Relation Among Anxiety, Depression, Sleep Quality and Health-Related Quality of Life Among Patients with Systemic Lupus Erythematosus: Path Analysis

Purpose

This study aimed to examine the relationship between anxiety, depression, sleep quality and health-related quality of life among systemic lupus erythematosus (SLE) patients in China.

Patients and Methods

After ethical approval and obtaining participants' informed consent, a cross-sectional study was conducted in The First Affiliated Hospital of Anhui Medical University between October 1, 2021 and January 30, 2022. The data comprised demographic information, number of SLE symptoms, Hospital Anxiety and Depression Scale (HADS), Pittsburgh Sleep Quality Index (PSQI) and Systemic Lupus Erythematosus-Specific Quality of Life Questionnaire (SLEQoL). We performed descriptive statistics, Spearman or Pearson correlations, and multiple linear regression. And Path analysis was performed to examine direct and indirect associations between these variables and health-related quality of life.

Results

A total of 580 patients were recruited and 513 met our target criteria. Our final model fitted the data well: goodness-of-fit index (GFI) =0.996; adjusted goodness-of-fit index (AGFI) =0.974; comparative fit index (CFI) =0.998; root mean square error of approximation (RMSEA) =0.043. This model explained 57.3% of the variance on health-related quality of life (HRQoL) in patients with SLE and all the hypothesized paths reached significance (P<0.05). Anxiety, depression, sleep quality, income/family, and number of SLE symptoms were related to health-related quality of life, and anxiety had the most influence on HRQoL (β=0.561).

Conclusion

The study model helps to explain the relation among anxiety, depression, sleep quality and health-related quality of life in patients with SLE. It also suggests that health care professionals should be aware of factors such as anxiety, sleep quality, number of SLE symptoms, and depression in their care for HRQoL of SLE patients.

Biomechanics of latissimus dorsi transfer for irreparable posterosuperior rotator cuff tears

BACKGROUND

Latissimus dorsi transfer is the treatment most frequently used for restoring function in shoulders with irreparable posterosuperior rotator cuff tears. Yet, functional outcomes of the transfers are unpredictable and vary among patients.

METHODS

A three-dimensional upper-extremity computational model was used to simulate and analyze the biomechanical consequences of transferring the latissimus dorsi to four attachment sites: the infraspinatus, supraspinatus, subscapularis and teres minor insertions. Functions of a normal shoulder were simulated, as well as those and of a shoulder with a posterosuperior rotator cuff tear before and after muscle transfers were simulated. Parameters such as active and passive moment-generating capacity, and the moment arm and fiber excursion ratio of the transferred muscle were analyzed.

FINDINGS

All muscle transfers resulted in a large increase in shoulder external rotation strength. The latissimus dorsi was an external rotator after the transfer, but the fiber excursion ratio decreased accordingly. When the latissimus dorsi was transferred to the infraspinatus, supraspinatus or subscapularis insertion, it changed from extensor to flexor at the beginning of flexion. The flexion moment arm of the latissimus dorsi after the transfers was generally decreased. Shoulder abduction strength did not improve. Decrease in fiber excursion ratio during abduction and flexion was observed after the transfer. Side effects of the muscle transfers, such as the reduction of active adduction, extension and internal rotation of the shoulder, were explored.

INTERPRETATION

A transfer to teres minor insertion was not recommended. Infraspinatus insertion was found to be a preferred attachment site in latissimus dorsi transfer, provided that the patient had a strong deltoid.

Strain dependence of ultrasound speed in bovine articular cartilage under compression in vitro

The change of the ultrasound (US) speed in articular cartilage (artC) under applied strain conditions may induce significant measurement errors of the mechanical properties of the artC during both indentation and compression tests using US. In this paper, the strain dependence of the US speed in bovine artC (n = 20) under compression in vitro was investigated by virtue of using a custom-made US compression testing system. The US speed of the artC at the instant after the compression and that after a period of stress-relaxation were estimated under the applied strain ranging from 0% to 20%. Moreover, the instantaneous modulus and the modulus after the stress-relaxation of the artC were measured and correlated with the US speed. There was no significant difference (p > 0.05) between the US speed at the instant after the compression and that after the stress-relaxation, although there was a discrepancy between the instantaneous modulus and the modulus after stress-relaxation. The US speed was found to be highly correlated to the applied strain (r(2) = 0.98, p < 0.001) in a quadratic relation and changed by 7.8% (from 1581 +/- 36 m/s to 1671 +/- 56 m/s) when the applied strain reached 20%. The results suggest that the strain-dependent effect on the US speed in artC should be considered when the US is deployed for the assessment of artC using the compression or indentation test.

[Preliminary study of traditional Chinese medicine-Western medicine treatment of patients with primary liver carcinoma]

In order to improve the therapeutic efficacy for patients with primary liver carcinoma (PLC), the authors treated 30 patients by routine chemotherapy in combination with the immunostimulators Bai Nian Le ( ), levamisole and cimetidine. As a result, the NK activity and percentage of lymphoblast transformation of patients were significantly elevated, expansion of the tumor mass was checked, with clinical conditions obviously improved. So the short term effect of the therapy was satisfactory. The study suggested that Bai Nian Le in combination with levamisole and cimetidine was able to elevate the immune response and therapeutic effect. It may be one of the useful adjuvant therapy for PLC patients.

Stereospecific absorption and degradation of cephalexin

Stereospecific absorption and degradation of two stereoisomers about the alpha-amino group at the 7-position of cephalexin (CEX) have been investigated in the rat intestine. The L-isomer (L-CEX) was not found to be present either in serum or urine after oral administration, but the D-isomer (D-CEX) was well absorbed. In contrast to the saturable uptake of D-CEX (Kt = 10.54 +/- 1.73 mM, pH = 6.0) by the in-vitro everted intestinal sac, no appreciable uptake of L-CEX was observed. However, L-CEX competitively inhibited the uptake of D-CEX by the in-vitro everted intestine and the inhibitory constant (Ki) of L-CEX was determined to be 0.67 +/- 0.09 mM. L-CEX was rapidly degraded in-vitro in the intestinal tissue homogenate, serum and urine, while there was no appreciable degradation of D-CEX. Analysis of the major metabolite of L-CEX by high-performance liquid chromatography identified it as 7-aminodeacetoxycephalosporanic acid (7-ADCA). Furthermore, 7-ADCA was detected in serum after oral administration of L-CEX, indicating significant absorption of L-CEX as well as D-CEX. The results obtained suggest that both L- and D-CEX can be absorbed through the intestinal brush-border membrane via the same mechanism, most likely through the dipeptide transport system, and that the affinity of L-CEX to the carrier system is higher than that of D-CEX.(ABSTRACT TRUNCATED AT 250 WORDS)

Late Cretaceous (Maestrichtian?) Silicoflagellates from the Alpha Cordillera of the Arctic Ocean

A Late Cretaceous (probably Maestrichtian) silicoflagellate assemblage has been recovered for the first time from the middle section of a core taken from the Alpha Cordillera in the central Arctic Ocean. The finding of Globigerina pachyderma in the top and very rarely in the bottom part of the core suggests a faulting or slumping process in the area.