A new hybrid classification system for traumatic brain injury which helps predict long-term consciousness: a single-center retrospective study.

BACKGROUND: To develop and validate a refined traumatic brain injury (TBI) classification system to supplement the existing systems which have limited accuracy for predicting long-term consciousness recovery. METHODS: The refined classification system was developed using medical records of 527 patients according to clinical presentations within 12-24 hrs after injury. Multiple linear regression was applied to identify protective and risk factors for Glasgow Coma Scale (GCS) and Glasgow Outcome Scale (GOS) score at 12-month follow-up. The TBI severity was moved to a less or more severe level when more than half of the protective or risk factors were present. The capability and reliability of each system for predicting 12 month GCS and GOS scores, and mortality were assessed using ROC curve analysis and Cronbach's Alpha reliability coefficient. RESULTS: One protective factor and four risk factors were identified for predicting long-term outcomes. The refined system had higher sensitivity and specificity in predicting 12-month GCS and GOS scores, and mortality than the other two systems. The refined system had lower reliability than the GCS system and higher reliability than the Chinese system. CONCLUSIONS: The refined system incorporates the advantages of both GCS and Chinese systems and provides a better prediction of long-term consciousness outcome.

Anti-angiogenic therapy for advanced primary pulmonary lymphoepithelioma-like carcinoma: a retrospective multicenter study.

PURPOSE: Primary pulmonary lympho-epithelioma-like carcinoma (PPLELC) is a rare subtype of primary non-small cell lung cancer (NSCLC). Currently, there is still lack of research data on anti-angiogenic therapy of advanced PPLELC. The purpose of this study was to investigate the efficacy and safety of anti-angiogenic therapy combined with chemotherapy compared with traditional chemotherapy for these patients. METHODS: Advanced PPLELC patients admitted to six grade A hospitals from January 2013 to January 2021 were selected. The patients received anti-angiogenic therapy combined with chemotherapy (AT group) or chemotherapy (CT group) alone. RESULTS: A total of 65 patients were included in this study, including 31 patients in the AT group treated with anti-angiogenic therapy combined with chemotherapy and 34 patients in the CT group treated with chemotherapy alone. As of October 1, 2021, the median progression-free survival (PFS) in the AT group was 11.2 months [95% confidence interval (CI), 5.9-16.5]. The median PFS in the CT group was 7.0 months [95%CI, 5.1-8.9] [Hazard Ratio (HR), 0.49; 95%CI, 0.29-0.83; P = 0.008]. The 1-year PFS rates were 41.9% and 17.6%, respectively. The overall response rates (ORR) of two groups were 45.2% (95% CI, 0.27-0.64), 38.2% (95% CI, 0.21-0.56), (P = 0.571). The disease control rates (DCR) of two groups were 93.5% (95% CI, 0.84-1.03), 88.2% (95% CI, 0.77-1.00), (P = 0.756). CONCLUSION: Among patients with advanced PPLELC, the PFS of patients with anti-angiogenic therapy combined with chemotherapy is better than that of patients with chemotherapy alone. Anti-angiogenic therapy combined with chemotherapy is an optional treatment scheme.

The dysfunction of processing task-irrelevant emotional faces in pituitary patients: an evidence from expression-related visual mismatch negativity.

Evidence showed impaired cognitive ability of patients with pituitary adenoma as an intracranial tumor. In the present study, we investigated the preattentive processing of emotional faces in pituitary adenoma patients by recording and analyzing the visual mismatch negativity elicited by deviant emotional faces. In the normal control group, deviant emotional faces elicited expression-related mismatch negativity (EMMN), with a more pronounced negative waveform for sad than happy face conditions. Compared with the normal group, EMMN related to sad faces was smaller in patients, whereas the EMMN related to happy faces remained the same. These data indicate the functional dysfunction of negative emotional processing at the preattentive stage of information processing in pituitary adenoma patients.

Correlation between standardized assessment of concussion scores and small-world brain network in mild traumatic brain injury.

This study investigated the characteristics of the small-world brain network architecture of patients with mild traumatic brain injury (MTBI), and a correlation between brain functional connectivity network properties in the resting-state fMRI and Standardized Assessment of Concussion (SAC) parameters. The neurological conditions of 22 MTBI patients and 17 normal control individuals were evaluated according to the SAC. Resting-state fMRI was performed in all subjects 3 and 7days after injury respectively. After preprocessing the fMRI data, cortex functional regions were marked using AAL90 and Dosenbach160 templates. The small-world network parameters and areas under the integral curves were computed in the range of sparsity from 0.01 to 0.5. Independent-sample t-tests were used to compare these parameters between the MTBI and control group. Significantly different parameters were investigated for correlations with SAC scores; those that correlated were chosen for further curve fitting. The clustering coefficient, the communication efficiency across in local networks, and the strength of connectivity were all higher in MTBI patients relative to control individuals. Parameters in 160 brain regions of the MTBI group significantly correlated with total SAC score and score for attention; the network parameters may be a quadratic function of attention scores of SAC and a cubic function of SAC scores. MTBI patients were characterized by elevated communication efficiency across global brain regions, and in local networks, and strength of mean connectivity. These features may be associated with brain function compensation. The network parameters significantly correlated with SAC total and attention scores.

The dysfunction of inhibition control in pituitary patients: evidence from the Go/Nogo event-related potential study.

Pituitary tumor is an intracranial tumor; because of the development of neuroimaging technology in recent years, morbidity is likely to increase. Evidence showed impaired cognitive ability of patients with pituitary adenoma. There is evidence that neurobehavioral disorders are common in pituitary adenoma patients. This disorder is because of the cognitive and emotional function of the important functional areas of the brain oppressed and hormone imbalance. Individuals' mental activity is controlled by the brain and the abnormal mental activity is caused by both the structural abnormalities of the brain and neurochemical dysfunction. Event-related potentials have been used widely in the early assessment of cognitive functions associated with disease, taking advantage of the high temporal resolution, and then analyzing the characteristics of emotional competence from the perspective of cognitive processing. A visual Go/Nogo task was used. A larger Nogo-N2 and Nogo-P3 was found in the control group compared with the pituitary group. This reflects the nonphysiological process of conflict monitoring and inhibitory control in pituitary patients. The results also showed that the difference waves between Go and Nogo conditions (N2d and P3d) over the frontal electrode sites were more robust and earlier in the control group compared with the pituitary group, which reflects frontal dysfunction in the pituitary group. These data suggest reduced earlier and later stages of inhibitory processes in pituitary individuals, implicating the dysfunction of conflict detection and inhibitory control.