Abstract:Objective To investigate the efficacy and safety of different doses of butylphthalide in the treatment of acute ischemic stroke(AIS).Methods A total of 86 AIS patients admitted to our hospital from January 2019 to November 2020 were selected and randomly assigned into an observation group and a control group,with 43 patients in each group.Both groups received conventional treatment.On this basis,the control group was treated with 100 ml of butylphthalide injection once daily,while the observation group received 100 mL twice daily,for a total of 14 days.The National Institute of Health Stroke Scale(NIHSS),Activity of Daily Living Scale(ADL),and Fugl-Meyer Assessment(FMA)scores were evaluated before and after treatment.Serum levels of C-reactive protein(CRP),protein kinase C(PKC),pentameter protein 3(PTX3),tumor necrosis factor-α(TNF-α),osteoprotegerin(OPG),and soluble tumor necrosis factor-related apoptosis-inducing ligand(sTRAIL)were detected.Adverse reactions during treatment were recorded.Results After 14 days of treatment,the total effective rate in the observation group was significantly higher than that in the control group(93.02%vs 74.42%,P<0.05)and the NIHSS score was lower in the observation group compared to the control group(7.23±1.18 vs 9.47±1.36,P<0.05),while ADL and FMA scores were significantly higher in the observation group(P<0.05).The levels of CRP,PKC,PTX3,sTRAIL,OPG,and TNF-αdecreased in both groups,with the observation group showing significantly lower levels than the control group(all P<0.05).At the 3-month follow-up,the observation group continued to show superior neurological and functional recovery(P<0.05).There was no significant difference in the incidence of adverse reactions between the two groups(P>0.05).Conclusions Combined treatment with a high dose of butylphthalide(100 ml,twice daily)on the basis of conventional therapy can more effectively improve neurological function,daily living ability,and motor function in AIS patients.It significantly reduces the levels of inflammatory and apoptosis-related markers without increasing adverse reactions,demonstrating good safety.

Abstract:Objective To explore the clinical effect of neuroendoscopic hematoma removal via anterior middle frontal gyrus approach in the treatment of non-cerebral hernia basal ganglia hemorrhage and its influence on the postoperative edema volume around hematoma.Methods A total of 82 patients with non-cerebral hernia basal ganglia hemorrhage admitted to the First Affiliated Hospital of Henan University of Science and Technology from January 2022 to January 2025 were selected.According to different surgical methods,42 patients who underwent neuroendoscopic hematoma removal via anterior middle frontal gyrus approach were included in the neuroendoscopic group,and 40 patients who underwent microscopic craniotomy and hematoma removal via temporal lobe cortex approach were included in the microscopic craniotomy group.The surgery-related indicators(intraoperative blood loss volume,surgical time,hemostasis time,postoperative hospitalization time)and clinical efficacy(hematoma removal rate,total effective rate),hematoma volume and edema volume around hematoma before surgery and on the 5th day after surgery,occurrence of postoperative complications and prognosis-related indicators[modified Rankin scale(mRS)score and National Institutes of Health stroke scale(NIHSS)score at 6 months after surgery]were compared between the two groups.Results Compared with the microscopic craniotomy group,the neuroendoscopic group had less intraoperative blood loss volume,shorter surgical time,hemostasis time and postoperative hospitalization time as well as a significantly higher total effective rate of hematoma removal(P<0.05).The hematoma volume of patients in both groups was significantly reduced on the 5th day after surgery compared to that before surgery,and the volume in the neuroendoscopic group was significantly less than that in the microscopic craniotomy group(P<0.05).The edema volume around hematoma was significantly increased in the two groups compared to that before surgery,and the edema volume in the neuroendoscopic group was obviously less than that in the microscopic craniotomy group(P<0.05).The total incidence rate of postoperative complications was significantly lower in the neuroendoscopic group(11.90%)than that in the microscopic craniotomy group(32.50%)(P<0.05).At 6 months after surgery,the mRS score and NIHSS score in the neuroendoscopic group were significantly lower than those in the microscopic craniotomy group(P<0.05).Conclusions Neuroendoscopic hematoma removal via anterior middle frontal gyrus approach has the advantages of shorter surgical time,lesser intraoperative blood loss and faster hemostasis in the treatment of non-cerebral hernia basal ganglia hemorrhage.It can effectively remove the hematoma,and has small edema around hematoma,low risk of postoperative complications and good prognosis,thus this procedure is worthy of clinical promotion and application.

Abstract:Objective To discuss the effects of suspension training combined with graded motor imagery(GMI)therapy on muscle tone and neurological function in patients with stroke-induced hemiplegia.Methods 80 patients with stroke-induced hemiplegia admitted to Qingdao Special Service Convalescent Center from June 2023 to May 2025 were randomly separated into the training group(n=40,suspension training)and the combined group(n=40,suspension training combined with GMI).After 8 weeks of therapy,the neurological function,physical coordination,muscle tone and quality of life were evaluated.Results The NIHSS scores decreased in both groups,lower in the combined group than in the training group(7.54±1.86 vs 9.32±2.14,MD=1.78,95%CI=0.89-2.67,P<0.05).BBS and FMA scores of both groups prominently increased,and the combined group had higher scores than the training group(BBS:37.09±5.87 vs 30.25±5.08,MD=6.84,95%CI=4.40-9.28;FMA:39.41±5.85 vs 32.35±5.38,MD=7.06,95%CI=4.56-9.56,P<0.05).Both groups showed a prominent decrease in TUGT time,with the combined group having shorter time than the training group(MD=3.73,95%CI=1.54-5.92,P<0.05)and a prominent increase in muscle tone and various SF-36 scores,with the combined group being higher than the training group(P<0.05).Conclusions Suspension training combined with GMI therapy can effectively improve muscle tone,nerve function and body coordination of stroke-induced hemiplegic patients,and thus improve their quality of life.

Abstract:Objective To explore the occurrence of delirium in emergency patients with cerebral hemorrhage,analyze its multi-dimensional influencing factors and construct a risk prediction model.Methods A retrospective analysis was conducted on 200 patients with cerebral hemorrhage admitted to emergency department of the First Affiliated Hospital with Nanjing Medical University(Jiangsu Provincial People's Hospital)from February 2023 to February 2025,and the incidence rate of delirium was counted.Logistic regression analysis was performed to analyze the influencing factors of delirium occurrence.A risk prediction model was constructed based on the significant variables,and receiver operating characteristic(ROC)curve was utilized to evaluate the predictive value of the model on the occurrence of delirium.Results The 200 emergency patients with cerebral hemorrhage were divided into the delirium occurrence group(n=76,38.00%)and the non-delirium occurrence group(n=124,62.00%).Compared with the non-delirium occurrence group,the patients in the delirium occurrence group were older,and had lower Glasgow coma score,higher proportions of history of hypertension,history of coronary heart disease,use of sedative drugs and increased intracranial pressure,more cerebral hemorrhage volume,and longer hospital stay(P<0.05).Logistic regression analysis suggested that age,Glasgow coma score,history of hypertension,use of sedative drugs,increased intracranial pressure,cerebral hemorrhage volume,and hospital stay were all multi-dimensional influencing factors of delirium occurrence(P<0.05).A risk prediction model was constructed as Ln(P/1-P)=-18.695+0.076×age+0.438×history of hypertension+0.084×cerebral hemorrhage volume-0.064×Glasgow coma score+0.438×use of sedative drugs+0.537×increased intracranial pressure+0.067×hospital stay.ROC curve analysis revealed that the area under the ROC curve,sensitivity,specificity,and 95%CI of the model prediction were 0.922,0.921,0.782 and 0.884～0.961.In the validation set,the AUC,sensitivity and specificity were 0.892(95%CI:0.805～0.979),0.885 and 0.756.Conclusions The risk of delirium is relatively higher in emergency patients with cerebral hemorrhage,and its occurrence is closely related to multiple factors such as age,Glasgow coma score,history of hypertension,use of sedative drugs,intracranial pressure level,cerebral hemorrhage volume,and hospital stay.By integrating the above variables,a risk prediction model can provide a reference for the early assessment of delirium risk.

Abstract:Objective To translate psychological tolerance questionnaire for second victims of adverse events(WS-PSY-Q)into Chinese,and analyze its reliability and validity so as to provide a reliable tool for assessing and intervening in neurosurgery nurses'psychological resilience.Methods The scale was literally adapted by following the translation-back-translation method and culturally adapted through two rounds of expert consultation(involving 7 neurosurgical nursing experts in clinical practice and management).A formal survey was then conducted among 250 neurosurgical nurses from six tertiary grade A hospitals in Jiangsu province,who were selected by stratified cluster sampling.Reliability and validity analyses were performed using SPSS 28.0 software.Results The Chinese version of the WS-PSY-Q comprised of two sub-questionnaires:the psychological distress questionnaire and the coping strategy questionnaire.The former included three dimensions(emotional response,cognitive dissonance,and somatization symptoms)with a total of 25 items.The latter included three dimensions(problem-focused strategies,emotion regulation strategies,and social support utilization)with a total of 27 items.Reliability analysis showed that Cronbach's alpha coefficient of the total scale was 0.941,a split-half reliability coefficient of 0.879,and a test-retest reliability of 0.845.Content validity analysis indicated that content validity index(CVI)for the total scale was 0.94,with item-level CVIs ranging from 0.86 to 1.00.Factor analysis revealed a KMO value of 0.891,and Bartlett's test of sphericity was significant(χ2=3246.75,P<0.05).The psychological distress questionnaire contained three factors,explaining 61.7%of the total variance.The coping strategy questionnaire contained three factors,explaining 68.3%of the total variance.Factor loadings of items on their respective common factors ranged from 0.52 to 0.86.Correlation analysis showed that the correlation coefficients between each item and its respective dimension ranged from 0.65 to 0.83,and the correlation coefficients between each item and the total scale ranged from 0.65 to 0.86(all P<0.05).Criterion-related validity analysis found that using the General Health Questionnaire(GHQ-12)as the criterion,the total score of the psychological distress questionnaire was significantly positively correlated with the GHQ-12(r=0.71,P<0.05),while the total score of the coping strategy questionnaire was significantly negatively correlated with the GHQ-12(r=-0.63,P<0.05).Conclusions The Chinese version of the WS-PSY-Q demonstrates good reliability and validity.It can serve as a standardized assessment tool in China to evaluate psychological resilience of the second victims of adverse nursing events.It can effectively identify neurosurgical nurses at high psychological risk,providing a basis for hospitals to conduct psychological resilience assessment and intervention for nurses.

Abstract:Pituitary stalk thickening(PST)can cause physiological and pathological functional changes,with particularly significant effects on children and adolescents in the growth and development period.The causes of PST in children and adolescents may involve tumors,infections/inflammations,congenital diseases,etc.The core of diagnosis and treatment lies in differentiating tumor diseases from non-tumor lesions to avoid the serious impact of misdiagnosis,mistreatment,missed diagnosis,and delayed diagnosis on the quality of life and prognosis of children and adolescents,so multidisciplinary diagnosis and treatment are often required.For this purpose our project team invited experts to write the guidelines for multidisciplinary diagnosis and treatment of PST in Chinese children and adolescents,aiming to provide a reference for clinical treatment and guide clinical medical staff in the rational treatment of PST in children and adolescents.

Abstract:Objective To investigate the mechanism for the dynamic evolution of professional identity awareness among military medical university freshmen from the perspective of the interactive effects of home-school collaboration,the military academy environment,and personal traits.Methods The professional identity scale was used to measure the occupational cognition,affect,volition,values,and efficacy of the participants'professional identity levels.The longitudinal trajectories of change over the first academic year were tracked for 277 freshmen via latent class growth modeling(LCGM),with multidimensional influencing factors analyzed using multivariate logistic regression.Results LCGM analysis yielded three distinct latent classes based on the dynamic trajectories of professional identity:rapid growth C2 group(126 cases,45.5%),slow growth C1 group(96 cases,34.6%),and persistent low-level C0 group(55 cases,19.9%).Univariate analysis revealed significant intergroup differences in military school satisfaction,parent-child relationships,frequency of communication with unit leaders,family structure,personality traits,home-school communication frequency,geographical origin,and family income(all P<0.05).Multivariate logistic regression analysis revealed that in the C1 vs.C0 results,the following factors were statistically significant(all P<0.05):moderate and high military academy satisfaction,home-school communication frequency of 6-9 and≥10 per year,and outgoing personality.In the C2 vs.C0 results,the following factors were statistically significant(all P<0.05):high military academy satisfaction,close parent-child relationship,communication frequency with unit leaders twice or more,home-school communication frequency≥10 per year,two-parent family structure,and outgoing personality.Conclusions The development of professional identity in military medical freshmen is influenced by the interplay of individual,family,and environmental factors.It is essential to establish a home-school collaborative mechanism and strengthen environmental support and family connectivity for the low-identity group so as to enhance their professional adaptability.

Abstract:Objective To investigate the etiology,examination methods and related treatment of vertebral artery dissection(VAD).Methods The clinical manifestations,relevant examinations,treatment options and prognosis were analyzed of a patient in the Department of Neurology of the First People's Hospital of Nanyang City,Henan Province who developed acute nervous system dysfunction symptoms after receiving neck massage,and relevant literature was reviewed.Results After the patient developed symptoms,complete head and neck CTA,skull MRA and DSA confirmed that he had acute cerebral infarction caused by right vertebral artery dissection.He recovered well after receiving intravenous thrombolysis and bridging endovascular treatment.Conclusions Vertebral artery dissection is a common cause of acute ischemic stroke in young people and neck massage is one of the common inducements.Endovascular treatment can effectively improve the occluded blood vessels caused by VAD,resulting in a good prognosis.

Abstract:Objective To investigate the predictive value of carotid ultrasound quantitative parameters combined with C-reactive protein-to-albumin ratio(CAR)and neutrophil to lymphocyte ratio(NLR)for postoperative cerebral infarction(PCI)in patients with severe traumatic brain injury(sTBI).Methods A retrospective review was conducted on sTBI patients treated at the 922th Hospital of the Joint Logistics Support Force(February 2019-November 2024).Based on the occurrence of postoperative cerebral infarction(PCI),they were assigned to either a PCI group(n=50)or a non-PCI group(n=72).General clinical data,carotid Doppler ultrasound parameters(common carotid artery intima-media thickness[IMT],peak systolic velocity[PSV]),and serum CAR/NLR levels were compared between these groups.Multivariate logistic regression was used to identify risk factors for PCI,while receiver operating characteristic(ROC)curves were used to evaluate the predictive performance of the combined markers.Results There were statistically significant differences in age,DIC score,IMT,PSV,CAR and NLR levels between the two groups(P<0.05).Logistic regression showed that higher DIC score,IMT,CAR,and NLR levels,and lower PSV were independent risk factors for PCI in sTBI patients(P<0.05).ROC curve analysis indicated that the area under the curve for the quantitative carotid artery ultrasound parameters(IMT,PSV)combined with CAR and NLR in predicting PCI in sTBI patients was 0.966(95%CI 0.939～0.992).Conclusions The combination of carotid ultrasound parameters(IMT,PSV)with CAR and NLR exhibits excellent predictive accuracy for PCI in sTBI patients,potentially serving as a clinical biomarker panel for early risk stratification.

Abstract:Objective This commentary focuses on the diagnostic and management strategies for multi-organ cancer with neurological metastasis in the human body.Neurological metastasis is a type of serious complications faced by cancer patients,significantly affecting survival and quality of life.This article first introduces the epidemiology and pathological mechanisms of cancer metastasis to the nervous system,including the incidence population of the primary cancer types,metastasis tendencies,and molecular-level metastasis mechanisms.Following this,in terms of diagnosis aspect,it discusses in detail imaging examinations(CT,MRI,PET-CT),molecular diagnostic techniques(liquid biopsy,genetic testing),as well as the clinical manifestations of neurological symptoms and signs.Treatment strategies cover surgical treatment,radiotherapy(whole brain radiotherapy and stereotactic radiosurgery),systemic treatment(chemotherapy,targeted therapy,and immunotherapy),as well as supportive treatment and symptom management.The prognosis assessment part analyzes the key factors affecting prognosis,introduces several commonly used survival assessment models,and emphasizes the importance of quality of life assessment in treatment decisions.Finally,it looks forward to future research directions,including the development of early diagnosis technologies,the optimization of individualized treatment strategies,and the exploration of new therapeutic methods.The conclusion indicates that although significant progress has been made in diagnosis and treatment in recent years,the management of nervous system metastasis still faces many challenges.With the deepening of basic research and clinical trials,it is expected that the management of nervous system metastasis will become more individualized,precise,and humanized,ultimately and significantly improving the prognosis of these patients.

Abstract:Objective To analyze the incidence trends of idiopathic epilepsy in the elderly population in China from 1990 to 2021,examining changes across different age groups,and to predict future trends over the next 20 years to inform public health policy decisions.Methods Joinpoint regression model was applied on the data from the Global Burden of Disease database to identify inflection points in incidence trends.The age-period-cohort model was used to examine age,period,and cohort effects on epilepsy incidence,and the Nordpred model was employed to project future incidence trends.Results Between 1990 and 2021,the incidence of idiopathic epilepsy in the elderly showed a slow initial increase,followed by a decline from 2004 to 2019,and then a sharp rise from 2019 to 2021,particularly pronounced among those aged 85 and above.Projections indicated that by 2044,the incidence rate will continue to rise,with a notable increase in the number of cases,indicating a growing burden of epilepsy among the elderly each year.Conclusions This study reveals a significant upward trend in idiopathic epilepsy incidence among the elderly in China,with a heavier burden among the oldest age groups.Enhanced monitoring and preventive measures for the elderly,especially for those in advanced age,are recommended.Additionally,efforts should be made to improve diagnostic capacities in community and rural areas and to establish robust social support systems to address the public health challenges posed by epilepsy.

Abstract:Objective To explore the diagnostic value of continuous monitoring of dynamic changes in internal carotid artery blood flow velocity by patch ultrasound in the acute stage of hypertensive intracerebral hemorrhage(HICH).Methods A prospective study was conducted on twenty-nine randomly selected patients(18 males,11 females,with an average age of 65±13 years)with HICH admitted to the Department of Neurosurgery of the Sixth Medical Center of the PLA General Hospital from April 2024 to April 2025.Patch ultrasound was used to continuously monitor the internal carotid artery blood flow velocity of patients after cerebral hemorrhage,and the peak systolic velocity(Vs)and the end diastolic velocity(Vd),time-averaged velocity(Vm),pulsatility index(PI),and resistivity index(RI)were also measured.Patients with HICH were classified into gradesⅠto Ⅳ based on the amount of bleeding,and the internal carotid artery blood flow velocity indicators of different grades were compared.Meanwhile,a correlation analysis was conducted between the intracranial pressure(ICP)values and the internal carotid artery flow velocity indicators within 3 days after the operation in 8 patients with HICH.The internal carotid artery flow velocity indicators of the remaining 21 patients were recorded at 4 hours,24 hours,48 hours and 72 hours after cerebral hemorrhage respectively,and a correlation analysis was conducted on the volume of cerebral edema.The variation pattern of internal carotid artery velocity was analyzed in combination with the patient's condition,treatment outcome,etc.Results Among the 29 patients with HICH,16 underwent conservative treatment and the other 13 received surgery.According to the Karnofsky Performance Status(KPS)score of the patients'prognosis after treatment,they were categorized into 23 cases with a good prognosis and 6 cases with a poor prognosis(including 3 deaths),and the overall good prognosis rate was 79.31%.The differences in Vs,Vd,Vm,PI and RI among patients with different HICH grades were statistically significant(all P<0.05).Among them,Vs,Vd and Vm showed a decreasing trend with the increase of grades fromⅠto Ⅳ in HICH patients,while PI and RI showed an increasing trend.The ICP monitoring indicators within 3 days after surgery in 8 patients with HICH were negatively correlated with the internal carotid artery blood flow indicators Vs,Vd and Vm,and positively correlated with PI and RI(P<0.05).The internal carotid artery velocity indicators Vs,Vd and Vm within 3 days after cerebral hemorrhage in the remaining 21 patients decreased with the increase of cerebral edema volume,showing a negative correlation(P<0.05),while PI and RI increased,showing a positive correlation(P<0.05).Conclusions Patch-type ultrasound monitoring of internal carotid artery blood flow velocity can provide diagnostic basis for the amount of bleeding,changes in intracranial pressure,cerebral edema status,disease changes and treatment effectiveness of patients with HICH.

Abstract:Objective To explore the application effect of the TPACK(Technological Pedagogical Content Knowledge)educational framework in neurosurgery clinical practical teaching.Methods 60 undergraduate clinical medicine interns from our hospital between May 2024 and April 2025 were selected as research subjects,with 30 of them assigned to the control group(traditional teaching method),and the other 30 to the experimental group(TPACK framework teaching method).Teaching quality,student learning outcomes,and teaching satisfaction were compared between the two groups.Results Through establishing a TPACK workshop to implement tiered training and applying an intelligent evaluation system,the integration of technology,design of pedagogical strategies,and clinical practice guidance capabilities of the teaching faculty were significantly enhanced.The teaching quality score of the experimental group was(91.13±6.69)points,rated overall as"Excellent,"while the control group scored(81.80±12.16)points,rated as"Good."The experimental group scored higher than the control group in teaching attitude,content,methods,and effectiveness(P<0.05).Student assessments in critical thinking,adaptability,learning ability,and clinical competence were all significantly higher in the experimental group(all P<0.05).Furthermore,scores for practical knowledge structure,academic engagement of teaching content,and diversity of teaching methods were significantly higher in the experimental group(all P<0.05).Conclusions The in-depth application of the TPACK educational framework can effectively promote the structural reform of neurosurgery clinical teaching.By organically integrating technological tools with pedagogy,it significantly enhances the technological pedagogical literacy of clinical instructors and establishes a new paradigm for neurosurgery practical teaching that meets the needs of modern medical education,which provides transferable experience for clinical teaching reforms in similar disciplines.

Abstract:Objective To explore the latent profiles of decision-making dilemmas of surrogate decision-makers for patients with severe traumatic brain injury(sTBI)and analyze the influencing factors.Methods A total of 160 sTBI patients and their surrogate decision-makers admitted to our hospital from May 2023 to December 2024 were selected as the research subjects.General information questionnaires,Decision-Making Dilemma Scale(DCS),Social Support Rating Scale(SSRS),and Wake Forest Physician Trust Scale(WFPTS)were used for questionnaire surveys.Pearson correlation analysis was conducted to explore the correlation between decision-making dilemmas of surrogate decision-makers for sTBI patients and social support and trust in physicians.Mplus7.2 statistical software was used for latent profile analysis(LPA)of decision-making dilemmas of surrogate decision-makers for sTBI patients.The influencing factors of latent profile categories of decision-making dilemmas of surrogate decision-makers for sTBI patients were investigated by multivariate logistic stepwise regression analysis.Results The total scores of DCS,SSRS and WFPTS for surrogate decision-makers of sTBI patients were(32.46±4.28),(38.48±4.41)and(31.39±4.25)respectively.Decision-making dilemmas of surrogate decision-makers for sTBI patients were negatively correlated with social support and trust in physicians(P<0.05).Latent profile analysis showed that decision-making dilemmas of surrogate decision-makers for sTBI patients could be divided into three latent profile categories,including low decision-making dilemma group(n=61,38.13%),medium decision-making dilemma group(n=67,41.87%),and high decision-making dilemma group(n=32,20.00%).There were statistically significant differences in family per capita monthly income,decision-maker age,decision-maker educational level,decision-maker employment status,decision-maker's understanding of the disease,decision-maker's understanding of the treatment plan,social support score,and trust in physicians score among different latent profile categories(P<0.05).High family per capita monthly income,high decision-maker educational level,and high trust in physicians were protective factors for decision-making dilemmas of surrogate decision-makers for sTBI patients(P<0.05);high family per capita monthly income,high decision-maker educational level,high decision-maker's understanding of the disease,high social support level,and high trust in physicians were protective factors for high decision-making dilemmas of surrogate decision-makers for sTBI patients(P<0.05).Conclusions Decision-making dilemmas of surrogate decision-makers for sTBI patients can be divided into three latent profile categories,with significant individual differences.Family per capita monthly income,decision-maker educational level,decision-maker's understanding of the disease,social support,and trust in physicians can effectively predict different latent profile categories of decision-making dilemmas.

Abstract:Objective To analyze the risk factors for deep vein thrombosis(DVT)after thrombolysis in patients with acute ischemic stroke(AIS)and construct a nomogram model.Methods A total of 212 AIS patients who received intravenous thrombolysis in our hospital from April 2023 to March 2025 were selected and divided into DVT group(n=47)and non-DVT group(n=165)based on the occurrence of DVT in hospital.The influencing factors of DVT after thrombolysis were evaluated by multivariate logistic regression.A nomogram model for predicting DVT after thrombolysis was constructed,and its predictive value was evaluated by the ROC curve.Results The DVT group had higher proportions of older age,diabetes history,and consciousness disorder,longer time from onset to thrombolysis and bed rest time,and higher NIHSS score,platelet count,LDL-C,and D-dimer level at admission than the non-DVT group(P<0.05).Multivariate analysis showed that older age(OR=1.960,95%CI:1.399～2.746),diabetes history(OR=2.392,95%CI:1.626～3.519),consciousness disorder(OR=2.838,95%CI:1.869～4.308),longer bed rest time(OR=1.774,95%CI:1.314～2.394),and higher D-dimer level(OR=1.863,95%CI:1.351～2.569)were risk factors for DVT after thrombolysis in AIS patients(P<0.05).The consistency index(C-index)of the nomogram model was 0.897(95%CI:0.846～0.948),and the original curve was close to the ideal curve.The area under the curve(AUC)(95%CI)of the nomogram model for predicting DVT after thrombolysis in AIS patients was 0.906(0.855～0.957),with a specificity of 68.42%and a sensitivity of 91.79%.Conclusions Age,history of diabetes,disturbance of consciousness,bed time,and D-dimer are risk factors for DVT in hospital after thrombolysis in AIS patients.The nomogram model based on this conclusion has good prediction performance and clinical application value.

Abstract:Objective To investigate the predictive value of platelet/high density lipoprotein cholesterol ratio(PHR)for the prognosis of patients with acute ischemic stroke after endovascular interventional therapy(EIT).Methods A total of 104 patients with acute ischemic stroke who underwent EIT(mechanical thrombectomy)at Xingtai Central Hospital/Affiliated Hospital of Xingtai Medical College from April 2023 to March 2025 were selected.After a 3-month follow-up,the modified Rankin Scale(mRS)was used to divide the patients into a good prognosis group(<3 points,n=43)and a poor prognosis group(≥3 points,n=61).The blood platelet count(PLT),high-density lipoprotein cholesterol(HDL-C),and PHR levels between the two groups were compared.Receiver operating characteristic(ROC)was applied to evaluate the predictive value of each indicator.Multivariate logistic stepwise regression was used to analyze the influencing factors of prognosis.Results PLT and PHR levels in the poor prognosis group were higher,whereas the HDL-C level in the poor prognosis group was lower(P<0.05).The AUC of predicting EIT prognosis in patients with acute ischemic stroke using PHR was 0.911(Z=8.269,P<0.001),which was higher than that of PLT(AUC=0.874,Z=7.334,P<0.001)and HDL-C prediction(AUC=0.762,Z=6.815,P<0.001).The proportion of patients with age≥60 years,history of diabetes,postoperative bleeding transformation in the poor prognosis group was higher than that in the good prognosis group,with a higher NIHSS score at admission(P<0.05).Multivariate analysis showed that high NIHSS score at admission(OR=2.323,95%CI:1.582～3.412),postoperative bleeding conversion(OR=2.662,95%CI:1.750～4.049),and high PHR(OR=2.901,95%CI:1.863～4.518)were independent risk factors for poor prognosis of EIT(P<0.05).Conclusions High PHR is associated with the risk of poor prognosis of EIT in patients with acute ischemic stroke,and can be used as a potential important marker to predict the prognosis of EIT.

Abstract:Objective To integrate clinical and imaging features of patients with moderate traumatic brain injury and develop a prediction model for early neurological deterioration,so as to enhance risk assessment accuracy and provide a basis for early intervention.Methods A multicenter retrospective exploratory study was employed on patients with moderate traumatic brain injury admitted to the 987th Hospital of the Joint Logistics Support Force,Baoji Hospital of Traditional Chinese Medicine,and the Affiliated Xi'an Central Hospital of Xi'an Jiaotong University between January 2019 and July 2025.Nine machine learning methods-Logistic Regression,Decision Tree,Random Forest,Support Vector Machine,Neural Network,Extreme Gradient Boosting(XGBoost),Naive Bayes,Gradient Boosting Machine(GBM),and KNearest Neighbors(KNN)-were used to construct prediction models.Indicators such as the neutrophil-to-lymphocyte ratio,triglyceride-glucose index,venous-to-fingertip blood glucose ratio,and systemic inflammatory response index were calculated.Model performance was evaluated using the area under the curve(AUC),sensitivity,specificity,F1score,Youden index,decision curve analysis,and calibration curves.The Shapley Additive Explanations(SHAP)method was applied to interpret feature importance.Results A total of 160 patients were included,with 115 in the training set(60 in the deterioration group,55 in the non-deterioration group)and 45 in the external validation set(10 in the deterioration group,35 in the non-deterioration group).Among the nine machine learning models,Random Forest performed the best,achieving a training set AUC of 0.819 and an external validation AUC of 0.731.SHAP analysis further revealed the contribution of each feature to the prediction outcome.Conclusions This study presents a preliminary prediction model for early neurological deterioration in patients with moderate traumatic brain injury.The model shows effective predictive capability and provides an important reference for future large-scale clinical research and application.

Abstract:Covert consciousness refers to an established phenomenon in which patients with severe brain injuries retain cognitive functions but exhibit no observable behavioral responses.Its core manifestation is cognitive-motor dissociation(CMD).Identifying covert consciousness is essential for evaluating residual brain function,predicting neurological outcomes,and guiding treatment decisions.This article explores the research course on covert consciousness,the employed detection technologies and their clinical applications.It also addresses the limitations of current detection techniques and highlights promising avenues for future research in this field.

Abstract:Objective To explore the predictive value of combined monitoring of intracranial pressure(ICP),brain tissue oxygen partial pressure(PbtO2),and serum S100B for the prognosis of patients with traumatic brain injury(TBI).Methods A total of 148 TBI patients from January 2022 to January 2025 were divided into a good prognosis group(n=103)and a poor prognosis group(n=45)based on the prognosis at 3-month follow-up.The levels of ICP,PbtO2,and serum S100B were compared in these two groups.The predictive value of ICP,PbtO2,and S100B for the prognosis of TBI patients was evaluated using the ROC curve.The influencing factors of prognosis in TBI patients were investigated by multivariate logistic stepwise regression.Results The levels of ICP and serum S100B were higher in the poor prognosis group than in the good prognosis group,while PbtO2 was lower in the poor prognosis group than in the good prognosis group(P<0.05).The area under the curve(AUC)for predicting the prognosis of TBI patients by ICP,PbtO2 and S100B was 0.768,0.810 and 0.861 respectively(Z=4.680,4.091,2.893,all P<0.001),which was lower than that of the combined prediction of the three indicators(AUC=0.945).The proportion of patients aged≥60 years,hematoma volume,and the proportion of patients with brain herniation in the poor prognosis group were higher than those in the good prognosis group,but the Glasgow Coma Scale(GCS)score at admission of the poor prognosis group was lower(P<0.05).Low GCS score at admission(OR=0.051,95%CI:0.012～0.218),brain herniation(OR=7.283,95%CI:1.332～39.826),high ICP(OR=11.879,95%CI:2.802～50.356),low PbtO2(OR=0.101,95%CI:0.024～0.413),and elevated S100B level(OR=16.127,95%CI:3.744～69.462)were risk factors for poor prognosis in TBI patients(P<0.05).Conclusions Elevated ICP,decreased PbtO2,and elevated serum S100B level are associated with the increased risk of poor prognosis in TBI patients,and the combined prediction of the three indicators has a higher value in predicting the prognosis of such patients.

Abstract:In recent years,the correlation between hyperuricemia and cerebrovascular diseases(cerebral infarction,cerebral hemorrhage,subarachnoid hemorrhage and cerebral small vessel disease)has attracted great attention.Hyperuricemia has complex correlation with the risk of onset and clinical prognosis of cerebral infarction and cerebral hemorrhage,which has practical clinical significance for guiding the diagnosis and treatment of cerebral infarction and cerebral hemorrhage,but there are also many disputes and challenges.Hyperuricemia is associated with the occurrence and progression of cerebrovascular disease,and is a risk factor for cognitive and emotional dysfunction.This paper reviews the correlation between hyperuricemia and cerebrovascular diseases,and its specific mechanism of action,so as to provide basis for exploring the relevant precise intervention targets in the later stage.