Development and validation of a 30-day death nomogram in patients with spontaneous cerebral hemorrhage: a retrospective cohort study.

The purpose of this study was to establish and validate a nomogram to estimate the 30-day probability of death in patients with spontaneous cerebral hemorrhage. From January 2015 to December 2017, a cohort of 450 patients with clinically diagnosed cerebral hemorrhage was collected for model development. The minimum absolute contraction and the selection operator (lasso) regression model were used to select the strongest prediction of patients with cerebral hemorrhage. Discrimination and calibration were used to evaluate the performance of the resulting nomogram. After internal validation, the nomogram was further assessed in a different cohort containing 148 consecutive subjects examined between January 2018 and December 2018. The nomogram included five predictors from the lasso regression analysis, including: Glasgow coma scale (GCS), hematoma location, hematoma volume, white blood cells, and D-dimer. Internal verification showed that the model had good discrimination, (the area under the curve is 0.955), and good calibration [unreliability (U) statistic, p = 0.739]. The nomogram still showed good discrimination (area under the curve = 0.888) and good calibration [U statistic, p = 0.926] in the verification cohort data. Decision curve analysis showed that the prediction nomogram was clinically useful. The current study delineates a predictive nomogram combining clinical and imaging features, which can help identify patients who may die of cerebral hemorrhage.

Development and Validation of a Nomogram for Predicting Death within 2 days After Intracerebral Hemorrhage.

OBJECTIVE: This study aimed to establish and verify a model for predicting death within 2 days after spontaneous cerebral hemorrhage based on the patient's characteristics at the time of admission. METHODS: During 2015-2017, the records of a cohort of 397 patients with clinically diagnosed cerebral hemorrhage were collected for model development. Minimum absolute contraction and the selection operator (lasso) regression model were used to determine factors that most consistently and correctly predicted death after cerebral hemorrhage. Discrimination and calibration were used to evaluate the performance of the resulting nomogram. After internal validation, the nomogram was further assessed during 2017-2018 using a different cohort of 200 consecutive subjects. RESULTS: The nomogram included four predictors from the lasso regression analysis: Glasgow Coma Scale, hematoma location, hematoma volume, and primary intraventricular hemorrhage. The nomogram showed good discrimination and good calibration for both training and verification cohorts. Decision curve analysis showed that the prediction nomogram was clinically useful. CONCLUSION: This prediction model can be used for early, simple, and accurate prediction of early death following cerebral hemorrhage.

Application of intraoperative electrophysiological monitoring in vertebral canal decompression surgery for acute spinal cord injury.

OBJECTIVE: This study aimed to evaluate the joint monitoring of somatosensory evoked potentials (SEPs) and motor evoked potentials (MEPs) in vertebral canal decompression surgery for acute spinal cord injury. METHODS: Twenty-four patients, who were admitted to the hospital for the surgical treatment of spinal cord injury with SEP and MEP monitoring, were assigned to the intraoperative monitoring group (group I). In addition, 24 patients who were admitted to the hospital for the surgical treatment of spinal cord injury without SEP or MEP monitoring were assigned to the control group (group C). RESULTS: In group I, there were significant changes before and after decompression surgery in the P40 latency and amplitude, and in the latency of MEP in the abductor hallucis brevis (AHB), in patients with improved spinal nerve function following surgery. In contrast, there were no significant differences in the P40 latency or amplitude, or the latency of MEP in the AHB, in patients who showed no improvement after surgery. CONCLUSION: In vertebral canal decompression surgery for acute spinal cord injury, the application of joint MEP and SEP monitoring can timely reflect changes in spinal cord function.

ROCK2 regulates autophagy in the hippocampus of rats after subarachnoid hemorrhage.

The role of autophagy in subarachnoid hemorrhage (SAH) remains unclear. This study aimed to investigate the role of ROCK2 in the regulation of hippocampus autophagy after SAH. Thirty-six Sprague-Dawley rats were randomly divided into three groups - the sham group, the SAH group, and the SAH+ ROCK2 inhibitor group (or the drug group) - and analyzed through a behavior test. The hippocampus tissues were analyzed using immunochemistry and western blot analysis. We observed injured morphology in the hippocampus and impaired learning and memory ability in the rats in the SAH group, accompanied by upregulated ROCK2 expression and increased beclin-1 and LC3-II expression. Compared with the SAH group, we observed normal morphology in the hippocampus and better learning and memory ability in the rats in the drug group, accompanied by downregulated ROCK2 expression and increased beclin-1 and LC3-II expression. SAH activates autophagy in the hippocampus, but this could be inhibited by ROCK2. Inhibition of ROCK2 promotes autophagy and reduces the injury in the hippocampus, leading to the recovery of learning and memory ability following SAH. ROCK2 may represent a new target for the treatment of SAH.

The interventional effect of new drugs combined with the Stupp protocol on glioblastoma: A network meta-analysis.

OBJECTIVE: New therapeutic agents in combination with the standard Stupp protocol (a protocol about the temozolomide combined with radiotherapy treatment with glioblastoma was research by Stupp R in 2005) were assessed to evaluate whether they were superior to the Stupp protocol alone, to determine the optimum treatment regimen for patients with newly diagnosed glioblastoma. PATIENTS AND METHODS: We implemented a search strategy to identify studies in the following databases: PubMed, Cochrane Library, EMBASE, CNKI, CBM, Wanfang, and VIP, and assessed the quality of extracted data from the trials included. Statistical software was used to perform network meta-analysis. RESULTS: The use of novel therapeutic agents in combination with the Stupp protocol were all shown to be superior than the Stupp protocol alone for the treatment of newly diagnosed glioblastoma, ranked as follows: cilengitide 2000mg/5/week, bevacizumab in combination with irinotecan, nimotuzumab, bevacizumab, cilengitide 2000mg/2/week, cytokine-induced killer cell immunotherapy, and the Stupp protocol. In terms of serious adverse effects, the intervention group showed a 29% increase in the incidence of adverse events compared with the control group (patients treated only with Stupp protocol) with a statistically significant difference (RR=1.29; 95%CI 1.17-1.43; P<0.001). The most common adverse events were thrombocytopenia, lymphopenia, neutropenia, pneumonia, nausea, and vomiting, none of which were significantly different between the groups except for neutropenia, pneumonia, and embolism. CONCLUSIONS: All intervention drugs evaluated in our study were superior to the Stupp protocol alone when used in combination with it. However, we could not conclusively confirm whether cilengitide 2000mg/5/week was the optimum regime, as only one trial using this protocol was included in our study.

[Clinical research on bedsores treated with fire needle therapy].

OBJECTIVE: To discuss the clinical efficacy of fire needle therapy on bedsores. METHODS: Fifty-four cases of bedsores were divided randomly into a fire needling group and a filiform needling group, 27 cases in each one. In fire needling group, fire needle therapy was applied. In fifliform needling group, common needling technique with filiform needle was adopted. The wound surface and Ashi points around the sores were punctured in either group. The efficacy and the treatment session required in different phases were observed in two groups. RESULTS: The satisfactory rate of the efficacy was 91.4% (53/58) in fire needling group and was 75.9% (41/54) in common needling group, indicating statistical significant difference in comparison (P < 0.05). The sessions in the phases III and IV of bedsores increased significantly as compared with those in the phase II of two groups (both P < 0.05), of which, the sessions in phases III and IV of fire needling group were shortened apparently as compared with those of filiform needling group (P < 0.05). CONCLUSION: The efficacy of the fire needling therapy is superior to that of common needling on bedsores, and it is an effective approach to bedsores.

[Dynamic observation of pathological changes and expression of nuclear factor-kappaB in the intestinal mucosa of rats after diffuse brain injury].

OBJECTIVE: To investigate the dynamic pathological changes in the intestinal mucosa of rats and the role of activation of nuclear factor-kappaB (NF-kappaB) in the alteration in intestinal mucosal barrier dysfunction after diffuse brain injury. METHODS: The animal model established by Marmarou was used to produce diffuse brain injury. One hundred and fifty male Wistar rats were randomly divided into nine groups in terms of postinjury time: 1, 2, 4, 8, 12, 24, 48, 72, 168 hours after injury, and control group. Mucosal thickness, villous height and width were estimated under light microscope, and expression of NF-kappaB was assessed with immunohistochemical staining in control group to compare with those in injury groups. RESULTS: Mucosal thickness, villous height and width were diminished and the optical density of expression of NF-kappaB was much higher in the injury groups than those of control group. CONCLUSION: The structure of intestinal mucosa is damaged in the earlier stages after diffuse brain injury. NF-kappaB is activated by cellular stress, which may be involved in the pathogenesis of secondary intestinal lesion.

[The relationship between expression of fas mRNA and apoptosis after traumatic brain injury in rats and the role of GM-1 in protecting the brain].

OBJECTIVE: To explore the mechanism of apoptosis after traumatic brain injury (TBI) in rats and elucidate the role of GM-1 by detecting the expression of Fas mRNA and apoptosis in hippocampi. METHODS: After creating the model of Marmarou cranio-cerebral trauma and offering GM-1 therapy, we observed the expression of Fas mRNA and apoptotic cell death using in situ hybridization and terminal deoxynucleotidyl transferase-mediated dUTP-biotin in situ nick end labeling (TUNEL) technique. RESULTS: Increased expression of Fas mRNA and increased apoptotic cells in hippocampi after TBI were observed. GM-1 could decrease the expression of Fas mRNA and apoptotic cell death. CONCLUSION: The increased expression of Fas mRNA may be a noteworthy cause of apoptotic cell death after traumatic brain injury. GM-1 may play a protective role by way of decreasing the expression of Fas mRNA and apoptotic cell death.