Objective:To summarize the concept, theoretical basis, evaluation tools and mechanisms, influencing factors, and intervention measures of kinesiophobia.Methods:The literature on kinesiophobia in patients undergoing total knee replacement was electronically searched on databases such as China National Knowledge Infrastructure, China Biology Medicine disc, WanFang Data, PubMed, CINAHL, Web of Science, Embase, Scopus, PsycINFO, Cochrane Library. The search period was from database establishment to June 24, 2023. This study extracted and analyzed data from the included literature.Results:A total of 32 articles were included. The Tampa Scale for Kinesiophobia was a widely used tool for evaluating kinesiophobia. The influencing factors of kinesiophobia were demographic and disease factors, body motor function, and psychological and social factors. The intervention measures for kinesiophobia mainly included cognitive behavioral intervention, pain health education, exercise, art video or music intervention, multidisciplinary collaborative intervention, and so on.Conclusions:The concept and theoretical basis of kinesiophobia are not yet complete. It is necessary to revise and improve the theoretical model and assessment tool for kinesiophobia and construct an intervention program for kinesiophobia in combination with the concept of rapid rehabilitation.

Objective To explore the current situation and influencing factors of caregiver readiness of elderly patients with chronic heart failure.Methods From March 2021 to April 2022,the convenient sampling method was used to select 335 caregivers of elderly patients with chronic heart failure who were hospitalized in 6 hospitals in Hangzhou as the survey subjects.The general information questionnaire,Caregiver Readiness Scale and Caregiver Burden Scale were used to investigate the caregivers of elderly patients with chronic heart failure.Results A total of 326 valid questionnaires were collected.The score of Caregiver Readiness Scale for elderly patients with chronic heart failure was(18.88±6.36),and 61.04%of the caregivers had mild to moderate burden.The results of multiple linear regression analysis showed that the caregiver's age,education level and cumulative care time were the positive influencing factors of the caregiver readiness,and the caregiver burden was the negative influencing factor of the caregiver readiness(P＜0.001).Conclusion The caregiver readiness of elderly patients with chronic heart failure is at a medium level.Caregivers who are older,more educated,have a longer cumulative caregiving time,and have a lighter caregiving burden are more prepared.Medical staff should pay attention to the motivation of caregivers,provide professional support from multiple aspects,and reduce the burden of care,increase readiness level.

Objective:To assess the association between short-term ambient air pollution exposure and arterial stiffness and whether obesity modifies these associations.Methods:A cross-sectional study was conducted based on Fangshan family cohort in Beijing. The 24 hours average air pollutant levels on the day cohort participants took baseline survey were calculated as short-term air pollution. A generalized additive model (GAM) with Gaussian links was used to estimate changes in typical carotid artery intima-media thickness (CIMT), brachial-ankle pulse wave velocity (BAPWV), pulse pressure (PP) and ankle-branchial index (ABI) after short-term exposure to each air pollution (PM 2.5, PM 10, SO 2, NO 2, CO). The cross-product terms of each air pollution, body mass index (BMI), and waist-to-hip ratio were included in the GAM model to test the interaction. Further, they conducted a stratified analysis to test their effects on the relationship between short-term exposure to each air pollution and the arterial stiffness indicators. Results:A total of 4 211 individuals were included in the analysis. Individuals' age was (58.9±8.7) years, of which 2 268 (53.9%) were female. Several covariates, including sociodemographic factors, lifestyle behaviors, and history of drugs, were included in the analysis. The results of the GAM analysis showed that an increase in PM 2.5 ( β=2.912×10 -4, 95% CI: 1.424×10 -4-4.400×10 -4, P<0.001), CO ( β=0.027, 95% CI: 0.011-0.043, P<0.001), SO 2 ( β=2.070×10 -3, 95% CI: 7.060×10 -4-3.430×10 -3, P=0.003), and NO 2 ( β=3.650×10 -4, 95% CI: 2.340×10 -5-7.060×10 -4, P=0.036) were associated with an increase in CIMT, while an increase in PM 10 ( β=0.018, 95% CI: 0.002-0.033, P=0.028) was associated with an increase in PP in the study population. Besides, the waist-to-hip ratio had an effect-modification on the correlation of short-term exposure of PM 2.5 (interaction P=0.015), NO 2 (interaction P=0.008), and CO (interaction P=0.044) with CIMT, and the correlation between short-term exposure of PM 2.5 (interaction P=0.002), NO 2 (interaction P=0.010), CO (interaction P=0.029), PM 10 (interaction P<0.001) with PP. The significant association between CIMT, PP, and air pollution concentrations was more visible in people with lower waist-to-hip ratios. Conclusions:Short-term ambient air pollution exposure was associated with arterial stiffness indicators, and there was an effect modification of waist-to-hip ratio on these associations, and lower waist-to-hip ratios may enhance the association between air pollution exposure and indicators.

Objective:To delve into the intricate relationship between common genetic variations across the entire genome and the risk of non-syndromic cleft lip with or without cleft palate(NSCL/P).Methods:Utilizing summary statistics data from genome-wide association studies(GW AS),a thorough investigation to evaluate the impact of common variations on the genome were undertook.This involved assessing single nucleotide polymorphism(SNP)heritability across the entire genome,as well as within specific genomic regions.To ensure the robustness of our analysis,stringent quality control measures were applied to the GWAS summary statistics data.Criteria for inclusion encompassed the absence of missing values,a minor allele frequency≥1％,P-values falling within the range of 0 to 1,and clear SNP strand orientation.SNP meeting these stringent criteria were then meticulously included in our analy-sis.The SNP heritability of NSCL/P was calculated using linkage disequilibrium score regression.Addi-tionally,hierarchical linkage disequilibrium score regression to partition SNP heritability within coding re-gions,promoters,introns,enhancers,and super enhancers were employed,and the enrichment levels within different genomic regions using LDSC(v1.0.1)software were further elucidated.Results:Our study drew upon GWAS summary statistics data obtained from 806 NSCL/P trios,comprising a total of 2 418 individuals from the Chinese population.Following rigorous quality control procedures,490 593 out of 492 993 SNP were deemed suitable for inclusion in SNP heritability calculations.The observed SNP heritability of NSCL/P was 0.55(95％CI:0.28-0.82).Adjusting for the elevated disease pre-valence within our sample,the SNP heritability scaled down to 0.37(95％CI:0.19-0.55)based on the prevalence observed in the general Chinese population.Notably,our enrichment analysis unveiled significant enrichment of SNP heritability within enhancer regions(15.70,P=0.04)and super enhan-cer regions(3.18,P=0.03).Conclusion:Our study sheds light on the intricate interplay between common genetic variations and the risk of NSCL/P in the Chinese population.By elucidating the SNP heritability landscape across different genomic regions,we contribute valuable insights into the genetic basis of NSCL/P.The significant enrichment of SNP heritability within enhancer and super enhancer re-gions underscores the potential role of these regulatory elements in shaping the genetic susceptibility to NSCL/P.This paves the way for further research aimed at uncovering novel genetic pathogenic factors un-derlying NSCL/P pathogenesis.

Objective:To evaluate the efficacy and safety of oral anisodine hydrobromide tablets in the treatment of nonarteritic anterior ischemic optic neuropathy (NAION).Methods:A multicenter nonrandomized controlled trial was conducted.A total of 282 acute NAION patients (282 eyes) were recruited from 16 hospitals in China from July 2020 to May 2021.Patients were divided into two groups according to treatment methods, which were control group (124 cases, 124 eyes) receiving regular treatment including citicoline sodium plus Ginkgo biloba leaf liquid extract or Ginkgo biloba leaf extract tablets plus mecobalamin, and experimental group (158 cases, 158 eyes) receiving treatment in control group plus oral anisodine hydrobromide tablets 1 mg, twice daily for 2 to 3 months.Best corrected visual acuity (BCVA), visual field index (VFI), peripapillary retinal nerve fiber layer (pRNFL) and radial peripapillary capillary vessel density (RPC) were assessed at 1, 2, 3, and 6 months after enrollment using the standard decimal visual acuity chart, 750i Humphery visual field analyzer, Cirrus HD-OCT 4000/Cirrus HD-OCT 5000, RTVue-XR optical coherence tomography respectively.The primary outcomes were BCVA and VFI, and the secondary outcomes were pRNFL, RPC, and the side effects during the follow-up.The study adhered to the Declaration of Helsinki.All patients were fully informed about the treatment and purpose of this study and voluntarily signed the informed consent form.The study protocol was approved by Chinese PLA General Hospital (No.S2020-021-01). Results:In all, 242 patients (242 eyes) completed the follow-up of BCVA, and 98 patients (98 eyes) completed the VFI follow-up.In terms of visual function, BCVA and VFI improved significantly over time in the two groups, and BCVA and VFI were better in experimental group than in control group at various follow-up time points (all at P<0.05). In terms of structure, pRNFL gradually decreased in both groups with the extension of treatment, and pRNFL was significanthy thinner in experimental group than in control group at various follow-up time points (all at P<0.05). There was no significant difference in RPC between the two groups at the last follow-up ( P>0.05). There were two cases with side effects and one case was discontinued due to side effects 25 days after enrollment. Conclusions:Oral anisodine hydrobromide can improve visual acuity and visual field in NAION and accelerate the regression of optic disc edema, with good safety.

OBJECTIVE To analyze the public participation mechanism of National Institute for Health and Care Excellence （NICE） health technology assessment in England and to provide experience for the dynamic adjustment of Chinese medical insurance catalog. METHODS By retrieving related literature and official websites， types and mechanisms of public participation （management organization， selection method， participation mode， evaluation feedback） in NICE health technology assessment were analyzed comprehensively； and based on this， suggestions were put forward to adjust the public participation in Chinese medical insurance catalog. RESULTS & CONCLUSIONS The current public participation types of NICE health technology assessment were patient and carer organizations， HTA committee lay members， patient expert and public observers. At the management level， NICE has set up a public participation team and made guidelines on public participation matters. For different public participation types， NICE has established different selection procedures， such as expression of interest， NICE invitation， open recruitment， nomination， NICE decision， etc. The public participation types are various and in the whole assessing process from the initial determination of the scope of the health technology assessment to the final appeal. Also， NICE has established a flexible and dynamic evaluation feedback system to optimize the way of public participation and the health technology assessment process； NICE has undertaken extensive international cooperation and exchanges to promote public participation at the national and international levels. It is suggested that our country should combine the national conditions， clarify the channel of public participation in health technology evaluation， set up a working group of public participation affairs， strengthen patients’ participation in evaluation and feedback， improve decision-making transparency， and improve the public participation mechanism of health technology evaluation from the aspects of channel opening， management mechanism， evaluation feedback， information disclosure and so on.

BACKGROUND: The phenotype maintenance of diced cartilage is a very important factor to reduce cartilage absorption rate in augmentation rhinoplasty. A novel method which combined diced cartilage with chondrocyte spheroids in gelatin methacrylate (GelMA) hydrogel may have potentially good performance in phenotype maintenance, and is worth exploring. METHODS: The complex grafts formed by loading diced cartilage with chondrocyte spheroids into GelMA hydrogel were used as the experimental group, and the grafts formed of diced cartilage in GelMA were used as the control group.The two groups of grafts were implanted subcutaneously in nude mice. After 1 month and 3 months, the grafts were taken for general observation and histological analysis. The diameter changes of cartilage, the nuclei loss of chondrocyte, and glycosaminoglycan secretion were analyzed. RESULTS: Chondrocyte spheroids with obvious proliferation can be seen in the experimental group. Some diced cartilages had become a whole through the interconnection of chondrocyte spheroids. In addition, the diameter of the chondrocyte spheroids—diced cartilage complex in the experimental group increased significantly, and its nuclei loss rate was less than 1/2 of that in the control group. The maintenance of proteoglycans in diced cartilages in the experimental group was significantly better than that in the control group. CONCLUSION The combination of diced cartilage with chondrocyte spheroids in GelMA hydrogel can significantly reduce the absorption of cartilage extracellular matrix, enhance phenotype maintenance during subcutaneous ectopic implantation, and can produce inter-chondral connections.

Objective To observe the influence of the staining phenomenon after fluorescein sodium staining on eye irritation in normal rabbits.MethodsIn the experimental rabbit eye irritation test conducted with sodium chloride eye drops, Siwei Zhenceng Bingpeng eye drops, sodium hyaluronate eye drops, sodium cromoglycate eye drops, and compound aspartate eye drops (4 in each group, half male and half female), the left eyes of rabbits were administered normal saline (self-negative control) and the right eyes were administered the experimental medicine; the eyes were stained with 1% sodium fluorescein, and eye irritation was observed and scored using slit lamp microscope for 31 days. Morphological changes of corneal epithelial staining were recorded and the incidence of staining was calculated. After the observation, the eyeballs and Hasselblad glands were examined histopathologically, and the staining rate of the left eye was compared with that of the right eye which was administered the corresponding medicine.ResultsNeither eye had any irritation symptoms; the scores were 0, and the total incidences of corneal staining were 3% (left) and 1% (right), respectively. There was no significant difference between the two groups (P > 0.05). Corneal epithelial staining showed single-spot staining, scattered dot, localized, or large areas of fusion staining. No histopathological changes were found in the eyeballs or Hasselblad glands, and the results were evaluated as non-irritative.Conclusion The irregularity of corneal epithelial staining in rabbits did not influence the results of the ocular irritation test.

Objective:To investigate the changes of the zygoma, circumzygomatic sutures, and zygomatic arch in children after trans-sutural distraction osteogenesis (TSDO).Methods:A retrospective analysis was performed on skull CT data of cleft lip and palate patients who underwent TSDO to correct midfacial hypoplasia between 2005 and 2019 in Peking University Third Hospital. The Mimics 20.0 software was used for three-dimensional(3D) model reconstruction to observe the morphological changes of the zygoma, circumzygomatic sutures, and zygomatic arch at the end of the traction period after TSDO. Measurements were taken and analyzed for the distances from mp point to 3D reference planes, zygoma height, zygoma width 1, zygoma width 2, zygoma thickness, zygoma volume, zygomaticomaxillary suture width, zygomaticotemporal suture width, zygomaticofrontal suture width, zygomatic arch length, and distances from zygomatic arch landmarks (tp point, zy point, and ju point) to the 3D reference planes. All data were divided into cleft and non-cleft sides. GraphPad Prism 9.4.1 software was used to analyze the changes before and after TSDO. Measurement data of normal distribution was expressed by ± s and the comparison between groups before and after traction was analyzed by paired t-test. Measurement data of non-normal distribution was expressed by M(IQR) and the comparison between groups before and after traction was analyzed by paired Wilcoxon test. If P<0.05, the difference was statistically significant. Results:A total of 27 patients were included in the study, including 23 males and 4 females, with a mean age of (11.19±2.35) years (5-15 years). Of these patients, 10 had bilateral cleft lip and palate, and 17 had unilateral cleft lip and palate (9 on the left side and 8 on the right side). The average traction period was (40.26±11.43) days. The midfacial depression of the patients was corrected after TSDO, and the zygoma grew forward, downward, and horizontally. The circumzygomatic sutures shifted forward. The zygomatic arch showed forward and downward growth. The measurements of zygoma showed that the mp point moved forward by (7.82±3.95) mm on the cleft side and 4.26(5.72) mm on the non-cleft side with statistical differences ( P<0.05). The mp point moved slightly downward, and outward after TSDO compared to before surgery, and these differences were statistically significant ( P<0.05). After TSDO, the zygoma height, width, and volume were all increased compared to preoperative levels, and these differences were statistically significant ( P<0.05). The width of the lower part of the zygomatic bone showed the most significant change, increasing by 4.33(5.17) mm on the cleft side and (3.42±2.67) mm on the non-cleft side and these differences were statistically significant ( P<0.05). There was no statistically significant difference in the thickness of the zygoma after TSDO compared to before surgery ( P>0.05). The widths of circumzygomatic sutures were all increased after TSDO compared to before surgery, and these differences were statistically significant ( P<0.05). The width of zygomaticofrontal suture showed the greatest increase and the width of zygomaticomaxillary suture showed the smallest increase. The length of the zygomatic arch increased after TSDO compared to before surgery, with an increase of (4.78±2.71) mm on the cleft side and (2.03±1.48) mm on the non-cleft side, and these differences were statistically significant ( P<0.05). There was no statistically significant difference in the position of the tp point after TSDO compared to before surgery ( P>0.05), while the position of the zy point and the ju point moved significantly forward and downward, and these differences were statistically significant ( P<0.05). In the horizontal direction, there was no statistically significant difference in the position of the zy point and ju point after TSDO compared to before surgery ( P>0.05). Conclusion:After TSDO, the zygoma shows three-dimensional growth with significant increases in height, width, and volume. The position of zygoma moves forward, downward, and outward. The circumzygomatic sutures widen due to the distraction force, and the zygomatic arch grows forward and downward, with an increase in length.

Objective:To investigate the changes of the zygoma, circumzygomatic sutures, and zygomatic arch in children after trans-sutural distraction osteogenesis (TSDO).Methods:A retrospective analysis was performed on skull CT data of cleft lip and palate patients who underwent TSDO to correct midfacial hypoplasia between 2005 and 2019 in Peking University Third Hospital. The Mimics 20.0 software was used for three-dimensional(3D) model reconstruction to observe the morphological changes of the zygoma, circumzygomatic sutures, and zygomatic arch at the end of the traction period after TSDO. Measurements were taken and analyzed for the distances from mp point to 3D reference planes, zygoma height, zygoma width 1, zygoma width 2, zygoma thickness, zygoma volume, zygomaticomaxillary suture width, zygomaticotemporal suture width, zygomaticofrontal suture width, zygomatic arch length, and distances from zygomatic arch landmarks (tp point, zy point, and ju point) to the 3D reference planes. All data were divided into cleft and non-cleft sides. GraphPad Prism 9.4.1 software was used to analyze the changes before and after TSDO. Measurement data of normal distribution was expressed by ± s and the comparison between groups before and after traction was analyzed by paired t-test. Measurement data of non-normal distribution was expressed by M(IQR) and the comparison between groups before and after traction was analyzed by paired Wilcoxon test. If P<0.05, the difference was statistically significant. Results:A total of 27 patients were included in the study, including 23 males and 4 females, with a mean age of (11.19±2.35) years (5-15 years). Of these patients, 10 had bilateral cleft lip and palate, and 17 had unilateral cleft lip and palate (9 on the left side and 8 on the right side). The average traction period was (40.26±11.43) days. The midfacial depression of the patients was corrected after TSDO, and the zygoma grew forward, downward, and horizontally. The circumzygomatic sutures shifted forward. The zygomatic arch showed forward and downward growth. The measurements of zygoma showed that the mp point moved forward by (7.82±3.95) mm on the cleft side and 4.26(5.72) mm on the non-cleft side with statistical differences ( P<0.05). The mp point moved slightly downward, and outward after TSDO compared to before surgery, and these differences were statistically significant ( P<0.05). After TSDO, the zygoma height, width, and volume were all increased compared to preoperative levels, and these differences were statistically significant ( P<0.05). The width of the lower part of the zygomatic bone showed the most significant change, increasing by 4.33(5.17) mm on the cleft side and (3.42±2.67) mm on the non-cleft side and these differences were statistically significant ( P<0.05). There was no statistically significant difference in the thickness of the zygoma after TSDO compared to before surgery ( P>0.05). The widths of circumzygomatic sutures were all increased after TSDO compared to before surgery, and these differences were statistically significant ( P<0.05). The width of zygomaticofrontal suture showed the greatest increase and the width of zygomaticomaxillary suture showed the smallest increase. The length of the zygomatic arch increased after TSDO compared to before surgery, with an increase of (4.78±2.71) mm on the cleft side and (2.03±1.48) mm on the non-cleft side, and these differences were statistically significant ( P<0.05). There was no statistically significant difference in the position of the tp point after TSDO compared to before surgery ( P>0.05), while the position of the zy point and the ju point moved significantly forward and downward, and these differences were statistically significant ( P<0.05). In the horizontal direction, there was no statistically significant difference in the position of the zy point and ju point after TSDO compared to before surgery ( P>0.05). Conclusion:After TSDO, the zygoma shows three-dimensional growth with significant increases in height, width, and volume. The position of zygoma moves forward, downward, and outward. The circumzygomatic sutures widen due to the distraction force, and the zygomatic arch grows forward and downward, with an increase in length.