[Clinical advantage staging and underlying mechanisms of Wangbi Tablets against knee osteoarthritis based on "disease-formula" interaction network].

The clinical advantage staging and underlying mechanisms of Wangbi Tablets against knee osteoarthritis(KOA) were studied based on the "disease-formula" interaction network. Firstly, the clinical symptoms and related genes corresponding to Wangbi Tablets and KOA in the acute, remission, and recovery phases were collected from clinical guidelines/consensus and SoFDA database, and the putative targets of Wangbi Tablets were obtained from ETCM 2.0. Then, Jaccard similarity and cosine similarity were employed to assess the similarities of clinical symptoms, genes, and enriched pathways between Wangbi Tablets and KOA in different phases. The "disease-formula" interaction network of the drug targets and disease genes was constructed, and the key targets were screened by topological feature calculation. KEGG and Reactome database were used for the functional enrichment of the key targets, on the basis of which the functional characteristics of Wangbi Tablets against KOA in the acute, remission, and recovery phases were predicted. Finally, the SW1353 cells exposed to lipopolysaccharide were used to decipher the mechanism of Wangbi Tablets against KOA. The results showed that 92/3 921, 138/3 708, 139/3 800, and 196/3 946 clinical symptoms and the related genes corresponded to KOA in the acute, remission, and recovery phases and Wangbi Tablets were collected from SoFDA, and 260 putative targets of Wangbi Tablets were obtained from ETCM 2.0. Wangbi Tablets had highest similarity of clinical symptoms, genes, and enriched pathways with KOA in the remission phase and the secondary highest similarity with KOA in the recovery phase. The key targets of Wangbi Tablets mainly participated in the regulation of immunity-inflammation imbalance and exerted pain-relieving and bone-protecting effects to alleviate symptoms such as knee joint pain, joint swelling, soreness, fatigue, and dysfunction. Intriguingly, the key targets of Wangbi Tablets possessed antioxidant effects during KOA in the acute and remission phases, while they maintained material and energy metabolism homeostasis and protected vessels during KOA in the recovery phase. The cell experiment indicated that Wangbi Tablets down-regulated the expression of interleukin(IL)-6, IL-1ß, tumor necrosis factor-α(TNF-α), and Bcl-2-associated X protein(Bax)/B-cell lymphoma 2(Bcl-2) via regulating the phosphatidylinositol 3-kinase(PI3K)-protein kinase B(Akt) signaling pathway. The findings lay a theoretical foundation for further clarifying the clinical advantage stage and precise clinical application of Wangbi Tablets in treating KOA.

Blood pressure response during exercise testing in individuals with and without hypertension: The value of the recovery phase.

BACKGROUND: Hypertension and exercise testing are essential for cardiovascular risk assessment. However, an exact description of blood pressure (BP) in patients with a hypertensive response during exercise (HRE), especially in the recovery phase is lacking. Herein, we aimed to analyse BP and heart rate during exercise testing and recovery in patients with an HRE. METHODS: 800 patients aged 17-90 with an HRE during a standardized bicycle ergometry test were recruited. The BP behaviour during exercise testing was correlated with clinical data. Furthermore, data were analysed according to the presence of pre-existent hypertension. RESULTS: Of the 800 patients included in this study 497 (62%) were previously diagnosed with hypertension. Analysis of covariance showed a significantly faster systolic (ß [95% CI] 8.0 [4.9-11.1]) and diastolic (2.4 [0.4-4.4]) BP recovery 3 min after maximal exercise in patients without hypertension in univariable models. These results remained robust in fully adjusted models taking into account age, sex, body mass index, cardiovascular disease, and antihypertensive treatment for systolic (5.3 [1.2-9.4]) and diastolic BP (4.5 [1.9-7.0]). Furthermore, patients with hypertension displayed higher systolic BP during maximal exercise in univariable (3.8 [0.1-7.5]) and fully adjusted (5.5 [1.1-10.0]) models. There was no difference in maximum diastolic BP between groups. CONCLUSION: In this large cohort study, patients without hypertension showed a faster systolic and diastolic BP recovery and lower maximal systolic BP compared to patients with hypertension. Overall, this study provides new insights into cardiovascular health during recovery phase.

Changes in soil bacterial community characteristics in patches of different vegetation types under different stages of restoration in the desert of northern China.

In desert areas, the process of mobile sandy land changing to semi-fixed sandy land and eventually to fixed sandy land after undergoing vegetation restoration is inevitable. The presence of shrub patches and herb patches is common in this restoration process. No relevant studies have reported the soil bacterial community characteristics of different vegetation-type patches (shrub patches and herb patches) under different stages of restoration. Therefore, we utilized long-established experimental plots to collect soil from 0-20 cm soil layer under shrub patches (dominated by Salix psammophila) and herb patches under different stages of restoration (i.e., mobile sand land, semi-fixed sand land, and fixed sand land), by determining soil physicochemical properties, enzyme activities, and soil bacterial communities. Our results found that soil bacterial α-diversity under different restoration stages showed higher shrub patches than herb patches. The dominant bacterial communities (phyla) in shrub patches and herb patches at different recovery stages were Actinobacteria, Proteobacteria, and Bacteroidota. When the mobile sandy land returned to fixed sandy land, the relative abundance of Actinobacteria and Bacteroidota gradually decreased under shrub patches and herb patches, while the relative abundance of Proteobacteria increased significantly. In addition, herb patches significantly increased the relative abundance of bacteria (genus) relative to shrub patches at different stages of recovery. Soil nutrients, soil fine particles, and soil enzyme activities were significantly higher under shrub patches than under herb patches when fixed sandy land due to differences in life form and architecture between shrub patches and herb patches. Based on this, soil bacterial community composition and diversity under shrub patches were driven by more soil properties during the restoration of sandy land. This study complements the dynamic recovery processes and driving mechanisms of soil bacterial community structure under different vegetation patches in sandy areas, especially in the context of global climate change.

Lipid metabolic reprogramming mediated by circulating Nrg4 alleviates metabolic dysfunction-associated steatotic liver disease during the early recovery phase after sleeve gastrectomy.

BACKGROUND: The metabolic benefits of bariatric surgery that contribute to the alleviation of metabolic dysfunction-associated steatotic liver disease (MASLD) have been reported. However, the processes and mechanisms underlying the contribution of lipid metabolic reprogramming after bariatric surgery to attenuating MASLD remain elusive. METHODS: A case-control study was designed to evaluate the impact of three of the most common adipokines (Nrg4, leptin, and adiponectin) on hepatic steatosis in the early recovery phase following sleeve gastrectomy (SG). A series of rodent and cell line experiments were subsequently used to determine the role and mechanism of secreted adipokines following SG in the alleviation of MASLD. RESULTS: In morbidly obese patients, an increase in circulating Nrg4 levels is associated with the alleviation of hepatic steatosis in the early recovery phase following SG before remarkable weight loss. The temporal parameters of the mice confirmed that an increase in circulating Nrg4 levels was initially stimulated by SG and contributed to the beneficial effect of SG on hepatic lipid deposition. Moreover, this occurred early following bariatric surgery. Mechanistically, gain- and loss-of-function studies in mice or cell lines revealed that circulating Nrg4 activates ErbB4, which could positively regulate fatty acid oxidation in hepatocytes to reduce intracellular lipid deposition. CONCLUSIONS: This study demonstrated that the rapid effect of SG on hepatic lipid metabolic reprogramming mediated by circulating Nrg4 alleviates MASLD.

Awareness and support for post-stroke fatigue among medical professionals in the recovery phase rehabilitation ward.

Sato M, Hyakuta T. Awareness and support for post-stroke fatigue among medical professionals in the recovery phase rehabilitation ward. Jpn J Compr Rehabil Sci 2023; 14: 39-48. Objective: To clarify the level of awareness of and support for post-stroke fatigue among medical professionals working in recovery phase rehabilitation wards. Methods: We conducted a questionnaire survey targeting all medical professionals (physicians, nurses, physical therapists, occupational therapists, and speech therapists) working in recovery phase rehabilitation wards of three facilities to evaluate their awareness of post-stroke fatigue and the support they were offering to address this. Quantitative data were subjected to statistical analysis and free description data were subjected to content analysis. Results: Of the 130 participants, we obtained responses from 94 (collection rate, 72.3%; valid response rate, 100%). Those who felt that post-stroke patients are always tired or tire easily comprised 63.8%. Those who acknowledged the importance of post-stroke fatigue as a problem and that it is an issue that must be addressed comprised 70.2% and 73.4%, respectively. Issues emerging due to post-stroke fatigue were extracted as follows: "Difficulty continuing with rehabilitation," "Decreased drive," "Difficulty with emotional control/depression," "Fewer interactions with others," and "Loss of goals." Support for post-stroke fatigue was offered by 57.4% of medical professionals, most commonly as individual support such as "Ensure rest." The effects of support were described as "Cannot say either way" (44.4%), with 3.7% noting that they were not very effective. Awareness and support rates among therapists were significantly higher than those among nurses. Conclusions: Post-stroke fatigue is acknowledged by medical professionals as a critical issue that negatively influences the patient's physical, emotional, and daily living functions. Unfortunately, effective support is not currently being offered, demonstrating the need for the development of appropriate interventions.

The differences in renal hemodynamic response following high-intensity exercise between younger and older males.

BACKGROUND: Renal blood flow (RBF) decreases with exercise, but this change is only temporary, and habitual exercise may be an effective method to improve renal function. The kidney shows structural and functional changes with aging, but it is unclear how aging affects the hemodynamic response of the kidneys to exercise. Therefore, we evaluated the differences in the hemodynamic response of the kidneys to high-intensity exercise between younger and older men. METHODS: Sixteen men (8 young and 8 older) underwent an incremental exercise test using a cycle ergometer with a 1-min warm up followed by exercise at 10-20 W/min until the discontinuation criteria were met. Renal hemodynamics were assessed before exercise, immediately after exercise, and at 60-min after exercise using ultrasound echo. RESULTS: High-intensity exercise significantly reduced RBF in both groups (younger: ∆ - 53 ± 16%, p = 0.0005; older: ∆ - 53 ± 19%, p = 0.0004). In the younger group, RBF returned to the pre-exercise level 60-min after exercise (∆ - 0.4 ± 5.7%, p > 0.9999). In contrast, RBF 60-min after exercise was significantly lower than that before exercise in the older group (∆ - 24 ± 19%, p = 0.0006). The older group had significantly lower RBF than younger adults 60-min after exercise (423 ± 32 vs. 301 ± 98 mL/min, p = 0.0283). CONCLUSIONS: Our findings demonstrate that RBF following high-intensity exercise recovered 60-min after exercise in younger group, whereas RBF recovery was delayed in the older group.

Effectiveness of Xiangsha Liujun pills on decreased digestive function in convalescent patients of coronavirus disease 2019: a randomized, double blind, placebo controlled clinical trial.

OBJECTIVE: To evaluate the effectiveness and safety of Xiangsha Liujun pills on the decreased digestive function in patients in the recovery phase of the Coronavirus disease 2019 (COVID-19). METHODS: A randomized, double blind, placebo controlled clinical trial was conducted. A total of 200 COVID-19 patients in the recovery phase were included in our study in Ezhou Hospital of Traditional Chinese Medicine. Totally 200 subjects were randomly divided into a treatment group (Xiangsha Liujun pills) and a control group (placebo), with 100 in each group. Subjects took Xiangsha Liujun pills or placebo orally three times a day for two weeks. Three visits were scheduled at week 0 (baseline), week 1 (the middle of the intervention) and week 2 (the end of the intervention) for each eligible patient. The total efficacy rates for improving the Traditional Chinese Medicine (TCM) symptoms (fatigue, poor appetite, abdominal distension and loose stools) and the disappearance rates of symptoms were observed and compared in the treatment and control groups. Adverse events were recorded during the study period. SAS 9.4 was used to analyze the data. RESULTS: A total of 200 patients were included in this study, among which 4 participants withdrew because the drugs did not work. Three patients were excluded for age. Before the treatment, there was no significant difference between the TCM symptoms scores of subjects. After 1 week of treatment, the full analysis set (FAS) showed that the efficacy rates for abdominal distension and loose stools in the treatment group were significantly higher than the control group ( 0.05). There were no significant differences in the efficacy rates for fatigue and poor appetite between the two groups (0.05). In addition, the disappearance rate of fatigue in the treatment group was significantly higher than the control group (0.05); there were no significant differences between the two groups after treatment in the rates of poor appetite, abdominal distension, and loose stools (>0.05). After 2 weeks of treatment, the efficacy rates for fatigue, poor appetite, abdominal distension, and loose stools in the treatment group were significantly higher than the control group (0.05). The disappearance rate of loose stools in the treatment group was significantly higher than the control group ( 0.05). However, there were no significant differences in the disappearance rates of fatigue, poor appetite, and abdominal distension between the two groups ( 0.05). No severe adverse events were reported by subjects during the study. CONCLUSIONS: This clinical study confirmed that Xiangsha Liujun pills can effectively improve the symptoms related to the decreased digestive function in COVID-19 convalescent patients.

Residential greenness and air pollution's association with nasal microbiota among asthmatic children.

Both greenness and air pollution have widely been linked with asthma. However, the potential mechanism has rarely been investigated. This study aimed to identify the association between residential greenness and air pollution (fine particulate matter [PM2.5]; nitrogen dioxide [NO2]; ozone [O3]) with nasal microbiota among asthmatic children during the recovery phase. The normalized difference vegetation index was used to assess the extent of residential greenness. Spatiotemporal air pollution variation was estimated using an integrated hybrid kriging-LUR with the XG-Boost algorithm. These exposures were measured in 250-m intervals for four incremental buffer ranges. Nasal microbiota was collected from 47 children during the recovery phase. A generalized additive model controlled for various covariates was applied to evaluate the exposure-outcome association. The lag-time effect of greenness and air pollution related to the nasal microbiota also was examined. A significant negative association was observed between short-term exposure to air pollution and nasal bacterial diversity, as a one-unit increment in PM2.5 or O3 significantly decreased the observed species (PM2.5: -0.59, 95%CI -1.13, -0.05 and O3: -0.93, 95%CI -1.54, -0.32) and species richness (PM2.5: -0.64, 95%CI -1.25, -0.02 and O3: -0.68, 95%CI -1.43, -0.07). Considering the lag-time effect, we found a significant positive association between greenness and both the observed species and species richness. In addition, we identified a significant negative association for all pollutants with the observed species richness. These findings add to the evidence base of the links between nasal microbiota and air pollution and greenness. This study establishes a foundation for future studies of how environmental exposure plays a role in nasal microbiota, which in turn may affect the development of asthma.

Meta-analysis of 16S rRNA microbial data identified alterations of the gut microbiota in COVID-19 patients during the acute and recovery phases.

BACKGROUND: Dozens of studies have demonstrated gut dysbiosis in COVID-19 patients during the acute and recovery phases. However, a consensus on the specific COVID-19 associated bacteria is missing. In this study, we performed a meta-analysis to explore whether robust and reproducible alterations in the gut microbiota of COVID-19 patients exist across different populations. METHODS: A systematic review was conducted for studies published prior to May 2022 in electronic databases. After review, we included 16 studies that comparing the gut microbiota in COVID-19 patients to those of controls. The 16S rRNA sequence data of these studies were then re-analyzed using a standardized workflow and synthesized by meta-analysis. RESULTS: We found that gut bacterial diversity of COVID-19 patients in both the acute and recovery phases was consistently lower than non-COVID-19 individuals. Microbial differential abundance analysis showed depletion of anti-inflammatory butyrate-producing bacteria and enrichment of taxa with pro-inflammatory properties in COVID-19 patients during the acute phase compared to non-COVID-19 individuals. Analysis of microbial communities showed that the gut microbiota of COVID-19 recovered patients were still in unhealthy ecostates. CONCLUSIONS: Our results provided a comprehensive synthesis to better understand gut microbial perturbations associated with COVID-19 and identified underlying biomarkers for microbiome-based diagnostics and therapeutics.

Clinical analysis of the epidemiology and changes in inflammatory indexes of Mycoplasma pneumonia in acute and recovery stage pediatric patients.

Background: As Mycoplasma pneumoniae pneumonia (MPP) is on the rise in children and adolescents, this work explored the clinical analysis of epidemiological and inflammatory changes in children with MPP during the acute and convalescent phases, and analyzed their relationship with clinical manifestations. Methods: One hundred and twenty MP patients (experimental group) and 100 healthy children (control group) were selected as the research objects. Enzyme-linked immunosorbent assay (ELISA) was used to detect the changes in tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6), interleukin-8 (IL-8), interleukin-10 (IL-10) and procalcitonin (PCT). Results: The proportion of children aged 3-7 years was significantly higher than that of other age groups (0-1, 1-3, and 7-14 years old) (P<0.05). The serum levels of TNF-α, IL-6, IL-8, IL-10, and PCT in children with MP were significantly higher than those in the control group (P<0.05). Changes in pulmonary fibrosis and serum and pleural fluid TNF-α, IL-6, IL-8, IL-10, and PCT concentrations on chest X-ray and computed tomography (CT) in children with MP with pleural effusion significantly higher than that in children without pulmonary fibrosis (P<0.05). Conclusions: MPP was more common in children aged 3-7 years. In addition, the changes of inflammatory markers TNF-α, IL-6, IL-8, IL-10, and PCT in serum and pleural effusion of children with MP were of great value for the diagnosis, treatment, and prognosis of the disease.

Clinical Significance of Ventricular Premature Contraction Provoked by the Treadmill Test.

Background and Objectives: The treadmill test (TMT) is a predictive tool for myocardial ischemia. Recently, exercise-provoked ventricular premature contracture (VPC) during TMT was shown to have a relation with coronary artery disease and cardiovascular mortality. Therefore, we evaluate clinical correlates of exercise-provoked VPC and compare the predictive power for myocardial ischemia and cardiovascular events. Method: Data of 408 patients (≥18 years of age) who underwent TMT for work up of angina, palpitation, dyspnea, syncope, or arrhythmia between February 2015, and January 2016, were collected with consent at Samsung Medical Center, Seoul, Republic of Korea. Among total of 408 patients, 208 were excluded according to the previous history of PCI or CABG, previous MI, decreased left ventricular ejection fraction lower than 50%, arrhythmia that could affect ST-segment change on ECG. Results: Among 200 patients, 32 (16.0%) developed exercise-provoked VPC (21 patients in the exercise phase, 20 patients in the recovery phase). Of them, 20 patients (10.0%) showed positive TMT, and 4 patients (2.0%) underwent revascularization after TMT. Among 21 patients showing exercise phase VPC, 5 (23.8%) showed positive TMT results. In patients younger than 65 years, exercise phase VPC was associated with positive TMT (odds ratio 6.879, 1.458-32.453) considering demographics and previous medical history in multivariable analysis. Among the 20 patients showing recovery phase VPC, 2 (10.0%) underwent revascularization after TMT. In multivariable analysis, recovery phase VPC was associated with revascularization (odds ratio 9.381, 1.144-76.948) considering age, sex, BMI, and TMT result. Conclusion: VPC during the treadmill test was a useful predictor of myocardial ischemia in this study.

Differences in the Kinematic and Kinetic Characteristics between Successful and Failed Sit-to-stand Trials in Patients with Stroke / The Japanese Journal of Rehabilitation Medicine

Objects：Sit-to-stand (STS) interventions are frequently used as part of stroke rehabilitation. This study aimed to clarify the kinematic and kinetic characteristics of patients recovering from stroke, who have difficulties with STS movement.Method：The participants included 26 stroke patients who struggled to complete the STS maneuver. Using a 3D motion analysis system, the kinematic and kinetic parameters during STS were retrospectively analyzed and compared between failed and successful trials. The kinematic parameters of the trunk and lower limbs were obtained within the seat-off phases, and the kinetic indices of the lower limbs were obtained from measurements taken before and after the seat-off phase. The weight-bearing ratio on the unaffected side was calculated from the vertical ground reaction forces.Results：In the successful trials, analyses of the parameters revealed more forward tilting of the pelvic and thoracic regions, a further forward and downward shift of the center of mass, and larger hip and knee extension moments than those of the failed trials. However, there was no difference in the weight-bearing ratio on the non-paralyzed side.Conclusion：This study revealed that the kinematic and kinetic properties of the STS maneuver differed between successful and failed trials among patients with stroke. The study therefore provides useful information for clinical evaluation and rehabilitation.

Differences in the Kinematic and Kinetic Characteristics between Successful and Failed Sit-to-stand Trials in Patients with Stroke / The Japanese Journal of Rehabilitation Medicine

Objects：Sit-to-stand (STS) interventions are frequently used as part of stroke rehabilitation. This study aimed to clarify the kinematic and kinetic characteristics of patients recovering from stroke, who have difficulties with STS movement.Method：The participants included 26 stroke patients who struggled to complete the STS maneuver. Using a 3D motion analysis system, the kinematic and kinetic parameters during STS were retrospectively analyzed and compared between failed and successful trials. The kinematic parameters of the trunk and lower limbs were obtained within the seat-off phases, and the kinetic indices of the lower limbs were obtained from measurements taken before and after the seat-off phase. The weight-bearing ratio on the unaffected side was calculated from the vertical ground reaction forces.Results：In the successful trials, analyses of the parameters revealed more forward tilting of the pelvic and thoracic regions, a further forward and downward shift of the center of mass, and larger hip and knee extension moments than those of the failed trials. However, there was no difference in the weight-bearing ratio on the non-paralyzed side.Conclusion：This study revealed that the kinematic and kinetic properties of the STS maneuver differed between successful and failed trials among patients with stroke. The study therefore provides useful information for clinical evaluation and rehabilitation.

Lower limb muscle activation patterns in ice-hockey skating and associations with skating speed.

In this study, we aimed to describe lower limb kinematic and muscle activation patterns and then to examine the potential associations between those variables and skating speed in highly trained ice-hockey players. Twelve players (age 18.4-22.0 years) performed five maximal 30-metre forward skating sprints. Skating speeds, muscle activities from eight lower limb muscles (gluteus maximus, gluteus medius, adductor magnus, rectus femoris, vastus lateralis, biceps femoris, tibialis anterior and soleus), and sagittal plane joint angles from the hip and knee joint were measured. A lower activity of the gluteus maximus (r = -0.651, p = 0.022, ß = -0.08) and a reduced gluteus maximus to rectus femoris coactivity (r = -0.786, p = 0.002, ß = -3.26) during the recovery phase were found to be associated with faster skating speed. No significant associations were observed between sagittal plane hip and knee kinematics and skating speed. This study provides evidence that muscle activities during the recovery phase of skating may have an important role in skating performance.

A Study of Biofeedback Gait Training in Cerebral Stroke Patients in the Early Recovery Phase with Stance Phase as Target Parameter.

Walking function disorders are typical for patients after cerebral stroke. Biofeedback technology (BFB) is currently considered effective and promising for training walking function, including in patients after cerebral stroke. Most studies recognize that BFB training is a promising tool for improving walking function; however, the data on the use of highly selective walking parameters for BFB training are very limited. The aim of our study was to investigate the feasibility of using BFB training targeting one of the basic parameters of gait symmetry-stance phase duration-in cerebral stroke patients in the early recovery period. The study included 20 hemiparetic patients in the early recovery period after the first hemispheric ischemic stroke. The control group included 20 healthy subjects. The BFB training and biomechanical analysis of walking (before and after all BFB sessions) were done using an inertial system. The mean number of BFB sessions was nine (from 8 to 11) during the three weeks in clinic. There was not a single negative response to BFB training among the study patients, either during the sessions or later. The spatiotemporal parameters of walking showed the whole syndrome complex of slow walking and typical asymmetry of temporal walking parameters, and did not change significantly as a result of the study therapy. The changes were more significant for the functioning of hip and knee joints. The contralateral hip amplitude returned to the normal range. For the knee joint, the amplitude of the first flexion increased and the value of the amplitude of hyperextension decreased in the middle of the stance phase. Concerning muscle function, the observed significant decrease in the function of m. Gastrocnemius and the hamstring muscles on the paretic side remained without change at the end of the treatment course. We obtained positive dynamics of the biomechanical parameters of walking in patients after the BFB training course. The feasibility and efficacy of their use for targeted correction need further research.

Serum surfactant protein D in COVID-19 is elevated and correlated with disease severity.

BACKGROUND: The serum surfactant protein D (SP-D) level is suggested to be a useful biomarker for acute lung injuries and acute respiratory distress syndrome. Whether the serum SP-D level could identify the severity of coronavirus disease 2019 (COVID-19) in the early stage has not been elucidated. METHODS: We performed an observational study on 39 laboratory-confirmed COVID-19 patients from The Fourth People's Hospital of Yiyang, Hunan, China. Receiver operating characteristic (ROC) curve analysis, correlation analysis, and multivariate logistic regression model analysis were performed. RESULTS: In the acute phase, the serum levels of SP-D were elevated significantly in severe COVID-19 patients than in mild cases (mean value ± standard deviation (SD), 449.7 ± 125.8 vs 245.9 ± 90.0 ng/mL, P<0.001), while the serum levels of SP-D in the recovery period were decreased dramatically than that in the acute phase (mean value ± SD, 129.5 ± 51.7 vs 292.9 ± 130.7 ng/ml, P<0.001), and so were for the stratified patients. The chest CT imaging scores were considerably higher in the severe group compared with those in the mild group (median value, 10.0 vs 9.0, P = 0.011), while markedly lower in the recovery period than those in the acute phase (median value, 2.0 vs 9.0, P<0.001), and so were for the stratified patients. ROC curve analysis revealed that areas under the curve of lymphocyte counts (LYM), C-reaction protein (CRP), erythrocyte sedimentation rate (ESR), interleukin-6 (IL-6), and SP-D for severe COVID-19 were 0.719, 0.833, 0.817, 0.837, and 0.922, respectively. Correlation analysis showed that the SP-D levels were negatively correlated with LYM (r = - 0.320, P = 0.047), while positively correlated with CRP (r = 0.658, P<0.001), IL-6 (r = 0.471, P = 0.002), the duration of nucleic acid of throat swab turning negative (r = 0.668, P<0.001), chest CT imaging score on admission (r = 0.695, P<0.001) and length of stay (r = 0.420, P = 0.008). Multivariate logistic regression model analysis showed that age (P = 0.041, OR = 1.093) and SP-D (P = 0.008, OR = 1.018) were risk factors for severe COVID-19. CONCLUSIONS: Elevated serum SP-D level was a potential biomarker for the severity of COVID-19; this may be useful in identifying patients whose condition worsens at an early stage.

Acute motor-sensory axonal polyneuropathy variant of Guillain-Barre syndrome complicating the recovery phase of coronavirus disease 2019 infection: a case report.

INTRODUCTION: The novel coronavirus, since its first identification in China, in December 2019, has shown remarkable heterogeneity in its clinical behavior. It has affected humans on every continent. Clinically, it has affected every organ system. The outcome has also been variable, with most of the older patients showing grave outcomes as compared with the younger individuals. Here we present a rare and severe variant of Guillain-Barre syndrome that complicated the disease in recovery phase. CASE PRESENTATION: A 60-year-old Afghan man, who had been recovering from symptoms related to novel coronavirus associated disease, presented with sudden onset of progressive muscle weakness and oxygen desaturation. Electrophysiological workup confirmed the diagnosis of Guillain-Barre syndrome, and early institution of intravenous immunoglobulin resulted in complete resolution. CONCLUSION: Guillain-Barre syndrome has recently been reported in many patients diagnosed with novel coronavirus associated disease. While clinical suspicion is mandatory to guide towards an effective diagnostic workup, early diagnosis of this complication and timely institution of therapeutic interventions are indispensable and lifesaving.

Oxyhemoglobin Concentration and Oxygen Uptake Signal During Recovery From Exhaustive Exercise in Healthy Subjects-Relationship With Aerobic Capacity.

This proof of concept study is dedicated to the quantification of the short-term recovery phase of the muscle oxygenation and whole-body oxygen uptake kinetics following an exhaustive cycling protocol. Data of 15 healthy young participants (age 26.1 ± 2.8 years, peak oxygen uptake 54.1 ± 5.1 mL∗min-1∗kg-1) were recorded during 5 min cool down-cycling with a power output of 50 W on an electro-magnetically braked cycle ergometer. The oxygen uptake (VO2) signal during recovery was modeled by exponential function. Using the model parameters, the time (T1/2) needed to return VO2 to 50% of VO2 peak was determined. The Hill's model was used to analyze the kinetics of oxyhemoglobin concentration (Sm, %), non-invasively recorded by near-infrared spectroscopy (NIRS) over the M. vastus lateralis. Analysis of the Pearson correlation results in statistically significant negative relationships between T1/2 and relative VO2 peak (r = -0.7). Relevant significant correlations were determined between constant defining the slope of VO2 decrease (parameter B) and the duration of the anaerobic phase (r = -0.59), as well as between Hill's coefficient and average median Smmax for the final 2 min of recovery. The high correlation between traditional variables commonly used to represent the cardio-metabolic capacity and the parameters of fits from exponential and Hill models attests the validity of our approach. Thus, proposed descriptors, derived from non-invasive NIRS monitoring during recovery, seem to reflect aerobic capacity. However, the practical usefulness of such modeling for clinical or other vulnerable populations has to be explored in studies using alternative testing protocols.

A transition out of the darkness: Patients' experience of the recovery phase after treatment for head and neck cancer.

PURPOSE: To explore the recovery experience of patients who completed medical treatment for head and neck cancer (HNC). METHOD: The study conducted interviews with a strategic sample of 12 patients at an oncology clinic. Interview data were analyzed by qualitative content analysis with a deductive approach based on transition theory. RESULTS: The transition theory coding frame for patients' descriptions of their recovery process produced four categories: properties, personal conditions, process indicators, and outcome indicators. Personal conditions, such as cultural beliefs and attitudes, impact the outcome of recovery, and necessitate interaction throughout the care chain using the person-centered care approach to help survivors master their changed living conditions during recovery after HNC. The transition was described as a journey out of a dark period characterized by a struggle with the side effects of chemotherapy and radiation treatment. CONCLUSIONS: This study highlighted the use of person-centered care to facilitate transition in the recovery phase, supported by an intra-professional team that collaborates during the care chain (primary care to hospital care). Patient education and self-care are tools that improve the transition from illness to everyday life.

Temporal metabolomic alteration in rat brains of experimental intracerebral hemorrhage.

BACKGROUND: Intracerebral hemorrhage (ICH) is the top lethal and disabling form of stroke. The pathophysiology of ICH is not fully understood yet. Metabolites are indicators and regulators of cellular processes. However, the overall brain metabolic pattern and the temporal alterations after ICH remain unknown. METHODS: A total of 40 male rats were randomly assigned to sham group and ICH group. ICH was induced by collagenase Ⅶ. Body weight was assessed. Neurological deficits were evaluated by modified neurological severity score. Then, the perihematomal brain tissues were collected for metabolites detection using high-performance liquid chromatography-tandem mass spectrometry (HPLC-MS). The metabolic profiles were displayed by principal component analysis (PCA), partial least-squares-discriminant analysis (PLS-DA) and cluster analysis. The significant differential metabolites were screened by fold change > 2.0, the false discovery rate (FDR) < 0.05 and Variable Importance of Projection (VIP) > 1. Next, the relevant metabolic pathways were discerned by MetaboAnalyst website. A metabolite-protein interaction network was subsequentially constructed to further annotate the function of differential metabolites. RESULTS: Rats suffered from compromised body weight increasement and impaired neurological function. The metabolomics profiles of brain tissues in the post-ICH rats were markedly different from those in the sham group on days 3 and 14. Thirty-four metabolites (bilirubin, uric acid, 6-Methylnicotinamide et al.) were abnormally upregulated in the acute stage, while 27 metabolites were disturbed in the recovery stage, including bilirubin, uric acid, and histamine et al. Seven and three metabolic pathways altered in the acute and recovery stage, respectively. Metabolite-protein interaction analysis revealed that the disturbed metabolites may participate in ICH pathophysiology by altering amino acid metabolism, peroxisome proliferators-activated receptor signaling pathway, fatty acid metabolism and urea cycle in the acute stage, while influencing amino acid metabolism, urea cycle and peroxisome in the recovery stage. CONCLUSIONS: Our study mapped the pathological metabolomics profiles of the post-ICH rat brains in the acute and recovery phases. This work will assist in discovering novel therapeutic targets and treatments for ICH.