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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.

The pineapple peel cellulose(PPC) was used as raw material to dissolve in an alkali/urea solution with incorporation of bentonite, then further chemically cross-linked and in-situ embedded with magnetic Fe3O4 to form composite hydrogels. The structure and dye adsorption properties of hydrogels were studied. The results confirmed the successful intercalation of bentonite and Fe3O4 in the hydrogels. The bentonite effectively improved the cross-linked porous network structure, thermal stability and swelling properties of the hydrogel. The bentonite also enhanced the methylene blue adsorption performance of the hydrogels, showing an increased saturated adsorption capacity from 28. 09 mg/g to 55. 87 mg/g. The adsorption process conformed to the pseudo-second-order kinetic model and Langmuir model, belonging to chemical adsorption and monolayer adsorption. [ABSTRACT FROM AUTHOR]