Association of muscle health impairment and atherosclerosis with major osteoporotic fracture risk in Taiwanese Vegetarians.

Objectives: Despite the beneficial effects of "vegetarian style" diet on atherosclerosis, it is also proven potentially detrimental to bone health. The influence of muscle health or atherosclerosis on major osteoporotic fracture (MOF) risk in vegetarians has rarely been explored. This prospective study aimed to investigate an association of MOF risk with muscle health and atherosclerosis in vegetarians. Materials and Methods: We conducted a questionnaire survey with the Mini-Nutritional Assessment (MNA) on 39 vegetarians. The 10-year probability of MOF was determined using the Taiwanese Fracture Risk Assessment (FRAX®) calculator. Appendicular skeletal muscle (ASM) mass and bone mineral density were measured with dual-energy X-ray absorptiometry. Physical performance was evaluated using the 6-min walk test (6MWT). Common carotid artery intima-media thickness (ccIMT) was determined using sonography. Serum levels of parathyroid hormone (PTH), Vitamin D, adiponectin, and leptin were measured. Results: Eleven (28.2%) of 39 vegetarians had a moderate-high risk of MOF, defined by FRAX-calculated risk ≥10%. These subjects had lower ASM (P < 0.005) and 6MWT distances (P < 0.01) but greater ccIMT than those with low risk. The MOF risk was negatively correlated with ASM (r = -0.51, P < 0.001) and 6MWT distances (r = -0.62, P < 0.001) but positively correlated with ccIMT (r = 0.56, P < 0.001). Linear regression analysis revealed that MOF risk scores were negatively associated with ASM and 6MWT distance while positively associated with ccIMT. There was no significant association of MOF risk with MNA scores, serum levels of PTH, Vitamin D, adiponectin, or leptin. Conclusion: Decreased ASM mass, reduced physical performance, and atherosclerosis are significantly associated with MOF risk in vegetarians.

Comparative Efficacy of Micro-Needle-Knife Therapy and Acupuncture in Acute Ankle Sprains: A Randomized Controlled Trial.

BACKGROUND Micro-needle knife (MNK) therapy releases the superficial fascia to alleviate pain and improve joint function in patients with acute ankle sprains (AAS). We aimed to evaluate the efficacy and safety of MNK therapy vs that of acupuncture. MATERIAL AND METHODS This blinded assessor, randomized controlled trial allocated 80 patients with AAS to 2 parallel groups in a 1: 1 ratio. The experimental group received MNK therapy; the control group underwent conventional acupuncture treatment at specified acupoints. Clinical efficacy differences between the 2 groups before (time-point 1 [TP1]) and after treatment (TP2) were evaluated using the visual analogue scale (VAS) and Kofoed ankle score. Safety records and evaluations of adverse events were documented. One-month follow-up after treatment (TP3) was conducted to assess the intervention scheme's reliability. RESULTS VAS and Kofoed ankle scores significantly improved in both groups. No patients dropped due to adverse events. At TP1, there were no significant differences between the 2 groups in terms of VAS and Kofoed scores (P>0.05). However, at TP2, efficacy of MNK therapy in releasing the superficial fascia was significantly superior to that of acupuncture treatment (P<0.001). At TP3, no significant differences in scores existed between the groups (P>0.05). CONCLUSIONS This study demonstrates that 6 sessions of MNK therapy to release the superficial fascia safely and effectively alleviated pain and enhanced ankle joint function in patients with AAS, surpassing the efficacy of conventional acupuncture treatment. Future studies should increase the sample size and introduce additional control groups to further validate the superior clinical efficacy of this intervention.

Evaluation of sustainability of mycorrhizal industry development in Fujian Province-based on a combination of CRITIC empowerment method and cloud model.

The sustainable development of mycorrhizal industry is the key to solve the problem of "mycorrhizal forestry contradiction". As a major province of edible mushroom production and forestry resources in China, Fujian Province is also an important origin of mycorrhizal technology research and development, so it is more typical and practical to establish an index system to evaluate the sustainability of mycorrhizal industry development in Fujian Province. Through research interviews and data collection, a sustainable capacity evaluation system of mycorrhizal industry was established with 21 indicators in six dimensions: economic, ecological, social, cultural, political, and technological. A combination of CRITIC empowerment method and cloud model was used to evaluate the sustainability of mycorrhizal industry development in Fujian Province. The results show that although the economic sustainability of the mycorrhizal industry in Fujian Province is average, the overall development trend is good and there are not too many problems. The sustainability of ecological, social and technological levels all have large differences in the development of indicators and the overall development status is average, but overall, the ecological, social and technological levels show a steady forward development from 2017 to 2020. The cultural and political dimensions of sustainability not only have large differences in the development of indicators and an average overall development status, but also have a small development span from 2017 to 2020 and a slow overall development.

Erianin alleviates collagen-induced arthritis in mice by inhibiting Th17 cell differentiation.

Rheumatoid arthritis (RA) is a chronic autoimmune disorder. Its pathogenesis is complicated but highly related to aberrant Th17 overactivation. Uncontrolled Th17 cell expansion and activation in populations and associated activities contribute to the progression of RA. Although clinical RA remedies are available, not all RA patients respond to these treatments, and adverse effects are always a concerning issue during treatment. To expand the repertoire of possible anti-RA remedies, we chose the phytochemical compound erianin, isolated from Dendrobium sp., and evaluated its antiarthritic effect in vitro and in vivo. We found that erianin efficiently controlled the differentiation and activation of Th17 cell development from primary CD4 T cells, limiting IL-17A cytokine production and RORγT transcript generation. In line with molecular docking models, the essential signaling pathway for Th17 polarization, the JAK/STAT3 pathway, was inhibited upon erianin treatment, with dose-dependent inhibition of phosphorylation shown by western blotting. More importantly, erianin treatment reduced arthritic manifestations and proinflammatory cytokine levels in collagen-induced arthritis (CIA) mice, as well as protecting the joint histological microstructure. Overall, erianin revealed a promising inhibitory effect on Th17 overactivation and decreased disability in CIA mice. Therefore, erianin could be further developed as a candidate RA remedy.

Predictive Factors for Nasogastric Tube Removal in Post-Stroke Patients.

Background and Objectives: Stroke patients have different levels of functional impairment, and rehabilitation is essential to achieving functional recovery. Many post-stroke patients transition from acute treatment to post-acute care (PAC) with nasogastric tubes (NGTs) for rehabilitation. However, long-term NGT placement can lead to several complications, and its earlier removal can effectively reduce the incidence of mortality. This study aimed to use a PAC-cerebrovascular disease (CVD) program and physical functional evaluation scale tools to demonstrate the factors associated with NGT removal before post-stroke patient discharge. Materials and Methods: In this retrospective cohort study, data were collected between January 2017 and August 2022. We divided patients who had NGTs at admission into discharged with and without NGT groups to compare their baseline characteristics and physical functional status. Logistic regression analysis was used to detect the predictive factors for NGT removal. Results: There were 63 participants: 22 without NGT removal and 41 with NGT removal. The NGT removal rate was 65%. Age and scores for the activities of daily living by the Barthel index (BI), Functional Oral Intake Scale (FOIS), Mini-Mental State Examination, and Concise Chinese Aphasia Test were significantly different in terms of NGT removal status, but only the BI and FOIS were significantly correlated with NGT removal. Patients' BI scores indicating severe to moderate dependence (21-90) had a 4.55 times greater chance of NGT removal (odds ratio, 4.55; p < 0.05) than patients who had total dependence (<20). Every one-point increase in FOIS score indicated a 3.07 times greater chance of NGT removal (odds ratio, 3.07; p < 0.05). Conclusions: The BI and FOIS evaluations may indicate the probability of NGT removal in patients.

Lightweight Deep Neural Network Embedded with Stochastic Variational Inference Loss Function for Fast Detection of Human Postures.

Fusing object detection techniques and stochastic variational inference, we proposed a new scheme for lightweight neural network models, which could simultaneously reduce model sizes and raise the inference speed. This technique was then applied in fast human posture identification. The integer-arithmetic-only algorithm and the feature pyramid network were adopted to reduce the computational complexity in training and to capture features of small objects, respectively. Features of sequential human motion frames (i.e., the centroid coordinates of bounding boxes) were extracted by the self-attention mechanism. With the techniques of Bayesian neural network and stochastic variational inference, human postures could be promptly classified by fast resolving of the Gaussian mixture model for human posture classification. The model took instant centroid features as inputs and indicated possible human postures in the probabilistic maps. Our model had better overall performance than the baseline model ResNet in mean average precision (32.5 vs. 34.6), inference speed (27 vs. 48 milliseconds), and model size (46.2 vs. 227.8 MB). The model could also alert a suspected human falling event about 0.66 s in advance.

Long-Term Results of Serial Exercise Testing and Echocardiography Examinations in Patients with Pulmonary Stenosis.

Pulmonary stenosis (PS) affects cardiopulmonary function and exercise performance. Cardiopulmonary exercise testing (CPET) together with transthoracic echocardiography (TTE) can measure exercise performance, PS progression, and treatment effects. We assessed exercise capacity in PS patients using these methods. We enrolled 28 PS patients aged 6-35 years who received surgery, balloon pulmonary valvuloplasty, and follow-up care. The control population was selected by a 1:1 matching on age, sex, and body mass index. Baseline and follow-up peak pulmonary artery pulse wave velocity (PAV) were compared using TTE. Initial CPET revealed no significant differences in anaerobic metabolic equivalent (MET), peak oxygen consumption (VO2), and heart rate recovery between the two groups, nor were significant differences in pulmonary function identified. Within the PS group, there were no significant differences in MET, peak VO2, and heart rate recovery between the baseline and final CPET. Similarly, no significant differences were observed between the baseline and final PAV. The exercise capacity of patients with properly managed PS was comparable to that of healthy individuals. However, during the follow-up, declining trends in pulmonary function, aerobic metabolism, and peak exercise load capacity were observed among adolescents with PS. This study provides long-term data suggesting that PS patients should be encouraged to perform physical activity. Regular reevaluation should also be encouraged to limit performance deterioration.

Preliminary Recommendations on the Timing of Lung Surgery after Novel Coronavirus Infection in Patients with Pulmonary Nodules and Lung Cancer / 中国肺癌杂志

In recent years, the corona virus disease 2019 (COVID-19) pandemic has had a huge impact on the global medical, political and economic fields. Since the beginning of the COVID-19 epidemic, our understanding of the impact of COVID-19 has grown exponentially. Recently, the COVID-19 epidemic has changed rapidly in China, and there has been controversy over how to carry out surgical operations for patients with lung neoplastic lesions. Some studies have shown that lung cancer patients undergoing surgery are more likely to experience respiratory failure and perioperative death after contracting COVID-19 than the general population, however, delays in cancer treatment are also associated with increased mortality among these patients. In particular, the novel coronavirus Omikron variant has a higher transmissibility and may escape the immunity obtained through the previous novel coronavirus infection and vaccination. In order to minimize the risk of novel coronavirus infection in surgical patients, it is necessary to develop new treatment guidelines, expert consensus and preventive measures. However, the current rapid change of the epidemic situation has led to insufficient time and evidence to develop guidelines and consensus. Therefore, thoracic surgeons need to evaluate specific patient populations at higher risk of severe complications before surgery and weigh the benefit of surgical treatment against the risk of novel coronavirus infection. We try to give some recommendations on lung surgery during the current domestic epidemic situation based on the guidelines and consensus of oncology and thoracic surgery organizations in different regions on lung surgery.
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Analysis of influencing factors on post-treatment in-stent stenosis of intracranial aneurysm using Pipeline embolization device / 中华放射学杂志

Objective:To evaluate the incidence, clinical significance and influencing factors on in-stent stenosis(ISS) after treatment of intracranial aneurysms by Pipeline embolization device(PED).Methods:A retrospective analysis was conducted on the clinical data of 161 patients with intracranial aneurysms treated with PED at the Department of Interventional Radiology of the First Affiliated Hospital of Zhengzhou University from April 2015 to July 2021. PED was implanted into the parent artery through the femoral artery approach after general anesthesia. The first DSA follow-up duration time and imaging data were collected, and the patients were divided into ISS group and non-ISS group accordingly. The degree of aneurysm occlusion was evaluated by O′Kelly-Marotta(OKM) grading scale. Univariate and multivariate logistic regression analysis were applied to identify the factors related to ISS.Results:A total of 179 PED were employed in 161 patients with 168 aneurysms. Eighty-eight (52.38%) aneurysms were treated by PED only, and 80 (47.62%) aneurysms by PED combined with coiling. After a median follow-up of 6 (5, 7) months, 31(18.45%) aneurysms had ISS within the PED, of which 16(9.52%) cases were with mild stenosis (<50%), 13 (7.74%) were with moderate stenosis (50%-75%), and 2(1.19%) were with severe stenosis (>75%). All patients with ISS showed no relevant clinical symptoms. One (0.60%) patient with ISS underwent balloon angioplasty. Univariate analysis showed that the stent diameter, aneurysm location, triglyceride level, the diameter of distal parent artery, and the diameter of proximal parent artery were associated to ISS. Further multivariate logistic regression analysis showed the stent diameter (OR=0.332, 95%CI 0.191-0.578, P<0.001) and triglyceride level (OR=1.641, 95%CI 1.034-2.605, P=0.036) were independent factors of ISS. Conclusions:ISS is a common benign complication after PED treatment. The current results suggest that small stent diameter and high triglyceride level are independent factors of ISS.

Preliminary exploration of endovascular treatment for cerebral infarction caused by middle cerebral artery stenosis with hypoperfusion in the blood supply area of the lenticulostriate artery / 中华神经科杂志

Objective:To evaluate the necessity, safety and efficacy of endovascular treatment for cerebral infarction caused by middle cerebral artery (MCA) stenosis with hypoperfusion in the blood supply area of the lenticulostriate artery.Methods:The clinical and surgical data of patients with MCA atherosclerotic disease who underwent endovascular treatment in the First Affiliated Hospital of Zhengzhou University from January 2014 to October 2021 were retrospectively analyzed. A total of 6 patients with cerebral infarction caused by MCA stenosis with hypoperfusion in the blood supply area of the lenticulostriate artery were selected. The preoperative and postoperative clinical imaging characteristics, perioperative complications and follow-up of these 6 patients were summarized and evaluated.Results:After the endovascular treatment, the imaging of the lenticulostriate artery in all the 6 patients was clearer than that before the operation, and the number of main trunks of the lenticulostriate artery shown by imaging in 2 patients was more than that before operation. The computer tomography perfusion of 6 patients after the endovascular treatment showed that perfusion in the supply area of the lenticulostriate artery was significantly improved compared with pre-operation. No stroke, transient ischemic attack (TIA) and death occurred during the perioperative period. The time of clinical follow-up was 360 (322, 495) days, and there were no stroke, TIA or death occurring in the corresponding artery. All the 6 patients underwent imaging follow-up, of which 3 patients underwent digital subtraction angiography and 3 underwent CT angiography. The lumen of the target vessels showed patency in all patients.Conclusions:With rigorous imaging evaluation, endovascular treatment may be safe and effective for cerebral infarction caused by MCA stenosis with hypoperfusion in the blood supply area of the lenticulostriate artery.

Intravascular Laser Irradiation of Blood Improves Functional Independence in Subacute Post-Stroke Patients: A Retrospective Observational Study from a Post-Stroke Acute Care Center in Taiwan.

Objective: To investigate the effect of intravascular laser irradiation of blood (ILIB) in patients with post-stroke disability. Background: Helium-neon intravascular laser at a wavelength of 632.8 nm has been applied in post-stroke rehabilitation for many years in Taiwan. Data were collected from our practice to validate its effectiveness. Materials and methods: This was a single-center, retrospective, observational study. Data from 34 patients with first-episode ischemic stroke who participated in the post-acute care program and had an initial modified Rankin Scale (mRS) score of 4 between July 2018 and June 2021 were retrospectively reviewed. Twelve patients who received conventional rehabilitation plus ILIB were in the ILIB group. Twenty-two patients who received conventional rehabilitation only were in the control group. Assessments, including the mRS, Barthel Index (BI), Berg Balance Scale (BBS), 6-min walk test (6MWT), and Fugl-Meyer Assessment of the upper extremity (FMA-UE), were performed to evaluate any post-treatment improvement. Results: Patients who received ILIB had significantly superior mRS scores than those who received only conventional rehabilitation (p = 0.028). Patients in the ILIB group experienced more improvements in the BI, 6MWT, and FMA-UE; however, these were nonsignificant. In addition, the control group experienced a greater improvement in the BBS than the ILIB group. Further studies are required to elucidate the mechanism of action of ILIB therapy fully. There was no major adverse event reported in patients receiving ILIB therapy. Conclusions: ILIB improved independence in post-stroke patients, suggesting that ILIB is a promising treatment for facilitating post-stroke recovery.

Correlation between the accumulation of skin glycosylation end products and the development of type 2 diabetic peripheral neuropathy.

BACKGROUND: The accumulation of advanced glycation end products (AGEs) occurring in skin tissues can be measured by AGE Reader. Here, we assessed the correlation between AGEs values and the development of type 2 diabetic peripheral neuropathy (DPN). METHODS: The basic clinical information of 560 patients with T2DM was collected through an electronic system. AGEs and diabetic complication risk score was measured by AGE Reader, a non-invasive optical signal detector. All of the participants were classified into 4 groups based on Dyck criteria: grade 0 (non-DPN group), grade 1 (early stage group), grade 2 (middle stage group) and grade 3 (advanced group). Pearson correlation analysis and Spearman correlation analysis were used to evaluate the correlation between AGEs and other indexes. The sensitivity and specificity of glycosylated products were evaluated by ROC curve. RESULTS: With the increase of DPN severity, the accumulative AGEs showed an increasing trend. Significant differences (P = 0.000) of AGEs were found among grades 0, 1, 2, and 3 of DPN, and significant differences (P = 0.000) of AGEs were found between grades 1 and 3. There were significant differences in DPN risk score between grades 0, 1, 2, and 3, between grades 1, 2, and 3, and between grades 2 and 3 (P < 0.01 or P < 0.05). AGEs were positively correlated with age, blood uric acid, disease course, systolic blood pressure, the risk scores of the four major complications of diabetes, renal function indicators (serum creatinine, Cystatin C, homocysteine, the ratio of urinary albumin and creatinine, urinary microalbumin, α-microglobulin, urinary transferrin, urinary immunoglobulin), inflammatory indicators (white blood cell count, neutrophil count, neutrophil-to-lymphocyte ratio, C-reactive protein), and TCSS score. However, it was negatively correlated with BMI,fasting insulin, insulin 1-3 h postprandial, lymphocyte count, HOMA insulin resistance index and estimated glomerular filtration rate. The area under the AGEs cumulant and neuropathy risk score curve was 0.769 and 0.743, respectively. The confidence intervals were (71.2-82.6%) and (68.8-79.9%), respectively. The maximum Youden's index of AGEs cumulant was 0.440, and the corresponding AGEs cumulant value was 77.65. The corresponding sensitivity and specificity were 0.731 and 0.709, respectively. Furthermore, the maximum Youden's index of neuropathy risk score was 0.385, and the corresponding neuropathy risk score was 66.25. The corresponding sensitivity and the specificity were 0.676 and 0.709, respectively. CONCLUSION: The cumulative amount of skin AGEs can be used as the diagnostic index and the prediction and evaluation index of DPN severity. Moreover, the diabetic peripheral neuropathy risk score can predict the risk of DPN in patients with T2DM.

The Berg Balance Scale at Admission Can Predict Community Ambulation at Discharge in Patients with Stroke.

Background and Objectives: To regain the ability of community ambulation is a meaningful goal for stroke patients. Recent research recommended that the distance accomplished during the six-minute walk test (≥205 m in 6MWT) is the fittest for defining community ambulation. Until now, there are few studies that have used the updated definition to investigate the related predictors. The aim of this study was to investigate the association between the admission clinical parameters and community ambulation measured by the 6MWT at discharge. The other aim was to find the admission Berg Balance Scale (BBS) cut-off score to discriminate between household or community ambulators. Materials and Methods: This cohort study collected the data of patients who entered the post-acute Care Cerebrovascular Diseases program. Multivariate logistic regression was used to identify significant predictors measured at admission that are associated with community ambulation, and a receiver operating characteristic was adopted to calculate the cut-off value for admission status. There were 120 participants included in this study, and 25% (n = 30) of them regained the ability of community ambulation at discharge. The BBS on admission was identified as the only significant predictor for community ambulation (odds ratio 1.06). Results: The optimal cut-off score for the BBS at admission was 29, and the area under the curve for BBS scores on admission when discriminating between household and community ambulators at discharge was 0.74. Conclusions: The admission BBS scores could be used to predict household and community ambulators at discharge in stroke patients. The results of this study could help clinical physicians set appropriate discharge goals early.

Kurarinone Attenuates Collagen-Induced Arthritis in Mice by Inhibiting Th1/Th17 Cell Responses and Oxidative Stress.

Kurarinone is a flavanone, extracted from Sophora flavescens Aiton, with multiple biological effects. Here, we determine the therapeutic potential of kurarinone and elucidate the interplay between kurarinone and the autoimmune disease rheumatoid arthritis (RA). Arthritis was recapitulated by induction of bovine collagen II (CII) in DBA/1 mice as a collagen-induced arthritis (CIA) model. After the establishment of the CIA, kurarinone was given orally from day 21 to 42 (100 mg/kg/day) followed by determination of the severity based on a symptom scoring scale and with histopathology. Levels of cytokines, anti-CII antibodies, and the proliferation and lineages of T cells from the draining lymph nodes were measured using ELISA and flow cytometry, respectively. The expressional changes, including STAT1, STAT3, Nrf2, KEAP-1, and heme oxygenase-1 (HO-1) changes in the paw tissues, were evaluated by Western blot assay. Oxidative stress featured with malondiadehyde (MDA) and hydrogen peroxide (H2O2) activities in paw tissues were also evaluated. Results showed that kurarinone treatment reduced arthritis severity of CIA mice, as well as their levels of proinflammatory cytokines, TNF-α, IL-6, IFN-γ, and IL-17A, in the serum and paw tissues. T cell proliferation was also reduced by kurarinone even under the stimulation of CII and anti-CD3 antibody. In addition, kurarinone reduced STAT1 and STAT3 phosphorylation and the proportions of Th1 and Th17 cells in lymph nodes. Moreover, kurarinone suppressed the production of MDA and H2O2. All while promoting enzymatic activities of key antioxidant enzymes, SOD and GSH-Px. In the paw tissues, upregulation of Nrf-2 and HO-1, and downregulation of KEAP-1 were observed. Overall, kurarinone showed an anti-inflammatory effect by inhibiting Th1 and Th17 cell differentiation and an antioxidant effect exerted in part through activating the Nrf-2/KEAP-1 pathway. These beneficial effects in CIA mice contributed to the amelioration of their arthritis, indicating that kurarinone might be an adjunct treatment option for rheumatoid arthritis.

Cardiopulmonary Function Assessment in Children With Pulmonary Valve Stenosis.

OBJECTIVE: Pulmonary valve (PV) stenosis affects cardiac pulmonary function and exercise performance. A cardiopulmonary exercise test (CPET) combined with a transthoracic echocardiogram (TTE) can measure exercise performance, disease progression, and treatment effects. We assessed the exercise capacity in children with PV stenosis by conducting CPET and TTE. METHODS: From 2005 to 2021, 84 patients with PV stenosis aged 6-18 years were enrolled; 43 were treated with balloon pulmonary valvuloplasty (BPV) (Group A), and 41 received follow-up care (Group B), and their CPET and pulmonary function test results were compared with 84 healthy, matched individuals (Control). We also conducted TTE to compare the peak pulmonary artery pulse wave velocity and pulmonary valve (PV) area before and after catheterization and follow-up care. RESULTS: There were no significant differences among the CPET parameters of the patient groups and controls in anaerobic metabolic equivalent (MET) (group A: 6.44 ± 0.58; group B: 6.28 ± 0.47, control: 6.92 ± 0.39, p = 0.110), peak MET (group A: 9.32 ± 0.74; group B: 9.13 ± 0.63; control: 9.80 ± 0.52, p = 0.263), and heart rate recovery (group A: 28.04 ± 4.70; group B: 26.44 ± 3.43, control:26.10 ± 2.42, p = 0.718). No significant differences were found in the pulmonary functions between the three groups. The pulmonary artery pulse wave velocity significantly decreased after catheterization (3.97 ± 1.50 vs. 1.95 ± 0.94, p < 0.0001), but not after follow-up care (1.67 ± 0.77 vs. 1.75 ± 0.66, p = 0.129). The pulmonary vale area significantly improved in group A (0.89 ± 0.71 vs. 1.16 ± 0.58, p < 0.0001), whereas only insignificant progression of PV stenosis was observed in group B (1.60 ± 0.64 vs. 1.57 ± 0.65, p = 0.110). CONCLUSIONS: Patients treated with BPV had a similar exercise capacity with that of patients under follow-up care and the healthy controls. Larger or multi-center studies should be conducted to confirm the physical fitness of pediatric patients with PV stenosis after management.

Rehabilitation programs for patients with COronaVIrus Disease 2019: consensus statements of Taiwan Academy of Cardiovascular and Pulmonary Rehabilitation.

The COronaVIrus Disease 2019 (COVID-19), which developed into a pandemic in 2020, has become a major healthcare challenge for governments and healthcare workers worldwide. Despite several medical treatment protocols having been established, a comprehensive rehabilitation program that can promote functional recovery is still frequently ignored. An online consensus meeting of an expert panel comprising members of the Taiwan Academy of Cardiovascular and Pulmonary Rehabilitation was held to provide recommendations for rehabilitation protocols in each of the five COVID-19 stages, namely (1) outpatients with mild disease and no risk factors, (2) outpatients with mild disease and epidemiological risk factors, (3) hospitalized patients with moderate to severe disease, (4) ventilator-supported patients with clear cognitive function, and (5) ventilator-supported patients with impaired cognitive function. Apart from medications and life support care, a proper rehabilitation protocol that facilitates recovery from COVID-19 needs to be established and emphasized in clinical practice.

Alleviation of Collagen-Induced Arthritis by Crotonoside through Modulation of Dendritic Cell Differentiation and Activation.

Crotonoside, a guanosine analog originally isolated from Croton tiglium, is reported to be a potent tyrosine kinase inhibitor with immunosuppressive effects on immune cells. Due to its potential immunotherapeutic effects, we aimed to evaluate the anti-arthritic activity of crotonoside and explore its immunomodulatory properties in alleviating the severity of arthritic symptoms. To this end, we implemented the treatment of crotonoside on collagen-induced arthritic (CIA) DBA/1 mice and investigated its underlying mechanisms towards pathogenic dendritic cells (DCs). Our results suggest that crotonoside treatment remarkably improved clinical arthritic symptoms in this CIA mouse model as indicated by decreased pro-inflammatory cytokine production in the serum and suppressed expression of co-stimulatory molecules, CD40, CD80, and MHC class II, on CD11c+ DCs from the CIA mouse spleens. Additionally, crotonoside treatment significantly reduced the infiltration of CD11c+ DCs into the synovial tissues. Our in vitro study further demonstrated that bone marrow-derived DCs (BMDCs) exhibited lower yield in numbers and expressed lower levels of CD40, CD80, and MHC-II when incubated with crotonoside. Furthermore, LPS-stimulated mature DCs exhibited limited capability to prime antigen-specific CD4+ and T-cell proliferation, cytokine secretions, and co-stimulatory molecule expressions when treated with crotonoside. Our pioneer study highlights the immunotherapeutic role of crotonoside in the alleviation of the CIA via modulation of pathogenic DCs, thus creating possible applications of crotonoside as an immunosuppressive agent that could be utilized and further explored in treating autoimmune disorders in the future.

Limited Knee-Joint Range of Motion in Patients With Tophaceous Gout Improved With Medical Treatment: A 18-Months Follow Up.

Objectives: Tophi may occur within the knee joint causing limited knee-joint range of motion (knee motion). We investigated the relationships between knee motion, total intra-articular tophi size (tIA-tophi), and total subcutaneous tophi size (tSC-tophi) and determined knee motion improvement after continual urate-lowering therapy (ULT). Methods: A total of 26 patients with tophaceous gout and limited knee motion were enrolled. Inclusion criteria were age ≤ 60 years and preserved knee joint space on a plain radiograph. tSC-tophi were measured using a Vernier caliper and tIA-tophi were measured using magnetic resonance imaging software. All patients were re-evaluated after 12-24 months of continual ULT. Upon initial visit, knee motion was related to tIA-tophi and tSC-tophi. Results: After an average of 18.2 months of ULT, the reduction in tSC-tophi was correlated with the reduction in tIA-tophi (P = 0.014, r = 0.395) and improvement in knee motion (P = 0.038, r = 0.408). Knee motion can be eventually improved even in cases of poor initial knee motion (P = 0.000, r = -0.911) or large initial tIA-tophi (P = 0.014, r = 0.476). Tophi can occur in any location within the knee joint. In multiple lineal regression, knee motion was predicted to improve 8.39° for every 10cm of tIA-tophi reduction. Conclusions: Limited knee motion in patients with intra-articular tophi improved with medical treatment, regardless of initial severity. Furthermore, tSC-tophi can be used as an indicator of limited knee motion and their improvement as a predictor of knee motion improvement.

A functional recovery profile for patients with stroke following post-acute rehabilitation care in Taiwan.

BACKGROUND: Functional impairment is frequently seen in patients with stroke. Although the progression of functional recovery after stroke has been proposed, the recovery profile after acute stroke is not well described. The objective of this study is to investigate functional recovery in stroke patients entering post-acute rehabilitation care. METHODS: A retrospective cohort study collected the data of patients who entered the stroke Post-acute Care (PAC) programs. Ninety-five patients after stroke with a modified Ranking Scale (mRS) score of 3-4 who were referred to a post-acute care unit for intensive rehabilitation were recruited. The patients underwent functional, quality of life, and neuropsychological evaluation tests at admission and before discharge. The test scores before discharge were used as outcome variables and were compared with the test scores at admission to show functional recovery. RESULTS: The average length of stay was 58.15 days. After an intensive rehabilitation intervention, significant improvements were observed in all test scores. Additionally, a significant removal rate for nasogastric tubes (p = 0.000) and Foley catheters (p = 0.003) was found at discharge. CONCLUSION: This study showed that the PAC rehabilitation unit was beneficial for patients with acute stroke who had functional impairments. The study results may call for further investigation to identify and develop better models for the delivery of rehabilitation in the stroke PAC unit.