Suture Net Technique for Mid-face Superficial Fat Compartments Restoration.

BACKGROUND: Facial fold and groove formation is influenced by the ptosis of the superficial fat compartments in the mid-face region. OBJECTIVE: This study aimed to design a facial rejuvenation technique that targets sagging of the mid-face fat compartments and achieves a youthful facial configuration. MATERIALS AND METHODS: A total of 102 patients underwent suture net restoration. Each specific ptosis fat compartment was carefully lifted and held at the regional facial ligaments to effectively restore volume distribution. Patient outcomes were evaluated through preoperative and postoperative photography comparison, 3-D photographic analysis, and postoperative evaluations. RESULTS: Significant mid-cheek rejuvenation was observed. The procedure resulted in a remarkable, 10.89% increase in malar projection. The nasolabial fold improved by at least 1 grade in 61.43% of the patients and by at least 2 grades in 37.14%. A total of 87.65% of the patients expressed high satisfaction or satisfaction with the outcomes of the procedure. CONCLUSION: By specifically targeting the mid-face ptosis fat compartments, the technique demonstrated significant enhancements of both the nasolabial fold and the malar projection. The results indicate that this novel technique holds promise as an efficient approach for satisfactorily addressing facial aging concerns.

Exploring expectations of Chinese patients for total knee arthroplasty: once the medicine is taken, the symptoms vanish.

BACKGROUND: Preoperative expectations of total knee arthroplasty (TKA) outcomes are important determinants of patient satisfaction. However, expectations of patients in different countries are affected by cultural background. The general goal of this study was to describe Chinese TKA patients' expectations. METHODS: Patients scheduled for TKA were recruited in a quantitative study(n = 198). The Hospital for Special Surgery Total Knee Replacement Expectations Survey Questionnaire was used for survey TKA patients' expectations. Descriptive phenomenological design was used for the qualitative research. Semi-structured interviews were conducted with 15 TKA patients. Colaizzi's method was used for interview data analysis. RESULTS: The mean expectation score of Chinese TKA patients was 89.17 points. The 4 highest score items were walk short distance, remove the need for walker, relieve pain and make knee or leg straight. The 2 lowest score items were employed for monetary reimbursement and sexual activity. Five main themes and 12 sub-themes emerged from the interview data, including multiple factors raised expectations, expectations of physical comfort, expect various activities back to normal, hope for a long joint lifespan, and expect a better mood. CONCLUSIONS: Chinese TKA patients reported a relatively high level of expectations, and differences across cultures result in different expectation points than other national populations, requiring adjustment of items when using assessment tools across cultures. Strategies for expectation management should be further developed. LEVEL OF EVIDENCE: Level IV.

The efficacy of low-level laser therapy for the healing of second-degree burn wounds on lower limbs of glucocorticoid-dependent patients.

This study was designed to investigate the effect of 630 ~ 650-nm red light on treating second-degree burns on lower limbs of glucocorticoid-dependent patients. Sixty-two glucocorticoid-dependent patients with the second-degree burns on lower limbs were divided into the control group (n = 25) and the observation group (n = 37) according to the treatment sequence and the patients' willingness. The patients in both groups were conventionally treated with 1% sulfadiazine silver cream dressing, with the only difference that the observation group received an additional 630-650-nm red light irradiation for 20 min before dressing. Each group was observed for 21 days, and observation ended if the wound healing was terminated. The wound healing rates, wound secretions, marginal response, and pain/itching levels were monitored and assessed. Compared with the control group, the observation group showed higher wound healing rate, fewer wound secretions, and more relief in marginal response. Clinical observation showed that 630-650-nm red light could effectively reduce wound purulent drainage/discharge, relieve the marginal response as well as pain, and promote wound healing.

Surgical Removal of Foreign Material by Suction Curettage After Injection Rhinoplasty: Patient-Reported Outcomes.

BACKGROUND: Though generally safe, injection rhinoplasty with synthetic non-hyaluronic fillers may lead to various deformities, which impose a psychological burden on the patients. As the injected material is technically hard to be fully cleared in the nose, the surgery is primarily chosen to address the patients' psychological distress caused by injection. Unfortunately, there is a paucity of data regarding patient-reported outcomes of this procedure. METHODS: From August of 2017 to June of 2021, the authors retrospectively reviewed all cases who underwent the foreign material removals by suction curettage after injection rhinoplasties. The relevant demographic, treatment characteristics and complication details were collected. The modified Rhinoplasty Outcome Evaluation (ROE) questionnaires were prospectively completed before and 6 months after the surgery. RESULTS: Of the 46 patients, four cases developed minor surface irregularities on the nasal dorsum postoperatively; two cases who had recurrent nasal dorsum redness and swelling before the surgery still exhibited the redness with a less degree after the surgery; no patients needed secondary revision. There was a significant improvement in any of patient-reported outcomes at 6-month follow-up, relative to the preoperative baseline scores. CONCLUSION: The injected foreign material in the nose could be effectively removed by suction curettage with minimal complications. The patients' satisfaction and quality of life, which was severely impaired preoperatively, could be significantly improved after the surgery. LEVEL OF EVIDENCE IV: Therapeutic study. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors   www.springer.com/00266 .

Elevated Serum Glucose-6-Phosphate Isomerase Level in Patients with Knee Osteoarthritis.

BACKGROUND: The present study aims to analyze the serum level of glucose 6-phosphate isomerase (GPI) in patients with knee osteoarthritis (KOA) and evaluate its value in the diagnosis of KOA. METHODS: One hundred patients with confirmed KOA were selected and 100 healthy people in the same period were selected as the control group. ELISA assay was performed to detect the serum GPI level of the subjects. The concentrations of GPI were also analyzed according the severity of KOA. Pearson's correlation was used to analyze the correlation between serum GPI and clinical index in diagnosing KOA. RESULTS: We showed novel data that the concentration of GPI in KOA patients was significantly enhanced compared to controls. Furthermore, the concentration of GPI was highest in the severe group, followed by that in moderate group and mild group. Pearson's correlation assay indicated a positive correlation between serum GPI and the severity of KOA. Meanwhile, a positive correlation was identified between serum GPI concentration and C-reactive protein (CRP) as well as erythrocyte sedimentation rate (ESR) in KOA patients. Receiver operating characteristic (ROC) analysis showed that serum GPI could screen KOA patients from controls. CONCLUSIONS: Collectively, elevated serum GPI concentration contributed to the progression of KOA, and targeting GPI may be useful for the therapy of KOA.

Effect of Salvia Miltiorrhiza Injection in Patients With Autologous Fat Grafting to the Breast: A Preliminary Comparative Study.

BACKGROUND: Salvia miltiorrhiza (SM) is an herb used in Chinese medicine formulations for promoting blood circulation and minimizing vascular stasis. It has been successfully utilized in treating cardiovascular diseases, such as atherosclerosis, thromboembolism, and angina. OBJECTIVES: The authors sought to study the effect of SM injections in autologous fat grafting to the breast. METHODS: Fifteen women who elected to undergo breast augmentation with autologous fat grafting were included in this study. Of these, 10 were given intravenous infusions of SM for 4 weeks perioperatively, and the remaining 5 did not receive herbal infusion. The increase in breast volume after fat grafting was measured in both the groups using a three-dimensional scanner. Breast tissue specimens were harvested just before the second fat injection procedure and were analyzed by the immunofluorescence staining test. RESULTS: All of the patients showed improvement in breast volume after fat grafting. The fat graft retention rate in the SM group was 60.06 ± 16.12%, whereas that in the non-SM group was 34.04 ± 11.15%. In addition, the SMG showed good breast morphology and absence of cyst formation. CONCLUSIONS: SM has the potential to increase the retention rate of fat grafts in breast augmentation.

Developing a Guideline for Endotracheal Suctioning of Adults With Artificial Airways in the Perianesthesia Setting in China.

PURPOSE: This study aimed to adapt a guideline for endotracheal suctioning of adults with artificial airways in the perianesthesia setting in China. DESIGN: This study was guided by the ADAPTE framework. METHODS: The development process consisted of setup, adaptation, and finalization phases. A heterogeneous consultant panel that included a patient representative was established to contribute guidance and suggestions regarding guideline development. Relevant evidence documents were searched, critically appraised, selected, and synthesized to develop the draft guideline. After revisions, the adapted guideline was evaluated by 20 external reviewers. FINDINGS: A 155-page adapted guideline was developed with 26 key recommendations (including 3 procedure phases and 17 points of care). CONCLUSIONS: The adapted guideline provided the best evidence for endotracheal suctioning of adults with artificial airways and supported practitioner decisions about appropriate endotracheal suctioning practices for this population. The study also lays the groundwork for future projects on quality improvement and knowledge translation.

Computer-Assisted Volumetric Analysis and Quantitatively Anophthalmic Orbit Reconstruction With Dorsalis Pedis Flap and Bone Graft.

Current approaches to orbit reconstruction are based on the assumption of facial symmetry and surgeons' experiences, and the reconstructed orbits are not precise. Through computer-assisted volumetric quantitative analysis, the volume of the bony orbit, and the volume of the soft tissues in both the anophthalmic orbit and the contralateral orbit are calculated in 39 anophthalmic patients. The rib graft is used for orbit reconstruction; the dosalis pedis flap and lipo-injection were used for soft tissue reconstruction and skin socket reconstruction. The size and the shape of the rib graft and soft tissues were designed according to the volumetric analysis. The size and the shape of the skin socket were designed according to measurement during surgery. Asymmetry eye sockets with adequate size were created in the 37 patients. Two patients presented with a poor asymmetry with the contralateral orbit, and got gradual extrusion of the eye prosthesis 4 months after operation, which was because of necrosis of the flaps. The flaps were remedied by frontal island flap and skin grafting. Further surgeries, such as lipoinjection, lid surgery, and canthoplasty, were applied to improve the surgical results. The eye prostheses fitted well in all of the reconstructed sockets using this technique. Our studies suggest that the computer-assisted volumetric analysis technique combined with quantitative bone graft and dorsalis pedis flap transfer, ± lipoinjection proved to be an accurate method and a quality assurance for optimization of bony orbit, soft tissue and skin socket reconstruction, and promised a successful postoperative outcome for patients' functional and esthetic appearance.

Indicators and medical tests to identify lower limb swelling causes after total knee arthroplasty: a Delphi study with multidisciplinary experts.

BACKGROUND: Lower limb swelling after total knee arthroplasty (TKA) hinders surgical effectiveness. The poor results of studies on swelling interventions are due to the lack of a classification of swelling causes through appropriate medical tests. A gold standard is missing. This study aimed to clarify the causes of TKA postoperative swelling and how to identify them through indicators and medical tests by consulting a wide range of experts from multiple disciplines. METHOD: The Delphi method was used. A first draft of the index was prepared based on a systematic search of the literature. A total of 11 experts from several disciplines were invited to evaluate the rationality of the indicators and suggest modifications. After two rounds of consultation, the experts reached a consensus, and the consultation was stopped. RESULTS: The response rate of the 11 experts was 100%, and the authoritative Cr was 0.896. Kendall's W values for opinion coordination of the two rounds of consultation were 0.262 and 0.226, respectively (P < 0.001). Among the final indicators, there were 4 primary indicators for swelling cause classification (inflammatory response, poor venous return, joint hematoma, muscle damage, and healing), 19 secondary and 19 tertiary indicators. CONCLUSION: The indications obtained by systematic literature review and multidisciplinary expert consultation are reliable and scientific. Multiple causes of lower extremity swelling after TKA were identified. Blood test indicators can reflect an inflammatory response, suggest poor venous return, and reflect muscle damage and healing progress. Ultrasound scans are needed to identify underlying thrombotic or valvular problems, joint hematomas, and muscle damage. These tests help clinicians and researchers determine the cause of swelling after TKA and take appropriate management.

Geochronological results from the Zhela Formation volcanics of the Tethyan Himalaya and their implications for the breakup of eastern Gondwana.

The relationship between the Kerguelen mantle plume and the breakup of eastern Gondwana is still debated. The new Zircon SHRIMP U-Pb dating of 139.9 ± 4.6 Ma, as well as previous ages from the Zhela Formation volcanic rocks in the Tethyan Himalaya, show that the studied Zhela Formation volcanic rocks formed during the Late Jurassic-Early Cretaceous, rather than the Middle Jurassic. The calculated volume of the Comei-Bunbury igneous rocks is ~ 114,250 km3, which is compatible with the large igneous provinces and, consequently, the typical mantle plume models. The new date results, along with existing dates, show that the volcanism attributed to the Kerguelen mantle plume in the Tethyan Himalaya ranges from ca.147 Ma to ca.124 Ma, with two peaks at approximately 141 Ma and 133 Ma. This new finding, together with geochemical and palaeomagnetic data obtained from the Comei-Bunbury igneous rocks, indicate that the Kerguelen mantle plume contributed significantly to the breakup of eastern Gondwana and that eastern Gondwana first disintegrated and dispersed at ca.147 Ma, the Indian plate separated completely from the eastern Gondwana before ca.125 Ma.

Vertical V-Y Advancement Lifting Based on Fat Compartments: A New Approach for Lower Eyelid and Midcheek Rejuvenation.

BACKGROUND: Lower blepharoplasty techniques continue to improve over time. With discovery of the numerous fat compartments of the face, surgeons noticed that the appearance of the lower eyelid area through aging could be improved through midface lifting. This article introduces a vertical V-Y advancement lifting technique using the concept of fat compartments for lower lid and midcheek rejuvenation. METHODS: Eighty female patients were categorized into four age groups at 20 patients each from 20 to 59 years old. The average measurement for the lower lid length in each group was recorded. An additional 318 patients who underwent lower eyelid blepharoplasty combined with fat compartments advancement lifting for lid-cheek junction rejuvenation from April of 2015 to May of 2018 were included in this study. The postoperative effect was evaluated based on preoperative and postoperative photographs, lower lid length measurements, and three-dimensional facial analyses. RESULTS: Lower lid lengths gradually increased with age, with the greatest increase occurring in the 30- to 39-year-old group. A total of 318 Asian female patients (age range, 35 to 58 years) underwent the surgical procedure. Measurements of lower lid length showed an average reduction of 0.31 cm 6 months after surgery. Three-dimensional facial analysis indicated that midcheek volume increased at varying degrees after surgery. CONCLUSIONS: Lower eyelid blepharoplasty combined with vertical V-Y advancement lifting makes it possible to restore facial fat compartments. This procedure improves projection in the midcheek without fillers, thus achieving a more youthful appearance of the lower lid and lid-cheek contour in middle-aged women. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.

Risk of heart disease following treatment for breast cancer - results from a population-based cohort study.

Background: There is a rising concern about treatment-associated cardiotoxicities in breast cancer patients. This study aimed to determine the time- and treatment-specific incidence of arrhythmia, heart failure, and ischemic heart disease in women diagnosed with breast cancer. Methods: A register-based matched cohort study was conducted including 8015 breast cancer patients diagnosed from 2001 to 2008 in the Stockholm-Gotland region and followed up until 2017. Time-dependent risks of arrhythmia, heart failure, and ischemic heart disease in breast cancer patients were assessed using flexible parametric models as compared to matched controls from general population. Treatment-specific effects were estimated in breast cancer patients using Cox model. Results: Time-dependent analyses revealed long-term increased risks of arrhythmia and heart failure following breast cancer diagnosis. Hazard ratios (HRs) within the first year of diagnosis were 2.14 (95% CI = 1.63-2.81) for arrhythmia and 2.71 (95% CI = 1.70-4.33) for heart failure. HR more than 10 years following diagnosis was 1.42 (95% CI = 1.21-1.67) for arrhythmia and 1.28 (95% CI = 1.03-1.59) for heart failure. The risk for ischemic heart disease was significantly increased only during the first year after diagnosis (HR = 1.45, 95% CI = 1.03-2.04). Trastuzumab and anthracyclines were associated with increased risk of heart failure. Aromatase inhibitors, but not tamoxifen, were associated with risk of ischemic heart disease. No increased risk of heart disease was identified following locoregional radiotherapy. Conclusions: Administration of systemic adjuvant therapies appears to be associated with increased risks of heart disease. The risk estimates observed in this study may aid adjuvant therapy decision-making and patient counseling in oncology practices. Funding: This work was supported by the Swedish Research Council (grant no: 2018-02547); Swedish Cancer Society (grant no: CAN-19-0266); and FORTE (grant no: 2016-00081).

Spectrofluorimetric determination of bilirubin in serum samples.

A new spectrofluorimetric method was developed for determination of trace amount of bilirubin. Using oxytetracycline-Eu(3+) as a fluorescent probe, in the buffer solution of pH = 7.3, bilirubin can reduce remarkably the fluorescence intensity of the oxytetracycline-Eu(3+) complex at λ = 612 nm and the reduced fluorescence intensity was in proportion to the concentration of bilirubin. Optimum conditions for the determination of bilirubin were also investigated. The linear range and limit of detection for the determination of bilirubin were 5.0 × 10(-7) , 3.0 × 10(-5) and 7.7 × 10(-8) mol L(-1) , respectively. This method is simple, practical and relatively free of interference from coexisting substances and can be successfully applied to assess bilirubin in serum samples and compared with the modified Jendrassik-Grof method in clinical analysis. The quenching mechanism of the fluorescence intensity in the system is also discussed.

Effect of knowledge acquisition on gravida's anxiety during COVID-19.

OBJECTIVES: Pregnant women in China are among those most affected by COVID-19. This article assesses Chinese pregnant women's COVID-19 and pregnancy knowledge levels, including the modality through which such knowledge was acquired, the degree of difficulty in acquiring the knowledge, the means of confirming the accuracy of the knowledge, and difficulties in seeking help from people who possess relevant medical knowledge. METHOD: The Mantel-Haenszel chi-square test was used to assess trends in binomial proportions. Multivariable binary logistic regression was performed to identify the association between knowledge acquisition and anxiety among pregnant women. RESULTS: Low scores on knowledge about pregnancy, acquiring COVID-19 and pregnancy information through communication with others, verifying COVID-19 and pregnancy information either independently or via friends, and experiencing difficulties in seeking professional help regarding COVID-19 and pregnancy significantly increased anxiety among pregnant women. CONCLUSIONS: Pregnant women's anxiety can be effectively reduced through developing and disseminating targeted information, including how to cope in an emergency (such as a major disease outbreak), through popular and social media, along with the provision of convenient consultation services.

The Effect of Displacement Amplitude on Fretting Wear Behavior and Damage Mechanism of Alloy 690 in Different Gaseous Atmospheres.

The effect of displacement amplitude on fretting wear behavior and damage mechanisms of alloy 690 in air and nitrogen atmospheres was investigated in detail. The results showed that in air, the friction coefficient gradually increased with the increase in displacement amplitude which conformed to the universal law. In nitrogen, however, it had the highest point at the displacement amplitude of 60 µm due to very strong adhesion. Whether in air or nitrogen, the wear volume gradually increased with the increase in displacement amplitude. The wear volume in air was larger than that in nitrogen except at 30 µm. At 30 µm, the wear volume in air was slightly smaller. With an increase in displacement amplitude, a transformation of fretting running status between partial slip, mixed stick-slip, and final gross slip occurred along with the change of Ft-D curves from linear, to elliptic, to, finally, parallelogrammical. Correspondingly, the fretting regime changed from a partial slip regime to a mixed regime to a gross slip regime. With the increase in displacement amplitude, the transition from partial slip to gross slip in nitrogen was delayed as compared with in air due to the strong adhesion actuated by low oxygen content in a reducing environment. Whether in air or nitrogen, the competitive relation between fretting-induced fatigue and fretting-induced wear was prominent. The cracking velocity was more rapid than the wear. Fretting-induced fatigue dominated at 30 µm in air but at 30-60 µm in nitrogen. Fretting-induced wear won the competition at 45-90 µm in air but at 75-90 µm in nitrogen.

Sensitive and rapid detection of Cr3+ in live cells by a red turn-on fluorescent probe.

A new probe RB-CR for the detection of Cr3+ was constructed based on the conjugation between rhodamine B and phenylthiourea. The Cr3+ could trigger opening of the rhodamine spirolactam of RB-CR upon complexation selectively, sensitively and rapidly, resulting in a pronounced enhancement of absorption and fluorescence signal. Further fluorescence imaging study has suggested that RB-CR could be applied as a probe for Cr3+ surveillance in living HepG2 cells with low cytotoxicity, which provide us the feasibility of exploring the Cr3+ recognition process by the turn-on fluorescence response.

The perioral muscle continuum affects premaxillary development in Wistar rats.

Craniofacial deformities involve soft tissue and skeletal abnormalities. Facial bone growth is based on congenital defects and iatrogenic factors, in which muscle activity is important. Understanding the effects of muscle function on facial bone growth may help us in clinical treatment. Although there have been some studies, fewer have focused on the effects of perioral muscle continuity on maxillary development, which needs further research. In our study, mimic perioral muscle surgeries were performed in twenty 3-day Wistar rats, which were divided into four equal groups, including five untreated rats as control (Ctrl), five rats by unilateral perioral muscle incision (MI), five rats by unilateral perioral muscle incision combined with muscle stripping (MIMS) and five rats treated by unilateral perioral muscle incision combined with periosteal stripping (MIPS). After six weeks, skulls were imaged and measured by micro-CT scan and hematoxylin-eosin staining. Differences in the rats' premaxilla were analyzed with self-contrasted and group-control studies. Compared with Ctrl group, there were significant premaxillary developmental defects in the affected side of the rats in all three surgical groups. In the affected side, both the width and the length of the premaxilla were less than the unaffected side, particularly in MIMS and MIPS groups. Group-control study showed that the ratio of premaxillary length of affected side to unaffected side had significant differences between MI and MIMS. The conclusion was that complete perioral muscle continuity with intact muscle attachment on the premaxilla is the driving force for the premaxillary development.

Zoledronic acid re­sensitises gefitinib­resistant lung cancer cells by inhibiting the JAK/STAT3 signalling pathway and reversing epithelial­mesenchymal transition.

Studies have shown that suppression of both the JAK/STAT3 pathway and epithelial­mesenchymal transition (EMT) may overturn the resistance of non­small cell lung cancer (NSCLC) cells to gefitinib. Zoledronic acid (ZA) injection is used to treat and prevent multiple forms of osteoporosis, hypercalcemia and bone metastasis­related complications of malignancy. Clinical research has shown that ZA may exert antitumour effects and delay the progression of NSCLC. In the present study, we investigated whether ZA combined with gefitinib could re­sensitise NSCLC cells to gefitinib in vitro and in vivo through inhibition of the JAK/STAT3 signalling pathway and EMT reversal. The results revealed that ZA potently increased the sensitivity of gefitinib­resistant lung cancer cells to gefitinib. ZA decreased activation of JAK/STAT3 signalling and reversed EMT in the H1975 and HCC827GR cell lines. Furthermore, addition of IL­6 to ZA­pretreated gefitinib­resistant cell lines abrogated the effect of ZA and restored the cellular resistance to tyrosine kinase inhibitors. Finally, ZA­based combinatorial therapy effectively inhibited the growth of xenografts derived from gefitinib­resistant cancer cells, which was correlated with the inhibition of the JAK/STAT3 signalling pathway and EMT reversal. In conclusion, ZA re­sensitised gefitinib­resistant lung cancer cells through inhibition of the JAK/STAT3 signalling pathway and EMT reversal. The combination of ZA and gefitinib may be a promising therapeutic strategy to reverse gefitinib resistance and prolong the survival of patients with NSCLC.

Mental health status and quality of life in elderly patients with coronary heart disease.

BACKGROUND: Coronary heart disease (CHD) is the leading cause of morbidity and mortality among elderly individuals. Patients with CHD are at high risk for mental health disorders, and psychological issues may affect the quality of life (QoL) of these patients. Nevertheless, there is little evidence regarding the psychological issues and QoL of patients with CHD among the elderly population. This study aimed to investigate the relationship between comorbidities and mental status as well as QoL among elderly patients with CHD. METHODS: Overall, 216 patients were included in this cross-sectional, observational, single-center study. The demographics and clinical manifestations of the patients were collected from electronic medical records. All patients were interviewed using the Chinese version of Symptom Checklist 90 (SCL-90) to assess the mental health status and the World Health Organization Quality of Life-BREF questionnaire (WHOQOL-BREF) to assess the QoL. RESULTS: In total, 96 men and 120 women, with a mean age of 71.69 ±  8.30 years, were included. When controlling for the patients' sex, marital status and stroke, multiple stepwise linear regression analyses suggested that for CHD patients, comorbid type 2 diabetes mellitus had the significant influence on average positive factors (Coef., 5.809; 95% CI [2.467-9.152] p = 0.001); when controlling for the patients' sex, marital status and type 2 diabetes mellitus, multiple stepwise linear regression analyses suggested that for CHD patients, comorbid stroke had the significant influence on average positive factors (Coef., 8.680; 95% CI [4.826-12.534]; p < 0.001); when controlling for the patients' sex, marital status, type 2 diabetes mellitus and stroke, multiple stepwise linear regression analyses suggested that for CHD patients, comorbid primary hypertension had the significant influence on phobic anxiety (Coef., 0.178; 95% CI [0.010-0.347]; p = 0.038). CONCLUSIONS: For elderly CHD patients, comorbid type 2 diabetes mellitus and stroke were at risk for psychological problems and lower QoL. Our findings may guide patients and clinicians to make better decisions and achieve better outcomes.

Porous Organic Polymers as Fire-Resistant Additives and Precursors for Hyperporous Carbon towards Oxygen Reduction Reactions.

Cyclotriphosphazene (CP) based porous organic polymers (POPs) have been designed and prepared. The introduction of CP into the porous skeleton endowed special thermal stability and outstanding flame retardancy to prepared polymers. The nonflammable level of PNK-CMP fabricated via the condensation of 2,2'-(1,4-phenylene)diacetonitrile (DAN) and hexakis(4-acetylphenoxy)cyclotriphosphazene (HACTP) through Knoevenagel reaction, in vertical burning tests reached V-2 class (UL-94) and the limiting oxygen index (LOI) reached 20.8 %. When used as additive, PNK-CMP could suppress the dissolving out of PEPA effectively, reducing environment pollution and improving the flame retardant efficiency. The POP and PEPA co-added PU (mPOP%: mPEPA%=5.0 %: 5.0 %) could not be ignited under simulated real-scale fire conditions. The nonflammable level of POP/PEPA/PU in vertical burning tests (UL-94) reached V-0 class with a LOI as high as 23.2 %. The smoke emission could also be suppressed, thus reducing the potential for flame spread and fire hazards. Furthermore, carbonization of PNK-CMP under the activation of KOH yield a hyperporous carbon (PNKA-800) with ultrahigh BET surface area (3001 m2 g-1) and ultramicropore size showing excellent ORR activity in alkaline conditions.