Shiqi Xie

Background: Patients with inflammatory bowel disease (IBD) frequently face high nutritional risk, persistent intestinal inflammation, and a high prevalence of comorbid depression. Dysregulation of the gut–brain axis is hypothesized to mediate the association between nutritional status and quality of life (QOL). However, the serial mediating roles of fecal calprotectin (FC) and depression in this pathway remain unclear. This study aimed to examine this serial mediation and provide evidence for developing integrated care models centered on nutritional management to modulate inflammation, manage psychological complications, and improve patient outcomes. Methods: This cross-sectional study enrolled 327 IBD patients from four tertiary hospitals in Southwest China. Nutritional risk, depressive symptoms, and QOL were assessed using the Nutritional Risk Screening 2002 (NRS2002), the Patient Health Questionnaire-9 (PHQ-9), and the Inflammatory Bowel Disease Questionnaire (IBDQ), respectively. FC levels were measured using an enzyme-linked immunosorbent assay (ELISA). The serial mediating effects were examined using Model 6 of the SPSS PROCESS macro with 5,000 bootstrap resamples. Results: Nutritional risk was positively correlated with FC ( β = 1.866, p < 0.05), which in turn was positively associated with depression ( β = 0.021, p < 0.05). Depression was negatively associated with QOL ( β = −1.417, p < 0.001). The total indirect effect accounted for 43.86% of the total association and consisted of contributions from three pathways. Of these three pathways, the independent mediating effect of depression alone contributed 8.55%, and the serial mediating effect of FC and depression accounted for 6.36%; both were statistically significant. The remaining portion of the total indirect effect was attributable to the non-significant pathway via FC alone. Conclusion: Nutritional risk is associated with impaired QOL in IBD patients both directly and indirectly through a sequential pathway involving intestinal inflammation (FC) and depression. These findings suggest a shift in clinical practice toward an integrated care model anchored in proactive nutritional management, coupled with concurrent monitoring of inflammation and screening for depression. This model presents a targeted strategy for modulating inflammation, managing comorbidities, and ultimately improving symptoms and QOL in IBD.

Background: The Children's Dietary Inflammatory Index (C-DII) is associated with elevated body mass index (BMI), a major risk factor for pediatric obstructive sleep apnea-hypopnea syndrome (OSAHS). However, the interrelationships between pro-inflammatory diets, BMI, and OSAHS severity in children remain unclear. This study aimed to examine the association between C-DII and OSAHS severity and assess whether BMI statistically explained the association. Methods: This cross-sectional study involved 297 children diagnosed with OSAHS. Dietary intake was assessed using a 3-day 24-h dietary recall (including two weekdays and one weekend) to calculate the C-DII scores. All participants underwent polysomnography to determine the obstructive apnea-hypopnea index (OAHI) as an indicator of OSAHS severity. Multiple linear regression analyses evaluated the association between C-DII tertiles (T1 as reference compared to T2 and T3) and OAHI, adjusting for key sociodemographic and clinical covariates. A mediation analysis using the PROCESS macro quantified the proportion of the association statistically attributable to BMI. Results: After covariate adjustment, the highest C-DII tertile (T3, pro-inflammatory diet) had a significantly higher OAHI vs. the lowest tertile (T1) (β = 2.04, 95% CI: 0.07–4.01, p = 0.042). This difference is equivalent to an increase of approximately two obstructive events per hour. The association attenuated and lost significance after adding BMI to the model (β = 1.58, 95% CI: −0.37–3.54, p = 0.112). BMI remained strongly associated with OAHI (β = 0.53, p = 0.001). Mediation analysis indicated that BMI statistically accounted for 20.18% of the total observed association between C-DII on OAHI. Conclusions: A pro-inflammatory diet (higher C-DII score) is associated with more severe pediatric OSAHS. This association was largely statistically explained by BMI. Causality cannot be inferred from this cross-sectional study. These findings support integrating dietary and weight strategies in pediatric OSAHS care. Nonetheless, longitudinal studies are needed to clarify diet-specific effects beyond weight control.

Background: Weight loss represents a cornerstone therapy for individuals living with obesity and obstructive sleep apnea-hypopnea syndrome (OSAHS). However, long-term effectiveness is often limited by complex behavioral barriers, with over 70% of patients experiencing weight regain. This study explored patient-perceived barriers to sustainable weight loss and modifiable facilitators to clarify the interplay among cognitive, behavioral, and environmental factors in this population. Methods: This qualitative study employed the Theoretical Domains Framework (TDF) guided by a critical realist epistemology. Semi-structured interviews were conducted with 26 purposively recruited participants living with obesity and OSAHS (mean age 43.2 ± 9.9 years, 73.1% male) from a tertiary sleep clinic in China. Recruitment continued until information power was achieved. Data were analyzed using abductive thematic analysis following Braun and Clarke’s six-phase framework, with coding moving iteratively between deductive TDF domain assignment and inductive theme development. Results: Analysis mapped barriers and facilitators onto all 14 TDF domains. Key findings included knowledge misconceptions that actively shaped treatment preferences, a lack of behavioral repertoire rather than motivation driving unsuccessful attempts, and passive drift from goals indicating self-regulatory deficits. Environmental disruptions evoked helplessness, while social influences showed dual effects: supportive family enhanced adherence, yet well-intentioned behaviors sometimes undermined efforts. Facilitators included personal experience-grounded knowledge, health-related anxiety as a motivator, and desire for structured professional guidance. Conclusion: This first application of the TDF to OSAHS weight management identified key intervention targets across capability, opportunity, and motivation dimensions. The findings provide preliminary evidence for developing theory-informed, multidimensional strategies and support a shift toward structured, personalized interventions. Given the exploratory nature of this study, these conclusions warrant further investigation in diverse populations.

BackgroundPoor adherence to rehabilitation is a major challenge in stroke recovery, closely linked to psychological factors such as diminished well-being. Although nurses are ideally positioned to provide psychosocial support, the absence of structured, evidence-based frameworks constitutes a critical barrier, resulting in a significant psychological-care gap. The PERMA model from positive psychology offers a promising structured framework to address this gap.MethodsThis was a single-blind, randomized controlled trial involving 80 patients with ischemic stroke, allocated to an experimental (n=40) or control (n=40) group. The experimental group received an 8-week, nurse-led intervention grounded in the PERMA model, comprising twice-weekly, 30-minute sessions plus usual care. The control group received standard care matched in frequency. Primary outcomes were subjective well-being (IWB) and rehabilitation adherence (EAQ); secondary outcomes included depressive symptoms (HADS-D) and neurological function (mRS). Assessments occurred at baseline, post-intervention (week 8), and 15-week follow-up. Data were analyzed using Generalized Estimating Equations (GEE) based on the intention-to-treat principle.ResultsSignificant group-by-time interactions were observed for subjective well-being (F=5.53, P=0.005) and rehabilitation adherence (F=3.98, P=0.025). At post-intervention, the experimental group showed significantly greater improvements in subjective well-being (9.27±1.01 vs. 8.08±0.96, mean difference [MD]=1.19, P<0.01) and rehabilitation adherence (34.96±4.56 vs. 31.85±4.67, MD=3.11, P<0.01), along with a greater reduction in depressive symptoms (7.08±3.22 vs. 8.85±3.02, MD=-1.77, P<0.05). The improvement in subjective well-being was sustained at follow-up (9.45±1.32 vs. 8.56±0.92, MD=0.89, P<0.05), whereas the between-group difference in adherence was not maintained. No significant differences were found in anxiety symptoms or neurological function.ConclusionThis study provides evidence for the efficacy of a structured, nurse-led positive psychology intervention, offering an operational toolkit to bridge the psychological-care gap in stroke rehabilitation. The findings justify the formal integration of these strategies into standard rehabilitation protocols and highlight the need for policy changes that recognize and support the expanded role of nurses in multidisciplinary teams.

Background: Weight loss is a key adjunctive therapy for obstructive sleep apnea-hypopnea syndrome (OSAHS) patients with obesity; however, its long-term success rate remains low. Time-restricted eating (TRE) is an emerging dietary strategy for weight-loss, but its application in obese OSAHS patients is still limited. This study aimed to evaluate the effects of TRE on weight loss, sleep, and quality of life (QoL) in obese OSAHS patients. Methods: In this randomized controlled trial, 68 obese adults with OSAHS were allocated (1:1) to an 8-h TRE group (eating window: 10 a.m. to 6 p.m.) or a control group receiving standard care for 12 weeks. The primary outcomes were changes in body mass index (BMI) and sleep quality (Pittsburgh Sleep Quality Index, PSQI). Secondary outcomes included changes in daytime sleepiness (Epworth Sleepiness Scale, ESS), QoL (Calgary Sleep Apnea Quality of Life Index, SAQLI), and OSAHS risk (STOP-Bang questionnaire, SBQ). Results: Sixty participants completed the study. At 12 weeks, while the between-group difference in BMI change was not significant [adjusted mean difference (MD): −0.18 kg/m ² ; p = 0.641], the TRE group showed a significant within-group reduction (−0.86 kg/m ² ; p = 0.033). Compared with the control group, the TRE group showed greater improvements in sleep latency (adjusted MD: 0.44; p = 0.007), sleep duration (adjusted MD: 0.54; p = 0.003), and sleep efficiency (adjusted MD: −0.55; p = 0.001). The TRE group also had greater improvements in the total QoL score (adjusted MD: 0.36; p = 0.027) and in the emotional functioning (adjusted MD: 0.58; p = 0.008). Conclusion: A 12-week 8-h TRE intervention effectively induced weight loss and improved specific aspects of sleep and QoL in obese patients with OSAHS. TRE shows promise as a beneficial dietary intervention within the comprehensive management of OSAHS and obesity.

Purpose: To examine the orofacial myofunctional profile and its determinants in adults with obstructive sleep apnea (OSA). Patients and Methods: A sample of 229 patients with OSA who underwent polysomnographic monitoring from June 1 to July 31, 2023, were enrolled in the study. All participants completed questionnaires, scales, and physical measurements to obtain information on general demographics, orofacial myofunction, degree of snoring, neck circumference, waist circumference, BMI, and OSA characteristics. Results: The proportions of participants with normal weight, overweight, and obesity were 24.5%, 44.1%, and 31.4%, respectively. Mild, moderate, and severe OSA patients accounted for 16.6%, 21.4%, and 62%, respectively. The median total orofacial myofunction score was 90. Larger neck circumference (r=− 0.18, P=0.007), higher BMI (r=− 0.216, P=0.001), and more severe OSA (r=− 0.191, P=0.004) were associated with poorer orofacial myofunction. Age, obesity, diabetes, and RDI were significant predictors of total orofacial myofunction. Conclusion: All OSA patients have varying degrees of orofacial myofunction insufficiency in this study, which is more pronounced in overweight and obese individuals. The evaluation and intervention of orofacial myofunction should be emphasized in patients with OSA who are older, overweight or obese, who have comorbidities of other metabolic disorders, and who have poor PSG indicators.

Inflammatory bowel disease (IBD) significantly impaired patients’ quality of life and might have affected their life satisfaction. Based on the psychosocial stress model and the conservation of resources theory, this study aimed to investigate the level of life satisfaction among patients with IBD and explored the relationships among social support, resilience, and life satisfaction in these patients. A sample of 153 IBD patients completed questionnaires assessing social support (SSRS), resilience (RS-IBD), depression (PHQ-9), and life satisfaction (SWLS). Correlation and mediation analyses were conducted using SPSS PROCESS macro. Results revealed that 73.9% of patients reported life satisfaction (SWLS ≥ 21). Significant correlations emerged between life satisfaction and social support (r = 0.537, p < 0.01), resilience (r = 0.522, p < 0.01), and depression (r = − 0.325, p < 0.01). Mediation analysis indicated that resilience partially mediated the effect of social support on life satisfaction (β = 0.101, 95% CI: 0.025–0.177), accounting for 27.67% of the total effect. Social support was associated with life satisfaction (64.38% of total effect), while resilience and depression jointly mediated 8.77% of the effect. Comprehensive intervention programs focusing on enhancing social support, improving resilience, and alleviating depression are crucial for boosting IBD patients’ life satisfaction.

Purpose: OSAHS patients’ quality of life is significantly impacted by poor sleep. This study examines the mediating role of depression in the relationship between sleep quality and life quality among OSAHS patients. Patients and Methods: Convenience sampling was applied to gather participants at a Chongqing tertiary hospital. Participants filled out questionnaires measuring their quality of life, depression, and sleep quality. Sleep quality was gauged by the Pittsburgh Sleep Quality Index (PSQI), depression was assessed by the Patient Health Questionnaire (PHQ-9), and quality of life was assessed by the Quebec Sleep Questionnaire (QSQ). Mediation analysis was performed via SPSS PROCESS. Results: The study found that depressive symptoms (r=− 0.705, p< 0.01) and sleep quality (r=− 0.578, p< 0.01) were adversely associated with quality of life in OSAHS patients. Depressive symptoms were found to significantly mediate the relationship between sleep quality and quality of life in OSAHS patients (Bootstrap 95% CI − 0.0992, − 0.0483), with 49.55% of the effect size attributable to the pathway from sleep quality to depression to quality of life. Conclusion: Sleep quality and depressive symptoms are important indicators of quality of life in OSAHS patients. Depression serves as a partial mediator (In this study, the mediating factor refers to the element that controls the association between quality of life and sleep quality) in the relationship between sleep quality and quality of life. Interventions aimed at enhancing sleep quality and alleviating depressive symptoms may lead to an improved quality of life for OSAHS patients.

Respiratory dysfunction is a common nonmotor symptom in patients with Parkinson’s disease that may be easily overlooked. Incorporating respiratory function rehabilitation into routine rehabilitation programs for these patients is important. However, previous studies have focused primarily on professional devices and training processes that require additional professional guidance, making wide implementation challenging. In this assessor-masked, randomized clinical trial, eligible participants were randomized into an experimental group and a control group. The experimental group received Liu Zi Jue Qigong exercise for 12 weeks, while the control group underwent conventional rehabilitation exercises. Primary outcomes included measures of respiratory function, such as forced vital capacity (FVC), forced expiratory volume in 1 s (FEV1), the ratio of forced expiratory volume in 1 s to forced vital capacity(FEV1/FVC), peak expiratory flow (PEF), maximal inspiratory pressure (MIP), and maximal expiratory pressure (MEP). Secondary outcomes included motor symptoms, quality of life, depression, and anxiety. The results from a study involving 51 Parkinson’s disease patients showed significant improvements in the FVC, FEV1, PEF, and MEP in the experimental group compared to those in the control group after the 12-week intervention. Additionally, there was a noticeable decrease in depression and anxiety scores in the experimental group, with statistically significant reductions compared to those in the control group. Liuzijue Qigong exercise has the potential to enhance respiratory function and mental health in patients with Parkinson’s disease in the early and middle stages. These findings could serve as a valuable reference for implementing home-based rehabilitation techniques for individuals with Parkinson’s disease. Chinese Clinical Trial Registry: ChiCTR2200056762(Retrospectively registered, Registration Date: February 15, 2022).