Traumatic brain injury(TBI)is mostly caused by motor vehicle traffic accidents or competitive sports,with high mortality and disability.TBI mainly includes primary injury and secondary injury.Primary injuries were caused directly by external forces.Secondary injuries include brain edema,excitotoxic effect of neuron cells,oxidative stress and neuroinflammation,etc.Effective intervention of secondary injury not only helps to improve the prognosis of patients with TBI,but also reduces the risk of Parkinson's disease and other neurodegenerative diseases related to TBI.Autophagy is one of approaches to regulate homeostasis in cells,and autophagy dysfunction has been found in several neurodegenerative diseases and TBI.It is speculated that autophagy dysfunction may play an important role in TBI and explain why patients with TBI have higher risk of neurodegenerative disease.Discovering the role of autophagy in the pathological mechanism of TBI may provide new targets for TBI clinical treatment and cognitive impairment prevention in patients with TBI.

Objective To explore the value of inflammatory markers in predicting paroxysmal sympathetic hyperactivity(PSH)after traumatic brain injury(TBI).Methods A total of 84 TBI patients who were admitted to The Second Affiliated Hospital of Naval Medical University(Second Military Medical University)from Dec.2016 to Nov.2020 were retrospectively analyzed.They were classified into PSH group(n=41)and non-PSH group(n=43)according to whether PSH occurred during hospitalization.The baseline data and laboratory results of the 2 groups were collected and compared.Kendall correlation analysis was used to analyze the correlation between inflammatory markers and the occurrence of PSH after TBI,and receiver operating characteristic(ROC)curve was used to analyze the predictive value of inflammatory markers to PSH.Results There were no significant differences in baseline data,including age,gender,or Glasgow coma scale score,between the 2 groups(all P＞0.05).Compared with patients in the non-PSH group,the neutrophil to lymphocyte ratio(NLR),platelet to lymphocyte ratio(PLR),systemic immune-inflammation index(SII),neutrophils and leukocytes in the PSH group were significantly increased(all P＜0.05).NLR,SII and neutrophil were positively correlated with PSH(r=0.360,0.308,0.289;all P＜0.01),with the corresponding ROC area under curve values being 0.752,0.716 and 0.702,respectively.Conclusion NLR,SII and neutrophils have a value in predicting the occurrence of PSH after TBI.

Objective To evaluate the role and potential mechanism of apolipoprotein E(APOE)in drug resistance of colon cancer by bioinformatic tools and cellular experiments.Methods After downloading the microarray dataset GSE196900 from the GEO database,the online tool GEO2R was used to identify genes that were expressed differently in the drug-resistant and control groups.The differently expressed genes were then examined for Gene Ontology(GO)and Kyoto Encyclopedia of Genes and Genomes(KEGG)pathway enrichment.The STRING database and Cytoscape software were used to build protein-protein interaction(PPI)networks and find hub genes.Hub genes'predictive significance in colon cancer was further assessed.Western blod and qRT-PCR were used to identify changes in APOE expression,whereas Transwell was used to identify changes in the colon cancer cells'capacity for invasion and migration.Results The analysis of GO and KEGG enrichment revealed that the differential genes derived from the GSE196900 dataset were primarily focused on receptor-ligand activity and cytokine-cytokine receptor interaction pathways.Using the CytoNCA plug-in in Cytoscape software,ten hub genes were obtained through PPI construction.Of these,the prognosis of the patients with colon cancer was negatively correlated with the expression of the APOE gene(P<0.05)and the overexpression of the APOE gene might significantly increase the migration and nvasivenessability of colon cancer cells(P<0.05).Conclusion The increased expression of APOE significantly promotes the migration and invasion ability of colon cancer cells,which may be one of the mechanisms by which APOE gene promotes tumor progression in the patients with colon cancer.

Objective:To explore the association between triglyceride glucose index (TyG)- waist to height ratio (WHtR)(TyG-WHtR) and cognitive impairment in middle-aged and elderly population.Methods:A cohort database was constructed using the data from the China Health and Retirement Longitudinal Study, with 8 946 participants in 2011 and 2015 as the baseline population. Cox proportional hazards regression models were used to estimate the association between TyG-WHtR levels at baseline and the risk of cognitive impairment in middle-aged and elderly population. The analysis was stratified by age and gender, respectively.Results:A total of 8 946 participants were included, with an average follow-up of 7.08 person-years and incidence density of cognitive impairment for 21.15 per 1 000 person-years. Compared with the Q1 level of TyG-WHtR, its Q3 and Q4 level increased the risk of cognitive impairment by 32% ( HR=1.32, 95% CI: 1.09-1.60) and 47% ( HR=1.47, 95% CI: 1.14-1.91), respectively. Trend test showed that the risk of cognitive impairment increased with the increase of TyG-WHtR level, and there was a dose-response relationship ( P=0.001). Stratified analysis showed that in the population aged 45-59 years, compared with the Q1 level of TyG-WHtR, its Q3 level increased the risk of cognitive impairment by 34% ( HR=1.34, 95% CI: 1.02-1.78). In the population aged 60 years and above, compared with the Q1 level, its Q3 and Q4 level increased the risk of cognitive impairment by 31% ( HR=1.31, 95% CI: 1.01-1.72) and 63% ( HR=1.63, 95% CI: 1.15-2.31), respectively. In the male group, there was no significant association between TyG-WHtR level and the risk of cognitive impairment ( P>0.05). In the female group, compared with the Q1 level of TyG-WHtR, its Q4 level increased the risk of cognitive impairment by 76% ( HR=1.76, 95% CI: 1.26-2.46). Conclusions:Middle-aged and elderly population with a higher TyG-WHtR level may increase the risk of cognitive impairment, and there were age and sex differences. Early cardiovascular health management and scientific and reasonable weight management are of great significance to preventing cognitive impairment.

The brain has been considered to be completely isolated from the peripheral lymphatic system due to lack of conventional lymphatic structures.However,with the discoveries of perivascular spaces,glymphatic system and meningeal lymphatic vessels,the brain has been recognized to have its own unique lymphatic drainage pathway connected with peripheral lymphatic system.Traumatic brain injury,as one of diseases influencing the treatment outcomes of neurosurgery,has not been reasonably explained for its long term neurodegenerative symptoms such as memory decline and cognitive dysfunction after injury.With the deepening of research,it has been found that the perivascular spaces,glymphatic system,and meningeal lymphatic vessels are all damaged to a certain extent after traumatic brain injury,leading to a decline in the function of intracranial lymphatic system and a large accumulation of metabolites in brain tissue,thereby affecting neurological function and resulting in neurodegenerative symptoms.

Objective To study the splenic injuries caused by high-altitude falling and underwater explosion and the 2-dimensional ultrasound and contrast-enhanced ultrasound(CEUS)characteristics.Methods Twenty-three healthy Beagle dogs were divided into high-altitude falling group(n=13)and underwater explosion group(n=10).Free-fall high-platform device and gram-grade trinitrotoluene were used to simulate high-altitude falling injury and underwater explosion injury in Beagle dogs,respectively.Ultrasound examination of the spleen was performed immediately after injury,with follow-up examinations every hour.CEUS examination was performed in surviving dogs.Spleen specimens were taken from deceased dogs after injury to observe gross injuries.Pathological changes in tissue morphology and cell apoptosis were observed by hematoxylin-eosin(H-E)staining.Results In the high-altitude falling model,6,2,1,and 1 dogs died in the 6 m,7 m,8 m,and 9 m groups,respectively;in the underwater explosion model,1 and 4 dogs died in the buoyancy and frogman groups,respectively.Two-dimensional ultrasound examination of the high-altitude falling model showed spleen rupture(disruption of splenic parenchymal structure),perisplenic fluid accumulation,subcapsular hematoma,intrasplenic hematoma,increased splenic vein echo,and uneven splenic parenchymal echo.Two-dimensional ultrasound examination of the underwater explosion model showed increased splenic vein echo and uneven splenic parenchymal echo,which were less serious compared with the high-altitude falling model.CEUS results indicated 4 major contrast patterns in both models.The Beagle dogs with type Ⅰ(large focal contrast defect),type Ⅱ(diffuse contrast defect),or type Ⅲ(no contrast agent entry into the splenic vein)contrast patterns all had splenic rupture after injury.H-E staining results showed true splenic rupture,diffuse intrasplenic hemorrhage,splenic hematoma/ecchymosis,subcapsular hematoma/ecchymosis,and venous congestion after spleen injury,which were consistent with the 2-dimensional ultrasound findings.Conclusion High-altitude falling causes more serious spleen injuries in Beagle dogs compared with underwater explosions.Routine ultrasound performs well in diagnosing typical splenic injuries,while CEUS has advantages in evaluating atypical splenic injuries and has good predictive ability for delayed splenic rupture.

Objective To investigate the effect of smoking on the semen quality in infertile men.Methods A total of 360 male infertility patients were enrolled and divided into the smoking group(n=190)and non-smoking group(n=170)based on whether they smoked or not.Furthermore,the smoking group was subdivided into group A(≤10 sticks/d,n=63),group B(11～20 sticks/d,n=80),and group C(>20 sticks/d group,n=47)according to the amount of smoking.Semen volume,liquefaction time,sperm concentration,motility,DNA fragmentation rate and normal morphological rate were observed and compared between and within the groups.Results There were significant differences in semen volume,liquefaction time,sperm motility,normal morphological rate and DNA fragmentation rate between the smoking group and the non-smoking group(P<0.05).The semen volume,sperm motility and normal morphological rate of the smoking group were lower than those in the non-smoking group,and the DNA fragmentation rate and semen liquefaction time were higher than those in the non-smoking group.And with the increase of smoking volume,sperm motility and normal morphological rate decreased,semen liquefaction time and DNA fragmentation rate increased,and there was no significant difference in the sperm concentration between the smoking group and non-smoking group(P>0.05).There was no significant difference in the semen volume between the three groups with different smoking amounts(P>0.05).Conclusion Smoking has a negative impact on the sperm quality parameters such as semen volume,sperm motility,normal morphological rate,sperm motility,liquefaction time and DNA fragmentation,and the effect of heavy smoking is particularly obvious.We should strengthen the comprehensive health education,promote the healthy lifestyles and reduce smoking.

Craniocerebral injury with seawater immersion is a special kind of compound injury, with low temperature, high permeability, high alkali, high salt content, and bacterial infection being the main causes. The injury is also characterized with complex damage mechanisms, difficulty to treat, and poor prognosis. At present, the damage mechanisms of craniocerebral injury with seawater immersion are mainly studied by establishing the experimental animal models at the levels of tissue, cell, organelle, molecule, etc. However, the craniocerebral injury with seawater immersion is more complex than the simple onshore craniocerebral injury, therefore, a stable disease model is not easy to construct. Most researches on the specific injury mechanisms are relatively single and one-sided, with many different views in existence, and the damage mechanisms of craniocerebral injury with seawater immersion have hitherto not been clear. The authors reviewed the research progress in the damage mechanisms of craniocerebral injury with seawater immersion, in order to promote the in-depth study of the mechanism of craniocerebral injury with seawater immersion and provide reference for its clinical treatment.

Traumatic supraorbital fissure syndrome (TSOFS) is a symptom complex caused by nerve entrapment in the supraorbital fissure after skull base trauma. If the compressed cranial nerve in the supraorbital fissure is not decompressed surgically, ptosis, diplopia and eye movement disorder may exist for a long time and seriously affect the patients′ quality of life. Since its overall incidence is not high, it is not familiarized with the majority of neurosurgeons and some TSOFS may be complicated with skull base vascular injury. If the supraorbital fissure surgery is performed without treatment of vascular injury, it may cause massive hemorrhage, and disability and even life-threatening in severe cases. At present, there is no consensus or guideline on the diagnosis and treatment of TSOFS that can be referred to both domestically and internationally. To improve the understanding of TSOFS among clinical physicians and establish standardized diagnosis and treatment plans, the Skull Base Trauma Group of the Neurorepair Professional Committee of the Chinese Medical Doctor Association, Neurotrauma Group of the Neurosurgery Branch of the Chinese Medical Association, Neurotrauma Group of the Traumatology Branch of the Chinese Medical Association, and Editorial Committee of Chinese Journal of Trauma organized relevant experts to formulate Chinese expert consensus on the diagnosis and treatment of traumatic supraorbital fissure syndrome ( version 2024) based on evidence of evidence-based medicine and clinical experience of diagnosis and treatment. This consensus puts forward 12 recommendations on the diagnosis, classification, treatment, efficacy evaluation and follow-up of TSOFS, aiming to provide references for neurosurgeons from hospitals of all levels to standardize the diagnosis and treatment of TSOFS.

Objective:To investigate the clinical applicability of the four-grade grading(G4) advocated by the academy in recent years compared with the guideline-recommended three-grade grading(G3) in functional tricuspid regurgitation (FTR).Methods:A total of 137 consecutive patients were prospectively included from outpatient and inpatient clinics at Tangdu Hospital, Air Force Medical University from May to December 2023. All patients underwent echocardiography and were graded for regurgitation based on the 2017 American Society of Echocardiography Valve Evaluation Guidelines as the reference standard. The patients with regurgitation were grouped according to the G3 based on the guidelines and the G4 advocated by the academic community in recent years, respectively. The consistency of the regurgitation grading between multi-indicators and single-indicators was analyzed using the Kappa test for both G3 and G4. The quantitative regurgitation relevant parameters were analyzed using ROC curves to evaluate the diagnostic efficacies for G4, including the vena contracta width (VCW), the area of the color flow jet (A Jet), and the radius of the PISA (R PISA). Results:The results of consistency analysis showed that the consistency of regurgitation volume (RVol) was significantly higher in the G4 multi-indicators comprehensive assessment versus the single-indicators assessment compared with the G3, with a Kappa value of 0.84 vs. 0.30. The consistency of effective regurgitant orifice area (EROA) and VCW remained unchanged, with a Kappa value of 0.76 vs. 0.89, 0.51 vs. 0.66. ROC curve analysis showed that for the G4, the area under the curve (AUC) for moderate regurgitation were 0.854, 0.993, and 0.894, respectively, while for moderate-severe regurgitation, these values were 0.899, 0.979, and 0.917, respectively.Conclusions:For FTR, the G4 currently advocated by the academic community has better consistency between single-indicators and comprehensive indicators grading than the G3 based on the guideline, which is clinically applicable; A Jet, R PISA, and VCW can be supplemented to the G4, which helps to improve the quantitative assessment system.