Construction of a Column Line Chart-Based Predictive Model for Postoperative Pulmonary Infection Severity in Tracheostomized Patients with Cranial Brain Injuries.

Objective: To explore the construction of a column line chart-based predictive model for postoperative pulmonary infection severity in tracheostomized patients with cranial brain injuries. Methods: The study included 187 patients with cranial brain injuries who underwent tracheostomy between December 2021 and June 2023. These patients were categorized into moderate-to-severe and mild groups based on the severity of postoperative pulmonary infections. Logistic regression analysis was employed to pinpoint the autonomous risk elements for the severity of postoperative pulmonary infection in tracheostomized patients with cranial brain injuries, and a column line chart predictive model was established using these identified independent risk factors. Receiver Operating Characteristic (ROC) curves and calibration curves were used to assess the predictive performance and clinical application potential of the column line chart model for postoperative pulmonary infection risk in tracheostomized patients with cranial brain injuries. Results: Among the 187 patients, 83 (44.39%) experienced moderate-to-severe pulmonary infection. Factors such as age ≥60 years, GCS score <8, a history of long-term smoking, ASA >II, non-washable tracheal tubes, malnutrition, using a ventilator, and longer operative time were more prevalent in the moderate-to-severe group compared to the mild group (P < .05). Multivariate logistic regression analysis revealed that age ≥60 years, GCS score <8, a history of long-term smoking, ASA >II, non-washable tracheal tubes, malnutrition, using a ventilator, and longer operative time were independent risk factors for moderate-to-severe pulmonary infection in tracheostomized patients with cranial brain injuries (P < .05). Build a predictive model based on the above six independent risk factors and plot the ROC curve. ROC curve analysis demonstrated that the AUC values for age ≥60 years, GCS score <8, a history of long-term smoking, ASA >II, non-washable tracheal tubes, malnutrition, using a ventilator, and longer operative time in the column line chart model were 0.578, 0.654, 0.711, 0.652, 0.892, 0.598, 0.712, and 0.752, respectively, indicating good predictive performance of the model. Conclusion: The column line chart-based predictive model for postoperative pulmonary infection severity in tracheostomized patients with cranial brain injuries has a high discriminative power and predictive accuracy. It provides a reliable and intuitive means of predicting the severity of postoperative pulmonary infections in these individuals, enabling healthcare personnel to implement timely intervention measures, thus reducing the occurrence of pulmonary infections.

Advantages of Small Bone-Window Craniotomy Under Microscope Combined Postoperative Intracranial Pressure Monitoring in the Treatment of Hypertensive Intracerebral Hemorrhage.

OBJECTIVE: The aim of this study is to analyze the clinical effect of small bone-window craniotomy with microscope combined postoperative ICP monitoring, and further explore an appropriate treatment for HICH patients. METHODS: One hundred fifty patients with HICH were selected according to inclusion and exclusion criteria and divided into 3 groups at random, 50 each group. Patients in 3 groups were treated with conventional craniotomy, small bone-window craniotomy and small bone-window craniotomy combined ICP monitoring respectively. The surgical efficiency, treatment effect and outcomes were recorded and analyzed. RESULTS: The intraoperative blood loss and operation time of small window groups were significantly less than that of conventional group, and the hematoma clearance rate in small window groups were significantly higher than in conventional group (P < 0.05). Compared with conventional group, the hospital stays and mannitol dose used were less in small window groups and least in small window combined ICP monitoring group (P < 0.05). The complication rate in small window combined ICP monitoring group was 10%, which was significantly lower than in conventional group (26%, P < 0.05), while no significant difference was found between small window group (18%) compared with the other 2 groups respectively (P > 0.05). The difference of morality rate between 3 groups wasn't significant (P > 0.05). Three treatment significantly increased the Barthel index score, and the improvement of small window combined ICP monitoring group was significantly higher than in other 2 groups respectively (P < 0.05), while the difference between this two groups wasn't significant (P > 0.05). CONCLUSION: Small bone-window craniotomy is more efficient and convenient than conventional craniotomy in the treatment of HICH. In the meantime, small bone-window craniotomy simultaneous with ICP monitoring significantly improved clinical effect and treatment outcomes of HICH patients.

Early decompressive surgery improves long-term prognosis in patients with intracerebral hemorrhage.

BACKGROUND: Multiple studies have shown that early decompressive surgery in patients with intracerebral hemorrhage can effectively limit hematoma expansion, reduce perihematomal edema, and improve prognosis. However, these studies are limited by small sample sizes and short follow-up times. OBJECTIVE: To analyze the effect of early decompressive surgery on the long-term prognosis of patients with cerebral hemorrhage and identify the influencing factors for poor prognosis. METHODS: A retrospective analysis of 78 patients with cerebral hemorrhage admitted between January 2020 and December 2022 was conducted. Patients were divided into early and delayed surgery groups for comparison of outcomes such as mortality rate, modified Rankin Scale score, and Short Form-36 scores. Additionally, factors influencing long-term prognosis were analyzed through logistic regression based on significant differences observed between groups. RESULTS: The early decompressive surgery group showed superior outcomes with lower mortality rates, modified Rankin Scale (mRS) scores, hematoma expansion rates, and perihematomal edema volumes compared to the delayed surgery group (P< 0.05). Additionally, age, preoperative Glasgow Coma Scale (GCS) score, preoperative hematoma volume, and a history of hypertension or diabetes were identified as independent prognostic factors for patients with cerebral hemorrhage, with odds ratios (ORs) greater than 1. CONCLUSIONS: Early decompressive surgery can improve the long-term prognosis and quality of life of patients with cerebral hemorrhage, reduce mortality rates, and decrease hematoma expansion and perihematomal edema. Older patients, those with higher preoperative hematoma volume and GCS score, and those with coexisting hypertension and diabetes should be given special attention to decrease the occurrence of adverse prognosis.

Decreased expression of microRNA-200b is an independent unfavorable prognostic factor for glioma patients.

BACKGROUND AND AIM: As a member of the microRNA (miR)-200 family, miR-200b has been recognized as one of the fundamental regulators of epithelial-mesenchymal transition, chemosensitivity, cell proliferation, and cell cycle. Especially in glioma, miR-200b targets the CREB1 gene and suppresses the tumor cell growth in vitro. However, its involvement in human glioma has not yet been determined. The aim of this study was to investigate the clinical significance of miR-200b expression in this disease. METHODS: miR-200b expression in 266 pairs of human gliomas and matched nonneoplastic brain tissues was measured by real-time quantitative RT-PCR assay. RESULTS: Compared with nonneoplastic brain tissues, the expression level of miR-200b was significantly decreased in glioma tissues (tumor vs. normal: 2.87 ± 2.05 vs. 8.78 ± 2.50, P<0.001). Of 266 patients with gliomas, 166 (62.41%) were in low miR-200b expression group. In addition, we found that the glioma tissues from high-grade tumors (grade III and IV) had much lower miR-200b expression than glioma tissues from low grade tumors (grade I and II). Moreover, the expression level of miR-200b was positively correlated with Karnofsky performance status (KPS) scores of glioma tissues. The results of a 60-month follow-up in 266 glioma patients further demonstrated that lower miR-200b expression was correlated with worse progression-free survival and overall survival in the patients with grade III and IV gliomas. Both univariate and multivariate analyses revealed that miR-200b was an independent prognostic indicator for glioma. CONCLUSION: These findings prove that the decreased expression of miR-200b may be associated with malignant tumor progression and poor prognosis in patients with gliomas, suggesting the potential role of miR-200b in glioma management. miR-200b may be a novel and valuable signature for predicting the clinical outcome of patients with gliomas.