Mediation analysis of activities of daily living and kinesiophobia in association between cardiac function and health status of patients with chronic heart failure.

AIMS: To explore the mediational effect of activities of daily living (ADL) and kinesiophobia on the cardiac function and health status of patients with chronic heart failure (CHF). METHODS: From October 2021 to January 2022, a total of 244 CHF patients treated in the Department of Cardiology of general hospitals were recruited by the convenience sampling method. They were investigated with the Tampa Scale for Kinesiophobia Heart (TSK-SV Heart), the Barthel index for assessing ADL, and the EuroQol five-dimensional questionnaire (EQ-5D) for assessing the health status. RESULTS: The cardiac function and kinesiophobia of CHF patients were both negatively correlated with their health status (r = -.390 and -0.410, respectively, both p < .01). Besides, the ADL of CHF patients was positively correlated with the health status (r = .320, p < .01). The cardiac function of CHF patients was negatively correlated with the ADL (r = -.412, p < .01), but positively correlated with kinesiophobia (r = .180, p < .01). The mediation proportion of ADL plus kinesiophobia between the cardiac function and health status of CHF patients was 43.48%. Both ADL and kinesiophobia partially mediated the effect of cardiac function on health status in CHF patients, but their mediational effects showed no significant difference (p = .777). CONCLUSION: Both ADL and kinesiophobia exert obvious mediational effects between cardiac function and health status in CHF patients. Individualized cardiac rehabilitation (CR) programs based on the cardiac function, ADL and kinesiophobia of CHF patients may contribute to reduce the medical burden and improve the well-being of affected people.

Diagnosis and treatment of atlantoaxial dislocation / 中华骨科杂志

Atlantoaxial dislocation is a pathological anatomical condition caused by the loss of stability between the atlantoaxial joints, which is a serious disabling disease in spine surgery, and may even endanger the patient's life. The causes of atlantoaxial dislocation include traumatic, congenital, inflammatory, degenerative, tumor, and other factors. Since the symptoms and signs are not specific in clinic, imaging examination is particularly important. Atlantoaxial dislocation is mainly classified according to the etiology, the relative position of atlas and axis, and the difficulty of reduction. Accurate classification is of great significance for the selection of treatment options. There is no popular guideline for surgical indications of atlantoaxial dislocation. Patients presenting with related symptoms or spinal cord dysfunction are generally recognized surgical indications in clinical practice. With the continuous improvement and optimization of atlantoaxial screw placement, reduction and fusion technology, supplemented by new equipment in spine surgery, the surgery-related risks and complications have been greatly reduced, and the surgical treatment of atlantoaxial dislocation can obtain good reduction and fusion results. This tutorial summariz the etiology, diagnosis, classification, treatment, complications, and prognosis of atlantoaxial dislocation, in order to provide a more complete and refined reference for clinical diagnosis and treatment.

Effect of aerobic pedal exercise on sleep quality and energy metabolism of female college students with mild sleep disorder / 中国学校卫生

Objective@#To explore the intervention effect of aerobic step exercise on sleep quality of female college students, so as to provide a new perspective to improve the sleep quality of female college students.@*Methods@#In the 2020 fall semester, a total of 41 female college students with mild or more severe sleep disorders were selected from Beijing Normal University through a questionnaire and were randomly divided into experimental group ( n =29) and control group ( n =12). The experimental group received 55 minutes/time step aerobic exercise intervention for 8 weeks, three times a week, while the control group received no exercise intervention from October to December. The two groups maintained the original learning and living habits, without additional physical activity. The Pittsburgh Sleep Quality Index Scale and portable sleep monitor were used to assess the subjects sleep quality from both subjective and objective aspects. Changes in energy metabolism were observed by triaxial accelerometer and standing body composition analyzer.@*Results@#After exercise intervention, subjective sleep quality factor (1.24±0.43, 0.86±0.58), sleep efficiency factor (0.66±0.67, 0.07±0.25), sleep disorder factor (1.24± 0.51 , 1.03±0.18), daytime dysfunction factor (1.90±0.86, 1.48± 0.82 ) and PSQI score (7.21±1.85, 5.66±2.09) significantly improved ( t=3.64, 4.63, 2.27, 2.36, 3.29, P <0.05). The ratio of sleep to wakefulness decreased (25.54±7.86, 20.85± 5.13), the ratio of deep sleep (31.79±12.20, 38.32±10.19) and sleep efficiency (73.99±7.91, 78.68±5.12) increased significantly ( t=-2.12, -2.39, -2.21, P <0.05). Lean body mass [(38.55±2.95, 39.07±2.94)g] and basal metabolic rate [(1 257.45±41.14, 1 262.66 ±42.22)kcal] of the experimental group significantly increased after the intervention of medium high intensity aerobic pedal exercise ( F=5.95, 3.49, P <0.05). Total energy expenditure was positively correlated with subjective sleep quality and sleep efficiency ( r=-0.26, -0.44, P <0.05).@*Conclusions@#The 8 week aerobic step exercise intervention can increase the daytime energy consumption and basic metabolism of female college students. Improve the sleep depth and efficiency of female college students, reduce sleep disorders, and then effectively improve sleep quality.

Advancements in the posterial fixation with axial isthmus screws / 中华骨科杂志

Axial pedicle screw fixation technique, as a classic posterior fixation technique, is the first choice and gold standard of posterior axial screw fixation. Since it can pass through the whole vertebrae and play the role of three-column fixation, it has excellent biomechanical properties and is widely used in cervical spine surgery. However, with the deepening of clinical research, some scholars found that the application of axial pedicle screws was limited in patients with pedicle hypoplasia, high-riding vertebral artery and irreducible atlantoaxial dislocation. At the same time, in order to expose bone markers during screw placement, the muscle dissection of pedicle screws is wider compared with that of isthmus screws. Isthmus screw fixation, as a complementary technique for pedicle screw technique, has gradually attracted the attention of scholars in recent years and has been applied in the surgical treatment of various types of cervical spine diseases. The entry point of axial isthmus screw is closer to the midline of the spine and the inferior facet joint than pedicle screw, to avoid extensive muscle dissection during the operation, so that the paravertebral muscles can be protected, which make the surgery more minimally invasive and the invasion of the operation further reduced. At the same time, compared with the lateral mass or pedicle screw of the atlas combined with axial pedicle screw fixation, the lateral mass or pedicle screw of the atlas combined with axial isthmus screw fixation can increase the anteroposterior and vertical distance between the heads of C 1 and C 2 screws due to the change of screw entry points, which can provide a wider operative space for the three dimensional reduction of atlantoaxial dislocation. However, since the axis is a transitional vertebra between the upper and lower cervical spine which has complexity and variability in anatomical structure, many scholars have limited understanding of this new technique. There are no unified standards for screw placement and surgical details, which are mostly based on the personal experience of clinicians. Meanwhile, the biomechanical properties, surgical complications and long-term efficacy of this technique have received little attention and concern, resulting in the limitation of clinical application and promotion for this technique. This review evaluates the relative advantages of axial isthmus screws according to existing literature reports, and analyzes the anatomy, biomechanics, clinical applications and surgical complications of axial isthmus screw fixation technique, aiming to provide a reference for the safety and feasibility of axial isthmus screw placement.

Symptom Cluster of ICU Nurses Treating COVID-19 Pneumonia Patients in Wuhan, China.

BACKGROUND: In treating highly infectious coronavirus disease-19 (COVID-19) pneumonia, intensive care unit (ICU) nurses face a high risk of developing somatic symptom disorder (SSD).The symptom clusters in one population may show overlaps and involvements, a phenomenon that should be deliberately resolved to improve the management efficiency. OBJECTIVES: The present study aims to investigate the symptoms and causes of SSD of ICU nurses treating COVID-19 pneumonia. The research results are expected to provide evidence for the establishment of a better management strategy. METHODS: This study enrolled a total of 140 ICU nurses who were selected by Jiangsu Province Hospital to work in Wuhan (the epicenter of the COVID-19 epidemic in China) on February 3, 2020. A questionnaire, Somatic symptom disorders for ICU nurses in Wuhan No. 1 Hospital, was designed based on the International Classification of Functioning, Disability and Health. Exploratory factor analysis was performed to cluster the symptoms and logistic regression analysis to find the risk factors of the symptoms. RESULTS: Five major symptoms were chest discomfort and palpitation (31.4%), dyspnea (30.7%), nausea (21.4%), headache (19.3%), and dizziness (17.9%). In exploratory factor analysis, the symptoms were classified into three clusters: Cluster A of breathing and sleep disturbances (dizziness, sleepiness, and dyspnea); Cluster B of gastrointestinal complaints and pain (nausea and headache), and Cluster C of general symptoms (xerostomia, fatigue, as well as chest discomfort and palpitation). In Cluster A, urine/feces splash, sex, and sputum splash were independent predictive factors. In Cluster B, fall of protective glasses and urine/feces splash were independent predictive factors. In Cluster C, urine/feces splash and urine/feces clearance were independent predictive factors. CONCLUSION: The ICU nurses in Wuhan showed varying and overlapping SSDs. These SSDs could be classified into three symptom clusters. Based on the characteristics of their SSDs, specific interventions could be implemented to safeguard the health of ICU nurses.

Design and synthesis of selective sphingosine-1-phosphate receptor 1 agonists with increased phosphorylation rates

FTY720 and IMMH002, prodrugs for sphingosine-1-phosphate receptor 1 (S1P) agonists, show inadequate and inconsistent levels of phosphorylation in humans compared to that in rats. In this study, FTY720 or IMMH002 analogues (-) were designed and synthesized with modified head pieces to improve the biotransformation of the prodrugs to the active phosphorylated forms. Target compounds were synthesized a convergent route using the key and optically pure building block , which was first synthesized asymmetrically catalyzed amination. The phosphorylation rates of these analogues in rat or human blood were compared. The new methyl-substituted analogue compound showed higher phosphorylation rates in both rats and humans than the parent compound, whereas compound showed improvements in rats, but not in humans. In pharmacokinetics studies of rats, compounds and both had higher levels of phosphorylation than FTY720 and IMMH002. Thus, our study not only yielded new compounds with therapeutic potential, but also showed species differences between rats and humans in response to the structural modifications, which might be useful for predicting the biotransformation behavior and efficacy of this class of prodrugs in the clinic.

Effects of comprehensive intervention on glucose and lipid metabolism, liver and kidney function and cardiovascular function in obese adolescents / 中国学校卫生

Objective@#To investigate the effects of exercise combined with dietary intervention on glucose and lipid metabolism, liver and kidney function and cardiovascular function in obese adolescents.@*Methods@#Seventy-one obese adolescents were enrolled in this study. Six weeks of exercise combined with dietary intervention were performed to determine anthropometry, glucose and lipid metabolism, liver and kidney function and cardiovascular function before and after intervention.@*Results@#After 6 weeks of comprehensive intervention, in addition to significant improvement in anthropometry indicators, fasting insulin [(18.76±11.46 vs 11.32±6.54)uU/L], LDL-C [(2.96±0.69 vs 2.22±0.62)mmol/L], TG [(1.57±0.82 vs 0.89±0.37)mmol/L] and TC [(4.52±0.76 vs 3.53±0.62)mmol/L] decreased significantly and insulin resistance improved significantly. AST [(36.1±32.28 vs 22.89±7.27)U/L], ALT [(57.42±61.25 vs 27.86±22.12)U/L], blood urea nitrogen [(4.78±0.89 vs 3.44±0.79)mmol/L] and uric acid [(498.83±120.6 vs 471.07±120.96)mmol/L] were significantly decreased and the detection rates of fatty liver and kidney were significantly decreased(P<0.05), RHI(1.34±0.28 vs 1.69±0.45) and nitric oxide/ endothelin-1 (ET-1) (1.69±0.41 vs 2.67±0.86) significantly increased and atherogenic index (3.06±0.96 vs 2.58±0.80) significantly decreased(P<0.01).@*Conclusion@#The comprehensive intervention of exercise combined with diet can effectively improve anthropometry indicators, glycolipid metabolism, liver and kidney function as well as cardiovascular function of obese adolescents.

Advancements in the pathogenesis of ossification of the posterior longitudinal ligament / 中华骨科杂志

Ossification of the posterior longitudinal ligament (OPLL) is a degenerative disease with a series of clinical manifestations caused by compression of the spinal cord and nerve roots.The disease is prevalent in East Asian countries,and the average prevalence rate of Chinese people is 3.08％.Disease progression can lead to paraplegia,but there is no effective prevention and cure.The pathogenesis of OPLL is still unclear.Most scholars suggest it may be related to genes,hormones,environment,lifestyle and other factors,but all stay in the stage of hypothesis and theory.In this paper,we searched Pubmed,Embase,CNKI and Wanfang database.According to the included literatures,the pathogenesis of OPLL was divided into the following parts:extracellular microenvironment,intracellular cytokines,genetic factors,biomechanical factors,and endocrine and living habits.We summarized and analyzed these literatures.These existing studies independently elucidated the possible mechanisms of OPLL from different angles.Different pathogenic factors promote mesenchymal stem cells to differentiate into osteoblasts through corresponding molecular pathways,initiate osteogenesis,and lead to the formation of ectopic ossification.However,none of these studies have clarified the complete pathogenesis of OPLL.Most of the studies focused on the field of genetics.In recent years,a large number of susceptible genes or loci related to the pathogenesis of OPLL have been screened,but they have shortcomings such as insufficient sample size,ethnic regional differences,and poor reproducibility.

Study on the imaging quality of hepatic portal venography by using dual-energy fusion technique / 实用放射学杂志

Objective To explore the value of linear blending and non-linear blending images of dual-energy CT in improving the image quality of portal venography.Methods 60 patients clinically confirmed as liver cirrhosis with portal hypertension and gastric fundus esophageal varices were enrolled in the study.The patients underwent dual-energy (Sn140/80 kVp) scans in the portal phase, and four groups with 80 kVp and 140 kVp were defined as group A (linear blending images with M=0.3), B (linear ones with M=1.0), C (non-linear ones with c=150 and w=200) and D [non-linear ones with c=(CThepatic portal+CThepatic parenchymal)/2 and w=(CThepatic portal-CThepatic parenchymal)/2, and the CThepatic portal and CThepatic parenchymal were measured on M=0.3 image].The in portal vein enhancements, image noise, signal-to-noise ratio (SNR),contrast-to-noise ratio (CNR) and CT value difference between portal vein and liver parenchyma among four groups were compared by one-way ANOVA analysis of variance test.VRT imaging quality among four groups were assessed by Kruskal-Wallis test and Mann-Whitney U test.Results In four groups, the SNR and CNR of portal vein,and the CT value difference between portal vein and liver parenchyma(14.36 HU±3.23 HU,9.78 HU±2.39 HU,107.66 HU±21.28 HU) of group D were the highest (F=34.94,68.10 and 162.43,all P<0.01),and VRT image quality score of group D(4.78±0.42) was the best when compared to others (all P<0.01).Conclusion Non-linear blending technique of group D can improve the image quality of CT portography, which may be used in clinical practice.

Feasibility of reducing bolus-tracking monitor frequency in coronary CT angiology with dual-source CT / 中华放射学杂志

Objective To investigate the feasibility of reducing bolus?tracking monitor frequency in coronary CT angiography (CTA). Methods This prospective study including 120 patients with suspected coronary artery disease (CAD). According to the examination registration order, the patients were divided into groups A, B and C (n=40 for each group). All patients underwent coronary CTA with bolus?tracking technology, and were monitored at 10 s after the injection of contrast. The monitoring frequency of bolus?tracking for Group A was every 1.14 s, that for Group B was every 1.47 s , and for Group C was every 2.00 s, while the trigger threshold was set as 100 HU. To evaluate the image quality, the objective evaluation included signal noise ratio (SNR) and contrast noise ratio (CNR) of aorta (AO), CNR of left main coronary artery (LM) and right coronary artery (RCA), and the subjective score was recorded for each coronary artery segment. The monitoring times when CT density of the region of interest (ROI) reached the threshold, the CT value and the effective dose (ED) in the 3 groups were recorded. Objective image quality, monitoring parameters and radiation dose were compared using analysis of variance method, subjective image quality was compared withχ2 tests. Results There was no significant difference in AO (SNR and CNR), LM (CNR) and RCA (CNR) among the 3 groups, respectively (P>0.05). Subjective image quality scores of groups A, B, C were (1.879±0.042), (1.876±0.042), (1.881±0.042 ), with no significant difference (χ2=0.003,P>0.05). The monitoring times of to reach the threshold in groups A, B, C were (4.78±2.37), (3.76±1.39), (2.77±0.99), and ED were (0.058±0.031),(0.031±0.011), (0.021±0.007) mSv, with the significant difference (F=9.009, 31.998, respectively, P<0.01). Peak CT values during monitoring among three groups were (133 ± 24), (142 ± 39), (137±26) HU, respectively, with no significant difference (F=0.575,P=0.565). Conclusions It is feasible to reduce monitoring times when performing coronary CTA in dual?source CT scanner. The bolus?tracking monitor frequency in every 2 seconds can not only obtain satisfactory image quality, but also significantly reduce radiation dose.

Practice of X-ray Examination Table Controlled by PLC / 医疗卫生装备

Objective By the modern manufacture regulation of original equipment manufacture(OEM),the quality of large scale X-ray equipment is ensured by means of assembling the purchased key components,such as high frequency and high voltage generators and X-TV systems,etc.Methods The technology of Programmable Logic Controller(PLC)was utilized to improve the reliability of X-ray examination table.Results The design of PLC-controlled X-ray examination table was used in the digital X-ray equipment yeas ago.The malfunction probability of mechanic parts was very low,whereas the electric circuit part was almost zero.Conclusion The practice of PLC improves the reliability and control level for X-ray equipment.

Digital Practice of Large Scale X-Ray Equipment / 医疗卫生装备

Objective To improve X-ray equipment for better medical treatment by digitally transform normal X-ray equipment.Methods Digital image workstation was equipped for digital photography so that ordinary X-ray equipment has the function of a digital X-ray equipment.Results The digital transformation enhance the clinical performance of X-ray equipment.Conclusion It has been proved that some ordinary X-ray equipment can be equipped with digital workstation.