Effects of nurses-led multidisciplinary-based psychological management in spinal surgery: a retrospective, propensity-score-matching comparative study.

BACKGROUND: Patients in spine surgery often have emotional disorders which is caused by multi-factors. Therefore, a multidisciplinary and multimodal intervention program is required to improve emotional disorders during the perioperative period. However, related studies were rare. This study aimed to confirm that the multidisciplinary-based psychological management leading by nurses was effective in treating emotional disorders and show the assignments of the members of the multidisciplinary team with the orientations of nurses. DESIGN: A retrospective, comparative study. METHOD: This study was a retrospective cohort research and compared the results between the intervention group and control group using the Huaxi Emotional Distress Index (HEI) which was used to evaluate emotional disorders. The intervention group consisted of patients who underwent surgery between January 2018 and December 2020 after psychological management was implemented. The control group consisted of patients with regular care who underwent surgery between January 2015 and December 2017. To improve comparability between the two groups, baseline data from the recruited patients were analyzed using propensity-score-matching (PSM) based on age, sex, marital status, education, and disease region. RESULTS: A total of 539 (11.5%) people developed emotional disorders, of which 319 (6.8%), 151 (3.2%) and 69 (1.5%) had mild, moderate mood and severe emotional disorders, respectively. 2107 pairs of patients were matched after PSM. Scores of HEI in the intervention group were heightened compared with those in the control group (P<0.001) after matching. Moreover, the incidence of emotional disorders in patients decreased after implementing psychological management (P = 0.001). The severity of emotional disorders was alleviated with statistical significance as well (P = 0.010). CONCLUSIONS: Nurses-led Multidisciplinary-Based psychological management was able to reduce the incidence of emotional disorders and improve the severity of these in spine surgery patients.

Clinical Effect of Shibing Xingnao Granules on Vascular Dementia Patients and Its Effect on Serum Neuronal Apoptosis Molecules.

It was intended to study the clinical effect of Shibing Xingnao Granules on patients with vascular dementia (VD) and to explore its effect on serum neuronal apoptosis molecule levels in VD patients. For this purpose, 78 VD patients, as research objects, were grouped into a control group (acupuncture therapy) and an observation group (acupuncture therapy + Shibing Xingnao Granules) using the random number table method, with 39 cases per group. The clinical effect, cognitive function, neurological function, activity of daily living (ADL) score, and serum B-cell lymphoma-2 (Bcl-2), Bcl-2 associated X protein (Bax), as well as Caspase-3 (Casp3) levels in two groups were observed. Results showed that the markedly effective rate (MER) (82.05%) and total effective rate (TER) (100%) in the observation group were higher than the control group (56.41%, 92.31%) (P<0.05). After treatment, the Mini-mental State Examination (MMSE) score, the distributions of mild VD and normal patients, ADL score, and Bcl-2 level were higher in the observation group than in the control group. National Institutes of Health Stroke Scale (NIHSS) score, Bax, and Casp3 levels were lower in the observation group (P<0.05). The conclusion was that Shibing Xingnao Granules could further enhance the therapeutic effect of VD patients, and could increase Bcl-2 level and reduce Bax and Casp3 levels.

Structural basis for zinc-induced activation of a zinc uptake transcriptional regulator.

The zinc uptake regulator (Zur) is a member of the Fur (ferric uptake regulator) family transcriptional regulators that plays important roles in zinc homeostasis and virulence of bacteria. Upon zinc perception, Zur binds to the promoters of zinc responsive genes and controls their transcription. However, the mechanism underlying zinc-mediated Zur activation remains unclear. Here we report a 2.2-Å crystal structure of apo Zur from the phytopathogen Xanthomonas campestris pv. campestris (XcZur), which reveals the molecular mechanism that XcZur exists in a closed inactive state before regulatory zinc binding. Subsequently, we present a 1.9-Å crystal structure of holo XcZur, which, by contrast, adopts an open state that has enough capacity to bind DNA. Structural comparison and hydrogen deuterium exchange mass spectrometry (HDX-MS) analyses uncover that binding of a zinc atom in the regulatory site, formed by the hinge region, the dimerization domain and the DNA binding domain, drives a closed-to-open conformational change that is essential for XcZur activation. Moreover, key residues responsible for DNA recognition are identified by site-directed mutagenesis. This work provides important insights into zinc-induced XcZur activation and valuable discussions on the mechanism of DNA recognition.

[Nomographic Model for Predicting Severe Foot Pain in Nurses from Tertiary Hospitals in China].

Objective: To investigate the prevalence and common sites of severe foot pain among nurses, to define the risk factors of severe foot pain in nurses in tertiary hospital in China, and to construct a nomograph model for predicting individuals' risks for severe foot pain. Methods: Between August 2019 and December 2019, a stratified global sampling method was used to select 10691 nurses from 351 tertiary hospitals in China to investigate the incidence of severe foot pain among them. The variables that may affect the occurrence of severe foot pain were analyzed by single factor analysis to identify the influencing factors of severe foot pain in nurses. Furthermore, the independent risk factors of severe foot pain were analyzed by stepwise logistic regression analysis. The statistically significant factors identified in the multivariate regression analysis were incorporated into the nomograph prediction model. The predictive performance of the nomograph was measured by the consistency index (C-index) and calibrated with 1000 Bootstrap samples. Results: A total of 3419 nurses out of the 10691 had foot pain, resulting in an incidence of 31.98%. The incidence of severe pain (VAS score 7-10) was 2.27% (243 of 10691). The locations of severe pain were more commonly found in the soles and heels of both feet. Six factors, including age, education, the material of the work shoes, comfortableness of the work shoes, number of complications, and foot injure history, were incorporated in the nomograph predicting model. The C-index value was 0.706 and the standard curve fitted well with the calibrated prediction curve. Conclusion: The risk prediction model constructed in this study showed sound performance in predicting the risk of severe foot pain in nurses, and all the indicators involved are simple and the relevant data are easily obtained. The model can provide reference for preventing severe foot pain in nurses.

The Effect of Chitosan in Wound Healing: A Systematic Review.

OBJECTIVE: To systematically review the effectiveness of chitosan in wound healing. DATA SOURCES: References were retrieved from PubMed, EMBASE, the Cochrane library, and Web of Science based on Medical Subject Headings and keywords ("chitosan" OR "chitin" OR "poliglusam" AND "wound healing"). STUDY SELECTION: Eligible articles were randomized controlled trials (RCTs) that required interventions for chitosan and its derivative dressings and included endpoints associated with wound healing. In summary, five RCTs (N = 319) were included in the final analysis. DATA SYNTHESIS: Only two RCTS (40%) reported significant beneficial effects of chitosan on wound healing compared with conventional gauze dressings (eg, tulle gras, petroleum jelly). The remaining three studies reported that chitosan had no significant effect on clinical wound healing compared with other biologic dressings (eg, alginate, hydrocolloid). CONCLUSIONS: Although the number of trials of new chitosan dressings has been increasing, studies on the relationship between chitosan and wound healing have been limited. Current data suggest that chitosan does not slow wound healing. However, the small number of available trials restricted adequate interpretation of the existing results. Future research needs to be rigorously designed to confirm any clinically relevant effect of chitosan in wound healing.

An Endo-Selective Epoxide-Opening Cascade for the Fast Assembly of the Polycyclic Core Structure of Marine Ladder Polyethers.

The rapid synthesis of marine ladder polyethers from polyepoxide precursors (in analogy with the biosynthetic pathway hypothesized by Nakanishi) is hampered by the fact that the exo-selective epoxide-opening cyclization cascade that gives THF-type polyethers is preferred over the endo-selective cascade that gives the desired products. We found that perfluoro-tert-butanol (PFTB) cooperating with 1-ethyl-3-methylimidazolium tetrafluoroborate ([EMIM]BF4 ) can promote endo-selective epoxide-opening cyclization reactions of trisubstituted epoxy alcohols. Starting from readily accessible homochiral polyepoxy alcohols with a methyl group at all the endo-cyclization sites, we were able to construct polyethers up to five consecutive fused 6-, 7-, and/or 8-membered rings in one step. Notably, molecules with the 7/7/6/6 and 7/7/6/7/6 polyether frameworks of hemibrevetoxin B and brevenal, respectively, could be synthesized in 40 % and 17 % chemical yields.

The crystal structure of the phytopathogenic bacterial sensor PcrK reveals different cytokinin recognition mechanism from the plant sensor AHK4.

Plant cytokinins (CKs) are essential for many central cellular processes and play important roles in the interaction between bacteria and plants. Perception of CK is executed by the CHASE domain in the histidine kinase sensors of a class of two-component regulatory systems. Despite advances in understanding the structural basis for CK perception by the sensor AHK4 in Arabidopsis, the molecular mechanism of CK binding by other sensors is unclear. Here, we report the crystal structure of the CHASE domain in the histidine kinase PcrK of the bacterial plant pathogen Xanthomonas campestris pathovar campestris, which senses plant CK, determined at 2.55 Šresolution. The structure reveals that the PcrK has an AHK4-like overall topology and assembles into a homodimer. Strikingly, detailed structural analysis unveils two unique features of the PcrK ligand binding pocket: the size of the pocket is restricted for CK binding, and the PcrK applies a positively charged arginine but not a negatively charged aspartate to recognize the ligand. We propose a model to explain how the PcrK accommodates CK-sized compounds through conformational changes, providing a potential mechanistic framework for understanding ligand recognition by the PcrK.

Hydride ion (H-) transport behavior in barium hydride under high pressure.

Hydride ions (H-) have an appropriate size for fast transport, which makes the conduction of H- attractive. In this work, the H- transport properties of BaH2 have been investigated under pressure using in situ impedance spectroscopy measurements up to 11.2 GPa and density functional theoretical calculations. The H- transport properties, including ionic migration resistance, relaxation frequency, and relative permittivity, change significantly with pressure around 2.3 GPa, which can be attributed to the structural phase transition of BaH2. The ionic migration barrier energy of the P63/mmc phase decreases with pressure, which is responsible for the increased ionic conductivity. A huge dielectric constant at low frequencies is observed, which is related to the polarization of the H- dipoles. The current study establishes general guidelines for developing high-energy storage and conversion devices based on hydride ion transportation.

New insight into the structural evolution of PbTiO3: an unbiased structure search.

Understanding the structural evolution of materials is a challenging problem of condensed matter physics. Solving this problem would open new ways for understanding the behaviors of materials. In this context, we here report unbiased structure searches for a prototypical perovskite oxide, PbTiO3, based on the CALYPSO (Crystal structure AnaLYsis by Particle Swarm Optimization) method in conjunction with first-principles calculations. For the first time, we decipher the structure evolution of PbTiO3 from a zero dimensional (0D) cluster to a two dimensional (2D) layered structure and in the end to a three dimensional (3D) bulk solid. Our unbiased structure search is successful in reproducing the cubic Pm3[combining macron]m and tetragonal P4mm phases of PbTiO3 at ambient pressure. We also predict a new quasi-planar kite shape structure of the PbTiO3 cluster, with Cs symmetry and a surprisingly large HOMO-LUMO gap. Furthermore, by using this method, we predict that the 2D planar PbTiO3 monolayer is unstable in the perpendicular direction and the 2D PbTiO3 double layer is dynamically stable, with a hope that it can provide guidance to future synthesis of low dimensional perovskite oxides.

Structure and Electronic Properties of Neutral and Negatively Charged RhBn Clusters (n = 3-10): A Density Functional Theory Study.

The geometrical structure and electronic properties of the neutral RhBn and singly negatively charged RhBn- clusters are obtained in the range of 3 ≤ n ≤ 10 using the unbiased CALYPSO structure search method and density functional theory (DFT). A combination of the PBE0 functional and the def2-TZVP basis set is used for determining global minima on potential energy surfaces of the Rh-doped Bn clusters. The photoelectron spectra of the anions are simulated using the time-dependent density functional theory (TD-DFT) method. Good agreement between our simulated and experimentally obtained photoelectron spectra for RhB9- provides support to the validity of our theoretical method. The relative stabilities of the ground-state RhBn and RhBn- clusters are estimated using the calculated binding energies, second-order total energy differences, and HOMO-LUMO gaps. It is found that RhB7 and RhB8- are the most stable species in the neutral and anionic series, respectively. The chemical bonding analysis reveals that the RhB8-cluster possesses two sets of delocalized σ and π bonds. In both cases, the Hückel 4N + 2 rule is fulfilled and this cluster possesses both σ and π aromaticities.

FOREVER YOUNG FLOWER Negatively Regulates Ethylene Response DNA-Binding Factors by Activating an Ethylene-Responsive Factor to Control Arabidopsis Floral Organ Senescence and Abscission.

In this study of Arabidopsis (Arabidopsis thaliana), we investigated the relationship between FOREVER YOUNG FLOWER (FYF) and Ethylene Response DNA-binding Factors (EDFs) and functionally analyzed a key FYF target, an Ethylene-Responsive Factor (ERF), that controls flower senescence/abscission. Ectopic expression of EDF1/2/3/4 caused promotion of flower senescence/abscission and the activation of the senescence-associated genes. The presence of a repressor domain in EDFs and the enhancement of the promotion of senescence/abscission in EDF1/2/3/4+SRDX (converting EDFs to strong repressors by fusion with the ERF-associated amphiphilic repression motif repression domain SRDX) transgenic plants suggested that EDFs act as repressors. The significant reduction of ß-glucuronidase (GUS) expression by 35S:FYF in EDF1/2/3/4:GUS plants indicates that EDF1/2/3/4 functions downstream of FYF in regulating flower senescence/abscission. In this study, we also characterized an ERF gene, FOREVER YOUNG FLOWER UP-REGULATING FACTOR1 (FUF1), which is up-regulated by FYF during flower development. Ectopic expression of FUF1 caused similar delayed flower senescence/abscission as seen in 35S:FYF plants. This phenotype was correlated with deficient abscission zone formation, ethylene insensitivity, and down-regulation of EDF1/2/3/4 and abscission-associated genes in 35S:FUF1 flowers. In contrast, significant promotion of flower senescence/abscission and up-regulation of EDF1/2/3/4 were observed in 35S:FUF1+SRDX transgenic dominant-negative plants, in which FUF1 is converted to a potent repressor by fusion to an SRDX-suppressing motif. Thus, FUF1 acts as an activator in suppressing EDF1/2/3/4 function and senescence/abscission of the flowers. Our results reveal that FYF regulates flower senescence/abscission by negatively regulating EDF1/2/3/4, which is the downstream gene in the ethylene response, by activating FUF1 in Arabidopsis.

Hot water-promoted cyclopropylcarbinyl rearrangement facilitates construction of homoallylic alcohols.

In refluxing 9 : 1 (v/v) H2O-1,4-dioxane and without an additional catalyst, the rearrangements of various types of cyclopropyl carbinols were attempted. It was found that the reactions generally gave homoallylic alcohols in good to very high chemical yields. Rearrangements of bicyclic or tricyclic cyclopropyl carbinols readily gave the desired ring-expanded cyclic homoallylic alcohols which are difficult to synthesize by other means.

1,n-Rearrangement of allylic alcohols promoted by hot water: application to the synthesis of navenone B, a polyene natural product.

It was reported for the first time that hot water as a mildly acidic catalyst efficiently promoted 1,n-rearrangement (n = 3, 5, 7, 9) of allylic alcohols. In some cases, the rearrangement reactions joined isolated C-C double or triple bonds to generate conjugated polyene or enyne structure motifs. We used the 1,3-rearrangement reaction of an allylic alcohol in hot water as part of an attractive new strategy for construction of the polyene natural product navenone B by iterative use of a Grignard reaction, a 1,3-rearrangement of the resulting allylic alcohol, and subsequent oxidation of the rearranged product.

Predictors Associated with Forgotten Knee in Patients with Total Knee Arthroplasty Based on Multivariable Linear Regression.

OBJECTIVE: Existing studies have conflicting results about the predictors of forgotten joints in patients with total knee arthroplasty (TKA), and the relationship between psychosocial factors and forgotten knees is unknown. The purpose of this study was to confirm predictors for the forgotten joint in TKA patients. METHODS: This was an observational, prospective longitudinal study. A total of 205 patients who underwent TKA and a 6-month follow-up were included between August 2020 and September 2021. Demographic characteristics, clinical characteristics, and psychosocial variables were collected before TKA surgery (T0). The forgotten joint score (FJS) was taken before TKA surgery (T0) and at 1 month (T1), 3 months (T3), and 6 months (T6) after TKA surgery. The psychosocial variables were also completed at T6. Bivariate and multivariable linear regressions (LR) were performed to screen the predictors associated with FJS (T6). RESULTS: Patients who underwent TKA in our study had a mean FJS of 20.3 ± 12.2 before surgery, 15.9 ± 10.3 at 1 month, 28.7 ± 12.6 at 3 months, and 40.3 ± 12.5 at 6 months. The predictors were sex, combined musculoskeletal disorders (MSD), operation time, FJS (T3), range of motion (ROM) (T6), pain score (T6), Groningen orthopaedic social support scale (GO-SSS) score (T6), and the generalized anxiety disorder scale (GAD) score (T6). The data satisfied the assumptions of multivariable linear regressions. The multiple R2 of LR was 0.71, and the adjusted R2 was 0.70. The F-statistic of the LR model was 59.5 (p < 0.000). CONCLUSION: Our study revealed the level of forgotten knee decreased slightly from preoperation to 1 month postoperatively and then increased from 1 month postoperatively to 6 months postoperatively in TKA patients. The main predictors associated with the FJS at 6 months after surgery were sex, combined MSD, operation time, FJS (T3), ROM (T6), pain score (T6), GO-SSS score (T6), and anxiety (T6).

Assessing multidisciplinary follow-up pattern efficiency and cost in follow-up care for patients in cervical spondylosis surgery: a non-randomized controlled study.

Background: The use of multidisciplinary treatment programs in out-of-hospital healthcare is a new area of research. Little is known about the benefits of this method in the management of discharged patients undergoing cervical spondylosis surgery. Objective: This study aimed to explore the effect of a contracted-based, multidisciplinary follow-up plan in patients after cervical spondylosis surgery. Methods: This non-blinded non-randomized controlled study was conducted with 88 patients (44 in the intervention group, 44 in the control group). The clinical outcomes, including Neck Disability Index (NDI), pain score (VAS), Self-Efficacy for Managing Chronic Disease 6-item Scale (SECD-6), and 12-Item Short-Form Health Survey (SF-12) score were assessed at the time of discharge, 24-72 h, 1 month, and 3 months post-discharge. The complications, patient satisfaction, and economic indicators were assessed at the final follow-up (3 months). Results: Patients who received contracted follow-up showed greater improvement in neck dysfunction at 24-72 h, 1 month, and 3 months after discharge compared to those who received routine follow-up (p < 0.001). At 1 month after discharge, the intervention group exhibited better self-efficacy (p = 0.001) and quality of life (p < 0.001) than the control group, and these improvements lasted for 3 months. The intervention group reported lower pain scores at 24-72 h and 1 month (p = 0.008; p = 0.026) compared to the control group. The incidence of complications was significantly lower in the intervention group (11.4%) compared to the control group (40.9%). The total satisfaction score was significant difference between the two groups (p < 0.001). Additionally, the intervention group had lower direct medical costs (p < 0.001), direct non-medical costs (p = 0.035), and total costs (p = 0.04) compared to the control group. However, there was no statistically significant difference in indirect costs between the two groups (p = 0.59). Conclusion: A multidisciplinary contract follow-up plan has significant advantages regarding neck disability, self-efficacy, quality of life, postoperative complications, patient satisfaction, and direct costs compared with routine follow-up.

Physical compatibility of Xuebijing injection with 53 intravenous drugs during simulated Y-site administration.

OBJECTIVE: Xuebijing injection (XBJ) is a commonly used herbal medicine injection in China. However, the physical compatibility of XBJ with other intravenous drugs remains unclear. The purpose of this research is to evaluate physical compatibility of Xuebijing injection (XBJ) with 53 intravenous drugs (including 31 Chinese medicine injections and 22 chemicals) during simulated Y-site administration. METHODS: Y-site administration was simulated in vitro by admixing 0.33 ml/ml XBJ with an equal volume of other diluted 53 intravenous drugs, respectively. Physical compatibility including visual inspection, Tyndall beam, particle limits, turbidity, pH, chromacity value, spectroscopic absorption of 550 nm and 420 nm (A550 nm and A420 nm) were observed and assessed at 0, 1, 2, and 4 h. Physical compatibility was defined as all solutions with no color changes, no gas evolution, particulate formation and no Tyndall beam within 4 hours, turbidity changes <0.5 nephelometric turbidity unit (NTU) compared to 0 h, particle limits allowed by the Chinese Pharmacopoeia (Ch.P) 2020 edition, pH changes <10% compared to 0, chromacity value changes <200 compared to 0 h, or photometrical changes of A420 nm <0.0400 or A550 nm <0.0100 compared to 0 h. RESULTS: XBJ was physically incompatible with 27 of the 53 intravenous drugs tested, 26 were compatible with XBJ for 4 h. CONCLUSIONS: XBJ should not be simultaneously co-administered with 27 of the 53 intravenous drugs during simulated Y-site. If coadministration was inevitable, flushing tube with NS or D5W before and after infusion of XBJ was needed. Assessment included visual inspection, Tyndall beam, turbidity measurement, particle counts, pH measurement, chromacity value measurement and absorption of A550 nm were proved to be valid and robust for the quality control of infusion and compatibility of Chinese herbal injection.

Protective effects of human urinary kallidinogenase against corticospinal tract damage in acute ischemic stroke patients.

This study aimed to assess the effects of human urinary kallidinogenase (HUK) on motor function outcome and corticospinal tract recovery in patients with acute ischemic stroke (AIS). This study was a randomized, controlled, single-blinded trial. Eighty AIS patients were split into two groups: the HUK and control groups. The HUK group was administered HUK and standard treatment, while the control group received standard treatment only. At admission and discharge, the National Institutes of Health Stroke Scale (NIHSS), Barthel Index (BI) and muscle strength were scored. The primary endpoint was the short-term outcomes of AIS patients under different treatments. The secondary endpoint was the degree of corticospinal tract fiber damage under different treatments. There was a significant improvement in the NIHSS Scale, BI and muscle strength scores in the HUK group compared with controls (Mann-Whitney U test; P  < 0.05). Diffusion tensor tractography classification and intracranial arterial stenosis were independent predictors of short-term recovery by linear regression analysis. The changes in fractional anisotropy (FA) and apparent diffusion coefficient (ADC) decline rate were significantly smaller in the HUK group than in the control group ( P <  0.05). Vascular endothelial growth factor (VEGF) increased significantly after HUK treatment ( P  < 0.05), and the VEGF change was negatively correlated with changes in ADC. HUK is beneficial for the outcome in AIS patients especially in motor function recovery. It may have protective effects on the corticospinal tract which is reflected by the reduction in the FA and ADC decline rates and increased VEGF expression. The study was registered on ClinicalTrials.gov (unique identifier: NCT04102956).

High-pressure crystal structures and superconductivity of Stannane (SnH4).

There is great interest in the exploration of hydrogen-rich compounds upon strong compression where they can become superconductors. Stannane (SnH(4)) has been proposed to be a potential high-temperature superconductor under pressure, but its high-pressure crystal structures, fundamental for the understanding of superconductivity, remain unsolved. Using an ab initio evolutionary algorithm for crystal structure prediction, we propose the existence of two unique high-pressure metallic phases having space groups Ama2 and P6(3)/mmc, which both contain hexagonal layers of Sn atoms and semimolecular (perhydride) H(2) units. Enthalpy calculations reveal that the Ama2 and P6(3)/mmc structures are stable at 96-180 GPa and above 180 GPa, respectively, while below 96 GPa SnH(4) is unstable with respect to elemental decomposition. The application of the Allen-Dynes modified McMillan equation reveals high superconducting temperatures of 15-22 K for the Ama2 phase at 120 GPa and 52-62 K for the P6(3)/mmc phase at 200 GPa.

Measuring patient compliance with wearing graduated compression stockings.

BACKGROUND: Patient compliance is an essential precondition for assessing the effectiveness of graduated compression stockings (GCS). However, patient compliance with use of GCS has not received sufficient attention. Only a few clinical studies have explicitly evaluated patients' adherence to GCS therapy, and the instruments used to measure patient compliance have either not been well adapted to daily use or lacked scientific development techniques. Most instruments have focused on "wear or not wear" or "how long did you wear" questions, which do not consider all the perspectives on patient compliance. In the present study, we used scale development and validation steps to create a self-reported questionnaire to measure patients' compliance with wearing GCS. METHODS: We designed a questionnaire to measure compliance with wearing GCS among patients who had undergone invasive treatment of superficial varicose veins of the lower extremities. The initial questions were determined after a literature review and interviews with experts and patients. Reliability was evaluated using the Delphi method with expert judges, pretesting, Cronbach's alpha, and test-retest reliability. Exploratory and confirmatory factor analyses were used to test the questionnaire's validity. RESULTS: The developed questionnaire had 11 questions with the responses rated from 1 to 4 and included three factors: compliance with correct GCS wearing methods, compliance with GCS wearing cautions, and compliance with seeking advice. The Cronbach alpha for the overall questionnaire was 0.853 (factor 1, 0.934; factor 2, 0.803; factor 3, 0.789), its content validity was good, and the factor structure fitted the data well. CONCLUSIONS: We have presented our initial version of the questionnaire for patients who have undergone invasive treatment of superficial varicose veins of the lower extremities. The questionnaire can be used to evaluate patient compliance with wearing GCS thoroughly and effectively. However, further work is still required to maximize its reliability and validity for its use in daily practice in the future.

Modulated structure and molecular dissociation of solid chlorine at high pressures.

Among diatomic molecular halogen solids, high pressure structures of solid chlorine (Cl(2)) remain elusive and least studied. We here report first-principles structural search on solid Cl(2) at high pressures through our developed particle-swarm optimization algorithm. We successfully reproduced the known molecular Cmca phase (phase I) at low pressure and found that it remains stable up to a high pressure 142 GPa. At 150 GPa, our structural searches identified several energetically competitive, structurally similar, and modulated structures. Analysis of the structural results and their similarity with those in solid Br(2) and I(2), it was suggested that solid Cl(2) adopts an incommensurate modulated structure with a modulation wave close to 2∕7 in a narrow pressure range 142-157 GPa. Eventually, our simulations at >157 GPa were able to predict the molecular dissociation of solid Cl(2) into monatomic phases having body centered orthorhombic (bco) and face-centered cubic (fcc) structures, respectively. One unique monatomic structural feature of solid Cl(2) is the absence of intermediate body centered tetragonal (bct) structure during the bco → fcc transition, which however has been observed or theoretically predicted in solid Br(2) and I(2). Electron-phonon coupling calculations revealed that solid Cl(2) becomes superconductors within bco and fcc phases possessing a highest superconducting temperature of 13.03 K at 380 GPa. We further probed the molecular Cmca → incommensurate phase transition mechanism and found that the softening of the A(g) vibrational (rotational) Raman mode in the Cmca phase might be the driving force to initiate the transition.