The diagnostic and prognostic value of glial fibrillary acidic protein in traumatic brain injury: a systematic review and meta-analysis.

OBJECTIVES: Over the years, blood biomarkers have been extensively applied for diagnostic and prognostic assessment of traumatic brain injury (TBI). Herein, we conducted a meta-analysis to evaluate the diagnostic and prognostic value of glial fibrillary acidic protein (GFAP) for TBI patients. METHODS: The online databases, including PubMed, Embase, Cochrane Library, CNKI, and WFSD, were systematically retrieved from inception until May 2021. The RevMan 5.3 software and Stata 15 were used to conduct data analysis. RESULTS: A total of 22 eligible studies comprising 3709 patients were included in this meta-analysis. The pooled results indicated that serum GFAP had a diagnostic value in detecting traumatic intracranial lesions (AUC 0.81; 95% CI 0.77-0.84; p < 0.00001). The pooled sensitivity and specificity were 0.93 (95% CI 0.81-0.98), and 0.66 (95% 0.53-0.77; p < 0.00001), respectively. For assessment of unfavorable outcome, the pooled sensitivity, specificity and AUC value were 0.66 (95% CI 0.54-0.76; p < 0.00001), 0.82(95% CI 0.72-0.90; p < 0.00001), and 0.82 (95% CI 0.76-0.88; p < 0.00001), respectively. Besides, GFAP exhibited a significant value in predicting mortality (AUC 0.81; 95% CI 0.77-0.84; p < 0.00001), with high sensitivity and specificity (0.86, 95% CI 0.79-0.92, p < 0.00001, and 0.66, 95% CI 0.52-0.77, p < 0.00001). The subgroup analysis indicated that the type of TBI and cut-off value were potential sources of heterogeneity, which influenced the pooled AUC values for mortality prediction. CONCLUSIONS: Our meta-analysis indicated that GFAP had diagnostic and prognostic value for TBI patients, especially during the early TBI.

[Design and application of a multi-assisted function incision and orifice closure buckle].

Incision infection is one of the common complications in surgery. Infected incisions usually need to perform procedures including suture removal, debridement, drainage, sterilization and anti-inflammatory. Until, the wound edge was sutured again after the wound infection was controlled. This contributes to considerable physical and psychological suffering for patients. To this end, with Dalian Medical University as the main inventor and other several experts, a multi-assistance function incision and orifice closure buckle have been designed and obtained the national utility model patent (patent number: ZL 2019 2 1803918.4). The closure buckle with was composed of two blocks with an adhesive layer and one tensioning mechanism. The device is easy to operate, and could effectively play an analgesic, antibacterial and promote healing on the basis of perfecting its wound margins and orifice. It has certain clinical application value.

IoT-CCAC: a blockchain-based consortium capability access control approach for IoT.

Access control is a critical aspect for improving the privacy and security of IoT systems. A consortium is a public or private association or a group of two or more institutes, businesses, and companies that collaborate to achieve common goals or form a resource pool to enable the sharing economy aspect. However, most access control methods are based on centralized solutions, which may lead to problems like data leakage and single-point failure. Blockchain technology has its intrinsic feature of distribution, which can be used to tackle the centralized problem of traditional access control schemes. Nevertheless, blockchain itself comes with certain limitations like the lack of scalability and poor performance. To bridge the gap of these problems, here we present a decentralized capability-based access control architecture designed for IoT consortium networks named IoT-CCAC. A blockchain-based database is utilized in our solution for better performance since it exhibits favorable features of both blockchain and conventional databases. The performance of IoT-CCAC is evaluated to demonstrate the superiority of our proposed architecture. IoT-CCAC is a secure, salable, effective solution that meets the enterprise and business's needs and adaptable for different IoT interoperability scenarios.

Incidence of cerebrovascular disease as a comorbidity in patients with COVID-19: A meta-analysis.

It is essential to know whether COVID-19 patients have a history of cerebrovascular disease, as it may be predictive of prognosis and useful for allocation of limited medical resources. This meta-analysis was performed to assess the incidence of cerebrovascular disease as a comorbidity in COVID-19 patients. The PubMed, Cochrane Library, Embase, CNKI, WFSD, and VIP databases were systematically searched. The pooled analysis of relevant data was conducted using RevMan 5.3 software. The primary outcome was incidence of cerebrovascular disease as a comorbidity. Forty-seven studies involving 16,143 COVID-19 patients were included in this analysis. The incidences of a history of cerebrovascular disease and hypertension in COVID-19 patients were estimated to be 3.0% (95% CI, 2.0%-4.0%; P<0.00001) and 23.0% (95% CI, 16.0%-29.0%; P<0.00001), respectively. The incidence of dizziness/headache as the first symptom in COVID-19 patients was estimated to be 14.0% (95% CI, 8.0%-20.0%; P<0.00001). Subgroup analyses indicated that country, sex ratio, and sample size are potential influencing factors affecting the incidences of cerebrovascular disease, hypertension, and dizziness/headache. These findings suggest that cerebrovascular disease is an underlying comorbidity among patients with COVID-19. In addition, patients experiencing dizziness/headache as the first symptom of COVID-19 should receive a neurological examination.

The Diagnostic and Antibiotic Reference Values of Procalcitonin for Intracranial Infection After Craniotomy.

OBJECTIVE: To evaluate values of cerebrospinal fluid (CSF) and serum procalcitonin (PCT) for diagnosis of intracranial infection after craniotomy and relationship between them and to explore value of PCT in guiding clinical use of antibiotics. METHODS: The incidence of intracranial infection in 21 patients undergoing craniotomy was reviewed. CSF samples and venous blood were collected for analysis. Diagnostic parameters were calculated via receiver operating characteristic curves, and inflammatory indicators were analyzed before and after administration of antibiotics in the infection group. As a control group, 32 patients without infection were recruited for the same measurements. RESULTS: CSF and serum PCT levels in the infection group were higher than levels in the noninfection group (P < 0.05), and diagnostic efficiency of CSF PCT (area under the curve = 0.86, diagnostic odds ratio = 41.40) was superior to serum PCT (area under the curve = 0.66, diagnostic odds ratio = 3.40). Diagnostic efficiency was more powerful when serial testing was used (specificity = 0.99, positive likelihood ratio = 37.10, diagnostic odds ratio = 54.45). All inflammatory indicators decreased after administration of antibiotics except CSF protein (P = 0.129), and no obvious correlation was seen between CSF and serum PCT. Dynamic change of PCT can be used as a reference for adjusting antibiotics. CSF PCT can also be used as an indicator to identify intracranial infection with gram-negative bacteria. CONCLUSIONS: CSF PCT is a good marker for intracranial infection and could be used to help confirm intracranial infection and provide guidance for clinical use of antibiotics when combined with serum PCT.