BACKGROUND:Tenecteplase improves reperfusion and functional outcomes compared with alteplase in patients with large vessel occlusion. We assessed whether this superiority varies with thrombolysis-to-puncture time (TTP). METHODS:This retrospective analysis of a prospective multicenter cohort included patients with large vessel occlusion who received bridging therapy with either tenecteplase or alteplase between January 2022 and September 2025. Patients were stratified by TTP (<60 versus ≥60 minutes). We subsequently assessed the association of TTP with efficacy and safety outcomes between the alteplase and tenecteplase groups using multivariable logistic regression adjusted for age, baseline National Institutes of Health Stroke Scale score, and time from stroke onset to arterial puncture. Functional independence was defined as a modified Rankin Scale score of 0 to 2 at 3 months. RESULTS:Of 1106 patients who received bridging therapy, 1003 were included in the primary analysis (tenecteplase, 488; alteplase, 515). The median age was 68 (interquartile range, 58-75) years in both groups, with men comprising 64.3% and 66.0%, respectively. Tenecteplase was associated with superior 3-month functional independence compared with alteplase (53.6% versus 48.1%; adjusted odds ratio, 1.37 [95% CI, 1.03-1.82]). This benefit was concentrated in patients with a TTP <60 minutes, where tenecteplase yielded higher rates of both early recanalization (19.0% versus 9.1%; adjusted odds ratio, 2.36 [95% CI, 1.32-4.23]; Pinteraction=0.047) and functional independence (61.0% versus 49.0%; adjusted odds ratio, 1.77 [95% CI, 1.13-2.77]; Pinteraction=0.111). No between-agent differences were significant with TTP ≥60 minutes. Safety outcomes were comparable, but each 30-minute TTP increase independently elevated hemorrhagic risks for both agents. CONCLUSIONS:The recanalization superiority of tenecteplase over alteplase is time-dependent, evident only within a TTP <60 minutes. Although the translation of this advantage into functional outcome was not statistically modified by time, optimizing workflow to achieve this rapid window maximizes the potential benefit of tenecteplase, which should be prioritized in capable settings.

AIMS:Chronic cerebral hypoperfusion drives the progression of intracranial atherosclerotic stenosis (ICAS) and increases ischemic risk. Endothelial angiogenic adaptation initially preserves cerebral perfusion but deteriorates with disease progression. We investigated whether the HCG11/QKI5 axis represents a regulatory node with therapeutic potential in cerebral hypoperfusion. METHODS:Circulating hypoxia- and angiogenesis-related biomarkers were compared between asymptomatic and symptomatic ICAS patients to reflect different progression stages. Endothelial function was assessed in oxygen-glucose deprivation models following HCG11 overexpression or QKI5 knockdown. A rat model of chronic cerebral hypoperfusion was used to evaluate temporal changes in vivo. RESULTS:Pro-angiogenic factors were elevated in asymptomatic ICAS but reduced in symptomatic patients, indicating progressive impairment of vascular compensation. HCG11 overexpression enhanced endothelial proliferation and tube formation, whereas QKI5 silencing attenuated these responses. These effects were associated with modulation of HIF-1α/VEGF signaling. In vivo, early hypoperfusion activated QKI5 and angiogenic pathways, followed by a gradual decline during sustained hypoperfusion. CONCLUSION:Progressive attenuation of the HCG11/QKI5-mediated angiogenic program may underlie endothelial adaptive failure in cerebral hypoperfusion. Targeting this RNA-regulatory axis may represent a potential therapeutic strategy to preserve vascular compensation and mitigate disease progression in ICAS.

Ischemic stroke (IS) is the most prevalent cerebrovascular disease, with a high proportion of patients developing lifelong disability. Cerebral microcirculatory dysfunction is a key driver of poor IS prognosis. Hypoxia-induced cerebral angiogenesis could improve cerebral perfusion but risks blood-brain barrier (BBB) disruption, worsening outcomes. We previously found that intermittent hypoxia (IH) promotes cerebral angiogenesis and improves IS outcomes, but whether it maintains BBB integrity during angiogenesis and the underlying mechanism remains unclear. This study established mouse hypoxia models, including IH and continuous hypoxia (CH) treatment groups. We found that both IH and CH transiently increased cerebrovascular permeability via angiogenesis activation. However, IH restored permeability to baseline over time, with astrocyte end-foot wrapping, pericyte coverage, and tight junction protein ZO-1 level in neovessels comparable to controls. In contrast, CH failed to recover vascular leakage and BBB integrity within the same period. Mechanistically, IH uniquely activated both hypoxia-inducible factor (HIF)-1α and HIF-2α, while CH only activated HIF-2α. HIF-1α-specific activation in the IH group promoted downstream vascular endothelial growth factor (VEGF)-B transcription, which antagonized VEGFA-mediated endothelial barrier disruption and adhesion molecule upregulation. This study demonstrates that IH maintains neovascular BBB integrity via the HIF-1α/VEGFB pathway, providing a theoretical basis for novel IS interventions and targeted drug development.

BACKGROUND:Covert brain infarction is a common neuroimaging-defined manifestation of covert cerebrovascular disease and is associated with increased risks of future stroke and cognitive decline. Covert brain infarction has been included as an outcome in randomized trials evaluating coagulation-pathway-targeting strategies. However, whether these strategies consistently reduce incident covert brain infarction and whether treatment effects on covert brain infarction parallel those for acute ischemic stroke remain uncertain. METHODS:Following PRISMA 2020 guidelines, we searched PubMed, Ovid MEDLINE, Embase, and Web of Science through 10 November 2025, for randomized controlled trials and magnetic resonance imaging substudies enrolling patients without an established indication for anticoagulation. Eligible trials compared antithrombotic strategies targeting the coagulation pathway (oral anticoagulation or direct factor inhibition, with or without background antiplatelet therapy) with antiplatelet-based regimens and reported incident covert brain infarction on follow-up magnetic resonance imaging. Trial-level treatment effects for covert brain infarction, acute ischemic stroke, and their composite were compared. Exploratory cross-outcome comparisons were performed using the ratio of relative risks with prespecified interpretability bounds. RESULTS:Six randomized trials met the inclusion criteria, encompassing diverse clinical populations and varying antiplatelet regimens in the control arms. In stratified analyses according to treatment structure, coagulation-pathway strategies were not associated with a statistically significant reduction in incident covert brain infarction compared with antiplatelet therapy alone, with similar estimates across treatment strata and no evidence of interaction (P_interaction = 0.249). An exploratory pooled estimate was similar (risk ratio, 0.95; 95% confidence interval, 0.81-1.12). Findings were consistent across covert brain infarction subtypes, including lacunar and non-lacunar lesions. In trials reporting all three outcomes, these strategies were not associated with significant reductions in covert brain infarction, acute ischemic stroke (risk ratio, 0.85; 95% confidence interval, 0.65-1.11), or their composite endpoint (risk ratio, 0.97; 95% confidence interval, 0.84-1.11). The composite endpoint was predominantly driven by covert brain infarction (~70% of events). Exploratory cross-outcome comparisons yielded point estimates favoring acute ischemic stroke over covert brain infarction, although confidence intervals crossed unity. CONCLUSION:In clinical settings without a mandatory indication for anticoagulation, coagulation-pathway strategies were not associated with reduced incident covert brain infarction compared with antiplatelet therapy. Although effect estimates for covert brain infarction and acute ischemic stroke were broadly similar, uncertainty remains. Composite endpoints predominantly driven by covert brain infarction warrant cautious interpretation when inferring treatment effects on clinically manifest ischemic stroke.

BACKGROUND:Intracranial atherosclerotic stenosis is a prevalent cause of stroke worldwide and carries a high risk of recurrence. This study aimed to develop and validate a simple and effective model for predicting individualised risks of recurrent ischaemic stroke in patients with symptomatic intracranial atherosclerotic stenosis (ICAS). METHODS:This multivariable prediction model was built and validated using participants with symptomatic ICAS within 30 days of symptom onset from a large randomised controlled trial (RICA). The trial enrolled 3033 participants across 84 hospitals in China between Oct 28, 2015, and Feb 28, 2019. Participants were non-randomly divided by hospitals location into training and validation sets. Eligible participants were aged 40-80 years and had experienced an ischaemic stroke or transient ischaemic attack attributable to 50-99% stenosis of a major intracranial artery. The primary outcome of the model was time to first ischaemic stroke recurrence within 1 year. A Cox proportional hazards model was developed using the Akaike information criterion and validated both internally and externally. Model performance was assessed by discrimination (Harrell's concordance index [C-index]), calibration (modified Hosmer-Lemeshow test and calibration plots), and clinical utility (decision curve analysis and Kaplan-Meier curves). FINDINGS:2995 participants from the RICA trial were divided into the training (n=2137) and validation (n=858) sets. The PROMISE model included age, BMI, hypertension, type 1 and type 2 diabetes, current smoking status, LDL cholesterol, location of symptomatic stenosis, and stenosis degree of qualifying artery as predictors. The C-index for the prediction model was 0·81 (95% CI 0·80-0·83) in the training set and 0·78 (0·77-0·84) in the validation set. Model calibration was satisfactory across the full risk profile (modified Hosmer-Lemeshow test χ2=5·32, p=0·38). Furthermore, decision curve analysis curves indicated that this prediction model provided clinical benefits. Additionally, participants were classified into three distinct risk groups (low, medium, and high) by Kaplan-Meier curves based on the prediction model. The corresponding C-indices for these groups were 0·80 (95% CI 0·80-0·86), 0·68 (0·67-0·77), and 0·71 (0·69-0·81) in the training set, and 0·76 (0·75-0·88), 0·67 (0·65-0·82), and 0·68 (0·67-0·86) in the validation set. Based on the final model, an online risk calculator was developed. INTERPRETATION:We developed the PROMISE model and an online calculator using accessible clinical variables to predict ischaemic stroke recurrence, identify individuals at high risk, and support symptomatic ICAS patient management. The model had a strong discriminative ability and good calibration. Further validation and model optimisation should be conducted to support stroke care. FUNDING:National Natural Science Foundation of China, Beijing Natural Science Foundation, Noncommunicable Chronic Diseases-National Science and Technology Major Project, and Beijing Physician Scientist Training Project.

Background and Purpose In patients with large vessel occlusion (LVO), intravenous thrombolysis (IVT) frequently alters thrombus location; however, the clinical impact of this phenomenon remains unclear. We aimed to compare post-IVT thrombus dynamics between tenecteplase and alteplase and to evaluate the association between thrombus dynamics and 3-month outcomes. Methods This retrospective study analyzed prospectively collected, multicenter data from consecutive patients with LVO who underwent bridging therapy between January 2022 and December 2024. Thrombus dynamics were classified as resolution, migration, or stability. Analyses incorporated propensity score matching with weighting to balance baseline characteristics. Results Of the 806 initially included patients, 746 were included after matching (373 treated with tenecteplase and 373 treated with alteplase). The incidence of thrombus migration was significantly higher in the tenecteplase group than in the alteplase group (19.3% vs. 11.3%; odds ratio [OR]: 1.92; 95% confidence interval [CI] 1.27–2.91). The advantage of tenecteplase over alteplase was restricted to patients with an IVT-to-puncture time of <60 minutes (18.6% vs. 6.2%; P=0.001) and was no longer significant when the interval ≥60 minutes (19.7% vs. 15.0%; P=0.204; Pinteraction=0.043). Additionally, thrombus migration was associated with a better functional outcome (OR: 1.62; 95% CI 1.04–2.53). Finally, tenecteplase was associated with improved functional independence compared with alteplase (OR: 1.43; 95% CI 1.04–1.95). Conclusions Tenecteplase demonstrated superior efficacy in inducing thrombus migration compared with alteplase, particularly within 60 minutes of IVT administration. Thrombus migration independently predicted improved functional independence. These findings support the preferential use of tenecteplase for bridging therapy in patients with LVO.

The comparative efficacy of tenecteplase versus alteplase in achieving early recanalization (ER) before mechanical thrombectomy (MT) for large-vessel occlusion (LVO) remains uncertain. This study was a retrospective analysis of prospectively collected data of consecutive patients with LVO underwent intravenous thrombolysis (IVT) and brain angiography between January 2022 and December 2023. ER was defined as ≥ 50

Aim Investigate the role of mobile stroke unit (MSU) and rendezvous transport with emergency medical service (EMS) in timely large vessel occlusion (LVO) identification and direct transfer to the comprehensive stroke center.Methods The fifth-generation MSU (5G-MSU) program was first implemented in 2019, directly dispatched through the 120 emergency medical services. The rendezvous transport was initiated in 2020. We report the first case of rendezvous transport plus prehospital computed tomography angiography (CTA) on 5G-MSU for endovascular treatment of LVO.Results A 5G-MSU was dispatched for a patient with reported right-sided hemiparesis and reduced consciousness at a primary stroke center, located at a distance of 106 km. The 5G-MSU and EMS coordinated a rendezvous transport to transfer the patient. CTA performed on the 5G-MSU revealed basilar artery occlusion, prompting immediate contact with the main hospital's angiography suite. Upon arrival, the patient was directly transferred to the angiography suite for endovascular therapy, achieving successful recanalization. Consequently, the call-to-puncture time was successfully achieved within 103 min, across a distance of 106 km.Discussion Rendezvous transport combined with prehospital CTA on the 5G-MSU in rural areas is feasible. This approach allows the MSU to extend beyond its conventional treatment coverage, rapidly identify large vessel occlusions, and thereby significantly reduce call-to-treatment time.

Vascular cognitive impairment and dementia is a debilitating neurological disorder caused by chronic cerebral hypoperfusion, for which no effective causative treatments are currently available. Intermittent hypoxia has been shown to enhance cerebral blood flow in mice, but its efficacy in a model of vascular cognitive impairment and dementia remains unclear. In this study, we established a mouse model of vascular cognitive impairment and dementia by bilateral carotid artery stenosis. Intermittent hypoxia was induced before and after this stenosis. We found that intermittent hypoxia increased cerebral blood flow, oxygen saturation, and microcirculation in the prefrontal cortex and hippocampus in the model mice, without causing neurovascular damage. Additionally, intermittent hypoxia significantly improved cognitive function in the mouse model of vascular cognitive impairment and dementia, with perconditioning showing greater efficacy than preconditioning. Improvements in cerebral microcirculation and blood flow were positively correlated with cognitive recovery. Even in a mouse model of vascular cognitive impairment and dementia with comorbidities induced by a high-fat, high-fructose diet, intermittent hypoxic perconditioning demonstrated protective effects on cognitive function. Proteomic analysis indicated that mitochondrial protection is a key mechanism, particularly through upregulating NDUFB8 expression and increasing the activity of mitochondrial complex I. These findings suggest that intermittent hypoxia is a potential noninvasive strategy for the prevention and treatment of vascular cognitive impairment and dementia.

BACKGROUND:Mobile stroke units (MSUs) improve outcomes in acute ischemic stroke (AIS), but their effectiveness is constrained by limited service radii. Integrating a rendezvous strategy with emergency medical services (EMS) may extend the operational reach of MSUs in rural areas. AIM:We evaluated whether a novel rendezvous approach between MSUs and EMS could enhance thrombolysis efficiency for rural AIS patients in a larger service area. METHODS:We conducted a single-center, pragmatic, non-randomized, operationally allocated comparative study in Suzhou, Anhui, from 1 January to 31 December 2024. When a suspected stroke call originated from a remote location, a nearby conventional ambulance was dispatched. Subsequently, the MSU was dispatched via an EMS call, met the EMS at a predetermined midway point en route to the stroke center, and treated the patient when MSU was available. Inclusion criteria were: age ⩾ 18 years; onset location ⩾ 20 km from the MSU center; and onset-to-call time ⩽ 4 h. Patients with a final diagnosis of cerebral ischemia were analyzed based on transport method (MSU rendezvous vs EMS only). The primary outcome was the thrombolysis rate; secondary outcomes included time metrics, 90-day functional prognosis, and incidence of symptomatic intracranial hemorrhage (sICH). Propensity score matching (PSM) was used to balance baseline characteristics. RESULTS:A total of 307 patients with AIS were included; the median age was 72 years (IQR, 63-79), and 192 (62.50%) were male. One hundred ninety-three patients were transferred through rendezvous transport, and 114 patients were transferred through EMS-only. The median distance from onset location to hospital in the rendezvous transport group was 39.00 km (24.23 miles) (IQR 30.00-47.00 km), with a maximum of 68.00 km (42.25 miles). Compared with EMS-only transfers, patients transferred through rendezvous transport had a nearly 3-fold increase in thrombolysis rates (68.90% vs 17.50%, p < 0.001), reduced dispatch-to-door time by 12.5 min, door-to-needle time by 46 min, and onset-to-needle time by 60 min (all p < 0.001). In addition, in terms of clinical outcomes, patients in the rendezvous group had lower median 90-day modified Rankin Scale scores (2.0 (1.0-3.0) vs 3.0 (1.5-5.0), p < 0.001). These findings remained consistent after PSM. CONCLUSION:Our study demonstrates that the novel MSU-EMS rendezvous approach significantly improves thrombolysis rates and functional outcomes, serving as a viable strategy to expand acute stroke care to remote populations.Data access statement:Data collected for the study may be made available from the corresponding author to others upon reasonable request.

Stroke-associated pneumonia (SAP) is one of the most common complications in acute ischemic stroke (AIS) patients, affecting 8.5

Background We aimed to determine whether and how the combination of acetazolamide and remote ischemic preconditioning (RIPC) reduced the incidence and severity of acute mountain sickness (AMS). Methods This is a prospective, randomized, open-label, blinded endpoint (PROBE) study involving 250 healthy volunteers. Participants were randomized (1:1:1:1:1) to following five groups: Ripc (RIPC twice daily, 6 days), Rapid-Ripc (RIPC four times daily, 3 days), Acetazolamide (twice daily, 2 days), Combined (Acetazolamide plus Rapid-Ripc), and Control group. After interventions, participants entered a normobaric hypoxic chamber (equivalent to 4000 m) and stayed for 6 h. The primary outcomes included the incidence and severity of AMS, and SpO 2 after hypoxic exposure. Secondary outcomes included systolic and diastolic blood pressure, and heart rate after hypoxic exposure. The mechanisms of the combined regime were investigated through exploratory outcomes, including analysis of venous blood gas, complete blood count, human cytokine antibody array, ELISA validation for PDGF-AB, and detection of PDGF gene polymorphisms. Results The combination of acetazolamide and RIPC exhibited powerful efficacy in preventing AMS, reducing the incidence of AMS from 26.0 to 6.0% (Combined vs Control: RR 0.23, 95% CI 0.07–0.70, P = 0.006), without significantly increasing the incidence of adverse reactions. Combined group also showed the lowest AMS score (0.92 ± 1.10). Mechanistically, acetazolamide induced a mild metabolic acidosis (pH 7.30 ~ 7.31; HCO 3 − 18.1 ~ 20.8 mmol/L) and improved SpO 2 (89 ~ 91%) following hypoxic exposure. Additionally, thirty differentially expressed proteins (DEPs) related to immune-inflammatory process were identified after hypoxia, among which PDGF-AB was involved. Further validation of PDGF-AB in all individuals showed that both acetazolamide and RIPC downregulated PDGF-AB before hypoxic exposure, suggesting a possible protective mechanism. Furthermore, genetic analyses demonstrated that individuals carrying the PDGFA rs2070958 C allele, rs9690350 G allele, or rs1800814 G allele did not display a decrease in PDGF-AB levels after interventions, and were associated with a higher risk of AMS. Conclusions The combination of acetazolamide and RIPC exerts a powerful anti-hypoxic effect and represents an innovative and promising strategy for rapid ascent to high altitudes. Acetazolamide improves oxygen saturation. RIPC further aids acetazolamide, which synergistically regulates PDGF-AB, potentially involved in the pathogenesis of AMS. Trial registration ClinicalTrials.gov NCT05023941.

Introduction: The present study aimed to investigate whether and how normobaric intermittent hypoxic training (IHT) or remote ischemic preconditioning (RIPC) plus normoxic training (RNT) has a synergistic protective effect on lipid metabolism and vascular function compared with normoxic training (NT) in overweight or obese adults. Methods: A total of 37 overweight or obese adults (36.03 ± 10.48 years) were randomly assigned to 3 groups: NT group (exercise intervention in normoxia), IHT group (exercise intervention in normobaric hypoxic chamber), and RNT group (exercise intervention in normoxia + RIPC twice daily). All participants carried out the same 1-h exercise intervention for a total of 4 weeks, 5 days per week. Physical fitness parameters were evaluated at pre- and postexercise intervention. Results: After training, all three groups had a significantly decreased body mass index (p < 0.05). The IHT group had reduced body fat percentage, visceral fat mass (p < 0.05), blood pressure (p < 0.01), left ankle-brachial index (ABI), maximal heart rate (HRmax) (p < 0.05), expression of peroxisome proliferator-activated receptor-γ (PPARγ) (p < 0.01) and increased expression of SIRT1 (p < 0.05), VEGF (p < 0.01). The RNT group had lowered waist-to-hip ratio, visceral fat mass, blood pressure (p < 0.05), and HRmax (p < 0.01). Conclusion: IHT could effectively reduce visceral fat mass and improve vascular elasticity in overweight or obese individuals than pure NT with the activation of SIRT1-related pathways. And RNT also produced similar benefits on body composition and vascular function, which were weaker than those of IHT but stronger than NT. Given the convenience and economy of RNT, both intermittent hypoxic and ischemic training have the potential to be successful health promotion strategies for the overweight/obese population.

Purpose Accumulating evidence highlights the association of calcium characteristics and cardiovascular events, but its role in cerebrovascular stenosis has not been well studied. We aimed to investigate the contribution of calcium patterns and density to recurrent ischemic stroke in patients with symptomatic intracranial atherosclerotic stenosis (ICAS). Methods In this prospective study, 155 patients with symptomatic ICAS in the anterior circulation were included, and all subjects underwent computed tomography angiography. The median follow-up for all patients was 22 months and recurrent ischemic stroke were recorded. Cox regression analysis was performed to examine whether calcium patterns and density were associated with recurrent ischemic stroke. Results During the follow-up, 29 patients who experienced recurrent ischemic stroke were older than those without recurrent ischemic stroke (62.93 ± 8.10 years vs. 57.00 ± 12.07 years, p = 0.027). A significantly higher prevalence of intracranial spotty calcium (86.2% vs. 40.5%, p < 0.001) and very low-density intracranial calcium (72.4% vs. 37.3%, p = 0.001) were observed in patients with recurrent ischemic stroke. Multivariable Cox regression analysis showed that intracranial spotty calcium, rather than very low-density intracranial calcium, remained an independent predictor of recurrent ischemic stroke (adjusted hazard ratio 5.35, 95% confidence interval 1.32–21.69, p = 0.019). Conclusion In patients with symptomatic ICAS, intracranial spotty calcium is an independent predictor of recurrent ischemic stroke, which will further facilitate risk stratification and suggest that more aggressive treatment should be considered for these patients.

Objective:To analyze the preliminary explorations and practical effects of strengthening the process management of nursing special projects in a tertiary general hospital, so as to explore the refined management strategy of hospital projects and provide reference for improving the management level of the research project.Methods:This article takes a series of refined measures taken by the hospital in the process management of nursing special projects from August 2016 to August 2021 as the research example, including setting up subject directions around key disciplines, setting application conditions at different levels, standardizing selection procedures, strengthening mid-term assessments, strictly controlling final acceptance, establishing integrity files, and promoting the transformation of scientific achievements, etc. and these measures are deeply analyzed and discussed.Results:Through a series of measures, the hospital nursing team has significantly improved in terms of research paper publication, patent authorization, approval of projects above the bureau level, and nursing specialties ranking of Chinese hospital Science and Technology Evaluation Metrics (STEM) in the past six years.Conclusions:By strengthening the process management of nursing special research project, the construction level of nursing disciplines has been significantly improved, and the development of nursing disciplines has been greatly promoted.

Background: We aimed to determine whether and how the combination of acetazolamide and remote ischemic preconditioning (RIPC) minimized the incidence and severity of acute mountain sickness (AMS).Methods: This is a prospective, randomized, open-label, blinded endpoint (PROBE) study involving 250 healthy volunteers. Participants were randomized (1:1:1:1:1) to following groups: Ripc (RIPC twice daily, six days), Rapid-Ripc (RIPC fourth daily, three days), Acetazolamide (twice daily, two days), Combined (Acetazolamide plus Rapid-Ripc), and Control group. After interventions, participants entered a normobaric hypoxic chamber (equivalent to 4000m) and stayed for 6 hours. The primary outcome was AMS incidence. Secondary outcomes included the severity of AMS, SpO2, and hematological parameters measured by venous blood gas, human protein microarray, etc. Candidate proteins were validated using ELISA.Findings: The incidences of AMS in Control, Ripc, Rapid-Ripc, Acetazolamide, and Combined group were 26.0%, 22.0%, 28.0%, 14.0%, and 6.0% (P = 0.030). Combined group showed the lowest AMS score (0.92 (1.10). Acetazolamide and Combined group showed higher SpO2 (89-90%), lower pH (7.30-7.31) and HCO3- (18.1-20.8mmol/L). Thirty differentially expressed proteins (DEPs) related to immune-inflammatory process were identified after hypoxia, among which PDGF was involved. A significant reduction of PDGF-AB (-1.75 ng/ml, 95% CI: -2.3 to -1.2, P < 0.001) or PDGF-BB (-0.42 ng/ml, 95% CI: -0.7 to -0.1, P = 0.002) prior to hypoxia was associated with non-AMS. Both acetazolamide and RIPC down-regulated PDGF-AB, and RIPC also reduced PDGF-BB.Interpretation: The combination of acetazolamide and RIPC exerts a powerful anti-hypoxic effect and represents an innovative and promising strategy for rapid ascent to high altitudes. Acetazolamide induces mild metabolic acidosis to improve oxygen saturation. RIPC further assists acetazolamide in synergistically regulating PDGF, which probably protects vascular and barrier functions and ultimately prevents AMS following acute hypoxic exposure.Trial Registration: Registered on ClinicalTrials.gov (NCT05023941).Funding: Key Medical Professional Development Program of Beijing Hospital Management Center (ZYLX202139); National Natural Science Foundation of China (82171302); Beijing Health Technology Achievements and Appropriate Technology Promotion Project (BHTPP2022095).Declaration of Interest: We declare no competing interests.Ethical Approval: The study was approved by the Ethics Committee of the Xuanwu Hospital. All participants provided written informed consent. The study was conducted in compliance with the Declaration of Helsinki and Good Clinical Practice guidelines.

目的 根据公立医院高质量发展要求,探索基于双因素理论下的医学青年创新激励路径,为推动公立医院高质量发展提供参考与借鉴.方法 使用文献分析法对双因素理论、医院科研奖励机制和青年人才科研奖励机制进行调研;同时结合双因素理论与实践经验,分析公立医院在青年医学人才创新激励政策中存在的问题,提出相应对策,以构建双因素理论下青年医学人才创新激励路径.结果 管理者应在青年医学人才需求特征分析的基础上,区分保健因素和激励因素,从两方面入手实施激励.利用提高个人成就感、创造个人成长环境、晋升职称等手段提供激励因素,激发青年人才的创新动力;从工作条件、物质利益、薪酬水平等方面入手,落实保健因素.结论 高质量发展作为一种新的发展理念,不仅体现在以科技创新驱动的高质量发展上,更体现于管理机制的创新,让制度创新先行成为高质量发展的动力源.

目的 探讨基于心脑一体化CT血管成像(CTA)的心脑血管系统斑块特点及动脉狭窄情况对主要心血管不良事件(MACE)的预测作用.方法 前瞻性连续纳入2017年1月至2019年12月首都医科大学宣武医院神经内科具有心脑血管疾病危险因素的患者,对所有入组患者行心脑一体化CTA检查,评估血管狭窄情况和斑块特点,主要评估部位包括冠状动脉、主动脉弓、颅外颈动脉、颅内动脉4个部位的血管床.随后根据随访患者是否发生MACE事件(恶性心律失常、心肌梗死、心源性猝死、血运重建、脑血管缺血事件)将患者分为MACE组和无MACE组,采用多因素Logistic回归分析发生MACE的危险因素,采用受试者工作特征(ROC)曲线分析心脑血管系统的影像特点预测MACE的价值.结果 最终纳入研究的患者共328例,其中MACE组59例(恶性心律失常6例,心肌梗死11例,心源性猝死2例,血运重建14例,脑血管缺血事件26例),无MACE组269例.多因素Logistic回归分析结果显示,冠状动脉的点状钙化[OR=1.246(95％CI:1.044～1.486)]、冠状动脉狭窄程度越重[OR=2.886(95％CI:1.563～5.329)]和冠状动脉狭窄范围越大[OR=2.435(95％CI:1.261～4.701)]、颅外颈动脉的点状钙化[OR=1.451(95％CI:1.072～1.965)]是MACE的独立危险因素.ROC曲线分析结果显示,综合了冠状动脉点状钙化、冠状动脉狭窄程度、冠状动脉狭窄范围、颅外颈动脉点状钙化的心脑血管系统的影像评估模型对MACE的预测作用[曲线下面积为0.927(95％CI:0.893～0.953)]优于冠状动脉狭窄[包括狭窄范围和狭窄程度,其曲线下面积分别为0.875(95％CI:0.834～0.909)和0.904(95％CI:0.866～0.933)],差异均有统计学意义(均P<0.01).结论 心脑一体化CTA可以在一次扫描中实现对心脑大血管钙化斑块特点及血管狭窄的评估,对具有心脑血管疾病危险因素的患者进行MACE风险评估时需考虑心脑血管系统的斑块特点.

Objective:To evaluate the construction effect of famous doctor studio and the correlation among the acceptance indexes by analyzing the achievements of famous doctor studio in the First Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine.Methods:R software was used to count the relevant data of national famous medical studios approved from 2010 to 2018, and the advantages were analyzed by radar chart; Spearman correlation coefficient was calculated, and R software was used to draw the correlation heat map between the evaluation indexes; papers published by studio members during the construction period were retrieved, which were transformed into refworks format, imported into CiteSpace software to draw a visual knowledge map.Results:A total number of 506 articles were included in this study, involving 25 evaluation indexes and 22 national famous doctors' studios. The statistical analysis results showed that there was a significant positive correlation between the number of academic experience papers of famous and senior TCM experts published in core journals (V3) and the number of diagnosis and treatment schemes of dominant diseases (V1), and there was a significant negative correlation between 8 groups of indexes; Tinnitus, insomnia, premature ovarian failure, acupuncture and acupuncture therapy are research hotspots.Conclusions:When evaluating the construction effect of famous doctor studio, various indicators should be considered comprehensively, appropriately control of the number of members is helpful to improve the quality of talent training, and pay attention should be paid to experience exchange and thought collision during the training process.