Long-term Bed Rest Research Articles

The Effect Of Virginia Coconut Oil (VCO) On The Prevention Of Decubitus In Prolonged Bed Rest Patients

Decubitus is a condition where external pressure causes damage or injury to local tissue. Trauma and surgical wounds can cause damage to skin integrity, long-term pressure on the skin can also cause irritation and the formation of decubitus, People who experience nerve damage due to stroke, traumatic injury, diabetes mellitus, or coma are also more likely to experience decubitus. The purpose of this study was to determine the effect of administering virgin coconut oil (VCO) on the risk of decubitus. The research method used the Pre Experiment design method with a one group pre post test design. The population in this study were all patients in the Akasia Inpatient Room, Siti Fatimah Az-Zahra Hospital, South Sumatra Province. The total number of patients treated was 30 respondents. Sampling was carried out using the total sampling technique. The results of the study showed that there was an effect of administering virginia coconut oil on the risk of decubitus in patients with long-term bed rest, the significant value of the non-parametric statistical test (Wilcoxon) was 0.000 (p value 0.000 <0.05). Suggestions are expected as input and sources of information in providing counseling to patients who are bedridden for a long time to use pharmacological therapy in preventing decubitus, and routinely use Virginia Coconut Oil which has many benefits.

Clinical Features and Risk Factors of 134 HA-PTE Patients

<i>Objective</i>: The objective of this study was to determine the clinical features and risk factors for hospital-associated pulmonary thromboembolism (HA-PTE) in Taizhou Hospital of Zhejiang Province. <i>Methods</i>: The clinical data of 513 pulmonary thromboembolism (PTE) patients who were admitted to Taizhou Hospital of Zhejiang Province in from January 1st, 2020, to December 31st, 2022, were retrospectively analyzed. The HA-PTE group and the community-associated PTE (CA-PTE) group were classified according to whether these disorders occurred during hospitalization or within a 90-day period of admission to the hospital (including inpatients with at least two days of hospitalization stay or a surgical procedure under or regional anesthesia). Differences in clinical features, risk factors and other indicators were also analyzed between the two groups. <i>Results</i>: A total of 513 patients with acute PTE were analyzed in the present study. Among them, 134 patients had HA-PTE, and 379 patients had CA-PTE. Patients in the HA-PTE group had less dyspnea or hemoptysis and more fever and chest pain. The all-cause mortality rate in the HA-PTE group was greater than that in the CA-PTE group, but it was not statistically significant. In comparison to community-acquired pulmonary thromboembolism (CA-PTE), long-term bed rest, active malignancy, lung infection, acute cerebral infarction, and fracture were observed as more prevalent risk factors in the hospital-acquired pulmonary thromboembolism (HA-PTE) group. Additionally, recent surgery (within one month post-operation) and central venous catheterization were identified as independent risk factors in the HA-PTE group. According to the subgroup analysis of the HA-PTE group, the all-cause mortality rate of patients who experienced HA-PTE in the hospital was lower than that of patients who experienced HA-PTE which in 90 days after admission (1.56% versus 2.85%, respectively); however, the difference was not statistically significant. <i>Conclusion</i>: More than half of the HA-PTE events were associated with recent hospitalization. HA-PTE and CA-PTE have different risk factors; when combined with different clinical symptoms, they have a higher incidence of HA-PTE occurring in the hospital. More attention should be given to inpatients to reduce the incidence of HA-PTE.

Feasibility and effectiveness of a foam rolling intervention in pregnant women requiring bed rest for foetal protection: a randomised controlled trial

BackgroundBed rest during pregnancy can lead to reduced physical activity, impairing lower limb venous blood flow and increasing the risk of deep vein thrombosis (DVT) and muscle atrophy. We investigated the clinical efficacy of foam rolling intervention (FRI) in enhancing lower limb venous blood flow, mitigating the risk of DVT and muscle atrophy in pregnant women on bed rest.MethodsThis single-blind, randomised controlled trial enrolled 86 pregnant women with long-term bed rest for foetal protection (≥ 7 days), gestational age ≥ 20 weeks, and maternal age < 40 years. Participants were randomly assigned to a control or experimental group using a random number table. The control group received standard care, whereas the experimental group underwent FRI. Researchers and statisticians were aware of the treatment groups, however, the participants were blinded. Lower limb blood flow velocity, D-dimer levels, incidence of DVT, and the extent of lower limb muscle atrophy were assessed in both groups at baseline and post-intervention (day 7). To account for a 5% attrition rate and potential sampling error, the estimated sample size for each experimental and control group was 40.ResultsBefore the intervention, no significant differences were observed between the experimental and control groups in peak blood flow, mean flow velocity, D-dimer values, or leg circumference (P > 0.05), however, the peak blood velocities of the popliteal veins were significantly higher in the control group (P = 0.031). On the seventh day post-intervention, the experimental group had significantly higher mean and peak blood velocities in femoral and popliteal veins, significantly (P < 0.05), lower mean D-dimer levels (P = 0.035), and a significantly smaller reduction in thigh and calf circumference (P < 0.001). Consequently, the rate of thigh muscle atrophy was significantly slower in the experimental group (P = 0.011).ConclusionsFRI is an effective intervention for improving lower limb venous blood flow, mitigating the risk of DVT and muscle atrophy in pregnant women on bed rest.Trial registrationThis trial was retrospectively registered with the Chinese Clinical Trial Registry on June 18, 2024 (registration number: ChiCTR2400085770).

Research progress of pelvic acetabular fractures combined venous thromboembolic disease

Pelvic acetabular fractures(PAFs) are one of the most common types of pelvic fractures, mostly high-energy injuries, with complex pelvic acetabular structure and limited surgical methods. The trauma of the acetabular fracture itself and the need for long-term bed rest after surgery cause particularly complicated clinical complications. Venous thromboembolism (VTE) is one of its high incidence and serious complications. This review mainly focuses on VTE after PAFs, and describes the epidemiology, risk factors and prevention measures of VTE, aiming to help improve the prognosis and avoid the occurrence of serious complications.

Evaluation of the effectiveness of preventive nursing measures for pressure injuries in patients in the neurology intensive care unit.

Patients in neurology intensive care units (ICU) are prone to pressure injuries (PU) due to factors such as severe illness, long-term bed rest, and physiological dysfunction. PU not only causes pain and complications to patients, but also increases medical burden, prolongs hospitalization time, and affects the recovery process. To evaluate and optimize the effectiveness of pressure injury prevention nursing measures in neurology ICU patients. A retrospective study was conducted, and 60 patients who were admitted to the ICU of the Department of Neurology were selected and divided into an observation group and a control group according to the order of admission, with 30 people in each group. The observation group implemented pressure injury prevention and nursing measures, while the control group adopted routine care. Comparison between observation and control groups following pressure injury prevention nursing intervention revealed significantly lower incidence rates in the observation group compared to the control group at 48 h (8.3% vs 26.7%), 7 d (16.7% vs 43.3%), and 14 d (20.0% vs 50.0%). This suggests a substantial reduction in pressure injury incidence in the observation group, with the gap widening over time. Additionally, patients in the observation group exhibited quicker recovery, with a shorter average time to get out of bed (48 h vs 72 h) and a shorter average length of stay (12 d vs 15 d) compared to the control group. Furthermore, post-intervention, patients in the observation group reported significantly improved quality of life scores, including higher scores in body satisfaction, feeling and function, and comfort (both psychological and physiological), indicating enhanced overall well-being and comfort following the implementation of pressure injury prevention nursing measures. Implementing pressure injury preventive care measures for neurology ICU patients will have better results.

INFLUENCES OF BEDREST DECONDITIONING ON ORTHOSTATIC HYPERTENSION RISK

Objective: Orthostatic hypertension defined as systolic blood pressure (SBP) increase of more than 20 mmHg when standing up with hypertensive upright SBP heralds increased cardiovascular risk. The phenomenon is caused by sympathetic overactivation and occurs in conditions associated with poor cardiopulmonary fitness or hypovolemia. We hypothesized that head-down tilt bedrest, which induces cardiopulmonary deconditioning, hypovolemia, and sympathetic activation increases the likelihood of experiencing orthostatic hypertension. Design and method: We pooled data from two strict head-down tilt bedrest studies, the 60 days AGBRESA study (n=24, 8 women/ 16 men, 33.3±9 years) and the 30 days SANS countermeasure study (n=47, 20 women/ 27 men, 35±9 years), which both included healthy persons on no medications. In both studies, participants were on controlled sodium diets and caloric intake was adjusted to maintain body weight. Before and immediately after bedrest, we measured supine and upright blood pressure and heart rate during head-up tilt testing. We measured plasma volume using carbon monoxide rebreathing before and after bedrest. Results: Supine SBP was 128±9 mmHg before and 133±10 mmHg after bedrest (p&lt;0.0001). While 5 minutes standing, SBP changed 2±8 mmHg before and 3±8 mmHg after bedrest (p=0.5825). 1 out of 67 participants fulfilled diagnostic criteria of orthostatic hypertension before and 3 out of 57 after bedrest. Supine heart rate was 69±11 bpm before and 79±15 bpm after bedrest (p&lt;0.0001). With standing, heart rate increased 21±12 bpm before and 39±16 bpm after bedrest (p&lt;0.0001). Plasma volume decreased by 367±348 ml with bedrest (p&lt;0.0001). Conclusions: We conclude that in most healthy persons, cardiovascular deconditioning and volume loss associated with long-term bedrest are not sufficient to elicit orthostatic hypertension. There may be a smaller subgroup of susceptible individuals.

Exercise Training Attenuates the Muscle Mitochondria Genomic Response to Bed Rest.

Exercise training during the National Aeronautics and Space Administration 70-d bed rest study effectively counteracted the decline in aerobic capacity, muscle mass, strength, and endurance. We aimed to characterize the genomic response of the participants' vastus lateralis on day 64 of bed rest with and without exercise countermeasures. Twenty-two healthy young males were randomized into three groups: 1) bed rest only ( n = 7), 2) bed rest + aerobic (6 d·wk -1 ) and resistance training (3 d·wk -1 ) on standard equipment ( n = 7), and 3) bed rest + aerobic and resistance training using a flywheel device ( n = 8). The vastus lateralis gene and microRNA microarrays were analyzed using GeneSpring GX 14.9.1 (Agilent Technologies, Palo Alto, CA). Bed rest significantly altered the expression of 2113 annotated genes in at least one out of the three study groups (fold change (FC) > 1.2; P < 0.05). Interaction analysis revealed that exercise attenuated the bed rest effect of 511 annotated genes (FC = 1.2, P < 0.05). In the bed rest only group, a predominant downregulation of genes was observed, whereas in the two exercise groups, there was a notable attenuation or reversal of this effect, with no significant differences between the two exercise modalities. Enrichment analysis identified functional categories and gene pathways, many of them related to the mitochondria. In addition, bed rest significantly altered the expression of 35 microRNAs (FC > 1.2, P < 0.05) with no difference between the three groups. Twelve are known to regulate some of the mitochondrial-related genes that were altered following bed rest. Mitochondrial gene expression was a significant component of the molecular response to long-term bed rest. Although exercise attenuated the FC in the downregulation of many genes, it did not completely counteract all the molecular consequences.

The impact of bed rest on human skeletal muscle metabolism

Insulin sensitivity and metabolic flexibility decrease in response to bed rest, but the temporal and causal adaptations in human skeletal muscle metabolism are not fully defined. Here, we use an integrative approach to assess human skeletal muscle metabolism during bed rest and provide a multi-system analysis of how skeletal muscle and the circulatory system adapt to short- and long-term bed rest (German Clinical Trials: DRKS00015677). We uncover that intracellular glycogen accumulation after short-term bed rest accompanies a rapid reduction in systemic insulin sensitivity and less GLUT4 localization at the muscle cell membrane, preventing further intracellular glycogen deposition after long-term bed rest. We provide evidence of a temporal link between the accumulation of intracellular triglycerides, lipotoxic ceramides, and sphingomyelins and an altered skeletal muscle mitochondrial structure and function after long-term bed rest. An intracellular nutrient overload therefore represents a crucial determinant for rapid skeletal muscle insulin insensitivity and mitochondrial alterations after prolonged bed rest.

Alrizomadlin (APG-115) Alone or Combined with Azacitidine (AZA) in Patients (pts) with Relapsed or Refractory (R/R) Acute Myeloid Leukemia (AML) or Relapsed or Progressive Higher-Risk Myelodysplastic Syndrome (HR-MDS): Phase 1b Trial Results

*Drs. Yifan Zhai and Jianxiang Wang are co-corresponding authors. Background Pts with R/R AML and HR-MDS failing hypomethylating agents have limited therapeutic options and relatively dismal outcomes with available therapies. Investigational alrizomadlin is a novel, orally active, potent, small-molecule selective inhibitor that destabilizes the p53-MDM2 complex and activates p53-mediated apoptosis in tumor cells and has shown apoptotic activity in AML and MDS xenograft models, alone and combined with AZA. Here, we present safety and efficacy results of this therapy in these pts. Methods This open-label dose escalation and expansion trial included adults with R/R AML or relapsed/progressed HR-MDS (IPSS-R ≥ 4.5). MTD and RP2D of alrizomadlin ± AZA were determined by dose escalation. Alrizomadlin (100/150/200/250 mg) was administered orally on Days (D) 1-7 in 28-day cycles. In the combination dose escalation group, alrizomadlin (100/150/200 mg) + AZA (75 mg/m 2) was administered orally once daily on D 1-7 in 28-day cycles and at the combination RP2D during dose expansion. Responses were assessed per revised International Working Group (IWG) Response Criteria 2003, ELN 2017 classifications for AML, and IWG 2006 for MDS. Extensive pharmacokinetic (PK) analyses were performed. Results As of June 1, 2023, 29 pts were enrolled in China. In the monotherapy group, 21 pts (median [range] age, 65 [32-76] years; 76.2%, R/R AML) had a median (range) of 2 (1-10) prior lines of therapy. In the combination group, 8 pts (median [range] age of 69.5 [20-76] years; 50%, R/R AML) had a median (range) of 2 (1-4) prior lines of therapy. In both groups, common any-grade treatment-related adverse events (TRAEs; ≥ 20%) were hematologic- and gastrointestinal-related toxicities, hypokalemia, and dizziness, and most grade ≥ 3 TRAEs were hematologic toxicities. No grade ≥ 3 gastrointestinal toxicities were reported (Figure 1). One DLT, a pulmonary embolism (PE), was reported among 6 evaluable patients at the alrizomadlin 100 mg + AZA dose level: a 59-year-old pt with MDS had a prior COVID-19 infection and abnormal coagulation function before (and during) study treatment. The study investigator attributed the PE to the pt's COVID-19 infection, age, primary disease, and long-term bed rest. One pt in each arm discontinued treatment because of AEs. In pts with AML, the overall response rate (ORR) was defined as complete remission (CR) + CR with incomplete hematologic recovery (CRi) + partial response (PR) + morphologic leukemia-free state (MLFS). In pts with MDS, ORR was defined as CR + PR + marrow CR (mCR). In the monotherapy group, the ORR and CR/CRi rates among pts with R/R AML were 25% (4/16) and 18.75% (3/16), respectively. Three of 6 pts with MDS that progressed to R/R AML experienced responses, including 2 CRis and 1 MLFS. One of 10 pts with R/R AML treated with venetoclax + HMA experienced a CRi. In the monotherapy cohort, 4 pts with MDS refractory to HMAs were evaluated, of whom 2 experienced an mCR. The monotherapy RP2D was determined as 200 mg. In the combination group, 6 pts had an efficacy evaluation at least once. Among these pts, 3 of 3 with MDS experienced an mCR and 1 of 3 with R/R AML, MLFS. Among 4 pts with prior venetoclax + HMA treatment, 2 with MDS experienced an mCR and 2 with R/R AML showed a half marrow blast reduction at the end of C1 (Table 1). No PK drug-drug interaction between alrizomadlin and AZA was observed. Conclusions Alrizomadlin alone or combined with AZA demonstrated a manageable safety profile and preliminary efficacy in pts with R/R AML and HMA-refractory MDS. An antileukemic effect was observed in both monotherapy and combination settings, including a few pts whose disease failed on prior venetoclax treatment. Evaluation of the alrizomadlin + AZA cohort is ongoing. Internal study (CT.gov) identifiers: APG-115-AC101 (NCT04275518).

A deep learning model for predicting multidrug-resistant organism infection in critically ill patients

BackgroundThis study aimed to apply the backpropagation neural network (BPNN) to develop a model for predicting multidrug-resistant organism (MDRO) infection in critically ill patients.MethodsThis study collected patient information admitted to the intensive care unit (ICU) of the Affiliated Hospital of Qingdao University from August 2021 to January 2022. All patients enrolled were divided randomly into a training set (80%) and a test set (20%). The least absolute shrinkage and selection operator and stepwise regression analysis were used to determine the independent risk factors for MDRO infection. A BPNN model was constructed based on these factors. Then, we externally validated this model in patients from May 2022 to July 2022 over the same center. The model performance was evaluated by the calibration curve, the area under the curve (AUC), sensitivity, specificity, and accuracy.ResultsIn the primary cohort, 688 patients were enrolled, including 109 (15.84%) MDRO infection patients. Risk factors for MDRO infection, as determined by the primary cohort, included length of hospitalization, length of ICU stay, long-term bed rest, antibiotics use before ICU, acute physiology and chronic health evaluation II, invasive operation before ICU, quantity of antibiotics, chronic lung disease, and hypoproteinemia. There were 238 patients in the validation set, including 31 (13.03%) MDRO infection patients. This BPNN model yielded good calibration. The AUC of the training set, the test set and the validation set were 0.889 (95% CI 0.852–0.925), 0.919 (95% CI 0.856–0.983), and 0.811 (95% CI 0.731–0.891), respectively.ConclusionsThis study confirmed nine independent risk factors for MDRO infection. The BPNN model performed well and was potentially used to predict MDRO infection in ICU patients.

High-protein diet with excess leucine prevents inactivity-induced insulin resistance in women

Background and aimsMuscle inactivity leads to muscle atrophy and insulin resistance. The branched-chain amino acid (BCAA) leucine interacts with the insulin signaling pathway to modulate glucose metabolism. We have tested the ability of a high-protein BCAA-enriched diet to prevent insulin resistance during long-term bed rest (BR). MethodsStable isotopes were infused to determine glucose and protein kinetics in the postabsorptive state and during a hyperinsulinemic-euglycemic clamp in combination with amino acid infusion (Clamp+AA) before and at the end of 60 days of BR in two groups of healthy, young women receiving eucaloric diets containing 1 g of protein/kg per day (n=8) or 1.45 g of protein/kg per day enriched with 0.15 g/kg per day of BCAAs (leucine/valine/isoleucine=2/1/1) (n=8). Body composition was determined by Dual X-ray Absorptiometry. ResultsBR decreased lean body mass by 7.6±0.3% and 7.2±0.8% in the groups receiving conventional or high protein-BCAA diets, respectively. Fat mass was unchanged in both groups.At the end of BR, percent changes of insulin-mediated glucose uptake significantly (p=0.01) decreased in the conventional diet group from 155±23% to 84±10% while did not change significantly in the high protein-BCAA diet group from 126±20% to 141±27% (BR effect, p=0.32; BR/diet interaction, p=0.01; Repeated Measures ANCOVA). In contrast, there were no BR/diet interactions on proteolysis and protein synthesis Clamp+AA changes in the conventional diet and the high protein-BCAA diet groups. ConclusionA high protein-BCAA enriched diet prevented inactivity-induced insulin resistance in healthy women.

COMPARISON BETWEEN DIRECT ANTERIOR APPROACH AND MINIMALLY INVASIVE POSTEROLATERAL APPROACH FOR BIPOLAR HEMIARTHROPLASTY IN ELDERLY PATIENTS WITH FEMORAL NECK FRACTURE

Background: This study was performed to compare the clinical effect of bipolar hemiarthroplasty via the direct anterior approach (DAA) or minimally invasive posterolateral approach (MIPA) in elderly patients with femoral neck fracture. Methods: In total, 196 elderly patients with femoral neck fractures were divided into the DAA group ([Formula: see text]) and MIPA group ([Formula: see text]). The clinical data, postoperative pain and complications, time until able to remain seated for 1 hour and walk independently, postoperative Harris score of functional activity at 6 weeks and 2 years postoperatively, and mortality at 2 years postoperatively were compared between the groups. Results: The DAA group had a longer operation time but a lower incidence of pneumonia 72 hours postoperatively, lower visual analogue scale score 24 hours postoperatively, and earlier time until able to remain seated for 1 hour and walk independently ([Formula: see text]). Six weeks postoperatively, the Harris scores for putting on socks, tying shoelaces, sitting comfortably on a chair, and climbing stairs were better in the DAA than the MIPA group ([Formula: see text]). After 2 years, there was no significant difference in the Harris scores between the two groups ([Formula: see text]). Conclusion: In elderly patients undergoing bipolar hemiarthroplasty, the DAA can be more effective than the MIPA in reducing the incidence of complications associated with long-term bed rest, relieving early postoperative pain, and improving early postoperative hip function.

Identification of prophylaxis and treatment for hospitalized patients associated with venous thromboembolism.

Identification of prophylaxis and treatment for hospitalized patients associated with venous thromboembolism.

The impact of physical inactivity on glucose homeostasis when diet is adjusted to maintain energy balance in healthy, young males

It is unclear if dietary adjustments to maintain energy balance during reduced physical activity can offset inactivity-induced reductions in insulin sensitivity and glucose disposal to produce normal daily glucose concentrations and meal responses. Therefore, the aim of the present study was to examine the impact of long-term physical inactivity (60 days of bed rest) on daily glycemia when in energy balance. Interstitial glucose concentrations were measured using Continuous Glucose Monitoring Systems (CGMS) for 5 days before and towards the end of bed rest in 20 healthy, young males (Age: 34±8 years; BMI: 23.5±1.8kg/m2). Energy intake was reduced during bed rest to match energy expenditure, but the types of foods and timing of meals was maintained. Fasting venous glucose and insulin concentrations were determined, as well as the change in whole-body glucose disposal using a hyperinsulinemic-euglycemic clamp (HIEC). Following long-term bed rest, fasting plasma insulin concentration increased 40% (p=0.004) and glucose disposal during the HIEC decreased 24% (p<0.001). Interstitial daily glucose total area under the curve (tAUC) from pre-to post-bed rest increased on average by 6% (p=0.041), despite a 20 and 25% reduction in total caloric and carbohydrate intake, respectively. The nocturnal period (00:00-06:00) showed the greatest change to glycemia with glucose tAUC for this period increasing by 9% (p=0.005). CGMS measures of daily glycemic variability (SD, J-Index, M-value and MAG) were not changed during bed rest. Reduced physical activity (bed rest) increases glycemia even when daily energy intake is reduced to maintain energy balance. However, the disturbance to daily glucose homeostasis was much more modest than the reduced capacity to dispose of glucose, and glycemic variability was not negatively affected by bed rest, likely due to positive mitigating effects from the contemporaneous reduction in dietary energy and carbohydrate intake. NCT03594799 (registered July 20, 2018) (https://clinicaltrials.gov/ct2/show/NCT03594799).

The enhanced recovery after surgery (ERAS) protocol in elderly patients with acute cholecystitis: A retrospective study.

Enhanced recovery after surgery (ERAS) protocol is a perioperative management theory aimed at reducing the injury of surgical patients and accelerating postoperative recovery. It has been widely recognized and applied in elective surgery. This study aimed to evaluate the clinical value of the ERAS protocol during the perioperative period of laparoscopic cholecystectomy in elderly patients with acute cholecystitis. This study aimed to evaluate the clinical value of the ERAS protocol during the perioperative period of laparoscopic cholecystectomy in elderly patients with acute cholecystitis. We collected medical data from 126 elderly patients with acute cholecystitis from October 2018 to August 2021. Among the 126 patients, 70 were included in the ERAS group and 56 in the traditional group. We analyzed the clinical data and postoperative indicators of the 2 groups. No significant differences were observed regarding the general characteristics of the 2 groups (P > .05). The ERAS group had significantly earlier time to first flatus, time to first ambulation, and time to solid intake, compared with the traditional group (P < .001); additionally, the ERAS group had significantly shorter stay and gentler feeling of postoperative pain (P < .001). Furthermore, the ERAS group had significant incidences of lower postoperative lung (P = .029) and abdominal cavity infection (P = .025) compared to the traditional group. No significant difference was observed regarding the incidences of other postoperative complications between the 2 groups (P > .05). The ERAS protocol helps reduce elderly patients' stress reactions and accelerate postoperative recovery. Thus, it is effective and beneficial to implement the ERAS protocol during the perioperative period of elderly patients with acute cholecystitis.

Effectiveness and prognostic factors of different minimally invasive surgeries for vertebral compression fractures

BackgroundThe aging of China's population has led to an increase in the incidence rate of osteoporosis, which indirectly increases the risk of OVCF in osteoporosis patients. Low back pain is the main symptom of OVCF, and severe patients can further develop kyphosis. Although the conservative treatment of OVCF can effectively control the patient's condition, long-term bed rest will increase the risk of OVCF complications. Minimally invasive surgery is a common solution for OVCF.Methods100 OVCF patients admitted to our hospital from January 2021 to January 2022 are selected for analysis and randomly divided into PVP group and PKP group, 50 cases in each group. The PVP group and the PKP group undergo PVP and PKP operations respectively. The differences in efficacy indicators and adverse reactions are compared, and the multivariate Logistic regression method is used to analyze the influencing factors of postoperative secondary fractures in patients with vertebral compression fractures.ResultsCompared with the PVP group, the total effective rate of PKP group is significantly increased, and the VAS, ODI score, kyphotic Cobb Angle, lateral distribution rate of bone cement and bone cement leakage rate are significantly decreased (P < 0.05). Age ≥ 80 years old, female, glucocorticoid use, lateral distribution of bone cement and bone cement leakage are significantly higher in the proportion of secondary fractures and are independent risk factors for postoperative secondary fractures in patients with OVCF.ConclusionPKP surgery has a higher efficacy in the treatment of OVCF patients, which can reduce the incidence of pain, adverse reactions and promote the recovery of kyphotic Cobb Angle. PKP surgery has a higher value in the treatment of OVCF. In addition, the influencing factors of secondary fracture after minimally invasive surgery in OVCF patients include age, gender, glucocorticoid use, bone cement distribution pattern, bone cement leakage, etc.

Early lean mass sparing effect of high-protein diet with excess leucine during long-term bed rest in women.

Muscle inactivity leads to muscle atrophy. Leucine is known to inhibit protein degradation and to promote protein synthesis in skeletal muscle. We tested the ability of a high-protein diet enriched with branched-chain amino acids (BCAAs) to prevent muscle atrophy during long-term bed rest (BR). We determined body composition (using dual energy x-ray absorptiometry) at baseline and every 2-weeks during 60 days of BR in 16 healthy young women. Nitrogen (N) balance was assessed daily as the difference between N intake and N urinary excretion. The subjects were randomized into two groups: one received a conventional diet (1.1 ± 0.03 g protein/kg, 4.9 ± 0.3 g leucine per day) and the other a high protein, BCAA-enriched regimen (1.6 ± 0.03 g protein-amino acid/kg, 11.4 ± 0.6 g leucine per day). There were significant BR and BR × diet interaction effects on changes in lean body mass (LBM) and N balance throughout the experimental period (repeated measures ANCOVA). During the first 15 days of BR, lean mass decreased by 4.1 ± 0.9 and 2.4 ± 2.1% (p < 0.05) in the conventional and high protein-BCAA diet groups, respectively, while at the end of the 60-day BR, LBM decreased similarly in the two groups by 7.4 ± 0.7 and 6.8 ± 2.4%. During the first 15 days of BR, mean N balance was 2.5 times greater (p < 0.05) in subjects on the high protein-BCAA diet than in those on the conventional diet, while we did not find significant differences during the following time intervals. In conclusion, during 60 days of BR in females, a high protein-BCAA diet was associated with an early protein-LBM sparing effect, which ceased in the medium and long term.

Capillary rarefaction during bed rest is proportionally less than fibre atrophy and loss of oxidative capacity.

Muscle disuse from bed rest or spaceflight results in losses in muscle mass, strength and oxidative capacity. Capillary rarefaction may contribute to muscle atrophy and the reduction in oxidative capacity during bed rest. Artificial gravity may attenuate the negative effects of long-term space missions or bed rest. The aim of the present study was to assess (1) the effects of bed rest on muscle fibre size, fibre type composition, capillarization and oxidative capacity in the vastus lateralis and soleus muscles after 6 and 55days of bed rest and (2) the effectiveness of artificial gravity in mitigating bed-rest-induced detriments to these parameters. Nineteen participants were assigned to a control group (control, n=6) or an intervention group undergoing 30min of centrifugation (n=13). All underwent 55days of head-down tilt bed rest. Vastus lateralis and soleus biopsies were taken at baseline and after 6 and 55days of bed rest. Fibre type composition, fibre cross-sectional area, capillarization indices and oxidative capacity were determined. After just 6days of bed rest, fibre atrophy (-23.2±12.4%, P<0.001) and reductions in capillary-to-fibre ratio (C:F; 1.97±0.57 vs. 1.56±0.41, P<0.001) were proportional in both muscles as reflected by a maintained capillary density. Fibre atrophy proceeded at a much slower rate between 6 and 55days of bed rest (-11.6±12.1% of 6days, P=0.032) and was accompanied by a 19.1% reduction in succinate dehydrogenase stain optical density (P<0.001), without any further significant decrements in C:F (1.56±0.41 vs. 1.49±0.37, P=0.459). Consequently, after 55days of bed rest, the capillary supply-oxidative capacity ratio of a fibre had increased by 41.9% (P<0.001), indicating a capillarization in relative excess of oxidative capacity. Even though the heterogeneity of capillary spacing (LogR SD) was increased after 55days by 12.7% (P=0.004), tissue oxygenation at maximal oxygen consumption of the fibres was improved after 55days bed rest. Daily centrifugation failed to blunt the bed-rest-induced reductions in fibre size and oxidative capacity and capillary rarefaction. The relationship between fibre size and oxidative capacity with the capillary supply of a fibre is uncoupled during prolonged bed rest as reflected by a rapid loss of muscle mass and capillaries, followed at later stages by a more than proportional loss of mitochondria without further capillary loss. The resulting excessive capillary supply of the muscle after prolonged bed rest is advantageous for the delivery of substrates needed for subsequent muscle recovery.

Running vs. resistance exercise to counteract deconditioning induced by 90-day head-down bedrest.

Spaceflight is associated with enhanced inactivity, resulting in muscular and cardiovascular deconditioning. Although physical exercise is commonly used as a countermeasure, separate applications of running and resistive exercise modalities have never been directly compared during long-term bedrest. This study aimed to compare the effectiveness of two exercise countermeasure programs, running and resistance training, applied separately, for counteracting cardiovascular deconditioning induced by 90-day head-down bedrest (HDBR). Maximal oxygen uptake (O2max), orthostatic tolerance, continuous ECG and blood pressure (BP), body composition, and leg circumferences were measured in the control group (CON: n = 8), running exercise group (RUN: n = 7), and resistive exercise group (RES: n = 7). After HDBR, the decrease in O2max was prevented by RUN countermeasure and limited by RES countermeasure (−26% in CON p < 0.05, −15% in RES p < 0.05, and −4% in RUN ns). Subjects demonstrated surprisingly modest orthostatic tolerance decrease for different groups, including controls. Lean mass loss was limited by RES and RUN protocols (−10% in CON vs. −5% to 6% in RES and RUN). Both countermeasures prevented the loss in thigh circumference (−7% in CON p < 0.05, −2% in RES ns, and −0.6% in RUN ns) and limited loss in calf circumference (−10% in CON vs. −7% in RES vs. −5% in RUN). Day–night variations in systolic BP were preserved during HDBR. Decrease in O2max positively correlated with decrease in thigh (r = 0.54 and p = 0.009) and calf (r = 0.52 and p = 0.012) circumferences. During this 90-day strict HDBR, running exercise successfully preserved O2max, and resistance exercise limited its decline. Both countermeasures limited loss in global lean mass and leg circumferences. The O2max reduction seems to be conditioned more by muscular than by cardiovascular parameters.

Treadmill Exercise Decreases Inflammation Via Modulating IL-6 Expression in the Rat Model of Middle Cerebral Artery Occlusion.

Long-term bed rest in neurointensive care (NIC) patients leads to skeletal muscle atrophy and cognitive dysfunction, which seriously affects the physical fitness and final prognosis of critically ill patients. Exercise therapy plays an increasingly important role in the treatment and rehabilitation of patients with sarcopenia. However, the therapeutic effect and mechanism of exercise therapy for patients with neurological impairment remain unclear. Serum samples of NIC patients before and after exercise therapy and normal people were collected to detect interleukin-6 (IL-6) and interleukin-1β levels by enzyme-linked immunosorbent assay (ELISA). Middle cerebral artery occlusion (MCAO) was used for the construction of a rat model. The Morris water maze test, exploration test, and open-field test were used to assess neurological function in rats. Western blot and quantitative real-time polymerase chain reaction were performed to evaluate the activation of IL-6/adenosine-monophosphate-activated protein kinase (AMPK) signaling. Exercise therapy attenuated IL-6 expression in NIC patients. Exercise therapy alleviated cognitive dysfunctions and decreased IL-6 expression in MCAO rats. Exercise therapy alleviated gastrocnemius muscle injury in rats after MCAO by modulating IL-6/AMPK signaling. Treadmill exercise decreases inflammation in MCAO rats via modulating IL-6/AMPK signaling.