Objective To investigate the prognostic value of the platelet-to-lymphocyte ratio(PLR)at different early time points in adult patients undergoing veno-arterial extracorporeal membrane oxygenation(VA-ECMO).Methods A retrospective study was conducted,selecting 55 adult patients who underwent VA-ECMO treatment at the First Hospital of Jiaxing from June 2020 to October 2022 as the study subjects.Then,the patients'gender,age,past history[including hypertension,diabetes,heart disease,chronic obstructive pulmonary disease(COPD)],and the reason for extracorporeal membrane pulmonary oxygenation(ECMO)adjuvant therapy[including severe myocarditis,acute myocardia infarction,in-hospital and out-of-hospital cardiac arrest,severe closed craniocerebral injury,severe pneumonia,pelvic fracture,other(pulmonary embolism,electrocution,traumatic hepatic rupture,post-partum hemorrhage,severe acute pancreatitis,crush syndrome)],acute physiology and chronic health evaluationⅡ(APACHEⅡ),sequential organ failure assessment(SOFA)at the time of admission,and ECMO peripheral blood tests[creatinine,alanine aminotransferase(ALT),aspartate aminotransferase(AST),blood lactate acid(Lac),white blood cell count(WBC),neutrophil count(NEU),lymphocyte count(LYM),hemoglobin(Hb),and platelet count(PLT)]and the last time prior to ECMO assistance,24 hours prior to the occurrence of acute kidney injury(AKI),and 24 hours after the occurrence of AKI.PLR levels at 24 hours ECMO,and the proportion of continuous renal replacement therapy(CRRT).The patients were divided into a death group and a survival group based on their 30-day prognosis and further categorized into a CRRT group and a non-CRRT group based on whether CRRT was administered.Clinical indicators of patients with different prognosis and the differences in PLR levels between CRRT and non-CRRT groups were compared.Logistic regression analysis was used to identify independent risk factors affecting the 30-day prognosis of VA-ECMO patients.The receiver operator characteristic(ROC curves)were plotted to evaluate the prognostic predictive value of each risk factor.Results Compared to the survival group,the death group had significantly higher APACHEⅡscores,SOFA scores,LYM and proportion receiving CRRT[APACHEⅡscore:34.00(28.50,36.00)vs.25.00(14.75,34.00),SOFA score:5.00(4.00,6.50)vs.3.00(2.00,5.25),LYM(×109/L):3.40±1.97 vs.2.24±2.11,proportion receiving CRRT:91.30%(21/23)vs.62.50%(20/32)],and a significantly lower level of the last PLR prior to ECMO adjuvant[30.00(21.06,48.17)vs.58.82(41.80,145.72)],and the differences were statistically significant(all P<0.05).Logistic regression analysis showed that the levels of the last PLR before ECMO assistance[odds ratio(OR)=0.965,95%confidence interval(95%CI)was 0.938-0.993,P=0.013],APACHEⅡscore at the time of admission(OR=1.121,95%CI was 1.018-1.234,P=0.020),and CRRT(OR=7.734,95%CI was 1.042-57.401,P=0.045)were independent risk factors affecting the prognosis of the VA-ECMO patients at 30 days after adjuvant;the ROC curve analysis showed that APACHEⅡscore,CRRT and the last PLR level before ECMO assistance had a predictive value for the prognosis of VA-ECMO patients 30 days after assistance,in which the APACHEⅡscore+the last PLR level before ECMO assistance had the greatest predictive value in predicting the prognosis of the patients,with area under the curve(AUC)of 0.846,with a sensitivity of 62.5%and a specificity of 95.7%.Higher early PLR levels were associated with better prognosis.In the CRRT group,PLR levels at 24 hours before ECMO initiation,24 hours before AKI onset,and 24 hours after AKI onset were significantly lower than those in the non-CRRT group(all P<0.05).Conclusion Early PLR levels and CRRT administration have significant predictive value for the prognosis of patients undergoing VA-ECMO therapy.

Bedridden patients with cardiopulmonary diseases,elderly long-term bedridden patients,and certain postoperative patients require elevation of their lower limbs to a position above the heart.Traditionally,this is achieved by placing items such as clothing,blankets,or soft objects like leg pads under the lower limb as cushions.However,this method can lead to uneven force distribution on the patient's legs,potentially causing vascular compression and discomfort.To address these issues,the medical staff of department of brain surgery of the Second People's Hospital of Tongxiang City had developed a multi-functional foot pad device incorporating height adjustment,pressure dispersion,and heating functions,based on biomechanical principles.This device has been granted a National Utility Model Patent of China(patent number:ZL 2021 2 3217248.8).The device consists of a cushion plate,a backing plate,a raised block,a rotating shaft,a fixed shaft,a support frame,a chute,a footrest,a gaiter strap,a connecting belt,an extension plate,a drive motor,and a power cord.It allows for angular adjustments ranging from 15°-45° through the use of a rotating backing plate and a chute-supported frame.The arc-shaped footrest,designed ergonomically,and an intelligent temperature control system enable precise adaptation to individual anatomical characteristics.The usage procedure involves placing the adjustable foot pad on a flat bed,positioning the patient's leg in the footrest,securing it with the gaiter strap,adjusting it to a comfortable height,activating the intelligent temperature control system for heating,and promoting limb blood circulation.This device offers an innovative solution for preventing lower extremity deep vein thrombosis(LE-DVT)by employing a multi-dimensional intervention strategy that combines mechanical prevention with physical therapy effects.The adjustable heating foot pad is easy to operate,provides comfort and convenience,and reduces complications such as LE-DVT formation,thereby alleviating the economic burden on patients,enhancing quality of life,and increasing patient and family satisfaction.It is highly suitable for clinical application.

Objective:To explore the effect of different swallowing tasks on cortex activation and functional connectivity in stroke survivors with dysphagia using functional near-infrared spectroscopy (fNIRS).Methods:Thirty stroke survivors with dysphagia performed three different swallowing tasks: swallowing action observation (SO), swallowing action execution (SE), and swallowing action imagination (SI). During each task, fNIRS was used to document the brain concentrations of oxyhemoglobin and deoxyhemoglobin. Cortex activation (β value) and brain functional connectivity were assessed.Results:Compared with the resting state, the areas activated during the SO task included the left primary sensory cortex and the right prefrontal cortex. During the SE and SI tasks the left prefrontal cortex and the left motor cortex were activated as well. Compared with hemorrhagic stroke survivors, ischemic stroke survivors showed significantly greater activation of the right primary sensory cortex, the right motor cortex, and the left primary sensory cortex during the SE task. Functional connectivity during the SO, SE and SI tasks was significantly greater than in the resting state, with the average connectivity values during the SE task significantly higher than during the SI task.Conclusions:Stroke survivors with dysphagia exhibit increased activation in the prefrontal cortex and primary sensory cortex during different swallowing tasks. Such tasks can improve their brain functional connectivity.

Objective To investigate the expression level of centromere protein(CENP)Ⅰin lung adenocarcinoma cells,to study the effects of CENPⅠon the proliferation,invasion,migration,apoptosis,and epithelial-mesenchymal transition(EMT)of lung adenocarci-noma cells,and to explore the possible mechanisms related to its occurrence.Methods The expression of CENPⅠmRNA and protein in four types of lung adenocarcinoma cells and normal alveolar epithelial cells were detected by quantitative real-time polymerase chain reaction(RT-qPCR)and Western blotting.The expression of CENPⅠin H1650 cells was knocked down by the siRNA technique,The transfection efficiency was detected by RT-qPCR and Western blotting.The effects of knock-down CENPⅠon proliferation,cell cycle,apoptosis,invasion and migration of H1650 cells were detected by the cell counting kit-8 assay,the transwell assay,and flow cytometry.Western blotting was used to detect the expression of E-cadherin,N-cadherin,vimentin,Ki-67,cyclin D1,Bcl-2,PI3K,AKT,mTOR,p-PI3K,p-AKT,and p-mTOR.Results After the knock-down of CENPⅠ,the proliferative ability of the H1650 cells significantly decreased,the number of apoptotic cells significantly decreased,and the cell invasion and migration abilities significantly decreased(P<0.01).E-cadherin expression was upregulated and N-cadherin,vimentin,Ki-67,cyclin D1,Bcl-2,p-PI3K,p-AKT,and p-mTOR expres-sion were down-regulated in the CENTI group compared with the control group(P<0.05).The expression of p-PI3K,p-AKT,and p-mTOR in the si-CENPⅠ+IGF-1 group was upregulated compared to that in the si-CENPⅠgroup(P<0.05).Conclusion High expression of CENPⅠin lung adenocarcinoma cells promotes the proliferation,invasion,and migration of lung adenocarcinoma H1650 cells and EMT inhibits apoptosis,which may be related to the activation of the PI3K/AKT/mTOR signaling pathway.

Objective:To explore the effect of different swallowing tasks on cortex activation and functional connectivity in stroke survivors with dysphagia using functional near-infrared spectroscopy (fNIRS).Methods:Thirty stroke survivors with dysphagia performed three different swallowing tasks: swallowing action observation (SO), swallowing action execution (SE), and swallowing action imagination (SI). During each task, fNIRS was used to document the brain concentrations of oxyhemoglobin and deoxyhemoglobin. Cortex activation (β value) and brain functional connectivity were assessed.Results:Compared with the resting state, the areas activated during the SO task included the left primary sensory cortex and the right prefrontal cortex. During the SE and SI tasks the left prefrontal cortex and the left motor cortex were activated as well. Compared with hemorrhagic stroke survivors, ischemic stroke survivors showed significantly greater activation of the right primary sensory cortex, the right motor cortex, and the left primary sensory cortex during the SE task. Functional connectivity during the SO, SE and SI tasks was significantly greater than in the resting state, with the average connectivity values during the SE task significantly higher than during the SI task.Conclusions:Stroke survivors with dysphagia exhibit increased activation in the prefrontal cortex and primary sensory cortex during different swallowing tasks. Such tasks can improve their brain functional connectivity.

BACKGROUND:Increasing evidence has indicated that early reinforcement of correct posture is particularly important for improving abnormal gait in stroke patients.Wearable exoskeleton-assisted training can improve patients'walking function in a short period of time,and can also assist the coordinated movement of muscles around the pelvis,hip,knee,and ankle joints,control the walking trajectory of the lower limbs,and improve walking ability in patients with stroke.OBJECTIVE:To explore the improvement of abnormal gait in stroke patients by a wearable exoskeleton with posture feedback,and to explore the rehabilitation mechanism.METHODS:A total of 52 patients in the recovery period of stroke admitted to the Affiliated Hospital of Jining Medical College from January 2023 to January 2024 were included in this study and randomly divided into an experimental group(n=26)and a control group(n=26)using a random number table method.Based on conventional rehabilitation training,the patients in the experimental group participated in training using a wearable exoskeleton with posture feedback(15 minutes per day,6 times per week),while those in the control group were given conventional gait therapy(15 minutes per day,6 times per week).Training in each group lasted for 4 weeks.Before and after training,the lower limb motor function scores,gait parameters(step length,step speed,step width)and gait symmetry were compared between the two groups,and the brain functional connectivity values of the prefrontal motor area,the primary motor cortex and the sensorimotor area were detected using portable near-infrared spectroscopy.RESULTS AND CONCLUSION:After training,lower limb motor function scores,gait parameters and gait symmetry were significantly improved in the two groups(P＜0.05).Meanwhile,the experimental group was superior to the control group in terms of gait parameters and gait symmetry(P＜0.05).Brain functional connectivity values of the right sensorimotor area-left prefrontal motor area and right sensorimotor area-right prefrontal motor area were significantly increased in the two groups after training(P＜0.05).The functional connectivity values of the left sensorimotor area-right primary motor cortex and left sensorimotor area-left primary motor cortex in the experimental group were increased after training(P＜0.05).Compared with the control group,the functional connectivity values of the left sensorimotor area-right primary motor cortex and left sensorimotor area-left primary motor cortex were increased in the experimental group after training(P＜0.05).To conclude,based on conventional rehabilitation training,a wearable exoskeleton with posture feedback can not only effectively improve the abnormal gait of stroke patients,but also activate the functional sensorimotor areas of the brain associated with abnormal gait.

Critically ill with capillary leakage syndrome（CLS）presents with damaged vascular endothelial cells with glycocalyx degraded,which increases vascular permeability,and leads to the protein-rich fluid from the intravascular extravasate into the interstitial space.CLS can concomitant symptoms of hypovolemia and fluid overload.Fluid therapy is the most critical element in the treatment of CLS,but still lack of sufficient evidence to guide the choice of fluid management.Based on accurately hemodynamic monitoring,balanced salt or crystalloid + albumin or fresh frozen plasma may be input to ensure effective circulating blood volume.Albumin or fresh frozen plasma is particularly suitable for CLS patients failed to respond to crystalloids during the leakage period.In the later stage of leakage,conservative fluid management with “de-resuscitation”strategy was mainly used with diuretic and hemofiltration (renal replacement therapy/continuous renal replacement therapy) for attenuating fluid overload.Steroids and ulinastatin may be effective in CLS caused by sepsis.

Serotonin syndrome (SS), also known as serotonin toxicity, is a rare but life-threatening drug reaction syndrome. This case involves a 17-year-old female patient who developed tremors, fatigue, and tachycardia after taking fluoxetine combined with bupropion and tandospirone for five days. SS was highly suspected, and her symptoms improved following treatment targeted at serotonin syndrome. This case is reported to raise awareness among clinicians about the potential adverse reactions of drug combinations, the importance of early identification of SS symptoms, and precautions when prescribing combined medications to avoid serious consequences.

Objective:To introduce the research and innovations around the application of aquatic rehabilitation techniques in the treatment of lumbago, and to summarize specific methods and applications in aeromedicine. Literature resource and selection Literature on the prevention and treatment of lumbago using aquatic rehabilitation techniques as well as on the rehabilitation of lumbago in pilots was retrieved and selected. Literature quotation Sixty-one references were cited. Literature synthesis Aquatic rehabilitation techniques can be classified into shower therapy, immersion therapy, and aquatic exercise therapy according to treatment regimens. Among them, immersion therapy and aquatic exercise therapy are commonly used in the treatment of lumbago. Aquatic rehabilitation techniques can effectively alleviate patients′ lumbago, improve their functional disorders, and enhance their quality of life. Prior to aquatic therapy, patients with lumbago need to have their motor function assessed to tailor the treatment protocol based on diagnostic findings and specific therapeutic objectives. Aquatic rehabilitation techniques, when used to prevent and treat lumbago in pilots under convalescence, are not only more effective than land-based training, but also more accessible to pilots due to their comfort and compliance. Many of our military rehabilitation and convalescent centers in China have integrated modern aquatic rehabilitation techniques into rehabilitation treatment by drawing on their rich water resources so as to improve the physical and mental health, social adaptability and military adaptability of pilots. Conclusions:When used for the prevention and treatment of lumbago, aquatic rehabilitation techniques are highly effective, safe and enjoyable, so they should be made more accessible to pilots during convalescence.