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Objective: Many patients with chronic obstructive pulmonary disease (COPD) feel anxious during the pulmonary rehabilitation process. How to reduce the anxious level in patients with COPD is a worthy issue for mental health. Johann Pachelbel’s Canon is a commonly used musical material in clinical practice. In this pilot study, we intended to investigate the effectiveness of using Pachelbel’s Canon in D major as a music therapy to reduce anxiety levels in patients receiving pulmonary rehabilitation for chronic obstructive pulmonary disease (COPD). Methods: Fifty patients with COPD receiving pulmonary rehabilitation from a hospital in New Taipei City. They were randomly assigned in blocks for two groups, control group in a quiet environment, and experimental group listened to the Pachelbel’s canon in D major. Results: A significant difference in the anxiety score during pulmonary rehabilitation between the experimental group and the control group was found through an independent sample t-test in this study (p < 0.05). Conclusion: Listening to the music of Pachelbel’s canon in D Major decreased the anxiety level of patients with COPD during pulmonary rehabilitation.

Utilizing a large-scale cross-sectional survey, the present study tested the advanced psychometric properties of Fear of COVID-19 Scale (FCV-19S) in specific populations (i.e., primary and middle schoolteachers, and their students). The present study also examined the association between perceived fear of COVID-19 and psychological distress among home-room teachers (i.e., teachers who teach all their students in one classroom all day) and their students. The results among participants (11,134 teachers and 4,335 students) indicated good internal reliability of FCV-19S and excellent factorial validity with a two-factor structure utilizing these specific populations. Furthermore, the multilevel analysis showed that home-room teachers' psychological distress, but not fear of COVID-19, was positively associated with their students. In sum, the FCV-19S is a useful tool to assess the fear of COVID-19 on potentially vulnerable populations (i.e., primary/middle schoolteachers and their students). Future studies are encouraged to use the present study's findings to investigate possible underlying mechanisms for developing effective coping strategies and interventions., Author(s): I-Hua Chen [sup.1] , Chao-Ying Chen [sup.2] , Ke-Yun Zhao [sup.3] , Jeffrey H. Gamble [sup.4] , Chung-Ying Lin [sup.5] [sup.6] [sup.7] , Mark D. Griffiths [sup.8] , Amir [...]

Background. In pediatric patients with severe COVID-19, if the respiratory support provided using high-flow nasal cannula (HFNC) becomes insufficient, no definitive evidence exists to support the escalation to noninvasive ventilation (NIV) or mechanical ventilation (MV). Case Presentation. A 9-year-old boy being treated with face mask-delivered biphasic positive airway pressure ventilation developed fever, tachypnea, and frequent desaturation. The COVID-19 polymerase chain reaction test and urine antigen test for Streptococcus pneumoniae were both positive, and sputum culture yielded Pseudomonas aeruginosa. The do-not-resuscitate order precluded the use of endotracheal intubation. After 2 h of HFNC support, the respiratory rate oxygenation (ROX) index declined from 7.86 to 3.71, indicating impending HFNC failure. A helmet was used to deliver NIV, and SpO2 was maintained at >90%. Dyspnea and desaturation gradually improved, and the patient was switched to HFNC 6 days later and discharged 10 days later. Conclusion. In some cases, acute respiratory distress syndrome severity cannot be measured using the oxygenation index or oxygenation saturation index, and the SpO2/FiO2 ratio and ROX index may serve as useful alternatives. Although NIV delivered through a facemask or HFNC is more popular than helmet-delivered NIV, in certain circumstances, it can help escalate respiratory support while providing adequate protection to healthcare professionals.

Abstract Background Carotid atherosclerosis (CAS), an important factor in the development of stroke, is a major public health concern. The aim of this study was to establish and validate machine learning (ML) models for early screening of CAS using routine health check-up indicators in northeast China. Methods A total of 69,601 health check-up records from the health examination center of the First Hospital of China Medical University (Shenyang, China) were collected between 2018 and 2019. For the 2019 records, 80% were assigned to the training set and 20% to the testing set. The 2018 records were used as the external validation dataset. Ten ML algorithms, including decision tree (DT), K-nearest neighbors (KNN), logistic regression (LR), naive Bayes (NB), random forest (RF), multiplayer perceptron (MLP), extreme gradient boosting machine (XGB), gradient boosting decision tree (GBDT), linear support vector machine (SVM-linear), and non-linear support vector machine (SVM-nonlinear), were used to construct CAS screening models. The area under the receiver operating characteristic curve (auROC) and precision-recall curve (auPR) were used as measures of model performance. The SHapley Additive exPlanations (SHAP) method was used to demonstrate the interpretability of the optimal model. Results A total of 6315 records of patients undergoing carotid ultrasonography were collected; of these, 1632, 407, and 1141 patients were diagnosed with CAS in the training, internal validation, and external validation datasets, respectively. The GBDT model achieved the highest performance metrics with auROC of 0.860 (95% CI 0.839–0.880) in the internal validation dataset and 0.851 (95% CI 0.837–0.863) in the external validation dataset. Individuals with diabetes or those over 65 years of age showed low negative predictive value. In the interpretability analysis, age was the most important factor influencing the performance of the GBDT model, followed by sex and non-high-density lipoprotein cholesterol. Conclusions The ML models developed could provide good performance for CAS identification using routine health check-up indicators and could hopefully be applied in scenarios without ethnic and geographic heterogeneity for CAS prevention.

Abstract Many intensive care unit patients who undergo endotracheal extubation experience extubation failure and require reintubation. Because of the high mortality rate associated with reintubation, postextubation respiratory management is crucial, especially for high-risk populations. We conducted the present study to compare the effectiveness of oxygen therapy administered using high-flow nasal cannulae (HFNC) and noninvasive positive pressure ventilation (NIPPV) in preventing reintubation among patients receiving prolonged mechanical ventilation (PMV). This single-center, prospective, unblinded randomized controlled trial was at the respiratory care center (RCC). Participants were randomized to an HFNC group or an NIPPV group (20 patients in each) and received noninvasive respiratory support (NRS) administered using their assigned method. The primary outcome was reintubation within7 days after extubation. None of the patients in the NIPPV group required reintubation, whereas 5 (25%) of the patients in the HFNC group required reintubation (P = 0.047). The 90-day mortality rates of the NIPPV and HFNC groups (four patients [20%] vs. two patients [10%], respectively) did not differ significantly. No significant differences in length of RCC stay, length of hospital stay, time to liberation from NRS, and ventilator-free days at 28-day were identified. The time to event outcome analysis also revealed that the risk of reintubation in the HFNC group was higher than that in the NIPPV group (P = 0.018). Although HFNC is becoming increasingly common as a form of postextubation NRS, HFNC may not be as effective as NIPPV in preventing reintubation among patients who have been receiving PMV for at least 2 weeks. Additional studies evaluating HFNC as an alternative to NIPPV for patients receiving PMV are warranted. ClinicalTrial.gov ID: NCT04564859; IRB number: 20160901R. Trial registration: ClinicalTrial.gov ( https://clinicaltrials.gov/ct2/show/NCT04564859 ).

Abstract This study aims at identifying characteristics, risk factors and mortality of community-acquired (CAP) and health-care-associated pneumonia (HCAP) by Staphylococcus aureus (S. aureus). We retrieved adults with S. aureus CAP or HCAP diagnosed by blood or pleural effusion culture in 2.6 years, and compared with those of Streptococcus pneumoniae (S. pneumoniae) CAP or HCAP diagnosed by blood or respiratory culture, or urine antigen. We found 18 patients with CAP and 9 HCAP due to S. aureus (female 33%, 66.6 ± 12.4 years-old), and 48 patients with CAP and 15 HCAP due to S pneumoniae (female 41%, 69.5 ± 17.5 years). Diabetes mellitus (52% vs. 24%, p = 0.019), hemodialysis (11% vs. 0%, p = 0.046), skin lesions (44% vs. 0%, p

Raynaud's phenomenon is a common vasospasm response, and current medical therapies and surgical treatments show limited clinical effects. Botulinum toxin type A has certain effectiveness and safety in treating Raynaud's phenomenon. It can relax blood vessels, relieve pain, and has a good long-term effect. Its side effects are mild, such as pain at the injection site, bruises, or transient muscle weakness. In recent years, some research has broadened the scope of application of the treatment and determined more effective injection doses and injection methods to reduce the side effects. More large-sample randomized double-blind controlled trials and animal experiments are needed to provide information for explaining the treatment mechanisms and illstrating the efficacy.

Abstract Background Aldehyde dehydrogenase 1 (encoded by ALDH1A1) has been shown to protect against Parkinson’s disease (PD) by reducing toxic metabolites of dopamine. We herein revealed an antisense Alu element insertion/deletion polymorphism in intron 4 of ALDH1A1, and hypothesized that it might play a role in PD. Methods A Han Chinese cohort comprising 488 PD patients and 515 controls was recruited to validate the Alu insertion/deletion polymorphism following a previous study of tag-single nucleotide polymorphisms, where rs7043217 was shown to be significantly associated with PD. Functional analyses of the Alu element insertion were performed. Results The Alu element of ALDH1A1 was identified to be a variant of Yb8 subfamily and termed as Yb8c4. The antisense Yb8c4 insertion/deletion polymorphism (named asYb8c4ins and asYb8c4del, respectively) appeared to be in a complete linkage disequilibrium with rs7043217 and was validated to be significantly associated with PD susceptibility with asYb8c4ins serving as a risk allele (P = 0.030, OR = 1.224, 95% CI = 1.020–1.470). Multiple functional analyses including ALDH1A1 mRNA expression in blood cells of carriers, and reporters of EGFP and luciferase showed that the asYb8c4ins had a suppressive activity on gene transcription. Mechanistic explorations suggested that the asYb8c4ins induced no changes in CpG methylation and mRNA splicing of ALDH1A1 and appeared no binding of transcription factors. Conclusions Our results consolidate an involvement of ALDH1 in PD pathogenesis. The asYb8c4 polymorphism may be a functional output of its linkage disequilibrium-linked single nucleotide polymorphisms.

Abstract Noninvasive ventilation improves exercise performance in patients with chronic obstructive pulmonary disease (COPD). However, the effect of helmet ventilation (HV) on the short-term self-paced exercise performance of patients with COPD remains unclear. This study investigated the use of HV during a 6 min walk test (6MWT) and analyzed its short-term cardiopulmonary outcomes in patients with stable COPD. A single-site crossover trial was conducted in a pulmonary rehabilitation outpatient department. A total of 20 stable patients with COPD without disability were enrolled. The participants performed 6MWTs with and without HV on two consecutive days. The outcome measures were the distance walked in the 6MWT and the physiological and cardiopulmonary parameters. The mean difference in meters walked between the HV-aided and unaided walk tests was 15.4 ± 37.2 (95% confidence interval: − 2.03 to 32.8 m; p = .145). During the 6MWT, the peak heart rate was significantly higher when walking was aided by HV than when it was unaided (p

Rough set theory is a mathematical tool for dealing with uncertain information.The core notions of rough set theory is approximation operators of approximation spaces.Pawlak approximation operators are established by using equivalence relations on the universe.They are extended to generalized rough approximation operators based on arbitrary binary relations.The topolo-gical structures of approximation operators are important topics in rough set theory.This paper is devoted to the study of topological properties of generalized rough approximation operators induced by arbitrary binary relations.Four types of topologies induced by generalized approximation operators based on granules and subsystems are presented and the relationships among these four types of topologies are discussed.The bases of the topologies induced by generalized approximation operators based on granules are presented by the right-neighborhood systems for objects,and the normality and regularity for related topologies are investigated.By analyzing the properties of the generalized upper approximation operators based on the subsystem,it is proved that the topologies induced by the subsystem-based generalized upper approximation operators can be transformed into the topologies induced by the generalized lower approximation operators based on the objects.

The performance of a diesel engine is closely related to the injector, and the fuel pressure shock signal for monitoring the state of the injector always contains multiple natural oscillation modes at different levels. Therefore, it is very necessary to detect the dynamic changes of the injector signal from multiple levels. Multi-scale Diversity Entropy (MDE) is a recent commonly used method of information entropy. However, due to its inherent defects, it limits the wide application of MDE in fault feature extraction. Therefore, this paper proposes a new nonlinear dynamics method, called the Refined Composite Hierarchical Bidirectional Diversity Entropy (RCHBDE). The ability of RCHBDE to extract signal complexity changes was verified through simulation signals, which is superior to MDE and multi-scale bidirectional diversity entropy (MBDE). On this basis, this article proposes a diagnostic framework for fuel injector fault type and degree based on RCHBDE and Seagull optimized Support Vector Machine. We apply the proposed method to the injector failure test data. The results show that RCHBDE can better reflect the dynamic change process of the injector fault signal than MDE and MBDE. Moreover, compared with existing methods, the proposed method in this paper improves the accuracy and efficiency of fault diagnosis. [ABSTRACT FROM AUTHOR]

The article presents a study which investigated whether a three-dimensional (3D)-printed bronchial tree model induced greater learning efficacy and student satisfaction than a traditional slide-based presentation among respiratory therapy students. Topics discussed include production of 3D-printed bronchial tree model, characteristics of participants and written examination scores, and limitations of the study.