Trends and patterns in the global burden of intracerebral hemorrhage: a comprehensive analysis from 1990 to 2019.

Objective: Intracerebral hemorrhage (ICH) is a significant cause of global mortality and morbidity. This study aimed to analyze the burden of ICH and its variation trends across 204 countries and territories from 1990 to 2019. Materials and methods: The study population comprised individuals of all ages and genders with ICH in 204 countries and regions between 1990 and 2019. Utilizing data from the Global Burden of Disease (GBD) study 2019, we collected information on age-standardized incidence rate (ASIR), age-standardized death rate (ASDR), and disability-adjusted life-years (DALYs) rate, which were compared by age, gender, and socio-demographic index (SDI). Results: In 2019, there were an estimated 3.4 million (3.0-3.9) incident cases, resulting in 2.8 million (2.6-3.0) deaths and 68.5 million (63.2-73.6) DALYs due to ICH. Between 1990 and 2019, the absolute number of incident cases, deaths, and DALYs increased by 43.0% (41.0-45.0), 37.0% (22.0-51.0), and 25.0% (12.0-36.0), respectively. However, the ASIR, ASDR, and DALYs showed a decreasing trend of-29.0% (-28.0 to -30.0), -36.0% (-29.0 to -43.0), and - 37.0% (-43.0 to -31.0), respectively. Countries with lower SDI tended to have higher ASIR, ASDR, and DALY rates. Conclusion: While the ASDR and DALY rates decreased from 1990 to 2019, the decline in ASIR was less pronounced. The global burden of ICH remains high, exhibiting significant variation across different genders, age groups, and SDI levels.

Assessment of Contact Toxicity and Repellent Effects of Essential Oils from Piper Plants Piper yunnanense and Piper boehmeriifolium against Three Stored-Product Insects.

Storage is a crucial part during grain production for the massive spoilage caused by stored product insects. Essential oils (EOs) of plant origin have been highly recommended to combating insects which are biodegradable and safe mode of action. Hence, to make the fullest use of natural resources, essential oils of different parts from Piper yunnanense (the whole part, PYW; fruits, PYF; leaves, PYL) and Piper boehmeriifolium (leaves, PBL) were extracted by steam distillation method in the present study. Gas chromatography-mass spectrometry (GC-MS) characterization revealed bicyclogermacrene (PYW), γ-muurolene (PYF), δ-cadinene (PYL) and methyl 4,7,10,13,16,19-docosahexaenoate (PBL) as the principal compound of each essential oil. Sesquiterpene hydrocarbons were also recognized as the richest class accounting for 56.3 %-94.9 % of the total oil. Three storage pests, Tribolium castaneum, Lasioderma serricorne and Liposceis bostrychophila, were exposed to different concentrations of EOs to determine their insecticidal effects. All tested samples performed modest contact toxicity in contrast to a bioactive ingredient pyrethrin, among which the most substantial effects were observed in PYF EOs against T. castaneum (35.84 µg/adult), PBL EOs against L. serricorne (15.76 µg/adult) and PYW EOs against L. bostrychophila (57.70 µg/cm2 ). In terms of repellency tests, essential oils of PYF at 78.63 nL/cm2 demonstrated to have a remarkable repellence against T. castaneum at 2h and 4h post-exposure. The investigations indicate diverse variations in the chemical profiles and insecticidal efficacies of P. yunnanense and P. boehmeriifolium EOs, providing more experimental evidence for the use of the Piper plants.

Exploring the Potential of Flow-Induced Vibration Energy Harvesting Using a Corrugated Hyperstructure Bluff Body.

Fluid-induced vibration is a common phenomenon in fluid-structure interaction. A flow-induced vibrational energy harvester based on a corrugated hyperstructure bluff body which can improve energy collection efficiency under low wind speeds is proposed in this paper. CFD simulation of the proposed energy harvester was carried out with COMSOL Multiphysics. The flow field around the harvester and the output voltage in different flow velocities is discussed and validated with experiments. Simulation results show that the proposed harvester has an improved harvesting efficiency and higher output voltage. Experimental results show that the output voltage amplitude of the harvester increased by 189% under 2 m/s wind speed.

Research on Vibration Energy Harvester Based on Two-Dimensional Acoustic Black Hole.

The wave energy focus effect of an acoustic black hole (ABH) is used for broadband vibration energy harvesting and boosts the harvested power. A vibration energy harvester based on two-dimensional ABH is proposed in this study, which consists of a rectangle plate with 2-D ABH and PZT film attached. The structure of ABH was designed and analyzed based on numerical simulation. The optimal parameters of the ABH were obtained, such as the power index, truncation thickness, cross-sectional length, and round table diameter, which were 3, 0.4 mm, 40 mm, and 24 mm, respectively. The quadratic velocity of the plate surface with ABH is up to 22.33 times that of a flat plate, and PZT film adheres to the corresponding positions of the ABH structure and plate structure, respectively. In the same condition, the average output power of a PZT with an ABH structure is higher than that of a flat plate under the same excitation-vibration condition.

40 Hz Blue LED Relieves the Gamma Oscillations Changes Caused by Traumatic Brain Injury in Rat.

Background: Photobiomodulation (PBM) using low-level light-emitting diodes (LEDs) can be rapidly applied to various neurological disorders safely and non-invasively. Materials and Methods: Forty-eight rats were involved in this study. The traumatic brain injury (TBI) model of rat was set up by a controlled cortical impact (CCI) injury. An 8-channel cortex electrode EEG was fixed to two hemispheres, and gamma oscillations were extracted according to each electrode. A 40 hz blue LED stimulation was set at four points of the frontal and parietal regions for 60 s each, six times per day for 1 week. Modified Neurologic Severity Scores (mNSS) were used to evaluate the level of neurological function. Results: In the right-side TBI model, the gamma oscillation decreased in electrodes Fp2, T4, C4, and O2; but significantly increased after 1 week of 40 hz Blue LED intervention. In the left-side TBI model, the gamma oscillation decreased in electrodes Fp1, T3, C3, and O1; and similarly increased after 1 week of 40 hz Blue LED intervention. Both left and right side TBI rats performed significantly better in mNSS after 40 hz Blue LED intervention. Conclusion: TBI causes the decrease of gamma oscillations on the injured side of the brain of rats. The 40 hz Blue LED therapy could relieve the gamma oscillation changes caused by TBI and improve the prognosis of TBI.

Luminous efficacy enhancement for LED lamps using highly reflective quantum dot-based photoluminescent films.

In this study, a strongly reflective and photoluminescent (PL) poly(lactic-co-glycolic acid) quantum dot (QD) hybrid nanofiber (PQHN) structure is introduced to enhance the luminous efficacy of QD-phosphor hybrid white light-emitting diodes (QD-WLEDs). As the thickness of PQHN film increases, the PL is found to continuously increase, exhibiting a maximum peak intensity at 120 µm, which is 1.92 times that at 12 µm, and showing the highest diffuse reflectance of 94.4% at 640 nm. Consequently, while using the QD-WLEDs, the PQHN structure achieves a 53.8% improvement in luminous flux compared with the traditional structure under a similar correlated color temperature (CCT) of 3,540 K, achieving a high luminous efficacy of 202.11 lm W-1 for QD-WLEDs. In addition, the maximum deviation of the CCT is only 11 K when the current is changed from 50 to 950 mA, demonstrating good stability. Therefore, the PQHN films have great potential in lighting systems as a hybrid functional film including light conversion and reflectance.

Association of Preoperative Cerebrospinal Fluids Parameters With Early Shunt Obstruction in Patients With Post-hemorrhagic Hydrocephalus Treated by Lumboperitoneal Shunt.

Background: Early shunt obstruction (SO) remains the most common cause of lumboperitoneal shunt (LPS) failure. Although there is anecdotal evidence that the level of cerebrospinal fluid (CSF) parameters might affect shunt performance, its association with early LPS obstruction in adults with post-hemorrhagic hydrocephalus (PHH) is unclear. Methods: The retrospective study was performed by reviewing the adults with PHH treated by LPS from years 2014 to 2018. We included patients with CSF samples analyzed within 1 week prior to shunt insertion or at the time of shunt insertion. Baseline characteristics of each patient were collected. The primary outcomes were the incidence rate and associated factors of SO occurring within 3 months of shunt placement. The secondary outcomes included scores on the National Institute of Health Stroke Scale (NIHSS) and Evans Index at discharge. Results: A total of 76 eligible patients were analyzed, of whom 61 were obstruction-free and 15 were early SO. The overall rate of early SO was 15.6%. The RBCs count and nucleated cells count in preoperative CSF were actually higher in patients with early SO, compared to patients in the control group. Multivariate analysis identified RBC elevation (>0 × 106/L; OR: 10.629, 95% CI: 1.238-91.224, p = 0.031) as a dependent risk factor for early SO. NIHSS dramatically decreased at discharge while the alteration of ventricular size was not observed. Conclusions: This study suggested that the presence of RBCs in preoperative CSF was associated with early SO in patients with PHH treated by LPS.

Shunting outcomes in communicating hydrocephalus: protocol for a multicentre, open-label, randomised controlled trial.

INTRODUCTION: Ventriculoperitoneal shunt (VPS) remains the most widely used methods to treat communicating hydrocephalus. More recently, lumboperitoneal shunt (LPS) has been suggested as a reasonable option in some studies. However, there is lack of high-quality studies comparing these two techniques in order to certain the benefits and harms to use one of these two methods. The purpose of the current study is to determine the effectiveness and safety of the LPS versus the VPS in patients with communicating hydrocephalus. METHODS AND ANALYSIS: All eligible patients aged 18-90 years with communicating hydrocephalus will be recruited and then randomly allocated into LPS or VPS group in a ratio of 1:1. All patients will be analysed before shunt insertion, at the time of discharge, 1 month, 6 months, 12 months and 24 months postoperatively. The primary outcome measure is the rate of shunt failure at a 2-year follow-up term. The secondary outcomes include Keifer's Hydrocephalus Scale, National Institute of Health Stroke Scale, Glasgow Outcome Scale Extended, Evans index, safety endpoints and cost-effectiveness of hospital stay. ETHICS AND DISSEMINATION: The study will be performed in compliance with the Declaration of Helsinki (2002) of the World Medical Association. The study was approved by Institutional Review Board of West China Hospital. All patients will be fully informed the potential benefits, potential risks and responsibilities, those who will sign the informed consents once they are included. Preliminary and final results will be published in peer-reviewed journals and presented at national and international congresses. TRIAL REGISTRATION NUMBER: ChiCTR2100043839.

Optical Performance and Moisture Stability Enhancement of Flexible Luminescent Films Based on Quantum-Dot/Epoxy Composite Particles.

Quantum dots (QDs) have been widely applied in luminescent sources due to their strong optical characteristics. However, a moisture environment causes their quenching, leading to an inferior optical performance in commercial applications. In this study, based on the high moisture resistance of epoxy resin, a novel epoxy/QDs composite particle structure was proposed to solve this issue. Flexible luminescent films could be obtained by packaging composite particles in silicone resin, combining the hydrophobicity of epoxy resin and the flexibility of PDMS simultaneously. The photoluminescence and light extraction were improved due to the scattering properties of the structure of composite particles, which was caused by the refractive index mismatch between the epoxy and silicone resin. Compared to the QD/silicone film under similar lighting conditions, the proposed flexible film demonstrated increased light efficiency as well as high moisture stability. The results revealed that a light-emitting diode (LED) device using the composite particle flexible (CPF) structure obtained a 34.2% performance enhancement in luminous efficiency as well as a 32% improvement in color conversion efficiency compared to those of devices with QD/silicone film (QSF) structure. Furthermore, the CPF structure exhibited strong thermal and moisture stability against extreme ambient conditions of 85 °C and 85% relative humidity simultaneously. The normalized luminous flux degradation of devices embedded in CPF and QSF structures after aging for 118 h were ~20.2% and ~43.8%, respectively. The satisfactory performance of the CPF structure in terms of optical and moisture stability shows its great potential value in flexible commercial QD-based LED displays and lighting applications.

Preoperative evaluation using external lumbar drainage for patients with posthemorrhagic hydrocephalus: A prospective, monocentric, randomized controlled trial.

BACKGROUND: External lumbar drainage (ELD) remains the most common used methods with a higher sensitivity before lumboperitoneal shunt (LPS) implantation to predict the shunt outcomes in the treatment of idiopathic normal pressure hydrocephalus. However, the benefits of such supplemental test have not been tested in the treatment of post-hemorrhagic hydrocephalus (PHH). METHODS AND DESIGN: In the current trial, 100 eligible patients with PHH will be recruited and randomly assigned to the ELD group (study group) and non-ELD group (control group). Lumbar puncture (LP) will be performed for participants in non-ELD group. LP plus ELD will be performed for participants in ELD group, those who will then be investigated the suitability of potential LPS 4 days after ELD. Two independent and practiced assessors will collect the baseline data and evaluate each participant 4 days after ELD or LP, 1 day after LPS, at the time of discharge and 1 month after LPS. The primary outcome is the shunting outcomes 1 month after surgery. The secondary outcomes include the complications related to ELD, complications related to LPS, and Evens index at each evaluation point. Meanwhile, serious adverse events occurring at any time is recorded to determine the safety of this trial. DISCUSSION: The results of this trial will demonstrate whether preoperative evaluation using temporary ELD for patients with PHH could attenuate the risk of LPS failure. TRIAL REGISTRATION NUMBER: ChiCTR2000034094; Pre-results.

Evaluation of titanium cranioplasty and polyetheretherketone cranioplasty after decompressive craniectomy for traumatic brain injury: A prospective, multicenter, non-randomized controlled trial.

INTRODUCTION: Cranioplasty following decompressive craniectomy is routinely performed to restore integrity of skull and improve neurological function. However, reconstructing the cranial defect brings many challenges to neurosurgeons and search for ideal implant materials is one of the most controversial issues. Although many studies have compared the outcomes of titanium and polyetheretherketone (PEEK) cranioplasty, yet no prospective study exists to guide the choice of titanium and PEEK materials. METHODS/DESIGN: A non-randomized, partially blinded, prospective cohort study is described that comprehensively compares the long-term outcomes of titanium cranioplasty versus PEEK cranioplasty. One hundred forty-five patients for each group will be recruited. Eligible patients are those with cranial defect due to traumatic brain injury (≥ 16 years), defect size is over 25 cm and they must agree to participate in the trial. Each participant is evaluated before surgery, on discharge, 3, 6, and 12 months after cranioplasty. The primary outcome is the infection, implant failure and implant deformation requiring revision surgery within 12 months. Secondary outcomes include postoperative complication rate, neurological outcomes, motor function, and cosmetic outcome over a 6-month period. DISCUSSION: Search for ideal implant materials is throughout the history of cranioplasty. This study will provide robust evidence for the choice of cranioplasty materials. TRIAL REGISTRATION NUMBER: ChiCTR2000033406.

Shunting outcomes in post-hemorrhagic hydrocephalus: A protocol for systematic review and meta-analysis.

BACKGROUND: The best treatment option for patients with post-hemorrhagic hydrocephalus (PHH) remains controversial. The objective of the current meta-analysis is to systematically evaluate the long-term outcomes of patients with PHH treated by ventriculoperitoneal shunt (VPS) and lumboperitoneal shunt (LPS). METHODS: We search literatures through PubMed, Web of Science, Embase, Cochrane Library, China National Knowledge Infrastructure (CNKI), the Chinese Science and Technology Periodical Database (VIP) and Wan fang databases, and Chinese Biomedical Literature Database (CBM) from its beginning to June 15, 2020. Randomized controlled trials (RCTs) and non-RCTs in English or Chinese studies will be considered. The primary outcome is the rate of shunt failure after shunt implantationThe secondary outcome is the rate of complications that are associated with shunt surgery. RESULTS AND CONCLUSION: The study will compare the 2 types of shunt surgery in the treatment of PHH, providing evidence for the treatment option for the patients with PHH. STUDY REGISTRATION NUMBER: The study is priorly registered through International Platform of Registered Systematic Review and Meta-analysis Protocols on June 17, 2020 (INPLASY202060063).

Risk factors for bone flap resorption after autologous bone cranioplasty: Protocol for a systematic review and meta-analysis.

BACKGROUND: One of the most common complications following autologous cranioplasty is bone flap resorption (BFR). Severe BFR can lead to revision surgery with implantation of synthetic bone flap and also necessarily lead to higher hospital expenses. This study aims to perform a meta-analysis to summarize available evidence regarding risk factors of BFR requiring a second surgery in patients with autologous cranioplasty. METHODS: Cohort, case-control, and cross-sectional studies that report the incidence and risk factors of BFR among patients with autologous cranioplasty, published in English, will be considered for selection. Three databases from inception to May 2020 will be searched. The process of data selection, quality assessment, and data extraction will be assessed by 2 authors independently. The study quality will be assessed by Newcastle-Ottawa Scale (NOS) and Agency for Healthcare Research and Quality checklist.The statistical analysis of this meta-analysis will be calculated by Review manager version 5.3. RESULTS: The results of this systematic review and meta-analysis will be disseminated through academic conferences and expected to publish in a peer-reviewed journal CONCLUSION:: This study will offer high-quality evidence about risk factors for BFR after autologous cranioplasty. REGISTRATION NUMBER: INPLASY202050063.

Comparison of ventriculoperitoneal shunt to lumboperitoneal shunt in the treatment of posthemorrhagic hydrocephalus: A prospective, monocentric, non-randomized controlled trial.

BACKGROUND: Ventriculoperitoneal shunt (VPS) surgery remains the most widely accepted and used option method to treat post-hemorrhagic hydrocephalus (PHH) worldwide while lumboperitoneal shunt (LPS) serves as an effectively alternative treatment. However, the outcomes of VPS and LPS in the treatment of PHH have not been compared in a prospective trial. METHODS AND DESIGN: In this monocentric, assessor-blinded, non-randomized controlled trial, 75 eligible patients with PHH for each group will be recruited to compare the outcomes of VPS cohort with that of LPS cohort. Each participant is evaluated before surgery, at the time of discharge, 3, and 6 months after surgery by experienced and practiced assessors. The primary outcome is the rate of shunt failure 6 months after shunt surgery. The secondary measure of efficacy is National Institute of Health stroke scale, together along with Glasgow coma scale, modified Rankin Scale, and Evans index at the evaluation point. A favorable outcome is defined as shunt success with an improvement of more than 1 point in the National Institute of Health stroke scale. Complication events occurring within 6 months after surgery are investigated. A serious adverse events throughout the study are recorded regarding the safety of shunts. DISCUSSION: The results of this trial will provide evidence for the treatment options for patients with PHH.

Rational design of secondary operation for penetrating head injury: A case report.

Penetrating head injury is rare, and thus management of such injuries is non-standard. Early diagnosis and intraoperative comprehensive exploration are necessary considering the complexity and severity of the trauma. However, because of the lack of microsurgical techniques in local hospitals, the possible retained foreign bodies and other postoperative complications such as cerebrospinal fluid (CSF) leak usually require a rational design for a secondary operation to deal with. We present a case of a 15-year-old boy who was stabbed with a bamboo stick in his left eye. The chopsticks passed through the orbit roof and penetrated the skull base. In subsequent days, the patient sustained CSF leak and intracranial infection after an unsatisfied primary treatment in the local hospital and had to request a secondary operation in our department. Computed tomography including plain scan, three dimension reconstruction and computed tomographic angiography are used to determine the course and extent of head injury. A frontal craniotomy was performed. Three pieces of stick were found residual and removed with the comminuted orbit bone fragments. A pedicled temporalis muscle fascia graft was applied to repair the frontier skull base and a free temporalis muscle flap to seal the frontal sinus defect. Aggressive broad-spectrum antibiotics of vancomycin and meropenem were administrated for persistent fever after operation. CSF external drainage system continued for 12 days, and was removed 10 days after temperature returned to normal. The Glasgow coma scale score was improved to 15 at postoperative day 7 and the patient was discharged at day 22 uneventfully. We believe that appropriate preoperative surgical plan and thorough surgical exploration by microsurgery is essential for attaining a favorable outcome, especially in secondary operation. Good postoperative recovery depends on successfully management before and after operation for possible complications as well.

Evaluation of titanium mesh cranioplasty and polyetheretherketone cranioplasty: protocol for a multicentre, assessor-blinded, randomised controlled trial.

INTRODUCTION: Cranioplasty is a common surgery in neurosurgery department. However, restoring the integrity of skull brings many challenges to surgeons, and the selection of ideal implant materials is throughout the history of cranioplasty. Although titanium mesh was still preferred by many neurosurgeons in cranial reconstruction, the new polyetheretherketone (PEEK) material, for example, is gaining popularity for craniofacial reconstruction today. There remain limited data that compare the outcome of PEEK cranioplasty and titanium mesh cranioplasty. It is necessary to conduct a study to compare outcome of different materials for cranioplasty. METHODS/DESIGN: In this multicentre, assessor-blinded, randomised controlled study, we will randomise 140 patients in a 1:1 ratio to PEEK cranioplasty versus titanium cranioplasty. Eligible patients are adults who were diagnosed with cranial defect (due to severe traumatic brain injury, ischaemic stroke, haemorrhagic stroke, infiltrative tumour and so on), the defect size is over 25 cm2, and they need to agree to participate in this trial. Instead of standard examinations, the enrolled patients receive neurological, motor, cognitive function and cerebral hemodynamics examinations as well as cosmetic evaluation. The procedures are repeated 3, 6 months after cranioplasty. The primary outcome, defined as infection or implant exposure after surgery, is the implant failure rate within 6 months. Secondary outcomes include postoperative complication rates, neurological outcomes, motor function, cerebral hemodynamics, cosmetic outcome and the total cost over a 6-month period. ETHICS AND DISSEMINATION: This trial protocol has been approved by Biomedical Research Ethics Committee of West China Hospital of Sichuan University. All patients will be fully informed the implant materials, potential complications after surgery, responsibilities during the trial, and they will sign the informed consent before joining in this trial. If the patient's cognitive function is impaired, the patient's next of kin would be carefully informed. The results will be disseminated through academic conferences, student theses and will be published in a peer-reviewed journal. TRAIL REGISTRATION NUMBER: ChiCTR1900024625; Pre-results.

Four new species of Gesneriaceae from Yunnan, Southwest China.

Four new species of Gesneriaceae from Yunnan, southwest China, are described and illustrated. They are Petrocosmea rhombifolia, Petrocosmea tsaii, Didymocarpus brevipedunculatus, and Henckelia xinpingensis. Diagnostic characters between the new species and their morphologically close relatives are provided. Their distribution, ecology, phenology, and conservation status are also described.

One-year outcome of patients with posttraumatic hydrocephalus treated by lumboperitoneal shunt: an observational study from China.

BACKGROUND: Lumboperitoneal shunt (LPS) attracts increasing number of research interest in the treatment of hydrocephalus due to minimal invasiveness. However, the outcome of LPS-treated posttraumatic hydrocephalus (PTH) is poorly learnt, remaining unknown to date. METHODS: We retrospectively analyzed adult patients with PTH treated by LPS in our department between May 2013 and Apr 2017. Baseline characteristics, preoperative clinical features, symptomatic and imageologic improvement, and postoperative complications were synchronously investigated. All patients were followed up to 1 year after LPS to determine the shunt outcome and quality of life. Furthermore, the Kaplan-Meier curve was drawn and binary logistic regression analysis was used to identify the possible predictive factors of shunt failure. RESULTS: Thirty-eight eligible patients were included in our study. Five days after LPS, chronic hydrocephalus scores (CHS; 10.26 ± 5.17 vs 5.21 ± 3.75; P < 0.001) and Evans index (0.36 ± 0.06 vs 0.28 ± 0.06; P < 0.001) were significantly improved with statistical difference. The overall incidence of complications was 50% (19 patients) while hydrocephalus-associated death or shunt failure was not observed immediately after LPS. According to the 1-year follow-up, most of the patients obtained good prognosis while 16 patients (42.1%) were failed, including 15 patients (39.5%) underwent shunt revision and one patient (2.6%) was dead ascribing to shunt malfunction. However, we failed to screen out any factors contributing to LPS failure. CONCLUSION: To sum up, we have, for the first time, demonstrated that LPS could be a potential option to treat PTH.

Establishing a Preoperative Evaluation System for Lumboperitoneal Shunt: Approach to Attenuate the Risk of Shunt Failure.

OBJECTIVE: Lumboperitoneal shunt (LPS) has been demonstrated an effective method for the treatment of communicating hydrocephalus in the presence of frequent shunt failure. The objective of the present study was to determine whether establishing a preoperative evaluation system could benefit patients, thus attenuating the risk of LPS failure. METHODS: In this 3-year study, treated by LPS, patients undergoing preoperative evaluation were included into the study group and other individuals without preoperative evaluation were included into the control group. Perioperative conditions, including Keifer's hydrocephalus score, symptomatic control rate, Evans index, complications, long-term shunt revision rate, and quality of life, were synchronously investigated. RESULTS: A total of 93 eligible patients were included in the study (study group, 51; control group, 42). The baseline characteristics of the 2 groups were basically similar. The results showed that patients in the study group had better short-term improvement in symptoms and imageology, including higher symptomatic control rate (median, 62.5% vs. 50%; P = 0.001), more reduction in Evans index (0.08 ± 0.05 vs. 0.05 ± 0.04; P = 0.002), and lower incidence of postoperative complications (median, 35.3% vs. 57.1%; P = 0.04). Similarly, the incidence of shunt revision in the study group was dramatically lower than in the control group (median, 15.7% vs. 40.9%; P = 0.006) in line with the revision-free curve (P = 0.002), which suggested that most of patients received revision, if needed, within 3 months. In addition, patients in the study group had better quality of life. CONCLUSIONS: In conclusion, patients who underwent evaluation before LPS had better short-term and long-term outcomes, suggesting that it would be a promising strategy to correctly select patients for LPS with prolonged favorable shunt outcomes.

A Large Multicenter Retrospective Research on Embedded Cranioplasty and Covered Cranioplasty.

OBJECTIVE: Cranioplasty (CP) can be either embedded or covered, according to the implants used. However, determining which one is better in treating cranial defects is difficult. This study aimed to compare the clinical outcomes and complications of embedded CP and covered CP. METHODS: A multicenter retrospective study was undertaken with patients who underwent CP with polyetheretherketone (PEEK) implants and titanium implants between January 2014 and March 2017. The medical records of these patients were reviewed retrospectively and analyzed statistically. RESULTS: There were 185 patients, including 75 patients (40.5%) who underwent embedded CP with PEEK implants (PEEK group) and 110 patients (59.5%) who underwent covered CP using titanium mesh (titanium group), in this study. Compared with the titanium group, the incidence of overall complications (P = 0.03), postoperative new seizures (P = 0.01), postoperative implant exposure (P = 0.03), and reoperation (P = 0.01) was significantly lower in PEEK group. The rate of brain function improvement (P = 0.01) after CP and satisfaction with CP (P = 0.01) in patients in the PEEK group were higher than that in the titanium group. CONCLUSIONS: Our results show that embedded CP with PEEK has a distinct advantage in brain function improvement and fewer postoperative complications compared with covered CP with titanium mesh. However, the high cost of PEEK is an obvious drawback. This study can help both neurosurgeons and patients in choosing a better therapeutic method to achieve the most satisfactory outcome in treating cranial defects.