Disability Rates Research Articles

Analysis of Factors Associated to Hemorrhagic Transformation After Recanalization of Acute Ischemic Stroke

Ischemic stroke is associated with high rates of mortality and disability, making it an urgent issue that requires immediate attention. However, patients with acute ischemic stroke (AIS) can open the occluded cerebral vessels timelier, restore cerebral perfusion, save the ischemic penumbra, and bring better prognosis. However, a considerable number of patients still have poor clinical outcome due to complications such as hemorrhagic transformation (HT) after vascular reopening. The specific mechanism of HT after recanalization treatment is currently not fully understood. Studies have shown that multiple factors are associated with bleeding transformation after mechanical thrombectomy in AIS patients. Some studies suggest that the damage of ischemia and reperfusion and vascular permeability may play a role. This paper summarizes the possible mechanisms and related influencing factors of HT after vascular recanalization treatment of AIS patients to further guide the treatment and management decisions of AIS patients.

Exploiting the role of CSF NfL, CHIT1, and miR-181b as potential diagnostic and prognostic biomarkers for ALS.

Amyotrophic lateral sclerosis (ALS) is a rare neurodegenerative disorder characterized by relentless and progressive loss of motor neurons. A molecular diagnosis, supported by the identification of specific biomarkers, might promote the definition of multiple biological subtypes of ALS, improving patient stratification and providing prognostic information. Here, we investigated the levels of neurofilament light chain (NfL), chitotriosidase (CHIT1) and microRNA-181b (miR-181b) in the cerebrospinal fluid (CSF) of ALS subjects (N = 210) as well as neurologically healthy and neurological disease controls (N = 218, including N = 74 with other neurodegenerative diseases) from a large European multicentric cohort, evaluating their specific or combined utility as diagnostic and prognostic biomarkers. NfL, CHIT1 and miR-181b all showed significantly higher levels in ALS subjects compared to controls, with NfL showing the most effective diagnostic performance. Importantly, all three biomarkers were increased compared to neurodegenerative disease controls and, specifically, to patients with Alzheimer's disease (AD; N = 44), with NfL and CHIT1 being also higher in ALS than in alpha-synucleinopathies (N = 22). Notably, ALS patients displayed increased CHIT1 levels despite having, compared to controls, a higher prevalence of a polymorphism lowering CHIT1 expression. While no relationship was found between CSF miR-181b and clinical measures in ALS (disease duration, functional disability, and disease progression rate), CSF NfL was the best independent predictor of disease progression and survival. This study deepens our knowledge of ALS biomarkers, highlighting the relative specificity of CHIT1 for ALS among neurodegenerative diseases and appraising the potential diagnostic utility of CSF miR-181b.

Clinical Treatment Progress for Large Metacarpal and Phalangeal Bone Defects.

Large metacarpal and phalangeal bone defects are a hot topic for orthopedic surgeons due to its high clinical incidence, disability rate, and postsurgical amputation rate, along with its difficult treatment, long treatment course, high cost, and poor effect, all of which have a negative impact on the appearance and function of the patient's hands. There are currently a variety of treatment options for large metacarpal and phalangeal bone defects, each with its own benefits and drawbacks. However, there is no treatment method capable of perfectly resolving all the problems of patients with these defects. In this paper, the authors introduce several common plans for and progress of large metacarpal and phalangeal bone defect treatment.

Association between marine corps safety management system assessment results and injury rates and outcomes

Occupational health and safety management systems (OHSMSs) have been proposed as a method of managing human health and safety risk and reduce injuries and illnesses. The investigation objective was to determine the association between OHSMS performance, as measured by scores from assessments and inspections, and mishap rates and mishap outcomes. Results for 55 OHSMS assessments/inspections across 15 organizations from the years 2017–2022 were analyzed. Results were paired with 545 mishaps and according to mishap classification, mishap category, and mishap severity. Correlation analysis was conducted to determine strength and significance of association between OHSMS performance and mishap rates. Improved OHSMS performance, as measured by scores from assessments and inspections, was associated with lower severity mishap occurrence such as reduced rates of fatalities, permanent total and partial disability, and property damage. Mishaps involving fatalities and permanent total disability had the strongest association with measured OHSMS performance. This research indicates that higher levels of OHSMS performance may help reduce severe worker injuries and illnesses and reduce mishap costs.

Adverse health effects of climate change and air pollution in people with disabilities: a systematic review.

Global warming and air pollution adversely affect the health of the entire human population, particularly older adults, people with disabilities (PWDs), and children. In this systematic review, we investigated the adverse health effects of climate change and air pollution in PWDs. We conducted a comprehensive literature search of the PubMed database using the terms "disab*," "air pollution," and "climate change" on July 4, 2023, and August 8, 2023 and searched the Web of Science (WOS) database on December 28, 2023. We identified 425 and 1169 studies on climate change cited in PubMed and WOS, respectively, as well as 333 studies on air pollution in PubMed and 495 studies on air pollution in WOS. The studies were classified by type of exposure, and full-text screening was conducted to confirm that the population, intervention or exposure, comparator, outcome statement, and inclusion and exclusion criteria were met. The Newcastle-Ottawa Scale was used to assess the quality of the included cohort and case-control studies and for data analysis. In extreme temperatures, PWDs experienced higher rates of injury, heat-related illness, functional impairment, heart disease, mental disorders, and mortality than people who were nondisabled (ND). Exposure to air pollution resulted in higher rates of obesity, cardiovascular disease, poststroke neurological and functional disability, and mortality in PWDs than in people who were ND. Therefore, because PWDs were more affected by climate change and air pollution than people who were ND, sensitive policies and preparedness measures should be developed for PWDs.

Single-dose psilocybin for U.S. military Veterans with severe treatment-resistant depression – A first-in-kind open-label pilot study

BackgroundThe enduring and severe depression often suffered by Veterans causes immense suffering and is associated with high rates of suicide and disability. This is the first study to evaluate the efficacy and safety of psilocybin in Veterans with severe treatment-resistant depression (TRD). Methods15 Veterans with severe TRD (major depressive episode failing to respond to ≥5 treatments, or lasting >2 years) received 25 mg of psilocybin. Primary outcome was change in Montgomery-Åsberg Depression Rating scale (MADRS) at 3 weeks posttreatment. Response was defined s ≥ 50 % reduction in MADRS, and remission as ≤10 MADRS score. Psychedelic experience was assessed using the Five-Dimensional Altered States of Consciousness scale (5D-ASC). Safety measures included assessment of suicidality and adverse events. Participants on antidepressants were tapered to avoid drug interactions. ResultsOf 15 participants, 60 % met response and 53 % met remission criteria at Week 3. At 12 weeks, 47 % maintained response, and 40 % remission. Co-morbid PTSD did not significantly influence study outcomes. The psychedelic experience reported in 5D-ASC did not correlate with response. Participants judged to need antidepressants were restarted and considered non-responders from that timepoint (n = 4). No unexpected adverse events occurred. LimitationsLimitations include the small sample size, and the uncontrolled and unblinded nature of the study. ConclusionsIn this first study on psilocybin for Veterans with severe TRD, a surprising response and remission was seen. Many Veterans had PTSD though no moderating impact of response was observed. The degree of psychedelic experience did not correlate with depression changes. Further study is warranted.TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT04433858.

Research Progress on the Intervention of Traditional Chinese Medicine in Signal Pathways Related to Acute Cerebral Infarction

Acute cerebral infarction is a disease with high incidence, mortality, and disability rates. Its etiology is complex, and the exact pathogenesis is not yet fully understood. Current studies often involve inflammatory responses, apoptosis, oxidative stress, atherosclerosis, excitotoxicity, and free radical chain reactions. Signal pathways play a crucial role in the occurrence and development of this condition. Traditional Chinese medicine can improve the condition of patients with acute cerebral infarction by intervening in multiple signal pathways. This paper systematically reviews recent literature, identifying 11 key signal pathways, including NLRP3, TLR4/NF-κB, Nrf2/ARE, CD40/CD40L, JAK/STAT, PI3K/AKT, JNK/p38 MAPK, Wnt, Notch, RhoA/ROCK, and ERK1/2. The aim is to provide some reference for the research on traditional Chinese medicine treatments for acute cerebral infarction.

Thoracic Trauma: Diagnosis And Treatment

The study of chest injuries which profoundly impact quality of life, life expectancy, disability rates, and mortality is of significant importance. In clinical research, the authors analyzed diagnostic results from 527 patients aged 18 to 85 with closed chest trauma, consisting of 82% men and 18% women. The study confirms that traumatic chest injuries are severe conditions that necessitate strict adherence to well-defined diagnostic and treatment guidelines. It is advisable to utilize thoracoscopy and video-assisted thoracoscopy for managing hemothoraxes with small volumes of bleeding, as these minimally invasive techniques can enhance patient outcomes and reduce recovery times. The incorporation of advanced three-dimensional (3D) printing technologies into medical practice for chest injuries is also recommended, as it can improve surgical planning and enable personalized treatment strategies. Moreover, 3D printing can aid in the fabrication of patient-specific implants and prosthetics, thereby enhancing the effectiveness of reconstructive surgeries. Further research is needed on pharmacotherapy when using medications in accordance with the codes of the 11th revision of the International Classification of Diseases, to optimize therapeutic efficacy. Additionally, an in-depth study of the integrated ABC/VEN-analysis of drug prescriptions in pharmacotherapeutic regimens for thoracic trauma treatment dynamics in both inpatient and outpatient healthcare facilities is recommended. This could lead to better resource allocation, improved patient care, and the development of more effective treatment protocols. Emphasizing interdisciplinary collaboration among surgeons, radiologists, and pharmacologists is crucial to advance the management of chest trauma, ensuring that patients receive comprehensive and holistic care throughout their recovery process.

Use of biomarkers in the diagnosis of Alzheimer's disease in adults with intellectual disability.

People with intellectual disability are a vulnerable cohort who face challenges accessing health care. Compared with the general population, people with intellectual disability have an elevated risk of developing dementia, which often presents at a younger age and with atypical symptoms. The lifelong cognitive and functional difficulties faced by people with intellectual disability further complicate the diagnostic process. Specialised intellectual disability memory services and evaluation using reliable biomarkers of neurodegeneration are needed to improve diagnostic and prognostic certainty in this group. Inadequate specialist services and paucity of research on biomarkers in this population hinders progress and impedes the delivery of adequate health care. Although cerebrospinal fluid-based biomarkers and radiological biomarkers are used routinely in the evaluation of Alzheimer's disease in the general population, biological variation within the clinically heterogenous group of people with intellectual disability could affect the clinical utility of existing biomarkers. As disease-modifying therapies become available for the treatment of early Alzheimer's disease, and hopefully other neurodegenerative conditions in the future, biomarkers will serve as gatekeepers to establish the eligibility for such therapies. Inadequate representation of adults with intellectual disability in biomarker research will result in their exclusion from treatment with disease-modifying therapies, thus perpetuating the inequity in health care that is already faced by this group. The aim of this Series paper is to summarise current evidence on the application of biomarkers for Alzheimer's disease in a population with intellectual disability (that is not attributable to Down syndrome) and suspected cognitive decline.

Are combined conservative interventions effective in reducing pain, disability and/or global rating of pain in people with sciatica with known neuropathic pain mechanisms?

National Clinical Guidelines recommend an integrated combination of conservative management strategies for sciatica. However, the efficacy of such combinations have not been established. The purpose of this systemic review with meta-analysis was to determine the efficacy of combined conservative (non-pharmacological) compared to single interventions for people with sciatica with a confirmed neuropathic mechanism. The systematic review was registered on PROSPERO CRD42023464011. The databases included were the Cochrane Central Register of Controlled Trials (CENTRAL), CINAHL (EBSCO), Embase, PubMed, Scopus, APA PsycINFO, and grey literature sources from inception until January 2024. Inclusion criteria were randomized controlled trials that assessed the effectiveness of combined non-pharmacological interventions in comparison to a control intervention among individuals with sciatica of a neuropathic origin identified using diagnostic or clinical tests. Primary outcomes were back pain, leg pain, and disability. The secondary outcome was global rating of change. Study selection, data extraction and risk of bias assessment (using Cochrane ROB2) were assessed by two reviewers. Meta-analysis was performed with a random effects model with inverse variance weighting used for the metanalysis using SPSS v 29. 3,370 articles were identified, of which 6 were included. Risk of bias was high in one study and had some concerns in the remaining 5 studies for each outcome measure. There was evidence of efficacy for combined interventions for back pain in the short-and long-term (SMD - 0.56 (95% CI -0.91, -0.22, p = 0.01, I2 = 0.2; SMD - 0.44 (95% CI -0.79, -0.1, p = 0.03, I2 = 0.00), and for disability in the short term (SMD - 0.48 (95% CI -0.92, -0.04, p = 0.04, I2 = 0.72). There was no evidence of efficacy for leg pain at any time point (( short term SMD - 0.45 (95% CI -0.91, 0.02, p = 0.06, I2 = 0.65), medium term (SMD - 0.29 (95% CI -1.12, 0.54, p = 0.35, I2 = 0.82), long term (SMD - 0.40 (95% CI -1.23, 0.44, p = 0.18, I2 = 0.57).Certainty of evidence ranged from very low to moderate. There are few studies that have combined conservative (non-pharmacological) interventions for the management of sciatica with a neuropathic component pain mechanism, as recommended by National Clinical Guidelines. This review indicates that combining conservative (no-pharmacological) management strategies appeared more effective than single interventions for the outcomes of low back pain in the short and long term, and for disability in the short term, but not for leg pain at any time point. The overall low certainty of evidence, suggests that future studies with more robust methodologies are needed.

Hyperbaric oxygen for moderate-to-severe traumatic brain injury: outcomes 5-8 years after injury.

The use of hyperbaric oxygen (HBO 2 ) in the field of traumatic brain injury (TBI) is becoming more widespread and increasing yearly, however there are few prognostic reports on long-term functional efficacy. The aim of this study was to assess the functional prognosis of patients with moderate-to-severe TBI 5-8 years following HBO 2 treatments and to explore the optimal HBO 2 regimen associated with prognosis, using a retrospective study. Clinical data were retrospectively collected as a baseline for patients with moderate-to-severe TBI treated with HBO 2 during inpatient rehabilitation from January 2014 to December 2017. The primary outcome measure was the Disability Rating Scale (DRS) and the secondary outcome measure was the Glasgow Outcome Scale. A total of 133 patients enrolled, with 9 (6.8%) dying, 41 (30.8%) remaining moderately disabled or worse (DRS scores 4-29), 83 (62.4%) remaining partially/mildly disabled or no disability (DRS scores 0-3). Logistic regression analysis revealed that age at injury (odds ratio (OR), 0.96; 95% confidence interval (CI), 0.92-0.99), length of intensive care unit stay (OR, 0.94; 95% CI, 0.88-0.99), and HBO 2 sessions (OR, 0.97; 95% CI, 0.95-0.99) were variables that independently influenced long-term prognosis. Cubic fitting models revealed that 14 and 21.6 sessions of HBO 2 could be effective for moderate and severe TBI, respectively. This study highlighted that HBO 2 in moderate-to-severe TBI may contribute to minimize death and reduce overall disability in the long-term. However, clinicians should be cautious of the potential risk of adverse long-term prognosis from excessive HBO 2 exposure when tailoring individualized HBO 2 regimens for patients with moderate-to-severe TBI. The study was registered on ClinicalTrials.gov (NCT05387018) on March 31, 2022.

Some risk factors for recurrent ischemic stroke caused by middle cerebral artery damage

Background and Purpose: Recurrent ischemic stroke due to damage to the middle cerebral artery causes deterioration of neurological function and increases the rate of disability, death, and treatment costs many times compared to the first ischemic stroke. Assessing risk factors plays an extremely important role in preventing recurrent ischemic stroke. We have discuss some risk factors for recurrent ischemic stroke caused by middle cerebral artery damage. Research subjects and methods: Cross-sectional descriptive study on 77 patients with recurrent ischemic stroke due to middle cerebral artery damage at the Neurology Center - Bach Mai Hospital from July 2021 to August 2022. Summary of review: There were 22 female patients and 55 male patients with an average age of 65 ± 11 years old, predominantly in the age group of 61 - 70 years old (making up 44.2% of the total). The majority of patients experienced their first recurrence (64.9%). The timeframe between the most recent ischemic stroke and the recurrent event ranged from 12 months to 5 years, with the highest occurrence rate at 33.8%. Hypertension has the highest rate among risk factors (88.3%); Hyperlipidemia follows as the second leading risk factor (49.4%). Patients with recurrent ischemic stroke caused by middle cerebral artery damage showed limited effectiveness in recurrence prevention treatment: 68.8% did not adhere to antiplatelet medication or had recently stopped taking them. 81.8% did not consistently receive statin treatment as prescribed. There is a significant difference in clinical recovery levels based on the mRS among patients with and without hypertension (p=0.023); with and without hyperlipidemia (p=0.044); among patients receiving regular and irregular antithrombotic therapy (p < 0.005); among patients receiving regular and irregular statin therapy (p = 0.01). Conclusion: Our research indicates that recurrent ischemic stroke resulting from middle cerebral artery damage presents a higher number of risk factors, and the efficacy of recurrence prevention treatment is suboptimal.

Exploring the role of traditional Chinese medicine rehabilitation in stroke based on microRNA-mediated pyroptosis: A review.

Stroke, also known as "cerebrovascular accident," is a disease caused by acute impairment of brain circulation, which has a high rate of disability and mortality. Ischemic stroke (IS) is the most common type of stroke and a major cause of death and disability worldwide. At present, there are still many limitations in the treatment of IS, so it may be urgent to explore more treatments for IS. In recent years, the clinical application of traditional Chinese medicine rehabilitation methods such as traditional Chinese medicine, acupuncture, massage, traditional exercises and modern rehabilitation technology has achieved good results in the treatment of IS. Concurrently, studies have identified microRNA (miRNA), which are intimately associated with traditional Chinese medicine rehabilitation, as regulators of pyroptosis through their influence on microglia activity, inflammatory response, oxidative stress, angiogenesis and other factors, but at present, the mechanism of this direction has not been systematically summarized. Consequently, this article delineates in detail the specific role of miRNA in IS and the related activation pathways of pyroptosis in IS. This article presents a detailed discussion of the role of microRNA-mediated pyroptosis in IS, with a particular focus on the signaling pathways involved. The aim is to provide new insights for the research of traditional Chinese medicine (TCM) rehabilitation in the prevention and treatment of IS. In addition, the article explores the potential of TCM rehabilitation in regulating miRNA-mediated pyroptosis to intervene in IS.

Comorbidity and Disease Activity in Multiple Sclerosis

Multiple studies suggest that comorbidity worsens clinically relevant outcomes in multiple sclerosis (MS), including the severity of disability at diagnosis and rate of disability worsening after diagnosis. However, less is known regarding the association of comorbidity with measures of disease activity, such as relapse rate and magnetic resonance imaging lesion accrual, which are relevant to clinicians and clinical trialists. To evaluate the association of comorbidities with disease activity in clinical trials of disease-modifying therapies (DMTs) in populations with MS. A 2-stage meta-analytic approach was used in this cohort study of individual participant data from phase 3 clinical trials of MS DMTs that had 2 years of follow-up and were conducted from November 2001 to March 2018. Data were analyzed from February 2023 to June 2024. Comorbidity burden and individual comorbidities present at trial enrollment, including hypertension; hyperlipidemia; functional cardiovascular disease, ischemic heart, cerebrovascular, and peripheral vascular disease; diabetes; autoimmune thyroid and miscellaneous autoimmune conditions; migraine; lung and skin conditions; depression; anxiety; and other psychiatric disorders. The main outcome was evidence of disease activity (EDA) over 2 years of follow-up, defined as confirmed relapse activity, disability worsening, or any new lesions on magnetic resonance imaging. A total of 16 794 participants with MS were included from 17 clinical trials (67.2% female). Over the 2-year follow-up, 61.0% (95% CI, 56.2%-66.3%; I2 = 97.9%) of the pooled trials had EDA. After adjusting for multiple factors, the presence of 3 or more comorbidities was associated with an increased hazard of EDA (adjusted hazard ratio [AHR], 1.14; 95% CI, 1.02-1.28) compared with no comorbidity. Presence of 2 or more cardiometabolic conditions was also associated with an increased hazard of EDA (AHR, 1.21; 95% CI, 1.08-1.37) compared with no cardiometabolic comorbidity. Presence of 1 psychiatric disorder was associated with an increased hazard of EDA (AHR, 1.07; 95% CI, 1.02-1.14). In this study, a higher burden of comorbidity was associated with worse clinical outcomes in people with MS, although comorbidity could potentially be a partial mediator of other negative prognostic factors. Our findings suggest a substantial adverse association of the comorbidities investigated with MS disease activity and that prevention and management of comorbidities should be a pressing concern in clinical practice.

Insights into epidemiological trends of severe chest injuries: an analysis of age, period, and cohort from 1990 to 2019 using the Global Burden of Disease study 2019

BackgroundThis study assessed the global trends and burden of severe chest injury, including rib fractures, lung contusions, and heart injuries from 1990 to 2019. Herein, we predicted the burden patterns and temporal trends of severe chest injuries to provide epidemiological evidence globally and in China.MethodsIn our analysis, the age-standardized incidence rate (ASIR), prevalence rate (ASPR), and years lived with disability rate (ASYR) of severe chest injury were analyzed by gender, age, sociodemographic index, and geographical region between 1990 and 2019 using data from the Global Burden of Disease study 2019. Trends were depicted by calculating the estimated annual percentage changes (EAPCs). The impact of age, period, and cohort factors was assessed using an Age-Period-Cohort model. Autoregressive integrated moving average (ARIMA) model was employed to predict severe chest injury trends from 2020 to 2050.ResultsIn 2019, the global number of severe chest injury cases reached 7.95 million, with the highest incidence rate observed in Central Europe (209.61). Afghanistan had the highest ASIRs at 277.52, while North Korea had the lowest ASIRs at 41.02. From 1990 to 2019, the Syrian Arab Republic saw significant increases in ASIR, ASPR, and ASYR, with EAPCs of 10.4%, 9.31%, and 10.3%, respectively. Burundi experienced a decrease in ASIR with an EAPC of − 6.85% (95% confidence interval [CI] − 11.11, − 2.37), while Liberia’s ASPR and ASYR declined with EAPCs of − 3.22% (95% CI − 4.73, − 1.69) and − 5.67% (95% CI − 8.00, − 3.28), respectively. Falls and road injuries remained the most common causes. The relative risk of severe chest injury by age, period, and cohort demonstrated a complex effect globally and in China. The ARIMA model forecasted a steady increase in global numbers from 2020 to 2050, while in China, it forecasted an increase in incidence, a decrease in ASIR and ASYR, and an increase in ASPR.ConclusionsThis study provides a groundbreaking analysis of global severe chest injury, shedding light on its measures and impact. These findings highlight the need for timely, specialized care and addressing regional disparities to mitigate the severe chest injury burden.

Current Patient Management for Bacterial Meningitis Simultaneously Affected by Stroke.

Bacterial meningitis (BM) is a critical central nervous system infection characterized by increased risks of complications and potentially fatal outcomes. The chances of full recovery are significantly reduced in the presence of concomitant neurovascular complications such as ischemic and hemorrhagic strokes, intracerebral hemorrhage, and cerebral sinus thrombosis. Effective treatment of BM requires a targeted approach that simultaneously addresses the causative pathogen and manages the neurologically related complications. However, clinicians continue to face challenges in determining optimal pharmacotherapy for these patients.The presence of neurological complications is pivotal in determining patient outcomes, contributing to high disability and mortality rates. Early medical management is crucial and begins with essential stabilization followed by rapid diagnostic testing and the administration of empirical broad-spectrum antimicrobial therapy. The use of targeted antibiotics based on culture results is standard, with adjunct therapies such as dexamethasone and, in some cases, anticoagulants playing supportive roles. Despite the deployment of such comprehensive therapeutic strategies, the variability in treatment response and the high incidence of adverse outcomes necessitate ongoing research. This includes exploring novel therapeutic approaches and enhancing current clinical practices through retrospective studies and clinical trials to mitigate the high morbidity and mortality rates associated with BM and its complications. Strategic management is crucial for patient recovery, considering the substantial risk, a broad spectrum of complications, and fatal outcomes from this meningeal infection and stroke. The use of antimicrobial therapy with intravenous adjunct dexamethasone isthe current standard of care for patients with cerebrovascular complications and acute BM. In addition, other options that can provide benefits in complicated cases include anticoagulants and neurosurgery. Further investigation into treatment algorithms for patients with meningeal infection complicated by stroke and/or increased intracranial pressure is still needed.

Global trends of Pauwels type III femoral neck fractures: bibliometric analysis and visualized study.

Pauwels type III femoral neck fractures, as a serious type of femoral neck fractures, have brought about a heavy economic burden on families and society for the high disability rate. Through bibliometric research and visualized analysis, this study aimed at elucidating the global research status of Pauwels type III femoral neck fractures to date, and predicting the future research trends in this field. Publications and associated information on Pauwels type III femoral neck fractures to date were retrieved from Web of Science Core Collection, and by VoSviewer and R package "bibliometrix", bibliometric analysis and visual presentation was conducted. By retrieval, a total of 98 studies were refinedly extracted, and the volume of publications in this field increased year-over-year. China ranked first in terms of total publication volume and H-Index, with its total citation records second only to the United States. The country with the highest average citation frequency was Switzerland. SHANGHAI JIAO TONG UNIVERSITY was the most productive research institution. Among the authors in this field, Li, Jiantao had published the most researches. INJURY INTERNATIONAL JOURNAL OF THE CARE OF THE INJURED and JOURNAL OF ORTHOPAEDIC TRAUMA were the two magazines with the highest publication volume, total citation records, and H-index. According to keywords co-occurrence analysis, the research content in the past 24 years is mainly divided into four different dimensions. Finite element analysis, femoral neck system, medial buttress plate, cannulated screws, hip screw, open reduction, complications are hot topics for future research. According to the global trends analysis of publications production, Pauwels type III femoral neck fractures are receiving increasing attention and input from scholars. China has made the greatest scientific research contribution among countries, but its academic quality should be improved further. The modified therapeutic methods designed for addressing the complications of traditional internal fixation for Pauwels III femoral neck fractures will be the future research hotspot.

The Aging Immune System: A Critical Attack on Ischemic Stroke.

Ischemic stroke caused by cerebrovascular embolism is an age-related disease with high rates of disability and mortality. Although the mechanisms of immune and inflammatory development after stroke have been of great interest, most studies have neglected the critical and unavoidable factor of age. As the global aging trend intensifies, the number of stroke patients is constantly increasing, emphasizing the urgency of finding effective measures to address the needs of elderly stroke patients. The concept of "immunosenescence" appears to explain the worse stroke outcomes in older individuals. Immune remodeling due to aging involves dynamic changes at all levels of the immune system, and the overall consequences of central (brain-resident) and peripheral (non-brain-resident) immune cells in stroke vary according to the age of the individual. Lastly, the review outlines recent strategies aimed at immunosenescence to improve stroke prognosis.

ROS exhaustion reverses the effects of hyperbaric oxygen on hemorrhagic transformation through reactivating microglia in post-stroke hyperglycemic mice

Acute ischemic stroke (AIS) is a major global health concern due to its high mortality and disability rates. Hemorrhagic transformation, a common complication of AIS, leads to poor prognosis yet lacks effective treatments. Preclinical studies indicate that hyperbaric oxygen (HBO) treatment within 12 h of AIS onset alleviates ischemia/reperfusion injuries, including hemorrhagic transformation. However, clinical trials have yielded conflicting results, suggesting some underlying mechanisms remain unclear. In this study, we confirmed that HBO treatments beginning within 1 h post reperfusion significantly alleviated the haemorrhage and neurological deficits in hyperglycemic transient middle cerebral arterial occlusion (tMCAO) mice, partly due to the inhibition of the NLRP3 inflammasome-mediated pro-inflammatory response in microglia. Notably, reactive oxygen species (ROS) mediate the anti-inflammatory and protective effect of early HBO treatment, as edaravone and N-Acetyl-l-Cysteine (NAC), two commonly used antioxidants, reversed the suppressive effect of HBO treatment on NLRP3 inflammasome-mediated inflammation in microglia. Furthermore, NAC countered the protective effect of early HBO treatment in tMCAO mice with hyperglycemia. These findings support that early HBO treatment is a promising intervention for AIS, however, caution is warranted when combining antioxidants with HBO treatment. Further assessments are needed to clarify the role of antioxidants in HBO therapy for AIS.

Investigating the Effects of Simultaneous Administration of Melatonin and Atorvastatin against High Glucose-Induced Oxidative Stress and Apoptosis in Cultured Chondrocytes.

Osteoarthritis (OA) is a prevalent joint disorder categorized into phenotypic subtypes, including those associated with age, traumatic events, and metabolic syndrome. In the aging population, type 2 diabetes mellitus (T2DM) and osteoarthritis (OA) frequently coexist. This can result in higher rates of disability and a greater financial burden. This study aimed to investigate the protective effects of melatonin and atorvastatin together against oxidative stress and apoptosis induced by high glucose in C28I2 human chondrocytes. After being pretreated for 6 hours with melatonin (10 and 100 μM) and atorvastatin (0.01 and 0.1 μM), C28I2 cells were exposed to a high concentration of D-glucose (75 mM) for 72 hours. The impact of a high D-glucose concentration (75 mM), with or without melatonin and/or atorvastatin, on cell viability, intra-cellular ROS generation, lipid peroxidation level, antioxidant activities, and the expression of proteins, including Bax, Bcl-2, and caspase-3, was analyzed. Melatonin and atorvastatin combination effectively inhibited high glucose-induced cytotoxicity, ROS production, and MDA and mitochondrial membrane potential levels. The combination of melatonin and atorvastatin was more successful in reducing ROS production compared to each of the drugs alone. Melatonin, but not atorvastatin, reversed high glucose-induced alteration in the catalase activity. Furthermore, the combination of melatonin and atorvastatin significantly enhanced the ability of each medication to lower the expression of pro-apoptotic protein Bax. The combination of melatonin and atorvastatin exerted greater protective effects against hyperglycemia-induced toxicity in chondrocytes.