Background: Testicular germ cell tumors (TGCTs) are the most common solid malignancies in young men. In real-world clinical practice, non-random treatment allocation may result in confounding by indication, as patients with a greater disease burden are more likely to receive chemotherapy. We evaluated the association between treatment strategy and recurrence-free survival using propensity score-based inverse probability of treatment weighting (IPTW). Methods: We retrospectively analyzed 114 patients who underwent radical orchiectomy for TGCT between 2015 and 2024. Patients were classified into active surveillance and chemotherapy groups. Stabilized IPTW was used to balance baseline clinicopathological characteristics. Recurrence-free survival was evaluated using Kaplan-Meier analysis and Cox proportional hazards regression. Residual post-weighting imbalance was addressed by additional covariate adjustment. Results: During follow-up, 29 of 114 patients (25.4%) experienced recurrence. Unadjusted Kaplan-Meier analysis demonstrated no statistically significant difference in recurrence-free survival between treatment groups (log-rank p = 0.150). Consistently, the unadjusted Cox proportional hazards model showed no statistically significant association between treatment strategy and recurrence-free survival (HR = 1.85, 95% CI 0.79-4.34; p = 0.158). After IPTW, treatment strategy remained not significantly associated with recurrence-free survival (HR = 0.96, 95% CI 0.43-2.13; p = 0.911). Additional adjustment for residual post-weighting imbalance yielded similar results (HR = 0.94, 95% CI 0.43-2.03; p = 0.876). Conclusions: After adjustment for measured baseline differences using IPTW, treatment strategy was not statistically significantly associated with recurrence-free survival. Given the limited number of recurrence events, wide confidence intervals, residual covariate imbalance, incomplete propensity-score overlap, and evidence of non-proportional hazards, these findings should be considered exploratory and should not be interpreted as evidence of equivalence.

Dedifferentiated liposarcoma (DDLPS) can exhibit myxoid morphology that closely mimics myxoid liposarcoma (MLPS), creating significant diagnostic challenges. DDIT3 immunohistochemistry (IHC), a specific marker for MLPS, has been reported in a subset of DDLPS cases, but its frequency, staining pattern, and clinical significance remain poorly characterised. We retrospectively analysed 46 DDLPS cases with prominent myxoid features (≥ 10% myxoid component) confirmed by MDM2 IHC and fluorescence in situ hybridisation (FISH), treated at a single tertiary centre between January 2007 and January 2026. DDIT3 IHC was scored using a semiquantitative H-score system. DDIT3 positivity occurred in 11 of 46 cases (23.9%, 95% CI: 12.6-38.8%), predominantly as focal staining (9/11, 81.8%). All DDIT3-positive cases exhibited myxoid components comprising > 25% of tumour volume, versus variable myxoid extent in DDIT3-negative cases (p < 0.001). Mean H-score in DDIT3-positive cases was 48.6 ± 32.4 (range 15-120), significantly lower than in true MLPS controls (mean 278 ± 22, p < 0.001). Tumour size > 15 cm significantly increased the risk of local recurrence (risk ratio [RR] = 2.31, 95% CI: 1.02-5.24, p = 0.048). DDIT3 expression showed no significant association with local recurrence (p = 0.337), distant metastasis (p = 0.825), or mortality (p = 0.805). Kaplan-Meier analysis revealed no significant difference in overall survival (log-rank p = 0.782) or recurrence-free survival (log-rank p = 0.614) between DDIT3-positive and DDIT3-negative groups. DDIT3 positivity in DDLPS with myxoid features predominantly produces focal, low-intensity staining that distinguishes it from true MLPS. DDIT3 expression reflects chromosomal co-amplification within the 12q13-15 amplicon and lacks prognostic significance. Combined MDM2 and DDIT3 IHC with careful morphological assessment aids differential diagnosis, particularly when molecular testing is unavailable.

Background/Objectives: Paragangliomas (PGLs) are rare neuroendocrine tumors, and data describing them from a medical oncology perspective are limited. We characterized clinicopathological features, tumor localization, and treatment outcomes. Methods: We retrospectively analyzed 43 patients with PGL at a single medical oncology department. The primary endpoint was recurrence-free survival (RFS), defined as time to first recurrence or death from any cause; overall survival (OS), objective response rate (ORR), disease control rate (DCR), and prognostic associations were secondary. Results: Median age was 44 years, 60.5% were female, and tumors were sympathetic (extra-adrenal) in 55.8% and parasympathetic (head and neck) in 39.5%. After a median follow-up of 116.8 months, 40 patients (93.0%) underwent resection, among whom 14 RFS events occurred (13 recurrences, 1 unrelated death). Median RFS and OS were not reached (60-month RFS, 67.1%; 120-month OS, 83.3%). Among nine patients receiving first-line systemic therapy (eight response-evaluable), ORR was 12.5% and DCR 37.5%. In exploratory univariable analysis, a Ki-67 index ≥ 3% correlated with recurrence (time-averaged hazard ratio, 4.53; 95% CI, 1.55–13.19; p = 0.006), alongside an R1 resection margin (not significant after Bonferroni correction). Conclusions: These findings may support further evaluation of Ki-67 within risk-adapted surveillance but do not replace germline testing.

BACKGROUND:Liver dysfunction is recognized as a risk factor for poor outcome after. stroke. The FIB-4 index, a laboratory test for predicting liver fibrosis, has been shown to be. associated with poor prognosis in cardiovascular and cerebrovascular diseases. The aim of. this study was to explore the relationship between FIB-4 score and hemorrhagic. transformation, mortality, and prognosis in patients with acute ischemic stroke who received. intravenous thrombolytic therapy (IV tPA). METHODS:The records of 255 consecutive patients who received IV tPA for acute. ischemic stroke were retrospectively reviewed. Patients were divided into two groups. according to their FIB-4 scores: group 1 (FIB-4 ≤ 2.67) and group 2 (FIB-4 > 2.67). The. demographic data, NIHSS scores at admission, THRIVE scores, intracranial bleeding rates, (using the Heidelberg Bleeding Classification, NINDS and ECASS criteria for symptomatic. intracranial hemorrhage), stroke etiology subtypes (using the automated Causative. Classification System), and mRS scores at the third month were recorded. RESULTS:On logistic regression analysis, group 2 patients were older, had higher mRS. scores at the third month and had increased mortality within 3 months when compared with. group 1 (p ≤ 0.05). Although group 2 patients had a higher rate of intracranial hemorrhage, the difference was not statistically significant. CONCLUSIONS:The FIB-4 index may serve as a a useful predictor of poor prognosis in patients with acute ischemic stroke who received IV tPA. Large-scale prospective studies are needed to confirm this relationship and provide valuable insights for clinical practice.

OBJECTIVE:Primary Aldosteronism (PA) is the most common cause of secondary hypertension. Immunohistochemical analysis of PA is based on specific monoclonal antibodies targeting CYP11B1 and CYP11B2, which are enzymes responsible for the aldosterone production in the adrenal cortex. The recently proposed HISTALDO classification introduced CYP11B2 immunohistochemistry to define clinically relevant diagnostic categories. We aimed to investigate the relationship between clinical characteristics and immunohistochemistry of CYP11B2 in PA and also evaluate staining in cortisol-producing cells by comparing patients with Cushing's Syndrome (CS). Consecutive patients diagnosed with PA (n=21) and CS (n=20) were included between 2015-2022. All of them underwent unilateral adrenalectomy in our tertiary center. METHODS:Following hematoxylin and eosin (H&E) staining of the pathological specimens, all slides were re-evaluated and immunostained for CYP11B2. A semiquantitative H-score was assessed for each patient and compared with staining intensity. Patients with PA were grouped and classified according to the HISTALDO classification. RESULTS:The mean size of adenoma in patients with PA was much smaller compared to patients with CS (p=0.001). An increase in the immunohistochemical H-score of the patients with PA (121.36 ±81.04 vs 73.94±57.70, p=0.045) was observed in comparison to the patients with CS. When comparing the patients with PA according to HISTALDO criteria, the H-score of the patients with Aldosterone Producing Adenoma (APA, n=10) was 136.6±78.86 compared to the non-APA group, which was 86.81±85.3 (n=11, p=0.05). Moreover, mean preoperative aldosterone levels (p=0.06) and aldosterone-to-renin ratio (ARR, p=0.03) were higher in patients with APA compared to non-APA patients. Response to surgical therapy was more favorable in patients with APA than the patients with non-APA. CONCLUSION:CYP11B2 is a key enzyme responsible for the synthesis of aldosterone. CYP11B2 expression, as assessed by immunostaining, was associated with the clinical characteristics, severity of PA, and response to the treatment. Hence, immunohistochemical analysis of CYP11B2 should be incorporated into the routine clinical workup to better localize aldosterone-producing cells.

OBJECTIVE:We aimed to explore the role of hyperventilation (HV) during routine EEG recordings in the diagnosis of adults with epilepsy. METHODS:During the COVID-19 pandemic we removed HV from routine EEG recordings due to the transmission risks. Routine EEGs conducted in the year before and after the COVID-19 pandemic were re-evaluated. RESULTS:A total of 167 HV + and 199 HV - EEGs were analyzed. To ensure comparability between the two groups with respect to age and conditions that could contraindicate HV, patients ≥ 55 years and with any conditions contraindicating HV were excluded from both groups. In patients with a diagnosis of epilepsy the prevalence of epileptiform abnormalities was 26.7 % in the HV + and 24.5 % in the HV - group (p = 0.727). CONCLUSIONS:This study did not reveal any evidence indicating that HV improves the diagnostic sensitivity of routine EEG in adults with epilepsy. In adults, hyperventilation during routine EEG recordings may be most useful in incre in patients with a history of absence seizures or seizures triggered by hyperventilation.

Microplastic particles with a size of less than 5 mm make up a significant component of the plastic pollution in freshwater and the ocean. This study was designed to investigate the effects of eight-week exposure to high-molecular-weight polyvinyl chloride (HMW-PVC) on young rats. A total of 40 rats were divided into two assay groups of 15 rats (Group 1, Group 2, a total of 30 rats) and a control group of 10 rats. The rats in the first and second assay groups were fed with food containing HMW-PVC at rates of 1 and 2% of their weight, respectively. The control group was fed food without HMW-PVC. The rats’ weights were recorded every 15 days. After eight weeks of feeding, the rats’ intestines, kidneys, and livers were removed and underwent histopathological examinations. Additionally, mRNA expression levels of Cyp3A2, Pepck, and Fasn genes in the liver, UT-A1, UT-A2, renin, and Cyp27B1 genes in the kidney, and Muc2, Fabp2, and PepT1 genes in the intestine were determined by using the RT-PCR technique. Our study revealed that rats exposed to microplastic particles exhibited non-significant weight loss and obvious organ degeneration. Furthermore, mRNA expression levels of the examined genes were either elevated or suppressed by regular exposure to high-molecular-weight PVC.

The present study investigates microplastic (MP) contamination in the gills and gastrointestinal tract (GIT) of common carp (Cyprinus carpio), mirror carp (Cyprinus carpio carpio) and European perch (Perca fluviatilis) specimens obtained from Gelingüllü Reservoir (Türkiye). MP particles were found in 58 (75.3

Microplastic (MP) pollution has been observed in various ecosystems as a result of the rapid increase in plastic production over the past half-century. Nevertheless, the extent of MP pollution in different ecosystems, particularly in freshwater ecosystems, has not been well-studied, and there are limited investigations on this particular topic, specifically in Türkiye. Here, we quantify the occurrence and distribution of MPs in surface water samples collected from Topçu Pond (Türkiye) for the first time. Water samples were collected at five stations and filtered (30 L for each station) through stacked stainless steel sieves (5 mm, 328 µm, and 61 µm mesh size) with a diameter of 30 cm. The abundance, size, color, shape, and type of collected debris samples were analyzed after the wet peroxide oxidation process. MP particles were observed in all samples at an average abundance of 2.4 MPs/L. The most abundant MP size class and type were 0–999 µm and fiber respectively. On the other hand, prevalent colors were black and colorless in general. According to the Raman analysis results, the identified MP derivatives were polypropylene (40

You have accessJournal of UrologyKidney Cancer: Localized: Surgical Therapy V (MP67)1 May 2024MP67-08 BIOCHEMICAL AND HISTOPATHOLOGICAL COMPARISON OF THE EFFECTS OF RENAL ARTERY VEIN CLAMPING AND RENAL ARTERY ONLY CLAMPING DURING PARTIAL NEPHRECTOMY IN RATS WITH SOLITARY KIDNEY Tunahan Ates, Mutlu Deger, Nebil Akdogan, Ismail Onder Yilmaz, Ozlem Goruroglu Ozturk, Tugba Toyran, Seyda Erdogan, Volkan Izol, and Ibrahim Atilla Aridogan Tunahan AtesTunahan Ates , Mutlu DegerMutlu Deger , Nebil AkdoganNebil Akdogan , Ismail Onder YilmazIsmail Onder Yilmaz , Ozlem Goruroglu OzturkOzlem Goruroglu Ozturk , Tugba ToyranTugba Toyran , Seyda ErdoganSeyda Erdogan , Volkan IzolVolkan Izol , and Ibrahim Atilla AridoganIbrahim Atilla Aridogan View All Author Informationhttps://doi.org/10.1097/01.JU.0001009496.54470.10.08AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The standard surgical treatment of renal masses is radical nephrectomy (RN) or partial nephrectomy (PN). PN is performed with (vascular clamping) or without ischemia. In the literature, the superiority of artery only (AO) clamping over artery-vein (AV) clamping has been investigated. We aimed to investigate whether AO clamping or AV clamping is superior by performing an animal experiment. METHODS: A total of 24 animals were divided into 3 groups: Control (C) group, artery only (AO) group and artery-vein (AV) group. All rats underwent right nephrectomy first. Then, left nephrectomy was performed 6 days later in the C group, left PN was performed 3 days later in the AO group by clamping the AO, and left PN was performed 3 days later in the AV group by clamping the AV. The experiment was then terminated. Total antioxidant status, total oxidant status, oxidative stress index, malondialdehyde acid, super oxide dismutase, nitric oxide, tyrosine hydroxylase, 8-isoprostane, creatinine, interleukin-6 were determined from rat sera with ELISA kits. In left nephrectomy materials, Bowman's capsule enlargement, tubular necrosis, vasa recta leukocyte infiltration (VRLI), tubular regeneration, interstitial inflammation, tubular dilatation and presence of mitosis were examined histopathologically. Markers and histopathologic findings were compared.Chi-square test or Fisher's test was used to compare categorical variables, Kruskal Wallis test was used to compare continuous measurements and Mann Whitney U Test was used for post-hoc comparisons. The p level was taken as 0.017 for significance with Bonferroni correction. RESULTS: There was no statistically significant difference between the groups in terms of biochemical measurements. In the comparison of Bowman's capsule enlargement, tubular necrosis, mitosis, VRLI, and tubular dilatation; statistically significant difference was found between ischemia groups and control groups. CONCLUSIONS: This study demonstrated that AO and AV clamping yielded similar results. According to the current situation, the decision of the appropriateness of AO or AV clamping should be left to the surgeon. Source of Funding: Çukurova University Scientific Research Projects © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e1099 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Tunahan Ates More articles by this author Mutlu Deger More articles by this author Nebil Akdogan More articles by this author Ismail Onder Yilmaz More articles by this author Ozlem Goruroglu Ozturk More articles by this author Tugba Toyran More articles by this author Seyda Erdogan More articles by this author Volkan Izol More articles by this author Ibrahim Atilla Aridogan More articles by this author Expand All Advertisement PDF downloadLoading ...

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Abstract Background Evaluation of the effect of additional surgical margin parameters on biochemical recurrence (BCR) in patients with positive surgical margins (PSM) after radical prostatectomy (RP). Methods Clinicopathological and outcome data from 91 patients with PSM who underwent RP were retrospectively analyzed. Additional surgical margin parameters (PSM length, highest Gleason grade (GG), localization of PSM (apex, bladder neck, or posterolateral), and unifocality or multifocality) were examined and their effects on BCR were investigated. Results Fifty patients with PSM were included in the study. The mean age of the patients was 63.6 ± 6.9 years. The laparoscopic approach was undertaken more frequently, used for 36 (72%) patients compared to open RP performed in 14 cases (28%). The median follow-up time was 57.0 months (24.0–125.0 months). BCR developed in 14 (28%) patients during the follow-up period. Although mean BCR-free survival was shorter in cases with PSM length ≥ 3 mm compared to those with PSM length < 3 mm (90.4 vs. 108.2 months), multifocality compared to those with unifocality (62 vs. 97.4 months) and surgical margin GG ≥ 4 compared to those with GG 3 (87.4 vs. 97.5 months), the differences were not statistically significant (p = 0.251, p = 0.509 and p = 0.317, respectively). In addition, none of the PSM localizations affected BCR-free survival (p = 0.619). In univariate Cox regression analysis, PSM length affected BCR at a level close to statistical significance (HR = 1.16; p = 0.052). In multiple Cox regression analysis, main tumor Gleason score was determined to be a risk factor associated with BCR (HR = 4.75; p = 0.041). Conclusions Although BCR-free survival was shortened in the presence of poor prognostic features (multifocal PSM, PSM length ≥ 3 mm, surgical margin GG ≥ 4) at the surgical margin, none of these parameters affected BCR at a statistically significant level. Gleason score of the main tumor was found to be a better prognostic factor for BCR.

Microplastic (MP) pollution has been observed in a variety of ecosystems, but there is a limited number of studies on reservoir ecosystems. The aim of this study was to determine the levels of MP contamination in sediment, water and commercially important fish species (Cyprinus carpio, Perca fluviatilis, Atherina boyeri and Sander lucioperca) collected from the Yamula Reservoir in Türkiye.Water samples were collectes at five stations. Four sediment samples were collected from the lake. As sediments from the lake represent a vital element of the lake ecosystem, they function as a historical archive that reflects alterations in land use and the characteristics of the lake over time.The average amounts of MPs observed in sediment and water samples were 0.12 MP/g and 0.58 MP/m3 respectively. The digestive systems of 30 individuals of each fish species were examined. The highest amount of MP was observed for C. carpio (6 ± 5.9 MP/individual), while the lowest amount of MP was observed for A. boyeri (1.8 ± 1.7 MP/individual). MP abundance in S. lucioperca and P. fluviatilis was 2 ± 2.8 and 4.6 ± 6.3 MP per individual. The most commonly observed polymer types were polypropylene (67%), polyvinyl alcohol (13%), polyethylene resin (13%) and high-density polyethylene (7%). The pollution load indexes determined for each fish species from the highest to the lowest were as follows: 1.83 (C. carpio) 1.6 (S. lucioperca) 1.05 (P. fluviatilis) and, 1 (A. boyeri). The findings of the study indicate that all sampling stations, including both sediment and water, are contaminated with MPs. Furthermore, the results demonstrate that all examined fish species ingest MPs. Additionally, the results indicate that fish inhabiting a wide range of habitats and consuming diverse diets are more susceptible to MP contamination.

Myxoid glioneuronal tumor of the septum pellucidum is an uncommon clinical entity, previously referred to dysembryoplastic neuroepithelial tumor located in the septum pellucidum. This study was conducted following PRISMA guidelines. A comprehensive literature search was performed in the PubMed/MEDLINE, Web of Science, and Scopus databases. In addition to the literature review, we report a rare case of a 10-year-old male patient with septal myxoid glioneuronal tumor who underwent endoscopic tumor resection as an exemplary case. A total of 10 pediatric patients from 7 published records were included in this review. An analysis encompassing 11 patients, including the present patient, was performed. The mean age of the patients was 11.36 ± 3.35 years, with a male predominance. The most common presenting symptoms were headache (50

Background/aim:Amyotrophic lateral sclerosis (ALS) is a fatal neurodegenerative disease. Several studies have shown that alterations of microbiota increase the risk of neurodegenerative disorders. We aimed to reveal whether there is a difference in the gut microbiota of patients with ALS. Materials and methods:The participants are divided into three groups. Group 1 comprised patients with ALS. Healthy family members living in the same house of the patients formed Group 2. Lastly, sex- and age-matched healthy people were included in Group 3. Fecal samples were collected in 15-mL falcon tubes and stored at -80 °C. Genomic DNA isolation was performed on samples. Bacterial primers selected from the 16S rRNA region for the bacterial genome and ITS1 and ITS4 (internal transcribed spacer) were used for the identification of DNA. Next generation sequence analysis (NGS) and taxonomic analyses were performed at the level of bacterial phylum, class, order, family, genus, and species. Alpha and beta diversity indexes were used. The linear discriminant analysis (LDA) effect size method (LEfSe) was applied to identify a microbial taxon specific to ALS disease. Results:The relative abundances of the Succinivibrionaceae and Lachnospiraceae families were significantly lower in patients. The dominant families among patients were Streptococcaceae and Ruminococcaceae, while the dominant families among healthy controls were Bacteroidaceae and Succinivibrionaceae. The LEfSe analysis revealed that four families (Atopobiaceae, Actinomycetaceae, Erysipelatoclostridiaceae, Peptococcacceae) differed significantly between the patients and healthy controls (LDA values> 2.5, p < 0.05). Conclusion:Comparison with family members living in the same house is the strength of this study. We found that there were changes in the microbiota of the patients, consistent with the literature. Studies that analyze the composition of the gut microbiota in the predisease period may be needed to understand whether dysbiosis is caused by the mechanisms inherent in the disease or whether it is dysbiosis that initiates the disease.

Progressive multifocal leukoencephalopathy (PML) is a severe, demyelinating disease of the central nervous system caused by JC virus infection. The disease can be seen in sarcoidosis patients without additional risk factors. Here, we present an individual with PML secondary to sarcoidosis treated with 8 doses of pembrolizumab, a Programmed Cell-Death-1 (PD-1) Immune Checkpoint Inhibitor who showed significant improvement. This report illustrates the objective clinical and radiological improvement in a patient with PML due to sarcoidosis, and suggests further study of immune checkpoint inhibitors as a potential treatment for sarcoidosis patients with PML.

Cystic dysplasia of the rete testis is a benign tumor of the testis, which occurs most frequently in pediatric age and is often accompanied by renal anomalies. It is necessary to differentiate this condition from malignant testicular tumors. Different approaches, such as orchiectomy, testis-sparing surgery, or conservative follow-up, can be utilized in treatment. Herein, we reported a five-year-old patient with cystic dysplasia of the rete testis who was admitted with scrotal pain and underwent orchiectomy.

Objective We aimed to assess the effects of neuroserpin and its combination with hypothermia on hypoxic-ischemic (HI) brain injury in neonatal rats. Neuroserpin is an axon-secreted serine protease inhibitor and is important for brain development, neuronal survival, and synaptic plasticity. Study Design Male Wistar-Albino rats on postnatal day 7 (P7) were randomly divided into five groups: sham group (n = 10), (HI; n = 10), hypoxic-ischemic hypothermia (HIH; n = 10), hypoxic-ischemic neuroserpin (HIN; n = 10), and hypoxic-ischemic neuroserpin-hypothermia (HINH; n = 10). The P7 rat brain's maturation is similar to a late preterm human brain at 34 to 36weeks of gestation. HI was induced in rats on P7 as previously described. A single dose of 0.2 mu M neuroserpin (HINH and HIN) or an equivalent volume of phosphate-buffered saline (sham, HIH, and HI) was administered intraventricularly by a Hamilton syringe immediately after hypoxia. In the follow-up, pups were subjected to systemic hypothermia or normothermia for 2 hours. Euthanasia was performed for histopathological evaluation on P10. Apoptosis was detected by caspase-3 activity and terminal deoxynucleotidyl transferase-mediated dUTP nick end-labeling (TUNEL) staining and was counted in the hippocampus. Results In comparison to the HI group, the TUNEL-positive and caspase-3-positive neurons in the sham, HIN, HIH, and HINH groups were considerably lower (13.4 +/- 1.0 vs. 1.9 +/- 0.9, 6.0 +/- 0.9, 5.3 +/- 1.6, and 4.0 +/- 1.1; p< 0.001) and (13.5 +/- 1.7 vs. 1.2 +/- 0.7, 9.1 +/- 2.7, 4.8 +/- 1.0, and 3.9 +/- 1.6; p< 0.001). HIN, HIH, and HINH, compared to the sham group, showed more TUNEL-positive and caspase-3-positive neurons (6.0 +/- 0.9, 5.3 +/- 1.6, 4.0 +/- 1.1 vs. 1.9 +/- 0.9 and 9.1 +/- 2.7, 4.8 +/- 1.0, 3.9 +/- 1.6 vs. 1.2 +/- 0.7; p< 0.001). The HINH group (synergistic effect) had significantly fewer TUNEL-positive neurons and caspase-3-positive neurons than the HIN group (4.0 +/- 1.1vs. 6.0 +/- 0.9 and 3.9 +/- 1.6 vs. 9.1 +/- 2.7; p< 0.001). Conclusion Our study showed that both neuroserpin alone and as an adjuvant treatment for hypothermia may have a neuroprotective effect on brain injury.