Alzheimer's disease (AD) is a neurodegenerative disease with clinical hallmarks of progressive cognitive impairment. Synergistic effects of the Aβ-Tau cascade reaction are tightly implicated in AD pathology, and microglial NLRP3 inflammasome activation drives neuronal tauopathy. However, the underlying mechanism of how Aβ mediates NLRP3 inflammasome remains unclear. Herein, we determined that oligomeric Aβ (o-Aβ) bound to microglial Kv2.1 and promoted Kv2.1-dependent potassium efflux to activate NLRP3 inflammasome resulting in neuronal tauopathy by using Kv2.1 inhibitor drofenine (Dfe) as a probe. The underlying mechanism has been intensively investigated by assays with Kv2.1 knockdown in vitro (si-Kv2.1) and in vivo (AAV-ePHP-si-Kv2.1). Dfe deprived o-Aβ of its capability to promote microglial NLRP3 inflammasome activation and neuronal Tau hyperphosphorylation by inhibiting the Kv2.1/JNK/NF-κB pathway while improving the cognitive impairment of 5×FAD-AD model mice. Our results have highly addressed that the Kv2.1 channel is required for o-Aβ-driven microglial NLRP3 inflammasome activation and neuronal tauopathy in AD model mice and highlighted that Dfe as a Kv2.1 inhibitor shows potential in the treatment of AD.

Objective:To explore the classification of bilobar anterolateral thigh perforator flaps assisted by color Doppler ultrasonography and its impact on their donor sites.Methods:A retrospective analysis was conducted of the data of 67 patients with large soft tissue defects who had been repaired with anterolateral thigh perforator flaps at Department of Orthopaedics, The Hospital Affiliated to The Second Medical University of Shandong, Department of Orthopaedics, The 80th Group Army Hospital of the People's Liberation Army, and Department of Orthopaedics, Weifang Traditional Chinese Medicine Hospital. The patients were divided into 2 groups according to their flaps used: a unilobar group and a bilobar group. In the unilobar group, 36 cases [25 males and 11 females with an age of (40.3±8.3) years] were repaired with a unilobar anterolateral thigh perforator flap from March 2015 to April 2019. In the bilobar group, 31 cases [22 males and 9 females with an age of (38.9±7.4) years] were repaired with a bilobar anterolateral thigh perforator flap from May 2019 to August 2023. Color Doppler ultrasonography was used to classify the bilobar flaps into 4 types according to the different distributions of perforating vessels: common trunk type, separate trunks type, fascia dependent type, and composite mixed type. The number of perforating vessels and type of perforator flap found by preoperative color Doppler ultrasound were compared with the intraoperative findings in the bilobar group. One year after operation, recovery rate of donor muscle strength, rate of skin paresthesia, scar length at the donor site, the widest scar width and motor function were compared between the 2 groups.Results:The number of perforating vessels and type of perforator flap found by preoperative color Doppler ultrasound were consistent with the intraoperative findings ( P<0.05). There was no significant difference in the preoperative general data between the 2 groups, indicating comparability ( P>0.05). One year after operation in the bilobar group, the recovery rate of donor muscle strength was 96.8% (30/31), significantly higher than that in the unilobar group [77.8% (28/36)], the rate of skin paresthesia 6.5% (2/31), significantly lower than that in the unilobar group [27.8% (10/36)], the scar length at the donor site (22.18±5.02) cm, significantly longer than that in unilobar group [(17.35±3.11) cm], the widest scar width (7.26±1.58) mm, significantly narrower than that in the unilobar group [(43.72±9.81) mm], and the scores of Vancouver Scar Assessment Scale and Fugl-Meyer lower limb motor function scale were (1.95±0.57) points and (8.39±2.17) points, respectively, significantly lower than those in the unilobar group [(6.38±1.72) points and (14.02±3.54) points] ( P<0.05). Conclusions:Preoperative classification of bilobar anterolateral thigh perforator flaps assisted by color Doppler ultrasonography may provide guidance for flap harvesting and lobe layout of the flap. Compared to traditional unilobar flaps, bilobar ones may minimize tissue damage at a donor site.

Objective:To explore the classification of bilobar anterolateral thigh perforator flaps assisted by color Doppler ultrasonography and its impact on their donor sites.Methods:A retrospective analysis was conducted of the data of 67 patients with large soft tissue defects who had been repaired with anterolateral thigh perforator flaps at Department of Orthopaedics, The Hospital Affiliated to The Second Medical University of Shandong, Department of Orthopaedics, The 80th Group Army Hospital of the People's Liberation Army, and Department of Orthopaedics, Weifang Traditional Chinese Medicine Hospital. The patients were divided into 2 groups according to their flaps used: a unilobar group and a bilobar group. In the unilobar group, 36 cases [25 males and 11 females with an age of (40.3±8.3) years] were repaired with a unilobar anterolateral thigh perforator flap from March 2015 to April 2019. In the bilobar group, 31 cases [22 males and 9 females with an age of (38.9±7.4) years] were repaired with a bilobar anterolateral thigh perforator flap from May 2019 to August 2023. Color Doppler ultrasonography was used to classify the bilobar flaps into 4 types according to the different distributions of perforating vessels: common trunk type, separate trunks type, fascia dependent type, and composite mixed type. The number of perforating vessels and type of perforator flap found by preoperative color Doppler ultrasound were compared with the intraoperative findings in the bilobar group. One year after operation, recovery rate of donor muscle strength, rate of skin paresthesia, scar length at the donor site, the widest scar width and motor function were compared between the 2 groups.Results:The number of perforating vessels and type of perforator flap found by preoperative color Doppler ultrasound were consistent with the intraoperative findings ( P<0.05). There was no significant difference in the preoperative general data between the 2 groups, indicating comparability ( P>0.05). One year after operation in the bilobar group, the recovery rate of donor muscle strength was 96.8% (30/31), significantly higher than that in the unilobar group [77.8% (28/36)], the rate of skin paresthesia 6.5% (2/31), significantly lower than that in the unilobar group [27.8% (10/36)], the scar length at the donor site (22.18±5.02) cm, significantly longer than that in unilobar group [(17.35±3.11) cm], the widest scar width (7.26±1.58) mm, significantly narrower than that in the unilobar group [(43.72±9.81) mm], and the scores of Vancouver Scar Assessment Scale and Fugl-Meyer lower limb motor function scale were (1.95±0.57) points and (8.39±2.17) points, respectively, significantly lower than those in the unilobar group [(6.38±1.72) points and (14.02±3.54) points] ( P<0.05). Conclusions:Preoperative classification of bilobar anterolateral thigh perforator flaps assisted by color Doppler ultrasonography may provide guidance for flap harvesting and lobe layout of the flap. Compared to traditional unilobar flaps, bilobar ones may minimize tissue damage at a donor site.

The brain-computer interface (BCI) based on motor imagery electroencephalography (EEG) shows great potential in neurorehabilitation due to its non-invasive nature and ease of use. However, motor imagery EEG signals have low signal-to-noise ratios and spatiotemporal resolutions, leading to low decoding recognition rates with traditional neural networks. To address this, this paper proposed a three-dimensional (3D) convolutional neural network (CNN) method that learns spatial-frequency feature maps, using Welch method to calculate the power spectrum of EEG frequency bands, converted time-series EEG into a brain topographical map with spatial-frequency information. A 3D network with one-dimensional and two-dimensional convolutional layers was designed to effectively learn these features. Comparative experiments demonstrated that the average decoding recognition rate reached 86.89%, outperforming traditional methods and validating the effectiveness of this approach in motor imagery EEG decoding.
Electroencephalography/methods* ; Humans ; Brain-Computer Interfaces ; Neural Networks, Computer ; Imagination/physiology* ; Signal Processing, Computer-Assisted ; Brain/physiology* ; Convolutional Neural Networks

Objective:To explore the application of isokinetic muscle strength test in the evaluation of flying cadets′ G-tolerance by investigating the leg strength characteristics of different G-tolerance flying cadets.Methods:G-tolerance test: the AMSACC-4E human centrifuge closed-loop mode was used to test the +8 G z tolerance of 89 male fighter flying cadets. The G-tolerance end point of the flying cadets were determined according to physiological signal monitoring, facial expression characteristics and objective comments. According to the test results, the flying cadets were divided into 3 groups: excellent group, good group and failing group.The grouping criteria: excellent group: could complete the +8 G z 10 s test at one time, with no change in the main complaint light and good consciousness. Good group: could complete the +8 G z 10 s test at one time, the main complaint peripheral light dimmed or disappeared, the central light did not change. Failing group: failure to complete the +8 G z 10 s test at one time, occur G-induced loss of consciousness or almost loss of consciousness. Isokinetic muscle strength test: Biodex System 4 Pro isometric test system was used to test the maximum strength, strength endurance and muscle force balance of the leg flexor and extensor muscles of flying cadets. The test indicators include: peak torque, relative peak torque, average power and peak torque flexion ratio. The test site was knee joint of legs. The test angular speeds were 60°/s and 180°/s. The flying cadets were tested once at each angular speed. They were required to do their best to complete 5 times of consecutive flexion and extension at 60°/s, and 20 times of consecutive flexion and extension at 180°/s. Resting 1 min between different speed, and 3 min between different legs test. The leg strength characteristics were compared among 3 groups. Results:There were 52 flying cadets in excellent group, 29 in good group and 8 in failing group. In terms of leg strength: ①maximum strength: under the test of angular speed 60°/s, there was no significant difference in the peak moment and relative peak moment of leg flexor and extensor muscles among 3 groups (all P>0.05). The peak moment and relative peak moment of flexor muscle of left leg in excellent group were lower than those of right leg, with significant differences ( t=2.14, 2.20, P=0.037, 0.032). ②Strength endurance: under the test of angular speed 180°/s, there was a significant difference in the average power of right leg extensor muscle among 3 groups ( F=3.39, P=0.038). The average power of right leg extensor muscle in excellent group was higher than that in good group, with significant difference ( P=0.015). The average power of the left leg flexor muscle in the excellent group was lower than that of the right leg ( t=2.78, P=0.008). ③Muscle force balance: there were no significant differences between the leg peak torque flexion ratio of flying cadets at 60°/s and 180°/s angular speeds (all P>0.05). The peak torque flexion ratio of the left leg of the excellent group was lower than that of the right leg at both angular speeds ( t=3.96, 3.30, P<0.001,=0.002). Conclusions:The strength endurance of the right leg extensor muscles of the flying cadets with excellent G-tolerance is better, suggesting that under the test of angular speed 180°/s, there may be a certain correlation between the average power of leg extensor muscles and the G-tolerance. Maximum strength and muscle balance of the leg are not significant to the G-tolerance of the flying cadets.

Objective:To explore the application of isokinetic muscle strength test in the evaluation of flying cadets′ G-tolerance by investigating the leg strength characteristics of different G-tolerance flying cadets.Methods:G-tolerance test: the AMSACC-4E human centrifuge closed-loop mode was used to test the +8 G z tolerance of 89 male fighter flying cadets. The G-tolerance end point of the flying cadets were determined according to physiological signal monitoring, facial expression characteristics and objective comments. According to the test results, the flying cadets were divided into 3 groups: excellent group, good group and failing group.The grouping criteria: excellent group: could complete the +8 G z 10 s test at one time, with no change in the main complaint light and good consciousness. Good group: could complete the +8 G z 10 s test at one time, the main complaint peripheral light dimmed or disappeared, the central light did not change. Failing group: failure to complete the +8 G z 10 s test at one time, occur G-induced loss of consciousness or almost loss of consciousness. Isokinetic muscle strength test: Biodex System 4 Pro isometric test system was used to test the maximum strength, strength endurance and muscle force balance of the leg flexor and extensor muscles of flying cadets. The test indicators include: peak torque, relative peak torque, average power and peak torque flexion ratio. The test site was knee joint of legs. The test angular speeds were 60°/s and 180°/s. The flying cadets were tested once at each angular speed. They were required to do their best to complete 5 times of consecutive flexion and extension at 60°/s, and 20 times of consecutive flexion and extension at 180°/s. Resting 1 min between different speed, and 3 min between different legs test. The leg strength characteristics were compared among 3 groups. Results:There were 52 flying cadets in excellent group, 29 in good group and 8 in failing group. In terms of leg strength: ①maximum strength: under the test of angular speed 60°/s, there was no significant difference in the peak moment and relative peak moment of leg flexor and extensor muscles among 3 groups (all P>0.05). The peak moment and relative peak moment of flexor muscle of left leg in excellent group were lower than those of right leg, with significant differences ( t=2.14, 2.20, P=0.037, 0.032). ②Strength endurance: under the test of angular speed 180°/s, there was a significant difference in the average power of right leg extensor muscle among 3 groups ( F=3.39, P=0.038). The average power of right leg extensor muscle in excellent group was higher than that in good group, with significant difference ( P=0.015). The average power of the left leg flexor muscle in the excellent group was lower than that of the right leg ( t=2.78, P=0.008). ③Muscle force balance: there were no significant differences between the leg peak torque flexion ratio of flying cadets at 60°/s and 180°/s angular speeds (all P>0.05). The peak torque flexion ratio of the left leg of the excellent group was lower than that of the right leg at both angular speeds ( t=3.96, 3.30, P<0.001,=0.002). Conclusions:The strength endurance of the right leg extensor muscles of the flying cadets with excellent G-tolerance is better, suggesting that under the test of angular speed 180°/s, there may be a certain correlation between the average power of leg extensor muscles and the G-tolerance. Maximum strength and muscle balance of the leg are not significant to the G-tolerance of the flying cadets.

OBJECTIVE Alzheimer disease(AD)is a neurodegenerative disease with clinical hallmarks of pro-gressive cognitive impairment.Synergistic effects of Aβ-tau cascade reaction are tightly implicated in AD patholo-gy,and microglial NLRP3 inflammasome activation drives neuronal tauopathy through microglia and neurons cross-talk.However,the underlying mechanism of how Aβ medi-ates NLRP3 inflammasome remains unclear.Shab related potassium channel member 1(Kv2.1)as a voltage gated po-tassium channel widely distributed in the central nervous system and plays an important role in regulating the out-ward potassium flow in neurons and glial cells.In current work,we aimed to explore the underlying mechanism of Kv2.1 in regulating Aβ/NLRP3 inflammasome/tau axis by using a determined Kv2.1 inhibitor drofenine(Dfe).METHODS Cell-based assays including Western blot-ting and immunofluorescence staining against primary microglia or neurons were carried out to expound the role of Kv2.1 channel in NLRP3 inflammasome activa-tion and subsequent neuronal tau hyperphosphorylation.For animal studies,new object recognition,Y-maze and Morris water maze were performed to evaluate the ame-lioration of Kv2.1 inhibition through either Kv2.1 inhibitor Dfe treatment or adeno-associated virus AAV-ePHP-si-Kv2.1injectionon5×FADADmodel mice.Assays of histol-ogy and immunostaining of tissue sections and Western blotting of brain tissues were performed to verify the con-clusion of cellular assays.RESULTS We reported that oligomeric Aβ(o-Aβ)bound to microglial Kv2.1 and pro-moted Kv2.1-dependent potassium leakage to activate NLRP3 inflammasome through JNK/NF-κB pathway sub-sequently resulting in neuronal tauopathy.Treatment of either Kv2.1 inhibitor Dfe or AAV-ePHP-si-Kv2.1 for brain-specific Kv2.1 knockdown deprived o-A β of its capability in inducing microglial NLRP3 inflammasome activation and neuronal tau hyperphosphorylation,while improved the cognitive impairment of 5×FAD AD model mice.CONCLUSION Our results have highly addressed that Kv2.1 channel is required for o-Aβ driving NLRP3 inflammasome activation and neuronal tauopathy in AD model mice and highlighted that Kv2.1 inhibition is a prom-ising therapeutical strategy for AD and Dfe as a Kv2.1 inhibitor shows potential in the treatment of this disease.

Objective:To establish a mortality risk prediction model of severe bacterial infection in children and compare it with the pediatric early warning score (PEWS), pediatric critical illness score (PCIS) and pediatric risk of mortality score Ⅲ (PRISM Ⅲ).Methods:A total of 178 critically ill children were selected from the PICU of the Children's Hospital of Nanjing Medical University from May 2017 to June 2022. After obtaining the informed consent of the parents/guardians, basic information such as sex, age, height and weight, as well as indicators such as heart rate, systolic blood pressure and respiratory rate were collected from all children. A standard questionnaire was used to score the child 24 h after admission to the PICU. The children were divided into the survival and death groups according to their survival status at 28 d after admission. A mortality risk prediction model was constructed and nomogram was drawn. The value of the mortality risk prediction model, PEWS, PCIS and PRISM in predicting the risk of death was assessed and compared using the receiver operating characteristic (ROC) curve and the area under the ROC curve (AUC).Results:Among the 178 critically ill children, 11 cases were excluded due to severe data deficiencies and hospitalization not exceeding 24 h. A total of 167 children were included in the analysis, including 134 in the survival group and 33 in the death group. A mortality risk prediction model for children with severe bacterial infection was constructed using pupillary changes, state of consciousness, skin color, mechanical ventilation, total cholesterol and prothrombin time. ROC curve analysis showed that the AUCs of mortality risk prediction model was 0.888 ( P<0.05). The AUCs of PEWS, PCIS and PRISM Ⅲ in predicting death in children with severe bacterial infection were 0.769 ( P< 0.05), 0.575 ( P< 0.05) and 0.759 ( P< 0.05), respectively. Hosmer-Lemeshow goodness-of-fit test showed the best agreement between risk of death and PEWS predicted morbidity and mortality and actual morbidity and mortality (χ 2 = 5.180, P = 0.738; χ 2 = 4.939, P = 0.764), and the PCIS and PRISM Ⅲ predicted mortality rates fitted reasonably well with actual mortality rates (χ 2= 9.110, P= 0333; χ 2 = 8.943, P= 0.347). Conclusions:The mortality risk prediction model for predicting the death risk has better prognostic value than PEWS, PCIS and PRISM Ⅲ for children with severe bacterial infection.

Objective:To investigate the application value of the Nottingham Hip Fracture Score (NHFS) in China and establish a formula specifically designed to assess the risk for 30-day mortality after surgery for hip fracture patients in China.Methods:A retrospective study was conducted to analyze the clinical data of 824 hip fracture patients who had been treated at Department of Orthopaedics, The First Hospital Affiliated to Zhengzhou University from August 2019 to May 2022. There were 312 males and 512 females with a median age of 73 (63, 82) years. The clinical data were compared between patients with different survival outcomes. The 30-day mortality was calculated by the formula according to the patients' NHFS, and compared with the actual one to validate the effectiveness of the original prediction model. The patients were divided into a training group ( n=577) and a validation group ( n=247). Binary logistic regression analysis was performed to establish a new prediction model for the patients in the training group. The discrimination, calibration, and clinical effectiveness of the predictive model were assessed in both the training and validation groups. Results:Multivariate logistic regression analysis showed that advanced age (≥86 years old) ( OR=3.775, 95% CI: 1.099 to 12.972, P=0.035), male ( OR=3.151, 95% CI: 1.574 to 6.306, P=0.001), admission hemoglobin concentration ≤100 g/L ( OR=2.402, 95% CI: 1.189 to 4.850, P=0.015), dependence on others for care before admission ( OR=2.673, 95% CI: 1.298 to 5.505, P=0.008), and comorbidities ≥2 ( OR=4.988, 95% CI: 1.874 to 13.274, P=0.001) were identified as risk factors for postoperative 30-day mortality (all P<0.05). In validation of the original prediction model, the C-index was found to be 0.764, indicating good discrimination. However, there was a significant discrepancy between the mortality forecast by the original prediction model and the actual mortality ( P<0.05), indicating poor calibration. After the prediction model was recalibrated, 30-day mortality (%) = 100/[1 + e (5.818-NHFS×0.599)]. After the new prediction model was validated in both the training and validation groups, the C-indexes were 0.762 and 0.780, indicating a good level of discrimination. The predicted 30-day mortality by the prediction model was closely aligned with the actual mortality ( P>0.05), demonstrating good calibration. When the threshold probabilities of the training and the validation groups were 0 to 26% and 0 to 35%, respectively, the patients might benefit from clinical intervention, showing clinical effectiveness of the model. Conclusions:The NHFS can predict the risk for 30-day mortality after hip fracture surgery. The new NHFS prediction model after calibration has a good predictive value for 30-day mortality after hip fracture surgery in Chinese population.