Stroke is one of the most common and serious neurological complications associated with extracorporeal membrane oxygenation （ECMO） therapy， and close monitoring， early recognition， and timely intervention can reduce the incidence rate of stroke and the mortality rate of patients. Transcranial Doppler （TCD） and transcranial color Doppler ultrasonography （TCCD） have emerged as the preferred modalities for monitoring cerebral blood flow in ECMO patients due to their bedside applicability， ability to provide real-time dynamic assessments， and noninvasive safety. This article summarizes the spectral characteristics of cerebral blood flow in patients undergoing various ECMO modalities and elaborates on the latest research advances and clinical significance of TCD/TCCD in predicting stroke events， monitoring cerebral microembolic signals， reflecting the change in intracranial pressure， confirming brain death， and providing prognostic evaluation.
Stroke

Objective:To investigate the clinical characteristics of residual dizziness（RD） after repositioning in patients with benign paroxysmal positional vertigo（BPPV）, identify its potential risk factors, and develop a predictive risk model. Methods:A total of 137 patients diagnosed with BPPV at the First Affiliated Hospital of Xi'an Jiaotong University between January 2023 and June 2023 were enrolled. Based on the presence or absence of subjective discomfort within 3 months after successful repositioning, patients were divided into the non-RD group（NRD, n=93） and the RD group（n=44）. Differences in demographic characteristics, comorbidities, and disease-related features were compared between groups. Multivariate logistic regression analysis was used to identify independent risk factors for RD, and a nomogram was constructed based on these factors. The predictive performance of the model was assessed using the area under the curve（AUC）. Results:The RD group showed significantly higher values in body mass index, prevalence of diabetes and motion sickness history, dizziness duration before repositioning, history of repositioning at external hospitals, number of treatments, and recurrence（all P<0.001）. Multivariate logistic regression revealed that diabetes（adjusted OR=8.73, P=0.039）, motion sickness history（adjusted OR=23.08, P<0.001）, dizziness duration ≥30 days before repositioning（adjusted OR=15.16, P<0.001）, and recurrence（adjusted OR=15.72, P=0.001） were independent risk factors for RD. The nomogram model based on these variables demonstrated good predictive ability, with an AUC of 0.804（95%CI 0.684-0.924）. Conclusion:Diabetes, motion sickness history, dizziness duration ≥30 days, and recurrence are independent risk factors for RD after repositioning in patients with BPPV. The nomogram model based on these variables shows good predictive performance, with recurrence having the highest predictive value. This model can aid in early identification of high-risk patients and guide individualized intervention strategies.
Humans ; Nomograms ; Benign Paroxysmal Positional Vertigo/therapy* ; Dizziness/etiology* ; Risk Factors ; Risk Assessment ; Multivariate Analysis ; Male ; Female ; Logistic Models ; Middle Aged ; Patient Positioning ; Adult

Ischemia-reperfusion (I/R) injury following skin flap transplantation is a critical factor leading to flap necrosis and transplant failure. Antagonizing inflammatory responses and oxidative stress are regarded as crucial targets for mitigating reperfusion injury and enhancing flap survival. In this study, caffeic acid-vanadium metal polyphenol nanoparticles (CA-V NPs) were prepared for the treatment of skin flap ischemia and reperfusion. This study was conducted using a one-step method to prepare new types of CA-V NPs with uniform sizes and stable structures. In vitro, the CA-V NPs exhibited CAT-like and SOD-like activities and could effectively scavenge ROS, generate oxygen, and alleviate oxidative stress. In the H₂O₂-induced cellular oxidative stress model, CA-V NPs effectively reduced ROS levels and inhibited apoptosis through the XIAP/Caspase-3 pathway. In the cellular inflammation model induced by LPS combined with IFN-γ, CA-V NPs reprogrammed macrophage polarization toward the M2 phenotype and reduced inflammatory responses by reducing the expression of the chemokines CCL4 and CXCL2. In addition, animal experiments have shown that CA-V NPs can alleviate oxidative stress in skin flap tissues, inhibit apoptosis, promote angiogenesis, and ultimately improve the survival rate of skin flaps. CA-V NPs provide a new target and strategy for the treatment of flap I/R injury.

Objectives:To investigate the efficacy of dexmedetomidine for foraminal endoscopic surgery.Methods:A total of 75 patients with lumbar disc herniation who received treatment at the First Affiliated Hospital of Anhui Medical University between September 2020 and May 2021 were included in this study. Using a case-control study method, these patients were divided into three groups according to different treatment methods, with 25 patients in each group. The three groups underwent a single-segment unilateral approach for foraminal endoscopic surgery. Group A received simple process infiltration anesthesia, while Group B and Group C received a pump injection of 0.5 μg/kg/h dexmedetomidine for 20 minutes prior to surgery. Group B underwent post-surgical anesthesia adjustments, which involved joint process infiltration anesthesia that was seamlessly integrated with a pump-administered dexmedetomidine infusion at a rate of 0.4 μg/kg/h throughout the surgical procedure. Group C received joint process infiltration anesthesia that was seamlessly integrated with a pump-administered dexmedetomidine infusion at a rate of 0.6 μg/kg/h throughout the surgical procedure. Vital signs, sedation status, sedation score, length of hospital stay, pain score (VAS) immediately after surgery, pain scores at 3 and 6 hours after surgery, and changes in vital signs at different points during surgery were compared among the three groups.Results:There were no significant differences in age, sex, or surgical segment among the three groups (all P > 0.05). The postoperative length of hospital stay in Groups A, B, and C was (5.12 ± 1.15) days, (3.02 ± 0.42) days, and (3.82 ± 0.54) days, respectively ( F = 32.04, P < 0.01). At the beginning of surgery, the sedation scores in Groups A, B, and C were (1.22 ± 0.29) points, (1.28 ± 0.36) points, and (1.46 ± 0.38) points, respectively ( F = 3.28, P < 0.05). At 30 minutes after surgery, the sedation scores in the three groups were (2.12 ± 0.22) points, (2.16 ± 0.24) points, and (2.20 ± 0.24) points, respectively ( F = 3.72, P < 0.01). Immediately after surgery, the Visual Analogue Scale (VAS) scores in the three groups were (3.52 ± 0.33) points, (2.92 ± 0.55) points, and (2.82 ± 0.54) points, respectively ( F = 15.16, P < 0.01). At 3 hours after surgery, the VAS scores in the three groups were (3.64 ± 0.39) points, (2.60 ± 0.58) points, and (2.74 ± 0.54) points ( F = 30.47, P < 0.01). At 6 hours after surgery, the VAS scores in the three groups were (3.78 ± 0.43) points, (2.52 ± 0.47) points, and (2.74 ± 0.52) points, respectively ( F = 49.90, P < 0.01). There were significant differences in VAS score, heart rate, and mean arterial pressure among the three groups during articular process puncture, cannula expansion of the intervertebral foramen, and capture of the perinerve protrusion nucleus pulposus ( F = 34.59, 148.65, 164.08, 5.08, 10.81, 38.06, 43.62, 37.46, and 38.76, all P < 0.05). Conclusion:Preoperative dexmedetomidine can effectively maintain hemodynamic stability, ensure sedation levels, reduce postoperative pain, and accelerate patient recovery after surgery.

The Daurian ground squirrel(Spermophilus dauricus)is the main animal model used for hibernation research in China.This species has many striking physiological adaptive characteristics,such as an adaptation to extreme hypothermia,a low metabolism,resistance to ischemia-reperfusion injury,disuse muscular atrophy,and unique mechanisms of body fat accumulation.These characteristics make the Daurian ground squirrel a unique and significant reference model with research value in clinical and space flight applications.The application of the Daurian ground squirrel as a model animal will help us to further explore the physiological mechanisms mentioned above.This review summarizes the biological characteristics and research values of Daurian ground squirrels in clinical and space flight applications.We also introduce the current progress made in the breeding and experimental animalization of Daurian ground squirrels for laboratory and field research,and advise on precautions that need to be considered during the experimental animalization of this species.

Long non-coding RNAs(lncRNAs)play an indispensable role in the occurrence and development of ovarian cancer(OC).However,the potential involvement of lncRNAs in the progression of OC is largely unknown.To investigate the detailed roles and mechanisms of RAD51 homolog B-antisense 1(RAD51B-AS1),a novel lncRNA in OC,reverse transcription-quantitative polymerase chain reaction(RT-qPCR)was performed to verify the expression of RAD51B-AS1.Cellular proliferation,metastasis,and apoptosis were detected using the cell counting kit-8(CCK-8),colony-formation,transwell,and flow cytometry assays.Mouse xenograft models were established for the detection of tumorigenesis.The results revealed that RAD51B-AS1 was significantly upregulated in a highly metastatic human OC cell line and OC tissues.RAD51B-AS1 significantly increased the proliferation and metastasis of OC cells and enhanced their resistance to anoikis.Biogenetics prediction analysis revealed that the only target gene of RAD51B-AS1 was RAD51B.Subsequent gene function experiments revealed that RAD51B exerts the same biological effects as RAD51B-AS1.Rescue experiments demonstrated that the malignant biological behaviors promoted by RAD51B-AS1 overexpression were partially or completely reversed by RAD51B silencing in vitro and in vivo.Thus,RAD51B-AS1 promotes the malignant biological behaviors of OC and activates the protein kinase B(Akt)/B cell lymphoma protein-2(Bcl-2)signaling pathway,and these effects may be associated with the positive regulation of RAD51B expression.RAD51B-AS1 is expected to serve as a novel molecular biomarker for the diagnosis and prediction of poor prognosis in OC,and as a potential therapeutic target for disease management.

Chemokines and their receptors play crucial roles in nervous system diseases,among which the CXC chemokine receptor 3(CXCR3)is an important mediator of intercellular communication.CXCR3 not only participates in inflammatory chemotaxis and malignant behaviors of tumor cells but also regulates the neurologic diseases.CXCR3 and its ligands directly or indirectly contribute to neuroinflammation and neuroimmunity,and potentially serve as therapeutic targets for diseases like multiple sclerosis,Alzheimer's disease,and glioma and so on.This review discusses the expression and impact of CXCR3 and its ligands in neurological diseases such as multiple sclerosis,neurologic tumors,neurodegenerative diseases,and neuropathic pain,as well as their associations with CXCR3 ligands.Understanding the mechanisms linking CXCR3 to these diseases could facilitate its potential as an early diagnostic biomarker and a target for drug intervention,and provide the basis of studying the occurrence and developmant of nervous system disease.

Patients with severe trauma require an extremely timely treatment and transfusion plays an irreplaceable role in the emergency treatment of such patients. An increasing number of evidence-based medicinal evidences and clinical practices suggest that patients with severe traumatic bleeding benefit from early transfusion of low-titer group O whole blood or hemostatic resuscitation with red blood cells, plasma and platelet of a balanced ratio. However, the current domestic mode of blood supply cannot fully meet the requirements of timely and effective blood transfusion for emergency treatment of patients with severe trauma in clinical practice. In order to solve the key problems in blood supply and blood transfusion strategies for emergency treatment of severe trauma, Branch of Clinical Transfusion Medicine of Chinese Medical Association, Group for Trauma Emergency Care and Multiple Injuries of Trauma Branch of Chinese Medical Association, Young Scholar Group of Disaster Medicine Branch of Chinese Medical Association organized domestic experts of blood transfusion medicine and trauma treatment to jointly formulate Chinese expert consensus on blood support mode and blood transfusion strategies for emergency treatment of severe trauma patients ( version 2024). Based on the evidence-based medical evidence and Delphi method of expert consultation and voting, 10 recommendations were put forward from two aspects of blood support mode and transfusion strategies, aiming to provide a reference for transfusion resuscitation in the emergency treatment of severe trauma and further improve the success rate of treatment of patients with severe trauma.

Purpose: Prostate cancer (PCa) is an epithelial malignancy that originates in the prostate gland and is generally categorized into low, intermediate, and high-risk groups. The primary diagnostic indicator for PCa is the measurement of serum prostate-specific antigen (PSA) values. However, reliance on PSA levels can result in false positives, leading to unnecessary biopsies and an increased risk of invasive injuries. Therefore, it is imperative to develop an efficient and accurate method for PCa risk stratification. Many recent studies on PCa risk stratification based on clinical data have employed a binary classification, distinguishing between low to intermediate and high risk. In this paper, we propose a novel machine learning (ML) approach utilizing a stacking learning strategy for predicting the tripartite risk stratification of PCa. Methods: Clinical records, featuring attributes selected using the lasso method, were utilized with 5 ML classifiers. The outputs of these classifiers underwent transformation by various nonlinear transformers and were then concatenated with the lasso-selected features, resulting in a set of new features. A stacking learning strategy, integrating different ML classifiers, was developed based on these new features. Results: Our proposed approach demonstrated superior performance, achieving an accuracy of 0.83 and an area under the receiver operating characteristic curve value of 0.88 in a dataset comprising 197 PCa patients with 42 clinical characteristics. Conclusions This study aimed to improve clinicians’ ability to rapidly assess PCa risk stratification while reducing the burden on patients. This was achieved by using artificial intelligence-related technologies as an auxiliary method for diagnosing PCa.

Objective:To evaluate the role of virtual bronchoscopy intelligent system in improving the theory and operation level of bronchoscopy in pulmonary and critical care medicine (PCCM) teaching for standardized training specialists.Methods:A total of 50 PCCM physicians who had participated in virtual bronchoscopy training in Xijing Hospital, Air Force Medical University from 2018 to 2021 were selected as research subjects. In this study, self-controlled method was adopted to evaluate the change of assessment indicators after 1 week and 2 weeks of training. Questionnaire survey was also used to evaluate the training effect. SPSS 23.0 software was used for paired t-test and Chi-square test. Results:All the 50 PCCM physicians successfully completed the training of virtual bronchoscopy operation. The theoretical score was significantly improved after the training [(80.0±5.2) points vs. (92.4±3.8) points]. The basic operation time [(1 050.9±103.3) s vs. (386.4±47.7) s], and the number of hitting the bronchial wall [(88.3±12.7) times vs. (27.0±5.3) times] were significantly reduced. The recovery rate of alveolar lavage fluid [(27.6±7.4)% vs. (58.0±8.2)%] and the positive rate of biopsy [(19.2±13.1)% vs. (86.8±10.8)%] were significantly increased. The learning curve of the final score indicated that the score improved more rapidly in the first week of training, and the score improved more slowly in the second week of training. Questionnaires before and after the training indicated that virtual intelligent training could significantly improve the confidence and proficiency of students in bronchoscopy.Conclusion:Through the systematic training of virtual bronchoscopy intelligent system, the PCCM physicians have significantly improved their theoretical knowledge and operational proficiency. Therefore, the virtual bronchoscopy training system has practical significance for improving the overall training effect of clinical bronchoscopy for PCCM trainees, which is worthy of promotion.