Objective To investigate the diagnostic value of 4 novel inflammatory markers related to routine blood tests, namely neutrophil-to-lymphocyte ratio (NLR), red blood cell distribution width (RDW), hemoglobin-to-RDW ratio (HRR) and systemic immune-inflammation index (SII), in elderly patients with chronic cardiovascular disease (CVD) complicated with frailty. Methods Retrospectively analyze 110 patients with chronic stable CVD who were hospitalized in the cadre ward of cardiovascular medicine at the Air Force Characteristic Medical Center from January 2022 to June 2023. According to the assessment results of the Fried scale, they were divided into three groups: non-frailty group (Fried score=0, n=30), the pre-frailty group (Fried score 1 or 2, n=40) and frailty group (Fried score ≥3, n=40). The differences in general information, the impairment rate of daily living activities, miniature nutritional assessment-short form (MNA-SF) scores, mini-mental state examination (MMSE) scores, and the indicators such as NLR, RDW, HRR, and SII among the three groups were compared. Spearman rank correlation was used to analyze the correlation between NLR, RDW, HRR, SII and frailty scores as well as each frailty indicator. Multivariate logistic regression analysis was performed to identify the independent risk factors for frailty in elderly patients with chronic CVD, and the receiver operating characteristic (ROC) curve was used to assess the clinical diagnostic value of NLR and HRR in elderly patients with chronic CVD complicated with frailty. Results Compared with non-frailty group and pre-frailty group, patients in frailty group were older, with higher impaired rates of daily living activities, NLR, RDW, and SII, and lower MNA-SF scores, MMSE scores, and HRR, and differences were statistically significant (P<0.05). Spearman rank correlation analysis showed that the frailty score was positively correlated with NLR (r_s=0.354, P<0.001), and RDW (r_s=0.448, P<0.001), negatively correlated with HRR (r_s=-0.232, P=0.024), and had no significant correlation with SII (r_s=0.144,P=0.167). Further analysis of the correlation between the above novel inflammatory markers and the 5 components of frailty showed that NLR was positively correlated with fatigue (r_s=0.228, P=0.017), slowed walking speed (r_s=0.299, P<0.001), and low physical function(r_s=0.319, P<0.001); RDW was positively correlated with decreased grip strength (r_s=0.321, P<0.001), slowed walking speed (r_s=0.422,P<0.001), and low physical function (r_s=0.246, P=0.001); and HRR was negatively correlated with slowed walking speed (r_s=-0.230, P=0.025), and low physical function (r_s=-0.299, P=0.003). Multivariate logistic regression analysis showed that MNA-SF score (OR=0.577, 95%CI 0.342-0.973) was an independent protective factor for pre-frailty in elderly patients with chronic CVD (P<0.05); NLR (OR=7.866, 95%CI 1.101-56.185) was an independent risk factor for frailty, while HRR (OR=0.344, 95%CI 0.120-0.983) and MNA-SF score (OR=0.292, 95%CI 0.146-0.580) were independent protective factors for frailty in elderly CVD patients (P<0.05). The area under the ROC curve of NLR and HRR for diagnosing frailty in elderly patients with chronic CVD were 0.778 and 0.749, respectively. Conclusion NLR and HRR have high clinical diagnostic value for frailty in elderly patients with chronic CVD, and are expected to become effective inflammatory markers for screening elderly patients with chronic CVD complicated with frailty.

Objective To explore the relationship between C-reactive protein/albumin ratio (CAR) and the disease severity in patients with severe pneumonia, and its predictive value for 28-day mortality risk. Methods A retrospective analysis was conducted on 152 patients with severe pneumonia admitted to Fuyang People's Hospital from January 2020 to January 2022. They were divided into non-critical illness group (n=51), critical illness group (n=63), and extremely critical illness group (n=38) based on the disease severity. The clinical data such as age and gender of patients was collected, and Pearson correlation analysis was used to explore the correlation between CAR and the severity of illness [determined by Acute Physiology and Chronic Health Evaluation Ⅱ (APACHE Ⅱ) score]. Multivariate logistic regression was employed to identify independent influencing factors of the severity of illness. According to the survival status of patients after 28 days of treatment, they were divided into survival group (n=107) and death group (n=45). CAR was categorized into quintiles (Q₁-Q₅), and multivariate logistic regression analysis was conducted to explore the correlation between CAR and 28-day mortality risk in severe pneumonia patients. A restricted cubic spline (RCS) model was used to analyze the dose-response relationship between CAR and mortality risk. The predictive value of CAR and related indicators for patient mortality risk was evaluated using the receiver operating characteristic curve (ROC). Results CAR was significantly positively correlated with the severity of the disease (APACHE Ⅱ score) (r=0.716, P<0.05). Neutrophil/lymphocyte ratio (NLR), blood lactate (Lac), and high CAR were independent risk factors for the disease severity in patients with severe pneumonia (P<0.05). After adjusting for confounding factors, the mortality risk increased with the increase of CAR (P<0.05). Subgroup analysis of the screened confounding factors revealed that the correlation between CAR and 28-day mortality risk in severe pneumonia patients remained stable across different APACHE Ⅱ scores, GCS scores, SOFA scores, white blood cell counts (WBC), neutrophils (NEU), red cell volume distribution width (RDW), procalcitonin (PCT), and Lac, with interactions observed between NLR and Lac subgroups (P<0.05). The RCS model indicated that there was no non-linear dose-response relationship between CAR and 28-day mortality risk in patients with severe pneumonia of different genders. ROC curve analysis showed that CAR, Lac, and NLR had good predictive value for 28-day mortality in severe pneumonia patients, with the combined predictive efficacy being significantly higher than that of individual indicators. Conclusion There is a close relationship between CAR and the progression and prognosis of severe pneumonia, making it a new approach to assessing the severity of illness and predicting mortality risk in patients.

Objective To investigate the clinical characteristics and management strategies of spinal infarction (SCI) combined with hypoxic-ischemic encephalopathy (HIE). Methods We report a case of SCI induced by cardiopulmonary arrest in a patient admitted to the General Hospital of Southern Theater Command in June 2021. A review of the relevant literature published in PubMed and CNKI from January 2014 to March 2024, was conducted to summarize the etiology, features, and treatment approaches for SCI. Results The patient presented with clinical features of quadriplegia accompanied by paresthesia, lumbar and cervical pain with paresthesia, dysphagia, dysphonia, and urinary and fecal incontinence. Spinal MRI revealed abnormal signals in the anterior and lateral columns at the C₂-T₁ spinal level, with no enhancement observed in contrast-enhanced scan. The patient was diagnosed as SCI combined with HIE, and was treated with antiplatelet therapy and rehabilitation. Literature review revealed that SCI is a rare central nervous system disease with multiple causes, often related to aortic surgery or pathology, presenting with segmental sensory disturbances among other clinical manifestations. MRI plays a significant role in its diagnosis, and there is currently no specific effective treatment available. Conclusions SCI has a sudden onset and is often insidious, frequently accompanying other diseases, leading to a high risk of misdiagnosis. In this case, SCI was considered to be caused by low blood pressure and vertebral artery tenuity. Clinical manifestations include paraplegia at the lesion level along with back/neck pain or limb paresthesia. Diagnosis primarily relies on MRI imaging while treatment involves secondary stroke prevention measures, rehabilitation training, complication prevention strategies as well as hyperbaric oxygen therapy.

Objective To investigate the protective effects of secretomes released by three-dimensional cultured mesenchymal stem cells (MSCs) on neurons subjected to seawater immersion (SW) and stretch injury (SI), and to provide new insights into neuronal repair following SW combined with traumatic brain injury (TBI). Methods MSCs were cultured using the hanging drop method, and the conditioned medium (CM) containing MSCs secretomes was collected. A cellular model combining SW with SI was established using mouse hippocampal neuronal cells (HT22 cells). HT22 cells were randomly assigned to five groups: control, SI, SI+SW, SI+CM, and SI+SW+CM groups. Cell viability was assessed using the CCK-8 assay, apoptosis rate was measured by flow cytometry, cell migration ability was evaluated by scratch assay, and the expression levels of apoptosis-related proteins Bcl-2 and Bcl-2-associated protein (Bax), and ferroptosis-related proteins long-chain acyl-CoA synthetase 4 (ACSL4) and cyclooxygenase-2 (COX-2) were detected by Western blotting. Results Immersion in 15% seawater for 12 h significantly decreased HT22 cell viability (P<0.05). The CCK-8 assay indicated that cell viability in both the SI and SI+SW groups was significantly lower than that in control group after 12 h of treatment (P<0.05). Treatment with CM containing MSCs secretomes significantly increased cell viability in SI+CM group compared to SI group (P<0.0001), and in SI+SW+CM group compared to SI+SW group (P<0.001). Flow cytometry results revealed that the apoptosis rate in SI and SI+SW groups was significantly higher than that in control group (P<0.05 or P<0.001), while in SI+CM group was lower than that in SI group (P<0.05), and in SI+SW+CM group was lower than that in SI+SW group (P<0.05). Western blotting showed that compared to control group, SI and SI+SW groups exhibited reduced Bcl-2 expression level (P<0.01 or P<0.0001) and increased expression levels of Bax, ACSL4, and COX-2 (P<0.01 or P<0.0001). Compared to SI group, the SI+CM group displayed increased Bcl-2 expression level (P<0.05) and decreased expression levels of Bax, ACSL4, and COX-2 (P<0.05). Compared to SI+SW group, SI+SW+CM group exhibited increased Bcl-2 expression level (P<0.01) and decreased expression levels of Bax, ACSL4, and COX-2 (P<0.01 or P<0.001). Scratch assay results demonstrated that at both 12 h and 24 h, the cell migration rate in SI and SI+SW groups was significantly lower than that in control group (P<0.01 or P<0.0001), while the migration rate in SI+CM group was significantly higher than that in SI group (P<0.0001 or P<0.01), and the migration rate in SI+SW+CM group was significantly higher than that in SI+SW group (P<0.0001). Conclusion Secretomes derived from MSCs cultured using the hanging drop method can alleviate neuronal damage caused by SW and TBI, potentially offering a therapeutic approach for SW combined with TBI.

Objective To explore the role and mechanism of silent information regulator 1 (SIRT1) in postoperative cognitive dysfunction (POCD) of aged mice following sevoflurane (SEV) anesthesia. Methods (1) Fifteen-month-old male C57BL/6 mice were randomly divided into control group (n=8) and SEV group (n=24), and SIRT1 expression in hippocampus of mice was assessed using Western blotting on the 1st, 3rd and 7th day after 2% SEV exposure. (2) Fifteen-month-old male C57BL/6 mice were randomly divided into AAV-GFP, AAV-SIRT1, SEV+AAV-GFP and SEV+AAV-SIRT1 groups (n=20). AAV-SIRT1 and control AAV-GFP vectors were transfected into the brain of mice respectively. Five days after the transfection, the corresponding groups of mice were exposed to 2% SEV for 5 h. Morris water maze test was used to evaluate the spatial memory of mice before and after SEV exposure, TUNEL staining was applied to assess hippocampal neurons apoptosis, and Western blotting was utilized to measure the expression levels of SIRT1, xCT and glutathione peroxidase 4 (GPX4). (3) Hippocampal neurons of mice were divided into control, AAV-SIRT1, Fer-1, SEV, SEV+AAV-SIRT1 and SEV+ferrostatin-1 (Fer-1) groups. Neurons in SEV, SEV+AAV-SIRT1 and SEV+Fer-1 groups were exposed to 5% SEV for 4 h. SEV+AAV-SIRT1 and SEV+Fer-1 groups were transfected with AAV-SIRT1 or treated with Fer-1 respectively prior to SEV exposure. Neuronal death was evaluated via propidium iodide (PI) staining. Malondialdehyde (MDA) level and iron content were determined using ELISA, reactive oxygen species (ROS) level was determined using fluorescence probes. Results (1) Western blotting revealed a significant reduction in SIRT1 protein expression levels in the hippocampus tissue of SEV group mice compared to control group (P<0.05). (2) Morris water maze test results showed that, compared with AAV-GFP group, the escape latency of mice in SEV+AAV-GFP and SEV+AAV-SIRT1 groups significantly prolonged (P<0.05), and the frequency of crossing the platform significantly decreased (P<0.05). Compared with SEV+AAV-GFP group, the escape latency of mice in SEV+AAV-SIRT1 group shortened (P<0.05), and the frequency of crossing the platform on the 7th day increased (P<0.05). TUNEL staining, Western blotting and immunohistochemistry indicated that the apoptosis of hippocampal neurons, Bax and cleaved-caspase-3 protein expression levels significantly increased in SEV+AAV-GFP and SEV+AAV-SIRT1 groups compared with those in AAV-GFP group, while the expression of Bcl-2, GPX4, and xCT protein expression levels significantly decreased (P<0.05 or P<0.01 or P<0.001). Compared with SEV+AAV-GFP group, SEV+AAV-SIRT1 group showed that apoptosis of hippocampal neurons, Bax and cleaved-caspase-3 protein expression levels significantly decreased (P<0.05), while Bcl-2, GPX4, and xCT protein expression levels significantly increased (P<0.05). (3) In vitro, PI staining and ELISA demonstrated significantly increased PI positive rate, MDA level and iron content in hippocampus neurons of SEV group compared to control group (P<0.01). Compared with SEV group, the positive rate of PI staining, MDA level, iron content and ROS level in hippocampus neurons of SEV+AAV-SIRT1 and SEV+Fer-1 groups significantly decreased (P<0.05). Conclusions SEV anesthesia leads to a decrease in SIRT1 expression in hippocampus and neurons of aged mice, and the upregulation of SIRT1 could alleviate SEV-induced neuronal death and ferroptosis.

Non-steroidal anti-inflammatory drugs (NSAIDs), commonly utilized analgesics, are extensively employed for managing pain associated with musculoskeletal disorders or injuries. Recent clinical studies have demonstrated a heightened risk of bone stress injuries (BSI) in soldiers and athletes, particularly during high-intensity training, due to NSAID usage. Furthermore, the impact of NSAIDs on fracture healing is well-documented; however, the precise mechanism by which their use during training contributes to an increased incidence of stress bone injuries remains unclear. This article aims to summarize potential mechanisms through an extensive review of domestic and international literature in order to standardize the utilization and clinical management of NSAIDs, optimize pain management strategies, and prevent stress bone injuries or fractures in specific populations such as soldiers and elite athletes.

Preeclampsia (PE) is a severe hypertensive disorder during pregnancy that seriously affects the health of pregnant women and fetuses. Currently, the treatment is merely symptomatic, with unsatisfactory efficacy and often resulting in an increased incidence of therapeutic preterm birth. An increasing number of studies on PE suggest that the "unitary" theory is no longer adequate to elucidate its pathogenesis. PE is regarded as a syndrome influenced by multiple factors, featuring a complex pathogenesis and the potential to affect multiple organs and systems. This review summarizes the latest advancements in the classification, etiology, pathogenesis, and research models (including animal and in vitro models) of PE, aiming to provide references for subsequent research and offer assistance in clinical prevention, screening, and treatment.

Spinal cord injury (SCI) is a structural and functional disruption of the spinal cord caused by various factors, leading to neurological dysfunction. As a common central nervous system disorder in clinical practice, SCI poses significant risks to human life and health. Its pathological mechanism is exceedingly complex, involving multiple pathological processes. Given the irreversibility of primary injury, targeting secondary injury has gradually become the main direction for the clinical treatment of SCI in recent years. Recent studies have highlighted the crucial role of blood-spinal cord barrier damage and microvascular dysfunction in the progression of secondary injury following SCI. Therefore, investigating the pathological mechanisms of microcirculation and exploring targeted therapies could provide valuable insights for clinical SCI treatment. This paper aims to provide an objective review of the role of microcirculation in SCI, identify the critical regulators of microvascular function, and summarize strategies for treating SCI by targeting microcirculation. The findings of this study may offer novel references for the clinical management of SCI.

Traumatic brain injury (TBI) is a serious condition characterized by high rates of mortality and disability. Deaths caused by severe TBI usually occur within the first few hours after the injury. Timely and effective management of TBI during pre-hospital and emergency treatment phases is crucial for improving patients' prognosis. To address this issue, the Emergency Physicians Branch of the Chinese Medical Doctor Association, the Emergency Medicine Professional Committee of the People's Liberation Army, the Beijing Emergency Medicine Society, and the Chinese Emergency Medicine Specialist Association have jointly selected national experts in emergency medicine and neurosurgery to formulate the "Chinese Expert Consensus on the Pre-hospital and Emergency Diagnosis and Treatment of Adult Traumatic Brain Injury". This consensus consists of two parts focusing on pre-hospital and emergency diagnosis and treatment of TBI, with 24 recommendations put forward to guide relevant clinical practices in pre-hospital and emergency management.

Objective To explore the correlation of bilateral knee joint strength asymmetry with balance, walking ability, and motor function in hemiplegic stroke patients, providing a reference for clinical assessment of stroke patients. Methods A total of 46 hemiplegic stroke patients admitted to the Rehabilitation Medicine Department of People's Hospital of Shijiazhuang from February to December 2023 were selected. According to the Berg Balance Scale (BBS) scores, patients were divided into Group A (BBS score ≤20, n=23) and Group B (BBS score >20, n=23). The peak torque and differences of bilateral knee flexors and extensors were compared between two groups. Isokinetic technology was used to assess the differences in peak torque of bilateral knee joints at 60°/s and 120°/s. BBS, Functional Ambulation Classification (FAC), and Fugl-Meyer Assessment of Lower Extremity (FMA-LE) were used to evaluate patients' balance, walking ability, and lower limb motor function. The correlation between bilateral knee joint peak torque and its difference with the scores of three functional scales was analyzed. Results The peak torque of knee flexors and extensors at 60°/s in group A was significantly lower than that in group B (P<0.05). At both 60°/s and 120°/s the differences in peak torque between the healthy and affected sides of knee flexors and extensors were greater than those in group B (P<0.05). At 60°/s, the difference in peak torque of bilateral knee extensors in hemiplegic stroke patients was negatively correlated with the scores of BBS, FAC, and FMA-LE (r=-0.569, -0.582, -0.606, P<0.01), as did the knee flexors (r=-0.534, -0.386, -0.458, P<0.05). At 120°/s, similar negative correlations were observed for both knee extensors (r=-0.304, -0.304, -0.443, P<0.05) and flexors (r=-0.337, -0.349, -0.370, P<0.05). Conclusions Bilateral knee joint strength asymmetry in hemiplegic stroke patients is negatively correlated with balance and walking ability. The difference in strength between the two sides of knee joint may be one of the clinical indicators for evaluating the motor function of stroke patients.