The role of adiposity,diet and inflammation on the discordance between LDL-C and apolipoprotein B

Background and aimsWhile low-density lipoprotein cholesterol (LDL-C) is a good predictor of atherosclerotic cardiovascular disease, apolipoprotein B (ApoB) is superior when the two markers are discordant. We aimed to determine the impact of adiposity, diet and inflammation upon ApoB and LDL-C discordance.Methods and resultsMachine learning (ML) and structural equation models (SEMs) were applied to the National Health and Nutrition Examination Survey to investigate cardiometabolic and dietary factors when LDL-C and ApoB are concordant/discordant. Mendelian randomisation (MR) determined whether adiposity and inflammation exposures were causal of elevated/decreased LDL-C and/or ApoB. ML showed body mass index (BMI), dietary saturated fatty acids (SFA), dietary fibre, serum C-reactive protein (CRP) and uric acid were the most strongly associated variables (R² = 0.70) in those with low LDL-C and high ApoB. SEMs revealed that fibre (b = ?0.42, p = 0.001) and SFA (b = 0.28, p = 0.014) had a significant association with our outcome (joined effect of ApoB and LDL-C). BMI (b = 0.65, p = 0.001), fibre (b = ?0.24, p = 0.014) and SFA (b = 0.26, p = 0.032) had significant associations with CRP. MR analysis showed genetically higher body fat percentage had a significant causal effect on ApoB (Inverse variance weighted (IVW) = Beta: 0.172, p = 0.0001) but not LDL-C (IVW = Beta: 0.006, p = 0.845).ConclusionOur data show increased discordance between ApoB and LDL-C is associated with cardiometabolic, clinical and dietary abnormalities and that body fat percentage is causal of elevated ApoB.     

Reliability Validity and Responsiveness of the Spinal Cord Independence Measure 4th Version in a Multicultural Setup

ObjectiveTo examine the fourth version of the Spinal Cord Independence Measure for reliability and validity.DesignPartly blinded comparison with the criterion standard Spinal Cord Independence Measure III, and between examiners and examinations.SettingA multicultural cohort from 19 spinal cord injury units in 11 countries.ParticipantsA total of 648 patients with spinal cord injury.InterventionAssessment with Spinal Cord Independence Measure (SCIM IV) and Spinal Cord Independence Measure (SCIM III) on admission to inpatient rehabilitation and before discharge.Main outcome measuresSCIM IV interrater reliability, internal consistency, correlation with and difference from SCIM III, and responsiveness.ResultsTotal agreement between examiners was above 80% on most SCIM IV tasks. All Kappa coefficients were above 0.70 and statistically significant (P<.001). Pearson's coefficients of the correlation between the examiners were above 0.90, and intraclass correlation coefficients were above 0.90. Cronbach's alpha was above 0.96 for the entire SCIM IV, above 0.66 for the subscales, and usually decreased when an item was eliminated. Reliability values were lower for the subscale of respiration and sphincter management, and on admission than at discharge. SCIM IV and SCIM III mean values were very close, and the coefficients of Pearson correlation between them were 0.91-0.96 (P<.001). The responsiveness of SCIM IV was not significantly different from that of SCIM III in most of the comparisons.ConclusionsThe validity, reliability, and responsiveness of SCIM IV, which was adjusted to assess specific patient conditions or situations that SCIM III does not address, and which includes more accurate definitions of certain scoring criteria, are very good and quite similar to those of SCIM III. SCIM IV can be used for clinical and research trials, including international multi-center studies, and its group scores can be compared with those of SCIM III.     

Effectiveness of Home-Based Exercise for Nonspecific Shoulder Pain: A Systematic Review and Meta-analysis

ObjectiveTo evaluate the effectiveness of home-based exercise to treat nonspecific shoulder pain (NSSP).Data SourcesMEDLINE, Embase, Cumulative Index to Nursing and Allied Health, Cochrane Controlled Register of Trials, and Physiotherapy Evidence Database were searched from inception to January 2022.Study SelectionIndependent reviewers selected randomized controlled trials that compared the effects of home-based exercise alone with no treatment or other conservative treatments in individuals with nonsurgical painful shoulder disorders. The primary outcomes were shoulder pain intensity and function, and the secondary outcome was shoulder range of motion (ROM).Data ExtractionTwo reviewers independently conducted data extraction. The risk of bias was assessed using the Cochrane Risk of Bias 2.0 tool, and the overall quality of the evidence was evaluated using the Grading of Recommendation Assessment, Development, and Evaluation approach.Data SynthesisTwelve studies were included in the review, and 10 studies were included in the meta-analysis. Low to moderate quality of evidence indicated that home-based exercise alone and other conservative treatments showed equal improvements in pain intensity reduction (mean difference [MD], 0.27; 95% confidence interval [CI], ?0.12 to 0.65; I²=30%), function (standardized mean difference [SMD], 0.12; 95% CI, ?0.14 to 0.38; I²=16%), flexion ROM (MD, 4.61; 95% CI, ?1.16 to 10.38; I²=54%), and abduction ROM (MD, 3.74; 95% CI, ?12.44 to 19.93; I²=82%). Very low quality of evidence indicated that home-based exercise alone was more effective than no treatment for pain intensity reduction (MD, ?1.47; 95% CI, ?2.33 to -0.61) and function improvement (SMD, ?0.81; 95% CI, ?1.31 to -0.31; large effect).ConclusionsHome-based exercise alone may be equally effective as other conservative treatments and superior to no treatment for the treatment of NSSP. To draw firmer conclusions, further research is required to validate these findings.     

发展康复事业促进实现“健康中国2030”目标北大核心CSCD

目的回顾中国康复事业发展的历程,总结发展经验,研究康复事业发展的法律法规政策和规划以及服务发展。方法采用文献研究和政策研究方法,回顾中国康复事业,总结发展经验,并对相关法律、法规、政策和规划进行系统的内容分析。结果2021年是中国共产党建党百年。本文回顾中国康复事业的历史发展和宝贵经验,分析中国康复事业相关法律法规的产生背景、主要内容和社会意义,着重对《“健康中国2030”规划纲要》和《关于加快推进康复医疗工作发展的意见》相关康复政策进行研讨。结论中国康复事业是健康服务体系的重要组成部分,基于健康服务的视角,中国康复事业的发展,提升了康复相关领导力和治理能力,建立了康复事业发展的筹资机制,培养了大批康复专业技术人员,建立了覆盖三级医疗服务的康复医疗服务体系,并且将辅助技术纳入到现代康复服务体系中,建立了相应的卫生健康信息系统。康复事业在实现“健康中国2030”规划纲要相关目标中发挥着重要作用。     

一次性和反复性力竭运动后不同时相大鼠心肌Kir6.1的表达

目的:探讨力竭运动后不同时相大鼠心肌Kir6.1基因表达的变化特点.方法:健康雄性SD大鼠80只,分为一次力竭游泳运动组和2周反复力竭游泳运动组及相应安静对照组.依据Thomas实验方案,建立不同程度的运动性心肌微损伤实验动物模型.力竭运动后,分时相取材,采用RT-PCR定量反转录方法分析心肌离子通道亚基Kir6.1在mRNA表达水平的变化.结果:(1)一次性力竭运动和反复力竭运动后24小时,心房肌中Kir6.1基因表达均显著下降(P＜0.05).(2)一次性力竭运动和反复力竭运动后4、12、24小时,心室肌中Kir6.1基因表达均显著升高(P＜0.01).结论:(1)力竭运动后,心室肌Kir6.1基因的表达水平总体呈上调变化,心房肌Kir6.1基因的表达水平在运动后24小时呈下调变化.(2)心室肌Kir6.1基因表达的上调对运动心肌有保护作用,而心房肌Kir6.1基因表达下调是心房肌易损伤的机制之一.     

膝关节前交叉韧带非接触性损伤的生物力学研究进展

背景：膝关节前交叉韧带非接触性损伤严重的挑战着人体健康以及运动能力,对损伤的生物力学研究有助于探究和预防膝关节前交叉韧带损伤. 目的：对膝关节前交叉韧带非接触性损伤的生物力学因素进行阐述,探讨损伤的研究方法以及预防措施的新进展. 方法：由作者应用计算机检索PubMed数据库及CNKI数据1979至2011年相关文献,在英文标题和摘要中以“anterior cruciate ligament,injury”和“anterior cruciate ligament,biomechanics”等关键词检索,中文文献检索以“逆向动力学”为关键词,选择内容与膝关节前交叉韧带损伤的生物力学研究、落地与损伤的关系、损伤的预防等相关的文献.共纳入文献67篇. 结果与结论：膝关节前交叉韧带非接触性损伤的因素较为复杂,且各种因素相互交错.对不同损伤因素的影响程度的研究较为有限.但是损伤的生物力学因素可以较为直观的解释运动中损伤的原理机制.因而损伤的生物力学研究方法的创新为揭示膝关节前交叉韧带损伤的本质原理和损伤的预防提供了新思路.同时应用正确的训练方法对预防损伤尤其是膝关节前交叉韧带非接触性损伤具有良好的效果.