ABSTRACT
Objective:To explore the risk factors of neurological complications after interventional treatment of ruptured intracranial aneurysms(RIAS), and to establish a predictive model of nomogram.Methods:The clinical data of 89 patients with RIAS who underwent endovascular treatment in Nanyang Second General Hospital Affiliated to Xingxiang Medical University from January 2016 to January 2019 were retrospectively studied.The clinical imaging data were collected and followed up for 6 months.The patients were divided into two groups: no neurological complications group (61 cases) and neurological complications group (28 cases). To analyze the clinical indicators and the possible related factors of neurological complications after RIAS interventional therapy.A nomogram was established to score the influencing factors, and a scoring prediction model was constructed; the clinical calibration of the model was evaluated by consistency index (C-index) and calibration curve, and the clinical differentiation of the model was evaluated by nomogram relying on ROC curve.Results:Multivariate logistic regression analysis showed that Hunt-Hess classification ( OR=4.927, 95% CI: 1.189-20.426, P=0.028), Fisher classification ( OR=4.633, 95% CI: 1.012-21.208, P=0.048 ), aneurysm cyst xiaofu ( OR=5.918, 95% CI: 1.104-24.948, P=0.015), wide carotid aneurysm ( OR=4.381, 95% CI: 1.029-18.645, P=0.046) and treatment Strategy ( OR=4.887, 95% CI: 1.235-19.329, P=0.024) is an independent risk factor for nerve-related complications after RIAs interventional therapy.The predictive model of nomogram showed that Hunt-Hess classification (grade IV, V) was 100, aneurysm bleb (with) 98, treatment strategy (stent implantation) 95, wide-necked aneurysm (yes) 92 and Fisher grade (grade III, IV) 81; the C-index of the predictive model was 0.871; the nomogram relied on ROC curve AUC 0.871, and the treatment strategy (stent implantation) was 95; the Fisher grade (grade III, IV) was 81; the C-index of the predictive model was 0.871.The sensitivity and specificity were 85.71%(24/28) and 77.05%(47/61) respectively. Conclusion:Hunt Hess classification, Fisher classification, aneurysmal sac caruncle, wide necked aneurysms and treatment strategies will affect the occurrence of neurological complications after RIAS interventional therapy.The nomogram established by this method can provide intuitive and reliable reference for clinical practice.
ABSTRACT
Objective:To investigate the expression of octamer-binding transcription factor 4(OCT4) in glioma tissues and its relationship with prognosis of patients.Methods:From March 2015 to June 2016, 168 patients with glioma and 72 normal brain tissues in the Second People's Hospital of Nanyang were collected.The expression levels of OCT4A and OCT4B were detected by reverse transcription-polymerase chain reaction(RT-PCR), and the relationship between clinicopathological characteristics and prognosis of glioma patients was analyzed.Results:The relative expressions of OCT4A(2.28±0.85) and OCT4B(2.84±1.29) in 168 glioma tissues were significantly higher than those in normal tissues [(1.05±0.41), (1.18±0.46)] ( t=11.649, 14.798, all P<0.01), and there was a positive correlation between OCT4A and OCT4B in glioma tissues( r=0.682, P=0.001). The expression levels of OCT4A and OCT4B in glioma patients with different pathological stages, pathological types, degree of differentiation and depth of invasion had statistically significant differences( t=14.695, 11.309, 16.038, 13.721, 17.216, 15.083, 14.871, 15.417, all P<0.01). Taking the median value of OCT4A and OCT4B mRNA expression as the cutoff value, the patients were divided into low expression group and high expression group.The overall survival of patients with low expression of OCT4A and OCT4B was (24.17±3.41)months and (25.30±4.16)months, which were significantly longer than (15.80±2.93)months and (15.94±3.07)months of high expression patients, the differences were statistically significant( t=15.639, 16.143, all P=0.000). Cox regression model analysis showed that the expression levels of OCT4A and OCT4B were independent factors affecting the prognosis of glioma patients.The hazard ratio (95% CI) was 1.731(0.804-3.181) and 1.605(0.795-2.942), respectively. Conclusion:The expression levels of OCT4A and OCT4B in glioma tissues are abnormally elevated, which is closely related to the severity of the disease.The patients with high expression of OCT4A and OCT4B have a shorter overall survival period, which has a certain predictive value for the treatment effect and prognosis of glioma.