Is near-infrared spectroscopy a promising predictor for early intracranial hemorrhage diagnosis in the Emergency Department?

Intracranial hemorrhage (ICH) is a serious medical condition that can lead to significant morbidity and mortality if not diagnosed and treated promptly. Early detection and treatment are essential for improving the outcome in patients with ICH. Near-infrared spectroscopy (NIRS) is a non-invasive imaging technique that has been used to detect changes in brain tissue oxygenation and blood flow in various conditions. The aim of this study was to investigate the predictive potential of NIRS for early diagnosis of ICH in patients presenting to the Emergency Department (ED) triage with headache. A total of 378 patients were included in the study. According to the final diagnosis of the patients, 4 groups were formed: migraine, tension-cluster headache, intracranial hemorrhage and intracranial mass, and control group. Cerebral NIRS values "rSO2" were measured at the first professional medical contact with the patient. The right and left rSO2 (RrSO2, LrSO2) were significantly lower and the rSO2 difference was significantly higher in the intracranial hemorrhage group compared to all other patient groups (P<0.001). The cut-off values determined in the receiver operating characteristics (ROC) analysis were RrSO2 ≤67, LrSO2 ≤67, and ΔrSO2 ≥9. This study found that a difference of more than 9 in cerebral right-left NIRS values can be a non-invasive, easy-to-administer, rapid, and reliable diagnostic test for early detection of intracranial bleeding. NIRS holds promise as an objective method in ED triage for patients with intracranial hemorrhage. However, further research is needed to fully understand the potential benefits and limitations of this method.

Complicaciones neurológicas de la prematuridad / Neurological consequences of prematurity

Resumen Los nacimientos prematuros representan un in dicador importante de salud de un país. Estos niños tienen un mayor riesgo de mortalidad y morbilidad. Las principales lesiones encefálicas en los prematuros incluyen lesiones de la sustancia blanca, hemorragias intracraneanas y lesiones cerebelosas, que pueden ser detectadas mediante ecografía encefálica y resonancia magnética, siendo esta última la técnica más sensible. Estas lesiones pueden tener repercusión a largo plazo en el neurodesarrollo de los prematuros, con un mayor riesgo de parálisis cerebral, trastornos cognitivos, con ductuales, sensoriales y del aprendizaje, entre otros. Es fundamental aplicar estrategias de prevención y aten ción temprana para reducir las consecuencias negativas de las lesiones encefálicas asociadas a la prematuridad.

Abstract Premature births are an important health indicator for a country. These children have a higher risk of mor tality and morbidity. The main brain injuries in preterm infants include white matter injuries, intracranial hem orrhages, and cerebellar injuries. These injuries can be detected through brain ultrasound and magnetic reso nance imaging (MRI), with MRI being the most sensitive technique. Perinatal brain injuries may have long-term consequences on the neurodevelopment of preterm infants, with an increased risk of cerebral palsy, cogni tive, behavioral, sensory, and learning disorders, among others. It is key to implement prevention strategies and early intervention to reduce the negative consequences of brain injuries associated with prematurity.

Anatomical and surgical considerations and outcomes in infantile Terson syndrome

Purpose: To study the presentation and outcomes of infantile Terson syndrome (TS). Methods: This was a retrospective analysis of 18 eyes of nine infants diagnosed to have TS?related intraocular hemorrhage (IOH). Results: Nine infants (seven males) were diagnosed to have IOH secondary to TS, of which eight infants had imaging features suggestive of intracranial bleed meeting our definite criteria. Median age at presentation was 5 months. In 11 eyes of six infants with suspected birth trauma, the median age of presentation was 4.5 months (range 1–5 months) of which one baby had a history of suction cup?aided delivery and four babies had a history of seizures. Vitreous hemorrhage (VH) was noted in 15 eyes (extensive in 11 eyes). Ten of these eyes showed membranous vitreous echoes, or triangular hyperechoic space with apex at the optic nerve head (ONH) posteriorly and base at the posterior lens capsule anteriorly, with or without dot echoes in the rest of the vitreous cavity, with a configuration of “tornado?like hemorrhage” suggestive of Cloquet’s canal hemorrhage (CCH). Eight eyes underwent lens?sparing vitrectomy (LSV) and one eye underwent lensectomy with vitrectomy (LV). On follow?up, disc pallor and retinal atrophy were noted in 11 and 10 eyes, respectively. The mean follow?up was 62 months (1.5 month–16 years). Visual acuity/behavior improved in all cases at the final follow?up. Developmental delay was noted in four children. Conclusion: Unexplained and altered vitreous hemorrhage with typical ultrasonography (USG) features should raise the suspicion of CCH in TS. Despite early intervention to clear visual axis, anatomical and visual behavior may remain subnormal.

Study on Compound Musk in the treatment of hypertensive cerebral hemorrhage after operation / 中国医师进修杂志

Objective:To investigate the efficacy of Compound Musk combined with nimodipine combined with minimally invasive surgery in the treatment of hypertensive cerebral hemorrhage and the effects on serum inflammation, stress and apoptosis.Methods:Prospective research methods was used. A total of 118 patients with hypertensive intracerebral hemorrhage who received treatment in the First Affiliated Hospital of Heilongjiang University of Traditional Chinese Medicine from March 2017 to January 2021 were randomly divided into control group and Compound Musk group (59 cases in each group). After minimally invasive surgery, patients in the control group were treated with nimodipine on the basis of conventional treatment, while patients in the Compound Musk group were treated with compound musk on the basis of the control group. After 2 weeks, the efficacy was evaluated and the levels of serum inflammatory indexes, oxidative stress indexes and apoptosis indexes were measured.Results:The total effective rate in Compound Musk group was higher than that in control group: 98.3% (58/59) vs. 88.1% (52/59), and the difference was statistically significant ( P<0.05). After 2 weeks of treatment, serum inflammatory indexes including nuclear factor-κB (NF-κB), interleukin-1β (IL-1β), matrix metalloproteinase-3 (MMP-3), matrix metalloproteinase-9 (MMP-9); apoptosis indexes including soluble Fas receptor (sFas), soluble Fas ligand (sFAS-L); oxidative stress indexes including advanced oxidation protein products (AOPP), malondialdehyde (MDA) decreased, and some oxidative stress indexes including glutathione peroxidase (GSH-Px), catalase (CAT) increased. The levels of the above inflammatory indexes, apoptosis indexes and oxidative stress indexes in Compound Musk group were lower than those in control group, NF-κB: (18.96 ± 2.17) ng/L vs. (24.10 ± 3.23) ng/L, IL-1β: (12.88 ± 1.74) ng/L vs. (15.19 ± 1.63) ng/L, MMP-3: (5.62 ± 0.95) ng/L vs. (7.97 ± 0.86) ng/L, MMP-9: (7.07 ± 0.86) ng/L vs. (9.26 ± 1.13) ng/L, sFas: (3.24 ± 0.38) μg/L vs. (4.19 ± 0.53) μg/L, sFas-L: (209.17 ± 24.39) ng/L vs. (288.54 ± 37.61) ng/L, AOPP: (10.76 ± 1.84) μg/L vs. (13.51 ± 2.09) μg/L, MDA: (2.87 ± 0.32) μmol/L vs. (3.45 ± 0.34) μmol/L, and the differences were statistically significant ( P<0.05). Some of the above oxidative stress indexes were higher than those in control group, GSH-Px: (3 274.91 ± 376.09) U/L vs. (2 854.19 ± 325.22) U/L, CAT: (60.82 ± 7.43) U/L vs. (52.17 ± 6.48) U/L, the differences were statistically significant ( P<0.05). During treatment, there was no significant difference in the incidence of rash, diarrhea, drug-induced liver and myocardial injury between two groups ( P>0.05). Conclusions:Compound Musk has a positive effect on improving the curative effect and internal environment of patients with hypertensive intracerebral hemorrhage after minimally invasive surgery, and will not increase the occurrence of serious adverse reactions.

Clinical effect of minimally invasive catheterization based on computer 3D-Slicer software system in the treatment of hypertensive intracerebral hemorrhage / 中国医师进修杂志

Objective:To investigate the clinical effect of minimally invasive catheterization based on computer 3D-Slicer software system in the treatment of hypertensive intracerebral hemorrhage (HICH).Methods:Three hundred and fifty patients with HICH treated in People′s Hospital of Lanling County in Shandongfrom June 2019 to June 2020 were selected as the research object. According to the operation method, they were divided into 3D-Slicer group (175 cases) and CT group (175 cases). They were treated with 3D-Slicer software-assisted minimally invasive catheterization and minimally invasive soft-channel drainage under CT localization, respectively. The general conditions of the surgery, hematoma clearance rate and laboratory indexes, oxidative stress index and prognosis were compared between the two groups.Results:The intraoperative blood loss, the hospitalizationtimein the 3D-Slicer group were lower than those in the CT group: (81.42 ± 12.33) ml vs. (101.54 ± 11.71) ml, (15.67 ± 3.71) d vs. (17.22 ± 3.52) d; the success rate of one-time successful puncture to preset position in the 3D-Slicer group was higher than that in the CT group: 100.00%(175/175) vs. 81.14%(142/175), there were statistical differences ( χ 2 = 34.26, P<0.05). The hematoma clearance rate after the surgery for 1, 3 and 7d in the 3D-Slicer group were higher than those in the CT group:(87.93 ± 8.54)% vs. (66.43 ± 7.99)%, (92.48 ± 10.31)% vs. (89.52 ± 11.74)%, (96.37 ± 10.22)% vs. (94.30 ± 9.25)%, there were statistical differences( P<0.05). After the surgery for 7 d, the levels of glutathione peroxidase (GSH-Px), superoxide dismutase (SOD) and catalase (CAT) in the 3D-Slicer group were higher than those in the CT group: (121.36 ± 10.59)U/L vs. (109.14 ± 9.05) U/L, (92.80 ± 8.63) μg/L vs. (81.45 ± 9.11) μg/L, (24.64 ± 5.43) U/L vs. (20.84 ± 3.47) U/L; while the level of malondialdehyde (MDA) was lower than that in the CT group: (4.42 ± 0.57)μmol/L vs. (5.19 ± 0.51) μmol/L, there were statistical differences ( P<0.05). After the surgery for 3 months, the rate of favorable prognosis in the 3D-Slicer group was higher than that in the CT group 73.71%(129/175) vs. 62.29%(199/175), there was statistical difference ( χ2 = 5.25, P<0.05). Conclusions:Minimally invasive catheterization based on 3D-Slicer software system in the treatment of HICH can not only improve the clinical efficacy, but also shorten the hospitalization time, reduce intraoperative blood loss, and improve the prognosis.

Antithrombotic therapy resumption after intracranial hemorrhage / 中华神经科杂志

Patients with intracranial hemorrhage and indications of antithrombotic therapy are common in clinical practice. However, whether and when to start anticoagulant or antiplatelet therapy after intracranial hemorrhage are still debatable. Clinicians are posed with huge challenges without available guidelines. Through reviewing relevant literature, this article analyzed the risks of thromboembolism and hemorrhage recurrence after initiation of anticoagulant or antiplatelet therapy in patients with intracranial hemorrhage due to various etiologies. This article also presented the initiation time and specific antithrombotic plan in current clinical practice, aiming to propose references for clinicians.

Neonatal hydrocephalus: single-center 10-year experiences / 中国新生儿科杂志

Objective:To study the past 10 years' experiences of neonatal hydrocephalus in a single-center.Methods:From January 2010 to December 2019, clinical data of infants with hydrocephalus admitted to Neonatology Department of our hospital were retrospectively analyzed. The infants were assigned into different groups according to gestational age, different etiologies and treatments. Their clinical characteristics and outcomes were compared.Results:A total of 223 infants with hydrocephalus were included. 136 (61.0%) infants were in the preterm group and 87 (39.0%) in the full-term group. The incidence of post-intracranial hemorrhage (ICH) hydrocephalus in preterm infants was significantly higher than full-term infants ( P<0.001). According to the etiologies, 58 infants (26.0%) had congenital hydrocephalus (congenital group), 82 cases (36.8%) developed post-ICH hydrocephalus (ICH group), 48 cases (21.5%) had post-CNS-infection hydrocephalus (infection group) and 35 cases (15.7%) had post-ICH+CNS-infection hydrocephalus (ICH+infection group). The incidences of perinatal asphyxia, neonatal resuscitation and endotracheal intubation within 3 d after birth in the ICH group were significantly higher than the other groups ( P<0.05). Among the four groups, the infection group had the highest incidence of neonatal sepsis, the congenital group had the highest incidence of patent ductus arteriosus and the ICH group had the highest incidence of respiratory diseases (all P<0.05).137 cases (61.4%) received non-surgical therapy, 48 cases (21.5%) had temporary drainage, 37 cases (16.6%) with permanent shunt and 1 case (0.4%) intracranial hematoma removal. The congenital group and ICH group with permanent shunt showed significantly higher rate of improvement than temporary drainage group and non-surgical group ( P<0.001). Conclusions:The main etiologies of neonatal hydrocephalus are ICH and CNS infection. The incidence of post-ICH hydrocephalus in premature infants was quite high. Hydrocephalus of different etiologies have different comorbidities. Maternal and infant care during pregnancy and delivery, prevention of neonatal sepsis and ICH are crucial in the prevention of hydrocephalus. More studies are needed for better treatment.

Analysis of the efficacy of 3D printing-assisted hematoma puncture and drainage in the treatment of hypertensive intracerebral hemorrhage and the factors of postoperative brain dysfunction / 国际外科学杂志

Objective:To observe the efficacy of 3D printing-assisted hematoma puncture and drainage in the treatment of hypertensive intracerebral hemorrhage and to explore the factors affecting postoperative brain dysfunction.Methods:A retrospective Case-control study was conducted to select 168 hypertensive intracerebral hemorrhage patients who were treated with 3D printing assisted hematoma puncture and drainage in the People′s Hospital of Yuechi County from January 2020 to September 2022 as the observation group, and 125 hypertensive intracerebral hemorrhage patients who were treated with CT guided hematoma puncture and drainage in the People′s Hospital of Yuechi County at the same time as the control group. The clinical efficacy of the two groups of patients was compared. According to the occurrence of postoperative brain dysfunction, the patients in the observation group were divided into normal brain function group ( n=121) and brain dysfunction group ( n=47). The clinical data of age, preoperative cerebral hernia, blood loss, ventilator-assisted ventilation, postoperative Glasgow coma index score (GCS) and postoperative complications were compared between the two groups. Multivariate Logistic regression was used to analyze the factors affecting postoperative brain dysfunction in the observation group, and a line chart model was constructed and its predictive efficiency was evaluated. The measurement data of normal distribution is expressed as mean ± standard deviation ( ± s), and independent sample t-test is used for inter group comparison. Chi-square test was used for comparison between count data groups. Results:The proportion of the drainage tube in the hematoma, hematoma clearance rate at 3 and 7 days after surgery, total effective rate of treatment, and GCS score at 1 week after surgery in the observation group were 88.69%(149/168), 54.17%(91/168), 96.43%(162/168), 92.86%(156/168), and 10.72±3.45, respectively, the control group was 75.20%(94/125), 36.80%(46/125), 81.60%(102/125), 76.80%(96/125), and 9.08±3.22, respectively, the difference between the two groups was statistically significant ( P<0.05). Advanced age ( OR=1.983, 95% CI: 1.169-2.732, P=0.017), preoperative cerebral hernia ( OR=1.532, 95% CI: 1.113-2.139, P=0.029), bleeding volume ≥ 50 mL ( OR=2.538, 95% CI: 1.802-3.347, P=0.003), postoperative GCS score 3-5 ( OR=2.874, 95% CI: 2.265-3.449, P<0.001), postoperative hypoxemia ( OR=2.251, 95% CI: 1.673-2.842, P=0.010) and postoperative chronic hydrocephalus ( OR=1.642, 95% CI: 1.214-2.021, P=0.022) were risk factors for postoperative brain dysfunction, while ventilator-assisted ventilation ( OR=0.656, 95% CI: 0.132-0.828, P=0.038) was protective factors. The internal verification of the line chart model by Bootstrap resampling method shows that the model has high differentiation, accuracy and validity. Conclusion:The application of 3D printing-assisted localization in hematoma puncture and drainage can improve the puncture condition and the hematoma clearance rate and clinical effect of patients with hypertensive intracerebral hemorrhage. Advanced age, preoperative cerebral hernia and bleeding volume are related to postoperative brain dysfunction. Clinical attention should be paid to patients with risk indicators of postoperative brain dysfunction.

Nuevos paradigmas: 12 años de trombólisis sistémica. Unidad ACV, Hospital de Clínicas / New paradigms: 12 years of systemic thrombolysis. Stroke Unit, Clinicas Hospital / Novos paradigmas: 12 anos de trombólise sistêmica. Unidade AVC, Hospital de Clínicas

Introducción: el ACV constituye un problema de salud y la trombólisis sistémica una estrategia de reperfusión con alto nivel de evidencia para su tratamiento. Los reportes nacionales sobre su utilización son escasos. Objetivos: comunicar y analizar los resultados de esta terapia en el Hospital de Clínicas. Establecer predictores de buena evolución, hemorragia intracraneana y mortalidad. Métodos: estudio observacional analítico de los pacientes trombolizados en el Hospital de Clínicas (2010-2021). Resultados: se realizó trombólisis sistémica a 268 pacientes. La mediana del NIHSS al ingreso fue 12 puntos. Un 42% fueron infartos totales de la circulación anterior. La cardioembolia constituyó la etiopatogenia más frecuente. El 59,3% de los pacientes fueron externalizados con independencia funcional y 55,2% con déficit neurológico mínimo. Las tasas de hemorragia intracraneana sintomática y mortalidad fueron 7,1% y 18,7% respectivamente. El 57% de los pacientes se trataron con tiempo puerta aguja ≤60 minutos. El porcentaje de trombólisis en el total de ACV fue 18,9%. La edad, NIHSS al ingreso e internación en unidad de ACV se comportaron como variables importantes para predecir buena evolución, hemorragia intracraneana y muerte. Discusión y conclusiones: se comunicó la mayor casuística nacional sobre el tema. Los parámetros de efectividad y seguridad del tratamiento fueron comparables a los reportados internacionalmente. Se destacaron los buenos tiempos puerta aguja y tasa trombólisis sobre ACV totales como indicadores satisfactorios de calidad asistencial. La internación en unidad de ACV se comportó como un factor predictor de independencia funcional y protector frente a mortalidad hospitalaria.

Introduction: Strokes are a health problem and systemic thrombolysis constitutes a reperfusion strategy backed up by significant evidence on its positive therapeutic impact. National reports on its use are scarce. Objectives: To report and analyze results obtained with this therapeutic approach at the Clinicas Hospital. To establish predictive factors for a good evolution, intracranial hemorrhage and mortality. Method: Observational, analytical study of thrombolysed patients at Clinicas Hospital (2010-2021). Results: Systemic thrombolysis was performed in 268 patients. Average NIHSS score was 12 points when admitted to hospital.42 % of cases were total anterior circulation infarct (TACI). Cardioembolic ischaemmic stroke was the most frequent etiopahogenesis. 59.3% of patients were discharged with functional independence and 55.2% had minimal neurologic deficit. Symptomatic intracranial hemorrhage and mortality rates were 7.1% and 18.7% respectively. 57% of patients were assisted within ≤60 minutes they showed up at the ER. Thrombolysis percentage in total number of strokes was 18.9%. Age, NIHSS score upon arrival to hospital and admission to the stroke unit were significant variables to predict a good evolution, intracranial hemorrhage and death. Discussion and conclusions: The large number of cases in the country was reported. Effectiveness and safety parameters for this treatment were comparable to those reported internationally. The good door-to-needle time and thrombolysis rate versus total number of strokes stood out as satisfactory indicators of healthcare quality. Admission to the stroke unit behaved as a predictive factor of functional independence and it protected patients from hospital mortality.

Introdução: o AVC é um problema de saúde sendo a trombólise sistêmica uma estratégia de reperfusão com alto nível de evidência para seu tratamento. Os dados nacionais sobre seu uso são escassos. Objetivos: comunicar e analisar os resultados desta terapia no Hospital de Clínicas. Estabelecer preditores de boa evolução, hemorragia intracraniana e mortalidade. Métodos: estudo observacional analítico de pacientes trombolisados no Hospital de Clínicas (2010-2021). Resultados: a trombólise sistêmica foi realizada em 268 pacientes. A mediana do índice NIHSS na admissão foi de 12 pontos. 42% eram infartos totais da circulação anterior. A cardioembolia foi a etiopatogenia mais frequente. 59,3% dos pacientes tiveram alta da unidade com independência funcional e 55,2% com déficit neurológico mínimo. As taxas de hemorragia intracraniana sintomática e mortalidade foram de 7,1% e 18,7%, respectivamente. 57% dos pacientes foram tratados com tempo porta-agulha ≤60 minutos. A porcentagem de trombólise no AVC total foi de 18,9%. Idade, NIHSS na admissão e internação na unidade de AVC se comportaram como variáveis importantes para prever boa evolução, hemorragia intracraniana e óbito. Discussão e conclusões: este trabajo inclui a maior casuística nacional sobre o tema. Os parâmetros de eficácia e segurança do tratamento foram comparáveis aos descritos na bibliografia internacional. Foram destacados como indicadores satisfatórios da qualidade do atendimento os bons tempos porta-agulha e taxa de trombólise em relação ao AVC total. A internação em unidade de AVC comportou-se como preditor de independência funcional e protetor contra a mortalidade hospitalar.

Efficacy of bedside gastric ultrasound in guiding enteral nutrition therapy in patients with spontaneous cerebral hemorrhage / 中华麻醉学杂志

Objective:To evaluate the efficacy of bedside gastric ultrasound in guiding enteral nutrition therapy in the patients with spontaneous cerebral hemorrhage.Methods:Sixty-one patients with spontaneous intracerebral hemorrhage in the intensive care unit (ICU) of our hospital, aged 18-60 yr, with the European malnutrition risk screening score in 2002 was ≥ 3, who could not eat orally, were selected.All patients received decompression or aneurysm clipping under general anesthesia.Patients were divided into 2 groups using a random number table method: control group ( n=30) and ultrasound group ( n=31). Nutrient infusion pump was used to infuse standard whole protein formula enteral nutrition continuously through a nasogastric tube.In control group, gastric residual volume, residual traits and bowel sounds were evaluated according to gastric drainage to start or adjust enteral nutrition treatment.In ultrasound group, the antral motility index and gastric residual volume were monitored by the modified antral single section method under ultrasound to start or adjust enteral nutrition treatment.The starting time of enteral nutrition, time to reach the target feeding amount, rate of reaching the target feeding standard within 96 h, interruption of enteral nutrition, duration of hospitalization in ICU, and occurrence of intraperitoneal hypertension, aspiration, diarrhea, gastrointestinal bleeding and new pulmonary infection during enteral nutrition therapy were recorded. Results:Compared with control group, the initiation time of enteral nutrition and time to reach the target feeding amount were significantly shortened, the interruption rate of enteral nutrition was decreased, the rate of reaching the target feeding standard within 96 h was increased, the incidence of aspiration and new pulmonary infection was decreased ( P<0.05), and no significant change was found in the duration of hospitalization in ICU and incidence of intraperitoneal hypertension, diarrhea and upper gastrointestinal bleeding in ultrasound group ( P>0.05). Conclusions:Bedside gastric ultrasound-guided enteral nutrition therapy can improve the therapeutic effect with higher safety in the patients with spontaneous intracerebral hemorrhage.

Comparison of two surgical treatments for hypertensive basal ganglia hemorrhage / 中国基层医药

Objective:To investigate the efficacy of minimally invasive puncture and drainage versus small bone window craniotomy in the treatment of hypertensive basal ganglia hemorrhage. Methods:Seventy-three patients with hypertensive basal ganglia hemorrhage who received treatment in Hequ County People's Hospital from April 2018 to December 2020 were included in this study. They were divided into a minimally invasive puncture and drainage group ( n = 38) and a small bone window craniotomy group ( n = 35) according to surgical methods. Clinical efficacy and postoperative complications were compared between the two groups. Results:At 3 months post-surgery, the National Institutes of Health Stroke Scale score in the minimally invasive puncture and drainage group was significantly lower than that in the small bone window craniotomy group [(3.58 ± 1.23) points vs. (6.87 ± 0.97) points, t = 12.62, P < 0.001]. Barthel index in the minimally invasive puncture and drainage group was significantly higher than that in the small bone window craniotomy group [(62.15 ± 6.78) points vs. (43.15 ± 7.15) points, t = 11.65, P < 0.001]. The total response rate in the minimally invasive puncture and drainage group was significantly higher than that in the small bone window craniotomy group [92.11% (35/38) vs. 74.3% (26/35), χ2 = 4.21, P < 0.05]. The incidence of complications in the minimally invasive puncture and drainage group was significantly lower than that in the small bone window craniotomy group [5.2% (2/38) vs. 25.7% (9/35), χ2 = 6.18, P < 0.05]. Conclusion:Minimally invasive puncture and drainage have better clinical efficacy and fewer postoperative complications in the treatment of hypertensive basal ganglia hemorrhage than small bone window craniotomy. Therefore, minimally invasive puncture and drainage for the treatment of hypertensive basal ganglia hemorrhage are worthy of clinical promotion.

Treatment of a moderate volume of hypertensive intracerebral hemorrhage in the basal ganglia by 3D printed guide plate-assisted hematoma puncture and catheter drainage / 中国基层医药

Objective:To investigate the clinical efficacy of 3D printed guide plate-assisted hematoma puncture and catheter drainage in the treatment of a moderate volume of hypertensive intracerebral hemorrhage in the basal ganglia.Methods:The clinical data of 42 patients with a moderate volume of hypertensive intracerebral hemorrhage in the basal ganglia who received treatment with 3D printed guide plate-assisted hematoma puncture and catheter drainage in Dazhu Hospital of North Sichuan Medical College from January 2016 to January 2021 were retrospectively analyzed. In the traditional puncture group, there were 19 patients who received traditional punctures according to preoperative cranial CT findings (traditional puncture group). In the 3D printed guide plate puncture group, there were 23 patients who received hematoma puncture and catheter drainage assisted by a 3D printed guide plate. Preoperative preparation time (from admission to operation), operative time, the number of hematoma punctures, hematoma clearance rate, postoperative indwelling time of drainage tube, residual hematoma rate, the occurrence of puncture canal bleeding, intracranial infection, Glasgow Coma Scale score measured at 3 and 7 days after surgery, and Glasgow Outcome Scale score measured at 1, 3 and 6 months after surgery were compared between the two groups.Results:There were no significant differences in preoperative preparation time and operative time between the two groups ( t = 0.25, 0.40, both P > 0.05). 3D-printed guide plate-assisted hematoma puncture reduced the probability of reveiving one more hematoma puncture during the surgery. There was no significant difference in the number of hematoma puncture between the two groups ( χ2= 0.48, P > 0.05). There were no significant differences in the probabilities of puncture canal bleeding and intracranial infection between the two groups ( χ2 = 0.05, 0.03, both P > 0.05). Postoperative indwelling time of the drainage tube in the 3D printed guide plate puncture group was significantly shorter than that in the traditional puncture group [(3.10 ± 0.38) vs. (3.46 ± 0.52) days, t = 2.65, P < 0.05]. The residual hematoma rate in the 3D printed guide plate puncture group was significantly lower than that in the traditional puncture group [(32.04 ± 5.33)% vs. (37.37 ± 5.51)%, χ2 = 3.20, P < 0.05]. There were significant differences in Glasgow Coma Scale score measured at 3 and 7 days after surgery between the two groups [(12.04 ± 1.19) points vs. (11.26 ± 0.93) points, (13.65 ± 0.88) points vs. (12.94 ± 0.97) points, t = 2.33, 2.46, both P < 0.05]. Glasgow Outcome Scale score measured at 1, 3, and 6 months after surgery in the 3D printed guide plate puncture group was 18, 21, and 22 points, respectively, which was significantly higher than 9, 11, and 12 points in the traditional puncture group ( χ2 = 4.34, 4.69, 5.17, all P < 0.05). Conclusion:3D printed guide plate assisted hematoma puncture and catheter drainage for treatment of a moderate volume of hypertensive intracerebral hemorrhage in the basal ganglia can increase the accuracy of puncture, decrease hematoma residual rate, improve short- and long-term prognosis, does not prolong preoperative preparation time. Moreover, it costs low, is safe, and is easy to learn.

Efficacy of different surgical treatments for hypertensive cerebral hemorrhage in older adult patients and their effects on traumatic stress and cerebral edema / 中国基层医药

Objective:To investigate the efficacy of different surgical treatments for hypertensive cerebral hemorrhage in older adult patients and their effects on traumatic stress and cerebral edema.Methods:A total of 100 older adult patients with hypertensive cerebral hemorrhage who received treatment in Zhejiang Xin'an International Hospital from January 2018 to June 2020 were included in this study. They underwent either craniotomy (craniotomy group, n = 50) or hard channel minimally invasive puncture drainage (minimally invasive puncture group, n = 50) according to the willingness of patients and their close relatives. Perioperative indexes, Barthel index after treatment, nerve injury indexes before and after treatment, prognosis related indexes, trauma stress indexes and brain edema were compared between the two groups. Results:Operative time, intraoperative blood loss and postoperative hospital stay in the craniotomy group were (147.21 ± 31.35) minutes, (289.74 ± 22.75) mL and (42.74 ± 6.82 ) days, respectively, which were significantly longer or greater than (41.88 ± 7.19) minutes, (4.62 ± 0.88) mL and (16.27 ± 4.02) days in the minimally invasive puncture group ( t = 38.73, 62.17, 23.17, all P < 0.001). Barthel index at 1 and 3 months after treatment in the minimally invasive puncture group was (63.11± 9.64) and (93.51 ± 11.38), respectively, which was significantly greater than (44.78 ± 8.85) and (81.29 ± 10.37) in the craniotomy group ( t = 3.17, 6.21, both P < 0.05). Before treatment, there were no significant differences in nerve injury index, prognosis index, trauma stress index and brain edema between the two groups (all P > 0.05). At different time points after treatment, each indicator in the minimally invasive puncture group was significantly superior to that in the craniotomy group (all P < 0.05). Conclusion:Hard channel minimally invasive puncture drainage exhibits advantages over traditional craniotomy in the treatment of hypertensive cerebral hemorrhage in older adult patients. Hard channel minimally invasive puncture drainage can more greatly reduce injury to brain tissue, better control nerve injury and brain edema, and more remarkably improve patient's quality of life than traditional craniotomy.

Application experience of ventricular intracranial pressure monitoring in the treatment of traumatic multiple intracranial hematoma / 中国医师进修杂志

Objective:To investigate the significance of ventricular intracranial pressure monitoring in the treatment of traumatic multiple intracranial hematoma (TMIH).Methods:The clinical data of 14 TMIH patients treated with ventricular intracranial pressure monitoring from January 2016 to August 2021 in Beijing Luhe Hospital, Capital Medical University were analyzed retrospectively. The patients were followed up 6 months after injury, and the Glasgow outcome score (GOS) was assessed.Results:All the 14 patients successfully completed ventricular intracranial pressure probe placement. Among them, 8 patients recovered well after continuous monitoring of ventricular intracranial pressure and continuous cerebrospinal fluid drainage. Their ventricular intracranial pressure probe was placed for 5 to 10 (7.3 ± 2.2) d, with no intracranial infection occurred; and their GOS was 5 scores 6-month follow-up after injury. Six cases underwent craniotomy for hematoma removal due to the expansion of intracranial hematoma or aggravation of edema, and decompressive craniectomy was performed during the operation; 6-month follow-up after injury, GOS of 5 scores was in 3 cases, 4 scores in 2 cases, 3 scores in 1 case.Conclusions:The condition of TMIH patients is complex and changeable, and ventricular intracranial pressure monitoring can improve the prognosis of TMIH patients.

Postinterventional cerebral hyperdensities Alberta Stroke Program Early CT Score predicts symptomatic intracranial hemorrhage in patients with ischemic stroke / 国际脑血管病杂志

Objective:To evaluate the distribution characteristics of postinterventional cerebral hyperdensities (PCHDs) in patients with acute anterior circulation large vessel occlusive stroke after interventional therapy using the Alberta Stroke Program Early CT Score (ASPECTS) and to investigate its predictive value for symptomatic intracranial hemorrhage (sICH).Methods:Consecutive patients with acute anterior circulation large vessel occlusive stroke underwent endovascular mechanical thrombectomy (EMT) in the Stroke Center of Dongguan People's Hospital from January 2018 to December 2020 were retrospectively enrolled. The clinical, imaging and follow-up data were collected. The immediate PCHDs-ASPECTS after endovascular therapy were analyzed. Multivariate logistic regression analysis and receiver operator characteristic (ROC) curve were used to investigate its predictive value for sICH. Results:A total of 161 patients were enrolled in the study, including 115 males (71.4%). The baseline National Institutes of Health Stroke Scale (NIHSS) score was 13.6±5.6; 66 patients (41.0%) developed PCHDs and 35 (21.7%) had sICH. The baseline NIHSS score, the proportion of patients with severe stroke, the number of retrieval attempts and the detection rate of PCHDs in the sICH group were significantly higher than those in the non-sICH group, while diffusion weighted imaging-ASPECTS and PCHDs-ASPECTS were significantly lower than those in the non-sICH group (all P<0.05). Multivariate logistic regression analysis showed that PCHDs had a significant independent positive correlation with sICH (odds ratio 6.036, 95% confidence interval 1.45-25.123; P=0.013), and PCHDs-ASPECTS had a significant independent negative correlation with sICH (odds ratio 0.70, 95% confidence interval 0.496-0.992; P=0.045). ROC analysis showed that the area under the curve predicted by PCHDs-ASPECTS was 0.832 ( P<0.05). When its cut-off value was 8 points, the sensitivity and specificity were 74.3% and 83.3% respectively. Conclusions:In patients with acute anterior circulation large vessel occlusive stroke treated with EMT, the immediate postoperative PCHDs is an independent predictor of sICH, and PCHDs-ASPECTS can early predict the risk of sICH after EMT.

The effect of drilling and drainage based on spiral CT-guided on hematoma clearance and serum inflammatory factors levels in patients with basal ganglia region hypertensive cerebral hemorrhage / 中国医师进修杂志

Objective:To investigate the effect of drilling and drainage based on spiral CT-guided on hematoma clearance and serum inflammatory factors levels in patients with basal ganglia region hypertensive cerebral hemorrhage.Methods:A total of 112 patients with basal ganglia region hypertensive cerebral hemorrhage admitted to Lanling County People′s Hospital from May 2017 to February 2020 were selected as the research objects, and 56 patients performed traditional craniotomy(craniotomy group), and 56 patients used spinal CT to locate the hematoma area and puncture point before the surgery, and performed drilling and drainage according the scanning results (drilling group). The operation conditions, hematoma volume changes and hematoma clearance rate in two groups were compared. The levels of neuron-specific enolase (NSE), specific protein S100B, interleukin(IL)-17, IL-1β and C-reactive protein (CRP) in two groups before and after the treatment for 1 month were compared. The scores of National Institute of Health Stroke Scale (NIHSS) and Barthel Index Scale(BI) in two groups before and after the treatment for 3 months were compared.Results:The operative time, intraoperative blood loss, postoperative drainage volume in the drilling group were lower than those in the craniotomy group: (1.21 ± 0.28) h vs. (2.43 ± 0.37) h, (131.98 ± 39.51) ml vs. (231.64 ± 47.65) ml, (41.05 ± 5.68) ml vs. (62.93 ± 7.83) ml; the hematoma clearance rate in the drilling group was higher than that in the craniotomy group: (89.57 ± 6.15)% vs. (77.95 ± 5.92)%, there were statistical differences ( P<0.05). After treatment for 1 month, the levels of S100B, NES, IL-17, IL-1β, CRP in the drilling group were lower than those in the craniotomy group: (0.49 ± 0.18) μg/L vs. (0.67 ± 0.24) μg/L, (15.32 ± 1.67) μg/L vs. (17.61 ± 1.59) μg/L, (147.38 ± 14.86) ng/L vs. (172.59 ± 12.94) ng/L, (84.17 ± 10.48) ng/L vs. (107.43 ± 9.35) ng/L, (33.78 ± 4.77) mg/L vs. (47.01 ± 4.15) mg/L, there were statistical differences ( P<0.05). After treatment for 3 months, the scores of NIHSS in the drilling group was lower than that in the craniotomy group and the scores of BI in thedrilling group was higher than that in the craniotomy group: (3.57 ± 2.13) scores vs. (7.83 ± 2.96) scores, (84.56 ± 8.16) scores vs. (67.43 ± 6.95) scores, there were statistical differences ( P<0.05). The complication rate in the two groups had no statistically differences ( P>0.05). Conclusions:Compared with traditional craniotomy, the drilling and drainage based on spiral CT-guided on hematoma clearance has the advantages of shorter operation time, less injury, better regulation of inflammation and better improvement of neurological function.

Diagnostic accuracy of a near-infrared spectroscopy device for detecting intracranial hemorrhage in mild closed traumatic brain injury at a Philippine Trauma Center

OBJECTIVE@#This study aimed to evaluate the sensitivity, specificity, positive predictive value, negative predictive value, positive likelihood ratio, and negative likelihood ratio of a handheld Near Infrared Spectroscopy (NIRS) device (Infrascanner 2000®) in detecting intracranial hemorrhage in mild, closed traumatic brain injury patients in the emergency room setting.@*METHODS@#This prospective study evaluated the diagnostic validity of a NIRS device in hemodynamically stable patients with mild, closed traumatic brain injury. The authors included patients aged 15 to 65 years who were consecutively admitted to the Emergency Department of the Philippine General Hospital from June 2017 to September 2017. Patients were scanned by a trained research assistant with the NIRS device in the frontal, temporal, parietal, and occipital areas of the brain bilaterally. A cranial computed tomography scan was used as a reference standard for comparison.@*RESULTS@#A total of 83 participants with mild, closed traumatic brain injury were included in the final analysis. There were 68 (82%) males, and the mean age was 29.52 years old. Of the 83 participants, 41 had intracranial hemorrhages (23 subdural, 13 epidural, 5 intraprenchymal). The NIRS device exhibited a sensitivity, 85.37% [55-96.19%]; specificity, 92.86% [85.07-100.00%]; PPV, 92.12% [83.53-100.00%]; NPV, 86.67% [76.74-96.60%]; PLR, 11.96 [3.99- 35.82]; and NLR, 0.16 [0.07-0.33].@*CONCLUSION@#The NIRS device can reliably screen for hemorrhages in patients with mild, closed traumatic brain injury using CT scan results as the gold standard. These diagnostic values suggest the potential role of the NIRS device in the early evaluation of patients with traumatic brain injury requiring urgent care.

Performance of low-dose CT image reconstruction for detecting intracerebral hemorrhage: selection of dose, algorithms and their combinations / 南方医科大学学报

OBJECTIVE@#To investigate the performance of different low-dose CT image reconstruction algorithms for detecting intracerebral hemorrhage.@*METHODS@#Low-dose CT imaging simulation was performed on CT images of intracerebral hemorrhage at 30%, 25% and 20% of normal dose level (defined as 100% dose). Seven algorithms were tested to reconstruct low-dose CT images for noise suppression, including filtered back projection algorithm (FBP), penalized weighted least squares-total variation (PWLS-TV), non-local mean filter (NLM), block matching 3D (BM3D), residual encoding-decoding convolutional neural network (REDCNN), the FBP convolutional neural network (FBPConvNet) and image restoration iterative residual convolutional network (IRLNet). A deep learning-based model (CNN-LSTM) was used to detect intracerebral hemorrhage on normal dose CT images and low-dose CT images reconstructed using the 7 algorithms. The performance of different reconstruction algorithms for detecting intracerebral hemorrhage was evaluated by comparing the results between normal dose CT images and low-dose CT images.@*RESULTS@#At different dose levels, the low-dose CT images reconstructed by FBP had accuracies of detecting intracerebral hemorrhage of 82.21%, 74.61% and 65.55% at 30%, 25% and 20% dose levels, respectively. At the same dose level (30% dose), the images reconstructed by FBP, PWLS-TV, NLM, BM3D, REDCNN, FBPConvNet and IRLNet algorithms had accuracies for detecting intracerebral hemorrhage of 82.21%, 86.80%, 89.37%, 81.43%, 90.05%, 90.72% and 93.51%, respectively. The images reconstructed by IRLNet at 30%, 25% and 20% dose levels had accuracies for detecting intracerebral hemorrhage of 93.51%, 93.51% and 93.06%, respectively.@*CONCLUSION@#The performance of reconstructed low-dose CT images for detecting intracerebral hemorrhage is significantly affected by both dose and reconstruction algorithms. In clinical practice, choosing appropriate dose level and reconstruction algorithm can greatly reduce the radiation dose and ensure the detection performance of CT imaging for intracerebral hemorrhage.

Estratégias de Revascularização em Doentes com Infarto Agudo do Miocárdio em Choque Cardiogênico - Resultados do Registo Português de Síndromes Coronárias Agudas / Revascularization Strategies in Patients with Acute Myocardial Infarction and Cardiogenic Shock: Results from the Portuguese Registry on Acute Coronary Syndromes

Resumo Fundamento: Em doentes com infarto agudo do miocárdio (IAM), choque cardiogênico (CC) e doença multivaso (DMV) persistem dúvidas sobre a intervenção nas artérias não responsáveis. Objetivos: 1) caracterizar a amostra de doentes com IAM, CC e DMV incluídos no Registo Nacional Português de Síndromes Coronárias Agudas (RNSCA); 2) comparar os eventos associados a diferentes estratégias de revascularização; e 3) identificar preditores de mortalidade intra-hospitalar nesta amostra. Métodos: Estudo observacional retrospetivo de doentes com IAM, CC e DMV incluídos no RNSCA entre 2010 e 2018. Compararam-se duas estratégias de revascularização: completa durante o procedimento índice (grupo 1); e completa diferida ou incompleta durante o internamento (grupo 2-3). O endpoint primário foi a ocorrência de reinfarto ou morte intra-hospitalar. A significância estatística foi definida por um valor p < 0,05. Resultados: Identificaram-se 127 doentes com IAM, CC e DMV (18,1% no grupo 1 e 81,9% no grupo 2-3), com idade média de 70 ± 12 anos e 92,9% com IAM com supradesnivelamento do segmento ST. O endpoint primário ocorreu em 47,8% dos doentes do grupo 1 e em 37,5% do grupo 2-3 (p = 0,359). As taxas de mortalidade intra-hospitalar, reinfarto, acidente vascular cerebral e hemorragia major foram também semelhantes nos dois grupos. Os preditores de mortalidade intra-hospitalar nesta amostra foram a presença na admissão de disfunção ventricular esquerda (OR 16,8), bloqueio completo de ramo direito (OR 7,6) e anemia (OR 5,2), (p ≤ 0,02). Conclusões: Entre os doentes com IAM, CC e DMV, incluídos no RNSCA, não se verificou diferença significativa entre revascularização completa no evento índex e completa diferida ou incompleta durante o internamento, relativamente à ocorrência de morte intra-hospitalar ou reinfarto. (Arq Bras Cardiol. 2021; 116(5):867-876)

Abstract Background: In patients with acute myocardial infarction (MI), cardiogenic shock (CS), and multivessel disease (MVD) questions remain unanswered when it comes to intervention on non-culprit arteries. Objective: This article aims to 1) characterize patients with MI, CS and MVD included in the Portuguese Registry on Acute Coronary Syndromes (ProACS); 2) compare different revascularization strategies in the sample; 3) identify predictors of in-hospital mortality among these patients. Methods: Observational retrospective study of patients with MI, CS and MVD included in the ProACS between 2010 and 2018. Two revascularization strategies were compared: complete during the index procedure (group 1); and complete or incomplete during the index hospitalization (groups 2-3). The primary endpoint was a composite of in-hospital death or MI. Statistical significance was defined by a p-value <0.05. Results: We identified 127 patients with MI, CS, and MVD (18.1% in group 1, and 81.9% in groups 2-3), with a mean age of 7012 years, and 92.9% of the sample being diagnosed with ST-segment elevation MI (STEMI). The primary endpoint occurred in 47.8% of the patients in group 1 and 37.5% in group 2-3 (p = 0.359). The rates of in-hospital death, recurrent MI, stroke, and major bleeding were also similar. The predictors of in-hospital death in this sample were the presence of left ventricle systolic dysfunction on admission (OR 16.8), right bundle branch block (OR 7.6), and anemia (OR 5.2) (p ≤ 0.02 for both). Conclusions: Among patients with MI, CS, and MVD included in the ProACS, there was no significant difference between complete and incomplete revascularization during the index hospitalization regarding the occurrence of in-hospital death or MI. (Arq Bras Cardiol. 2021; 116(5):867-876)