled trial to assess the effectiveness of Tai Chi Quan versus that of physical therapy in treating chronic low back pain. Methods: We will perform a single-blind randomized controlled trial on elderly people with chronic low back pain. 138 participants will be randomly assigned to the Tai Chi Quan group (60-min classes, three times per week for 12 weeks) or physical therapy group (10 min of evaluation and warm-up, 40 min of therapist-directed exercise therapy, and 10 min of relaxation, three times per week for 12 weeks) with an allocation of 1:1. The participants will be followed up for 40 weeks for the study of long-term effects. The primary outcomes include pain intensity and back-related function at 12 weeks. Secondary outcomes include lumbar quantitative sensory testing, balance, cognitive function, psychosocial function, cost-effectiveness, compliance and adverse events. We will perform the intention-to-treat analysis for withdrawal and missing data. Discussion: The study will be the first randomized trial with comparative-effectiveness of Tai Chi Quan and physical therapy for chronic low back pain. Standardized protocol, large sample size, and comprehensive outcomes are important features in this trial. This study aims to determine the feasibility and effectiveness of Tai Chi Quan for low back pain. The results of this study will be beneficial for elderly people with low back pain and medical rehabilitation personnel. Clinical Trial Registration: www.chictr.org.cn, identifier ChiCTR2000029723.

Neuroimaging Assessment of Pain.

Pain is an unpleasant sensory and emotional experience. Understanding the neural mechanisms of acute and chronic pain and the brain changes affecting pain factors is important for finding pain treatment methods. The emergence and progress of non-invasive neuroimaging technology can help us better understand pain at the neural level. Recent developments in identifying brain-based biomarkers of pain through advances in advanced imaging can provide some foundations for predicting and detecting pain. For example, a neurologic pain signature (involving brain regions that receive nociceptive afferents) and a stimulus intensity-independent pain signature (involving brain regions that do not show increased activity in proportion to noxious stimulus intensity) were developed based on multivariate modeling to identify processes related to the pain experience. However, an accurate and comprehensive review of common neuroimaging techniques for evaluating pain is lacking. This paper reviews the mechanism, clinical application, reliability, strengths, and limitations of common neuroimaging techniques for assessing pain to promote our further understanding of pain.

Intra-rater and inter-rater reliability of pressure pain threshold assessment in stroke patients.

BACKGROUND: As pain is a common symptom following a stroke, pressure pain threshold (PPT) assessment can be used to evaluate pain status or pain sensitivity of patients. However, the reliability of PPT test in stroke patients is still unknown. AIM: To examine the intra- and inter-rater reliability of PPT measurements in poststroke survivors and explore their factors. DESIGN: An observational study. SETTING: The setting of the study is a rehabilitation hospital. POPULATION: The population of the study was represented by a total of 54 patients after stroke. METHODS: The study included 16 measured points on the affected and unaffected sides. PPT was assessed by two raters in turn. Intra- and inter-rater reliability was evaluated by intraclass correlation coefficients (ICC). RESULTS: All intra-rater (ICC=0.84-0.97) and inter-rater (ICC=0.83-0.95) reliability for PPT assessment were good or excellent in stroke patients. Of the 16 points, 12 showed higher intra-rater ICC values than inter-rater, whereas no evident difference was observed between the affected and unaffected sides. Furthermore, patients who were male, ischemic, or with higher motor function generally performed higher ICC values than those who were female (24 out of 32 results), hemorrhagic (28 out of 32 results), or mobility dysfunction (26 out of 32 results), respectively. CONCLUSIONS: PPT assessment with good or excellent reliability can be used in stroke patients. Neither of the two sides (affected or unaffected) affects PPT reliability, and intra-rater reliability is better than inter-rater reliability. In addition, gender, stroke type, and motor function can affect the reliability of measuring mechanical pain threshold in poststroke survivors. CLINICAL REHABILITATION IMPACT: The pressure algometer can be used as a reliable and portable tool to assess the mechanical pain tolerance and sensory function in stroke patients in clinics.

New methods for quantification of Fenton's reagent addition based on aged sludge indicators to improve filterability.

Fenton oxidation can effectively improve the dewaterability of aged sludge. Quantification of the addition of optimal reagents is central to the conditioning and dewatering of aged sludge. Improving the accuracy of quantification is significant to promote cost effectiveness. The effects of reagent addition and the mechanism governing the improved filterability of the aged sludge need to be understood uniformly. In this study, the optimal reagent additions have been determined using the response surface method (RSM) for five out of the eight aged sludges that were investigated. The physicochemical characteristics of eight aged sludges, including the extracellular polymer substance, undissolved organic matter, and suspension structure network, were investigated. Meanwhile, a comprehensive correlation analysis of critical indicators was conducted to investigate the interactions among the properties of the aged sludge. The effects of these interactions on the conditioning and filtration processes were examined, and a unified understanding of the combination of factors affecting the optimal reagent addition was obtained. The key factors were aggregate size, dewatering extent, yield stress, and organic substance content. Based on these results, a new reagent addition quantification method was developed along with an empirical model of the relationship between physicochemical properties and the economically optimal reagent addition.

A systematic assessment of aeration rate effect on aerobic degradation of municipal solid waste based on leachate chemical oxygen demand removal.

Aeration is one mainstream technique to accelerate municipal solid waste (MSW) degradation in landfills. The determination of an appropriate aeration rate is critical to the design and operation of a landfill aeration system. In this study, we analyze 132 waste degradation tests reported in forty one studies in the literature. We use L min-1 kg-1 dry organic matter (L min-1 kg-1 DOM) as the uniform unit to quantify the aeration rates in all tests. The first order rate coefficient for chemical oxygen demand (COD) removal in leachate (kCOD) is selected as the parameter to characterize MSW degradation process. We further divide aerobic tests into five aerobic groups base on the respective aeration rates, i.e., <0.02, 0.02-0.1, 0.1-0.3, 0.3-1, and >1 L min-1 kg-1 DOM. With an increase in the aeration rate, the kCOD increases first and then decreases. The aeration rate between 0.1 and 0.3 L min-1 kg-1 DOM has the best enhancement on the kCOD. The kCOD values are not much higher than the anaerobic and semi-aerobic tests when the aeration rates are <0.1 L min-1 kg-1 DOM, because such aeration rates may be lower than the actual oxygen consumption rates. An aeration rate >0.3 L min-1 kg-1 DOM reduces the kCOD likely due to excess water evaporation and ventilation cooling. Among the analyzed results, the aeration rate is the most related to the kCOD in principal component analysis than the other factors, including liquid recirculation and addition, waste total density, waste degradation level, and waste initial temperature.

Objective Assessment of Regional Stiffness in Achilles Tendon in Different Ankle Joint Positions Using the MyotonPRO.

BACKGROUND Achilles tendinopathy commonly occurs in specific regions of the tendon, and Achilles tendon stiffness can be related to local pathological changes in the tendon. The MyotonPRO is a new handheld device that conveniently assesses stiffness of muscles and tendons. This study aimed to 1) evaluate the intra- and inter-rater reliability of stiffness measurements of the Achilles tendon at different ankle positions, 2) investigate the modulation of stiffness at different ankle joint angles, and 3) examine the differences between 2 regions of Achilles tendon stiffness. MATERIAL AND METHODS Thirty healthy young adults (15 men and 15 women) participated in this study. The regional Achilles tendon stiffness at 0 cm (AT-0) and 6 cm (AT-6) above the tendon insertion were evaluated by the MyotonPRO in the neutral position and 10° dorsiflexion of the ankle joint. Measurements of stiffness were taken by 2 raters on the first day and 5 days later. The stiffness data were compared by repeated measures analysis of variance (ANOVA). RESULTS The intra- and inter-rater reliability of stiffness measurements at AT-0 and AT-6 for each ankle position were good (all intraclass correlation coefficients >0.84). A significant modulation of Achilles tendon stiffness was obtained at different ankle joint angles (P<0.05). Stiffness at AT-0 was higher than at AT-6 (P<0.05) in both positions. CONCLUSIONS These results suggest the MyotonPRO reliably assessed Achilles tendon stiffness and monitors its modulation, and tendon stiffness increased with ankle dorsiflexion. Stiffness was also nonuniform along the length of the tendon.

[Cloning of Taenia pisiformis Actin Gene and Assessment of Its Use as An Internal Control].

Objective: To clone the full-length cDNA of actin gene of Taenia pisiformis (Tp-actin), and analyze the gene structure, phylogenetic evolution and its use as an internal control. Methods: Tp-actin was amplified by RT-PCR and the cDNA of 3' and 5' ends were obtained through RACE-PCR. After sequencing, these segments were linked to produce full-length cDNA of Tp-actin. The gene structure and phylogenetic evolution were analyzed using bioinformatics software. Primers for Tp-actin and cysteine peptidase (TpCP) were designed using Primer Express software. Primer specificity and amplification efficiency were analyzed with real-time fluorescence quantitative PCR (qRT-PCR). In addition, by using Tp-actin as an internal control, the expression of TpCP in T. pisiformis at various developmental stages was analyzed. Results: As expected, sequencing results showed that the Tp-actin fragment was 1 048 bp in length, and the 3' and 5' ends were 428 bp and 945 bp, respectively. The full-length cDNA of Tp-actin generated from the 3 segments (submitted to GenBank with accession No. JX624787) was 1 279 bp, containing a 30-bp 5'-untranslated region（5'-UTR）, a 118-bp 3'-UTR, and a 1 131-bp open reading frame (ORF). Bioinformatics analysis showed that the Tp-actin encoded a protein of 356 amino acids, with a predicted relative molecular weight of 41 749 and a PI value of 5.29. This protein was predicted to contain 6 functional sites and 3 typical signatures of the actin family. Phylogenetic analysis showed that the Tp-actin was 100% and 99.7% homologous in amino acid sequence to those of Taenia solium and Diphyllobothrium dendriticum. qRT-PCR resulted in specific products of 82 bp and 108 bp from Tp-actin and TpCP, respectively, melting curves of which both showed a single signal peak, verifying the high specificity of primers. The linear correlation coefficient（R2） in standard curve of Tp-actin was 0.999, showing high amplification efficiency. Using Tp-actin as the internal control, the relative expression ratio of TpCP gene in gravid proglottid of T. pisiformis（1.65） was significantly higher than that in oncospheres （1.00）, mature proglottids （0.87） and cysticercus (0.62) (P<0.05). Conclusion: Tp-actin gene is highly conserved and can be used as a reliable internal control.

[Economic burden and related factors on inpatients with HBV-related diseases in Shandong province].

OBJECTIVE: To investigate the economic burden of patients with acute and chronic hepatitis B, cirrhosis and liver cancer caused by hepatitis B virus (HBV). METHODS: Cluster sampling was used on cases consecutively collected during the study period. Questionnaire survey was conducted and information on the expenses during hospitalization was collected from the hospital records and through interviewing those patients. RESULTS: Yearly costs related to patients with acute hepatitis B, severe hepatitis B, chronic hepatitis B, cirrhosis, hepatocellular carcinoma were 66.7, 138.1, 127.4, 151.7 and 377.2 thousand Yuan, respectively. RESULTS: from multiple linear regression model showed that the type of medical insurance scheme, annual days of hospitalization, classifications of HBV-related diseases and personal income were major influencing factors on the cost. CONCLUSION: HBV infection caused considerable burden to families and the society, indicating that HBV infection control programs would bring huge potential benefits. The reform of insurance scheme should be administrated to promote social fairness.

A new synthesis and an antiviral assessment of the 4'-fluoro derivative of 4'-deoxy-5'-noraristeromycin.

A synthetic route to (1S,2S,3R,5S)-3-(6-amino-9H-purin-9-yl)-5-fluorocyclopentane-1,2-diol (that is, the 4'-fluoro derivative of 4'-deoxy-5'-noraristeromycin, 3) is described via a fluorinated cyclopentanol, which is in contrast to existing schemes where fluorination occurred once the purine ring was present. Compound 3 was assayed versus a number of viruses. A favorable response was observed towards measles (IC(50) of 1.2 microg/mL in the neutral red assay and 14 microg/mL by the visual assay) but this was accompanied by cytotoxicity in the CV-1 host cells (21-36 microg/mL). Among the viruses unaffected by 3 were human cytomegalovirus and the poxviruses (vaccinia and cowpox), which are three viruses that were inhibited by the 4',4'-difluoro analog of 3 (that is, 2).