To evaluate the features of carotid web (CW) by ultrasonography.

A total of 66 patients with CW were retrospectively enrolled from January 2018 to June 2019 at Xuanwu Hospital, Capital Medical University. All patients were examined by both ultrasonography and CTA, and were divided into either a<50% stenosis group (54 cases) or a ≥50% stenosis group (12 cases). The ultrasonographic characteristics of CW, including the length, thickness, direction (forward or backward to the flow), acute angle between the web and carotid wall, and thrombus between the web and carotid wall were compared between the two groups. The stenosis degrees of carotid artery were compared between patients with and without ischemic stroke.

Forty-two (42/66, 63.6%) patients were diagnosed with CW by initial CDFI examination, of whom 21 (21/66, 31.8%) were diagnosed with ulcerative plaque and 3 (3/66, 4.5%) were diagnosed with carotid dissection at first but confirmed by second examination. There were no differences in the web length, thickness, direction, or thrombus detected between the two groups (P>0.05). The angle between the web and carotid wall in the<50% stenosis group was significantly smaller than that of the ≥50% stenosis group (median angel 39o vs 73o, P=0.002), and the percentage of patients with an angle≤ 60o in the<50% stenosis group was significantly higher than that of the ≥50% stenosis group (74.1% vs 41.7%, P=0.042). The diameter of the residual carotid artery at CW location in the<50% stenosis group was significantly larger and peak systolic velocity was significantly higher in the<50% stenosis group than in the≥50% stenosis group (P<0.001). The stenosis degrees of carotid artery were not statistically different between patients with and without ischemic stroke (P=0.321).

Ultrasonography can be used to evaluate the characteristics of carotid web in 2D and color mode. When the angle between the CW and carotid wall is large, the carotid artery stenosis ≥ 50% is more likely to happen, but carotid artery stenosis is not the main cause of ischemic stroke.

The aim of the present study was to evaluate the efficiency of sling exercise, therapeuticultrasound, therapeuticultrasound and sling exercise in patients to alleviate pain and improve lumbar function with lumbar disc herniation.

Individuals were selected from a list of patients being followed at the department of Rehabilitation in the third hospital of Hebei Medical University. 30 patients who were diagnosed with lumbar disc herniation were collected, the diagnoses were established upon medical history, physical examination, and results of imaging studies. The patients were randomly divided into three groups: therapeuticultrasound group received 14 sessions of ultrasonic therapy to the lumbar region, Sling exercise group received 14 sessions of sling exercise, and therapeuticultrasound and sling exercise group received therapeuticultrasound and sling exercise therapy 14 sessions of therapeuticultrasound to the lumbar region,7 sessions per week, 2 weeks. The VAS and ODI were compared with the assessment of the patients before and at the end of the therapy.

At the end of treatment, three groups VAS scores (F=3.069, P=0.043) and ODI scores (t=12.676, P<0.001) was lower than that at the beginning of treatment (P<0.05), at the end of treatment the VAS scores (F=59.400, P<0.001) and of the ODI scores (t=12.737, P<0.001) of ultrasonic and sling exercise therapy group was lower than the other group, the difference is significantly.

All three groups could reduce pain and improve lumbar function, and the ultrasonic and sling exercise therapy was most effective for lumbar disc herniation treatment in the three groups.

To analyze the treatment of different types of traumatic cerebral infarction in children, and explore its pathogenesis in combination with literature so as to improve the cure rate and reduce disability rate.

The clinical data of 42 cases of traumatic cerebral infarction in children were retrospectively analyzed in The Hospital of 81^st Group Army PLA from January 2015 to December 2019. The diagnosis of traumatic cerebral infarction in children was made by CT scan and MRI scan. According to different conditions, children with traumatic cerebral infarction were classified, and different treatment strategies were selected. Children with lacunar infarction were treated with calcium antagonists and neurotrophic drugs, supplemented by hyperbaric oxygen and exercise rehabilitation. The children of focal cerebral infarction and complex cerebral infarction treated by junior dehydrant and hormone also included the calcium antagonist and nutritional nerve drugs. The therapeutic regimen perhaps adjusted by the evolution of the disease. The children of extensive cerebral infarction underwent emergency cranial decompression, and was treated by reducing intracranial pressure and preventing complications after operation. The treatment results and recovery were observed.

In 42 cases of traumatic cerebral infarction in children, 35 cases (83.3%) were good recovery, 4 cases (9.5%) were moderate disability, 2 cases (4.8%) were severe disability, 1 case (2.4%) died, and no vegetative state. The good recovery rate of lacunar infarction was 100%, that of focal cerebral infarction was 62.5%, that of mixed cerebral infarction was 60%, and that of extensive cerebral infarction was 50%.

It is of great significance to improve the therapeutic effect and prognosis of children with traumatic cerebral infarction to adopt different treatment schemes for different types of cerebral infarction.

To characterize the patients with supratentorial hypertensive intracerebral hemorrhage (ICH) in the Tibetan Plateau over an altitude of 4000 meters.

A total of 68 cases with supratentorial hypertensive ICH were retrospectively included in Ali Regional People’s Hospital from January 2017 to September 2018. The clinical and laboratory data were collected. A simple linear correlation analysis was applied to analyze the correlation between the amount of bleeding and sex, age, nationality, time from onset , systolic blood pressure (SBP), diastolic blood pressure (DBP), hemoglobin (Hb), serum triglyceride (TG), and cholesterol. According to computed tomography (CT) findings, 68 cases were divided into the basal ganglia ICH group (33 cases) and the lobar ICH group (35 cases). The characteristics between two groups were analyzed using t-test or χ² test.

The data of sex, age, nationality, time from onset, SBP, DBP, Hb, TG, and cholesterol of 68 cases on admission did not show any definitive correlation with the hematoma volumes (P＞0.05). The SBP and DBP of patients in the basal ganglia ICH group were significantly higher than that in the lobar ICH group, respectively [(184.9±28.5) mmHg vs (164.6±24.4) mmHg; (113.0±18.1) mmHg vs (103.0±18.4) mmHg] (t=0.499, 0.486; P=0.002, 0.033).

The relevant factors of hematoma volumes in patients with ICH in plateau area were not yet clear. Diastolic and systolic blood pressure of patients in the basal ganglia ICH group was higher than that in those in lobar ICH group.

To compare the efficacy evaluation of electrospun composite biomaterials and a porcine small intestine submucosa mesh for hernia repair.

A randomized, single-blind, controlled multicenter trial was performed in 3 hospitals in Shanghai. Eligible adult patients with primary unilateral reducible groin hernias were randomly assigned (1∶1) to electrospun composite biomaterials (experimental group) or porcine small intestine submucosa (control group) mesh groups. Patients were treated with the tARB technique and assessed at 1,3 and 6 months after the surgery. The primary endpoint was hernia recurrence. The secondary endpoints were postoperative complications including groin pain and operative site infections.

172 patients were assigned to experimental (n=86) and control (n=86) groups. At 6 months follow-up, postoperative complications occurred in 5 patients (5/86, 5.95%) and 2 (2/86, 2.35%) patients in the control and experimental groups, respectively (P>0.05). There was no significant difference in VAS or SVS score between the two groups.

We demonstrate that electrospun composite biomaterial mesh can be used as a ideal choice for inguinal hernia repair. Electrospun composite biomaterial has the characteristics of low recurrence rate, absorbability and long-term comfort.It can be further applied in clinical practice in the future.

Pancreaticoduodenectomy(PD)remains one of the most complicated hepatobiliary operations. The development of minimally invasive surgery for PD has always been an hot spot. Laparoscopic pancreaticoduodenectomy(LPD) has not been widespread carried out due to its difficulty and long learning curve. LPD accounts for 9% of all PD, according to the National Cancer Data base. Compared with laparoscopic surgery, robotic surgery system has significant advantages in the field of minimally invasive PD, including stereotactic amplified vision, filtering hand tremor and simulating the wrist. The article would review the surgical techniques and notes, which could provide clinical reference for other surgeons.

To explore the application value and practical effect of case discussion in the standardized training of resident physicians in the department of neurology.

Resident physicians undergoing standardized training in the Department of Neurology at the First Affiliated Hospital of Harbin Medical University from January 2023 to January 2024 were randomly divided into a treatment group (n=16) and a control group (n=16). The control group only received conventional training, including theoretical lectures, clinical teaching, and skill operation training. On the basis of conventional training, the treatment group additionally conducted monthly case discussions, covering typical cases such as multiple sclerosis, autoimmune encephalitis, and neuromyelitis optica spectrum disorders. Each case discussion included case report, free discussion, and summary comments. Meanwhile, an annual case report meeting was held. The training effects were compared through theoretical assessment, clinical skill assessment, case analysis ability evaluation, questionnaire survey, and a 1-year follow-up. All assessment scores were independently scored by associate chief physicians using a double-blind method. Statistical analysis between the two groups was performed using independent samples t-test and chi-square test with SPSS 26.0 software.

Compared to control group, the treatment group showed significantly higher average scores in theoretical assessment (89.54±6.22 vs 78.29±7.51, t=4.624, P<0.001) and clinical skill assessment (91.23±5.81 vs 82.14±6.68, t=4.117, P<0.001). The excellent rate of case analysis ability was 81.25% (13/16) in the treatment group versus 43.75% (7/16) in the control group (χ²=4.800, P=0.028). After 1 year of follow-up, the proportion of resident physicians independently handling cases was 87.50% (14/16) in the treatment group versus 50.00% (8/16) in the control group (χ²=5.236, P=0.022). In the questionnaire survey, the scores of clinical thinking (4.42±0.54 vs 3.52±0.62), teamwork (4.51±0.44 vs 3.72±0.64), knowledge expansion (4.55±0.40 vs 3.75±0.68), learning interest (4.51±0.44 vs 3.61±0.66), and professional identity (4.31±0.59 vs 3.41±0.72) of resident physicians in the treatment group were significantly higher than those in the control group, with statistically significant differences (t=4.377, 4.102, 4.052, 4.508, 3.892; all P＜0.001).

Compared with traditional teaching methods, monthly case discussions can effectively improve the theoretical level, clinical skills, clinical thinking, and clinical decision-making ability of resident physicians receiving standardized training in neurology residents.

To investigate the current status, influencing factors, and potential interventions for job burnout among neurology residents.

A questionnaire survey on the job burnout status was conducted using the Chinese version of the Maslach Burnout Inventory-General Survey (MBI-GS) among neurology residents trained at Peking University Third Hospital and Peking University Sixth Hospital from February 2024 to January 2025. The cutoff scores for emotional exhaustion, depersonalization, and reduced personal accomplishment were >12, >7, and >18, respectively. Burnout severity was categorized as follows: 0 dimensions (no burnout), 1 dimension (mild), 2 dimensions (moderate), and 3 dimensions (severe). Differences between severe and non-severe burnout groups in age, gender, training status, duration, job position, leisure time availability, marital status, working hours, income satisfaction, and sleep duration were analyzed using t-tests, non-parametric tests, Chi-square tests, or Fisher's exact tests.

Among the 26 participants, 4 (15.4%) had no burnout, 22 (84.6%) had varying degrees of burnout, and 10 (38.5%) had severe burnout. A significant difference was observed in leisure time availability between the severe burnout group (10.0%) and non-severe group (56.3%, χ²=5.562, P=0.037). Seventeen suggestions for reducing burnout were collected: increased training (35.3%, 6/17), psychological counseling (23.5%, 4/17), team-building activities (17.6%, 3/17), simplified workflows (11.8%, 2/17), salary increases (5.9%, 1/17), and additional staffing (5.9%, 1/17).

Job burnout is prevalent among neurology residents, with a high proportion of severe cases. Interventions such as enhanced training, psychological support, team-building, workflow optimization, salary adjustments, and increased staffing may mitigate burnout.

To investigate the effect of chain process management on improving iodine contrast medium extravasation (CME) in multi-mode CT examination for acute stroke via the green channel.

A total of 864 patients with suspected stroke who underwent green channel multi-mode CT in the First Affiliated Hospital of Naval Medical University from June to November 2023 were enrolled. Based on the nursing management process implementation phase, 404 patients from June to August were assigned to the control group (routine nursing), and 460 from September to November to the treatment group (chain process management). CME incidence, grading, and time from admission to intravenous access establishment were compared using Chi-square test, Fisher's exact test, and one-way ANOVA, respectively.

The CME incidence was significantly lower in the treatment group than that in the control group [0.87% (4/460) vs 4.46% (18/404), χ²=11.146, P=0.001]. The treatment group had 3 cases of mild and 1 case of moderate iodine CME, and the control group had 3 cases of mild and 15 cases of moderate iodine CME. The grade of iodine CME in treatment groups was significantly lower than that in control group (P=0.046). The time from admission to venous access did not differ significantly between groups [(306.52±141.95) s in control vs (300.04±125.58) s in treatment (t=0.707，P=0.480)].

Chain process management effectively reduces the incidence and severity of CME in acute stroke patients undergoing multi-mode CT via the green channel, without delaying venous access establishment.

Acute ischemic stroke (AIS) remains one of the leading causes of mortality and long-term disability worldwide. Reperfusion therapy, as the cornerstone of AIS management, primarily includes intravenous thrombolysis (IVT) and mechanical thrombectomy (MT), both of which significantly improve outcomes by restoring blood flow to the ischemic area. In recent years, significant advances have been made in this field: ① the repertoire of IVT agents has expanded beyond alteplase to include tenecteplase, reteplase, and recombinant human prourokinase; ② imaging advancements have continuously extended the therapeutic time window; and ③ the indications for MT have broadened from anterior circulation large vessel occlusions to include posterior circulation occlusions and patients with large core infarcts. Furthermore, notable progress has been achieved in optimizing direct MT versus bridging therapy, managing reperfusion injury, and integrating artificial intelligence into diagnosis and treatment. However, persistent clinical challenges include precise the determination of the time window, management for special populations, inequitable access to medical resources, and complication mitigation. This article systematically reviews recent advances in IVT, MT, combined therapy, management of special populations, and technological innovations, aiming to provide a reference for clinical practice.

Ischemic stroke, as a major cause of disability and mortality worldwide, has a complex pathophysiological mechanism. However, current treatments such as intravenous thrombolysis and mechanical thrombectomy remain limited by narrow time windows and restricted eligibility. Therefore, it is urgent to explore new intervention targets. In recent years, circular RNA (circRNA) has gradually become a promising focus in the diagnosis and treatment of ischemic stroke due to its high stability, tissue specificity, and ability to regulate multiple pathways. Therefore, this article summarizes the regulatory role of circRNA in key links such as regulating astrocyte function and neuronal inflammatory injury, regulating apoptosis and ferroptosis, regulating cerebrovascular function and post-stroke vascular repair, and influencing endothelial cell function and blood-brain barrier integrity, in order to guide further research and explore new therapeutic targets for improving ischemic stroke.

With rising living standards and accelerated population aging, stroke has become the leading cause of premature death in China. Among all patients with ischemic stroke, about 30% of patients lack a clearly identifiable cause of the disease, known as cryptogenic stroke. In recent years, it has been found that right-to-left shunt (RLS) is closely related to cryptogenic stroke. This article reviews the recent progress in the study of the relationship between RLS and cryptogenic stroke.

Cardiogenic stroke, also defined as cardioembolic stroke (CES), accounts for 20%-30% of all ischemic stroke. Compared to ischemic stroke caused by other causes, CES has more severe clinical symptoms, poorer prognosis, and higher recurrence rate. Therefore, effective prevention and control of CES, especially the identification and intervention of its risk factors, has become a key clinical priority. This review summarizes recent advances in the understanding of risk factors for CES.

To investigate the effects and underlying mechanisms of human embryonic stem cell derived mesenchymal stem cells (hESC-MSCs) on post-resuscitation cardiac dysfunction in a porcine model of cardiac arrest (CA).

Twenty-seven healthy male white pigs were randomly allocated to three groups (9 pigs per group) using a random number table: a Sham group, a cardiopulmonary resuscitation (CPR) group, and an hESC-MSCs group. The Sham group only completed the preparations related to surgical catheter placement. The CA-CPR model was established by inducing ventricular fibrillation for 10 minutes via a right ventricular electrode, followed by 6 minutes of CPR in the CPR group and the hESC-MSCs group. At 5 minutes after successful resuscitation, the hESC-MSCs group received an intravenous infusion of 2.5 × 10⁶ cells/kg hESC-MSCs in 1 hour; the Sham and CPR groups received an equivalent volume of 0.9% NaCl solution. Cardiac function parameters, including stroke volume (SV) and global ejection fraction (GEF), were monitored using pulse indicator continuous cardiac output (PiCCO) at 2, 4, 8, 24, 48, and 72 hours after resuscitation, and serum concentrations of cardiac troponin I (cTnI) and creatine kinase MB (CKMB) were quantified via enzyme-linked immunosorbent assay (ELISA). At 24, 48, and 72 hours after resuscitation, three pigs per group were euthanized, and left ventricular myocardial tissue samples were collected. Myocardial apoptosis was assessed using TdT-mediated dUTP nick labeling (TUNEL). Expression levels of protein kinase R-like endoplasmic reticulum kinase (PERK), C/EBP homologous protein (CHOP), cysteinyl aspartate specific proteinase 12 (caspase 12), and caspase 3 were determined via western-blotting.

Significant differences were observed in SV (F = 97.956, 54.970, 46.893, 8.685, 17.754, 18.070; all P < 0.05), GEF (F = 219.499, 95.886, 43.986, 15.809, 16.337, 8.050; all P < 0.05), serum cTnI (F = 112.367, 259.559, 83.680, 69.664, 55.522, 102.025; all P < 0.05), and serum CKMB (F = 77.607, 77.995, 64.601, 43.265, 47.544, 25.836; all P < 0.05) among the three groups at all post-resuscitation time points (2, 4, 8, 24, 48, and 72 hours). Compared with the CPR group, the hESC-MSCs group demonstrated significantly higher SV and GEF at all post-resuscitation time points (all P < 0.05). Significant differences were also observed in the myocardial apoptosis index (F = 68.585, 156.766, 189.283; all P < 0.001) and protein expression of PERK (F = 108.029, 33.089, 42.870; all P < 0.001), CHOP (F = 32.813, 34.275, 69.464; all P < 0.001), caspase 12 (F = 41.344, 16.836, 82.824; all P < 0.001), and caspase 3 (F = 74.913, 41.634, 43.085; all P < 0.001) among the three groups at 24, 48, and 72 hours after resuscitation. Compared with the CPR group, the hESC-MSCs group showed significantly reduced myocardial apoptosis index and downregulated expression of endoplasmic reticulum (ER) stress-related apoptotic proteins at the same time points (all P < 0.05).

Post-resuscitation treatment with hESC-MSCs ameliorates cardiac dysfunction in a porcine CA model, potentially via inhibition of ER stress-induced apoptotic pathways.

To investigate the effects of hydrogen inhalation on the expression of autophagy-related proteins and neural repair function in rats after spinal cord injury (SCI).

Forty-five female Sprague-Dawley rats were selected and divided into three groups using a random number table method, with 15 rats in each group: the control group (treated with only lamina resection), the SCI group (treated with a modified Allen method for modeling after laminectomy), and the hydrogen treatment group (SCI + H₂ group, given hydrogen inhalation after modeling). The Basso-Beattie-Bresnahan (BBB) score was used to evaluate the hind limb motor function of rats in each group at 1, 3, 7, 14, 21, and 28 days after SCI. Hematoxylin-eosin (HE) staining was used to observe the structural and morphological changes of the anterior horn of the spinal cord and the tissue at the injury site; Nissl staining was used to observe the morphological changes of spinal cord neurons. The protein expression levels of phosphatidylinositol 3 kinase (PI3K), protein kinase B (Akt), phosphorylated Akt (p-Akt), mammalian target of rapamycin (mTOR), and phosphorylated mTOR (p-mTOR) in the spinal cord tissue of rats in each group after SCI were detected by western-blotting. The levels of microtubule-associated protein 1 light chain 3 (LC3), Beclin-1, glial fibrillary acidic protein (GFAP), microtubule-associated protein 2 (MAP2), myelin basic protein (MBP), and Tuj-1 of rats in each group after SCI were detected by immunofluorescence staining.

There were significant differences in the BBB scores of the three groups at 1, 3, 7, 14, 21, and 28 days after modeling (F = 4 805.000, 571.200, 323.400, 134.400, 62.740, 28.720, all P < 0.001), and at 21 and 28 days after modeling, the BBB scores in the SCI + H₂ group were significantly higher than those in the SCI group (both P < 0.05). HE staining revealed that the spinal cord structure of the control group was intact, while obvious tissue cavities and neuronal loss occurred in the SCI group. The injury degree of the SCI + H₂ group was significantly improved compared with the SCI group. The Nissl staining showed that the number of Nissl bodies in the SCI + H₂ group was significantly increased compared with the SCI group, but was less than that in the control group. Western-blotting showed that there were significant differences in the ratios of p-mTOR/mTOR (F = 17.030, P = 0.006) and p-AKT/Akt (F = 13.000, P = 0.004) among the three groups. Moreover, the ratios of p-mTOR/mTOR and p-AKT/Akt in the SCI + H₂ group and the control group were much higher than those in the SCI group (all P < 0.05). However, there was no statistically significant difference in the PI3K expression among the three groups (F = 0.267, P = 0.861). The immunofluorescence staining indicated that in the three groups, the average fluorescence intensities of GFAP (F = 181.100, P = 0.001), MAP2 (F = 264.800, P = 0.005), MBP (F = 239.800, P = 0.001), Tuj-1 (F = 105.400, P = 0.001), LC-3 (F = 105.500, P = 0.001), and Beclin-1 (F = 39.530, P = 0.003) all showed statistically significant differences. Moreover, compared with the SCI group, the average fluorescence intensities of GFAP, LC3, and Beclin-1 in the SCI + H₂ group were significantly decreased, while the average fluorescence intensities of MAP2, MBP, and Tuj-1 were significantly increased (all P < 0.05).

Hydrogen inhalation can improve the recovery of motor function in rats after SCI by inhibiting the excessive autophagy response and promoting the expression of proteins related to neural tissue repair.

To explore the predictive value of hemoglobin-to-age ratio (HAR) for 28-day mortality in patients with community-acquired pneumonia (CAP).

Based on the medical information mart for intensive care Ⅳ (MIMIC-Ⅳ) database of American critical care medicine, 6 203 patients who were admitted to the ICU for the first time and met the diagnostic criteria for CAP were included. Demographic information, comorbidities, vital signs, disease severity score, laboratory indicators, and therapeutic measures were extracted. Patients were divided into a Q1 group (0.650 ≤ HAR < 1.200, n = 1 551), a Q2 group (1.200 ≤ HAR < 1.460, n = 1 551), a Q3 group (1.460 ≤ HAR < 1.830, n = 1 552), and a Q4 group (1.830 ≤ HAR ≤ 7.520, n = 1 549) according to HAR values. Kaplan-Meier survival analysis, multivariate Cox regression, and restricted cubic spline (RCS) models were used to explore the association between HAR and 28-day all-cause mortality in CAP patients. The predictive value of HAR for death within 28 days was also clarified by constructing a multivariate Cox model.

There were statistically significant differences in age, body weight, gender, tumor, kidney disease, heart rate, pulse oxygen saturation, acute physiology score Ⅲ, Oxford acute severity of illness score, hemoglobin, 24-hour output, invasive mechanical ventilation use, ICU stay days, and 28-day mortality among patients in the Q1-Q4 groups (all P < 0.05). Based on 28-day survival status, 6 203 patients were divided into a survival group (4 435 patients) and a mortality group (1 768 patients). The age, body mass, HAR, complication, vital signs, disease severity score, laboratory examination, 24-hour output, invasive mechanical ventilation use, vasopressor use, length of hospital stay, and ICU admission duration were compared between the two groups, and there were significant differences (all P < 0.05). The Kaplan-Meier survival curve revealed a statistically significant difference in survival rates among the Q1-Q4 groups (χ² = 118.208, P < 0.001), with the Q4 group showing a markedly higher survival rate than the Q1-Q3 group (χ² = 92.768, P < 0.001). Cox regression showed that HAR was an independent influencing factor for the 28-day mortality of CAP patients [hazard ratio (HR) = 0.651, 95% confidence interval (CI) (0.586, 0.722), P < 0.001]. The HR and 95%CI for 28-day mortality decreased with the increase of HAR quartiles, ranging from 1.000 to 0.883 [95%CI (0.780, 0.999)], 0.783 [95%CI (0.687, 0.893)], and 0.534 [95%CI (0.456, 0.625)] respectively. Further analysis using RCS showed that HAR had a non-linear relationship with the 28-day mortality of patients admitted to the ICU. When HAR was below 2.872, the mortality increased sharply with the decrease of HAR (P < 0.001).

HAR is negatively correlated with 28-day mortality in CAP patients. HAR levels can help identify patients at a higher risk of adverse outcomes, guiding clinicians in stratification and early intervention.

To investigate the relationship between the expression of serum long non-coding RNA growth arrest specific 5 (LncRNA-GAS5) and microRNA-221-3p (miR-221-3p) and the pulmonary hypertension (PH) in patients with idiopathic pulmonary fibrosis (IPF).

A total of 137 IPF patients (IPF group) and 70 healthy volunteers (control group) were enrolled at the Xi'an Hospital of Traditional Chinese Medicine from January 2021 to January 2023. According to the presence of PH, the IPF patients were divided into a PH group (n = 42) and a non-PH group (n = 95). Serum LncRNA-GAS5 and miR-221-3p expression levels were measured using quantitative real-time polymerase chain reaction (qPCR). Potential binding sites between LncRNA-GAS5 and miR-221-3p were predicted using the StarBase database, and Pearson correlation analysis assessed their association. Multivariate logistic regression was applied to identify independent factors influencing PH in IPF patients and to construct a predictive model. Receiver operating characteristic (ROC) curve analysis evaluated the predictive value of individual factors and the model.

Compared with the controls, IPF patients exhibited lower serum LncRNA-GAS5 and higher miR-221-3p expression (t = 6.489, 8.962; both P < 0.001). The incidence of PH in IPF patients was 30.66% (42/137). PH patients had significantly lower LncRNA-GAS5 and higher miR-221-3p levels compared with non-PH patients (t = 5.553, 5.694; both P < 0.001). LncRNA-GAS5 and miR-221-3p had binding sites and were negatively correlated in the serum of IPF patients (r = -0.788, P < 0.001). Multivariate logistic regression indicated that higher diffusion lung capacity of carbon monoxide as a percentage of predicted value (DLco%pred) [odds ratio (OR) = 0.864, 95% confidence interval (CI) (0.796, 0.938), P = 0.001] and LncRNA-GAS5 expression [OR = 0.463, 95%CI (0.282, 0.759), P = 0.002] were independent protective factors, while elevated B-type natriuretic peptide (BNP) [OR = 1.020, 95%CI (1.009, 1.032), P < 0.001] and miR-221-3p [OR = 2.269, 95%CI (1.423, 3.617), P = 0.001] were independent risk factors for PH in IPF patients. The predictive model equation was: Logit(P) = -1.518 - 0.042 × DLco%pred + 0.019 × BNP - 0.641 × LncRNA-GAS5 + 0.637 × miR-221-3p. The Hosmer-Lemeshow test indicated good model fit (χ² = 7.316, P = 0.412). ROC curve analysis showed that the model had an area under the curve (AUC) of 0.909, superior to DLco%pred (0.708), BNP (0.744), LncRNA-GAS5 (0.779), and miR-221-3p (0.773) alone (Z = 3.899, 3.633, 2.653, 2.760; all P < 0.001).

Low serum LncRNA-GAS5 and high miR-221-3p expression are closely associated with PH in IPF patients. The predictive model integrating LncRNA-GAS5, miR-221-3p, DLco%pred, and BNP demonstrates good predictive value for PH in this population.

To investigate the association between cathepsin S (CTSS) and the severity and prognosis of pneumonia-related acute respiratory distress syndrome (p-ARDS).

This study was a single-center prospective observational study. Twenty-three patients with p-ARDS admitted to the intensive care unit of the Second Hospital of Tianjin Medical University between July 2022 and December 2022 were included as the p-ARDS group. Ten patients with pneumonia alone who were admitted to the respiratory ward during the same period were selected as the pneumonia group. Matched bronchoalveolar lavage fluid (BALF) and serum samples were collected from both groups. The levels of CTSS, interleukin 6 (IL-6), IL-8, and lung surfactant protein D (SP-D) were determined using a Luminex^® magnetic bead multiplex kit. The levels of CTSS were compared based on clinical diagnosis, severity of lung injury, and clinical outcomes. The clinical utility of CTSS was assessed using the receiver operating characteristic (ROC) curve, Spearman correlation, and logistic regression analyses.

Among the p-ARDS group, 10 patients were classified with mild lung injury, 9 with moderate lung injury, and 4 with severe lung injury. Within 28 days of admission, 10 patients in the p-ARDS group died, resulting in a mortality rate of 43.5% (10/23). The level of CTSS in BALF (CTSS^BALF) was higher in the p-ARDS group than in the pneumonia group [94 (76, 103) × 10³ ng/L vs. 15 (5, 54) × 10³ ng/L, Z = 4.152, P < 0.001], whereas there was no significant difference in serum CTSS levels between the two groups [6 (4, 10) × 10³ ng/L vs. 6 (4, 7) × 10³ ng/L, Z = 0.407, P = 0.684]. ROC curve analysis demonstrated that the CTSS^BALF level could effectively distinguish p-ARDS from common pneumonia [area under the curve (AUC) = 0.961, 95% confidence interval (CI) (0.829, 0.998), P < 0.001]. The CTSS^BALF levels were observed to increase with the worsening severity of lung injury and were negatively correlated with the oxygenation index (r = -0.689, P < 0.001). According to the clinical outcomes at 28 days after hospitalization, the 23 p-ARDS patients were divided into a death group (10 cases) and a survival group (13 cases). Among the p-ARDS patients, the non-survivors showed significantly higher CTSS^BALF levels compared to survivors (Z = 2.729, P = 0.006). Logistic regression analysis revealed a trend of an independent correlation between CTSS^BALF and 28-day mortality, but the result did not reach statistical significance [odds ratio = 1.409, 95%CI (0.974, 2.038), P = 0.069].

CTSS^BALF may serve as a valuable biomarker for diagnostic grading and prognostic assessment of patients with p-ARDS.