Physical therapy for acute and sub-acute low back pain: A systematic review and expert consensus.

OBJECTIVE: To review the effectiveness of different physical therapies for acute and sub-acute low back pain supported by evidence, and create clinical recommendations and expert consensus for physiotherapists on clinical prescriptions. DATA SOURCES: A systematic search was conducted in PubMed and the Cochrane Library for studies published within the previous 15 years. REVIEW METHODS: Systematic review and meta-analysis, randomized controlled trials assessing patients with acute and sub-acute low back pain were included. Two reviewers independently screened relevant studies using the same inclusion criteria. The Physiotherapy Evidence Database and the Assessment of Multiple Systematic Reviews tool were used to grade the quality assessment of randomized controlled trials and systematic reviews, respectively. The final recommendation grades were based on the consensus discussion results of the Delphi of 22 international experts. RESULTS: Twenty-one systematic reviews and 21 randomized controlled trials were included. Spinal manipulative therapy and low-level laser therapy are recommended for acute low back pain. Core stability exercise/motor control, spinal manipulative therapy, and massage can be used to treat sub-acute low back pain. CONCLUSIONS: The consensus statements provided medical staff with appliable recommendations of physical therapy for acute and sub-acute low back pain. This consensus statement will require regular updates after 5-10 years.

A highly stable chain-based EuIII metal-organic framework as a turn-on and blue-shift luminescent sensor for dipicolinic acid.

The development of a rapid and selective method for the identification of dipicolinic acid (DPA), a specific biomarker in Bacillus anthracis spores, is of great importance for the avoidance of anthrax infection. Herein, a chain-based EuIII metal-organic framework with the formula {[Eu3(BTDB)3(µ3-OH)3(H2O)]·solvents}n (JXUST-38, H2BTDB = (benzo[c][1,2,5]thiadiazole-4,7-diyl)dibenzoic acid) was obtained using 2-fluorobenzoic acid as the pH regulator. JXUST-38 exhibits good chemical and thermal stability and can specifically recognize DPA in N,N-dimethylformamide solution through luminescence enhancement and blue-shift effects with a detection limit of 0.05 µM. Furthermore, the significant luminescence enhancement and blue shift under UV lamps are obviously observable by the naked eye. The luminescence sensing mechanism is attributed to absorbance-induced enhancement between JXUST-38 and DPA. Test paper and mixed-matrix membrane based on JXUST-38 are designed for DPA detection. In addition, the feasibility of using JXUST-38 in biosensing is discussed in detail.

Association between motoric cognitive risk syndrome and future falls among Chinese community-dwelling elderly: A nationwide cohort study.

BACKGROUND: Motoric Cognitive Risk syndrome (MCR), known as the predementia stage, is characterized by both subjective cognitive complaint (SCC) and slow gait. This study aimed to investigate the causal relationship between MCR, its components, and falls. METHODS: Participants aged ≥ 60 years were selected from China Health and Retirement Longitudinal Study. SCC was determined by participants' responses to the question "How would you rate your memory at present?" with "poor" being the indicative answer. Slow gait was defined as one standard deviation or more below age- and gender-appropriate mean values of gait speed. MCR was identified when both SCC and slow gait were presented. Future falls were investigated by the question "have you fallen down during follow-up until wave 4 in 2018?" Logistic regression analysis was performed to test the longitudinal association of MCR, its components and future falls during the following 3 years. RESULTS: Of 3748 samples in this study, the prevalence of MCR, SCC, and slow gait was 5.92%, 33.06%, and 15.21%, respectively. MCR increased the risk of falls during the following 3 years by 66.7% compared to non-MCR after controlling for covariates. In the fully adjusted models, with the healthy group as reference, MCR (OR = 1.519, 95%CI = 1.086-2.126) and SCC (OR = 1.241, 95%CI = 1.018-1.513), but not slow gait, increased the risk of future falls. CONCLUSIONS: MCR independently predicts future falls risk in the following 3 years. Measuring MCR can be a pragmatic tool for early identification of falls risk.

Association between Respiratory Function and Motor Function in Different Stages of Parkinson's Disease.

INTRODUCTION: Respiratory dysfunction in patients with Parkinson's disease (PD) could present in the early stage and worsen in the late stages. These changes could be a factor affecting the ability of daily living and quality of life of patients with PD. The primary objective of this study was to assess the respiratory function and its association with motor function in patients with different stages of PD. METHODS: This was a cross-sectional study conducted at the Huashan Hospital of Fudan University in Shanghai, China. The study included 65 patients diagnosed with PD (the Hoehn and Yahr scale between 1 and 4) and 20 healthy individuals of similar age, gender, weight, and height. The ventilatory function was assessed using the spirometry. Motor function was evaluated using subscale III of the United Parkinson's disease rating scale (UPDRS-III). After confirming the normality of data distribution, we performed one-way ANOVA with a Tukey's post hoc test. RESULTS: Compared with the healthy individuals, there was no statistical significance in forced vital capacity (FVC), forced expiratory volume in 1 s (FEV1), and forced expiratory volume in 1 s/forced vital capacity (FEV1/FVC) in the H&Y 1 group and H&Y 2 group (p > 0.05) but reduced peak expiratory flow (PEF) in the H&Y 2 group (p = 0.002). Reduced FVC, FEV1, and PEF was seen in the H&Y 3 group (p = 0.002, p = 0.001, and p = 0.0001, respectively). Reduced FVC, FEV1, PEF, and FEF25-75% was seen in the H&Y 4 group (p = 0.001, p = 0.0001, p = 0.0001, and p = 0.025, respectively). The correlation analysis revealed that there was a significant negative correlation between FVC and UPDRS-III scores (r = -0.248, p = 0.046), disease duration (r = -0.276, p = 0.026), H&Y scale (r = -0.415, p = 0.001). FEV1 was negatively correlated with UPDRS-III scores (r = -0.277, p = 0.025), disease duration (r = -0.291, p = 0.019), H&Y scale (r = -0.434, p = 0.0001). FEF25-75% was negatively correlated with disease duration (r = -0.247, p = 0.047), H&Y scale (r = -0.278, p = 0.025). CONCLUSION: Our findings revealed that respiratory impairment is present in moderate and advanced PD patients, and directly related to the severity of the disease. It is important to conduct respiratory function test in the clinical practice.

Highly pH-Responsive Sensor Based on a EuIII Metal-Organic Framework with Efficient Recognition of Arginine and Lysine in Living Cells.

A lanthanide-based three-dimensional metal-organic framework with excellent water, acid/base, and solvent stability, namely {[(CH3)2NH2]0.7[Eu2(BTDBA)1.5(lac)0.7(H2O)2]·2H2O·2DMF·2CH3CN}n (JXUST-29, H4BTDBA = 4',4‴-(benzo[c][1,2,5]thiadiazole-4,7-diyl)bis([1,1'-biphenyl]-3,5-dicarboxylic acid), Hlac = lactic acid), has been synthesized and characterized. Since the N atoms of the thiadiazole group will not coordinate with lanthanide ions, JXUST-29 has a free basic N-site accessible to small H+ ions, which allows it to be used as a promising pH fluorescence sensor. Interestingly, the luminescence signal was significantly enhanced, with an approximately 54-fold enhancement in the emission intensity when the pH value was increased from 2 to 5, which is the typical behavior of pH probes. In addition, JXUST-29 can also be used as a luminescence sensor to detect l-arginine (Arg) and l-lysine (Lys) in an aqueous solution through fluorescence enhancement and the blue-shift effect. The detection limits were 0.023 and 0.077 µM, respectively. In addition, JXUST-29-based devices were designed and developed to facilitate detection. Importantly, JXUST-29 is also capable of detecting and sensing Arg and Lys in living cells.

Management of hip fracture in COVID-19 infected patients.

Given that the global population of elderly individuals is expanding and the difficulty of recovery, hip fractures will be a huge challenge and a critical health issue for all of humanity. Although people have spent more time at home during the coronavirus disease 2019 (COVID-19) pandemic, hip fractures show no sign of abating. Extensive studies have shown that patients with hip fracture and COVID-19 have a multifold increase in mortality compared to those uninfected and a more complex clinical condition. At present, no detailed research has systematically analyzed the relationship between these two conditions and proposed a comprehensive solution. This article aims to systematically review the impact of COVID-19 on hip fracture and provide practical suggestions. We found that hip fracture patients with COVID-19 have higher mortality rates and more complicated clinical outcomes. Indirectly, COVID-19 prevents hip fracture patients from receiving regular medical treatment. With regard to the problems we encounter, we provide clinical recommendations based on existing research evidence and a clinical flowchart for the management of hip fracture patients who are COVID-19 positive. Our study will help clinicians adequately prepare in advance when dealing with such patients and optimize treatment decisions.

Physical energy-based ultrasound shifts M1 macrophage differentiation towards M2 state.

Recently, we read with interest the article entitled "Unveiling the Morphogenetic Code: A New Path at the Intersection of Physical Energies and Chemical Signaling". In this paper, the investigation into the systematic and comprehensive bio-effects of physical energies prompted us to reflect on our research. We believe that ultrasound, which possesses a special physical energy, also has a certain positive regulatory effect on macrophages, and we have already obtained some preliminary research results that support our hypothesis.

The therapeutic effects of low-intensity pulsed ultrasound in musculoskeletal soft tissue injuries: Focusing on the molecular mechanism.

Musculoskeletal soft tissue injuries are very common and usually occur during both sporting and everyday activities. The intervention of adjuvant therapies to promote tissue regeneration is of great importance to improving people's quality of life and extending their productive lives. Though many studies have focused on the positive results and effectiveness of the LIPUS on soft tissue, the molecular mechanisms standing behind LIPUS effects are much less explored and reported, especially the intracellular signaling pathways. We incorporated all research on LIPUS in soft tissue diseases since 2005 and summarized studies that uncovered the intracellular molecular mechanism. This review will also provide the latest evidence-based research progress in this field and suggest research directions for future experiments.

New-onset depression after hip fracture surgery among older patients: Effects on associated clinical outcomes and what can we do?

BACKGROUND: Hip fracture in the elderly is a worldwide medical problem. New-onset depression after hip fracture has also received attention because of its increasing incidence and negative impact on recovery. AIM: To provide a synthesis of the literature addressing two very important questions arising from postoperative hip fracture depression (PHFD) research: the risk factors and associated clinical outcomes of PHFD, and the optimal options for intervention in PHFD. METHODS: We searched the PubMed, Web of Science, EMBASE, and PsycINFO databases for English papers published from 2000 to 2021. RESULTS: Our results showed that PHFD may result in poor clinical outcomes, such as poor physical function and more medical support. In addition, the risk factors for PHFD were summarized, which made it possible to assess patients preoperatively. Moreover, our work preliminarily suggested that comprehensive care may be the optimal treatment option for PHFDs, while interdisciplinary intervention can also be clinically useful. CONCLUSION: We suggest that clinicians should assess risk factors for PHFDs preoperatively, and future research should further validate current treatment methods in more countries and regions and explore more advanced solutions.

The Muscle Activation Differences in Post-Stroke Upper Limb Flexion Synergy Based on Spinal Cord Segments: A Preliminary Proof-of-Concept Study.

Objective: This study examined the activation difference of muscles innervated by cervical cord 5-6 (C5-C6) and cervical cord 8- thoracic cord 1 (C8-T1) in upper limb flexion synergy after stroke. Methods: Surface electromyography (sEMG) signals were collected during elbow flexion in stroke patients and healthy controls. The study compared normalized activation of two pairs of muscles that could cause similar joint movement but which dominated different spinal cord segments (clavicular part of the pectoralis major, PC vs. Sternocostal part of the pectoralis major, PS; Flexor carpi radialis, FCR vs. Flexor carpi ulnaris, FCU). In each muscle pair, one muscle was innervated by the same spinal cord segment (C5-C6), dominating the elbow flexion and the other was not. The comparison of the activation of the same muscle between patients and healthy controls was undertaken after standardization based on the activation of the biceps brachii in elbow flexion. Results: There was no difference between the PC and PS's normalized activation in healthy controls while the PC's normalized activation was higher than PS in stroke patients during elbow flexion. Similarly, there was no significant difference in normalized activation between FCR and FCU in healthy controls, and the same is true for stroke patients. However, the standardized activation of both FCR and FCU in stroke patients was significantly lower than that in healthy controls. Conclusion: After stroke, the activation of the distal muscles of the upper limb decreased significantly regardless of the difference of spinal cord segments; while the activation of the proximal muscles innervated by the same spinal cord segment (C5-C6) dominating the elbow flexion showed higher activation during flexion synergy. The difference in muscle activation based on spinal cord segments may be the reason for the stereotyped joint movement of upper limb flexion synergy.

Cortical excitability signatures for the degree of sleepiness in human.

Sleep is essential in maintaining physiological homeostasis in the brain. While the underlying mechanism is not fully understood, a 'synaptic homeostasis' theory has been proposed that synapses continue to strengthen during awake and undergo downscaling during sleep. This theory predicts that brain excitability increases with sleepiness. Here, we collected transcranial magnetic stimulation measurements in 38 subjects in a 34 hr program and decoded the relationship between cortical excitability and self-report sleepiness using advanced statistical methods. By utilizing a combination of partial least squares regression and mixed-effect models, we identified a robust pattern of excitability changes, which can quantitatively predict the degree of sleepiness. Moreover, we found that synaptic strengthen occurred in both excitatory and inhibitory connections after sleep deprivation. In sum, our study provides supportive evidence for the synaptic homeostasis theory in human sleep and clarifies the process of synaptic strength modulation during sleepiness.

The effect of magnetic stimulation on differentiation of human induced pluripotent stem cells into neuron.

The effect of stem cell transplantation in the treatment of neural lesions is so far not satisfactory. Magnetic stimulation is a feasible exogenous interference to improve transplantation outcome. However, the effect of magnetic stimulation on the differentiation of induced pluripotent stem cells (iPSCs) into neuron has not been studied. In this experiment, an in vitro neuron differentiation system from human iPSCs were established and confirmed. Three magnetic stimuli (high frequency [HF], low frequency [LF], intermittent theta-burst stimulation [iTBS]) were applied twice a day during the differentiation process. Immunofluorescence and quantitative polymerase chain reaction (Q-PCR) were performed to analyze the effect of magnetic stimulation. Neural stem cells were obtained on day 12, manifested as floating neurospheres expressing neural precursor markers. All groups can differentiate into neurons while glial cell markers were not detected. Both Immunofluorescence and PCR results showed LF and iTBS increased the transcription and expression of neuronal nuclei (NeuN). HF significantly increased vesicular glutamate transporters2 transcription while iTBS promoted transcription of both synaptophysin and postsynaptic density protein 95. These results indicate that LF and iTBS can promote the generation of mature neurons from human iPSCs; HF may promote differentiate into glutamatergic neurons while iTBS may promote synapse formation during the differentiation.

[Preparation Technology of Huayu Xiaozhong Spray Films].

OBJECTIVE: The extraction process and film-forming preparation technology of Huayu Xiaozhong spray film was optimized respectively by orthogonal design and central composite design/response surface method (CCD-RSM). METHODS: With the extraction rate of amygdalin as the index, the orthogonal experiment was adopted for the optimization of extraction process. With the film-forming time, spraying effect, thickness and maintain time of spray film as the indexes, the dosages of PVA 1788, PVP k30 and glycerin as factors, the prescription was optimized by CCD-RSM. RESULTS: The optimal extract processing was: immersing rude powder with 12 times of 60% ethanol for 24 hours. The optimal formula of Huayu Xiaozhong spray film was 5% of PVA 1788, 4.5% of glycerin and 5% of PVP-k30. CONCLUSION: Under the optimum condition, the extraction efficiency of amygdalin is 96.7%. Under the optimum technological condition of preparation, the spray film meets the demand of quality.

Long-term three-stage rehabilitation intervention alleviates spasticity of the elbows, fingers, and plantar flexors and improves activities of daily living in ischemic stroke patients: a randomized, controlled trial.

To investigate the effects of rehabilitation interventions on spasticity and activities of daily living (ADL) in ischemic stroke patients. A total of 165 ischemic stroke patients were recruited and assigned randomly to a control group (CG, n=82) or a therapeutic group (TG, n=83). Rehabilitation interventions were performed in the TG. The Modified Ashworth Scale was used to evaluate the severity of spasticity in the fingers, elbows, and plantar flexors, and the Modified Barthel Index (MBI) was used to measure ADL performance. Evaluations were performed at baseline (M0) and at the end of the first, third, and sixth months (M1, M3, M6) after enrollment. At M0, 20.8% (16/77) in the CG and 29.9% (23/77) in the TG developed spasticity, whereas at M6, the incidence of spasticity increased to 36.4% (28/77) in the TG and 42.9% (33/77) of patients in the CG. Fewer patients developed spasticity in the fingers, elbows, and ankles in the TG than CG, respectively. Both groups showed significant improvements in MBI scores (M6 vs. M0, P<0.01). MBI scores correlated negatively with the severity of spasticity in both groups at M6. Long-term standardized rehabilitation interventions alleviate spasticity and promote ADL with the presence of minor spasticity (Supplementary video, Supplemental digital content 1, http://links.lww.com/WNR/A291).

[Design and synthesis of imine compound for metal cation logical gates recognition and setup of double-control fluorescent molecule switch].

The Schiff base's reduced product N,N-bis(4-methoxybenzyl) ethane-1,2-diamine, which was used as a receptor L, was designed and synthesized for the first time in the present article. It was found that Cu2+ and Fe3+ could quench L in fluorescence observably and Zn2+ and Cd2+ could enhance L remarkably. So the two pair metal cation could set up "OR" logical gate relation with the receptor molecule L, then a logical recognition system be formed. The data of resolved ZnL's single crystal indicated that ZnL belonged to monoclinic (CCDC No. 747994). Integrated spectrum instrument was used to characterize the structure of its alike series of complex compound. According to ZnL's excellent fluorescence character and the ability to exchange with contiguous metal cation, ZnZ+/ZnL/Co2+, Zn2+/ZnL/Nit+ fluorescent molecule switch was designed. It is hoped that the work above could be positive for the development of molecule computer, bio-intellectualized inspection technology (therapy) and instrument.

[Synthesis, characterization and relaxivity of DTPA double alkyl esters heterocyclic gadolinium(III) complexes].

The DTPA ligand modified by heterocyclic compound and linked through double alkyl ester covalent bond was synthesized by acylation reaction between diethylenetriamine pentaacetic (DTPA) bisanhydride and a novel heterocyclic compound. The corresponding paramagnetic Gd(III) complex was gained by the reaction of the DTPA ligand with GdCl3.6H2O. The structure of the ligand and its Gd(III) complex was characterized by elemental analysis, FTIR and 1H NMR, and the longitudinal relaxivity (R1) was measured. Besides, the magnetic resonance imaging of the new Gd(III) complex in vitro was studied. The result suggested that the stability of the complex was well, and when the Gd(III) quantity was identical, the R1 of the Gd(III) complex (5.12 mmol x L(-1) x s(-1)) was higher than the clinical magnetic resonance imaging contrast agent Gd-DTPA (3.64 mmol x L(-1).

[Clinical observation on effect of Chinese herbs in adjusting hypoestrogenemia status by clomiphene to promote ovulation].

OBJECTIVE: To explore the effect of Yijing Huoxue Cuyun Decoction (YHCD) in adjusting hypoestrogenemic response induced by clomiphene. METHODS: Infertile patients caused by ovulation disturbance were randomly divided into 2 groups. The 60 patients in the observed group were treated with clomiphine plus YHCD, and the 58 patients in the control group were given clomiphine plus estradiol valerate. RESULTS: By scoring on the cervical relaxation and improvement of cervical mucus, 38 patients (63.3%) in the observed group had Insler score of more than 8 points, while that in the control group was only 25 (43.1%), comparison between the two groups showed significant difference (P < 0.05). The endometrium thickening in the observed group was 0.98 +/- 0.19 cm, significantly different to that in the control group (0.85 +/- 0.21 cm, P < 0.01). Twenty-five patients in the observed group (41.7%), and fourteen patients in the control group (24.1%), respectively got pregnancy, the pregnant rate in the former was obviously higher than that in the latter (P < 0.05). CONCLUSION: YHCD can ameliorate hypoestrinemia induced by clomiphene and increase the pregnant rate in patients.

[Effects of standardized three-stage rehabilitation on recovery of neurological function in stroke patients with hemiplegia].

OBJECTIVE: To explore the effects of standardized three stages' rehabilitation on the neurological function in stroke patients with hemiplegia. METHODS: All 52 patients firstly are brought into two blocks: primary cerebral infarction and primary cerebral hemorrhage then are divided into treated group and controlled group randomly. Patients in the treated group are given Standardized Three Stages' Rehabilitation, while those in the controlled group are only given normal internal medicine treatments that are the same as the treated group but without Standardized Three Stages' Rehabilitation. All patients would be assessed with the scale of Clinical Neurological Function Defects (CNFD) at the entering time, the end of 1st month, 3rd month and 6th month respectively after stroke. RESULTS: The scores of the treated group are lower than those of the controlled group (P < 0.001) at every stage, the margins between every stage's scores in the treated group are greater than those in the controlled group (P < 0.001). The scores of the treated group's patients are about 51%, 34%, 18% and 8% of total scores at the entering time, the end of 1st month, 3rd month and 6th month after stroke differently, but that of the controlled group are about 58%, 54%, 42% and 37% of total scores differently. The margins between the scores of entering time and that of the end of 1st month, 3rd month and 6th month in the treated group are 17%, 33% and 43% of total scores respectively, but that of the controlled group are about 5%, 16% and 21% of total scores differently. CONCLUSION: Standardized three stages' rehabilitation could promote stroke patients' motor function of every stage obviously.