Heat stroke is a heat-related illness caused by an imbalance between the body's heat production and heat dissipation, which could lead to multiple organ dysfunction syndrome with a high mortality rate. Rapid and effective reduction of core body temperature is key to successful treatment. This article reviews recent progress in the treatment of heat stroke, including new understandings of organ injury mechanisms, the timing, velocity and goals of cooling treatment, evaluation and selection of traditional cooling techniques (such as cold water immersion), and scientific evaluation of new cooling technologies (such as blood purification technology and intravascular heat exchange cooling technology), aiming to promote understanding and treatment of heat stroke.

White matter hyperintensities (WMH) are abnormal high-signal manifestations in white matter areas on magnetic resonance T₂-weighted or fluid-attenuated inversion recovery (FLAIR) sequences, with vasogenic WMH being the most common. Its pathological mechanism is related to cerebrovascular lesions and can lead to multi-dimensional brain functional impairments in cognition, movement, and emotions. Due to their unique working conditions, aircrews are more prone to vasogenic WMH than the general population. Moreover, with the widespread use of magnetic resonance imaging in cranial disease screening for aircrews, the detection rate of vasogenic WMH in aircrews has significantly increased. However, to date, no national or academic organization has issued standardized aviation medical assessment criteria for vasogenic WMH in aircrews. Therefore, led by Xijing Hospital of Air Force Medical University and the Chinese PLA General Hospital, a multi-disciplinary expert panel involved in aviation medicine, neurology, radiology, psychology, and related fields was assembled to formulate this consensus. The document integrates evidence from a systematic review of PubMed, CNKI, Wanfang Data, and VIP databases, incorporates existing WMH guidelines, and synthesizes clinical expertise from Chinese specialists. The consensus outlines three key domains: target population, neuroimaging protocols for vasogenic WMH screening, and clinical assessment and aeromedical identification for aircrews with vasogenic WMH. The aim is to provide evidence-based support and expert recommendations for standardizing and improving the accuracy of aviation medical evaluations of vasogenic WMH in aircrews.

Objective To systematically review and quantitatively analyze the safety of biologic agents for the clinical treatment of psoriasis during pregnancy and lactation. Methods The literature from start of database to June 27, 2023, was searched in MEDLINE (PubMed), Embase, Cochrane Library, and Web of Science by two researcher. Quality of included studies was assessed by the quality evaluation tool of case series from Australian JBI Evidence Based Healthcare Centre. According to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), a systematic review and was conducted to assess pregnancy or breastfeeding outcomes in psoriasis patients exposed to biologics within 3 months prior to pregnancy, during pregnancy or breastfeeding. Data on pregnancy and exposure characteristics were pooled, and the prevalence of adverse pregnancy outcome was summarized using a random effects model. Results A total of 54 studies involving 1206 pregnancies in 1177 female patients with psoriasis exposed to biologic agents were included in the analysis. Systematic review results demonstrated that the majority of the exposures were limited to early pregnancy, with pooled spontaneous abortion rates, elective abortion rates, overall mortality, preterm birth rates, incidence of low birth weights, and congenital anomalies similar to those of general population (P>0.05). Furthermore, no serious adverse reactions were reported during lactation. Conclusions The use of biologic agents in pregnant and breastfeeding women with psoriasis does not significantly increase the risk of adverse pregnancy outcomes and does not affect neonatal health or growth. However, the limited available safety data underscores the necessity of further studies to establish the relationship between psoriasis, biologic agents, and pregnancy/lactation outcomes, thereby providing comprehensive guidance for clinical practice.

Objective To investigate the effects of advanced maternal age (AMA) on synaptic pruning of the hippocampus of offspring rats. Methods Offspring of 3-month-old SD female rats and 3-month-old SD male rats were designated as the appropriate age group (Ctl group), while offspring of 12-month-old SD female rats and 3-month-old SD male rats were assigned to AMA group. Hippocampal tissues from both groups (n=3 per group at each time point) were subjected to Golgi staining on postnatal days (P) 7, 28, and 60. Dendritic complexity, spine density (DS), and morphology of immature brain neurons at different age stages were compared between the two groups. Results Compared with Ctl group, the dendritic length of AMA group on P7, P28, and P60 was significantly shortened, and the average number of intersections between dendrites and concentric circles on P28 and P60 was also significantly decreased (P<0.05). Compared with Ctl group, the dendritic spine density of AMA group was significantly decreased on P7, P28, and P60. Notably, the density of thin-shaped dendritic spines in AMA group was increased on P7, whereas the densities of stubby-shaped and mushroom-shaped dendritic spines were decreased (P<0.05). On P28 in AMA group, the densities of thin-shaped and mushroom-shaped dendritic spines were significantly increased compared with Ctl group, while the density of stubby-shaped dendritic spines was significantly decreased (P<0.05). The densities of stubby-shaped and mushroom-shaped dendritic spine were markedly lower in AMA group on P60 than those in Ctl group (P<0.05). Conclusions During postnatal brain development periods, there were abnormalities in synaptic pruning in the hippocampal region of the offspring of the AMA, which manifested as reduced dendritic complexity, decreased dendritic spine density, and disorganized dendritic spine morphology. It could be one of the key mechanisms underlying brain dysfunction in the offspring of AMA.

Objective To assess the effectiveness of the evaluation of military physical function (EMPF) system in predicting the occurrence of military training injuries among new recruits to provide scientific guidance and methodological choice for military training. Methods A total of 527 new recruits from 5 grassroots units from July 2016 to February 2018 were selected for the study. The recruits underwent EMPF testing, and their military training injuries were monitored over a 2-year follow-up period. Those who sustained injuries during training were divided into injury group (n=163), while the remaining recruits were placed in healthy group (n=364). The predictive ability of the total EMPF score for training injuries was assessed using the receiver operating characteristic curve (ROC), and the correlation between the total EMPF score, individual test scores, and military training injuries were analyzed using binary logistic regression. Results The total EMPF score of new recruits in injury group (19.52±1.97) was significantly lower than that of healthy group (24.31±1.54) (P<0.001), which also demonstrated a high diagnostic value in predicting the risk of military training injuries, with an area under the curve (AUC) of ROC of 0.971 (P<0.001). A cut-off value of 22 scores was found to have the highest accuracy in predicting future training injuries, with an odds ratio (OR) of 25.63, sensitivity of 0.939, specificity of 0.879, positive likelihood ratio of 7.76, and a post-test probability of 0.67. Binary logistic regression analysis revealed that 6 EMPF tests, including holding the ball over and leaning back, bending forward and touching the ground with the ball, lunge squat and twist, swallow balance with holding the ball afterward, vertical jump, and respiratory pattern assessment, were negatively associated with the risk of military training injuries (P<0.0001). Conclusion The EMPF system can effectively predict the risk of military training injuries, with military personnel whose total EMPF score is less than 22 being at higher risk of sustaining such injuries.

Objective To investigate the role of peptidyl prolyl cis-trans isomerase 1 (Pin1) in mediating stemness of tumor cells and the molecular mechanism of inducing epithelial-mesenchymal transition (EMT) in cervical cancer cells. Methods The Siha and Hele cells of Pin1 low-expression stable transfection uterine cervical neoplasm cell lines were constructed using lentivirus transfection technology and were divided into control group (shPin1-NON), knockdown group 1 (shPin1-1) and knockdown group 2 (shPin1-2). Western blotting and quantitative real-time polymerase chain reaction (qRT-PCR) were used to detect the expressions of Sex-determining region Y transcription factor 2 (SOX2), Aldehyde dehydrogenase 1A1 (ALDH1A1), and Cell adhesion molecule 44 (CD44). The serum-free spheroidization method was used to induce cervical cancer spheroids, with the adherent culture of cervical cancer cells as a control. Subsequently, Western blotting and qRT-PCR were employed to detect the expression of SOX2, ALDH1A1 and CD44 in both spheroid cells and adherent cells. Spheroid formation assay was used to detect the spheroid formation of cervical cancer cells after Pin1 knockdown. Transwell assay was used to detect the migration and invasion abilities of cervical cancer cells following down-regulation of Pin1. Western blotting and qRT-PCR were used to detect the expression of E-cadherin and N-cadherin attribute proteins in cervical cancer cells after transfection with pin1 low expression lentivirus. Western blotting and qRT-PCR were also used to assess the effects of Pin1 low expression on the expression levels of key proteins (c-Jun and c-Fos) of the transcriptional complex of Activator protein 1 (AP-1). Immunofluorescence combined with co-immunoprecipitation assays were conducted to detect the interaction and colocalization of Pin1 with c-Jun. Results In Siha and Hele cells, the mRNA and protein expression levels of Pin1, SOX2, ALDH1A1 and CD44 in shPin1-NON group were significantly higher than those in shPin1-1 group and shPin1-2 group (P<0.05). The expression levels of SOX2, ALDH1A1 and CD44 mRNA and protein in cervical cancer spheroid group were significantly higher than those in adherent cervical cancer cells (P<0.05). Compared with shPin1-NON group, the spheroidism and migration invasion abilities of shPin1-1 group and shPin1-2 group were significantly reduced (P<0.05). Compared with shPin1-NON group, the mRNA and protein expressions of E-cadherin in shPin1-1 and shPin1-2 groups were significantly increased (P<0.05), while the mRNA and protein expression levels of N-cadherin were significantly decreased (P<0.05). The mRNA and protein expression levels of c-Jun and c-Fos in shPin1-NON group were significantly higher than those in shPin1-1 group and shPin1-2 group (P<0.05). Conclusions Down-regulation of Pin1 can inhibit the stemness and migration invasion of cervical cancer cells, and Pin1 may mediate AP-1 to regulate the occurrence of stemness-induced epithelial-mesenchymal transition in cervical cancer cells.

Objective To investigate the effects and underlying molecular mechanisms of typhaneoside (TYP) on lung adenocarcinoma based on network pharmacology and in vitro experiments. Methods TYP-lung adenocarcinoma-related genes were obtained from the prediction target website SwissTargetPrediction, The Cancer Genome Atlas (TCGA) database, GeneCards database, and Gene Expression Omnibus (GEO) database. Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) analyses were performed on the obtained TYP-lung adenocarcinoma-related genes. Protein-protein network interactions analysis was carried out using the String database, and molecular docking was conducted with the Vina software. These network pharmacological analysis methods were employed to explore the theoretical action pathways of TYP on lung adenocarcinoma. PC9 cells were divided into control group (normal culture), low-TYP group (treated with 50 μmol/L TYP for 48 h), high-TYP group (treated with 100 μmol/L TYP for 48 h), and ferrostatin-1 (Fer-1)+TYP group (treated with 1 μmol/L Fer-1+100 μmol/L TYP for 48 h). The cell viability was detected by the CCK-8 assay, the cell proliferation ability was detected by the EdU assay, and the cell migration and invasion ability was detected by scratch assay, Transwell migration assay and Transwell invasion assay. The occurrence of ferroptosis was detected by reduced glutathione (GSH) assay kit, reactive oxygen species (ROS) assay kit, mitochondrial membrane potential assay kit, ferrous ion fluorescent probe, and transmission electron microscopy. Protein and mRNA expression levels of ferroptosis-related key molecules, solute carrier family 7 member 11 (SLC7A11) and glutathione peroxidase 4 (GPX4), were measured by Western blotting and reverse transcription-quantitative PCR (RT-qPCR). PC9 cells were transfected with SLC7A11 overexpression plasmid and divided into vector group (transfected with empty plasmid), vector+TYP group (transfected with empty plasmid and treated with 100 μmol/L TYP for 48 h), OE-SLC7A11 group (transfected with SLC7A11 overexpression plasmid) and OE-SLC7A11+TYP group (transfected with SLC7A11 overexpression plasmid and treated with 100 μmol/L TYP for 48 h). The molecular mechanism of SLC7A11 in the effect of TYP on PC9 was verified by CCK-8 assay, ferrous ion fluorescence probe, and protein expression levels of SLC7A11 and GPX4. Results A total of 73 TYP-lung adenocarcinoma-related target genes were predicted. GO analysis showed that the target genes were mainly involved in biological processes such as positive regulation of kinase activity, and were enriched in cellular components like transferase complex (transferring phosphorus-containing groups), revealing molecular functions such as transmembrane receptor protein tyrosine kinase activity. KEGG analysis identified 124 related pathways, mainly including epidermal growth factor receptor (EGFR) tyrosine kinase inhibitor resistance pathway. Protein-protein interaction network analysis obtained 7 core targets such as serine/threonine kinase 1 (Akt1). Molecular docking results showed that the binding energies of TYP with core target genes and the ferroptosis-related proteins (SLC7A11 and GPX4) were all ≤-5.0 kcal/mol, indicating significant binding activity. CCK-8 assay showed that TYP significantly inhibited PC9 cell viability (P<0.05). EdU assay demonstrated that the proportion of proliferating cells in TYP group was significantly lower than that in control group (P<0.05). Scratch assay, Transwell migration assay, and invasion assay revealed that, compared with control group, the migration and invasion abilities of PC9 cells in TYP group significantly decreased (P<0.05), and GSH content and mitochondrial membrane potential in TYP group also significantly decreased (P<0.05), while ROS and Fe²⁺ contents increased significantly (P<0.01), and protein and mRNA expression levels of SLC7A11 and GPX4 decreased significantly (P<0.05). Transmission electron microscopy results showed that cells in TYP group exhibited specific ferroptosis-related changes such as reduced mitochondrial cristae and increased membrane density, compared with control group. Compared with vector+TYP group, OE-SLC7A11+TYP group had higher cell viability (P<0.05), lower Fe²⁺ content (P<0.05), and higher protein expression levels of SLC7A11 and GPX4 (P<0.05). Conclusion TYP may induce ferroptosis in lung adenocarcinoma cells and inhibit their malignant behaviors such as proliferation, migration and invasion by regulating the SLC7A11-GPX4 axis.

Objective To explore the application value of musculoskeletal ultrasound (MSUS) in grading acute gastrocnemius muscle injuries. Methods A retrospective analysis was conducted on ultrasound images of 291 patients who presented with sudden calf pain and suspected acute gastrocnemius muscle injury in the General Hospital of Central Theater Command from March 2019 to July 2024. The images were independently reviewed and assessed by three ultrasound doctors with different qualifications to determine the presence and grade of gastrocnemius muscle injury. The consistency of grading results among three doctors was compared. The diagnostic results of three doctors were summarized. Then, the diagnostic results of 29 patients who underwent routine MRI scans were compared with those of MSUS, and the agreement between the two imaging modalities was assessed using the Kappa test. Results Among the 291 patients, 171 cases (58.8%) were diagnosed with gastrocnemius muscle injury, including 55 cases (32.2%) with grade Ⅰ, 109 cases (63.7%) with grade Ⅱ, and 7 cases (4.1%) with grade Ⅲ. There were 159 cases (93.0%) of unilateral medial head injury, 10 cases (5.8%) of unilateral lateral head injury, and 2 cases (1.2%) of bilateral medial and lateral head injury. Compared with patients without gastrocnemius muscle injury, patients with gastrocnemius muscle injury were older (P<0.05), with no significant difference in gender and laterality (P>0.05). No significant differences in baseline characteristics were found among patients with different grades of injury (P>0.05). The three doctors diagnosed 173 (59.5%), 171 (58.8%), and 171 (58.8%) cases of injury, respectively, with an inter-class correlation coefficient (ICC) of 0.947 (P<0.001). Among 29 patients who underwent MRI, the diagnostic agreement between MRI and ultrasound for grade Ⅰ, Ⅱ and Ⅲ injury was 8 (27.6%), 18 (62.1%) and 3 (10.3%) for MRI; and 9 (31.0%), 17 (58.6%) and 3 (10.3%) for MSUS, respectively, with a Kappa value of 0.808 (P<0.001). Conclusions MSUS is effective for assessing the grade of acute gastrocnemius muscle injury, and shows high diagnostic consistency among doctors with different qualifications. It is recommended as the preferred method for diagnosing gastrocnemius muscle injury.

Objective To analyze the relationship between the visceral adiposity index (VAI) and nocturia in the US adult population. Methods A cross-sectional study was performed. Data from subjects aged ≥20 years in the National Health and Nutrition Examination Survey (NHANES) database from 2007 to 2020 were collected, including waist circumference, triglyceride, body mass index (BMI), high-density lipoprotein, age, gender, race, poverty income ratio, education level, marital status, smoking, alcohol consumption, sleep disorders, depression, occupation, hypertension, diabetes, congestive heart failure, cancer, and nocturnal urination frequency. Weighted analysis, multivariate logistic regression, generalized additive model (GAM), and curve fitting were employed to evaluate the association between VAI and nocturia, adjusting for age, gender, race, poverty income ratio, education level, marital status, smoking, alcohol consumption, sleep disorders, depression, occupation, hypertension, diabetes, congestive heart failure, and cancer. Subgroup analyses were conducted based on age, gender, race, hypertension and diabetes to further evaluate the relationship between VAI and the risk of nocturia. Results A total of 29,196 American adults were included. All subjects were divided into 4 groups based on VAI quartiles: Q₁ group (0.32≤VAI<1.01), Q₂ group (1.01≤VAI<1.70), Q₃ group (1.70≤VAI<2.95), and Q₄ group (2.95≤VAI<13.59), with nocturia prevalence rates of 28.5%, 31.4%, 33.3%, and 34.9%, respectively. In subgroup analyses, the risk of nocturia significantly increased with higher VAI in the 20-40 age group, females and other Hispanics (OR=1.04, 95%CI 1.01-1.08, P=0.006; OR=1.02, 95% CI 1.00-1.04, P=0.035; OR=1.05, 95%CI 1.01-1.09, P=0.026). GAM analysis results showed a nonlinear relationship between VAI and nocturia. Conclusion VAI is positively associated with the risk of nocturia, and may be an effective indicator for predicting the risk of nocturia occurrence.

Objective To compare the effects of different exercise acclimatization (EA) durations on liver injury and inflammatory response in mice with exertional heatstroke (EHS). Methods A total of 168 male C57BL/6 mice were randomly assigned to four groups using a random number table: no exercise acclimation group (EA0W, n=54), 1-week exercise acclimation group (EA1W, n=54), 2-week exercise acclimation group (EA2W, n=54), and blank control group (n=6). The blank control group did not undergo acclimatization training or EHS modeling. The EA1W and EA2W groups underwent daily 2-hour exercise training at a speed of 10 m/min in an environment maintained at (26.0±0.5) ℃ for 1 and 2 weeks, respectively, followed by a 2-day rest after training completion. EHS modeling was performed in mice of EA0W, EA1W, and EA2W groups through running at 10 m/min under controlled environmental conditions (39.5 ℃ ambient temperature, 65% relative humidity). The modeling endpoint was defined as loss of consciousness accompanied by a core body temperature ≥42.7 ℃. All modeling procedures were systematically documented. Following modeling, 18 mice from EA0W, EA1W, and EA2W groups underwent 24-hour survival analysis. Blood samples from the abdominal aorta and liver tissues were collected at 6, 12 and 24 hours post-modeling (6 mice per time point for each group). Plasma levels of alanine aminotransferase (ALT), aspartate aminotransferase (AST), and creatine kinase (CK) were quantified. Interleukin (IL)-1β and IL-6 concentrations were determined using enzyme-linked immunosorbent assay (ELISA). Liver tissue specimens underwent hematoxylin-eosin (HE) staining and pathological scoring. Results The EHS model was successfully established in all EA groups. When all mice in EA0W group developed EHS (65 min after the modeling initiation), the incidence rates in EA1W and EA2W groups were 50.0% and 22.2%, respectively, with a statistically significant difference between EA0W group and the latter two groups (P<0.05). When all mice in the three groups developed EHS, the time to EHS onset was significantly longer in both EA1W and EA2W groups compared to EA0W group, with EA2W group showing a longer onset time than EA1W group (P<0.05). Survival analysis revealed a significantly higher 24-hour survival rate in EA2W group (61.1%) compared to EA0W group (33.3%) (P<0.05), while no significant difference was observed between EA1W group and the other two groups (P>0.05). The levels of IL-1β, IL-6, and CK were highest at 6 h post-modeling in all EA groups (P<0.05), and liver injury was most severe at 12 h post-modeling (P<0.05). Compared to EA0W group, the levels of ALT, AST, and IL-1β, as well as liver pathology scores, were significantly lower at 12 h post-modeling in both EA1W and EA2W groups (P<0.05), with EA2W group showing significantly lower ALT and AST levels, as well as liver pathology scores than EA1W group (P<0.05). At 6 h post-modeling, CK levels were significantly higher in EA1W and EA2W groups compared to EA0W group (P<0.05), with EA2W group exhibiting higher CK levels than in EA1W group (P<0.05). Conclusions Exercise acclimation helps reduce the incidence of EHS. Following EHS onset, the survival rate of exercise-acclimated mice is higher than that non-acclimated mice, with a significantly higher survival rate in mice acclimated for 2 weeks compared to non-acclimated mice. However, no significant difference in survival rate is observed between mice acclimated for 1 week and non-acclimated mice. Additionally, exercise acclimation for 2 weeks is more effective in reducing liver injury and inflammatory responses compared to 1-week acclimation.