A scoring system categorizing risk factors to evaluate the need for ventriculoperitoneal shunt in pediatric patients after brain tumor resection.

Objectives: To develop a scoring system based on independent predictors of the need for ventriculoperitoneal (VP) shunt after brain tumor resection in pediatric patients. Methods: A total of 416 pediatric patients (≤ 14 years old) with brain tumors who underwent surgery were randomly assigned to the training (n = 333) and validation cohorts (n = 83). Based on the implementation of VP shunt, the training cohort was divided into the VP shunt group (n = 35) and the non-VP shunt group (n = 298). Univariate and multivariate logistic analyses were performed. A scoring system was developed based on clinical characteristics and operative data, and scores and corresponding risks were calculated. Results: Age < 3 (p = 0.010, odds ratio [OR] = 3.162), blood loss (BL) (p = 0.005, OR = 1.300), midline tumor location (p < 0.001, OR = 5.750), preoperative hydrocephalus (p = 0.001, OR = 7.044), and total resection (p = 0.025, OR = 0.284) were identified as independent predictors. The area under the curve (AUC) of the scoring system was higher than those of age < 3, BL, midline tumor location, preoperative hydrocephalus, and total resection (0.859 vs. 0.598, 0.717, 0.725, 0.705, and 0.555, respectively; p < 0.001). Furthermore, the scoring system showed good performance in the validation cohort (AUC = 0.971). The cutoff value for predictive scores was 5.5 points, which categorized patients into low risk (0-5 points) and high risk (6-14 points) groups. Conclusions: Our scoring system, integrating age < 3, BL, midline tumor location, preoperative hydrocephalus, and total resection, provides a practical evaluation. Scores ranging from 6 to 14 points indicate high risk.

A method for evaluating the safety of freeway tunnel sections based on driving comfort - a naturalistic driving study.

OBJECTIVE: Driving comfort is crucial for tunnel safety because tunnel sections on freeways often introduce significant environmental changes that can compromise comfort and increase the risk of traffic accidents. This study aimed to quantitatively evaluate the driving comfort in tunnel sections and its implications for safety management. METHODS: Four indicators were used to assess the driving comfort: heart rate growth rate (Hrgr), skin conductance response (SCR), speed, and acceleration. The CRITIC weighting method was employed to calculate a quantitative driving comfort score, and the presence and severity of discomfort were used to evaluate the safety of each tunnel area. In addition, the evaluation was based on a naturalistic test consisting of Hrgr, SCR, speed, and acceleration data. A total of 32 participants were recruited based on a web-based questionnaire screening process, after which they were tested while driving through 30 tunnel sections on the roadway. These 30 tunnels included 14 short (< 500 m), 12 medium (500-1,000 m), and 4 long (1,000-3,000 m) tunnels. RESULTS: The results revealed that the four selected indicators exhibited minimal multicollinearity and effectively captured the driving comfort. Among the indicators, SCR had the most significant contribution to the driving comfort score. Most drivers did not experience substantial discomfort while driving through tunnels. The area where drivers were most susceptible to discomfort was the middle zones of tunnels. However, drivers were more likely to experience strong discomfort in the outside exit, entrance, and middle zones of short, medium, and long tunnels, respectively. CONCLUSIONS: This study provides a comprehensive set of safety evaluation methods for tunnel sections on freeways, with a focus on quantifying the driving comfort. The findings provide theoretical support for freeway management personnel in implementing personalized controls in different tunnel areas with the aim of enhancing tunnel safety and mitigating the occurrence of traffic accidents.

Blood Loss in Operation Is Independently Predictive of Postoperative Ventriculoperitoneal Shunt in Pediatric Patients With Posterior Fossa Tumors.

BACKGROUND: To identify the risk factors for postoperative hydrocephalus and the need for ventriculoperitoneal (VP) shunt after posterior fossa tumor (PFT) resection in pediatric patients and establish a predictive model. METHODS: A total of 217 pediatric patients (≤14 years old) with PFTs who underwent tumor resection from November 2010 to December 2020 were divided into a VP shunt group (n = 29) and non-VP shunt group (n = 188). Univariate and multivariate logistic regression were performed. A predictive model was established based on the independent predictors. Receiver operating characteristic curves were generated to determine the cutoff values and areas under the curve (AUCs). The Delong test was performed to compare the AUCs. RESULTS: Age less than three years (P = 0.015, odds ratio [OR] = 3.760), blood loss (BL) (P = 0.002, OR = 1.601), and locations at fourth ventricle (P < 0.001, OR = 7.697) were the independent predictors. The predictive model was as follows: total score = age (<3; yes = 2, no = 0) + BL + tumor locations (fourth ventricle; yes = 5, no = 0). The AUC of our model was higher than those of age less than three years, BL, locations at the fourth ventricle, and compound factors (age <3 + locations) (0.842 vs 0.609, 0.734, 0.732, and 0.788, respectively). The cutoff values of the model and BL were 7.5 points and 2.75 U, respectively. CONCLUSIONS: BL, age less than three years, and tumors at the fourth ventricle were independent predictors. Model scores over 7.5 points predict a high risk.

Evaluating the effects of the route guidance variable message signs on driving behaviors-a driving simulation study.

OBJECTIVE: Route guidance variable message signs (VMS) are widely applied in traffic incident management on highways by providing real-time spatiotemporal guidance information. The improper panel of route guidance VMS is likely to diminish the compliance with guidance and induce risky driving behaviors, disrupting the traffic flow or even causing crashes. This article aims to investigate the effects of route guidance VMS on driving behaviors in three aspects, vehicle operation, visual perception, and route choice. METHODS: A driving simulation study with 32 participants was carried out to investigate the driving performance under four different VMS recognizing conditions: baseline (a typical guide sign) and three route guidance VMS panel schemes. RESULTS: Significant differences in average speed, speed fluctuation, average acceleration, and fixation proportion were found under various VMS recognition conditions. VMS3 had the least negative effects on vehicle operation and visual perception, and the compliance rate under VMS3 was the highest. The possible reasons are as follows: VMS3 has the simplified highway network structure and highlights the road directions with an eye-catching symbol, which can increase the comprehensibility of the guidance information while driving. CONCLUSIONS: Drivers need to take multiple actions under high-speed driving conditions while recognizing VMS, including reading the route guidance VMS, remaking route decisions, and operating the vehicle concurrently. Under such circumstances, the improper VMS panel would attract more drivers' attention and induce excessive risk compensatory behaviors, reducing drivers' compliance with guidance and situation awareness, and increasing crash risks. In addition, some VMS related traffic management strategies were proposed to improve safety and mobility of highways and further provide a basis for the formulation of related standards.

Clinical features and outcomes of pediatric intracranial gliomas: results from single center's 226 cases and corroborated with SEER database.

BACKGROUND: Pediatric gliomas are the most common central nervous system (CNS) tumors in children and adolescents and show different clinical and histopathological characteristics from the adult. The prognostic factors were poorly defined in pediatric intracranial gliomas. METHODS: We collected pediatric intracranial glioma cases in our institution between February 2011 and June 2022. The patient clinical data, tumor growth characteristics, treatments, and follow-up data were analyzed by Cox regression analysis to identify impact factors on the prognosis of pediatric intracranial glioma patients. To corroborate our data, an independent cohort of pediatric intracranial glioma from the Surveillance, Epidemiology, and End Results Program (SEER) database was analyzed. RESULTS: A total of 181 cases of pediatric low-grade glioma (PLGG) and 45 cases of pediatric high-grade glioma (PHGG) were included. In multivariate Cox regression analysis, tumor size > 59.5 mm (p = 0.006) and non-gross total resection (non-GTR; subtotal resection, STR, p = 0.042; biopsy, p = 0.012) were associated with decreased overall survival (OS) in PLGG patients. In PHGG patients, only chemotherapy (p = 0.023) was associated with OS while tumor size was marginally prognostic for OS (p = 0.051). Additional independent analysis of 2734 PLGG and 741 PHGG from the SEER database corroborated that larger tumor size was associated with decreased OS in LGG (p = 0.001) and HGG (p < 0.001) patients, separately. CONCLUSION: In this study, we found that tumor size was a significant prognostic factor for the OS of PLGG patients in our series. Besides the tumor size, the extent of resection also independently impacted the prognosis of PLGG patients. While in PHGG patients, only chemotherapy was associated with improved OS and tumor size was marginally prognostic.

TGFBI secreted by tumor-associated macrophages promotes glioblastoma stem cell-driven tumor growth via integrin αvß5-Src-Stat3 signaling.

Rationale: In the glioblastoma (GBM) microenvironment, tumor-associated macrophages (TAMs) are prominent components and facilitate tumor growth. The exact molecular mechanisms underlying TAMs' function in promoting glioma stem cells (GSCs) maintenance and tumor growth remain largely unknown. We found a candidate molecule, transforming growth factor beta-induced (TGFBI), that was specifically expressed by TAMs and extremely low in GBM and GSC cells, and meanwhile closely related to glioma WHO grades and patient prognosis. The exact mechanism of TGFBI linking TAM functions to GSC-driven tumor growth was explored. Methods: Western blot, quantitative real-time PCR (qRT-PCR), enzyme-linked immunosorbent assay (ELISA), immunofluorescence (IF), immunohistochemistry staining (IHC) and public datasets were used to evaluate TGFBI origin and level in GBM. The response of GSCs to recombinant human TGFBI was assessed in vitro and orthotopic xenografts were established to investigate the function and mechanism in vivo. Results: M2-like TAMs infiltration was elevated in high-grade gliomas. TGFBI was preferentially secreted by M2-like TAMs and associated with a poor prognosis for patients with GBM. TGFBI promoted the maintenance of GSCs and GBM malignant growth through integrin αvß5-Src-Stat3 signaling in vitro and in vivo. Of clinical relevance, TGFBI was enriched in the serum and CSF of GBM patients and significantly decreased after tumor resection. Conclusion: TAM-derived TGFBI promotes GSC-driven tumor growth through integrin αvß5-Src-Stat3 signaling. High serum or CSF TGFBI may serve as a potential diagnostic and prognostic bio-index for GBMs.

Driver operational level identification of driving risk and graded time-based alarm under near-crash conditions: A driving simulator study.

Rear-end collision and side collision are two types of accidents with the highest accident rate in the world. Numerous studies have focused on rear-end accident research, but only a few constructive countermeasures are put forward. Driving risk evolution at the driver operational level before an accident is critical to collision avoidance. This paper puts forward a driver operational level identification of driving risk and graded alarm under near-crash conditions. Firstly, driving simulation is utilized to acquire the operation data of SV (subjective vehicle) under the condition of emergent deceleration of LV (leading vehicle). The kinematic model is built to characterize the law of the risk discrimination indices of SV including THW (time headway), SHW (space headway) and TTCi (the reciprocal of time to collision). The predicted results are consistent with the naturalistic driving data. Secondly, the three-dimensional distribution 'speed-spacing-TTCi' is applied to classify the risky driving state of SV. The precarious distribution is concentrated at the area where relative velocity increased to 23-40 km/h and spacing decreased to 18-30 m. Finally, based on the reaction time and braking distance reduction, the optimal external intervention is determined to be the acousto-optic way by driving simulation. For moderate drivers, a three-level alarm of 2.94 s, 1.94 s and 1.1 s is calibrated considering different driving styles and cumulative frequency curve of reaction time.

Investigating Causal Relationships Between Psychiatric Traits and Intracranial Aneurysms: A Bi-directional Two-Sample Mendelian Randomization Study.

Background Despite psychiatric traits were associated with intracranial aneurysms (IAs) in observational studies, their causal relationships remain largely undefined. We aimed to assess the causality between psychiatric traits and IAs. Methods We firstly collected the genome-wide association statistics of IAs (sample size, n = 79,429) and ten psychiatric traits from Europeans, including insomnia (n = 1,331,010), mood instability (n = 363,705), anxiety disorder (n = 83,566), major depressive disorder (MDD) (n = 480,359), subjective wellbeing (n = 388,538), attention deficit/hyperactivity disorder (ADHD) (n = 53,293), autism spectrum disorder (ASD) (n = 46,350), bipolar disorder (BIP) (n = 51,710), schizophrenia (SCZ) (n = 105,318), and neuroticism (n = 168,105). We then conducted a series of bi-directional two-sample Mendelian randomization (MR) analyses, of which the Robust Adjusted Profile Score (RAPS) was the primary method to estimate the causal effects between these psychiatric traits and IAs. Results We found that insomnia exhibited a significant risk effect on IAs with the odds ratio (OR) being 1.22 (95% CI: 1.11-1.34, p = 4.61 × 10-5) from the RAPS method. There was suggestive evidence for risk effect of mood instability on IAs (RAPS, OR = 4.16, 95% CI: 1.02-17.00, p = 0.047). However, no clear evidence of causal effects on IAs for the rest eight psychiatric traits (anxiety disorder, MDD, subjective wellbeing, ADHD, ASD, BIP, SCZ, and neuroticism) was identified. In the reverse MR analyses, no causal effects of IAs on psychiatric traits were found. Conclusions Our findings provide strong evidence for a causal risk effect of insomnia on IAs and suggestive evidence for mood instability as a causal risk effect on IAs. These results could inform the prevention and clinical intervention of IAs.

Investigating the uniqueness of crash injury severity in freeway tunnels: A comparative study in Guizhou, China.

INTRODUCTION: With the rapid development of transportation infrastructures in precipitous areas, the mileage of freeway tunnels in China has been mounting during the past decade. Provided the semi-constrained space and the monotonous driving environment of freeway tunnels, safety concerns still remain. This study aims to investigate the uniqueness of the relationships between crash severity in freeway tunnels and various contributory factors. METHOD: The information of 10,081 crashes in the entire freeway network of Guizhou Province, China in 2018 is adopted, from which a subset of 591 crashes in tunnels is extracted. To address spatial variations across various road segments, a two-level binary logistic approach is applied to model crash severity in freeway tunnels. A similar model is also established for crash severity on general freeways as a benchmark. RESULTS: The uniqueness of crash severity in tunnels mainly includes three aspects: (a) the road-segment-level effects are quantifiable with the environmental factors for crash severity in tunnels, but only exist in the random effects for general freeways; (b) tunnel has a significantly higher propensity to cause severe injury in a crash than other locations of a freeway; and (c) different influential factors and levels of contributions are found to crash severity in tunnels compared with on general freeways. Factors including speed limit, tunnel length, truck involvement, rear-end crash, rainy and foggy weather and sequential crash have positive contributions to crash severity in freeway tunnels. Practical applications: Policy implications for traffic control and management are advised to improve traffic safety level in freeway tunnels.

Driving risk assessment using driving behavior data under continuous tunnel environment.

Objective: Driving behavior is the key feature for determining the nature of traffic stream qualities and reflecting the risk of operating environments. However, evaluating the driving risk accurately and practically in continuous tunnels (tunnels with a space more than 250 m and less than 1000 m) still faces severe challenges due to the complex driving conditions. The objective of this study is to predict the driving risk indicators and determine different risk levels.Methods: The naturalistic driving system equipped with a road environment and driving behavior data acquisition system combined with the fixed-point test method was used for data collection in 130 tunnels on four highways. A traditional AASHTO braking model and convex hull algorithm were adopted to predict the critical safety speed and the critical time headway of each risk feature point in tunnels. According to the risk constraints under free-flow, car-following and lane-changing conditions, the average traffic flow risk index (TFRI) representing six risk levels and the safety threshold of the corresponding risk indicators were determined.Results: The findings of this study revealed that the critical safety speed at nighttime is slower than in other daytime conditions in continuous tunnels. The time headway slightly changes under 90 km/h. As the speed continues to increase, speed has a significant influence on the critical time headway. The only reliable interaction involved the different adverse weather conditions on the mean critical safety speed in the continuous tunnels (short plus long) (F = 9.730, p＜0.05) and single long tunnels (F = 12.365, p＜0.05).Conclusions: It can be concluded that driving behaviors significantly vary in different tunnel risk feature points and the combined effect of high speed and luminance variation may result in high driving risk. The performance validation indicted that the risk assessment level determined by the proposed approach is consistent with the real safety situations. The study provides an effective and generally acceptable method for identifying driving risk criteria that can also be applied for traffic management and safety countermeasures with a view to possible implementation in continuous tunnels.