Objective:To observe the effect of rehabilitative exercise on knee function after anterior cruciate ligament (ACL) reconstruction.Methods:Fifty-eight patients with a reconstructed ACL were divided at random into a control group of 28 and an experimental group of 30. In addition to conventional basic treatment, the control group received routine orthopedic rehabilitation training, while the experimental group underwent exercise-based rehabilitation training 6 days a week for 6 weeks. Before and after the treatment, the efficacy in both groups was evaluated using Lysholm knee scoring (LKSS), numerical pain scoring (NRS), maximum knee flexion angle, and a thigh muscle atrophy index.Results:Both groups had significantly higher LKSS scores, lower NRS scores, larger maximum knee flexion angles, and increased thigh muscle atrophy indices, on average, after their treatments. Compared with the control group, the experimental group tended to have significantly higher LKSS scores, larger maximum knee flexion angles, and lower thigh muscle atrophy indices after the treatment. There was, however, no significant difference between the groups in their average NRS scores.Conclusions:Exercise-based rehabilitation training significantly improves the knee function of patients after ACL reconstruction, and its efficacy is superior to conventional orthopedic rehabilitation training.

Objective:To observe the effect of rehabilitative exercise on knee function after anterior cruciate ligament (ACL) reconstruction.Methods:Fifty-eight patients with a reconstructed ACL were divided at random into a control group of 28 and an experimental group of 30. In addition to conventional basic treatment, the control group received routine orthopedic rehabilitation training, while the experimental group underwent exercise-based rehabilitation training 6 days a week for 6 weeks. Before and after the treatment, the efficacy in both groups was evaluated using Lysholm knee scoring (LKSS), numerical pain scoring (NRS), maximum knee flexion angle, and a thigh muscle atrophy index.Results:Both groups had significantly higher LKSS scores, lower NRS scores, larger maximum knee flexion angles, and increased thigh muscle atrophy indices, on average, after their treatments. Compared with the control group, the experimental group tended to have significantly higher LKSS scores, larger maximum knee flexion angles, and lower thigh muscle atrophy indices after the treatment. There was, however, no significant difference between the groups in their average NRS scores.Conclusions:Exercise-based rehabilitation training significantly improves the knee function of patients after ACL reconstruction, and its efficacy is superior to conventional orthopedic rehabilitation training.

Objective:To understand intensive care unit(ICU)doctors'opinions and suggestions on implementing palliative care,and provides a reference basis for the implementation of palliative care in Chinese ICU.Methods:A purposive sampling technique was used to conduct one-on-one semi-structured interviews with 11 ICU doctors.Colaizzi's phenomenological analysis method was utilized to code,classify,interpret,and comprehensively analyze the interview data.Results:A total of 4 themes and 18 sub-themes was extracted,including cognitive biases toward palliative care,the belief that implementing palliative care in the ICU has significant humanistic implications(palliative care practice is the most perfect embodiment of medical humanities,palliative care in the ICU can alleviate patient pain and reduce invasive operations,palliative care can achieve comfortable care for ICU patients,palliative care focuses on maintaining the dignity of ICU patients,palliative care can pay attention to the inner voice of ICU patients,and implementing palliative care will help to more effectively allocate resources),difficulties faced by ICU in carrying out palliative care(lack of clarity in relevant policies at the legal level,closed management environment in the ICU,insufficient manpower in the ICU and lack of palliative care professional team,inadequate understanding of ICU patients'families,lack of death education,not included in medical insurance payments,and lack of communication skills of young doctors),strategies to promote the development of palliative care in the ICU(ICU palliative care can be piloted first,the development of ICU palliative care screening tools will help with the development of palliative care,the palliative environment and the handling of death procedures can be further optimized,and the application and implementation of scientific methods to shorten the gap between evidence and practice of palliative care).Conclusions:The integration of palliative care and ICU in China is still blank.The significance of implementing palliative care in ICU should be emphasized,ICU doctors'knowledge and skills of palliative care should be improved from multiple perspectives,patient preference should be emphasized to improve the knowledge and acceptance of palliative care of ICU patients'families,and the promotion of palliative care in ICU clinical practice should be pioneered and piloted.

Objective:To analyze the genetic evolution and molecular characteristics of H7N9 avian influenza virus (AIV) isolated in a live poultry market.Methods:Samples such as poultry feces, sewage, and hair removal machine and chopping board swabs were collected. Real-time fluorescent quantitative PCR was used to detect influenza A virus and H7N9 AIV in the samples. The whole genome of H7N9 AIV was amplified with influenza A virus universal primers and sequenced. BLAST and MEGA X were used for sequence alignment, phylogenetic analysis and molecular characterization.Results:Seven poultry-related environment samples were collected in the live poultry market in Xuchang city in February 2023, and four were positive for H7N9 AIV. The whole genome sequences of three H7N9 AIV isolates were successfully obtained, and the isolates shared high nucleotide identity in different genes (98.37%-100.00%). BLAST analysis showed they were highly identical to H7N9 strains isolated from domestic poultry in China from 2020 to 2021. Genetic evolution analysis showed that the three isolates clustered in the same branch and were closer to the recent environmental isolates than to the recent strains isolated from human or avian. Through comparison with the sequences of the representative strains in different periods, it was found that the isolated strains in this study showed high avian pathogenicity with four amino acids KRAA inserted at the cleavage site; the hemagglutinin receptor-binding site was QSG, which was an avian binding receptor; there was a G186I mutation in hemagglutinin. Mammalian-adaptive mutation E627K was not detected in polymerase basic protein 2. Mutations (R292K and I38T) associated with drug resistance to neuraminidase inhibitor (oseltamivir) and polymerase acidic protein inhibitor (baloshavir) were not detected, suggesting that these isolates remained susceptible to these drugs. A S31N mutation was found in M2 protein, indicating they were resistant to alkamines.Conclusions:The three H7N9 AIV strains isolated in the live poultry market have high avian pathogenicity, but there are no significant increase in mutations related to the binding ability to human receptors, mammalian pathogenicity, viral transmissibility, or drug resistance as compared with previous representative strains causing human or avian infection.

Objective:To observe the impact of core stability training in the sling exercise therapy pattern on the balance of stroke survivors.Methods:Sixty stroke survivors were randomly divided into a control group ( n=30) and an experimental group ( n=30). In addition to routine rehabilitation training, the control group received traditional core stability training, while the experimental group underwent core stability training applying the sling exercise therapy pattern. Before and after 4 weeks of training, the standing balance of both groups was evaluated using the Prokin balance trainer, with the length and area of motion recorded when performing the balance test with the eyes open and closed. Surface electromyography was used to record the average EMG (AEMG) values of the bilateral erector spinae and multifidus muscles during the balance testing. Results:After the 4 weeks of training the length and the area of progression of the center of the pressure were both significantly smaller for both groups than before the training with the eyes both open and closed. The average length and area in the experimental group were significantly less than among the controls. The AEMG values recorded during the balance tests were significantly higher than those before the intervention for both groups, with the multifidus muscle averages on the affected side significantly greater in the experimental group than among the controls when performing the balance test with the eyes closed.Conclusion:Core stability training in the sling exercise therapy pattern is superior to conventional core stability training because it can better improve the balance of stroke survivors.

OBJECTIVES: This study aims to investigate the genome-wide DNA methylation and transcriptome expression profiles of peripheral blood mononuclear cells (PBMCs) in patients with systemic sclerosis (SSc) with interstitial lung disease (ILD), and to analyze the effects of DNA methylation on Wnt/β-catenin and chemokine signaling pathways. METHODS: PBMCs were collected from 19 patients with SSc (SSc group) and 18 healthy persons (control group). Among SSc patients, there were 10 patients with ILD (SSc with ILD subgroup) and 9 patients without ILD (SSc without ILD subgroup). The genome-wide DNA methylation and gene expression level were analyzed by using Illumina 450K methylation chip and Illumina HT-12 v4.0 gene expression profiling chip. The effect of DNA methylation on Wnt/β-catenin and chemokine signal pathways was investigated. RESULTS: Genome-wide DNA methylation analysis identified 71 hypermethylated CpG sites and 98 hypomethylated CpG sites in the SSc with ILD subgroup compared with the SSc without ILD subgroup. Transcriptome analysis distinguished 164 upregulated genes and 191 downregulated genes in the SSc with ILD subgroup as compared with the SSc without ILD subgroup. In PBMCs of the SSc group, 35 genes in Wnt/β-catenin signaling pathway were hypomethylated, while frizzled-1 (FZD1), mitogen-activated protein kinase 9 (MAPK9), mothers against DPP homolog 2 (SMAD2), transcription factor 7-like 2 (TCF7L2), and wingless-type MMTV integration site family, member 5B (WNT5B) mRNA expressions were upregulated as compared with the control group (all P<0.05). Compared with the SSc without ILD subgroup, the mRNA expressions of dickkopf homolog 2 (DKK2), FZD1, MAPK9 were upregulated in the SSc with ILD subgroup, but the differences were not statistically significant (all P>0.05). In PBMCs of the SSc group, 38 genes in chemokine signaling pathway were hypomethylated, while β-arrestin 1 (ARRB1), C-X-C motif chemokine ligand 10 (CXCL10), C-X-C motif chemokine ligand 16 (CXCL16), FGR, and neutrophil cytosolic factor 1C (NCF1C) mRNA expressions were upregulated as compared with the control group (all P<0.05). Compared with the SSc without ILD subgroup, the mRNA expressions of ARRB1, CXCL10, CXCL16 were upregulated in the SSc with ILD subgroup, but the differences were not statistically significant (all P>0.05). CONCLUSIONS There are differences in DNA methylation and transcriptome profiles between SSc with ILD and SSc without ILD. The expression levels of multiple genes in Wnt/β- catenin and chemokine signaling pathways are upregulated, which might be associatea with the pathogenesis of SSc.
Humans ; DNA Methylation ; Transcriptome ; beta Catenin ; Leukocytes, Mononuclear ; Ligands ; DNA ; RNA, Messenger/genetics*

Objective:To investigate the relationship between niacin skin reaction sensitivity and cognitive function by comparing the difference of niacin skin flushing response and cognitive function between the patients with depression and the normal control group.Method:A cross-sectional study was conducted to recruit 40 patients with depression who met the diagnostic criteria of DSM-Ⅳ (American Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition) at The Second People′s Hospital of Zhumadian from July 2018 to August 2019. In the meanwhile, 32 gender-and-education-matched patients were recruited and allocated into the control group. General demographic and clinical data were collected. Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) was used to test individual′s cognitive functions. A Swedish laser Doppler blood flow meter, PeriFlux 5000, was used to test the skin flushing reaction of forearm niacin at eight concentrations (10 -5 mol/L, 10 -4 mol/L, 10 -3.5 mol/L, 10 -3 mol/L, 10 -2.5 mol/L, 10 -2 mol/L, 10 -1.5 mol/L, and 10 -1 mol/L) gradient. The difference of blood flow values in 8 concentration gradients between the two groups was analyzed by repeated measurement multiple comparison and simple effect. The MBF value and LogEC50 were analyzed by non-parametric test. Spearman rank correlation analysis was used to analyze the correlation between LogEC50 and cognitive function scores. Result:In the skin flushing reaction of niacin test, when the concentration of niacin solution was 10 -3.5 mol/L and 10 -3mol/L, there was a significant difference in Blood Flow (BF) between patients with depression and normal subjects ( t=-0.490,-4.626, P<0.01, respectively). The BF value of the normal control group was higher than that of depressed patients. LogEC50 was significantly different between the two groups ( t=4.196, P<0.01). LogEC50 of the normal control group (-3.513±0.848) was lower than that of the depression group (-2.776±0.568). The difference in RBANS between the two groups was tested by independent sample t test. Compared with the normal control group, the scores of the depressed group were significantly lower on the test of list learning ( t=-2.127, P=0.037), coding test ( t=-3.226, P=0, 002), list recall ( t=-3.697, P<0.01), story recall ( t=-2.687, P=0.009), and figure recall ( t=-2.660, P=0.010). There was a negative correlation between list recall ( r=-0.407, P=0.032), story recall ( r=-0.376, P=0.049) and figure recall ( r=-0.455, P=0.015) in the depression group. Maximal blood flow (MBF) was positively correlated with figure copying ( r=0.428, P=0.023). Conclusion:The niacin sensitivity and the score of cognitive function of depression patients are lower than those of the normal control group, and the decrease of cognitive function of depression patients may be related to the disorder of phospholipase A2 (PLA2) signaling pathway.

Objective:To investigate the clinical characteristics of Guillain-Barré syndrome (GBS) combined with hyponatremia in Southern China and its risk factors for prognosis.Methods:The retrospective cohort study involved patients who met the diagnostic criteria of GBS from 18 upper first-class hospitals of 6 provinces/cities in southern China (south of Huaihe River) from January 1, 2013 to September 30, 2016. The clinical data of these patients were collected. According to serum sodium levels, they were divided into hyponatremia group (serum sodium concentration<135 mmol/L) and normal serum sodium group (serum sodium concentrations≥135 mmol/L). Based on Medical Research Coucil sum scores at nadir, these patients were divided into mild GBS group (>40), moderate GBS group (30-40), and severe GBS group (<30). Furthermore, according to the Hughes GBS disability scale (H-GBS-DS) scores at discharge, these GBS patients with hyponatremia were divided into favorable prognosis group (H-GBS-DS<3) and poor prognosis group (H-GBS-DS≥3). The incidence of hyponatremia in patients from the mild GBS group, moderate GBS group, and severe GBS group were compared. Multivariate Logistic regression analysis was performed to determine the clinical risk factors for hyponatremia in GBS patients. The clinical data of hyponatremia patients from favorable prognosis group and poor prognosis group were compared; multivariate Logistic regression analysis was used to determine the risk factors for poor prognosis in GBS patients with hyponatremia.Results:(1) Among the 570 patients, 354 had mild GBS, 94 had moderate GBS, and 122 had severe GBS; 134 GBS patients were combined with hyponatremia, 436 GBS patients had normal serum sodium. The hyponatremia incidence in mild, moderate and severe GBS groups increased successively, ( P<0.05). Multivariate Logistic regression analysis showed that facial paralysis ( OR=1.979, 95%CI: 1.172-3.342, P=0.011), respiratory muscle paralysis ( OR=3.218, 95%CI: 1.611-6.428, P=0.001), secondary pulmonary infection ( OR=4.822, 95%CI: 2.835-8.201, P=0.000), severe GBS ( OR=2.611, 95%CI: 1.444-4.721, P=0.001) and length of hospital stay ( OR=1.029, 95%CI: 1.009-1.050, P=0.004) were risk factors for hyponatremia in GBS patients. (2) Among 134 GBS patients with hyponatremia, 80 had poor prognosis and 54 had favorable prognosis. As compared with the favorable group, the poor prognosis group had significantly lower proportion of patients with extraocular muscle paralysis, statistically higher proportions of patients with respiratory muscle paralysis and secondary pulmonary infection, significantly different severities of GBS, signficantly higher proportion of patients accepted intravenous immunoglobulin (IVIG) and hormone treatments, statistically longer length of hospital stay ( P<0.05). Respiratory muscle paralysis ( OR=25.590, 95%CI: 9.433-69.423, P=0.000), moderate GBS ( OR=17.030, 95%CI: 8.441-34.361, P=0.000), and severe GBS ( OR=51.042, 95%CI: 24.596-105.926, P=0.000) were independent risk factors for poor short-term prognosis of GBS patients with hyponatremia. Conclusions:Severe GBS patients with facial paralysis, respiratory muscle palsy, secondary pulmonary infection, and long hospital stay trend to have hyponatremia. Hyponatremia patients with respiratory muscle paralysis and moderate/severe GBS have poor short-term prognosis.

Objective:To investigate the relationship between niacin skin reaction sensitivity and cognitive function by comparing the difference of niacin skin flushing response and cognitive function between the patients with depression and the normal control group.Method:A cross-sectional study was conducted to recruit 40 patients with depression who met the diagnostic criteria of DSM-Ⅳ (American Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition) at The Second People′s Hospital of Zhumadian from July 2018 to August 2019. In the meanwhile, 32 gender-and-education-matched patients were recruited and allocated into the control group. General demographic and clinical data were collected. Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) was used to test individual′s cognitive functions. A Swedish laser Doppler blood flow meter, PeriFlux 5000, was used to test the skin flushing reaction of forearm niacin at eight concentrations (10 -5 mol/L, 10 -4 mol/L, 10 -3.5 mol/L, 10 -3 mol/L, 10 -2.5 mol/L, 10 -2 mol/L, 10 -1.5 mol/L, and 10 -1 mol/L) gradient. The difference of blood flow values in 8 concentration gradients between the two groups was analyzed by repeated measurement multiple comparison and simple effect. The MBF value and LogEC50 were analyzed by non-parametric test. Spearman rank correlation analysis was used to analyze the correlation between LogEC50 and cognitive function scores. Result:In the skin flushing reaction of niacin test, when the concentration of niacin solution was 10 -3.5 mol/L and 10 -3mol/L, there was a significant difference in Blood Flow (BF) between patients with depression and normal subjects ( t=-0.490,-4.626, P<0.01, respectively). The BF value of the normal control group was higher than that of depressed patients. LogEC50 was significantly different between the two groups ( t=4.196, P<0.01). LogEC50 of the normal control group (-3.513±0.848) was lower than that of the depression group (-2.776±0.568). The difference in RBANS between the two groups was tested by independent sample t test. Compared with the normal control group, the scores of the depressed group were significantly lower on the test of list learning ( t=-2.127, P=0.037), coding test ( t=-3.226, P=0, 002), list recall ( t=-3.697, P<0.01), story recall ( t=-2.687, P=0.009), and figure recall ( t=-2.660, P=0.010). There was a negative correlation between list recall ( r=-0.407, P=0.032), story recall ( r=-0.376, P=0.049) and figure recall ( r=-0.455, P=0.015) in the depression group. Maximal blood flow (MBF) was positively correlated with figure copying ( r=0.428, P=0.023). Conclusion:The niacin sensitivity and the score of cognitive function of depression patients are lower than those of the normal control group, and the decrease of cognitive function of depression patients may be related to the disorder of phospholipase A2 (PLA2) signaling pathway.

Objective To reveal the early elastic dysfunction of common carotid artery may have occurred in systemic lupus erythematosus( SLE) patients ,the circumferential strain parameters of common carotid artery intima in SLE patients at different serum complement levels were quantitatively evaluated by layer-specific strain imaging . Methods Seventy-two patients suffered from SLE without evidence of atherosclerosis were enrolled ,and the results of laboratory examination of serum complement C 3 in patients with SLE were recorded in detail ,49 cases of SLE patients whose serum C3 was lower than the normal reference range(SLE C3+ group) ,23 cases of SLE patients whose serum C3 was in the range of normal reference value(SLE C3 - group) . And a matched healthy control group ( n =38) were selected . Carotid ultrasound were performed in all three groups ,and the common carotid artery conventional parameters ,such as common carotid artery intima-media thickness ( CCA-IM T ) ,peak systolic velocity ( PSV ) ,end-diastolic velocity(EDV) ,resistance index(RI) and circumferential strain related parameters ,such as circumferential strain of common carotid artery intima(CSendo) and circumferential strain rate(CSr) were measured and derived.Therelatedparametersamongthosegroupswerecomparedfordifference.Results ①Therewas no significant difference in RI among the three groups(all P >0 .05) . The values of CCA-IMT in the SLE C3+ group and SLE C3- group were larger than that in the control group( all P <0 .05) . ②The values of CSendo and CSr in the SLE C3+ group and SLE C3 - group were lower than those in the control group ,the values of SLE C3+ group were significantly lower than those in the control group ( P <0 .001) ,and there was no significant difference between the SLE C3- group and control group( P >0 .05) . ③The CSendo and CSr in the SLE C3+ group were lower than those in the SLE C3- group(all P < 0 .05) . Conclusions CSendo which is provided by new ultrasonic technology of layer-specific strain combined with recent changes in serum complement C3 may provide visual evidence for assessing early elastic disfunction of carotid intima in SLE patients .