Objective To explore the predictive value of brain temperature (BT) and intracranial pressure (ICP) for prognosis in patients with acute brain injury. Methods Fifty patients with acute brain injury admitted to He'nan Provincial People's Hospital and The 901st Hospital of Joint Logistics Support Force from March 2024 to June 2025 were included. BT and ICP were continuously and dynamically monitored for 5-7d. Poor prognosis was defined as a Glasgow Outcome Scale-Extended (GOS-E) score<4, and good prognosis as a GOS-E score≥4 at 90-day after discharge. Univariate and multivariate Logistic regression analyses were used to screen for risk factors of prognosis. Receiver operating characteristic (ROC) curve was drawn to determine the optimal cut-off value of BT and ICP. Based on this, BT and ICP were divided into low-value group and high-value group. Kaplan-Meier curve was drawn, and univariate and multivariate Cox proportional hazards regression models were used to analyze risk factors for 90-day survival after discharge. Results The BT (P=0.000) and ICP (P=0.000) in good prognosis group (n=27) were lower than those in poor prognosis group (n=23). Logistic regression analysis showed that increased BT (OR=6.145, 95%CI: 1.569-24.063; P=0.009) and ICP (OR=1.827, 95%CI: 1.200-2.780; P=0.005) were risk factors for poor prognosis in patients with acute brain injury. The ROC curve showed that the area under the curve (AUC) for predicting poor prognosis by BT and ICP was 0.833 (95%CI: 0.719-0.946, P=0.000) and 0.860 (95%CI: 0.737-0.961, P=0.000), respectively, with the optimal cut-off values being 37.8℃ and 17 mm Hg. The 90-day after discharge survival rate was 58% (29/50). Kaplan-Meier survival analysis showed that the survival rate of patients with high BT (≥37.8℃) was lower than that with low BT (<37.8℃; HR=5.240, 95%CI: 1.938-14.169, P=0.001), with high ICP (≥17mmHg) was also lower than that with low ICP (<17mmHg; HR=3.104, 95%CI: 1.373-7.021, P=0.007). The survival rate of the low BT+ICP group remained at a relatively high level, with the best prognosis among 4 groups. Only 2 groups (high BT group and high ICP group) showed an increase in a single indicator, and the survival rate was between the low BT + ICP group and the high BT+ICP group. Multivariate Cox proportional hazards regression analysis showed that patients with BT≥37.8℃ (HR=4.561, 95%CI: 1.615-12.879; P=0.004) and ICP≥17mmHg (HR=2.995, 95%CI: 1.283-6.807; P=0.011) had a higher risk of death. Conclusions BT and ICP have a good predictive value for the prognosis of patients with acute brain injury, and can be used as an effective tool for clinical risk stratification.

Our study aimed to assess the association between intracranial pressure (ICP) trajectories and 30-day, 90-day, 180-day, and 365-day all-cause mortality in patients with non-traumatic subarachnoid hemorrhage (SAH). We identified patients diagnosed with non-traumatic SAH from the MIMIC-IV 3.1 database. Group-based trajectory modeling was applied to identify ICP trajectories with selection based on Log-likelihood, Akaike information criterion (AIC), Bayesian information criterion (BIC), Hannan-Quinn information criterion (HQIC), Odds of correct classification (Occ), and Average posterior probability (Avepp) to determine the optimal number of classes. Logistic regression with a multi-model approach was used to compare all-cause mortality among patients with different ICP trajectories. Subgroup analyses were performed to assess the interactions. To demonstrate robustness, the relationship between traditional ICP metrics and all-cause mortality was evaluated using restricted cubic splines (RCS) and receiver operating characteristic (ROC) curves. Of the 1052 patients with non-traumatic SAH, 312 were included. Four distinct ICP trajectories were identified: (1) Class 1 (sustained decline and stabilization at a low level), (2) Class 2 (stabilization at the lowest level), (3) Class 3 (initial decline followed by elevation with fluctuations at moderate-to-high levels), and (4) Class 4 (initial highest level followed by decline with high fluctuations). Class 4 had significantly higher mortality rates at all time points. Additionally, multi-model logistic regression analyses showed that, compared to Class 1, Class 4 was associated with a higher risk of death at 30 days (adjusted OR: 5.36, 95

Objective This study aimed to develop and validate a machine learning (ML) prediction model for assessing the risk of sepsis in intensive care unit (ICU) patients with non-traumatic subarachnoid hemorrhage (SAH), thereby providing a reference for the early clinical identification of high risk patients.Methods We conducted a retrospective cohort study using data from the Medical Information Mart for Intensive Care (MIMIC-IV) database, which includes admissions between 2008 and 2022. We extracted demographic information, laboratory parameters, complications, and other clinical data. Patients were randomly divided into a training set and a test set in an 8:2 ratio. Least Absolute Shrinkage and Selection Operator regression was used to identify core predictive features. Fourteen machine learning models were constructed, including Random Forest, Gradient Boosting, Kernel-based SVM, Logistic Regression, K-Nearest Neighbors, Partial Least Squares, Boosting Method, Neural Network, Naive Bayes, Discriminant Analysis, Lasso, XGBoost, CATBoost, and LightGBM. Key evaluation metrics included sensitivity, specificity, accuracy, F1 score, Youden index, and the area under the curve (AUC). SHapley Additive exPlanations (SHAP) analysis was employed to interpret the model's decision logic, and Decision Curve Analysis (DCA) was used to assess clinical utility.Results A total of 1,052 patients with non-traumatic SAH were enrolled, with 841 assigned to the training set and 211 to the test set. Lasso regression identified 11 core predictive features, including pneumonia, norepinephrine use, mechanical ventilation, Glasgow Coma Scale (GCS) grade, and acute kidney injury (AKI). The CATBoost model demonstrated the best performance: in the training set, it achieved an AUC of 88.9%, sensitivity of 73.2%, specificity of 85.9%, and a Youden index of 0.592; in the test set, it achieved an AUC of 0.887, sensitivity of 75.5%, specificity of 82.3%, and a Youden index of 0.578. Performance fluctuation between the training and test sets was less than 2%, indicating excellent stability. SHAP analysis revealed that pneumonia, norepinephrine use, and mechanical ventilation were the top three features influencing sepsis risk, with pneumonia significantly increasing the risk. DCA results showed that the CATBoost model had the highest net benefit in the high-risk threshold range of 0.2-0.6.Conclusion The machine learning model developed based on the MIMIC-IV database can effectively predict the risk of sepsis in ICU patients with non-traumatic SAH. It demonstrates good interpretability and clinical utility, providing a basis for clinical risk stratification and precise intervention.

Early brain injury (EBI) has been identified as a key factor leading to the poor prognosis of patients with subarachnoid hemorrhage (SAH). At present, apart from surgical treatment, there is a lack of effective neuroprotective drugs. In this study, a biomimetic nanozyme V-MDL-800 was constructed by coordinating Vanadium Single-atom enzymes (V/SAE) and the allosteric activator MDL-800 of Sirt6, and encapsulated into NM@V-MDL-800 with neutropenia cell membrane (NM). By clearing ROS, the xCT/GPX4 pathway was activated, blocking the pathophysiological process of EBI after SAH can improve prognosis. NM@V-MDL-800 recruits through the blood-brain barrier (BBB) at the site of hemorrhagic injury by relying on the chemotactic property of neutrophils. Among them, the catalase-like, superoxide dismutase-like, and hydroxyl radical scavenging effects of V/SAE can eliminate excessive reactive oxygen species (ROS) within cells and inhibit oxidative stress; at the same time, as an allosteric activator of Sirt6, it activates the downstream xCT/GPX4 pathway, improving lipid metabolism abnormalities. Regulating the key core pathway of lipid peroxidation on ferroptosis promotes the polarization of microglia from the pro-inflammatory M1 form to the anti-inflammatory M2 morphology to inhibit the pathophysiological process of neuroinflammation in EBI. In addition, in vivo imaging of mice confirmed the targeted effect of NM@V-MDL-800 through the blood-brain barrier and recruited at the site of bleeding injury. The therapeutic effect of NM@V-MDL-800 on the SAH model has also been confirmed in vivo and in vitro experiments. This provides new ideas for SAH drug therapy regimens of SAH targeting microglial ferroptosis.

Objective To investigate the predictive value of transcranial Doppler ultrasonography (TCD) related parameters for hemorrhagic transformation (HT) in patients with acute ischemic stroke after mechanical thrombectomy. Methods A total of 106 patients with acute ischemic stroke who underwent mechanical thrombectomy were enrolled from He'nan Provincial People's Hospital between November 2023 and March 2025. All patients underwent TCD monitoring within 24h after surgery. TCD related parameters collected included peak systolic velocity (PSV), mean velocity (Vm), and pulsatility index (PI) of the middle cerebral artery (MCA) blood flow on both ipsilateral and contralateral sides, as well as the ratio of ipsilateral to contralateral PSV, the ratio of ipsilateral to contralateral Vm, and the ratio of ipsilateral Vm to mean arterial pressure (MAP). Univariate and multivariate Logistic regression analyses were used to screen for influencing factors of HT after mechanical thrombectomy for acute ischemic stroke patients. Receiver operating characteristic (ROC) curves were plotted to explore the predictive efficacy of TCD related parameters for HT after mechanical thrombectomy. Results According to the results of cranial imaging examinations at 7 d postoperatively, patients were divided into the HT group (n=35) and the non-HT group (n=71). Multivariate Logistic regression analysis showed that a higher National Institutes of Health Stroke Scale (NIHSS) score at admission (OR=1.178, 95%CI: 1.006-1.380; P=0.042), a lower Alberta Stroke Program Early CT Score (ASPECTS) at admission (OR=0.509, 95%CI: 0.298-0.871; P=0.014), a higher ratio of ipsilateral to contralateral PSV (OR=10.803, 95%CI: 1.767-66.054; P=0.010), a higher ratio of ipsilateral to contralateral Vm (OR=3.931, 95%CI: 1.554-9.947; P=0.004), and a higher ratio of ipsilateral Vm to MAP (OR=8.015, 95%CI: 1.616-39.746; P=0.011) were the risk factors for HT after mechanical thrombectomy in acute ischemic stroke patients. The ROC curves showed that the area under the curve (AUC) of NIHSS score at admission, ASPECTS at admission, the ratio of ipsilateral to contralateral PSV, the ratio of ipsilateral to contralateral Vm, the ratio of ipsilateral Vm to MAP, and the combination of these 5 indicators for predicting HT after mechanical thrombectomy in acute ischemic stroke patients were 0.727, 0.752, 0.768, 0.703, 0.782 and 0.901, respectively. Moreover, the predictive efficacy of the combined indicators was higher than that of each individual predictive indicator (Z=3.394, P=0.000; Z=3.510, P=0.000; Z=3.034, P=0.002; Z=4.060, P=0.000; Z=2.698, P=0.007). Conclusions The TCD related parameters have certain predictive value for HT after mechanical thrombectomy in acute ischemic stroke patients.

Over decades of development, the management of diagnosis and treatment in neurocritical care medicine has evolved from single-parameter monitoring to multimodal neuromonitoring. Through the integration of intracranial pressure (ICP), cerebral blood flow, brain function and other multi-parameter monitoring data, combined with artificial intelligence (AI) and big data model, it can realize the risk early warning of multiple complications. Digital and intelligent technologies are driving innovations in diagnosis and treatment. Although facing challenges such as difficult data standardization and model adaptation, it will continue to develop towards precision, individualization, digital intelligence and networking in the future.

This multicenter prospective study aimed to evaluate the feasibility and safety of high-quality targeted temperature management (TTM) in patients with poor-grade aneurysmal subarachnoid hemorrhage (aSAH). A prospective parallel-controlled clinical trial was conducted across three hospitals in China. Patients with poor-grade aSAH were enrolled between April 2022 and April 2024. Eligible patients with poor-grade aSAH (Hunt-Hess grade IV-V) were divided into TTM (n = 45) and normothermia (n = 45) groups after 1:1 propensity score matching (PSM) with nearest neighbor using age, gender, disease severity, comorbidities, and surgical variables. The TTM protocol involved initial 36–37℃, cooling to 34℃ post-aneurysm repair, hypothermia lasted for 3–5 days, followed by gradual rewarming with 0.1–0.25 °C/hour and normothermia maintenance. The TTM device used a temperature feedback system and a medical wrapped ice blanket. Primary outcomes included 3-month favorable functional prognosis [modified Rankin Scale (mRS) 0–3], with secondary outcomes assessing mortality, complications, and hospitalization metrics. Statistical analyses employed multivariable logistic regression and subgroup analyses to adjust for confounders. Among 124 enrolled patients, 90 (72.6

Objective To explore predictive efficiency of amplitude integrated electroencephalography (aEEG) combined with heart rate variability (HRV) parameters in early prognosis of acute ischemic stroke patients after mechanical thrombectomy. Methods A total of 137 patients with acute ischemic stroke undergoing mechanical thrombectomy in He'nan Provincial People's Hospital were enrolled as the research objects between April 2021 and August 2024. According to 90 d prognosis by modified Rankin Scale (mRS), they were divided into good prognosis group (mRS score≤2, n=77) and poor prognosis group (mRS score>2, n=60). The clinical data (sociodemographic data, laboratory examination data at admission) were collected, preoperative aEEG data were collected to obtain aEEG score. After admission dynamic ECG examination was performed to obtain HRV parameters [standard deviation of normal R-R intervals (SDNN), standard deviation of normal R-R intervals index (SDNN index), root mean square successive difference of normal R-R intervals (RMSSD), and percentage of normal-to-normal intervals differing by more than 50ms (pNN50)]. The influencing factors of early prognosis in acute ischemic stroke patients after mechanical thrombectomy were screened by univariate and multivariate Logistic regression analyses, and predictive efficiency of aEEG score and HRV parameters of early prognosis in acute ischemic stroke patients after mechanical thrombectomy was evaluated by area under the curve (AUC) of receiver operating characteristic (ROC) curve. Results Multivariate Logistic regression analysis showed that higher National Institutes of Health Stroke Scale (NIHSS) score (OR=1.779, 95%CI: 1.038-3.050; P=0.037), higher neutrophil-to-lymphocyte ratio (OR=1.718, 95%CI: 1.016-2.905; P=0.044), and higher aEEG score (OR=1.933, 95%CI: 1.071-3.487; P=0.029) were risk factors for early poor prognosis in acute ischemic stroke patients after mechanial thrombectomy, while higher SDNN (OR=0.908, 95%CI: 0.864-0.953; P=0.000) and higher pNN50 (OR=0.930, 95%CI: 0.866-0.998; P=0.043) were protective factors for good prognosis. The AUC values of aEEG score, SDNN, SDNN index, RMSSD and pNN50 for predicting early poor prognosis were 0.673, 0.685, 0.685, 0.734 and 0.774, respectively. AUC of combined detection was 0.882, greater than those of single index (Z=4.742, P=0.000; Z=4.346, P=0.000; Z=4.360, P=0.000; Z=3.726, P=0.000; Z=2.776, P=0.006). Conclusions aEEG score combined with HRV parameters have high predictive efficiency for early prognosis in acute ischemic stroke patients after mechanical thrombectomy, which can assist clinical determination.

Objective To investigate the short-term efficacy,long-term outcome and safety of recanalization treatment in patients with acute ischemic stroke presenting with large infarct core caused by intracranial atherosclerotic stenosis(ICAS)versus cardiac embolism(CE).Methods A total of 96 acute ischemic stroke patients with large infarct core who underwent recanalization treatment at The People's Hospital of Anyang City from January 2022 to January 2023 were enrolled.Based on etiology,patients were divided into ICAS group(n=52)and CE group(n=44).Short-term efficacy was assessed using the National Institutes of Health Stroke Scale(NIHSS)at 14 d postoperatively,while long-term outcome was evaluated using the modified Rankin Scale(mRS)at 90 d postoperatively.Safety outcome included rate of symptomatic intracranial hemorrhage(sICH),intracranial hemorrhage,cerebral herniation within 24 h postoperatively,and fatality rate at 90 d postoperatively.Results A statistically significant difference in NIHSS score was observed between the ICAS group and the CE group(F=5.821,P=0.023),with the CE group having higher NIHSS score than the ICAS group at admission(t=-2.324,P=0.022).Both groups showed significant differences in NIHSS score between admission and 14 d postoperatively(F=589.322,P=0.000),with the CE group demonstrating lower NIHSS score at 14 d postoperatively compared to admission(t=4.173,P=0.001).The ICAS group exhibited a higher rate of favorable outcome at 90 d postoperatively[44.23%(23/52)vs.25%(11/44);χ2=3.853,P=0.050].No significant differences were observed between the 2 groups in sICH,intracranial hemorrhage,cerebral herniation rate,or 90 d fatality rate(P>0.05,for all).Conclusions Recanalization treatment for acute ischemic stroke patients with large infarct core caused by CE demonstrates more pronounced short-term efficacy,while ICAS presenting with better long-term outcome,and there is no significant difference in safety between the 2 groups.

OBJECTIVE:This study aims to evaluate the clinical utility of metagenomic next-generation sequencing (mNGS) for diagnosing central nervous system infections (CNSIs) during the perioperative period in neurosurgical intensive care unit (ICU) patients. METHODS:In this prospective study, we included patients suspected of CNSIs during the perioperative period who were admitted to the neurosurgical ICU at Henan Provincial People's Hospital. Clinical samples were tested using both mNGS and conventional pathogen culture methods. Based on comprehensive clinical diagnoses, patients were categorized into the CNSIs and non-CNSIs groups. The diagnostic performance of mNGS was compared with traditional methods, including time to pathogen detection and evaluation of optimal testing conditions. Additionally, the study assessed whether antibiotic resistance genes detected by mNGS could predict drug resistance phenotypes. RESULTS:Between January 2022 and December 2023, 116 patients were enrolled, including 48 in the CNSIs group and 30 in the non-CNSIs group. mNGS identified a greater variety and quantity of pathogens compared to conventional methods. First, mNGS results were consistent with traditional culture in 5 cases. mNGS exhibited superior sensitivity (85.42% vs. 10.42%) and a higher negative predictive value (80.00% vs. 40.10%) compared to traditional cultures. Second, only 8.33% of CNSIs patients showed identical pathogens in both cerebrospinal fluid and blood samples. Third, 28.6% of cerebrospinal fluid samples with an mNGS detection interval of more than 7 days showed complete pathogen consistency, while 60% of samples with a detection interval of less than 3 days were consistent. Moreover, the antibiotic resistance genes detected by mNGS largely corresponded with the resistance phenotypes identified by antibiotic susceptibility testing. CONCLUSIONS:To sum up, mNGS offers excellent diagnostic accuracy and significant clinical value in CNSIs diagnosis during the perioperative period in the neurosurgical ICU, complementing traditional culture methods effectively.

PURPOSE:Delayed cerebral ischemia (DCI) is a common complication that occurs in aneurysmal subarachnoid hemorrhage (aSAH). This complication can lead to clinical deterioration and poor prognosis. The aim of this study is to explore the risk factors for DCI in aSAH patients in neurological ICU, develop a nomogram including quantitative electroencephalography (qEEG) parameters, and evaluate its performance. METHODS:We retrospectively analyzed and processed Severe aneurysmal subarachnoid hemorrhage (SaSAH) patients from June 2022 to May 2024 who underwent bedside qEEG monitoring and analyzed the qEEG indices, brain CT, and clinical data of these patients. Logistic multivariate regression analysis was employed to identify the independent risk factors of DCI. A clinical prediction model in the form of a nomogram for DCI was developed using the R programming language and subsequently evaluated for its performance and quality. RESULTS:A total of 145 patients with SaSAH were included in the analysis, comprising 101 patients in the training set and 44 patients in the validation set. 77 patients (53.10 %) developed DCI. Multivariate regression analysis revealed that GCS, modified Fisher grade, hypothermia, alpha/delta ratio (ADR) and PAV grade were independent risk factors for DCI. The nomogram exhibited excellent discriminative performance in both the training set (AUC = 0.84) and the validation set (AUC = 0.80). CONCLUSION:Quantitative EEG can predict DCI following SaSAH, the resulting nomogram demonstrated substantial predictive value and may help target therapies to patients at highest risk of secondary brain injury. It needs to be further confirmed in the future by multi-center large sample studies.

Objective To explore and evaluate the application value of pressure reactivity index (PRx) based on invasive intracranial pressure (ICP) and mean flow index (Mx) based on transcranial Doppler ultrasonography (TCD) noninvasive monitoring in severe traumatic brain injury (sTBI). Methods The clinical data of 64 patients with sTBI treated in He'nan Provincial People's Hospital from January 2024 to February 2025 were included. According to the Glasgow Outcome Scale (GOS), the patients were divided into the good prognosis (GOS score 3-5) group (n=31) and the poor prognosis (GOS score 1-2) group (n=33). All patients received ICP monitoring immediately after surgery for 3-7d. The ICP-related indicators including average ICP, cerebral perfusion pressure (CPP) and PRx were collected, and the ICP dose with a threshold of 20 mm Hg (DICP20) was obtained. All patients were monitored by TCD with an interval of≥3d immediately after operation, and the specific value of Mx was obtained. Univariate and multivariate Logistic regression analyses were used to analyze of influencing factors for 6-month post-discharge prognostic outcomes in patients with sTBI. The receiver operating characteristic (ROC) curve was further drawn, and the area under the curve (AUC) was calculated to evaluate the ability of each parameter to predict poor prognosis. Pearson correlation analysis was used to further analyze the correlation between PRx and Mx. Results Logistic regression analysis showed that higher ICP (OR=2.439, 95%CI: 1.077-5.526; P=0.033), higher PRx (OR=14.932, 95%CI: 2.215-100.666; P=0.005) and higher Mx (OR=3.087, 95%CI: 1.145-8.324; P=0.026) were risk factors for 6-month post-discharge prognostic outcomes in patients with sTBI. The AUC of ICP, PRx and Mx was 0.912 (95%CI: 0.814-0.968, P=0.033), 0.958 (95%CI: 0.876-0.992, P=0.005) and 0.859 (95%CI: 0.749-0.933, P=0.026), and the prediction efficiency of the three was the same (Z=0.850, P=0.396; Z=1.128, P=0.259; Z=1.856, P=0.063). Pearson correlation analysis showed that the overall correlation between the mean values of all records of PRx and Mx was moderate (r=0.521, P=0.000). Conclusions ICP, PRx and Mx were the risk factors for 6-month post-discharge prognostic outcomes in patients with sTBI. Mx can be used as a noninvasive way to evaluate the cerebral autoregulation (CA) function of patients with sTBI, and has a certain predictive ability for the prognosis. There was a moderate correlation between PRx and Mx, suggesting that they provide different information of CA function.

OBJECTIVE:The study aimed to evaluate the relationship between baseline platelet-to-red blood cell distribution width ratio (PRR) and mortality in critically ill patients with non-traumatic subarachnoid hemorrhage (SAH). METHODS:This cohort study of adults with non-traumatic SAH used Medical Information Mart for Intensive Care (MIMIC-IV) data from 2008-2022 admissions at the Intensive Care Unit (ICU). We collected the PRR levels at admission and determined the all-cause death rates for the ICU and hospital. Cox proportional hazards models were utilized to analyze the association between baseline PRR level and all-cause mortality. Kaplan-Meier survival curve analysis was used to examine the consistency of these correlations. Restricted Cubic Splines (RCS) analysis was used to determine the relationship curve between all-cause mortality and PRR level and examine the threshold saturation effect. To evaluate the consistency of correlations, interaction and subgroup analyses were also conducted. RESULTS:A total of 1056 patients with non-traumatic SAH were included in this study. All-cause mortalities in the ICU and hospital were 14.8% (156/1056) and 18.6% (196/1056), respectively. Compared to individuals with lower PRR Q1(≤12.67), the adjusted HR values in Q2 (12.68-15.99), Q3 (16.00-19.41), and Q4 (≥19.42) were 0.61 (95%CI:0.40-0.92, p = 0.017), 0.60 (95%CI: 0.39-0.92, p = 0.020), and 0.60 (95% CI:0.39-0.93, p = 0.019), respectively. Kaplan-Meier analysis showed that patients with low PRR levels had significantly higher ICU and in-hospital mortality (p < 0.001). The association between the PRR level and ICU and in-hospital mortality exhibited a non-linear relationship (p < 0.05). The threshold breakpoint value of 22.6 was calculated using RCS analysis. When the PRR level was lower than 22.6, the risk of ICU and in-hospital mortality rates decreased with an HR of 0.91 (95%CI: 0.88-0.94, p < 0.001) and 0.94 (95%CI: 0.92-0.96, p < 0.001), respectively. When the PRR level was higher than 22.6, the risk of ICU mortality (HR = 1.03, 95% CI: 0.97-1.10, p = 0.312) and in-hospital mortality (HR = 1.01, 95%CI: 0.95-1.08, p = 0.693) almost hardly increased with the increase in the PRR level. The interaction between the PRR and all subgroup factors was analyzed, and significant interactions were not observed. CONCLUSION:There was a non-linear connection between the baseline PRR level and in-hospital mortality. A low level of PRR could increase the risk of death in participants with non-traumatic SAH.

OBJECTIVE:This multicenter retrospective study aimed to identify significant risk factors influencing hemorrhage volume in patients with aneurysmal subarachnoid hemorrhage (SAH). METHODS:A total of 891 patients diagnosed with SAH were included from multiple medical centers. Data encompassing demographic characteristics, medical history, clinical parameters at admission, and radiographic findings were collected and analyzed. Univariate and multivariate logistic regression analyses were conducted to investigate associations between various risk factors and hemorrhage volume. RESULTS:This study identifies several factors significantly associated with increased hemorrhage volume in patients with subarachnoid hemorrhage (SAH). Multivariate analysis revealed that diabetes (P = 0.022), hypertension (P = 0.047), and saccular aneurysm morphology (P = 0.008) were independent risk factors for high hemorrhage volume. Additionally, larger aneurysm size (maximum diameter: P = 0.007, neck diameter: P = 0.021) and higher systolic blood pressure after onset (P = 0.002) were also significant predictors of increased hemorrhage volume. Factors such as age (P = 0.05) and time interval to the first CT scan (P = 0.022) were found to be associated with hemorrhage volume in univariate analysis but did not maintain independent significance in multivariate regression. CONCLUSION:This study highlights key risk factors, including diabetes, hypertension, and saccular aneurysm morphology, which independently contribute to higher hemorrhage volume in SAH patients. Management strategies focusing on early detection and control of these factors may improve clinical outcomes by reducing the risk of hemorrhagic complications. While other factors such as age and time interval to the first CT scan were associated with hemorrhage volume, they did not demonstrate independent causality in the multivariate analysis, suggesting that their role in hemorrhage volume may be secondary or context-dependent.

Objective To explore the efficacy and safety of mild hypothermia therapy in patients with acute anterior circulation massive cerebral infarction after endovascular mechanical thrombectomy.Methods Eighty-two patients with acute anterior circulation massive cerebral infarction admitted to He'nan Provincial People's Hospital from January 2023 to August 2024,who underwent mechanical thrombectomy,were included.Hypothermia group(n=41)received mild hypothermia therapy with a target core temperature of 33-34℃for 48-72 h immediately after surgery,and the others didn't(mechanical thrombectomy group,n=41).Serum neuron-specific enolase(NSE)levels were measured 72 h after operation;prognosis was assessed using the modified Rankin Scale(mRS)at 3 months after discharge,and good prognosis and morbidity and mortality rates were recorded;as well as the complication rates were recorded during hospitalization after surgery.Univariate and multivariate Logistic regression analyses were used to screen for factors influencing prognosis after mechanical thrombectomy in patients with acute anterior circulation massive cerebral infarction.Results The serum NSE level at 72 h after operation in the hypothermia group was lower than the mechanical thrombectomy group[18.86(13.35,30.54)μg/L vs.21.43(18.30,32.90)μg/L;Z=-2.147,P=0.032],and the good prognosis rate at 3 months after discharge was higher than the mechanical thrombectomy group[46.34%(19/41)vs.21.95%(9/41);χ2=5.423,P=0.020],and the mortality rate(χ2=0.734,P=0.391),incidence of hemorrhagic transformation(χ2=0.497,P=0.481),vascular reocclusion(χ2=0.945,P=0.331),malignant brain edema(χ2=1.058,P=0.304),pulmonary infection(χ2=2.614,P=0.106),electrolyte disturbance(χ2=1.222,P=0.269),arrhythmia(χ2=0.456,P=0.499),deep venous thrombosis(χ2=0.311,P=0.577),and abnormal coagulation function(χ2=1.246,P=0.264)during hospitalization between the 2 groups were not statistically significant.Logistic regression analysis showed that mild hypothermia was a protective factor for good prognosis after mechanical thrombectomy for acute anterior circulation massive cerebral infarction(OR=4.457,95%CI:1.503-13.759;P=0.007),while age increase(OR=0.915,95%CI:0.856-0.978;P=0.009),history of hypertension(OR=0.175,95%CI:0.055-0.562;P=0.003)were risk factors for poor prognosis.Conclusions Mild hypothermia after mechanical thrombectomy in patients with acute anterior circulation massive cerebral infarction is safe and feasible.Reducing NSE release may be one of its action pathways,and large-scale randomized controlled trials are needed to further verify its efficacy.

Objective To explore the clinical effect of external ventricular drainage combined with lumbar cistern drainage under intracranial pressure (ICP) monitoring in severe aneurysmal subarachnoid hemorrhage (SaSAH). Methods From March 2019 to March 2023, 106 patients with SaSAH admitted to Department of Neurosurgical Intensive Care Unit of He'nan Provincial People's Hospital were randomly divided into ICP monitoring group (n=52) and without ICP monitoring group (n=54). The ICP monitoring group was treated with external ventricular drainage combined with lumbar cistern drainage under ICP monitoring, while without ICP monitoring group was treated with external ventricular drainage combined with lumbar cistern drainage under non-ICP monitoring. Cerebrospinal fluid drainage volume, the incidence of in-hospital and long-term complications were recorded. The modified Rankin Scale (mRS) and Glasgow Outcome Scale-Extended (GOS-E) were used to evaluate the neurological prognosis, and the good prognosis rate was calculated. Results The cerebrospinal fluid drainage volume between ICP monitoring group and without ICP monitoring group was statistically significant (F=59.843, P=0.000), and the cerebrospinal fluid drainage volume at different measurement times was also statistically significant (F=5.352, P=0.000), and there was interaction between treatment factors and measurement time (F=19.800, P=0.000). There was no significant difference of cerebrospinal fluid drainage volume between the 2 groups on the 1-3d (P>0.05, for all), and the cerebrospinal fluid drainage volume of ICP monitoring group on the 4-7d was lower than that of the without ICP monitoring group (P=0.000, for all). In without ICP monitoring group, postoperative cerebrospinal fluid drainage volume gradually decreased, with drainage on postoperative 4-7d being lower than on 1d (P=0.000, 0.000, 0.000, 0.000), 2d (P=0.000, 0.000, 0.000, 0.000) and 3d (P=0.004, 0.036, 0.000, 0.007). In ICP monitoring group, the incidence of cerebral vascular spasm (χ2=4.850, P=0.028), hydrocephalus (χ2=5.804, P=0.016), delayed cerebral infarction (χ2=6.722, P=0.010), brain hernia (χ2=5.681, P=0.017), renal failure (χ2=5.903, P=0.015), electrolyte disturbance (χ2=6.389, P=0.011) and shunt dependent hydrocephalus (χ2=6.286, P=0.012) were lower than without ICP monitoring group. At 6 months postoperatively, the ICP monitoring group had a lower mRS score (Z=-2.484, P=0.013) and a higher GOS-E score (Z=-3.018, P=0.003) than without ICP monitoring group. The good prognosis rate of ICP monitoring group was higher than that of without ICP monitoring group (χ2=5.403, P=0.020). Conclusions External ventricular drainage combined with lumbar cistern drainage under ICP monitoring for SaSAH can reduce the incidence of complications and improve the prognosis.

Subarachnoid hemorrhage (SAH) occurs when blood enters the subarachnoid space, typically due to aneurysm rupture, triggering complex pathophysiological processes. A reliable animal model is crucial for simulating SAH and investigating mechanisms of brain white matter injury. SAH was induced in C57BL/6J mice using an intraluminal perforation technique. Various filaments were tested to determine the optimal one, and filament depth was carefully measured. Postoperative evaluations included monitoring body weight, blood distribution on the skull, and clot formation. Cerebral blood flow was assessed, and neurological function was evaluated using modified Garcia scores, open field tests, and gait analysis. Myelin integrity was assessed by Luxol fast blue staining, and immunofluorescence was used to examine myelin, microglia, and neuronal integrity in the cortex and striatum. Using 4 - 0 polypropylene filaments advanced to 13 ± 1 mm at a 15-20 degree, we established a stable SAH mouse model with a success rate of 91.43% and a mortality rate of 6.25%. The SAH group showed motor impairments at 48 h post-surgery, along with myelin damage in the corpus callosum and striatum, oligodendrocyte damage, and neuronal injury.Our improved intraluminal perforation technique offers a stable and standardized SAH model, providing a reliable platform for studying SAH pathophysiology and testing new therapies.

Paroxysmal sympathetic hyperactivity (PSH) is characterized by episodes of excessive sympathetic activity and is associated with poor outcomes in brain injuries, yet its impact on severe intracerebral hemorrhage (ICH) remains unclear. This study investigates the association between PSH and clinical outcomes in patients with severe ICH. We conducted a prospective observational cohort study of patients with severe ICH from January 2018 to December 2022. Severe ICH was defined as ICH with a Glasgow Coma Scale score ≤ 8 on admission, indicating significant neurological impairment. Patients were assessed for PSH using the PSH-Assessment Measure, and categorized into probable, possible, and unlikely PSH groups. Propensity score matching was used to adjust for baseline differences among three groups. The primary outcome was the 90-day mortality rate. Secondary outcomes included a favorable functional outcome at 90 days, defined by a modified Rankin Scale score of 0–2. Statistical analyses were performed using Cox proportional hazards regression and Kaplan–Meier survival analysis. After propensity score matching, 177 patients (59 in each group) were analyzed. The 90-day mortality rate was significantly higher (P < 0.01) in the probable PSH group (67.8

BackgroundThe effect of targeted temperature management (TTM) combined with decompressive craniectomy (DC) on poor-grade aneurysmal subarachnoid hemorrhage (aSAH) has not been previously addressed in the literature. This study aims to investigate the therapeutic outcomes of the combination of TTM and DC in patients with poor-grade aSAH.MethodsThis study represents a secondary analysis of the Multicenter Clinical Research on Targeted Temperature Management of Poor-grade Aneurysmal Subarachnoid Hemorrhage (High-Quality TTM for PaSAH), a multicenter prospective study conducted in China. The High-Quality TTM for PaSAH study enrolled patients aged 18 years and older who were transported to the intensive care units (ICU) of three tertiary care hospitals in China between April 2022 and April 2024. Among these patients, those who underwent DC were included in the present analysis. Patients were divided into two groups: the DC-alone group and the TTM combined with the DC (TTM-DC) group. The DC-alone group maintained normothermia. The TTM-DC group used automated devices with a temperature feedback system (TFS). TTM was initiated with core temperatures between 36°C-37°C immediately after diagnosing poor-grade aSAH, and concurrent emergency aneurysm repair. This was followed by a rapid induction to 34°C-35°C, maintained for a minimum of 72 h. Subsequently, a slow rewarming process reached 36°C-37°C, which was maintained for at least 48 h. Primary outcomes were evaluated using the Modified Rankin Scale (mRS) score at 3 months. Secondary outcomes included the Glasgow Coma Scale (GCS) at discharge, ICU stay duration, length of hospitalization, proportion of external ventricular drainage (EVD), mechanical ventilation time, tracheostomy, midline shift, hydrocephalus, and delayed cerebral ischemia (DCI) on the 7th day. Safety outcomes comprised the incidence of pneumonia, myocardial infarction, stress hyperglycemia, thrombocytopenia, acute liver injury, hypokalemia, hypoproteinemia, and death at 90 days.ResultsOf the 141 patients enrolled in the High-Quality TTM for PaSAH study, 43 (25 in the TTM-DC group and 18 in the DC-alone group) were eligible for this secondary analysis. The TTM-DC group had a higher proportion of favorable outcomes (mRS 0–3: 56% vs. 22%, aOR 5.97, 95%CI 0.96–52.2, p = 0.071). After propensity score matching, the TTM combined with DC improved favorable outcome at 3 months (mRS 0–3: 61% vs. 22%, OR 5.50, 95%CI 1.36–26.3, p = 0.022). In addition, the TTM-DC group increased GCS score at discharge compared with the DC-alone group (9 vs. 3, β 2.58, 95%CI 0.32–4.84, p = 0.032). The incidence of safety outcomes was not increased in the TTM-DC group.ConclusionTTM combined with DC can improve clinical conditions at discharge and ameliorate short-term neurological outcomes in poor-grade aSAH patients. TTM should be considered one of the main treatments for poor-grade aSAH patients who underwent DC.