What is the relationship between health-related quality of life among scoliosis patients and their caregiver burden? A cross-sectional study in China.

BACKGROUND: Caregivers play a vital role in the recovery of scoliosis patients, but limited studies evaluate the caregivers' HRQoL and burden in health care. This study aimed to explore the health-related quality of life (HRQoL) of scoliosis patients and their caregivers, and identify the factors influencing caregiver burden in Eastern China. METHODS: This cross-sectional study was conducted from August 2018 to January 2019 at the Shandong Provincial Hospital, Jinan, China. The HRQoL of scoliosis patients was measured by the Scoliosis Research Society-22r (SRS-22r), five-level EQ-5D (EQ-5D-5L) and Child Health Utility 9D (CHU9D). The caregivers' questionnaires consist of the EQ-5D-5L, WHO-five wellbeing index (WHO-5), 22-item Zarit Caregiver Burden Interview (ZBI-22) and Social Support Rating Scale (SSRS). Spearman correlation coefficients were used to estimate the relationship among caregivers' burden, social support, HRQoL, and SWB. Cohen's effect size (Cohen's d) was used to assess the ZBI-22 total score between different groups. Multiple stepwise hierarchical linear regression models were conducted to assess the associated factors of caregiver burden. RESULTS: There were 59 scoliosis patients and their caregivers (n = 59) included in the analysis. The mean health state utility of adolescent scoliosis patients (n = 39) was 0.718 (95%CI: 0.654, 0.782) based on CHU9D and adult scoliosis patients (n = 20) was 0.663 (95%CI: 0.471, 0.855) based on EQ-5D-5L. The mean health state utility of male scoliosis patients (0.792/0.667) was higher than females (0.681/0.662) based on CHU9D and EQ-5D-5L (p > 0.05), respectively. The ZBI-22 total score of scoliosis patients' caregivers was 27.86 (SD: 20.59). Scoliosis patients' HRQoL was significantly inversely correlated with caregiver burden, and the HRQoL and subjective wellbeing (SWB) of caregivers were moderately and inversely correlated with caregiver burden. The regression results showed that the patients' age and caregivers' SWB were key characteristics associated with caregiver burden. CONCLUSIONS: The caregiver burden of adolescent patients was higher than that of adult patients, and the satisfaction rate of adolescent scoliosis patients was higher than that of adult scoliosis patients. Improving the functional state of scoliosis patients and providing appropriate nursing practice education from health professionals would be necessary to effectively improve caregivers SWB and alleviate caregiver burden.

Research Progress and Development Demand of Nanocellulose Reinforced Polymer Composites.

Nanocellulose is a type of nanomaterial with high strength, high specific surface area and high surface energy. Additionally, it is nontoxic, harmless, biocompatible and environmentally friendly and can be extracted from biomass resources. The surface groups of cellulose show high surface energy and binding activity on the nanoscale and can be modified by using various methods. Because nanocellulose has a high elastic modulus, rigidity and a low thermal expansion coefficient, it is an excellent material for polymer reinforcement. This paper summarizes the reinforcement mechanisms of nanocellulose polymer composites with a focus on the role of theoretical models in elucidating these mechanisms. Furthermore, the influence of various factors on the properties of nanocellulose reinforced polymer composites are discussed in combination with analyses and comparisons of specific research results in related fields. Finally, research focus and development directions for the design of high-performance nanocellulose reinforced polymer composites are proposed.

Green biorefinery - the ultra-high hydrolysis rate and behavior of Populus tomentosa hemicellulose autohydrolysis under moderate subcritical water conditions.

A high monosaccharide conversion rate of hemicellulose in a green solvent and under moderate reaction conditions for industrialization is one of the most important keys in a lignocellulosic biorefinery. The behavior of Populus tomentosa hemicellulose polysaccharides, crystallinity and the furfural formation in the autohydrolysis process under moderate subcritical water conditions (160-180 °C, 0.618-1.002 MPa) were studied. The results have shown that the hemicellulose was converted to corresponding monosaccharides at an ultra-high hydrolysis rate. Factor analysis indicates that the temperature is the most important factor affecting hemicellulose autohydrolysis. When the autohydrolysis temperature increased from 160 to 180 °C for 2 h, the hydrolysis rate of xylose, rhamnose, galactose, mannose, and glucose from hemicellulose increased from 70% to 91%, 71% to 100%, 82% to 95%, 42% to 58%, and 34% to 37%, respectively. Arabinose was completely dissolved in 30 min. The xylose, rhamnose, galactose, and arabinose from hemicellulose could be almost completely removed under the conditions. The hemicellulose removal rate obtained herein exceeded the values reported for most acid, alkali, ionic liquid, or deep eutectic solvent treatments. It is notable that almost all glucose in hemicellulose was dissolved and the glucose in cellulose was partially hydrolyzed. An analysis of the sugar composition and the crystallinity change in the process at 180 °C demonstrate that hydrolysis reaction started to shift from amorphous regions to crystalline regions, due to the partial hydrolysis of crystalline cellulose after 90 min at 180 °C. Overall, these results show that the moderate subcritical water autohydrolysis of hemicellulose in Populus tomentosa may be a potential bio-refinery process.