In military training, when the physiological heat stress load is excessive and cannot be corrected in time, heat illness may occur, and in severe cases, exertional heat stroke may occur, which will seriously affect the combat effectiveness. Rapid, effective and uninterrupted cooling is the key measure to relieve excessive heat stress reaction and prevent heat illness/stroke. Based on nearly 10 years of clinical practice experience, the scientific research achievements in heatstroke prevention areas, as well as domestic and foreign latest evidence, Expert Group of Heat Stroke Prevention and Treatment of the Chinese PLA summarized the temperature monitoring, preventive and therapeutic cooling strategies in the whole process of military training, and widely consulted the opinions of emergency and critical care experts in the military, and finally formed the consensus, thus being intended to provide guidance for the implementation of effective temperature management in military training.

Virtual reality (VR) technology is a comprehensive multimedia technology. Since its development from the 1950s, VR technology has been widely applied in the field of military medicine. Armed forces around the world utilize VR technology to conduct psychological adjustment and skill training for front-line combat personnel and to educate health service personnel. Meanwhile, the high simulation of the real environment by VR enables rear medical personnel to carry out exposure therapy for patients suffering from post-traumatic stress disorder (PTSD) or other psychological trauma, in a reconstructed virtual environment which is extremely similar to battlefield but with far higher safety. It can also carry out rehabilitation training, health education or combat capability assessment for the wounded with brain injury or disability with higher efficiency. This paper reviews the origin and development of VR, expounds the development and application of VR technology in the field of military medicine, and prospects its possible development in near future.

Military traumatic brain injury (TBI) belongs to military psychiatry, which is a new subcategory of psychiatry. Military TBI has become a landmark injury in modern military conflicts, which not only has a high incidence and death rate, but also has many sequelae, bringing heavy burden to patients and society. There have been frequent reports on TBI, but the pathophysiological mechanism of trauma to human brain tissue caused by military action and war has not been extensively studied. In this paper, epidemiological data, pathogenesis, molecular biological diagnosis and research achievements of existing therapeutic techniques related to TBI were reviewed, especially in terms of pathophysiological mechanism, and the pathogenesis, pathophysiological changes, blood-brain barrier injury, neuroinflammation and immune response of military TBI induced concussion and impact brain injury were summarized. It will provide useful reference for further study of military TBI.

Objective To discuss the correlation between triglyceride-glucose index (TYG) and the major ischemic events in the past year in patients with acute myocardial infarction (AMI) treated with primary percutaneous coronary interventions (PCI). Methods The present study is a retrospective analysis based on a single-center registration database. From March 2016 to March 2019, the clinical data of 2203 eligible patients with AMI undergoing primary PCI were collected from the General Hospital of Northern Theater Command, and divided into two groups according to the median TYG index at admission [TYG <9.1047 group (n=1101) and TYG ≥9.1047 group (n=1102)]. The demographic characteristics, risk factors and complication, laboratory test, operation characteristics and medication after discharge were compared between the two groups. Meanwhile, the one-year ischemic events (cardiac death, myocardial infarction and/or ischemic stroke) and all-cause death were compared between the two groups. The Cox regression models were used to analyze the correlation between TYG and main outcomes. To evaluate the predictive value of TYG for one-year ischemic events using the ROC curve. Results Compared with TYG <9.1047 group, patients in TYG ≥9.1047 group were younger, less male, and had a higher proportion of hypertension and diabetes (P<0.05), and higher incidence with significant differences (P<0.05) in the frequency of one-year ischemic events, cardiac death and all-cause death. The TYG showed acceptable performance in prediction of one-year ischemic events and all-cause death with areas under the curve (AUC) of 0.62(95%CI 0.55-0.68) for ischemic events and 0.61(95%CI 0.55-0.68) for all-cause death. The best cut-off point for distinguishing the main end point from one-year ischemic events was 9.5948, the sensitivity was 47.3%, and the specificity was 76.5%. Conclusion Excessive TYG at admission of AMI patients is significantly related to the incidence of one-year ischemic events after PCI.

Parkinson's disease (PD) is a common chronic inflammatory disease of the nervous system in the middle-aged and elderly. The main pathological basis of PD is the decrease of dopaminergic neurons in the substantia nigra and the formation of Louie bodies. The clinical manifestations of PD are usually quiescent tremor, bradykinesia, enhanced muscle tone and abnormal posture and gait. The pathogenesis of PD is very complex, which may be related to age, environment, heredity, oxidative stress and mitochondrial dysfunction. In this review, we summarized research progress on the mechanisms and treatment methods of α-synuclein, oxidative stress, mitochondrial dysfunction, LRRK2 gene mutation and other factors leading to the degeneration of dopaminergic neurons in PD, in order to provide a reference for basic and clinical research of PD.

Objective To investigate the effects of stem cells from human deciduous teeth (SHED) on temporomandibular joint osteoarthritis (TMJOA) in rats. Methods Sixty 8-week-old male SD rats were randomly divided into control group, sodium iodoacetate (MIA)-induced TMJOA group (MIA group) and SHED treatment TMJOA group (SHED group), 20 rats in each group, and 10 animals were sacrificed in each group 2 and 4 weeks after treatment and were collected. Temporomandibular joint (TMJ) on the left was used for morphological detection, and right TMJ condylar cartilage for molecular biology detection. The degree of cartilage degeneration was evaluated by HE and Saffron O-solid green staining, the expression of type collagen Ⅱ in condylar cartilage was detected by immunohistochemical staining, and the expression changes of cleaved-CASP3, the key molecule of apoptosis, and the pro-inflammatory factor tumor necrosis factor-α (TNF-α), were detected by Western blotting. Results Compared with control group, the arrangement of cells in each layer of condylar cartilage in MIA group was disordered, a large number of cell-free areas were visible, and the fibrous layer was significantly thickened (P<0.001). After SHED treatment, the morphology of SHED group basically returned to normal, and there was no significant difference between SHED group and control group. The histological score of Mankin's osteoarthritis of condylar cartilage in MIA group was significantly higher than that in control group (P<0.001). After treatment, the score decreased significantly in SHED group (P<0.001). The positive area ratio of Saffron-O staining and the percentage of positive area of collagen Ⅱ. Of condylar cartilage in MIA group were significantly lower than those in control group (P<0.001). After treatment, the value increased significantly in SHED group (P<0.01) and there was no significant difference compared with control group. The number of TUNEL-positive cells in the condylar cartilage in MIA group was significantly higher than that in control group (P<0.001). After treatment, this value decreased significantly in SHED group (P<0.001). Western blotting results showed that the protein expression levels of cleaved-CASP3 and TNF-α in the condylar cartilage of MIA group were significantly higher than those in control group (P<0.001). After treatment, this value decreased significantly in SHED group (P<0.001) and there was no significant difference compared with control group. Conclusion Intra-articular injection of SHED can reverse condylar cartilage degeneration induced by MIA.

Objective To investigate the effect of carbamazepine (CBZ) on Kv7.4 channels of dopaminergic (DA) neurons in the ventral tegmental area (VTA) of the midbrain of epileptic rats. Methods 50 male Wistar rats were randomly divided into 5 groups: control group, epilepsy group, and low, medium, high concentration CBZ group, 10 in each group. Except control group, rats in other groups were induced epilepsy with lithium chloride and pilocarpine to establish epilepsy rat model. After the model was successfully constructed, the rats in low, medium, and high concentration CBZ groups were given CBZ (10, 30, and 50 mg/kg) by gavage respectively, while rats in control group and epilepsy group were given the same amount of normal saline by gavage once a day for 7 days. The behavior changes of rats were observed. The malondialdehyde (MDA), glutathione (GSH) content and superoxide dismutase (SOD) activity in VTA were determinate by spectrophotometric. The protein expression of tyrosine hydroxylase (TH) and kv7.4 in VTA were detected by immunofluorescence and laser confocal microscopy. Western blotting was used to detecte the TH and Kv7.4 expression. Results No abnormal behavior showed with rats in control group. After pilocarpine injection, rats in epilepsy group experienced symptoms such as convulsions, chewing, and salivation, and the symptoms in low, medium, and high concentration CBZ group were alleviated. Compared with rats in control group, the MDA content of the rats in epilepsy group was significantly increased (P<0.05), the GSH content, SOD activity, number of DA neurons in the VTA region, and the expression of TH and Kv7.4 protein were significantly reduced (P<0.05). Compared with rats in epilepsy group, the seizure latency, GSH content, SOD activity, number of DA neurons in VTA area, and TH and Kv7.4 protein expression levels significantly increased in the low, medium and high concentration CBZ group (P<0.05); seizure rate and MDA content significantly decreased in the medium and high concentration CBZ group (P<0.05). Conclusions CBZ could alleviate oxidative stress response in brain of epileptic rats, promote DA neuron activity at VTA, activate Kv7.4 channels, and relieve epileptic seizures.

Diabetic cardiomyopathy (DCM) is a specific cardiomyopathy, independent of hypertension, coronary heart disease, valvular disease, congenital heart disease or other cardiovascular diseases. The pathogenesis of DCM is one of the current research hot spots in recent years. Due to the imbalance of glucose and lipid metabolism, the increase of oxidative stress and the activation of various inflammatory reactions, further mediating the myocardial cell and extracellular damage, resulting in pathological myocardial remodeling, diastolic and systolic dysfunction and eventually evolving into heart failure. At present, the effective methods for early screening and treatment of DCM are still limited. In order to better understand the specific mechanism of the occurrence and development of DCM, the latest research progress on pathophysiological mechanism, clinical manifestation and therapeutic prospect of DCM were reviewed for providing reference for the early clinical prevention and treatment of DCM.

Objective To evaluate the therapeutic effect of everolimus on tuberous sclerosis related renal angiomyolipoma (TSC-RAML) based on tumor components, and identify the types of main components in reducing RAML by everolimus. Methods To retrospectiely analyze the clinical data of 47 patients with TSC-RAML who were treated in the Urology Department of the First Affiliated Hospital of the Air Force Medical University and met the diagnostic criteria of ITSCCC from September 2017 to September 2022. According to the attenuation range of CT tissue specific threshold, patients were divided into fat rich group (HU ≤-10, n=26) and fat deficient group (HU ≥30, n=21). Collect patients' baseline CT data and 6 months after treatment, record the average CT value of RAML before and after treatment. Three-dimensional reconstruction of RAML was performed using Mimics software, and record the volume of RAML before and after treatment. The volume of RAML and mean CT value were compared between the two groups before and after treatment. Results No statistical difference existed in baseline characteristics between the two groups (P>0.05). The median reduction of tumor volume in fat rich group and fat deficient group of patients were 4.94 (3.12, 27.23) cm³ and 27.31 (10.83, 40.38) cm³, respectively, and the volume response rates were 11.52%±0.96% and 62.09%±12.60% respectively, the differences were statistically significant (P<0.05). The differences of average CT values between the fat rich group and fat deficient group were (4.23±3.01) HU and (14.52±3.61) HU respectively, and the reduction rates of CT values were 14.25%±11.94% and 29.23%±0.53% respectively, all were statistically significant (P<0.05). After treatment, the average CT value of tumors in fat deficient group decreased significantly compared to that in fat rich group with statistically significant difference (P<0.05). Six months after treatment with everolimus, the composition of high-density cord like vascular tissue in RAML tumors reduced significantly and fat conversion occurred. Conclusions The effect of everolimus on reducing tumor volume and average CT value of tumor in fat deficient RAML is better and significant, which confirmed that the reduction is the high-density component of TSC-RAML mainly composed of vascular components.

Objective To analyze the level of reactive oxygen species (ROS) produced by neutrophils and to explore its clinical significance in patients with chronic hepatitis B virus (HBV) infection. Methods Eighty-eight chronic HBV infected patients who admitted to the Fifth Medical Center of Chinese PLA General Hospital from April 2022 to September 2022 were enrolled in this study. Thirty patients who received nucleoside (acid) analogues (NAs) treatment were classified as the treated group, and fifty-eight did not receive treatment were classified as the untreated group. Simultaneously, twenty healthy individuals were classified as control group. The differences in clinical and virological parameters were compared between the three groups. The spontaneous ROS production by neutrophils after incubation with DHR 123 fluorescent dye were detected by flow cytometry. And the correlation between the spontaneous ROS and HBV DNA viral load, hepatitis B surface antigen (HBsAg), white blood cell (WBC), C-reactive protein (CRP), alanine transaminase (ALT) and aspartate transaminase (AST) were further analyzed. Culture medium, HepG2 cell supernatant and HepG2.2.15 cell supernatant were used to co-culture with neutrophils from healthy controls, respectively, to verify the effect of HBV virus particles and proteins on neutrophil spontaneous ROS in vitro. The secondary ROS production by neutrophils after lipopolysaccharide (LPS) stimulation was compared between the three groups. Results The spontaneous ROS production by neutrophils in the untreated group was higher than control group (P<0.05). The spontaneous ROS production by neutrophils in untreated patients was positively correlated with HBV DNA viral load and HBsAg quantification (r=0.315, P=0.016; r=0.326, P=0.013), but had no significant correlation with WBC, CRP, ALT and AST. HepG2.2.15 cell supernatant could induce the spontaneous ROS production by neutrophils in a dose-dependent manner (P<0.05). After LPS stimulation, the secondary ROS production by neutrophils in the untreated group and the treated group were lower than the control group (P<0.05). Conclusion Reducing the viral load by antiviral treatment contributes to reduction of spontaneous ROS production by neutrophils but not to restore the secondary ROS production by neutrophils after stimulated by LPS.