Artificial neural network predicts hemorrhagic contusions following decompressive craniotomy in traumatic brain injury.

BACKGROUND: This study aimed to explore relevant factors of hemorrhagic contusions following decompressive craniotomy (DC) in traumatic brain injury (TBI) and create an artificial neural network (ANN) prediction model of the risk factors of hemorrhagic contusions. METHODS: This study analyzed 425 patients with TBI who underwent DC in the Neurosurgery Department of Shaoxing People's Hospital between 2009 and 2014. Patients were divided into two groups according to the first postoperative CT scans: hemorrhage group and non-hemorrhage group. Gender, age, preoperative situations (Initial Rotterdam CT Score, GCS Score, pupillary response, laboratory data and preoperative hematoma), the time gap between trauma and DC, postoperative CT scans, and Glasgow Outcome Scale (GOS) scores were recorded. ANN was used to predict hematoma. Correlation analysis was used to state the relationship between increased hemorrhage volumes and GOS scores. RESULTS: The ANN prediction model was established. This model included 11 parameters: initial Rotterdam CT score, GCS score, C-reactive protein, age, the time gap between trauma and DC, pupillary response, platelet count, bone-flap size, glucose level, hernia magnitude and preoperative hematoma volume. The overall predictive accuracy of the model was 73.0%. CONCLUSIONS: Initial Rotterdam CT scores and GCS scores may predict the risk of expansion contusions following DC. The ANN prediction model has a high accuracy to forecast hemorrhage.

Esophageal Histological Precursor Lesions and Subsequent 8.5-Year Cancer Risk in a Population-Based Prospective Study in China.

INTRODUCTION: Data on the associations between esophageal histological lesions and risk of esophageal squamous cell carcinoma (ESCC) in general populations are limited. We aimed to investigate these associations in a large Chinese general population to inform future Chinese ESCC screening guidelines. METHODS: We performed endoscopic screening of 21,111 participants aged 40-69 years from 3 high-risk areas of China in 2005-2009, and followed the cohort through 2016. Cumulative incidence and mortality rates of ESCC were calculated by baseline histological diagnosis, and hazard ratios of ESCC, overall and by age and sex, were assessed using the Cox proportional hazards models. RESULTS: We identified 143 new ESCC cases (0.68%) and 62 ESCC deaths (0.29%) during a median follow-up of 8.5 years. Increasing grades of squamous dysplasia were associated with the increasing risk of ESCC incidence and mortality. The cumulative ESCC incidence rates for severe dysplasia/carcinoma in situ, moderate dysplasia (MD), and mild dysplasia were 15.5%, 4.5%, and 1.4%, respectively. Older individuals (50-69 years) had 3.1 times higher ESCC incidence than younger individuals (40-49 years), and men had 2.4 times higher ESCC incidence than women. DISCUSSION: This study confirmed that increasing grades of squamous dysplasia are associated with increasing risk of ESCC and that severe dysplasia and carcinoma in situ require clinical treatment. This study suggests that in high-risk areas of China, patients with endoscopically worrisome MD should also receive therapy, the first screening can be postponed to 50 years, and endoscopic surveillance intervals for unremarkable MD and mild dysplasia can be lengthened to 3 and 5 years, respectively.

3D printing of intracranial aneurysm based on intracranial digital subtraction angiography and its clinical application.

The study aimed to develop simulation models including intracranial aneurysmal and parent vessel geometries, as well as vascular branches, through 3D printing technology. The simulation models focused on the benefits of aneurysmal treatments and clinical education. This prospective study included 13 consecutive patients who suffered from intracranial aneurysms confirmed by digital subtraction angiography (DSA) in the Neurosurgery Department of Shaoxing People's Hospital. The original 3D-DSA image data were extracted through the picture archiving and communication system and imported into Mimics. After reconstructing and transforming to Binary STL format, the simulation models of the hollow vascular tree were printed using 3D devices. The intracranial aneurysm 3D printing simulation model was developed based on DSA to assist neurosurgeons in aneurysmal treatments and residency training. Seven neurosurgical residents and 15 standardization training residents received their simulation model training and gave high assessments for the educational course with the follow-up qualitative questionnaire. 3D printed simulation models based on DSA can perfectly reveal target aneurysms and help neurosurgeons select therapeutic strategies precisely. As an educational tool, the 3D aneurysm vascular simulation model is useful for training residents.

Morphological Effect on Wall Shear Stress in Intracranial Aneurysms.

BACKGROUND AND STUDY AIMS: Both high and low wall shear stress (WSS) play important roles in the development and rupture of intracranial aneurysms (IAs). This study aimed to determine the morphological factors that affect WSS in the IA and the parent artery. MATERIAL AND METHODS: We studied a total of 66 IAs with three-dimensional imaging. Computational fluid dynamics (CFD) models were constructed and used to characterize the hemodynamics quantitatively. Aneurysms were grouped according to the mean neck width. The associations among hemodynamics and morphology were analyzed. RESULTS: Aspect ratio was correlated to lowest WSS (r = - 0.576), aneurysm-to-parent vessel (A-P) WSS ratio (r = - 0.500), and lowest-parent vessel (L-P) WSS ratio (r = - 0.575). Height-to-width ratio and height were correlated to WSS. Mean aneurysm WSS (p = 0.023), lowest WSS (p < 0.0001), highest-to-lowest WSS ratio (p = 0.004), L-P WSS ratio (p < 0.0001), highest-parent vessel (H-P) WSS ratio (p = 0.008), A-P WSS ratio (p < 0.001), and height (p < 0.001) were different between the two groups of aneurysms that were divided by the relationship between the diameters of the aneurysms and the necks. Multivariable analysis showed that the lowest WSS (p = 0.028) and A-P WSS ratio (p = 0.001) were independently associated with neck width. CONCLUSION: Morphological characteristics are associated with IA and parent vessel WSS. Aneurysms with different neck widths have different hemodynamics. These results could help in understanding the progression of IA and in building predictive models for IA rupture.

Serum caspase-cleaved cytokeratin-18 levels and outcomes after aneurysmal subarachnoid hemorrhage.

OBJECTIVE: Cell apoptosis is involved in acute brain injury after aneurysmal subarachnoid hemorrhage (aSAH). The protein cytokeratin-18 (CK-18) is cleaved by the action of caspases during apoptosis, and the resulting fragments are released into the blood as caspase-cleaved CK (CCCK)-18. Our study examined the relationship between circulating CCCK-18 levels and long-term clinical outcomes among aSAH patients. METHODS: We recruited 128 aSAH patients and 128 controls (matched on age and sex). Serum was collected at admission to the emergency department. Unfavorable outcome was defined as the Glasgow Outcome Score scores of 1-3. After a 6-month follow-up period, outcomes were assessed using a logistic regression analyses. The prognostic predictive values were evaluated according to receiver operating curves analysis. RESULTS: aSAH patients had higher plasma CCCK-18 levels compared to controls (235.1 ± 86.8 U/L vs. 25.6 ± 23.4 U/L, P<0.001). CCCK-18 was independently associated with World Federation of Neurological Surgeons (WFNS) scores (t=4.460, P<0.001) and modified Fisher scores (t=3.781, P<0.001). Furthermore, CCCK-18 levels were markedly higher among patients with an unfavorable outcome and among non-survivors. CCCK-18 was yet identified as an independent prognostic predictor for mortality (odds ratio, 5.769; 95% confidence interval, 1.196-27.832; P=0.029) and unfavorable outcome (odds ratio, 4.909; 95% confidence interval, 1.521-15.838; P=0.008), as well as had similar predictive values for them compared with WFNS scores and modified Fisher scores. CONCLUSIONS: High circulating CCCK-18 levels were associated with injury severity and a poor clinical outcome after aSAH and CCCK-18 had the potential to be a good prognostic biomarker for aSAH.

Mini-arteriotomy to remove misplaced Gugliemi detachable coils: case report and technical note.

Coil-related thromboembolic complications due to misplacement of coils in embolization of the intracranial aneurysms might result in severe neurological deficits. We describe an unusual case of a ruptured posterior communicating artery (PcomA) aneurysm in a woman who underwent a Mini-Arteriotomy to rescue error embolism in the left middle cerebral artery (MCA). This surgical procedure might be considered as an alternative route in selected patients with coil-related thromboembolic complications. This novel technology gives us a simple and practical method to remedy the misplacement of coils in a wide region of the cerebral vascular after interventional treatment.

[Correlative factors of traumatic embolism in superficial cerebral vein].

OBJECTIVE: To analyze the correlative factors of traumatic embolism in superficial cerebral vein and explore their corresponding treatments. METHODS: A total of 74 cases were divided into 3 groups according to their injury mechanisms. Group A: traumatic brain injury in superficial cerebral vein with cerebral contusion, acute intracerebral hematoma and subdural hematoma in the same place; Group B: traumatic brain injury in superficial cerebral vein with acute intracerebral hematoma, subdural hematoma and skull fracture in the same place; Group C: traumatic brain injury in superficial cerebral vein with acute subdural hematoma and skull fracture in the same place, without cerebral contusion or acute intracerebral hematoma. They were divided into different groups according to gender, age, pre-operative GCS and cerebral hernia. RESULTS: Among 74 cases, 28, 39 and 7 cases belonged to groups A, B and C respectively. There was significant difference among injured veins in three groups (P < 0.01). Cerebral infarction was found in 37 cases in groups A and B while only 2 cases in group C. Cerebral infarction had no correlation with sex, age, pre-operative GCS and cerebral hernia. CONCLUSION: Injuries in superficial cerebral vein are mainly caused by skull fracture, contre-coup injury and shearing force. Cerebral infarction often exists if there is cerebral contusion. It is necessary to protect injured primary superficial cerebral veins and ambient venous network, remove intracranial hematoma and large bone flap to reduce intracranial hypertension and dilute blood post-operatively to prevent venous embolism.

[Analysis of the changing trends of frequency and localization of gastric cancers arising from different sites of the stomach in population of the high incidence area of esophageal and gastric cancers in Hebei province].

OBJECTIVE: To analyze the changing trends of frequency and localization of gastric cancers arising from the gastric cardia, corpus and antrum during the past 14 years in population of the high incidence area of esophageal and gastric carcinoma in Hebei province, China. METHODS: The clinicopathological data of 4334 cases of gastric carcinomas among the local residents of Cixian and Zanhuang counties, initially diagnosed in our department from 1993 to 2006, were retrospectively analyzed. The proportion of gastric carcinomas arising from the gastric cardia, corpus and antrum in different years and in patients with different sex and ages were analyzed and compared, and the changing trends of the frequency of gastric carcinoma arising from different sites of the stomach were statistically analyzed. RESULTS: Among all the 4334 gastric carcinomas, gastric cardia carcinoma accounted for 68.0%, significantly higher than that of corpus (24.2%) and antrum (7.9%; chi(2) = 124.396, P < 0.0001). An increasing tendency in the proportion of gastric cardia carcinoma from 1993 to 2006 was seen. The percentage of cardiac carcinoma in the high incidence area of esophageal carcinoma (Cixian county) was higher than that in the high incidence area of gastric cancer (Zanhuang county) (71.2% vs. 51.2%; chi(2) = 109.648, P < 0.0001). The increase in the incidence of cardiac carcinoma in Cixian county was mainly due to the increase of cardiac carcinoma from 1993 to 2006, while the contributing factor for the increase in the proportion of cardiac carcinomas was resulted from the decrease of incidence of antrum carcinoma in Zanhuang county during the same period. The occurring site of gastric carcinoma was related with age of patients (chi(2) = 58.380, P < 0.0001). The percentage of carcinoma of the gastric body was highest in < 50 year age group, while that in the gastric cardia was highest in 61 - 70 year age group (71.6%). CONCLUSION: The major occurring site of gastric carcinoma is the gastric cardia among the local residents in population of the high incidence areas of esophageal and gastric carcinomas during the past 14 years in Hebei province, China. The increasing trend of cardiac carcinoma and decreasing trend of corpus carcinoma in Cixian county and antrum carcinoma in Zanhuang county will be maintained in the coming years if the epidemiological conditions will not be changed.

Endoscopic survey of esophageal cancer in a high-risk area of China.

AIM: To characterize the histological types of esophageal and cardiac mucosa by endoscopic survey of a population in a high-risk area of esophageal cancer of China. METHODS: A selected cohort of residents in Cixian County during December 2001 and May 2002 was surveyed by using Lugol's staining, followed by computer-based statistical analysis of the data with SPSS 10.0 software. RESULTS: Histologically, the detection rates of squamous epithelial acanthosis, squamous epithelial atrophy, and basal cell hyperplasia in the esophagus were 1.9% (38/2,013), 0.1% (3/2,013) and 0.9% (18/2,013) respectively, and those of mild, moderate, and severe esophagitis were 34.9% (703/2,013), 1.6% (33/2,013) and 0.2% (2/2,013) respectively. Mild, moderate, and severe esophageal dysplasia were detected in 8.6% (172/2,013), 7.8% (157/2,013) and 2.6% (53/2,013) respectively in the selected population, whereas in situ carcinoma, intramucosal carcinoma, invasive squamous carcinoma of the esophagus in 2.5% (50/2,013), 0.2% (4/2,013) and 0.7% (14/2,013) respectively. The detection rates of non-atrophic gastritis and atrophic gastritis of the cardia were 36.3% (730/2,013) and 11.5% (232/2,013) respectively, with mild and severe dysplasia of the cardia detected in 2.5% (51/2,013) and 0.8% (17/2,013), respectively, in this population; the rates of intramucosal adenocarcinoma and invasive adenocarcinoma of the cardia were 0.1% (3/2,013) and 0.8% (17/2,013) respectively. The detection rate of esophageal cancer at early stage was 79.4% (54/68). The survey rate (ratio of examined population to expected population) was 73.8% (2,013/2,725). CONCLUSION: Histologic types of the esophageal and cardiac mucosa were characterized by endoscopic survey in a high-risk population of esophageal cancer, which may help the early detection and treatment of esophageal and cardiac cancers and dysplasia, and reduce the mortality of such malignancies.

[Infrared absorption spectroscopy of optical waveguide in proton-exchanged LiNbO3].

Z-cut proton-exchanged LiNbO3 optical waveguides exchanged with different proton sources mixed with adipic acid and benzoic acid in different mol ratios were analyzed by infrared absorption spectroscopy. The result shows that there is an absorption peak of OH- free group at 3500 cm(-1) with the characteristic of substitute protons, and the absorption peak of H-bond is nearby 700 cm(-1) with the characteristic of packing protons. The different mixing ratios and different concentrations of H+ in the proton source, result in different proton-exchanged velocities and bring on the change in these absorption peaks. It is very important to study the change in these absorption peaks for making high quality LiNbO3 optical waveguide.

Nonlinear optical switching matrix.

We show that nonlinear directional couplers with variable coupling coefficients can be used to compose a special kind of switching matrix. The switching matrix can be controlled by the signal itself or by a strong pump. Light routing is realized by adjustment of the power of the signal or the pump. Because light routing is based on the optical Kerr effect, ultrafast routing is possible.

[HPV detection and FHIT expression in esophageal squamous carcinoma from high incidence area in Cixian County].

BACKGROUND & OBJECTIVE: Cixian County is one of the high incidence areas of esophageal carcinoma in China. Up to now, no work has been conducted on the possible etiological role of human papilloma virus (HPV) infection on esophageal carcinoma in this local area. The aim of this study was to explore the putative roles of HPV infection on the esophageal carcinogenesis of the patients in Cixian and to elucidate the possible relationship between HPV existence and fragile histidine triad gene (FHIT gene, a putative tumor suppressor gene), expression in squamous cell carcinoma of esophagus. METHODS: The existence of HPV DNA and the expression of FHIT gene at protein level in esophageal carcinoma tissues were determined with PCR and immunohistochemical staining, respectively, in 128 archival paraffin-embedded tissue blocks of esophageal squamous carcinoma from the high incidence area of Cixian and 24 tissue blocks from the non-high incidence area. RESULTS: PCR results showed that the positive detection rate of HPV in esophageal carcinoma tissues from the high incidence area was 20.3%, which was slightly higher than that from the non-high incidence area (8.3%)(P >0.05). Immunohistochemically, aberrant expression of FHIT gene in esophageal carcinoma tissue was found in 75.6% cases from the high incidence area and only 54.2% from the non-high incidence area, which was significantly lower than that of the former (P< 0.05). No correlation was found between the abnormal expression of FHIT and existence of HPV DNA in esophageal squamous carcinoma tissues. CONCLUSION: HPV DNA could be detected in partial esophageal carcinoma cases from the high incidence area of esophageal carcinoma in Cixian. The aberrant expression rate of FHIT protein in the cases from the high incidence area of esophageal carcinoma in Cixian is higher than that from the non-high incidence area.