Multimodality management for chronic subdural hematoma in China: protocol and characteristics of an ambidirectional, nationwide, multicenter registry study.

BACKGROUND: Despite its prevalence, there is ongoing debate regarding the optimal management strategy for chronic subdural hematoma (CSDH), reflecting the variability in clinical presentation and treatment outcomes. This ambidirectional, nationwide, multicenter registry study aims to assess the efficacy and safety of multimodality treatment approaches for CSDH in the Chinese population. METHODS/DESIGN: A multicenter cohort of CSDH patients from 59 participating hospitals in mainland China was enrolled in this study. The treatment modalities encompassed a range of options and baseline demographics, clinical characteristics, radiographic findings, and surgical techniques were documented. Clinical outcomes, including hematoma resolution, recurrence rates, neurological status, and complications, were assessed at regular intervals during treatment, 3 months, 6 months, 1 year, and 2 years follow-up. RESULT: Between March 2022 and August 2023, a comprehensive cohort comprising 2173 individuals who met the criterion was assembled across 59 participating clinical sites. Of those patients, 81.1% were male, exhibiting an average age of 70.12 ± 14.53 years. A historical record of trauma was documented in 48.0% of cases, while headache constituted the predominant clinical presentation in 58.1% of patients. The foremost surgical modality employed was the burr hole (61.3%), with conservative management accounting for 25.6% of cases. Notably, a favorable clinical prognosis was observed in 88.9% of CSDH patients at 3 months, and the recurrence rate was found to be 2.4%. CONCLUSION: This registry study provides critical insights into the multimodality treatment of CSDH in China, offering a foundation for advancing clinical practices, optimizing patient management, and ultimately, improving the quality of life for individuals suffering from this challenging neurosurgical condition. TRIAL REGISTRATION: ChiCTR2200057179.

Improvements of the Tada formula in estimating the intracerebral hemorrhage volume based on computed tomography.

Background: The Tada formula has been used widely for assessing intracerebral hemorrhage (ICH) volume. However, it is only suitable for calculating regular and small volume hematomas. Therefore, we attempted to improve the formula to increase its accuracy and maintain its efficiency. Methods: Computed tomography (CT) data of 15 balls of different shapes filled with predetermined volumes of water were collected to verify the high accuracy of FireVoxel in measuring the volume. CT data from 329 patients with ICH from two different hospitals grouped by hematoma shape and volume were retrospectively reviewed. The distinctly shaped ICH volumes of 245 patients from one of the hospitals were estimated using FireVoxel and the Tada formula grouped by the hematoma shape and volume. Taking the hematoma volumes measured by FireVoxel as the reference standard, the accuracy and reliability of the Tada formula were evaluated. Polynomial fitting was employed to determine the associations of the values calculated between the Tada formula and FireVoxel. Then, a corrected Tada formula (C-Tada formula) was produced, and the limits of agreement between the C-Tada formula and Tada formula were analyzed with Bland-Altman analysis. The C-Tada formula was validated by the CT data of 84 patients from another hospital. Results: The volume measured by FireVoxel can be set as the reference standard. The ICH volume calculated by the Tada formula was significantly greater than that calculated by FireVoxel for different shapes and volumes. The percentage deviation between the volumes calculated by FireVoxel and the Tada formula was also statistically significant and influenced by ICH shape and volume. The limits of agreement between the C-Tada formula and FireVoxel were tighter than those between the Tada formula and FireVoxel. The percentage deviation of the C-Tada formula calculation from the FireVoxel estimate was greatly reduced relative to that for the Tada formula for each group. Conclusions: The C-Tada formula is more clinically valuable than the Tada formula, given its sufficient efficiency and greater accuracy and reliability in ICH volume calculation.

Predictors for short-term successful weaning from continuous renal replacement therapy: a systematic review and meta-analysis.

The systemic review and meta-analysis aimed to identify the predictors for short-term successful weaning from CRRT in severe AKI patients. PubMed, Embase, the Cochrane Library, and grey literature were searched for relevant studies investigating variables for short-term successful weaning from CRRT to August 2022. Our criteria included patients with AKI who required CRRT but excluded patients with kidney failure. The pooled odds ratios (OR) and 95% confidence intervals (CI) were calculated using fixed-effect (I2≤50% and P-value of the Q statistic > 0.1) or random-effect models (I2>50% or p-value of the Q statistic ≤ 0.1) as appropriate. Our search yielded 11 studies and described 11 variables. The pooled analysis showed that chronic kidney disease (OR = 0.638, 95% CI: 0.491-0.829), CRRT duration (OR = 0.913, 95% CI: 0.882-0.946), and urine output at the cessation of CRRT (per 100 mL/day increase) (OR = 1.084, 95% CI: 1.061-1.108) were predictive factors for short-term successful weaning from CRRT. Male (OR = 0.827, 95% CI: 0.627-1.092), diabetes mellitus (OR = 0.970, 95% CI: 0.761-1.237), and sepsis (OR = 0.911, 95% CI: 0.717-1.158) were unrelated to the short-term weaning from CRRT. The relationship between hypertension, use of vasopressors or inotropes at the starting of CRRT, use of vasopressors or inotropes at the cessation of CRRT, use of diuretics at the cessation of CRRT, serum creatinine at the cessation of CRRT, and short-term weaning from CRRT remains unclear. Additional prospective studies are needed to evaluate this relationship further.

Association between preadmission low-density lipoprotein cholesterol concentration and risk of large intracerebral hemorrhage: Results from the Kailuan study.

BACKGROUND: To examine the association between low-density lipoprotein cholesterol (LDL-C) concentrations and the risk of a large hematoma volume after intracerebral hemorrhage (ICH). METHODS: Patients from the Kailuan study (Tangshan, China) who were hospitalized with ICH during 2006 and 2020 were included in this study. The concentration of lipid concentrations, hematoma volume and other clinical characteristics were retrospectively collected and analyzed. Hematoma volumes were measured on the first available brain scan using the ABC/2 method. LDL-C concentrations were obtained from the last physical examination before the occurrence of ICH. LDL-C concentration was categorized into four groups in accordance with the quartiles. Logistic regression was used to assess the association between LDL-C concentrations and the risk of a large hematoma volume of ≥30 ml. A generalized linear regression model was used to analyze the dose-response relationship between LDL-C concentration and hematoma volume. RESULTS: A total of 836 patients with ICH were evaluated. In the Multivariate logistic regression, compared to the second quartile of LDL_C, the first quartile of LDL_C had a significantly higher risk of a large hematoma volume (OR 2.49 [95% CI 1.54-4.01]), and the higher quartile of LDL_C is not associated with higher odds of large hematoma volume. In the generalized linear regression model, the adjusted ß for the association between LDL-C concentration and hematoma volume was 9.46 (95% confidence interval 2.87-16.04), whereas higher LDL-C concentration was not associated with a large hematoma volume. CONCLUSIONS: This study confirmed that low LDL-C concentrations prior to ICH are associated with a higher risk of a large hematoma volume.

A Cu(II)-based Coordination Polymer: Treatment Activity on Tuberculosis by Inhibiting the Survival of the Mycobacterium in Alveolar Macrophages.

Via utilizing the mixed-ligand method, a novel coordination polymer (CP) containing Cu(II) has been prepared by self-assembly at the ambient temperature, and its chemical formula is {[Cu(BINDI)0.5 (bpe)]·3H2O} n (1, bpe = 1,2-bis(4-pyridyl)ethylene and H4BINDI = N,N'-bis(5-isophthalic acid) naphthalenediimide). For the treatment of the tuberculosis, its biological function was evaluated as well. The CFU assay was performed to determine the bacterial numbers of the Mycobacterium in alveolar macrophages. In addition to this, the ropA gene of the Mycobacterium in alveolar macrophages was also detected through the real time RT-PCR method. Only the oxygen atoms on the metal complex are identified to be able to interact with the probe protein by molecular docking simulation.

A facile slow-gel method for bulk Al-doped carboxymethyl cellulose aerogels with excellent flame retardancy.

Bulk Al-doped carboxymethyl cellulose aerogels were obtained via a facile slow-gel method and freeze-drying technology. In this method, the cross-linker Al3+ was released slowly and completely with enough d-(+)-gluconic acid δ-lactone as a sustained-release agent. Depended on controlled releasing of Al3+, the reaction speed between Al3+ and carboxyl groups was controlled and Al3+ was well-distributed in the aerogels. The coordination type between Al3+ and carboxymethyl cellulose was the bidentate bridging coordination. By adjusting the amount of Al3+ and the degree of substitution of carboxymethyl cellulose, interconnected network and closely packed sheet-like structure presented, respectively. According to the nitrogen adsorption-desorption isotherms, the aerogels were a kind of mesoporous material with pore blocking or cavitation. In addition, the aerogels exhibited outstanding weight-bearing capacity and excellent flame retardancy. This work provided a valuable reference for doping metal ions into polysaccharide aerogels and expanding the application fields of aerogels.

Converting untreated waste office paper and chitosan into aerogel adsorbent for the removal of heavy metal ions.

The utilization of waste paper, an obsolete recyclable resource, helps to save resources and protect environment. In this paper, an aerogel was prepared to convert the waste paper into a useful material, which was used to adsorb heavy metal ions and handle water pollution. Combining waste office paper and chitosan, the aerogel obtained the enhanced mechanical strength, acid resistance and high adsorption capacity (up to 156.3 mg/g for Cu2+). This adsorption process obeyed the pseudo-second order model and the Langmuir model. The research showed that a coordination compound was formed between amino group and Cu2+ during the adsorption process. The adsorbent could be regenerated well in 0.1 M H2SO4 with up to 98.3% desorption efficiency. The low cost, environmental friendliness, excellent adsorption capacity and regeneration ability made this novel aerogel a promising adsorbent for heavy metal ions. And this conversion is an effective reuse way of waste paper too.

Excellent reusable chitosan/cellulose aerogel as an oil and organic solvent absorbent.

Absorption is one of the most important methods for oil spill cleanup. An ideal absorbent is expected to possess advantages of low cost, green, high absorption capacity and excellent reusability. In this paper, a new kind of cellulose aerogel was successfully fabricated via cellulose oxidation, crosslinking, freeze drying and cold plasma modification. The obtained aerogel (water contact angle up to 152.8°) exhibited outstanding oil/water selectivity and high absorption capacity (13.77-28.20 g/g) for various oils and organic solvents. What's more, this kind of aerogel could be reused by simple compression. The absorption-desorption process could be repeated for at least 50 cycles. Through the kinetic analysis, it was found that the pseudo-second order model was more appropriate for the aerogel's oil absorption process. Owing to its low cost, hydrophobicity, high absorption capacity and excellent reusability, this kind of aerogel is expected to be used in oils and organic solvents spill cleanup and oil/water separation field.

Dual responsive aerogel made from thermo/pH sensitive graft copolymer alginate-g-P(NIPAM-co-NHMAM) for drug controlled release.

Alginate was grafted with NIPAM and NHMAM successfully, and a new responsive copolymer, alginate-g-P(NIPAM-co-NHMAM), was obtained. A novel dual responsive polysaccharide-based aerogel with thermo/pH sensitive properties was designed from the copolymer as drug controlled release system. The chemical structure of the copolymer was characterized by FT-IR and 1H NMR. Lower critical solution temperature (LCST) of the copolymer covered a wide temperature range from 27.6 °C to 42.2 °C, which could be adjusted with changing the ratio between NIPAM and NHMAM. The dual responsive aerogel had a three-dimensional network structure. As a drug controlled release system, the aerogel was high responsive to both temperature and pH with drug loading efficiency up to 13.24%. Above LCST, the aerogel had a faster drug release, and drug was completely released in neutral environment, while the drug release was obstructed in acid environment. Furthermore, the drug release mechanism of the aerogel was illuminated. These results indicated that the dual responsive aerogel was a promising candidate for drug carriers.

Effects of atorvastatin in the regulation of circulating EPCs and angiogenesis in traumatic brain injury in rats.

Circulating endothelial progenitor cells (EPCs) play an important role in angiogenesis and vasculogenesis. Statins administered promote functional improvement in rats, independent of their capability to lower cholesterol. Whether statin treatment regulates circulating EPCs after traumatic brain injury (TBI) has not been investigated. We hypothesized that atorvastatin increases circulating EPCs and promotes angiogenesis in TBI rats. Wistar rats (20 months old) were subjected to TBI and treated with or without atorvastatin (orally administered, 1mg/kg/day) starting 1h after TBI and then daily for 14 consecutive days. Long term potentiation (LTP) in the cornu ammonis1 of the hippocampus as well as the Modified Neurological Severity Score (mNSS) and the Morris Water Maze (MWM) functional tests were performed. Blood circulating EPCs were identified by flow cytometry. Rats were sacrificed 25 days after TBI. vWF and CD31 immunostaining was performed. We found that atorvastatin administration significantly induced angiogenesis and increased circulating EPC levels as well as improved functional recovery when compared with non-treatment TBI-control rats (P<0.05). The circulating EPC level is correlated with vascular density (r=0.878, P <0.05) and CD31 positive cell number in the injured brain (r=0.921, P <0.05). The results suggest that increasing circulating EPCs with atorvastatin treatment may contribute to the observed increase in angiogenesis and improved functional outcome after TBI.

Progesterone increases circulating endothelial progenitor cells and induces neural regeneration after traumatic brain injury in aged rats.

Vascular remodeling plays a key role in neural regeneration in the injured brain. Circulating endothelial progenitor cells (EPCs) are a mediator of the vascular remodeling process. Previous studies have found that progesterone treatment of traumatic brain injury (TBI) decreases cerebral edema and cellular apoptosis and inhibits inflammation, which in concert promote neuroprotective effects in young adult rats. However, whether progesterone treatment regulates circulating EPC level and fosters vascular remodeling after TBI have not been investigated. In this study, we hypothesize that progesterone treatment following TBI increases circulating EPC levels and promotes vascular remodeling in the injured brain in aged rats. Male Wistar 20-month-old rats were subjected to a moderate unilateral parietal cortical contusion injury and were treated with or without progesterone (n=54/group). Progesterone was administered intraperitoneally at a dose of 16mg/kg at 1 h post-TBI and was subsequently injected subcutaneously daily for 14 days. Neurological functional tests and immnunostaining were performed. Circulating EPCs were measured by flow cytometry. Progesterone treatment significantly improved neurological outcome after TBI measured by the modified neurological severity score, Morris Water Maze and the long term potentiation in the hippocampus as well as increased the circulating EPC levels compared to TBI controls (p<0.05). Progesterone treatment also significantly increased CD34 and CD31 positive cell number and vessel density in the injured brain compared to TBI controls (p<0.05). These data indicate that progesterone treatment of TBI improves multiple neurological functional outcomes, increases the circulating EPC level, and facilitates vascular remodeling in the injured brain after TBI in aged rats.

[Study on flame temperature measurement of pyrotechnics using multi-spectral thermometer].

The radiation spectrum of pyrotechnics' burning flame was analyzed using transient spectrum radiometer. The working principle of multi-spectral thermometry was described. Combined with the radiation spectrum of pyrotechnics' burning flame, the multi-spectral thermometer system was designed which had twelve working channels. The tester can choose the right working channels to calculate according to the radiation spectrum of the flame to be tested. The system is composed by optics part, electronic part, data acquisition part and data processing part. In this paper, the emissive power of black powder's flame has been tested using the multi-spectral thermometer system. The burning flame temperature-time curve was showed after iteration calculation Experiments indicate that the multi-spectral thermometer system can be well used to measure the flame temperature of pyrotechnics based on analyzing the emissive power when choosing the right working channels. This method lays a foundation for the research of combustion output characteristics of pyrotechnics.