Abstract:The cultivation of clinical practice ability and medical literacy of neurology medical students is of great significance to the health and wellness sector and the healthcare industry.Starting from the requirements of the construction of"New Medicine"and the need of such a medical education,this article analyzes the role and implementation path of the practical teaching method of PBL combined with RPT in undergraduate clinical internship teaching of neurology.A closed-loop implementation path is proposed,i.e.,"construction of clinical problem framework-role play enhancement-clinical scenario design-practical teaching feedback".Teaching practice has confirmed that this teaching method,by focusing on the dual core goals of"practical ability"and"medical literacy",can effectively improve teaching effectiveness and provide a reference paradigm for the reform of clinical internship teaching in neurology.

Abstract:Objective To investigate the short-term efficacy of dual-scope(microscope combined with neuroendoscope)neurolysis in the treatment of diabetic painful peripheral neuropathy.Methods The study retrospectively included 21 patients with painful diabetic peripheral neuropathy who underwent surgical treatment in the Department of Neurosurgery at the First Affiliated Hospital of Soochow University from January 2023 to December 2024.All patients underwent neurolysis using the dual-scope technique.General data,including age and diabetes history,as well as preoperative electromyography and musculoskeletal ultrasound findings,were collected.Perioperative assessments included the Visual Analog Scale(VAS),Toronto Clinical Scoring System(TCSS),surgical incision length,and postoperative wound healing.Results All patients successfully completed the surgery,with a total of 86 nerves released.Incision lengths ranged from 3-4 cm for ulnar nerve release at the Guyon's canal and tibial nerve release,and 1-2 cm for other nerves.Preoperative VAS and TCSS scores were 6.57±0.87 and 13.76±1.73 respectively.At 1-month follow-up,scores improved significantly to 1.76±1.09(VAS)and 9.10±1.14(TCSS)(both P<0.01).No complications,such as poor wound healing or infection,occurred during the perioperative or follow-up periods.Conclusions The dual-scope neurolysis technique innovatively integrates microscope and neuroendoscope technologies,providing a stereoscopic and clear surgical field while minimizing incision size.This approach reduces the risk of poor wound healing in diabetic patients and offers a novel surgical strategy for diabetic peripheral neuropathy.

Abstract:Radiotherapy,the use of ionizing radiation to destroy tumor cells,is one of the crucial methods for treating central nervous system tumors in clinical practice.However,radiotherapy can at the same time damage the surrounding healthy brain tissue,leading to irreversible cognitive impairments.Recently,ultra-high dose rate FLASH radiotherapy(FLASH-RT),which delivers doses exceeding 40 Gy/s,has shown the potential to effectively target brain tumors while minimizing its damage to normal brain tissue,thereby expanding the therapeutic window for treating central nervous system tumors.To gain deeper insights into the radiobiological effects and principles of FLASH-RT in central nervous system tumors,this article reviews recent foundational research and potential mechanisms related to FLASH-RT both domestically and internationally.

Abstract:Objective To explore the effect of external ventricular drainage with new method on postoperative intracranial infection.Methods Clinical data of 227 patients admitted to the Department of Neurosurgery of the Third Affiliated Hospital of Guangxi Medical University from January 2018 to July 2021 were retrospectively selected.According to different treatment methods,patients admitted from January 2018 to June 2019 were selected as the control group(n=116),patients admitted between July 2019 and July 2021 were included in the new approach group(n=111).The control group underwent lateral ventricular puncture by conventional method,and the new method group underwent external ventricular drainage by new method.The incidence of cerebrospinal fluid leakage rate and infection rate were observed in the two groups.Results Cerebrospinal fluid leakage occurred in 17 cases(14.66%)in the control group and 5 cases(4.50%)in the new method group.The rate of cerebrospinal fluid leakage in the new method group was significantly lower than that in the control group,with statistical significance(χ²=6.678,P=0.010).Intracranial infection occurred in 12 cases(10.34%)in the control group and 4 cases(3.60%)in the new method group,and the infection rate in the new method group was significantly lower than that in the control group,with statistical significance(χ²=3.934,P=0.047).Conclusions The new surgical method can reduce the incidence of cerebrospinal fluid leakage and intracranial infection after external ventricular drainage,which is worthy of clinical application.

Abstract:Objective To construct and validate a nomogram model of the influencing factors of hemorrhagic transformation(HT)in acute cerebral infarction(ACI)after intravenous thrombolysis(IVT).Methods A retrospective analysis was performed on the clinical data of 114 patients with ACI who underwent IVT in 904th Hospital of Wuxi Joint Logistics Support Force from January 2021 to December 2024.According to presence or absence of HT,they were divided into HT group(n=25)and non-HT group(n=89).The influencing factors of HT in ACI patients after IVT were analyzed by univariate and multivariate logistic regression analysis,and a nomogram model was constructed based on these factors,and its predictive value was evaluated by Hosmer-Lemeshow goodness of fit test and receiver operating characteristic(ROC)curve.Results The interval from onset to thrombolysis,score of National Institutes of Health stroke scale(NIHSS)at admission,neutrophil-to-lymphocyte count ratio(NLR),level of total bilirubin(TBIL),proportions of massive cerebral infarction(MCI)and severe overall burden of cerebral small vessel disease(CSVD)in HT group were higher than those in non-HT group,while levels of blood urea nitrogen(BUN)and blood potassium,prognostic nutritional index(PNI)and dosage of thrombolytic drug were lower than those in non-HT group(P<0.05).Multivariate logistic regression analysis showed that increased TBIL,decreased blood potassium,decreased PNI and severe overall burden of CSVD were risk factors of HT in ACI patients after IVT(P<0.05).Results of the nomogram model constructed on the above four factors showed that Hosmer-Lemeshow goodness of fit test was χ2=0.392,P=1.000.The predicted probability was relatively closer to the actual probability,and its area under the curve(AUC),sensitivity and specificity were 0.972(95%CI:0.945-0.998),88.00%and 94.38%respectively.Conclusions The influencing factors of HT include TBIL,blood potassium,PNI and overall burden of CSVD in ACI patients after IVT,and the nomogram model constructed on these factors has a high predictive value in HT.

Abstract:Objective To explore the predictive value of monocyte-to-lymphocyte ratio(MLR)and non-high-density lipoprotein cholesterol-to-high-density lipoprotein cholesterol ratio(NHHR)on hemorrhagic transformation(HT)after intravenous thrombolysis with tenecteplase(TNK)in patients with ACI.Methods A total of 42 cases with ACI who received TNK intravenous thrombolysis and developed HT from January 2023 to January 2025 were included in the HT group,and 217 cases with ACI who received TNK intravenous thrombolysis and did not develop HT were included in the non-HT group.The predictive value of MLR and NHHR was evaluated by ROC curve.The influencing factors of HT after TNK intravenous thrombolysis were explored by multivariate logistic stepwise regression.Results The monocyte count,non-HDL-C,MLR,and NHHR in the HT group were higher compared with non-HT group,while the lymphocyte count and HDL-C were lower than those in the non-HT group(P<0.05).The area under the ROC curve(AUC)(95%CI)of MLR combined with NHHR for predicting HT after TNK intravenous thrombolysis in patients with acute cerebral infarction was 0.903(0.853～0.952),which was higher than that of MLR and NHHR alone,0.755(0.705～0.804)and 0.843(0.795～0.894),respectively(Z=9.567,8.347,P<0.001).The proportion of history of hypertension and atrial fibrillation in the HT group was higher compared with non-HT group,and the NIHSS score at admission,time from onset to thrombolysis,neutrophil count,D-dimer,fasting blood glucose,and aspartate aminotransferase were higher in the HT group than in the non-HT group(P<0.05).Multivariate analysis showed that atrial fibrillation(OR=3.080,95%CI:1.563～6.069),increased NIHSS score at admission(OR=2.793,95%CI:1.342～5.813),increased D-dimer(OR=1.962,95%CI:1.360～2.831),MLR≥0.23(OR=2.875,95%CI:1.523～5.425),and NHHR≥3.22(OR=3.360,95%CI:1.643～6.872)were independent risk factors for HT after TNK intravenous thrombolysis(P<0.05).Conclusions Elevated MLR and NHHR are closely related to HT after TNK intravenous thrombolysis in patients with ACI and can be used as predictive indicators for HT.The predictive efficacy of the combination of the two is better than that of a single indicator.

Abstract:Objective To evaluate the therapeutic efficacy of neuromorphic transcutaneous electrical nerve stimulation(nTENS)in patients with spinal cord injury(SCI).Methods A total of 46 SCI patients admitted to our hospital between January 2024 and December 2024 were enrolled and randomly assigned to either the control group(n=23)or the experimental group(n=23)using a computer-generated random sequence.The control group received conventional treatments,including anti-infection measures and neurotrophic therapies,whereas the experimental group received additional neuromorphic transcutaneous electrical nerve stimulation.Clinical outcomes were assessed before and after intervention,including sensory and motor function scores,based on the American Spinal Injury Association(ASIA)standards,spinal cord independence measureⅢ(SCIM-Ⅲ),functional independence measure(FIM),and visual analogue scale(VAS)scores for pain evaluation.Results Following nTENS treatment,the experimental group demonstrated significant improvements in ASIA sensory and motor function scores.Moreover,the ASIA motor function score of patients in the experimental group after treatment was significantly higher than that of the control group,with a statistically significant difference(t=-2.034,P<0.05).Likewise,SCIM-Ⅲ and FIM scores were markedly improved in the experimental group post-treatment,and the FIM score of patients in the experimental group after treatment was significantly higher than that of the control group,with a statistically significant difference(t=-2.049,P<0.05).Additionally,both groups exhibited significant reductions in VAS pain scores after treatment,with the experimental group demonstrating a more pronounced reduction(t=3.848,P<0.05).Conclusions Neuromorphic transcutaneous electrical nerve stimulation exhibits considerable therapeutic efficacy in treating spinal cord injury patients.This intervention significantly enhances sensory and motor functions,promotes independence in daily living activities,and effectively alleviates pain,demonstrating promising clinical applicability and potential for improving patient outcomes.

Abstract:Cerebrospinal fluid(CSF)rhinorrhea is one of the most common postoperative complications of neuroendoscopic transnasal approach for pituitary adenoma resection.The risk factors for such postoperative cerebrospinal fluid rhinorrhea are a current hot research topic,though there is still controversy regarding whether these factors influence postoperative cerebrospinal fluid rhinorrhea.By comprehensively analyzing these factors,this paper intends to probe into the mechanism of the occurrence and development of cerebrospinal fluid leakage,which can help doctors take targeted preventive measures and improve the safety and success rate of such surgeries.This paper reviews the risk factors and the current research progress on cerebrospinal fluid nasal leakage after neuroendoscopic resection of pituitary tumors by transnasal approach,which can provide reference for clinical practice.

Abstract:Objective To construct a prediction model based on non-contrast computed tomography(CT)features and clinical parameters for assessing the risk of hematoma enlargement in patients with hypertensive intracerebral hemorrhage(HICH)and to evaluate its predictive efficacy.Methods The clinical and imaging data of 216 HICH patients admitted to Suzhou First People's Hospital from December 2021 to May 2024 were retrospectively analyzed.Patients were categorized into a hematoma enlargement group(n=84)and a non-hematoma enlargement group(n=132)based on the criteria of hematoma enlargement exceeding 33%in relative volume or 6 mL in absolute volume.The dataset was randomly split into training and test sets in a 7:3 ratio.The candidate predictors were selected using univariate analysis,LASSO regression,and the Max-Relevance and Min-Redundancy(mRMR)algorithm.Multivariate logistic regression was employed to establish a nomogram model for predicting hematoma enlargement in HICH patients,as well as the related clinical and hematoma sign models.The predictive efficacy of each model was assessed using area under receiver operating characteristic(ROC)curve(AUC)and calibration curve,and clinical decision curve analysis was used to evaluate the clinical utility of the models.Patients were then categorized into low-and high-risk subgroups.Results The results of the CT scan review revealed that hematoma enlargement occurred in 84 patients,representing an incidence of 38.89%(84/216).Univariate analysis indicated statistically significant differences between the hematoma enlargement and non-hematoma enlargement groups in terms of age,interval between CT reexamination,irregular use of antihypertensive medication,pre-admission Glasgow Coma Scale(GCS)score,presence of cerebral hernia,ventricular involvement,hematoma volume,hematoma location,hemorrhage margin irregularity,as well as the swirl sign,blend sign,satellite sign,and island sign(P<0.05).Moreover,the nomogram model demonstrated the most favorable predictive efficacy(AUC=0.926)when compared to the clinical model and the hematoma sign model in the training set.Furthermore,the AUC value of the nomogram model in the test set reached 0.951.Calibration curves for the nomogram model in both the training and test sets showed satisfactory results,exhibiting good agreement(Hosmer-Lemeshow P>0.05).Clinical decision curve analysis revealed that the nomogram model provided superior clinical decision guidance for assessing hematoma enlargement risk in HICH patients.The incidence of hematoma enlargement differed significantly between the high-risk and low-risk subgroups(P<0.001).Conclusions This study constructs a nomogram model based on non-contrast CT features and clinical parameters,including hematoma volume,hemorrhage margin irregularity,blend sign,swirl sign,satellite sign,island sign,age,irregular use of antihypertensive medication,interval between CT reexamination,and pre-admission GCS score.This model provides an effective personalized risk assessment tool for predicting the occurrence of hematoma enlargement in HICH patients,allowing early identification of high-risk individuals,and demonstrating potential for clinical application.

Abstract:Objective To investigate the characteristics and patterns of protein alterations during the progression of human traumatic brain injury(TBI)to chronic traumatic encephalopathy(CTE),thereby providing novel targets and insights into the pathogenesis of CTE and offering a theoretical basis for its intervention and treatment.Methods Proteomic data for CTE and TBI were obtained from the ProteomeXchange database.Functional enrichment analysis of the identified proteins was conducted using the Metascape database,Gene Ontology(GO)database,Kyoto Encyclopedia of Genes and Genomes(KEGG),and some interactive gene search tools.Results 13 differentially expressed proteins in both severe TBI(sTBI)and CTE were identified,which are primarily associated with inflammatory and immune responses,the cGMP-PKG signaling pathway,cytoskeletal structure,and intercellular junctions.A total of 151 differentially expressed proteins specific to sTBI were mainly linked to inflammation,immunity,and energy metabolism,whereas 746 differentially expressed proteins specific to CTE were predominantly involved in protein translation and transport,synaptic function,and energy metabolism.Conclusions Inflammatory and immune processes,energy metabolism,the cGMP-PKG signaling pathway,cytoskeletal integrity,and intercellular connectivity may play crucial roles in the development of CTE following human TBI.

Abstract:With the rapid development of artificial intelligence(AI)technology,its applications in neurosurgery have become increasingly widespread,encompassing disease diagnosis,surgical planning and navigation,postoperative monitoring,and prognosis evaluation,among other areas.This article provides a detailed exploration of the specific applications of AI in neurosurgery,analyzes the challenges and limitations it faces,and envisions future directions for its development.Through in-depth analysis,this article aims to offer valuable insights for neurosurgeons and researchers,promoting the further application and advancement of AI technology in neurosurgery.

Abstract:Objective To analyze the correlation between monocyte/apolipoprotein A1 ratio(MAR)and carotid plaque in cases with ischemic stroke(CIS).Methods A total of 206 CIS patients admitted to Handan 285 Hospital from December 2021 to October 2024 were selected as the study subjects.According to the stability of carotid artery plaques,they were divided into the stable group(n=88)and the unstable group(n=118).Meanwhile,256 healthy people in Handan 285 Hospital were selected as the control group.All the included subjects were tested for monocyte(M),apolipoprotein A1(ApoA1),and other related indicators,and MAR was calculated.General data and MAR of each group were compared.Spearman analysis was used to analyze the correlation between MAR and carotid plaque instability in CIS cases.The diagnostic value of MAR for carotid plaque instability in CIS cases was evaluated by the ROC curve and area under the curve(AUC)(Bootstrap internal validation).The related factors affecting carotid plaque instability in CIS cases were evaluated by multivariate logistic regression.Results The levels of M and MAR in the peripheral blood of the study group were higher than the control group,while the ApoA1 level was lower than the control group(P<0.05).Unstable group National Institutes of Health Stroke Scale(NIHSS)score,Intima-Media Thickness of the artery,the levels of IMT,peripheral blood monocytes(M),High-sensitivity C-reactive Protein(hs-CRP),and MAR were all higher than those in the stable group,while the level of ApoA1 was lower than that in the stable group(P<0.05).Spearman analysis showed that MAR was positively correlated with carotid plaque instability in CIS cases(r=0.542,P<0.001).The ROC curve results showed that the AUC of MAR for diagnosing carotid plaque instability in CIS patients was 0.902(95%CI:0.852 to 0.952).The corrected AUC verified by Bootstrap was 0.896(95%CI:0.840 to 0.925).NIHSS score≥7.80(OR=1.984),IMT≥1.20mm(OR=2.625),hs-CRP≥3.45mg/L(OR=2.396),and MAR≥0.55(OR=3.789)were all risk factors for carotid plaque instability in CIS cases(P<0.05).Conclusions Abnormally elevated MAR is closely related to carotid plaque instability in CIS patients and can be used as an efficient biological indicator for diagnosing carotid plaque instability.In clinical practice,MAR can be used as an auxiliary screening indicator,combined with indicators such as NIHSS and IMT to assess the risk of carotid plaque instability in CIS patients,which provides a basis for early intervention and treatment.

Abstract:Objective To explore the application effect of enteral nutrition management under multidisciplinary team collaboration in patients with severe traumatic brain injury(sTBI).Methods 108 patients with sTBI admitted to Henan Provincial People's Hospital from May 2022 to April 2025 were randomly divided into two groups using the random number table method.The control group(n=54)received conventional nutrition management,while the observation group(n=54)received additional enteral nutrition management under multidisciplinary team collaboration on the basis of the control group.The enteral nutrition related status(initiation time,enteral nutrition compliance rate after 1 week of feeding,and feeding interruption rate),nutritional indicators[total protein(TP),albumin(ALB),hemoglobin(Hb)],immune indicators[immunoglobulin A(IgA),immunoglobulin G(IgG),immunoglobulin M(IgM)],and incidence of enteral nutrition related complications between two groups of patients were compared.Results The initiation time of enteral nutrition in the observation group was shorter than that in the control group,the achievement rate of enteral nutrition target was higher than that in the control group,and the interruption rate of enteral nutrition feeding was lower than that in the control group,with statistical significance(P<0.05).After intervention,the levels of TP,ALB,and Hb in the observation group were higher than those in the control group,and the differences were statistically significant(P<0.05).After intervention,the levels of IgA,IgG,and IgM in the observation group were higher than those in the control group,and the difference was statistically significant(P<0.05).The incidence of enteral nutrition-related complications in the observation group was lower than that in the control group,and the difference was statistically significant(P<0.05).Conclusions Enteral nutrition management under multidisciplinary team collaboration can effectively improve the nutritional status and immune function of patients with sTBI and reduce the incidence of enteral nutrition-related complications.

Abstract:Objective To analyze the efficacy of ginkgo biloba extract tablets combined with betahistine mesylate tablets and otolith repositioning instrument in the treatment of secondary benign paroxysmal positional vertigo(BPPV).Methods Sixty patients with secondary BPPV treated in Yellow River Sanmenxia Hospital from December 2023 to September 2024 were selected as subjects.They were randomly divided into control group(n=29)and experimental group(n=31)according to the random number table method.Patients in the control group were treated with betahistine mesylate tablets+otolith reset instrument,and patients in the experimental group were treated with ginkgo biloba extract in addition to the regimen used in the control group.The clinical efficacy,symptom relief time,vestibular function and incidence of adverse reactions of the two groups were compared.Results 1 month and 6 months after treatment,the total effective rate of clinical efficacy in the experimental group was significantly higher than that in the control group(P<0.05).During the treatment,the remission time of each symptom in the experimental group was significantly lower than that in the control group(P<0.05).At 6 months after treatment,the IAR of cervical vestibular evoked myogenic potential(C-VEMP)and O-VEMP in the experimental group were significantly lower than those in the control group(P<0.05),and the normal rates of p13-n23 amplitude,n10-p15 amplitude,video head impulse test(vHIT)gain value and CP value were significantly higher than those in the control group(P<0.05).There was no significant difference in the incidence of total adverse reactions between the two groups(P>0.05).Conclusions Ginkgo biloba extract tablets,in combination with betahistine mesylate tablets and otolith reset instrument,can effectively treat secondary BPPV,improve vestibular function and reduce vertigo disability,with a high level of clinical safety.

Abstract:Objective To observe the effects of galantamine hydrobromide injection(galantamine)and butylphthalide sodium chloride injection(butylphthalide)on the rehabilitation of patients'motor function after 2-week treatment by means of 3D-diffusion tensor imaging(3D-DTI)technology.Methods A total of 77 patients were enrolled and divided into a treatment group(38 cases)and a control group(39 cases).Diagnosed on 3D-DTI images,the patients received corresponding drug treatments.The changes in motor function were evaluated by the National Institutes of Health Stroke Scale(NIHSS),Fugl-Meyer Assessment(FMA),and Barthel Index(BI).Results In ultra-early,acute,and sub-acute phase patients,the NIHSS,FMA,and BI scores improved after treatment(P<0.05),with more significant improvements in the ultra-early and acute phases(P<0.01).Moreover,the therapeutic effect of galantamine was superior to that of butylphthalide in the ultra-early phase(P<0.05).DTI showed that there were significant inter-group differences in apparent diffusion coefficient(ADC)values in the ultra-early phase(P<0.05),and fractional anisotropy(FA)value differences gradually emerged in the acute phase and later stage(P<0.05).Conclusions 3D-DTI can refine the staging of stroke,and galantamine has a better effect than butylphthalide in improving motor function during the ultra-early treatment of ischemic stroke.

Abstract:Objective To analyze mortality trend of elderly population(≥65 years)with ischemic stroke in China from 1990 to 2021,and predict its trends in the next 20 years.Methods Based on mortality data of elderly people with ischemic stroke in China from 1990 to 2021,this study used the Joinpoint regression model to identify significant change points and analyze the impact of different ages,periods,and birth cohorts on mortality through the age-period-cohort model.The Nordpred model was applied to predict mortality and death number of elderly population with ischemic stroke in the next 20 years.Results The death number of elderly people with ischemic stroke in China increased from 344 182 in 1990 to 1 061 572 in 2021,with the highest mortality in those aged 80 and above,and consistently higher rates in men than in women.Joinpoint analysis indicated that the annual percent change(APC)from 1998 to 2004 reached 3.17%,then gradually declined to-1.07%by 2021.Age-period-cohort model analysis showed that mortality among men with ischemic stroke who aged 90-94 exceeded 6 000 per 100 000,higher than that of women in the same age.Nordpred model predicted that by 2044,the estimated number of deaths of elderly people with ischemic stroke would increase to 2 366 561,and the estimated crude mortality would rise to 646.95 per 100 000.In the next 20 years,the mortality of male ischemic stroke population will continue to be higher than that of female,reaching 810.83 per 100 000 and 540.67 per 100 000 respectively.Conclusions This study reveals trends and gender differences of the estimated mortality of the elderly population with ischemic stroke in China,and emphasizes the importance of prevention and control of ischemic stroke in this group,especially among those aged 80 and older and the male population.

Abstract:Objective To explore the risk factors for hypostatic pneumonia in patients with severe traumatic brain injury(sTBI)undergoing tracheotomy.Methods A total of 113 patients with sTBI who underwent tracheotomy in the Department of Intensive Care Medicine at Hubei Provincial Hospital of TCM(Hubei Shizhen Laboratory/Affiliated Hospital of Hubei University of Chinese Medicine)from June 2021 to June 2024 were retrospectively selected as the study subjects.According to the occurrence of hypostatic pneumonia,the patients were divided into pneumonia group(n=27)and control group(n=86).Multivariate logistic regression analysis was used to identify independent risk factors for hypostatic pneumonia in patients with sTBI,and a risk prediction model was constructed.Homser-Lemeshow test was used to evaluate the goodness of fit of the prediction model,and the receiver operating characteristic(ROC)curve was used to evaluate its predictive performance.Results The incidence of hypostatic pneumonia in this study was 23.89%(27/113).The proportions of patients with chronic respiratory diseases,Glasgow coma scale(GCS)score≤5,non-prone bed rest posture,and hypoalbuminemia in the pneumonia group were higher than those in the control group,and the differences were statistically significant(P<0.05).Multivariate logistic regression analysis showed that GCS score≤5 and hypoalbuminemia were independent risk factors for hypostatic pneumonia in patients with sTBI undergoing tracheotomy,while prone bed rest posture was a protective factor(P<0.05).A prediction model was constructed as follows:Logistic(P)=1.540-1.185×GCS score+1.206×bed rest posture-1.993×hypoalbuminemia.Homser-Lemeshow goodness of fit test showed 2=7.314,P>0.05.ROC curve analysis showed that the AUC,sensitivity and specificity of the prediction model were 0.837(95%CI:0.762-0.912),66.67%and 81.40%.Conclusions GCS score,hypoalbuminemia,and bed rest posture are factors influencing the occurrence of hypostatic pneumonia in patients with sTBI undergoing tracheotomy.The prediction model constructed on these factors can be used to predict the occurrence of hypostatic pneumonia in patients with sTBI undergoing tracheotomy.

Abstract:Objective To analyze the risk factors and serological predictors of hemorrhagic transformation of acute massive cerebral infarction.Methods A retrospective analysis was conducted on the case data of 120 patients with acute massive cerebral infarction in the 904th Hospital of Wuxi Joint Logistic Support Force from January 2023 to January 2025.According to the occurrence of hemorrhagic transformation,42 patients with hemorrhagic transformation were included in group A,and 78 patients without hemorrhagic transformation were enrolled as group B.The clinical case data in the two groups of patients were collected.The risk factors of hemorrhagic transformation in patients with acute massive cerebral infarction were analyzed by univariate analysis and multivariate logistic regression analysis.Receiver operating characteristic(ROC)curve was drawn to analyze the predictive efficiency of relevant serological indicators.Results Univariate analysis showed that group A had significantly longer time from symptom onset to treatment and higher proportion of thrombolytic therapy,proportion of atrial fibrillation history,matrix metalloproteinase(MMP)-9,D-dimer and lipoprotein-associated phospholipase A2(Lp-PLA2),and significantly lower low-density lipoprotein cholesterol(LDL-C)(P<0.05).Logistic multivariate analysis showed that long time from symptom onset to treatment,thrombolytic therapy,history of atrial fibrillation,low LDL-C level,high MMP-9 level,high D-dimer level and high Lp-PLA2 level were risk factors for hemorrhagic transformation in patients with acute massive cerebral infarction.ROC curve found that the areas under the ROC curves(AUCs)of serum MMP-9,D-dimer and Lp-PLA2 for predicting hemorrhagic transformation of acute massive cerebral infarction were 0.706,0.872 and 0.746 respectively.The AUC of combined prediction of the three serological indicators was 0.918.Conclusion In patients with acute massive cerebral infarction,the risk of hemorrhagic transformation is higher in patients with long time from symptom onset to treatment,history of thrombolytic therapy,history of atrial fibrillation,low LDL-C and high serum MMP-9,D-dimer and Lp-PLA2 levels.Serum MMP-9,D-dimer and Lp-PLA2 levels have certain predictive values on hemorrhagic transformation of acute massive cerebral infarction,and the combined predictive value is the highest.

Abstract:Objective To study the changes of serum microRNA-124(miR-124),homocysteine(Hcy)and lipoprotein-associated phospholipase A2(Lp-PLA2)in patients with cerebral infarction and analyze their relationship with disease severity.Methods The data of 156 patients with cerebral infarction(study group)in the Third Affiliated Hospital of Xinxiang Medical University were retrospectively analyzed,and 160 healthy people with physical examination were selected as control group.The severity of the condition was assessed using the National Institutes of Health Stroke Scale(NIHSS)score,and patients were divided into mild,moderate,and severe groups.The differences in serological indicators among different groups were compared.Spearman correlation analysis was conducted to analyze the relationship between serum miR-124,Hcy and Lp-PLA2 levels and the severity of cerebral infarction.According to the prognosis status within 1 year of follow-up,participants were stratified into good prognosis and poor prognosis groups,and the differences in clinical data and serum indicators were compared.Receiver operating characteristic(ROC)curve analysis was employed to assess the predictive value of miR-124,Hcy and Lp-PLA2 on prognosis.Results The levels of serum miR-124,Hcy and Lp-PLA2 in study group were higher than those in control group(P<0.05),and the above levels were lower in mild group than those in moderate and severe groups(P<0.05),and were lower in moderate group than those in severe group(P<0.05).Spearman correlation analysis showed that serum miR-124,Hcy and Lp-PLA2 were positively correlated with disease severity(P<0.05).The proportion of infarction size>20cm2,proportion of multi-vessel lesions,NIHSS score at admission and serum indicators in poor prognosis group were higher than those in good prognosis group(P<0.05).ROC curve analysis showed that the sensitivities of serum miR-124,Hcy,Lp-PLA2 alone and in combination in predicting the prognosis of patients with cerebral infarction were 69.56%,80.43%,80.43%and 91.30%,and the specificities were 70.91%,68.18%,70.91%and 65.45%,and the areas under the curves(ACUs)were 0.676,0.782,0.828 and 0.910 respectively,which indicated that the combination of miR-124,Hcy and Lp-PLA2 had higher predictive value on prognosis.Conclusions The levels of serum miR-124,Hcy and Lp-PLA2 in patients with cerebral infarction increase significantly with the aggravation of disease,and combination of the above three indicators can better predict the prognosis of patients.

Abstract:Objective To analyze the incidence trends of intracerebral hemorrhage among the global adolescent population from 1990 to 2021,and examine its associations with age,period,and cohort effects in order to provide a reference for developing effective prevention and control strategies.Methods Data were sourced from the GBD 2021 database to extract incidence rates,crude incidence rates,and standardized incidence rates of intracerebral hemorrhage within the global adolescent population(aged 15-39).The temporal trend of incidence from 1990 to 2021 was analyzed by using Joinpoint software.Annual percentage change(APC)and average annual percentage change(AAPC)were calculated,and,an age-period-cohort model was employed to investigate the effects of age,period,and birth cohort on incidence.Results Analysis via Joinpoint software indicated that between 1990 and 2021,both total population-adjusted and sex-standardized incidences of intracerebral hemorrhage exhibited a declining trend among the global adolescent population.The AAPC was-1.19%for the overall population,-0.86%for males,and-1.60%for females-each demonstrating statistical significance(P<0.001).Notably,during the period from 2014 to 2019 there was an increase in overall incidence(APC=0.15,P<0.05),with men consistently at higher risk than women throughout this timeframe.Findings from the age-period-cohort model revealed that globally between 1992 and 2021 as adolescents became older,their risk of intracerebral hemorrhage increased,especially among males aged between 35-39 years old their rate of intracerebral hemorrhage incidence reached approximately 1.78 times greater than those observed in females within the same age bracket.Furthermore,it was noted that later birth cohorts experienced lower disease risks associated with advancing age at diagnosis.Conclusion There are overall fluctuations characterized by a general decline of incidences of intracerebral hemorrhage among adolescents worldwide from 1990 to 2021,whereas there are increases during specific intervals such as those occurring between 2014 and 2019.Men consistently demonstrate higher incidences compared to women,which significantly escalate alongside increased age.Therefore,it is recommended to strengthen the prevention and control of intracerebral hemorrhage in the male population.