[A prospective randomized controlled study on the effects of progressive core muscle group training combined with lower limb intelligent rehabilitation training for burn patients with lower limb dysfunction]

Objective: To observe the effect of progressive core muscle group training combined with lower limb intelligent rehabilitation training on burn patients with lower limb dysfunction. Methods: A prospective randomized controlled study was conducted. From March 2017 to May 2020, 60 patients with motor and balance dysfunction after deep partial-thickness burns or full-thickness burns of both lower extremities who met the inclusion criteria were admitted to the First Affiliated Hospital of Air Force Military Medical University. They were divided into simple intelligent rehabilitation group (30 cases, 20 males and 10 females, aged (40±3) years) and combined rehabilitation group (30 cases, 16 males and 14 females, aged (39±3) years) according to the random number table method. The patients in both groups started red light treatment after the wound healing or when the scattered residual wound area was less than 5% total body surface area. After 2 weeks of red light treatment, patients in the combined rehabilitation group started progressive core muscle group training on the basis of lower limb intelligent rehabilitation training in simple intelligent rehabilitation group, and the training time was 6 weeks. Before and after 6 weeks of training, the lower limb motor function was evaluated with the simple Fugl-Meyer scale, the balance capacity was evaluated with the Berg balance scale, and the walking capacity was evaluated with the Holden walking ability rating scale. After 6 weeks of training, a self-designed questionnaire was used to investigate patients' satisfaction for the treatment effect. The patients were followed up for 6 months after the treatment to observe the balance stability of standing on one foot in the flexion position and their participation in activities of daily life. Data were statistically analyzed with independent sample t test, paired sample t test, and chi-square test. Results: Before training, the lower limb motor function score of patients in simple intelligent rehabilitation group was 24.9±2.7, which was close to 23.9±2.3 in combined rehabilitation group (P>0.05). After 6 weeks of training, the lower limb motor function score of patients in combined rehabilitation group was 29.6±3.9, which was significantly higher than 27.3±3.8 in simple rehabilitation group (t=-2.28, P<0.05). The lower limb motor function scores of patients in combined rehabilitation group and simple intelligent rehabilitation group after 6 weeks of training were significantly higher than those before training (with t values of -6.50 and -3.21, respectively, P<0.01). After 6 weeks of training, the balance capacity score of patients in combined rehabilitation group was 41±7, which was significantly higher than 36±5 in simple intelligent rehabilitation group (t=-2.68, P<0.05); the balance capacity scores of patients in combined rehabilitation group and simple intelligent rehabilitation group after 6 weeks of training were significantly higher than those before training (with t values of -8.72 and -8.09, respectively, P<0.01). After 6 weeks of training, the walking capacity grading of patients in combined rehabilitation group was significantly improved compared with that in simple intelligent rehabilitation group (χ2=-2.14, P<0.05), and the walking capacity grading of patients in simple intelligent rehabilitation group and combined rehabilitation group after 6 weeks of training was significantly improved compared with that before treatment (with χ2 values of -4.94 and -5.26, respectively, P<0.01). After 6 weeks of training, the satisfaction score for the treatment effect of patients in combined rehabilitation group was 13.7±1.2, which was significantly higher than 7.8±1.4 in simple intelligent rehabilitation group (t=22.84, P<0.01). The patients in both groups could stand on one foot to maintain balance in the flexion position of lower limb, and their activities of daily life were not affected 6 months after treatment. Conclusions: On the basis of conventional rehabilitation therapy, the combination of progressive core muscle group training and lower limb intelligent rehabilitation training can significantly promote the recovery of lower limb motor and balance function of burn patients.

[Analysis of the current status of needle and syringe exchange programmes for injecting drug users in China]

Objective: To analyze the needle and syringe exchange programme (NSEP) implementation among injecting drug users (IDUs) in China and provide data support and a scientific reference for intervention among IDUs. Methods: All the statistical reports of high-risk behavior interventions during 2007-2021 were collected from the HIV/AIDS Comprehensive Response Information Management System. Descriptive analysis was used to analyze the changes in the number of NSEP points, regional distribution of NSEP points, the number of people covered, and the HIV detection rate in China from 2007 to 2021. Excel 2016 software was used to plot the variation trend. SAS 9.4 software was used for the needle recovery and HIV-positive detection rate to do the χ² trend test. Results: There were 578 NSEP sites in 11 provinces (autonomous regions and municipalities) by the end of 2021, covering 21 215 IDUs. 2014-2021, the number of NSEP sites and the number of IDUs covered decreased year by year. Each injecting drug user participating in NSEP received more than 200 clean needles annually. The needle recovery rate showed an increasing trend(Z=170.26, P<0.001) from 2009 to 2016 but showed a decreasing trend (Z=-91.96, P<0.001) from 2016 to 2021. The rate of HIV-positive in IDUs participating in NSEP showed a downward trend (Z=-66.53, P<0.001), which decreased from 5.8% (2 709/46 591) in 2011 to 0.1% (19/21 215) in 2021, decreasing 98.3%. Conclusions: NSEP is a vital intervention to prevent HIV transmission through injecting drugs. There were still many difficulties. It is necessary to strengthen further communication and coordination with government and public security departments to understand and support for NSEP. Targeted publicity and education are needed to be carried out for local IDUs to encourage them to participate in NSEP and reduce their dropout. Meanwhile, peer educators supervision and management also need to be strengthened.

[Differential diagnosis model of benign and malignant breast BI-RADS category 4 nodules based on serum SP70 and conventional laboratory indicators]

Objective: To develop a nomogram model for the differential diagnosis of benign and malignant breast BI-RADS (Breast Imaging Reporting and Data System) category 4 nodules based on serum tumor specific protein 70 (SP70) and conventional laboratory indicators and validate its predictive efficacy. Methods: A case-control study design was used to retrospectively analyze the data of 429 female patients diagnosed with BI-RADS category 4 breast nodules by breast color doppler flow imaging at the First Affiliated Hospital of Nanjing Medical University from January 2021 to April 2022 with an age range of 16 to 91 years and a median age of 50 years, and the patients were divided into a training cohort (314 patients) and a validation cohort (115 patients) according to the inclusion time successively. Using postoperative pathological findings as the"gold standard", univariate and multivariate logistic regression analyses were used to identify the predictor variables used for the model. The nomogram, receiver operating characteristic (ROC) curves and calibration curves were drawn for the prediction model, and the discrimination and calibration of the model were evaluated using the consistency index (C-index) and calibration plots. Results: The postoperative pathological results showed that 286 (66.7%) were malignant nodules and 143 (33.3%) were benign nodules of 429 breast BI-RADS category 4 nodules. The serum SP70 (OR=1.227,95%CI: 1.033-1.458,P=0.020), NLR (OR=1.545,95%CI: 1.047-2.280,P=0.028), LDL-C (OR=2.215, 95%CI: 1.354-3.622, P=0.002), GLU (OR=2.050,95%CI:1.222-3.438,P=0.007), PT (OR=1.383,95%CI: 1.046-1.828,P=0.023), nodule diameter (OR=1.042, 95%CI: 1.008-1.076, P=0.015) and age (OR=1.062,95%CI: 1.011-1.116,P=0.016) were independent risk factors which could be used to distinguish benign and malignant breast BI-RADS category 4 nodules (P<0.05). The nomogram was plotted by the above seven independent variables, and the concordance index (C-index) for the training cohort and validation cohort were 0.842 (95%CI:0.786-0.898) and 0.787 (95%CI:0.687-0.886), respectively. The sensitivity and specificity of using this model to identify benign and malignant breast BI-RADS category 4 nodules in the training and validation cohort were 83.5%, 72.5% and 79.2%, 73.6%, respectively. The calibration curves showed good agreement between the predicted and actual values in the nomogram. Conclusions: This study combined serum SP70, conventional laboratory indicators and breast color doppler flow imaging to develop a nomogram model for the differential diagnosis of benign and malignant breast BI-RADS category 4 nodules. The model may have good predictive efficacy and may provide a basis for clinical treatment options, which is beneficial for guiding breast cancer screening and prevention.

[Status and related factors on the drinking behavior among primary and secondary students in China rural middle and western regions in 2019]

Objective: To analyze the daily drinking behavior and related factors of primary and middle school students in the Nutrition Improvement Program for Rural Compulsory Education Students (NIPRCES) pilot regions. Methods: Multi-stage stratified random cluster sampling method was used to select one to three national pilot counties in 22 provinces in central and western China where the NIPRCES was implemented in 2019. According to different feeding patterns, two primary schools and two middle schools were selected as key monitoring schools. One or two classes were selected from grade 3 to grade 9. The student questionnaire was used to collect the basic information and daily drinking behavior. Taking whether the drinking water ≥5 cups every day as the dependent variable, multivariate logistic regression model was used to analyze the related factors of drinking behavior among students. Results: A total of 27 374 students were included. On average, primary and middle school students in the regions where NIPRCES was implemented had 3.9 cups of water every day. Logistic regression model showed that boys (OR=1.230, P<0.001), primary school students (OR=1.379, P<0.001), father worked outside the home (OR=1.169, P<0.001), both parents worked outside the home (OR=1.228, P<0.001), non-resident students (OR=1.142, P<0.001), the school in the village (OR=1.638, P<0.001) or township (OR=1.358, P<0.001), school feeding (OR=1.252, P<0.001), the school building with flush toilets (OR=1.384, P<0.001) and the central regions (OR=1.300, P<0.001) students were more likely to drink ≥5 cups water every day. Conclusion: The water consumption of primary and middle school students in the pilot regions of NIPRCES is low, and their drinking behaviors are affected by many factors.

Associations between residential greenness and blood lipids in Chinese elderly population

OBJECTIVE

Previous studies on residential green space were inconsistent with blood lipid levels and hyperlipidemia. Thus, our study aims to explore the relationship between urban residential greenness and the blood lipid level and hyperlipidemia of the Chinese elderly population.

METHODS

A total of 59,865 older adults were collected from the Shenzhen healthy aging Research (SHARE). Blood lipid levels [total cholesterol (TC), triglycerides (TG), low-density lipoprotein cholesterol (LDL-C), and high-density lipoprotein cholesterol (HDL-C)] were measured. Participants' exposure to residential greenness was measured by the satellite-based normalized difference vegetation index (NDVI). Generalized linear mixed models (GLMMs) and logistic regression were performed to assess the associations of residential greenness with lipid levels and dyslipidemia (high TG, high TC, low HDL-C, and high LDL-C).

RESULTS

Each per 1 standard deviation (SD) increase in NDVI_250-m was associated with a higher HDL-C level (β = 0.003, 95% (confidence interval, CI):0.001-0.005) and lower TG level (β = - 0.005, 95% CI - 0.141-0.121), after fully adjusting for covariates. Each increment in per interquartile range (IQR)-unit increase in NDVI_250-m was associated with lower odds of high TG (odds ratio, OR 0.94, 95% CI 0.91-0.97) and low HDL-C (OR 0.96, 95% CI 0.94-0.99). The NDVI_250-m has the highest protective effect on the incidence of high TG and low HDL-C, followed by NDVI_500-m and NDVI_1250-m. Stratified analyses showed that association between residential greenness and hyperlipidemia was modified by sex, age, BMI, household registration, and physical activity.

CONCLUSION

Higher greenness exposure was beneficially associated with lipid levels and dyslipidemia among Chinese city-dwelling older adults.

[Current status and prospects of artificial intelligence in schistosomiasis prevention and control]

Schistosomiasis is a parasitic disease that seriously endangers human health and affects socioeconomic developments. Artificial intelligence technology has been widely used in clinical medical sciences, including tumor screening, and electrocardiogram, imaging and pathological analyses, which has potential for precision control of schistosomiasis. Currently, artificial intelligence technology has been employed for clinical assessment of schistosomiasis-associated hepatic fibrosis and ectopic schistosomiasis, prognostic prediction of advanced schistosomiasis, automated identification of Oncomelania hupensis and Schistosoma japonicum eggs and miracidia, epidemiological surveillance of schistosomiasis, and drug discovery. This review summarizes the advances in the applications of artificial intelligence technology in the management of schistosomiasis and proposes the prospects for the use of artificial intelligence in schistosomiasis elimination.

[Efficacy and safety of daratumumab in patients with relapsed/refractory multiple myeloma]

Objective: To investigate the efficacy and safety of daratumumab in relapsed/refractory multiple myeloma (RRMM) patients. Methods: Fifty-two RRMM patients treated with daratumumab from September 2019 to November 2021 in West China Hospital were retrospectively enrolled, including 31 males and 21 females. The mean age of these patients at the first diagnosis of multiple myeloma was (58±10) years. According to the dosage of daratumumab, patients were divided into low dosage group (n=10) and high dosage group (n=42). Overall response rate (ORR), progression-free survival (PFS), overall survival (OS), and adverse event rates were investigated. Univariate and multivariate analysis of potential factors were conducted. Results: Of the 52 patients, 8 received daratumumab monotherapy, 27 received daratumumab plus immuno-modulatory drug (IMiD) treatment, 4 received daratumumab plus proteosome inhibitor (PI) treatment, and 11 received daratumumab plus dexamethasone treatment. The diagnosis age of high dosage group patients was (57±9) years, which was significantly younger than that of low dosage group [(66±10) years] (P=0.009). The baseline creatinine level of high dosage group patients [M (Q₁, Q₃)] was 91 (68, 196) μmol/L, which was significantly higher than that of low dosage group [66 (51, 76) μmol/L] (P=0.021). There was no significant difference in other baseline clinical characteristics, previous treatment regimens, previous lines of treatment, and regimen and cycles of daratumumab between the high dosage group and low dosage group (all P>0.05). The ORR for the 52 patients was 71.2% (37/52). The ORR for daratumumab plus IMiD group was 81.5% (22/27), which was significantly higher than that in monotherapy or dexamethasone group [ORR: 52.6% (10/19), P=0.036). With a median follow-up [M (Q₁, Q₃)] of 7 (5, 26) months, the median PFS for overall cohort was 17 (95%CI: 9.6-24.4) months. The median PFS for daratumumab plus IMiD group was 26 (95%CI: 6.0-46.0) months, which was significantly better than that in monotherapy or dexamethasone group [12 (95%CI: 3.5-20.5) months] (HR=0.231, 95%CI: 0.075-0.715, P=0.011). Higher diagnosis age was the risk factor of progression (HR=1.085, 95%CI: 1.016-1.158, P=0.014), while more cycles of daratumumab treatment was the protective factor of progression (HR=0.669, 95%CI: 0.495-0.904, P=0.009). There was no significant influence of daratumumab dosage on progression (high dosage vs low dosage, HR=1.016, 95%CI: 0.221-4.668, P=0.984). The median OS for overall cohort was 26 (95%CI: 13.1-38.9) months. Higher serum calcium was the independent risk factor of death (HR=12.190, 95%CI: 1.170-127.048, P=0.037). There was no significant influence of daratumumab dosage on death (high dosage vs low dosage, HR=0.818, 95%CI: 0.171-3.917, P=0.802). Adverse events included infections (43.2%, 16/37), infusion-associated reactions (29.7%, 11/37), and thrombocytopenia (27.0%, 10/37). Conclusions: Daratumumab is effective to treat RRMM. The dosage of daratumumab has no significant influence on prognosis when used in combined treatment. The incidence of adverse events is relatively low, with a favorable safety profile.

[Diagnostic value of rapid antigen testing for the detection of SARS-CoV-2 infection]

Objective: To investigate the diagnostic value of rapid antigen test based on colloidal gold immunochromatographic assay for the detection of SARS-CoV-2 infection in symptomatic patients. Methods: From May 20 to June 5 2022, 76 hospitalized children and their 55 accompanying family members with confirmed SARS-CoV-2 infection in the COVID-19 isolation unit of the Children's Hospital of Fudan University (designated referral hospital for SARS-CoV-2 infection in Shanghai) enrolled. Their nasopharyngeal swab specimens were consecutively collected. The samples were tested for SARS-CoV-2 nucleic acid by real-time quantitative. SARS-CoV-2 antigen was tested by immunochromatography. The correlation between the antigen detection results and the change of the cycle threshold (Ct) values were evaluated, as well as the sensitivity and specificity of SARS-CoV-2 antigen detection at different periods after the onset of the disease. Kappa consistency test was conducted to investigate the consistency between the 2 diagnostic methods. Results: Of the enrolled SARS-CoV-2 symptomatic infections, 76 were children, including 41 males and 35 females, with an age of 5 (2, 9) years; 55 were accompanying families, including 8 males and 47 females, with an age of 38 (32, 41) years. All 478 samples were simultaneously tested for SARS-CoV-2 antigen and nucleic acid. In any period from disease onset to negative conversion of viral nucleic acid, the overall sensitivity of the rapid antigen test was 48.2% (119/247), the specificity was 98.3% (227/231), and antigen test and nucleic acid test showed moderate consistency (κ=0.46, P<0.05). The sensitivity of antigen test was 100% (82/82) when the Ct value was ≤25. And the sensitivity of antigen test was 8/10, 4/15 and 8.3% (3/36) when the Ct value was 26, 30 and 35, respectively. All antigen tests were negative when Ct value was >35. During the period of 1-2 days, 3-5 days, 6-7 days, 8-10 days and >10 days after onset, the sensitivity and specificity of SARS-CoV-2 antigen test were 5/8 and 5/5, 90.2% (37/41) and 5/5, 88.9% (24/27) and 2/5, 45.0% (36/80) and 94.1% (32/34), 18.7% (17/91) and 98.9% (183/185) respectively. The Ct values of nasopharyngeal swabs were<26 during 2 to 7 days after onset, 28.7±5.0 on day 8, 34.5±2.9 on day 13 and > 35 after 14 days, respectively. Conclusion: SARS-CoV-2 antigen test in the patients with SARS-CoV-2 infection shows acceptable sensitivity and specificity within 7 days after onset of disease, and the sensitivity was positively correlated with viral load and negatively correlated with onset time.

Advances in the modulation of ROS and transdermal administration for anti-psoriatic nanotherapies

Reactive oxygen species (ROS) at supraphysiological concentration have a determinate role in contributing to immuno-metabolic disorders in the epithelial immune microenvironment (EIME) of psoriatic lesions. With an exclusive focus on the gene-oxidative stress environment interaction in the EIME, a comprehensive strategy based on ROS-regulating nanomedicines is greatly anticipated to become the mainstay of anti-psoriasis treatment. This potential therapeutic modality could inhibit the acceleration of psoriasis via remodeling the redox equilibrium and reshaping the EIME. Herein, we present a marked overview of the current progress in the pathomechanisms of psoriasis, with particular concerns on the potential pathogenic role of ROS, which significantly dysregulates redox metabolism of keratinocytes (KCs) and skin-resident or -infiltrating cells. Meanwhile, the emergence of versatile nanomaterial-guided evolution for transdermal drug delivery has been attractive for the percutaneous administration of antipsoriatic therapies in recent years. We emphasize the underlying molecular mechanism of ROS-based nanoreactors for improved therapeutic outcomes against psoriasis and summarize up-to-date progress relating to the advantages and limitations of nanotherapeutic application for transdermal administration, as well as update an insight into potential future directions for nanotherapies in ROS-related skin diseases.

[Analysis on the scrap situation of COVID-19 vaccine in Suzhou city]

To analyze the usage and loss of the COVID-19 vaccine in ten districts of Suzhou city from December 18, 2020 to April 30, 2021.The results showed the loss rate was 0.222‰ in Suzhou city. The loss rate of pre-filled packaging COVID-19 vaccine was higher than that of vial packaging. The loss rate of 40 packaging was the lowest in vial packaging. The loss rate of all kinds of COVID-19 vaccine in stable inoculation unit was the lowest. It is recommended to distribute 40 vial packaging COVID-19 vaccine for centralized vaccination to reduce the loss of COVID-19 vaccine.

Ascertainment of aortic valve disease using administrative claims

Background

Administrative claims may be useful for characterizing patients with aortic stenosis (AS) and aortic regurgitation (AR) and estimating disease prevalence. However, the accuracy of diagnostic codes for aortic valve disease has not been well studied.

Purpose

To evaluate the validity of International Classification of Diseases, 10th Revision (ICD-10) codes for identification of AS and AR.

Methods

Using a large, transthoracic echocardiographic (TTE) report dataset linked to Medicare Fee-for-service (FFS) claims, 2017–2018, the performance of candidate claims to ascertain AS/AR status using standard TTE definitions was evaluated. Recursive partitioning with 10-fold cross validation was used to build the optimal prediction tree for AS/AR status using all ICD-10 codes as candidate predictors. The optimal performing claims algorithm was tested against patient outcomes in a separate 100% sample of Medicare FFS inpatient and outpatient claims, 2017–2019.

Results

Of those included in the derivation dataset (N=5497, mean age 74.4±11.0 years, 49.7% female), any AS or AR was present in 24% and 38.8%, respectively. The code I35.0 was optimal for identification of any AS with a sensitivity and specificity for any AS of 53.1% and 94.8%, respectively (Table 1). Amongst those with an I35.0 code, 40.3% had severe AS. Claims were unable to distinguish disease severity (i.e. severe vs. non-severe) or subtypes (e.g. bicuspid or rheumatic AS), and were insensitive and nonspecific for AR of any severity. Among all Medicare beneficiaries who received an TTE (N=3,783,249), those with an I35.0 code, compared to those without, had a higher risk of all-cause mortality (HR 1.65, 95% CI 1.63–1.67), heart failure hospitalization (HR 2.17, 95% CI 2.11–2.24), and aortic valve replacement (HR 32.35, 95% CI 31.46–33.27) (Table 2).

Conclusions

Amongst those receiving TTE, the ICD-10 code I35.0 in any position was optimal for identification of AS and identified a population at significant greater risk of all-cause mortality, heart failure hospitalization, and receipt of aortic valve replacement. Though 40.3% of those with I35.0 had severe AS, claims were unable to distinguish disease severity of subtype. Claims may be feasibly used to identify those with AS who may be at risk for adverse valve-related cardiovascular events and require future treatment.

Funding Acknowledgement

Type of funding sources: Public Institution(s). Main funding source(s): National, Heart, Lung, and Blood Institute

THIRD bedside ultrasound protocol for rapid diagnosis of undifferentiated shock: a prospective observational study

INTRODUCTION

It is clinically challenging to differentiate the pathophysiological types of shock in emergency situations. Here, we evaluated the ability of a novel bedside ultrasound protocol (Tamponade/tension pneumothorax, Heart, Inferior vena cava, Respiratory system, Deep venous thrombosis/aorta dissection [THIRD]) to predict types of shock in the emergency department.

METHODS

An emergency physician performed the THIRD protocol on all patients with shock who were admitted to the emergency department. All patients were closely followed to determine their final clinical diagnoses. The kappa index, sensitivity, specificity, positive predictive value, and negative predictive value were calculated for the initial diagnostic impression provided by the THIRD protocol, compared with each patient's final diagnosis.

RESULTS

In total, 112 patients were enrolled in this study. The kappa index between initial impression and final diagnosis was 0.81 (95% confidence interval=0.73-0.89; P<0.001). For hypovolaemic, cardiogenic, distributive, and obstructive types of shock, the sensitivities of the THIRD protocol were 100%, 100%, 93%, and 100%, respectively; the sensitivity for a 'mixed' shock aetiology was 86%. The negative predictive value of the THIRD protocol for all five types of shock was ≥96%.

CONCLUSION

Initial diagnostic judgements determined using the THIRD protocol showed favourable agreement with the final diagnosis in patients who presented with undifferentiated shock. The THIRD protocol has great potential for use as a bedside approach that can guide the rapid management of undifferentiated shock in emergency settings, particularly for patients with obstructive, hypovolaemic, or cardiogenic shock.