Background Meteorological factors are among the key extrinsic triggers for the onset and exacerbation of cardiovascular and cerebrovascular diseases (CVD). Against the backdrop of sustained global warming, elucidating the impact of ambient temperature and atmospheric pressure on CVD, especially on pre-hospital CVD emergent events, has become imperative for evidence-based prevention and emergency preparedness. Objective To quantify the temporal trends of daily mean temperature and atmospheric pressure and their associations with pre-hospital CVD emergent events in Yantai, and to explore effect modification by demographic subgroups and geographic areas, thereby providing an empirical basis for the rational allocation of emergency medical resources. Methods Pre-hospital CVD emergency data from January 1, 2016 to December 31, 2022 were selected from the Yantai 120 Emergency Medical Command System. Synchronous meteorological factors and environmental pollutant data were obtained from the websites of the National Oceanic and Atmospheric Administration and the National Centers for Environmental Information of the United States. Time-series analysis combined with distributed lag non-linear model was used to analyze the association between daily temperature, atmospheric pressure, and pre-hospital CVD emergencies. Average annual percentage changes (AAPC) were calculated using Joinpoint (version 5.2.0.0) to reflect temporal trends. Spearman correlation analysis was employed to screen variables with low collinearity for inclusion in the multi-pollutant adjusted models. Results From 2016 to 2022, a total of 268275 pre-hospital CVD emergency cases were recorded in Yantai City, showing an increasing annual trend (AAPC=7.16%, P=0.002). Emergency volume, daily temperature, atmospheric pressure, and PM₁₀ displayed marked seasonal patterns, with summer bottoms and winter peaks for emergencies, daily temperature higher in summer and lower in winter, and the inverse for atmospheric pressure. Correlation analysis showed that both daily temperature and atmospheric pressure were positively correlated with O₃, with correlation coefficients of 0.745 and 0.723, respectively; negatively correlated with PM_2.5, with correlation coefficients of −0.246 and −0.235, respectively; and negatively correlated with PM₁₀, with correlation coefficients of −0.241 and −0.229, respectively (P < 0.05). A U-shaped correlation was revealed between daily temperature and pre-hospital CVD emergency risk. Using 24 °C as the reference, risk was elevated at both low and high daily temperatures, with the strongest cold effect at –11 ℃ (RR=1.53, 95%CI: 1.35, 1.73) and strongest heat effect at 30 ℃ (RR=1.06, 95%CI: 1.01, 1.11); cold effects were prolonged (lag0–14d) compared to heat effects. Atmospheric pressure exhibited a positive association with emergencies; using a median of 1012.2 hPa as the reference, the maximum risk occurred at 1037 hPa (RR=1.25, 95%CI: 1.03, 1.52), with a 0–5 d lag. In the subgroup analysis, the impact of low temperature was more pronounced among females (RR_{−9 ℃}=1.66), people over 60 years (RR_{−9 ℃}=1.91), and rural residents (RR_{−9 ℃}=1.76). High atmospheric pressure significantly increased the risk of pre-hospital CVD emergency among females (RR_{1035 hPa}=1.54), people under 18 years (RR_{1035 hPa}=3.62), and rural residents (RR_{1035 hPa}=1.46). The sensitivity analysis results indicated that, after excluding the impact of pandemic and the degrees of freedom for time variations, the effects of daily average temperature and atmospheric pressure on pre-hospital CVD emergency volume were consistent with the primary analysis findings. Conclusion Both non-optimal temperature and atmospheric pressure significantly increase the pre-hospital CVD emergency volume; therefore, emergency medical services should develop targeted response protocols, optimize resource allocation, and intensify public health education to mitigate the pre-hospital burden attributable to temperature and pressure fluctuations.

OBJECTIVES: To investigate the relationship between the polygenic risks for various psychiatric disorders and clinical and neuropsychological characteristics in children with attention-deficit/hyperactivity disorder (ADHD). METHODS: Using a cross-sectional design, 285 children with ADHD and 107 healthy controls were assessed using the Child Behavior Checklist, the Behavior Rating Inventory of Executive Function for parents, the Wechsler Intelligence Scale for Children, Fourth Edition, and the Cambridge Neuropsychological Test Automated Battery. Blood samples were collected for genetic data. Polygenic risk scores (PRSs) for various psychiatric disorders were calculated using the PRSice-2 software. RESULTS: Compared with the healthy controls, the children with ADHD displayed significantly higher PRSs for ADHD, major depressive disorder, anxiety disorder, and obsessive-compulsive disorder (P<0.05). In terms of daily-life executive function, ADHD-related PRS was significantly correlated with the working memory factor; panic disorder-related PRS was significantly correlated with the initiation factor; bipolar disorder-related PRS was significantly correlated with the shift factor; schizophrenia-related PRS was significantly correlated with the inhibition, emotional control, initiation, working memory, planning, organization, and monitoring factors (P<0.05). The PRS related to anxiety disorders was negatively correlated with total IQ and processing speed index (P<0.05). The PRS related to obsessive-compulsive disorder was negatively correlated with the processing speed index and positively correlated with the stop-signal reaction time index of the stop-signal task (P<0.05). CONCLUSIONS PRSs for various psychiatric disorders are closely correlated with the behavioral and cognitive characteristics in children with ADHD, which provides more insights into the heterogeneity of ADHD.
Humans ; Attention Deficit Disorder with Hyperactivity/genetics* ; Child ; Male ; Female ; Cross-Sectional Studies ; Neuropsychological Tests ; Multifactorial Inheritance ; Adolescent ; Mental Disorders/etiology* ; Executive Function ; Genetic Risk Score

Objective To investigate the effects of different doses of Yiyi Ren aqueous prepara-tion on blood lipid regulation and spleen-strengthening and dampness-eliminating effects in hyperlipi-demia rats with syndrome of spleen deficiency and excessive dampness.Methods Sixty SD male rats were randomly divided into blank control group,model group,low-dose,medium-dose,high-dose Yiyi Ren aqueous preparation groups,and positive drug control group,with 10 rats in each group.A hyperlipidemia rat model with syndrome of spleen deficiency and excessive dampness was estab-lished by feeding with a high-fat diet for 21 consecutive days combined with a damp bedding environment.After drug administration,behavioral tests such as grip strength,weighted swimming test,and open field test were conducted;changes in body weight in each group were observed;serum levels of total cholesterol(TC),triglycerides(TG),high-density lipoprotein cholesterol(HDL-C),and low-den-sity lipoprotein cholesterol(LDL-C)were detected;levels of vasoactive intestinal peptide(VIP),an-tidiuretic hormone(ADH),and aldosterone(ALD)were measured by enzyme-linked immunosorbent assay(ELISA).Results Compared with the blank control group,the model group showed decreased HDL-C,grip strength,exhaustive swimming time,and total distance,as well as increased TC,TG,LDL-C,ADH,ALD,and VIP(P＜0.05).Compared with the model group,TC,TG,and LDL-C levels were decreased in the medium-dose,high-dose Yiyi Ren aqueous preparation groups,and the positive drug control group,while the HDL-C levels were increased in the low-dose,medium-dose,and high-dose Yiyi Ren aqueous preparation groups and the positive drug control group(P＜0.05).Compared with the model group,the high-dose Yiyi Ren aqueous preparation group showed in-creased grip strength,exhaustive swimming time and total distance and decreased serum ADH levels(P＜0.05).Compared with the model group,the medium and high-dose Yiyi Ren aqueous prepa-ration groups showed decreased serum ALD and VIP levels(P＜0.05).Conclusion Yiyi Ren aqueous preparation has an effect on regulating blood lipid levels in hyperlipidemia rats with syn-drome of spleen deficiency and excessive dampness,and it can alleviate physical fatigue,improve abnormal exploratory behavior,and maintain normal water metabolism and motor function in rats.

Sepsis is a systemic inflammatory response caused by severe infection or trauma, and is one of the common causes of acute lung injury(ALI) and acute respiratory distress syndrome(ARDS). Sepsis-acute lung injury(SALI) is a critical clinical condition with high morbidity and mortality. Its pathogenesis is complex and not yet fully understood, and there is currently a lack of targeted and effective treatment options. Pyroptosis, a novel form of programmed cell death, plays a key role in the pathological process of SALI by activating inflammasomes and releasing inflammatory factors, making it a potential therapeutic target. In recent years, the role of traditional Chinese medicine(TCM) in regulating signaling pathways related to pyroptosis through multi-components and multi-targets has attracted increasing attention. TCM may intervene in pyroptosis by inhibiting the activation of NLRP3 inflammasomes and regulating the expression of Caspase family proteins, thus alleviating inflammatory damage in lung tissues. This paper systematically reviews the molecular regulatory network of pyroptosis in SALI and explores the potential mechanisms and research progress on TCM intervention in cellular pyroptosis. The aim is to provide new ideas and theoretical support for basic research and clinical treatment strategies of TCM in SALI.
Pyroptosis/drug effects* ; Humans ; Sepsis/genetics* ; Acute Lung Injury/physiopathology* ; Animals ; Drugs, Chinese Herbal/therapeutic use* ; Medicine, Chinese Traditional ; Inflammasomes/metabolism* ; NLR Family, Pyrin Domain-Containing 3 Protein/genetics*

Objective This study aims to develop an early in-hospital temperature management protocol for heat stroke patients and assess its effectiveness,providing guidance for rapid cooling and precise target temperature control.Methods The protocol was developed through a Delphi expert consultation combined with expert panel meetings.A multi-center,non-randomized,historical control study was conducted,utilizing convenience sampling to select heat stroke patients from the emergency departments of 7 tertiary hospitals in Zhejiang Province,China,between June and August 2024 as an experimental group.The protocol was implemented in this group,while the control group consisted of heat stroke patients treated between June and August 2022,prior to protocol implementation.Cooling rates,target temperature attainment rates,and clinical outcomes were compared between the 2 groups.Results The final protocol included 6 primary indicators,23 secondary indicators,and 56 tertiary indicators.After protocol implementation,the experimental group achieved a cooling rate of 0.08(0.05～0.09)℃/min within 0.5 hours,significantly higher than the control group,which had a rate of 0.04(0.02～0.06)℃/min(P＜0.001).The target temperature attainment rates at 0.5 hours and 2.0 hours were 55.93％and 98.31％,respectively,significantly higher than the rates of 15.87％and 61.11％in the control group(P＜0.001).The mechanical ventilation rate,hospitalization rate,ICU admission rate,and mortality rate in the experimental group were 25.42％,61.02％,44.07％,and 8.47％,respectively.Logistic regression analysis revealed that the early in-hospital temperature management protocol significantly reduced the risk of mechanical ventilation and hospitalization in heat stroke patients,with odds ratios(ORs)of 0.294 and 0.300,respectively(both P＜0.05).Conclusion The developed protocol for early in-hospital temperature management in heat stroke patients is scientific,systematic,and practical.It improves cooling rates and target temperature attainment,thereby enhancing the prognosis of heat stroke patients.

Dysfunction of the diaphragm is a common problem in mechanically ventilated patients and is closely related to various adverse outcomes.This review summarizes the evaluation methods of diaphragm function,the association between diaphragm dysfunction and adverse clinical outcomes in critically ill mechanically ventilated patients,and the protective effect of diaphragm function on adverse outcomes related to mechanical ventilation.The aim is to provide references for medical staff to optimize evaluation techniques,develop personalized nursing plans,and improve patients' quality of life and health outcomes.

Vertebral refracture following percutaneous vertebral augmentation (PVA) is commonly seen in elderly patients with osteoporotic thoracolumbar compression fractures (OTLCF). It can lead to recurrent pain, loss of vertebral height, progression of kyphosis, and even neurological dysfunction, significantly impairing patients′ quality of life. Current diagnosis and treatment face multiple challenges, including high misdiagnosis rate, difficulty in choosing between surgical and non-surgical treatment options, lack of standardized surgical protocols, interference from intralesional bone cement during procedures, inadequate stability of internal fixation in osteoporotic bone, and suboptimal compliance of anti-osteoporotic therapy. Establishing a standardized diagnostic and therapeutic framework is urgently needed. To standardize the management process and improve outcomes for vertebral refractures after PVA in elderly OTLCF patients, Spinal Trauma Group of the Orthopedic Branch of Chinese Medical Doctor Association organized experts in the field to develop Guideline for the diagnosis and treatment of vertebral refracture after percutaneous vertebral augmentation in elderly patients with osteoporotic thoracolumbar compression fractures ( version 2025), based on current literature and clinical experience, and adhering to principles of scientific rigor and clinical applicability. A total of 11 recommendations were proposed, encompassing diagnosis, treatment, and rehabilitation of vertebral refracture after PVA in elderly patients with OTLCF, aiming to provide a foundation for a standardized management.

Spine fracture and dislocation are common traumatic spinal conditions that often require surgical intervention due to compromised spinal stability. Surgical approaches include anterior, posterior, and combined anterior-posterior spinal procedures. According to the specific surgical requirements, patients may be placed in the prone position or repositioned between prone and supine positions during surgery. Intraoperative repositioning has become an essential step in patient positioning. However, during repositioning, patients with spinal fracture and dislocation are at increased risk for complications such as hemodynamic instability, nerve injury, and pressure injuries to the skin and soft tissue. Notably, due to the instability of the spinal cord, even minor manipulations can further exacerbate the damage, potentially leading to severe outcomes like paraplegia. Although the current clinical guidelines provide instructive recommendations for standard position, there remains no specific protocols for intraoperative repositioning in patients with spine fracture and dislocation. With a concern for the lack of clinical studies on positioning techniques, risk prevention, and operational norms for special patients, no applicable guidelines or standards are available. A consensus was required to provide clinical reference, meet the requirements of surgical treatment, and minimize the safety risks of patients caused by improper placement of positions. Professional Committee of Operating Room Nursing of Shaanxi Nursing Association organized experts in nursing management and operating room nursing from major hospitals across China to formulate Expert consensus on intraoperative repositioning for patients with spinal fracture and dislocation ( version 2025). The consensus provides 11 recommendations covering pre-repositioning preparation, intraoperative maneuvers, and post-repositioning observation, aiming to provide references for clinical standardization of the intraoperative repositioning process and protection of patients′ safety.

Objective:To analyze the correlation and predictive value of obesity measurement indicators and cerebrovascular function scores in healthy physical examination population.Methods:It was a cross-sectional analysis that employed a simple random sampling method to select 3 496 individuals who underwent healthy physical examinations and cerebrovascular function tests at the Physical Examination Center of the Affiliated Hospital of Guizhou Medical University from January to December 2022. The general information, physical examination data, biochemical examination results, human component analyses, and cerebrovascular function integral data were collected. Based on cerebrovascular function scores, the participants were divided into high-risk group (0-24 points, 70 cases), medium-risk group (25-49 points, 317 cases), low-risk group (50-74 points, 787 cases), and normal group (≥75 points, 2 322 cases). Spearman correlation analysis and receiver operating characteristic (ROC) curve analyses were utilized to assess the correlation and predictive value of obesity measurement indicators and cerebrovascular function integrals.Results:Among the 3 496 subjects included in the analysis, 2 018 were male and 1 478 were female, with an average age of (46.4±7.9) years. The age, systolic blood pressure, diastolic blood pressure, body mass index, waist-to-hip ratio, body fat ratio, body fat content, visceral fat area, fasting blood glucose, total cholesterol, low-density lipoprotein, homocysteine all exhibited an increasing trend as the cerebrovascular function integral value decreased (all P<0.05). The skeletal muscle content in the low-risk group was significantly higher than those in the high-risk group, medium-risk group, and normal group [45.00 (36.80, 50.60) vs 44.10 (36.98, 50.45), 44.50 (37.80, 50.20), and 42.75 (36.30, 48.60) kg, respectively] ( P<0.05). The triglyceride level in the medium-risk group was higher when compared to those in the high-risk group, low-risk group, and normal group[1.87 (1.29, 2.70) vs 1.71 (1.24, 2.80), 1.75 (1.18, 2.70), and 1.43 (1.00, 2.14) mmol/L] ( P<0.05). The high-density lipoprotein level in the normal group was higher than the high-risk group, medium-risk group, and low-risk group[1.26 (1.05, 1.51) vs 1.16 (0.94, 1.36), 1.15 (0.99, 1.39), and 1.16 (0.97, 1.39) mmol/L, respectively] ( P<0.05). The increases in systolic blood pressure, diastolic blood pressure, body mass index, and body fat content were all moderately negatively correlated with the cerebrovascular function score ( rs=-0.347, -0.335, -0.370, and -0.340, respectively, all P<0.05). The increase in age ( OR=1.012, 95% CI: 1.002-1.022), systolic blood pressure ( OR=1.027, 95% CI: 1.017-1.036), diastolic blood pressure ( OR=1.028, 95% CI: 1.014-1.042), body mass index ( OR=1.157, 95% CI: 1.083-1.237), body fat rate ( OR=1.021, 95% CI: 1.007-1.035), and fasting blood glucose ( OR=1.072, 95% CI: 1.020-1.127) were all positively correlated with the decrease of the cerebrovascular function score; conversely, the increase in skeletal muscle content ( OR=0.967, 95% CI: 0.951-0.982) was negatively correlated with the decrease in cerebrovascular function score (all P<0.05). The area under the curve for the combined prediction of cerebrovascular function integral value by age, systolic blood pressure, diastolic blood pressure, body mass index, body fat rate, skeletal muscle content, and fasting blood glucose was 0.754. Conclusions:As the body mass index and body fat content increase and the skeletal muscle content decreases in the healthy physical examination population, the likelihood of abnormal cerebrovascular function integral values rises; the combination of age, systolic blood pressure, diastolic blood pressure, body mass index, body fat percentage, skeletal muscle content, and fasting blood glucose indicators can predict the increased risk of cerebrovascular function integral values.