Design of a Novel Variable-Diameter Cortical Threaded Screw and its Application in Improving Cortical Bone Trajectory in Lumbar Spine / 医用生物力学

Objective A novel variable-diameter cortical threaded screw used in a modified cortical bone trajectory(MCBT)was designed to verify its mechanical properties using the MCBT technique.Methods According to MCBT technology,the screw pitch was fixed at 2 mm,the total length was 45 mm,the diameter of the thick rod was 5.5 mm,the diameter of the thin rod was 4.0-4.5 mm,and the length of variable-diameter position connecting the thick rod and the thin rod was 2 mm.The parameters were set based on three aspects:variable-diameter position,thread depth,and thread type.Three-factor and three-level L9 tests were conducted and screw models were established.The torsion and the bending and pull-out force of the designed screws were calculated based on the finite element method,the results were analyzed using range analysis,and then the screw models were determined.The three-dimensional(3D)model of L4 vertebral body in osteoporosis specimens was established and screws were placed according to the MCBT technique.The pull-out force of the novel variable-diameter cortical threaded screw was compared with that of a conventional non-variable-diameter cortical threaded screw.Results Range analysis showed that screw No.6(variable-diameter position:24 mm from the screw head,thread depth:0.7 mm,45° symmetrical thread)was the optimal screw.The anti-pull-out force of the No.6 variable-diameter cortical threaded screw was 13.1%higher than that of the 4.5 mm conventional non-variable-diameter cortical threaded screw,and no statistical difference in anti-pull-out force was found between the No.6 variable-diameter cortical threaded screw and the 5.5 mm conventional non-variable-diameter cortical threaded screw.Conclusions The variable-diameter position has the smallest influence on pull-out force of the screw,the thread type has the largest influence on pull-out force,and the thread depth has the largest influence on torsion and bending.Compared with that of the conventional non-variable-diameter cortical threaded screw,the variable-diameter cortical threaded screw had a smaller front end,which prevented splitting at the entrance point of the screw.The screw has a large diameter at rear end,thereby showing improved pull-out performance.The results provide a new theoretical basis for the clinical application of MCBT technology.

Disease trajectory research in critical illness: applications, examples, and prospects / 中华危重病急救医学

Trajectories refer to the motion paths followed by objects in space. Disease trajectories, which depict the evolution of disease processes over time, are significantly important for assessing diseases, formulating treatment strategies, and predicting prognosis. Critical illness is one of the leading causes of death. With advances in critical care medicine, there is increasing focus on the occurrence and development of critical illnesses. Understanding the development trajectory of critical illness is helpful to promote the early identification, intervention, and treatment of high-risk patients, avoid prolongation of the course of disease, reduce the risk of multiple organ failure, and provide important reference for the development of targeted prevention and intervention strategies, thereby reducing the incidence and mortality of critical illness. In recent years, various trajectory modeling methods have been applied to the study of critical illness. These include, but are not limited to, latent growth curve modeling (LGCM), growth mixture modeling (GMM), group-based trajectory modeling (GBTM), latent transition analysis (LTA), and latent class analysis (LCA). The aim of this article is to review the definition of disease trajectories, the methods used in trajectory modeling, and their applications and future prospects in critical illness research.

Development trajectories and influencing factors of self-neglect behavior in older adults / 中华行为医学与脑科学杂志

Objective:To identify the development trajectories of self-neglect behavior in older adults and explore the associated influencing factors.Methods:A fixed cohort was constructed based on the data from three surveys of Chinese longitudinal healthy longevity survey (CLHLS) from 2011 to 2018. A total of eight variables from 4 dimensions including living environment, lifestyle, social interaction, and health care were selected to evaluate self-neglect. Group-based trajectory model was used to identify the development trajectory of self-neglect behavior in the older adults, and polynomial Logistic regression model was used to explore its influencing factors by Stata 16.1.Results:Finally, 2 754 older adults aged 60 and above were included.The development trajectory of self-neglect behavior in older adults, based on the group-based trajectory model, can be classified into stable-low group ( n=268, 9.7%), descending-moderate group ( n=2 224, 80.8%), and decreasing-high group ( n=262, 9.5%). Polynomial Logistic regression showed that, compared with stable-low group, living in rural areas ( B=1.116, OR=3.053, 95% CI= 2.278-4.091) and higher activities of daily living scores( B=0.137, OR=1.147, 95% CI=1.046-1.258) were the risk factors of descending-moderate group. Education levels with 1-6 years( B=-0.398, OR=0.672, 95% CI=0.469-0.963), >6 years( B=-1.072, OR=0.342, 95% CI=0.229-0.513), being married( B=-0.476, OR=0.621, 95% CI=0.444-0.870), self-reported good health( B=-0.808, OR=0.446, 95% CI= 0.213-0.932), improved health status( B=-0.704, OR=0.495, 95% CI=0.320-0.766), self-reported average economic status( B=-1.065, OR=0.345, 95% CI=0.148-0.802), self-reported good economic status( B=-1.634, OR=0.195, 95% CI=0.082-0.467), and a higher cognition score( B=-0.142, OR=0.867, 95% CI=0.798-0.942) served as protective factors of descending-moderate group. In addition to the above factors, being in the age group of 75-89 years( B=0.481, OR=1.617, 95% CI=1.057-2.473) was a risk factor for decreasing-high group compared to stable-low group. Conclusions:Three types of self-neglect behavior trajectories among older adults were identified in this study, suggesting that physical health and economy are the influencing factors of the development trajectory of self-neglect of the elderly.

Robot foot trajectory planning based on central pattern generator / 中国医学物理学杂志

A foot trajectory control method is proposed for biomimetic robot.Compared with traditional methods,the method uses a single CPG neuron to directly apply the foot trajectory generated by the oscillator to the hexapod robot.The joint angles is solved reversely for realizing the rhythmic foot swing,thereby achieving lateral walking.The step distance and step amplitude in foot trajectory,and the forward and backward swing trajectories during the swing phase can be adjusted by setting the load factor,period,amplitude and other parameters in the CPG oscillator.The feasibility of applying the improved Hopf model to foot trajectory is verified through the joint simulation using Matlab and Coppeliasim.Compared with traditional methods,the improved model has high flexibility in parameter adjustment and performs well in concurrency processing.

Research progress on environmental heavy metal exposure during pregnancy and children's physical development level and growth trajectory / 环境与职业医学

Low-level exposure to environmental heavy metals during pregnancy is common, and the effects of such exposure on the growth and development of the fetus may continue after birth. In this paper, we reviewed the epidemiological studies on heavy metal exposure during pregnancy and children's physical development at home and abroad in recent years, focusing on the associations between four common heavy metals, namely, cadmium, mercury, lead, and arsenic, and children's physical development levels and growth trajectories. The results of existing studies showed that cadmium and mercury exposure during pregnancy was associated with early childhood obesity, lead exposure during pregnancy may lead to dual effects of childhood obesity and growth retardation, and arsenic exposure during pregnancy was associated with childhood growth retardation. At the same time, cadmium and lead exposure during pregnancy had a more significant effect on boys, and there was a sex effect. Most studies of children's growth trajectory showed that exposure to cadmium, arsenic, and lead during pregnancy was often associated with lower childhood body mass index (BMI)/weight-for-age Z-score (WAZ) and height-for-age Z-score (HAZ) growth trajectories, even into adolescence, where the first trimester and the third trimester may be critical windows for cadmium and lead exposure, respectively. The results of mercury exposure during pregnancy associated with children's growth trajectories were controversial due to differences in methods for evaluating mercury exposure. In addition, there may be certain combined effects of mixed exposure to heavy metals during pregnancy on the physical growth and development of children. There is still a need to further elucidate the effects of single metal and multiple heavy metal interactions on children's physical development by combining population-based epidemiological studies with multiple sample sources and time points, and to strengthen basic research to broaden the new understanding of involved mechanisms.

Research progress in data processing methods of neuronal soma calcium imaging / 军事医学

The recording and analysis of activities of calcium signals in neurons is of critical importance in the field of neuroscience.Over the past three decades,various fluorescent calcium imaging techniques not only have been used in the imaging study of functional activities of neuronal communities,but also can be combined with specific markers to record the functional activities of specific types of neuronal communities.To analyze neural activities at the cellular level,a series of preprocessing such as motion correction,cell body recognition,calcium signal extraction and peak deconvolution is required for the collected video.However,current methods for manual preprocessing are time-consuming and laborious,so computer automatic analysis technology is urgently needed to quickly repair the jitter in the video,identify the position and outline of a single cell,extract its activity trajectory and infer the action potential peak.In this paper,the methods of calcium imaging data processing used in recent years are summarized,and the future developments are predicted.

Correlation between dynamic high-density lipoprotein trajectories and clinical outcomes in critically ill children / 中华实用儿科临床杂志

Objective:To characterize the longitudinal and dynamic high-density lipoprotein (HDL) trajectories in critically ill children and explore their correlation with clinical outcomes.Methods:Retrospective cohort study.All critically ill children admitted to the Pediatric Intensive Care Unit (PICU) of West China Hospital, Sichuan University from January 1, 2015 to October 1, 2020 were included in this retrospective study.Group-based trajectory modeling (GBTM) was applied to characterize the HDL trajectories in days 0-6 post-PICU admission and develop HDL trajectory groups.The in-hospital mortality rate was reported as frequency (%) and then compared by the Chi-square test or Fisher′s exact test between HDL trajectory groups.The length of stay (LOS) in the PICU was described by M( Q1, Q3), and its difference between HDL trajectory groups was evaluated by the Kruskal Wallis test.Logistic regression and multiple linear regression were used to determine the correlation between HDL trajectories and clinical outcomes.The primary outcome was in-hospital mortality rate, and the secondary outcome was LOS in the PICU. Results:A total of 4 384 critically ill children were ultimately enrolled in the study, and 6 HDL trajectory groups were developed based on GBTM analyses: group 1 (758 cases), the lowest HDL group; group 2 (1 413 cases), the low HDL group; group 3 (74 cases), the low-to-high HDL group; group 4 (621 cases), the medium HDL group; group 5 (1 371 cases), the high HDL group; and group 6 (147 cases), the highest HDL group.Logistic regression analysis showed that compared with critically ill children in group 1, those belonging to groups 2, 3, 4, 5, and 6 were at lower risks of in-hospital mortality with odds ratio ( OR): 0.475, 95%confidence interval ( CI): 0.352-0.641, P<0.001; OR: 0.093, 95% CI: 0.013-0.679, P=0.019; OR: 0.322, 95% CI: 0.208-0.479, P<0.001; OR: 0.263, 95% CI: 0.185-0.374, P<0.001, and OR: 0.142, 95% CI: 0.044-0.454, P=0.001, respectively.Multiple linear regression analysis revealed that compared with critically ill children in group 1, those belonging to groups 4, 5, and 6 had the trend of shorter LOS in PICU, and the β value and 95% CI were β: -4.332, 95% CI: -5.238- -3.426, P<0.001; β: -3.053, 95% CI: -3.809--2.297, P<0.001; β: -6.281, 95% CI: -7.842--4.721, P<0.001, respectively. Conclusions:The dynamic HDL trajectories during 0-6 days after PICU admission are associated with in-hospital mortality rate of critically ill children.The HDL trajectory at a persistently low level is associated with higher mortality, while the HDL trajectory at a persistently high level or with the trend from a low level rising to a high level shows a lower risk of mortality.It is suggested that the HDL trajectory model may become an indicator to predict the condition and prognosis of critically ill children.

Trajectories and influencing factors of post-traumatic stress disorder in women with multiple in vitro fertilization embryo transfer failures / 中国实用护理杂志

Objective:To explore the potential categories of post-traumatic stress disorder (PTSD) trajectories in women with multiple in vitro fertilization-embryo transfer (IVF-ET) failures, and to analyze the effects of different demographic characteristics and psychological factors on the potential categories of PTSD trajectories.Methods:This was a prospective empirical research, from May 2021 to October 2022, women with IVF-ET failure ≥ 2 times in the reproductive department of Shanghai First People′s Hospital from May 2021 to October 2022 were selected as the research objects. Post-traumatic stress disorder civilian version scale was used for 4 follow-ups at 3 d (T1), 10 d (T2), 20 d (T3) after the last transplantation failure and 3 d before the next transplantation cycle (T4). Telephone follow-up and online follow-up were combined to obtain the PTSD level at 4 time points. Potential categories of PTSD score trajectories at four time points were identified using a latent category growth model, and analyze influencing factors using unordered multi classification logistic analysis.Results:Totally 196 IVF-ET women were admitted, aged (29.42 ± 4.13) years. Three PTSD trajectories were fitted in this study, including 82 cases (42%) in non-PTSD group, 61 cases (31%) in mild PTSD group and 53 cases (27%) in elevated PTSD group. Logistic regression analysis showed that age, education level, fertility pressure and marital adjustment level were the predictors of PTSD trajectory in women with multiple IVF-ET failures. Compared with the non-PTSD group, women aged ≥35 years, with lower education level and marital adjustment level were more likely to enter the elevated PTSD group ( OR=4.570, 8.540, 0.949, all P<0.05). Women aged 35 years and with greater reproductive pressure were more likely to enter the mild PTSD group ( OR=3.871, 1.063, both P<0.05). Conclusions:There is group heterogeneity in the trajectories of PTSD in women with multiple IVF-ET failures in the next transplantation cycle. Old age, low education level, high fertility pressure and poor marital adjustment can predict the trajectories of PTSD. Fertility stress and marriage adjustment are changeable variables. Medical staff can relieve women′s fertility pressure through health education and mindfulness intervention, promote a good state of marriage adjustment, and minimize the adverse effects of PTSD on the next cycle of conception.

Mechanical analysis of cortical bone trajectory screw placement in lumbar revision / 中国组织工程研究

BACKGROUND:At present,there are shortcomings and risks in the surgical revision of vertebral bodies that failed to be fixed in clinical practice.To avoid the risks of conventional revision surgery,the cortical bone trajectory technique is used to perform revision surgery on vertebral bodies that failed to be fixed.However,the mechanical properties of cortical bone trajectory technique screws in revision surgery are not clear. OBJECTIVE:The mechanical properties of cortical bone trajectory in lumbar revision surgery were analyzed by the finite element method to provide a theoretical basis for the clinical application of cortical bone trajectory in revision surgery. METHODS:CT scan data of the osteoporotic vertebral body were obtained and the L4 vertebral body model was established.The initial cortical bone trajectory placement and traditional pedicle screw in the L4 vertebral body model were completed,respectively,and their mechanical data were taken as the baseline standard for later evaluation of revision surgical performance.The traditional pedicle screw was removed and the screw path was retained.The cortical bone trajectory screw was used for secondary screw placement on the vertebral body to achieve lumbar refixation.The axial pull-out force,stability,and lumbar motion range of the revised screw were analyzed by the finite element method. RESULTS AND CONCLUSION:(1)The screw axial pull-out force of the cortical bone trajectory revision group was 25.6%higher than that of the traditional pedicle initial group.(2)In the lower,left,and right working conditions,the load-displacement ratio of screws in the cortical bone trajectory revision group increased by 18.5%,41.3%,and 35.0%,respectively,compared with the traditional pedicle initial group.The load-displacement ratio of screws in the cortical bone trajectory revision group was slightly higher than that in the traditional pedicle initial group under the above condition,but there was no statistically significant difference(P>0.05).(3)In anterior and posterior flexion conditions,lumbar motion range in the cortical bone trajectory revision group was increased by 45.5%and 36.1%compared with the traditional pedicle initial group,but there was no statistically significant difference in left bend,right bend,and axial rotation conditions(P>0.05).(4)There were no statistically significant differences in screw axial pull-out force,screw load-displacement ratio,and lumbar motion range between the cortical bone trajectory revision group and cortical bone trajectory initial group(P>0.05).(5)The mechanical data exhibited that although the revised nail track bone was damaged or lost to a certain extent,the mechanical properties of the cortical bone trajectory revision group were still better than those of the traditional pedicle initial group to a certain extent.Moreover,there was no significant difference in the mechanical properties between the cortical bone trajectory revision group and the cortical bone trajectory initial group.It provides a reference for revision surgery of lumbar internal fixation with cortical bone trajectory technique in patients with failed traditional pedicle fixation.

Trayectoria del compromiso académico en estudiantes secundarios de la provincia de Entre Ríos, Argentina

El objetivo del presente trabajo fue conocer la trayectoria del compromiso académico en estudiantes secundarios de Entre Ríos, Argentina, en tres tiempos de su recorrido escolar. El diseño fue cuantitativo, siendo un estudio de tipo longitudinal. El muestreo utilizado fue no probabilístico intencional. La muestra se constituyó por adolescentes escolarizados de Entre Ríos, consistió en 105 sujetos para el primer tiempo, 101 para el segundo y 97 para el tercero. Las edades abarcaron desde los 13 hasta los 15 años. En cuanto al instrumento, se utilizó la adaptación argentina de la Utrecht-Work Engagement Scale en su versión para estudiantes. Se realizaron análisis de estadística descriptiva básica y análisis de modelos de curva de crecimiento latente. Los resultados evidencian bajos niveles de compromiso de los estudiantes con sus actividades escolares. Además, en relación a la trayectoria del engagement, los hallazgos indican que el compromiso se mantuvo constante en el tiempo en la dimensión vigor y disminuyó en los componentes dedicación y absorción hacia el tercer tiempo de evaluación. Se reflexiona sobre la importancia de la promoción del compromiso académico en población adolescente, por ejemplo, a través de la ejecución de intervenciones.

The objective of the work was to know the trajectory of academic engagement in secondary students from Entre Ríos, Argentina, in three stages of their school journey. The design was quantitative, being a longitudinal study. The sampling used was intentional non-probabilistic. The sample was made up of school adolescents from Entre Ríos. It consisted of 105 subjects for the first time, 101 for the second and 97 for the third. The ages ranged from 13 to 15 years. Regarding the instrument, the Argentine adaptation of the Utrecht-Work Engagement Scale in its version for students was used. Analysis of basic descriptive statistics and Analysis of Latent Growth Curve Models were performed; The results show low levels of student engagement to their school activities. In addition, in relation to the trajectory of engagement over time, the findings indicate that the commitment remained constant over time in the vigor dimension and decreased in the dedication and absorption components towards the third evaluation period.

Dual trajectory of sleep and frail in elderly people / 中南大学学报(医学版)

The high incidence of dual sleep and frail disorders in the elderly people, often occurring together, seriously affects the physical and mental health of the older people, effective research on the dynamics of dual sleep and frail disorders is important for improving the quality of life for the older people and responding to global ageing trend. While trajectory studies provide a unique practical scientific perspective to grasp the dynamics of development, dual trajectories unite dual barriers provide an opportunity to study the dynamic dependence of both sleep and frailty simultaneously sleep trajectories and frailty trajectories in older people are interrelated and interacted through deeper mechanisms. Therefore, it is necessary for the study not only focus on the ongoing development of health problems, but also needs to consider multiple aspects and propose targeted intervention program.

A cohort study on the correlation between serum uric acid trajectory and the progression of renal function in patients with Type 2 diabetes mellitus / 中南大学学报(医学版)

OBJECTIVES@#Diabetic kidney disease is one of the most serious complications of diabetes mellitus (DM), and it is a main cause for chronic kidney disease and end-stage kidney disease (ESRD). It is important to find out the factors that cause the progression of renal function. The study aims to explore the relationship between serum uric acid (SUA) trajectory and the progression of renal function in patients with Type 2 diabetes mellitus (T2DM).@*METHODS@#A total of 846 patients with T2DM, who were admitted to the Department of Nephrology and Endocrinology, the Third Xiangya Hospital of Central South University, from January 2009 to December 2021 and met the criteria of baseline estimated glomerular filtration rate (eGFR)≥60 mL/(min·1.73 m2), were selected as the research subjects. The SUA data of multiple measurements were collected and identified as different SUA trajectories by group-based trajectory modeling (GBTM). According to the SUA trajectories, the patients were divided into a low trajectory group (105 cases), a middle trajectory group (396 cases), a middle high trajectory group (278 cases), and a high trajectory group (67 cases). Cox regression analysis was used to examine the effect of SUA trajectory on the progression of renal function in patients with T2DM. Subgroup analysis was performed by sex, age, course of disease, body mass index (BMI) and hemoglobin A1c (HbA1c).@*RESULTS@#The median follow-up was 4.8 years. At the end of follow-up, 158 patients had different degrees of decline in renal function. After adjusting for multiple confounding factors by Cox regression analysis, the risks of eGFR<60 mL/(min·1.73 m2), eGFR reduction rate≥50%, serum creatinine (Scr) doubling and composite endpoint (eGFR reduction rate≥50%, Scr doubling or ESRD) in the high trajectory group were significantly higher than those in the low trajectory group, with HR of 3.84 (95% CI 1.83 to 8.05), 6.90 (95% CI 2.27 to 20.96), 6.29 (95% CI 2.03 to 19.52), and 8.04 (95% CI 2.68 to 24.18), respectively. There was no significant difference in the risk of ESRD among the above 4 groups (all P>0.05). Subgroup analysis showed that: compared with the low trajectory group, the risks of eGFR<60 mL/(min·1.73 m2) in patients with high trajectory in the subgroup of male, female, age<65 years, course of disease<10 years, BMI≥24 kg/m2 and HbA1c≥7% were increased (all P<0.05). The SUA trajectory had no interaction with sex, age, course of disease, BMI and HbA1c (all interactive P>0.05).@*CONCLUSIONS@#The high SUA trajectory increases the risk for progression of renal function in patients with T2DM. Long-term longitudinal changes of SUA should be paid attention to.

Comparison of clinical efficacies between cortical bone trajectory screw and pedicle screw fixation techniques under robot-assisted technology in posterior lumbar short-segment decompression and fu-sion / 中国脊柱脊髓杂志

Objectives:To compare the clinical efficacy between robot-assisted cortical bone trajectory screw(RCBTS)and robot-assisted pedicle screw(RPS)for patients with lumbar spinal stenosis(LSS)undergoing sin-gle-level decompression and fusion.Methods:In this retrospective cohort study,LSS patients who underwent robot-assisted single-level decompression and fusion in Beijing Shijitan Hospital between June 2020 and June 2022 were reviewed.A total of 99 patients were included and divided into RCBTS group of 41 patients and RPS group of 58 patients.There were 59 males and 40 females,with an average age of 67.07±4.65 years old.The incision length,operative time,intraoperative blood loss,24h postoperative drainage,and postopera-tive hospital stay were compared between groups.The Japanese Orthopaedic Association(JOA)score and visual analogue scale(VAS)of low back pain were compared at 3d,3 months and 6 months after operation,and the fixed effects of JOA score and VAS score changes were tested.The screw positions were graded according to the Gertzbein-Robbins method.The accuracy of screw placement of the two surgical methods was evaluated by reviewing the postoperative imaging data.The perioperative and postoperative 3 months of complications were compared between the two groups.Results:There were no significant differences in baseline data be-tween the two groups(P＜0.05).Comparing with the RPS group,the RCBTS group was shorter in operative time(134.39±22.23min vs 152.93±19.10min,P＜0.001),smaller in incision length(64.93±3.71mm vs 78.84±3.82mm,P＜0.001),less in intraoperative blood loss(155.61±37.15mL vs 172.41±43.22mL,P=0.001)and postoperative drainage within 24h(83.66±21.54mL vs 101.21±29.80mL,P=0.002),and shorter in postoperative hospital stay(4.90±1.26d vs 6.26±1.66d,P＜0.001),with statistical significance.There was no significant difference in JOA score and VAS score changes between the two groups at each time point(P＞0.05).The fixed effect test showed that time was a fixed effect of JOA and VAS score changes(P＜0.001).The RCBTS group was no sig-nificantly different from the RPS group in the accuracy of screw placement(grade A:152/164 vs 211/232,P=0.538;grade B:9/164 vs 15/232,P=0.688;grade C:3/164 vs 6/232,P=0.619),the rate of clinically accept-able screw placement(161/164 vs 226/232,P=0.619),the rate of bad screw placement(3/164 vs 6/232,P=0.619),and the incidence of postoperative complications(only 1 patient in the RCBTS group developed delayed wound healing)(P＞0.05).Conclusions:Compared with RPS,RCBTS has significant advantages in operative time,incision length,intraoperative blood loss,volume of postoperative drainage,and postoperative hospital stay.However,there is no significant difference between the two groups in terms of postoperative functional recovery and alleviation in low back pain.

The reliation between trajectory of triglyceride glucose index combined with body mass index and new-onset non-alcoholic fatty liver disease / 中华健康管理学杂志

Objective:To investigate the correlation between the trajectory of triglyceride-glucose index multiplied by body mass index (TyG×BMI) and the incidence of new-onset non-alcoholic fatty liver disease (NAFLD).Methods:It was a retrospective cohort study. A total of 2 304 subjects who underwent health examinations at the Health Management Center of the First Affiliated Hospital of Zhengzhou University from 2017 to 2019 were included as the study population. Based on the TyG×BMI values from the health examinations, a latent class modeling approach was used to determine four distinct TyG×BMI trajectory groups: low-stable, moderate-stable, high-stable, and extremely high-stable group. The incidence of NAFLD was followed-up during the 2020 and 2021 health examinations for each group. The differences in NAFLD incidence among different TyG×BMI trajectory groups were compared using the log-rank test, and the correlation between different TyG×BMI trajectories and the incidence of new-onset NAFLD was analyzed using Cox proportional hazards regression models.Results:The incidence of NAFLD increased with the elevation of TyG×BMI trajectories. The cumulative incidence rates of NAFLD for the low-stable, moderate-stable, high-stable, and extremely high-stable groups was 13.00%, 16.70%, 20.10% and 26.60%, respectively, with statistically significant differences ( χ2=35.155, P<0.01). Compared with the low-stable group, the high-stable and extremely high-stable groups had higher risks of NAFLD (HRs for high-stable group was 1.564, 1.428, 1.426, 1.289, respectively; HRs for extremely high-stable group was 2.121, 1.670, 1.659, 1.607, respectively; all P<0.05). After adjusting for various confounding factors such as gender, waist circumference, BMI, blood glucose, blood lipids and liver function in model 4, the risks of NAFLD for the high-stable and extremely high-stable groups were still 1.389 and 1.607 times higher than that in the low-stable group (95% CIs: 1.035-1.864, 1.207-2.140). Conclusion:The risk of NAFLD increases with the elevation of TyG×BMI trajectories, suggesting that TyG×BMI can serve as a predictive index for NAFLD.

The trajectory of NT-proBNP within two years after percutaneous coronary intervention for stable coronary artery disease and its predictive significance in prognosis: A longitudinal cohort study / 中华检验医学杂志

Objective:This study aimed to investigate the predictive value of N-terminal pro-B-type natriuretic peptide (NT-proBNP) trajectory on future major adverse cardiovascular events (MACE) in patients with stable coronary artery disease (SCAD) after percutaneous coronary intervention (PCI).Methods:A retrospective cohort study was conducted on SCAD patients admitted to the Department of Cardiology at Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, from January 2013 to December 2021. A total of 828 subjects were enrolled, comprising 592 males and 236 females, with an average age of (66.44±11.71) years. SCAD patients post-percutaneous coronary intervention (PCI) were stratified into three NT-proBNP trajectory groups: T1 Low-Low (219 cases), T2 Medium-Low (363 cases), and T3 High-High (246 cases). The median follow-up time was 2.1 years, and the maximum follow-up time was 9 years. The primary clinical endpoint event was MACE. The NT-proBNP concentration in patients′ serum was measured using enzyme-linked fluorescent assay, and different trajectory groups were determined using latent class trajectory modeling. The association between NT-proBNP trajectory and occurrence of MACE in SCAD patients was evaluated using Kaplan-Meier survival curves and multivariable Cox proportional hazards regression models.Results:A total of 67 (8.1%) major adverse cardiovascular events occurred, including 43 cases (5.2%) of all-cause mortality, 13 cases (1.6%) of heart failure death, 9 cases (1.1%) of non-fatal myocardial infarction, and 15 cases (1.8%) of non-fatal stroke. Kaplan-Meier survival curve analysis showed significant differences in survival rates among T1, T2, and T3 groups of SCAD patients for MACE, all-cause mortality, and heart failure death (all P<0.001). In the multivariable Cox regression analysis, the risk of MACE occurrence for patients in the T2 group and T3 group was 1.708 times (95% CI 0.72-4.05) and 3.842 times (95% CI 1.625-9.081) compared to the T1 group, respectively. Moreover, a statistically significant linear trend was observed for the risk of MACE occurrence across trajectory groups ( P<0.001). Conclusions:NT-proBNP trajectory groups after PCI in SCAD patients are strongly associated with the risk of MACE occurrence and can serve as an independent predictor for MACE. Dynamic monitoring of NT-proBNP during follow-up to obtain longitudinal trajectories helps identify high-risk SCAD patients and implement timely effective intervention measures.

A longitudinal study of trajectories of change in benefit finding among family caregivers of patients with lung cancer / 中国实用护理杂志

Objective:To explore the change trajectory and influencing factors of benefit finding of family caregivers of patients with lung cancer, so as to provide reference for formulating individualized intervention strategies.Methods:This study was a cross-sectional survey. From September 2021 to October 2022, 232 family caregivers of patients with lung cancer from General Hospital of PLA Central Theater Command and Tianyou Hospital affiliated to Wuhan University of Science and Technology were collected by convenience sampling method. The level of benefit finding of family caregivers was investigated at 1 month, 3 months and 6 month, after the patients were diagnosed. Growth Mixture Model was applied to identify distinct trajectory categories. Multinomial Logistic regressions were performed to analyze predictors of trajectory categories.Results:The overall level of benefit finding of family caregivers of lung cancer patients showed an upward trend over time ( F=83.06, P<0.01), from 1 month (47.02 ± 14.79) to 6 months (58.13 ± 13.18). Three categories of benefit finding trajectories were identified, named as "the high level-decline group" 12 cases, "the moderate level-stability group" 67 cases, and "the low level-elevation group" 153 cases. Univariate analysis showed that age and education level of family caregivers, average income per person in patient family, type of medical payment, whether the tumor was metastasized, the treatment method of the patient, whether they lived with the patient, and whether they had co-caregivers were related to the category of benefit finding trajectory ( χ2 values were 6.71-15.05, all P<0.05). Multivariate Logistic regression analysis showed that age and education level of family caregivers, average income per person in patient family, treatment method of the patient and whether they lived with the patients were the main influencing factors of benefit finding trajectory categories(all P<0.05). Conclusions:The benefit finding of family caregivers of lung cancer patients showed different trajectories with the time of diagnosis, and the overall level shows an upward trend. More than half of the family caregivers belong to the low level-elevation group. Medical staff should give family caregivers stage and specific nursing intervention according to the change trajectory of benefit finding and its influencing factors.

Construction of self-management intervention program for breast cancer patients undergoing chemotherapy based on chronic disease trajectory model / 中国实用护理杂志

Objective:To construct a self-management intervention program for patients with adenocarcinoma chemotherapy based on chronic disease trajectory model, and to provide reference for clinical nursing intervention.Methods:From October 2021 to June 2022, a research team was established. Based on the chronic disease trajectory model and self-management theory, through preliminary quantitative research, literature review and semi-structured interview, the first draft of the intervention plan was prepared. 24 experts were selected for two rounds of Delphi expert correspondence consultation to determine the self-management intervention plan for breast cancer patients undergoing chemotherapy based on the trajectory model of chronic disease.Results:The effective questionnaire recovery rates of the two rounds of expert letter consultation were 100%, and the coefficient of expert authority degree was 0.805 and 0.863, respectively. The mean values of importance were 4.21- 4.96 and 4.46 - 5.00, the coefficients of variation were 0.00 - 0.19 and 0.00-0.17, and the Kendall concordant coefficients were 0.123 and 0.149 ( both P<0.01). Finally, the self-management intervention scheme for breast cancer chemotherapy patients based on the trajectory model of chronic disease was constructed, including 3 first-level indicators, 6 second-level indicators and 27 third-level indicators. Conclusions:The self-management intervention program for patients with adenocarcinoma chemotherapy based on chronic disease trajectory model constructed in this study can provide a certain reference for clinical nurses to carry out targeted self-management interventions.

Application of Press-Z-track-Turn intramuscular injection in the injection of Fluvastatin / 中国实用护理杂志

Objective:To investigate the application effect of Press-Z-track-Turn (PZT) intramuscular injection on the extravasation, local reaction, local pain after injection and patient satisfaction after Fulvestrant injection.Methods:Used a self-controlled study, 63 patients who underwent bilateral intramuscular injection of Fluvastatin in the outpatient injection room of Tianjin Medical University Cancer Hospital from August to October 2022 were conveniently selected. The observation time was two treatment cycles after inclusion in this study. Before the injection of the first treatment cycle, a coin toss was used to randomly decide to use traditional intramuscular injection and PZT intramuscular injection method for injection and record. After 28 days, another injection method was used, with a total of 126 injections per injection method. Observed the extravasation of drug solution and local reactions at the injection site within 7 days after injection using two injection methods, as well as the pain and satisfaction of patients within 7 days after injection.Results:The extravasation rate of drug solution for the PZT intramuscular injection was 1.59% (2/126), which was lower than 7.14% (9/126) for the traditional intramuscular injection, and the difference was statistically significant ( χ2=4.66, P<0.05); the incidence of mild and moderate local reactions for the PZT intramuscular injection was 3.97% (5/126) and 1.59% (2/126), respectively, lower than that for the traditional intramuscular injection 11.11% (14/126) and 5.56% (7/126), and the difference was statistically significant ( χ2=8.26, P<0.05); the pain score of the PZT intramuscular injection was (2.08 ± 0.85) points, lower than that of the traditional intramuscular injection (5.03 ± 1.06) points, and the satisfaction score of the PZT intramuscular injection was (23.68 ± 1.64) points, higher than that of the traditional intramuscular injection (20.10 ± 2.58) points. The difference was statistically significant ( t=-17.24, 9.16, both P<0.01). Conclusions:PZT intramuscular injection can effectively reduce the overflow rate, the incidence of grade 1 and 2 local reactions and the degree of pain of patients, and improve patient satisfaction, which is worthy of clinical application.

Feasibility of using cortical bone trajectory screws in osteoporotic thoracolumbar fixation based on evaluation of bone CT values at bone-screw interface / 中华创伤骨科杂志

Objective:To evaluate the feasibility of using cortical bone trajectory (CBT) screws in the osteoporotic thoracolumbar fixation by comparing the bone CT values at the bone-screw interface between traditional trajectory (TT) screws and CBT screws in patients with different bone densities.Methods:The high-resolution CT imaging data of thoracolumbar segments following thoracic or lumbar spine fractures from April 2020 to October 2022 were collected at The Second Hospital Affiliated to Wenzhou Medical University for retrospective analysis. They were divided into 3 groups: a normal bone mass group, an osteopenia group and an osteoporosis group. From each group 30 cases were chosen (90 cases in total, 36 males and 54 females). All the data were imported into Mimics 18.0 for three-dimensional bone reconstruction in which placement of TT and CBT screws was simulated on the vertebrae from T10 to L2 (non-fractured vertebrae). Regions of interest (ROI) where each simulated screw intersected the bone were segmented to measure their CT bone values. For each vertebra in each group, the relative difference percentage in average CT value of ROI between TT and CBT screws was calculated. The CT values of ROI were compared in the same group between TT and CBT screws from T10 to L2; the CT values of ROI were compared in the same screws among the 3 groups from T10 to L2; the CT values of ROI were compared between the CBT screws in the osteopenia and osteoporosis groups and the TT screws in the normal bone mass group; the relative difference percentages in average CT value of ROI between CBT and TT screws were compared between the 3 groups from T10 to L2.Results:The average CT value of ROI for CBT screws was significantly higher than that for TT screws from T10 to L2 in every group ( P< 0.001); as for the CT values of ROI for CBT and TT screws from T10 to L2, the osteoporosis group<the osteopenia group<the normal bone mass group ( P<0.001); from T10 to L2, the CT value of ROI for CBT screws in the osteopenia group was significantly higher than that for TT screws in the normal bone mass group ( P<0.001); the CT value of ROI for CBT screws in the osteoporosis group was not significantly different from that for TT screws in the normal bone mass group ( P>0.05). At T10, T12, and L1, the relative difference percentage in average CT value of ROI between CBT and TT screws was significantly higher in the osteopenia and osteoporosis groups than that in the normal bone mass group ( P<0.05), but there was no such a difference between the osteopenia and the osteoporosis groups ( P>0.05). At T11 and L2, there was no significant difference between the 3 groups in the relative difference percentage in average CT value of ROI between CBT and TT screws ( P>0.05). Conclusions:As bone mass decreases, both CBT and TT screws lead to a significant decrease in the bone density at the bone-screw interface. In patients with osteoporosis, CBT screws can still lead to a higher bone density at the bone-screw interface than TT screws, thus providing a higher strength at the bone-screw interface.

Association between the trajectory of waist-to-height ratio from childhood to adulthood and the risk of adult hypertension / 中华健康管理学杂志

Objective:To analyze the trajectory of waist-to-height ratio (WHtR) from childhood to adulthood and its association with the risk of hypertension in adulthood.Methods:In this retrospective cohort study, based on the data of China Health and Nutrition Survey (CHNS) from 1991 to 2015, the group-based trajectory model was applied to identify the trajectory of WHtR in 1 794 subjects aged from 7 to 40 years living in 15 provinces, autonomous regions and municipalities in China. The subjects aged 18 years and above with a systolic blood pressure≥140 mmHg (1 mmHg=0.133 kPa) or diastolic blood pressure ≥90 mmHg or those currently taking antihypertensive drugs were defined as having adult hypertension. And further, the Poisson regression model was used to assess the effect of WHtR trajectory from childhood to adulthood on adult hypertension, and the “E-value” approach was employed to evaluate the potential impact of unobserved confounders on the robustness of the results.Results:Of all the subjects surveyed, 3 trajectory groups were identified, and 750 (41.8%), 958 (53.4%) and 86 (4.8%) subjects were identified as having persistent normal, slow-growing and fast-growing WHtR trajectory, respectively; the incidence of adulthood hypertension in the up-mentioned 3 trajectory groups was 2.1%, 4.7% and 14.0%, respectively ( P<0.001). The risk of adult hypertension in the slow-growing trajectory group ( RR=1.94, 95% CI: 1.12-3.36) and the fast-growing trajectory group ( RR=5.70, 95% CI: 2.65-12.24) were both significantly higher than that in the persistent normal group (both P<0.05). The results of sensitivity analysis showed that the results were relatively robust (E-value was 3.29 and 10.88, respectively). Conclusion:Different trajectories of WHtR from childhood to adulthood exist in the surveyed population, and the increase of WHtR would be positively correlated with the risk of adulthood hypertension.