Objective:This study aims to investigate the differences in emotional status and cognitive function among patients with vestibular migraine (VM), Meniere′s disease (MD), and their comorbidity (VMMD), and to analyze key factors influencing cognitive function.Methods:This cross-sectional study included 96 outpatients (32 males, 64 females, aged 21-73 years) from the Department of Otorhinolaryngology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, between December 2022 and December 2023. The study population consisted of 31 VM patients (VM group), 36 MD patients (MD group), and 29 VMMD patients (VMMD group), along with 32 healthy controls (16 males, 16 females, aged 19-74 years). Cognitive function was assessed using the Montreal Cognitive Assessment (MoCA), while emotional status and somatization symptoms were evaluated through the Generalized Anxiety Disorder scale, Patient Health Questionnaire Depression scale, Symptom Checklist-90, and the Self-rating Somatization Symptom scale. Multiple linear regression analysis was conducted to explore the influence of different variables on cognitive function.Results:The total MoCA score in the VMMD group (26.0 [24.5, 28.0]) was significantly lower than that in the control group (28.0 [27.0, 29.0]) and the MD group (28.0 [26.0, 30.0]) ( P=0.006). VMMD patients exhibited significant impairments in specific cognitive domains, including visuospatial/executive function, delayed recall, and orientation ( P<0.05). Patients with VM, MD, and VMMD showed higher rates of anxiety, depression, and somatization symptoms compared to the control group ( P<0.05), with the VMMD group experiencing the most severe emotional distress. Multiple linear regression analysis identified education level and vestibular disease type as key factors affecting cognitive function, with a university-level education predicting higher MoCA scores ( P<0.001), while VMMD was associated with cognitive decline ( P<0.01). Conclusions:Patients with VM and MD, particularly those with comorbid VMMD, exhibit significant emotional distress. Cognitive impairments are present in VM and VMMD patients, affecting different cognitive domains. These factors should be comprehensively considered in clinical assessments to develop more effective treatment strategies.

Objective:To construct an objective evaluation system for disorders of consciousness(DOC)on the basis of visual stimulation of wearable device,so as to objectively evaluate DOC patients in clinical practice,and reduce misdiagnosis rate,and provide references for clinical treatment plans aimed at DOC.Methods:Twelve patients with disorders of consciousness,including vegetative state(VS),minimally conscious state(MCS),and suspected VS,who were treated at the Seventh Medical Center of Chinese People's Liberation Army General Hospital from March to May 2019,were selected and included in the DOC group.Twelve healthy subjects recruited during the same period were included in the healthy control group.Based on the Glasgow Coma Scale(GCS),the Coma Recovery Scale-Revised(CRS-R),and the Chinese Vegetative State Scale(CVSS),wearable devices were used to apply visual stimulation to the subjects,and eye movement feedback data were collected to design a quantitative scale.The scores of eye movement data in the visual positioning scheme and the visual tracking scheme were compared and analyzed.Results:The score of the visual tracking scheme in the healthy control group was(0.967±0.033)points,and the score of the visual positioning scheme was(0.005±0.004)points.There were statistically significant differences compared with the scores of patients in the DOC group in the three states(F=97.88,23.04,P＜0.05).According to the distribution characteristics of the eye movement data of the two groups,an objective evaluation scale for DOC was designed.Conclusion:The objective DOC evaluation system based on visual stimulation of wearable device can compensate the defect of higher subjectivity in the assessed results of clinical DOC by the indicators with objective data after it collects feedback data of eye-tracking based on visual stimulation,and processes and analyzes the designed quantitative scale.

Objective To explore the efficacy of single and combined parameters from 4 non-Gaussian diffusion models for differentiating breast imaging reporting and data system(BI-RADS)MRI category 4 benign and malignant breast tumors.Methods A total of 161 BI-RADS MRI category 4 breast lesions from 159 patients were retrospectively enrolled.Based on pathological results,the lesions were divided into malignant group(n=132)and benign group(n=29).The apparent diffusion coefficient(ADC)values were calculated from diffusion weighted imaging(DWI)sequences.Multi-b-value diffusion imaging data were acquired and fitted using 4 non-Gaussian models to obtain respective parameters,including diffusion kurtosis imaging(DKI),stretched exponential model(SEM),continuous-time random walk(CTRW)and fractional order calculus(FROC)model.Univariable and multivariable logistic regression analyses were employed to identify the diffusion quantitative indicators useful for differentiating benign and malignant BI-RADS MRI category 4 breast tumors.Receiver operating characteristic(ROC)curves were drawn,and the optimal threshold was determined using Youden index.The differentiating performance of ADC value,single parameter and their combination from non-Gaussian diffusion models were assessed and compared according to the area under the curve(AUC)of ROC curves,as well as the sensitivity,specificity and accuracy under the optimal thresholds.Results In malignant group,αCTRW,KDKI and μFROC values were higher,while ADC,DCTRW,DFROC,DDCSEM,αSEM and DDKI values were lower than those in benign group(all P＜0.05).Multivariable logistic regression analysis identified DCTRW and αCTRW values as independent factors for differentiating benign and malignant BI-RADS MRI category 4 breast tumors(both P＜0.05),and a combined model was then constructed.The AUC of the combined model was higher than that of each single parameter including ADC,DCTRW and αCTRW values(all P＜0.05).Conclusion The combined model of DCTRW and αCTRW had better efficacy than each single parameter for differentiating benign and malignant BI-RADS MRI category 4 breast tumors.

Objective To explore the efficacy of single and combined parameters from 4 non-Gaussian diffusion models for differentiating breast imaging reporting and data system(BI-RADS)MRI category 4 benign and malignant breast tumors.Methods A total of 161 BI-RADS MRI category 4 breast lesions from 159 patients were retrospectively enrolled.Based on pathological results,the lesions were divided into malignant group(n=132)and benign group(n=29).The apparent diffusion coefficient(ADC)values were calculated from diffusion weighted imaging(DWI)sequences.Multi-b-value diffusion imaging data were acquired and fitted using 4 non-Gaussian models to obtain respective parameters,including diffusion kurtosis imaging(DKI),stretched exponential model(SEM),continuous-time random walk(CTRW)and fractional order calculus(FROC)model.Univariable and multivariable logistic regression analyses were employed to identify the diffusion quantitative indicators useful for differentiating benign and malignant BI-RADS MRI category 4 breast tumors.Receiver operating characteristic(ROC)curves were drawn,and the optimal threshold was determined using Youden index.The differentiating performance of ADC value,single parameter and their combination from non-Gaussian diffusion models were assessed and compared according to the area under the curve(AUC)of ROC curves,as well as the sensitivity,specificity and accuracy under the optimal thresholds.Results In malignant group,αCTRW,KDKI and μFROC values were higher,while ADC,DCTRW,DFROC,DDCSEM,αSEM and DDKI values were lower than those in benign group(all P＜0.05).Multivariable logistic regression analysis identified DCTRW and αCTRW values as independent factors for differentiating benign and malignant BI-RADS MRI category 4 breast tumors(both P＜0.05),and a combined model was then constructed.The AUC of the combined model was higher than that of each single parameter including ADC,DCTRW and αCTRW values(all P＜0.05).Conclusion The combined model of DCTRW and αCTRW had better efficacy than each single parameter for differentiating benign and malignant BI-RADS MRI category 4 breast tumors.

Objective:To construct an objective evaluation system for disorders of consciousness(DOC)on the basis of visual stimulation of wearable device,so as to objectively evaluate DOC patients in clinical practice,and reduce misdiagnosis rate,and provide references for clinical treatment plans aimed at DOC.Methods:Twelve patients with disorders of consciousness,including vegetative state(VS),minimally conscious state(MCS),and suspected VS,who were treated at the Seventh Medical Center of Chinese People's Liberation Army General Hospital from March to May 2019,were selected and included in the DOC group.Twelve healthy subjects recruited during the same period were included in the healthy control group.Based on the Glasgow Coma Scale(GCS),the Coma Recovery Scale-Revised(CRS-R),and the Chinese Vegetative State Scale(CVSS),wearable devices were used to apply visual stimulation to the subjects,and eye movement feedback data were collected to design a quantitative scale.The scores of eye movement data in the visual positioning scheme and the visual tracking scheme were compared and analyzed.Results:The score of the visual tracking scheme in the healthy control group was(0.967±0.033)points,and the score of the visual positioning scheme was(0.005±0.004)points.There were statistically significant differences compared with the scores of patients in the DOC group in the three states(F=97.88,23.04,P＜0.05).According to the distribution characteristics of the eye movement data of the two groups,an objective evaluation scale for DOC was designed.Conclusion:The objective DOC evaluation system based on visual stimulation of wearable device can compensate the defect of higher subjectivity in the assessed results of clinical DOC by the indicators with objective data after it collects feedback data of eye-tracking based on visual stimulation,and processes and analyzes the designed quantitative scale.

Objective:This study aims to investigate the differences in emotional status and cognitive function among patients with vestibular migraine (VM), Meniere′s disease (MD), and their comorbidity (VMMD), and to analyze key factors influencing cognitive function.Methods:This cross-sectional study included 96 outpatients (32 males, 64 females, aged 21-73 years) from the Department of Otorhinolaryngology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, between December 2022 and December 2023. The study population consisted of 31 VM patients (VM group), 36 MD patients (MD group), and 29 VMMD patients (VMMD group), along with 32 healthy controls (16 males, 16 females, aged 19-74 years). Cognitive function was assessed using the Montreal Cognitive Assessment (MoCA), while emotional status and somatization symptoms were evaluated through the Generalized Anxiety Disorder scale, Patient Health Questionnaire Depression scale, Symptom Checklist-90, and the Self-rating Somatization Symptom scale. Multiple linear regression analysis was conducted to explore the influence of different variables on cognitive function.Results:The total MoCA score in the VMMD group (26.0 [24.5, 28.0]) was significantly lower than that in the control group (28.0 [27.0, 29.0]) and the MD group (28.0 [26.0, 30.0]) ( P=0.006). VMMD patients exhibited significant impairments in specific cognitive domains, including visuospatial/executive function, delayed recall, and orientation ( P<0.05). Patients with VM, MD, and VMMD showed higher rates of anxiety, depression, and somatization symptoms compared to the control group ( P<0.05), with the VMMD group experiencing the most severe emotional distress. Multiple linear regression analysis identified education level and vestibular disease type as key factors affecting cognitive function, with a university-level education predicting higher MoCA scores ( P<0.001), while VMMD was associated with cognitive decline ( P<0.01). Conclusions:Patients with VM and MD, particularly those with comorbid VMMD, exhibit significant emotional distress. Cognitive impairments are present in VM and VMMD patients, affecting different cognitive domains. These factors should be comprehensively considered in clinical assessments to develop more effective treatment strategies.

Alzheimer's disease (AD) is a neurodegenerative disorder characterized by hallmark pathological features, including β-amyloid deposition, neurofibrillary tangles formed by hyperphosphorylated tau protein, and chronic neuroinflammation. Recent studies have revealed that the glymphatic-meningeal-cervical lymphatic system plays a pivotal role in intracranial metabolic waste clearance, and its dysfunction may impair the clearance efficiency of β-amyloid and tau proteins. Based on this mechanism, domestic scholars have innovatively proposed lympho-microsurgical reconstruction of the brain-cervical lymphatic drainage pathway, aiming to ameliorate AD pathological progression and cognitive function by enhancing intracranial waste clearance. Through a comprehensive literature review, this article focuses on the theoretical rationale for lympho-microsurgical intervention in AD. While critically evaluating existing surgical approaches and efficacy assessment systems, it further examines the fundamental scientific challenges and clinical translation barriers in directly applying this technique to AD treatment, with the goal of providing theoretical insights and methodological guidance for future research.

Objective:To investigate whether ultra-high dose rate (FLASH) irradiation can reduce radiation-induced intestinal injuries of mice compared to conventional dose rate (CONV) irradiation.Methods:Both FLASH and CONV irradiation were delivered with electron beam, with dose rates of 750 Gy/s and 0.5G y/s, respectively. A total of 105 mice were randomly divided into groups using a simple randomization method. Twenty-one mice were selected for weight observation, 7 mice in each group. After 9 Gy FLASH and CONV irradiation on the abdomen, the weight changes of mice were measured every other day, and compared among three groups. Twenty-four mice were selected for pathological examination including 5 mice in the control group. Three-and-a-half-day days after 12 Gy FLASH ( n=10) and CONV irradiation ( n=9) on the abdomen, the intestines of the mice were taken. Pathological sections were stained with hematoxylin-eosin (HE) to compare the number and percentage of regenerated crypts of the small intestine between two groups. After 12 Gy FLASH ( n=10) and CONV irradiation ( n=10) on the abdomen, the survival of 20 mice was observed. After FLASH using 4.5 Gy×2 times ( n=10) and CONV irradiation at 9 Gy×1 time ( n=10) on the abdomen, the weight changes were observed. After FLASH using 6 Gy×2 times ( n=10) and CONV irradiation at 12 Gy×1 time ( n=10) on the abdomen, the survival of mice was observed. The time interval between two irradiation was 1 min. EBT3 film was employed to monitor the actual exposure dose of the mice. The variables conforming to normal distribution were expressed by Mean±SD. Inter group comparison was performed by independent t-test. The survival of mice among different groups was compared by log-rank test. Results:After 9 Gy of abdominal irradiation, the mean weight of mice in the FLASH group was significantly higher than that in the CONV group. The weight of mice in the FLASH and CONV groups was (19.8±0.8) g and (18.0±1.8)g ( P=0.036) at 7 days after irradiation, (22.0±1.0)g and (21.2±0.5)g ( P=0.075) at 15 days after irradiation, and (24.2±1.4)g and (22.0±1.2)g ( P=0.012) at 25 days after irradiation, respectively. After 12 Gy irradiation, the mean survival of mice in FLASH and CONV groups was 4 days and 4.7 days ( P=0.029). After 12 Gy total abdominal irradiation, the mean number of intestinal regenerative crypts in the FLASH and CONV groups was 2.9/mm and 1.2/mm ( P=0.041), and the percentage of intestinal regenerative crypts was 34.1% and 14.1%, respectively. The survival of mice irradiated by FLASH using 6 Gy×2 times was longer compared with that of mice after CONV irradiation at 12 Gy×1 time. The weight of mice after 4.5 Gy×2 times irradiation was higher than that of mice after CONV irradiation at 9 Gy×1 time. Conclusion:Weight, survival and the number of intestinal regenerative crypts in the FLASH group are higher than those in the CONV group after irradiation, indicating that radiation-induced intestinal injury caused by FLASH irradiation is slighter than that of CONV irradiation.

OBJECTIVE To investigate the current situation of the review and comment on inpatient medical orders in Beijing municipal hospitals， and to put forward countermeasures and suggestions for further improving related work. METHODS A questionnaire survey was conducted to investigate the current situation of the review and comment on inpatient medical orders in 22 Beijing municipal hospitals. The statistical analysis was conducted for the survey results. RESULTS A total of 22 questionnaires were distributed， with recovery effective rate of 100%. The 22 hospitals carried out inpatient medical order comment， but their proportion varied among hospitals （0.88%-98.54%）； medical order comment mainly focused on antibiotics， proton pump inhibitors， anesthetic drugs/class Ⅰ psychotropic drugs， auxiliary drugs and other categories； 205 pharmacists participated in the comment of inpatient medical orders， most of whom hold intermediate or higher professional titles （89.27%）； 21 hospitals conducted inpatient medical order comment and feedback the results to relevant departments/responsible persons， but the intervention situation was not the same. Eighteen hospitals had carried out the review of inpatient medical orders； reviewed drug category was roughly the same as the category involved in the medical order comment； review content involved the suitability of administration routes， dosage， etc. The review was conducted mainly through the cooperation of audit software and pharmacists. CONCLUSIONS The comment and review of inpatient medical orders in Beijing municipal hospitals carried out in an orderly manner， and preliminary results have been achieved； at the same time， it is necessary to further increase the ability of participating pharmacists， improve audit standards， optimize pre-audit （No.ZYLX201805） software， and promote rational drug use among hospitalized patients through doctor-pharmacist collaboration.

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.