To investigate the predictive role of transcranial Doppler (TCD) ultrasound combined with invasive intracranial pressure (ICP) monitoring in the early outcomes for patients with moderate-to-severe traumatic brain injury (msTBI) after ICP probe insertion surgery.

A retrospective case-control analysis was conducted on the clinical data of 65 msTBI patients who underwent invasive ICP probe insertion surgery within 24 h after injury and routine TCD examination postoperatively in No. 904 Hospital of Joint Logistic Support Force of Chinese PLA between January 2021 and March 2025. Based on whether disease progression met the indications for craniotomy, they were divided into a failed conservative treatm ent group (n=28) and a successful conservative treatment group (n=37). Baseline clinical data, and parameters of TCD and ICP monitoring were collected in both groups. Univariate analysis was used for comparing differences in various parameters between the groups. The variables related to ICP and TCD were denoted as Model 1, and variables that significantly affected the outcome were incorporated as potential confounding factors into Model 2 based on clinical experience. Multivariate logistic regression analysis was performed to screen for independent predictors of conservative treatment failure. Receiver operating characteristic (ROC) curves were plotted to evaluate the diagnostic efficacy of each predictive factor.

Statistical differences were observed between the 2 groups in terms of Glasgow Coma Scale (GCS) score at admission, postoperative mean intracranial pressure (ICPm), postoperative mean cerebral perfusion pressure (CPPm), and pulsatility index (PI) of the ipsilateral internal carotid artery extracranial segment (ICAt), and mean flow velocity (Vm) and pulsatility index (PI) of the ipsilateral middle cerebral artery (MCA) (all P<0.01). After adjusting for age, GCS score at admission, hematoma volum, and mean postoperative brain temperature, multivariate logistic regression analysis revealed that ICPm (OR=1.248, 95%CI: 1.044~1.491, P=0.015), ipsilateral MCA.Vm (OR=0.964, 95%CI: 0.933~0.997, P=0.034), and ipsilateral MCA.PI (OR=1.612, 95%CI: 1.026~2.533, P=0.038) were independent predictors of failure in conservative treatment in msTBI patients. After adjustment, ROC curve analysis demonstrated that the combined model of ipsilateral MCA.PI, ipsilateral MCA.Vm, and ICPm achieved a predictive efficacy of 0.931 (95%CI: 0.873~0.988), which was obviously higher than that of the single model of ICPm (0.875, 95%CI: 0.791~0.959).

Combined monitoring of TCD and ICP can provide a more accurate prediction of the early outcomes for msTBI patients after ICP probe insertion, providing a more effective assessment for clinical diagnosis and treatment.

To stratify the estrogen receptor (ER) positive while human epidermal growth factor receptor 2 (HER2) negative breast cancer patients by the expression level of ER, providing new evidence for prognostic prediction and guiding precision endocrine therapy (ET) for those with different ER expression levels.

A retrospective cohort study was conducted on 1 962 ER-positive/HER2-negative breast cancer patients treated in our department from January 1, 2013 to December 31, 2018. X-tile was used to calculate the optimal cutoff point of ER expression level, and then based on the results, they were divided into low (1%~10%), moderate (11%~30%), and high expression (31%~100%) groups. After propensity score matching (PSM) was performed to balance baseline characteristics, their prognostic outcomes were compared and the responses to ET were analyzed in the groups. Cox proportional risk regression model was applied to analyze the prognostic factors, and subgroup analysis was further performed.

After PAM, 129 (11.5%) were assigned into a low ER expression group, 151 (13.5%) and 840 (75%) into moderate and high ER expression groups, respectively. Statistical differences were observed in disease-free survival (DFS) and overall survival (OS) among the 3 groups (P=8e-6, P=8e-14). In the low ER expression group, the patients treated with selective estrogen receptor modulators (SERMs) showed no significant differences in DFS and OS than those treated with aromatase inhibitors (AIs) (P>0.05). However, the patients from the moderate and high ER expression groups demonstrated significantly better DFS when treated with AI than with SERM (P=0.02, P=0.03). Multivariate analysis showed that compared with the moderate ER expression group, the high ER expression group exhibited significantly lower risk of disease recurrence/metastasis (HR=0.62, 95%CI: 0.43~0.88, P=0.009) and risk of death (HR=0.49, 95%CI: 0.26~0.93, P=0.03). Subgroup analysis revealed that when compared with the high ER expression group, the moderate ER expression group exhibited notably worse DFS in the following subgroups: oral SERM, non-breast-conserving surgery, lymph node metastasis, TNM stage Ⅱ, and chemotherapy, and shorter OS in the subgroups of oral SERM, non-breast-conserving surgery, lymph node metastasis, TNM stage Ⅱ subgroup, and chemotherapy.

Taking ER expression of 11%~30% as an independent stratification criterion can guide more accurate prognostic assessment and more rational ET selection in ER-positive/HER2-negative breast cancer patients.

To investigate the effect of gender on prognosis after transcatheter patent foramen ovale (PFO) closure in patients with cerebral infarction or transient ischemic attack.

A retrospective cohort study was conducted involving patients with cerebral infarction or transient ischemic attack (TIA) who underwent PFO closure at our hospital between January 2013 and December 2023. The patients were grouped by gender, and related data were collected, including age, comorbidities, Risk of Paradoxical Embolism (RoPE) score, laboratory results, findings of transthoracic/transesophageal echocardiography (TTE/TEE), and post-procedural complications, such as device-related thrombosis (DRT), recurrent stroke, bleeding, and atrial fibrillation (AF).

A total of 112 patients were enrolled, including 59 males and 53 females, at a mean age of 42.47±12.35 years. The females had significantly higher preoperative RoPE score than the males (6.6±1.4 vs 6.0±1.5, P=0.046), and a statistical difference was observed in the distribution of infarction sites between them (Chi-square=10.25, P=0.006), indicating that the males were prone to posterior circulation infarction. Intraoperative transthoracic echocardiography revealed a greater distance from the PFO to the aortic root in the females (9.3±2.4 mm vs 7.6±2.0 mm, P<0.001). During a median follow-up of 4 years, the male group had 1 case of myocardial infarction, 1 cerebral hemorrhage, 1 paroxysmal AF, 2 gingival bleeding episodes, and 1 skin ecchymosis. In the female group, 1 case experienced pulmonary embolism, 1 paroxysmal atrial fibrillation, 3 gingival bleeding episodes, 2 skin ecchymoses, 2 recurrent cerebral infarctions, and 2 recurrent TIAs. There was no statistical difference in overall adverse events between gender (P=0.291). Although the females had higher rates of recurrent cerebral infarction and TIA, this difference lacked statistical significance (P=0.222). Multivariate Cox regression analysis indicated that after adjusting for various potential confounding factors, such as RoPE score, age, hypertension, coronary heart disease, and other factors, gender was not an independent predictor of composite endpoint events after surgery.

Gender does not significantly affect overall prognosis after PFO closure in patients with cerebral infarction or TIA. However, females showed a trend toward higher rates of recurrent cerebral infarction and TIA.

To investigate the correlation between thyroid hormone levels and cognitive function in schizophrenia (SCZ) patients with metabolic syndrome (MetS), as well as the mediating role of thyroid hormones in the relationship between MetS-related indicators and cognitive function.

A cross-sectional trial was conducted on 120 SCZ inpatients and outpatients (40 cases of MetS and 80 cases of non-MetS) and 80 healthy controls admitted in the Chongqing Mental Health Center from August 2023 to December 2024. Thyroid function indicators [Thyroid-stimulating hormone (TSH), triiodothyronine (T3), thyroxine (T4), free triiodothyronine (FT3), and free thyroxine (FT4)], MetS-related parameters [blood glucose, triglycerides (TG), high-density lipoprotein cholesterol (HDL-C), and waist circumference], Positive and Negative Syndrome Scale (PANSS) score, and Montreal Cognitive Assessment (MoCA) scores were collected. One-way ANOVA or Kruskal-Wallis rank sum test was applied to analyze the differences among the 3 groups, and LSD test or Bonferroni correction was performed for post hoc analysis. Pearson correlation analysis was conducted to assess the relationship between thyroid hormone levels and metabolic parameters as well as cognitive/clinical scale scores (MoCA, PANSS) in the MetS group.

The MetS group exhibited significantly lower FT4 level (P<0.05) and MoCA score (P=0.001), but higher TSH level (P<0.05) and PANSS negative symptom score (P<0.001) when compared to the non-MetS group. Correlation analysis indicated that in the MetS group, TSH level was positively correlated with TG (r=0.672, P<0.001) and PANSS negative symptom score (r=0.458, P<0.05), and negatively with HDL-C (r=-0.377, P=0.017) and MoCA score (r=-0.667, P<0.001); FT4 level was positively correlated with MoCA score (r=0.534, P<0.001). In the non-MetS group, TSH level was positively correlated with PANSS negative symptom score (r=0.267, P=0.017) and negatively with HDL-C (r=-0.236, P=0.036), T3 was positively with waist circumference (r=0.268,P=0.017). No correlation was observed in FT4 level with HDL-C (r=-0.207, P=0.067) or MoCA score (r=0.216, P=0.055). Mediation analysis revealed that TSH partially mediated the association between TG and MoCA score, with a mediation effect accounting for 29.91% of the total effect. The mediating effect was not significant in the non-MetS group.

Abnormal elevation of TSH may serve as a critical link between MetS and cognitive impairment in SCZ patients, which providing novel insights into the mechanisms underlying cognitive dysfunction in the patients.

To analyze the burden of atherosclerotic cardiovascular disease (ASCVD) attributable to lifestyle and metabolic factors in China from 1990 to 2021 and predict its future trends, providing evidence for public health prevention and control.

Based on the Global Burden of Disease (GBD) 2021 database, we extracted disability-adjusted life years (DALYs) of ASCVD attributable to 7 key risk factors: dietary, low physical activity, smoking, high body mass index (BMI), high fasting blood glucose, high low-density lipid cholesterol (LDL-C), and hypertension. Age-standardized DALY rates (ASDR) were also calculated to account for variations in age structure, and an ARIMA model was applied to predict future trends.

① Overall trend analysis showed the leading risk factor for ischemic heart disease (IHD) shifted from dietary risks in 1990 to hypertension in 2021, while hypertension and smoking remained the primary risk factors for ischemic stroke (IS) and peripheral artery disease (PAD), respectively. ② In BRICS nations, hypertension was the dominant risk factor for both IHD and IS, whereas in China, smoking and high fasting blood glucose continued to be the major drivers of PAD burden. ③ Sex-specific analysis revealed that hypertension was the leading risk factor for IHD and IS in both males and females. For PAD, smoking was the main risk factor in males, while high fasting blood glucose was for females. Age-stratified analysis revealed that in the 15-49 age group, dietary, high LDL-C and smoking were the primary factor for IHD, IS and PAD, respectively; in the 50-69 group, dietary predominated IHD risk, hypertension IS, and smoking PAD; and among those aged ≥70 years, hypertension was the leading risk factor for both IHD and IS, and high fasting blood glucose was for PAD. ④ ARIMA model forecasted that by 2035, DALYs for IHD, IS, and PAD will increase to 82.816 million, 46.808 million, and 0.192 million person-years, respectively.

The ASCVD burden attributable to lifestyle and metabolic factors continues to rise in China from 1990 to 2021, and is projected to further increase by 2035. Countermeasures　We suggest that current prevention and control priorities are enhanced management of metabolic factors, tailored interventions by sex and age, promotion of healthy lifestyles and tobacco control, and establishment of an integrated system of prevention-treatment-rehabilitation-research.

To explore the early detection value of estimated glucose disposal rate (eGDR) for non-alcoholic fatty liver disease (NAFLD), providing a simple tool for precise clinical intervention.

A cross-sectional analysis was conducted on totally 3 262 participants with complete data from the National Health and Nutrition Survey Database of the United States from 2007 to 2018. Univariate regression and multivariate logistic regression analyses were used to explore the correlation between the estimated glucose treatment rate and the incidence of non-alcoholic fatty liver disease. Subgroup analysis, restricted cubic spline and threshold effect analysis were conducted to investigate the potential factor influences and nonlinear relationships.

Among all the included populations, 948 cases (25.29%) were diagnosed with NAFLD, and the number gradually decreased with the increase of the estimated glucose treatment rate (P<0.001). Multivariate logistic regression showed that the estimated grape processing rate was negatively correlated with non-alcoholic fatty liver disease (OR=0.86, 95%CI:0.83~0.88, P<0.001), and when the estimated glucose processing rate was ≥10.246, it could significantly reduce the risk of non-alcoholic fatty liver disease (OR=0.20, 95%CI:0.10~0.39, P<0.001), and stratified analysis further confirmed this result.

The eGDR is significantly associated with the incidence risk of NAFLD. A higher eGDR indicates a lower risk of NAFLD. This implies that in clinical practice, the risk of disease detection can be quantified through this indicator, thereby identifying potential patients earlier and initiating intervention. Countermeasures　As decision-makers, they should strengthen public health education on non-alcoholic fatty liver disease, reduce health risks by promoting healthy diets and lifestyle interventions, and pay attention to the cardiovascular health of high-risk groups for non-alcoholic fatty liver disease. At the same time, promote the research and application of drugs, and dynamically adjust policies through continuous disease monitoring to comprehensively reduce the burden of non-alcoholic fatty liver disease.

To investigate the association between the variability of remnant cholesterol inflammatory index (RCII), a novel composite biomarker, and the risk of stroke, in order to provide a theoretical basis for stroke prevention.

A prospective cohort study was conducted on 38 659 Kailuan individuals who took annual physical examinations in 2006, 2008, and 2010. These subjects were grouped based on the quartiles of RCII variability, which was represented by standard deviation (SD) and average real variability (ARV), and were followed up every 2 years, with the occurrence of stroke (including ischemic and hemorrhagic strokes), death, or the end of follow-up on December 31, 2022 as the endpoints. Kaplan-Meier method was used to calculate the cumulative incidence rate of endpoint events across different groups, and log-rank test was used to compare the difference of cumulative incidence of endpoint events in each group. Multivariate Cox proportional hazards regression model was adopted to analyze the association between RCII variability and risk of stroke.

Among the 38 659 participants, a total of 2 539 strokes occurred during a mean follow-up period of 11.22±2.26 years. After adjusting confounding factors, when the participants were grouped by the quartiles of RCII-SD, the hazard ratio (HR) for stroke was 1.034 (95%CI: 0.917~1.167, P=0.584), 1.146 (95%CI: 1.018~1.290, P=0.025), and 1.209 (95%CI: 1.066~1.370, P=0.003), respectively in the Q2, Q3, and Q4 groups, when compared with the Q1 group (P_trend <0.05). When they were grouped by the quartiles of RCII-ARV, the HR for stroke was 1.008 (95%CI: 0.894~1.136, P=0.901), 1.109 (95%CI: 0.986~1.248, P=0.085), and 1.152 (95%CI: 1.018~1.303, P=0.025), respectively, in the Q2, Q3, and Q4 groups, when compared with the Q1 group. Furthermore, both sensitivity and stratified analyses yielded similar results.

RCII variability is significantly associated with stroke, and the risk of stroke is gradually increasing with increment of the variability. Countermeasures Relevant authorities can focus on reducing RCII variability as a central objective by establishing regular monitoring mechanism, strengthening lifestyle interventions, and standardizing dietary, exercise, and weight management in order to suppress the index fluctuations. The principle of stable lipid-lowering in medication and optimization of therapeutic regimens with stable efficacy should be emphasized to prevent the risk of additional vascular damage.

To develop a personalized recommendation strategy for tranexamic acid administration during the perioperative period of orthopedic surgery based on machine learning, aiming to reduce perioperative bleeding and related complications and improving clinical outcomes.

A total of 11 727 patients undergoing orthopedic surgery from the INSPIRE database were subjected in this study. Missing data were handled using multiple imputation methods, and relevant feature variables were screened using Boruta analysis. We constructed various machine learning models, including Gradient Boosting Machine (GBM), Generalized Linear Model (GLM), eXtreme Gradient Boosting (XGBoost), K-Nearest Neighbors (KNN), Neural Network (NNET), Naive Bayes (NB), and Random Forest (RF), to evaluate their performance in predicting intraoperative bleeding and prolonged postoperative length of hospital stay. The optimal model was then selected and further integrated using a weighted ensemble, aiming to achieve the best prognosis by recommending usage strategies for tranexamic acid. The predictive performance of the constructed model was then verified against the testing set, and compared with the physician decision-making to complete the evaluation.

In predicting intraoperative bleeding, the RF model achieved an area under the receiver operating characteristic curve (AUC) of 0.73, which was significantly better than other models. In predicting the prolonged postoperative length of hospital stay, the XGBoost model performed the best, with an AUC value of 0.84. Based on the above best-performing models, an ensemble strategy was implemented. The patients who followed the recommended strategy had reduced intraoperative bleeding and shorter postoperative length of hospital stay.

The use of tranexamic acid is associated with intraoperative bleeding and postoperative length of hospital stay. Personalized decision-making recommendation based on our constructed model can effectively improve the outcomes of the patients undergoing orthopedic surgery.

To investigate the protective effect of mitochondrial fission inhibitor 1 (Mdivi-1), on organ function in rats with explosive blast injury combined with hemorrhagic shock.

A total of 192 SD rats (half male and half female, 12 weeks old, weighing about 220 g) were randomly divided into 6 groups: Sham group (only surgical incision along the midline of the abdomen), model group (ESH group, thermal radiation and shock wave injury followed by femoral artery hemorrhage), lactated Ringer’s solution resuscitation group (ESH+LR group, LR solution infusion in the femoral vein for resuscitation), and low-, middle- and high-dose Mdivi-1 groups (0.1, 0.5 and 1.0 mg/kg Mdivi-1 intervention after infusion of LR solution). Fluorescent protein tracing was used to determine the leakage amount of fluorescent protein in the lung and kidney tissues to evaluate the vascular permeability. Evans blue dye staining was employed to observe the intestinal permeability and pulmonary vascular permeability. Laser Doppler flowmetry was applied to monitor the tissue blood perfusion in the liver, kidneys, and intestine. Serum levels of cardiac injury marker troponin I (TNI), liver function markers aspartate aminotransferase (AST) and alanine aminotransferase (ALT), and renal function markers serum creatinine (Scr) and blood urea nitrogen (BUN) were detected to evaluate the functions of corresponding organs. The water contents of the lungs and brain were calculated by measuring wet weight and dry weight of the lung and brain tissues. Blood pressure, heart rate, and respiratory rate were monitored. The survival time and 72-hour survival rate were recorded and calculated.

Compared with the Sham group, the ESH group exhibited significantly increased vascular permeability in the lungs and kidneys as well as intestinal tissue (P<0.05), along with obviously elevated water contents in the lungs and brain (P<0.05), and decreased blood perfusion in the liver, kidneys, and intestine by 57.1%, 39.2%, and 43.2% of the Sham group, respectively (P<0.05), elevated levels of TNI, AST, ALT, Scr and BUN (P<0.05), mean survival time of 3.8±1.1 h, and a 72-hour survival rate of 0 (P<0.05). Although LR solution resuscitation reduced vascular permeability and alleviated organ injury in rats with explosive injury combined with hemorrhagic shock, there were no significant differences compared to the ESH group (P>0.05). Mdivi-1 treatment notably decreased vascular permeability in the lungs and kidneys and intestine, and water contents in the lungs and brain when compared with the LR group (P<0.05), with the dose of 0.5 mg/kg demonstrating the most significant effect. Additionally, Mdivi-1 treatment also significantly enhanced organ perfusion, improved organ functions, prolonged survival time, and increased survival rate. The 0.5 mg/kg treatment resulted in a 72-hour average survival time 55.64 h and a survival rate of 62.5%.

Mitochondrial fission inhibitor Mdivi-1 can reduce the permeabilities in the lungs, kidneys and intestine, improve tissue blood perfusion, protect the organ functions of the heart, liver and kidneys, and finally prolong survival time and increase survival rate in rats with concomitant explosive blast injury and hemorrhagic shock.

To investigate the role of trichostatin A (TSA) in regulating CD4⁺T cell subpopulations during Escherichia coli (E.coli) inflammatory infections.

Male mice (8 weeks old, weighing 22~25 g) were randomly divided into 3 groups (n=16): a dimethyl sulfoxide (DMSO) control group, an infection group (DMSO+E.coli), and an intervention group (E.coli+TSA). E.coli was administered via intraperitoneal injection at a concentration of 3×10⁸ CFU/mL to establish an infection model. The E.coli+TSA group was further subdivided into 3 subgroups based on different TSA concentrations (2.5, 5.0, 10.0 mg/kg). Then the samples were collected at different time points (12, 24, 48, 96 h) after TSA intervention. The efficacy of TSA in treating E.coli-induced inflammatory responses and its relationship with CD4⁺T cell subsets were evaluated by survival rate observation, body weight monitoring, histopathological staining for small intestine, ELISA detection, transcriptomics sequencing, flow cytometry and RT-qPCR analysis.

Compared with the E.coli group, 5 mg/kg TSA significantly increased survival rate, suppressed body weight loss, improved pathological damage in the small intestinal, reduced serum TNF-α level in 24 h after infection (P<0.000 1), and elevated IL-10 level (P<0.05). Transcriptomic analysis revealed that 5 mg/kg TSA intervention for 24 h modulated the T cell differentiation signaling pathways, including those regulating FoxO, Th17, and Th1/2. Flow cytometry and RT-qPCR results showed that compared to the E.coli group, 5 mg/kg TSA down-regulated the expression of the Th17 cell marker RORγt in mice 96 h after infection while significantly up-regulated the expression of the Treg cell marker Foxp3 (P<0.05).

TSA may alleviate bacterial infectious inflammatory diseases by regulating the differentiation of CD4⁺T cells toward the Treg subset while simultaneously inhibiting their differentiation toward the Th17 subset, thereby suppressing the release of proinflammatory cytokines.