This comprehensive review synthesizes the latest advancements in understanding inflammatory disorders affecting cerebral small vessels, a distinct yet understudied category within cerebral small vessel diseases (SVD). Unlike classical SVD, these inflammatory conditions exhibit unique clinical presentations, imaging patterns, and pathophysiological mechanisms, posing significant diagnostic and therapeutic challenges. Highlighting their heterogeneity, this review spans primary angiitis of the central nervous system, cerebral amyloid angiopathy-related inflammation, systemic vasculitis, secondary vasculitis, and vasculitis in autoinflammatory diseases. Key discussions focus on emerging insights into immune-mediated processes, neuroimaging characteristics, and histopathological distinctions. Furthermore, this review underscores the importance of standardized diagnostic frameworks, individualized immunomodulation approaches, and novel targeted therapies to address unmet clinical demands.
Humans ; Cerebral Small Vessel Diseases/pathology* ; Inflammation/pathology* ; Cerebral Amyloid Angiopathy/pathology* ; Vasculitis, Central Nervous System/pathology* ; Vasculitis/pathology*

With the development of critical medical emergency technology, the success rate of sepsis treatment has been significantly improved, and the improvement of the long-term quality of life of sepsis survivors has also attracted more and more attention. ICU-acquired weakness (ICU-AW) refers to a group of syndromes with systemic and symmetrical muscle weakness during the intensive care unit (ICU) hospitalization and cannot be explained by the patient's own disease, which often involve diaphragm and skeletal muscle, resulting in difficulty in weaning and nosocomial infection. The incidence of ICU-AW in sepsis patients is over 50%, making it an important factor affecting the prognosis of these patients. The occurrence of sepsis ICU-AW is related to many factors, which can be summarized into two categories, including sepsis-related factors such as sepsis-associated inflammatory response, sepsis-associated encephalopathy (SAE), and treatment-related factors such as physical immobilization and insufficient nutritional support. The current ICU-AW risk assessment tools are mainly on subjective assessment scales, but there are some limitations in clinical application, and objective assessment tools including predictive model and imaging assessment, which are still in the research stage. "ABCDEF bundle strategy" is an important measure to prevent ICU-AW, in which early rehabilitation is the core element. This review of the literature from the risk factors, risk assessment and early rehabilitation of ICU-AW, and focuses on the timing, content, method and safety assessment of early rehabilitation, aims to improve the understanding of ICU-AW, strengthen the prevention of sepsis with ICU-AW, and improve the prognosis of sepsis patients, not only survive, but also live better.
Humans ; Sepsis/complications* ; Muscle Weakness/etiology* ; Intensive Care Units ; Prognosis ; Quality of Life

OBJECTIVE: To investigate the potential mechanisms of sepsis pathogenesis in intensive care unit (ICU), with a specific focus on the role of skin microbiota, and to evaluate the causal relationships between skin microbiota and ICU sepsis using Mendelian randomization (MR). METHODS: A two-sample MR analysis was performed using skin microbiota genome-wide association study (GWAS) summary data from German population cohorts as exposures, combined with ICU sepsis susceptibility and 28-day mortality GWAS summary data from the IEU OpenGWAS database as outcomes. The primary causal effect estimates were generated using the inverse variance weighted (IVW) method, supplemented by validation through MR-Egger and weighted median approaches. Heterogeneity and pleiotropy tests, along with sensitivity analyses, were conducted to evaluate the robustness of the results. RESULTS: Regarding risk of ICU sepsis, IVW analysis showed that order Pseudomonadales [odds ratio (OR) = 0.93, 95% confidence interval (95%CI) was 0.88-0.98], family Flavobacteriaceae (OR = 0.93, 95%CI was 0.90-0.96), and genus Acinetobacter (OR = 0.96, 95%CI was 0.93-0.99) were significantly negatively correlated with the risk of ICU sepsis (all P < 0.05). There was a significant positive correlation between the risk of ICU sepsis and the presence of β-Proteobacteria (OR = 1.05, 95%CI was 1.00-1.11) and Actinobacteria (OR = 1.05, 95%CI was 1.00-1.11), both P < 0.05. Regarding 28-day mortality of ICU sepsis, IVW analysis showed that phylum Bacteroidetes (OR = 0.92, 95%CI was 0.86-0.99), family Streptococcaceae (OR = 0.92, 95%CI was 0.85-0.98), family Flavobacteriaceae (OR = 0.90, 95%CI was 0.83-0.97), genus Streptococcus (OR = 0.92, 95%CI was 0.86-0.99), ASV016 [Enhydrobacter] (OR = 0.92, 95%CI was 0.87-0.98), and ASV042 [Acinetobacter] (OR = 0.92, 95%CI was 0.88-0.97) were significantly negatively correlated with the 28-day mortality of ICU sepsis (all P < 0.05); family Moraxellaceae (OR = 1.09, 95%CI was 1.00-1.18) and ASV008 [Staphylococcus] (OR = 1.08, 95%CI was 1.03-1.14) was significantly positively correlated with the 28-day mortality of ICU sepsis (both P < 0.05). Sensitivity analysis and MR-PRESSO showed no heterogeneity, pleiotropy, or horizontal pleiotropy between skin microbiota and ICU sepsis risk and 28-day mortality rate. Analysis of confounding factors showed that single nucleotide polymorphisms (SNPs) associated with relevant skin bacteria could independently and causally affect the risk of ICU sepsis or ICU sepsis related mortality rate, independent of other confounding factors. The Steiger test results indicated that the established causal relationship was not due to reverse causality. CONCLUSIONS Skin microbiota composition may influence both sepsis susceptibility and 28-day mortality in ICU settings. Family Flavobacteriaceae demonstrated protective effects against sepsis onset and mortality. These findings provide new perspectives for early detection and management strategies.
Humans ; Sepsis/mortality* ; Intensive Care Units ; Mendelian Randomization Analysis ; Microbiota ; Skin/microbiology* ; Genome-Wide Association Study ; Risk Factors ; Skin Microbiome

To develop a milestone-based evaluation system for the core "knowledge and skills" competency of neurology residents that is tailored to China's medical context, so as to provide precise guidance for their training and assessment.

Objective This study aimed to explore the prescription regularity of Mercury(Zuotai)detoxification formula in Tibetan classic medical literatures based on data mining.Methods Mercury(Zuotai)detoxification formula of were collected from 22 ancient Tibetan medical literatures including the Four Medical Tantras,Medicine of Moon King,One Hundred Thousand Fists and Eight Essential Collections of Medicine,et al.The database of drugs,medicinal properties,five-source,six-flavor,and three-chemical flavor was established.R 4.2.2,IBM SPSS Modeler 18.0,Origion 2024 and other software were used to conduct frequency statistical analysis,Apriori association rule analysis and cluster analysis of the category,property and flavor,and five-source of Mercury(Zuotai)detoxification compound drugs,and interpret the statistical results in combination with the theory of Tibetan medicine.Results A total of 52 formulas were collected,containing 213 Tibetan medicines,with a cumulative frequency of 1066 times.The medicines involved in the prescription are mainly plant-based,and most of them are"cold"drugs;the medicinal flavor of drugs is mainly bitter,sweet,and pungent,with the five sources of emptiness,wind and water predominating;the most frequently occurring medicine was Mercury(Zuotai),followed by Terminalia Chebula,Musk,Geranium,Saffron,and Nutmeg.High-frequency medicines such as Mercury(Zuotai),Musk,Strychni Semen,Aconitum Tanguticum,Pedicularis Trichoglossa,Swertia Verticillifolia,and Sinapis Alba have detoxification effects.Musk also has the effect of aromatherapy,Terminalia Chebula can reconcile the nature of the medicine and the three causes of the disease effectively.The"six good medicines",including Geranium,Saffron,Nutmeg,White cardamom,Cloves,and Tsaoko Amomum Fruit,can harmonize qi and blood,and treat diseases of internal organs of the body.The analysis of association rules showed 24 pairs of medicines combinations with a support degree exceeding 59.62,and 9 groups of three-drug combinations,predominantly involving Mercury(Zuotai),Terminalia Chebula,Musk,and"six good medicines".The cluster analysis of medicines with a frequency of>10 produced 7 clustered formulas,primarily characterized by their efficacy in clearing away heat and toxins,as well as regulating the five internal organs and six viscera.Conclusion Most medicines in the Mercury(Zuotai)detoxification formula are primarily composed of botanicals,cold and bitter drugs,which is consistent with the heat-clearing and detoxifying therapy in Tibetan medicine.The medication pattern of the Mercury(Zuotai)detoxification formula is characterized by the use of Terminalia Chebula to reconcile the medicinal properties,detoxifying medicines to detoxify,aromatic drugs to rapidly eliminate or expel toxins,and six good medicines to protect the viscera.The combined use of these medicines plays a role in clearing away heat and toxins,opening up the orifices and collaterals,and harmonizing the functions of the viscera.The study provides data to support the medication rules of the Tibetan medicine Mercury(Zuotai)detoxification prescription.

Objective:To investigate the diagnostic value of an intelligent assisted grading algorithm for nuclear cataract using anterior segment optical coherence tomography (AS-OCT) images.Methods:A diagnostic test study was conducted.AS-OCT image data were collected from 939 cases of 1 608 eyes of nuclear cataract patients at the Shanghai Tenth People's Hospital of Tongji University from November 2020 to September 2021.The data were obtained from the electronic case system and met the requirements for clinical reading clarity.Among them, there were 398 cases of 664 male eyes and 541 cases of 944 female eyes.The ages of the patients ranged from 18 to 94 years, with a mean age of (65.7±18.6) years.The AS-OCT images were labelled manually from one to six levels according to the Lens Opacities Classification System Ⅲ (LOCS Ⅲ grading system) by three experienced clinicians.This study proposed a global-local cataract grading algorithm based on multi-level ranking, which contains five basic binary classification global local network (GL-Net).Each GL-Net aggregates multi-scale information, including the cataract nucleus region and original image, for nuclear cataract grading.Based on ablation test and model comparison test, the model's performance was evaluated using accuracy, precision, sensitivity, F1 and Kappa, and all results were cross-validated by five-fold.This study adhered to the Declaration of Helsinjki and was approrved by Shanghai Tenth People's Hospital of Tongji University (No.21K216).Results:The model achieved the results with an accuracy of 87.81%, precision of 88.88%, sensitivity of 88.33%, F1 of 88.51%, and Kappa of 85.22% on the cataract dataset.The ablation experiments demonstrated that ResNet18 combining local and global features for multi-level ranking classification improved the accuracy, recall, specificity, F1, and Kappa metrics.Compared with ResNet34, VGG16, Ranking-CNN, MRF-Net models, the performance index of this model were improved.Conclusions:The deep learning-based AS-OCT nuclear cataract image multi-level ranking classification algorithm demonstrates high accuracy in grading cataracts.This algorithm may help ophthalmologists in improving the diagnostic accuracy and efficiency of nuclear cataract.

Objective:To evaluate the effect of ultrasound-guided adductor canal block with bupivacaine liposome on analgesia in elderly patients undergoing total knee arthroplasty.Methods:This was a prospective study. Sixty American Society of Anesthesiologists Physical Status classification Ⅱ or Ⅲ patients, regardless of gender, aged 65-83 yr, weighing 50-80 kg, scheduled for elective unilateral total knee arthroplasty under subarachnoid anesthesia from April 2023 to January 2024 in Zhengzhou Orthopaedic Hospital, were divided into 2 groups ( n=30 each) using a random number table method: bupivacaine liposome group (LB group) and ropivacaine group (R group). Ultrasound-guided adductor canal block was performed at 30 min before subarachnoid anesthesia, bupivacaine liposome diluent 20 ml (133 mg) was injected in LB group, and 0.5% ropivacaine 20 ml was injected in R group. Patient-controlled intravenous analgesia was performed after operation, and tramadol was used for rescue analgesia when the visual analogue scale (VAS) score ≥3. VAS scores at rest and during activity were recorded at 8, 12, 24, 48 and 72 h after surgery. The time to the first pressing analgesia pump and rescue analgesia were recorded within 72 h after surgery. The quadriceps muscle strength was measured at 1 day before surgery and 12, 24, 48 and 72 h after surgery. The knee joint range of motion was assessed at 1 day before surgery and 24, 48 and 72 h after surgery. Patient′s satisfaction with analgesia was recorded at 72 h after surgery. The adverse reactions within 72 h after surgery were also recorded. Results:Compared with R group, VAS scores at rest and during activity were significantly decreased at 12, 24, 48 and 72 h after surgery, the time to the first pressing analgesia pump was prolonged, the rate of rescue analgesia after surgery was decreased, the score for the patient′s satisfaction with analgesia was increased, the knee joint range of motion was increased ( P<0.05), and no significant change was found in the quadriceps muscle strength and incidence of adverse reactions in LB group ( P>0.05). Conclusions:Ultrasound-guided adductor canal block with bupivacaine liposome provides better analgesia than ropivacaine in elderly patients undergoing total knee arthroplasty.

Objective:To evaluate the relationship between inositol-requiring enzyme 1α-X box-binding protein 1 (IRE1α-XBP1) signaling pathway in endoplasmic reticulum and neutrophil extracellular traps during endotoxin-induced acute lung injury (ALI) in mice.Methods:Forty-eight SPF healthy male C57BL/6 mice, aged 6-8 weeks, weighing 25-30 g, were divided into 4 groups ( n=12 each) using a random number table method: control group (C group), STF-083010 group (ST group), lipopolysaccharide (LPS)-induced ALI group (ALI group) and LPS-induced ALI + STF-083010 group (ALI+ ST group). The ALI model was established by inhaling aerosolized LPS in ALI group and ALI+ ST group. The equal volume of aerosolized normal saline was inhaled in C and ST groups. IRE1α inhibitor STF-083010 50 mg/kg was intraperitoneally injected at 1 h before developing the model in ST and ALI+ ST groups, and the equal volume of normal saline was intraperitoneally injected in the other two groups. The mice were sacrificed after anesthesia at 24 h after developing the model. Bronchoalveolar lavage fluid (BALF) and lung tissues were collected for determination of the pathological changes (by light microscopy) which were scored, wet/dry lung weight (W/D) ratio, concentrations of interleukin-1beta (IL-1β), IL-18 and myeloperoxidase (MPO) in the BALF supernatant, and expression of phosphorylated IRE1α(p-IRE1α), XBP1s and citrullinated histone H3 (Cit H3) in lung tissues (using Western blot). Results:Compared to group C, the lung injury scores and W/D ratio were significantly increased at 24 h after developing the model, the concentrations of IL-1β, IL-18 and MPO in BALF were increased, and the expression of p-IRE1α, XBP1s and Cit H3 in lung tissues was up-regulated in ALI and ALI+ ST groups. Compared to group L, the lung injury scores and W/D ratio were significantly decreased at 24 h after developing the model, the concentrations of IL-1β, IL-18 and MPO in BALF were decreased, and the expression of p-IRE1α, XBP1s and Cit H3 in lung tissues was down-regulated in group ALT+ ST ( P<0.05). Conclusions:The IRE1α-XBP1 signaling pathway in endoplasmic reticulum is involved in endotoxin-induced ALI by up-regulating the expression of neutrophil extracellular traps in mice.