Abstract:Objective To evaluate the individualized surgical decision-making,selection of surgical methods,perioperative management,and prognostic outcomes for hypertensive thalamic hemorrhage.Methods Clinical data of 65 patients with hypertensive thalamic hemorrhage treated between January 2015 and December 2023 were retrospectively analyzed.Individualized surgical treatment was implemented based on hematoma volume,morphology,clinical manifestations,and imaging characteristics.Results At 3 months postoperatively,Glasgow Outcome Scale(GOS)assessment showed good recovery in 22 cases(33.8%),moderate disability in 11(16.9%),severe disability in 20(30.8%),vegetative state in 9(13.8%),and death in 3(4.6%).Conclusions Multidimensional individualized surgical decision-making incorporating hematoma characteristics,clinical manifestations,imaging features,and systemic conditions can significantly reduce mortality and improve functional outcomes in hypertensive thalamic hemorrhage,when combined with minimally invasive techniques(stereotactic aspiration,neuroendoscopic evacuation,EVD)and refined perioperative management.

Abstract:Objective To compare the efficacy of neuroendoscopic minimally invasive surgery and small bone window craniotomy for supratentorial hemorrhage≤50 mL.Methods A retrospective selection was made of 136 patients with supratentorial intracerebral hemorrhage with a hematoma volume of≤50 mL from June 2022 to August 2024.They were divided into the neuroendoscopy group(n=75)and the craniotomy group(n=61)according to the different surgical methods in the data.The neuroendoscopy group underwent neuroendoscopic minimally invasive surgery,while the craniotomy group underwent small bone window craniotomy.The surgical-related indicators,treatment effects(GOS),neurological functions(NFDS),quality of life(ADL,WHOQOL-BREF),and postoperative complications were analyzed.Results The operation time,catheterization time,and hospital stay of the neuroendoscopy group were significantly shorter,and the hematoma clearance rate was higher compared with craniotomy group(P<0.05).The effective rate of the neuroendoscopy group was 84.00%(63/75),higher than that of the craniotomy group(65.57%,40/61)(P<0.05).For the comparison of NFDS scores between the two groups before operation,1 month after operation and 3 months after operation,the time effect,group effect,and the interaction effect between time and group were all statistically significant(P<0.001);After 1,3 months of operation,the NFDS scores of both groups were decreased,and the NFDS score in neuroendoscopy group was lower(P<0.05).For the comparison of ADL and WHOQOL-BREF scores between the two groups before operation and 3 months after operation,the time effect,group effect,and the interaction effect between time and group were all statistically significant(P<0.001);After 3 months of operation,the ADL scores and WHOQOL-BREF scores of both groups were higher than those before the operation,and the ADL scores and WHOQOL-BREF scores in neuroendoscopy group were higher(P<0.05).The total rate of postoperative complications in neuroendoscopy group(8.00%)was lower compared with craniotomy group(27.87%)(χ2=9.451,P=0.002).Conclusions Neuroendoscopic minimally invasive surgery has definite efficacy for supratentorial hemorrhage≤50 mL compared with small bone window craniotomy,with the advantages of rapidity,fewer complications,and faster recovery.It can better improve the neurological deficits and quality of life of the patients.

Abstract:Cerebral hemorrhage is a disease with extremely high incidence and mortality rate in China,and cerebral edema is its critical pathological process after cerebral hemorrhage,which is quite challenging to manage.Proper management of cerebral edema can significantly reduce mortality.Currently,the treatment options for post-hemorrhagic cerebral edema include hyperosmolar therapy,cerebrospinal fluid drainage,steroid treatment,therapeutic hypothermia,deep sedation with anesthetics,and decompressive craniectomy.These treatments mainly aim to prevent the increase in intracranial pressure and brain herniation in the short term,without addressing the root cause for cerebral edema.Therefore,there is an urgent need to develop novel drugs targeting specific molecular pathways for treating cerebral edema.Utilizing molecular pathophysiology to prevent or reduce the formation of edema is a feature of the next generation anti-edema therapy.This article reviews the latest research on the mechanisms of post-hemorrhagic cerebral edema,and provides ideas for the exploration of new treatment methods.

Abstract:Objective To analyze the incidence trends of subarachnoid hemorrhage(SAH)and assess the impact of age,period,and cohort on their occurrences among adolescents and young adults(aged 15-39)from 1990 to 2021 and predict future trends in incidence,thereby provide valuable insights for the prevention and management of SAH in this demography.Methods Based on the 2021 Global Burden of Disease Database,this study extracted relevant statistical data related to the incidence and incidence rates of subarachnoid hemorrhage in the global adolescent and young adult population.A joinpoint regression model was employed to analyze the long-term trends of the age-standardized incidence rates for this group from 1990 to 2021.Annual percentage change(APC)and average annual percentage change(AAPC)were calculated to identify trend turning points and assess the overall magnitude of changes in incidence rates.Additionally,an age-period-cohort model was utilized to analyze the independent effects of age,period,and birth cohort on the incidence rates of subarachnoid hemorrhage in this population.Finally,the Nordpred model was used to predict future trends in global incidence rates.Results From 1990 to 2021,the incidence of subarachnoid hemorrhage(SAH)among the global population of adolescents and young adults increased from 73,678 cases to 79,619 cases,representing an 8.1%rise;the crude incidence rate decreased from 4.01 per 100,000 to 3.3 per 100,000,a decline of 17.71%;the age-standardized incidence rate fell from 4.12 per 100,000 to 3.25 per 100,000,a decrease of 21.1%.Joinpoint regression model analysis indicated that from 1990 to 2021 the overall age-standardized incidence rates of SAH among global adolescents and young adults,as well as among males and females,showed a general declining trend.The AAPC value for the entire population group was-0.77%(P<0.01).However,from 2014 to 2021,the incidence rate exhibited a reversal,demonstrating an upward trend,with the most significant increase occurring from 2019 to 2021,reflected in an APC value of 1.1%(P<0.01).Analysis of the age-period-cohort model showed that the risk of disease increased with age but decreased with period effects and birth cohort effects.Predictions indicated that from 2022 to 2044,the incidence rate of subarachnoid hemorrhage among the global adolescent and young adult population would experience a slight increase.Conclusions From 1990 to 2021,the standardized incidence rate of subarachnoid hemorrhage among global adolescents and youth has shown an overall declining trend,however,its evolution exhibits nonlinear characteristics:in recent years,the incidence rate has fluctuated and rebounded,while the absolute number of cases continues to rise,indicating that the disease burden remains concerning.Furthermore,the incidence rate among males consistently exceeds that of females,with significant differences observed in different periods and birth cohorts.Therefore,to further reduce the disease burden,it is essential to optimize health promotion strategies for youth based on risks related to gender,age,and historical context to achieve precise control over the global disease burden.

Abstract:Objective To explore the predictive value of intracranial pressure(ICP)-related parameter monitoring on the prognosis of patients with large-area cerebral infarction undergoing decompressive craniectomy.Methods 68 patients with large-area cerebral infarction admitted to the neurosurgery department of our hospital from July 2020 to July 2024 were selected.All patients underwent decompressive craniectomy by the same medical team and were followed up for 6 months after the operation.According to the modified Rankin scale(MRS)score,the patients were divided into the good-prognosis group(≤2 points)and the poor-prognosis group(>2 points).Univariate analysis was performed on the clinical data of the two groups.Multivariate logistic regression analysis was used to analyze the independent risk factors for poor postoperative prognosis in patients.Receiver operating characteristic(ROC)curve analysis was used to analyze the predictive value of ICP-related parameters for evaluating prognosis.Results Univariate analysis showed that the probabilities of preoperative Glasgow Coma Scale(GCS)≤8 points,ICP>15 mmHg,cerebral perfusion pressure<70 mmHg,pressure-reactivity index>0.6,correlation coefficient between ICP amplitude and arterial pressure amplitude>0.6,and the incidence of postoperative complications in the good-prognosis group were all lower than those in the poor-prognosis group,and there were differences between the two groups(P<0.05).Multivariate logistic regression analysis showed that ICP>15 mmHg,cerebral perfusion pressure<70 mmHg,pressure-reactivity index>0.6,and correlation coefficient between ICP amplitude and arterial pressure amplitude>0.6 were all independent risk factors for poor prognosis(P<0.05).There were differences in various ICP-related parameters between the two groups(P<0.05).ROC curve analysis showed that the combined detection of ICP,cerebral perfusion pressure,pressure-reactivity index,and correlation coefficient between ICP amplitude and arterial pressure amplitude had higher prediction sensitivity and specificity for poor prognosis(P<0.05).Conclusions ICP-related parameters are independent risk factors for poor prognosis in patients with large-area cerebral infarction undergoing decompressive craniectomy.Combined detection of multiple indicators can further improve the predictive value.

Abstract:Objective To investigate the changes in migraine incidence in adolescents and young adults by using the Joinpoint and Age-Period-Cohort model so as to provide reference for related health policies.Methods The data on migraine incidence from 1990 to 2021were taken from the Global Burden of Diseases(GBD)database.The Joinpoint regression model was employed to analyze the trends in migraine incidence,and Wald χ² tests were utilized to assess differences in migraine incidence across different age groups,time periods,and birth cohorts.Data organization was conducted using Excel,while statistical analyses were performed using Joinpoint 4.9.0.1 software and R language analysis tools,with a significance level set at α=0.05.Results Data analysis indicated significant changes in migraine incidence among adolescents and young adults between 1990 and 2021.The annual percent change(APC)fluctuated in different time periods,while the average annual percentage change(AAPC)was 0.04,indicating an overall slow growth trend.The age-standardized incidence rate(ASIR)in the male population increased the most from 2015 to 2019,with an APC value of 0.51%.The largest increase in ASIR in the female population was recorded in 2000-2004,with an APC value of 0.17%.Comparisons of different age groups showed that the overall incidence was higher in females than in males,and that the incidence of the sexes showed alternating variations over different time periods.Birth cohort risk analysis indicated that the years 1972-1981 represented a critical turning point for incidence risk between males and females,with a subsequent increase in male risk and a decrease in female risk.Conclusions The migraine incidence among global adolescents is undergoing significant changes,with notable differences in trends and risks between males and females.The findings of this study provide important references for the formulation of public health policies,which will help improve the health status of this population and reduce the burden of migraines,necessitating further attention and intervention in this field.

Abstract:Objective To explore the correlation between NAR,MHR and early neurological deterioration(END)after intravenous thrombolysis in patients with AIS.Methods A total of 110 AIS patients who underwent intravenous thrombolysis from January 2022 to June 2024 were selected.According to the END occurrence,the patients were divided into the END group(n=21)and the non-END group(n=89).Neutrophil count,monocyte count,apo A1,HDL-C were detected,and NAR and MHR were calculated.The predictive value of NAR and MHR for END after intravenous thrombolysis in AIS patients was evaluated by the receiver operating characteristic curve.The influencing factors of END after intravenous thrombolysis in AIS patients were analyzed by multivariate Logistic stepwise regression.Results The levels of neutrophils,monocytes,NAR and MHR in the END group were higher than those in the non-END group,while apo A1 and HDL-C were lower(P<0.05).The AUC(95%CI)of NAR and MHR for predicting END after intravenous thrombolysis in AIS patients were 0.842(0.795～0.891)and 0.758(0.704～0.802)respectively.The AUC(95%CI)of the combined prediction of NAR and MHR was 0.904(0.856～0.955).Increased time from onset to thrombolysis(OR=1.728,95%CI:1.342～2.225),high NIHSS score(OR=2.399,95%CI:1.546～3.721),elevated NAR(OR=2.776,95%CI:1.200～6.423),and elevated MHR(OR=3.086,95%CI:1.557～6.117)were independent risk factors for END in AIS patients(P<0.05).Conclusions NAR and MHR levels in END patients are significantly increased.NAR and MHR are risk factors for END after intravenous thrombolysis in AIS patients,and the combined prediction has higher efficacy.

Abstract:Objective To explore the expression level of X-box binding protein 1(XBP1)in glioma tissues and analyze its relationship with clinicopathological characteristics and temozolomide(TMZ)chemotherapy effects.Methods The data of 120 patients with glioma admitted to Hefei Hospital Affiliated to Anhui Medical University from September 2022 to December 2024 were retrospectively analyzed.Tumor tissue samples were obtained by surgery or biopsy in all patients,and the expression level of XBP1 protein was detected by immunohistochemistry.The differences in XBP1 expression were compared among patients with different genders,ages,WHO grades and other clinicopathological characteristics,and Kendall's tau-b correlation coefficient analysis was performed.All patients received standard TMZ chemoradiotherapy regimen after surgery.The efficacy of chemotherapy was evaluated according to RANO criteria.The patients were divided into effective group(complete remission,partial remission,stable disease)and ineffective group(disease progression),and the positive rate of XBP1 was compared between the groups.Logistic regression analysis was applied to explore the influence of XBP1 expression on chemotherapy effect,and kappa consistency analysis was utilized to verify the predictive value of positive XBP1 on chemotherapy ineffectiveness.Results Among the 120 patients,78 cases were positive for XBP1,with the positive rate of XBP1 of 65.00%.There were differences in the positive rates of XBP1 in glioma tissues of patients with different WHO grades,Karnofsky performance status(KPS)scores,IDH mutation shapes and MGMT promoter methylation status(P<0.05).Kendall's tau-b correlation coefficient analysis revealed that the positive rate of XBP1 in glioma tissues was correlated with WHO grading,KPS score,IDH and MGMT promoter methylation status(P<0.05).There were 38 cases with chemotherapy ineffectiveness,accounting for 31.67%.The positive rate of XBP1 in the ineffective group was higher compared with that in the effective group(P<0.05).Logistic regression analysis indicated that positive XBP1 was the influencing factor of TMZ chemotherapy in patients with glioma(P<0.05).The specificity,sensitivity and accuracy rate of positive XBP1 in predicting TMZ chemotherapy ineffectiveness were 45.12%(37/82),86.84%(33/38)and 58.33%(70/120)respectively,and the kappa value with actual chemotherapy efficacy was 0.249.Conclusions The expression of XBP1 is increased in glioma tissues,and is related to tumor malignancy degree and TMZ chemotherapy ineffectiveness.The detection of XBP1 has a certain significance in evaluating the pathological characteristics of patients with glioma and exploring the mechanism of chemotherapy resistance.However,due to its low predictive specificity,it is not recommended to use positive XBP1 alone to predict TMZ chemotherapy effect,and comprehensive evaluation should be performed in combination with other biomarkers.

Abstract:Objective To investigate and analyze the current status of surrogate decision-making self-efficacy in neurosurgical inpatients and the care burden of their caregivers.Methods 200 primary caregivers of neurosurgical inpatients admitted to Huai'an First Hospital Affiliated to Nanjing Medical University between June 2023 and June 2025 were selected as study subjects by convenience sampling.General information questionnaires,the Self-Efficacy Scale for Shared Decision-Making(SDM-SES),and the Zarit Burden of Care Scale(ZBI)were used to collect demographic data on patients and caregivers,along with caregivers'SDM-SES and ZBI scores.Pearson correlation analysis was performed to examine the relationship between self-efficacy and total caregiver burden scores,as well as scores across individual dimensions.Results The total score for the Surrogate Decision-Making Scale(SDM-SES)was(15.08±3.05)points,with the following dimension scores:Decision Confidence(3.05±0.74)points,Decision Optimality(3.03±0.80)points,risk-benefit trade-offs(3.08±0.77)points,information access and utilization(3.04±0.76)points,and informed understanding of options(2.87±0.86)points.Comparative analysis of general characteristics between patients and caregivers revealed statistically significant differences in caregivers'SDM-SES scores across multiple dimensions(P<0.05),including patient admission duration,disease type,caregiver gender,age,education level,relationship to patient,and monthly household income per capita.Caregivers'total ZBI scores were(32.79±6.53)points,with role burden dimension scores of(11.72±3.11)points and personal burden dimension scores of(13.16±4.97)points.After grouping and comparing general patient and caregiver characteristics,statistically significant differences in caregivers'ZBI scores were observed across disease type,caregiver gender,age,education level,relationship to the patient,duration of caregiving,and monthly household income per capita(P<0.05).Pearson correlation analysis revealed significant negative correlations between self-efficacy and both the total ZBI score and scores across all dimensions(P<0.05).Conclusions There is a statistically significant interaction effect between self-efficacy and caregiver burden among surrogate decision-makers for neurosurgical inpatients,and both are jointly moderated by demographic,socioeconomic,and relational role factors.

Abstract:Objective To reveal the differences between brain metastases and primary tumors at the cellular and molecular levels,with a focus on the immune microenvironment and genomic alterations,and develop a prediction model for patient prognosis.Methods Single-cell RNA sequencing was employed to analyze tumor samples.Doublet cells were identified using Scrublet,and data integration was performed with Scanpy.Highly variable genes were filtered,and batch effects were corrected using the Harmony algorithm.Differential gene expression was analyzed with the Wilcoxon rank-sum test,while copy number variations(CNVs)were inferred using infercnvpy.Prognostic models were developed using univariate Cox regression,LASSO regression,and multivariate Cox regression analyses.Results The study found that brain metastases exhibited a higher proportion of tumor cells and fewer immune cells compared to primary tumors,indicating an immunosuppressive microenvironment.Myeloid cells were predominantly lipid-metabolizing macrophages,with a significant reduction in dendritic cells,suggesting impaired antigen presentation.Natural killer(NK)cells and T cells were scarce,which further supported the immunosuppressive nature of brain metastases.CNV analysis revealed increased genomic alterations in brain metastases,which were associated with cell cycle dysregulation.Genes such as PLTP,CP,and ADGRG6 were identified as significantly associated with patient survival,suggesting their potential as prognostic biomarkers.Conclusions This study highlights the unique immunosuppressive environment and genomic complexity of brain metastases.The developed prognostic model shows potential for clinical application.Future therapeutic research should focus on targeting these pathways to improve the prognosis of patients with brain metastases.

Abstract:The low-pressure,low-oxygen environment of plateaus has been shown to have a significant influence on the occurrence and development of acute and chronic plateau brain injury.Intense exposure can induce acute mountain sickness(AMS)and high-altitude cerebral oedema(HACE),which is manifested by blood-brain barrier(BBB)disruption,mitochondrial dysfunction,and neuroinflammation.Prolonged residence,on the other hand,is closely associated with high-altitude polycythemia(HAPC)and neurodegenerative changes(e.g.,Alzheimer's disease).This review systematically summarises the molecular mechanisms of plateau brain injury:Firstly,the activation of the hypoxia-inducible factor(HIF)pathway exacerbates brain injury by modulating vascular permeability,oxidative stress and inflammatory responses.Secondly,mitochondrial dysfunction leads to energy metabolism disorders and ROS accumulation.Thirdly,microglia M1 polarisation and NLRP3 inflammatory vesicle activation drive neuroinflammation.Finally,chronic hypoxia is associated with Aβ deposition through tau phosphorylation and autophagy loss,tau phosphorylation and autophagy dysregulation promoting neurodegeneration.With regard to intervention strategies,the efficacy of antioxidants(e.g.,Nrf2 activators),HIF pathway modulation(e.g.,roxarestat),and lifestyle interventions(stepwise habilitation)has been demonstrated.In the future,there is a need to combine multi-omics technology and clinical translational research to make a deep analysis of the molecular network of plateau brain injury,so as to provide the basis for precise prevention and treatment.

Abstract:Objective To elucidate the mechanisms through which Mettl3 influences the pathophysiological changes following ICH.Methods Utilizing collagenase VII-S and C57bl/6 mice,a model of brain hemorrhage was established and its Mettl3 expression was quantified via qPCR and WB.GSE222968 dataset was harnessed from GEO database to investigate m6A modifications and differential gene expressions,which was complemented by GO and KEGG enrichment analyses,along with assessments of immune cell infiltration and protein interaction networks.WGCNA was employed to pinpoint genes that co-express with Mettl3,intersecting them with differentially expressed genes to identify key players.Lasso regression was then applied to refine the selection of core genes,with subsequent ROC analysis to ascertain their diagnostic potential.Results Post-ICH,Mettl3 expression was found to be elevated,with 5316 m6A-modified genes and 1148 differentially expressed genes implicated in immune biology,alongside significant variations in immune cell infiltration profiles.2077 genes were identified to be co-expressed with Mettl3,narrowing down to the critical genes Apold1,B2m,Cox8b,and Tnnt1 upon intersection with differentially expressed genes.Lasso regression singled out Apold1 and Tnnt1 as pivotal genes,with ROC analysis underscoring the diagnostic significance of Apold1.Conclusions The modulation of Apold1 by Mettl3 serves as a potential biomarker for ICH diagnosis and a target for novel immunotherapeutic strategies.

Abstract:Objective Neuro-navigation technology represents a revolutionary advancement in neurosurgery,with its core lying in the fusion of multimodal imaging and real-time spatial positioning to provide surgeons with high-precision anatomical and functional guidance.Currently,this technology is widely applied to brain tumor,cerebrovascular disease,functional neurosurgery,and spinal surgery.Its advantages are mainly reflected in precise localization,minimally invasive approach,real-time dynamic updates,and multi-technology integration.Precise localization,achieved by combining high-resolution MRI/CT and DTI fiber tract imaging,can clearly display the relationship between the lesion and its surrounding functional areas.Minimally invasive approach can reduce intraoperative exploration damage,and is especially suitable for lesions deep or adjacent to important neural and vascular structures.Real-time dynamic updates can correct brain shift errors through intraoperative ultrasound or iMRI,enhancing surgical safety.Multi-technology integration,when combined with fluorescence imaging and electrophysiological monitoring,can further optimize surgical outcomes.Nowadays,neuro-navigation systems are evolving towards intelligence-oriented approaches,such as AI algorithm-assisted path planning and AR visual overlay navigation.However,their widespread adoption still faces challenges such as high cost and technical complexity.In the future,with the application of 5G remote surgery,quantum computing,and biosensors,neuro-navigation is expected to achieve full-process automation and personalization,and hence becomes the gold standard in neurosurgery.Studies have shown that using neuro-navigation technology in tumor resection can increase the total resection rate by 20%to 30%and significantly reduce the postoperative neurological dysfunction rate.The continuous innovation of this technology will bring broader prospects for clinical diagnosis and treatment in neurosurgery.From the concept of medical education,this article aims to help trainees achieve a thorough understanding through step-by-step learning from theory to practice.

Abstract:Objective To analyze the influencing factors of acute stress disorder(ASD)after thrombolysis in young and middle-aged patients with first-onset acute cerebral infarction(ACI)and to construct a risk prediction model.Methods Based on the occurrence of ASD,216 young and middle-aged patients with first onset ACI who received thrombolytic therapy at Baoding First Central Hospital from February 2020 to January 2025 were divided into ASD group(n=82)and non-ASD group(n=134).Pearson correlation analysis was used to explore the correlation between ASD and psychological resilience and self-perceived burden after thrombolysis in young and middle-aged patients with first-onset ACI.Multivariate logistic stepwise regression analysis was used to explore the influencing factors of ASD after thrombolysis in young and middle-aged patients with first-onset ACI.A nomogram model was constructed and its predictive value for ASD after thrombolysis in young and middle-aged patients with first-onset ACI was evaluated.Results ASD after thrombolysis in young and middle-aged patients with first-onset ACI was negatively correlated with psychological resilience and positively correlated with self-perceived burden(P<0.05).The age and National Institutes of Health Stroke Scale(NIHSS)score at admission in the ASD group were higher than those in the non-ASD group.The proportions of those with education level below high school,unemployed,monthly per capita family income<4000 RMB yuan,introverted personality,dysphagia,and hemiplegia in the ASD group were all higher than those in the non-ASD group(P<0.05).The risk factors of ASD in young and middle-aged patients with first-episode ACI after thrombolytic therapy were lower than high school education,introverted personality,hemiplegia and heavy burden of self-feeling,and good psychological resilience was the protective factor(P<0.05).The area under the curve(AUC)(95%CI)of the nomogram model for predicting ASD after thrombolysis in young and middle-aged patients with first-onset ACI was 0.904(0.852～0.956),with a specificity of 67.93%and a sensitivity of 92.37%.Conclusions The nomogram model constructed on ASD related factors in young and middle-aged first-onset ACI patients after thrombolysis has good predictive value and can be used to guide individualized risk assessment in clinical practice.

Abstract:With the evolution of modern warfare toward informatization and intelligentization,the early identification and rapid diagnosis of battlefield traumatic brain injuries have become critical to improving the success rate of combat casualty care.In recent years,continuous progress has been made in rapid diagnostic methods for frontline care,including tools for detecting intracranial hemorrhage,biofluid biomarker tests,pathogen detection for post-injury infections,portable imaging equipment,and emerging technologies such as artificial intelligence and telemedicine systems,which are gradually being applied in real combat and training environments.Although some of these technologies have been validated in conflicts such as Afghanistan and Ukraine or during our military exercises,bottlenecks remain in terms of adaptability,deployment efficiency,data integration,and usage protocols.Enhancing the capability for rapid frontline diagnosis is the prerequisite for swift and precise medical intervention,and it is imperative to intensify research on core rapid diagnostic technologies to establish a rapid diagnosis and treatment system tailored to our military's needs for battlefield traumatic brain injuries.

Abstract:Battlefield traumatic brain injury(TBI)has emerged as a significant cause of disability and death in modern warfare.As battlefield environments become more and more complex and there is increased focus on the safety of combat personnel,the prevention and treatment of battlefield TBI are receiving heightened attention.The effective prevention and management of TBI not only influences the survival rates of military personnel but also affects overall operational effectiveness.Although considerable progress has been made in research related to this issue,new perspectives continue to arise.This review aims to synthesize recent advancements in strategies for preventing and treating battlefield TBI,especially those tailored to the realities of combat zones.By examining innovative approaches in preemptive protection and acute care interventions,this article provides practical references that can enhance battlefield medical protocols,ultimately striving to improve casualty outcomes through evidence-based solutions in tactical medicine.

Abstract:Objective To address complex anatomy and high complications risks from misoperation in skull base neurosurgery by means of a semantic segmentation neural network to realize real-time recognition/segmentation of the sellar floor surgical area.Methods Clinical data of 20 patients(10 males,mean age(55±18)years;10 females,mean age(45±19)years)who underwent transsphenoidal endoscopic sellar surgery at Shanghai Renji Hospital and Fujian Fuding Hospital(Aug.2023-Aug.2024)were chosen as study subjects.Endoscopic videos were used to build datasets.ResNet101 was applied for sellar floor classification.RefineNet(ResNet-based,multi-level feature fusion)was used for sellar floor segmentation.The two networks formed a segmented neural network with shared ResNet feature extraction layer,receiving gradient optimization from both tasks during backpropagation.Results Based on endoscopic videos of these 20 patients,a classification dataset of over 1 million images and a segmentation dataset of over 100 000 images(a subset of the classification dataset)were constructed.The segmented neural network achieved a classification accuracy of 94.73%and a segmentation accuracy of 92.41%,both superior to those of the networks trained individually.Conclusions Neural networks can be successfully applied to skull base endoscopic surgery.The segmented architecture can improve computational efficiency and recognition accuracy via feature sharing,aiding intraoperative sellar floor localization.Future integration with surgical instrument recognition and preoperative navigation will optimize real-time anatomical annotation.

Abstract:Objective To investigate the role of Kelch-like epichlorohydrin associated protein 1(Keap1)/nuclear factor erythroid derived 2 related factor 2(Nrf2)signaling pathways on inflammatory response in subarachnoid hemorrhage(SAH)cell model.Methods A 25 μM oxyhemoglobin treatment was used in the neuron-microglia co-culture system for 24 hours to simulate the SAH cell model,which was further divided into four groups:Control,OxyHb,OxyHb+sh-Keap1 and OxyHb+sh-NC.Cell proliferation was measured by CCK8;ELISA was conducted to test the expressions of IL-6,TNF-α,IL-10,and TGF-β;DCFH probe was used to detect changes in ROS;the expressions of Keap1,Nrf2,BIP,IRE1α,PERK,p-PERK,and ATF6 in cells were measured by Western Blot,the levels of MDA and GSH were expressed using commercial kit respectively;real-time quantitative reverse transcription PCR(qRT-PCR)was conducted to detect mRNA levels of M1 surface marker(iNOS)and M2 surface marker(Arg1).Results Compared to the control group,cell proliferation in the OxyHb group decreased significantly due to oxidative stress and inflammation(P<0.05).Keap1 knockdown activated the Nrf2 signaling pathways,alleviating oxidative stress and inflammation(P<0.05),and significantly increased cell proliferation(P<0.05).The levels of M2 microglial polarization significantly increased in the OxyHb+sh-Keap1 group compared to the OxyHb group(P<0.05).Conclusions The Keap1-Nrf2 signaling pathway can regulate inflammation by modulating endoplasmic reticulum oxidative stress and microglial polarization in the SAH cell model,which may provide new therapeutic targets for the treatment of subarachnoid hemorrhage.

Abstract:Objective To explore the clinical value of serum furin and 3-NT levels in predicting hemorrhagic transformation(HT)after mechanical thrombectomy in patients with acute cerebral infarction(ACI).Methods A total of 102 patients with ACI who underwent mechanical thrombectomy in Xingtai Central Hospital from June 2022 to November 2024 were selected.Three days after the treatment,the patients were divided into the non-HT group(n=69)and the HT group(n=33)based on the results of imaging examinations.The serum levels of furin and 3-nitrotyrosine(3-NT)were compared between the two groups of patients at admission.The value of serum furin,3-NT,and their combination in predicting HT after mechanical thrombectomy in ACI patients was evaluated by receiver operating characteristic(ROC)curve.The influencing factors of HT after mechanical thrombectomy in ACI patients were analyzed by multivariate logistic stepwise regression analysis.Results The serum furin and 3-NT levels in the HT group were higher than those in the non-HT group(P<0.05).The area under the curve(AUC)(95%CI)of serum furin,3-NT,and their combination in predicting HT after mechanical thrombectomy in ACI patients were 0.837(0.792-0.887),0.756(0.711-0.806),and 0.913(0.868-0.963)respectively.Serum furin and 3-NT had certain predictive value for HT after mechanical thrombectomy in ACI patients,and their combination had the best predictive performance.The proportion of patients with atrial fibrillation,modified Thrombolysis in Cerebral Infarction(mTICI)grade 0-2a after thrombectomy,and the preoperative National Institutes of Health Stroke Scale(NIHSS)score and modified Rankin Scale(mRS)score in the HT group were higher than those in the non-HT group(P<0.05).Multivariate analysis showed that atrial fibrillation(OR=2.396,95%CI:1.109-5.177),mTICI grade after thrombectomy(OR=2.489,95%CI:1.261-4.914),serum furin(OR=4.200,95%CI:2.208-7.988),and serum 3-NT(OR=3.695,95%CI:1.181-7.542)were risk factors for HT after mechanical thrombectomy in ACI patients(P<0.05).Serum furin(OR=4.200)and 3-NT(OR=3.695)had the strongest predictive power for HT,with significantly higher OR values than atrial fibrillation(OR=2.396)and mTICI grading after thrombectomy(OR=2.489),indicating that serum furin and 3-NT had higher independent risk weights.Conclusions Serum furin and 3-NT levels have predictive value for HT after mechanical thrombectomy in ACI patients.Their preoperative elevation can be used as potential warning indicators,and combined detection may provide a basis for early clinical risk assessment.However,this study is a single center,small sample study,and extrapolation of results should be cautious.In addition,long-term prognostic effects and other potential confounding factors have not been evaluated,and further validation through multi center large sample studies is needed in the future.

Abstract:Objective To explore the safety,efficacy and influencing factors of microsurgery in the treatment of brain arteriovenous malformation(BAVM).Methods The clinical and imaging data of BAVM patients who underwent microsurgery in the Department of Neurosurgery of the Tangdu Hospital of Air Force Medical University from November 2014 to October 2021 were collected.Univariate and multivariate logistic regression analyses were used to screen for independent risk factors affecting cure and the occurrence of fatal or disabling complications.Results Among the 86 patients,82 underwent cerebral angiography reexamination after one year(82/86,95.35%),with 71 cases showing complete disappearance of the lesion,and the cure rate was 86.59%.Among the 71 cases,the cure rate was 91.94%for SM gradeⅠ-Ⅱ,81.82%for SM grade Ⅲ,and 55.56%for SM grade Ⅳ.The postoperative fatal and disabling complications rate was 5.81%,with 3.03%for SM gradeⅠ-Ⅱand 15.00%for SM grade Ⅲ-Ⅳ.Deep venous drainage was an independent risk factor affecting the cure rate of microsurgery(OR=5.354,95%CI:1.42～20.25,P=0.013).Conclusions Microsurgery is safe and effective in the treatment of SM grade I-II BAVM,but the risk of SM grade Ⅲ-Ⅳ is high,so surgical treatment on grade Ⅲ-Ⅳ should be cautious.Compared with superficial venous drainage lesions,deep venous drainage lesions have an increased risk of residual malformations after surgery.High SM grades may be associated with fatal and disabling postoperative complications,but this correlation requires further verification through studies with larger sample sizes.