Abstract:Objective To investigate the predictive value of blood pressure variability for the prognosis of decompressive craniectomy in patients with severe traumatic brain injury(sTBI).Methods Clinical data of 86 sTBI patients who underwent decompressive craniectomy,were analyzed retrospectively.Prognosis was assessed using the Glasgow Outcome Scale(GOS)at 3 months postoperatively,and patients were divided into a poor prognosis group(n=42,GOS≤3 points)and a good prognosis group(n=44,GOS≥4 points)based on GOS scores.Differences in clinical data between the two groups were compared.The LASSO-logistic regression model and the receiver operating characteristic(ROC)curve were used to analyze the impact of blood pressure variability,including the standard deviation(SD)and coefficient of blood pressure variation(CV)of systolic pressure(SBP)and diastolic pressure(DBP)at admission and 24 and 72 h post-admission,on the prognosis of sTBI patients.Results The poor prognosis group had higher intracranial hematoma volume,preoperative intracranial pressure,and proportion of patients with preoperative midline shift≥10 mm compared to the good prognosis group,while the preoperative Glasgow Coma Scale(GCS)score was lower in the poor prognosis group(all P<0.05).The SD of SBP(SDSBP),SD of DBP(SDDBP),CV of SBP(CVSBP),and CV of DBP(CVDBP)at 24 and 72 h post-admission were all higher in the poor prognosis group than in the good prognosis group(all P<0.05).LASSO screening identified four non-zero coefficients(intracranial pressure,intracranial hematoma volume,72-h SDSBP,and 72-h CVSBP).Further multivariate logistic regression analysis showed that intracranial pressure(OR=1.161,95%CI:1.043-1.293),72-h SDSBP(OR=1.344,95%CI:1.073-1.683),and 72-h CVSBP(OR=6.031,95%CI:2.332-15.601)were risk factors for poor prognosis after decompressive craniectomy in sTBI patients(all P<0.05).The ROC curve indicated that the area under the curve(AUC)for predicting poor prognosis in sTBI patients was 0.801(95%CI:0.711-0.892)for 72-h SDSBP and 0.810(95%CI:0.719-0.901)for 72-h CVSBP.Conclusions The 72-h SDSBP and CVSBP are key predictors of poor prognosis after decompressive craniectomy in sTBI patients and demonstrate good predictive efficacy for patient prognosis.

Abstract:Objective To explore the influencing factors of foot muscle tone disorders in patients with Parkinson's disease(PD)and to construct and validate a risk prediction model.Methods Clinical data of 124 PD patients were analyzed retrospectively,who were divided into the occurrence group and the non-occurrence group based on the presence or absence of foot muscle tone disorders.Multivariate logistic regression analysis was used to identify the influencing factors of foot muscle tone disorder in PD patients,and a nomogram risk prediction model for foot muscle tone disorder in PD patients was developed.The discrimination and calibration of the nomogram model were evaluated using the receiver operating characteristic(ROC)curve and calibration curve.Results There were 23 patients(18.55%)in the occurrence group and 101 patients(81.45%)in the non-occurrence group.Statistically significant differences were observed between the two groups in terms of the mini-mental state examination(MMSE)score,activities of daily living(ADL)score,C-reactive protein(CRP)level,interleukin-6(IL-6)level,unified Parkinson's Disease rating scale(UPDRS)Ⅰ and Ⅲ scores,PD disease duration,age of PD onset,gender,and PD stage(all P<0.05).Multivariate logistic regression analysis revealed that female gender,disease duration≥5 years,age of onset<60 years,advanced PD stage,high UPDRS Ⅰ score,and elevated IL-6 level were independent risk factors for foot dystonia in PD patients(all P<0.05).Internal validation showed that the C-index of the nomogram model for predicting foot muscle tone disorders in PD patients was 0.810.The ROC curve of the nomogram indicated that the area under the curve(AUC)for predicting foot muscle tone disorders in PD patients was 0.919(95%CI:0.806～0.977),with a sensitivity of 89.47%and a specificity of 87.10%,demonstrating good predictive performance.The calibration curve of the nomogram model for predicting foot muscle tone disorders in PD patients was close to the ideal curve,indicating high accuracy of the prediction results.Conclusions The nomogram model constructed based on gender,disease duration,age of onset,PD stage,UPDRS Ⅰ score,and serum inflammatory factor levels can effectively predict the risk of foot muscle tone disorders in PD patients,demonstrating good clinical application value and providing a basis for early clinical intervention.

Abstract:Objective To investigate the risk factors for re-occlusion after mechanical thrombectomy in patients with cerebral infarction and to construct a Nomogram predictive model.Methods A total of 257 patients with cerebral infarction treated with mechanical thrombectomy were selected and divided into a modeling set(180 cases)and a validation set(77 cases).After a 1-year follow-up,patients in the modeling set were grouped based on the occurrence of re-occlusion,with 50 cases in the re-occlusion group and 130 cases in the non-re-occlusion group.The incidence of re-occlusion after mechanical thrombectomy was approximately 27.78%.Baseline data of patients with cerebral infarction in the modeling set were analyzed.Univariate and logistic regression analyses were employed to screen for risk factors for re-occlusion after mechanical thrombectomy in patients with cerebral infarction.A nomogram predictive model was constructed using R software,and a goodness-of-fit test was performed.Results Statistically significant differences were observed between the two groups of patients with cerebral infarction in terms of the infarction site,time from onset to recanalization,presence of comorbid diabetes,D-dimer levels,platelet count,and white blood cell count(all P<0.05).The infarction site,time from onset to recanalization,comorbid diabetes,D-dimer levels,and white blood cell count were identified as risk factors for re-occlusion after mechanical thrombectomy in patients with cerebral infarction(all P<0.05).The nomogram model demonstrated excellent performance in predicting the risk of re-occlusion after mechanical thrombectomy in patients with cerebral infarction,with a C-index of 0.991(95%CI:0.982-1.000).The calibration curve indicated high consistency between observed and predicted data.The decision curve showed that the model effectively provided standardized net benefits when the risk threshold was set at>0.14.Additionally,the validation set demonstrated good predictive accuracy of the model.Conclusions The infarction site,time from onset to recanalization,comorbid diabetes,D-dimer levels,and white blood cell count all influence the occurrence of re-occlusion after mechanical thrombectomy in patients with cerebral infarction.The nomogram model constructed based on these risk factors exhibits good predictive performance.

Abstract:Objective To investigate the impact of visinin-like protein 1(VILIP1),caveolin-1(Cav-1),and fibroblast growth factor receptor 1(FGFR1)levels on the prognosis of patients with severe traumatic brain injury(sTBI).Methods Clinical data of 86 sTBI patients(observation group)were analyzed retrospectively,and 50 healthy individuals who underwent physical examinations during the same period were selected as the control group.The levels of VILIP1,Cav-1,and FGFR1 were compared between the two groups.Based on the Glasgow Outcome Scale(GOS)score at three months after surgery,sTBI patients were divided into a good prognosis group(GOS≥4 points)and a poor prognosis group(GOS≤3 points).The levels of VILIP1,Cav-1,and FGFR1 were compared between sTBI patients with different prognoses.Binary logistic regression analysis was used to identify independent risk factors for poor prognosis in sTBI patients.The receiver operating characteristic(ROC)curve was used to analyze the clinical value of VILIP1,Cav-1,and FGFR1 levels in predicting poor prognosis in sTBI patients.Results Compared with the control group,the observation group had higher levels of VILIP1 and Cav-1 but lower levels of FGFR1(all P<0.05).Compared with the good prognosis group,the poor prognosis group had higher levels of VILIP1 and Cav-1 but lower levels of FGFR1(all P<0.05).Binary logistic regression analysis showed that high levels of VILIP1 and Cav-1 and low levels of FGFR1 were independent risk factors for poor prognosis in sTBI patients(all P<0.05).ROC analysis showed that the optimal cut-off values for predicting poor prognosis in sTBI patients were≥8.40 μg/L for VILIP1,≥25.30 μg/L for Cav-1,and≤4.88 μg/L for FGFR1,with area under the curve(AUC)values of 0.946,0.946,and 0.816,sensitivities of 84.62%,92.31%,and 92.31%,and specificities of 98.33%,88.33%,and 66.67%,respectively.The combined diagnosis yielded an AUC of 0.994,with a sensitivity of 96.15%and a specificity of 96.67%,demonstrating higher diagnostic efficacy compared to VILIP1 or FGFR1 alone(both P<0.05).Conclusions sTBI patients exhibit higher levels of VILIP1 and Cav-1 but lower levels of FGFR1.Those with a poor prognosis have even higher levels of VILIP1 and Cav-1 and lower levels of FGFR1.Detecting these three indicators is of great significance in predicting poor prognosis in sTBI patients.

Abstract:Objective To investigate the clinical efficacy of vertebral canal decompression,prying reduction,bone grafting,and internal fixation in the treatment of thoracolumbar burst fractures with nerve injury.Methods Ninety patients with thoracolumbar burst fractures and nerve injury were randomly divided into a control group(n=45,treated with conventional posterior pedicle screw internal fixation)and an observation group(n=45,treated with vertebral canal decompression,prying reduction,bone grafting,and internal fixation)using a random number table.The ratios of the anterior height of the injured vertebra,Cobb angle of the injured vertebra,proportion of the mid-sagittal diameter of the spinal canal at the injured level,the Visual Analogue Scale(VAS)score,and the Japanese Orthopaedic Association(JOA)lumbar score were compared between the two groups before surgery and at 3 months postoperatively.Additionally,the American Spinal Injury Association(ASIA)nerve injury grades were compared before surgery and at 6 months postoperatively.Continuous follow-up was conducted for 12 months,and the bone graft fusion rate and internal fixation failure rate were calculated for both groups.Results Compared with preoperative values,at 3 months postoperatively,both groups showed an increase in the ratio of the anterior height of the injured vertebra and the proportion of the mid-sagittal diameter of the spinal canal at the injured level,along with a decrease in the Cobb angle of the injured vertebra.The magnitude of change in these indicators was greater in the observation group than in the control group,with statistically significant differences(all P<0.05).Compared with preoperative values,at 3 months postoperatively,both groups exhibited a decrease in VAS scores and an increase in JOA scores,with the observation group showing lower VAS scores and higher JOA scores than the control group,the differences were statistically significant(both P<0.05).Compared with preoperative values,at 6 months postoperatively,both groups demonstrated significant improvement in ASIA neural injury grading,with the observation group showing superior ASIA grading to the control group at this time point,a difference that was statistically significant(P<0.05).The bone graft fusion rate in the observation group was 95.56%,higher than that in the control group(86.67%),while the internal fixation failure rate in the observation group was 6.67%,lower than that in the control group(13.33%),although these differences between groups were not statistically significant(both P>0.05).Conclusions Vertebral canal decompression,prying reduction,bone grafting,and internal fixation exhibit favorable clinical efficacy in treating thoracolumbar burst fractures with nerve injury,effectively restoring local anatomical structures,alleviating postoperative pain,and promoting the recovery of nerve and lumbar functions.

Abstract:Objective To investigate the correlation between ferroptosis in peripheral blood mononuclear cells(PBMC)and the occurrence of postoperative delirium in patients with hypertensive intracerebral hemorrhage(HICH).Methods Clinical data of 162 HICH patients who underwent surgical treatment were analyzed retrospectively.Based on whether postoperative delirium occurred within one week after surgery,the patients were divided into a control group(n=110,without postoperative delirium)and an observation group(n=52,with postoperative delirium).Baseline data,as well as levels of S100 calcium-binding protein β(S100-β),neuron-specific enolase(NSE),long-chain acyl-CoA synthetase 4(ACSL4),glutathione peroxidase 4(GPX4),and ferritin in PBMCs,were compared between the two groups.Binary logistic regression analysis was used to identify risk factors influencing the occurrence of postoperative delirium in HICH patients.Pearson correlation analysis was employed to assess the correlation between the levels of ACSL4,GPX4,and ferritin in PBMCs and the levels of S100-β and NSE in HICH patients.The receiver operator characteristic(ROC)curve was used to analyze the clinical value of ACSL4,GPX4,and ferritin levels in PBMCs in predicting postoperative delirium in HICH patients.Results Univariate analysis and binary logistic regression analysis revealed that a large volume of cerebral hemorrhage,low GPX4 levels,and high ACSL4 and ferritin levels were independent risk factors for the occurrence of postoperative delirium in HICH patients(all P<0.05).Pearson correlation analysis showed positive correlations between ACSL4 and ferritin levels in PBMCs and S100-β and NSE levels in HICH patients,while GPX4 levels were negatively correlated with S100-β and NSE levels(all P<0.001).ROC analysis indicated that the optimal cut-off values for predicting postoperative delirium in HICH patients were≥192.90 μg/L for ACSL4,≤25.65 μg/L for GPX4,and≥14.30 μg/L for ferritin in PBMCs,with area under the curve values of 0.863,0.857,and 0.796,respectively,sensitivities of 71.15%,92.31%,and 75.00%,and specificities of 88.18%,68.18%,and 72.73%,respectively.Conclusions The levels of ACSL4,GPX4,and ferritin in PBMCs can effectively reflect the degree of neurological injury in HICH patients and have certain value in predicting the occurrence of postoperative delirium.

Abstract:Ischemic stroke is a common disease which often cause both death and disability.Clinical treatment can reduce morbidity and mortality,but many patients still face serious neural deficit.The lack of treatment that promotes neural repair creates opportunities for exploring the development and use of biomaterials.Among the methods at present,hydrogels offer great hope for neural repair and tissue regeneration after stroke.As an ideal transport system,hydrogels have good biocompatibility,physical and chemical regulation,excellent load performance,and can improve the adverse microenvironment of stroke,help endogenous and exogenous regeneration and repair process.This article reviews recent advances in hydrogels for cerebral regeneration after ischemic stroke.

Abstract:Objective To investigate the impact of intracranial pressure(ICP)on the prognosis of patients with severe traumatic brain injury(sTBI)undergoing decompressive craniectomy.Methods The clinical data of 82 patients with sTBI were analyzed retrospectively,who underwent decompressive craniectomy.All patients received pre-and postoperative ICP monitoring.Based on the Glasgow Outcome Scale(GOS)scores at 6 months postoperatively,patients were divided into a good prognosis group(GOS≥4)and a poor prognosis group(GOS≤3).Clinical data were compared between the two groups,and multivariate logistic regression analysis and receiver operating characteristic(ROC)curve analysis were performed to evaluate the impact of ICP on patient prognosis.Additionally,differences in ICP levels among patients with different poor prognostic statuses(death,vegetative state,severe disability)and the predictive value of ICP for these outcomes were analyzed.Results Among the 82 sTBI patients,42 had poor prognosis(poor prognosis group),including 10 deaths,12 vegetative states,and 20 severe disabilities;40 had a favorable prognosis(good prognosis group),including 14 mild disabilities and 26 good recoveries.The poor prognosis group exhibited significantly higher intracranial hematoma volume,initial ICP,and postoperative ICP compared to the good prognosis group(all P<0.05).Multivariate logistic regression analysis revealed that intracranial hematoma volume(OR=1.459,95%CI:1.112-1.913),initial ICP(OR=1.260,95%CI:1.083-1.466),and postoperative ICP(OR=1.752,95%CI:1.228-2.501)were risk factors for a poor prognosis in sTBI patients(all P<0.05).Among patients with poor prognosis,significant differences were found in initial and postoperative ICP levels between those who died,were in a vegetative state,or had severe disability(all P<0.05).ROC curve analysis demonstrated that postoperative ICP had the highest area under the curve(AUC)for predicting a poor prognosis in sTBI patients(AUC=0.908,95%CI:0.823-0.960),with a specificity of 92.50%and a sensitivity of 76.19%.Conclusion Initial and postoperative ICP are influential factors for the prognosis of sTBI patients undergoing decompressive craniectomy.Elevated initial ICP and sustained postoperative ICP increases are indicative of a poorer prognosis and demonstrate high predictive value for patient mortality.

Abstract:Objective To investigate the clinical diagnosis and treatment strategies for chordoma combined with pituitary adenoma,aiming to improve the diagnostic and therapeutic proficiency of such rare condition.Methods The clinical data of a 23-year-old male patient was analyzed retrospectively,who presented with weight gain and breast enlargement for 13 years.Preoperative MRI revealed space-occupying lesions in the sellar region and clivus.The tumors were resected via a neuroendoscopic endonasal transsphenoidal approach.Results Gross total resection of the tumor was achieved under microscope.Postoperative pathology confirmed the coexistence of chordoma and prolactin-secreting pituitary adenoma.Immunohistochemistry demonstrated positive staining for synaptophysin(Syn)and prolactin(PRL)in the pituitary adenoma region,while the chordoma region showed positive staining for cytokeratin(CK)and Brachyury gene.Postoperatively,the patient's hormonal levels normalized without new neurological deficits.Conclusions Chordoma combined with pituitary adenoma is rare and prone to misdiagnosis.Comprehensive evaluation incorporating imaging,clinical manifestations,and pathological examination is essential.Neuroendoscopic endonasal transsphenoidal surgery enables total tumor resection,and long-term follow-up is required to monitor recurrence.This case provides valuable insights for the clinical diagnosis and treatment of such complex conditions.

Abstract:Objective To investigate the effect of a rehabilitation nursing model based on the enhanced recovery after surgery(ERAS)concept on functional recovery in patients with hypertensive intracerebral hemorrhage.Methods A total of 100 patients with hypertensive intracerebral hemorrhage were randomly assigned into a control group(n=50)receiving routine nursing care and an observation group(n=50)receiving rehabilitation nursing intervention based on the ERAS concept.The National Institutes of Health Stroke Scale(NIHSS),Mini-Mental State Examination(MMSE),Self-Rating Anxiety Scale(SAS),Self-Rating Depression Scale(SDS),Fugl-Meyer Assessment(FMA),and Modified Barthel Index(MBI)were used to compare neurological function,cognitive function,psychological status,and limb motor function between the two groups at admission,1 month after intervention,and 3 months after intervention.Results There were no statistically significant differences between the two groups in NIHSS,MMSE,SAS,SDS,FMA,and MBI before intervention,indicating comparable baselines(all P>0.05).Compared to pre-intervention scores,both groups showed improvements in NIHSS,MMSE,SAS,SDS,FMA,and MBI scores post-intervention,with the observation group showing greater improvements compared to the control group(all P<0.05).Conclusions The rehabilitation nursing model based on the ERAS concept effectively improves neurological function,cognitive function,motor function,activities of daily living,and psychological status in patients with hypertensive intracerebral hemorrhage,thus being worth promoting in clinical practice.

Abstract:Objective To explore the preoperative assessment methods for patients with primary normal pressure hydrocephalus(NPH)and predict the effectiveness of ventriculoperitoneal shunt(V-P shunt)surgery.Methods The clinical data of 35 patients with NPH were analyzed retrospectively.After admission,patients underwent three-dimensional gait analysis(including stride frequency,gait speed,stride length,swing phase,and double support phase),Mini-Mental State Examination(MMSE)scoring,and urinary incontinence scoring,followed by a continuous lumbar drainage trial with approximately 150 ml drained daily.After 2 days,the lumbar drain was removed,and the above evaluations were repeated.Based on the reference values of these three indicators before and after the continuous lumbar drainage trial,patients underwent V-P shunt surgery.Postoperative evaluations,including three-dimensional gait analysis,MMSE scoring,and urinary incontinence scoring,were performed at 7,30 and 90 days after V-P shunt surgery to assess treatment efficacy.Results In patients with effective V-P shunt outcomes,significant improvements were observed in stride frequency,gait speed,stride length,and double support phase before and after the lumbar drainage trial(all P<0.05).The swing phase showed no significant improvement during the lumbar drainage trial but demonstrated marked improvement at 7,30 and 90 days post-V-P shunt surgery(all P<0.05).Statistical analysis revealed that the predictive value of three-dimensional gait analysis was superior to that of MMSE score alone,urinary incontinence score alone,or their combined analysis.However,its predictive accuracy was equivalent to that of three-dimensional gait analysis combined with MMSE score or urinary incontinence score.Conclusions Three-dimensional gait analysis before and after the continuous lumbar drainage trial may provide valuable objective reference indicators for predicting the efficacy of V-P shunt surgery in NPH patients.

Abstract:Objective To explore the clinical efficacy and surgical details of autologous skull flap cranioplasty after decompressive craniectomy.Methods Clinical data of 96 patients who underwent autologous skull cranioplasty were analyzed retrospectively.All the patients had their autologous bone flaps preserved using bone tissue bank technology after decompressive craniectomy.Among them,there were 50 cases of spontaneous cerebral hemorrhage,40 cases of severe traumatic brain injury,and 6 cases of large cerebral infarction.Results The autologous skull flaps of all 96 patients were preserved using bone tissue bank technology.During cranioplasty,no significant defects or thinning of the bone flaps were observed,and all exhibited normal bony structures.Postoperatively,there were 2 cases of poor wound healing(1 case was cured after anti-infection treatment and scalp negative pressure suction,and 1 case required bone flap removal),and 5 cases of subcutaneous fluid accumulation(all improved with conservative treatment).There were no cases of intracranial or subcutaneous infection.During follow-up,no patients exhibited severe skull absorption,required secondary cranioplasty with artificial materials,or experienced postoperative intracranial hemorrhage.Conclusions Autologous skull cranioplasty using bone tissue bank preservation technology is a relatively safe surgical approach that maximally preserves the biological characteristics of the bone flap and demonstrates favorable clinical outcomes.Attention to meticulous surgical details is essential during autologous skull cranioplasty.

Abstract:Objective To investigate whether extracranial surgery affect the short-term clinical outcomes of patients with traumatic brain injury(TBI).Methods Clinical data of 253 TBI patients were analyzed retrospectively.Based on whether they underwent extracranial surgery,patients were divided into a non-extracranial group(n=191)and an extracranial group(n=62).Baseline characteristics,post-injury cognitive function,and survival status were compared between the two groups.Multivariate analysis was applied to explore factors influencing post-injury cognitive function and survival status in TBI patients.Results Survival status at 6 months post-injury revealed no deaths among patients with mild TBI.Logistic regression analysis revealed that,in patients with moderate or severe TBI,six-month mortality was not significantly associated with extracranial surgery(all P>0.05).MMSE scores at 2 weeks and 6 months post-injury indicated that extracranial surgery had no statistically significant impact on cognitive function in patients with mild TBI(both P>0.05).Logistic regression analysis revealed that extracranial surgery significantly reduced MMSE scores at 2 weeks and 6 months post-injury in patients with moderate or severe TBI,demonstrating a strong association between extracranial surgery and short-term cognitive dysfunction in these patients(all P<0.05).Conclusions Exposure to extracranial surgery is associated with adverse short-term neurological outcomes in patients with moderate or severe TBI.Non-emergency surgeries should be delayed until the patient's traumatic brain injury stabilizes,after which elective procedures for other sites can be performed.

Abstract:Objective To observe the efficacy of cranial flap fixation and skull reconstruction using the Rapid Resorbable Fixation System(RRFS)combined with calcium phosphate cement(CPC).Methods The clinical data of 36 patients were analyzed retrospectively.Based on the method of bone flap reposition and fixation,patients were divided into the observation group(n=18)and the control group(n=18).In the observation group,the RRFS was used for cranial flap repositioning during craniotomy,and the CPC was applied for cranial remodeling.In the control group,titanium plates were used for bone flap fixation after craniotomy.The incidence of postoperative complications,bone flap healing,fixation efficacy,and patient satisfaction with the cosmetic outcome were assessed for both methods.Results The follow-up period ranged from 3 to 16 months,with an average of 12 months.In the observation group,there were no postoperative complications such as subcutaneous effusion or infection.Postoperative CT and MRI scans showed no artifacts.After the absorbable fixation system was absorbed by the body,the cranial flap fixation was stable in the observation group,with no noticeable displacement or resorption of the flap,and patients reported high satisfaction with the appearance of the cranial repair.In the control group,there were 4 cases of postoperative complications,including 3 cases of subcutaneous effusion and 1 case of incision infection,and 8 patients expressed dissatisfaction with the overall appearance.The difference in appearance satisfaction between the two groups was statistically significant(P<0.05).Conclusion The use of the RRFS combined with CPC for cranial flap fixation in craniotomy offers a safer and more effective solution for bone flap fixation.

Abstract:Objective To explore the relationship between cerebrospinal fluid(CSF)levels of Parkinson's disease protein 7(PARK7)and chitinase protein 40(YKL-40)and cognitive impairment in elderly patients with Parkinson's disease(PD).Methods A retrospective analysis was conducted on the medical records of 150 elderly patients with PD.Cognitive impairment was assessed using the Montreal Cognitive Assessment(MoCA)scale,with patients scoring<26 classified into the mild cognitive impairment(MCI)group(n=64)and those scoring≥26 into the non-MCI group(n=86).CSF levels of PARK7 and YKL-40 were compared between the two groups.Risk factors influencing the development of cognitive impairment in elderly PD patients were analyzed,along with the predictive value of these biomarkers for cognitive impairment.Results The proportion of patients with Hoehn-Yahr(H-Y)stagesⅢ～Ⅳand CSF levels of PARK7 and YKL-40 were significantly higher in the MCI group than in the non-MCI group(all P<0.05).Multivariate regression analysis revealed that H-Y stage,CSF PARK7 level,and CSF YKL-40 level were independent risk factors for cognitive impairment in elderly PD patients(all P<0.05).Receiver operating characteristic(ROC)analysis indicated that the optimal cut-off values for predicting cognitive impairment in elderly PD patients were 33.89 μg/L for CSF PARK7 and 3.63 mg/L for CSF YKL-40.The combined sensitivity,specificity,and area under the curve(AUC)were 82.81%,98.84%,and 0.951(95%CI:0.903-0.980),respectively.Conclusion CSF levels of PARK7 and YKL-40 are abnormally elevated in elderly PD patients with cognitive impairment.Clinical detection of CSF PARK7 and YKL-40 levels can serve as indicators for predicting cognitive impairment in elderly PD patients,with higher predictive value when used in combination.

Abstract:With the continuous advancement of endoscopic sinus surgery,the endoscopic endonasal approach for skull base lesion resection has been widely adopted in clinical practice.This technique can circumvent the damage to normal brain tissue associated with traditional craniotomy;however,it may lead to complications such as cerebrospinal fluid(CSF)leakage and intracranial infection,particularly postoperative CSF leakage,which constitutes a critical factor limiting the development of endoscopic endonasal skull base surgery and affecting patients'postoperative quality of life.Consequently,the importance of skull base reconstruction in preventing CSF leakage and intracranial infection has become increasingly prominent.The nasoseptal flap,as a commonly utilized vascularized tissue flap,has gained extensive application in skull base reconstruction due to its operational convenience,abundant blood supply,and minimal complications.This review aims to summarize the theoretical foundations and latest research advancements in the application of nasoseptal flaps in skull base reconstruction,providing references and practical insights for further optimizing the endoscopic endonasal approach for skull base lesion resection.

Abstract:Objective To investigate the correlation between serum calmodulin(CaM)levels and both postoperative brain edema and prognosis in the patients with cerebral hemorrhage.Methods Clinical data of 120 patients with cerebral hemorrhage were analyzed retrospectively.According to the Glasgow Outcome Scale(GOS)score at 3 months postoperatively,the patients were divided into a poor prognosis group(GOS≤3 points)and a good prognosis group(GOS≥4 points).Serum CaM levels and brain edema volume were measured upon admission for all the patients.Pearson correlation analysis was used to assess the correlation between serum CaM levels and brain edema volume.Multivariate logistic regression analysis was performed to identify the factors influencing patient prognosis,and restricted cubic spline plots were utilized to analyze the association between serum CaM levels and patient prognosis.Results After a 3-month follow-up,11 out of 120 patients with cerebral hemorrhage were lost to follow-up,leaving 109 patients for analysis,including 42(38.53%)with a poor prognosis.Statistically significant differences were observed between the poor and good prognosis groups in terms of intracranial hematoma volume,midline shift,National Institutes of Health Stroke Scale(NIHSS)score,brain edema volume,CaM,and C-reactive protein(CRP)levels(all P<0.05).Multivariate logistic regression analysis revealed that NIHSS score(OR=2.520,95%CI:1.160-5.476),brain edema volume(OR=2.635,95%CI:1.049-6.616),CaM(OR=1.060,95%CI:1.015-1.107),and CRP(OR=2.678,95%CI:1.325-5.413)were independent risk factors for poor prognosis(all P<0.05).Pearson correlation analysis demonstrated a positive correlation between serum CaM levels and brain edema volume in patients with cerebral hemorrhage(r=0.677,P<0.001).Restricted cubic spline plots indicated a significant nonlinear relationship between serum CaM levels and prognosis in the patients with cerebral hemorrhage(χ²=9.630,P=0.022).Conclusion The higher the pre-treatment serum CaM level in the patients with cerebral hemorrhage,the larger the volume of cerebral edema and the potentially worse the prognosis.