Objective:To explore the correlation between CYP2C19 gene polymorphism and clopidogrel resistance in patients with atherosclerotic thrombotic cerebral infarction (ATCI) in Ha'an area.Methods:Three hundred and fifty patients with ATCI admitted to Neurology Department of Hai'an People's Hospital were selected, and classified into extensive metabolizers (EM, n=157), intermediate metabolizers (IM, n=108) and poor metabolizers (PM, n=85) according to CYP2C19 genotype. All patients received clopidogrel treatment for one week upon admission. CYP2C19 genotyping was detected by fluorescence in situ hybridization. The inhibition of adenosine diphosphate (ADP) induced platelet aggregation and maximum amplitude (MA) of clot formation in patients with different CYP2C19 genotypes were measured by thrombelastogram. Then the related factors affecting clopidogrel resistance in ATCI patients were screened.Results:Statistical difference was noted in the smoking, diabetes history, glycosylated hemoglobin (HbAlc) and low-density lipoprotein cholesterol (LDL-C) among different CYP2C19 metabolizers (P<0.05). The inhibition rate of ADP-induced platelet aggregation among different metabolizers was the highest in EM phenotype, followed by IM phenotype, and was the lowest in PM phenotype, with statistical difference (P<0.05). The MA of clot formation among different metabolizers was the largest in PM phenotype, followed by IM phenotype, and was the smallest in EM phenotype, with statistical difference (P<0.05). The incidence rate of clopidogrel resistance in PM phenotype was significantly higher than that of IM and EM phenotype, with statistical difference (P<0.05). Univariate analysis revealed that there were statistically significant differences in smoking, diabetes, and CYP2C19 genotypes among patients with different clopidogrel resistance (P<0.05). Multivariate Logistic regression analysis denoted that smoking, diabetes, CYP2C19 PM and IM phenotype were independent risk factors for clopidogrel resistance in ATCI patients (P<0.05).Conclusion:Clopidogrel resistance is highly prevalent in ATCI patients with CYP2C19 PM and IM phenotype in Hai'an area, and smoking, diabetes mellitus and CYP2C19 PM and IM phenotype are all independent risk factors for the development of clopidogrel resistance in patients.
Objective:To investigate the effect of acupuncture on brain derived neurotrophic factor (BDNF) expression and receptor tyrosine kinase B (TrkB) activity after moderate traumatic brain injury (TBI).Methods:Forty-two adult SD male rats were randomly divided into TBI group (21 rats) and TBI+acupuncture group (21 rats) according to random number table method. The moderate TBI model was established by fluid percussion instrument in both groups. The TBI group was only modeled, and the TBI+acupuncture group was given acupuncture treatment after the TBI model was established. Tissue homogenates and sections were harvested 21 d after moderate TBI. The level of BDNF was examined by ELISA. Immunofluorescence staining was used to detect the expression level of TrkB protein at 6 and 12 h after moderate TBI, Western blot was used to detect the expression levels of TrkB protein at 48, 96, and 168 h after moderate TBI, and the expression of protein kinase B (Akt) and extracellular regulated protein kinase 1/2 (ERK1/2) at 12 and 48 h.Results:The expression level of BDNF protein in two groups of rats reached its peak at 12 h after moderate TBI and gradually decreased at 48 h. The BDNF protein levels in the TBI+acupuncture group were higher than those in the TBI group at 6, 48, 96, 168 h after TBI, with statistical significance (P<0.05), there was no statistically significant difference in BDNF protein levels at 12 h (P>0.05). The levels of p-TrkB protein in the TBI+acupuncture group were higher than those in the TBI group at 6, 12, 48, 96, 168 h, while p-Akt and p-Erk1/2 protein levels were higher than those in the TBI group at 12, 48 h, with statistical significance (P<0.05).Conclusion:Acupuncture therapy can upregulate the expression level of BDNF protein after moderate TBI, and activate TrkB protein by phosphorylation, ultimately activating its downstream signaling pathway.
胆脂瘤常发生于脑桥小脑角区，手术切除是其首选治疗方式。颅神经功能障碍是术后主要并发症，术中神经电生理监测技术的应用降低了术后颅神经功能障碍的发生率，其中对耳蜗神经的保护尤其重要。近些年，多种听力功能监测的方法已在桥小脑角区胆脂瘤切除术中得到了广泛的应用。脑干听觉诱发电位（ABR）联合耳蜗电图（ECochG）在桥小脑角区胆脂瘤切除术中的应用较少，对术后听力丧失的预测价值不明确。本文主要针对ABR联合ECochG在桥小脑角区胆脂瘤切除术中的应用作一介绍。
Objective:To investigate the predictive effect of transcranial color Doppler ultrasound (TCCS) combined with soluble CD40 ligand (sCD40L), fibrinogen (Fib) and platelet activating factor (PAF) on cerebral infarction after transient ischemic attack (TIA).Methods:A total of 128 TIA patients diagnosed and treated by Ultrasound Diagnostic Department of the 82nd Group Military Hospital of PLA from May 2020 to June 2021 were retrospectively selected as the study objects, and were divided into cerebral infarction group (n=36) and non-cerebral infarction group (n=92) according to whether secondary cerebral infarction occurred within 7 d after TIA. TCD blood flow parameters [middle cerebral artery (MCA), peak systolic blood flow velocity (VS), end-diastolic blood flow velocity (Vd), pulsation index (PI), resistance index (RI)], sCD40L, Fib, and PAF were compared between the two groups. ROC curve model was used to analyze the predictive value of color Doppler ultrasound blood flow parameters (VS, Vd, PI, and RI), sCD40L, Fib, PAF and the four combinations in TIA patients with secondary cerebral infarction.Results:VS and Vd in cerebral infarction group were lower than those in non-cerebral infarction group, while PI and RI were higher than those in non-cerebral infarction group (P<0.05). The sCD40L, Fib, and PAF levels in cerebral infarction group were higher than those in non-cerebral infarction group (P<0.05). ROC curve analysis showed that the AUC values of VS, Vd, PI, RI, sCD40L, Fib, PAF and the combined prediction of TIA patients with secondary cerebral infarction were 0.609, 0.772, 0.673, 0.625, 0.677, 0.743, 0.768, 0.944 (P<0.05). Sensitivity was 50.00%, 88.90%, 41.70%, 47.20%, 50.00%, 52.80%, 58.30%, and 86.10%, respectively. The specificity was 93.50%, 62.00%, 97.80%, 100.00%, 92.40%, 90.20%, 93.50%, and 90.20%, respectively. VS, Vd, PI, RI, sCD40L, Fib, PAF were compared with the four combined AUC, and the differences were statistically significant (Z=4.095, 3.628, 4.304, 4.463, 4.178, 3.503, 3.117, all P<0.001).Conclusion:TCD, sCD40L, Fib, and PAF all have certain value in predicting secondary cerebral infarction in TIA patients, but the combined prediction efficiency of the four items is higher.
Intracranial pressure (ICP) is the pressure exerted by the contents of the skull cavity on the wall of the skull cavity. When ICP levels continue to increase in patients with traumatic brain injury (TBI), it may cause a series of nerve damage, and even lead to brain herniation leading to respiratory and circulatory failure and death. The emergence of multi-modal monitoring technology based on ICP monitoring enables clinicians to dynamically and real-time monitor the changes of ICP and related parameters in the treatment of TBI patients. At present, invasive monitoring techniques mainly focus on ventricular type ICP monitoring, with the most accurate results; while many new non-invasive monitoring techniques have also been widely concerned and studied. This article mainly reviews the application of multimodal ICP monitoring technology in TBI treatment, and compares the advantages and disadvantages of various monitoring technologies based on literature, providing a basis for clinical selection of corresponding monitoring methods.
Cerebroconvex meningioma is a common incidental brain tumor, accounting for approximately 15% to 25% of intracranial meningiomas. The optimal treatment plan for convex meningioma is currently controversial, and the recent advances in the biology and imaging studies of meningiomas allow for precise individualized clinical risk stratification of patients, which can guide decisions regarding imaging monitoring, surgery, and postoperative radiotherapy. An individualized approach can be used in clinical work to balance aggressive total tumor resection and the protection of adjacent neurofunctional structures, while considering the patient's own physical conditions, meningioma-specific factors (e.g., meningioma biology, specific location, and imaging features), and the possibility of radiotherapy. The stratified approach to the management of convexity meningiomas is highly individualized, taking into account the patient's age, life expectancy, current neurological status, natural history of the meningioma, priority of other concomitant diseases, and involves comprehensive decision-making around treatment goals, durability of tumor control, adverse events, and quality of life of the patient after different management measures. This article mainly reviews the personalized full process management of cerebral convex meningioma.
Objective:To analyze the clinical difference of neurosurgical site infection between HIV-infected and non-HIV-infected patients.Methods:A retrospective analysis was performed on HIV infected patients (HIV-infected group, n=34) and non HIV infected patients (non-HIV-infected group, n=43) who underwent surgical treatment in Neurosurgery Department of The Second Hospital of Nanjing from May 2019 to January 2022. Perioperative indexes of the HIV-infected group and the non-HIV-infected group were compared and analyzed, and the HIV-infected group was further divided into the intraoperative infected group and the intraoperative non-infected group, and the perioperative related indexes of the two groups were compared.Results:The infection rate in the surgical site of the HIV-infected group was higher than that of the non-HIV-infected group, but the difference was not statistically significant (P>0.05). There was a statistically significant difference in preoperative hemoglobin, preoperative white blood cell count, postoperative white blood cell count, body mass index, and antibiotic use between the HIV-infected group and the non-HIV-infected group (P<0.05). In the HIV-infection group, there were 6 cases of surgical infection and 28 cases of non-surgical infection, there was a statistically significant difference in CD4+T cell count, albumin count, and antibiotic use among patients (P<0.05).Conclusion:The incidence of surgical site infection in neurosurgery is higher in HIV-infected patients than in non-HIV-infected patients. The incidence of site infection can be effectively reduced by increasing the CD4+ T cell count and albumin content in HIV-infected patients and strengthening the use of antibiotics in perioperative period.
Objective:Utilizing bioinformatics analysis to investigate the potential role of the FSTL1 gene in the development of gliomas.Methods:The glioma gene expression levels and clinical data were downloaded from the Chinese Glioma Genome Atlas Project (CGGA) database. Glioma patients were categorized into high expression group (FSTL1 expression level ≥ 29.1 reads) and low expression group (FSTL1 expression level<29.1 reads) based on FSTL1 expression level. Differential gene analysis was conducted between the high and low expression groups, and perform gene ontology (GO) and gene set enrichment analysis (GSEA). The least absolute shrinkage and selection operator (LASSO) algorithm was applied to construct a prognostic model. It was also verified in the Glioma Longitudinal Analysis (GLASS) dataset.Results:High expression of FSTL1 is associated with poor clinical features, such as non-codelof 1p19q, IDH wildtype, higher grade (WHO Ⅲ-Ⅳ), etc. The prognosis of patients in the low expression group was significantly better than that in the high expression group, and the difference was statistically significant (P<0.05). GO analysis showed that DEGs is mainly concentrated in extracellular matrix tissue, immune-related, vascular system development, etc. The main pathways identified by gene enrichment analysis (GSEA) were: ECM_RECEPTOR_INTERACTION, G2M_CHECKPOINT, L6_JAK_STAT3_SIGNALING, and TNFA_SIGNALING_VIA_NFKB, etc. Compared with the low expression group, the high expression group showed higher immune and matrix scores, but lower purity scores (all P<0.001). Genes used for constructing the risk score were: ALDOC, GLC1, LINC00634, TGIF1, TPM4, and TRAM2. The Kaplan-Meier survival curve showed a poor prognosis of the high-risk score. Construct a survival prediction nomogram, and the subject operating characteristics and the correction curve all showed that the model had a good predictive ability.Conclusion:FSTL1 is related to the clinical and molecular characteristics of glioma, and its expression is related to the degree of tumor malignancy, being a potential therapeutic target and an independent prognostic factor in glioma patients.
Objective:To explore the clinical treatment experience of large central neurocytoma.Methods:A retrospective study was conducted on 35 patients with medium to large central neurocytoma treated by the same surgeon in Neurosurgery Department of Beijing Tiantan Hospital, Capital Medical University from April 2012 to September 2019. The patients were divided into large central neurocytoma (the largest diameter of tumor ≥5 cm) and non-large central neurocytoma (3 cm0.05). There was no statistically significant difference in tumor volume, extent of resection, and initial postoperative radiotherapy between patients with postoperative recurrence and those without recurrence (P>0.05).Conclusion:Transfrontal cortex fistulation is a reliable approach for resection of tumors in the middle and large central neurocytoma in the ventricles. After total resection of tumors, patients can live a long and high-quality life and achieve clinical cure. Postoperative radiotherapy and shunt surgery are not the core factors affecting the prognosis of patients.
每年全球有数百万人发生颅脑损伤（TBI），给社会经济造成了巨大的负担。重型颅脑损伤（sTBI）可能导致昏迷、脑水肿、颅内压升高、脑疝等严重后果，引起多种并发症，甚至导致死亡。由于TBI的复杂性和多样性，临床医生在诊断和治疗过程中需要综合考虑伤情的不同方面。本文探讨了不同类型sTBI的临床表现、影像学诊断和各种治疗方法，尤其强调复杂病例的诊断和微创技术的应用，有助于改善患者的救治质量，为临床实践提供有益的指导。
Objective:To investigate the predictive value of early detection of plasma phosphoglycerate kinase 1 (PGK1) on the severity and prognosis of patients with traumatic brain injury (TBI).Methods:Sixty-eight TBI patients admitted to Neurosurgery Department of the Second Affiliated Hospital of Nantong University from August 2020 to May 2022 were prospectively collected and categorized into mild TBI group (GCS 13-15 points), moderate TBI group (GCS 9-12 points), and severe TBI group (GCS 3-8 points) based on the GCS score, and were divided into adverse group and good group based on the GOS score at 6 months after TBI. One hundred healthy medical checkups who were admitted to the hospital for medical checkups in the same period were selected as the control group. Plasma PGK1 and interleukin-6 (IL-6) levels were measured by enzyme-linked immunosorbent assay within 12 h after the patients' admission to the hospital. The differences in plasma PGK1 and IL-6 levels in each group were analyzed, and the relationship between the two and the severity and prognosis was analyzed by Pearson linear correlation.Results:Plasma PGK1 and IL-6 levels were significantly higher in the TBI group compared with the control group, with statistical significance (P<0.05). TBI patients were divided into mild TBI group (25 cases), moderate TBI group (22 cases), and severe TBI group (21 cases). The plasma PGK1 and IL-6 levels in the moderate TBI group were significantly higher than those in the mild TBI group, and the severe TBI group was also significantly higher than those in the moderate TBI group, with a statistically significant difference (P<0.05). Pearson linear correlation showed that the plasma PGK1 level was strongly negatively correlated with GCS score (r=-0.697); IL-6 level was strongly negatively correlated with GCS score (r=-0.633); the plasma PGK1 level was strongly negatively correlated with GOS score (r=-0.641); IL-6 level was moderately negatively correlated with GOS score (r=-0.565); the plasma PGK1 level was moderately positively correlated with IL-6 (r=0.437), and the differences were statistically significant (P<0.05). Plasma PGK1 concentrations had a less predictive value of patient severity and prognosis than GCS scores, but exceeded IL-6 (AUC values of GCS, PGK1 and IL-6 were 0.965, 0.812 and 0.769, P<0.001).Conclusion:The plasma PGK1 level in TBI patients is significantly correlated with the severity and prognosis of brain injury, and is positively correlated with IL-6 level in plasma. The higher the levels of PGK1 and IL-6, the worse the condition and prognosis of TBI patients.
Objective:To systematically compare the cell damage characteristics of stretch injury model, oxygen-glucose deprivation (OGD) model and hydrogen peroxide (H2O2)-treated oxidative stress model, and to provide a reference for the selection of cell models in TBI research.Methods:After resuscitation of frozen HT-22 cells, HT-22 cells were seeded in Six-well plates, which were divided into experimental group and control group. The experimental group prepared cell stretch injury models, OGD models, and oxidative stress injury models respectively. The control group was cultured normally without any special treatment. The changes of cell morphology were observed by microscope, and cell viability was tested by CCK-8 analysis; cell proteins were extracted, and changes of apoptosis markers (Bcl-2, Bax), necroptosis markers (RIPK3, RIPK1), ferroptosis markers (ACSL4, GPX4, SLC7A11) were detected by Western blot.Results:Compared with the control group, all three injury models led to abnormal morphological changes in different degrees, restricted proliferation or cell shedding in HT-22 cells, indicating cell damage. CCK-8 analysis showed that the cell viability in different model treatment groups was significantly reduced (P<0.05). The results of Western blot demonstrated that the expression of GPX4, SLC7A11, Bax, RIPK3 and RIPK1 proteins in cells treated with 3.0 PSI tensile strength was significantly increased, with statistical significance (P<0.05). After OGD treatment for 12 h, the expression of SLC7A11 and Bax was significantly up-regulated, with statistical significance (P<0.05). After 800 μmol/L hydrogen peroxide treatment, the expression of Bcl-2 and RIPK1 proteins was significantly up-regulated, with statistical significance (P<0.05).Conclusion:The stretch model can better reflect the complex injury characteristics after TBI, and the OGD and H2O2 treatment models are more suitable for studying specific injury pathways.
脑动脉瘤破裂出血，常会造成广泛性蛛网膜下腔出血或者形成脑内血肿。若造成明显的占位效应，会严重影响脑组织的神经功能，甚至诱发脑疝威胁患者生命。显微手术开颅清除血肿并夹闭动脉瘤可作为动脉瘤破裂致脑内血肿的一种有效的治疗方法。
Objective:To explore the effects of repetitive transcranial magnetic stimulation combined with graded motor imagery training on motor function and neurological function in patients with hemiplegia after cerebral infarction.Methods:Ninety-six patients with hemiplegia after cerebral infarction who were prospectively admitted to Rehabilitation Medicine Department of the 900th Hospital of the PLA Joint Support Force from May 2018 to September 2020, were divided into control group and observation group, with 48 patients in each group. The patients in the control group were given repetitive transcranial magnetic stimulation, and the patients in the observer group were given repetitive transcranial magnetic stimulation combined with graded motor imagination training. The patients in both groups were treated for 4 weeks. The changes of Barthel index (BI), Fugl Meyer motor function scale (FMA) scores, National Institute of Health stroke scale (NIHSS) scores, serum nitric oxide (NO), endothelin-1 (ET-1) levels were observed before and after treatment.Results:After treatment, The BI and FMA score of the two groups were higher than those before treatment, and the BI and FMA score of the observation group were higher than those of the control group (P<0.05). After treatment, the NIHSS score of the two groups was lower than before treatment, and the observation group was lower than the control group (P<0.05). After treatment, the level of NO in the two groups was higher than that before treatment, and the level of ET-1 was lower than that before treatment, and the level of NO in the observation group was higher than that in the control group, and the level of ET-1 was lower than that in the control group (P<0.05).Conclusion:Repetitive transcranial magnetic stimulation combined with graded motor imagery training is effective in treating hemiplegia patients after cerebral infarction. It can improve the activity of daily living and motor function of patients, promote the recovery of patients' neurological function and protect vascular endothelial function, which is worthy of reference and promotion.
Objective:To search for genes related to nerve injury in heat stroke (HS) by bioinformatics, the possible molecular mechanism of nerve injury in HS was explored and preliminarily verified.Methods:(1) Taking April 2022 as the time cut-off, the expression profile datas of nerve inject-related genes in thermal radiation disease were screened based on GEO and other databases, and differentially expressed genes (DEGs) were obtained by retrieving datas set GSE64778, combined with GeneCards and CTD databases to retrieve HS related target genes, and the candidate target genes were obtained by intersection screening. The "ClusterProfiler" package in R language was used to perform GO and KEGG enrichment analysis for HS related target genes; STRING database was further used to construct the interaction network map of target genes and correlation analysis of key genes to obtain core genes. (2) Peripheral blood of patients with HS treated in Nantong First People's Hospital of Jiangsu Province from June 2022 to August 2022 were collected, and the expression of core genes were verified by PCR technology.Results:(1) SRA datas screening of the GSE64778 dataset yielded 1178 DEGs, of which 322 were up-regulated and 856 were down-regulated. 2914 genes were screened in the GeneCards database and 2377 genes were screened in the CTD database. The top 300 differentially expressed genes in the GSE64778 dataset were intersected with the search results of GeneCards and CTD databases, and 25 candidate DEGs were finally screened. (2) GO functional annotation results indicated that the target genes were mainly involved in apoptosis, stress response and negative regulation of cellular processes, and functioned in processes such as protein dimerization and protein binding. KEGG pathway enrichment analysis suggested that the candidate target genes were mainly enriched in PI3K-Akt signaling pathway. PPI network analysis suggested that Hsp90AA1 was the hub gene with the highest Degree value and enriched in PI3K-Akt signaling pathway. (3) qRT-PCR confirmed that the expression of Hsp90AA1 in the patients with nerve injury in the early stage of HS was consistent with the results of bioinformatics analysis.Conclusion:Hsp90AA1 may be the main affecting gene of nerve injury in HS, which is related to apoptosis, stress response and negative regulation of cellular processes.
Objective:To analyze the types of complications after cranioplasty in adults and their prevention and treatment strategies.Methods:The clinical data of 40 patients with complications after cranioplasty in Neurosurgery Department of the 940th Hospital of Joint Logistics Support Force of PLA from January 2017 to February 2022 were retrospectively analyzed. The types and causes of complications after cranioplasty were analyzed, and the diagnosis and treatment strategies were discussed based on the analysis of relevant literature.Results:After cranioplasty, epidural hematoma occurred in 8 patients, cerebral contusion and hematoma occurred in 1 patient, infection occurred in 9 patients, atrophy of local temporalis muscle occurred in 2 patients, exposure of infected repair material occurred in 4 patients, epilepsy occurred in 15 patients after surgery. After receiving corresponding clinical treatment, all patients were cured and discharged. Among them, 1 patient died of paradoxical brain herniation after surgery.Conclusion:The postoperative complications of cranial repair include skin and subcutaneous infection, exposure of repair material, intracranial hemorrhage, epilepsy, and paradoxical brain herniation, etc. Clinicians need to develop individualized treatment strategies to reduce the incidence of postoperative complications.
Objective:To explore the clinical efficacy of controlled decompression in the treatment of severe traumatic brain injury (sTBI).Methods:Thirty five patients with sTBI treated by applying controlled decompression surgery from September 2018 to September 2021 in Neurosurgery Department of Haikou Affiliated Hospital of Central South University Xiangya School of Medicine were enrolled into controlled decompression group, another 35 patients with sTBI treated by routine conventional decompression surgery from January 2015 to January 2018 were enrolled into conventional decompression group. The clinical data, complication, length of hospital stay, hospital costs and follow-up results of all cases were analyzed.Results:The surgical time of patients in the controlled decompression group was longer than that in the conventional decompression group, and the proportion of malignant encephalocele was significantly lower than that in the conventional decompression group, with statistical significance (P>0.05). The incidence, hospitalization time, and cost of postoperative complications (hydrocephalus and encephalocele) in the controlled decompression group were significantly lower than those in the conventional decompression group, and the differences were statistically significant (P>0.05). Following up for 6 months, 27 patients in the controlled decompression group achieved good results, 3 patients had severe disability, 3 patients had vegetative survival status, and 2 patients died of postoperative diffuse brain swelling. Among the 35 patients patients in the conventional decompression group, 18 were effective, 8 were severely disabled, 4 were in vegetative state, and 5 died. There was a statistically significant difference in prognosis between the two groups (P<0.05).Conclusion:Controlled decompression has a good effective in the treatment of patients with sTBI and could improve the prognosis of some patients.
Objective:To observe the clinical effects of Robot System Assistant (Rosa) localized burr hole hematoma removal and empirical localized burr hole hematoma removal in the treatment of spontaneous intracerebral hemorrhage (SICH).Methods:A total of 100 patients with SICH who were admitted to Neurosurgery Department of Gezhouba Central Hospital of Sinopharm between February 2017 and January 2019 were selected as the subjects. They were divided into the observation group (41 cases) and the control group (59 cases) according to the voluntary and non-randomized control principle. Patients in the observation group were treated with Rosa localized burr hole hematoma removal, and those in the control group were treated with empirical localized burr hole hematoma removal. Surgery related indicators of the two groups were recorded. The short-term and long-term curative effects and the occurrence of postoperative complications were compared between the two groups.Results:Compared with the control group, the operation time, hematoma removal time and postoperative hospital stay in the observation group were significantly shorter, the incidence rate of postoperative complications in the observation group was significantly reduced (P<0.05). At 1 month after surgery, the effective rate of treatment in the observation group was higher than that in the control group (P<0.05). There was no statistically significant difference in the good prognosis rate between the two groups at 6 months after surgery (P>0.05).Conclusion:Rosa localized burr hole hematoma removal has the same long-term effect as empirical localized burr hole hematoma removal in the treatment of SICH. However, the former can achieve better short-term effect, faster postoperative recovery and lower risk of complications, with characteristics of safety, efficiency and accuracy.
Post-traumatic stress disorder (PTSD) is a mental disorder that occurs in individuals after encountering sudden, catastrophic, or threatening events. The treatment methods mainly include psychological intervention, drug therapy, physical therapy, traditional Chinese medicine characteristic therapy, and nutritional intervention therapy, and the effects varies. Due to the complexity of PTSD pathogenesis, diversity of symptoms, and individual differences in patients, there is currently no unified and standardized clinical pathway for different types of PTSD patients. In this article, the latest research progress at home and abroad is summarized by referring to relevant international clinical practice guidelines, and the current treatment status of PTSD is sorted out and summarized, in order to provide a reference for further exploring the pathogenesis and precise and efficient treatment methods of PTSD.
Objective:To explore the risk factors affecting death and functional recovery in patients with primary brainstem hemorrhage (PBH).Methods:A retrospective analysis of the patients with brain stem hemorrhage admitted by Neurosurgery Department of Beijing Chao-yang Hospital, Capital Medical University from January 2016 to November 2021 was made. The general data, neurological signs at admission, laboratory tests, hematoma volume and treatment methods of the patients were collected, and the patients were divided into survival group and death group according to their survival status 30 d after the onset of the disease. From follow up to 90 d after onset, patients were divided into good prognosis group (mRS score 0-2) and poor prognosis group (mRS score 3-5) based on the modified Rankin scale (mRS) score. Risk factors for 30 d death and 90 d inability to take care of themselves in patients with PBH were analyzed and screened.Results:A total of 36 patients with PBH were included, 30 patients (83.3%) received conservative treatment, and 6 cases (16.7%) underwent surgical treatment, including 23 patients in the survival group (63.9%) and 13 patients in the death group (36.1%). From follow up to 90 d after onset, there were 14 cases in good prognosis group and 9 cases in poor prognosis group. The results of univariate analysis showed that there was a statistically significant difference in heart rate, GCS score, and mechanical ventilation between the survival group and the death group (P<0.05); there were statistically significant differences in GCS scores, bilateral light reflex disappearance, mechanical ventilation, absolute values of white blood cell, hematoma volume >5 mL, and hematoma breaking into the ventricle between the good prognosis group and the poor prognosis group (P<0.05). Multivariate Logistic regression analysis showed that GCS score ≤8 (OR=15.893, 95%CI: 1.528-165.323, P=0.021) was a risk factor for death in patients with PBH.Conclusion:Deep coma upon admission is an important risk factor for death and poor prognosis in patients with PBH.
