BackgroundIndividuals with chronic multimorbidity exhibit a high prevalence of sleep disturbances， which impair their physical and psychological well-being and impede chronic disease management. Although sleep quality is closely influencing with psychological functioning， empirical evidence regarding the longitudinal trajectories of sleep quality and their influencing factors in this population remains insufficient. ObjectiveTo investigate the longitudinal trajectories of sleep quality and associated factors among patients with chronic multimorbidity from hospitalization through 6 months post-discharge， aiming to facilitate the early identification of high-risk individuals and the development of personalized sleep interventions. MethodsA total of 228 inpatients with chronic multimorbidity， primarily with cardiovascular and metabolic chronic conditions， were enrolled via random sampling at The Third People's Hospital of Fuyang from January 2023 to September 2024. Baseline assessments were conducted during hospitalization using the general socio-demographic questionnaire， the Sleep Dysfunction Rating Scale （SDRS）， the Ruminative Response Scale （RRS）， and the Hospital Anxiety and Depression Scale （HADS）. Sleep quality was further evaluated using the SDRS at 1-， 3-， and 6-month post-discharge. Latent class growth model was employed to delineate trajectories of sleep quality. Multivariate logistic regression analysis was subsequently performed to identify influencing factors of sleep quality. ResultsA total of 201 patients with chronic diseases were included.Based on four predefined assessment time points （baseline， 1 month， 3 months， 6 months post-discharge）， the latent class growth model identified three distinct trajectories of sleep quality： persistent high sleep disturbance （n=72， 35.82%）， moderate sleep disturbance-progression （n=73， 36.32%）， and low sleep disturbance （n=56， 27.86%）. Multivariate logistic regression analysis revealed that， compared with the low sleep disturbance group， multiple factors increased the odds of membership in the persistent high sleep disturbance group： per capita monthly household income of <3 000 yuan （β=13.131， P<0.01） or 3 000–5 000 yuan （β=5.913， P<0.05）， aged 45–65 years （β=9.536， P<0.05）， presence of 3 （β=7.792， P<0.05） or >3 comorbid chronic conditions （β=6.626， P<0.05）， as well as higher RRS （β=0.334， P<0.01） and HADS score （β=1.628， P<0.01）. Additionally， patients aged 45–65 years （β=2.777， P<0.05）， with 3 （β=3.802， P<0.01） or >3 comorbid chronic conditions （β=2.463， P<0.01）， and with higher RRS （β=0.111， P<0.01） and HDAS scores （β=0.350， P<0.05） also demonstrated significantly increased odds of belonging to the moderate sleep disturbance–progression group. ConclusionThere is significant population heterogeneity in sleep quality trajectories among patients with chronic multimorbidity， with age， per capita household monthly income， number of comorbidities， rumination， and anxiety/depression symptoms being identify as the primary influencing factors.

ObjectiveTo evaluate the effectiveness and safety of Sufei Pingchuan Formula （肃肺平喘方） in the treatment of bronchiectasis with airflow limitation， phlegm-heat obstructing the lung， and lung-spleen qi deficiency syndrome. MethodsA randomized， double-blind， placebo-controlled trial was conducted. A total of 72 patients with stable bronchiectasis with airflow limitation of phlegm-heat obstructing the lung and lung-spleen qi deficiency syndrome were randomly divided into treatment group and control group， with 36 cases in each group. On the basis of regular inhalation of tiotropium bromide inhalation spray， the treatment group was given Sufei Pingchuan Formula granules， and the control group was given Sufei Pingchuan Formula granule simulant. The course of treatment in both groups was 12 weeks. The pulmonary function of both groups before and after treatment was observed， specifically focusing on forced expiratory volume in one second （FEV1）； the modified British Medical Research Council （mMRC） dyspnea scale， 24-hour sputum volume， COPD assessment test （CAT）， and traditional Chinese medicine （TCM） syndrome scores were assessed before treatment and after 4， 8， and 12 weeks of treatment； acute exacerbations were recorded at weeks 4， 8， and 12； additionally， changes in routine blood tests， urinalysis， liver and kidney function， and adverse events were monitored before and after treatment. ResultsAfter treatment， 4 patients in the treatment group and 6 in the control group dropped out. After 12 weeks of treatment， FEV1 increased in both groups compared to pre-treatment levels （P＜0.05）， but the difference between groups was not statistically significant （P＞0.05）. Compared to before treatment， the treatment group showed a reduction in mMRC scores after 12 weeks （P＜0.05） and a decrease in 24-hour sputum volume， CAT scores， and TCM syndrome scores at weeks 4， 8， and 12 （P＜0.05）. In the control group， 24-hour sputum volume decreased after 12 weeks （P＜0.05）， and TCM syndrome scores decreased at weeks 8 and 12 （P＜0.05）. Compared to the control group， the treatment group showed a greater reduction in mMRC scores at week 12 （P＜0.05）， a decrease in 24-hour sputum volume and TCM syndrome scores at weeks 4， 8， and 12 （P＜0.05）， and lower CAT scores at weeks 8 and 12 （P＜0.05）. The frequency and number of acute exacerbations in the treatment group were significantly lower than those in the control group at week 12 （P＜0.05）. No severe adverse events occurred in either group. ConclusionSufei Pingchuan Formula can improve the pulmonary function FEV1， the severity of dyspnea， reduce 24-hour sputum volume and frequent acute exacerbations， and improve the quality of life in patients with bronchiectasis and airflow limitation， with good safety.

BACKGROUND:Cervical disc herniation can cause pain in the neck and shoulder area,as well as radiating pain in the upper limbs.The incidence rate is increasing year by year and tends to affect younger individuals.Fully understanding the biomechanical characteristics of the cervical spine in adolescents is of great significance for preventing and delaying the onset of cervical disc herniation in this age group. OBJECTIVE:To reconstruct cervical spine models for both healthy adolescents and adolescent patients with cervical disc herniation utilizing finite element analysis techniques,to analyze the motion range of the C1-T1 cervical vertebrae as well as the biomechanical characteristics of the annulus fibrosus,nucleus pulposus,endplates,and the cartilage of the small joints. METHODS:A normal adolescent's cervical spine and an adolescent patient with cervical disc herniation were selected in this study.The continuous scan cervical spine CT raw image data were imported into Mimics 21.0 in DICOM format.The C1-T1 vertebrae were reconstructed separately.Subsequently,the established models were imported into the 3-Matic software for disc reconstruction.The perfected models were then imported into Hypermesh software for meshing of the vertebrae,nucleus pulposus,annulus fibrosus,and ligaments,creating valid geometric models.After assigning material properties,the final models were imported into ABAQUS software to observe the joint motion range of the C1-C7 cervical vertebrae segments under different conditions,and to analyze the biomechanical characteristics of the annulus fibrosus,nucleus pulposus,endplates,and small joint cartilage of each cervical spine segment. RESULTS AND CONCLUSION:(1)In six different conditions,the joint motion range of the C1 vertebra in the cervical spine models of both normal adolescent and adolescent patient with cervical disc herniation was higher than that of the other vertebrae.Additionally,the joint motion range of each cervical spine segment in normal adolescent was greater than that in adolescent patient with cervical disc herniation.(2)In the cervical spine model of normal adolescent,the maximum stress values in the annulus fibrosus and nucleus pulposus were found on the left side during C2-3 flexion conditions(0.43 MPa and 0.17 MPa,respectively).In the cervical spine model of adolescent patient with cervical disc herniation,the maximum stress values were found on the left side during C7-T1 flexion conditions(0.54 MPa and 0.18 MPa,respectively).(3)In the cervical spine model of normal adolescent,the maximum stress value on the endplate was found on the left side of the upper endplate of C3 during flexion conditions(1.46 MPa).In the model of adolescent patient with cervical disc herniation,the maximum stress value on the endplate was found on the left side of the lower endplate of C7 during flexion conditions(1.32 MPa).(4)In the cervical spine model of normal adolescent,the maximum stress value in the small joint cartilage was found in the C2-3 left rotation conditions(0.98 MPa).In adolescent patient with cervical disc herniation,the stress in the small joint cartilage significantly increased under different conditions,especially in C1-2,with the maximum stress found during left flexion(3.50 MPa).(5)It is concluded that compared to normal adolescent,adolescent patient with cervical disc herniation exhibits altered cervical curvature and a decrease in overall joint motion range in the cervical spine.In adolescent with cervical disc herniation,there is a significant increase in stress on the annulus fibrosus,nucleus pulposus,and endplates in the C7-T1 segment.The stress on the left articular cartilage of the C1-2 is notable.Abnormal cervical curvature may be the primary factor causing these stress changes.

Objective To make an investigation on the current situation of the general surgical nurse's knowledge-attitude-practice for mechanical prevention of venous thromboembolism(VTE),and to analyze its influencing factors,so as to provide scientific basis for improving the mechanical prevention care work of VTE.Methods Using convenience sampling method,from April 2023 to May 2023 a total of 508 general surgery nurses from 28 provinces,municipalities and autonomous regions were selected as the study subjects.A VTE mechanical prevention knowledge-attitude-practice questionnaire designed based on expert consensus was used to conduct the questionnaire survey.Linear regression analysis was used to determine the related factors affecting the knowledge-attitude-practice level of mechanical prevention care work of VTE in general surgery nurses.Results Multiple linear regression analysis showed that the sub-specialty of vascular surgery(P＜0.001)and the frequency of VTE mechanical prevention theory training in hospital(P=0.023)were the factors influencing VTE mechanical prevention knowledge dimension score of general surgery nurses;the sub-specialty of vascular surgery(P=0.033)was the factor influencing attitude dimension score;the sub-specialty of vascular surgery(P＜0.001)and the frequency of VTE mechanical prevention theory training in hospital(P=0.043)were the factors influencing practice dimension score.Conclusion General surgery nurses have a high level of attitude and practice in mechanical prevention of VTE for hospitalized patients,but their knowledge reserve is relatively insufficient.Therefore,the study of VTE-related knowledge and vascular surgery specialty should be strengthened,meanwhile,the frequency of VTE mechanical prevention training at the hospital and department level should be increased.

Objective To explore the expression and diagnostic value of serum cardiac troponin Ⅰ (cTn Ⅰ ) and neuron-specific enolase protein (NSE) in patients with cryptogenic stroke caused by patent foramen ovale (PFO). Methods A total of 108 patients with PFO admitted to Dazhou Central Hospital from December 2020 to December 2022 were selected and divided into 32 patients with cryptogenic stroke group (stroke group) and 76 patients with non-cryptogenic stroke group (non-stroke group) according to whether the patients caused cryptogenic stroke. According to the National Institutes of Health Stroke Scale (NIHSS),they were divided into mild group (<4points,n=10),moderate group (4～15points,n=15) and severe group (>15points,n=7). levels of fibrinogen (FIB),C-reactive protein (CRP),and alanine aminotransferase (ALT) were measured by an automatic biochemical analyzer in all patients. The serum levels of cTn Ⅰ and NSE were detected by ELISA-diagnostic value of serum cTn Ⅰ and NSE in PFO-induced cryptogenic stroke by ROC curve analysis. Logistic regression was applied to analyze the factors affecting the occurrence of cryptogenic stroke in PFO patients. Results Compared with the non-stroke group,the levels of FIB(3.20±0.36g/L vs 2.95±0.30g/L),CRP(73.58±7.43mg/L vs 62.52±7.11mg/L),ALT (68.58±6.82U/L vs 61.08±6.28U/L),cTn Ⅰ(0.78±0.10ng/L vs 0.58±0.08ng/L)and NSE(37.52±3.82μg/L vs 30.35±3.72μg/L)in the stroke group were increased,and the differences were statistically significant(t=3.722～10.994,all P<0.05). Compared with the mild group,the levels of cTn Ⅰ and NSE in the serum of patients in the moderate and severe groups were increased(t=5.891,7.177;3.458,4.105),the levels of cTn Ⅰ,NSE in the serum of the severe group were significantly higher than those in the moderate group (t=2.474,1.336),the differences were statistically significant (all P<0.05).The AUC (95％ CI) for the combined diagnosis of cryptogenic stroke in PFO patients was[0.981 (0.962～1.000)],which was higher than cTn Ⅰ[0.878(0.864～0.948)],NSE[0.911(0.850～0.972)]diagnosed alone (Z=8.621,6.477,all P<0.001). Logistic regression analysis showed that cTn Ⅰ (OR=2.631,95％CI:1.508～4.591),and NSE(OR=2.841,95％CI:1.514～5.330)were the influencing factors for the occurrence of cryptogenic stroke in PFO patients (P<0.05). Conclusion The serum levels of cTn Ⅰ and NSE in patients with cryptogenic stroke caused by PFO patients are significantly increased,which has certain diagnostic value for patients with cryptogenic stroke.

BACKGROUND:The asymmetrical biomechanical environment of adolescent idiopathic scoliosis can lead to further wedge deformation of the vertebral body,which may affect cardiopulmonary function and compress nerves in severe cases.Adolescent idiopathic scoliosis with different degrees of scoliosis should be treated with exercise,bracing,and surgery.However,the mechanical mechanism of selecting an orthopedic approach remains unclear due to the individual variability of patients.OBJECTIVE:To investigate the biomechanical mechanism of different orthopedic modalities for the treatment of adolescent idiopathic scoliosis to provide a basis for clinical selection of treatment modalities based on the spine model of adolescent idiopathic scoliosis patients.METHODS:Based on the CT images of an adolescent idiopathic scoliosis patient,a scoliosis model(C7-L5)was reconstructed in Mimics software in three dimensions,and lateral thrust force was applied at the T8/T9 thorax and vertical distraction force was applied over the C7 vertebra with the magnitude of 20,40,60,80,100,and 120 N.The intervertebral disc stress and vertebral displacement in concave and convex sides,and Cobb angle of the spine were analyzed under two orthopedic modalities.RESULTS AND CONCLUSION:(1)With lateral thrust,there was no significant change in the C7T1-T7T8 intervertebral disc.The concave and convex stress of T7T8-L4L5 segment decreased first and then increased with the increase of lateral thrust force.The correction effect of lateral thrust on the segment near T8T9 was obvious and weakened with the extension of the segment to the cephalic and caudal ends.At 120 N of lateral thrust,the thoracic Cobb angle changed from 53.2° to 32.5° and the lumbar Cobb angle changed from 50.2° to 43.9°.(2)With the vertical distraction,the thoracic intervertebral disc stresses first decreased and then increased,and all the lumbar disc stresses decreased.The C7 displacement was the most obvious,and the correction effect gradually diminished with the segment extended to the caudal end.At a vertical distraction force of 120 N,the thoracic Cobb angle changed from 53.2° to 39.4° and the lumbar Cobb angle changed from 50.2° to 47.6°.(3)It is concluded that both orthopedic modalities provide improvement in the degree of scoliosis,with the thoracic correction being greater than the lumbar correction.Also,the asymmetric stress distribution on the concave and convex sides is improved,which contributes to normal bone growth.A vertical distraction approach is appropriate for larger Cobb angles,and a lateral thrust approach is appropriate for smaller Cobb angles.The results of this study help to understand the mechanism of spinal orthosis and provide a theoretical basis for the choice of orthopedic approach.

Objective To assess the global and Chinese disease burden of early-onset lung cancer(di-agnosed in patients aged 15-49 years)and its major risk factors.Methods Based on the GLOBOCAN 2022 and Global Burden of Disease(GBD)2021 datasets,we evaluated the disease burden and associated risk fac-tors of early-onset lung cancer globally and in China,stratified by age,sex,geographic location,and human development index(HDI).Key indicators included age-standardized incidence rate(ASIR),age-standardized mortality rate(ASMR),and disability adjusted life years(DALYs)attributable to risk factors.Results In 2022,there were 137 705 new cases and 72 646 deaths from early-onset lung cancer globally,with ASIR and ASMR of 3.43 per 100 000 and 1.82 per 100 000 population,respectively.The disease burden was higher in males than in females(ASIR:3.72 per 100 000 vs.3.14 per 100 000;ASMR:2.31 per 100 000 vs.1.33 per 100 000).High-HDI regions exhibited the highest ASIR(5.51 per 100 000)and ASMR(2.57 per 100 000),with health inequality analysis revealing a concentration of disease burden in higher-HDI areas.China bore the heaviest burden,accounting for 48.69%of global new cases and 35.77%of deaths.China's ASIR(8.21 per 100 000)and ASMR(3.17 per 100 000)exceeded global averages,with incidence higher in fe-males(8.78 per 100 000 vs.7.67 per 100 000)but mortality higher in males(4.01 per 100 000 vs.2.29 per 100 000).Smoking and ambient particulate matter pollution were the leading risk factors globally(DALYs contribution:42.01%and15.62%)and in China(DALYs contribution:46.78%and 20.84%).Globally,household air pollution ranked third,whereas in China,secondhand smoke replaced it as the third leading risk factor,with household air pollution dropping to fifth.Risk factor profiles varied significantly across age groups,with modifiable risks contributing less to disease burden in the 15-24 age group.Conclusions The burden of early-onset lung cancer varies markedly by sex,region,and HDI,with China facing a disproportionately high burden.Policymakers should prioritize equitable resource allocation and targeted interventions,particularly in tobacco control and air pollution mitigation,to enhance cancer prevention and control efforts.

Based on CT scan data,a bionic model of lumbar spine injuries with high biofidelity is developed and validated through cadaver experiments.Decoupling the constraint system that affects occupants during collisions due to inertial forces and the subsequent pressure exerted by the seat upon returning to position,a simulated fall experiment is designed.The simulated outcomes are trained and predicted using deep learning algorithms,and the accuracy of the trained neural network prediction model is verified.Key parameters are analyzed for correlation using principal component analysis and cross-reverse methods.The results shows that the predicted lumbar spine injury model obtained from training has high reliability(R2>0.9).Comprehensive analysis reveals that after experiencing axial impact,the L4 vertebral body bears the highest impact load and can be used as a representative measure of lumbar spine injury.Among the environmental variables,the axial force on the L4 lumbar spine is mainly affected by torso mass and fall height,both of which have positive correlations.Torso mass,fall height,and posture angle all have positive effects on internal energy.Conversely,torso mass and fall height have negative correlations with stress.These research findings provide a scientific basis for further elucidating lumbar spine injury mechanisms in intelligent cockpit environments,devising corresponding safety protection measures,and evaluating occupant safety in automobiles.

Non-alcoholic fatty liver disease (NAFLD) is a metabolic disease characterized by abnormal deposition of lipid in hepatocytes. If not intervened in time, NAFLD may develop into liver fibrosis or liver cancer, and ultimately threatening life. NAFLD has complicated etiology and pathogenesis, and there are no effective therapeutic means and specific drugs. Currently, insulin sensitizers, lipid-lowering agents and hepatoprotective agents are often used for clinical intervention, but these drugs have obvious side effects, and their effectiveness and safety need to be further confirmed. Adenosine monophosphate (AMP)-activated protein kinase (AMPK) plays a central role in maintaining energy homeostasis. Activated AMPK can enhance lipid degradation, alleviate insulin resistance (IR), suppress oxidative stress and inflammatory response, and regulate autophagy, thereby alleviating NAFLD. Natural herbal medicines have received extensive attention recently because of their regulatory effects on AMPK and low side effects. In this article, we reviewed the biologically active natural herbal medicines (such as natural herbal medicine formulas, extracts, polysaccharides, and monomers) that reported in recent years to treat NAFLD via regulating AMPK, which can serve as a foundation for subsequent development of candidate drugs for NAFLD.

OBJECTIVE: To observe the clinical efficacy of Qihuang needle therapy for autism spectrum disorder (ASD) children with sleep disorder. METHODS: A total of 60 ASD children with sleep disorder were randomly divided into an observation group and a control group, 30 cases in each group. Both groups were treated with structured education intervention, 60 min each time, once a day, 6 times a week. Qihuang needle therapy was applied at Yintang (GV24⁺), Baihui (GV20) and bilateral Jueyinshu (BL14), Xinshu (BL15) in the observation group, multi-direction needling was delivered and without needle retaining. The treatment was given 2 times a week, each treatment was delivered at interval of 2 days at least. Behavioral intervention was adopted in the control group. Treatment for consecutive 12 weeks was required in both groups. Before and after treatment, the scores of children's sleep habits questionnaire (CSHQ), the autism behavior checklist (ABC), the childhood autism rating scale (CARS), and the childhood autism behavior scale (CABS) were observed in the two groups. RESULTS: After treatment, the scores of CSHQ, ABC, CARS and CABS were decreased compared with those before treatment (P<0.01), and the above scores in the observation group were lower than those in the control group (P<0.05). CONCLUSION Qihuang needle therapy can effectively treat ASD with sleep disorder, improve the core symptoms of ASD and the sleep quality.
Humans ; Autism Spectrum Disorder/physiopathology* ; Male ; Female ; Child ; Sleep Wake Disorders/physiopathology* ; Child, Preschool ; Acupuncture Therapy ; Acupuncture Points ; Treatment Outcome ; Sleep ; Needles