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Objective To quantitatively assess the structural changes of the lumbar paraspinal muscles in patients with chronic non-specific low back pain (CNLBP) using conventional magnetic resonance imaging (MRI) and diffusion tensor imaging (DTI) in order to provide a reference for the clinical diagnosis and treatment of CNLBP. Methods A total of 45 CNLBP patients admitted to our hospital from April 2022 to March 2023 were enrolled and assigned into CNLBP group, and another 28 healthy volunteers were recruited and assigned into control group. Sagittal and axial T2WI and DTI MRI scans were performed to all the subjects at the same time. The axial T2WI and DTI images at the L3/4, L4/5 and L5/S1 intervertebral disc levels were used to measure the functional cross-sectional area (FCSA), fat infiltration rate (FIR), fractional anisotropy (FA) and apparent diffusion coefficient (ADC) values of the bilateral multifidus and erector spinae muscle. Visual analog scale (VAS) and Oswestry disability index (ODI) were employed to assess the severity of pain and functional impairment in the patients. The general data (age, sex, height, body weight and BMI), and the relative functional cross-sectional area (RFCSA), FIR, FA and ADC values of bilateral multifidus and erector spinae muscles were compared between the CNBLP group and the control group. Multiple linear regression was applied to analyze the correlations of age, gender, BMI and lower back pain with the FIR value of bilateral multifidus and erector spinae muscle. Spearman analysis was performed to determine the correlations of VAS and ODI scores with RFCSA, FIR, FA and ADC values of the muscles. Results There were no statistical differences in the general data between the CNLBP and control groups. The RFCSA values of the bilateral multifidus and erector spinae muscles were decreased in the former group than the latter group, though no significant difference. The CNLBP group had obviously higher FIR values of the 2 muscles than the control group (P < 0.05). Multiple linear regression analysis showed that age was positively associated with FIR, BMI was not, and the females and the patients with LBP were more likely to develop fatty infiltration. Spearman analysis indicated that the ODI score was negatively correlated with the RFCSA values of the 2 muscles (P < 0.05), and both VAS and ODI scores were positively correlated with the FIR values of the 2 muscles (P < 0.05). A decrease in the FA value and an increase in the ADC value of the 2 muscles were found in the CNLBP group. And the differences in FA of the right multifidus muscle at the L3/4 segment and FA and ADC values of the bilateral multifidus muscle at the L4/5 and L5/S1 segments, and FA values at the L4/5 and L5/S1 segments and ADC values at the L5/S1 segment of the bilateral erector spinae muscle were statistically significant (P < 0.05). Conclusion CNLBP patients are accompanied by muscle atrophy, fat infiltration and changes in muscle fiber structure. Multimodal MRI technology can observe and quantitatively assess these changes in the muscle structure.

Objective To determine the effect of progressive and step-up mobilization and exercise training on functional rehabilitation in critically ill patients. Methods A total of 60 critically ill patients hospitalized in the Intensive Care Unit and High Dependence Unit of General Hospital of Southern Theater Command during September 1, 2019 and September 1, 2021 were prospectively recruited, and then randomly divided into observation group and control group, with 30 cases in each group. Both groups received routine treatment and nursing care. The patients of the control group received a conventional exercise rehabilitation training for 6 weeks, while those of the observation group underwent a 3-staged (passive, auxiliary, and active) progressive and step-up mobilization and exercise training for 6 weeks. Before and after the 6-week training, Fugl-Meyer Assessment of Lower Extremity (LE-FMA) was used to assess the motor function of the patient, and Modified Barthel Index (MBI) was used to assess their abilities for activities of daily living. Muscle function was assessed by Medical Research Council Scale (MRC) scale and bedside diaphragmatic ultrasonography before and at 2, 4, and 6 weeks after training. Results After 2 weeks of training, the muscle strength and diaphragm excursion were decreased in both groups compared, and the decrease was more obvious in the control group (P < 0.05). After 4 and 6 weeks of training, the muscle strength and diaphragm excursion were improved in both groups (P < 0.05), and the improvement was more significant in the observation group (P < 0.05). At the end of training, the scores of LE-FMA and MBI were improved in the 2 groups when compared with those before training (P < 0.05), and the scores of the observation group were significantly higher than those of the control group (P < 0.05). Conclusion Compared with the conventional exercise rehabilitation training, our progressive and step-up mobilization and exercise training can more significantly promote patient's diaphragm function, upper and lower limb muscle strength and lower limb motor function, and thus improve the quality of life in critically ill patients.

Aim: To evaluate the association between frailty and postoperative delirium (POD) in elderly cardiac surgery patients. Methods: A retrospective study was conducted of older patients admitted to the intensive care unit after cardiac surgery at a tertiary academic medical center in Boston from 2008 to 2019. Frailty was measured using the Modified Frailty Index (MFI), which categorized patients into frail (MFI ≥3) and non‐frail (MFI = 0–2) groups. Delirium was identified using the confusion assessment method for the intensive care unit and nursing notes. Logistic regression models were used to examine the association between frailty and POD, and odds ratios (OR) with 95% confidence intervals (CI) were calculated. Results: Of the 2080 patients included (median age approximately 74 years, 30.9% female), 614 were frail and 1466 were non‐frail. The incidence of delirium was significantly higher in the frail group (29.2% vs. 16.4%, p < 0.05). After adjustment for age, sex, race, marital status, Acute Physiology Score III (APSIII), sequential organ failure assessment (SOFA), albumin, creatinine, hemoglobin, white blood cell count, type of surgery, alcohol use, smoking, cerebrovascular disease, use of benzodiazepines, and mechanical ventilation, multivariate logistic regression indicated a significantly increased risk of delirium in frail patients (adjusted OR: 1.61, 95% CI: 1.23–2.10, p < 0.001, E‐value: 1.85). Conclusions: Frailty is an independent risk factor for POD in older patients after cardiac surgery. Further research should focus on frailty assessment and tailored interventions to improve outcomes. [ABSTRACT FROM AUTHOR]

Background: Compared with anti-infective drugs, immunosuppressants and other fields, the application of therapeutic drug monitoring (TDM) in oncology is somewhat limited. Objective: We aimed to provide a comprehensive understanding of TDM guidelines for antineoplastic drugs and to promote the development of individualized drug therapy in oncology. Design: This study type is a systematic review. Data sources and methods: This study was performed and reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 statement. Databases including PubMed, Embase, the official websites of TDM-related associations and Chinese databases were comprehensively searched up to March 2023. Two investigators independently screened the literature and extracted data. The methodological and reporting quality was evaluated using the Appraisal of Guidelines for Research and Evaluation II (AGREE II) and the Reporting Items for Practice Guidelines in Healthcare (RIGHT), respectively. Recommendations and quality evaluation results were presented by visual plots. This study was registered in PROSPERO (No. CRD42022325661). Results: A total of eight studies were included, with publication years ranging from 2014 to 2022. From the perspective of guideline development, two guidelines were developed using evidence-based methods. Among the included guidelines, four guidelines were for cytotoxic antineoplastic drugs, three for small molecule kinase inhibitors, and one for antineoplastic biosimilars. Currently available guidelines and clinical practice provided recommendations of individualized medication in oncology based on TDM, as well as influencing factors. With regard to methodological quality based on AGREE II, the average overall quality score was 55.21%. As for the reporting quality by RIGHT evaluation, the average reporting rate was 53.57%. Conclusion: From the perspective of current guidelines, TDM in oncology is now being expanded from cytotoxic antineoplastic drugs to newer targeted treatments. Whereas, the types of antineoplastic drugs involved are still small, and there is still room for quality improvement. Furthermore, the reflected gaps warrant future studies into the exposure–response relationships and population pharmacokinetics models. [ABSTRACT FROM AUTHOR]

Background: Dementia is a significant cause of death in the older population and is becoming an important public health issue as the population ages and the prevalence of dementia increases. The Braden score is one of the most commonly used clinical tools to assess the risk of skin pressure injury in patients, and some studies have reported that it may reflect the state of frailty of patients. The present study attempted to explore the association between Braden score and 90‐day mortality, pressure injury, and aspiration pneumonia in older patients with dementia in the intensive care unit (ICU). Methods: The study involved extracting crucial data from the Medical Information Market for Intensive Care IV (MIMIC‐IV) database using Structured Query Language, with a license certificate obtained after completing the necessary training and examination available on the MIMIC‐IV website. A retrospective analysis was performed on older patients with dementia, aged 65 or older, who were first admitted to the ICU. Ninth and tenth revision International Classification of Diseases codes were used to identify patients with dementia. The primary outcome was 90‐day mortality. Cox proportional hazards models were used to determine the association between Braden score and death, and hazard ratios (HR) and 95% confidence intervals (CI) were calculated. Propensity score matching and E‐value assessments were employed for sensitivity analysis. Results: A total of 2892 patients with a median age of approximately 85 years (interquartile range 78.74–89.59) were included, of whom 1625 were female (56.2%). Patients had a median Braden score of 14 (interquartile range 12–15) at ICU admission. Braden score at ICU admission was inversely associated with 90‐day mortality risk after adjustment for demographics, severity of illness, treatment and medications, delirium, and sepsis (adjusted HR: 0.92, 95% CI: 0.87–0.98, p = 0.006). Patients were divided into two groups with a cut‐off value of 15: high‐risk group and low‐risk group. Compared to the low‐risk group (Braden score >15), the risk of 90‐day mortality was significantly increased in the high‐risk group (Braden score ≤15) (adjusted HR: 1.52, 95% CI: 1.10–2.09, p = 0.011, E‐value: 2.01), the risk of pressure injury (adjusted OR: 2.62, 95% CI: 2.02–3.43, E‐value: 2.62) and aspiration pneumonia (adjusted OR: 2.55, 95% CI: 1.84–3.61, E‐value: 2.57) was also significantly higher. Conclusions: The Braden score may be a quick and simple screening tool to identify the risk of adverse outcomes in critically ill older adults with dementia. Key points: The Braden score, which is commonly used to assess the risk of pressure injury, may reflect frailty in patients.The Braden score at ICU admission was inversely associated with 90‐day mortality risk, suggesting its potential as a mortality predictor.The findings suggest that the Braden score could be a valuable tool for quickly identifying critically ill older adults with dementia who are at risk of adverse outcomes. [ABSTRACT FROM AUTHOR]

The consolidation characteristics of soft clay under multi-stage loading and single-stage loading exhibit significant differences. In order to investigate the consolidation behavior of soft clay under multi-stage loading, one-dimensional oedometer tests were conducted on marine sedimentary soft clay from northern China. The results indicate that the overall time-deformation pattern of multi-stage loading is a cyclic nonlinear extension of that of single-stage loading. The final deformation between multi-stage loading and single-stage loading is approximately equal; however, the consolidation rate of single-stage loading is four times that of multi-stage loading. Furthermore, the coefficient of consolidation (Cv) decreases with increasing stress. Subsequently, the traditional Terzaghi one-dimensional consolidation equation was modified and a consolidation equation suitable for multi-stage loading is proposed in this study. The analysis of engineering applications demonstrates that the traditional theory provides more accurate predictions of consolidation rate and settlement when the load is small. However, when the load is large, the settlement predicted using the Terzaghi one-dimensional consolidation equation may have an error of 0–25% compared to that using the modified equation. The modified Terzaghi one-dimensional consolidation equation provides a more accurate representation of the actual consolidation of soft soil. [ABSTRACT FROM AUTHOR]