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The elbow joint is prone to stiffness and adhesion after trauma or surgery. High-energy trauma easily led to loss of mobility of the elbow joint. Mild trauma can also cause stiffness in the elbow joint. In order to investigate the pathogenesis of stiffness and adhesion in elbow joint, a feedback-type elbow joint control system based on network is proposed in this paper. The simulation results show that it has significant differences in elbow bioelectrical impedance in patients with elbow trauma, and this new method realizes the control strategy of converting the patient’s elbow joint pathological information into elbow joint orthosis control information.

With the improvement of the traditional Chinese medicine fumigation (TCMF), more and more people are studying lumbar intervertebral disc herniation (LIDH) by TCMF. In order to clarify the thermodynamic mechanism of TCMF to LIDH and provide a model reference for individualized diagnosis, the lower control system is compiled by the microprocessor, and the upper control system is compiled by computer technology of VB. In this new system, the medical information of patients is recorded in the databases by the upper control system, and clinical diagnosis and treatment experience are packaged in the lower control system. The simulation results and clinical examples show that the new control system of TCMF has better clinical efficacy for LIDH patients, which not only effectively improves the pain symptoms of LIDH patients but is also economical and safe.

With the advent of posttraumatic elbow rehabilitation, prevention of elbow stiffness has become a key part of the development of sports medicine. In order to clarify the time point of joint movement after internal fixation to the elbow and to provide a mechanical model for individualized diagnosis. This paper uses electromagnetic wave detection technology to quickly detect the bioelectrical impedance signal of the patient's lesion location, then passes the message to the upper control system for processing, summarizes the improved Hilbert–Huang transform to deep learning, and deep learning algorithms and computer technology are used to mine the bioelectrical impedance signal of the elbow joint. The simulation and human experiment results show that bioelectrical impedance signals can clarify the pathogenesis of elbow joint stiffness and the relationship between rehabilitation treatment time and duration. It has the advantages of low cost, high fitting accuracy, strong robustness, and noninvasiveness.

Online peer support is increasingly important to encourage patients with chronic diseases to engage in successful self-management. However, studies mainly focus on individual-level participation and have not fully explored how to maximize the impact of online peer support through group identification. In this study, we aim to build an online social identity-based group to examine the impact of group identity on peer support. Twenty-five participants who completed the first phase of a larger study were randomly assigned either to the treatment group (identity-based group level, n = 15, three subgroups, five members in each subgroup) or to the control group (individual-level, n = 10). All participants in both treatment and control groups received the same tasks and incentives. Peer support behavior (informational support and emotional support), task completion (knowledge learning, self-tracking behavior), and health-related outcomes (self-efficacy [SE] and HbA1c) were collected for qualitative and quantitative analysis. Results from a 3-month pilot experiment showed that the treatment group offered substantial enhancement in peer support compared to the control group. It also significantly promoted improvement in SE. However, there was no significant difference in task completion or changes in HbA1c between the two groups. The results of the content analysis suggest that having a team leader, timely responsiveness, and intergroup competition played important roles in building social identity-based online groups and subsequently generating peer support. We provide some encouraging results that indicate how online groups may be effectively designed to promote peer support.

ObjectiveAwake craniotomy with intraoperative brain functional mapping effectively reduces the potential risk of neurological deficits in patients with glioma invading the eloquent areas. However, glioma patients frequently present with impaired neurocognitive function. The present study aimed to investigate the neurocognitive and functional outcomes of glioma patients after awake brain mapping and assess the experience of a tertiary neurosurgical center in China over eight years.MethodsThis retrospective study included 80 patients who underwent awake brain mapping for gliomas invading the eloquent cortex between January 2013 and December 2021. Clinical and surgical factors, such as the extent of resection (EOR), perioperative Karnofsky Performance Score (KPS), progression-free survival (PFS), and overall survival (OS), were evaluated. We also used the Montreal Cognitive Assessment (MoCA) to assess the neurocognitive status changes.ResultsThe most frequently observed location of glioma was the frontal lobe (33/80, 41.25%), whereas the tumor primarily invaded the language-related cortex (36/80, 45%). Most patients had supratotal resection (11/80, 13.75%) and total resection (45/80, 56.25%). The median PFS was 43.2 months, and the median OS was 48.9 months in our cohort. The transient (less than seven days) neurological deficit rate was 17.5%, whereas the rate of persistent deficit (lasting for three months) was 15%. At three months of follow-up, most patients (72/80, 90%) had KPS scores > 80. Meanwhile, compared to the preoperative baseline tests, the changes in MoCA scores presented significant improvements at discharge and three months follow-up tests.ConclusionAwake brain mapping is a feasible and safe method for treating glioma invading the eloquent cortex, with the benefit of minimizing neurological deficits, increasing EOR, and extending survival time. The results of MoCA test indicated that brain mapping plays a critical role in preserving neurocognitive function during tumor resection.

Background Hyperbilirubinemia (HB) is a serious complication in aortic arch surgery, which is associated with acute kidney injury (AKI). The association between HB and chronic kidney disease (CKD) is unknown. The aim of this study was to investigate the impact of HB associated AKI on CKD after aortic arch surgery. Methods We reviewed 284 patients who underwent aortic arch surgery from 2016 to 2020 in our hospital. AKI was defined as a 50% increase in sCr from baseline value within the first 7 postoperative days. HB was defined as total bilirubin > 51.3 μmol/L. Patients were divided into 3 groups based on AKI and HB: HB associated AKI (HB-AKI) group (AKI patients suffered HB within the first 7 postoperative days); AKI without HB group and Non-AKI group. Results Follow-up for 204 patients ranged from 3 to 12 months. Kaplan–Meier analysis showed that the 1-year cumulative incidence of CKD was highest in HB-AKI (32.6%) than AKI without HB (17.8%) and Non-AKI (7.4%, log-rank test, p Conclusions Patients suffering HB associated AKI were at more increased odds of CKD than patients suffering AKI without HB after aortic arch surgery.

AimsTo investigate whether the relative signal intensity surrounding the residual cavity on T2-fluid-attenuated inversion recovery (rFLAIR) can improve the survival prediction of lower-grade glioma (LGG) patients.MethodsClinical and pathological data and the follow-up MR imaging of 144 patients with LGG were analyzed. We calculated rFLAIR with Image J software. Logistic analysis was used to explore the significant impact factors on progression-free survival (PFS) and overall survival (OS). Several models were set up to predict the survival prognosis of LGG.ResultsA higher rFLAIR [1.81 (0.83)] [median (IQR)] of non-enhancing regions surrounding the residual cavity was detected in the progressed group (n=77) than that [1.55 (0.33)] [median (IQR)] of the not-progressed group (n = 67) (P1.622) were independent predictors for poor PFS (PConclusionHigher rFALIR (>1.622) in non-enhancing regions surrounding the residual cavity can be used as a biomarker of the poor survival of LGG. rFLAIR is helpful to improve the survival prediction of posttreatment LGG patients.

Background: Female-initiated prevention products could reduce HIV infection rates in contexts with pronounced gender inequality like South Africa, but uptake and adherence remain low when available. Insights into the behavior of target consumers are needed to effectively promote these products; however, perceptions of stigma may discourage honest reporting. Focus of the Article: To address this need, we examined differences among the consumer journeys of six segments of South African adolescent girls and young women (AGYW), who vary on sexual health beliefs, sexual experience, and self-enhancement, when buying hygiene products. Research Question: We hypothesized that segments would differ in what motivated their purchases and in engagement with different touchpoints, reflecting a need for targeted outreach strategies. Methods: 1,500 low-income, Black South African AGYW (14–25 years of age) were surveyed face-to-face in their homes about their consumer journeys when purchasing deodorant and sanitary products, with the aim of extending the insights obtained to HIV prevention. Results: We found notable similarities across segments but also several important differences underscoring the potential for tailored marketing of HIV prevention products. Among some of the segments, differences were found in prepurchase mindsets and touchpoints, retail and brand drivers, and postpurchase feelings. Recommendations for Research or Practice: These findings highlight the need for tailored outreach among AGYW and may inform the design of effective, personalized marketing strategies that enhance the appeal of HIV prevention products. Limitations: To circumvent potential stigma associated with HIV, survey questions were anchored on personal hygiene products. While this may encourage greater honesty, findings may not fully generalize to HIV prevention products.

Secondary injury is the main cause of high mortality and poor prognosis of TBI, which has recently been suggested to be related to ferroptosis. Polydatin, a monocrystalline compound extracted from the rhizome of Polygonum, has been shown to exert potential neuroprotective effects. However, its role and mechanism in the secondary injury of TBI has not been elucidated. In this study, the inhibition of Polydatin on ferroptosis was observed both in the hemoglobin treated Neuro2A cells in vitro and in TBI mouse model in vivo, characterized by reversion of accumulation or deposition of free Fe2+, increased content of MDA, decreased activity of key REDOX enzyme GPx4, cell death and tissues loss. Although Polydatin corrected the increased mRNA levels of ferroptosis signaling molecules GPX4, SLC7A11, PTGS2, and ATP5G3 after TBI, TBI and Polydatin treatment had no significant effect on their protein expression. Notably, Polydatin could completely reverse the decrease of GPx4 activity after TBI in vivo and in vitro, and the effect was stronger than that of the classical ferroptosis inhibitor FER-1 in vitro. Further, Polydatin has been shown to reduce the severity of acute neurological impairment and significantly improve subacute motor dysfunction in TBI mice. Our findings provided translational insight into neuroprotection with Polydatin in TBI by inhibiting ferroptosis mainly depending on the maintenance of GPx4 activity.

Background: Hyperbilirubinemia (HB) is a serious complication in aortic arch surgery, which is associated with acute kidney injury (AKI). The association between HB and chronic kidney disease (CKD) is unknown. The aim of this study was to investigate the impact of HB associated AKI on CKD after aortic arch surgery.Methods: We reviewed 284 patients who underwent aortic arch surgery from 2016 to 2020 in our hospital. AKI was defined as a 50% increase in sCr from baseline value within the first 7 postoperative days. HB was defined as total bilirubin >51.3 μmol/L. Patients were divided into 3 groups based on AKI and HB: HB associated AKI (HB-AKI) group (AKI patients suffered HB within the first 7 postoperative days); AKI without HB group and Non-AKI group. Results: Follow-up for 204 patients ranged from 3 to 12 months. Kaplan–Meier analysis showed that the 1-year cumulative incidence of CKD was highest in HB-AKI (32.6%) than AKI without HB (17.8%) and Non-AKI (7.4%, log-rank test, pConclusions: Patients suffering HB associated AKI were at more increased odds of CKD than patients suffering AKI without HB after aortic arch surgery.

Objective The aim of this study was to establish a preoperative prediction method for sparsely granulated (SG) growth hormone (GH) secreting pituitary adenoma, an aggressive tumor subtype with high recurrence risk, in acromegaly patients. Methods Eighty-three patients with GH-secreting pituitary adenomas were included in this study. GH measurements, cytokeratin immunostaining and electron microscopy were performed to detect granulation patterns. Preoperative factors, including general, radiological and endocrinological features and acute octreotide suppression test outcomes, were compared between SG and densely granulated (DG) groups. The predictive capabilities of these features were analyzed using a receiver operating characteristic (ROC) curve, and the most predictive features were combined to establish a grading scale. Results Thirty-nine of the 83 patients had SG GH-secreting pituitary adenomas; 44 had DG tumors. SG tumors tended to occur in younger patients and have larger diameters and volumes, higher Knosp grades, lower GH indexes and normalized insulin-like growth factor-1 (IGF-1) levels, and a lower ∆GH% after octreotide treatment. The tumor size, Knosp grade, GH index and ∆GH% after octreotide treatment had good predictive performance, with area under the curve (AUC) values ranging from 0.70 to 0.80. Combining four parameters, including diameter, Knosp grade, GH index and ∆GH% after octreotide treatment, we established a grading scale for predicting SG GH-secreting pituitary adenomas with an AUC of 0.84 and relatively high sensitivity and specificity. Conclusions We propose a predictive method for distinguishing SG and DG GH-secreting pituitary adenomas preoperatively. This method will help physicians identify candidates for presurgical medical treatment and neurosurgeons determine radical surgical strategies for high-risk tumors.

We use detailed clickstream data on online word-of-mouth (WOM) to uncover mechanisms underlying its influence on consumer decision making. A feature launch on a major doctor appointment booking platform allows us to examine the effects of online WOM on three dimensions of a consumer’s choice process: the consideration set size, the time taken to consider alternatives (web session duration), and the geographic dispersion of the choices considered. Results indicate that the effects of WOM on decision-making processes are not monotonic but rather are contingent on the abundance of WOM (number of rated doctors) in a market. When the abundance of WOM is high, the introduction of WOM makes patients consider fewer doctors, browse for a shorter duration, and focus on doctors that are geographically more proximate. In contrast, when the abundance of WOM is low, the introduction of WOM makes patients consider more doctors, browse for longer duration, and consider doctors that are geographically more dispersed. We also find that WOM can lead to a cannibalization effect: when ratings are published, the highly rated doctors reap the benefits (in the form of increased demand) at the expense of unrated doctors. Our study contributes to the extant literature on online WOM by providing new insights into how WOM influences consumer decision making and by examining this question at a more granular level than prior work. This paper was accepted by Anandhi Bharadwaj, information systems.

Traumatic brain injury (TBI) triggers the activation of the endogenous coagulation mechanism, and a large amount of thrombin is released to curb uncontrollable bleeding through thrombin receptors, also known as protease-activated receptors (PARs). However, thrombin is one of the most critical factors in secondary brain injury. Thus, the PARs may be effective targets against hemorrhagic brain injury. Since the PAR1 antagonist has an increased bleeding risk in clinical practice, PAR4 blockade has been suggested as a more promising treatment. Here, we explored the expression pattern of PAR4 in the brain of mice after TBI, and explored the effect and possible mechanism of BMS-986120 (BMS), a novel selective and reversible PAR4 antagonist on secondary brain injury. Treatment with BMS protected against TBI in mice. mRNA-seq analysis, Western blot, and qRT-PCR verification in vitro showed that BMS significantly inhibited thrombin-induced inflammation in astrocytes, and suggested that the Tab2/ERK/NF-κB signaling pathway plays a key role in this process. Our findings provide reliable evidence that blocking PAR4 is a safe and effective intervention for TBI, and suggest that BMS has a potential clinical application in the management of TBI. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1007/s12264-020-00601-8) contains supplementary material, which is available to authorized users.

Reed-type valve is widely used in refrigeration compressor; its dynamic performance directly affects the energy efficiency of compressors. In order to reveal the motion law of the reed-type valve of refrigeration compressor, a dynamic model based on vibration theory is established. According to the actual movement characteristics of the reed valve, the motion process of the reed is divided into two stages (i.e. before the reed bending to the limiter and after the reed bending to the limiter). The one-degree-of-freedom system is used to model before the valve reed bending to the limiter, and the vibration theory of Euler–Bernoulli beam is used to model after the reed bending to the limiter. The fourth-order Runge–Kutta method is applied to solve the new model in the MATLAB environment. In order to verify the validity of the new model, dynamic performance experiments of discharge reed valve at various operating conditions were carried out. The predicted results of the new model, the basic valve theory model and the cantilever beam model are compared with the experimental results. The analysis of error band and root mean square error shows that the calculation results of the new model can more accurately reveal the motion law of reed valve than that of other two models. Then, the effects of valve lift, reed stiffness and compressor speed on the valve dynamics and pressure loss are analyzed. This research can provide a reference for optimizing the structure parameters of reed-type valve and improving the energy efficiency of compressors.

Background Sepsis-associated encephalopathy (SAE) is related to increased short-term mortality in patients with sepsis. We aim to establish a user-friendly nomogram for individual prediction of 30-day risk of mortality in patients with SAE. Methods Data were retrospectively retrieved from the Medical Information Mart for Intensive Care (MIMIC III) open source clinical database. SAE was defined by Glasgow Coma Score (GCS) < 15 or delirium at the presence of sepsis. Prediction model with a nomogram was constructed in the training set by logistic regression analysis and then undergone internal validation and sensitivity analysis. Results SAE accounted for about 50% in patients with sepsis and was independently associated with the 30-day mortality of sepsis. Variables eligible for the nomogram included patient’s age and clinical parameters on the first day of ICU admission including the GCS score, lactate, bilirubin, red blood cell distribution width (RDW), mean value of respiratory rate and temperature, and the use of vasopressor. Compared with Sequential Organ Failure Assessment (SOFA) and Logistic Organ Dysfunction System (LODS), the nomogram exhibited better discrimination with an area under the receiver operating characteristic curve (AUROC) of 0.763 (95%CI 0.736–0.791, p < 0.001) and 0.753 (95%CI 0.713–0.794, p < 0.001) in the training and validation sets, respectively. The calibration plot revealed an adequate fit of the nomogram for predicting the risk of 30-day mortality in both sets. Regarding to clinical usefulness, the DCA of the nomogram exhibited greater net benefit than SOFA and LODS in both of the training and validation sets. Besides, the nomogram exhibited acceptable discrimination, calibration, and clinical usefulness in sensitivity analysis. Conclusions SAE is related to increased 30-day mortality of patients with sepsis. The nomogram presents excellent performance in predicting 30-day risk of mortality in SAE patients, which can be used to evaluate the prognosis of patients with SAE and may be more beneficial once specific treatments towards SAE are developed.

We sought to assess whether controlled, intraoperative lumbar drainage (LD) of cerebrospinal fluid (CSF) could facilitate resection of pituitary macroadenomas and reduce the rate of CSF leak.A retrospective cohort study from a prospective database was conducted on 189 patients with pituitary macroadenoma who received endoscopic transsphenoidal surgery between 2013 and 2017. Patients were classified into 2 groups: 119 patients received an intraoperative LD (LD group) and 70 patients underwent routine endoscopic surgery without LD (control group). In the LD group, lumbar catheters were placed preoperatively and CSF was drained intermittently during tumor resection. The rates of gross total resection (GTR) and CSF leaks were assessed both intraoperatively and postoperatively.Intraoperative LD was associated with a higher rate of GTR (92.4% in the LD group vs. 78.6% in the control group, P = 0.006), especially in macroadenomas with suprasellar extension (90.3% vs. 75.0%, P = 0.012). Both intraoperative and postoperative CSF leak rates were significantly decreased in the LD group (intraoperative: 10.1% vs. 31.4%, P0.001; postoperative: 3.4% vs. 11.4%, P = 0.035). In functioning adenomas, a better remission rate of excess-hormone secretion was observed in the LD group compared with the controls (89.1% vs. 60.6%, P = 0.001). Patients in the LD group also had an enhanced recovery with a shorter postoperative length of stay (7 days vs. 5 days, P = 0.020).Intraoperative LD may assist surgeons during endoscopic transsphenoidal resection of pituitary macroadenomas by achieving a higher rate of GTR and a lower rate of perioperative CSF leaks. Validation in prospective randomized controlled studies is needed.

In light of the controversies regarding the surgical treatment of adult Chiari malformation type I (CM-I) with syringomyelia, a retrospective study was conducted to evaluate the safety and efficacy of tonsillectomy followed by modified reconstruction of the cisterna magna with or without craniectomy. Between 2008 and 2017, 78 adult CM-I patients (36 males and 42 females, mean age 40.6 years old) with syringomyelia were treated with posterior fossa decompression (PFD) with tonsillectomy and modified reconstruction of the cisterna magna. Patients were divided into two study groups: group A (n = 40) underwent cranioplasty with replacement of the bone flap; group B (n = 38) underwent suboccipital craniectomy. Neurological outcomes were evaluated by traditional physician assessment (improved, unchanged, and worsened) and the Chicago Chiari Outcome Scale (CCOS). Syringomyelia outcomes were assessed radiologically. The procedure was successfully performed in all patients, and restoration of normal cerebrospinal fluid (CSF) flow was confirmed by intraoperative ultrasonography. The median postoperative follow-up was 20.3 months (range 18–60 months). Clinical improvement was evident in 66 (84.6%) patients, with no significant differences between the two groups (85.0% vs. 84.2%, P = 0.897). According to the CCOS, 36 patients (90.0%) in group A were labeled as “good” outcome, compared with that of 34 (86.8%) in group B (P = 0.734). Improvement of syringomyelia was also comparable between the groups, which was observed in 35 (87.5%) vs. 33 (86.8%) patients (P = 0.887). The postoperative overall (7.5% vs. 23.7%, P = 0.048) and CSF-related (2.5% vs. 18.4%, P = 0.027) complication rates were significantly lower in group A than group B. Tonsillectomy with modified reconstruction of the cisterna magna without craniectomy seems to be a safe and effective surgical option to treat adult CM-I patients with syringomyelia, though future well-powered prospective randomized studies are warranted to validate these findings.

We reported a case of awake surgery for the left frontal low-grade glioma and reviewed the literature on the strategy of awake surgical resection for glioma. The eloquent cerebral areas that are involved in motor, language, memory, and visuospatial functions, which have to be preserved during surgery, is identified through intraoperative use of brain mapping techniques. This technique of combining intraoperative ultrasound and neuronavigation enabled extension of the surgical indications and improved the extent of resection, while minimizing postoperative morbidity and safeguarding the patient's quality of life. This work was approved by the Institutional Review Board of Tangdu Hospital, Fourth Military Medical University, China.

With the development of minimally invasive technology, minimally invasive surgery transforaminal lumbar interbody fusion has become an effective way to treat lumbar spinal stenosis. Lumbar spinal stenosis is one of the common diseases that cause backache or lumbago and sciatica. This article compares and analyzes the clinical efficacy of 60 patients with lumbar spinal stenosis surgery. It can be seen that the wound by MIS-TLIF is significantly less than that of traditional open surgery, and the postoperative recovery of MIS-TLIF is faster. So, MIS-TLIF is one of the concepts of minimally invasive surgery. The age distribution ranged from 56 to 78 years, with an average of 65.7 years. 31 cases were treated with MIS-TLIF (MIS-TLIF group), and 29 were treated with traditional posterior open surgery (TLIF group). The operation time, intraoperative blood loss, and postoperative drainage of the operation area were recorded. After statistical testing, the intraoperative blood loss, incision size, and postoperative drainage volume of the wound in the MIS-TLIF group were significantly less than those in the TLIF group. The results of JOA score, ODI score, and VAS score during the postoperative follow-up period were comparable to those of open surgery. Therefore, minimally invasive transforaminal lumbar interbody fusion is effective in treating lumbar spinal stenosis.

Aims: To determine how consistently Chinese glioblastoma multiforme (GBM) patients were treated according to the Stupp regimen. Patients and methods: The proportion of treatments conforming to the Stupp regimen and reasons for nonconformity were evaluated in 202 newly diagnosed GBM patients. Results: Only 15.8% of GBM patients received treatments compliant with the Stupp regimen. The main deviations were temozolomide dosages >75 mg/m2 (58/120; 48.3%) and treatment durations 2 (89/101; 88.1%) in the maintenance phase. Median overall survival (27.09 vs 18.21 months) and progression-free survival (14.27 vs 12.10 months) were longer in patients who received Stupp regimen-compliant treatments. Conclusion: Increased conformity to the Stupp regimen is needed for GBM patients in China.

Introduction: Many CGM users find the magnitude and complexity of their data challenging. We developed an AI method for detecting and classifying discernable self-management events reflected in CGM data. Methods: Machine learning and signal detection techniques were used to detect CGM patterns which we call “CGM events.” The key features used for detection include raw glucose values, smoothed values, numeric derivatives of smoothed values, and features based on time and date of readings. For training, a 10-fold cross validation was used to tune the necessary parameters. We used mean square error, sensitivity, and specificity to evaluate the models’ performance. After detection, each event is classified according to clinical significance based on glucose levels, time above target, and a severity score. Results: We trained different models on 17280 data points from 20 patients over 60 days and then evaluated their performance using separate test data. The system accurately detected and classified CGM events from actual data. The severity score used in classifying events is significantly negatively correlated with the standard time in range measure. Conclusions: Advanced machine learning and signal detection techniques can be applied to accurately detect CGM events. The classification of detected events may give CGM users and providers more insights into glucose data and can be used for self-management or clinical decision support. Disclosure S. Liu: None. M. Shomali: Employee; Self; WellDoc, Inc. A. Kumbara: Employee; Self; WellDoc, Inc. A. K. Iyer: Employee; Self; WellDoc, Inc. M. Peeples: Employee; Self; WellDoc, Inc. M. A. Dugas: None. K. Crowley: None. G. Gao: None.

Introduction: The Ambulatory Glucose Profile (AGP) visualizes and summarizes complex CGM data and contains multiple and often difficult to interpret measures. Our objective was to create a simple visual summary of the data that can provide insights for CGM users. Methods: Repeated measure correlation was used to quantify the association among AGP metrics. Then, multilevel principal components analysis (PCA) was applied to determine the key metrics that explained the most variation within the data. We then created a 3-D measure using the relevant parameters and designed a 2-D visualization which interprets the 3-D measures and exhibits the trajectory of a patient’s glucose status over time. Results: Based on the correlation analysis, mean glucose, time in range (TIR) and time above range are strongly correlated. Two pairs, TIR and SD, time below range (TBR) and CV, are moderately correlated. In the PCA study, 3 components explained over 95% of the data variation. Considering the correlations and mPCA, we determined that TIR, CV, and TBR were sufficient to describe a patient’s status. Then, we constructed a 2-D framework to visualize the status changes over time. The figure shows a CGM user’s data over 4 weeks demonstrating improvement in the 3 key metrics over time. Conclusions: This novel data visualization based on the key metrics may assist CGM users and their clinicians in assessing overall progress with glucose control over time. Disclosure S. Liu: None. M. Shomali: Employee; Self; WellDoc, Inc. A. Kumbara: Employee; Self; WellDoc, Inc. A. K. Iyer: Employee; Self; WellDoc, Inc. M. Peeples: Employee; Self; WellDoc, Inc. M. A. Dugas: None. K. Crowley: None. G. Gao: None.

The healthcare system is undergoing a fundamental transformation fueled by regulatory shifts that reward value over volume, coupled with unprecedented advances in technological capabilities. To address the processes involved in defining, measuring, and delivering value in this shifting landscape, we develop the framework of value-centered marketing (VCM). Building on existing approaches in both healthcare and marketing, we propose three core dimensions of value in VCM: preferences, precision, and process. We also provide an overview of a trifecta of technological advances including the digital capture of health data, improvements in methodologies for data analysis, and exponential increases in processing power and storage capacity, which have created a perfect storm of opportunity for VCM. We describe how these emerging technologies can be combined with insights from marketing science to develop successful VCM strategy and highlight critical research questions. Finally, we discuss potential unintended consequences in the use of tech- and analytics-enabled healthcare.

In this paper, we use mobile messaging to leverage recipients’ social ties and encourage offline prosocial activities in groups. In particular, we conduct a randomized field experiment with 80,000 blood donors and study how behavioral interventions and economic rewards motivate offline group formation. We find that two commonly used interventions—reminder messages and individual reward—are ineffective in motivating group formation because they do not compensate donors for the cost of bringing friends. In contrast, we find that group reward—a new reward that is contingent on a donor bringing a friend—is effective in motivating group formation. Furthermore, group reward tends to attract different types of donors, especially those who are traditionally less active in online social settings but have more local social ties. Structural estimation further reveals the underlying mechanisms, suggesting that group reward is four times more cost-effective than individual reward in driving total donation. Our study suggests that motivating offline group formation is a promising approach to boost prosocial activities. The online appendix is available at https://doi.org/10.1287/mnsc.2018.3069 . This paper was accepted by Chris Forman, information systems.

OBJECTIVEAlthough enhanced recovery after surgery (ERAS) programs have gained acceptance in various surgical specialties, no established neurosurgical ERAS protocol for patients undergoing elective craniotomy has been reported in the literature. Here, the authors describe the design, implementation, safety, and efficacy of a novel neurosurgical ERAS protocol for elective craniotomy in a tertiary care medical center located in China.METHODSA multidisciplinary neurosurgical ERAS protocol for elective craniotomy was developed based on the best available evidence. A total of 140 patients undergoing elective craniotomy between October 2016 and May 2017 were enrolled in a randomized clinical trial comparing this novel protocol to conventional neurosurgical perioperative management. The primary endpoint of this study was the postoperative hospital length of stay (LOS). Postoperative morbidity, perioperative complications, postoperative pain scores, postoperative nausea and vomiting, duration of urinary catheterization, time to first solid meal, and patient satisfaction were secondary endpoints.RESULTSThe median postoperative hospital LOS (4 days) was significantly shorter with the incorporation of the ERAS protocol than that with conventional perioperative management (7 days, p < 0.0001). No 30-day readmission or reoperation occurred in either group. More patients in the ERAS group reported mild pain (visual analog scale score 1–3) on postoperative day 1 than those in the control group (79% vs. 33%, OR 7.49, 95% CI 3.51–15.99, p < 0.0001). Similarly, more patients in the ERAS group had a shortened duration of pain (1–2 days; 53% vs. 17%, OR 0.64, 95% CI 0.29–1.37, p = 0.0001). The urinary catheter was removed within 6 hours after surgery in 74% patients in the ERAS group (OR 400.1, 95% CI 23.56–6796, p < 0.0001). The time to first oral liquid intake was a median of 8 hours in the ERAS group compared to 11 hours in the control group (p < 0.0001), and solid food intake occurred at a median of 24 hours in the ERAS group compared to 72 hours in the control group (p < 0.0001).CONCLUSIONSThis multidisciplinary, evidence-based, neurosurgical ERAS protocol for elective craniotomy appears to have significant benefits over conventional perioperative management. Implementation of ERAS is associated with a significant reduction in the postoperative hospital stay and an acceleration in recovery, without increasing complication rates related to elective craniotomy. Further evaluation of this protocol in large multicenter studies is warranted.Clinical trial registration no.: ChiCTR-INR-16009662 (chictr.org.cn)

In order to reveal the failure process and its influencing factors of the reed-type valve motion in reciprocating compressor, the dynamic performance of the reed valve is studied in this paper. On the basis of the analysis of actual movement characteristics of the reed valve, the motion process of the valve reed is described as the composition of before bending segment and after bending segment. A mathematical model is presented to predict the dynamic performance of the reed valve. The relationship between the effective length, elastic force and mass of the valve reed with the change of displacement is taken into account in the new model. The influence of viscous effect arising from the oil between the reed and valve seat on the dynamic behavior of a reed valve is also considered in the new model. The fourth order Runge-Kutta method is used to solve the new model in MATLAB environment. In order to verify the validity of the model, the experimental system for measuring the displacement of discharge valve is established. The predicted results of the new model and one-degree-of-freedom model are compared with the experimental results. Analytical results have shown that the new model gave better results with smaller error band, root mean square error and scatter band than one-degree-of-freedom model. Thus the model proposed in this paper proves to be more accurate and effective in describing the valve dynamics. And then the influence of valve lift, reed stiffness, valve orifice diameter and compressor speed on the valve dynamics are analyzed. This research can provide a reference for the optimization and reliability design of the reed-type valve.

Background Both protective and therapeutic functions of insulin-like growth factor-1 (IGF-1) in brain injury have been reported, but its effects on cognitive sequelae after septic encephalopathy (SE) remain unclear. Materials and methods This study was divided into three parts, and a septic model was built by cecal ligation and puncture (CLP). First, survival analysis was performed, and IGF-1’s effects on long-term cognition and depressive emotion were assessed. Second, the characteristics of IGF-1 function in cognition were evaluated. Finally, cytochrome C, caspase-9, tumor necrosis factor receptor (TNFR), and caspase-8 levels as well as cell apoptosis in the hippocampus were evaluated. Results IGF-1 did not reduce mortality or alleviate depressive symptoms in septic rats, but improved the memory of noxious stimulation and spatial learning and memory. These effects were observed only when IGF-1 was administered within 0–6 hours after CLP. Moreover, cytochrome C and caspase-9 expression levels were increased at 6 hours after CLP in the hippocampus, while TNFR and caspase-8 amounts were not increased until 12 hours after CLP. Cell apoptosis increased at 12 hours after CLP, but was inhibited by IGF-1. Conclusion Cognitive impairment in rats recovering from SE is associated with cell apoptosis in the hippocampus. Supplementation of IGF-1 reduces cell apoptosis by preventing the over-expression of cytochrome C and TNFR, and results in improved cognitive function. However, improvement only occurs when IGF-1 is administered at the early stage (within 6 hours) of sepsis. As cytochrome C activation occurs earlier than that of TNFR in this study, cytochrome C may be the main factor inducing apoptosis in early SE.

Background: Deep brain stimulation (DBS) is currently used to treat addiction, with the nucleus accumbens (NAc) as one promising target. The anterior limb of the internal capsule (ALIC) is also a potential target, as it carries fiber tracts connecting the mesocorticolimbic circuits that are crucially involved in several psychiatric disorders, including addiction. Stimulating the NAc and ALIC simultaneously may have a synergistic effect against addiction. Methods: Eight patients with a long history of heroin use and multiple relapses, despite optimal conventional treatments, were enrolled. Customized electrodes were implanted through the ALIC into the NAc, and deep brain stimulation (DBS) treatment began two weeks after surgery. The patients were followed for at least 24 months. The duration of drug-free time, severity of drug cravings, psychometric evaluations, and PET studies of glucose metabolism before and after DBS were conducted. All adverse events were recorded. Results: With DBS, five patients were abstinent for more than three years, two relapsed after abstaining for six months, and one was lost of follow-up at three months. The degree of cravings for drug use after DBS was reduced if the patients remained abstinent (p

Yang Yang,1,* Shengru Liang,2,* Yuqian Li,1,* Fei Gao,1 Yuan Cao,3 Xiaoyu Zhao,4 Guodong Gao,1 Lihong Li1 1Department of Neurosurgery, Tangdu Hospital, Air Force Medical University, Xi’an, Shaanxi Province 710038, China; 2Department of Endocrinology, Xijing Hospital, Air Force Medical University, Xi’an, Shaanxi Province 710032, China; 3Department of Neurosurgery, Xijing Hospital, Air Force Medical University, Xi’an, Shaanxi Province 710032, China; 4Department of Neurosurgery, The 986th Hospital of Chinese People’s Libertation Army, Xi’an, Shaanxi Province 710054, China *These authors contributed equally to this work Background: Both protective and therapeutic functions of insulin-like growth factor-1 (IGF-1) in brain injury have been reported, but its effects on cognitive sequelae after septic encephalopathy (SE) remain unclear.Materials and methods: This study was divided into three parts, and a septic model was built by cecal ligation and puncture (CLP). First, survival analysis was performed, and IGF-1’s effects on long-term cognition and depressive emotion were assessed. Second, the characteristics of IGF-1 function in cognition were evaluated. Finally, cytochrome C, caspase-9, tumor necrosis factor receptor (TNFR), and caspase-8 levels as well as cell apoptosis in the hippocampus were evaluated.Results: IGF-1 did not reduce mortality or alleviate depressive symptoms in septic rats, but improved the memory of noxious stimulation and spatial learning and memory. These effects were observed only when IGF-1 was administered within 0–6 hours after CLP. Moreover, cytochrome C and caspase-9 expression levels were increased at 6 hours after CLP in the hippocampus, while TNFR and caspase-8 amounts were not increased until 12 hours after CLP. Cell apoptosis increased at 12 hours after CLP, but was inhibited by IGF-1.Conclusion: Cognitive impairment in rats recovering from SE is associated with cell apoptosis in the hippocampus. Supplementation of IGF-1 reduces cell apoptosis by preventing the over-expression of cytochrome C and TNFR, and results in improved cognitive function. However, improvement only occurs when IGF-1 is administered at the early stage (within 6 hours) of sepsis. As cytochrome C activation occurs earlier than that of TNFR in this study, cytochrome C may be the main factor inducing apoptosis in early SE. Keywords: septic encephalopy, memory, learning, IGF-1, cytochrome C, TNFR, apoptosis

Differences in climatic conditions have a significant impact on the bearing capacity and performance of asphalt pavements. The climatic conditions in Tibet are complex. Therefore, it is necessary to establish a climate division of asphalt pavement in Tibet. In this paper, the meteorological data of 28 meteorological stations in Tibet from 1991 to 2000 were used to analyze the main climatic factors affecting the performance of highway asphalt pavement by cluster analysis. The results are as follows: 1) The main climatic factors affecting the performance of highway asphalt pavement in Tibet include: solar radiation, maximum temperature, minimum temperature and large temperature difference. 2) The climate zoning indicators are the average daily solar radiation daily maximum temperature, the average annual extreme maximum temperature, the annual extreme temperature, and the average annual maximum temperature for seven consecutive days. 3) Tibet can be divided into five climate zones of I-V. In summary, the geographical boundaries and indicator distribution ranges of each sub-district can provide reference for the construction of highway asphalt pavement in Tibet.

Introduction Red blood cell (RBC) transfusion is associated with adverse outcomes, but there are few studies on the RBC volume. This study aimed to evaluate the relationship between intraoperative RBC volume and postoperative adverse outcomes for on-pump cardiac surgery. Methods Adult patients undergoing on-pump cardiac surgery from 1 January 2017 to 31 December 2018 were included. Those transfused with more than 6 units of RBC were excluded. The clinical characteristics of four groups with various RBC volume were compared. We analyzed the relationship between RBC volume and adverse outcomes through multivariable logistic regression. Results 12,143 patients were analyzed, of which 3353 (27.6%) were transfused with 1–6U RBC intraoperatively. The incidence of death, overall morbidity, acute kidney injury and prolonged mechanical ventilation were increased stepwise along with incremental RBC volume. After adjusting for possible confounders, patients transfused with 1–2U were associated with a 1.42-fold risk of death (99% CI, 1.21–2.34, p = 0.01) compared with patients without RBC, patients with 3–4U were associated with a 1.57-fold risk (99% CI, 1.32–2.80, p = 0.005) and patients with 5–6U had a 2.26-fold risk of death (99% CI, 1.65–3.88, p < 0.001). Similarly, the incidence of overall morbidity, acute kidney injury and prolonged mechanical ventilation increased several folds as the RBC numbers increased. Conclusions There was a significant dose-dependent influence of incremental intraoperative RBC volume on increased risk of adverse outcomes for on-pump cardiac surgery patients. Patient blood management practice should aim to reduce not only transfusion rate but also the volume of blood use.

Introduction: Extracorporeal membrane oxygenation (ECMO) is an imperative short-term cardiopulmonary support device now. We aimed to provide a single-center experience of veno-arterial (V-A) ECMO management and identify the risk factors of in-hospital mortality. Methods: We conducted a retrospective review of adult patients who received V-A ECMO between 2009 and 2019 in a cardiovascular disease center. The risk factor analysis of in-hospital mortality was conducted. Results: The study reviewed 236 patients, with an overall survival rate of 68.2%. The survivors’ blood lactate concentration is significantly lower than non-survivors [7.4 (7.8) vs 11.1 (9.7), p = 0.002]. Patients who received heart transplantation were with higher in-hospital survival rate. Survivors developed less hepatic dysfunction, acute kidney injury and myocardial damage [23 (14.3%) vs 19 (25.3%), p = 0.039; 81 (50.3%) vs 51 (68%), p = 0.011; 24 (14.9%) vs 22 (29.3%), p = 0.009, respectively], with higher rate of continuous renal replacement therapy (CRRT) [56 (34.8%) vs 53 (70.7%), p Conclusions: By providing a general description of V-A ECMO practice at a single-center in China. Post-heart transplant graft failure was associated with numerically, the greatest survival in our practice. Furthermore, female sex, pre-ECMO blood lactate concentration, hyperlipidemia, CRRT, and high blood loss in chest drains are predictors of mortality in patients who undergo V-A ECMO.

Backgroud: to investigate secondary glioblastoma (sGBM) patients undergoing resection and evaluate the impact of treatment on survival of malignant progression (PMS) and the prognostic factors of secondary glioblastoma. Method: the prognostic factors of secondary glioblastoma were analyzed retrospectively including gender, age, the interval between first diagnosis and second, the extent of resection, adjuvant treatment, postoperative Karnofsky score (KPS), 06-methylguanine-DNA methytransferase (MGMT) status, IDH1 mutation status, and PMS in patients with sGBM. Result: Thirty-four patients with sGBM were included in this study. Sixteen patients were female and eighteen were male. Median PMS in females was longer than male patients with sGBM (17.38 (95%CI 10.63–24.12) vs 10.06(95%CI 5.32–14.79), p = 0.032). 22(64.7%) patients achieved gross total resection (GTR),12(35.3%) patients achieved subtotal resection (STR). Kaplan-Meier analysis showed that GTR significantly improved survival after malignant progression (PMS) compared with STR (17.18(95%CI 10.97–23.40) vs 7.17(95%CI 4.97–9.36), p = 0.004). Adjuvant treatment after resection was executed in 17 (50.0%) patients, radiotherapy in one (2.9%) patient, chemotherapy in seven (20.6%) patients, and radio-chemotherapy in nine (26.5%) patients. Median preoperative KPS was 80(range 30–100), and 85(range 30–100) after surgery. The difference in PMS probability was significant between patients having a good postoperative clinical status (KPS༞70)versus poor (KPS ≤ 70). Long term survival could be achieved in patients with a good clinical status (16.57(95%CI 10.54–22.60) vs 9.00(95%CI 3.66–14.34), p = 0.02). Patients with a greater interval after initial diagnosis had longer survival than those with intervals less than 26.5 months (18.62(95%CI 10.81–26.43) vs 9.22(95%CI 5.61–12.83), p = 0.025). Conclusion: GTR and any adjuvant treatment significantly improved PMS in patients with secondary glioblastoma. Gender, postoperative KPS, time interval since the first diagnosis are associated with prognosis.

The Conference on Health IT and Analytics (CHITA) is an annual health information technology and analytics research summit, including a doctoral consortium that each year gathers prominent scholars from more than 40 research institutes, and leading policy and practitioner attendees in a vibrant setting to discuss opportunities and challenges in the design, implementation and management of health information technologies and advanced analytics including artificial intelligence and machine learning systems. CHITA’s goal is to deepen our understanding of strategy, policy and systems fostering health IT and analytics effective use, to stimulate new ideas with both policy and business implications, and to support the development of a health IT and healthcare advanced analytics research agenda. These Proceedings of the 11th Conference on Health IT & Analytics (CHITA 2020) represent the work of 45 papers and 146 authors working on the digitally-enabled future of healthcare. Convened by the Center for Health Information & Decision Systems (CHIDS), support for CHITA is provided by the Robert H. Smith School of Business, the University of Michigan School of Public Health, and the U.S. Agency for Healthcare Research and Quality.

Disasters, from hurricanes to pandemics, tremendously impact human lives and behaviors. Physical closeness to family post-disaster plays a critical role in mental healing and societal sustainability. Nonetheless, little is known about whether and how family colocation alters after a disaster, a topic of immense importance to a post-disaster society. We analyze 1 billion records of population-scale, granular, individual-level mobile location data to quantify family colocation, and examine the magnitude, dynamics, and socioeconomic heterogeneity of the shift in family colocation from the pre- to post-disaster period. Leveraging Hurricane Florence as a natural experiment, and Geographic Information System (GIS), machine learning, and statistical methods to investigate the shift across the landfall (treated) city of Wilmington, three partially treated cites on the hurricane’s path, and two control cities off the path, we uncover dramatic (18.9%), widespread (even among the partially treated cities), and enduring (over at least 3 months) escalations in family colocation. These findings reveal the powerful psychological and behavioral impacts of the disaster upon the broader populations, and simultaneously remarkable human resilience via behavioral adaptations during disastrous times. Importantly, the disaster created a gap across socioeconomic groups non-existent beforehand, with the disadvantaged displaying weaker lifts in family colocation. This sheds important lights on policy making and policy communication to promote sustainable family colocation, healthy coping strategies against traumatic experiences, social parity, and societal recovery.

The imaging signs which can accurately predict survival prognosis after standard treatment of high-grade glioma (HGG) are highly desirable. This study aims to explore the role of new enhancement beyond radiation field (NERF) in the survival prediction in patients with post-treatment HGG. The present study included 142 pathologically confirmed HGG patients who had received standard treatment. NERF, as well as other conventional MR findings and clinical variables, were included in univariate and multivariate analyses for evaluating their impactions on progression-free survival (PFS) and overall survival (OS). Univariate analysis showed that histological grade ( p = 0.008 ) and NERF ( p = 0.001 ) were the prognostic variables for poor PFS, whereas histological grade ( p = 0.017 ), NERF ( p = 0.001 ), and new subventricular zone enhancement (nSVZE) ( p = 0.001 ) were prognostic variables for poor OS. The multivariate analysis showed that NERF (HR 3.93; 95% CI 1.93–8.01; p = 0.001 ) and nSVZE (HR 3.92; 95% CI 1.95–7.89; p = 0.001 ) were the prognostic variables for poor OS. However, only nSVZE was (HR 3.29; 95% CI 2.04–5.28; p = 0.001 ) the prognostic variable for poor PFS. When combining the NERF with the clinical and other MR variables, the highest AUC (0.924) and specificity (0.899) for predicting poor OS were achieved. The location of new developed enhancements relevant to high dose radiation field appears to be the main determinant of their prognostic value. Our results suggest that the new enhancement beyond radiation field can improve the survival prediction in patients with HGG after standard treatment.

This article has been retracted. Please see the Retraction Notice for more detail: https://doi.org/10.1186/s12883-020-02027-1.

Adverse drug events (ADEs) are a serious health problem that can be life-threatening. While a lot of studies have been performed on detect correlation between a drug and an AE, limited studies have been conducted on personalized ADE risk prediction. Among treatment alternatives, avoiding the drug that has high likelihood of causing severe AE can help physicians to provide safer treatment to patients. Existing work on personalized ADE risk prediction uses the information obtained in the current medical visit. However, on the other hand, medical history reveals each patient's unique characteristics and comprehensive medical information. The goal of this study is to assess personalized ADE risks that a target drug may induce on a target patient, based on patient medical history recorded in claims codes, which provide information about diagnosis, drugs taken, related medical supplies besides billing information. We developed a HTNNR model (Hierarchical Time-aware Neural Network for ADE Risk) that capture characteristics of claim codes and their relationship. The empirical evaluation show that the proposed HTNNR model substantially outperforms the comparison methods, especially for rare drugs.

Endoscopic endonasal transsphenoidal resection has been accepted as a routine therapy for pituitary adenoma, but the postoperative hospital stay is typically several days long. With the advantages of reduced cost and improved patient satisfaction, the application of ambulatory surgery (AS) has developed rapidly. However, AS was still rarely adopted in neurosurgery. Here we designed an AS treatment protocol for pituitary adenoma with the endoscopic endonasal approach (EEA), and reported our initial experiences regarding the safety and efficacy of the AS protocol. 63 patients who presented with pituitary adenoma were screened at the Department of Neurosurgery, Tangdu Hospital from July to September, 2017. A total of 20 pituitary adenoma patients who met the inclusion criteria underwent EEA surgery using this evidence-based AS protocol, which emphasized adequate assessment for eligibility, full preparation to minimize invasiveness, enhanced recovery, and active perioperative patient education. Of the 20 patients enrolled, 18 were discharged on the afternoon of the operation day with a median total length of stay (LOS) of 31 hours (range, 29–32) hours. The median LOS after surgery was 6.5 (range, 5–8) hours. Two patients were transferred from the AS protocol to conventional care due to intraoperative cerebrospinal fluid leakage (one case) and an unsatisfying post-anesthetic discharge score (one case). Complications included transient and reversible mild postoperative nausea and vomiting [visual analog scale (VAS) score

A novel neurosurgical enhanced recovery after surgery (ERAS) program shortens postoperative hospital stay and accelerates functional recovery in elective craniotomy patients. There is a need to evaluate the impact of ERAS program on patients’ health-related quality of life (HRQOL). In a single-center randomized controlled trial, patients were randomized 1:1 to receive perioperative ERAS or conventional care. As a secondary outcome, HRQOL was measured with the EORTC QLQ-C30/BN20 prior to randomization (baseline), at discharge, and at 3- and 6-month follow-up. A total of 65 patients (ERAS: n = 36, conventional care: n = 29) with pathologically confirmed glioma (WHO grade 2–4) were included in the analysis. Progression-free survival at 6 months and HRQOL at baseline were similar between the two groups. Changes of scores did not vary significantly over time, but differed significantly between intervention groups. A clinically relevant better QoL (at 3-month follow-up), physical functioning (at 6-month follow-up) and role functioning (at discharge) was observed in patients in the ERAS group. Symptom scores of constipation (at discharge), motor dysfunction (at discharge, 3- and 6-month follow-up), drowsiness (at 3- and 6-month follow-up), weakness of legs (at 3-month follow-up), and nausea/vomiting (at discharge and 6-month follow-up) were significantly lower in the ERAS group. The neurosurgical ERAS program seems to improve functioning and symptoms scores in glioma patients within 6-month follow-up compared with conventional care. The intervention has a significant main effect HRQOL changes without significant interaction with time. Future well-powered multicenter studies are warranted to confirm this result and address long-term benefits. This study has been registered in the Chinese Clinical Trial Registry ( http://www.chictr.org.cn/showproj.aspx?proj=16480 ) with registration number ChiCTR-INR-16009662.

Background Infratentorial craniotomy patients have a high incidence of postoperative nausea and vomiting (PONV). Enhanced Recovery After Surgery (ERAS) protocols have been shown in multiple surgical disciplines to improve outcomes, including reduced PONV. However, very few studies have described the application of ERAS to infratentorial craniotomy. The aim of this study was to examine whether our ERAS protocol for infratentorial craniotomy could improve PONV. Methods We implemented an evidence-based, multimodal ERAS protocol for patients undergoing infratentorial craniotomy. A total of 105 patients who underwent infratentorial craniotomy were randomized into either the ERAS group (n = 50) or the control group (n = 55). Primary outcomes were the incidence of vomiting, nausea score, and use of rescue antiemetic during the first 72 h after surgery. Secondary outcomes included postoperative anxiety level, sleep quality, and complications. Results Over the entire 72 h post-craniotomy observation period, the cumulative incidence of vomiting was significantly lower in the ERAS group than in the control group. Meanwhile, the incidence of vomiting was significantly lower in the ERAS group on postoperative days (PODs) 2 and 3. Notably, the proportion of patients with mild nausea (VAS 0–4) was higher in the ERAS group as compared to the control group on PODs 2 or 3. Additionally, the postoperative anxiety level and quality of sleep were significantly better in the ERAS group. Conclusion Successful implementation of our ERAS protocol in infratentorial craniotomy patients could attenuate postoperative anxiety, improve sleep quality, and reduce the incidence of PONV, without increasing the rate of postoperative complications. Trial registration ChiCTR-INR-16009662, 27 Oct 2016, Clinical study on the development and efficacy evaluation of Enhanced Recovery After Surgery (ERAS) in Neurosurgery.