OBJECTIVE: To investigate the current status of kinesiophobia after lumbar fusion surgery in patients with lumbar disc herniation (LDH) and to analyze its influencing factors. METHODS: A total of 489 LDH patients who underwent lumbar fusion surgery in our hospital from January 2021 to December 2022 and effectively filled out the tampa scale for kinesiophobia (TSK) and other questionnaires on the first day after surgery were collected as the study subjects, the current status of kinesiophobia in LDH patients after lumbar fusion surgery were investigated using the TSK. The LDH patients were grouped into a kinesiophobia group (n=221) and a non kinesiophobia group (n=268) based on whether there was kinesiophobia after lumbar fusion surgery. The self-designed general data questionnaires were used to collect data, and Logistic regression was applied to analyze independent risk factors for kinesiophobia after lumbar fusion surgery in the LDH patients. RESULTS: In the study, 221 out of the 489 LDH patients (45.19%) had kinesiophobia after lumbar fusion surgery. Univariate analysis showed that there were statistically significant differences between the phobic group and the non phobic group in terms of gender, education level, course of disease, whether there was hypoproteinemia, pain level, self-efficacy, social support, whether there was anxiety, and whether there was depression (P < 0.05). There were no statistically significant differences in terms of age, body mass index, monthly family income, marital status, residence, medical expense payment form, whether there was hypertension, whether there was diabetes, whether there was cardiovascular and cerebrovascular disease, whether there was respiratory disease, whether there was surgery experience, whether there was anemia, work conditions, and responsibility segments (P>0.05). Male (95%CI: 3.289-10.586, P < 0.001), education level below undergraduate level (95%CI: 6.533-45.162, P < 0.001), severe pain (95%CI: 10.348-72.025, P < 0.001), moderate pain (95%CI: 6.247-37.787, P < 0.001), low self-efficacy (95%CI: 4.238-15.095, P < 0.001), and medium self-efficacy (95%CI: 2.804-8.643, P < 0.001) were influencing factors for kinesiophobia after lumbar fusion surgery in the patients with LDH (P < 0.05). CONCLUSION The incidence of kinesiophobia after lumbar fusion surgery in patients with LDH is high, and its influencing factors include gender, education level, pain level, and self-efficacy.
Humans ; Spinal Fusion/psychology* ; Intervertebral Disc Displacement/psychology* ; Lumbar Vertebrae/surgery* ; Male ; Female ; Middle Aged ; Phobic Disorders/etiology* ; Surveys and Questionnaires ; Adult ; Risk Factors ; Aged ; Fear ; Kinesiophobia

To summarize the nursing experience of a patient with acute injection botulism complicated with respiratory failure.The key nursing points include early standard use of botulinum antitoxin therapy to improve the signs of myasthenia;to strengthen respiratory support and airway management,to carry out respiratory training,and to promote the recovery of respiratory function;swallowing function training and dynamic evaluation were carried out to promote the recovery of swallowing function;narrative nursing was carried out to relieve patient's negative emotions.After 17 days of treatment and nursing care,the patient was removed from the tracheal tube on the 7th day,transferred to the general ward on the 14th day,and discharged successfully on the 17th day with a good prognosis.A telephone follow-up was conducted 4 months after discharge,and the patient recovered well.

Objective To explore the causal association between immune cells and allergic rhi-nitis using Mendelian randomization(MR)approach.Methods GWAS data for 731 types of im-mune cells and allergic rhinitis were obtained from genome-wide association study(GWAS)databas-es.A two-sample bidirectional MR analysis was conducted,with the inverse-variance weighted(IVW)method as the primary analytical approach,and the weighted median method,MR-Egger re-gression,simple mode method,and weighted mode method as supplementary approaches.Sensitivity analyses,including heterogeneity tests,pleiotropy tests,and the leave-one-out method,were per-formed.Bonferroni correction was applied to the preliminary results to enhance their reliability and rigor.Results The two-sample forward MR analysis revealed correlations between 67 immune cell phenotypes and allergic rhinitis.After Bonferroni correction,four immune cell phenotypes were finally identified.Among them,the expression of CD3 on CD39-positive activated CD4 regulatory T cells(OR=0.953,95％CI,0.931 to 0.978,P＜0.001,Padj=0.007),the expression of herpesvirus entry mediator(HVEM)on CD45RA-negative CD4+T cells(OR=0.965,95％CI,0.948 to 0.983,P＜0.001,Padj=0.008),and the percentage of human leukocyte antigen class DR(HLA-DR)-high-expressing monocytes among leukocytes(OR=0.929,95％CI,0.885 to 0.974,P=0.002,Padj=0.157)were protective factors for allergic rhinitis.In contrast,the percentage of transitional B cells among B cells(OR=1.094,95％CI,1.032 to 1.161,P=0.003,Padj=0.183)was a risk factor for allergic rhinitis.The reverse MR analysis showed no causal relationship between allergic rhinitis and the four immune cell phenotypes.Conclusion The two-sample forward MR analysis confirms a caus-al link between immune cells and allergic rhinitis.MR analysis has the advantages of reducing con-founding factor interference and avoiding reverse causation,providing a theoretical basis for in-depth research on immune mechanisms,sensitive biomarkers,and drug treatment targets of allergic rhinitis.

Objective:To investigate the impact of perceived barriers to cardiac rehabilitation on adherence to cardiac rehabilitation and the mediating effect of cardiac impact denial in elderly patients after percutaneous coronary intervention (PCI) .Methods:This study was a cross-sectional survey. From August 2023 to July 2024, 336 elderly patients with PCI who were discharged from the First Affiliated Hospital of Wenzhou Medical University and needed phaseⅡ cardiac rehabilitation were selected for the study. General Information Questionnaire, Adherence of Cardiac Rehabilitation Assessment Scale in Patients with Coronary Heart Disease (ACRAS-CHD) , Cardiac Rehabilitation Barriers Scale (CRBS) , and Cardiac Denial of Impact Scale (CDIS) were used to survey the patients. Bootstrap method was used to sample 5 000 for mediating effect tests.Results:A total of 336 questionnaires were distributed and 324 valid questionnaires were recovered, with a valid recovery rate of 96.43% (324/336) . Among 324 elderly patients after PCI, ACRAS-CHD score, CRBS score, and CDIS score were (73.19±5.46) , (79.35±6.60) , and (30.57±3.66) , respectively. The direct effect of perceived barriers to cardiac rehabilitation on adherence to cardiac rehabilitation in elderly patients after PCI was -0.368, which accounted for 74.49% (-0.368/-0.494) of the total effect. The mediating effect of cardiac impact denial between perceived barriers to cardiac rehabilitation and adherence to cardiac rehabilitation in elderly patients after PCI was -0.126, which accounted for 25.51% of the total effect (-0.126/-0.494) .Conclusions:Elderly patients after PCI have poor adherence to cardiac rehabilitation. Perceived cardiac rehabilitation barriers reduce cardiac rehabilitation adherence in elderly patients after PCI, and cardiac impact denial exerts a partial mediating effect between perceived cardiac rehabilitation barriers and cardiac rehabilitation adherence.

To summarize the nursing experience of a patient with acute injection botulism complicated with respiratory failure.The key nursing points include early standard use of botulinum antitoxin therapy to improve the signs of myasthenia;to strengthen respiratory support and airway management,to carry out respiratory training,and to promote the recovery of respiratory function;swallowing function training and dynamic evaluation were carried out to promote the recovery of swallowing function;narrative nursing was carried out to relieve patient's negative emotions.After 17 days of treatment and nursing care,the patient was removed from the tracheal tube on the 7th day,transferred to the general ward on the 14th day,and discharged successfully on the 17th day with a good prognosis.A telephone follow-up was conducted 4 months after discharge,and the patient recovered well.

Objective:To investigate the impact of perceived barriers to cardiac rehabilitation on adherence to cardiac rehabilitation and the mediating effect of cardiac impact denial in elderly patients after percutaneous coronary intervention (PCI) .Methods:This study was a cross-sectional survey. From August 2023 to July 2024, 336 elderly patients with PCI who were discharged from the First Affiliated Hospital of Wenzhou Medical University and needed phaseⅡ cardiac rehabilitation were selected for the study. General Information Questionnaire, Adherence of Cardiac Rehabilitation Assessment Scale in Patients with Coronary Heart Disease (ACRAS-CHD) , Cardiac Rehabilitation Barriers Scale (CRBS) , and Cardiac Denial of Impact Scale (CDIS) were used to survey the patients. Bootstrap method was used to sample 5 000 for mediating effect tests.Results:A total of 336 questionnaires were distributed and 324 valid questionnaires were recovered, with a valid recovery rate of 96.43% (324/336) . Among 324 elderly patients after PCI, ACRAS-CHD score, CRBS score, and CDIS score were (73.19±5.46) , (79.35±6.60) , and (30.57±3.66) , respectively. The direct effect of perceived barriers to cardiac rehabilitation on adherence to cardiac rehabilitation in elderly patients after PCI was -0.368, which accounted for 74.49% (-0.368/-0.494) of the total effect. The mediating effect of cardiac impact denial between perceived barriers to cardiac rehabilitation and adherence to cardiac rehabilitation in elderly patients after PCI was -0.126, which accounted for 25.51% of the total effect (-0.126/-0.494) .Conclusions:Elderly patients after PCI have poor adherence to cardiac rehabilitation. Perceived cardiac rehabilitation barriers reduce cardiac rehabilitation adherence in elderly patients after PCI, and cardiac impact denial exerts a partial mediating effect between perceived cardiac rehabilitation barriers and cardiac rehabilitation adherence.

Objective To investigate the causal association between bronchial asthma and bone mineral density at different sites using a two-sample Mendelian randomization (MR) approach. Methods Summary data for exposure factors and outcome were obtained from different genome-wide association studies.Single nucleotide polymorphisms strongly associated with bronchial asthma were selected as instrumental variables,and those in linkage disequilibrium were excluded.The inverse-variance weighted (IVW) method was used as the primary method for MR analysis,complemented by weighted median,simple mode,weighted mode,and MR-Egger regression methods.Sensitivity analyses were conducted to assess the stability of the results. Results The random-effects model of IVW analysis showed that heel bone mineral density (OR=0.986;95% CI,0.974 to 0.998;P=0.023) as the outcome dataset had a reverse causal effect with bronchial asthma,while lumbar spine bone mineral density (OR=1.031;95% CI,0.984 to 1.081;P=0.195),femoral neck bone mineral density (OR=1.014;95% CI,0.973 to 1.057;P=0.505),and forearm bone mineral density (OR=1.011;95% CI,0.935 to 1.094;P=0.775) as outcome datasets showed no causal effect with bronchial asthma.The MR-Egger intercept test results indicated that the P-values for the intercepts of lumbar bone mineral density,femoral neck bone mineral density,forearm bone mineral density,and calcaneal bone mineral density were all over 0.05,suggesting no horizontal pleiotropy and relatively stable results. Conclusion MR analysis reveals a reverse causal effect between bronchial asthma and heel bone mineral density,suggesting that clinicians should strengthen the monitoring of heel bone mineral density in patients with bronchial asthma to timely detect and intervene osteoporosis.

【Objective】 To confirm the role of Wnt signaling pathway in the occurrence and development of gastric cancer （GC）， establish a prognostic model composed of Wnt pathway related genes， and then evaluate the predictive value of the model. 【Methods】 We downloaded the gene expression data and survival data of GC in TCGA database， and used GSEA enrichment analysis to verify the enrichment of Wnt pathway in GC and para-cancer samples. In this study， univariable COX regression analysis and survival curve analysis were used to select the prognosis-related genes of GC. Then the multivariate COX proportional hazard regression model was used to obtain the prognostic model of Wnt signaling pathway related genes. Then， receiver operating characteristic （ROC） curve and forest plot were used to verify the clinical predictive value of the model. The model was then validated in GEO external database. Finally， by utilizing quantitative real-time PCR （qPCR）， we detected the expressions of Wnt signaling pathway related genes in 8 pairs of clinical GC and para-cancer samples. 【Results】 We downloaded 32 samples of normal para-cancer samples and 375 cancer samples and their corresponding clinical data. GSEA enrichment showed that compared with normal samples， Wnt pathway was significantly enriched in GC samples （P<0.05）. The results of univariate COX analysis showed that 13 Wnt pathway genes were closely related to the prognosis of GC patients. Multivariate COX determined that the model was multiplied and accumulated by ETV2， SERPINE1， CPZ， VPS35 and IGFBP1 and their corresponding coefficient β. The survival curve and ROC curve showed that the model could accurately predict the prognosis of GC patients， and the 1-year， 3-year， and 5-year areas under the curve （AUC） were 68.0%， 69.4% and 78.5%， respectively. Clinical univariate and multivariate COX analyses showed that the model could become an independent prognostic factor other than TNM system of GC. The external data set （GSE84437） validation results of GC showed that the model could better predict the prognosis of GC patients. qPCR results indicated that ETV2， SERPINE1， CPZ， VPS35 and IGFBP1 expressions were upregulated in GC samples compared with para-cancer samples. 【Conclusion】 This study further confirmed that Wnt pathway plays an important role in the progress of GC from the perspective of bioinformatics， and we have established a prognosis-related risk model， providing a new perspective for clinical genetic testing， targeted therapy and individualized therapy.

Objective:To summarize the hotspots and developmental status of non-suicidal self-injury research by clustering and co-occurrence to the literature on non-suicidal self-injury on the basis of Cite Space, and in order to provide references for future research and intervention.Methods:Non-suicidal self-injury literature included in the Web of science core collection from January 1975 to August 2020 was searched, and the included literature was visualized and analyzed using Cite Space 5.5.R2 knowledge mapping software.Results:A total of 974 articles were retrieved, and the number of articles published showed an increasing trend year by year, mostly in developed countries. The country with the highest cumulative number of articles was the United States, with a total of 412 articles, and the first organization was Katholieke Univ Leuven, with a total of 42 articles. Key words co-occurrence and clustering showed that the current research focus was on adolescents, suicidal behavior, dialectical behavior therapy, and borderline personality disorder. The most cited literature was by Muehlenkamp.Conclusions:Non-suicidal self-injury research has developed rapidly in recent years. At present, non-suicidal self-injury population, related intervention measures, screening and evaluation tools, Meta-analysis and risk factor analysis are its research frontiers and hot spots.

Objective:To study the predictive value of serum albumin (ALB) on the first day of life for early-onset sepsis (EOS) in very low birth weight infants (VLBWI).Methods:From January 2015 to December 2020, clinical data of VLBWI (gestational age < 34 weeks, birth weight < 1 500 g) born and hospitalized in our hospital were collected. Based on the serum ALB level at admission, the infants were assigned into high, moderate and low ALB groups. C-reactive protein (CRP) and procalcitonin (PCT) levels among different ALB groups were compared. The infants were also assigned into EOS and non-EOS groups according to the occurrence of EOS and perinatal complications were compared between the two groups. The relationship between EOS and ALB level was analyzed. The predictive value of serum ALB was studied using receiver operating characteristic (ROC) curve analysis.Results:A total of 183 infants were enrolled, including 62 in the high ALB group, 87 in the moderate ALB group and 34 in the low ALB group; and 36 in EOS group and 147 in non-EOS group. The incidence of maternal chorioamnionitis was significantly higher in EOS group than non-EOS group [33.3% (12/36) vs. 6.8% (10/147), P<0.001]. Serum CRP and PCT in the low and moderate ALB groups were significantly higher than the high ALB group ( P<0.05), and the low ALB group showed higher CRP and PCT than the moderate ALB group ( P<0.05). Compared with the non-EOS groups, ALB in the EOS group was significantly lower [24.9 (24.0, 28.5) g/L vs. 29.5 (27.4, 31.2) g/L, P<0.001] and the incidence of hypoproteinemia was significantly higher [52.8% vs.10.2%, P<0.001]. As ALB decreased, the incidence of EOS increased. The incidence of EOS was 55.9% in the low ALB group, 16.1% in the moderate ALB group and 4.8% in the high ALB group ( P<0.001). The sensitivity and specificity of ALB predicting EOS was 69.4% and 79.6%, respectively, with a cut-off value of 27.0 g/L. Conclusions:The VLBWI with maternal chorioamnionitis and serum albumin lower than 27.0 g/L on the first day of life have higher risk of EOS.