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.

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.

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.

Systemic lupus erythematosus (SLE) is a chronic diffuse connective tissue disease characterized by abnormal activation of the immune system, which attacks the body's tissues. It has a complex course and its pathological basis is vasculitis. In recent years, research on the relationship between SLE and the gut microbiota has increased significantly, but how to regulate the gut microbiota for the treatment of SLE remains unclear. Studies have found that the intestinal microbiota of SLE patients differs from that of healthy people in terms of Firmicutes, Bacteroidetes, Actinomycetes, and Proteobacteria, etc., and this has been verified in animal experiments. In this review, the changes of intestinal microbiota in SLE patients and their association with the pathogenesis and progression of the disease are systematically reviewed, aiming to provide new insights into the treatment of SLE.

Gastrointestinal stromal tumor (GIST) is the most prevalent mesenchymal tumor of the gastrointestinal tract, with imatinib serving as the first-line drug for metastatic GIST due to its good clinical efficacy. However, the majority of patients exhibit tumor progression within several years of drug therapy, primarily due to the high rate of drug resistance, which significantly impedes drug therapeutic outcome and patient prognosis. Traditional approaches to counteract resistance, including dosage increase and subsequent line therapy yielded suboptimal results. As a research hotspot, intestinal flora has been proven to be closely related to drug resistance of various tumors. In recent years, it has been observed that specific intestinal flora could serve as biomarkers for early GIST patient screening or as potential drug targets, and modulating the intestinal flora through interventions may delay or even reverse the progression of imatinib secondary drug resistance in GIST. This review delineates the drug resistance of GIST, correlations between intestinal flora and drug resistance of tumors, as well as the relationship between intestinal flora and drug resistance of GIST, aiming to provide novel perspectives and methodologies for clinical application.

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 explore the influencing factors of different types of small intestinal bacterial overgrowth (SIBO). Methods A total of 539 patients who were hospitalized in the Department of Gastroenterology, the Sixth Medical Center of PLA General Hospital from June 2021 to December 2021 and who underwent methane-hydrogen breath test were retrospectively selected. Based on breath test results, patients were divided into SIBO-negative group (n=300) and SIBO-positive group (n=239). The clinical data were compared between two groups. According to the specific values of breath test results, SIBO-positive patients were further divided into hydrogen-producing bacterial overgrowth (hydrogen-positive, n=103), intestinal methanogen overgrowth (methanogen-positive, n=80), and simultaneous methanogen and hydrogen-producing bacterial overgrowth (double positive, n=56) groups. Multivariate logistic regression analysis was employed to identify influencing factors of different SIBO types. Additionally, SIBO-positive patients were categorized by age into <45 years (n=23), 45-60 years (n=82), 60-75 years (n=124), and ≥75 years (n=10) to compare SIBO positivity rates across age groups. Results The patients in SIBO-positive and double positive groups were older and had a lower body mass index (BMI) than those in SIBO-negative group, with statistically significant differences (P<0.05). Compared with the patients in SIBO-negative group, those in hydrogen-positive group showed a higher proportion of history of coronary heart disease, those in methanogen-positive group were older, and higher proportion of statin use, with statistically significant differences (P<0.05). Multivariate logistic regression analysis revealed that, among different SIBO types, a history of coronary heart disease served as an independent risk factor for hydrogen-producing bacterial overgrowth (OR=2.728, 95%CI 1.271-5.857, P=0.010). For methanogen overgrowth, increasing age was identified as an independent risk factor (OR=1.040, 95%CI 1.009-1.063, P=0.010), while the application of statin played the role of an independent protective factor (OR=0.420, 95%CI 0.236-0.754, P=0.003). As for the simultaneous overgrowth of methane-producing and hydrogen-producing bacteria, increased BMI was found to be an independent protective factor (OR=0.870, 95%CI 0.786-0.964, P=0.008). In SIBO-positive group, it was found that for patients aged <45 years, both the methane-positive rate and the double-positive rate were significantly lower than the hydrogen positivity rate (P<0.05). Moreover, among patients aged 45-60 years, the double-positive rate was significantly lower than the hydrogen positivity rate (P<0.01). When it comes to the hydrogen-positive rate, it was significantly lower for patients aged 45-60 and 60-75 years compared with that of patients aged <45 years (P<0.05). In contrast, the methane-positive rate and the double-positive rate were significantly higher for patients aged 45-60 and 60-75 years than those of patients aged <45 years (P<0.01). Conclusion A history of coronary heart disease and increasing age are independent risk factors for intestinal hydrogen-producing bacterial overgrowth and methanogen overgrowth, respectively. The application of statins and increased BMI are independent protective factors for intestinal methanogen simultaneous overgrowth of methanogen and hydrogen-producing bacteria, respectively.

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.

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 analyze the classification characteristics of rheumatoid arthritis (RA)-related antibodies and to investigate the factors influencing the development of RA-related interstitial pulmonary diseases (RA-ILD) in RA patients using latent class analysis (LCA). Methods A retrospective analysis of 712 RA patients treated at the Department of Rheumatology and Immunology of the Second Hospital of Shanxi Medical University from December 2019 to October 2022 was conducted. According to whether patients had RA-ILD or not, they were divided into simple RA group (n=523) and RA-ILD group (n=189). Then, the differences in general data, clinical features, medication use and laboratory indicators were compared between the two groups. Based on the differences in RA-related antibody indicators, 712 patients were divided into 3 latent categories using LCA: high-risk group (n=364), medium-risk group (n=205), and low-risk group (n=143).One-way analysis of variance was employed to compare clinical characteristics of the 3 groups, and the prevalence of RA-ILD was calculated. Multivariate logistic regression analysis was utilized to identify independent affect factors of RA-ILD. Results Significant differences in gender, age, and smoking history were observed between simple RA group and RA-ILD group (P<0.05). The high, medium and low risk groups exhibited significant differences in gender, age, prednisone (PRED) and methotrexate (MTX) medication history, Red blood cell count (RBC), interleukin-2 (IL-2), IL-4, IL-10, IL-17, TNF-α, interferon-γ (INF-γ), serum globulins, and white blood albumins (P<0.05). The high-risk group had a higher proportion of males, RBC, IL-2, IL-4, IL-10, IL-17, TNF-α, INF-γ, and serum globulin levels, and a lower proportion of MTX medication compared with medium- and low-risk groups (P<0.05 or P<0.01). The medium-risk group had a higher proportion of MTX administration than that in high- and low-risk groups (P<0.05 or P<0.01). The low-risk group had a higher proportion of females and older age than those in other two groups (P<0.05 or P<0.01). The prevalence of RA-ILD was 30.5%, 23.9% and 20.3% in the three groups, respectively. Multivariate logistic regression analysis indicated that male (OR=2.920, 95%CI 1.722-4.952), age (OR=1.055, 95%CI 1.035-1.074), IL-17 (OR=1.013, 95%CI 1.003-1.023), TNF-α (OR=1.050, 95%CI 1.017-1.083), INF-γ (OR=0.962, 95%CI 0.932-0.993), Serum albumin (OR=0.919, 95%CI 0.869-0.971) and high risk antibody indicators (OR=1.725, 95%CI 1.084-2.745) were independent predictors for RA-ILD. Conclusions RA patients exhibit distinct categories of antibody indicators, with a higher prevalence in high-risk patients with RA-ILD. RA-ILD is more likely to occur in male, elderly patients with abnormal liver function and high-risk antibody indictors. More attention should be paid to these patients and individualized interventions should be developed and implemented in a timely manner to improve the quality of patient survival.