Cognition is the intelligent processing of the brain， which affects the acquisition and realization of knowledge in the body， including learning， memory， thinking， language， emotion， spirit， and other psychological and social activities. Cognitive impairment refers to abnormalities in the processing of higher-order intellectual activities in the brain， such as learning， memory， thinking， and judgment， which leads to severe learning and memory difficulties， and it is often accompanied by pathological developments including aphasia and apraxia， which is mainly caused by Alzheimer disease， cerebrovascular diseases， and traumatic brain injury. At present， the etiology of cognitive impairment remains unclear. Nowadays， with the continuous development of modern science and technology， proteomics technology has been widely used in the field of clinical medical research and can provide a scientific basis for the diagnosis and treatment of diseases and the development of new drugs. This article reviews the research advances in proteomics technologies， humoral proteomics of cognitive disorders， brain tissue proteomics， and proteomics research in cognitive disorders at high altitude， in order to further reveal the application and development of proteomics in cognitive disorders.
Biomarkers

High-altitude headache （HAH） is a type of headache associated with disorder of homoeostasis， and it often appears after ascent to 2 500 m or higher and resolves within 24 hours after descent to below 2 500 m. HAH may occur independently or in association with the onset of acute mountain sickness and chronic mountain sickness. This article describes the clinical features of HAH and discusses the possible pathogenesis， risk factors， preventive measures， treatment， and prognosis of HAH， in order to provide a theoretical basis for further research on HAH.
Headache

Objective To comparatively observe the value of TIPS combined with catheter-directed thrombolysis and percutaneous transhepatic portal vein catheterization thrombolysis for acute non-cirrhotic non-neoplastic portal vein thrombosis(PVT).Methods Twenty-five patients with acute non-cirrhotic non-neoplastic PVT were retrospectively enrolled and clustered into TIPS group(n=17,underwent TIPS combined with catheter-directed thrombolysis)and liver puncture group(n=8,underwent percutaneous transhepatic portal vein catheterization thrombolysis)according to the access of thrombolysis.The technical success rate,duration of catheter-directed thrombolysis,complications within 7 days,as well as portal vein patency 3 months after treatment,Child-Pugh grading of liver function and occurrence of hepatic encephalopathy(HE)were recorded and compared between groups.Results The technical success rates were both 100%in 2 groups.There was no significant difference of the duration of catheter-directed thrombolysis between groups(P＞0.05).The thrombolytic effect in TIPS group was better than that in liver puncture group(P＜0.05).No significant difference of the occurrence of bleeding within 7 days was found between groups(P＞0.05).After 3 months'follow-up,the degree of portal vein patency in TIPS group was higher than that in liver puncture group(P＜0.05).No significant difference of Child-Pugh grading of liver function nor occurrence of HE was found between groups(both P＞0.05).Conclusion Both TIPS combined with catheter-directed thrombolysis and percutaneous transhepatic portal vein catheterization thrombolysis were effective for treating acute non-cirrhotic non-neoplastic PVT,and the thrombolytic effect of the former was better than the latter.

Objective:To explore the pathogenesis of neuropsychiatric systemic lupus erythematosus (NPSLE) from imaging perspective by analyzing voxel-based morphology (VBM) and functional connectivity (FC) in resting state functional magnetic resonance imaging (rs-fMRI).Methods:Thirty-five patients with NPSLE and 30 patients with non-NPSLE admitted to Department of Rheumatology and Immunology, Taizhou People's Hospital Affiliated to Nanjing Medical University from June 2020 to March 2023 were enrolled; 31 healthy subjects were included as healthy control group during the same period. All subjects completed routine MRI and rs-fMRI, laboratory tests (C3, C4, IgA, IgM and IgG levels), mini-mental state examination (MMSE), hospital anxiety and depression scale (HADS), and fatigue scale for motor and cognitive functions (FSMC). Whole brain gray matter volume in subjects of the 3 groups was analyzed by VBM method, and the brain regions enjoying significant differences in gray matter volume between the NPSLE group and non-NPSLE group were selected as regions of interest (ROIs) for whole brain FC analysis. Partial correlation method was used to analyze the correlations of imaging indexes in brain regions enjoying significant differences with clinical indexes and imaging scores between NPSLE group and non-NPSLE group. Efficacy of imaging indexes in brain regions enjoying significant difference in differentiating NPSLE from non-NPSLE was analyzed by receiver operating characteristic (ROC) curve.Results:(1) Covariance analysis among the 3 groups showed that the gray matter volume in the left inferior frontal gyrus of orbit, left superior frontal gyrus, right rectus gyrus, right transverse temporal gyrus, and right superior frontal gyrus was significantly different among the 3 groups ( P<0.001, FDR corrected); compared with the healthy control group, the NPSLE group had significantly reduced gray matter volume in the left inferior frontal gyrus of orbit, left superior frontal gyrus of orbit, right rectus gyrus, right transverse temporal gyrus, and right superior frontal gyrus ( P<0.001, FDR corrected); compared with the non-NPSLE group, the NPSLE group had significantly decreased gray matter volume in the left inferior frontal gyrus of orbit, right rectus gyrus, and right transverse temporal gyrus ( P<0.001, FDR corrected). (2) Whole brain FC analysis with brain regions enjoying significant differences as seed points showed that Fisher z-transformed FC (zFC) in the right transverse temporal gyrus and bilateral postcentral gyrus of the NPSLE group were significantly decreased ( P<0.001, FDR corrected). (3) Partial correlation analysis showed that, in the NPSLE group, zFC from the right transverse temporal gyrus to left posterior central gyrus was negatively correlated with disease course ( r=-0.390, P=0.027); gray matter volume in the right orbital superior frontal gyrus was negatively correlated with FSMC-cognitive ( r=-0.401, P=0.023); the gray matter volume in the right orbital superior frontal gyrus was negatively correlated with FSMC-motor ( r=-0.374, P=0.035). (4) ROC curve found that gray matter volume in the right rectus gyrus and zFC from the right transverse temporal gyrus to the right posterior central gyrus had relatively high efficacy in differentiating NPSLE from non-NPSLE, with AUC of 0.771 (95% CI: 0.658-0.885, P<0.001) and 0.794 (95% CI: 0.685-0.904, P<0.001), respectively. Conclusion:NPSLE patients have reduced gray matter volume in multiple brain regions (concentrating in the prefrontal limbic system); and reduced FC with some brain regions is noted; multiple indexes are correlated with clinical indexes.

Cerebral small vessel disease（CSVD）is one of the most major causes of cognitive dysfunction. With the acceleration of population aging in China and the development of medical imaging technology，the incidence rate of CSVD has been on the rise，and related cognitive dysfunction has become an increasingly concerning issue. Due to its insidious onset，slow progression，and lack of early warning signs，CSVD is typically found when moderate or severe cognitive impairment or even dementia already occurs，often causing irreversible damage and heavy medical burden to patients. This article reviews the impact of different imaging types of CSVD and total MRI load on cognitive function to further understand the relationship between CSVD and cognitive function，aiming to provide a reference for the identification and prevention of cognitive dysfunction caused by CSVD.

Objective To identify the differentially expressed proteins associated with cognitive impairment between the high-altitude population and the plain population， and to investigate the biological functions and signaling pathways of the differentially expressed proteins. Methods A total of 30 individuals living in the plain area （with an altitude of 400 m） and 30 individuals living in the high-altitude area （with an altitude of 3 960 m） were enrolled as plain group and high-altitude group， respectively， and general information was collected from all subjects. Montreal Cognitive Assessment （MoCA） was used to assess cognitive function. Blood samples were collected from each group， and the tims TOF Pro mass spectrometer was used to measure the serum levels of proteins after centrifugation. SPSS 25.0 was used for statistical analysis to investigate he association between proteomics and cognitive impairment. Results The results of MoCA assessment for both groups showed that the high-altitude group had a significantly lower MoCA score than the plain group， suggesting that there was significant cognitive impairment in the high-altitude group， with the main manifestation of impairment in visual space/executive ability， attention， delayed memory， and orientation. The proteomic analysis of serum samples from the subjects identified 169 differentially expressed proteins （84 upregulated proteins and 85 downregulated proteins）， among which 39 proteins were associated with cognitive impairment. The enrichment analysis of the differentially expressed proteins showed that these differentially expressed proteins were involved in the regulation of multiple signaling pathways and metabolic pathways. Conclusion Significant cognitive impairment is observed in the high-altitude population， and there are differentially expressed proteins associated with cognitive function between the high-altitude population and the plain population.
Proteomics

The plateau environment has a significant impact on the physiological and psychological functions of the human body due to its unique characteristics such as low oxygen and low air pressure. In recent years， important progress has been made in the research on the impact of plateau environment on cognitive function and its mechanisms. This article reviews the epidemiology of cognitive impairment at high altitude， its impact on cognitive function， pathophysiologic mechanisms， and preventive and treatment measures， which has important significance for the development of effective preventive and intervention measures.

Objective:To analyze the risk factors for early neurological deterioration(END)in elderly patients with acute ischemic stroke(AIS)after intravenous thrombolysis.Methods:Clinical data of 118 patients with AIS who had received thrombolysis were collected retrospectively.According to the occurrence of END, cases were divided into the END group(n=28)and the non-END group(n=90). Univariate analysis was used to compare general characteristics, clinical data, laboratory test results, TOAST classification, infarct location, and degree of culprit vessel stenosis between the two groups.Multivariate Logistic regression analysis was used to analyze the related factors for END.Results:Univariate analysis showed that the proportion of patients with diabetes mellitus and previous cerebral infarction was higher in the END group than in the non-END group( χ2=4.000 and 8.056, P=0.046 and 0.005). There were significant differences in National Institutes of Health Stroke Scale(NIHSS)score, time from onset to thrombolysis, thrombolysis time, swallowing dysfunction, albumin, leukocyte count, neutrophil count, lymphocyte count, glycosylated hemoglobin(HbA1c), creatinine, total cholesterol(TC), low density lipoprotein cholesterol(LDL-C), high density lipoprotein cholesterol(HDL-C)and lipoprotein(a)levels between the two groups(all P<0.05). There were also significant differences between the two groups in TOAST classification, infarct location and degree of culprit vessel stenosis( χ2=13.109 and 9.509, Z=2.912, P=0.004, 0.023 and 0.004). Multivariate Logistic regression analysis showed that NIHSS score, HbA1c, cardiogenic stroke, degree of culprit vessel stenosis and leukocyte count on admission were independent risk factors for END( OR=1.122, 2.131, 1.965, 1.876 and 1.563, P=0.036, 0.024, 0.028, 0.030 and 0.041). Conclusions:NIHSS score, HbA1c, cardiogenic stroke, degree of culprit vascular stenosis and leukocyte count on admission are independent risk factors for END, which should be closely monitored and managed with well formulated preventive measures in order to improve the prognosis of AIS patients.

Objective:To summarize our experience in 13 cases of intestinal autotransplantation (IATx) after resection of lesions involving the roots of mesenteric vessels.Methods:The clinical data of 13 patients undergoing IATx in Xijing hospital were retrospectively analyzed. The etiology, surgical procedure and complications were analyzed. The patients were followed up by telephone and regular evaluations.Results:All 13 cases of IATx were successfully completed. For 12 patients who were diagnosed with tumors involving the mesenteric roots, the tumors were removed for cure intent avoiding massive intestinal resection. Pancreaticoduodenectomy was carried out simultaneously in 11 cases. The postoperative complication rate was 85% (11/13). The autograft was resected in 1 patient on the 1st postoperative day due to necrosis from mesenteric thrombosis, leading to short bowel syndrome. One-year survival was 69% (9/13). Among 4 deaths, 1 patient died of liver metastasis, and another died of liver and lung metastases. Five patients were alive 2 years postoperatively.Conclusion:IATx while-technically challenging, avoiding short small bowel syndrome in properly selected patients after resection of lesions especially benign ones involving the roots of mesenteric vessels that were traditionally considered to be "unresectable".

Objective To discuss the correlation of apolipoprotein E (ApoE) gene polymorphism with cerebral infarction (CI)and intracerebral hemorrhage (ICH) among Tibetan nationality with cerebrovascular diseases in Qinghai Province, seek the differences in each allele of ApoE in Tibetan nationality. Methods The data from a total of 94 patients with cerebrovascular diseases was collected from the people's hospital of qinghai province, the people's hospital of guoluo prefecture , and the people's hospital of yushu prefecture as the cerebrovascular disease group, including 48 cases of cerebral infarction. There were 46 cases of cerebral hemorrhage. A total of 96 healthy Tibetan subjects were selected as the control group. DNA was extracted from all subjects. Real－time PCR was used to detect ApoE. The correlation between ApoE genotype and cerebral infarction and cerebral hemorrhage was analyzed. Results E2/E3 gene was common in Tibetan nationality with cerebrovascular diseases. E2/E3 genotype accounted for 50% in cerebral infarction group. E2/E3 (65.2%) was the most common in intracerebral hemorrhage group. E2/E4 (64.6%) was the most common in the control group. There was a statistically significant difference between the two groups (P＜0.01). In the Tibetan population, ε3 allele genome (48.0%) was the most common in cerebral infarction group and ε2(43.5%) were the most common alleles in intracerebral hemorrhage group. In the normal control group, ε4 (49.0%) was the most common allele. Conclusion E2/E3 genotype may be related to cerebrovascular diseases. ε3 allele may be the susceptible factor of cerebral infarction wherase ε4 may be the protective factor of cerebrovascular diseases in Tibetan population.