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Objective:To obtain the parameters associated with hematoma morpholoy by finite element analysis(FEA) and investigated their performance on predicting and diagnosis hematoma expansion(HE) in patients with spontaneous intracrebral hemorrhage(SICH).Methods:Patients with SICH who met research criteria were retrospective enrolled between June 2015 and December 2017. Clinical parameters on admission were collected, Perform 2 independent methodology on same patient to analysis the hematoma shape base on computed tomography(CT): Clinical routine method that performed by clinical investigator to identified margin irregularity of hematoma by CT ,and calculated the volume of hematoma by simplify Tada formula(ABC/2);The FEA method performed by FEA investigator and gain the hematoma 3 dimensional morphology and variables, include Volume, Surface area, and The quantity of triangles per square milimet surface(TQOT/mm 2). The HE was defined as volume enlargement of >33% compared with that on addmission. All patients were divided into HE and none HE group ,respectively, ABC/2 and FEA generated thire own HE and none HE group as different volume calcuation. The HE risk factors of ABC/2 and FEA were assessed in univariate and multivariable Logistic regression models. and the risk fators diagnosis value for HE were determined by the receiver operating characteristic(ROC) curves. Results:Total of 127 patients were enrolled, The mean time of symptom onset to hospital admitted was 3.08±1.34 h. There were 34(26.77%) cases HE identifed by ABC/2 and 31(24.41%)by FEA. Althought there are significant different (pearson χ2=53.66, P<0.01) of HE identification between ABC/2 and FEA, the 2 methods has moderate consistency (Kappa=0.65). All patients’ hematoma 3D reconstruction were performed by FEA and general observation show that TQOT/mm 2 most likely correlate to irregularity of hematoma 3D shape. Multivariable Logistic regression models indicated that ICH score( OR=1.79, 95% CI:1.19~2.68)was independent HE risk factor for ABC/2, respectively, TQOT/mm 2≥1.95/mm 2 ( OR=16.99,95% CI:5.98~48.33)and Ultraearly Hematoma Growth,(uHG) ( OR=1.05, 95% CI:1.01~1.09)were independent HE risk factor for FEA. With ROC analysis, both the ICH score of ABC/2 and uHG of FEA have low HE predictive and diagnosis value ,the area under the curve (AUC) were 0.64 and 0.67 respectively. However, TQOT/mm 2 was found to have excellent diagnosis value (AUC:0.9), sensitivity and specificity were 77% and 83% when the cut-off value was 1.95. Panel parameter model (TQOT/mm 2+uHG) was not be found to have a significant higher AUC than single parameter on FEA and the clinical routine parameters panel model (ICH +SB P>180 mmHg on addmission) have a unacceptable AUC(<0.7) as well as single parameters. Conclusions:Hematoma shape could be reconstructed and analysis by FEA and TQOT/mm 2 was likely relevance to hematoma morphology. TQOT/mm 2≥1.95 was indicate to have a better HE predicting and diagnosis value than any other risk factors and clinical parameters panel models in our reaserch.
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Objective To investigate the role of three-dimensional (3D) reconstruction based parameters of hematoma cavity and encephalocoele in predicting hematoma expansion and hospitalized poor outcome in patients with primary brainstem hemorrhage (PBH). Methods Thirty-two PBH patients met research criterion were enrolled from intensive care unit (ICU) between June 2015 and December 2017. Baseline clinical characteristics, CT images on admission and within 48 h of admission were collected. The 3D reconstruction of hematoma cavity and encephalocoele based on CT images was performed by Mimics10.0, and quantity of triangles per square milimet surface (TQOT/mm2), and hematoma volume (HV) and encephalocoele volume (EV) were obtained. All patients were divided into hematoma expansion group and non-hematoma expansion group according to whether hematoma expansion appeared (hematoma expanded>33％ within 48 h of admission as compared with that on admission), and hospitalized poor outcome group and hospitalized non-poor outcome group according to whether hospitalized poor outcome appeared (modified Rankin scale scores>4 at discharge or hospitalized deaths), respectively. The risk factors of hematoma expansion were investigated by multivariable Logistic regression analysis. Multivariable Cox hazard regression was used to analyze the risk factors of poor outcome; Kaplain-Meier survival curve analysis and Log-rank test were used to compare the differences in survival curves between independent risk factors screened by Cox regression analysis. Results There were 11 patients (34.4％) with hematoma expansion and 14 (43.8％) with ventriculomegaly in 32 patients; in these 11 patients with hematoma expansion, 8 had ventriculomegaly, and the two had positive correlation (rp=0.423, P=0.016). Fifteen patients (46.9％) had poor outcome, in which 11 (34.4％) died in hospital; 5 had hematoma expansion and 8 had ventriculomegaly. Multivariate Logistic regression analysis showed that baseline lactate >2.0 mmol/L (OR=11.986, 95％CI: 1.084-132.552, P=0.043) and TQOT/mm2>2 (OR=10.223, 95％CI: 1.424-73.396, P=0.021) were independent risk factors of hematoma expansion. Baseline HV (HR=1.102, 95％ CI: 1.020-1.143, P=0.002) and EV (HR=3.485, 95％ CI:1.071-11.463, P=0.040) were risk factors of hospitalized poor outcome identified by multivariable Cox analysis. Kaplan-Meier survival analysis showed that the hospitalization days of hospitalized poor outcome were (74.0±10.6) d and (25.5±7.0) d between patients have hematoma expansion Cut-off value of 7 mL, with significant difference (Log-rank: χ2=11.832, P=0.001), and the hospitalization days of hospitalized poor outcome in patients with and without ventriculomegaly were (68.1±9.0) d and (29.9± 8.8) d, respectively, with significant difference (Log-rank: χ2=7.483, P=0.006). Conclusions There is correlation between hematoma expansion and ventriculomegaly; patients with TQOT/mm2>2 might have high risk of hematoma expansion; patients with baseline HV>7 mL and ventriculomegaly would sooner have hospitalized poor outcome.
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Objective To analyze the differences between CyberKnife radiotherapy with different numbers of gold markers.Methods A total of 424 patients undergoing CyberKnife with gold markers from 2013 to 2014 were enrolled and analyzed.In these patients,330 patients with no less than 3 gold markers were assigned to observation group and 94 patients with less than 3 gold markers were assigned to control group.The setup error and treatment error were recorded and analyzed for each patient.Results The mean setup error and mean treatment error were 0.031 mm and 0.314 mm in the observation group and 0.057 mm and 1.122 mm in the control group,respectively.Conclusion Tracking no less than 3 gold markers can substantially improve the accuracy and quality of treatment.
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ObjectiveTo assess negative risk factors associate with short-term and long-term poor outcome of acute heart failure syndromes(AHFS) and provide evidence to emergently proceed to AHFS low risk stratification.Methods A retrospective cohort study was conducted. 125 AHFS patients who met research criterion were enrolled from Guangxi Baise People's Hospital and Youjiang District People's Hospital of Baise City. The patients were divided into poor outcome and relatively low-risk groups by the results of short- and long-term follow-up of their outcomes. The patient's vital signs and disease history were collected at the first time after admission, and auxillary examination parameters were recorded. The poor outcomes occurring in the follow-up periods from the admission to after discharge for 30 days(short-term) and 1 year(long-term)were recorded, and Cox hazard regression was used to analyze the negative risk factor in the short- and long-term.Results There were 58 cases(46.4%)with poor outcome and 30 cases(24.0%)dead in short-term, and there were 111 cases(88.8%) with poor outcome and 39 cases(31.2%) dead in the long-term follow up. Seven negative risk factors were identified by Cox regression. They were no previous or de novo myocardial infarction〔short-term: hazard ratio(HR)=0.36, 95% confidence interval (95%CI)=0.20-0.65,P=0.001〕, lymphocyte ratio 0.20-0.40(short-term:HR=0.13, 95%CI=0.04-0.47, P=0.002; long-term:HR=0.42, 95%CI=0.26-0.68,P=0.001),oxygenation index(PaO2/FiO2)>300 mmHg (1 mmHg=0.133 kPa,short-term:HR=0.23, 95%CI=0.09-0.54,P=0.001),estimated glomerular filtration rate (eGFR)>60 mL·min-1·1.73 m-2(short-term:HR=0.31, 95%CI=0.16-0.64,P=0.002;long-term:HR=0.54, 95%CI=0.36-0.83,P=0.004),left ventricular ejection fraction(LVEF)>0.50(short-term:HR=0.29, 95%CI= 0.10-0.85,P=0.024), P wave terminal force in lead V1(PtfV1)>-0.04 mm·s(short-term:HR=0.29, 95%CI= 0.14-0.60,P=0.001), planar QRS-T angle300 mmHg, eGFR>60 mL·min-1·1.73 m-2, PtfV1>-0.04 mm·s, LVEF>0.50 and planar QRS-T angle<90°are more likely to have optimal short-term and long-term outcome.
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Objective To observe the effects of drainage with vacuum and closure (VAC) on acute wounds, and explore the mechanism of drainage with VAC in promoting wound healing.Methods Twenty-four acute wounds were inflicted on the backs of 12 New Zealand white rabbits (each rabbit two wounds), and the rabbits were divided into a drainage with VAC group and a control group randomly. The drainage with VAC group was treated with drainage with VAC. The control group was treated with wet saline gauze. The wounds were observed 3 and 7 days after treatment. Patho-morphological changes in tissues from the compressed area were observed by HE staining. The expression level of Cx 43 mRNA was detected using a RT-PCR.Results At the 3rd and 7th day after treatment, the wounds of the drainage with VAC group were clean, fresh and had less edema compared with those of the control group. Pathomorphological tissue changes were more obvious in the drainage with VAC group. The expression of Cx 43 mRNA in the drainage with VAC group had declined significantly compared with the control group.Conclusion Drainage with VAC can promote inflammatory cell infiltration, down-regulate the expression of Cx 43 mRNA, and promote wound healing.