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The condition of patients with severe traumatic brain injury (sTBI) complicated by corona virus 2019 disease (COVID-19) is complex. sTBI can significantly increase the probability of COVID-19 developing into severe or critical stage, while COVID-19 can also increase the surgical risk of sTBI and the severity of postoperative lung lesions. There are many contradictions in the treatment process, which brings difficulties to the clinical treatment of such patients. Up to now, there are few clinical studies and therapeutic norms relevant to sTBI complicated by COVID-19. In order to standardize the clinical treatment of such patients, Critical Care Medicine Branch of China International Exchange and Promotive Association for Medical and Healthcare and Editorial Board of Chinese Journal of Trauma organized relevant experts to formulate the Chinese expert consensus on clinical treatment of adult patients with severe traumatic brain injury complicated by corona virus infection 2019 ( version 2023) based on the joint prevention and control mechanism scheme of the State Council and domestic and foreign literatures on sTBI and COVID-19 in the past 3 years of the international epidemic. Fifteen recommendations focused on emergency treatment, emergency surgery and comprehensive management were put forward to provide a guidance for the diagnosis and treatment of sTBI complicated by COVID-19.
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BACKGROUND: Approximately one-third of spontaneous intracerebral hemorrhage patients did not know the onset time and were excluded from studies about time-dependent treatments for hyperacute spontaneous intracerebral hemorrhage. AIMS: To help clinicians explore the benefit of time-dependent treatments for unclear-onset patients, we presented artificial intelligence models to identify onset time using non-contrast computed tomography (NCCT) based on weakly supervised multitask learning (WS-MTL) structure. METHODS: The patients with reliable symptom onset time (strong label) or repeat CT (weak label) were included and split into training set and test set (internal and external). The WS-MTL structure utilized strong and weak labels simultaneously to improve performance. The models included three binary classification models for classifying whether NCCT acquired within 6, 8 or 12 h for different treatments measured by area under curve, and a regression model for determining the exact onset time measured by mean absolute error. The generalizability of models was also explored in comprehensive analysis. RESULTS: A total of 4004 patients with 10,780 NCCT scans were included. The performance of WS-MTL classification model showed high accuracy, and that of regression model was satisfactory in ≤6 h subgroup. In comprehensive analysis, the WS-MTL showed better performance for larger hematomas and thinner scans. And the performance improved effectively as training amounts increasing and could be improved steadily through retraining. CONCLUSIONS: The WS-MTL models showed good performance and generalizability. Considering the large number of unclear-onset spontaneous intracerebral hemorrhage patients, it may be worth to integrate the WS-MTL model into clinical practice to identify the onset time.
Subject(s)
Artificial Intelligence , Stroke , Cerebral Hemorrhage/diagnostic imaging , Hematoma , Humans , Tomography, X-Ray ComputedABSTRACT
Objectives: Hemorrhage expansion (HE) is a common and serious condition in patients with intracerebral hemorrhage (ICH). In contrast to the volume changes, little is known about the morphological changes that occur during HE. We developed a novel method to explore the patterns of morphological change and investigate the clinical significance of this change in ICH patients. Methods: The morphological changes in the hematomas of ICH patients with available paired non-contrast CT data were described in quantitative terms, including the diameters of each hematoma in three dimensions, the longitudinal axis type, the surface regularity (SR) index, the length and direction changes of the diameters, and the distance and direction of movement of the center of the hematoma. The patterns were explored by descriptive analysis and difference analysis in subgroups. We also established a prognostic nomogram model for poor outcomes in ICH patients using both morphological changes and clinical parameters. Results: A total of 1,094 eligible patients from four medical centers met the inclusion criteria. In 266 (24.3%) cases, the hematomas enlarged; the median absolute increase in volume was 14.0 [interquartile range (IQR), 17.9] mL. The initial hematomas tended to have a more irregular shape, reflected by a larger surface regularity index, than the developed hematomas. In subtentorial and deep supratentorial hematomas, the center moved in the direction of gravity. The distance of center movement and the length changes of the diameters were small, with median values of less than 4 mm. The most common longitudinal axis type was anterior-posterior (64.7%), and the axis type did not change between initial and repeat imaging in most patients (95.2%). A prognostic nomogram model including lateral expansion, a parameter of morphological change, showed good performance in predicting poor clinical outcomes in ICH patients. Conclusions: The present study provides a morphological perspective on HE using a novel automatic approach. We identified certain patterns of morphological change in HE, and we believe that some morphological change parameters could help physicians predict the prognosis of ICH patients.
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Objective To investigate the value of electromagnetic navigation in microsurgical resection of intracranial cavernous hemangioma of different locations.Methods The microsurgical resection of intracranial cavernous hemangioma of different locations with the guide of electromagnetic navigation of COMPASS Cygnus system,There were 47 cavernous hemangioma of 43 patients,including of multiple cavernous hemangioma of 3 cases,one case had 3,the other 2 cases had 2 ; Including 25 deep in the cerebral cortex(including of 4 deep in the cerebellar cortex),twenty shallow in the cerebral cortex,two were in the orbital apex,including of 4 deep in the sensorimotor cortex,four deep in the language center,and 2 deep in the visual center.Results All 47 cavernous hemangioma of 43 patients,the accuracy was 100％.The resection rate was 100％,including of 16 patients were removed with a straight incision.There was no one with the neurological dysfunction worse postoperative,with no deaths,with 1 case of normal perfusion pressure breakthrough and was cured by conservative treatment.Thirty cases were discharged within 1 week.The blood loss of 30 cases was less than 50 ml.The average registration error of navigation was 1.6 ± 0.4 mm.Conclusion The surgical incision and surgical approach can been designed with the help of electromagnetic navigation system before operation,and can accurately resect the lesions simultaneously avoid brain function area,protect the normal brain tissue,reduce postoperative complications,with the help of the electromagnetic navigation system intraoperative in real time.It is suitable for minimally invasive surgery for intracranial cavernous hemangioma.
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Objective To study the regional anatomy of the cavernous sinus for skull base surgery.Methods Continuous thin sections on coronary plane were performed with freezing milling technique on an head specimen from March 2008 to November 2011.After segmenting,labeling and extracting in a seraial sections,we finished the three dimensional reconstruction of the cavernous sinus.Results Three hundred and ninety thin coronary sections were obtained.The related structures were described in six typical sections.The cavernous sinuses were located on each side of the sphenoid sella.The sinus connects to the superior orbital fissure below and lateral to the anterior clinoid process,opens into the basilar sinuses lateral to the dorsum sellae.The four main spaces within the sinus,identified by their relation to the carotid artery,were the medial,the anteroinferior,the posterosuperior compartments and the lateral space.The four spaces were located differnently and communicate with each others in three dimensional images.Conclusion Combination of coronary section anatomy and three dimensional reconstruction can display the anatomical characters of the s cavernous sinus.The 3D models are video films that continuously and dynamically display anatomic structures in 3D space at different velocities.
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OBJECTIVE:To establish an RP-HPLC method for simultaneous determination of Berberin hydrochloride,Baicalin and Glibenclamide in Kangtang tablets.METHODS:Separation of samples was achieved on a Diamond C18 analytical column(250 mm?4.6 mm,5 ?m).The mobile phase consisted of methanol-0.3% H3PO4(containing 0.3% triethylamine,pH2.5)using gradient program at a flow rate of 1.0 mL?min-1 and a detection wavelength of 230 nm.RESULTS:The linear ranges of Berberin hydrochloride,Baicalin and Glibenclamide were 0.02～1.0 mg?mL-1,0.02～1.0 mg?mL-1,0.000 8～0.04 mg?mL-1,respectively.The average recoveries were 100.16%,99.32% and 97.23%,respectively.The RSD were 1.97%、1.77%、1.28%,respectively(n=6).CONCLUSION:The method is simple,sensitive with high recovery rates and it is suitable for the quality control of Kangtang tablets.
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OBJECTIVE:To observe the clinical efficacy of Lianhua qingwen capsules in treatment of influenza.METHODS:A total of 160 patients with influenza were randomly divided into control group and trial group:80 patients in trial group were assigned to receive Lianhua qingwen capsules(4 granules/time) tid per os for one week,and another 80 in control group to receive Kugan granules(8 g/time)tid per os for one week.RESULTS:The total effective rate in clinical syndrome,temperature,and symptoms in the trial group was significantly higher than in the control group(P
