GPT-agents based on medical guidelines can improve the responsiveness and explainability of outcomes for traumatic brain injury rehabilitation.

This study explored the application of generative pre-trained transformer (GPT) agents based on medical guidelines using large language model (LLM) technology for traumatic brain injury (TBI) rehabilitation-related questions. To assess the effectiveness of multiple agents (GPT-agents) created using GPT-4, a comparison was conducted using direct GPT-4 as the control group (GPT-4). The GPT-agents comprised multiple agents with distinct functions, including "Medical Guideline Classification", "Question Retrieval", "Matching Evaluation", "Intelligent Question Answering (QA)", and "Results Evaluation and Source Citation". Brain rehabilitation questions were selected from the doctor-patient Q&A database for assessment. The primary endpoint was a better answer. The secondary endpoints were accuracy, completeness, explainability, and empathy. Thirty questions were answered; overall GPT-agents took substantially longer and more words to respond than GPT-4 (time: 54.05 vs. 9.66 s, words: 371 vs. 57). However, GPT-agents provided superior answers in more cases compared to GPT-4 (66.7 vs. 33.3%). GPT-Agents surpassed GPT-4 in accuracy evaluation (3.8 ± 1.02 vs. 3.2 ± 0.96, p = 0.0234). No difference in incomplete answers was found (2 ± 0.87 vs. 1.7 ± 0.79, p = 0.213). However, in terms of explainability (2.79 ± 0.45 vs. 07 ± 0.52, p < 0.001) and empathy (2.63 ± 0.57 vs. 1.08 ± 0.51, p < 0.001) evaluation, the GPT-agents performed notably better. Based on medical guidelines, GPT-agents enhanced the accuracy and empathy of responses to TBI rehabilitation questions. This study provides guideline references and demonstrates improved clinical explainability. However, further validation through multicenter trials in a clinical setting is necessary. This study offers practical insights and establishes groundwork for the potential theoretical integration of LLM-agents medicine.

A novel non-segmented inverted water outline rendering method can improve the tracking of responsible blood vessels for hemifacial spasm.

This study aimed to explore a novel, non-segmented based on inverted water outline, and rapid 3D rendering method for identifying the responsible blood vessels for hemifacial spasm. First, the software was developed using the free and open-source 3D Slicer to process magnetic resonance images. Outlines of the water region were extracted and rendered in a three-dimensional space. The traditional image re-slicing technique (IMRT) was used for the control group, while non-segmented inverted water outline rendering (NSIWR) was used to observe the relevant blood vessels in the root entry/exit zone (REZ) of patients with hemifacial spasm. The intraoperative exploration results were considered the gold standard for comparing the differences in identifying relevant blood vessels between the two methods. Twenty-five patients were included, and the reconstruction effect evaluation suggested that NSIWR could effectively reconstruct the responsible blood vessels of the cochlea, facial nerve, and REZ. Compared with IMRT, NSIWR effectively improved the diagnosis of the responsible blood vessels in the REZ, clarified their sources and directions, and was consistent with intraoperative results. This study introduced a novel rapid rendering method based on NSIWR, which was successfully applied for hemifacial spasm. The method enhances accuracy in identifying responsible blood vessels in the REZ without needing multi-modal techniques. It has the potential to improve surgical effectiveness and reduce exploration time in treating hemifacial spasm.

Feasibility Study of the Low-Cost Motion Tracking System for Assessing Endoscope Holding Skills.

BACKGROUND: The ability to hold an endoscope is an important skill for surgeons and assistants performing endoscopic neurosurgery. Motion tracking can provide an objective assessment for surgical skills and may aid in endoscopic neurosurgery. We developed a cost-effective system to study the feasibility of objectively distinguishing performance levels for operating an endoscope. METHODS: The study was divided into 2 parts. First, a video motion tracking analysis tool was built based on a printed mark and free software (Kinovea 0.8.15). Second, the tool was used to distinguish the holding endoscope performance of the robotic arm by experts (surgeon, n = 3) and novice users (residents, n = 6) under both 0' and 30' endoscopes. RESULTS: Through the printed mark and free software, we successfully built a system for video motion tracking. The data analysis showed that for both 0' and 30' endoscopes, the experts had a shorter total distance and depth, smaller average speed and maximum acceleration, and a fewer number of extreme accelerations than their novice counterparts. Compared with experts and residents, the fixed arm had better results. CONCLUSIONS: The simple low-cost video motion tracking system can provide an objective assessment of an endoscope holding skill, which allows for discrimination between an expert and a novice, and can be used by clinical neurosurgeons to select a qualified assistant.

Novel Cost-Effective Tubular Port Based on Glove and Syringe for Endoscopic Surgery of Intracerebral Hematomas.

BACKGROUND: Intracerebral hematomas (ICH) is a common disease in the developing countries, and minimally invasive transportal resection of ICH is a widely accepted surgical technique. Many port systems are available, but most are disposable and expensive. We present a safe and cost-effective glove-syringe substitute for endoscopic hematoma evacuation, suitable for developing countries such as China. METHODS: A port substitute of different sizes and lengths was constructed using sterile gloves and syringes, commonly found in a surgical environment. RESULTS: We successfully performed endoscopic hematoma removal in 7 patients including 1 cerebellar hemorrhage case and the remaining 6 supratentorial basal ganglia cases (1 patient taking oral aspirin). Bipolar electrocoagulation was used to control bleeding from the ruptured blood vessels. There were no postsurgical complications. CONCLUSIONS: The glove-syringe port is a convenient, safe, and cost-effective tubular port system for endoscopic surgery of ICH. Such ports can be used as substitutes when commercial sleeves are unavailable, especially in rural areas and developing countries.

Recent advance in interventional embolization for chronic subdural hematoma / 中华神经医学杂志

Chronic subdural hematoma (cSDH) occurs in acute subdural hemorrhage after head trauma or converts from effusion. Traditional treatment is based on conservative treatment and surgical drainage. The effective rate of conservative treatment is only 3%-18%; even with drilling drainage treatment, the recurrence rate is as high as 33%. Recently, the middle meningeal artery embolization technique based on pathological analysis can greatly reduce the recurrence rate, and the operation is simple and curative effect is exact. This article reviews the pathogenesis of cSDH and progress of interventional therapy.

CCL18 is highly expressed in glioma tissues and promotes activity of glioblastoma cells / 中华神经医学杂志

Objective To explore the expression levels of chemokine (C-C motif) ligand 18 (CCL18) in human glioma tissues and its effects on the invasion,migration and proliferation ofglioma cells.Methods (1) Sixty samples were harvested from the glioma which was excised surgically and confirmed pathologically from the patients at the Department of Neurosurgery,Affiliated Hospital to Binzhou Medical College from January 2012 to December 2017.Of the samples,by the WHO grading,26 belonged to grade Ⅱ,18 to grade Ⅲ and 16 to grade Ⅳ.Ten samples of normal brain tissue were harvested as controls from the contemporary patients who underwent intracranial decompression and excision due to brain injury.CCL18 mRNA expression was determined by real-time RT-PCR and CCL18 protein expression in tumor cells by immunochemically histological staining.(2) U251 glioma cells cultured in vitro were incubated with CCL18 serum-free culture media (0 ng/mL,5 ng/mL and 10 ng/mL) for 24 h before they were subjected to Transwell,scarification and CCK-8 assays to measure cellular invasion,migration and proliferation.Results (1) The expression of CCL18 mRNA was significantly increased in the order from normal brain,glioma of grade Ⅱ,glioma of grade Ⅲ to glioma of grade Ⅳ (P＜0.05);the expression of CCL18 protein was significantly increased in the order from glioma of grade Ⅱ,glioma of grade Ⅲ to glioma of grade Ⅳ (P＜0.05).(2) The 24 h Transwell assay for invasion showed that the number of transmembrane cells was significantly increased in the order from 0 ng/mL group to 5 ng/mL group to 10 ng/mL group (43.5±8.3,202.0±18.5 and 279.7±18.6 cells) (P＜0.05).The widths of scratch (pixels) in the scarification assay for migration were 498.4±75.3,381.3±21.4 and 347.7±14.2 at 12 h,and 299.5±15.3,284.6±7.8 and 237.3±20.6 at 24 h,respectively,showing significant differences between the groups of 0 ng/mL,5 ng/mL and 10 ng/mL recombinant CCL18 (P＜0.05).The cell growth in CCK-8 assay for proliferation was 1.000±0.019,1.260±0.094 and 2.070±0.138 fold at 24 h,respectively,also showing significant differences between the groups of 0 ng/mL,5 ng/mL and 10 ng/mL recombinant CCL18 (P＜0.05).Conclusions Expression of CCL18 in glioma is associated with the malignancy of the tumor.As CCL 18 promotes invasion,migration and proliferation of glioma cells,it may be a potential biomarker for detecting and grading human glioma.

Bromocriptine induces autophagy-dependent cell death in pituitary adenomas / 中华神经医学杂志

Objective To study the mechanism of bromocriptine (BRC) inducing autophagy-dependent cell death in pituitary adenomas and to explore its significance.Methods Thirty pituitary adenomas excised in our hospital from June 2013 to December 2015 were collected;the expressions of LC3 and Bcl-2 in these pituitary adenomas and normal brain tissues were examined by immunohistochemical staining.The rat hypophysoma MMQ cells were conventionally cultured in vitro;after 24 h of treatment with 60 μmol/L BRC,cytometry was performed to detect the variation of these cell cycle;the protein expressions of microtubule-associated protein light chain 3-Ⅰ (LC3-Ⅰ) and light chain 3-1Ⅱ (LC3-1Ⅱ) and the ratio of Bcl-2/Bax were measured by Western blotting after 24 h of treatment with various concentrations BRC (0,30 and 60 μ moi/L) for the MMQ cells.Results The LC3 protein expression rate in the pituitary adenomas was 80％ (24/30) and that in the normal brain tissues was 0％ (0/30);Bcl-2 protein expression rate in the pituitary adenomas was 83.33％ (25/30) and that in the normal brain tissues was 0％ (0/30).The high expression rates of LC3 and Bcl-2 in pituitary adenomas were significantly higher than those of the normal brain tissues (P＜0.05).Patients with increased prolactin after BRC treatment had significantly higher expression rates of LC3 and Bcl-2 than those with decreased prolactin after BRC treatment (P＜0.05).After treatment with 60 μmol/L BRC for 24 h,the number of MMQ cells in G0-G1 phase was significantly larger than controls (P＜0.05).After 24 h of induction with various concentrations BRC,Western blotting showed that the conversion ratio of LC3-Ⅰ to LC3-Ⅱ in MMQ cells was significantly increased following the increase of BRC concentration (P＜0.05);the ratio of Bcl-2 and Bax showed no significant difference among the 0,30 and 60 μ mol/L BRC treatment groups (P＞0.05).Conclusion The death manner of BRC-treated pituitary adenoma cells is mainly autophagic cell death rather than apoptosis.

Microscopic and neuroendoscopy assisted microvascular decompression: a Meta-analysis / 中华神经医学杂志

Objective To compare the clinical efficacies of endoscopy-assisted microvascular decompression and microscopic microvascular decompression.Methods PubMed,Cochrane Library,Embase,VIP,CNKI and Wanfang database were retrieved.The randomized controlled trials comparing trigeminal neuralgia and hemifacial spasm treated with endoscopy-assisted microvascular decompression and microscopic microvascular decompression were chosen.The retrieval time was from the establishment of the database to April 1st,2017.After the detected literatures being screened,extracted and evaluated,a Meta-analysis was performed using RevMan 5.3 software.Results Finally,a total of 10 trials with 1010 patients were enrolled.The results of Meta-analysis showed:(1) in the aspect of effectiveness,patients from the neuroendoscope group had significantly better prognosis (RR=1.110,95％CI:1.060-1.160,P=0.000) and statistically lower relapse rate (RR=0.100,95％CI:0.020-0.530,P=0.007) as compared with the microsurgery group;(2) in the aspect of safety,patients from the neuroendoscope group had fewer postoperative complications (RR=0.650,95％CI:0.530-0.800,P=0.000) and lower postoperative paralysis incidence rate (RR=0.580,95％CI:0.360-0.930,P=0.020) as compared with the microscope group.There were no significant differences in the operation time,incidence of cerebrospinal fluid leakage,hearing loss or intracranial infections between the 2 groups (P＞0.05).Conclusion As compared with those in patients accepted microscopic microvascular decompression,the prognosis of patients accepted endoscopy-assisted microvascular decompression is better,the relapse rate is lower,and safety is higher.

Application of 3D printing guide system in minimally invasive puncture and drainage of cerebral hemorrhage surgery / 中华神经医学杂志

Objective To study the design and application of customized navigation module manufactured by digital modeling and 3D-printing technology in the minimal-invasive-puncture surgery for cerebral hemorrhage. Methods Eight patients with cerebral hemorrhage, admitted to our hospital from October 2015 to December 2015 and aged from 33-80 years old (with an average age of 55.7), including 6 male and 2 female, were chosen as study objects. The 3-dimensional image was obtained by three dimensional reconstruction technique. A perfectly personal navigation module included puncturing-guidance-channel was designed and printed by 3D-printing technology. The printing module was tested in surgery. The module was tightly attached to the puncturing area, and the puncturing was performed following the guide system during the surgery. Post-operation cerebral CT scan was performed to evaluate the surgery effect. Results All the 8 patients successfully received surgery. Post-operation cerebral CT scan showed satisfied results which were classified based on accuracy: 6 enjoyed highly accurate results, one qualified result and one acceptable result. The actual puncture direction was the same with that in the pre-operation mimic process. No puncture failure, blood vessel or nervous injury symptoms were found. Conclusion Pre-operation personal 3D printing navigation is an accurate, safe and effective novel method to treat cerebral hematoma.