Objective To investigate the changes and significance of serum cyclic RNA TTC3(circTTC3) and microRNA-138-5p(miR-138-5p) levels in elderly patients with acute cerebral infarction(ACI). Methods From September 2021 to September 2023, the Geriatric Medicine Center/Cadre Medical Department of West China Hospital of Sichuan University treated 128 elderly patients with ACI(ACI group), according to the National Institute of Health Stroke Scale(NIHSS), elderly ACI patients were separated into a mild group of 42 cases, a moderate group of 49 cases, and a severe group of 37 cases, meantime, 120 healthy individuals who came to the outpatient clinic for physical examination were regarded as a control group, real-time fluorescence quantitative PCR method was applied to determine the expression levels of circTTC3 and miR-138-5p in serum, Pearson method was applied to analyze the correlation between serum circTTC3 and miR-138-5p in elderly ACI patients, Spearman method was applied to analyze the correlation between serum circTTC3 and miR-138-5p levels and NIHSS scores in elderly ACI patients, ROC curve was applied to analyze the diagnostic value of serum circTTC3 and miR-138-5p expression levels in elderly ACI patients. Results Compared with the control group, the expression level of circTTC3 in serum of ACI group was increased, and miR-138-5p was decreased(t/P=17.207/<0.001, 16.239/<0.001). The serum circTTC3 level in mild subgroup was lower than that in moderate subgroup than that in severe subgroup, and the expression level of miR-138-5p in mild subgroup was higher than that in moderate subgroup than that in severe subgroup(F/P=26.579/<0.001, 105.935/<0.001). Serum circTTC3 expression level in elderly ACI patients was positively correlated with NIHSS score(r=0.521,P<0.001), and negatively correlated with MCA and ACA(r=-0.425,-0.392, all P<0.001). The expression level of miR-138-5p was negatively correlated with NIHSS score(r=-0.785, P<0.001), and positively correlated with MCA and ACA(r=0.571, 0.635, all P<0.001). The AUC of circTTC3, miR-138-5p and combined Mir-138-5P in the diagnosis of ACI nerve defect was 0.817, 0.810 and 0.878, respectively, and the combined diagnosis value was better than that of single diagnosis(Z=2.106, 2.406,P=0.035, 0.016). Conclusion The expression levels of circTTC3 and miR-138-5p in the serum of elderly ACI patients increase, and the expression levels of miR-138-5p decrease. The two are closely related to the severity of condition and may serve as targets for the diagnosis and treatment of ACI.

Objective To investigate the expression levels of serum high mobility group protein A2(HMGA2) and P-glycoprotein(P-gp) in elderly patients with progressive cerebral infarction and their relationship with prognosis.Methods A total of 67 elderly patients with progressive cerebral infarction and 79 elderly patients with non-progressive cerebral infarction admitted to the Department of Neurology of Dalian Central Hospital from February 2020 to February 2023 were selected as the progressive group and the non-progressive group, respectively. According to the neurological recovery at 3 months after treatment, the progressive group was divided into good prognosis subgroup(n=39, mRS Score 0-2) and poor prognosis subgroup(n=28, mRS Score 3-6). Serum HMGA2 and P-gp levels were detected by enzyme-linked immunosorbent assay. Pearson product-moment correlation analysis was used to analyze the relationship between serum HMGA2, P-gp and NIHSS score. Logistic regression analysis was used to analyze the influencing factors of poor prognosis in patients with progressive cerebral infarction. The receiver operating characteristic(ROC) curve was used to evaluate the predictive value of serum HMGA2 and P-gp for poor prognosis.Results The levels of serum HMGA2 and P-gp and NIHSS score in the progression group were higher than those in the non-progression group(t/P=13.672/<0.001, 8.095/<0.001, 8.226/<0.001).The serum levels of HMGA2 and P-gp were positively correlated with NIHSS score in patients with progressive cerebral infarction(r/P=0.732/<0.001, 0.708/<0.001).The patients in the poor prognosis subgroup were older than those in the good prognosis subgroup, and the serum HMGA2 and P-gp levels and NIHSS condition were higher than those in the good prognosis subgroup(t/P=5.092/<0.001, 5.103/<0.001, 4.449/<0.001, 2.357/0.021). Multivariate logistic regression analysis showed that, advanced age, elevated serum HMGA2, P-gp levels and NIHSS score were independent risk factors for poor prognosis in patients with progressive cerebral infarction[OR(95%CI)=1.429(1.093-1.869), 1.288(1.082-1.533); 1.586(1.161-2.165), 1.483(1.120-1.963)]; The AUC of serum HMGA2, P-gp and their combination in predicting poor prognosis of patients with progressive cerebral infarction were 0.738, 0.740 and 0.895, respectively, and the combination of HMGA2 and P-gp was better than each of them alone(Z=2.031, 2.006, P=0.002, 0.003).Conclusion Serum HMGA2 and P-gp levels are abnormally elevated in elderly patients with progressive cerebral infarction, and are related to the severity of the disease and poor prognosis. Early combined detection of the two indicators can predict the risk of poor prognosis in patients, so as to provide reference for clinical diagnosis and treatment.

Objective To investigate the effectiveness of the combination of lacosamide and levetiracetam in managing epilepsy in children, as well as its impact on serum BDNF, PGP, and other neurological function-related parameters.Methods During the period from January 2021 to July 2022, a total of 120 children diagnosed with primary epilepsy were enrolled from the Pediatrics Department of People's Hospital of Xinjiang Uygur Autonomous Region. These patients were randomly allocated into two groups: the observation group(n=60) and the control group(n=60). The children in the control group were given routine support therapy and oral treatment with levetiracetam, while the children in the control group received standard treatment, lacosamide tablets were administered to the children in the observation group on top of that, and all children were treated continuously for 6 months. A comparison was made between the two groups in terms of therapeutic effects and the occurrence of adverse events, and the changes of neurological function related indexes(MBP, S-100β, HMGB1, GFAP, PGP), epileptic seizure were compared between the two groups before and after treatment.Results The observation group exhibited a significantly higher overall effectiveness rate(98.33% vs. 90.00%,χ2/P=4.184/0.041), while the average number of seizures and duration of seizures were lower than those in the control group(t/P=13.288/<0.001, although="" there="" were="" no="" significant="" differences="" in="" the="" occurrence="" of="" adverse="" events="" between="" two="" p="">0.05). The levels of serum MBP, S-100β, HMGB1, GFAP, and PGP considerably decreased in the observed group after treatment, in comparison to the pre-treatment and control group levels. Meanwhile, the level of BDNF in the observed group notably increased in comparison to the pre-treatment and control group levels(t/P=2.858/0.005, 4.672/<0.001, 2.142/0.034, 3.521/<0.001, 5.054/<0.001, 10.310/<0.001). Correlation analysis indicated a positive relationship between the number of post-treatment seizures in children with epilepsy and the serum PGP level, while a negative correlation was observed with the BDNF level(r/P=0.577/<0.001,-0.338/<0.001).Conclusion Lacosamide combined with levetiracetam can significantly improve the related indexes of neurological function in children with epilepsy, so as to reduce the frequency of epileptic seizures and improve the efficiency of treatment. And the clinical safety of the treatment scheme is good, and it has a broad clinical application prospect for children with epilepsy.

Objective To study the relevant factors affecting the degree of tumor resection and tumor progression in patients with giant invasive pituitary adenoma treated surgically. Methods One hundred and twenty patients with giant invasive pituitary adenomas admitted to the Department of Neurosurgery of the Shijiazhuang People's Hospital from March 2017 to March 2021 were retrospectively selected, and were classified into 75 cases of near-total resection and total resection group, and 45 cases of sub-total resection group according to the type of surgery. According to their tumor progression, they were divided into 20 cases in the tumor progression group and 100 cases in the tumor non-progression group. The clinical data of the patients were analyzed by multifactorial analysis, and the above Logistic regression analysis was used to analyze the independent risk factors affecting the degree of tumor resection and tumor progression in patients with giant invasive pituitary adenoma treated by surgery.Results Univariate analysis showed that the proportion of patients with previous surgical treatment, previous radiotherapy, Knosp grade 3-4, maximum diameter of tumor >5 cm, tumor invasion into the posterior cranial fossa, inhomogeneous enhancement of MR lesions, hard and tough tumor texture, and lobulated or clumped tumor was higher in the subtotal resection group than in the subtotal resection and total resection groups(χ2/P=9.391/0.002, 6.487/0.011, 5.562/0.018, 9.700/0.007, 5.820/0.016, 10.901/0.001, 14.959/<0.001, and 14.415/0.001); the percentage of patients with mitosis phase, Ki-67 index ≥3%, and the degree of tumor resection as subtotal resection were all higher in the tumor progression group than in the tumor non-progression group(χ2/P=5.608/0.018, 4.631/0.031, 6.334/0.042). The results of multifactorial unconditional Logistic regression analysis showed that the texture of the tumor as hard and tough, and the Knosp grade of the tumor as grade 3-4 were independent risk factors affecting the extent of tumor resection in patients with giant invasive pituitary adenomas [OR(95%CI)=1.441(1.042-1.991), 1.592(1.040-2.436), both P<0.05]; the degree of tumor resection as subtotal resection, and nuclear schizophrenia visible on pathological examination were all independent risk factors affecting tumor progression in patients with hugely aggressive pituitary adenomas [OR(95%CI)=1.675(1.141-2.455), 1.422(1.074-1.882), both P<0.05].Conclusion Tumor texture is hard and tough, tumor Knosp grade 3-4 are independent risk factors affecting the degree of tumor resection in patients with giant invasive pituitary adenoma; tumor resection degree is subtotal resection, and nuclear schizophrenia can be seen in pathological examination are independent risk factors affecting the progression of the tumor in patients with giant invasive pituitary adenoma.

Objective To investigate the prognostic value of serum extracellular cold-induced RNA-binding protein(eCIRP) and soluble urokinase plasminogen activator receptor(suPAR) in patients with sepsis-induced acute respiratory distress syndrome(ARDS). Methods A total of 84 patients with sepsis-induced ARDS(ARDS group) admitted to Ninth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine from January 2019 to June 2023 were enrolled, and 84 patients with pure sepsis(non-ARDS group) were selected in a 1:1 ratio. According to the prognosis, the patients with sepsis-induced ARDS were divided into death subgroup(37 cases) and survival subgroup(47 cases). Enzyme-linked immunosorbent assay was used to measure serum levels of eCIRP and suPAR. The factors causing mortality in ARDS patients with sepsis and the predictive value of serum eCIRP and suPAR levels were analyzed through multiple Logistic regression and ROC curve analysis.Results Compared with the non ARDS group, the serum eCIRP and suPAR levels in the ARDS group increased(t/P=14.330/<0.001, 10.632/<0.001); The 90 day mortality rate of 84 patients with sepsis induced ARDS was 44.05%(37/84); The serum eCIRP, suPAR, proportion of septic shock, proportion of mechanical ventilation time ≥ 3d, sequential organ failure assessment(SOFA) score, procalcitonin, and blood lactate in the death subgroup were all higher than those in the survival subgroup(χ2/t/P=13.805/<0.001, 5.229/<0.001, 10.932/<0.001, 4.334/0.037, 4.850/<0.001, 7.592/<0.001, 5.926/<0.001); Increased SOFA score, elevated blood lactic acid, eCIRP and suPAR were independent risk factors for death in patients with sepsis-induced ARDS [OR(95%CI)=1.523(1.123-2.067), 2.558(1.123-5.824), 1.094(1.017-1.178), 1.365(1.117-1.670)]. The AUC of serum eCIRP, suPAR, and their combination for predicting the death of patients with sepsis-induced ARDS was 0.787, 0.779, and 0.871, respectively. The AUC of the combination of the two levels was greater than that of serum eCIRP or suPAR levels alone(Z/P=2.005/0.045, 2.205/0.028). Conclusion Elevated levels of serum eCIRP and suPAR are associated with poor prognosis in sepsis induced ARDS patients, and their combined predictive value is high.