ObjectiveTo establish and validate a new prediction model for the risk of death in patients with acute-on-chronic liver failure （ACLF） based on sarcopenia and other clinical indicators， and to improve the accuracy of prognostic assessment for ACLF patients. MethodsA total of 380 patients with ACLF who were admitted to Beijing YouAn Hospital， Capital Medical University， from January 2019 to January 2022 were enrolled， and they were divided into training group with 228 patients and testing group with 152 patients in a ratio of 6∶4 using the stratified random sampling method. For the training group， CT images were used to measure the cross-sectional area of the skeletal muscle at the third lumbar vertebra （L3）， and L3 skeletal muscle index （L3-SMI） was calculated. Sarcopenia was diagnosed based on the previously established L3-SMI reference values for healthy adults in northern China. Univariate and multivariable Cox regression analyses were used to establish a sarcopenia-ACLF model which integrated sarcopenia and clinical risk factors， and a nomogram was developed for presentation. The area under the ROC curve （AUC） was used to assess the predictive performance of the model， the calibration curve was used to assess the degree of calibration， and a decision curve analysis was used to investigate the clinical application value of the model. The independent-samples t test or the Mann-Whitney U test was used for comparison of continuous data between two groups， and the chi-square test was used for comparison of categorical data between two groups. The Kaplan-Meier method was used to plot survival curves， and the Log-rank test was used for comparison between groups. The DeLong test was used for comparison of AUC between different models. ResultsThe multivariate Cox regression analysis showed that sarcopenia （hazard ratio ［HR］=1.962， 95% confidence interval ［CI］： 1.185‍ ‍—‍ ‍3.250， P=0.009）， total bilirubin （HR=1.003， 95%CI： 1.002‍ ‍—‍ ‍1.005， P<0.001）， international normalized ratio （HR=1.997， 95%CI： 1.674‍ ‍—‍ ‍2.382， P<0.001）， and lactic acid （HR=1.382， 95%CI： 1.170‍ ‍—‍ ‍1.632， P<0.001） were included in the sarcopenia-ACLF model. In the training cohort， the sarcopenia-ACLF model had a larger AUC than MELD-Na score in predicting 90-day mortality in patients with ACLF （0.80 vs 0.73， Z=1.97， P=0.049）. In the test cohort， the sarcopenia-ACLF model had a significantly larger AUC than MELD score （0.79 vs 0.69， Z=2.70， P=0.007） and MELD-Na score （0.79 vs 0.68， Z=2.92， P=0.004）. The calibration curve showed that the model had good calibration ability， with a relatively good consistency between the predicted risk of mortality and the observed results. The DCA results showed that within a reasonable range of threshold probabilities， the sarcopenia-ACLF model showed a greater net benefit than MELD and MELD-Na scores in both the training cohort and the test cohort. ConclusionThe sarcopenia-ACLF model developed in this study provides a more accurate tool for predicting the risk of 90-day mortality in ACLF patients， which provides support for clinical decision-making and helps to optimize treatment strategies.

In order to accurately capture the respiratory muscle movement and extract the synchronization signals corresponding to the breathing phases, a comprehensive signal sensing system for sensing the movement of the respiratory muscle was developed with applying the thin-film varistor FSR402 IMS-C07A in this paper. The system integrated a sensor, a signal processing circuit, and an application program to collect, amplify and denoise electronic signals. Based on the respiratory muscle movement sensor and a STM32F107 development board, an experimental platform was designed to conduct experiments. The respiratory muscle movement data and respiratory airflow data were collected from 3 healthy adults for comparative analysis. In this paper, the results demonstrated that the method for determining respiratory phase based on the sensing the respiratory muscle movement exhibited strong real-time performance. Compared to traditional airflow-based respiratory phase detection, the proposed method showed a lead times ranging from 33 to 210 ms [(88.3 ± 47.9) ms] for expiration switched into inspiration and 17 to 222 ms [(92.9 ± 63.8) ms] for inspiration switched into expiration, respectively. When this system is applied to trigger the output of the ventilator, it will effectively improve the patient-ventilator synchrony and facilitate the ventilation treatment for patients with respiratory diseases.
Humans ; Respiratory Muscles/physiology* ; Signal Processing, Computer-Assisted ; Movement/physiology* ; Respiration ; Monitoring, Physiologic/methods* ; Adult

In the century-long evolution of insulin pharmaceuticals, each transformative advancement in this drug class has been closely tied to the ability to obtain new insulin isoforms for research. Despite this, the recently discovered naturally occurring isoforms of glycosylated human insulin have remained largely unattainable for proper characterization. Herein, we demonstrate for the first time that total chemical synthesis can be used to generate all isoforms. This achievement required maintaining the correct positions of the interchain disulfide bonds while effectively removing protecting groups on complex glycans. Notably, the availability of seven glycoforms reveals the important effects of natural sialylated glycans in suppressing insulin self-association and enhancing its solubility, surpassing the performance of currently employed rapid-acting insulin drugs. This work not only offers a readily adaptable platform for exploring natural O-glycosylation in other therapeutic proteins and peptides but also lays the groundwork for further research into harnessing natural glycosylation for therapeutic applications.

Objective Electrocardiogram(ECG)signal quality degrades when the level of activity is high and motion artifacts are severe.Poor quality signals may result in false alarms,poor patient monitoring,imprecise measurement,and misleading diagnosis.The quantitative assessment of ECG signal quality forms the basis of automatic ECG noise reduction and heart disease diagnosis.Methods The ECG signal quality index(SQI)was obtained by statistically analyzing the heartbeat similarity and the slope character,respectively,namely rSQI and kSQI.Results Using MIT-BIH Noise Stress Test Database to test,both rSQI and kSQI decreased when the Signal Noise Ratio(SNR)decreased,which revealed the ECG signal quality.Based on the quasiperiodic property,the waveform similarity,as a beat-to-beat index,is obtained by cross correlation between two ECG cycles with high precision but heavy computation.Slope-based method dispenses with QRS detection and is very simple and real-time,but its sensitivity is lower than similarity-based method and it only get statistical data.Conclusion Both morphology similarity and slope character algorithms could provide objective estimation of ECG quality.Slope-based method is an attractive measure due to its simplicity and mathematical convenience,while similarity-based method is more accurate and robust for ECG quality assessment.

Objective To explore the role in sleep staging from blood volume pulse(BVP)and triaxial acceleration(ACC)of body movement obtained by wristband.Methods The BVP and ACC obtained by Empatica E4 wristband were used from all 100 cases of sleep disorder subjects in the DREAMT public database.Two frequency domain characteristics(eS,LF/HF)and one time domain characteristic(vA)of the BVP baseline and the activity counts(CS)of the ACC were used for sleep-awakening classification based on random forest.Results The results of sleep-awakening classification of all 100 cases of sleep disorder subjects were obtained by leaving-one-out strategy.The accuracy is 79.8%and the Kappa coefficient is 0.56 by 4 features from BVP and ACC;the accuracy is 70.4%and the Kappa coefficient is 0.36 by 3 features of BVP;the accuracy is 75.1%and the Kappa coefficient is 0.47 based on activity counts.Conclusion The BVP and ACC obtained by the wristband can be used for the rough estimation of sleep and awakening for sleep disorder subjects,among which the importance of ACC is higher than that of BVP.

Objective Biomechanical analyses of straight techniques for Chinese male skaters during the 1 500-m race were conducted to determine the influence of motion techniques on sports performance.Methods Thirty-four male skaters participating in the 1 500-m National Speed Skating Championship race were selected as research subjects.Kinematic characteristics were collected using three-dimensional fixed-point video analysis.The correlations between the periodic characteristics,motion phase characteristics,moment characteristics,and periodic velocity were analyzed.Results The period distance(r=0.560),gliding distance(r=0.554),and push-off distance(r=0.512)showed strong positive correlations with the periodic velocity.The trunk range of motion(ROM)(r=0.651),ankle angle(r=0.434),and ankle ROM(r=0.446)showed moderate or high positive correlations with the gliding velocity.The trunk angle(r=-0.427)showed a moderate negative correlation with the gliding velocity.Additionally,the trunk angle(r=0.673),hip extension angle(r=0.804),abduction angle(r=0.560),and abduction angle speed(r=0.566)were highly positively correlated with the push-off velocity.The push-off angle(r=-0.605)showed a high negative correlation with the push-off velocity.Conclusions The velocity of a straight line in 1 500-m speed skating depends on the dancing distance.Greater gliding and push-off distances result in higher velocities.The trunk and ankle angles significantly influence the gliding velocity,and appropriately increasing the trunk ROM can effectively improve the gliding velocity.The trunk,hip,and push-off angles are key determinants affecting the push-off velocity,and actively extending the hip and pushing-off can effectively enhance the push-off velocity.

Objective To analyze the characteristics of work-related musculoskeletal disorders (WMSDs) among sonographers in Guangdong Province, and to explore the disease pattern of the cases. Methods A total of 512 sonographers from 31 hospitals in Guangdong Province were selected as the research subjects using stratified cluster sampling method. The prevalence of WMSDs in the past year was investigated using the Musculoskeletal Disorders Questionnaire, and the characteristics of WMSDs were analyzed. Latent class analysis was used to identify the disease pattern of WMSDs. Results The overall prevalence of WMSDs was 94.3%. The top five affected body parts were right shoulder, neck, right hand/wrist, lower back and right forearm/elbow, with the prevalence of 80.3%, 75.4%, 61.1%, 55.5% and 45.3%, respectively. The prevalence of WMSDs was higher on the right side for the shoulder, hand/wrist, forearm/elbow, hip/leg and knee compared with the left side (80.3% vs 31.3%, 61.1% vs 13.9%, 45.3% vs 10.0%, 17.4% vs 8.6%, 13.1% vs 8.4%, all P<0.05). The prevalence of WMSDs increased with work years, as well the prevalence of WMSDs in the top five affected body parts among the sonographers (all P<0.05). However, there were no statistical differences in prevalence of WMSDs between general hospitals and maternal and child health hospitals, tertiary hospitals and non-tertiary hospitals, Pearl River Delta hospitals and non-Pearl River Delta hospitals; there was also no statistical difference between different genders and age groups of the sonographers (all P>0.05). The best-fit latent disease pattern for sonographers WMSDs comprised three categories： symptom of neck-right shoulder, symptom of neck-lower back-right shoulder-right elbow-right hand/wrist, and symptom of multi-parts above the knees, with the latent probabilities of 0.438, 0.427 and 0.135, respectively. Conclusion The prevalence of WMSDs in sonographers is extremely high, with a dose-effect relationship with work years. The most common affected parts are neck, lower back and right shoulder, right hand/wrist, and right forearm/elbow. The prevalence of WMSDs in the right side of limb was higher than that in the left. WMSDs primarily occur in multiple parts simultaneously. The most common symptoms occur in the neck-right shoulder and neck-lower back-right shoulder-right elbow-right hand/wrist.

Chinese Society of Hepatology and Chinese Society of Infectious Diseases, Chinese Medical Association update the guidelines for the prevention and treatment of chronic hepatitis B (version 2022) in 2022. The latest guidelines recommend more extensive screening and more active antiviral treating for hepatitis B virus infection. This article interprets the essential updates in the guidelines to help deepen understanding and better guide the clinical practice.
Humans ; Hepatitis B, Chronic/drug therapy* ; Hepatitis B/drug therapy* ; Hepatitis B virus ; Antiviral Agents/therapeutic use* ; Gastroenterology

H 1-antihistamines are widely used in the treatment of various allergic diseases, but there are still many challenges in the safe and rational use of H 1-antihistamines in pediatrics, and there is a lack of guidance on the prescription review of H 1-antihistamines for children.In this paper, suggestions are put forward from the indications, dosage, route of administration, pathophysiological characteristics of children with individual difference and drug interactions, so as to provide reference for clinicians and pharmacists.

Sarcopenia, a common complication of cirrhosis, has an incidence rate as high as 40% ~ 70%. Furthermore, adverse events such as shortened survival, lower quality of life, prolonged hospital stay, increased complications, a higher mortality rate, and sometimes altering the liver transplantation prognostic outcome in patients with liver cirrhosis are closely related. In recent years, some progress has been made in the research on the treatment of sarcopenia, but there is no clear treatment plan at present; thus, research and development by researchers and clinicians still need to be strengthened. This article briefly describes the relevant treatment methods for sarcopenia in patients with cirrhosis.