Non-traumatic stroke (NTS) is associated with high mortality, and dynamic glucose patterns may provide prognostic information beyond static glucose measurements. This study aimed to identify glucose trajectory phenotypes in ICU patients with NTS and evaluate their association with in-hospital mortality. This multicenter retrospective cohort study included ICU patients with NTS from MIMIC-IV, eICU, and NSICU. Glucose trajectories during the first 168 h after ICU admission were identified using latent class growth modeling. Associations with in-hospital mortality were assessed using Cox regression, Kaplan-Meier analysis, competing-risk analysis, and subgroup analyses. Incremental predictive value was evaluated using AUC, integrated discrimination improvement (IDI), net reclassification improvement (NRI), and median improvement in predicted risk. Among 11,177 patients, four glucose trajectory phenotypes were identified: normoglycemia (NG, n = 5,515), stable mild hyperglycemia (SMH, n = 3,425), persistent hyperglycemia (PH, n = 2,080), and highly variable hyperglycemia (HVH, n = 157). Compared with NG, SMH, PH, and HVH were progressively associated with higher in-hospital mortality in the fully adjusted model, with HRs of 1.668 (95% CI: 1.469-1.894), 2.406 (95% CI: 2.083-2.779), and 5.766 (95% CI: 4.319-7.699), respectively. HVH remained associated with increased mortality in both diabetic and non-diabetic patients. Adding glucose trajectories to baseline prediction models modestly improved AUC, IDI, NRI, and predicted risk classification across LASSO, Boruta, and BSS-BIC models. In ICU patients with NTS, glucose trajectory phenotypes were associated with different risks of in-hospital mortality, with HVH showing the strongest association. Glucose trajectories may provide additional prognostic information for risk stratification beyond static glucose measurements.

BackgroundAcute brain injury (ABI) requires early, interpretable risk stratification to support ICU risk assessment. We evaluated whether longitudinal albumin-to–red cell distribution width ratio (ARR) trajectories provide time-dependent prognostic information and support prediction with multicenter validation.MethodsIn this multicenter, retrospective cohort study (NSICU, MIMIC-IV, eICU), latent class growth modeling identified ARR trajectories. Nonproportional hazards were addressed with time-stratified Cox models (0–7, 7–14, >14 days) and restricted mean survival time (RMST) at 7, 14, and 28 days. Multiple machine-learning classifiers were benchmarked to develop an interpretable prediction model with internal and external validation. Performance assessment included discrimination, calibration, decision-curve analysis, and SHAP-based interpretability.ResultsAmong 8,270 ICU patients (NSICU n = 5,093; MIMIC-IV n = 744; eICU n = 2,433), four ARR trajectories were identified. Relative to Gradual Decline, recovery-type trajectories were associated with lower early mortality risk (0–7 days: HRs 0.29 and 0.14; 7–14 days: HRs 0.43 and 0.50), whereas the Sustained High-Risk trajectory showed excess hazard primarily beyond 14 days (HR 1.42). These time-dependent patterns were broadly supported by RMST and sensitivity analyses. The final ExtraTrees model achieved AUROC 0.869 and Brier score 0.066 on the internal hold-out set; external validation yielded AUROC 0.731, PR AUC 0.429, and Brier score 0.161, indicating attenuated but informative external performance with modest decision-curve benefit. A web-based research calculator provides individualized risk estimates and SHAP explanations.ConclusionStandardized ARR trajectories provide dynamic, phase-specific prognostic information in ABI and complement static assessments. When integrated into an interpretable machine-learning model, these trajectories may support adjunctive risk estimation as patient status evolves. Prospective evaluation and site-level recalibration are warranted.

Background Dynamic metabolic changes may influence outcomes after acute brain injury (ABI), but most ICU studies use only a single triglyceride-glucose (TyG) value. We examined whether ICU TyG trajectories and a cumulative TyG burden provide time-sensitive prognostic information and can be embedded in an interpretable mortality model. Methods Adults with ABI from three ICU databases (NSICU, MIMIC-IV, eICU) were retrospectively analyzed. TyG trajectories were derived from serial ICU measurements, cumulative exposure was summarized as prespecified threshold-based mean area under the curve (TBM), and in-hospital mortality was evaluated with 7-day time-stratified Cox models. A machine-learning model including TyG trajectory, TBM, and routinely available clinical variables was trained in NSICU and validated in the pooled external cohort. Results Among 4,760 admissions, three trajectories were identified-low-slightly increasing (LSI), moderate-increasing (MI), and persistently high (PH). Mortality did not differ across trajectories during days 0-7, but after day 7 both MI (HR 1.48, 95% CI 1.18-1.86; P < 0.001) and PH (HR 1.51, 95% CI 1.17-1.93; P = 0.001) showed higher in-hospital mortality than LSI. TBM showed a parallel positive association; TBM8p7 remained significant in fully adjusted models (HR 1.42, 95% CI 1.18-1.70; P < 0.001). ExtraTrees was selected for its consistent internal and external validation performance, and model interpretability analyses placed TyG trajectory and TBM8p7 among the next most important predictors alongside SOFA score and vasopressor use. Conclusion In ICU-treated ABI, TyG is better modeled as a time-aware exposure: trajectory differences become prognostically relevant only after the first week, whereas cumulative TBM8p7 shows a graded, independent association with mortality. Both metrics add risk information beyond conventional severity indicators and can be integrated into an interpretable, externally tested model.

BACKGROUND:Acute brain injury (ABI) often elevates intracranial pressure (ICP), yet static measurements miss dynamic risk. We evaluated the prognostic value of early ICP trajectories. METHODS:We formed a multicenter ICU cohort from MIMIC-IV (2008-2022), eICU (2014-2015), and NSICU (2024-2025). Latent class growth modeling identified ICP trajectories over the first 120 h. Associations with in-hospital mortality were tested with Cox models, and incremental value beyond baseline clinical variables was quantified by AUC, integrated discrimination improvement (IDI), and net reclassification improvement (NRI). Sensitivity analyses were performed across datasets and age groups. RESULTS:Among 1700 patients with ABI, four trajectories emerged-Severe Progressive, Stabilized Elevated, Mildly Elevated Stable, and Normal. Versus Normal, mortality risk was highest for Severe Progressive (HR 13.54; 95% CI 9.35-19.59), followed by Stabilized Elevated (HR 2.53; 1.83-3.49) and Mildly Elevated Stable (HR 1.48; 1.16-1.91). In patients aged ≥ 55 years, risk with Stabilized Elevated was amplified (HR 2.87; 1.97-4.20). Adding trajectories improved risk stratification (IDI +0.065; NRI +0.201) with modest AUC gains. CONCLUSIONS:Early ICP trajectories define reproducible phenotypes with distinct mortality risk. Incorporating trajectories-particularly the stabilized-elevated pattern in older adults-adds prognostic value beyond clinical variables and supports prospective validation.

Objective:Fixed cerebral perfusion pressure (CPP) targets may not fully capture dynamic changes in acute brain injury (ABI). We aimed to identify CPP trajectory phenotypes, evaluate cumulative CPP metrics, and examine their associations with in-hospital mortality in ICU patients with ABI. Methods:This multicenter retrospective cohort study included 1,466 adults with ABI from three ICU databases (MIMIC-IV, eICU, and NSICU). CPP trajectory phenotypes were identified using latent class growth modeling. Cumulative CPP metrics were derived using threshold-specific methods at 50, 60, and 70 mmHg and a mixed-effects approach. Associations with in-hospital mortality were assessed using multivariable Cox regression and survival analyses. The incremental prognostic value of CPP trajectory was evaluated as a secondary exploratory analysis. Results:Four CPP trajectory phenotypes were identified: Stable Normal, Gradual Recovery, Labile Improvement, and Rapid Decline. Compared with Stable Normal, mortality risk increased progressively in Gradual Recovery (HR 1.720, 95% CI 1.252-2.362), Labile Improvement (HR 2.081, 95% CI 1.508-2.873), and Rapid Decline (HR 5.313, 95% CI 3.547-7.958; all P < 0.001). Higher cumulative CPP metrics derived from threshold-specific and mixed-effects approaches were consistently associated with lower in-hospital mortality (all P < 0.001). Survival analyses showed clear separation across phenotypes, with Stable Normal showing the highest survival probability and Rapid Decline the lowest. Adding CPP trajectory to a baseline model modestly improved discrimination and reclassification (AUC 0.759 to 0.773, P = 0.011; IDI 0.025; continuous NRI 0.157; both P < 0.001). Conclusions:Distinct CPP trajectory phenotypes and cumulative CPP metrics were associated with in-hospital mortality in ICU patients with ABI. CPP trajectory also provided modest incremental prognostic information and warrants prospective validation.

Traumatic brain injury (TBI) is a leading cause of death and disability. While the Glasgow Coma Scale (GCS) guides initial assessment, single values miss evolving neurological change. In this multicenter ICU cohort integrating NSICU, MIMIC-IV, and eICU databases, we analyzed adults (≥18 years) with TBI who had ≥3 GCS measurements within the first 120 ICU hours. Using 12-hourly measures, latent class growth modeling identified four dynamic GCS trajectories (Stable High, Rapidly Improving, Persistently Moderate, Persistently Low), and we quantified cumulative neurological burden with a mean threshold-based area-under-the-curve (TBM-AUC) summarizing time above prespecified GCS thresholds. Among 3,132 patients, mortality increased monotonically across trajectories, highest in the Persistently Low group (adjusted hazard ratio [HR] 4.95, 95% confidence interval: 3.14-7.81 vs. Stable High). Lower TBM-AUC was strongly associated with mortality; most pronounced at threshold 13 (HR 0.34). Age-stratified analyses showed a trajectory-by-age interaction (p = 0.013), with Persistently Low conferring the greatest risk in both younger and older adults. Adding trajectory class to baseline predictors improved discrimination (AUC: 0.820-0.861, p < 0.001) with consistent gains in integrated discrimination improvement, net reclassification improvement, and median risk score across Boruta-, LASSO-, and best-subset-based models. Dynamic GCS trajectories and TBM-AUC provide prognostic information beyond conventional assessments and may enhance risk stratification and clinical decision-making in neurocritical care; prospective validation is warranted.

Acute brain injury (ABI) is a leading cause of ICU admission and mortality. Effective sedation is essential for preventing secondary brain injury, and dexmedetomidine has emerged as a potential neuroprotective agent. We conducted a retrospective analysis using the MIMIC-IV v3.1 database, including adult patients admitted to the ICU with ABI. Patients were divided into two groups based on whether they received dexmedetomidine. Propensity score matching (PSM), weighting methods, and doubly robust estimation were used to adjust for confounding factors. Results from the doubly robust analysis showed that dexmedetomidine use was significantly associated with reduced in-hospital mortality (HR: 0.41, 95% CI: 0.35-0.48, p < 0.001) and ICU mortality (HR: 0.34, 95% CI: 0.28-0.41, p < 0.001). Additionally, dexmedetomidine was associated with significantly increased vasopressor-free days (MD: 2.64, 95% CI: 1.98-3.30, p < 0.001) and ventilation-free days (MD: 2.23, 95% CI: 1.59-2.86, p < 0.001). Further mediation analysis indicated that delirium mediated 37% of the effect of dexmedetomidine on in-hospital mortality and 60% of its effect on ICU mortality. This suggests that delirium may be a key mediator of dexmedetomidine's beneficial effects, consistent with its potential advantages in sedation and neuroprotection observed in previous studies. In conclusion, dexmedetomidine use in ICU patients with ABI is associated with significantly lower mortality and improved clinical outcomes, with delirium acting as a critical mediator.

Background and objectivePost-operative pneumonia (POP), a common complication, may be associated with prolonged hospitalization and long-term mortality in aneurysmal subarachnoid hemorrhage (aSAH) patients. This study aimed to explore the association between pre-operative prognostic nutrition index (PNI) and POP in aSAH patients.MethodsA total of 280 aSAH patients were enrolled from Nanjing Drum Tower Hospital. PNI was calculated as follows: [10 × albumin(gr/dl)] + [0.005 × absolute pre-operative lymphocyte count (per mm3)]. We utilized multivariate analyses, restricted cubic spline, net reclassification improvement (NRI), and integrated discrimination improvement (IDI) to elucidate the role of PNI in POP.ResultsPre-operative PNI levels in the POP group were higher, compared with the non-POP group (41.0 [39.0, 45.4] vs. 44.4 [40.5, 47.3], P = 0.001). When we included PNI as a categorical variable in the multivariate analysis, the levels of PNI were associated with POP (odds ratio, 0.433; 95% confidence interval, 0.253–0.743; P=0.002). In addition, when we included PNI as a continuous variable in the multivariate analysis, the PNI levels were also associated with POP (odds ratio, 0.942; 95% confidence interval, 0.892–0.994; P = 0.028). The level of albumin was also a predictor of the occurrence of POP, with a lower diagnostic power than PNI [AUC: 0.611 (95% confidence interval, 0.549–0.682; P = 0.001) for PNI vs. 0.584 (95% confidence interval, 0.517–0.650; P = 0.017) for albumin]. Multivariable-adjusted spline regression indicated a linear dose–response association between PNI and POP in aSAH participants (P for linearity = 0.027; P for non-linearity = 0.130). Reclassification assessed by IDI and NRI was significantly improved with the addition of PNI to the conventional model of POP in aSAH patients (NRI: 0.322 [0.089–0.555], P = 0.007; IDI: 0.016 [0.001–0.031], P = 0.040).ConclusionThe lower levels of pre-operative PNI may be associated with the higher incidence of POP in aSAH patients. Neurosurgeons are supposed to pay more attention to pre-operative nutrition status in aSAH patients.

Abstract Background Metformin is a well-known drug used in the treatment of type-2 diabetes; nevertheless, the efficacy of metformin as an adjuvant in cancer therapy is still up for debate. We analyzed data from randomized trials and cohort studies to assess metformin's potential in chemoradiotherapy for cancer patients. Method A systematic search of PubMed, Web of Science, Embase, and the Cochrane Library was conducted up to December 01, 2022; 16 randomized trials and 29 cohort studies were identified. The primary outcome was OS, followed by PFS. Hazard ratios (HRs) and 95% confidence intervals (CIs) were created using random-effects meta-analysis models. Meta-regression and subgroup analysis were used to investigate heterogeneity. Publication bias assessment was performed. Result Metformin usage was mainly shown to be substantially linked to OS (HR = 0.88, 95% CI = 0.80–0.97). Subgroup analysis revealed that diabetic individuals on metformin had a substantially decreased risk of mortality when grouped by whether the study population was diabetic or not (HR = 0.62, 95% CI: 0.50–0.76). Patients receiving just chemotherapy had a longer OS when grouped by radiation status (HR = 0.75, 95% CI: 0.63–0.89). Further stratified analysis found that in the diabetic population, metformin improves prognosis in all cases (chemoradiotherapy, HR = 0.64, 95% CI: 0.46–0.88; radiotherapy alone, HR = 0.25, 95% CI: 0.09–0.71). Metformin, on the other hand, enhanced prognosis in patients receiving chemotherapy alone in conjunction with diabetes alone (diabetic, HR = 0.61, 95% CI: 0.48–0.77; non-diabetic, HR = 0.91, 95% CI: 0.65–1.27; partial diabetes, HR = 0.82, 95% CI: 0.68–0.99). Metformin usage and PFS were not significantly correlated in the total study (HR = 0.97, 95% CI = 0.81–1.16). Analyses of subgroups failed to reach statistical significance either. Only diabetes had a substantial impact on the combined OS result, according to heterogeneity tests, but the combined PFS outcome was unaffected. In the research, there was no discernible publication bias. Conclusion The results of our meta-analysis showed that metformin helped cancer patients with diabetes have a better prognosis, whether they got radiation, chemotherapy, or all three at the same time.

Cell-free circulating tumor DNA (ctDNA) is synthesized by tumor cells, including metastatic tumors, and circulates in the bloodstream. Evidence suggests that ctDNA is a potential predictive and prognostic biomarker for colorectal cancer (CRC), but its predictive efficacy in detecting CRC liver metastasis (CLM) remains unclear. Additionally, its utility in the clinical setting needs further investigation. We conducted a meta-analysis to determine the utility of ctDNA as a biomarker for predicting the prognosis of CLM and investigate the relationship between CLM and ctDNA positivity. A literature search was performed in electronic databases to identify relevant studies published up to March 19, 2022. We retrieved data on overall survival (OS), disease-free survival (DFS), and recurrence-free survival (RFS) for both ctDNA-positive and ctDNA-negative colorectal liver metastasis (CLM) patients from the selected articles. Hazard ratios (HRs) were also calculated for these survival outcomes analysis was also performed. The stability of the combined meta-analysis was verified by sensitivity analysis and publication bias evaluation. Ten trials were included, and 615 patients were evaluated. In patients with CLM, pooled HRs revealed a substantial link between ctDNA positivity and RFS/DFS. Subgroup analysis revealed that ctDNA had a prospective detection value. Sensitivity analysis and publication bias evaluation indicated stable results. Although the results on pooled HR for OS suggested that ctDNA-positive patients had a shorter survival time, their pooled HRs had a relatively evident heterogeneity, and sensitivity analysis and publication bias evaluation indicated that pooled HRs were extremely unstable. In conclusion, our results demonstrate that ctDNA appears to be a prognostic biomarker for resectable CLM patients.

目的 探讨神经导航、超声、吲哚氰绿血管造影、神经电生理等多模态监测技术在脑动静脉畸形(AVMs)手术中的应用效果.方法 回顾性连续纳入2019年3月至2021年2月南京大学医学院附属鼓楼医院神经外科行显微外科治疗的AVMs患者51例,其中未破裂AVMs 25例,包括以癫痫发作为首发症状者10例(19.6％);破裂出血AVMs 26例(51.0％),包括伴癫痫发作者5例;Spetzler-Martin分级Ⅰ级3例、Ⅱ级5例、Ⅲ级16例、Ⅳ级22例、Ⅴ级5例.记录患者的临床疗效及术后并发症情况,对多模态监测技术用于AVMs显微手术的优缺点进行综合分析.所有患者接受神经导航、神经电生理监测以及术中超声监测,根据需要可反复使用微血管多普勒超声,对AVMs病变、引流静脉、供血动脉、畸形团内部、皮质或畸形团表面进行监测,并通过临时阻断可疑供血动脉后病灶内部血流信号的变化,以判断该动脉是否为主要供血动脉.对于AVMs位置表浅者,结合吲哚氰绿血管造影判断.AVMs病变位于功能区时,采用术中唤醒技术.术前合并癫痫发作进行皮质脑电图描记.手术并发症为术后30 d内,因手术及其相关原因引起的新发卒中、功能障碍(语言、运动、感觉、视觉)、颅内感染、脑积水以及死亡事件等.改良Rankin量表(mRS)评分0～2分为预后良好,mRS评分3～6分为预后不良.结果 51例AVMs患者共进行开颅手术51次,其中直接显微外科手术13例,分期选择性介入栓塞联合显微外科手术31例,同期选择性介入栓塞联合显微外科手术7例;手术时间5～16 h,平均(9.2±2.9)h.50例AVMs全切除,1例少量残留.所有患者接受神经导航、超声联合神经电生理监测,其中病灶位置表浅的30例患者接受吲哚氰绿血管造影,并应用FLOW 800技术对血流动力学参数进行分析;10例患者接受术中唤醒,7例神经电生理监测成功定位运动皮质及纤维传导束,3例定位语言区;15例患者术前有癫痫发作,术中皮质脑电监测下切除致痫灶.术后30 d内,未发生卒中或死亡事件,治愈率98.0％(50/51),1例为残留好转.手术并发症发生率21.6％(11/51),包括2例视觉障碍、1例感觉性失语、2例小脑及1例颞顶枕叶AVMs出血患者术后出现交通性脑积水、5例颅内感染.51例患者均完成了临床及影像学随访.随着术后时间的延长,预后良好占比增加[术后10 d和术后6个月分别为54.9％(28/51)、88.2％(45/51)],治疗前后mRS评分占比的差异有统计学意义(H=33.335,P<0.01).Spetzler-Martin分级与术后6个月mRS评分呈正相关(r=0.793,P<0.01).结论 多模态监测技术应用于显微外科手术切除AVMs中具有定位准确、及时发现异常、精准评估血流动力学等优点,可改善手术质量,其侧重各有不同,在临床上应选择性联合应用.本研究结论有待进一步验证.

目的 调查神经外科重症患者合并肺部感染的病原菌分布及耐药情况,并分析其肺部多重耐药菌(MDRO)感染的危险因素.方法 回顾性分析187例伴有肺部感染的神经重症患者的临床资料、肺部病原菌分布和MDRO的耐药情况,并根据其痰培养病原菌是否为多重耐药菌将患者分为耐药菌组和非耐药菌组,分析神经重症伴肺部感染患者感染MDRO的危险因素.结果 肺部非MDRO感染组54例,MDRO感染组133例.共分离出致病菌333株,其中MDRO有196株(58.85％).革兰氏阴性菌(73.98％)为主要致病菌,主要为鲍曼不动杆菌、肺炎克雷伯菌和铜绿假单胞菌.MDRO构成比由高到低依次是鲍曼不动杆菌、金黄色葡萄球菌、肺炎克雷伯菌和铜绿假单胞菌.单因素分析结果显示,入住神经外科重症监护病房(NSICU)时间,最低GCS评分,机械通气时间,人工气道的建立,抗菌药物使用时间及种类,联合用药,碳青霉烯类药物使用和糖皮质激素使用,差异均有统计学意义(均P＜0.05).多因素logistic回归分析结果显示,入住NSICU时间、抗菌药物使用时间及种类是神经重症伴肺部感染患者MDRO感染的危险因素.结论 神经重症患者肺部多重耐药菌感染率高,主要为革兰氏阴性杆菌感染.缩短住院时间,加强抗生素合理使用,减少抗生素使用时间和种类,对控制多重耐药菌感染有重大意义.加速康复外科的实行可能是一项有利措施.

Objective: The present study aimed to investigate the clinical significance of multiparameter intracranial pressure (ICP) monitoring in the prediction of the prognosis of hypertensive intracerebral hemorrhage (HICH). Methods: A retrospective analysis was performed on the clinical data of 53 HICH patients. The patients underwent removal of intracranial hemorrhage and decompressive craniectomy after admission. A ventricular ICP monitoring probe was used to continuously and invasively monitor mean arterial pressure (MAP) and ICP after surgery. The NEUMATIC system was used to collect ICP data, including pressure reactivity index (PRx), ICP dose (DICP), amplitude and pressure regression (RAP), and cerebral perfusion pressure (CPP). The mean PRx, CPP, RAP, ICP, and DICP20 mmHg × h were calculated with 1 h as the time segment. According to the Glasgow outcome scale (GOS) scores after discharge, the patients were grouped into the poor prognosis group (GOS I–III) and the good prognosis group (GOS IV and V). The two groups were compared in terms of GOS scores in the treatment and prediction of prognosis of patients. Results: The good prognosis group showed significantly lower values of mean ICP, DICP20 mmHg × h, RAP, and PRx than the poor prognosis group, while CPP was significantly higher (p < 0.001). Conclusions: PRx, DICP, RAP, and CPP could reflect intracranial changes in patients and were significantly correlated with the prognosis of the patients. Mean ICP, PRx, DICP20 mmHg × h, and RAP were negatively correlated with prognosis, while CPP was positively correlated with prognosis.

目的 观察开颅血肿清除术治疗重型脑干出血的临床效果.方法 重型脑干出血患者12例,格拉斯哥昏迷评分(GCS)3～4分,均采用开颅血肿清除术.术后12 h内复查颅脑CT;术后6个月时,进行格拉斯哥预后量表(GOS)评分.结果 颅脑CT显示,8例血肿接近完全清除(>95％)、4例大部分清除(85％～95％).术后6个月,GOS评分1分5例、2分2例、3分4例、4分1例,其中血肿量≥10 mL者均死亡.结论 开颅血肿清除术治疗重型脑干出血患者临床效果好,但对于血肿量≥10 mL者无效.

Objective:To observe the clinical effect of bevacizumab in the treatment of refractory brain edema.Methods:Eight patients with refractory brain edema who were treated with regular dehydration and hormone for one week in the neurosurgical intensive care unit of Neurosurgery Department of Nanjin Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School from July 2020 to June 2021 were selected as the research objects. All patients were given bevacizumab 200 mg, diluted to 0.8 mg/mL with 250 mL normal saline under sterile technology, and continued intravenous drip for more than 90 min. The amount of brain edema and the improvement of GCS score were compared before and after treatment.Results:For patients with refractory brain edema, bevacizumab could significantly improve brain edema. Imaging examination showed that brain edema was improved 2 d after treatment. The amount of brain edema measured 1 week after treatment of all patients were relieved compared with that before treatment, and the GCS score of all patients were higher than that before treatment.Conclusion:Bevacizumab is effective in the treatment of neurosurgical refractory brain edema, which can reduce brain edema and improve the clinical prognosis.

Objective To analyze the significance of intracranial pressure (ICP)-related parameters on outcome in patients with severe traumatic brain injury. The ICP-related parameters included ICP, ICP dose (DICP), regression of the correlation coefficient between amplitude and pressure (RAP), pressure reactivity index (PRx), and cerebral perfusion pressure (CPP). Methods A retrospective analysis was performed using clinical information from 29 patients with severe traumatic brain injury who were admitted to the Department of Neurosurgery from January 2018 to January 2019. All patients underwent ICP probe implantation after admission. Patients were followed up for 6 months after discharge, and were categorized into either the favorable or unfavorable outcome group based on their Glasgow Outcome Scale score. The differences in ICP, DICP, RAP, PRx, and CPP between the two groups were analyzed for their effects on outcome. Results The average ICP, DICP, PRx, and RAP values in patients with favorable outcomes were significantly lower than in patients with unfavorable outcomes, while CPP values were significantly higher in the favorable outcome group. Conclusion Average ICP, DICP, PRx, RAP, and CPP values may indicate disease status and relate to patient outcomes. It is important to use multiple parameters to predict patients’ disease severity and prognosis.

目的 探讨颅内压(ICP)及相关参数与老年高血压性脑出血预后的关系.方法 回顾性分析南京市溧水区人民医院神经外科2017年1月—2018年7月收治的37例老年高血压性脑出血患者的临床资料.根据患者出院后的格拉斯哥预后量表(GOS)评分分成预后良好组及预后不良组,分析比较两组患者的平均ICP、平均压力反应指数(PRx)、Dicp20及平均颅内压波幅(mean ICP wave amplitude,MWA)值的差异.结果 预后良好组患者的平均ICP、平均PRx、Dicp20及平均MWA值圴明显低于预后不良组,差异有统计学意义(均P<0.01).结论 平均ICP、平均PRx、Dicp20及平均MWA与老年高血压性脑出血患者的预后有密切的关系;其数值低的患者预后较好.

Objective: Traumatic brain injury (TBI) is a serious health problem with few available treatment options.Rh-erythropoietin (rh-EPO) is a potential therapeutic drug for TBI, but it cannot cross the blood-brain barrier (BBB) directly.In this regard, a novel strategy to deliver rh-EPO for enhanced TBI treatment is via the development of Tween 80 modified albumin nanoparticles using electrostatic spray technology.Methods: The rh-EPO loaded Tween 80 modified albumin nanoparticles (rh-EPO-Tw-ABNPs) were prepared by electrostatic spray technology, while the process parameters were optimized via a single factor design.Investigation of physicochemical properties, bioactivity and stability of rh-EPO-Tw-ABNPs was carried out.The in vitro release and biocompatibility with nerve cells were also analyzed.The in vivo brain targeting efficiency, brain edema relieving effect and the expression of aquaporin 4 (AQP4) and glial fibrillary acidic protein (GFAP) in the brain were evaluated in TBI model rats. Results:The particle size of optimal rh-EPO-Tw-ABNPs was about 438 ± 45 nm, with a zeta potential of -25.42 ± 0.8 mv.The average drug loading ratio of rh-EPO-Tw-ABNPs was 21.3± 3.7 IU/mg with a relative bioactivity of 91.6 ± 4.1%.The in vitro release of rh-EPO from the nanoparticles was rather slow, while neither the blank Tw-ABNPs nor rh-EPO-Tw-ABNPs exhibited toxicity on the microglia cells.Furthermore, in vivo experiments indicated that the rh-EPO-Tw-ABNPs could enhance the distribution of EPO in the brain and relieve brain edema more effectively.Moreover, compared with an rh-EPO injection, the rh-EPO-Tw-ABNPs could increase the AQP4 level but reduced GFAP expression in the brain with more efficiency. Conclusion:The rh-EPO-Tw-ABNPs could enhance the transport of rh-EPO into the brain with superior therapeutic effect for TBI.