With the aging population, the burden of diseases such as atrial fibrillation and venous thrombosis is gradually increasing. Anticoagulant therapy has a positive significance in preventing ischemic stroke, pulmonary embolism, and other related conditions in these patients. However, anticoagulant therapy can have the opposite effect on diseases caused by intracranial hemorrhage, such as falls in the elderly, cerebrovascular accidents, and car accidents. It is still difficult to determine whether and when to restart anticoagulation after cerebral hemorrhage. Although most studies have shown that restarting anticoagulant therapy can reduce stroke risk without significantly increasing bleeding risk, they are mostly based on observational studies, so more high-quality research is needed to guide clinical decision-making. This article reviews the research progress on restart anticoagulation, aiming to provide some assistance for clinical applications.

Venous thromboembolism is a common comorbidity in neurosurgery department that can lead to life-threatening pulmonary embolism, endangering patient health. The unique characteristics of neurosurgical conditions often present a high risk of bleeding, which complicates the treatment of venous thrombosis. Although numerous observational studies and meta-analyses support the feasibility of initiating early anticoagulation prevention or treatment after hemorrhage stabilization in intracranial hemorrhagic conditions such as traumatic brain injury and cerebral hemorrhage, there is a lack of high-quality clinical research. As a result, neurosurgeons tend to adopt a conservative approach regarding pharmacological prophylaxis and anticoagulant treatment for venous thromboembolism. Key aspects such as the timing of prevention, monitoring, and discontinuation of treatment still require high-quality research to establish definitive guidelines.

Ferroptosis is a form of iron-dependent cell death caused by a disorder of iron lipid metabolism.Its mechanism mainly includes lipid metabolism and iron metabolism,which are complicated and strictly regulated by various metabolic and signaling pathways.Current studies have shown that ferroptosis is associated with cancer,atherosclerosis,and neurological diseases.Traditional Chinese medicine(TCM)is characterized by various active ingredients,relatively high safety,and lower treatment costs,which possess unique advantages in clinical applications.It has been widely used in the treatment of various diseases.Taking the regulation of ferroptosis by traditional Chinese medicine as the entry point may be a new direction for the future prevention and treatment of various diseases.In this review,we discussed the mechanism of iron lipid metabolic disorders based on ferroptosis and the research progress of traditional Chinese medicine intervention to provide reference and treatment strategies for the prevention and treatment of related diseases.

Objective:To investigate the time characteristics from extracorporeal cardiopulmonary resuscitation (ECPR) initiation to termination.Methods:The data of ECPR patients in extracorporeal life support center of the First Affiliated Hospital of Nanjing Medical University from April 2015 to October 2023 were retrospectively analyzed. The patients were grouped by survival/death at 90 days, in-hospital/out-of-hospital cardiac arrest (IHCA/OHCA), daytime/evening initiation, and procedural/non-procedural termination. Data on age, sex, Charlson comorbidity index, interhospital transport, initial rhythm, ECPR initial blood gas pH and lactate value, no-flow time, time from cardiac arrest to extracorporeal membrane oxygenation (ECMO) initiation (CA-Pump On time), ECPR initiation/termination and ECMO treatment time, 90-day survival rate and so on were analyzed.Results:200 ECPR patients were enrolled, the cardiogenic etiologies were accounted for 70.5%, more men than women, 68 (34.0%) patients survived at 90 days, of whom 61 (89.7%) patients had good neurological outcomes. The 90-day survival group had a significantly lower of no-flow time, a higher proportion of IHCA and initial shockable heart rhythm, with a higher ECPR initial blood gas pH and a lower lactic acid value than those in the death group. 3. The no flow time in OHCA group was significantly longer than that in IHCA group, with a lower ECPR initial blood gas pH and a higher lactic acid value, 77.4% were non-procedural termination and the 90-day survival rate was 16.1%. ECPR were initiated in all time periods, IHCA-ECPR initiated at random, OHCA-ECPR were rare in the early morning, and the initiation time had no significant effect on ECPR outcomes. There were 75.5% of ECPR terminated at the daytime, 56.8% death cases were occurred within 3 days after ECPR, and 19.0% of patients in the procedural termination group died due to a combination of factors.Conclusions:ECPR had a potentially high benefit for patients with IHCA, initial shockable rhythm, and a short no-flow time. The ECPR initiation time were irregular and had no effect on ECPR outcomes. Death events tend to occur in the early days after ECPR, and ECPR terminated is mostly during the daytime working hours. The construction of full-time ECPR team should be strengthened.

Objective To analyze the expression of microRNA(miR)-200a and miR-4652-3p in cerebrospinal fluid of patients with tuberculous meningitis(TBM)and their predictive value for disease severity and prognosis.Methods A total of 187 patients with tuberculous meningitis who visited Qingdao Chest Hospital from January 2018 to December 2022 were regarded and separated into stage Ⅰ(n=62),stage Ⅱ(n=76)and stage Ⅲ(n=49)according to the severity of the condition.There were 131 cases in the good prognosis group and 56 cases in the poor prognosis group according to the prognosis.The qRT-PCR method was applied to detect the expression levels of miR-200a and miR-4652-3p in cerebrospinal fluid.Spearman method was used to analyze correlation among miR-200a,miR-4652-3p and clinical data.ROC curve was applied to analyze the predictive value of cerebrospinal fluid miR-200a and miR-4652-3p levels in evaluating the severity and prognosis of tuberculosis meningitis patients.Multivariate logistic regression was applied to analyze the influencing factors of poor prognosis in patients.Results The expression levels of miR-200a(1.05±0.14,0.91±0.14,0.76±0.13)and miR-4652-3p(0.92±0.11,0.78±0.11,0.65±0.10)in the cerebrospinal fluid of patients with stage Ⅰ,Ⅱ,and Ⅲ tuberculous meningitis were decreased sequentially,and the differences were significant(F=61.079,87.203,all P＜0.05).The expression levels of miR-200a(0.95±0.14)and miR-4652-3p(0.82±0.11)in cerebrospinal fluid of patients with good prognosis tuberculous meningitis were higher than those of patients with poor rognosis(0.84±0.13,0.73±0.10),and the differences were statistically significant(t=5.025,5.262,all P＜0.05),while the levels of cerebrospinal fluid adenosine deaminase,TNF-α,IL-23,LTB4,CRP and mRS scores in patients with good prognosis were lower than those in patients with poor prognosis(t=5.649,7.721,11.150,9.455,11.314,14.407,all P＜0.05).There was a positive correlation between the levels of miR-200a and miR-4652-3p in cerebrospinal fluid of patients with tuberculous meningitis(r=0.405,P＜0.001).The levels of miR-200a and miR-4652-3p in cerebrospinal fluid were negatively correlated with LTB4,TNF-ot,CRP,mRS scores,IL-23 and adenosine deaminase(r=-0.472,-0.466,-0.461,-0.435,-0.422,-0.419;-0.459,-0.531,-0.471,-0.417,-0.513,-0.408,all P＜0.05).The AUC(95％CI)of miR-200a and miR-4652-3p to assess disease severity were 0.881(0.825～0.923)and 0.878(0.822～0.921),respectively.The AUC(95％CI)of both combination in assessing the severity of patients was 0.945(0.902～0.973),which was higher than the single detection,and the differences were significant(Z=3.008,2.960,all P=0.003).The AUC(95％CI)of poor prognosis patients evaluated by cerebrospinal fluid miR-200a and miR-4652-3p levels were 0.749(0.681～0.809)and 0.756(0.688～0.816),and the AUC of poor prognosis patients evaluated by both combination was 0.839(0.778～0.889),which was higher than that measured separately,and the differences were significant(Z=2.994,2.697,P=0.003,0.007).Adenosine deaminase[OR(95％CI):1.106(1.033～1.185)],miR-200a[OR(95％CI):0.529(0.369～0.744)],miR-4652-3p[OR(95％CI):0.471(0.310～0.715)],C-reactive protein[OR(95％CI):4.423(1.459～13.412)],TNF-α[OR(95％CI):1.196(1.061～1.348)],IL-23[OR(95％CI):4.809(1.086～3.013)],and LTB4[OR(95％CI):1.327(1.064～1.655)]were influencing factors for poor prognosis in patients with tuberculous meningitis(all P＜0.05).Conclusion The expressions of miR-200a and miR-4652-3p in cerebrospinal fluid of patients with tuberculous meningitis were down-regulated,and they were closely related to the severity and prognosis of the disease.The combination of the miR-200a and miR-4652-3p could better predict the severity and prognosis of tuberculous meningitis,which may have a certain clinical value.

Objective:To summarize the experience and effect of extracorporeal cardiopulmonary resuscitation (ECPR) on the treatment of sudden cardiac death (SCD).Methods:The data of 120 adults with SCD-ECPR in emergency department of the first affiliated hospital of Nanjing Medical University from April 2015 to April 2023 were retrospectively analyzed. The patients were grouped by Survival/death at 90 days, OHCA/IHCA (out-of-hospital/in-hospital cardiac arrest), with/without acute myocardial infarction (AMI) and divided according to 60 min of the time from cardiac arrest to extracorporeal membrane oxygenation (ECMO) initiation (CA-Pump On time). Age, sex, Charlson comorbidity index, IHCA/OHCA, initial rhythm, no-flow time, CA-Pump On time, ECMO evacuation success rate, 90-day survival rate, ECMO treatment time were analyzed.Results:①Total of 114 adult patients with SCD-ECPR were enrolled, and 45 (39.5%) patients survived at 90 days, of whom 40 (88.9%) patients had good neurological outcomes.②Age and no-flow time were significantly lower in the 90-day survival group than that in death group, and the proportion of IHCA and shockable initial rhythm was higher. ③The no flow time in IHCA group was significantly lower than that in OHCA group, and the 90-day survival rate was higher. ④OHCA and regional interhospital transport prolonged CA-Pump On time and reduced the 90-day survival rate. ⑤The AMI group was older with a higher Charlson comorbidity index, and the 90-day survival rate was significantly lower than that in non-AMI group.Conclusions:ECPR improves the prognosis of patients with SCD, there are high benefits in patients with long healthy life expectancy, IHCA, shockable initial rhythm, and short no flow time. The smooth life-saving chain of SCD-ECPR improves survival rate, by screening high benefit candidates in patients with OHCA, delayed initiation of ECPR or requiring interhospital transport, despite CA-Pump On time > 60 min, there is still survival potential.

Objective:To investigate the major adverse kidney events (MAKE) in acute myocardial infarction (AMI) with extracorporeal cardiopulmonary resuscitation (ECPR).Methods:The data of 75 patients with AMI-ECPR in Emergency Medicine Department of the First Affiliated Hospital of Nanjing Medical University from April 2015 to April 2023 were retrospectively analyzed. The patients were grouped by survival/death at 90 days, with/without renal replacement therapy (RRT), and whether to initiate RRT because of acute kidney injury (AKI). age, sex, Charlson comorbidity index, OHCA/IHCA (out-of-hospital/in-hospital cardiac arrest), initial rhythm, Gensini score, ECPR initial blood gas pH and lactate value, no-flow time, time from cardiac arrest to extracorporeal membrane oxygenation (ECMO) initiation (CA-Pump On time), ECMO and RRT treatment time, 90-day survival rate were analyzed. Moreover, the renal function of the survivors was followed up.Results:① Total of 68 AMI-ECPR patients were enrolled, 22 (32.4%) patients survived at 90 days, 54 (79.4%) combined with RRT, and 48 (70.6%) MAKE within 90 days. ②Compared with the death group, the 90-day survival group had a higher proportion of initial shockable heart rhythm, a lower Gensini score, a higher ECPR initial blood gas pH and a lower lactic acid value. ③The severity of coronary artery disease, ECPR initial acidosis and hyperlactacemia in the RRT group was significantly higher than that in the non-RRT group, and all the non-RRT group patients survived. ④ There was no difference between the AKI-RRT group and the non-AKI-RRT group. Of 21 patients with stage 1 AKI initiating RRT, 5 survived, one of them still needs RRT for 90 days, and 7 patients with stage 2 to 3 AKI initiating RRT died.Conclusions:The 90-day MAKE rate in AMI-ECPR patients was as high as 70.6%, and the 90-day renal insufficiency rate in AMI-ECPR survivors with AKI was as high as 20.0%. Active initiation of RRT to avoid AKI or early initiation of RRT may improve the prognosis of AMI-ECPR patients.

Objective:Early identification of ischemic stroke patients with large vessel occlusion can improve referral efficiency and shorten reperfusion time. The purpose of this study was to analyze the characteristics of patients with large vessel occlusion and identify factors that could predict large vessel occlusion.Methods:The clinical data of 432 patients with ischemic stroke treated through emergency green channel were retrospectively analyzed, and the differences between the large vessel occlusion group (LVO group) and the non-large vessel occlusion group (non-LVO group) were compared, and two independent risk factors of the LVO group were screened out by logistics regression analysis: baseline NIHSS score and D-dimer value. The predicted cutoff values of NIHSS score and D-dimer were further determined by the receiver operating characteristic (ROC) curve.Results:A total of 432 patients with ischemic stroke had complete imaging data, with a mean age of 68.5±12.4 years, including 275 (63.7%) males, and 245 (56.7%) in the LVO group and 187 (43.3%) in the non-LVO group. Age, hemorrhagic transformation, thrombolytic therapy, endovascular treatment, atrial fibrillation, baseline NIHSS score [14.0 (6.0-20.0) vs. 3.0 (1.0-6.0), P<0.05], and D-dimer value at admission [0.9(0.4-2.3) mg/L vs. 0.3 (0.2-0.5)mg/L, P<0.05] were statistically significant different between the two groups. Multivariate Logistic regression analysis showed that higher baseline NIHSS score( OR=1.22,95% CI: 1.17-1.27)and higher D-dimer value( OR=3.10,95% CI: 2.14-4.47)were independent risk factors for large vessel occlusion. Baseline NIHSS score combined with D-dimer value was a good predictor of large vessel occlusion(AUC 0.85 [0.81-0.89]). ROC curve suggested that NIHSS score >6.5 and D-dimer >0.57 mg/L were the cutoff values for predicting large vessel occlusion. Conclusions:Higher baseline NIHSS score and D-dimer value are valuable for early prediction of large vessel occlusion, patients with NIHSS score >6.5 points and D-dimer >0.57 mg/L should be promptly transported to an advanced stroke center for treatment.

Objective Aiming at the problems of many items and long time to fill in the Constitution in Chinese Medicine Questionnaire(CCMQ)when evaluating individual constitution,the research uses artificial intelligence technology to select attributes,and to help construct a short version of the CCMQ.Methods Analyzing the constitution data provided by the Physical Examination Department of Jiangsu Province Hospital of Traditional Chinese Medicine,there are specific target variables as the classification of constitution types.Feature selection of genetic algorithm,cross-validation and KNN classification algorithm are used as filters to select problems,and the effect is evaluated by problem subset size,KNN classification accuracy and filling time.Results The method selected a short version of the CCMQ with 31 problems,and the average classification accuracy in the model was 86.16%,and the time was improved by 47.7%.Conclusion The algorithm can effectively find a better problem subset,achieve dimensionality reduction and have certain accuracy,thus helping to simplify the CCMQ.

Objective:To investigate the safety of early whole body computed tomography (WBCT) combined with coronary angiography (CAG) in patients with extracorporeal cardiopulmonary resuscitation (ECPR) and its application value in the diagnosis of cardiac arrest and complications of cardiopulmonary resuscitation (CPR).Methods:This was a retrospective study. Patients who underwent ECPR in the Emergency Department of the First Affiliated Hospital of Nanjing Medical University from January 2017 to July 2021 were enrolled in this research. Patients younger than 18 years or with incomplete clinical data were excluded. The results of WBCT and CAG examinations after ECPR were collected.Results:A total of 89 patients with ECPR, aged (47±17) years, were enrolled in the study, all underwent WBCT examination, and no adverse events such as ECMO and tracheal tube shedding occurred. WBCT found 7 cases of pulmonary embolism, 3 cases of aortic dissection and 2 cases of cerebral hemorrhage. WBCT identified CPR-related complications in 42 cases, including rib fractures ( n=20), pneumothorax ( n=5), mediastinal emphysema ( n=5), subcutaneous emphysema ( n=6), and hematoma or swelling at puncture site ( n=6). Fifty-five patients underwent CAG examination, the most common culprit vessels were the left anterior descending branch disease (58.2%) followed by the left circumflex branch disease (27.3%), the right coronary artery disease (21.8%) and left main artery disease (12.7%). Conclusions:Early WBCT and CAG examinations are of great significance and safety for the guidance of treatment in ECPR patients.