Objective To longitudinally analyze the changes in perioperative nutritional indicators in elderly patients with spontaneous intracerebral hemorrhage(ICH)and their correlation with the score of modified Rankin scale(mRS)score.Methods A total of 295 elderly ICH patients ad-mitted to the neurosurgery intensive care unit of North China University of Science and Technolo-gy Affiliated Hospital from June 2022 to November 2024 were consecutively enrolled in this study.The levels of relevant nutritional indicators were measured before(T1),and in 1(T2),3(T3),5(T4)and 7 d(T5)after surgery.According to the mRS score in 90 d after onset of the disease,they were divided into a good prognosis group(mRS score≤ 2,114 cases)and a poor prognosis group(mRS score≥3,181 cases).The general data and levels of nutritional indicators at above time points were compared between the two groups.Binary logistic regression analysis was applied to study the relationship between the perioperative nutritional indicator levels and the prognosis in elderly patients with spontaneous ICH.Results The poor prognosis group had significantly higher SBP,larger proportions of stroke history,hemorrhage in the brainstem and midline dis-placement,and increased NIHSS score than the good prognosis group(P＜0.05,P＜0.01).Obvi-ously lower BMI(56.48±9.54 kg vs 66.62±8.12 kg),decreased serum levels of albumin[40.24(39.10,41.16)g/L vs 43.30(40.65,45.50)g/L],prealbumin[203.00(164.00,261.00)mg/L vs 229.00(180.00,282.00)mg/L]and TC[4.68(4.11,5.39)mmol/L vs 4.91(4.47,5.66)mmol/L],reduced lymphocyte count[1.58(0.95,2.03)× 109/L vs 1.77(1.99,1.91)× 109/L],and reduced GCS[7.00(5.00,10.00)vs 9.00(7.00,13.00)]and Barthel[55.00(43.00,64.00)vs 61.00(52.00,69.00)]scores at admission were observed in the poor prognosis group than the good prognosis group(all P＜0.01).At all different time points,the poor prognosis group also got notably higher Controlling Nutritional Status(CONUT)scores(reaching the highest levels at 3 d after opera-tion),and lower Prognostic Nutritional Index(PNI)score and Geriatric Nutritional Risk Index(GNRI)score(both declining the lowest levels at same time)when compared with the poor prog-nosis group(all P＜0.01).Binary logistic regression analysis showed that COUNT scores,PNI scores and GNRI scores before(T1)and at 1(T2),3(T3),5(T4)and 7 d(T5)after operation were independent risk factors for 90-day poor prognosis in elderly patients with spontaneous ICH.Conclusion The fluctuations of 3 nutritional indicators at different time points in the periopera-tive period are closely associated with the 90-day prognosis of elderly ICH patients.Monitoring the changes in the nutritional indicators can quickly and conveniently predict the prognosis of the pa-tients,which has high clinical application value.

Objective To predict the value of admission dehydration state combined with fluid accumulation index for post-operative prognosis in elderly patients with intracerebral hemorrhage(ICH).Methods A retrospective study was conducted on 320 elderly ICH patients receiving surgical treatment in Department of Neurosurgery and then admitted to its Intensive Care Unit of the Affiliated Hospital of North China University of Science and Technology from May 2023 to March 2024.According to the survival status at 30 d after onset,they were divided into a survival group(202 cases)and a death group(118 cases).Clinical data such as basic information,admission vital signs,laboratory indicators,and fluid supplementation were compared between the two groups.ROC curve was plotted.Results The death group exhibited significantly advanced age,more bleeding sites,higher 7-day fluid accumulation index,and larger proportions of ventricular rupture,midline displacement and admission dehydration status,but lower uric acid level than the the survival group(P＜0.05,P＜0.01).Binary logistic regression analysis showed that admission dehydration status and 7-day fluid accumulation index were risk factors for 30-day mortality in elderly ICH patients after surgery(P＜0.01).ROC curve analysis showed that the AUC value of admission dehydration status combined with 7-day fluid accumulation index in predicting 30-day death of elderly ICH patients after surgery was 0.774(95％CI:0.722-0.825),and that of the combination was better than that of each indicator alone(P＜0.05).Conclusion Hospital dehydration status combined with 7-day fluid accumulation index has the best effectiveness in predicting 30-day mortality in elderly ICH patients after surgical treatment.

Objective To evaluate the reliability and validity of the Chinese version of the Repeatable Battery for the Assessment of Neuropsychological Status(RBANS)in patients with maintenance hemodialysis(MHD).Methods The general information and medical history of 84 MHD patients were collected,and the Mini-Mental State Exam(MMSE),Montreal Cognitive Assessment Scale(MoCA),and RBANS were conducted.The reliability of the scale was assessed by Cronbach α and split-half reliability.The structure and convergent validity of the scale were assessed by confirmatory factor analysis,and the RBANS scores'correlation to MoCA and MMSE scores was analyzed by Spearman correlation analysis.The predictive value of the RBANS total score on cognitive impairment(CI)was analyzed by receiver operating characteristic(ROC)curve.Results The Cronbach's alpha coefficient of the RBANS total scale was 0.896,split-half reliability was 0.911,and reliability for the five dimensions of the RBANS ranged from 0.618 to 0.791.Confirmatory factor analysis indicated that the overall fit of the five-dimensional model of the RBANS scale was acceptable(χ2/df=1.587,root mean square error of approximation=0.084,comparative fit index=0.967,incremental fit index=0.968,Tucker-Lewis index=0.947,goodness of fit index=0.891).The average variance extracted(AVE)for the five dimensions of the RBANS ranged from 0.525 to 0.863,while the composite reliability(CR)ranged from 0.733 to 0.926,indicating good convergent validity of the scale.Furthermore,Spearman correlation analysis revealed that the total RBANS score was negatively correlated to the age of MHD patients and positively correlated to years of education,as well as the total scores of MMSE and MoCA(all P<0.01).The ROC curve analysis indicated that the area under the curve(AUC)for the total RBANS score in predicting CI was 0.891(P<0.01),suggesting a high predictive value.Conclusion The Chinese version of RBANS has good reliability and validity in MHD patients,and can be used as a measure of cognitive function in MHD patients.

Objective:To evaluate the clinical efficacy, safety and treatment persistence of upadacitinib in Crohn's disease (CD) patients.Methods:The single-center retrospective cohort study was conducted. The patients with moderate-to-severe active CD initiating upadacitinib therapy from November 2023 to November 2024 in Nanjing Drum Tower Hospital were collected through searching the electronic medical records and paper-based patient databases. The primary outcome was the clinical remission rate at week 12. Secondary outcomes included the clinical response rate at week 12; clinical response and remission rates at weeks 4, 24 and 48; biomarker (fecal calprotectin or C-reactive protein) remission rates at all time points; as well as endoscopic remission and response rates, treatment persistence and safety evaluation.Results:A total of 44 CD patients were included, comprising 24 males (54.5%) and 20 females (45.5%). The median age was 33 (25, 40) years. The baseline Crohn's disease activity index (CDAI) score was 260.5 (225.9, 550.0) points. Patients had previously received a median of 2 (1, 2) biologic treatments. All 44 patients completed the 12-week induction therapy. With a median follow-up of 30.00 (16.25, 46.25) weeks, the clinical remission rate was 50.0% (22/44) at week 12. The clinical remission rate, clinical response rate, and biomarker remission rate were 52.3% (23/44), 88.6% (39/44) and 72.7% (32/44) respectively at week 4, and the clinical response rate and biomarker remission rate were 88.6% (39/44) and 77.2% (34/44) respectively at week 12. The clinical remission rates, clinical response rates and biomarker remission rates evolved to 43.3% (13/30), 86.7% (26/30) and 80.0% (24/30) at week 24, and further to 44.4% (4/9), 77.8% (7/9) and 77.8% (7/9) at week 48. During the follow-up period, 13 CD patients completing endoscopic evaluation, endoscopic remission and response rates were 30.8% and 23.1% respectively. CD-related surgery rate was 4.5% (2/44). Safety analysis demonstrated that the overall adverse events rate was 56.8% (25/44) including 7 patients with serious adverse events. A total of 8 patients discontinued treatment, among which 3 were due to primary loss of response, 1 due to secondary loss of response, 2 due to drug-related adverse events alone, and 2 due to concurrent primary loss of response and adverse events. The Kaplan-Meier curve for treatment persistence showed that among 39 CD patients who achieved clinical response at week 12, the continued treatment rates were 90.3% at week 12 and 85.3% at week 24 of follow-up. Two patients (5.6%) received dose escalation of upadacitinib, both of whom achieved clinical remission.Conclusion:Real-world research data demonstrate that upadacitinib exhibits significant clinical efficacy and a favorable safety profile in the treatment of moderate-to-severe active CD patients with prior biologic exposure, and no new unexpected adverse events are identified.

Objective To analyze changes in sleep,mood state,and brain function in healthy populations living in near-sea-level environments before and after exposure to high-altitude environment,and to explore the correlations between regional brain functional changes and variations in sleep and mood states.Methods A total of 45 healthy volunteers were enrolled.The participants came from regions of near-sea-level altitudes and were exposed to the high-altitude environment for a short period of time.The Pittsburgh Sleep Quality Index(PSQI),Zung Self-Rating Depression Scale(SDS),Patient Health Questionnaire-9(PHQ-9),Zung Self-Rating Anxiety Scale(SAS),and Generalized Anxiety Disorder-7(GAD-7)were administered to assess sleep quality as well as depressive and anxiety symptoms at 4 time points—prior to high-altitude exposure,immediately after exposure,one month after returning to low-altitude regions,and three months after returning to low-altitude regions.Resting-state functional magnetic resonance imaging(rs-fMRI)data were collected before and after high-altitude exposure,and regional brain functional parameters,including the amplitude of low-frequency fluctuations(ALFF)and functional connectivity strength,were analyzed.Statistical analyses were performed,including a linear mixed-effects model to evaluate longitudinal changes in scale scores,paired-sample t-tests to compare brain function differences before and after exposure,and Pearson correlation analyses to examine the relationship between brain functional changes and alterations in sleep and mood states.Results Compared with the pre-exposure findings,the participants exhibited significantly increased PSQI scores(8.89±4.41 vs.5.08±2.69,P<0.05)and PHQ-9 scores(3.60±4.19 vs.1.54±2.30,P<0.05)immediately after high-altitude exposure.One month after returning to the low-altitude environment,both sleep and depression scores decreased relative to the findings immediately after exposure(PSQI:3.88±2.13 vs.8.89±4.41,P<0.05;PHQ-9:1.50±2.25 vs.3.60±4.19,P<0.05)and showed no statistically significant difference compared with the pre-exposure findings(P>0.05).Three months after returning to near-sea-level environment,sleep,depression,and anxiety scores were all reduced compared with the findings immediately after exposure(PSQI:3.76±2.31 vs.8.89±4.41,P<0.05;PHQ-9:1.24±2.13 vs.3.60±4.19,P<0.05;SAS:23.84±5.93 vs.27.93±7.05,P<0.05),also showing no significant difference compared with the pre-exposure levels(P>0.05).Brain function analysis revealed that,relative to the pre-exposure levels,ALFF in the bilateral superior temporal gyrus,insula,and dorsolateral prefrontal cortex(DLPFC)increased after high-altitude exposure(P<0.05),and that functional connectivity strength in the DLPFC was also elevated(P<0.05).Furthermore,changes in DLPFC functional connectivity strength were positively correlated with changes in sleep and mood scores(P<0.05).Conclusion High-altitude exposure has a significant impact on the sleep,mood states,and brain function of populations from near-sea-level regions,and DLPFC,in particular,is closely associated with changes in sleep and mood states.The findings of this study provide a theoretical basis for health management and intervention strategies in high-altitude environments.

The theory of blood stasis originated from"The Yellow Emperor's Inner Canon(huang Di Nei Jing)",and the drugs used for promoting blood stasis originated from"Shennong's Classic of Materia Medica(Shen Nong Ben Cao Jing)".Finally,the medical sage Zhang Zhong-jing first put forward the name of"blood stasis"in"Synopsis of the Golden Chamber(Jin Gui Yao Lue)",and used the method of promoting blood stasis to treat various diseases,which provided ideas for the future study on the mechanism and treatment of blood stasis syndrome.Therefore,Zhang Zhong-jing was the founder of the theory of blood stasis.Moreover,the principles,methods,prescriptions and medicines which he put forward were still appropriate effectively in the clinic.On the basis of comprehensively combing the research achievements of Zhongjing's blood stasis theory,with combination with the current research hotspots,the review gives a novel understanding of the theory,method,prescription and medicine of Zhongjing's blood stasis theory from new aspects,including etiology,pathogenesis,treatment of blood stasis theory,and the active ingredients of anti-blood stasis Chinese medicines.We intend to promote the research progress of the scientific connotation of blood stasis theory,and improve the diagnosis and treatment level of clinicians in preventing and treating difficult diseases related to blood stasis syndrome through integrated summary and novel interpretation.

Objective To compare and analyze the predictive value of a variety of novel blood inflammation composite indicators in spontaneous intracerebral hemorrhage(sICH)patients'prognosis.Methods This retrospective study consecutively enrolled 329 sICH patients admitted to the Neurosurgical Intensive Care Unit of North China University of Science and Technology Affiliated Hospital between September 2022 and December 2024.Patients were categorized into favorable(with modified Rankin scale[mRS]score ≤2)or unfavorable(mRS score ≥ 3)prognosis groups based on 90-day post-onset assessments.Baseline and imaging data,included age,gender,smoking history,alcohol consumption history,admission systolic/diastolic blood pressure,medical history(diabetes,coronary heart disease,stroke),24-hour laboratory parameters after admission(albumin,hemoglobin,blood glucose,potassium,platelets,lymphocytes,monocytes,neutrophils,homocysteine,red cell distribution width[RDW]),site of hemorrhage(basil ganglia,lobes,cerebellum,brain stem),hemorrhage volume,the National Institutes of Health stroke scale(NIHSS)score.Systemic complications during hospitalization(pulmonary/urinary tract/bloodstream infections)were recorded.Head CT and CT angiography(CTA)were performed at 24 h after admission to measure hematoma volume.Calculate and analyze the comprised inflammatory indices including systemic immune-inflammation index(SII;platelets × neutrophils/lymphocytes),platelet-to-lymphocyte ratio(PLR),RDW to albumin ratio(RAR;RDW/albumin),hemoglobin to RDW ratio(HRR,hemoglobin/RDW),systemic inflammation response index(SIRI;neutrophils × monocytes/lymphocytes),lymphocyte-neutrophil-albumin ratio(LANR;lymphocytes × albumin/neutrophils),neutrophil-to-albumin ratio(NPAR;neutrophil％/albumin),glucose-to-lymphocyte ratio(GLR;glucose/lymphocytes),and glucose-to-potassium ratio(GPR,glucose/potassium).Variables with P＜0.05 in univariate analysis were included in a collinearity analysis(a tolerance＜0.1 or variance inflation factor[VIF]＞10 indicating collinearity).Significant non-collinear variables with P＜0.05 in univariate analysis were included in multivariate Logistic regression to identify factors influencing prognosis in sICH patients.Receiver operating characteristic(ROC)curves was utilized to compare the predictive power of each indictors through net reclassification improvement(NRI)and integrated discrimination improvement(IDI).With NRI/IDI＞0 indicated superiority of new models over the old ones(higher values denote greater improvement).Delong's test was performed to evaluate the area under the curve(AUC)differences.Results Among the 329 sICH patients enrolled(185 males,144 females;mean age[68±6]years,ranged 36-91),138 were categorized into the favorable prognosis group(mRS score≤ 2)and 191 into the unfavorable prognosis group(mRS score ≥ 3),all patients had received a standardized treatment.Significant differences were observed in alcohol consumption history,diabetes,prior stroke,albumin,hemoglobin,blood glucose,platelets,lymphocytes,monocytes,neutrophils,homocysteine,RDW,hematoma volume,lung infection,and NIHSS score between two groups(all P＜0.05).While no significant differences were observed in the rest baseline/imaging data between the two groups(all P＞0.05).The favorable prognosis group exhibited significantly lower GLR(4.67[3.76,5.92]vs.6.67[4.66,10.32]),SIRI(1.92[1.12,3.24]v.s.4.43[2.25,8.33]),PLR(125.11[105.11,156.20]vs.164.46[122.42,232.63]),RAR(0.28[0.27,0.29]vs.0.32[0.30,0.35]),and NPAR(0.18[0.13,0.21]vs.0.22[0.16,0.33];all P＜0.01);and significantly higher SII(1 632.90[882.18,2 429.78]vs.967.93[702.83,1 290.51]),LANR(9.63[7.75,13.10]vs.5.49[3.25,9.77]),and HRR(11.73[10.97,12.62]vs.10.89[10.00,11.82];all P＜0.01).No significant differences were found in GPR(2.15[1.80,2.65]vs.2.28[1.83,3.31])between the favorable and unfavorable prognosis groups(P=0.094).After excluding factors with multicollinearity(including,lymphocytes,platelets,neutrophils,monocytes,albumin,RDW and hemoglobin),the other factors were included in a multivariate analysis,which identified SIRI(OR,1.312,95％CI1.043-1.650,P=0.020),RAR(OR,1.578,95％CI 1.376-1.810,P＜0.01),and HRR(OR,0.641,95％CI 0.480-0.854,P=0.002)as independent predictors of poor 90-day prognosis for sICH patients.ROC analysis showed that the AUC of RAR,SIRI,and HRR were 0.862,0.739 and 0.683 respectively,with RAR demonstrating superior sensitivity(82.20％vs.SIRI 68.06％vs.HRR 51.83％)and specificity(78.26％vs.SIRI 69.57％vs.HRR 76.81％).IDI confirmed RAR's significantly greater predictive ability versus SIRI(IDI=0.210,P＜0.01)and HRR(IDI=0.263,P＜0.01),and SIRI have superior predictive ability over HRR(IDI=0.053,P=0.040).Delong test showed that RAR had significantly greater predictive power than both SIRI and HRR(both P＜0.01),while the predictive power of SIRI and HRR did not differ significantly(P=0.138).Conclusions The three blood inflammatory indicators(RAR,SIRI,HRR)are effective predictors of poor prognosis in sICH patients at 90 d from onset,and among the three composite inflammatory parameters,RAR is significantly more effective than SIRI and HRR indicators.

Hepatitis B is a major global public health issue. Through the implementation of comprehensive prevention and control strategies centered on hepatitis B vaccination， China has achieved remarkable progress in hepatitis B prevention and control， while there are still many issues and challenges. This article reviews the development of hepatitis B vaccination strategies in China， analyzes the goal and advances in vaccination in different populations， and problems and challenges， in order to provide a reference for further optimizing vaccination strategies and improving the levels of prevention and control.

Objective To explore the correlation between serum ferritin and the risk of metabolic syndrome, and to provide evidence for the prevention and control of metabolic syndrome. Methods Data was from the Jiang'an District survey data of the Chinese Resident Nutrition and Health Monitoring Project in 2022. A total of 399 adult residents were selected as the study subjects and the investigation was performed by questionnaire, physical examination and biochemical testing. Statistical analysis was conducted by SAS 9.4 software, and the association between serum ferritin and metabolic syndrome was analyzed by using multivariate logistic regression. Results The prevalence of metabolic syndrome in the study population was 43.61%, and 39.04% after standrdization. With the increase of serum ferritin levels, the prevalence of metabolic syndrome gradually increased (P<0.05). Serum ferritin was positively correlated with WC, DBP, TG, FPG, hsCRP, and HbA1c, while negatively correlated with HDL-C (P<0.05). Multivariate logistic regression analysis showed that after adjusting for confounding factors, female serum ferritin was positively correlated with the prevalence of metabolic syndrome (OR=3.59，95% CI：1.72-7.46); however, male serum ferritin level was not correlated with the prevalence of metabolic syndrome (OR=2.02，95% CI：0.76-3.40). Conclusion The prevalence of metabolic syndrome among residents in Jiang'an District is relatively high. Serum ferritin is associated with various components of metabolic syndrome, and the high serum ferritin level in women is associated with a higher risk of metabolic syndrome.

Objective To investigate the predictive value of early fluid balance combined with daily average fluid intake on the prognosis of patients who received hematoma evacuation for spontaneous intracerebral hemorrhage(sICH).Methods This study retrospectively and consecutively enrolled patients who underwent hematoma evacuation for sICH admitted to the Neurosurgical Intensive Care Unit of North China University of Science and Technology Affiliated Hospital between January 2023 and January 2025.Patients'baseline and clinical data were collected,including gender,age,admission vital signs(body temperature,respiratory rate,heart rate,systolic and diastolic blood pressure),medical history(hypertension,diabetes mellitus,coronary heart disease),admission Glasgow coma scale(GCS)score,admission laboratory parameters(including white blood cell count,red blood cell count,platelet count,urine bacterial levels,urine ketones,urine pH,homocysteine),hemorrhage location,hemorrhage volume,time from ictus to surgery,and hematoma evacuation rate(hematoma evacuation rate[％]=[preoperative hematoma volume-postoperative hematoma volume]/preoperative hematoma volume × 100％).Fluid intake,output,balance,daily average intake,and cumulative fluid balance during the early postoperative period(the first to seventh 24-hour periods)were assessed and recorded.Fluid intake comprised the sum of intravenously administered fluids(crystalloids,hypertonic fluids,colloids,blood products,and parenteral nutrition),enteral nutrition(nasogastric feeding solutions and water),and renal replacement therapy fluids.Fluid output comprised the sum of urine volume,vomitus,drainage fluid,and dialysis fluid losses.Fluid balance was defined as the difference between fluid intake and output.Daily average intake was calculated as the average of the fluid intake over the first seven postoperative 24-hour periods.Cumulative fluid balance was the sum of the fluid balances over the first seven postoperative 24-hour periods.Patient outcomes were assessed at 30 days postoperatively.Discharged patients underwent outpatient review or telephone follow-up,while inpatients were evaluated by neurosurgeons.Prognosis was evaluated using the 30-day modified Rankin scale(mRS)score:mRS scores 0-3 were classified as favorable prognosis,and mRS scores 4-6 as poor prognosis.Patients were subsequently divided into favorable prognosis and poor prognosis groups based on mRS scores.Factors with P＜0.05 in univariate comparisons and without collinearity(multicollinearity was defined by:tolerance＜0.1 and variance inflation factor＞10)were included in multivariate Logistic regression analysis to identify independent risk factors for poor 30-day prognosis after hematoma evacuation in sICH patients.Receiver operating characteristic(ROC)curve analysis was employed to evaluate the predictive value of relevant factors for poor 30-day prognosis after hematoma evacuation in sICH patients.Results A total of 320 patients who underwent hematoma evacuation for sICH were enrolled,including 192 males and 128 females,with an age range of 20-91 years(median age 62[53,68]years).Among them,144 patients were assigned to the favorable prognosis group and 176 to the poor prognosis group.The poor prognosis group exhibited significantly higher hemorrhage volume,homocysteine level,fluid intake at the 3rd,5th,6th,and 7th 24-hour periods,fluid balance at the 3rd,5th,6th,and 7th 24-hour periods,daily average intake,and cumulative fluid balance compared to the favorable prognosis group(all P＜0.05).The favorable prognosis group had a significantly higher hematoma evacuation rate,GCS score,proportion of supratentorial hemorrhage and negative urine ketones than the poor prognosis group(all P＜0.05).No significant differences were found in other clinical data(all P＞0.05).Fluid balance over the first seven postoperative 24-hour periods displayed a rise-decline-rise pattern in the poor prognosis group and a rise-decline pattern in the favorable prognosis group.Both groups peaked at the 3rd 24-hour period.Multivariate Logistic regression analysis identified fluid balance at the 3rd 24-hour period(OR,2.013,95％CI 1.386-2.922,P＜0.01)and daily average intake(OR,3.583,95％CI 1.793-7.161,P＜0.01)as independent influencing factors for poor 30-day prognosis after hematoma evacuation in sICH patients.ROC curve analysis revealed that the area under the curve(AUC)for fluid balance at the 3rd 24-hour period and daily average intake in predicting poor 30-day prognosis were 0.699(95％CI 0.642-0.757)and 0.765(95％CI 0.712-0.819),respectively.The combined model of fluid balance at the 3rd 24-hour period and daily average intake achieved an AUC of 0.804(95％CI 0.756-0.853),demonstrating significantly superior predictive performance compared to either variable alone(both P＜0.05).Conclusions The combination of fluid balance at the 3rd 24-hour period and daily average intake demonstrates modest predictive value for poor 30-day prognosis after hematoma evacuation in sICH patients.These findings require validation through multicenter,large-scale,prospective studies.